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INTRODUCTION
The International Classification of Diseases (ICD-10) defines mental disorders as illnesses that present psychological changes that can lead to impairment of the individual’s functional capacity, as they cause biological, social, psychological, genetic, physical, or even chemical disturbances. Furthermore, they are prone to changes in thinking or mood, which directly affect the patient’s overall performance1.
There are many distinct mental disorders, each with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviors, and relationships with others. Mental disorders include depression, bipolar disorder, schizophrenia, alcoholism, substance abuse disorders, psychosis in general, dementia, and developmental disorders, including autism2,3. Yet, it is one of the areas that receives the least attention and funding from public health. Around 1 billion people live with a mental disorder, 3 million people lose their lives every year due to the harmful use of alcohol, and one person dies every 40 seconds by suicide2,3. Health systems have not yet adequately responded to the burden of mental disorders. As a result, the gap between the need for treatment and its availability is wide worldwide. In low- and middle-income countries, between 76% and 85% of people with mental disorders do not receive treatment. In high-income countries, between 35% and 50% of people with mental disorders are in the same situation2,3.
Another problem that worries and worsens the health situation worldwide is mortality caused by mental disorders, with suicide being one of the main aggravating factors and means of such mortality, which is generally motivated by depression, schizophrenia, bipolar disorder, alcoholism, among others4.
Many studies have noted substantial excess mortality in individuals with mental illness for nearly all psychiatric disorders and all major causes of death. In many places, a considerable portion of the population has already received psychiatric treatment. Many studies have observed high mortality rates for all psychiatric diagnoses, with the highest risks observed for organic psychoses, dementia, and drug and alcohol abuse. Mortality rates were also higher for long-term psychiatric patients. An important finding observed in studies is that a high risk persists even after hospital discharge5,6,7.
The overall prevalence of mental and behavioral disorders does not appear to differ significantly between men and women. However, anxiety disorders and depression are much more common in women, while substance use disorders are more common in men8.
In Brazil, studies on mental disorders are scarce, but what is perceived is that some affect mostly females. Among several factors when it comes to mental disorders (MD), they are mainly related to the use of psychoactive substances, such as alcohol, and, as an associated cause, they were important in the mortality of women of childbearing age6,7,9.
Among the many problems caused by mental disorders, their mortality rate in Brazil, more specifically in the northern region, is an important factor to study, given the scarcity of studies on the subject and the significant damage that such a topic causes. yet provokes to the sector from the health, implying in the economy, node social and node scientific field of the region. Thus justifying the need for this study for a better understanding and possible solutions such as public policies on this topic
Therefore, the objective of this research was to analyze mortality due to mental and behavioral disorders in Brazil from 2009 to 2019.
METHODS
Study design
This observational, ecological, epidemiological study, with a cross-sectional approach, analyzed mortality from mental and behavioral disorders in Brazil from 2009 to 2019, based on unmanipulated official data from the Mortality Information System (SIM) and the Hospital Information System (SIH/SUS). Data were collected by location among patients during this period, and included Hospital Admission Authorization (AIH) and Hospitalization Notification Forms (FNI).
The data source was MS/SVS/CGIAE - Mortality Information System (SIM), http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10uf.def .
Study location and period
The research object was composed of patients in Brazil, covering the period from 2009 to 2019. During this period, data from the Brazilian Institute of Geography and Statistics (IBGE), referring to the 2018 update, indicated a population of 208.4 million inhabitants in the country, distributed in a territorial area of 8,515,767.049 km2. This geographic scenario resulted in a population density of 24.47 inhabitants per square kilometer10.
Study population and eligibility criteria
All deaths of residents in Brazil whose underlying cause of death was classified as a mental and behavioral disorder, Chapter V, Mental and Behavioral Disorders (F00-F99) were considered. The information was extracted from the Death Certificate, the SIM’s core document, which records, analyzes, processes, and makes available data on deaths from natural and external causes. Therefore, it is a mandatory reporting system for all deaths in Brazil.
Death data by Chapter V, Mental and Behavioral Disorders (F00-F99), were collected using the tenth revision of the International Classification of Diseases (ICD-10) and stratified by sex (male and female), race/color, age groups (<10 years, 10-19 years, 20-49 years, 50 years and older), types of mental and behavioral disorders).
Deaths of children under one year of age were excluded from the study for methodological reasons. In this age group, mental and behavioral disorders are extremely rare or not accurately diagnosable, which could distort the mortality analysis.
Additionally, the mortality pattern in very young children is generally related to neonatal or congenital causes, which do not fall under the umbrella of mental and behavioral disorders.
The exclusion was based on similar studies that evaluate mortality in mental and behavioral disorders, where age groups without epidemiological relevance for these types of disorders are commonly omitted to ensure the robustness of the results (examples from the literature or reports from international institutions such as the World Health Organization (WHO) that follow this logic can be cited).
Data collection
The data were extracted through the file transfer system and then converted into a database using the TabWin program. Population data were obtained through estimates made by the IBGE.
Data analysis
The study population consisted of deaths from mental and behavioral disorders. Crude and age-standardized mortality rates were calculated using the WHO World Standard Population (WHO) data from 2000 to 2025. Crude mortality rates were presented by age group and sex to understand gender differences in mental and behavioral disorders. Several studies indicate significant variations in mortality rates between men and women due to biological, social, and cultural factors.
The analyses used the crude mortality rate and the standardized mortality rate, adjusted by age group using the WHO standard population, to minimize differences in the population’s age structure over time and between regions. Rates were calculated per 100,000 population, by age group and year, for Brazilian regions. Annual Percent Change (APC) was calculated to quantify the annual percentage changes in mortality rates, allowing the identification of temporal trends (increasing, decreasing, or stationary).
A simple linear regression model was used to analyze the temporal trends of mortality rates from mental and behavioral disorders. In this model, the mortality rate was the dependent variable and time, in calendar years, was the independent variable. Linear regression was chosen because it is suitable for evaluating trends in time series when the objective is to determine whether there is a consistent increase or decrease in rates over time. The analysis was adjusted for age group and sex, as necessary, to ensure greater accuracy.
Marital status was included in the analysis as a stratification variable because it is a relevant social factor that can influence mortality in people with mental and behavioral disorders. Studies suggest that single, divorced, or widowed individuals may have higher mortality rates due to lower social support and greater vulnerability to adverse mental health conditions.
However, marital status was not mentioned in the previous sections to avoid information overload, being introduced in the mortality analysis to explore its possible associations with mental and behavioral disorders.
The late inclusion of marital status in this section was a strategic choice to focus the analysis on this specific point, facilitating the interpretation of the results. The confidence level adopted in the analyses was 95%. All analyses were performed using the statistical programs Data Analysis and Statistical Software for Professionals 16.0 (STATA) and/or The R Project for Statistical Computing (https://www.r-project.org/).
Ethical and legal aspects of the research
This research project was not submitted to the Research Ethics Committee for review, as it involved research using secondary databases from the SUS Information Technology Department (DATASUS) and the Violence and Accident Surveillance Information System (SIVVA). However, the recommendations of resolutions 466/2012 and 510/2016, as well as the interinstitutional prerogatives of the National Health Council, which establish specific ethical guidelines for the human and social sciences (CHS), were fully respected.
RESULTS
The North region showed a reduction in mortality among the younger age groups, however only at the ages of 25 to 29 years (β = -0.43, p = 0.017), 30 to 34 years (β = -0.82, p = 0.035) and 40 to 44 years (β = -1.12, p = 0.046), while for the age group of 55 to 59 years an increase was shown (β = 0.92, p = 0.024).
In the Northeast region, mortality showed a reduction in mortality at all ages below 69 years, but only the ages of 15 to 19 years, 25 to 29 years, 30 to 34 years, 35 to 39 years, 40 to 44 years, 45 to 49 years and 60 to 64 years had significant reductions (β = -0.16, p = 0.044; β = -0.36, p = 0.006; β = -1.58, p < 0.001; β = -2.78, p < 0.001; β = -3.49, p < 0.001; β = -3.42, p < 0.001 and; β = -1.05, p = 0.043, respectively) (table 1).
Table 1 : Deaths from mental and behavioral disorders (CMD) in the Brazilian population by region and age group and linear regression estimate for the period 2009-2019
| Regions | Deaths | Mortality put TMC | Mortality Proportional | ||||
|---|---|---|---|---|---|---|---|
| n | β | p | r2 | β | p | r2 | |
| North | |||||||
| 10 – 14 | 13 | -0.72 | 0.262 | 14.00 | -0.02 | 0.275 | 14.00 |
| 15 – 19 | 36 | -0.10 | 0.305 | 12.00 | -0.01 | 0.225 | 16.00 |
| 20 – 24 | 76 | 0.06 | 0.526 | 14.00 | 0.02 | 0.781 | 10.00 |
| 25 – 29 | 144 | -0.43 | 0.017 | 48.00 | -0.03 | 0.007 | 57.00 |
| 30 – 34 | 261 | -0.82 | 0.035 | 40.00 | -0.05 | 0.043 | 27.00 |
| 35 – 39 | 307 | -0.61 | 0.104 | 27.00 | -0.04 | 0.102 | 27.00 |
| 40 – 44 | 418 | -1.12 | 0.046 | 37.00 | -0.05 | 0.120 | 25.00 |
| 45 – 49 | 429 | -0.68 | 0.219 | 16.00 | -0.01 | 0.499 | 5.00 |
| 50 – 54 | 467 | -1.02 | 0.078 | 31.00 | -0.02 | 0.215 | 16.00 |
| 55 – 59 | 408 | 0.92 | 0.024 | 45.00 | 0.03 | 0.011 | 53.00 |
| 60 – 64 | 370 | 0.51 | 0.462 | 16.00 | 0.01 | 0.379 | 15.00 |
| 65 – 69 | 279 | 0.02 | 0.956 | 10.00 | 0.01 | 0.681 | 10.00 |
| 70 – 74 | 271 | -0.31 | 0.522 | 15.00 | -0.02 | 0.701 | 10.00 |
| 75 – 79 | 235 | 0.75 | 0.152 | 24.00 | 0.01 | 0.152 | 21.00 |
| > 79 | 665 | 2.69 | 0.101 | 28.00 | 0.01 | 0.169 | 20.00 |
| North East | |||||||
| 10 – 14 | 48 | -0.08 | 0.058 | 34.00 | -0.02 | 0.130 | 24.00 |
| 15 – 19 | 186 | -0.16 | 0.044 | 38.00 | -0.02 | 0.002 | 66.00 |
| 20 – 24 | 447 | -0.14 | 0.060 | 34.00 | -0.01 | 0.022 | 46.00 |
| 25 – 29 | 1085 | -0.36 | 0.006 | 59.00 | -0.03 | 0.008 | 56.00 |
| 30 – 34 | 2101 | -1.58 | <0.001 | 78.00 | -0.08 | 0.002 | 68.00 |
| 35 – 39 | 3069 | -2.78 | <0.001 | 95.00 | -0.13 | <0.001 | 90.00 |
| 40 – 44 | 3932 | -3.49 | <0.001 | 89.00 | -0.13 | <0.001 | 86.00 |
| 45 – 49 | 4446 | -3.42 | <0.001 | 84.00 | -0.1 | <0.001 | 78.00 |
| 50 – 54 | 4382 | -1.44 | 0.053 | 36.00 | -0.03 | 0.132 | 23.00 |
| 55 – 59 | 3695 | -0.82 | 0.131 | 24.00 | -0.01 | 0.399 | 40.00 |
| 60 – 64 | 3086 | -1.05 | 0.043 | 38.00 | -0.02 | 0.070 | 32.00 |
| 65 – 69 | 2754 | -0.59 | 0.117 | 25.00 | -0.01 | 0.057 | 35.00 |
| 70 – 74 | 2353 | 0.03 | 0.945 | 10.00 | 0.01 | 0.832 | 10.00 |
| 75 – 79 | 2265 | 0.39 | 0.320 | 15.00 | 0.01 | 0.535 | 32.00 |
| > 79 | 7467 | 2.44 | 0.164 | 20.00 | 0.02 | 0.416 | 35.00 |
| Southeast | |||||||
| 10 – 14 | 47 | -0.01 | 0.935 | 10.00 | 0.01 | 0.457 | 30.00 |
| 15 – 19 | 403 | 0.08 | 0.383 | 8.00 | 0.02 | 0.170 | 20.00 |
| 20 – 24 | 651 | 0.13 | 0.081 | 22.00 | 0.02 | 0.011 | 53.00 |
| 25 – 29 | 1037 | -0.37 | 0.040 | 40.00 | -0.01 | 0.347 | 10.00 |
| 30 – 34 | 1965 | -0.72 | 0.003 | 65.00 | -0.02 | 0.173 | 20.00 |
| 35 – 39 | 3234 | 1.4 | 0.001 | 75.00 | 0.05 | 0.030 | 43.00 |
| 40 – 44 | 4366 | -1.9 | <0.001 | 80.00 | -0.03 | 0.055 | 35.00 |
| 45 – 49 | 5697 | -1.82 | <0.001 | 79.00 | -0.01 | 0.142 | 22.00 |
| 50 – 54 | 6077 | -1.25 | 0.003 | 64.00 | 0.01 | 0.935 | 10.00 |
| 55 – 59 | 5683 | -0.16 | 0.475 | 5.00 | 0.02 | 0.009 | 55.00 |
| 60 – 64 | 4594 | 0.44 | 0.035 | 41.00 | 0.02 | <0.001 | 78.00 |
| 65 – 69 | 3780 | -41 | 0.324 | 11.00 | 0.01 | 0.464 | 16.00 |
| 70 – 74 | 3383 | 0.4 | 0.118 | 25.00 | 0.01 | 0.217 | 18.00 |
| 75 – 79 | 4083 | -1.14 | 0.033 | 41.00 | -0.01 | 0.311 | 11.00 |
| > 79 | 20582 | -2.55 | 0.144 | 22.00 | -0.03 | 0.088 | 30.00 |
| South | |||||||
| 10 - 14 | 24 | -0.03 | 0.502 | 5.00 | -0.03 | 0.881 | 10.00 |
| 15 - 19 | 85 | -0.11 | 0.265 | 14.00 | -0.01 | 0.742 | 74.00 |
| 20 - 24 | 202 | -0.28 | 0.209 | 17.00 | -0.01 | 0.518 | 14.00 |
| 25 - 29 | 442 | -0.41 | 0.043 | 38.00 | -0.02 | 0.630 | 20.00 |
| 30 - 34 | 782 | -0.56 | 0.019 | 47.00 | 0.01 | 0.704 | 16.00 |
| 35 - 39 | 1236 | -1.46 | 0.001 | 47.00 | -0.03 | 0.169 | 20.00 |
| 40 - 44 | 1813 | -1.25 | 0.004 | 62.00 | -0.001 | 0.989 | 35.00 |
| 45 - 49 | 2420 | -1.43 | 0.001 | 70.00 | 0.03 | 0.774 | 19.00 |
| 50 - 54 | 2683 | -0.14 | 0.650 | 2.00 | 0.05 | 0.001 | 71.00 |
| 55 - 59 | 2655 | 0.28 | 0.585 | 3.00 | 0.04 | 0.007 | 57.00 |
| 60 - 64 | 2084 | 0.59 | 0.309 | 11.00 | 0.03 | 0.028 | 43.00 |
| 65 - 69 | 1800 | -0.17 | 0.743 | 10.00 | 0.02 | 0.040 | 39.00 |
| 70 - 74 | 1261 | -1.16 | 0.075 | 31.00 | -0.01 | 0.636 | 25.00 |
| 75 - 79 | 1087 | -1.08 | 0.122 | 24.00 | -0.05 | 0.556 | 30.00 |
| > 79 | 2412 | -5.58 | 0.037 | 40.00 | -0.03 | 0.040 | 39.00 |
| Center- Oes | |||||||
| 10 - 14 | 15 | -0.19 | 0.304 | 12.00 | -0.04 | 0.358 | 29.00 |
| 15 - 19 | 62 | -0.32 | 0.081 | 30.00 | -0.03 | 0.105 | 26.00 |
| 20 - 24 | 117 | 0.03 | 0.909 | 10.00 | 0.01 | 0.527 | 45.00 |
| 25 - 29 | 253 | -0.03 | 0.929 | 10.00 | 0.02 | 0.421 | 17.00 |
| 30 - 34 | 538 | -1.14 | 0.010 | 54.00 | -0.03 | 0.233 | 15.00 |
| 35 - 39 | 772 | -1.51 | 0.003 | 65.00 | -0.05 | 0.057 | 35.00 |
| 40 - 44 | 1040 | -1.79 | 0.016 | 50.00 | -0.03 | 0.347 | 26.00 |
| 45 - 49 | 1201 | -1.65 | 0.040 | 39.00 | -0.01 | 0.790 | 13.00 |
| 50 - 54 | 1166 | -0.18 | 0.804 | 10.00 | 0.04 | 0.112 | 26.00 |
| 55 - 59 | 936 | 0.75 | 0.397 | 30.00 | 0.05 | 0.054 | 35.00 |
| 60 - 64 | 782 | -0.1 | 0.889 | 20.00 | 0.01 | 0.417 | 24.00 |
| 65 - 69 | 685 | -0.02 | 0.982 | 10.00 | 0.02 | 0.252 | 14.00 |
| 70 - 74 | 506 | 0.24 | 0.721 | 10.00 | 0.02 | 0.131 | 23.00 |
| 75 - 79 | 495 | 0.29 | 0.805 | 10.00 | 0.02 | 0.445 | 44.00 |
| > 79 | 1558 | 4.17 | 0.032 | 50.00 | 0.03 | 0.014 | 51.00 |
Deaths: International Classification of Diseases, 10th revision, Codes F 00 - F 99. Linear Regression: β : regression slope; r2: predictive capacity; 95% CI: 95% confidence interval. Source: Data provided by the Department of Information Technology of the Unified Health System (DATASUS—www.datasus.gov.br). Ministry of Health, Brazil.
For the Southeast region, only the ages 25 to 29 years (β = -0.37, p = 0.040), 30 to 34 years (β = -0.72, p = 0.003) and 40 to 44 years (β = -1.19, p <0.001), 50 to 54 years (β = -1.25, p = 0.003) and 75 to 79 years (β = -1.14, p = 0.033) showed a reduction in mortality. The ages 35 to 39 years (β = 1.40, p = 0.0301) and 60 to 64 years (β = 0.44, p = 0.035) had a statistically significant increase.
The South region had a reduction in the following ages, 25 to 29 years (β = -0.42, p=0.043), 30 to 34 years (β = -0.56, p=0.019), 35 to 39 years (β = -1.46, p=0.001), 40 to 49 years (β = -1.25, p=0.004), 45 to 49 years (β = -1.43, p=0.001) and 75 to 79 years (β = -1.08, p=0.037).
The Central-West region, the population aged 30 to 34 years (β = -1.14, p=0.010), 35 to 39 years (β = -1.51, p=0.003), 40 to 44 years (β = -1.79, p=0.016), 45 to 49 years (β = -1.65, p=0.040) had results of reduction in the mortality rate, only the population aged over 79 years showed an increase in mortality (β = 4.17, p=0.032) (table 1).
The age-standardized mortality rate varied negatively in all regions, however only the Northeast, Southeast and South regions showed a significant decline (β = -0.131, p=0.003; β = -0.115, p=0.013; (β = -0.128, p=0.038, respectively). And when analyzing Brazil, it was observed that a reduction was obtained (β = -0.112, p= 0.004) (table 2).
Table 2 : Standardized mortality rate from Mental and Behavioral Disorders per 100,000 inhabitants (95% confidence interval) and linear regression estimate between 2009 and 2019 according to the country’s regions
| Brazil/Regions | Mortality standardized put age* put Disorders mental and behavioral (x100,000 inhabitants) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | β | p | |
| North | 0.003 | 0.003 | 0.003 | 0.003 | 0.003 | 0.003 | 0.004 | 0.003 | 0.004 | 0.003 | 0.003 | -0.003 | 0.916 |
| North East | 7.702 | 7.796 | 8.266 | 7.402 | 8.142 | 7.329 | 7.568 | 6.915 | 6.807 | 6.626 | 6.949 | -0.131 | 0.003 |
| Southeast | 6.661 | 7.067 | 7.388 | 6.825 | 6.471 | 6.106 | 5.827 | 6.001 | 5.753 | 6.020 | 6.409 | -0.115 | 0.013 |
| South | 6.618 | 6.843 | 7.174 | 5.736 | 5.898 | 5.392 | 5.220 | 5.317 | 5.276 | 6.096 | 5.845 | -0.128 | 0.038 |
| Midwest | 5.921 | 6.864 | 7.401 | 6.860 | 6.717 | 6.710 | 6.007 | 5.903 | 6.692 | 7.057 | 6.408 | -0.014 | 0.779 |
| Brazil | 6.705 | 7.015 | 7.376 | 6.595 | 6.645 | 6.190 | 6.059 | 5.959 | 5.873 | 6.077 | 6.260 | -0.112 | 0.004 |
* Age-standardized according to the World Health Organization (WHO) global population. Deaths: International Classification of Diseases, 10th Revision, Codes F00–F99. Regression Linear: β: inclination from the regression; r 2 : capacity predictive; IC 95%: interval of trust of 95% Source: System of Information on Mortality (YES). Data made available for the Department of Computing of System Single of Health (DATASUS— www.datasus.gov.br). Ministry of Health, Brazil.
Analyzing mortality due to mental and behavioral disorders between sexes, it was noted that only males showed a reduction in the rate in all Brazilian regions, however, only the Northeast region (β = -0.27, p = 0.001), Southeast region (β = -0.20, p = 0.003) and South region (β = -0.19, p = 0.023) showed significant reductions. When performing a direct comparison at the national level, both sexes showed a reduction, but only males had a significant decline (male: β = -0.20, p = 0.001; female: β = -0.03, p = 0.146) (Table 3).
Table 3 : Rate of standardized mortality by Disorders Mental and Behavioral put 100,000 inhabitants (interval of trust of 95%) by sex, and estimate of regression linear between 2009 and 2019 of agreement with to the regions of country
| Brazil/Regions | Mortality male standardized put age* put Disorders mental and behavioral (x100,000 inhabitants) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | β | p | |
| North | 5.15 | 4.97 | 5.36 | 4.69 | 5.10 | 5.09 | 5.38 | 4.97 | 5.22 | 4.52 | 4.72 | -0.03 | 0.242 |
| North East | 12.89 | 13.06 | 13.61 | 12.40 | 13.56 | 12.10 | 12.31 | 11.27 | 11.17 | 10.63 | 10.99 | -0.27 | 0.001 |
| Southeast | 9.73 | 9.99 | 10.61 | 9.74 | 9.28 | 8.69 | 8.44 | 8.33 | 7.99 | 8.55 | 8.79 | -0.20 | 0.003 |
| South | 10.57 | 11.04 | 11.47 | 9.65 | 9.76 | 9.26 | 8.73 | 8.91 | 8.56 | 9.77 | 9.66 | -0.19 | 0.023 |
| Midwest | 9.48 | 10.65 | 11.66 | 11.09 | 10.88 | 10.14 | 9.58 | 9.15 | 10.31 | 11.11 | 10.12 | -0.03 | 0.635 |
| Brazil | 10.37 | 10.68 | 11.25 | 10.16 | 10.26 | 9.50 | 9.33 | 8.99 | 8.85 | 9.18 | 9.29 | -0.20 | 0.001 |
| Brazil/Regions | Mortality feminine standardized put age* put Disorders mental and behavioral (x100.000 inhabitants) | ||||||||||||
| 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | β | p | |
| North | 1.33 | 1.46 | 1.40 | 1.41 | 1.49 | 1.79 | 1.86 | 1.69 | 1.80 | 1.37 | 1.71 | 0.03 | 0.072 |
| North East | 3.10 | 3.14 | 3.54 | 2.99 | 3.38 | 3.14 | 3.44 | 3.09 | 2.99 | 3.14 | 3.44 | 0.002 | 0.885 |
| Southeast | 3.86 | 4.34 | 4.41 | 4.13 | 3.90 | 3.74 | 3.44 | 3.84 | 3.65 | 3.71 | 4.19 | -0.04 | 0.203 |
| South | 3.04 | 3.01 | 3.28 | 2.19 | 2.36 | 1.87 | 2.02 | 2.05 | 2.27 | 2.73 | 2.35 | -0.07 | 0.097 |
| Midwest | 2.51 | 3.24 | 3.36 | 2.89 | 2.81 | 3.48 | 2.67 | 2.88 | 3.33 | 3.30 | 2.98 | 0.03 | 0.504 |
| Brazil | 3.36 | 3.65 | 3.83 | 3.34 | 3.35 | 3.18 | 3.10 | 3.19 | 3.14 | 3.26 | 3.49 | -0.03 | 0.146 |
* Standardized to age of agreement with the population worldwide from the Organization World from the Health. Deaths: Classification International of illnesses, 10th revision, Codes F 00 - F 99. Regression Linear: β: inclination from the regression; r 2 : capacity predictive; IC 95%: interval of trust of 95%. Source: System of Information on Mortality (YES). Data made available for the Department of Computing of System Single of Health (DATASUS— www.datasus.gov.br). Ministry of Health, Brazil.
Males showed an increase in mortality among single individuals in the South (β = 10.98, p=0.034) and Central-West (β = 7.21, p=0.028) regions. For married men, there was a reduction in the Northeast (β = -22.55, p<0.001) and South (β = -13.87, p=0.009) regions. Widowed individuals had an increase in mortality in the Northeast (β = 5.72, p=0.009), Southeast (β = 6.03, p=0.036) and Central-West (β = 2.27, p=0.007) regions (table 4).
Table 4 : Deaths put Disorders Mental and Behavioral stratified put state civil, I estimated of regression linear between 2009 and 2019 according to the regions of the country
| Deaths male put state civil | ||||||||
|---|---|---|---|---|---|---|---|---|
| Brazil/Regions | Single | Married | Widower | Legally separated | ||||
| β | p | β | p | β | p | β | p | |
| North | 2.07 | 0.058 | -0.20 | 0.797 | 0.58 | 0.303 | 0.86 | 0.031 |
| North East | 10.19 | 0.067 | -22.55 | <0.001 | 5.72 | 0.009 | 6.49 | <0.001 |
| Southeast | 14.16 | 0.121 | -7.94 | 0.313 | 6.03 | 0.036 | 6.92 | 0.010 |
| South | 10.98 | 0.034 | -13.87 | 0.009 | -0.66 | 0.731 | 5.16 | 0.017 |
| Midwest | 7.21 | 0.028 | 2.50 | 0.047 | 2.27 | 0.007 | 3.46 | 0.005 |
| Brazil | 44.62 | 0.020 | -42.06 | 0.011 | 13.95 | 0.009 | 22.91 | <0.001 |
| Deaths feminine put state civil | ||||||||
| Brazil/Regions | Single | Married | Widower | Legally separated | ||||
| β | p | β | p | β | p | β | p | |
| North | 0.56 | 0.309 | 0.56 | 0.137 | 1.93 | 0.010 | 0.14 | 0.345 |
| North East | 6.21 | 0.024 | 2.12 | 0.089 | 18.05 | <0.001 | 1.71 | 0.003 |
| Southeast | 12.27 | 0.016 | 4.20 | 0.064 | 16.44 | 0.093 | 8.12 | <0.001 |
| South | 0.61 | 0.632 | -0.61 | 0.632 | -4.20 | 0.331 | 1.91 | 0.026 |
| Midwest | 3.53 | 0.006 | 0.86 | 0.128 | 4.00 | 0.001 | 0.93 | <0.001 |
| Brazil | 23.05 | 0.007 | 7.15 | 0.115 | 36.23 | 0.024 | 12.82 | <0.001 |
Deaths: Classification International of illnesses, 10th revision, Codes F 00 - F 99. Regression Linear: β: inclination from the regression; r 2 : capacity predictive; IC 95%: interval of trust of 95%. Source: System of Information on Mortality (YES). Data made available for the Department of Computing of System Single of Health (DATASUS— www.datasus.gov.br). Ministry of Health, Brazil.
Among single women, the Northeast (β = 6.21, p=0.024), Southeast (β = 12.27, p=0.016), and Central-West (β = 3.53, p=0.006) regions had an increase in mortality. Among widowed women, there was an increase in mortality in the North (β = 1.93, p=0.010), Northeast (β = 18.05, p<0.001), and Central-West (β = 4.00, p=0.001) regions (table 4).
DISCUSSION
The results obtained from statistical analyses conducted between 2009 and 2019 provide a comprehensive overview of mortality rates from Mental and Behavioral Disorders (MBDs) in Brazil. Overall, a reduction in mortality rates from MBDs was observed, particularly among younger age groups and among males, especially in the Northeast, Southeast, and South regions. These findings corroborate data from previous studies, such as those by Pereira et al.11, which also indicated a downward trend in hospitalization rates for MBDs in Brazil, especially in Rio de Janeiro.
From this perspective, mental disorders are seen as a factor that impacts morbidity levels, as well as impairments in the individual’s functional capacity and a reduction in the quality of life of those affected. Around 90% of mental health problems manifest as depression, anxiety, insomnia, fatigue, irritability, and memory and concentration dysfunction12.
Hiany et al.,12 claim that 12% of global illnesses are related to mental disorders, and only 1% of deaths are caused by them. Unfortunately, 40% of countries still lack effective mental health policies, and there is a lack of programs targeting this population group.
Among the Brazilian population, 3% of them suffer from severe and persistent mental disorders and another portion, 6%, from severe psychiatric disorders due to the use of alcohol or other drugs12.
Brazil is increasingly using information systems to research morbidities and costs recorded in hospital admission authorizations (AIHs). However, there are few studies on hospitalizations due to Mental and Behavioral Disorders (MBDs). However, it is known that these disorders cause high financial costs for public health11.
Data from the World Health Organization (WHO) indicate a 10% prevalence of mental disorders worldwide. They occur with high frequency, leading the ranking of diseases listed as the main causes of years lived with disability11.
Studies have shown a decline in mortality from Mental and Behavioral Disorders over the 10-year period evaluated, falling from a rate of 6,705 in 2009 to 6,260 in 2019.
Presenting greater significance in the Northeast, Southeast and South regions. Corroborating this, Pereira and collaborators11 in research in the state of Rio de Janeiro in the period from 1999 to 2010, identified a reduction in the number of hospitalizations due to Mental and Behavioral Disorders, with a decline of 70% between the values of 1999 and 2010.
Mental disorders are considered a factor in global morbidity rates, and even at low levels, they have long-term repercussions. By causing disabilities in those with the clinical condition, they negatively affect the individual’s mobility and quality of life. Furthermore, treatment is difficult, as there is low demand for health services and a lack of technical and scientific knowledge among professionals regarding mental health, delaying the process of identification, diagnosis, intervention, and treatment12.
Regarding mortality by age group, there was an increase in individuals over 79 years of age in the Central-West region, with a rate of 51.0. In general, the rates showed negative variation between Brazilian regions, with a broad reduction across the country.
That said, population aging was considered a result of increased life expectancy and birth control in society, thus triggering a greater prevalence of chronic-degenerative diseases, including mental and behavioral disorders, such as dementia syndrome13.
In contrast, data from 2015 indicate that 20.0% of individuals aged 60 or over suffer from some mental or neurological illness, the most frequent being dementia and depression13. A study carried out in São Paulo in 2013 found a prevalence of 29.7% in mental disorders, more pronounced in women; elderly people aged 80 or over; low income; sedentary people and those with chronic diseases14.
There was little divergence between the age range identified through the data analysis and the other studies analyzed. This shows how the elderly population constitutes a risk group for developing and dying from CMD in Brazil.
Another study, conducted in 2011 in São Paulo, found that mental and behavioral disorders accounted for 40.3% of hospitalizations15. Santos and collaborators13infer the vulnerability of elderly citizens to developing mental disorders, as they experience events such as bereavement; decline in their work activities; loss of autonomy; and retirement. The combination of these and many other factors can lead to isolation, resulting in loneliness and psychological changes.
In Brazil, from 2008 to 2014, 139,941 hospitalizations of elderly people due to mental and behavioral disorders were recorded, and during this period there was a decline in hospitalization rates. A reduction in annual hospitalization rates was also observed in almost all regions, especially in the North, Northeast, and Central-West regions. The exception was the South region, where the trend was stable and had the highest hospitalization rate in 201413.
While a significant decline in mortality from CMD was only observed in Brazil, in the 10-year period considered, in the Northeast, Southeast and South regions.
Regarding the reduction in deaths by sex, there is a greater reduction among male individuals throughout Brazil (rate from 10.37 to 9.29), although the data are more significant in the Northeast, Southeast and South regions.
In addition to these data, regarding the profile of hospitalized patients, throughout the studied period, there was a higher coefficient of males, with an age range of 60 to 69 years. Furthermore, in both sexes and all age groups, there was a decrease in the period from 2008 to 2014. Among the hospital mortality of elderly people hospitalized for CMD, the main related diagnosis was dementia (32.3%)13.
It can be noted that the male population is more affected among the values of deaths due to CMD, while the research showed a greater reduction in rates in the young population (0.017).
In contrast, Hiany and collaborators12, analyzing studies by other authors, found that the majority of the Brazilian population affected by mental disorders is female. For both sexes, diagnoses include mood disorders; neurotic disorders; followed by psychotic disorders. Epidemiological studies have shown that mood disorders are more common in females, and psychotic disorders and substance use are more common in males.
However, when analyzing the period from 1999 to 2010, in Rio de Janeiro, hospitalizations for CMD, there was a predominance of hospitalizations for mental disorders in male patients. They were higher in individuals aged 30 to 39 and 40 to 49 years for both sexes. The largest portion of diagnoses were schizophrenia and other schizotypal and delusional disorders (50 to 60%), with about 60% being men. Hospitalizations for schizophrenia were more frequent in male patients aged 20 to 30 years, and among female patients, there was a predominance in the 30 to 39 age group11.
Furthermore, data reveal that the second most common diagnosis in hospitalizations for mental disorders in men is alcohol abuse and dependence, while in women it is mood disorders. Hospitalizations due to substance use were predominant in the young population, aged 20 to 29, while those hospitalized for alcohol use disorders were on average 30 to 49 years old11.
Mood disorders showed a slight increase, accounting for almost a quarter of psychiatric hospitalizations in women between 2008 and 2010. The age range of these women is between 20 and 49 years old and 50 and 59 years old. It is worth noting that among mood disorders, the main cause of hospitalization in both sexes was bipolar disorders, followed by depressive disorders and manic episodes11.
With the data analyzed, higher mortality was evidenced among single male individuals (0.020), favoring this finding, in studies on mortality from mental and behavioral disorders due to the use of psychoactive substances in Brazil, between the years 2012 to 2016, data indicated that a large part of the deaths were due to alcohol consumption, in addition, 85.97% were male and 46.31% single16.
CONCLUSION
Mortality from mental and behavioral disorders reached its highest rates in 2011, with a rate of 7,376, with the highest proportion of deaths observed among males (11.25%), especially among single men, in all regions of Brazil. During the study period, an increase in mortality among women was observed, with a higher prevalence observed in the Northeast region and among those who were widowed.
