Psicose e Urbanidade: Qual a Relação? Um Estudo Comparativo entre uma Área Urbana e uma Rural em Portugal

Autores

DOI:

https://doi.org/10.51338/rppsm.416

Palavras-chave:

Perturbações Psicóticas, População Rural, População Urbana

Resumo

Introdução: Os estudos sobre urbanidade e psicose apresentam resultados contraditórios. Nos países do Norte da Europa e China existe uma relação positiva; nos países do sul da Europa e países subdesenvolvidos não se encontraram diferenças significativas entre as taxas rurais e urbanas de psicose.
Métodos: Realizamos um estudo retrospetivo observacional, com os doentes admitidos em duas unidades de internamento por primeiro episódio psicótico (PEP) durante 5 anos, numa área rural (Évora) e numa área urbana (Lisboa). Excluímos psicoses afetivas ou orgânicas. Extraímos e analisamos estatisticamente dados sociodemográficos e clínicos.
Resultados: A prevalência de PEP foi igual para ambas as áreas (42/100 000 habitantes), com predomínio de indivíduos desempregados (63%) e sem relacionamento afetivo (81% em Évora versus 72% em Lisboa). A média de idades foi semelhante (43,4 anos vs 41,4 anos). Lisboa apresentou maior diversidade de nacionalidade (16,3% vs 4,6%) e maior taxa de perturbação psicótica devido ao uso de substâncias (26,5% vs 21,6%). O diagnóstico mais prevalente em Lisboa foi perturbação psicótica não especificada (PPNE) (34,7%), enquanto em Évora foram perturbação delirante (PD) (21,5%) e perturbação psicótica aguda e transitória (21,5%). A PD foi um diagnóstico prevalente em ambas as áreas, afetando sobretudo mulheres e com idade média superior. A duração da psicose não tratada (DPNT) inferior a 1 mês
foi maior em Lisboa (24,5% vs 4,5%), mas houve uma elevada prevalência de DPNT superior a 2 anos em ambas as amostras (20,4% vs 23,1%).
Discussão: A idade média de PEP foi superior do que em outros estudos, o que pode traduzir uma prevalência significativa de PD ou refletir uma DPNT mais elevada. Uma reduzida DPNT inferior a 1 mês na área rural pode
ser explicada por maior isolamento da população, menor literacia em saúde ou maior integração dos doentes na comunidade. A prevalência de PPNE foi maior na área urbana, possivelmente por diferentes formas de registos ou uma menor DPNT.
Conclusão: Os resultados estão em linha com estudos reportados em países do sul da Europa, onde não foi encontrada associação entre psicose e urbanidade, sendo necessários mais estudos para elucidar esta questão.

Downloads

Não há dados estatísticos.

Referências

Figueira ML, Afonso P, Sampaio D. Manual de Psi‐ quiatria Clinica. Lisboa: Lidel; 2014.

Varchmin L, Montag C, Treusch Y, Kaminski J, Heinz A. Traumatic events, social adversity and discrimina‐ tion as risk factors for psychosis ‐ an umbrella review. Front Psychiatry. 2021;12:665957. doi: 10.3389/ fpsyt.2021.665957.

Toulopoulou T, Picchioni M, Mortensen PB, Petersen L. IQ, the Urban Environment, and Their Impact on Future Schizophrenia Risk in Men. Schizophr Bull. 2017;43:1056‐63. doi: 10.1093/schbul/sbw147.

Del‐Ben CM, Shuhama R, Loureiro CM, Ragazzi TC, Zanatta DP, Tenan SH, et al. Urbanicity and risk of first‐episode psychosis: incidence study in Bra‐ zil. Br J Psychiatry. 2019;215:726‐9. doi: 10.1192/ bjp.2019.110.

Krabbendam L, van Os J. Schizophrenia and urba‐ nicity: a major environmental influence‐‐conditional on genetic risk. Schizophr Bull. 2005;31:795‐9. doi: 10.1093/schbul/sbi060.

Abrahamyan Empson L, Baumann PS, Söderström O, Codeluppi Z, Söderström D, Conus P. Urbanicity: The need for new avenues to explore the link between urban living and psychosis. Early Interv Psychiatry. 2020;14:398‐409. doi: 10.1111/eip.12861.

Jongsma HE, Gayer‐Anderson C, Lasalvia A, Quat‐ trone D, Mulè A, Szöke A, et al. Treated Incidence of Psychotic Disorders in the Multinational EU‐GEI Study. JAMA Psychiatry. 2018;75:36‐46. doi: 10.1001/ jamapsychiatry.2017.3554.

Sundquist K, Frank G, Sundquist J. Urbanisation and incidence of psychosis and depression: follow‐up study of 4.4 million women and men in Sweden. Br J Psy‐ chiatry. 2004;184:293‐8. doi: 10.1192/bjp.184.4.293.

Coid JW, Zhang Y, Sun H, Yu H, Wei W, Li X, et al. Impact of urban birth and upbringing on

expression of psychosis in a Chinese undergradu‐ ate population. BMC Psychiatry. 2021;21:493. doi: 10.1186/s12888‐021‐03475‐w.

Wang C, Zhang Y. Season of birth and schizophrenia: Evidence from China. Psychiatry Res. 2017;253:189‐ ‐96. doi: 10.1016/j.psychres.2017.03.030.

DeVylder JE, Kelleher I, Lalane M, Oh H, Link BG, Koyanagi A. Association of Urbanicity With Psychosis in Low‐ and Middle‐Income Countries. JAMA Psychiatry. 2018;75:678‐86. doi: 10.1001/jamapsychiatry.2018.0577. Erratum in: JAMA Psychiatry. 2018;75:759.

Bocchetta A, Traccis F. The Sardinian Puzzle: Concentration of Major Psychoses and Suicide in the Same Sub‐Regions Across One Century. Clin Pract Epidemiol Ment Health. 2017;13:246‐54. doi: 10.2174/1745017901713010246.

Lasalvia A, Bonetto C, Tosato S, Zanatta G, Cristo‐ falo D, Salazzari D, et al. First‐contact incidence of psychosis in north‐eastern Italy: influence of age, gender, immigration and socioeconomic deprivation. Br J Psychiatry. 2014;205:127‐34. doi: 10.1192/bjp. bp.113.134445.

Schofield P, Thygesen M, Das‐Munshi J, Becares L, Cantor‐Graae E, Pedersen C, et al. Ethnic density, urbanicity and psychosis risk for migrant groups ‐ A population cohort study. Schizophr Res. 2017;190:82‐ ‐7. doi: 10.1016/j.schres.2017.03.032.

Cheng F, Kirkbride JB, Lennox BR, Perez J, Masson K, Lawrence K, et al. Administrative incidence of psy‐ chosis assessed in an early intervention service in En‐ gland: first epidemiological evidence from a diverse, rural and urban setting. Psychol Med. 2011;41:949‐58. doi: 10.1017/S0033291710002461.

Radua J, Ramella‐Cravaro V, Ioannidis JP, Reichen‐ berg A, Phiphopthatsanee N, Amir T, et al. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry. 2018;17:49‐66. doi: 10.1002/wps.20490.

Richardson L, Hameed Y, Perez J, Jones PB, Kirkbride

JB. Association of Environment With the Risk of De‐ veloping Psychotic Disorders in Rural Populations: Findings from the Social Epidemiology of Psychoses in East Anglia Study. JAMA Psychiatry. 2018;75:75‐ ‐83. doi: 10.1001/jamapsychiatry.2017.3582.

Badcock JC, Paulik G. A Clinical Introduction to Psy‐ chosis ‐ Foundations for Clinical Psychologists and Neuropsychologists. Amsterdam: Elsevier; 2020.

Fett AJ, Lemmers‐Jansen ILJ, Krabbendam L. Psy‐ chosis and urbanicity: a review of the recent liter‐ ature from epidemiology to neurourbanism. Curr Opin Psychiatry. 2019;32:232‐41. doi: 10.1097/ YCO.0000000000000486.

O’Donoghue B, Lyne JP, Renwick L, Lane A, Madigan K, Staines A, et al. Neighbourhood characteristics and the incidence of first‐episode psychosis and duration of untreated psychosis. Psychol Med. 2016;46:1367‐ ‐78. doi: 10.1017/S003329171500286X.

Zammit S, Lewis G, Rasbash J, Dalman C, Gus‐ tafsson JE, Allebeck P. Individuals, schools, and neighborhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Arch Gen Psychiatry. 2010;67(:914‐22. doi: 10.1001/ archgenpsychiatry.2010.101.

Kirkbride JB, Boydell J, Ploubidis GB, Morgan C, Dazzan P, McKenzie K, et al. Testing the association between the incidence of schizophrenia and social cap‐ ital in an urban area. Psychol Med. 2008;38:1083‐94. doi: 10.1017/S0033291707002085.

Hutchinson G, Haasen C. Migration and schizophrenia: the challenges for European psychiatry and implica‐ tions for the future. Soc Psychiatry Psychiatr Epidemi‐ ol. 2004;39:350‐7. doi: 10.1007/s00127‐004‐0766‐0.

Hou CL, Chen MY, Cai MY, Chen ZL, Cai SB, Xiao YN, et al. Antipsychotic‐Free Status in Community‐ ‐Dwelling Patients With Schizophrenia in China: Comparisons Within and Between Rural and Urban Areas. J Clin Psychiatry. 2018;79:17m11599. doi: 10.4088/JCP.17m11599.

Dolja‐Gore X, Loxton DJ, D’Este CA, Byles, J. E. Mental health service use: Is there a difference be‐ tween rural and non‐rural women in service uptake? Aust J Rural Health. 2014;22:92‐100.

Morales DA, Barksdale CL, Beckel‐Mitchener AC. A call to action to address rural mental health dispari‐ ties. J Clin Transl Sci. 2020;4:463‐7. doi: 10.1017/ cts.2020.42.

Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning JC. Childhood exposure to green space ‐ A novel risk‐decreasing mechanism for schizophrenia? Schizophr Res. 2018;199:142‐8. doi: 10.1016/j.schres.2018.03.026.

Frissen A, van Os J, Peeters S, Gronenschild E, Marcelis M; for Genetic Risk and Outcome in Psy‐ chosis (G.R.O.U.P.). Evidence that reduced gray matter volume in psychotic disorder is associated with

exposure to environmental risk factors. Psychiatry Res Neuroimaging. 2018;271:100‐10. doi: 10.1016/j. pscychresns.2017.11.004.

Hall SA, Kaufman JS, Ricketts TC. Defining ur‐ ban and rural areas in U.S. epidemiologic studies. J Urban Health. 2006;83:162‐75. doi: 10.1007/ s11524‐005‐9016‐3.

Ritchie H Roser M. Urbanization. [accessed Jan 2022] Available from: https://ourworldindata.org/ urbanization

Chen Y, Farooq S, Edwards J, Chew‐Graham CA, Shiers D, Frisher M, et al. Patterns of symptoms be‐ fore a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records. BMC Med. 2019;17:227. doi: 10.1186/ s12916‐019‐1462‐y.

O’Donoghue B, Lyne J, Madigan K, Lane A, Turner N, O’Callaghan E, et al. Environmental factors and the age at onset in first episode psychosis. Schizophr Res. 2015;168:106‐12. doi: 10.1016/j.schres.2015.07.004.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age‐of‐onset distributions of DSM‐IV disorders in the National Co‐ morbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593‐602. doi: 10.1001/archpsyc.62.6.593. Erratum in: Arch Gen Psychiatry. 2005;62:768.

Solmi M, Radua J, Olivola M, Croce E, Soardo L, Sa‐ lazar de Pablo G, et al. Age at onset of mental disorders worldwide: large‐scale meta‐analysis of 192 epidemi‐ ological studies. Mol Psychiatry. 2022;27:281‐95. doi: 10.1038/s41380‐021‐01161‐7.

Geddes JR, Andreasen NG. New Oxford textbook of Psychiatry. 3rd ed. Oxford: Oxford University Press; 2020.

Stegbauer C, Willms G, Kleine‐Budde K, Brames‐ feld A, Stammann C, Szecsenyi J. Development of indicators for a nationwide cross‐sectoral quality as‐ surance procedure for mental health care of patients with schizophrenia, schizotypal and delusional disor‐ ders in Germany. Z Evid Fortbild Qual Gesundhwes. 2017;126:13‐22. doi: 10.1016/j.zefq.2017.07.006.

Association American Psychiatry. Diagnostic and sta‐ tistical manual of mental disorders: DSM‐5TM. 5th ed. Chicago: American Psychiatric Publishing; 2013.

Jung YS, Kim YE, Go DS, Yoon SJ. The prevalence, incidence, and admission rate of diagnosed schizo‐ phrenia spectrum disorders in Korea, 2008‐2017: A nationwide population‐based study using claims big data analysis. PLoS One. 2021;16:e0256221. doi: 10.1371/journal.pone.0256221.

Saunders NR, Gill PJ, Holder L, Vigod S, Kurdyak P, Gandhi S, et al. Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population‐based study. CMAJ. 2018;190:E1183‐91. doi: 10.1503/ cmaj.180277.

Fundação Francisco Manuel dos Santos. População residente: total e por sexo. [consultado April 2022] Available:http://www.pordata.pt

Direção Geral da Saúde. Plano nacional de saúde men‐ tal 2007—2016 e propostas prioritárias para a extensão a 2020. Lisboa: DGS; 2017.

Ministério da Saúde, Portugal. Relatório da Avaliação do Plano Nacional de Saúde Mental 2007‐2016 e pro‐ postas prioritárias para a extensão a 2020 [consultado April 2022] Available: https://saudemental.min‐saude. pt/wp‐content/uploads/2020/09/RelAvPNSM2017_ compressed.pdf

Marinucci A, Grové C, Rozendorn G. “It’s Some‐ thing That We All Need to Know”: Australian Youth Perspectives of Mental Health Literacy and Action in Schools. Front Educ. 2022;7;1‐11.

Hampson ME, Watt BD, Hicks RE, Bode A, Hampson EJ. Changing hearts and minds: The importance of for‐ mal education in reducing stigma associated with men‐ tal health conditions. Health Educ J.2018;77:198‐211.

Thirthalli J, Reddy KS, Kare M, Das S, Gangadhar BN. Rural‐urban differences in accessing mental health treatment in patients with psychosis. Int J Soc Psychia‐ try. 2017;63:694‐8. doi: 10.1177/0020764017730849.

Chu CC, Sallach HS, Klein HE. Differences in symp‐ tomatology and social adjustment between urban and rural schizophrenics. Soc Psychiatry. 1986;21:10‐4. doi: 10.1007/BF00585316.

Yang LH, Phillips MR, Li X, Yu G, Zhang J, Shi Q, et al. Employment outcome for people with schizophre‐ nia in rural v. urban China: population‐based study. Br J Psychiatry. 2013;203:272‐9. doi: 10.1192/bjp. bp.112.118927.

Hopper K, Harrison G, Janca A, Sartorius N. Recov‐ ery from Schizophrenia: An International Perspective

‐ a Report from the WHO Collaborative Project; the International Syudy of Schizofrenia. Oxford: Oxford University Press; 2007.

Jorm AF. Mental health literacy: empowering the community to take action for better mental health. Am Psychol. 2012;67:231‐43. doi: 10.1037/a0025957.

Lam Y, Broaddus ET, Surkan PJ. Literacy and healthcare‐seeking among women with low ed‐ ucational attainment: analysis of cross‐sectional data from the 2011 Nepal Demographic and Health Survey. Int J Equity Health. 2013;12:95. doi: 10.1186/1475‐9276‐12‐95.

Instituto Nacional de Estatistica. Censos 2021. [ac‐ cessed Jan 2022] Available from: https://censos.ine.pt

Santelmann H, Franklin J, Bußhoff J, Baethge C. Inter‐ rater reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression ‐ A systematic review and meta‐analysis. Schizophr Res. 2016;176:357‐63. doi: 10.1016/j. schres.2016.07.012.

Sündermann O, Onwumere J, Bebbington P, Kuipers E. Social networks and support in early psychosis: potential mechanisms. Epidemiol Psychiatr Sci. 2013;22:147‐50. doi: 10.1017/S2045796012000601.

Sündermann O, Onwumere J, Kane F, Morgan C. Kui‐ pers E. Social networks and support in first‐episode psychosis: Exploring the role of loneliness and anxiety. Soc. Psychiatry Psychiatr Epidemiol. 2014;49:359–66.

Cotter J, Lin A, Drake RJ, Thompson A, Nelson B, McGorry P, et al. Long‐term employment among people at ultra‐high risk for psychosis. Schizophr Res. 2017;184:26‐31. doi: 10.1016/j.schres.2016.11.033.

Downloads

Publicado

2023-06-15

Como Citar

Lopes, J. S., Quintão, A. A., Santos, C. M., Urzal, M. de F., & Donas-Boto, I. (2023). Psicose e Urbanidade: Qual a Relação? Um Estudo Comparativo entre uma Área Urbana e uma Rural em Portugal. Revista Portuguesa De Psiquiatria E Saúde Mental, 9(2), 49–57. https://doi.org/10.51338/rppsm.416

Edição

Secção

Artigo Original