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This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued. Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente.

Background Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. Methods We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. Results In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (− 9.01%, − 11.66 to − 6.31). The highest proportion of YLD was observed in the age range of 15–64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil’s, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. Conclusions Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Introdução: Os Transtornos mentais e decorrentes do uso de sustâncias (TM), com destaque para os transtornos depressivos, são um dos principais contribuintes para a carga de doença não fatal em todo o mundo e estão relacionados à mortalidade por suicídio. O presente estudo teve como objetivo geral descrever e analisar as estimativas do Global Burden of Disease Study (GBD) para os TM e para o suicídio no Brasil e Unidades Federativas (UFs) e foi elaborado sob a forma de três artigos científicos. O objetivo do primeiro artigo foi descrever a carga dos TM no país e em suas UFs, no GBD-2015, por idade e sexo, nos anos de 1990 e 2015. O segundo artigo teve como objetivo descrever as estimativas de prevalência, anos de vida ajustados por incapacidade (DALY) e anos de vida vividos com incapacidade (YLD) do GBD 2017 para os transtornos depressivos no Brasil e UFs, por sexo e idade, em 1990 e 2017. As estimativas de YLD foram comparadas com as de outros sete países. Investigou-se ainda a razão entre o YLD observado versus esperado, com base no índice sociodemográfico (SDI). Finalmente, o terceiro artigo objetivou analisar as estimativas do GBD-2017 sobre a mortalidade e anos perdidos por morte prematura (YLL) por suicídio no Brasil e UFs por sexo e grupos etários, em 1990 e 2017. Métodos: Realizou-se um estudo descritivo com dados de base secundária do estudo GBD que mede a carga de doença em termos dos anos de vida ajustados por incapacidade (DALY = YLD+YLL). O cálculo do YLD foi realizado a partir da multiplicação da prevalência de cada transtorno mental ao seu peso da incapacidade (disability weight). Para cálculo do YLL, as informações sobre óbitos foram obtidas do Sistema de Informações de Mortalidade (SIM), submetido à correção do subregistro de óbitos e redistribuição de códigos garbage. As métricas foram apresentadas por idade, sexo e UFs. As taxas padronizadas por idade por 100 mil habitantes, foram produzidas pelo método direto de padronização, tendo como padrão a população mundial desenvolvida para o GBD. Para todas as estimativas foram considerados intervalos de incerteza de 95% (II 95%). Resultados: Artigo 1. Apesar da baixa taxa de mortalidade, observou-se alta carga para os TM desde 1990, com elevados YLD. Em 2015, os TM foram responsáveis por 9,5% do total de DALY do Brasil, ocupando a 3ª e a 1ª posições na classificação de DALY e YLD, respectivamente, com destaque para os transtornos depressivos e de ansiedade. Os transtornos decorrentes do uso de drogas apresentaram a maior elevação das taxas de DALY entre 1990 e 2015 (37,1%). A maior proporção de DALY ocorreu na idade adulta e no sexo feminino. Não houve diferenças substanciais na carga dos TM entre as UFs. Artigo 2. No GBD-2017, a prevalência dos transtornos depressivos no Brasil foi de 3,30% (II 95%: 3,08 a 3,57%), variando de 3,79% (3,53 a 4,09%) em Santa Catarina a 2,78% no Pará (2,56 a 3,03%), com diferenças significativas entre as UFs. Entre 1990 e 2017, houve aumento do número (55,19%, 49,57 a 60,73) e das taxas brutas de YLD (9,48%, 5,51 a 13,38%), mas diminuição das taxas padronizadas por idade (-9,01%, -11,66 a -6,31%). A maior proporção de YLD foi dos 15 aos 64 anos e no sexo feminino. Estes transtornos ocuparam a 4ª e a 13ª posições na classificação de YLD e DALY, respectivamente, no Brasil. Nos demais países de comparação, a posição destes transtornos na classificação de YLD foi próxima à do Brasil, enquanto na classificação de DALY, houve maior variabilidade. Todos os países apresentaram taxas de YLD semelhantes à taxa global. A razão do YLD observado/esperado variou de 0,81 no Pará a 1,16 em Santa Catarina. A morbidade dos transtornos depressivos não foi associada ao SDI. Artigo 3. Houve 14.145 (II 95%: 13.373 a 14.566) mortes por suicídio no Brasil em 2017, um aumento de 53,21% (43,24 a 59,40%) em relação à 1990. As taxas brutas de mortalidade e de YLL aumentaram 8,08% (1,05 a 12,44%) e 0,38% (-6,45 a 4,91) respectivamente, enquanto houve diminuição das taxas padronizadas por idade de mortalidade (-15,00%, -20,33 a -11,98%) e de YLL (-11,88%, -17,70 a -8,28%). Em 2017, as maiores taxas de mortalidade padronizadas por idade foram encontradas nas UFs do Sul, mas de 1990 a 2017, houve diminuição das taxas em todas as UFs do Sul e do Sudeste e aumento em quase todas as UFs do Nordeste. Em ambos os sexos, cerca de dois terços do número de suicídios ocorreram dos 15 aos 49 anos, enquanto as maiores taxas ocorreram nas idades mais avançadas, acima de 70 anos de idade. Os homens foram pelo menos três vezes mais acometidos do que as mulheres em todas as UFs e faixas etárias, exceto dos 10 aos 14 anos em que os números foram semelhantes. Somente na faixa etária de 10 a 14 anos houve aumento na taxa de suicídio entre 1990 e 2017. O suicídio foi a 3° principal causa de mortalidade em homens dos 15 aos 34 anos e a 4° em mulheres dos 15 aos 24 anos. Conclusões: Os TM, principalmente os transtornos depressivos, são altamente incapacitantes. Os transtornos depressivos e o suicídio estão atingindo um número maior de pessoas a cada ano, indicando a necessidade de ações preventivas e protetivas, em todos os níveis de atenção a estes casos. A elucidação dos aspectos epidemiológicos dos TM e do suicídio em todos os estados brasileiros é fundamental para o planejamento de ações direcionadas para as áreas de maior necessidade, tornando mais equânime o sistema de saúde no país, além de fornecer dados para ampliar a discussão sobre a distribuição e aspectos relacionados em cada localidade, ainda escassos no país. Introduction: Mental and substance use disorders (MD), especially depressive disorders, are among the leading causes of non-fatal disease burden worldwide and are associated to mortality for suicide. The present study aimed to describe and analyze the Global Burden of Disease Study (GBD) estimates for MD and suicide in Brazil and Federated Units (FUs) and was prepared in the form of three scientific articles. The objective of the first article was to describe the data related to the burden of MD, in GBD-2015, in Brazil and its FUs, by age and sex, in the years 1990 and 2015. The second article used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life years (DALY) and the years lived with disability (YLD) for depressive disorders in Brazil and FUs, by sex and age, in 1990 and 2017. The YLD estimates were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. Finally, the third article use the estimates from the GBD-2017 to describe mortality and years of life lost (YLL) by suicide in Brazil and FUs by sex and age groups, in 1990 and 2017. Methods: A descriptive study was carried out with secondary data from GBD study. In GBD studies, burden of disease is measured in terms of DALY, a composite indicator that results from the sum of YLD and YLL: DALY=YLD+YLL. The calculation of YLDs was performed by multiplying two components: the prevalence of depressive disorders and the disability weight. To estimate the YLL, the source of mortality data in Brazil is the Mortality Information System (Sistema de Informação sobre Mortalidade [SIM]). The GBD uses methodologies for correcting underreporting of deaths and garbage code. Age-standardised rates per 100 thousand inhabitants produced by the direct standardization method, with the world population developed for GBD. For all estimates, uncertainty intervals of 95% (95% UI) were considered. Results: Article 1. In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY in Brazil, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among FUs. Article 2. In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% UI: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the FUs. From 1990 to 2017, there was an increase in number (55.19%, 49.57 to 60.73) and crude rate of YLD (9.48%, 5.51 to 13.38), but a decrease in the age-standardized rates (-9.01%, -11.66 to - 6.31). The highest proportion of YLD was observed in the age range of 15-64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil´s, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. Article 3. There were 14 145 (95% UI: 13 373 to 14 566) suicide deaths in Brazil in 2017, an increase of 53.21% (43.24 to 59.40%) compared to 1990. The crude mortality and YLL rates increased by 8.08 % (1.05 to 12.44%) and 0.38% (-6.45 a 4.91) respectively, while there was a decrease in age-standardised rates of mortality (-15.00%, -20.33 to -11.98%) and YLL (-11.88%, -17.70 to -8.28%). In 2017, the highest age-standardised mortality rates were found in southern FUs, but from 1990 to 2017, there was a decrease in rates in all Southern and Southeastern FUs and an increase in almost all Northeastern UFs. In both sexes, about two-thirds of the number of suicides occurred between 15 and 49 years of age, while the highest rates occurred at more advanced ages, for ages 75 years or older. Men were at least three times more affected than women in all FUs and age groups, except for ages 10-14 years when the numbers were similar. Only for those aged 10-14 years there was an increase in the suicide rate between 1990 and 2017. Suicide was the 3rd leading cause of death in men aged 15-34 years and the 4th in women aged 15-24 years. Conclusions: Mental and substance use disorders, especially depressive disorders, are highly disabling. Depressive disorders and suicide are increasing every year, indicating the need for preventive and protective actions, at all levels of attention to these cases. The elucidation of epidemiological aspects of mental and substance use disorders and suicide in all Brazilian states is crucial for planning action aimed at the areas of greast need and to making the Brazilian health system more equitable. Furthermore, it provides data to expand the discussion about distribution and aspects related in each locality, which still are scarce in the country.

RESUMO: Introdução: Os transtornos mentais e decorrentes do uso de substâncias psicoativas (TM) são altamente prevalentes, gerando elevado custo social e econômico. Objetivo: Descrever a carga dos TM no Brasil e Unidades Federativas (UFs), em 1990 e 2015. Métodos: Estudo descritivo da carga de doença dos TM, por meio de estimativas padronizadas por idade do Global Burden of Disease Study 2015: anos de vida perdidos por morte prematura (YLL); anos vividos com incapacidade (YLD); e anos de vida perdidos por morte ou incapacidade (DALY=YLL+YLD). Resultados: No Brasil, apesar da baixa taxa de mortalidade, observa-se alta carga para os TM desde 1990, com elevados YLD. Em 2015, esses transtornos foram responsáveis por 9,5% do total de DALY, ocupando a 3ª e a 1ª posições na classificação de DALY e YLD, respectivamente, com destaque para os transtornos depressivos e de ansiedade. Os transtornos decorrentes do uso de drogas apresentaram a maior elevação das taxas de DALY entre 1990 e 2015 (37,1%). A maior proporção de DALY ocorreu na idade adulta e no sexo feminino. Não houve diferenças substanciais na carga dos TM entre as UFs. Conclusão: Apesar da baixa mortalidade, os TM são altamente incapacitantes, indicando necessidade de ações preventivas e protetivas, principalmente na atenção primária em saúde. A homogeneidade das estimativas em todas as UFs, obtidas a partir de estudos realizados majoritariamente nas regiões Sul e Sudeste, provavelmente não reflete a realidade do Brasil, e indica necessidade de estudos em todas as regiões do país. ABSTRACT: Introduction: Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost. Objective: To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015. Methods: Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD). Results: In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units. Conclusion: Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.

Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost.To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015.Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD).In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units.Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.