Transtorno de Estresse Pós-Traumático e Comorbidades: Um estudo de Base Populacional.

Abstract

This dissertation has as main objective to study patterns of comorbidity between PTSD and other psychiatric disorders, measuring its co-occurrence with other disorders as Depression, Anxiety Disorders and Alcohol Related Disorders. In addition, we studied differences in those patterns by gender. The study also evaluated the chronological relationship in between PTSD and other psychiatric disorders. The data used in the study came from population based enquiry done in Brazil s two largest cities, São Paulo and Rio de Janeiro, between 2007 and 2008, with 3744 respondents. The sample had a slight predominance of women, and half of the respondents aged between 15 and 34 years old. The majority were married and the most common range of years of schooling was between 9 and 12 years. About two thirds of the respondents were employed when interviewed. Concerning comorbidity with PTSD, we observed that the diagnosis of Depression, Other Anxiety Disorders and Alcohol Related Disorder was more prevalent in the population with PTSD than in the population without PTSD. When DSM-IV criteria were used, 57% PTSD cases had comorbid disorders, whereas, when ICD-10 criteria were used this proportion went up to 68%. The diagnosis that presented highest proportion of comorbidity with PTSD cases was Others Anxiety Disorders with about 50% overlap. In the case of Depression, this proportion was about 50% and in the case of Alcohol Related Disorders about 8%. Considering the temporal relationship, the diagnosis of Depression had fairly uniform distribution, having approximately the same proportion of cases with onset prior, subsequent, or in the same years of PTSD s onset. The other studied mental disorders initiated predominantly before the PTSD diagnosis comprising approximately 80% in the case of Other Anxiety Disorders and 50% in the case of Alcohol Related Disorders. Comorbidity between PTSD and other psychiatric disorders was found to be high, even when observed in a population-based study instead of a selected group of patients. This finding is relevant as comorbidity has been associated with severity, worst prognosis and poorer response to treatment. Therefore, clinical management of patients should take into account the high rates of comorbidity in PTSD in order to better suit treatment for those individuals. In addition, it is important for studies of risk factors and therapeutic trails to include patients with PTSD comorbid with other psychiatric disorders, in order to be more representative of cases in the wider population.