OBJECTIVE:To map evidence on workplace mental health practices for promotion, prevention, screening, and management of mental health and psychosocial risks, with attention to their potential relevance to the Brazilian occupational context. METHODS:A scoping review followed JBI guidance and was reported according to PRISMA-ScR. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, PsycINFO and Cochrane Library. Studies, protocols, and institutional documents published between 2020 and 2025 addressing workplace mental health practices in occupational settings were included. RESULTS:Sixty-eight records were included. Relatively stronger evidence for short-term psychological outcomes came from moderate-robustness randomized studies of ACT and resilience training. Mindfulness was more frequently studied but showed heterogeneous and mostly short-term effects. Evidence for exercise, CBT-based self-care, coaching, and leadership interventions was preliminary or mixed. Effect sizes, sustained benefits, and organizational outcomes were inconsistently reported. CONCLUSION:The mapped literature was heterogeneous and concentrated on individual-level approaches, with limited assessment of organizational outcomes. Five recurring domains were organized as a hypothesis-generating conceptual synthesis to support future consensus development, contextual adaptation, feasibility assessment, and implementation research in Brazil. This synthesis is not a validated model or recommendation for routine practice.
The rapid expansion of online gambling in Brazil has outpaced the consolidation of regulatory safeguards, raising concerns about gambling-related harm at the population level. The Third Brazilian National Alcohol and Drugs Survey (BNADS/LENAD III) investigated gambling participation and risk gambling, providing nationally representative estimates of the magnitude of the problem and identifying vulnerable groups to inform public policy. LENAD III is a survey conducted in Brazil in 2022-2023 with 16,608 individuals aged 14 years and older. Gambling participation and risk were assessed using the Problem Gambling Severity Index (PGSI). Weighted prevalence estimates and multivariable logistic regression models were used to examine associations between structural, sociodemographic, behavioural factors, and risk gambling. Past-year gambling was reported by 17.6% of the population. Overall, 6.6% fell within the PGSI risk spectrum, while 2.8% were classified as moderate- or high-risk. Risk gambling was substantially more frequent among online gamblers. In multivariable models, online gambling remained the strongest correlate of gambling-related harm. Risk gambling in Brazil is substantial and disproportionately concentrated in online betting. Regulatory responses should prioritize structural measures that address product design, advertising exposure, and access control. Strengthening enforcement and aligning regulation with public health principles are urgent priorities.
OBJECTIVE:Investigate spatial and temporal distribution of suicide mortality across the Regional Health Care Networks of São Paulo State, Brazil, from 2012 to 2022, evaluating associations with mental health service availability, psychiatric workforce density, and socioeconomic indicators. METHODS:Longitudinal retrospective ecological study using annual data from 19 Regional Health Care Networks. Suicide mortality (ICD-10 X60-X84) rates per 100,000 inhabitants were analyzed using descriptive epidemiology, exploratory spatial data analysis, and fixed-effects panel regression models with spatial error specifications and one-year lagged independent variables. RESULTS:Suicide rates increased from 4.8 to 6.3 per 100,000 (32%). Female aged 10-14 years experienced a 332% increase. Spatial clustering revealed persistent high-risk areas in inland regions. In panel regression models (within-R² = 0.53), psychiatrist density in the public health system demonstrated a protective association (β = -0.20, p < 0.05), as did psychiatric bed rates in lagged models (β = -0.01, p < 0.05). Psychosocial Care Centers coverage showed no significant association. GDP per capita was positively associated with suicide rates. CONCLUSIONS:Psychiatric workforce availability and acute care capacity emerge as key modifiable factors. Increase among female adolescents and persistent geographic disparities warrant targeted prevention strategies. Findings provide actionable evidence for suicide prevention resource allocation in middle-income settings.
OBJECTIVE:To examine differences in behavioral and emotional problems among children aged 1-4 years using baseline data from two independent Uruguayan cohort studies (2013 and 2018), and to investigate whether differences were explained by socioeconomic, maternal, and child characteristics. METHODS:Data from two independent Montevideo cohorts (2013: n=790; 2018: n=743) were analyzed. Behavioral and emotional problems were assessed through maternal report using the Child Behavior Checklist for Ages 1½-5 (CBCL 1½-5). Between-cohort differences were examined using ANCOVA with sequential adjustment for socioeconomic, maternal, and child characteristics. RESULTS:The 2018 cohort showed higher CBCL scores for total problems (mean difference=1.87, Cohen's d=0.10, 95%CI:0.00-0.20, p=0.049) and internalizing problems (mean difference=1.01, d=0.17, 95%CI:0.07-0.27, p=0.001). Externalizing scores showed a non-significant trend (mean difference=0.57, d=0.07, 95%CI:-0.02-0.17, p=0.140). After adjustment, emotionally reactive, anxious/depressed, withdrawn, and aggressive behavior scores remained significantly higher in 2018. Differences were largest among low-income families (CBCL total: adjusted mean difference=5.94, p=0.001; internalizing=2.63, p<0.001), with virtually no difference in the highest income tercile. CONCLUSIONS:Effect sizes were small overall, yet higher scores in the 2018 cohort were concentrated in lower-income families, suggesting socioeconomic patterning of behavioral and emotional problems across cohorts.
OBJECTIVE:Childhood trauma and psychotic symptoms are prevalent in bipolar disorder (BD) and independently linked to social cognition impairments, particularly Theory of Mind (ToM). However, it remains unclear whether trauma and psychosis exert cumulative effects on ToM performance in BD. METHODS:We conducted a cross-sectional study involving 54 euthymic individuals with BD reporting at least moderate childhood trauma (Childhood Trauma Questionnaire; CTQ). Participants completed the Reading the Mind in the Eyes Test (RMET) to assess ToM. Clinical and sociodemographic data were collected. Participants were stratified by lifetime psychotic symptoms for between-group comparisons. RESULTS:Individuals with a history of psychotic symptoms (n=18) reported significantly higher total CTQ scores (Mean=61.0, SD=15.7) than those without psychotic symptoms (Mean=44.5, SD=13.1; p=0.028) and exhibited significantly lower ToM accuracy (Mean RMET=23.0, SD=4.5 vs. 25.4, SD=3.4; p<0.001, d=0.58). CONCLUSIONS:In BD, the co-occurrence of childhood trauma and lifetime psychosis is associated with more pronounced ToM deficits. These results highlight the need for trauma-informed approaches and early cognitive interventions targeting social cognition in individuals with BD and psychosis history.
Autism spectrum disorder (ASD) is increasingly recognized in adulthood, yet unemployment and underemployment remain disproportionately high among autistic adults worldwide. Although Brazil has developed a comprehensive legal framework grounded in the biopsychosocial model of disability, including Law No. 12,764/2012, the Brazilian Inclusion Law (13,146/2015), and employment quota legislation, these advances have not consistently translated into sustainable workplace inclusion. This narrative review critically examines the Brazilian legal framework for labor inclusion of autistic adults, the limitations of current functional assessment instruments, particularly the Brazilian Functionality Index (IF-Br), and the implementation of reasonable accommodations from an International Classification of Functioning, Disability and Health (ICF) perspective, drawing on international policy experiences for comparison. Results indicate that Brazilian policy remains predominantly oriented toward quota-based hiring, with functional assessment instruments that inadequately capture context-dependent difficulties-such as sensory processing, executive functioning, and implicit social demands-particularly among individuals requiring level 1 support. This mismatch between formal inclusion and workplace accessibility may generate a self-reinforcing cycle of psychological distress, reduced occupational performance, and job loss. International models combining legal protections with individualized functional assessment and structured workplace support demonstrate more sustainable outcomes. The findings underscore the strategic role of psychiatrists in bridging clinical evaluation and public policy through workplace-oriented functional assessments and concrete recommendations for reasonable accommodations. Improving labor inclusion for autistic adults in Brazil depends less on new legislation and more on refining clinical and evaluative practices capable of translating formal rights into meaningful, sustainable occupational participation.
OBJECTIVE:Schizophrenia and first-episode psychosis often require long-term antipsychotic treatment, making metabolic adverse effects an important clinical concern. This study evaluated the long-term metabolic effects of aripiprazole compared with other antipsychotics. METHODS:This systematic review analyzed randomized controlled trials with at least one year of follow-up and was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The protocol was prospectively registered in PROSPERO (CRD4202563245). Two authors independently conducted a systematic search in MEDLINE/PubMed, Embase, and Cochrane databases from inception to December 2024. Adult patients with schizophrenia spectrum disorders or first-episode psychosis were included. Primary outcomes were weight, body mass index, and cholesterol. Two authors independently assessed the risk of bias in the included randomized clinical trials using the Cochrane Risk of Bias 2 tool, with any discrepancies resolved by a third reviewer. RESULTS:Long-term aripiprazole treatment was associated with comparable metabolic changes, including increases in body weight, BMI, and lipid parameters. However, head-to-head comparisons did not demonstrate a consistent pattern of greater metabolic worsening with aripiprazole relative to other antipsychotics. Some studies reported no statistically significant between-group differences in weight, BMI, or cholesterol, while others described numerically lower frequencies of selected metabolic adverse events with aripiprazole. Nevertheless, statistical testing and reporting of confidence intervals were inconsistent across studies, limiting firm comparative conclusions. CONCLUSIONS:These findings suggest that aripiprazole may have a comparably favorable metabolic profile for selected outcomes during chronic treatment; however, increases in weight, BMI, and lipid parameters were observed in some studies. Further long-term studies with standardized metabolic outcome reporting are warranted to clarify its comparative effects across broader clinical populations.
OBJECTIVE:Haloperidol is widely used for agitation, psychosis, and delirium, but concerns remain regarding QTc prolongation and ventricular arrhythmias. We evaluated the association between haloperidol and QTc prolongation in adults with psychiatric or behavioral indications and secondarily summarized clinically relevant proarrhythmic events. METHODS:We conducted a systematic review registered in PROSPERO (CRD420261306215) following PRISMA 2020. Randomized controlled trials and comparative observational studies enrolling adults receiving haloperidol versus placebo, no antipsychotic, or another antipsychotic were included. The primary outcome was QTc prolongation as defined by study authors. A sensitivity analysis assessed QTc ≥500 ms when explicitly reported by study arm. Meta-analyses were performed using odds ratios when appropriate. Risk of bias was assessed with RoB 2 and the Newcastle-Ottawa Scale; certainty was rated with GRADE. RESULTS:Sixteen unique studies (17 publications; 16,189 participants) were included. In placebo- or no-antipsychotic comparisons (k=3 randomized controlled trials), haloperidol was not associated with a clear difference in QTc prolongation by author-defined thresholds (random-effects OR=1.18, 95%CI 0.83-1.69; I²=0%). In the sensitivity analysis restricted to QTc ≥500 ms (k=2 randomized controlled trials), evidence was imprecise due to the small number of studies, low event frequency, and wide confidence interval (OR=1.00, 95%CI 0.38-2.65). Clinically relevant proarrhythmic events were infrequent and usually not reported by study arm or yielded double-zero data, precluding quantitative synthesis. CONCLUSIONS:: In placebo-controlled trials conducted in intensive care settings, haloperidol did not show an increase in QTc prolongation by author-defined criteria. Evidence for QTc ≥500 ms remains limited by imprecision, and clinically relevant proarrhythmic events were rare and inconsistently reported.
OBJECTIVE:The primary goal of this systematic review was to identify risk factors linked to mental health outcomes and related conditions, categorized across academic, biological, financial (academic/institutional funding), lifestyle, comorbidities, psychological, and social domains. The secondary goal was to estimate the prevalence of these mental health and related conditions. METHODS:This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review analyzed observational studies reporting risk factors associated with mental health outcomes and related conditions. RESULTS:Multiple factors associated with mental health outcomes and related conditions were identified, with the highest number of reports in the following domains: academic (37.0%; 47 factors) and psychological (19.7%; 25 factors), followed by social (13.4%; 17 factors), comorbidities (12.6%; 16 factors), biological (8.6%; 11 factors), lifestyle (6.3%; 8 factors), and financial (2.4%; 3 factors). Regarding prevalence estimates, perceived stress ranged from 18.6% to 88.0%; anxiety symptoms, from 18.8% to 75.0%; depressive symptoms, from 10.1% to 89.1%; suicide-related outcomes, from 1.8% to 9.9%; and problems with eating behavior, from 5.8% to 29.9%. CONCLUSIONS:The results of this systematic review demonstrate several risk factors associated with mental health outcomes and related conditions, suggesting that multiple aspects influence the mental health of graduate students. These findings, combined with the high prevalence estimates observed, justify the development of university policies to promote mental health in graduate education.
OBJECTIVE:To analyze the Brazilian National Prescription Control System (SNCR) for controlled medications in light of international electronic prescription monitoring models and to identify opportunities for regulatory and clinical improvement in the control of psychostimulants, benzodiazepines, and Z-drugs. METHODS:A comparative narrative review of international prescription monitoring systems was conducted. Case studies were selected according to predefined criteria, including implementation of electronic monitoring systems for controlled medications, availability of official documentation and scientific literature, relevance to international regulatory debates, and diversity of healthcare systems. Models from the United States, Canada, Australia, and the United Kingdom were analyzed and compared with the Brazilian SNCR established under RDC No. 873/2024. RESULTS:The Brazilian SNCR represents an important administrative advance by centralizing prescription numbering nationwide, enabling digital prescriptions, and improving document traceability. However, the system remains primarily focused on sanitary surveillance and administrative oversight, without providing clinicians access to patients' dispensing histories or tools to identify potentially inappropriate prescribing patterns. In contrast, international models incorporate real-time clinical access, prescription monitoring, automated alerts, audit mechanisms, and prescriber feedback. Evidence from international experiences suggests these systems are associated with reductions in duplicate prescribing, medication misuse, prescribing errors, and adverse drug events. CONCLUSIONS:Although Brazil has advanced in the digitalization of controlled prescriptions, strengthening the SNCR will require a transition toward integrated clinical pharmacovigilance systems. International experiences support the incorporation of interoperability, real-time monitoring, and structured prescriber feedback to improve patient safety and promote the rational use of psychotropic medications.
OBJECTIVE:To assess the prevalence and correlates of risky alcohol use among Brazilian university students and compare findings across a 12-year interval. METHODS:A questionnaire survey conducted in 2018 among a representative sample of students at the State University of Campinas. Alcohol use patterns were assessed using the Alcohol Use Disorders Identification Test, and associations with sociodemographic, academic, and mental health variables were analyzed. A bivariate analysis with a 1% significance level and multiple logistic regression with a 5% significance level were performed. RESULTS:A total of 6725 university students were evaluated regarding their alcohol consumption, 34.5% of which presenting risky alcohol use. Alcohol consumption was associated with being male, single, from a higher socioeconomic status, and living with peers. Significant associations were found between risky drinking and academic difficulties, risky behaviors, and mental health problems. The comparative analyses (2006/2018) showed an increase, particularly among women, in risk (20.1% x 34.7%), high-risk drinking (3.6% x 7.6%), and probable alcohol use disorder (1.1% x 2.9%), as well as an increase in the rates of sexual intercourse while intoxicated. CONCLUSION:High rates of risky alcohol use, particularly among women, highlight the importance of integrating individual support with population-level education and awareness initiatives.
BACKGROUND:Workplace mental health initiatives often overlook stigma, which may function as a "hidden demand", undermining psychological safety and help-seeking. OBJECTIVE:To assess psychosocial factors and perceived public stigma among employees related to mental-health programs in companies rated as the best workplaces in Brazil. METHODS:We surveyed 166 professionals from 36 companies using three Guarding Minds at Work (GM@W) domains and the Perceived Devaluation-Discrimination Questionnaire. Generalized linear models were used for quantitative data, and thematical analysis qualitative data originated from three mixed-role focus groups plus GM@W open-ended responses. RESULTS:Most respondents endorsed companies' effective response to identified psychological risks (81.5%) and that companies support employees with mental health problems (84.1%). However, only 59.2% reported employees are free from mental-illness stigma at work, and fewer endorsed adequate stress-coping support. Public stigma perception was correlated with worse GM@W scores. National companies and mental-health professionals reported poorer perceptions in key domains. Qualitative themes converged on leadership strain, uneven program quality/scale, return-to-work friction, stigma, and the need to embed mental health into strategy and prevention. CONCLUSIONS:Even in companies rated as the best workplaces in Brazil, psychosocial protection and stigma remain an issue. Strengthening leadership capability, governance, confidentiality safeguards, and evaluation is essential.
OBJECTIVE:To characterize the distribution, data completeness, and temporal trends of notifications of Work-Related Mental Disorders (WRMD) in Brazil from 2007 to 2023. METHODS:Cross-sectional and time-series study analyzing 22,378 notifications recorded in the Notifiable Diseases Information System (SINAN). Notifications were characterized according to demographic and clinical variables. Temporal trends were evaluated using the Joinpoint Regression Mode. RESULTS:WRMD notifications increased from 0.13 per 100,000 employed working-age individuals in 2007 to 3.51 in 2023, with an average annual percent change of 18.24%, and peaks in 2009, 2017, and 2021. Most notifications involved women (64.86%), predominantly aged 35-49 years (49.27%). The Southeast and Northeast accounted for most cases, and anxiety and mood disorders were the most frequent diagnoses. Data completeness was excellent for sex and age group, fair for race/skin color and education, and insufficient for clinical variables related to substance use Temporary disability was reported in 56.38% of cases. CONCLUSIONS:WRMD notifications increased substantially over the study period, particularly after 2021. Notifications predominated among women and workers aged 35-49 years, were concentrated in the Southeast and Northeast, and most frequently involved anxiety, stress-related, and somatoform disorders and mood disorders, with temporary disability reported in over half of cases.
OBJECTIVE:Examine associations between learning environment, academic stressors, and mental health among Brazilian medical students across different institutional contexts. METHODS:Cross-sectional study of 1,026 medical students from 74 public and private universities. Participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Johns Hopkins Learning Environment Scale (JHLES), and Medical Student Stressor Factor Scale (MSSF). Analyses included group comparisons, multiple regression, random forest modeling, and latent class analysis. RESULTS:Private university students reported significantly better learning environments than public university counterparts (M = 84.6 vs. 81.9, p < 0.001). Quota students, those admitted to universities through affirmative action policies, demonstrated higher depression scores (M = 14.2 vs. 12.8, p = 0.007) and academic stress levels (M = 134.0 vs. 129.1, p = 0.018). Academic stressors demonstrated significant associations with both depressive (β=0.103; p<0.001) and anxiety symptoms (β=0.103; p<0.001), while higher learning environment quality was associated with lower depressive symptom severity (β=-0.105; p=0.043). Latent classes identified high-risk (53.7%), moderate-distress (32.7%), and high-functioning (13.6%) profiles, with affirmative-action students overrepresented in higher-risk classes. CONCLUSION:Students admitted via affirmative action in public universities face compounded vulnerabilities. Interventions should focus on reducing academic stress and improving learning environments, especially in public institutions serving disadvantaged groups.
Transcranial direct current stimulation (tDCS) has emerged as a safe, cost-effective, and scalable therapeutic strategy, with moderate effects for depression in adult patients. However, there are no published studies on tDCS in children and adolescents with depression. This study is the first to investigate the simulated regional electric fields (EF) in adolescents at risk for or currently experiencing depression. A total of 150 Brazilian adolescents (50 at low risk, 50 at high risk of developing depression, and 50 diagnosed with depression) were drawn from the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) and compared to 51 adults with depression. Employing a tDCS protocol designed for adults, we measured the simulated EF magnitude in the bilateral dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), both key brain areas involved in depression. Statistically significant differences in EF magnitudes were observed between each adolescent group (low risk, high risk, and diagnosed with depression) and adults with depression, while no significant differences were found among the adolescent groups themselves. By focusing on a population that is often underrepresented in depression research, this study may pave the way for future trials to treat depressive disorder in adolescents with tDCS.
