The aim of this doctoral thesis is to – from a child perspective and with children as informants – describe and analyze childhood conditions for children whose parents suffer from severe mental illness. The method used is qualitative – 28 children, 10 boys and 18 girls, 7–18 years old, were interviewed about their parents’ mental disorder; the family situation and their own personal life – in school and during free time. The analyses are based on Sociology of Childhood and Family Sociology. Previous studies have, to a great extent, focused on the risk the children run of developing mental health- and social problems and what helps them to grow up healthy. The increased risk of mental health- and social problems has been well confirmed, but also that preventive interventions can contribute to resilience in the children. Although some studies have explored children’s experiences of their parents’ mental illness and the challenges they meet, research from a childhood perspective, has so far been scarce. The results of this study reveal different degrees of emotional, physical and social exposure for the children. Their childhood conditions were related to gender, relations, communication, problem load and social situation of the family. If the parent with a mental illness was a woman, the situation for the child was often more exposed than if it was the father – most likely due to parental roles and expectations on men and women in the Swedish society at that time. Girls seemed more emotionally involved in the parents’ problems than boys, especially if the parent with a mental illness was a father. Most of the parents were divorced or had never lived together. Parental conflicts complicated the life of the children, who were expected to have maintained relationships to both parents. Lack of communication about the parent’s mental disorder in - and outside the family - was common. The children were often uninformed about the parent’s problems.  If hindered to pass information between and outside their two homes, they were left to handle difficult, sometimes dangerous, situations with the mentally ill parent, alone. The home was not always the safe place for rest and recovery, as homes are expected to be. The heavier the total problem load of the family, the more exposed was the child. Most exposed were children whose both parents had severe problems – mental illness or addiction. They were often placed in out of home care, for longer or shorter periods. The kind and degree of exposure the children experienced varied. Four kinds of childhood sceneries could be recognized: (1) the well organized childhood, where the parent’s mental health problem was mainly an emotional burden for the children; (2) the complicated childhood, where the parents conflicts and inability to protect the child made the child either too involved or too lonely in handling the problems that the parent’s mental illness caused them; (3) the problematic childhood where the parent’s mental illness was not the only problem in the family, but factors like the other parent’s drinking, siblings’ problems, social and economical difficulties added to the burden and (4) the exposed childhood where none of the parents was able to take care of the child. Knowledge and openness, about the parents’ problems, seemed to increase competence and decrease feelings of guilt and responsibility for the parent. All of the children stood forward, not as passive victims, but as competent agents in their own lives – although often more or less powerless because of their dependence of their parents and other adults around them. It was clear, though, that there is a need for professionals in adult psychiatry, social services, school and preschool, to pay attention to the children of parents with mental health problems and see to that they get the information and support they need. Keywords: Children, childhood conditions, children as agents, parental mental illness/mental disorders, mental health knowledge, exposed life situations, competence.

Depuis la désinstitutionalisation dans les milieux psychiatriques, il a été souvent mentionné qu’une augmentation des admissions dans les milieux carcéraux et de psychiatrie légale était en cours afin de prendre soin des personnes atteintes de troubles mentaux graves (TMG). Parallèlement, plusieurs auteurs ont rapporté que les individus ayant des troubles mentaux sévères sont plus à risque de perpétrer des gestes antisociaux ou de violence. À l’égard de cette problématique, nous soutenons le modèle de la spécificité clinique. Celui-ci précise que des profils psychopathologiques particuliers augmentent le risque de violence, conduisent à différents types de fonctionnement social et articulent la demande de soins. L’environnement a, de plus, un effet modulateur au niveau du fonctionnement distinctif de l’individu. Une relation bidirectionnelle se construit entre la spécificité psychopathologique et l’environnement, plus particulièrement en ce qui a trait aux relations interpersonnelles, au milieu socioéconomique, au patron d’utilisation des services de psychiatrie et à l’interaction avec le système de justice qui déterminent subséquemment le type de prise en charge ou le statut légal du patient. Afin d’appuyer ce modèle, les profils des patients atteints de TMG en fonction des statuts légaux, du milieu de soins (psychiatrie générale et psychiatrie légale) et de l’utilisation des mesures d’isolement et de contentions ont été examinés. Les patients ont été évalués par des mesures sociodémographiques (indicateurs du fonctionnement social, des relations interpersonnelles et du milieu socioéconomique), psychodiagnostiques (SCID-I et II) et de la psychopathie. De même, le dossier criminel, les dossiers médicaux hospitaliers et administratifs (MED-ECHO et RAMQ) ont été observés. Les devis étaient rétrospectifs. Par ailleurs, au niveau de l’interaction entre les services de psychiatrie et l’individu atteint d’un TMG, nous avons exploré la perception subjective des intervenants en santé mentale quant à l’agressivité et la violence. Nous avons considéré l’impact de cette perception sur la manière d’offrir des soins, plus particulièrement en ce qui a trait aux mesures coercitives (mesures d’isolement avec ou sans contentions), lors des hospitalisations. Les cinq études ont appuyé l’idée d’une spécificité clinique tant sur le plan des profils cliniques des individus que sur la manière d’offrir les services, spécialement au niveau des mesures de contrôles. Les caractéristiques de la personne et de l’environnement semblent de ce fait jouer un rôle important dans le type de services que recevra un individu souffrant de TMG. Ces travaux ouvrent sur la possibilité de mieux déterminer l’étiologie et la gestion de la violence de même que la manière dont le système s’occupe des patients à risque de violence. / Since deinstitutionalization in psychiatry, it has often been mentioned that individuals who in the past would have been cared for in psychiatric hospitals are today ending up in forensic hospitals or, worse, in prison. Meanwhile, several authors have reported that individuals with severe mental illness are more likely to commit antisocial acts or violence. In respect of this issue, we support the clinical specificity model. It specifies that psychopathological profiles increase the risk of violence and lead to different types of social functioning. The environment has also a modulating effect on the functioning of the individual distinctiveness. A bidirectional relationship is built between the specific psychopathology and the environment, particularly with regard to interpersonal relationships, socioeconomic background, the pattern of psychiatric services use and the interaction with the justice system that subsequently determine the type of care or patient's legal status. To support this hypothesis, we examined the profiles of patients with severe mental illness based on legal status and care setting (general psychiatry and forensic psychiatry) and the use of seclusion and restraint. Patients were evaluated by sociodemographic measures (indicators of social functioning, interpersonal relationships and socioeconomic background) and measures of psychodiagnostic (SCID-I and II) and psychopathy. In addition, criminal records, official provincial government physician-billing and hospitalization files (MED-ECHO and Medicare) were observed. The designs were retrospectives. Moreover, in order to explore the subjective perception of aggression and violence of mental health workers, the level of interaction that occurs between psychiatric services and the individual suffering from severe mental illness, were evaluated. We considered the impact of this perception on how to provide care, particularly with respect to coercive measures (measures of seclusion with or without restraints) during hospitalization. The five studies have supported the clinical specificity of both the clinical profiles of individuals and the way to deliver services, especially coercion. The characteristics of the individual and the environment seem to play an important role in the type of service received by an individual with severe mental illness. This work opens the possibility in subsequent studies to better determine the etiology of aggression, how to manage violence and to identify the care offered on the issue.

Depression and stimulant drug addiction each result in massive losses of health, productivity and human lives every year. Despite decades of research, current treatment regimes for depression are ineffective in approximately half of all patients. Therapy available to stimulant drug addicts is largely ineffective and moreover, dedicated treatments for drug dependence (including abuse of cocaine) are non-existent. Thus, there is a pressing need to further understanding of the molecular mechanisms underlying these disorders in order to develop novel, targeted therapeutic strategies. Chromatin remodeling, including changes in histone acetylation, has been proposed to play a role in both the etiology and treatment of depression and stimulant abuse. Histone acetyltransferases (HATs) and histone deacetylases (HDACs) regulate numerous cellular processes, including transcription, cell cycle progression and differentiation. Moreover, histone acetylation has been shown to regulate hippocampal neurogenesis, a cellular response associated with the pathogenesis and treatment of depression and stimulant abuse (Hsieh et al., 2004, Yamaguchi et al., 2004, Fischer et al., 2007). Ultimately, such basic cellular processes impact higher order function, namely cognition and emotion. Indeed, recent studies suggest that HDAC activity in selected forebrain regions, including ventral striatum and hippocampus, modulate stimulant- and antidepressantinduced behavior (Kumar et al., 2005, Tsankova et al., 2006a, Fischer et al., 2007). These reports highlight an association between chromatin remodeling and diverse behavioral changes, including changes induced by the pleiotropic HDAC inhibitor, sodium butyrate (SB), (Kumar et al., 2005, Tsankova et al., 2006a, Fischer et al., 2007). However, behavioral, brain-metabolic and molecular effects of SB treatment in the context of rodent models of depression, dopaminergic sensitization and repeated cocaine administration remained unclear. The work described in this thesis illustrates the potential for chromatin modifying drugs in mechanisms underlying the experimental pharmacology of depression and stimulant addiction. Specifically, the data presented here support the view that treatment with the short chain fatty acid, sodium butyrate enhances: (1) antidepressant-like behavioral effects of the selective serotonin reuptake inhibitor (SSRI), fluoxetine (2) locomotor sensitization induced by repeated administration of the dopamine D1/D5 receptor agonist SKF82958; and(3) brain metabolic activation upon repeated cocaine administration as evidenced by fMRI in awake rats. Furthermore, this report provides evidence that these treatment paradigms will result in chromatin modification changes associated with active transcription, in addition to increased mRNA levels of plasticity-associated genes, including brain-derived neurotrophic factor (BDNF) at key brain regions implicated in the pathogenesis of depression and stimulant addiction. To date, little is known regarding the underlying mechanisms of action mediating the enhancing effects of sodium butyrate on the various antidepressant- and stimulantrelated paradigms. Our findings underscore the potential of chromatin-modifying drugs to profoundly affect the behavioral response of an animal to antidepressant and stimulant drugs and warrants consideration in the context of developing novel therapeutic strategies.

O estudo sustenta a tese que as características individuais e laborais e a suspeição de distúrbios psiquiátricos menores influenciam no absenteísmo ao trabalho. Trata-se de um estudo de coorte prospectivo, com abordagem quantitativa, cujo objetivo geral foi analisar as características individuais, o estresse laboral e os distúrbios psiquiátricos menores como preditores de absenteísmo em trabalhadores de enfermagem de um hospital universitário, em um intervalo de dois anos. Foram entrevistados 254 trabalhadores de enfermagem (amostra por conveniência e não probabilística) no início e no final de dois anos: a primeira entrevista ocorreu entre novembro de 2008 e maio de 2009 e a segunda entre janeiro e maio de 2011. O desfecho foi o absenteísmo ao trabalho no período de dois anos. Para a coleta de dados foram utilizados o Índice de Capacidade para o Trabalho, o Self-Report Questionaire, a Job Stress Scale e um instrumento para caracterização da amostra. O absenteísmo foi coletado por meio da base de dados eletrônica do hospital. Os dados foram analisados por estatística descritiva e analítica, considerando estatisticamente significativos aqueles com valor de p bicaudal menor a 0,05 ou com intervalo de confiança de 95%. Para o cálculo do Risco Relativo (RR), os trabalhadores foram divididos entre aqueles com ou sem absenteísmo, assim como aqueles com absenteísmo elevado (pertencentes ao quartil 75%) versus os outros. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. No período de dois anos, 83,9% dos trabalhadores apresentaram pelo menos um dia de falta ao trabalho e a mediana da taxa de absenteísmo foi de 1,7%, sendo que metade da amostra faltou até 60,8 horas e 25% faltaram acima de 139,6 horas nesse período. Evidenciou-se maior taxa de absenteísmo nos trabalhadores de enfermagem com menor escolaridade, com filho(s); sem tempo para lazer; com doenças osteomusculares com Diagnóstico Médico (DM); com suspeição de distúrbios psiquiátricos menores (DPM); com cargo de técnico/auxiliar de enfermagem; que possuíam outro emprego; insatisfeitos com o local de trabalho e com baixo Apoio Social no trabalho. O RR para absenteísmo em dois anos foi maior nos trabalhadores: sem tempo para lazer (RR=1,15 e IC95%=1,0-1,2); com doença com DM (RR=1,19, IC95%=1,0-1,3); com doença osteomuscular com DM (RR=1,11 e IC95%=1,0-1,2); com suspeição de DPM (RR=1,21 e IC95%=1,1-1,2); de Unidades de Alta Complexidade (RR=1,10 e IC95%=1,0-1,2) e insatisfeitos com o local de trabalho (RR=1,20 e IC95%=1,1- 1,2). No que tange ao RR para absenteísmo elevado em dois anos, foi maior nos trabalhadores de enfermagem com menor escolaridade (RR=1,64 e IC95%=1-2,6); sem tempo para lazer (RR=2,48, IC95%=1,5-3,8); com suspeição de DPM (RR=2,11 e IC95%=1,2-3,4); com cargo de técnico/auxiliar de enfermagem (RR=2,67 e IC95%=1,2-5,8); com outro emprego (RR=2,27 e IC95%=1,3-3,8); insatisfeitos com o local de trabalho (RR=2,29 e IC95%=1,2- 4,2) e com baixo Apoio Social no trabalho (RR=1,56 e IC95%=1,0-2,6). Na análise multivariada, verificou-se que a taxa de absenteísmo em dois anos foi significativamente influenciada pelas variáveis: tempo para lazer, número de doenças com DM, suspeição de DPM e turno de trabalho. Os resultados contribuem para reflexões a ações em saúde do trabalhador e para os gestores hospitalares, pois indicam as variáveis que influenciam o absenteísmo no trabalho de enfermagem e fornecem subsídios para a proposição de estratégias de prevenção e promoção da saúde e da qualidade de vida dos trabalhadores. / This study defends that individual and work-related features, and the suspicion of minor psychiatric disorders influence absenteeism from work. This is a prospective cohort study with a quantitative approach. Its general objective was to analyze individual features, work stress and minor psychiatric disorders as predictors of absenteeism in nursing workers from a university hospital in a two-year interval. 254 nurses were interviewed (non-probability, convenience sample) in the beginning and the end of two years: the first set of interviews took place from November, 2008, to May, 2009, and the second from January to May, 2011. The outcome was absenteeism from work in the two-year period. To collect the data the instruments used were the Work Ability Index, the Self-Report Questionnaire, the Job Stress Scale and an instrument to characterize the sample. Absenteeism was collected through the hospital's electronic database. The data were analyzed through descriptive and analytical statistics, considering as statistically significant those with a bicaudal p of less than 0.05 or with a confidence interval (CI) of 95%. To calculate the Relative Risk (RR), workers were divided between those with or without absenteeism, as well as between those with high absenteeism (those belonging to the 75% quartile) and the others. The project was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre. In the two-year interval, 83.9% of workers were absent from work for at least one day and the median rate of absenteeism was 1.7%. Half the sample was absent from work for up to 60.8 hours and 25% was absent for more than 139.6 hours in this interval. A higher rate of absenteeism was observed in less educated nursing workers, with child or children; with no leisure time; with musculoskeletal diseases with Medical Diagnosis (MD); with suspicion of Minor Psychiatric Disorders (MPD); working as nursing technician or nursing assistant; who had another job; who were unsatisfied with the workplace and had low Social Support at work. RR for absenteeism in two years was higher in workers: with no leisure time (RR=1.15 and CI95%=1.0-1.2); with diseases with MD (RR=1.19 and CI95%=1.0-1.3); with musculoskeletal diseases with MD (RR=1.11 and CI95%=1.0-1.2); with suspicion of MPD (RR=1.21 and CI95%=1.1-1.2); working in High Complexity Units (RR=1.10 and CI95%=1.0-1.2) and unsatisfied with the workplace (RR=1.20 and CI95%=1.1). RR for high absenteeism in two years was higher in less educated nursing workers (RR=1.64 and CI95%=1-2.6); with no leisure time (RR=2.48 and CI95%=1.5-3.8); with suspicion of MPD (RR=2.11 and CI95%=1.2-3.4); working as nursing technician or nursing assistant (RR=2.67 and CI95%=1.2-5.8); with another job (RR=2.27 and CI95%=1.3-3.8); unsatisfied with the workplace (RR=2.29 and CI95%=1.2-4.2) and with low Social Support at work (RR=1.56 and CI95%=1.0-2.6). The multivariate analysis showed that the rate of absenteeism in two years was significantly influenced by the variables: leisure time, number of diseases with MD, suspicion of MPD and work shift. Results contribute to thoughts and actions towards the worker's health and also help health managers, for they indicate the variables that influence absenteeism in the nursing work and aid the proposal of strategies for prevention and the promotion of health, and for the workers' quality of life. / El estudio defiende la tesis de que las características individuales y laborales y la sospecha de disturbios psiquiátricos menores influyen en el absentismo laboral. Se trata de un estudio de cohorte prospectivo, con análisis cuantitativo, cuyo objetivo general fue examinar las características individuales, el estrés laboral y los disturbios psiquiátricos menores como predictores de absentismo en trabajadores de enfermería de un hospital universitario, en un periodo de dos años. Se entrevistaron 254 trabajadores de enfermería (muestra por conveniencia y no probabilística) en el inicio y al final de dos años: la primera entrevista se realizó entre noviembre de 2008 y mayo de 2009, y la segunda entre enero y mayo de 2011. El desenlace fue el absentismo laboral en el periodo de dos años. Para colectar los datos se utilizaron el Índice de Capacidad Laboral, el Self Report Questionaire, la Job Stress Scale y un instrumento para la caracterización de la muestra. El absentismo fue colectado a través de la base de datos electrónica del hospital. Los datos fueron analizados por estadística descriptiva y analítica, considerando estadísticamente significativos los de valor p de dos colas menor a 0,05 o con intervalo de confianza de 95%. Para el cálculo del Riesgo Relativo (RR) se dividieron los trabajadores entre los clasificados como con o sin absentismo, y también los que mostraban absentismo elevado (pertenecientes al cuartil 75%) versus los otros. El proyecto fue aprobado por el Comité de Ética en Investigación del Hospital de Clínicas de Porto Alegre. En el periodo de dos años, el 83,9% de los trabajadores presentaron por lo menos un día de falta en el trabajo y el promedio de porcentaje de absentismo fue de 1,7%, siendo que la mitad de la muestra faltó hasta 60,8 horas y el 25% faltó más de 139,6 horas en ese periodo. Se evidenció un mayor porcentaje de absentismo laboral en los enfermeros con menor escolaridad, con hijo(s); sin tiempo para ocio; con enfermedades osteomusculares con Diagnóstico Médico (DM); con sospecha de Disturbios Psíquicos Menores (DPM); con cargo de técnico/auxiliar de enfermería; con otra ocupación; insatisfechos con el local de trabajo y con bajo Apoyo social en el trabajo. El RR para absentismo en dos años fue más alto en los trabajadores: sin tiempo de ocio (RR=1,15 y IC95%=1,0-1,2); con enfermedad con DM (RR=1,19, IC95%=1,0-1,3); con enfermedad osteomuscular con DM (RR=1,11 y IC95%=1,0-1,2); con sospecha de DPM (RR=1,21 y IC95%=1,1-1,2); de Unidades de Alta Complejidad (RR=1,10 y IC95%=1,0-1,2) e insatisfechos con el local de trabajo (RR=1,20 y IC95%=1,1-1,2). En lo que respecta al RR para absentismo elevado en dos años, fue más alto en los trabajadores de enfermería con menor escolaridad (RR=1,64 y IC95%=1-2,6); sin tiempo para ocio (RR=2,48, IC95%=1,5- 3,8); con sospecha de DPM (RR=2,11 y IC95%=1,2-3,4); con cargo de técnico/auxiliar de enfermería (RR=2,67 y IC95%=1,2-5,8); con otro empleo (RR=2,27 y IC95%=1,3-3,8); insatisfechos con el local de trabajo (RR=2,29 y IC95%=1,2-4,2) y con bajo Apoyo Social en el trabajo (RR=1,56 e IC95%=1,0-2,6). En el análisis multivariado se verificó que el porcentaje de absentismo en dos años fue significativamente influenciado por las variables: tiempo para ocio, número de enfermedades con DM, sospecha de DPM y turno de trabajo. Los resultados contribuyen a los reflexiones y acciones la salud del trabajador y para los gestores hospitalarios, pues indican las variables que influyen en el absentismo laboral de enfermería y proveen subsidios para proponer estrategias de prevención y promoción de la salud y de la calidad de vida de los trabajadores.

OBJETIVOS: Estimar a prevalência de transtornos mentais comuns (TMC) e transtornos de abuso e dependência de álcool (TADA) em população atendida por Estratégia Saúde da Família (ESF) do município de Santa Cruz do Sul, Brasil; estudar as associações entre TMC e TADA com variáveis sociodemográficas. METODOLOGIA: Todos moradores acima de 14 anos de 3 áreas atendidas por ESF foram convidados a participar no período de 10 de fevereiro de 2006 a 10 de fevereiro de 2007. RESULTADOS: Dos 2921 participantes, as prevalências de TMC e TADA foram de 29,93% (IC95%29,30%-30,56%) e 12,07% (IC95%11,63%-12,52%), respectivamente. Sexo feminino, situação ocupacional desfavorável, baixa escolaridade e baixa renda mostraram associação positiva e independente com TMC. Sexo masculino, situação ocupacional desfavorável e TMC apresentaram associação independente com TADA. DISCUSSÃO: Foram encontradas prevalências de TMC e TADA acima das relatadas em outros estudos brasileiros. Grupos com condições socioeconômicas desfavoráveis são os de maior risco para TMC e TADA. CONCLUSÕES: Os grupos de maior risco para TMC e TADA deveriam ser levados em consideração quando se planejam políticas públicas em saúde mental. / OBJECTIVE: Estimate the prevalence of common mental disorders (CMD) as well as alcohol abuse and dependence disorders (AADD) in a population assisted by Programa de Saúde da Família (PSF or Family Health Program) in the City of Santa Cruz do Sul, Southern Brazil; estimate the associations between CMD and AADD with socio-demographic variables. METHOD: All residents over 14 years of age from 3 areas assisted by the PSF were invited to participate between February 10, 2006 to February 10, 2007. RESULTS: Of 2,921 participants, the prevalence estimates of CMD and AADD were 29.93% (IC95%29.30%-30.56%) e 12.07% (IC95%11.63%-12.52%), respectively. Female, unfavorable employment situation, low schooling and low income showed a positive and independent association with CMD. Male, unfavorable employment situation and CMD showed an independent association with AADD. DISCUSSION: We found higher prevalence estimates of CMD and AADD in relation to the observed prevalence estimates in other Brazilian studies. Groups with unfavorable socioeconomic conditions present the highest risk. CONCLUSIONS: The groups with the highest risk for CMD and AADD should be taken into account when planning public mental health policies.

O envelhecimento populacional é um fato e não é diferente entre os portadores de transtornos mentais. O Centro de Atenção Psicossocial (CAPS) é um dos locais para o tratamento dessa população que necessita de cuidado contínuo. Entretanto, ainda são poucos os estudos que incluem usuários de CAPS acima de 60 anos. O presente estudo tem por objetivo identificar os determinantes sociodemográficos, clínicos e de capacidade funcional na qualidade de vida de idosos com transtornos mentais que frequentam um CAPS. Trata-se de um estudo transversal realizado com usuários de CAPS, com 60 anos ou mais, de ambos os sexos, não demenciados (Mini-Exame do Estado Mental – MEEM > 13), em atendimento no CAPS há pelo menos seis meses e com diagnóstico de transtorno mental. Para verificar a qualidade de vida (QV), foi utilizado o WHOQOL-BREF e, para complementar as informações, o WHOQOL-OLD. Para avaliar a intensidade dos sintomas de ansiedade e depressivos, foram utilizadas a escala de Hamilton-Ansiedade (HAM-A) e o Inventário de Depressão de Beck (BDI), respectivamente. A capacidade funcional foi mensurada pela Avaliação Sócio-Funcional em Idosos (IASFI). O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Sul (nº 21475). Um total de 50 idosos foi incluído, e o perfil da amostra que predominou foi o seguinte: 38(76%) indivíduos do sexo feminino, com média de idade (desvio padrão) de 67,5(5,72) anos, 28(56%) sem companheiro e 40(80%) com ensino fundamental incompleto, sendo 29(58%) pertencentes à classe econômica C. O diagnóstico mais prevalente em 31(62%) da amostra foi de depressão. Todos utilizavam pelo menos um tipo de psicofármaco, sendo em média (DP)=2,1(0,8) medicações, e a mais utilizada foram os antidepressivos por 39(78%) dos idosos. Também foi frequente a presença de comorbidade clínica em 39(78%) da amostra, sendo que 29(58%) com diagnóstico de hipertensão arterial sistêmica e 12(24%) para diabetes melito tipo 2. A mediana (intervalo interquartis) dos sintomas depressivos (BDI) foi de 15,5(8,75-29) e a média (DP) da ansiedade foi de 13,6(7,71). O total da pontuação da capacidade funcional foi, em média, de 159,7(15,13), categorizada como independência modificada/ completa, isto é, que não precisa de ajuda para executar as atividades. A maioria dos idosos (62%) frequentava o CAPS há mais de 2 anos, sendo 29(58%) na modalidade não intensiva e 38(76%) participavam de oficinas de terapia ocupacional. Para identificar os determinantes de QV, foi realizada uma análise de regressão linear hierárquica que considerou para a inclusão no modelo as variáveis com p<0,05 após a análise bivariada. O resultado da regressão demonstrou que as variáveis independentes que determinaram pior QV foram relacionadas, sobretudo, às características clínicas como sintomas depressivos mais intensos (média de -1,20 a -0,43 pontos) nos domínios avaliados pelo WHOQOL-BREF e WHOQOL-OLD e maior número de comorbidades clínicas (média de -3,15 a -5,39 pontos) nos domínios avaliados pelo WHOQOL-OLD. A melhor capacidade funcional nas atividades básicas de vida diária (média de 0,56 a 0,67 pontos) foi determinante para melhor QV em ambas as escalas. Concluiu-se que os principais determinantes de QV foram às características clínicas e de capacidade funcional, especialmente os sintomas depressivos e a presença de comorbidades clínicas. Considerando-se o envelhecimento da população, inclusive dos portadores de transtorno mental, os achados confirmam a importância de uma avaliação que contemple os diferentes aspectos do idoso para a elaboração do projeto terapêutico em CAPS. / Population aging is a fact and is no different among patients with mental disorders. The Psychosocial Care Center (CAPS) is a place for treating these types of patients who need ongoing care. However, few studies exist that include CAPS users over age 60. The purpose of this study is to identify the sociodemographic, clinical and functional capacity determinants in the quality of life of elderly people with mental disorders who are treated in a CAPS. It is a cross-sectional study conducted among CAPS users, over age 60, male or female and non-demented (Mini-Mental State Examination – MMSE > 13), who have been receiving treatment in a CAPS for at least six months for a diagnosed mental disorder. To determine quality of life (QOL), the WHOQOL-BREF was used and to complement the information, the WHOQOL-OLD. To assess the severity of anxiety and depression symptoms, the Hamilton-Anxiety (HAM-A) rating scale and the Beck Depression Inventory (BDI) were used, respectively. Functional capacity was measured through a Social and Functional Assessment of the Elderly. The study was approved by the Research Ethics Committee of Universidade Federal do Rio Grande do Sul (No. 21475). A total of 50 elderly people were included, and the sample profile that predominated was the following: 38 (76%) females, with an average age (standard deviation) of 67.5 (5.72) years; 28 (56%) without a mate; 40 (80%) with incomplete primary education and 29 (58%) belonging to economic class C. The most prevalent diagnosis in 31 (62%) from the sample was depression. All of them used at least one type of psychotropic drug, representing an average (SD) of 2.1 (0.8) medications, and antidepressants were the medication most used by 39 (78%) of the elderly. The presence of medical comorbidity was frequent, corresponding to 39 (78%) of the sample, with 29 (58%) diagnosed with hypertension and 12 (24%) with diabetes mellitus type 2. The median (interquartile range) of depressive symptoms (BDI) was 15.5 (8.75-29) and the mean (SD) for anxiety was 13.6 (7.71). The total functional capacity score was, on average, 159.7 (15.13), categorized as modified/full independence, that is, no assistance is needed to perform activities. Most of the elderly (62%) have been visiting the CAPS for over 2 years, with 29 (58%) in the non-intensive category and 38 (76%) have participated in occupational therapy workshops. In order to identify the QOL determinants, we conducted a hierarchical linear regression analysis that considered variables for inclusion in the model with p<0.05 after the bivariate analysis. The results of the regression analysis showed that the independent variables that determined lower QOL were mainly related to clinical characteristics such as more intense depressive symptoms (mean of -1.20 to -0.43 points) in the areas assessed by the WHOQOL-BREF and WHOQOL-OLD and a larger number of medical comorbidities (mean of -3.15 to -5.39 points) in the areas assessed by the WHOQOL-OLD. Better functional capacity in basic everyday activities (mean of 0.56 to 0.67 points) was a determining factor for better QOL in both rating scales. It was concluded that the main QOL determinants were clinical characteristics and functional capacity, especially depressive symptoms and the presence of medical comorbidities. Given the aging of the population, including those with mental disorders, the findings confirm the importance of assessments that encompass the different aspects of elderly patients in order to prepare therapeutic projects in CAPS. / El envejecimiento poblacional es un hecho y no es diferente entre los portadores de trastornos mentales. El Centro de Atención Psicosocial (CAPS) es uno de los locales para el tratamiento de esa población que necesita cuidado continuo. Sin embargo, todavía son pocos los estudios que incluyen usuarios de CAPS superior a 60 años. El presente estudio tiene por objetivo identificar los determinantes sociodemográficos, clínicos y de capacidad funcional en la calidad de vida de ancianos con trastornos mentales que frecuentan un CAPS. Se trata de un estudio transversal realizado con usuarios de CAPS, con 60 años o más, de ambos sexos, no demenciados (Miniexamen del Estado Mental – MEEM > 13), en atención en el CAPS hace por lo menos seis meses y con diagnóstico de trastorno mental. Para verificar la calidad de vida (QV), se utilizó el WHOQOL-BREF y, para complementar las informaciones, el WHOQOL-OLD. Para evaluar la intensidad de los síntomas de ansiedad y depresivos, se utilizó la escala de Hamilton-Ansiedad (HAM-A) y el Inventario de Depresión de Beck (BDI), respectivamente. La capacidad funcional fue mensurada por la Evaluación Sociofuncional en Ancianos (IASFI). El estudio fue aprobado por el Comité de Ética en Investigación de la Universidade Federal do Rio Grande do Sul (nº 21475). Un total de 50 ancianos fue incluido, y el perfil de la muestra que predominó fue el siguiente: 38(76%) individuos del sexo femenino, con promedio de edad (desvío estándar) de 67,5(5,72) años, 28(56%) sin compañero y 40(80%) con enseñanza fundamental incompleta, siendo 29(58%) pertenecientes a la clase económica C. El diagnóstico más prevalente en 31(62%) de la muestra fue de depresión. Todos utilizaban por lo menos un tipo de psicofármaco, siendo en promedio (DP)=2,1(0,8) medicaciones, y la más utilizada fueron los antidepresivos por 39(78%) de los ancianos. También fue frecuente la presencia de comorbidad clínica en 39(78%) de la muestra, el 29(58%) con diagnóstico de hipertensión arterial sistémica y el 12(24%) para diabetes melito tipo 2. La mediana (intervalo intercuartis) de los síntomas depresivos (BDI) fue de 15,5(8,75-29) y el promedio (DP) de la ansiedad fue de 13,6(7,71). El total de la puntuación de la capacidad funcional fue, un promedio, de 159,7(15,13), categorizada como independencia modificada/ completa, o sea, que no necesita ayuda para ejecutar las actividades. La mayoría de los ancianos (62%) frecuentaba el CAPS hace más de 2 años, el 29(58%) en la modalidad no intensiva y 38(76%) participaban de talleres de terapia ocupacional. Para identificar los determinantes de QV, se realizó un análisis de regresión lineal jerárquica que consideró para la inclusión en el modelo las variables con p<0,05 después del análisis bivariado. El resultado de la regresión demostró que las variables independientes que determinan peor QV fueron relacionadas, sobre todo, a las características clínicas como síntomas depresivos más intensos (promedio de -1,20 a -0,43 puntos) en los dominios evaluados por el WHOQOL-BREF y WHOQOL-OLD y mayor número de comorbidades clínicas (promedio de -3,15 a -5,39 puntos) en los dominios evaluados por el HOQOL-OLD. La mejor capacidad funcional en las actividades básicas de vida diaria (promedio de 0,56 a 0,67 puntos) fue determinante para mejor QV en ambas escalas. Se concluyó que los principales determinantes de QV fueron las características clínicas y de capacidad funcional, especialmente los síntomas depresivos y la presencia de comorbidades clínicas. Considerándose el envejecimiento de la población, inclusive de los portadores de trastorno mental, los estudios confirman la importancia de una evaluación que abarque los diferentes aspectos del anciano para la elaboración del proyecto terapéutico en CAPS.

A violência entre parceiros íntimos (VPI) e a depressão pós-parto (DPP) são as temáticas principais dessa Tese. Seu objetivo principal foi investigar se a violência física entre parceiros íntimos (VFPI) é um fator de risco para DPP. Adicionalmente, a estrutura dimensional da Edinburgh Postnatal Depression Scale (EPDS) foi reavaliada, e outro estudo estimou a prevalência de DPP entre mulheres usuárias de unidades básicas de saúde na cidade do Rio de Janeiro, Brazil. As informações que subjazem esses três artigos originaram-se de um inquérito realizado em cinco UABS no Rio de Janeiro, entre janeiro e junho de 2007. Foram selecionadas aleatoriamente mulheres com até cinco meses pós-parto que estivessem aguardando por consultas pediátricas, sendo consideradas inelegíveis aquelas que não haviam vivenciado ao menos um mês de relação íntima no ciclo grávido-puerperal, cujas gestações-índice foram gemelares, ou se houvesse contra-indicação absoluta para a amamentação. Dentre 852 mulheres selecionadas, 18 (2,1%) eram inelegíveis e 23 (2,8%) recusaram-se a participar, totalizando então 811 entrevistas completas. No artigo inicial a validade dimensional da EPDS foi reavaliada através de análise fatorial exploratória (AFE) e, em seguida, análise fatorial confirmatória (AFC). Os resultados da AFC apontaram que a EPDS é mais bem definida por uma solução fatorial que inclui três fatores de primeira ordem (&#8213;stress comum&#8214;, &#8213;ansiedade&#8214; e &#8213;depressão&#8214;) e um fator de segunda ordem, o qual parece representar o construto depressão pós-parto. O segundo artigo mostrou uma prevalência geral estimada de DPP na população estudada de 24,3%. Contudo, houve um pico de sintomas depressivos próximo ao terceiro mês pós-parto, quando a magnitude projetada de DPP atingiu 37,5%. Ainda neste período crítico, a prevalência estimada de DPP ultrapassou 50% entre mulheres com bebês prematuros ou cujos parceiros faziam uso excessivo de álcool. Quadro ainda mais grave foi observado entre mães sem parceiros fixos ou cujos companheiros usavam drogas ilícitas ou psicotrópicas, com mais de 70% delas apresentando-se provavelmente deprimidas. Em relação ao artigo principal dessa Tese, este revelou que a VFPI é um fator de risco para DPP mesmo após essa relação ser controlada para diversas covariadas. Foi também identificada uma interação significativa entre VFPI e o uso demasiado de álcool pelos companheiros (p-valor=0,026). Entre as mulheres cujos parceiros faziam mal uso de álcool, apenas um ato de VFPI não aumentou a probabilidade de DPP (OR=0,87, IC 95% 0,25-3,03), enquanto dois ou mais eventos foram significativamente associados à DPP (OR=3,62, IC 95% 1,64-7,99). Já entre aquelas cujos companheiros não faziam mal uso de álcool, o aumento na probabilidade de DPP deu-se especialmente com a ocorrência de um episódio de VFPI (OR=2,47, IC 95% 1,31-4,66), enquanto dois ou mais episódios mostraram uma menor associação com DPP (OR=1,66, IC 95% 1,00-2,75). Em síntese, vislumbra-se que os resultados dessa Tese possam colaborar para uma melhor saúde materno-infantil em nosso meio. Conforme já discutido por outros autores, a utilização da EPDS para uma abordagem inicial dos quadros depressivos pós-natais deve ser encorajada, especialmente em situações de elevado risco psicossocial. Adicionalmente, ações que visem à prevenção da DPP devem contemplar o enfrentamento da VPI. / The intimate partner violence (IPV) and the postpartum depression (PPD) are the main themes of this Thesis, whose main purpose was to investigate whether physical intimate partner violence (PIPV) is a risk factor for postpartum depression (PPD). Additionally, a methodological study reappraised the dimensional structure of the Edinburgh Postnatal Depression Scale (EPDS), and another descriptive study provided estimates of the prevalence of PPD among women seeking care in primary health care (PHC) settings. The information underlying these manuscripts were derived from a survey performed in five PHC units in Rio de Janeiro, between January and June 2007. The participants were randomly selected among women whose children were under five months of age and were waiting for pediatric care. Women were considered ineligible if they have not experienced at least one month of intimate relationship during pregnancy or postpartum period, whether their index pregnancies were twins, or there was an absolute contraindication for breastfeeding. Among 853 women invited to participate, 18 (2.1%) were ineligible and 23 (2.7%) refused to participate, then totalizing 811 completed interviews. In the first study the dimensional validity of the EPDS was reevaluated through exploratory factorial analysis (EFA) and, subsequently, confirmatory factor analysis (CFA). The CFA results disclosed that the EPDS is better defined by a factorial solution that includes three first-order factors (&#8213;general distress&#8214;, &#8213;anxiety&#8214; and &#8213;depression&#8214;) and a second-order factor, which can be interpreted as a synthesis of the construct &#8213;postpartum depression&#8214;. The second article shows that the estimated overall prevalence of PPD in the study population was 24.3%. However, there was a peak of depressive symptoms around the third postnatal month, when the magnitude of women probably depressed reached 37.5%. Moreover, in this critical period, the estimated prevalence of PPD was more than 50% among women with premature babies or whose partners misused alcohol. Situation even more serious was observed among mothers without steady partners or whose partners used illicit or psychotropic substances, with more than 70% of them presenting probable PPD. Finally, the principal article of this thesis showed that the PIPV is a risk factor for PPD, even after this relationship is controlled for several covariates. It was also identified a significant interaction between PIPV and misuse of alcohol by partners (p-valor=0.026). Among women whose partners misused alcohol, only one act of PIPV did not increase the likelihood of PPD (OR=0.87, IC 95% 0.25-3.03), whereas two or more events were significantly associated with PPD (OR=3.62, IC 95% 1.64-7.99). In contrast, among those women whose partners did not misuse alcohol, the likelihood of PPD increased principally after a single episode of VFPI, whereas two or more episodes showed a lower association with PPD (OR=1.66, IC 95% 1.00-2.75). As a synthesis, the results of this Thesis can contribute to improve the maternal and child health. As already discussed by other authors, the EPDS should be used in a first approach of depressive disorders after birth, especially among people presenting a high-risk psicossocial profile. In addition, actions directed to the prevention of PPD should address IPV.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Apesar do declínio dos déficits nutricionais em menores de cinco anos nas últimas décadas, a desnutrição infantil ainda se configura como problema de saúde pública, apresentando altas prevalências em algumas regiões do Brasil e em outros países em desenvolvimento, além de inúmeras repercussões negativas na morbi-mortalidade. A saúde mental materna (SMM) tem sido cada vez mais considerada como um aspecto relevante para a saúde infantil. Apesar disso, pouco enfoque tem sido dado às suas repercussões sobre o estado nutricional infantil. Investigar a associação entre SMM e estado nutricional infantil no sexto mês de vida. Conduziu-se um estudo seccional inserido em uma coorte prospectiva com 235 crianças aos seis meses advindas de unidades básicas de saúde do município do Rio de Janeiro. Para formar os desfechos, médias de peso-para-comprimento e peso-para-idade foram expressas em escores z usando a nova curva de referência da OMS (2006) para menores de cinco anos. Aplicou-se a versão em português do General Health Questionnaire com 12 itens (GHQ-12) e 4 opções de resposta para aferição da SMM. Utilizou-se sistemas de pontuação de forma a gerar duas variáveis discretas: GHQ-bimodal (zero a 12 pontos) e GHQ-Likert (zero a 36 pontos). Tomando como referência a variável GHQ-bimodal, foram empregados os pontos de corte >3 para detecção de transtornos mentais comuns (TMC), >5 para transtornos mentais mais graves e >9 para sintomas depressivos. A análise da associação entre SMM e desfechos nutricionais se baseou em modelos de regressão linear. A amostra revelou escores z médios de 0,23 para peso-para-comprimento e de 0,05 para peso-para-idade. As prevalências de TMC, transtornos mentais mais graves e sintomas depressivos foram de 39,9%, 23,7% e 8,3%, respectivamente. Após ajuste pelo peso ao nascer, maiores pontuações no GHQ-bimodal e GHQ-Likert estiveram associadas a menores médias de peso-para-comprimento. Para este desfecho, os filhos de mulheres com transtornos mentais mais graves tinham, em média, 0,37 escores-z mais baixos em relação aos filhos de mulheres sem estes agravos (p = 0,026). Observou-se, também, uma média de 0,67 escores-z mais baixos em filhos de mulheres com sintomas depressivos em relação aos filhos de mulheres não deprimidas (p = 0,010). Apenas sintomas depressivos na mãe estiveram associados significativamente com valores médios mais baixos de escore-z de peso-para-idade (p = 0,041). Não se observou associação significante entre TMC e os desfechos avaliados. A SMM esteve relacionada à inadequação do estado nutricional de crianças aos seis meses. O reconhecimento precoce e tratamento destes agravos durante o puerpério poderiam ser estratégias adjuvantes para melhorar a situação nutricional infantil e, por fim, reduzir a morbi-mortalidade associada aos déficits nutricionais. / Despite the decline of nutritional deficits in children under five years in the last decades, infant malnutrition remains a public health problem, with high prevalence in some regions of Brazil and other developing countries and numerous adverse effects on morbidity and mortality. Maternal mental health (MMH) is being increasingly considered a relevant aspect in the context of child health. Nevertheless, little focus has been given to the MMH impact on nutritional status. To investigate the association between maternal mental health and child nutritional status at six months of life. A cross-sectional study inserted in a prospective cohort was conducted with 235 children at six months of age recruited in primary health care centers in Rio de Janeiro, Brazil. To form the outcomes, means of weight-for-length and weight-for-age were expressed in z scores using the new WHO growth standards (2006) for children under five years of age. The Portuguese version of the General Health Questionnaire with 12 items and four answer options (GHQ-12) was applied to measure MMH. Two scoring systems were used to create discrete variables: GHQ-bimodal score (zero to 12 points) and GHQ-Likert score (zero to 36 points). Using the GHQ-bimodal score a cut-off point of >3 was used for the detection of common mental disorders (CMD), a cut-off of >5 for more severe mental disorders, and a cut-off of >9 for depressive symptoms. Analysis of association between MMH and nutritional outcomes was based on linear regression models. The sample showed average z scores of 0.23 for weight-for-length and 0.05 for weight-for-age. The prevalence of CMD, more severe mental disorders and depression was 39.9%, 23.7% and 8.3%, respectively. After adjusting for birth weight, higher scores of GHQ-bimodal and GHQ-Likert were associated with lower mean z scores of weight-for-length. For this outcome, children of women with more severe mental disorders had, on average, 0.37 z-scores lower when compared to children of women without these disorders (p = 0.026). Also, children of women with depressive symptoms had, on average, 0.67 z-scores lower than those from non-depressive mothers (p = 0.010). Only maternal depressive symptoms showed significantly association with lower weight-for-age (p = 0,041). There was no statistically significant association between TMC and both nutritional outcomes. MMH was related to inadequate nutritional status of children at six months of age. Early recognition and treatment of mental health problems in the postpartum period might be an adjuvant strategy to improve child nutritional status and ultimately reduce the morbidity and mortality associated with nutritional deficits.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The work of agents in the socio Socio-Educational Service Centers is ruled by a high concentration, fast pace, unpredictability, great responsibilities; which can lead to constant stress. Based on the guiding question: there is an association between high psychological demands at work, low worker control over work activities and development of minor psychiatric disorders (MSD) on these agents?, This study aimed to investigate the psychosocial dimensions - control and psychological demands of work and its association with the occurrence of MPD agents of socioeducational workers of CASE/RS. The central hypothesis is that the association is positive. It is a cross-sectional study with a sample of 381 socio agents. In order to evaluate MPD and groups of the Karasek demand-control model, the Brazilian versions of the Self Report Questionnaire-SRQ-20 and Job Stress Scale - JSS were respectively applied. Data collection was performed using self-administered questionnaire in the period from March to August 2011. Data insertion was conducted using Epi-Info ®, version 6.4, with double independent typing. After checking for errors and inconsistencies, the data analysis was performed in PASW® (Predictive Analytics Software) 18.0 for Windows. To examine associations, chi-square test has been applied, Odds Ratio and its respective confidence intervals (CI 95%). Sociodemographic, employment, health habits were tested and those associated (p<0.25) both the exposure and the outcome (satisfaction with the workplace, number of agents on the scale, shift, day off work, suspicion for alcoholism, leisure time, physical and psychological activity) were tested in the multivariate models. As a result, it was found that 19.2% of socioeducational agents are in the quadrant high demand. The overall prevalence of suspicion for MPD was 50.1%. After adjusting for potential confounders, the odds of mental disorders was higher in active work quadrant (OR = 1.99, CI 95%=1.09 - 3.63), followed by high demand quadrant (OR = 2.05, IC95% = 1.03 - 4.09) compared to the agents of low demand quadrant. When the dimensions psychological demands and control are evaluated individually, both were associated with MPD. These results indicate high psychological demand, which has negative health effects of these workers, even when job control is high. In this sense, it is necessary to consider the issues of work organization in the institution, besides the planning of actions to promote health, prevent mental illness of the socio agents. / O trabalho dos agentes socioeducadores nos Centros de Atendimento Socioeducativo (CASE) é regido por alta concentração, ritmo acelerado, imprevisibilidade, grandes responsabilidades, o que pode levar a situações constantes de estresse. A partir da questão norteadora: existe associação entre altas demandas psicológicas no trabalho, baixo controle do trabalhador sobre a atividade laboral e desenvolvimento de Distúrbio Psíquico Menor (DPM) nesses agentes?, este estudo teve por objetivo investigar as dimensões psicossociais demandas psicológicas e controle do trabalho e sua associação com a ocorrência de DPM em agentes socioeducadores dos CASE/RS. A hipótese central é de que a associação é positiva. Trata-se de um estudo transversal, com uma amostra de 381 agentes socioeducadores. Para avaliação dos DPM e dos grupos do modelo demanda-Controle de Karasek, utilizaram-se as versões brasileiras do Self Report Questionnaire- SRQ-20 e Job Stress Scale JSS, respectivamente. A coleta de dados foi realizada por meio de questionário autoaplicável no período de março a agosto de 2011. Para a inserção dos dados foi utilizado o programa Epi-info®, versão 6.4, com dupla digitação independente. Após a verificação de erros e inconsistências, a análise dos dados foi realizada no PASW® (Predictive Analytics Software) 18.0 for Windows. Para verificar associações, adotaram-se o teste qui-quadrado, Odds Ratio e seus respectivos intervalos de confiança (IC95%). Variáveis sociodemográficas, laborais, e de hábitos e saúde foram testadas e aquelas associadas (p<0,25) tanto à exposição quanto ao desfecho (satisfação com o local de trabalho, número de agentes na escala, turno, dias de afastamento do trabalho, suspeição para alcoolismo, tempo de lazer, atividade física e acompanhamento psicológico) foram testadas nos modelos multivariados. Como resultado, encontraram-se 19,2% dos agentes socioeducadores no quadrante de alta exigência. A prevalência global de suspeição para DPM foi de 50.1%. Após ajustes por potenciais confundidores, a chance de distúrbios psíquicos foi maior no quadrante trabalho ativo (OR=1,99; IC95%=1,09-3,63), seguido do quadrante alta exigência (OR=2,05; IC95%=1,03-4,09), quando comparado aos agentes do quadrante baixa exigência. Ao serem avaliadas individualmente as dimensões demandas psicológicas e controle, ambas mostram-se associadas aos DPM. Esses resultados sinalizam a alta demanda psicológica, que possui efeitos negativos à saúde destes trabalhadores, mesmo quando o controle sobre o trabalho é alto. Nesse sentido, faz-se necessário refletir sobre as questões de organização do trabalho na instituição, além do planejamento de ações de promoção à saúde, a fim de prevenir o adoecimento mental dos agentes socioeducadores.

OBJETIVOS: Estimar a prevalência de transtornos mentais comuns (TMC) e transtornos de abuso e dependência de álcool (TADA) em população atendida por Estratégia Saúde da Família (ESF) do município de Santa Cruz do Sul, Brasil; estudar as associações entre TMC e TADA com variáveis sociodemográficas. METODOLOGIA: Todos moradores acima de 14 anos de 3 áreas atendidas por ESF foram convidados a participar no período de 10 de fevereiro de 2006 a 10 de fevereiro de 2007. RESULTADOS: Dos 2921 participantes, as prevalências de TMC e TADA foram de 29,93% (IC95%29,30%-30,56%) e 12,07% (IC95%11,63%-12,52%), respectivamente. Sexo feminino, situação ocupacional desfavorável, baixa escolaridade e baixa renda mostraram associação positiva e independente com TMC. Sexo masculino, situação ocupacional desfavorável e TMC apresentaram associação independente com TADA. DISCUSSÃO: Foram encontradas prevalências de TMC e TADA acima das relatadas em outros estudos brasileiros. Grupos com condições socioeconômicas desfavoráveis são os de maior risco para TMC e TADA. CONCLUSÕES: Os grupos de maior risco para TMC e TADA deveriam ser levados em consideração quando se planejam políticas públicas em saúde mental. / OBJECTIVE: Estimate the prevalence of common mental disorders (CMD) as well as alcohol abuse and dependence disorders (AADD) in a population assisted by Programa de Saúde da Família (PSF or Family Health Program) in the City of Santa Cruz do Sul, Southern Brazil; estimate the associations between CMD and AADD with socio-demographic variables. METHOD: All residents over 14 years of age from 3 areas assisted by the PSF were invited to participate between February 10, 2006 to February 10, 2007. RESULTS: Of 2,921 participants, the prevalence estimates of CMD and AADD were 29.93% (IC95%29.30%-30.56%) e 12.07% (IC95%11.63%-12.52%), respectively. Female, unfavorable employment situation, low schooling and low income showed a positive and independent association with CMD. Male, unfavorable employment situation and CMD showed an independent association with AADD. DISCUSSION: We found higher prevalence estimates of CMD and AADD in relation to the observed prevalence estimates in other Brazilian studies. Groups with unfavorable socioeconomic conditions present the highest risk. CONCLUSIONS: The groups with the highest risk for CMD and AADD should be taken into account when planning public mental health policies.