O presente estudo teve como objetivo identificar os padrões de uso de "êxtase" na cidade de São Paulo. Os usuários foram recrutados através da técnica de amostragem snowball, também utilizada para o recrutamento do grupo controle, composto de indivíduos com estilo de vida semelhante aos primeiros mas que nunca haviam experimentado "êxtase" (não usuários). Usuários (52) e não usuários (52) foram entrevistados quanto às características sócio-demográficas e quanto ao uso de drogas psicotrópicas; usuários também responderam questões sobre circunstâncias de uso e efeitos do "êxtase". Através da Escala de Impulsividade de Barratt e dos Inventários de Depressão de Beck e de Ansiedade Traço-Estado (IDATE-traço) foram medidas impulsividade, depressão e ansiedade de ambos os grupos. Os dois grupos apresentaram características sócio-demográficas semelhantes: a maioria pertencia à classe média, era jovem, heterossexual, solteira e com nível superior. Entre os usuários o consumo de outras drogas psicotrópicas foi expressivamente superior. Outras características mais freqüentes no grupo de usuários foram a presença de tatuagens e piercings, a frequência a "raves" e a preferência pela música eletrônica. No Inventário de Depressão de Beck os usuários apresentaram pontuação significativamente menor quanto à depressão. Os resultados das escalas de impulsividade e ansiedade não apresentaram diferenças significativas entre os dois grupos. Os padrões de uso de "êxtase" dos usuários entrevistados são semelhantes aos padrões descritos por pesquisas realizadas na Europa e em Sidney: a maioria dos usuários consome um ou dois comprimidos a cada episódio de uso, apenas nos finais de semana ou férias, mais freqüentemente na companhia de várias pessoas, em ambientes ligados ao lazer noturno, como lugares para dançar, "raves" e festas. Os comprimidos são geralmente adquiridos de amigos ou conhecidos nesses locais. A maioria dos usuários associa "êxtase" a outras drogas psicotrópicas, particularmente maconha. As características sócio-demográficas dos usuários entrevistados e seus padrões de aquisição e consumo de "êxtase" indicam um caráter pouco marginal do uso. São sugeridas estratégias de Redução de Dano caso o uso de "êxtase" se difunda em São Paulo. / The present study was aimed at identifying patterns of ecstasy (MDMA) use in the city of São Paulo. Ecstasy users were recruited through the snowball technique. Using the same technique, a control group of subjects that had never tried the drug (non users) was recruited among individuals sharing with users a similar life style. Users (N=52) and non users (N=52) were interviewed in order to obtain socio-demographic data and data on use of psychoactive drugs; users were also questionned as to the circumstances surrounding their use of the drug. Besides, levels of anxiety, depression and impulsiveness were assessed through Spielberger's IDATE Trace Inventory, Beck's Depression Inventory and Barratt Impulsiveness Scale. Both users and non users revealed similar socio-demographic characteristics: most subjects were middle class young heterosexual single men and women who had a college degree. Multiple drug use was more frequent among users than among non users. Other features that were significantly more accentuated among users than among non users were the presence of tattoos and piercings, the frequency to raves and the preference for electronic music. Beck Inventory results pointed to significantly lower depression scores among users. No differences were observed between groups in anxiety and impulsiveness scores. Ecstasy consumption patterns among users are similar to those reported in Europe and Australia: most subjects take one or two pills per episode, during weekends or vacations, usually with company and in social gatherings such as dancings, raves and parties. The drug is predominantly acquired from friends or acquaintances in these same spots. Most users reported consuming ecstasy in combination with other psychoactive drugs, particularly marihuana. The socio-demographic features of users as well as the way they buy and consume the drug suggest that the present pattern of use is not connected to illegal or marginal activities. Harm reduction strategies are suggested in case of ecstasy's use increases and spreads among the young population of the city.

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.