São Paulo: Sick Megacity

Scientists are at last discovering what São Paulo residents have long known instinctively – urban stresses from the exasperating yet invigorating lifestyle of this south American megacity can drive you mad, as well as making you ill.

So if foreign visitors who visited the pollution-girt skyscrapers, gnarly traffic and gritty pavement life of São Paulo for the 2014 World Cup feel an overwhelming urge to head for the exits, then their instincts were probably about right.

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City’s mega health problem shows up in UN rankings for stress and anxiety.

Research to estimate the prevalence of mental disorders in highly urbanized São Paulo came up with a disturbing result: the city ranked first among the 24 countries included in the World Health Organization’s (WHO’s) World Mental Health Survey.

Above all, chronic anxiety is the daily experience of the paulista. Anxiety disorders were the most commonly found mental disorder and affected 19.9% of those interviewed in a survey conducted by University of São Paulo Medical School (FMUSP). Next were mood disorders (11%), impulse control disorders (4.3%) and problems related to substance abuse (3.6%). Nearly 10% of the cases were considered serious. Of these, only 30% had access to treatment.

Mental health issues fit into a wider context of the city’s health and disease – where the symptoms are far from evenly distributed. Rich and poor, young and old suffer from different diseases and different pairings of diseases. For instance, city neighbourhoods with glaring social inequality tend to be hotspots for cardiovascular disease and diabetes.

Unsurprisingly perhaps, males in more prosperous neighbourhoods suffer disproportionately from problems related to drugs, alcohol and tobacco. Women, meanwhile, suffer disproportionately more from migraines and other painful conditions, episodes of anxiety, depression and insomnia. However cancer and neurological conditions such as Alzheimer’s disease, are no respecters of gender, social boundaries or even economic groupings.

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São Paulo’s wealthier neighbourhoods suffer health problems too.

The São Paulo Megacity database analysis enabled the research group to divide the 14 chronic conditions mentioned by the interviewees into four patterns of diseases that were strongly correlated. One pattern is made up of painful diseases, anxiety and depression; a second consists of metabolic diseases and arthritis; a third is related to substance abuse; and a fourth, more biological pattern, includes cancer and neurological conditions.

What also became clear from the findings is that Brazil’s health system – whether publicly funded or private – has yet to adopt a “joined-up” approach to the physiological and psychological challenges of living in the city. Multimorbidity – the lifestyle-related linkage between diseases and conditions – means that many residents are being failed by Brazil’s highly-specialized healthcare industry. Mental disorders are very common and often occur together with other chronic diseases. Therefore, psychiatry needs to be included in planning strategies for treatment and prevention.

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Joined-up care: Clinicians and mental health professionals should work together.

These findings also indicated that cardiovascular disease, anxiety disorders and depression were the diseases that were the most highly associated with other chronic conditions. The researchers estimate that they have the greatest impact on the quality of life of those affected. These findings confirm the recent information found in the Global Burden of Disease Study 2010 for Brazil.

The findings are the result of years of research into São Paulo Megacity led by Wang Yuan Pang, a researcher at the Institute of Psychiatry at the Hospital das Clínicas (HC) of the University of São Paulo Medical School (FMUSP), along with Laura Helena Andrade, also of FMUSP.

This October The Lancet will publish an authoritative study of mental health and disease trends in South America’s largest city, which were presented in April at the World Health Summit – Regional Meeting Latin America.

The research was based on data from interviews conducted with 5,037 residents of the São Paulo Metropolitan Region. The interviews were conducted between 2005 and 2007 with a representative sample of the population of the São Paulo Metropolitan Region over age 18.

The analysis is an extension of the São Paulo Megacity Mental Health Survey (read more about it at: http://agencia.fapesp.br/en/15329) completed in 2009 within the scope of the thematic project entitled “Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economic burden,” funded by FAPESP and led by Laura Helena Andrade.

Researcher Wang Yuan Pang told Brazilian reporter Karina Toledo: “Our findings, as well as those from international studies, indicate that people with two or more chronic diseases are at an increased risk of developing other associated chronic conditions. The more advanced one’s age, and the lower one’s socioeconomic level, the greater is the risk, and this ends up creating clusters of physical and mental morbidity among the population”.

The study also received funding from FAPESP through the recently concluded project “Identification of subgroups of alcohol users and related factors in the São Paulo Metropolitan Area: gender differences, sociodemographic characteristics and psychiatric comorbidities.”


You can read a full report  by Brazilian journalist Karina Toledo by clicking here.

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