Os três “S”: Sono, Sociedade e Saúde Mental em um modelo multifatorial do uso de substâncias
Data
2024-12-20
Tipo
Tese de doutorado
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Resumo
Introdução: O uso de substâncias é um fenômeno amplamente observado em nossa sociedade, sendo que a prática de se consumir drogas que tenham efeito sobre o sistema nervoso central (SNC) envolve um grande número de variáveis e consequências. Dentre os muitos desdobramentos dessa prática, a iniciação do uso de substâncias, os possíveis fatores de risco que desencadeiam o consumo de drogas e os fatores influenciando o desenvolvimento do transtorno de uso de substâncias são frentes de pesquisa que precisam de expansão contínua. Estudos sugerem que elementos socioeconômicos/demográficos e sintomas psiquiátricos exercem uma influência decisiva sobre o uso de substâncias. Mais recentemente, evidências apontam para um papel fundamental do sono sobre o consumo de substâncias e suas facetas. Embora esses três pilares (sono, sintomas psiquiátricos e fatores socioeconômicos) tenham intersecções entre si, modelos que explorem os três simultaneamente ainda precisam ser elaborados. Objetivos: Analisar como a tríade sono, saúde mental e sociedade (fatores socioeconômicos/demográficos), chamados aqui de três “S”, interagem e modulam o uso de substâncias. Métodos: Três componentes distintos foram realizados a partir do banco de dados do EPISONO 2007, um estudo epidemiológico realizado para mapear as queixas de sono e os parâmetros de saúde dos habitantes da cidade de São Paulo. Voluntários do estudo preencheram questionários para avaliação de parâmetros de saúde e características subjetivas de sono, além de realizarem um exame polissonográfico de noite inteira para mapeamento do sono objetivo. Todas as nossas análises envolveram as respostas dos participantes no Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), questionário que avalia uso de substâncias. No primeiro componente desta Tese, avaliamos como o sono e fatores socioeconômicos e psiquiátricos interagem e afetam o risco para o uso de substâncias utilizando uma equação de modelagem estruturada (structural equation modelling – SEM). O segundo componente teve como foco a primeira pergunta do questionário ASSIST, e avaliou diferenças de gênero sobre os efeitos do uso na vida de substâncias sobre parâmetros de sono objetivos e subjetivos, controlando para sintomas psiquiátricos. O terceiro componente avaliou como atividade profissional e parâmetros de sono influenciam o risco envolvido no uso de substâncias. Resultados: No primeiro componente, elaboramos um modelo visual convergente que demonstrou que sono e fatores socioeconômicos e psiquiátricos modificam o risco para o consumo de tabaco. Regressões logísticas e lineares reforçaram esse modelo, sugerindo associação de parâmetros pertencentes aos três ”S” com o risco para o uso de tabaco e de álcool. No segundo componente, foram vistas discrepâncias de gênero para a relação entre alterações de sono e uso de substâncias na vida. Por exemplo, uso na vida de cannabis, em homens, foi associado a uma piora em parâmetros de sono, enquanto mulheres que fizeram uso dessa substância apresentaram uma melhora em parâmetros de sono, em relação aos seus respectivos controles (homens e mulheres que nunca consumiram cannabis). No terceiro componente, constatamos que atividade profissional e sono foram conjuntamente associados ao consumo de tabaco, enquanto para as demais drogas avaliadas, apenas variáveis de um dos dois conjuntos (atividade profissional ou sono) tiveram associação significativa com o risco para o consumo de drogas. Conclusões: Os três componentes incluídos nessa Tese evidenciaram que os três “S” estão relacionados, direta ou indiretamente, e de forma exclusiva ou mútua, com o uso de substâncias e o risco para o uso de substâncias em uma amostra representativa da cidade de São Paulo. A variedade de resultados obtidos ressalta a heterogeneidade de uma amostra utilizada para um estudo epidemiológico focado em um centro urbano de grande escala. Assim, nossos resultados podem direcionar ações acerca do uso de substâncias que beneficiem a população geral.
Introduction: Substance use is a phenomenon broadly observed in our society, with the practice of consuming centrally acting drugs being a complex advent that may involve a great number of variables and consequences. Among the many developments from this behavior, development of substance use, the initiation of this consumption habit, the possible risk factors behind drug consumption and the risk involved in substance use are lines of research that still need expansion. Studies suggest that socioeconomic/demographic elements and psychiatric symptoms exert a decisive influence on this practice. More recently, evidences point to sleep also being an important player on substance use and its characteristics. Although these three pillars (Sleep, psychiatric symptoms and socioeconomic factors) have known interfaces among them, models that simultaneously explore the effects of the three of them in substance use still need to be elaborated. Objectives: To evaluate how the three groups of variables, Sleep, mental health, and socioeconomic and demographic factors interact and affect the use of substances. Methods: Three components were performed using the database from EPISONO 2007, an epidemiologic study aimed at mapping Sleep complaints and health parameters in inhabitants of the city of São Paulo, Brazil. Participants filled in questionnaires evaluating their overall health and subjective sleep characteristics, besides undergoing a full-night polysomnographic exam to assess objective Sleep. All our analyses involved answers on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), a questionnaire that evaluates substance use. In the first component, we evaluated how socioeconomic, psychiatric and sleep factors affected risk in the consumption of substances using structural equation modelling (SEM). The second component focused on the first question of the ASSIST questionnaire, and evaluated sex differences concerning lifetime use of substances on subjective and objective sleep parameters. The third component evaluated how work- and Sleep-related factors influenced risk involved in substance use as reported with the final score in the ASSIST questionnaire. Results: In the first component, we elaborated a visual, convergent model demonstrating that sleep, socioeconomic factors and psychiatric symptoms could affect risk in tobacco consumption. Linear and logistic regressions reinforce this model by showing association of parameters pertaining to the three pillars with risk in consumption of alcohol and tobacco. In the second component, we saw sex differences in the relationship between sleep and lifetime substance use. For example, cannabis lifetime use in men was associated with a general worsening of sleep parameters, while in women, use of this substance at any point in life was associated with better sleep parameters, when comparing these groups with their respective controls (men and women who never consumed cannabis). In the third component, effects of work- and Sleep-related variables were simultaneously associated only to tobacco consumption, while for the other substances, only one of the two groups of variables (sleep- or work-related) presented any significant association. Conclusions: The three components included in this thesis evidenced, by different angles, how the three pillars (sleep, socioeconomic factors and mental health) were connected to substance use and its developments. The variety in results hereby exposed, with differences in the nature of the association between these three pillars and substance use in each component underlines the heterogeneity of the results from a sample of a large-scale epidemiologic study performed in a large urban center. In this sense, our results can direct actions regarding substance use benefitting the general population.
Introduction: Substance use is a phenomenon broadly observed in our society, with the practice of consuming centrally acting drugs being a complex advent that may involve a great number of variables and consequences. Among the many developments from this behavior, development of substance use, the initiation of this consumption habit, the possible risk factors behind drug consumption and the risk involved in substance use are lines of research that still need expansion. Studies suggest that socioeconomic/demographic elements and psychiatric symptoms exert a decisive influence on this practice. More recently, evidences point to sleep also being an important player on substance use and its characteristics. Although these three pillars (Sleep, psychiatric symptoms and socioeconomic factors) have known interfaces among them, models that simultaneously explore the effects of the three of them in substance use still need to be elaborated. Objectives: To evaluate how the three groups of variables, Sleep, mental health, and socioeconomic and demographic factors interact and affect the use of substances. Methods: Three components were performed using the database from EPISONO 2007, an epidemiologic study aimed at mapping Sleep complaints and health parameters in inhabitants of the city of São Paulo, Brazil. Participants filled in questionnaires evaluating their overall health and subjective sleep characteristics, besides undergoing a full-night polysomnographic exam to assess objective Sleep. All our analyses involved answers on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), a questionnaire that evaluates substance use. In the first component, we evaluated how socioeconomic, psychiatric and sleep factors affected risk in the consumption of substances using structural equation modelling (SEM). The second component focused on the first question of the ASSIST questionnaire, and evaluated sex differences concerning lifetime use of substances on subjective and objective sleep parameters. The third component evaluated how work- and Sleep-related factors influenced risk involved in substance use as reported with the final score in the ASSIST questionnaire. Results: In the first component, we elaborated a visual, convergent model demonstrating that sleep, socioeconomic factors and psychiatric symptoms could affect risk in tobacco consumption. Linear and logistic regressions reinforce this model by showing association of parameters pertaining to the three pillars with risk in consumption of alcohol and tobacco. In the second component, we saw sex differences in the relationship between sleep and lifetime substance use. For example, cannabis lifetime use in men was associated with a general worsening of sleep parameters, while in women, use of this substance at any point in life was associated with better sleep parameters, when comparing these groups with their respective controls (men and women who never consumed cannabis). In the third component, effects of work- and Sleep-related variables were simultaneously associated only to tobacco consumption, while for the other substances, only one of the two groups of variables (sleep- or work-related) presented any significant association. Conclusions: The three components included in this thesis evidenced, by different angles, how the three pillars (sleep, socioeconomic factors and mental health) were connected to substance use and its developments. The variety in results hereby exposed, with differences in the nature of the association between these three pillars and substance use in each component underlines the heterogeneity of the results from a sample of a large-scale epidemiologic study performed in a large urban center. In this sense, our results can direct actions regarding substance use benefitting the general population.
Descrição
Citação
SILVA, Vinícius Dokkedal. Os três “S”: Sono, Sociedade e Saúde Mental em um modelo multifatorial do uso de substâncias. 2024. 197 f. Tese (Doutorado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo., 2024.
ODS
3. Saúde e bem-estar