A narrative historical review of psychiatric epidemiology in Brazil: Focus on social and cultural determinants of mental health

Psychiatric research in Brazil has had a strong focus on social and cultural variables related to mental health. In the present narrative review, we provide historical context to the theoretical and methodological roots of psychiatric epidemiology in the country, from the era of proto-epidemiologic studies to the emergence of population neurosciences, showing the contribution of the field to approach social and cultural determinants of mental health. A periodization is proposed, including a proto-epidemiological phase and three subsequent generations. The available epidemiological data show extraordinary consistency and stability in terms of the prevalence of mental disorders in Brazil, which is very high as compared to other settings. Especially affected are vulnerable groups such as women, migrants, illiterates, low social class, unskilled workers, unemployed, people living in deteriorated urban sites, individuals exposed to violence, and in the socially excluded. Social inequalities and violence in Brazil play a noteworthy role as social determinants of poor mental health.