Perinatal and neonatal factors and mental disorders in children and adolescents: looking for the contributions of the early environment to common and dissociable aspects of psychopathology.

High rates of co-occurrence of mental disorders have been hypothesized to represent a result of common susceptibility to overall psychopathology. The purpose of this study is to test the hypothesis that commonalities among psychiatric disorders might be partially driven by sharable perinatal and neonatal environmental factors for mental disorders. Participants were 6-14 years of age children and their parents. Primary caregivers provided data on perinatal and neonatal information assessed retrospectively (n = 2231). Psychiatric disorders diagnoses were assessed using the Development and Well Being Behavior Assessment (DAWBA). We used bifactor models to disentangle common from dissociable aspects of psychopathology. These models allow modeling psychiatric disorders as the result of a common domain of psychopathology (p-factor) and three dissociable domains (fear, distress, and externalizing symptoms). Associations were tested using linear and tobit regression models. The p-factor was associated with male sex, low socioeconomic status, gestational smoking, gestational drinking, low levels of maternal education and presence of mental disorder in the mother. Associations with specific factors also emerged suggesting some risk factors might also have some role for fear, distress and externalizing factors. Our study supports the hypothesis that overall susceptibility to psychopathology might be partially driven by sharable perinatal and neonatal factors.

Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Trajectories of positive attributes from childhood to young adulthood and its associations with threat and deprivation.

OBJECTIVE: The aims of this study are to investigate the trajectory of positive attributes from childhood to early adulthood and to explore how those trajectories can be modified by two domains of childhood adversity - threat and deprivation. METHODS: A large prospective school-based community cohort of youths (n=2,511, 6-14 years of age, 45% female) was assessed and followed up for 3 years (80% retention) and 6 years (71% retention). Positive attributes were assessed by the Youth Strength Inventory (YSI). Childhood exposure to threat and deprivation were assessed by a composite measure using multiple indicators. RESULTS: Trajectories of YSI scores were non-linear and distinct for boys and girls. While boys presented a more stable trajectory; girls showed higher levels of positive attributes early in life that decrease over time around adolescence. Both exposure to threat and deprivation presented negative linear association with YSI over time. Furthermore, we found interactions between developmental stage and both adversity domains meaning that the effects of exposure to adversity were stronger at earlier developmental stages and almost non-significant closer to early adulthood. CONCLUSION: Our findings provide new evidence on trajectories of positive attributes in youth and reveal and how experiences of adversity in early life impact not only mental disorder but also positive aspects of mental health.

Experience of Service Questionnaire (ESQ) in children and adolescents: factor structure, reliability, validity, item parameters and interpretability of the parent version for practical use in Greece.

Background: Health systems need tools to assess patient's experience of service, but existing tools lack reliability and validity assessment. Our aim is to investigate the factor structure, reliability, validity, item parameters and interpretability of the parent version of the Experience of Service Questionnaire (ESQ) for practical use in Greece. Methods: A total of 265 caregivers that were using mental health services in Greece participated in this study as part of the Nationwide cross-sectional survey from the Child and Adolescent Mental Health Initiative (CAMHI). Confirmatory Factor Analysis was used to test factor structure. Reliability of all models were measured with omega coefficients. Tobit regression analysis was used to test for convergent and discriminant validity with specifically designed questions. Item parameters were assessed via Item Response Theory. Interpretability was assessed by means of IRT-based scores. Results: We found that ESQ is best represented and scored as a unidimensional construct, given potential subscales would not have enough reliability apart from a general factor. Convergent and discriminant validity was demonstrated, as caregivers who perceived that their child benefited from the received mental health care had 6.50 higher summed scores (SMD=1.14, p<0.001); while those who believed that their child needed additional help had 5.08 lower summed scores on the ESQ (SMD=-0.89, p<0.001). Average z-scores provided five meaningful categories of services, in terms of user satisfaction, compared to the national average. Conclusions: Our study presents evidence for the reliability and validity of the ESQ and provides recommendations for its practical use in Greece. ESQ can be used to measure experience of service and might help drive improvements in service delivery in the Greek mental health sector.

Beyond frequency: Evaluating the validity of assessing the context, duration, ability, and botherment of depression and anxiety symptoms in South Brazil.

Assessment tools for depression and anxiety usually inquire about the frequency of symptoms. However, evidence suggests that different question framings might trigger different responses. Our aim is to test if asking about symptom's context, ability, duration, and botherment adds validity to Patient Health Questionnaire-9, General Anxiety Disorder-7, and Patient-Related Outcome Measurement Information Systems depression and anxiety. Participants came from two cross-sectional convenience-sampled surveys (N = 1,871) of adults (66% females, aged 33.4 ± 13.2), weighted to approximate with the state-level population. We examined measurement invariance across the different question frames, estimated whether framing affected mean scores, and tested their independent validity using covariate-adjusted and sample-weighted structural equation models. Validity was tested using tools assessing general disability, alcohol use, loneliness, well-being, grit, and frequency-based questions from depression and anxiety questionnaires. A bifactor model was applied to test the internal consistency of the question frames under the presence of a general factor (i.e., depression or anxiety). Measurement invariance was supported across the different frames. Framing questions as ability (i.e., "How easily …") produced a higher score, compared with framing by context (i.e., "In which daily situations …"). Construct and criterion validity analysis demonstrate that variance explained using multiple question frames was similar to using only one. We detected a strong overarching factor for each instrument, with little variances left to be explained by the question frame. Therefore, it is unlikely that using different adverbial phrasings can help clinicians and researchers to improve their ability to detect depression or anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil.

BACKGROUND: Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. METHODS: For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6-14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010-11, and 1917 were assessed 8 years later (2018-19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. FINDINGS: DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20-2·18; CBCL 1·66, 1·19-2·30), but only CBCL independently predicted poor life chances (1·56, 1·19-2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. INTERPRETATION: Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes. FUNDING: Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de São Paulo; and Medical Research Council, European Research Council. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

The interplay between ADHD and school shift on educational outcomes in children and adolescents: A cross-sectional and longitudinal analysis.

Many countries implement a double-shift schooling system, offering morning or afternoon shifts, driven by diverse factors. Young people with ADHD may face educational problems attending morning shifts compared to afternoon shifts. To investigate this, we used data from a Brazilian school-based cohort (n = 2.240, 6-14 years old, 45.6% female; 50.2% in the morning shift; 11.2% with ADHD). ADHD was determined by child psychiatrists using semi-structured interview. Educational outcomes were measured cross-sectionally and three years later (80% retention) and included reading and writing ability, performance in school subjects, and any negative school events (repetition, suspension, or dropout). Generalized regression models tested the interaction between ADHD and school shift and were adjusted for age, sex, race/ethnicity, intelligence, parental education, socioeconomic status, and site. Attrition was adjusted with inverse probability weights. We used two dimensional measures of attentional problems as sensitivity analysis. ADHD and morning shift were independently associated with lower reading and writing ability and with higher odds for negative school events cross sectionally. ADHD independently predicted lower performance in school subjects and higher negative school events at follow-up. Interaction was found only at the cross-sectional level in a way that those studying in the afternoon present better educational outcomes compared with those studying in the morning only if they have lower ADHD symptom. Thus, ADHD was not associated with poorer educational outcomes among those studying in the morning. However, participants studying in the afternoon with lower levels of attentional problems presented better educational, despite these associations fade away over time.

Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece.

BACKGROUND: In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS: This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS: A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION: A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.

Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9)

Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde - 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

Inflammation and damage-associated molecular patterns in major psychiatric disorders

Abstract Background Emerging evidence indicates that inflammation plays an important role as a mechanism underlying mental disorders. However, most of the research on inflammatory mechanisms focuses on serum levels of interleukins and very few studies have investigated molecules that initiate and expand innate immune pathways such as damage-associated molecular patterns (DAMPs). Objectives This study investigated the levels of DAMPs among patients diagnosed with major depressive disorder (MDD), bipolar disorder (BD) I and II, schizophrenia (SCZ), and generalized anxiety disorder (GAD). We quantified serum levels of heat shock proteins (HSPs) 70 and 60 and of S100 calcium-binding protein B (S100B). Methods Serum levels of HSP70, HSP60, and S100B were assessed in a sample of participants with psychiatric disorders (n = 191) and a control group (CT) (n = 59) using enzyme-linked immunosorbent assay (ELISA). Results Serum HSP70 concentrations were significantly higher in the MDD group compared to the CT, SCZ, and BD groups. The GAD group had higher concentrations of HSP70 than the SCZ group. Exploring associations with medications, lithium (p = 0.003) and clozapine (p = 0.028) were associated with lower HSP70 levels. Approximately 64% of the sample had DAMPs levels below the limits of detection indicated by the respective ELISA kit. Conclusion This was the first study to assess DAMPs levels in a transdiagnostic sample. Our preliminary findings suggest that HSP70 may be associated with MDD pathophysiology. Medications such as lithium and clozapine were associated with lower HSP70 levels in BD and SCZ groups, respectively. Therefore, it is worth mentioning that all participants were medicated and many psychotropic drugs exert an anti-inflammatory effect, possibly reducing the signs of inflammation.

Diagnostic operationalization and phenomenological heterogeneity in psychiatry: the case of attention deficit hyperactivity disorder / Operacionalización diagnóstica y heterogeneidad fenomenológica en psiquiatría: el caso del trastorno por déficit de atención con hiperactividad

Abstract Introduction We assessed the impact of polythetic conceptualizations of mental disorders on the validity and reliability of psychiatric diagnosis, with a specific focus on two levels of heterogeneity: phenomenological and pathophysiological. Objective We investigated this issue using attention deficit hyperactivity disorder (ADHD) as an example. Method We examined individuals from two samples enriched for psychopathology (n = 1 255 children in Porto Alegre and 1 257 children in São Paulo, Brazil). We conducted a series of data analyses to investigate phenomenological heterogeneity, including confirmatory factor analysis. We also investigated pathophysiological heterogeneity using symptom-level regressions between ADHD symptoms and four neurocognitive processes consistently linked to ADHD (working memory, inhibitory control, intra-subject variability in reaction times, and temporal processing). Lastly, we assessed the performance of polythetic systems for reliability testing inter-rater and test-rest reliability of two well-known symptomatic scales. Results Among the 116 200 possible combinations of symptoms to achieve DSM symptomatic threshold for categorical ADHD diagnosis, we found 173 combinations in the two independent samples, and only four were replicated in both samples (2.3%). We also found that the number of ADHD symptoms is a poor indicator of variation in the general ADHD latent trait. Overall, symptoms did not have specific profiles of associations with any of the neurocognitive processes. Reliability analyses revealed that increasing the number of items augments overall reliability of measurements. Discussion and conclusion Our findings illustrate both potential benefits and problems inherent to the polythetic system for ADHD. Implications for the search of mechanisms underlying psychiatric disorders are discussed.

Resumen Antecedentes Evaluamos el impacto de las conceptualizaciones politécnicas de los trastornos mentales en la validez y la fiabilidad del diagnóstico psiquiátrico, con un enfoque específico en dos niveles de heterogeneidad: fenomenológico y fisiopatológico. Objetivos Investigamos este problema utilizando el trastorno por déficit de atención e hiperactividad (TDAH) como ejemplo. Método Examinamos individuos de dos muestras enriquecidas por psicopatología (n = 1 255 niños en Porto Alegre y 1 257 niños en São Paulo, Brasil). Llevamos a cabo una serie de análisis de datos para investigar la heterogeneidad fenomenológica, incluido el análisis factorial confirmatorio. También investigamos la heterogeneidad fisiopatológica utilizando regresiones al nivel de síntomas entre los síntomas del TDAH y cuatro procesos neurocognitivos consistentemente vinculados al TDAH (memoria de trabajo, control inhibitorio, variabilidad intrasujeto en tiempos de reacción y procesamiento temporal). Por último, evaluamos el rendimiento de los sistemas politéticos para la prueba de confiabilidad interevaluador y la confiabilidad test-rest de dos escalas sintomáticas bien conocidas. Resultados Entre las 116 200 posibles combinaciones de síntomas para alcanzar el umbral sintomático del DSM para el diagnóstico categórico de TDAH, encontramos 173 combinaciones en las dos muestras independientes y sólo cuatro se replicaron en ambas muestras (2.3%). También encontramos que la cantidad de síntomas de TDAH no es un buen indicador de la variación en el rasgo latente general del TDAH. En general, los síntomas no tenían perfiles específicos de asociaciones con ninguno de los procesos neurocognitivos. Los análisis de confiabilidad revelaron que aumentar el número de artículos aumenta la confiabilidad general de las mediciones. Discusión y conclusión Nuestros hallazgos ilustran tanto los beneficios potenciales como los problemas inherentes al sistema politécnico para el TDAH. Se discuten las implicaciones para la búsqueda de mecanismos subyacentes a los trastornos psiquiátricos.

Brazilian Portuguese version of the Anger Rumination Scale (ARS-Brazil) / Versão em português brasileiro da Escala de Ruminação de Raiva (ARS-Brasil)

Abstract Objective To describe the cross-cultural adaptation of the Anger Rumination Scale (ARS) for use in Brazil. Methods The cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. Results A final Brazilian version of the instrument (ARS-Brazil) was defined and is presented. Pretest results revealed that the instrument was generally well understood by adults as well as indicated a few modifications that were included in the final version presented here. Conclusion The Brazilian Portuguese version of the ARS seems to be very similar to the original ARS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of rumination symptoms of anger and irritability for adults in community, clinical, and research settings.

Resumo Objetivo Descrever a adaptação transcultural da Escala de Ruminação de Raiva (Anger Rumination Scale, ARS) para uso no Brasil. Método A adaptação transcultural seguiu um processo de quatro etapas baseado em literatura especializada: 1) investigação da equivalência conceitual e dos itens; 2) tradução e retrotradução; 3) pré-teste; e 4) investigação da equivalência operacional. Resultados Uma versão final brasileira do instrumento, denominada ARS-Brasil, foi obtida e é apresentada. Os resultados do pré-teste demonstraram que a escala foi predominantemente bem entendida entre adultos, e indicaram algumas modificações que foram incluídas na versão final. Conclusão A versão da ARS adaptada para o português brasileiro mostra-se muito similar à versão original da ARS no que diz respeito à equivalência conceitual e dos itens, semântica e equivalência operacional, sugerindo que futuros estudos transculturais poderiam se beneficiar desta primeira versão. Como resultado, um novo instrumento está agora disponível para a avaliação de sintomas de ruminação da raiva e da irritabilidade para adultos, em contextos comunitário, clínico e de pesquisa.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study / Desempenho em tarefas de atenção, memória, habilidades visuoconstrutivas e funções executivas em adolescentes com transtornos de ansiedade: um estudo comunitário caso-controle

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

Cross-cultural adaptation and preliminary psychometric properties of the Affective Reactivity Index in Brazilian Youth: implications for DSM-5 measured irritability / Adaptação transcultural e propriedades psicométricas preliminares do Affective Reactivity Index em jovens brasileiros: implicações para a irritabilidade medida pelo DSM-5

Objective: To describe the cross-cultural adaptation of the Affective Reactivity Index (ARI) to Brazilian Portuguese and to investigate preliminary psychometric properties of the adapted version. Methods: Cross-cultural adaptation was based on the investigation of the theoretical and operational equivalences of the original ARI in the Brazilian context, followed by a process of translation, back-translation, and review by a committee of experts. Data analysis was carried out in a community sample of 133 schoolchildren aged 8 to 17 years to investigate the following characteristics of the ARI: 1) factor structure; 2) internal consistency; 3) construct validity comparing differential relationships between irritability and anxiety dimensions and impairment; and 4) item response theory (IRT) parameters. Results: A final Brazilian Portuguese version of the instrument was defined and is presented. Internal consistency was good, and our analysis supported the original single-factor structure of the ARI. Correlations of the ARI with distress-related anxiety dimensions were higher than with phobic-related anxiety dimensions, supporting its construct validity. In addition, higher ARI scores were associated with higher irritability-related impairment. IRT analysis underscored frequency of loss of temper as essential to inform about pathological states of irritability. Conclusion: The Brazilian Portuguese version of the ARI seems to be very similar to the original instrument in terms of conceptual, item, semantic, and operational equivalence. Our preliminary analysis replicates and extends previous evidence confirming promising psychometric properties for the ARI.

Objetivo: Descrever a adaptação transcultural do Affective Reactivity Index (ARI) para o português do Brasil e investigar propriedades psicométricas preliminares da versão adaptada. Método: A adaptação transcultural foi baseada na investigação das equivalências teórica e operacional da versão original do ARI no contexto brasileiro, seguida do processo de tradução, retrotradução e revisão por comitê de especialistas. A análise dos dados foi realizada em uma amostra comunitária de 133 escolares com idade entre 8 e 17 anos para investigar as seguintes características do ARI: 1) estrutura fatorial; 2) consistência interna; 3) validade do construto, comparando as relações diferenciais entre irritabilidade e as dimensões de ansiedade e prejuízo; e 4) parâmetros de teoria da resposta ao item (TRI). Resultados: Uma versão final em português do Brasil do instrumento foi definida e é apresentada. A consistência interna foi boa, e nossa análise confirmou a estrutura unifatorial original do ARI. As correlações do ARI com as dimensões de ansiedade relacionadas a sofrimento foram maiores do que com as dimensões de ansiedade relacionadas a fobias, reforçando a validade do construto. Além disso, escores mais altos no ARI foram associados a maior prejuízo relacionado à irritabilidade. A análise do TRI enfatizou a frequência de perda de controle como essencial para determinar estados patológicos de irritabilidade. Conclusão: A versão em português do Brasil do ARI parece ser muito semelhante ao instrumento original em termos de equivalência conceitual, de itens, semântica e operacional. Nossa análise preliminar reproduz e estende evidências anteriores que confirmam propriedades psicométricas promissoras para o ARI.

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

Propriedades psicométricas da versão brasileira do behavioral inhibition instrument (BII) e associações com sintomas psicopatológicos / Psychometric properties of the brazilian version of the behavioral inhibition instrument (BII) and associations with psychopathological symptoms / Propiedades psicométricas de la versión brasileña del behavioral inhibition instrument (BII) e sus asociaciones con síntomas psicopatológicos

Os objetivos desse estudo foram investigar propriedades psicométricas da versão brasileira do Behavioral Inhibition Instrument (BII) e suas associações com sintomas de ansiedade e depressão em crianças e adolescentes. Participaram 838 estudantes com idades entre 9-18 anos (M=12,89; DP=2,10) de uma amostra comunitária respondendo a versão brasileira do BII e questionários de autorrelato de sintomas de ansiedade e depressão. Os resultados demonstraram que a prevalência de crianças e adolescentes na categoria de alta inibição comportamental foi de 16,6%. O BII apresentou propriedades psicométricas satisfatórias com maiores níveis de inibição comportamental correlacionados a maiores níveis de sintomas de ansiedade e depressão, especialmente para sintomas de fobia social. Além disso, participantes com altos escores de inibição comportamental tiveram maior probabilidade de apresentar sintomas de ansiedade em um espectro clínico ou subclínico, especialmente para fobia social. Implicações para intervenções preventivas precoces são brevemente discutidas...

The aims of this study were to investigate psychometric properties of the Behavioral Inhibition Instrument (BII) and their association with depression and anxiety symptoms in children and adolescents. Eight hundred and thirty-eight students aged 9-18 years (M=12.89, SD=2.10) from a community sample answered the Brazilian-Portuguese version of the BII and self-report questionnaires of depression and anxiety symptoms. Results showed the prevalence of children and adolescents in the high behavioral inhibition (BI) category was 16.6%. The BII presented satisfactory psychometric properties with higher levels of BI being correlated to higher levels of depression and anxiety symptoms, especially social phobia symptoms. Also participants with higher BI scores were more likely to present anxiety symptoms in a subclinical or clinical range, especially for social phobia. Implications for early preventive interventions are briefly discussed...

Los objetivos de este estudio fueron investigar las propiedades psicométricas de la versión brasileña del Behavioral Inhibition Instrument (BII) y sus asociaciones con los síntomas de ansiedad y depresión en niños y adolescentes. Ochocientos treinta y ocho (838) estudiantes con edades entre 9 y 18 años (M=12,89; DP=2,10) de una muestra comunitaria respondieron a la versión brasileña del BII y a cuestionarios auto-aplicables de síntomas de ansiedad y depresión. Los resultados demuestran que el predominio de niños y adolescentes en la categoría de alta inhibición conductual fue de 16,6%. El BII presentó propiedades psicométricas satisfactorias con mayores niveles de inhibición conductual correlacionándose a mayores niveles de síntomas de ansiedad y depresión, especialmente para fobia social. Además, los participantes con altos puntajes de inhibición conductual tuvieron mayor probabilidad de presentar síntomas de ansiedad en un espectro clínico o subclínico, especialmente para fobia social. Algunas implicancias para realizar intervenciones preventivas precoces son brevemente discutidas...

Youth Quality of Life Instrument-Research version (YQOL-R): propriedades psicométricas em uma amostra comunitária / Youth Quality of Life Instrument-Research version (YQOL-R): psychometric properties in a community sample

OBJETIVO: Testar algumas propriedades psicométricas da versão brasileira do Youth Quality of Life Instrument-Research (YQOL-R) em uma amostra comunitária de adolescentes brasileiros. MÉTODOS: Este é um estudo transversal comunitário realizado em seis escolas localizadas na área de abrangência de uma unidade de saúde da família. De uma população original de 2.754 estudantes com idade entre 10 e 17 anos, selecionamos aleatoriamente 419 para responder à versão brasileira do YQOL-R. Testamos a confiabilidade, as diferenças já conhecidas entre os grupos (utilizando sintomas de ansiedade e envolvimento em episódios de bullying) e a estrutura fatorial. RESULTADOS: O YQOL-R apresentou boa consistência interna, e as diferenças já conhecidas entre os grupos mostraram-se adequadas e estiveram dentro do esperado tanto com relação ao bullying quanto à ansiedade. A estrutura fatorial do modelo conceitual foi em parte fundamentada por nossa análise. CONCLUSÕES: A versão brasileira do YQOL-R apresentou propriedades psicométricas suficientemente boas. São necessários mais estudos a fim de melhor investigar configurações alternativas da estrutura fatorial.

OBJECTIVE: To test some psychometric properties of the Brazilian-Portuguese version of the Youth Quality of Life Instrument-Research (YQOL-R) in a community sample of Brazilian adolescents. METHODS: This is a cross-sectional community study conducted in six schools of the catchment area of a family health unit. From an original population of 2,754 students from 10 to 17 years old, we randomly selected 419 to answer the Brazilian-Portuguese version of the YQOL-R. We tested reliability, known group differences (using anxiety symptoms and bullying involvement), and factor structure. RESULTS: The YQOL-R showed a good internal consistency and had an adequate and expected known group differences with both bullying and anxiety. The factor structure of the conceptual model was partially supported by our analysis. CONCLUSIONS: The Brazilian-Portuguese version of the YQOL-R showed sufficiently good psychometric properties. Further studies are needed in order to better investigate alternative configurations of the factor structure.

Terapia cognitivo-comportamental com intervenção familiar para crianças e adolescentes com transtorno obsessivo-compulsivo: uma revisão sistemática / Cognitive behavioral therapy with family intervention for children and adolescents with obsessive-compulsive disorder: a systematic review

O transtorno obsessivo-compulsivo (TOC) é uma doença mental grave, com graves consequências para a dinâmica familiar. Desta forma, o envolvimento dos pais parece ser determinante na resolução dos sintomas desse transtorno. O objetivo deste estudo foi avaliar a qualidade da evidência para a recomendação de terapia cognitivo-comportamental (TCC) com intervenção familiar para crianças e adolescentes com TOC. A busca sistemática foi realizada nas bases de dados MEDLINE/PubMed, seguida da análise de resumos e artigos na íntegra por dois avaliadores independentes. Posteriormente, foi realizada a análise de evidência através do sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). O tamanho de efeito da intervenção foi calculado através do d de Cohen. Foram localizados 77 artigos no PubMed e mais 12 artigos após busca cruzada de referências. Destes, sete artigos foram incluídos na revisão, segundo os seguintes critérios: ser estudo de intervenção, envolver apenas crianças e/ou adolescentes e possuir diagnóstico clínico ou estruturado de TOC. A escala Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) foi utilizada por todos os artigos para a avaliação de desfecho, permitindo avaliar o tamanho de efeito das intervenções não controladas (d = 1,43), que resultou em uma diferença de médias de cerca 13 pontos (IC95 por cento 11,84-14,39; p < 0,001). Por outro lado, uma alta heterogeneidade foi detectada entre os estudos (I² = 67 por cento). A TCC com intervenção familiar parece ter um efeito importante na redução dos sintomas de TOC na infância e adolescência. No entanto, os poucos estudos disponíveis não nos permitem estabelecer um grau de evidência maior do que C para essa recomendação. Novos ensaios clínicos randomizados são necessários para confirmar essa recomendação.

Obsessive-compulsive disorder (OCD) is a severe mental disorder with serious consequences to family dynamics. Therefore, parental involvement seems to be a key factor for the successful treatment of this psychiatric disorder. The aim of this study was to evaluate the level of evidence available to allow recommendation of cognitive behavioral therapy (CBT) with family intervention for the treatment of children and adolescents with OCD. The systematic search was performed on MEDLINE/PubMed, followed by analysis of abstracts and full-length articles by two independent evaluators. Subsequently, an analysis of the evidence available was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The effect size of the intervention was calculated using Cohen’s d. We found 77 articles on PubMed, plus 12 articles via cross-reference search. Of these, seven articles were included in this review, according to the following criteria: intervention study, involving only children and/or adolescents, and a having a structured or clinical diagnosis of OCD. The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used for outcome evaluation in all articles, thus enabling assessment of the effect size of non-controlled interventions (d = 1.43), resulting in a mean difference of 13.11 points (95 percentCI 11.84-14.39; p < 0.001). Conversely, a high heterogeneity was detected among the studies (I² = 67 percent). Family-based CBT seems to have an important effect on the reduction of OCD symptoms in children and adolescents. However, the small number of studies available do not allow us to establish an evidence level higher than C for this recommendation. New randomized clinical trials are needed to confirm this recommendation.