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.

Translation and cross-cultural adaptation to Brazilian Portuguese of two brief screening tools for youth at risk of psychosis: the Prodromal Questionnaire (PQ-16) and the PRIME-Screen

Abstract Introduction Prodromal characteristics of psychosis have been described for more than a century. Over the last three decades, a variety of studies have proposed methods to prospectively identify individuals (and youth in particular) who are at high risk of developing a psychotic disorder. These studies have validated various screening instruments and made them available in several languages. Here, we describe the translation into Brazilian Portuguese and cross-cultural adaptation of two such screening tools - the Prodromal Questionnaire-16 (PQ-16) and the Prevention through Risk Identification, Management, and Education (PRIME)-Screen. Method Two bilingual native speakers of Brazilian Portuguese translated the questionnaires from English. A native English speaker then performed back-translations into English. These back-translated versions were submitted to the original authors. They provided feedback and later approved the final versions. Results After translation and cross-cultural adaptation, no items needed to be changed in the adapted PQ-16 and four items were revised in the PRIME-Screen. After the peer-review process, we included two suggestions in the PQ-16 to facilitate use of the tool in our cultural and social contexts. The PRIME-Screen did not need further changes. Conclusion These new instruments can help screen Brazilian Portuguese-speaking patients who are at risk of psychosis in primary care.

Adolescent depression and resting-state fMRI brain networks: a scoping review of longitudinal studies

The neurobiological factors associated with the emergence of major depressive disorder (MDD) in adolescence are still unclear. Previous cross-sectional studies have documented aberrant connectivity in resting-state functional magnetic resonance imaging (rs-fMRI) networks. However, whether these findings precede MDD onset has not been established. This scoping review mapped key methodological aspects and main findings of longitudinal rs-fMRI studies of MDD in adolescence. Three sets of neuroimaging methods to analyze rs-fMRI data were identified: seed-based analysis, independent component analysis, and network-based approaches. Main findings involved aberrant connectivity within and between the default mode network (DMN), the cognitive control network (CCN), and the salience network (SN). Accordingly, we utilized Menon's (2011) triple-network model for neuropsychiatric disorders to summarize key results. Adolescent MDD was associated with hyperconnectivity within the SN and between DMN and SN, as well as hypoconnectivity within the CCN. These findings suggested that dysfunctional connectivity among the three main large-scale brain networks preceded MDD onset. However, there was high heterogeneity in neuroimaging methods and sampling procedures, which may limit comparisons between studies. Future studies should consider some level of harmonization for clinical instruments and neuroimaging methods.

Measuring child maltreatment using multi-informant survey data: a higher-order confirmatory factor analysis / Dados de levantamento com múltiplos informantes para a mensuração de maus-tratos na infância: uma análise fatorial confirmatória de segunda ordem

Objective To investigate the validity and reliability of a multi-informant approach to measuring child maltreatment (CM) comprising seven questions assessing CM administered to children and their parents in a large community sample. Methods Our sample comprised 2,512 children aged 6 to 12 years and their parents. Child maltreatment (CM) was assessed with three questions answered by the children and four answered by their parents, covering physical abuse, physical neglect, emotional abuse and sexual abuse. Confirmatory factor analysis was used to compare the fit indices of different models. Convergent and divergent validity were tested using parent-report and teacher-report scores on the Strengths and Difficulties Questionnaire. Discriminant validity was investigated using the Development and Well-Being Assessment to divide subjects into five diagnostic groups: typically developing controls (n = 1,880), fear disorders (n = 108), distress disorders (n = 76), attention deficit hyperactivity disorder (n = 143) and oppositional defiant disorder/conduct disorder (n = 56). Results A higher-order model with one higher-order factor (child maltreatment) encompassing two lower-order factors (child report and parent report) exhibited the best fit to the data and this model's reliability results were acceptable. As expected, child maltreatment was positively associated with measures of psychopathology and negatively associated with prosocial measures. All diagnostic category groups had higher levels of overall child maltreatment than typically developing children. Conclusions We found evidence for the validity and reliability of this brief measure of child maltreatment using data from a large survey combining information from parents and their children.

Objetivo Investigar a validade e confiabilidade de uma abordagem de múltiplos informantes para a mensuração de maus-tratos na infância, composta por sete questões avaliando maus-tratos na infância respondidas pelas crianças e seus pais em uma ampla amostra comunitária. Métodos A amostra foi composta por 2.512 crianças com idades entre 6 e 12 anos e seus pais. Maus-tratos na infância foram avaliados com três questões respondidas pelas crianças e quatro respondidas pelos seus pais, investigando violência física, negligência física, violência emocional e violência sexual. Análises fatoriais confirmatórias foram utilizadas para comparar os índices de ajuste de diferentes modelos. Validade convergente e divergente foi testada utilizando escores de relato parental e de relato dos professores no Strengths and Difficulties Questionnaire. Validade discriminante foi investigada utilizando a entrevista Development and Well-Being Assessment para dividir os participantes em cinco grupos diagnósticos: controles com desenvolvimento típico (n = 1.880), transtornos do medo (n = 108), transtornos do estresse (n = 76), transtorno de déficit de atenção-hiperatividade (n = 143) e transtorno opositivo-desafiador/conduta (n = 56). Resultados Um modelo de segunda ordem com um fator de segunda ordem (maus-tratos na infância) englobando dois fatores de primeira ordem (relato da criança e relato parental) demonstrou o melhor ajuste aos dados, e os resultados de confiabilidade desse modelo foram aceitáveis. Como esperado, maus-tratos na infância estiveram positivamente associados a medidas de psicopatologia e negativamente associados a medidas pró-sociais. Todos os grupos de categorias diagnósticas tiveram níveis mais altos de maus-tratos na infância do que as crianças com desenvolvimento típico. Conclusões Foram encontradas evidências de validade e confiabilidade dessa medida breve de maus-tratos na infância utilizando dados de um grande levantamento combinando o relato de pais e seus filhos.

Translation and adaptation of the Bipolar Prodrome Symptom Scale-Retrospective: Patient Version to Brazilian portuguese / Tradução e adaptação da Bipolar Prodrome Symptom Scale-Retrospective: Patient Version para português brasileiro

BACKGROUND: Bipolar disorder (BD) is a chronic and often severe mental disease, associated with a significant burden in affected individuals. The characterization of a premorbid (prodromal) period and possible development of preventive interventions are recent advances in this field. Attempts to characterize high-risk stages in BD, identifying symptoms prior to the emergence of a first manic/hypomanic episode, have been limited by a lack of standardized criteria and instruments for assessment. The Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), developed by Correll and collaborators, retrospectively evaluates symptoms that occur prior to a first full mood episode in individuals with BD. OBJECTIVE: To describe the translation and adaptation process of the BPSS-R to Brazilian Portuguese. METHOD: Translation was conducted as follows: 1) translation of the scale from English to Brazilian Portuguese by authors who have Portuguese as their first language; 2) merging of the two versions by a committee of specialists; 3) back-translation to English by a translator who is an English native speaker; 4) correction of the new version in English by the author of the original scale; 5) finalization of the new version in Brazilian Portuguese. RESULTS: All the steps of the translation process were successfully accomplished, resulting in a final version of the instrument. CONCLUSIONS: The Brazilian Portuguese version of the BPSS-R is a potentially useful instrument to investigate prodromal period of BD in Brazil

INTRODUÇÃO: O transtorno bipolar (TB) é um transtorno mental crônico e muitas vezes grave, associado a um significativo prejuízo psicossocial nos indivíduos afetados. A caracterização de um período pré-mórbido (prodrômico) e o possível desenvolvimento de intervenções preventivas são avanços recentes na área. Tentativas de caracterizar estágios de alto risco para o TB, através da identificação de sintomas antes do aparecimento de um primeiro episódio maníaco/hipomaníaco, têm sido limitadas pela falta de critérios padronizados e instrumentos de avaliação. A Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), desenvolvida por Correll e colaboradores, avalia retrospectivamente os sintomas que ocorrem antes de um episódio sindrômico de humor em indivíduos com TB. OBJETIVO: Descrever o processo de tradução e adaptação da BPSS-R para português brasileiro. MÉTODO: A tradução foi conduzida como segue: 1) tradução da escala de inglês para português brasileiro por autores que têm o português como língua materna; 2) junção das duas versões por um comitê de especialistas; 3) retrotradução para inglês por um tradutor que tem inglês como língua materna; 4) correção da nova versão em inglês pelo autor do instrumento original; 5) finalização da nova versão em português brasileiro. RESULTADOS: Todos os passos do processo de tradução foram completados com sucesso, resultando em uma versão final do instrumento. CONCLUSÕES: A versão da BPSS-R em português brasileiro é um instrumento potencialmente útil para investigar o período prodrômico do TB no Brasil

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study / Adesão ao tratamento farmacológico e ao encaminhamento ambulatorial em um serviço psiquiátrico de emergência: um estudo de seguimento

OBJECTIVES: To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). METHOD: From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. RESULTS 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at follow-up (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475). CONCLUSIONS: Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

OBJETIVOS: Avaliar a adesão ao tratamento farmacológico prescrito e ao encaminhamento em pacientes atendidos em um Serviço de Emergências Psiquiátricas (SEP). MÉTODO: Foram coletados dados demográficos e clínicos de 330 pacientes atendidos em um SEP durante um ano. Sessenta dias após o atendimento, a adesão ao tratamento farmacológico e a continuidade do tratamento em caráter ambulatorial foram avaliadas através de contato telefônico. RESULTADOS: 227 pacientes (68,8%) receberam prescrição de medicações psicotrópicas. Todos os pacientes foram encaminhados para serviços psiquiátricos ambulatoriais. Cento e setenta e cinco pacientes concordaram em receber o contato telefônico. Desses pacientes, 97 (63,4%) estavam usando a medicação prescrita e 83 (54,2%) haviam marcado consulta após 60 dias. Os pacientes que receberam uma prescrição tiveram maior chance de estar em uso de medicações psicotrópicas no contato do seguimento (RC 2,88; IC 95% 1,33-6,22; p = 0,007). Entretanto, a prescrição não foi associada ao agendamento de consulta ambulatorial (RC 0,76; IC 95% 0,036-1,61; p = 0,475). CONCLUSÕES: Medicações psicotrópicas são prescritas rotineiramente para pacientes atendidos em SEP, mas esta prática não aumentou a adesão ao encaminhamento para tratamento ambulatorial após dois meses.

Early intervention for bipolar disorder: current imperatives, future directions / Intervenção precoce no transtorno bipolar: necessidades atuais, rumos futuros

OBJECTIVES: The objective of this article is to discuss the rationale/background for early intervention in bipolar disorder. METHOD: Narrative review. RESULTS: There are often significant delays before the diagnosis of bipolar disorder is made and effective management initiated. Growing evidence from both preclinical and clinical literature points to a clear need for improved early identification and early intervention in bipolar disorder. Increasing efforts are being applied to the identification of those at high risk of onset of bipolar disorder. It is hoped that identification of an early prodrome of illness will allow preventative measures to be taken. CONCLUSIONS: There is a clear rationale for improved early identification and early intervention in bipolar disorder.

OBJETIVOS: O objetivo do artigo é discutir os fundamentos para a intervenção precoce no transtorno bipolar. MÉTODO: Revisão narrativa. RESULTADOS: Frequentemente existe um atraso significativo com relação ao momento em que o transtorno bipolar é detectado e o início do tratamento. Evidências crescentes oriundas de estudos pré-clínicos e clínicos apontam para a clara necessidade de melhorar a detecção e o tratamento precoces no transtorno bipolar. Esforços também tem sido direcionados para a identificação de indivíduos em alto risco. Espera-se que a identificação do pródromo do transtorno bipolar permita a instauração de medidas preventivas. CONCLUSÕES: Existem bases claras para o investimento na melhora da detecção e tratamento precoces do transtorno bipolar.