Generalized anxiety disorder and prevalence of suicide risk among medical students / Prevalência do transtorno de ansiedade generalizada e do risco de suicídio em estudantes de medicina

Abstract: Introduction: Generalized anxiety disorder (GAD) is a common pathology in modern life. Furthermore, Brazil ranks among one of the countries in Latin America with the highest increase in the number of suicides. Objective: The goal of this study is to evaluate the prevalence of GAD and suicide risk and their association in medical students from Belém - PA. Methods: The observational, cross-sectional and quantitative study included undergraduate medical students attending the 1st, 3rd and 5th years of Universidade do Estado do Pará as subjects of this research, totaling 153 students. It used a protocol created by the authors and the Mini International Neuropsychiatric Interview. The software BioEstat® 5.3 was used to perform the statistical analysis. Results: 52 (32,7%) of the 159 students have GAD and 48 (30,2%) pose a suicide risk, of which 18 have a mild risk (11,3%), 17 a moderate risk (10,7%) and 13 a high risk (8,2%). 46,7% and 50% of the 1st and 3rd-year students, respectively, have higher risk of suicide, which could be related to the competition faced during the University admission process and also during the first years of the clinical cycle. Of the 5th year students who pose a suicide risk, only 21,7% have high risk. Conclusion: It can be observed that GAD and suicide risk show high prevalence among medical students, which has to be investigated and treated aiming to reduce the impacts of those disorders on health professionals and students.

Resumo: Introdução: O transtorno de ansiedade generalizada (TAG) é uma patologia comum da modernidade. Além disso, o Brasil figura entre um dos países da América Latina com o maior aumento do número de suicídios. Objetivo: Este estudo teve como objetivo avaliar a prevalência de TAG e risco de suicídio e a associação entre eles em estudantes de Medicina de Belém, no Pará. Métodos: O estudo observacional, transversal e quantitativo teve como sujeitos da pesquisa graduandos do curso de Medicina que estavam matriculados no primeiro, terceiro e quinto anos na Universidade do Estado do Pará, totalizando 159. Utilizaram-se questionário de autoria dos pesquisadores e o Mini International Neurophsychiatric Interview, sendo a análise estatística feita com o software BioEstat® 5.3. Resultados: Dos 159 estudantes, 52 (32,7%) apresentaram TAG; e 48 (30,2%), risco de suicídio, dos quais 18 tiveram risco leve (11,3%); 17, risco moderado (10,7%); e 13, risco elevado (8,2%). Dos alunos, 46,7% e 50%, respectivamente do primeiro e terceiro anos, apresentaram risco elevado de suicídio, fato que pode estar associado com a pressão do vestibular e do início do ciclo clínico. Dos alunos do quinto ano com risco de suicídio, somente 21,7% apresentaram risco elevado. Conclusão: Percebe-se uma importante taxa de TAG e de risco de suicídio entre os estudantes de Medicina, o que precisa ser investigado e trabalhado para minimizar os impactos desses transtornos nos discentes.

Prevalence of anxiety, depression, and their risk factors among lung cancer patients: A cross-sectional study in a tertiary care center, Kolkata

Background: Depression and anxiety disorders are common among lung cancer patients posing serious problem of treatment interruption, thereby poor prognosis and deterioration of quality of life. Objectives: The aim of the study was to find the prevalence of depression and anxiety among lung cancer patients and their respective determinants. Materials and Methods: An institution-based cross-sectional prospective study was conducted at the Department of Pulmonary Medicine of a tertiary care hospital at Kolkata over a period of 6 months. Patients were included by complete enumeration method, and an exit interview was conducted with the help of two standardized questionnaires: WHO Disability Assessment Schedule 2.0 to assess disability and Mini International Neuropsychiatric Interview English Version 5.0.0 DSM-IV to detect current major depressive episode (MDE) and generalized anxiety disorder (GAD). Collected data were entered and analyzed in SPSS 20.0 software. Results: A total of 210 patients were recruited. Nearly three-fourths of the study population (73.7%) were suffering from current GAD; a significant portion (42.1%) was suffering from current MDE. Both the disorders were diagnosed in 42.1% cases. Multivariate analyses revealed that patients who were currently unemployed or retired, time since diagnosis more than 1 month and suffering from higher degree of disability had higher risk of depression; while patients who were residing at urban area, currently not earning, financially dependent to others and suffering from higher degree of disability had greater risk of developing anxiety during the course of the disease. Conclusion: Both depression and anxiety were quite prevalent among lung cancer patients. Social and psychological supports are to be raised to achieve treatment success and a better quality of life by mitigating this problem.

Risco de suicídio em pacientes em hemodiálise: evolução e mortalidade em três anos / Risk of suicide in hemodyalisis patient: evolution and mortality in three years

A morte por suicídio em pacientes portadores de insuficiência renal crônica (IRC) em diálise tem sido reportada há décadas. No Brasil, raros são os estudos que têm mensurado sua prevalência, evolução e mortalidade. OBJETIVO: Identificar a presença de risco de suicídio, em duas unidades de diálise e analisar a evolução e a mortalidade por três anos. MÉTODO: O MINI foi utilizado em três etapas. Foram obtidas as freqüências do transtorno e sua evolução foi acompanhada. A curva de Kaplan-Meier e a regressão de Cox foram aplicadas para estudar a mortalidade. RESULTADOS: Participaram 244 pacientes na primeira etapa, 200, na segunda etapa e 110, na terceira etapa. O risco de suicídio foi diagnosticado em 40 pacientes na primeira etapa, 49, na segunda etapa e sete na terceira etapa. Da primeira para a segunda etapa, nove pacientes morreram, 29 continuaram e 20 outros pacientes passaram a apresentar a condição. Da segunda para a terceira etapa, 13 deles morreram, sete continuaram a apresentar e 29 evoluíram para outro transtorno. A incidência de óbitos naqueles sem o transtorno foi de 3,35 e naqueles com risco de suicídio, 9,91 (RR = 2,87; IC 95 por cento [1,69-4,87]). CONCLUSÕES: O risco de suicídio teve alta prevalência, e a mortalidade associada a esta condição é elevada.

Risk of suicide is associated with high rates of death in chronic hemodialysis patients. In Brazil only few studies have measured your prevalence, evolution and mortality. OBJECTIVE: Study the prevalence, evolution and mortality of risk of suicide in two nephrology units for three years. METHODS: The Mini was used in three moments. Frequency and evolution of Risk of Suicide was analyzed. Kaplan-Meier Curve and Cox Regression was used to study the mortality. RESULTS: 244 patients in 1st step, 200 in 2nd and 110 in 3rd. Risk of suicide was diagnosticated in 40 in 1st, 49 in 2nd and seven in 3rd period. Between the 1st and 2nd period, nine patients death, 29 followed with the condition and 20 others patients presented risk of suicide. Between the 2nd and 3rd period thirteen death, seven followed with the condition and 29 changed the disorder. The death incidence in patients without disorder was 3.35 and in patients with risk was, 9.91 (RR = 2.87; IC de 95 percent [1.69-4.87]). CONCLUSIONS: The prevalence of risk of suicide was high, and this condition was associated with high rates of mortality.

Prevalência de transtornos psiquiátricos em pacientes em hemodiálise no estado da Bahia / Prevalence of psychiatric disorders in patients in hemodialysis in the state of Bahia

INRODUÇÃO: Limitações da qualidade de vida dos pacientes com insuficiência renal crônica (IRC) em programa de hemodiálise estão associadas a maior prevalência de transtornos psiquiátricos. O diagnóstico precoce e preciso pode contribuir na elaboração de estratégias de tratamento. OBJETIVO: Estudar a prevalência e o padrão dos transtornos psiquiátricos em pacientes hemodialisados, identificando variáveis relacionadas com sua ocorrência. MÉTODOS: Foram estudados 244 pacientes e analisadas as variáveis associadas à ocorrência de transtornos psiquiátricos. Os pacientes foram avaliados através do Mini-International Neuropsychiatric Interview (MINI). RESULTADOS: Pelo menos um diagnóstico psiquiátrico foi apresentado por 91 pacientes (37,3 por cento). Os de ocorrência mais freqüente foram distimia (17,6 por cento), risco de suicídio (16,4 por cento) e episódio depressivo maior (8,6 por cento). O sexo feminino apresentou maior risco de transtornos psiquiátricos (razão de chance [RC] = 2,77; intervalo de confiança [IC] 95 por cento: 1,42-5,41). Os pacientes viúvos, separados e solteiros apresentaram maior risco de transtornos psiquiátricos do que os casados (RC= 5,507;IC95 por cento:1,348-22,551). Aqueles com menos de dois anos em diálise apresentaram risco maior (RC = 2,075; IC 95 por cento: 1,026-4,197). Os pacientes com clearance fracional de uréia (Kt/V) abaixo de 0,9 tiveram maior chance de apresentar transtornos psiquiátricos (RC = 3,955; IC 95 por cento: 1,069-11,012). CONCLUSÕES: A prevalência de transtornos psiquiátricos foi alta. Os transtornos afetivos foram os mais freqüentes. Nas mulheres e naqueles com Kt/V baixo, o risco foi maior. Nos pacientes casados e naqueles com mais de dois anos em tratamento o risco foi menor.

INTRODUCTION: Limiting factors of dialysis patients' quality of life are associated with high rates of psychiatric disease. Since effective treatment of psychiatric diseases can positively affect dialysis patients' prognosis and survival, there is a need for an early diagnosis. In Brazil only few studies have measured the prevalence of these disorders. OBJECTIVE: Study the prevalence and pattern of psychiatric disorders in chronic hemodialysis patients and assess the association between these diseases and some variables. METHODS: Two hundred forty-four patients were enrolled in two nephrology units at the state of Bahia, Brazil. The Mini-International Neuropsychiatric Interview (MINI) was used in all patients. RESULTS: Ninety-one patients (37.3 percent) presented at least one psychiatric diagnosis. The most common disorders included dysthymia (17.6 percent), risk of suicide (16.4 percent), and major depressive episode (8.6 percent). Women had higher risk of mental disorders than men (RC = 2.77; confidence interval [CI] 95 percent: 1.42-5.41). Widowed, divorced and single patients had higher risk than married patients (RC = 5.507; CI 95 percent: 1.348-22.551). Patients on treatment for less than two years had higher risk (RC = 2.075; CI 95 percent: 1.026-4.197). Those with Kt/V below 0.9 were at higher risk than those with a higher Kt/V (RC = 3.955; CI 95 percent: 1.069-11.012). CONCLUSIONS: The prevalence of psychiatric disorders in patients on dialysis was high (37.3 percent). Affective disorders were the most common ones. Women and patients with Kt/V below 0.9 were at increased risk. The risk was lower in patients at dialysis program for longer than two years and in married patients.