Depressão em pessoas sob aprisionamento no sistema carcerário: revisão integrativa / Depression among the incarcerated population: an integrative review / La dépression chez les personnes incarcérées dans le système pénitentiaire: une revue intégrative / Depresión en personas aprisionadas en el sistema penitenciario: revisión integrativa

Resumo Esta revisão integrativa objetivou reunir estudos sobre a depressão em pessoas sob aprisionamento no sistema carcerário. As bases de dados pesquisadas foram PePSIC, PsycINFO, SciELO e Web of Science. As ferramentas de suporte para a extração dos artigos selecionados foram o programa computacional StArt e as recomendações Prisma. Os termos usados na busca eletrônica foram "inmate", "prison", "prisoner", "penitentiary" e "depression". A amostra final foi composta por 10 estudos primários, os quais atenderam aos critérios de inclusão e à questão norteadora da revisão. Dentre os achados, a ocorrência de depressão foi evidente em todos os artigos selecionados, e o Inventário de Depressão de Beck foi o instrumento mais utilizado. Por fim, percebeu-se que a identificação precoce de sintomatologia depressiva pode minimizar prejuízos físicos e mentais na população em encarceramento.

Abstract This integrative review analyzed studies about depression among people imprisoned in the prison system. Bibliographic search was conducted on the PePSIC, PsycINFO, SciELO and Web of Science databases. Papers were selected following the PRISMA recommendations, and then extracted using the StArt software. The search strategy used the terms "inmate," "prison," "prisoner," "penitentiary" and "depression," The final sample included 10 primary studies that met the inclusion criteria and answered the research question. All selected articles indicated the occurrence of depression, assessed by the Beck Depression Inventory. Finally, early identification of depressive symptoms can minimize physical and mental harm in the incarcerated population.

Résumé Cette revue intégrative a analysé les études sur la dépression chez les personnes incarcérées dans le système pénitentiaire. Une recherche bibliographique a été menée sur les bases de données PePSIC, PsycINFO, SciELO et Web of Science. Les articles ont été sélectionnés en suivant les recommendations PRISMA, puis extraits à l'aide du logiciel StArt. La stratégie de recherche utilisait les termes "détenu", "prison", "prisonnier", "pénitencier" et "dépression". L'échantillon final comprenait 10 études primaires répondant aux critères d'inclusion et à la question de recherche. Tous les articles sélectionnés indiquaient la survenue d'une dépression, évaluée par l'inventaire de dépression de Beck. Enfin, l'identification précoce des symptômes dépressifs peut minimiser les dommages physiques et mentaux au sein de la population carcérale.

Resumen Esta revisión integradora tuvo como objetivo reunir estudios sobre la depresión en personas encarceladas en el sistema penitenciario. Las bases de datos buscadas fueron PePSIC, PsycINFO, SciELO y Web of Science. Se utilizaron el programa informático StArt como herramienta de apoyo para la extracción de los artículos seleccionados y las recomendaciones PRISMA. Los términos utilizados en la búsqueda electrónica fueron: "inmate", "prison", "prisoner", "penitentiary" y "depression". La muestra final estaba compuesta por 10 estudios primarios, que cumplían los criterios de inclusión y la pregunta guía de la revisión. Entre los hallazgos, la depresión fue evidente en todos los artículos seleccionados y el Inventario de Depresión de Beck fue el instrumento más utilizado. Finalmente, se percibió que la identificación temprana de la sintomatología depresiva puede minimizar los daños físicos y mentales en la población encarcelada.

Life satisfaction mediates the association between childhood maltreatment and depressive symptoms: a study in a sample of Brazilian adolescents

Objective: To evaluate the interrelationships between childhood maltreatment, life satisfaction (LS), and depressive symptoms, and to investigate LS as a mediating factor in the association between childhood maltreatment and depressive symptoms. Methods: The sample consisted of 342 adolescents, aged 11 to 17 years (mean = 13.3, SD = 1.52 years), recruited from a public school in Salvador, Brazil. Participants filled out instruments for the collection of sociodemographic data and evaluation of childhood maltreatment, LS, and depressive symptoms. Structural equation modeling (SEM) was used to evaluate the mediating effect of LS. Results: We detected significant negative correlations between childhood maltreatment and LS and between LS and depressive symptoms. We observed a significant positive correlation between childhood maltreatment and depressive symptoms. LS partially mediated the association between childhood maltreatment and depressive symptoms, mitigating the impact of maltreatment. Conclusion: LS played an important mediating role in the association between childhood maltreatment and depressive symptoms. Longitudinal studies are recommended to fully elucidate these associations, reinforcing the need for attention and care of this vulnerable population.

Rosacea associated with increased risk of generalized anxiety disorder: a case-control study of prevalence and risk of anxiety in patients with rosacea

Abstract Background: Rosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce. Objective: The aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea. Methods: A total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult. Results: Individuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p < 0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR = 2.8; 95% CI 1.15-7.37; p = 0.02). Study limitations: Single center study and limited sample size. Conclusions: Rosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being.

Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial / Regulação emocional como mediadora de reduções em ansiedade e depressão no Protocolo Unificado para o tratamento transdiagnóstico de transtornos psicológicos: ensaio clínico randomizado duplo-cego

Abstract Objective: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. Method: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. Results: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Conclusion: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Resumo Objetivo: É importante, na avaliação da eficácia de tratamentos, examinar como a intervenção tem efeito e identificar suas consequências. O presente estudo investiga o papel da regulação emocional enquanto mediadora de desfechos do tratamento que emprega o Protocolo Unificado (PU) para o tratamento transdiagnóstico de transtornos psicológicos. Método: Este artigo descreve um ensaio clínico randomizado duplo-cego. Uma amostra de 26 indivíduos foi selecionada com base em escores pré-estabelecidos para o Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck, e seus diagnósticos finais foram confirmados utilizando o instrumento Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). A amostra foi dividida aleatoriamente em dois grupos: controle e tratamento (13 pacientes em cada). O grupo tratamento recebeu 20 sessões de PU de 1 hora cada. O Inventário de Depressão de Beck, Inventário de Ansiedade de Beck Beck e Escala de Dificuldades de Regulação Emocional foram administrados em duas etapas, antes e depois do tratamento. Resultados: O PU reduziu a ansiedade e a depressão em pacientes, ao melhorar a regulação emocional. Além disso, os resultados mostraram que as subescalas dificuldade de se engajar em comportamentos orientados por objetivos e não aceitação de resposta emocional responderam por 62% da variância nos escores de ansiedade. Nos escores de depressão, duas subescalas, dificuldade de se engajar em comportamentos orientados por objetivos e falta de claridade emocional, explicaram 72% da variância. Conclusão: A regulação emocional pode ser considerada o principal fator mediador e também preditora de desfechos do tratamento transdiagnóstico baseado no PU. Registro do ensaio clínico: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Exposição ao aleitamento materno e transtornos mentais comuns na adolescência / Exposure to breastfeeding and common mental disorders in adolescence / Exposición a la lactancia materna y trastornos mentales comunes en la adolescencia

Resumo: O objetivo foi avaliar o efeito da exposição e do tempo de exposição ao aleitamento materno na ocorrência de transtornos mentais comuns (TMC) entre adolescentes escolares brasileiros. Este trabalho analisou dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), avaliando aqueles que tiveram o questionário referente ao aleitamento materno respondido pelos pais ou responsáveis. A presença de TMC foi identificada pelo General Health Questionnaire, versão 12 itens (GHQ-12), considerando-se dois pontos de corte (escores ≥ 3 e ≥ 5). As associações foram testadas em análises bivariadas e por meio de modelos de regressão logística múltipla, com ajustes por variáveis potenciais de confusão. Dentre os 41.723 adolescentes avaliados, a maioria foi composta por estudantes do sexo feminino (54,6%), que tinham idades entre 12 e 15 anos (71%), estudavam em escolas públicas (83,1%), residiam na Região Sudeste (51,9%) e eram das classes econômicas B (53,8%) e C (34,1%). Cerca de metade das mães dos adolescentes não tinha o ensino médio completo (51,7%). O grupo de adolescentes com mais de seis meses de aleitamento materno (51,8%) apresentou uma menor prevalência de TMC para os dois pontos de corte do GHQ-12 avaliados, quando comparado com o grupo que não recebeu aleitamento materno ou que o recebeu por período ≤ 1 mês (RI = 0,82; IC95%:0,69-0,97 e RI = 0,74; IC95%: 0,59-0,91 para 3 e 5 pontos, respectivamente). O aleitamento materno prolongado parece desempenhar um papel protetor para a ocorrência de TMC na adolescência.

Abstract: This article sought to evaluate the effect of exposure, and exposure time, to breastfeeding on the occurrence of common mental disorders (CMD) among Brazilian adolescents enrolled in school. This study analyzed data from the Study of Cardiovascular Risk in Adolescents (ERICA), evaluating those whose questionnaire regarding breastfeeding had been filled out by parents or guardians. The presence of CMD was identified using the General Health Questionnaire, version 12 items (GHQ-12), and we considered two cutoff points (scores ≥ 3 and ≥ 5). We tested the associations in bivariate analyses and through multiple logistical regression models, adjusting for potential confounding variables. Of the 41,723 adolescents we evaluated, most were students of the female sex (54.6%), aged between 12 and 15 years (71%), attended public schools (83.1%), resided in the Southeastern region (51.9%) and belonged to the economic classes B (53.8%) and C (34.1%). Around half of the adolescents' mothers had not completed their secondary education (51.7%). The group of adolescents who were breastfed for more than six months (51.8%) had a lower CMD prevalence for both GHQ-12 cutoff points, when compared with the group who were not breastfed or who were breastfed for ≤ 1 month (IR = 0.82; 95%CI: 0.69-0.97 and IR = 0.74; 95%CI: 0.59-0.91 for 3 and 5 points, respectively). Prolonged breastfeeding seems to play a protective role on the occurrence of CMD in adolescence.

Resumen: El objetivo fue evaluar el efecto de la exposición y del tiempo de exposición a la lactancia materna en la ocurrencia de trastornos mentales comunes (TMC) entre adolescentes escolares brasileñas. Este trabajo analizó datos del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA), evaluando aquellos, cuyo cuestionario -referente a la lactancia materna- había sido respondido por los padres o responsables legales. La presencia de TMC fue identificada por el General Health Questionnaire, versión 12 ítems (GHQ-12), considerándose dos puntos de corte (puntuaciones ≥ 3 y ≥ 5). Las asociaciones fueron probadas en análisis bivariados, y a través de modelos de regresión logística múltiple, con ajustes por variables potenciales de confusión. Entre los 41.723 adolescentes evaluados, la mayoría estuvo compuesta por estudiantes que eran del sexo femenino (54,6%), que tenían una edad entre 12 y 15 años (71%), estudiaban en escuelas públicas (83,1%), residían en la región Sudeste (51,9%) y eran de las clases económicas B (53,8%) y C (34,1%). Cerca de la mitad de las madres de los adolescentes no contaba con la enseñanza media completa (51,7%). El grupo de adolescentes con más de seis meses de lactancia materna (51,8%) presentó una menor prevalencia de TMC para los dos puntos de corte del GHQ-12 evaluados, cuando se comparan con el grupo que no recibió lactancia materna o que la recibió durante un período ≤ 1 mes (RI = 0,82; IC95%: 0,69-0,97 y RI = 0,74 y IC95%: 0,59-0,91 para 3 y 5 puntos, respectivamente). La lactancia materna prolongada parece desempeñar un papel protector para la ocurrencia de TMC en la adolescencia.

Sintomatologia depresiva y control metabólico en pacientes ambulatorios portadores de diabetes mellitus tipo 2 / Association between depressive symptoms and metabolic control in patients with type 2 diabetes mellitus: a cross-sectional study

Background: Patients with diabetes mellitus show a higher risk of developing depressive symptoms when compared to healthy people, hampering the management and prognosis of both diseases. However, national studies on the topic are scarce. Aim: To study the frequency and severity of depressive symptoms in patients with type 2 diabetes. Material and Methods: Beck Depression Inventory-IA and Morisky Green Levine scale were administered to diabetic patients under control at a primary care center. Pharmacological compliance was evaluated using glycosylated hemoglobin levels obtained from their clinical records. Results: We included 323 patients aged 64 ± 12 years (49% women). The frequency of depressive symptoms was 34.7%. Compared with their counterparts without depressive symptoms, patients with depression showed higher glycosylated hemoglobin levels (7.2 ± 1.7 and 6.7 ± 1.3% respectively), a higher frequency of non-compliance with treatment (63 and 43% respectively) and a higher frequency of metabolic decompensation (38 and 23% respectively). Depressive symptomatology was more common among women. Conclusions: Patients with type 2 diabetes mellitus and depressive symptoms exhibit a poorer treatment compliance and worse metabolic control as compared to their non-depressive counterparts.

Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction / Diferenças por Sexo na Ansiedade e Depressão após Infarto Agudo do Miocárdio

Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.

Resumo Fundamento: Os pacientes com doença cardíaca, depressão e transtornos de ansiedade são altamente prevalentes e persistentes. A depressão e a ansiedade desempenham um papel significativo na progressão da doença cardiovascular e são reconhecidas como fatores de risco independentes. No entanto, há muito pouca análise relacionada ao gênero em relação às doenças cardiovasculares e transtornos emocionais. Objetivo: Avaliar os níveis de depressão e ansiedade em pacientes com infarto do miocárdio (IM) no primeiro mês após o IM e avaliar a relação entre os fatores de risco para doença cardiovascular, indicadores demográficos e distúrbios emocionais, bem como determinar se existem diferenças ou semelhanças baseadas no sexo do paciente. Métodos: Esta pesquisa incluiu questões demográficas, características clínicas, questões sobre fatores de risco de doença cardiovascular e a Escala Hospitalar de Ansiedade e Depressão [HADS]. Todos os testes estatísticos foram bilaterais, e valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Determinou-se que 71,4% dos pacientes do sexo feminino e 60,4% dos pacientes do sexo masculino apresentavam sintomatologia concomitante de ansiedade e/ou depressão (p = 0,006). Utilizando os homens como o ponto de referência, as mulheres mostraram um risco elevado de apresentar qualquer distúrbio psiquiátrico (odds ratio, 2,86, p = 0,007). O escore da HADS-D foi notavelmente maior nas mulheres (8,66 ± 3,717) do que nos homens (6,87 ± 4,531, p = 0,004). Foi determinado que os pacientes do sexo masculino que desenvolveram depressão eram em média mais jovens do que aqueles sem depressão (p = 0,005). Conclusões: As mulheres demonstraram risco mais elevado de apresentar distúrbio de ansiedade e/ou depressão em comparação aos homens. Além disso, a gravidade da depressão aumentou com a idade entre os homens, enquanto o gravidade da ansiedade diminuiu. Em contraste, a gravidade da depressão e ansiedade foram semelhantes para mulheres de todas as idades após o IM. Um maior escore de depressão foi associado com diabetes e inatividade física, e o maior escore de ansiedade foi associado ao tabagismo nos homens. A hipercolesterolemia foi associada tanto aos maiores escores de ansiedade e depressão, enquanto um maior escore de depressão foi associado à inatividade física entre mulheres.

Depression and anxiety disorders among patients with human T-cell lymphotropic virus type-1: a cross-sectional study with a comparison group

Abstract INTRODUCTION: Studies have linked human T-cell lymphotropic virus type-1 (HTLV-1) to psychiatric disease. METHODS: Patients with HTLV-1 were compared to patients seen by family doctors using a semi-structured questionnaire and the Hospital Anxiety and Depression Scale. RESULTS: Participants with (n=58) and without (n=340) HTLV were compared. Anxiety and depression were associated with greater age, being a woman, spastic paraparesis (depression: PR=4.50, 95% CI: 3.10-6.53; anxiety: PR=2.96, 95% CI: 2.08-4.21), and asymptomatic HTLV (depression: PR=4.34, 95% CI: 3.02-6.24; anxiety: PR=2.81, 95% CI: 2.06-3.85). CONCLUSIONS: Symptomatic and asymptomatic patients with HTLV-1 experienced more anxiety and depression than uninfected patients.

Dysfunctional eating behaviors, anxiety, and depression in Italian boys and girls: the role of mass media

Objective: Extensive research has implicated identification with characters in mass media in the emergence of disordered eating behavior in adolescents. We explored the possible influence of the models offered by television (TV) on adolescents' body image, body uneasiness, eating-disordered behavior, depression, and anxiety. Methods: Three hundred and one adolescents (aged 14-19) from southern Italy participated. They completed a questionnaire on media exposure and body dissatisfaction, the Eating Disorder Inventory-2, the Body Uneasiness Test, the Beck Depression Inventory, and the State-Trait Anxiety Inventory - Form Y. Results: The main factors contributing to females' eating-disordered behaviors were their own desires to be similar to TV characters, the amount of reality and entertainment TV they watched, and the discrepancy between their perceptions of their bodies and those of TV characters. Friends' desire to be similar to TV characters contributed most to depression, anxiety, body uneasiness, and eating disorders for both males and females. Conclusion: Our data confirm that extensive watching of reality and entertainment TV correlates with eating-disordered behavior among females. Moreover, the well-known negative effects of the media on adolescents' eating-disordered behaviors may also be indirectly transmitted by friends who share identification with TV characters.

Efficacy, acceptability, and tolerability of antidepressant treatments for patients with post-stroke depression: a network meta-analysis

The aim of this study was to investigate the efficacy, acceptability, and tolerability of antidepressants in treating post-stroke depression (PSD) by performing a network meta-analysis of randomized controlled trials of the current literature. Eligible studies were retrieved from online databases, and relevant data were extracted. The primary outcome was efficacy as measured by the mean change in overall depressive symptoms. Secondary outcomes included discontinued treatment for any reason and specifically due to adverse events. Fourteen trials were eligible, which included 949 participants and 9 antidepressant treatments. Few significant differences were found for all outcomes. For the primary outcome, doxepin, paroxetine, and nortriptyline were significantly more effective than a placebo [standardized mean differences: −1.93 (95%CI=−3.56 to −0.29), −1.39 (95%CI=−2.59 to −0.21), and −1.25 (95%CI=−2.46 to −0.04), respectively]. Insufficient evidence exists to select a preferred antidepressant for treating patients with post-stroke depression, and our study provides little evidence that paroxetine may be the potential choice when starting treatment for PSD. Future studies with paroxetine and larger sample sizes, multiple medical centers, and sufficient intervention durations is needed for improving the current evidence.

Depression and adherence to antiretroviral treatment in HIV-positive men in São Paulo, the largest city in South America: Social and psychological implications

OBJECTIVES: The aim of the present study was to investigate the prevalence of depression and adherence to antiretroviral treatment in two groups of individuals: men who have sex with men (MSM) and men who have sex with women (MSW). METHODS: Two hundred and sixteen participants (MSM=116; MSW=100) who visited the Clinics Hospital of the School of the Medicine of the University of São Paulo completed two independent surveys (the BECK Depression Inventory and an adherence self-declared questionnaire) to evaluate their depression status and adherence to antiretroviral treatment, respectively. RESULTS: The study highlighted a positive relationship between depression and low adherence to Highly Active Antiretroviral Therapy in these patients regardless of age and sexual orientation. In addition, MSM subjects were two times more prone than MSW subjects to develop depression symptoms. White or mixed race men showed 7.6 times greater adherence to treatment than black men. The probability of complete adherence to treatment was 3.8 times higher in non-depressed subjects than in depressed subjects regardless of their ethnicity. The chance of developing depression was 4.17 times higher for an individual with non-adherent behavior than for an adherent individual. CONCLUSIONS: Individuals with low adherence rates have proportionally higher depression rates. Depressed men tend to show less adherence to treatment. Black but not mixed race or white men show less adherence to Highly Active Antiretroviral Therapy and have a greater chance of developing depression, which directly interferes with adherence. The chances of developing depression are four times greater for a patient with non-adherent behavior than for a patient with adherent behavior.

Frecuencia y variables asociadas a estigma-discriminación percibido en víctimas del conflicto armado colombiano / Frequency and variables associated with perceived devaluation-discrimination in victims of the armed conflict in Colombia / Frequência e variáveis associadas à estigma-discriminação percebido em vítimas do conflito armado colombiano

Resumen: Se desconoce la frecuencia de complejo estigma-discriminación percibido en víctimas del conflicto armado colombiano. El objetivo del estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia. Se realizó un estudio transversal con víctimas registradas en el Programa de Atención Psicosocial y Salud Integral a Víctimas. Los síntomas depresivos se cuantificaron con cuatro ítems dicotómicos (tres o más se clasificaron como alto nivel de síntomas depresivos) y el estigma-discriminación percibido se cuantificó con seis incisos dicotómicos (dos o más afirmaciones se categorizó como alto estigma-discriminación percibido). Participaron 943 adultos (M = 47,9; DE = 14,2); 67,4%, mujeres; 109 (11,6%) informaron alto nivel de síntomas depresivos y 217 (23%) presentaron alto estigma-discriminación percibido. El alto estigma-discriminación percibido se asoció a alto nivel de síntomas depresivos (OR = 6,47; IC95%: 4,23-9,88). Se concluye que un cuarto de las víctimas del conflicto armado en Magdalena informa alto estigma-discriminación percibido; éste se asocia significativamente a alto nivel de síntomas depresivos.

Abstract: There is no information on frequency of perceived devaluation-discrimination in victims of the armed conflict in Colombia. The aim of this study was thus to determine the frequency of perceived devaluation-discrimination and associated variables among victims of the armed conflict in municipalities in the Department of Magdalena, Colombia. A cross-sectional study was conducted among victims enrolled in the Program for Psychosocial Care and Comprehensive Healthcare for Victims. Depressive symptoms were quantified with four dichotomous items (three or more were classified as high level of depressive symptoms), and perceived devaluation-discrimination was quantified with six dichotomous items (two or more were classified as high perceived devaluation-discrimination). A total of 943 adults participated (M = 47.9; SD = 14.2); 67.4%, women; 109 (11.6%) reported high level of depressive symptoms and 217 (23%) showed high perceived devaluation-discrimination. High perceived devaluation-discrimination was associated with high level of depressive symptoms (OR = 6.47; 95%CI: 4.23-9.88). In conclusion, one-fourth of the victims of the armed conflict in Magdalena reported high perceived devaluation-discrimination, which was significantly associated with high level of depressive symptoms.

Resumo: É desconhecida a frequência do complexo estigma-discriminação percebido em vítimas do conflito armado colombiano. O objetivo do estudo foi estabelecer a frequência e variáveis associadas ao estigma-discriminação percebido em vítimas do conflito armado, em municípios do Departamento de Magdalena, Colômbia. Foi realizado um estudo transversal com vítimas registradas no Programa de Atenção Psicossocial e Saúde Integral às Vítimas. Os sintomas depressivos foram quantificados com quatro itens dicotômicos (três ou mais foram classificados como alto nível de sintomas depressivos), e o estigma-discriminação percebido foi quantificado com seis subsecções dicotômicas (com duas ou mais afirmações foi categorizado como alto estigma-discriminação percebido). Participaram 943 adultos (M = 47,9; DP = 14,2); 67,4%, mulheres; 109 (11,6%) informaram alto nível de sintomas depressivos e 217 (23%) presentaram um alto estigma-discriminação percebido. O alto estigma-discriminação percebido foi associado à alto nível de sintomas depressivos (OR = 6,47; IC95%: 4,23-9,88). Concluiu-se que um quarto das vítimas do conflito armado em Magdalena informa alto estigma-discriminação percebido, que foi associado significativamente à alto nível de sintomas depressivos.

Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la atención primaria en Chile / Association between adverse childhood experiences with depression in adults consulting in primary care

Background: Traumatic experiences during childhood may influence the development of mental disorders during adulthood. Aim: To determine clinical and psychosocial variables that are associated with a higher frequency of adverse childhood experiences (ACE) in patients who consult for depression in Primary Health Care clinics in Chile. Material and Methods: A socio-demographic interview, the mini international neuropsychiatric interview (MINI), a screening for ACE, a questionnaire for partner violence (PV), the Life Experiences Survey (LES) and the Hamilton Rating Scale for Depression (HRDS) were applied to 394 patients with major depression (87% women). Results: Eighty two percent of patients had experienced at least one ACE and 43% of them reported three or more. Positive correlations were observed between the number of ACE and severity of depressive symptoms (r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). Conclusions: These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood.

Características sociodemográficas y clínicas de pacientes diagnosticados con depresión en Centros Comunitarios de Salud Mental (COSAM) de Santiago, Chile / Sociodemographic and clinical characteristics of patients diagnosed with depression in Community Mental Health Centres (COSAM) in Santiago, Chile

Introduction: The study aimed to characterize a sample of depressive patients who attend to Community Mental Health Centres (COSAM) in Santiago, regarding their sociodemographic and clinical characteristics and the associations among these variables. Method: 88 patients treated at 5 different COSAM in Santiago were assessed with self-report questionnaires regarding sociodemographic variables, severity of depressive symptoms (BDI), general and social functioning (OQ-45) and health-related quality of life (SF-36). Descriptive and correlational analyses were performed to describe sociodemographic and clinical features of the participants, and to address the associations between depressive symptomatology, general functioning and quality of life. Results: Participants were mostly women, with chronic and severe depressive symptoms and high frequency of comorbid physical illnesses, they presented reduced quality of life and impairments in general and social functioning. Female gender and a history of physical illness were significant predictors of the severity of depressive symptoms. The latter, in turn, showed moderate to high correlations with the different dimensions of general functioning and quality of life, especially with lack of vitality, impact of health and emotional problems in social life, work and daily activities and, the perception of an impaired mental health. Conclusion: Depressive disorders in patients treated at COSAM are highly limiting and are associated with low quality of life. The observed profile describes mainly women patients with severe chronic symptoms, in whom physical, emotional and personality vulnerabilities are intertwined, suggesting the need for an articulated approach to physical and mental health and therapeutic resources considering these characteristics.

Este estudio describe características sociodemográficas y clínicas en una muestra de pacientes depresivos atendidos en Centros Comunitarios de Salud Mental (COSAM) en Santiago, y explora asociaciones entre estas variables. 88 pacientes consultantes en 5 COSAM fueron evaluados mediante cuestionarios de auto-reporte, respecto a variables sociodemográficas, severidad de los síntomas depresivos (BDI), funcionamiento general y social (OQ-45) y calidad de vida (SF-36). Se realizaron análisis descriptivos y correlacionales para describir características sociodemográficas y clínicas, y estudiar las asociaciones entre variables sociodemográficas y gravedad de la sintomatología depresiva, y entre esta última y el funcionamiento general y calidad de vida. Los participantes fueron mayoritariamente mujeres, con síntomas depresivos crónicos y severos, y alta frecuencia de comorbilidad médica. Presentaron disminución de su calidad de vida y alteraciones en el funcionamiento general y social. Sexo femenino e historia de enfermedad física fueron predictores significativos de gravedad de los síntomas depresivos. Estos, a su vez, mostraron correlaciones significativas con diferentes dimensiones del funcionamiento general y la calidad de vida, especialmente con la falta de vitalidad, impacto de la salud y problemas emocionales en la vida social, trabajo y actividades cotidianas, y percepción de una salud mental deteriorada. Los trastornos depresivos en pacientes atendidos en COSAM son altamente limitantes y están asociados a una baja calidad de vida. El perfil observado describe principalmente mujeres, con sintomatología severa y crónica, en la que se entrelazan vulnerabilidades físicas, emocionales y de personalidad, lo que sugiere la necesidad de un enfoque articulado de la salud física y mental y recursos terapéuticos que consideren estas características.

Depression and anxiety in a case series of amyotrophic lateral sclerosis: frequency and association with clinical features / Depressão e ansiedade em uma série de casos de esclerose lateral amiotrófica: frequência e associação com aspectos clínicos

ABSTRACT Objective To investigate the frequency of anxiety and depression and their association with clinical features of amyotrophic lateral sclerosis. Methods This is a cross-sectional and descriptive study including a consecutive series of patients with sporadic amyotrophic lateral sclerosis according to Awaji’s criteria. Patients underwent clinical and psychiatric assessment (anxiety and depression symptoms). Results We included 76 patients. The men/women ratio was 1.6:1. Participants’ mean age at disease onset was 55 years (SD±12.1). Sixty-six patients (86.8%) were able to complete psychiatric evaluation. Clinically significant anxiety was found in 23 patients (34.8%) while clinically significant depression was found in 24 patients (36.4%). When we compared patients with and without depression a significant difference was seen only in the frequency of anxiety symptoms (p<0.001). We did further analysis comparing subgroups of patients classified according to the presence or not of anxiety and or depression, without any significant difference regarding sex, age at onset, initial form, disease duration or functional measures. A positive correlation between anxiety and depressive symptoms was found (p<0.001). Conclusion Anxiety and depressive symptoms were highly correlated and frequent in patients with amyotrophic lateral sclerosis. In addition, anxiety and depression were not associated with disease duration and presentation, sex, age at onset, and functional score.

RESUMO Objetivo Investigar a frequência de ansiedade e depressão e sua associação com aspectos clínicos da esclerose lateral amiotrófica. Métodos Estudo transversal e descritivo de uma série consecutiva de pacientes com esclerose lateral amiotrófica esporádica conforme os critérios de Awaji. Os pacientes foram submetidos à avaliação clínica e psiquiátrica (sintomas depressivos e ansiosos). Resultados Foram incluídos 76 pacientes. A relação homem/mulher foi de 1,6:1. A média de idade de início dos sintomas foi de 55 anos (DP±12,1). Foram capazes de completar a avaliação psiquiátrica 66 (86,8%) pacientes. Ansiedade clinicamente significativa foi encontrada em 23 pacientes (34,8%), enquanto depressão clinicamente significativa foi encontrada em 24 pacientes (36,4%). Ao comparar os pacientes com e sem depressão, houve diferença significativa apenas na frequência de sintomas de ansiedade (p<0,001). Posteriormente, foram comparados subgrupos de pacientes categorizados em relação à presença ou não de ansiedade e/ou depressão, sem diferença significativa em relação a sexo, idade de início dos sintomas, forma inicial, duração da doença ou na escala funcional. Foi encontrada correlação positiva entre os sintomas de ansiedade e depressão (p<0,001). Conclusão Sintomas de ansiedade e depressão são frequentes em pacientes com esclerose lateral amiotrófica e estiveram altamente correlacionados. Ansiedade e depressão não foram associadas com duração da doença, forma inicial, sexo, idade de início dos sintomas e pontuação na escala funcional.

Depresión posparto en padres: ¿por qué también es importante? / Paternal postpartum depression. Why is it also important?

La supervisión de salud es una oportunidad privilegiada para acompañar a las nuevas familias en su transición a la parentalidad. Este período trae importantes desafíos para la madre y el padre, y en ocasiones la demanda puede superar los recursos emocionales de la familia; este desbalance puede favorecer que madres y padres presenten sintomatología depresiva. La depresión posparto puede afectar de uno a dos de cada diez hombres, siendo la depresión materna un factor de riesgo importante para desarrollarla. La depresión posparto en el padre impacta a todos los miembros de la familia, siendo el desarrollo infantil, el vínculo y la salud mental del niño los que pueden verse alteradas a corto, mediano y largo plazo. Parece relevante por lo tanto pensar en un tamizaje para pesquisar precozmente la depresión posparto no sólo en madres sino también en padres y dar así un primer paso a ampliar la mirada desde la diada madre-hijo a la triada. El control de salud del niño es una oportunidad única para poder realizar esta pesquisa, sin embargo la validación de una escala de tamizaje de depresión posparto en padres chilenos es una tarea pendiente.

Health supervision is a privileged opportunity to walk along with the new families during their transition to parenthood. This period is challenging for both mother and father, and there is the potential danger that demand surpasses the existing resources of the family. This imbalance may lead to mothers and fathers to develop depressive symptomatology. Postpartum depression may affect one to two out of ten men, and maternal depression is a major risk factor for developing it. The postpartum depression in the father impact all the family members, being the child development, the bonding, and the child´s mental health which can be disturb at a short, medium and long term. Therefore, it seems to be relevant to think about screening for post partum depression not only in mothers but also fathers, and give a first step to broaden the gaze from the dyad to the triad. The health supervision is a unique opportunity to be able to carry out this screening; however, the validation of a postpartum screening test for Chilean fathers is a pending task.

Depression and unemployment incidence rate evolution in Portugal, 1995-2013: General Practitioner Sentinel Network data / Evolução da taxa de incidência de depressão e do desemprego em Portugal entre 1995-2013: dados da Rede Médicos Sentinela

ABSTRACT OBJECTIVE Quantify, for both genders, the correlation between the depression incidence rate and the unemployment rate in Portugal between 1995 and 2013. METHODS An ecological study was developed to correlate the evolution of the depression incidence rates estimated by the General Practitioner Sentinel Network and the annual unemployment rates provided by the National Statistical Institute in official publications. RESULTS There was a positive correlation between the depression incidence rate and the unemployment rate in Portugal, which was significant only for males (R2 = 0.83, p = 0.04). For this gender, an increase of 37 new cases of depression per 100,000 inhabitants was estimated for each 1% increase in the unemployment rate between 1995 and 2013. CONCLUSIONS Although the study design does not allow the establishment of a causal association between unemployment and depression, the results suggest that the evolution of unemployment in Portugal may have had a significant impact on the level of mental health of the Portuguese, especially among men.

RESUMO OBJECTIVO Quantificar, para ambos os sexos, a correlação entre a taxa de incidência de depressão e a taxa de desemprego, em Portugal, entre 1995 e 2013. MÉTODOS Foi desenvolvido um estudo ecológico no qual se correlacionou a evolução das taxas de incidência de depressão estimadas pela Rede Médicos Sentinela e as taxas de desemprego anuais disponibilizadas pelo Instituto Nacional de Estatística em publicações oficiais. RESULTADOS Observou-se uma correlação positiva entre taxa de incidência de depressão e taxa de desemprego em Portugal, sendo esta significativa apenas para o sexo masculino (R2 = 0,83; p = 0,04). Estimou-se, para este sexo, um aumento de 37 novos casos de depressão por 100.000 habitantes a cada 1% de aumento da taxa de desemprego entre 1995 e 2013. CONCLUSÕES Embora o desenho do estudo não permita o estabelecimento de uma relação causal entre desemprego e depressão, os resultados obtidos sugerem que a evolução do desemprego em Portugal poderá ter tido um impacto não desprezável no nível de saúde mental dos portugueses, em especial no sexo masculino.

Stages of hyperglycemia and common mental disorders in adults - The Brazilian Study of Adult Health (ELSA-Brasil) / Estágios de hiperglicemia e transtornos mentais comuns em adultos - Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

ABSTRACT CONTEXT AND OBJECTIVE: Diabetes mellitus and depressive disorders frequently coexist. However, this relationship has been little evaluated across stages of hyperglycemia and for a broad range of common mental disorders (CMDs). The objective here was to investigate the association between CMDs and stages of glycemia. DESIGN AND SETTING: Cross-sectional study conducted among civil servants aged 35-74 years participating in the ELSA-Brasil cohort. METHODS: CMDs were classified using the Clinical Interview Schedule - Revised (CIS-R). Glycemia was classified in stages as normal, intermediate hyperglycemia, newly classified diabetes or previously known diabetes, based on oral glucose tolerance testing, glycated hemoglobin (HbA1c), self-reported diabetes and medication use. Blood glucose control was assessed according to HbA1c. RESULTS: CMDs were most prevalent in individuals with previously known diabetes. After adjustments, associations weakened considerably and remained significant only for those with a CIS-R score ≥ 12 (prevalence ratio, PR: 1.15; 95% confidence interval, CI: 1.03-1.29). Intermediate hyperglycemia did not show any association with CMDs. For individuals with previously known diabetes and newly classified diabetes, for every 1% increase in HbA1c, the prevalence of depressive disorders became, respectively, 12% and 23% greater (PR: 1.12; 95% CI: 1.00-1.26; and PR: 1.23; 95% CI: 1.04-1.44). CONCLUSION: Individuals with previously known diabetes had higher CIS-R scores. Among all individuals with diabetes, worse blood glucose control was correlated with depressive disorder. No relationship between intermediate hyperglycemia and CMDs was observed, thus suggesting that causal processes relating to CMDs, if present, must act more proximally to diabetes onset.

RESUMO CONTEXTO E OBJETIVO: Diabetes mellitus e transtornos depressivos frequentemente coexistem. No entanto, essa relação tem sido pouco avaliada nos estágios hiperglicêmicos e em uma amplitude maior de transtornos mentais comuns (TMCs). O objetivo foi investigar a associação entre TMCs e estágios de glicemia. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado com funcionários públicos com idade entre 35-74 anos participantes da coorte ELSA-Brasil. MÉTODOS: TMCs foram classificados usando o instrumento Clinical Interview Schedule - Revised (CIS-R). Para a classificação dos estágios de glicemia, foi utilizado o teste de tolerância a glicose, hemoglobina glicada (HbA1c), relato pessoal de diabetes e uso de medicamentos. A glicemia foi categorizada como: normal, hiperglicemia intermediária, classificação nova de diabetes, e diabetes prévio. Controle glicêmico foi avaliado pela HbA1c. RESULTADOS: TMCs foram mais prevalentes nos pacientes com diabetes prévio. Após ajustes, as associações foram consideravelmente enfraquecidas, permanecendo significativas somente para aqueles com escore do CIS-R ≥ 12 (razão de prevalência, RP: 1,15; intervalo de confiança de 95%, IC: 1,03-1,29). Hiperglicemia intermediária não teve associação com CMDs. Para aqueles com diabetes prévio e classificação nova de diabetes, para cada aumento de 1% na HbA1c, a prevalência de transtorno depressivo foi, respectivamente, 12% e 23% maior (RP: 1,12; IC: 1,00-1,26 e RP: 1,23; IC: 1,04-1,44). CONCLUSÃO: Aqueles com diabetes prévio tiveram escore do CIS-R mais elevado. Entre todos com diabetes, o controle glicêmico pior foi relacionado ao transtorno depressivo. Não foi observada relação entre hiperglicemia intermediária e TMCs, sugerindo que a relação causal relacionada aos TMCs, se presente, deve agir de forma mais próxima ao início de diabetes.

Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle / Dor, depressão e distúrbios do sono em pacientes diabéticos e não diabéticos com síndrome do tumor do carpo: um ciclo vicioso

ABSTRACT Carpal tunnel syndrome (CTS) is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and depression using the Beck Depression Inventory (BDI). The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4) questionnaire and a visual analogue scale (VAS). Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

RESUMO A síndrome do túnel do carpo (STC) é uma condição que envolve compressão do nervo frequentemente determinando dor neuropática crônica. Procuramos avaliar a qualidade do sono e parâmetros correlatos em pacientes diabéticos e não-diabéticos com STC. Método Este estudo incluiu 366 pacientes com STC crônica. A qualidade de sono destes pacientes foi avaliada pelo Pittsburgh Sleep Quality Index (PSQI) e a depressão foi avaliada usando Beck Depression Inventory (BDI). A gravidade da dor neuropática foi avaliada usando o questionário Douleur Neuropathique-4 (DN4) e a escala visual analógica (EVA). Resultados No grupo de pacientes não-diabéticos, o valor total do PSQI afetou BDI e VAS, enquanto no grupo de diabéticos a duração dos sintomas afetou VAS, BDI e níveis de glicemia de jejum. Conclusão Em pacientes diabéticos, depressão e cronificação da dor neuropática podem levar à deterioração da qualidade do sono. Assim, considerar todos estes parâmetros no tratamento pode quebrar este círculo vicioso.