Self-reported bruxism in patients with post-traumatic stress disorder.

OBJECTIVE: The present study aimed to investigate the association between self-reported awake/sleep bruxism, and orofacial pain with post-traumatic stress disorder (PTSD). METHODS: A case-control study with a convenience sample was designed. Participants were recruited from a university-based Trauma Ambulatory. The diagnosis of PTSD was established through a clinical interview and the Structured Clinical Interview (SCID-I/P). Thirty-eight PTSD patients and 38 controls completed the Research Diagnostic Criteria for Temporomandibular Disorders Axis-II to categorize awake/sleep bruxism and orofacial pain. Following this, we performed a short clinical examination of the temporomandibular joint and extraoral muscles. RESULTS: Adjusted logistic regression analysis showed that awake bruxism was associated with PTSD (OR = 3.38, 95% CI = 1.01-11.27, p = 0.047). Sleep bruxism was not associated with any covariate included in the model. In a Poisson regression model, PTSD (IRR = 3.01, 95% CI = 1.38-6.55, p = 0.005) and the muscle pain/discomfort (IRR = 5.12, 95% CI = 2.80-9.36, p < 0.001) were significant predictors for current orofacial pain. CONCLUSIONS: PTSD was associated with self-reported awake bruxism and low-intensity orofacial pain. These conditions were frequent outcomes in patients previously exposed to traumatic events. CLINICAL RELEVANCE: We suggest including a two-question screening for bruxism in psychiatry/psychology interviews to improve under-identification and to prevent harmful consequences at the orofacial level.

Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder.

BACKGROUND: Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). METHODS: Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. RESULTS: The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. CONCLUSIONS: Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.

An Empirical Investigation of Alleged Mediumistic Writing: A Case Study of Chico Xavier's Letters.

The scientific study of mediumship can contribute to the understanding of the mind-brain relationship. This study investigated a letter written by the influential Brazilian "medium" Chico Xavier, whose authorship was attributed to a deceased person. We identified the letter's pieces of information that were objectively verifiable, and we analyzed their accuracy based on documents and on interviews with the deceased's relatives, and the likelihood of Xavier's access to the information via ordinary means. All the 29 items of verifiable information conveyed on the letter were rated as "clear and precise fit." The information conveyed was highly specific (e.g., names, dates, and specific events). Fourteen items (48.3%) conveyed information that was also very private. We concluded that ordinary explanations for accuracy of the information (i.e., fraud, chance, information leakage, and cold reading) were highly unlikely. We recommend further research on the phenomenon of mediumistic writing, particularly experimental controlled studies with exceptionally gifted mediums.

Prevalence and correlates of depression, anxiety, and stress in medical residents of a Brazilian academic health system.

BACKGROUND: Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system. METHODS: In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15. RESULTS: A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores. CONCLUSIONS: Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.

Methodological guidelines to investigate altered states of consciousness and anomalous experiences.

Anomalous experiences (AE) (uncommon experiences or one that is believed to deviate from the usually accepted explanations of reality: hallucinations, synesthesia, experiences interpreted as telepathic…) and altered states of consciousness (ASC) have been described in all societies of all ages. Even so, scientists have long neglected the studies on this theme. To study AE and ASC is not necessary to share the beliefs we explore, they can be investigated as subjective experiences and correlated with other data, like any other human experience. This article presents some methodological guidelines to investigate these experiences, among them: to avoid dogmatic prejudice and to 'pathologize' the unusual; the value of a theory and a comprehensive literature review; to utilize a variety of criteria for pathology and normality; the investigation of clinical and non-clinical populations; development of new appropriate research instruments; to be careful to choose the wording to describe the AE; to distinguished the lived experience from its interpretations; to take into account the role of culture; to evaluate the validity and reliability of reports and, last but not least, creativity and diversity in choosing methods.

Evaluation of periodontitis in hospital outpatients with major depressive disorder. A focus on gingival and circulating cytokines.

An imbalance in stimulated cytokine production is associated with the etiopathogenesis of numerous diseases such as major depressive disorder (MDD) and periodontal disease. Increased cytokine levels have been reported in the gingival crevicular fluid (GCF) of patients with MDD. Thirty-six outpatients with MDD participated in this study. Each outpatient was age-matched (± 3 years) with a healthy control (n=36). The patients were controlled for race and smoking habits. Unstimulated and stimulated interleukin 6 (IL-6), interleukin 1ß (IL-1ß), and interferon-γ (INF-γ) production in whole blood culture (WBC) and IL-6 and IL-1ß levels in the GCF were evaluated. Circulating levels of IL-6 and IL-1ß (unstimulated) as well as GCF IL-1ß were modestly lower in MDD patients, compared to the levels in age-matched controls (Mann-Whitney, p=0.002, 0.0075, ANCOVA, p=0.025, respectively). In the unstimulated group, there was no correlation between the levels of circulating IL-6 and GCF IL-6 (r=0.07, p=0.67), and between the levels of circulating IL-1ß and the IL-1ß level in the CGF (r=-0.08, p=0.63). In the LPS stimulation group, there was no correlation between the levels of circulating levels of IL-6 and GCF IL-6 (r=0. 02, p=0.91) or between the circulating IL-1ß and GCF IL-1ß (r=0.13, p=0.42). We observed modest immunosuppression in MDD patients (evaluated by no stimulation whole blood culture [WBC]), especially in patients with melancholic depression, chronic depression, and severe depression.

Clinical utility of the Montgomery-Åsberg Depression Rating Scale for the detection of depression among bariatric surgery candidates.

BACKGROUND: Clinical assessment of depression is an important part of pre-surgical assessment among individuals with morbid obesity. However, there is no agreed-upon instrument to identify mood psychopathology in this population. We examined the reliability and criterion validity of the clinician-administered Montgomery-Åsberg Depression Rating Scale (MADRS) and the utility of a short version for bariatric surgery candidates. METHODS: The sample was 374 patients with obesity, consecutively recruited from the waiting list of a bariatric surgery clinic of University Hospital, Brazil: women 80%, mean BMI 47 kg/m(2), mean age 43.0 years. The 10-item MADRS was analyzed against the SCID-I. Items that showed small relevance to sample's characteristics and contribution to data variability were removed to develop the short 5-item version of scale. We calculated the sensitivity and specificity of cutoff points of both versions MADRS, and values were plotted as a receiver operating characteristic curve. RESULTS: For the 10-item MADRS, the Cronbach's alpha coefficient was 0.93. When compared against SCID-I, the best cut-off threshold was 13/14, yielding sensitivity of 0.81 and specificity 0.85. Following items were removed: reduced appetite, reduced sleep, concentration difficulties, suicide thought and lassitude. The 5-item version showed an alpha coefficient of 0.94 and a best cut-off threshold of 10/11, yielding sensitivity of 0.81 and specificity 0.87. Similar overall ability to discriminate depression of almost 90% was found for both 10-item and 5-item MADRS. CONCLUSION: The MADRS is a reliable and valid instrument to assess depressive symptoms among treatment-seeking bariatric patients. Systematic application of the abbreviated version of the MADRS can be recommended for enhancing the clinical detection of depression during perioperative period.

Adolescent Characters and Alcohol Use Scenes in Brazilian Movies, 2000-2008.

Quantitative structured assessment of 193 scenes depicting substance use from a convenience sample of 50 Brazilian movies was performed. Logistic regression and analysis of variance or multivariate analysis of variance models were employed to test for two different types of outcome regarding alcohol appearance: The mean length of alcohol scenes in seconds and the prevalence of alcohol use scenes. The presence of adolescent characters was associated with a higher prevalence of alcohol use scenes compared to nonalcohol use scenes. The presence of adolescents was also associated with a higher than average length of alcohol use scenes compared to the nonalcohol use scenes. Alcohol use was negatively associated with cannabis, cocaine, and other drugs use. However, when the use of cannabis, cocaine, or other drugs was present in the alcohol use scenes, a higher average length was found. This may mean that most vulnerable group may see drinking as a more attractive option leading to higher alcohol use.

DSM-5 alcohol use disorder criteria in "Crazy Heart" (2009)-a media content analysis with teaching purposes.

OBJECTIVE: The movie Crazy Heart (2009) draws our attention to alcohol disorders as it has a large number of scenes which portray alcohol consumption and fulfill the new DSM-5 Alcohol Use Disorder (DSM-5-AUD) criteria. In view of the recent launch of DSM-5, this is an appropriate opportunity to explore alcohol consumption in a large number of scenes employing the DSM-5-AUD criteria to study this. METHODS: We use media content analysis to identify DSM-5 AUD criteria as portrayed by the main protagonist of the movie Bad Blake in a structured manner. We studied his behavior and attitudes in the context of the film structure and storyline. RESULTS: The severity continuum of DSM-5 AUD can be demonstrated through the trajectory of the character Bad Blake. In the course of the movie, there is some reference to all the DSM-5-AUD criteria, which can be applied to this character within the 21 scenes selected for this study. CONCLUSION: This film can therefore be helpful and used to introduce students and trainees to the DSM-5-AUD criteria. It also allows teachers to discuss with their students and trainees the options of treatment including decision to quit drinking (total abstinence) and the recovery and relapse of this chronic condition.

Substance use and misuse in Brazilian movies (2000-2008).

Considering the absence of data on the appearance of drugs other than alcohol and tobacco in movie scenes, we decided to study the prevalence of portrayal of illicit drug use in a convenience sample of 50 Brazilian Movies. A total of 192 scenes (12h49'03(″)) meeting the inclusion criteria were identified and assessed in a structured manner. Despite several limitations regarding the nature of this comparison, we found that scenes show substance use and misuse almost similar to that in the general population, mainly alcohol (especially among people of low socioeconomic status), cannabis and inhalants. Main differences were found in cocaine and tranquilizers (over- and underexposure in movies, respectively).

Interpersonal psychotherapy for treatment of obesity: A systematic review and meta-analysis.

BACKGROUND: Social and interpersonal context are associated with the onset and persistence of psychiatric disorders. We compared the effects of short-term interpersonal psychotherapy (IPT) on weight loss, binge eating behaviors, and depressive symptoms against cognitive-behavioral therapy (CBT), health education (HE), and behavioral weight loss (BWL). METHODS: We searched until May 28th, 2022 following databases: PubMed, CINAHL, Science Direct, Web of Science, EMBASE, and Scopus. Articles on parallel randomized clinical trials were included. Outcomes were body mass index (BMI), binge days (bulimic episode), and depressive symptoms. These outcomes were self-reported or measured with specific scales (BMI) or instrument (depressive symptoms). RESULTS: The initial search retrieved 820 articles, a total of 10 studies met the eligibility criteria, and seven were included in the meta-analysis. Participants with overweight/obesity were women (62-100 %), aged between 11 and 50 years. There was a trivial to small effect on BMI favoring IPT over other interventions (standardized mean difference [SMD] = -0.10; 95%CI: -0.27 to 0.07, I2 = 0 %), especially when compared to health education (SMD = -0.21; 95%CI: -0.54 to 0.12, I2 = 0 %); no effect on number of binge days (SMD = -0.09; 95%CI: -0.30 to 0.11, I2 = 0 %); and a small effect on depressive symptoms (SMD = -0.25, 95%CI = -0.50 to 0.00, I2 = 0 %). LIMITATIONS: Small number of studies, the discrepancy in age cohorts, and racial diversity. Psychotherapeutic protocols and assessment tools had to be adapted across studies. CONCLUSIONS: Patients with overweight/obesity and depression had some benefit from IPT when compared with other interventions. In view of existing evidence, an IPT program adapted to obesity could help to achieve reliable and long-term effects.

VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY.

BACKGROUND: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.

Longitudinal patterns of comorbidity between anxiety, depression and binge eating symptoms among patients with obesity: A path analysis.

BACKGROUND: Depression, anxiety, and binge eating are common psychiatric symptoms among people with obesity. Although many studies seek to understand the mechanisms of association between these psychiatric symptoms, there is no still consensus about the longitudinal association. METHODS: 155 patients (124 women) were recruited from a university-based bariatric center and evaluated over three waves (T0-T1-T2). In the last period the sample comprised 126 (104 women) participants. Trained clinicians assessed psychiatric symptoms by telephone interview using measurement scales. Partial Least Squares (PLS) was applied to investigate the path effects between anxiety, depression and binge eating symptoms over time. RESULTS: The results of path coefficients (ß) showed that the effect of anxiety on depression was constantly significant in all periods T0 (ß = 0.74), T1 (ß = 0.71), and T2 (ß = 0.67). Anxiety had an effect on binge eating in T0 (ß = 0.39) and T2 (ß = 0.26) but not in T1. Binge eating affected depressive symptoms only in T2 (ß = 0.22). Two carry-over-effects were significant binge eating in T0-T1 (ß = 0.41) and T1-T2 (ß = 0.19). LIMITATIONS: Telephone interviews, social isolation due to the pandemic and the social desirability may have contributed to collection and information biases. CONCLUSION: Anxiety has significant path effects on depression and binge eating. Binge eating was shown to be the most unstable symptom over time. The time factor seems to contribute to path effects between the psychiatric symptoms. The results draw attention to the fact that psychiatric symptoms must be evaluated and treated in association with each other, and investigated over time.

Perspectives on a psychiatric outpatient service for immigrants and refugees in São Paulo, Brazil over a 15-year period.

BACKGROUND: Immigrants and refugees have specific mental health needs. Studies of immigrant/refugee psychiatric patients in Latin America are scarce. AIMS: Present the profile of patients from an outpatient psychiatric service in Sao Paulo (Brazil) to better inform mental health service planning for immigrants and refugees in the Global South. METHODS: Exploratory study to characterize the sociodemographic and mental health profile of refugees and immigrants attending outpatient psychiatric service from 2003 to 2018. Chi-square tests and logistic regressions were used to examine the association of demographic variables, exposure to violence, and immigrant status with psychiatric diagnosis. Cluster analysis was used to identify subgroups within the sample. RESULTS: A total of 162 immigrants and refugees referred to the service obtained treatment. Of these patients, 57.4% were men, 59.8% were refugees/asylum seekers, 51.9% were Black, 48.8% were single, 64.2% had 10 years of education, and 57.4% were unemployed; the mean age of the sample was 35.9. Half of the sample (52.5%) was exposed to violence. The most common diagnosis was depression (54.2%), followed by PTSD (16.6%). Approximately 34% of the participants sought psychiatric care within 6 months of arrival. Logistic regressions showed that men had lower odds of presenting with depression (OR = 0.34). Patients with PTSD were more likely to be refugees (OR = 3.9) and not have a university degree (OR = 3.1).In the cluster analysis, a cluster of patients with PTSD included almost all Black refugee men exposed to violence. Most patients diagnosed with psychotic disorders were also Black refugee men. CONCLUSION: Immigrants and refugees represent a vulnerable group. The majority of the sample was Black, refugee men, who were also more likely to present with PTSD. Future studies are needed to better understand issues in treatment adherence in relation to socioeconomic characteristics.

Exploratory study on the psychological impact of COVID-19 on the general Brazilian population.

The COVID-19 pandemic has become one of the main international concerns regarding its impact on mental health. The present study aims to investigate the prevalence of depression, anxiety, and stress symptoms, and behavioral aspects amidst the COVID-19 pandemic in a Brazilian population. An online survey was administered from May 22 to June 5, 2020 using a questionnaire comprising of sociodemographic information, the Depression, Anxiety, and Stress Scale (DASS-21), and the Coping Strategies Inventory. Participants comprised 3,000 people from Brazil's 26 states and the Federal District, with an average age of 39.8 years, women (83%), married (50.6%), graduates (70.1%) and employees (46.7%). Some contracted the virus (6.4%) and had dead friends or relatives (22.7%). There was more consumption of drugs, tobacco, medication, and food (40.8%). Almost half of participants expressed symptoms of depression (46.4%), anxiety (39.7%), and stress (42.2%). These were higher in women, people without children, students, patients with chronic diseases, and people who had contact with others diagnosed with COVID-19. The existence of a group more vulnerable to situations with a high stress burden requires greater attention regarding mental health during and after the pandemic. That said, it should be emphasized that these findings are preliminary and portray a moment still being faced by many people amid the pandemic and quarantine measures. Therefore, we understand that the magnitude of the impacts on mental health will only be more specific with continuous studies after total relaxation of the quarantine.

Substance Use Portrayal in Oscar-nominated Movies.

BACKGROUND: As one of the forms of media and art most consumed in the world, Oscar- nominated movies should have their drug use representation monitored because of possibly influencing but also reflecting society's behavior. OBJECTIVE: The present study aims to investigate drug use representation in scenes from movies nominated for the Academy Awards (Oscar) from 2008-2011 through media content analysis. METHODS: 437 scenes from Oscar-nominated movies (best film, best actor and best actress categories) showing drug consumption and/or its effects were assessed. Each drug represented and identified in a given scene (i.e., drug use incident) was counted as a unit for the present study (n = 515). Survey settings were used to control for over- or under-estimation of the prevalence of a variable in a given year or movie. RESULTS: All the Oscar-nominated movies portrayed at least one scene of drug use. There was a massive predominance of alcohol and tobacco in movies, with a high use among men who also use drugs, habitually or occasionally, but related to stress/tension, predominantly at home. However, there was a significant progressive increase in the use of drugs other than alcohol and tobacco, multiple drugs, and by women. CONCLUSION: These findings echo epidemiological studies on substance use in western countries, an overall trend towards greater home drug use representation and gender convergence since 1970, which increased since 2000. Monitoring drug use representation in Oscar-nominated movies may represent an important public health tool.

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial.

OBJECTIVE: To evaluate a protocol for acceptance and commitment therapy-based behavioral intervention for insomnia (ACT-BBI-I) in adults compared to cognitive behavioral therapy for insomnia (CBT-I). METHODS: Forty-five adults with chronic insomnia were randomized to ACT-BBI-I or CBT-I. Both interventions were performed in six weekly group sessions. The common treatment elements in both protocols included stimulus control and sleep restriction. CBT-I is focused on the cognitive restructuring of maladaptive beliefs about sleep and the daytime effects of insomnia. ACT-BBI-I focuses on therapeutic processes of acceptance, availability, values, defusion, and commitment. The results were evaluated through the following instruments: a sleep diary, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, and the Dysfunctional Beliefs and Attitudes about Sleep scale. RESULTS: Both interventions had a significant positive impact on sleep patterns, insomnia, anxiety, beliefs about sleep, and psychological flexibility. All improvement was maintained at the 6-month follow-up. CONCLUSION: The results suggest that integrating principles of ACT with behavioral techniques may be useful for treating insomnia. Further research should identify whether the principles of ACT result in added effectiveness compared to behavioral components alone. CLINICAL TRIAL REGISTRATION: RBR-7nc5wq.

The prevalence of psychopathology in offspring of bipolar women from a Brazilian tertiary center.

OBJECTIVE: No previous study has assessed the occurrence of psychopathology in offspring of bipolar women from South America. The objective of this study was to assess the prevalence of psychopathology in offspring of bipolar mothers from Brazil compared with two control groups. METHOD: Children and adolescents aged 6 to 18 years of bipolar disorders mothers (n = 43), mothers with other mild to moderate mental disorders (n = 53) and mothers without any psychiatric disorder (n = 53) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, the Child Behavior Checklist and the Youth Self-Report. Raters were blind to the mothers' diagnoses, who were interviewed by means of the Structured Clinical Interview. RESULTS: Bipolar offspring had twice the chance of having one or more lifetime Axis I diagnoses [prevalence ratio = 2.11 (95% CI: 1.30-3.42) and p = 0.003] and 2.8 higher risk of having a lifetime anxiety disorder [prevalence ratio = 2.83 (95% CI: 1.39-5.78) e p = 0.004] than the offspring of mothers with no mental disorder. In addition, significantly higher scores on Child Behavior Checklist thought problems and Youth Self-Report social problems, as well as anxiety/depression and internalizing problems were observed. CONCLUSION: Our results confirm previous findings suggesting higher psychiatric problems in offspring of bipolar mothers and extend them to the Brazilian society.

Predictors of quality of life in Brazilian medical students: a systematic review and meta-analysis.

OBJECTIVE: To examine predictors associated with quality of life (QoL) in Brazilian medical students. METHODS: PubMed, PsycINFO, EMBASE, LILACS, and Google Scholar were searched for research articles in English or Portuguese published through August 2018. Observational studies that measured QoL with standard instruments were selected. Three instruments were used to evaluate QoL: the World Health Organization QoL questionnaires (WHOQOL-Bref and WHOQOL-100) and 36-item Short Form Health Survey (SF-36). Hedges' g was used to calculate effect sizes. A random-effects model was used in meta-analyses. PRISMA guidelines were followed. RESULTS: The initial search retrieved 8,504 articles; 24 met the eligibility criteria for systematic review, and seven for meta-analyses of gender (n=3,402 students). Predictors of QoL such as gender, years of medical school(years of study), economic class, educational environment, academic efficacy, depression, burnout, resilience, empathic concern, sleep difficulties, chronic illness, body mass index, and leisure-time physical activity were identified in the systematic review. The most frequent predictors of QoL detected in Brazilian medical students were associated with gender and years of study. CONCLUSIONS: Female medical students had lower QoL scores in the physical health and psychological domains of WHOQOL-Bref compared to male students. Specific interventions should be designed for this group as appropriate. SYSTEMATIC REVIEW REGISTRY NUMBER: PROSPERO CRD-42018102259.