Homeopathy for Major Depressive Disorder: Protocol for N-of-1 Studies.

BACKGROUND: N-of-1 studies allow the formal assessment of a patient's treatment. A single participant receives different interventions the same number of times in a crossover, double-blind, randomized design. Using this methodology, we will investigate the effectiveness and safety of a standardized homeopathy protocol in treating 10 cases of major depression. METHODS: The method is described below: Design: crossover double-blind placebo-controlled randomized N-of-1 studies, with at most 28 weeks of duration per participant. PARTICIPANTS: women and men at age over 18 years with a diagnosis of a major depressive episode given by a psychiatrist, who have presented a therapeutic response, i.e., a reduction ≥50% of the baseline depressive symptoms, self-assessed by the Beck Depression Inventory - Second Edition (BDI-II), and sustained for at least 4 weeks during an open homeopathic treatment following the protocol of the sixth edition of the Organon, with or without concomitant use of psychotropic drugs. INTERVENTIONS: individualized homeopathy following the same protocol, one globule of the fifty-millesimal potency diluted in 20 mL of 30% alcohol; placebo - 20 mL of 30% alcohol, in the same posology as homeopathy. Crossover study: the participant will go through three consecutive treatment blocks, with two random and masked treatment periods (A or B), corresponding to homeopathy or placebo. Treatment periods will have 2, 4, and 8 weeks in the first, second, and third blocks, respectively. A clinically significant worsening (characterized by an augmentation in BDI-II inclusion score ≥30%) will result in the termination of study participation and resumption of the open treatment. PRIMARY MEASURE: progression of the depressive symptoms, self-assessed by the participant using the BDI-II scale at weeks 0, 2, 4, 8, 12, 16, 20, 24, 28 and analyzed throughout the study concerning homeopathy and placebo partitions. Secondary measures: score of the Clinical Global Impression Scale; mental and physical health scores assessed by the 12-Item Short-Form Health Survey; participant's blind preference for treatment A or B at each block; clinical worsening; and adverse events. DATA ANALYSIS: the participant, assistant physician, evaluator, and statistician will remain blinded for the study treatments until the completion of data analysis of each study. We will follow a 10-step procedure for analyzing N-of-1 observational data of each participant and conduct a meta-analysis of the combined results. DISCUSSION: We understand that each N-de-1 study will be a chapter with its teachings in a book of ten, allowing a broader view of the effectiveness of the homeopathy protocol of the sixth edition of the Organon in treating depression.Einzelpatienten- oder "n = 1"-Studien ermöglichen die formelle Beurteilung der Behandlung eines Patienten. Bei einem einzigen Teilnehmer werden verschiedene Maßnahmen in gleicher Zahl in einem doppelblinden, randomisierten Crossover-Design angewendet. Mit dieser Methode untersuchen wir die Wirksamkeit und Sicherheit eines standardisierten Homöopathie-Protokolls zur Behandlung von Major Depression in zehn Fällen.Aufbau der Studie: Doppelblinde, placebokontrollierte, randomisierte Einzelpatienten- oder "n = 1"-Studie von maximal 28 Wochen Dauer pro Teilnehmer. Teilnehmer: Frauen und Männer ab 18 Jahren mit durch einen Psychiater diagnostizierter Episode einer Major Depression und mit mindestens vier Wochen lang anhaltendem therapeutischem Ansprechen (in Form einer Reduktion der depressiven Symptome um ≥50% gegenüber Baseline laut Selbstbeurteilung mit dem Beck Depression Inventar, zweite Ausgabe [BDI-II]) unter einer offenen homöopathischen Behandlung gemäß dem Protokoll der sechsten Auflage des Organon, mit oder ohne gleichzeitige Anwendung von Psychopharmaka. Interventionen: Individualisierte Homöopathie gemäß demselben Protokoll, ein Globulus der Quinquaginta-Millesimal-Potenz, verdünnt in 20 mL 30%igem Alkohol; Placebo in Form von 20 mL 30%igem Alkohol, nach demselben Dosierungsschema wie die Homöopathie. Crossover-Studie: Der Teilnehmer durchläuft in zwei randomisierten und maskierten Behandlungszeiträumen (A oder B), die Homöopathie oder Placebo enstprechen, je drei aufeinanderfolgende Behandlungsblöcke. Innerhalb der Behandlungszeiträume umfassen der erste, zweite und dritte Block je zwei, vier beziehungsweise acht Wochen. Eine klinisch bedeutsame Verschlechterung (gekennzeichnet durch einen Anstieg des BDI-II-Scores um ≥30% gegenüber der Aufnahme) führt zum Abbruch der Studienteilnahme und zur Wiederaufnahme der offenen Behandlung. Primäre Messgröße: Verlauf der depressiven Symptome laut Selbstbeurteilung des Teilnehmers mit der BDI-II-Skala in Woche 0, 2, 4, 8, 12, 16, 20, 24, 28 und Auswertung im Verlauf der Studie nach Homöopathie-und Placebo-Abschnitten. Sekundäre Messgrößen: Score auf der Clinical Global Impression Scale; Scores für psychische und physische Gesundheit laut 12-Item Short-Form Health Survey; verblindete Teilnehmerpräferenz für Behandlung A oder B in jedem Block; klinische Ver-schlechterung und unerwünschte Ereignisse. Datenauswertung: Der Teilnehmer, behandelnde Arzt, Auswertende und Statistiker bleiben im Hinblick auf die Stu-dienbehandlungen verblindet, bis die Datenauswertung jeder Studie abgeschlossen ist. Wir werden in einem 10-schrittigen Vorgehen die "n = 1"-Beobachtungsdaten der einzelnen Teilnehmer auswerten und eine Metaanalyse der zusammengeführten Ergebnissee durchführen.Unserer Auffassung nach wird jede einzelne "n = 1"-Studie ein Kapitel mit eigenen Lehren innerhalb eines zehnteiligen Buches sein, welches eine umfassende Darstellung der Wirksamkeit des Homöopathie-Protokolls der sechsten Ausgabe des Organon zur Behandlung von Depressionen ermöglicht.

MAJOR DEPRESSIVE DISORDER IS ASSOCIATED WITH TYPE 2 DIABETES IN PATIENTS WITH CHRONIC HEPATITIS C INFECTION.

BACKGROUND: Major depressive disorder (MDD) is commonly reported in patients with chronic hepatitis C (CHC); however, the factors behind the co-occurrence of these conditions have not been completely clarified yet. OBJECTIVE: We aimed to evaluate the frequency of mental disorders in CHC patients and to investigate variables associated with MDD. METHODS: CHC patients (n=151) attending a referral Centre for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview and the Cut-Annoyed-Guilty-Eye (CAGE) Questionnaire. Multivariate analysis was used to evaluate independent covariates associated with current MDD. RESULTS: Seventy-six (50.3%) patients had, at least, one current psychiatric diagnosis with MDD (33.1%) being the most common. Current MDD was independently associated with age (≤50 yr.) (OR=2.57; 95%CI=1.25-5.29; P=0.01) and type 2 diabetes mellitus (OR=2.80, 95%CI=1.17-6.70; P=0.02). Cirrhosis was associated with type 2 diabetes mellitus (OR=5.09; 95%CI=1.73-15.04; P=0.03) and current alcohol abuse/dependence (OR=2.54; 95%CI=1.04-6.22; P=0.04). DISCUSSION: MDD is associated with type 2 diabetes in CHC patients. Even in the direct-acting antivirals (DAAs) era, characterized by great perspectives for the first ample cure of a chronic viral infection, we should ensure that the screening for psychiatric disorders takes place in the course of routine clinical care of patients chronically infected with hepatitis C virus.

Maternal mental health and gestational weight gain in a Brazilian Cohort.

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5-13, 20-26, 30-36, and 37-42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG.

Behavior and oxidative stress parameters in rats subjected to the animal's models induced by chronic mild stress and 6-hydroxydopamine.

Major depressive disorder (MDD) is one of the most prevalent forms of mental illness also affecting older adults. Recent evidence suggests a relationship between MDD and neurodegenerative diseases, including Parkinson's disease (PD). Individuals with PD have a predisposition to developing MDD, and both neurobiological conditions are associated with oxidative stress. Thus, we conducted this study to investigate depressive-like behavior and oxidative stress parameters using both animal models of PD and stress. Adult Wistar rats were subjected to chronic mild stress (CMS) protocol by 40 days and then it was used 6-hydroxydopamine (6-OHDA) as a model of PD, into the striatum. The experimental groups were: Control + Sham, Stress + Sham, Control+6-OHDA, and Stress+6-OHDA. Depressive like-behavior was evaluated by the forced swimming test (FST) and spontaneous locomotor activity by open-field test. Oxidative stress parameters were measured in the striatum, hippocampus, and prefrontal cortex (PFC). The results showed effects to increase immobility and decrease climbing times in the FST in Stress + Sham, Control+6-OHDA, and Stress+6-OHDA groups. The number of crossings and rearings were decreased in the Stress+6-OHDA group. The lipid peroxidation was increased in the PFC of Stress + Sham, and the hippocampus and striatum of Stress + Sham and Control+6-OHDA groups. Carbonyl protein levels increased in the PFC of Stress + Sham and striatum in Control+6-OHDA. Nitrite/Nitrate concentration was elevated in the PFC of Stress + Sham, in the hippocampus of Control+6-OHDA, the striatum of Stress + Sham, and Control+6-OHDA groups. Myeloperoxidase (MPO) activity was increased in the PFC and hippocampus of Stress + Sham and Control+6-OHDA groups. The activity of catalase decreased in the PFC of the Stress + Sham group. The activity of the superoxide dismutase (SOD) was decreased in the PFC of the Stress + Sham group, in the hippocampus of Stress + Sham and Control+6-OHDA groups, and the striatum of Control+6-OHDA group. These findings suggest that both stress and 6-OHDA induce depressive-like behavior and oxidative stress in the brain. The joining models have little evidence of the effects. Thus these findings suggest that other pathways are involved in the common point of the pathophysiology of PD and MDD.

Exposure to Armed Conflict in Childhood vs Older Ages and Subsequent Onset of Major Depressive Disorder.

Importance: This study offers a rare opportunity to evaluate life-course differences in the likelihood of developing major depressive disorder (MDD) after exposure to georeferenced neighborhood-level violence during an armed conflict. Objective: To examine age cohort (age <11 vs ≥11 years) differences in associations of neighborhood-level violence with subsequent depression onset, independently of individual exposure and other key characteristics. Design, Setting, and Participants: The Chitwan Valley Family Study is a population-representative panel study (1995 to present) conducted in Western Chitwan in Nepal, a low-income country that experienced a medium-intensity armed conflict from 2000 to 2006. Data for violent events were collected during the armed conflict and were linked to lifetime histories of MDD (collected in 2016-2018). The present cohort study analyzes 10 623 participants within 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15 to 59 years at MDD assessment were eligible (response rate, 93%). Data analysis was performed from May 2019 to July 2020. Exposures: Georeferenced number of armed conflict-related physical beatings within 1 km of residential neighborhood. Main Outcomes and Measures: The main outcome was onset of MDD, as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), during or after the conflict, stratified by children (aged <11 years) and older individuals (aged ≥11 years), assessed by the Nepal-specific World Mental Health-Composite International Diagnostic Instrument 3.0 with a life history calendar. Results: In total, 10 623 participants (5745 female [54.08%]; 4074 [38.35%] aged <11 years at the conflict start) contributed 171 899 person-years of exposure to the risk of MDD. Two or more beatings occurred within 1 km of 15 neighborhoods (9.9%). Discrete-time survival models showed that children (but not older individuals) living in neighborhoods with 2 or more beatings had a higher likelihood of developing MDD than those who lived in a community with no beatings (odds ratio, 1.82; 95% CI, 1.17-2.84; P = .008); there was also a significant interaction between age group and neighborhood beatings (odds ratio, 1.85; 95% CI, 1.27-2.70; P = .001). A confirmatory, multivariable, multilevel matching analysis showed a neighborhood association for children (z = -2.66; P = .008), but not older individuals (z = -0.454; P = .65). The mean (SE) incidence of MDD among children living in neighborhoods with 2 or more beatings nearby was 12.69% (2.37%) vs 5.08% (1.56%) in the matched unexposed sample. Conclusions and Relevance: The youngest individuals may be the most at risk during times of violence, with mental health consequences lasting long after conflicts have subsided and should be a priority for population-level interventions. Future research should consider other disorders, other types of violence, and elderly individuals.

Co-morbilidad neuro-psiquiátrica en infección por VIH / Neuropsychiatric comorbidity in HIV infection

Resumen Introducción: Aproximadamente 50% de las personas con infección por VIH padecen de alguna patología neuro-psiquiátrica. Características intrínsecas del virus, sus complicaciones, tratamiento y el contexto socio-cultural de los infectados facilitan el desarrollo de estas co-morbilidades, que determinan, en parte, el curso y pronóstico de las personas con infección por VIH. Objetivo: Introducir en la fisiopatología, características clínicas y manejo de la patología neuro-psiquiática en la infección por VIH, centrándose en dos de sus cuadros de mayor prevalencia: el trastorno neuro-cognitivo asociado al VIH (HAND) y el trastorno depresivo mayor (TDM). Desarrollo: En general, la detección y el tratamiento precoz de la patología neuropsiquiátrica en personas con infección por VIH mejora la calidad de vida de los pacientes, el curso clínico de la infección y mejora la adherencia al tratamiento anti-retroviral, lo que constituye una herramienta importante en el control de la propagación del VIH.

Abstract Background: The prevalence of neuropsychiatric disorders in HIV infected individuals is around 50%. Despite this, these diseases are often underdiagnosed and undertreated. Direct effects of the virus, opportunistic infections, adverse effects of antiretroviral therapy and the sociocultural context of the infected persons, contribute to the development of HIV associated neurocognitive disorder (HAND) and major depressive disorder (MDD), both of which have an impact in quality of life and disease progression. Aim: To introduce physicians in the pathophysiology, clinical features and management of psychiatric disease in seropositive patients. Content: Early detection and treatment of neuropsychiatric comorbidity in HIV infected individuals improve clinical outcomes, quality of life and is an important milestone in the control of the pandemic.

Prevalence of excessive daytime sleepiness and associated factors in adolescents of the RPS cohort, in São Luís (MA), Brazil. / Prevalência de sonolência diurna excessiva e fatores associados em adolescentes da coorte RPS, em São Luís (MA).

OBJECTIVES: To estimate the prevalence and factors associated with excessive daytime sleepiness (EDS) in adolescents from the São Luís, Maranhão birth cohort. METHOD: Cross-sectional study conducted with 2,514 adolescents aged 18 and 19 years old. A hierarchical approach was used, and prevalence ratios were calculated using Poisson regression with robust variance adjustment. Sociodemographic characteristics (gender, race, economic class, and occupation), lifestyle (leisure activities, smoking, alcohol, illicit drug use, coffee and energy consumption, physical activity, body adiposity, screen time, and depression), and factors related to sleep were studied. RESULTS: The prevalence of EDS was 36.8%. The female gender (PR = 1.33; 95%CI 1.19 - 1.49), high risk for alcohol consumption (PR = 1.26; 95%CI 1.09 - 1.46), current major depressive episode (PR = 1.26; 95%CI 1.08 - 1.46), sleep alteration score from 10 to 18 (PR = 1.43; 95%CI 1.10 - 1.85), and sleep score from 5 to 7 of daytime dysfunction (PR = 2.51; 95%CI 2.06 - 3.07) were risk factors for EDS. Economic class D/E was a protective factor for EDS (PR = 0.47; 95%CI 0.27 - 0.85). CONCLUSION: More than one-third of adolescents had EDS. Adolescents at higher risk need to improve their sleeping habits and lifestyle so that they no longer have EDS and can improve their quality of life.

A Game Theory-Based Model for Predicting Depression due to Frustration in Competitive Environments.

A computational model based on game theory is here proposed to forecast the prevalence of depression caused by frustration in a competitive environment. This model comprises a spatially structured game, in which the individuals are socially connected. This game, which is equivalent to the well-known prisoner's dilemma, represents the payoffs that can be received by the individuals in the labor market. These individuals may or may not have invested in a formal academic education. It is assumed that an individual becomes depressed when the difference between the average payoff earned by the neighbors in this game and the personal payoff surpasses a critical number, which can be distinct for men and women. Thus, the transition to depression depends on two thresholds, whose values are tuned for the model accurately predicting the percentage of individuals that become depressed due to a frustrating payoff. Here, this tuning is performed by using data of young adults living in the United Kingdom in 2014-2016.

[Neuropsychiatric comorbidity in HIV infection]. / Co-morbilidad neuro-psiquiátrica en infección por VIH.

BACKGROUND: The prevalence of neuropsychiatric disorders in HIV infected individuals is around 50%. Despite this, these diseases are often underdiagnosed and undertreated. Direct effects of the virus, opportunistic infections, adverse effects of antiretroviral therapy and the sociocultural context of the infected persons, contribute to the development of HIV associated neurocognitive disorder (HAND) and major depressive disorder (MDD), both of which have an impact in quality of life and disease progression. AIM: To introduce physicians in the pathophysiology, clinical features and management of psychiatric disease in seropositive patients. CONTENT: Early detection and treatment of neuropsychiatric comorbidity in HIV infected individuals improve clinical outcomes, quality of life and is an important milestone in the control of the pandemic.

Prevalência de sonolência diurna excessiva e fatores associados em adolescentes da coorte RPS, em São Luís (MA) / Prevalence of excessive daytime sleepiness and associated factors in adolescents of the RPS cohort, in São Luís (MA), Brazil

RESUMO: Objetivos: Estimar a prevalência de sonolência diurna excessiva (SDE) e os fatores associados a ela em adolescentes da coorte de nascimentos de São Luís (MA). Método: Estudo transversal realizado com 2.514 adolescentes com idade de 18 e 19 anos. Utilizou-se abordagem hierarquizada e calculou-se a razão de prevalências utilizando regressão de Poisson com ajuste robusto da variância. Foram estudadas características sociodemográficas (sexo, cor, classe econômica, ocupação), hábitos de vida (lazer, fumo, álcool, uso de drogas ilícitas, consumo de café e de bebidas energéticas, prática de atividade física, adiposidade corporal, tempo de tela, depressão) e fatores relacionados ao sono. Resultados: A prevalência de SDE foi de 36,8%. Sexo feminino (razão de prevalência - RP = 1,33; intervalo de confiança de 95% - IC95% 1,19 - 1,49), alto risco de consumo de bebidas alcoólicas (RP = 1,26; IC95% 1,09 - 1,46), episódio depressivo maior atual (RP = 1,26; IC95% 1,08 - 1,46), escore de 10 a 18 de alterações do sono (RP = 1,43; IC95% 1,10 - 1,85) e escore de 5 a 7 da disfunção durante o dia (RP = 2,51; IC95% 2,06 - 3,07) foram os fatores de risco para SDE. A classe econômica D/E foi fator de proteção para SDE (RP = 0,47; IC95% 0,27 - 0,85). Conclusão: Mais de um terço dos adolescentes apresentou SDE, e aqueles com maiores riscos precisam melhorar seus hábitos de vida e de sono para que não tenham mais SDE, visando melhorar sua qualidade de vida.

ABSTRACT: Objectives: To estimate the prevalence and factors associated with excessive daytime sleepiness (EDS) in adolescents from the São Luís, Maranhão birth cohort. Method: Cross-sectional study conducted with 2,514 adolescents aged 18 and 19 years old. A hierarchical approach was used, and prevalence ratios were calculated using Poisson regression with robust variance adjustment. Sociodemographic characteristics (gender, race, economic class, and occupation), lifestyle (leisure activities, smoking, alcohol, illicit drug use, coffee and energy consumption, physical activity, body adiposity, screen time, and depression), and factors related to sleep were studied. Results: The prevalence of EDS was 36.8%. The female gender (PR = 1.33; 95%CI 1.19 - 1.49), high risk for alcohol consumption (PR = 1.26; 95%CI 1.09 - 1.46), current major depressive episode (PR = 1.26; 95%CI 1.08 - 1.46), sleep alteration score from 10 to 18 (PR = 1.43; 95%CI 1.10 - 1.85), and sleep score from 5 to 7 of daytime dysfunction (PR = 2.51; 95%CI 2.06 - 3.07) were risk factors for EDS. Economic class D/E was a protective factor for EDS (PR = 0.47; 95%CI 0.27 - 0.85). Conclusion: More than one-third of adolescents had EDS. Adolescents at higher risk need to improve their sleeping habits and lifestyle so that they no longer have EDS and can improve their quality of life.

Pro-inflammatory monocyte profile in patients with major depressive disorder and suicide behaviour and how ketamine induces anti-inflammatory M2 macrophages by NMDAR and mTOR.

BACKGROUND: Depression is a highly prevalent disorder that is one of the leading causes of disability worldwide. Despite an unknown aetiology, evidence suggests that the innate and adaptive immune systems play a significant role in the development and maintenance of major depressive disorder (MDD). The non-competitive glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonist, (R,S)-ketamine (ketamine), has demonstrated rapid and robust efficacy as an antidepressant when administered at sub-anaesthetic doses. METHODS: Our goal was to characterize the pro-inflammatory profile of patients with MDD by measuring pro-inflammatory cytokines in plasma and circulating monocyte subsets and to understand how ketamine induces an anti-inflammatory program in monocyte and macrophages in vitro and vivo. FINDING: Our results show that patients with MDD without other comorbidities (N = 33) exhibited significantly higher levels of pro-inflammatory IL-12 and IL-6 in plasma and that these cytokines were associated with increased numbers of non-classical (CD11b+CD16brightCD14neg) monocytes and increased activation state (CD40+CD86+) of classical monocytes in circulation. Remarkably, we have demonstrated that sub-anaesthetic doses of ketamine programs human monocytes into M2c-like macrophages by inducing high levels of CD163 and MERTK with intermediate levels of CD64 and stimulating mTOR-associated gene expression in vitro. The NMDAR antagonist MK-801, but not the α-amino-3­hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) antagonist, NBQX, also polarizes macrophages to an M2c-like phenotype, but this phenotype disappears upon mTOR pathway inhibition. Sub-anaesthetic doses (10 mg/kg) of ketamine administration in mice both promote reduction of circulating classical pro-inflammatory monocytes and increase of alternative M2 macrophage subtypes in the spleen and CNS. INTERPRETATION: Our results suggest an anti-inflammatory property of ketamine that can skew macrophages to an M2-like phenotype, highlighting potential therapeutic implications not only for patients with MDD but also other inflammatory-based diseases. FUNDING: This study was supported by grants from the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT-FONCYT).

Sociodemographic, behavioral, and health-related risk factors for depression among men and women in a southern Brazilian city

Objective: To assess the prevalence of depression and sociodemographic, behavioral, and health-related risk factors therefor in a southern Brazilian city. Methods: Population-based, cross-sectional study of adults from Rio Grande, state of Rio Grande do Sul, Brazil. Individuals (n=1,295) were selected using a multistage sampling procedure. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for major depressive episodes (MDEs). We used a conceptual causal framework to organize and assess risk factors for MDE and calculated prevalence ratios (PR) using regression models. Results: The prevalence of MDE was 8.4% (95%CI 6.0-10.7) for men and 13.4% (95%CI 11.0-15.8) for women. For men, physical inactivity (PR 2.34, 95%CI 1.09-5.00) and perceived stress (PR 20.35, 95%CI 5.92-69.96) were associated with MDE. In women, MDE prevalence was higher among those in the first tertile of economic index (PR 2.61, 95%CI 1.53-4.45), with 0-8 years of schooling (PR 2.25, 95%CI 1.24-4.11), alcohol users (PR 1.91, 95%CI 1.21-3.02), those physically inactive (PR 2.49, 95%CI 1.22-5.09), with the highest perceived stress (PR 9.17, 95%CI 3.47-24.23), with another mental disorder (PR 1.85, 95%CI 1.32-2.59), and with more noncommunicable diseases (PR 1.85, 95%CI 1.06-3.22). Conclusion: Women had a higher prevalence of depression, and socioeconomic disadvantages were important for the occurrence of MDE; however, for men, only physical inactivity and stress were important predictors, suggesting possible different causal pathways for each sex.

Contextual risk factors of depression and suicidal thoughts in Brazilian adults: a multilevel analysis

Objective: To evaluate the association between social and health contextual variables, and between major depressive episodes (MDE) and suicidal thoughts in Brazilian adults. Methods: This population-based cross-sectional study used data from the 2013 National Health Survey (Pesquisa Nacional de Saúde). The Patient Health Questionnaire was used to evaluate the presence of MDE and suicidal thoughts. We used number of Family Health Strategy teams (FHS) per 20,000 state population, number of Psychosocial Care Centers (Centros de Atenção Psicossocial [CAPS]) per 1,000 state population, gross domestic product (GDP), and Gini index for each Brazilian state as contextual variables. Multilevel logistic regression models were used to calculate OR and the intraclass correlation coefficient (ICC). Results: Prevalence of MDE and suicidal thoughts was 4.1% (95%CI 3.8-4.4) and 3.8% (95%CI 3.5-4.1), respectively. Multilevel regression models showed an ICC of 1.1% for MDE (95%CI 0.5-2.3) and 1.3% for suicidal thoughts (95%CI 0.6-2.6). Neither GDP, Gini, FHS, or CAPS showed evidence of association with the outcomes. Conclusions: In general, contextual variables, within each Brazilian state, do not seem to affect the prevalence of MDE and suicidal thoughts.

Decreased Quality of Life in Individuals with Type 2 Diabetes Mellitus Is Associated with Emotional Distress.

Background: individuals with type 2 diabetes show emotional distress as they learn how to cope with the disease. The emotional distress increases the possibility of complications in these patients. The aims of the present study were to evaluate the impact of the emotional distress in the quality of life of individuals with diabetes, and to investigate the demographic and clinical characteristics associated with the emotional distress of living with diabetes in a Mexican population. Methods: a total of 422 Mexican individuals with type 2 diabetes were recruited from the outpatient Diabetes Clinic of the Hospital Regional de Alta Especialidad Dr. Gustavo A. Rovirosa of Villahermosa, Tabasco. Demographic and clinical characteristics along with quality of life (SF-36) were assessed in these individuals. The emotional distress of living with diabetes was measured using the 5-item Problem Areas in Diabetes. Patients were divided according to the presence of high or low distress. Results: we identified that 31.8% (n = 134) of patients presented high diabetes-related emotional distress. We observed that hepatic diseases as comorbidities (p = 0.008) and diagnosis of major depression (p = 0.04) are factors associated with the emotional distress of living with diabetes. These patients showed a reduced quality of life in all dimensions (p < 0.001); the most affected dimensions were physical role (d = 0.37) and general health (d = 0.89) showing lower scores in comparison with patients with low emotional distress. Conclusions: our results suggest that Mexican individuals with type 2 diabetes mellitus show high emotional distress living with the disease and have a decreased quality of life. Therefore, it is necessary to decrease factors associated with the high emotional distress of living with diabetes in patients with type 2 diabetes.

Contextual risk factors of depression and suicidal thoughts in Brazilian adults: a multilevel analysis.

OBJECTIVE: To evaluate the association between social and health contextual variables, and between major depressive episodes (MDE) and suicidal thoughts in Brazilian adults. METHODS: This population-based cross-sectional study used data from the 2013 National Health Survey (Pesquisa Nacional de Saúde). The Patient Health Questionnaire was used to evaluate the presence of MDE and suicidal thoughts. We used number of Family Health Strategy teams (FHS) per 20,000 state population, number of Psychosocial Care Centers (Centros de Atenção Psicossocial [CAPS]) per 1,000 state population, gross domestic product (GDP), and Gini index for each Brazilian state as contextual variables. Multilevel logistic regression models were used to calculate OR and the intraclass correlation coefficient (ICC). RESULTS: Prevalence of MDE and suicidal thoughts was 4.1% (95%CI 3.8-4.4) and 3.8% (95%CI 3.5-4.1), respectively. Multilevel regression models showed an ICC of 1.1% for MDE (95%CI 0.5-2.3) and 1.3% for suicidal thoughts (95%CI 0.6-2.6). Neither GDP, Gini, FHS, or CAPS showed evidence of association with the outcomes. CONCLUSIONS: In general, contextual variables, within each Brazilian state, do not seem to affect the prevalence of MDE and suicidal thoughts.

Sociodemographic, behavioral, and health-related risk factors for depression among men and women in a southern Brazilian city.

OBJECTIVE: To assess the prevalence of depression and sociodemographic, behavioral, and health-related risk factors therefor in a southern Brazilian city. METHODS: Population-based, cross-sectional study of adults from Rio Grande, state of Rio Grande do Sul, Brazil. Individuals (n=1,295) were selected using a multistage sampling procedure. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for major depressive episodes (MDEs). We used a conceptual causal framework to organize and assess risk factors for MDE and calculated prevalence ratios (PR) using regression models. RESULTS: The prevalence of MDE was 8.4% (95%CI 6.0-10.7) for men and 13.4% (95%CI 11.0-15.8) for women. For men, physical inactivity (PR 2.34, 95%CI 1.09-5.00) and perceived stress (PR 20.35, 95%CI 5.92-69.96) were associated with MDE. In women, MDE prevalence was higher among those in the first tertile of economic index (PR 2.61, 95%CI 1.53-4.45), with 0-8 years of schooling (PR 2.25, 95%CI 1.24-4.11), alcohol users (PR 1.91, 95%CI 1.21-3.02), those physically inactive (PR 2.49, 95%CI 1.22-5.09), with the highest perceived stress (PR 9.17, 95%CI 3.47-24.23), with another mental disorder (PR 1.85, 95%CI 1.32-2.59), and with more noncommunicable diseases (PR 1.85, 95%CI 1.06-3.22). CONCLUSION: Women had a higher prevalence of depression, and socioeconomic disadvantages were important for the occurrence of MDE; however, for men, only physical inactivity and stress were important predictors, suggesting possible different causal pathways for each sex.

Subsyndromal Manifestations of Depression in Children Predict the Development of Major Depression.

OBJECTIVE: To evaluate the utility of assessing subsyndromal symptoms of major depressive disorder in childhood, indexed through the Child Behavior Checklist (CBCL) anxiety/depression scale, in predicting risk of developing major depressive disorder in adolescent and young adult years. STUDY DESIGN: The sample consisted of 537 children, 6-17 years of age, originally ascertained for a longitudinal family genetic study of youth with and without attention-deficit hyperactivity disorder and their first-degree relatives who were followed prospectively and blindly for 10 years from childhood into young adult years. Children with full diagnosis major depressive disorder at baseline were excluded. For analysis, the sample was stratified into 4 groups based on the presence or absence of parental mood disorders and by the presence or absence of subsyndromal scores on the CBCL anxiety/depression scale at baseline assessment in childhood. RESULTS: Children of parents with mood disorders plus subsyndromal scores on the CBCL anxiety/depression scale at baseline (n = 22) had the highest risk for developing major depressive disorder and anxiety disorders at the 10-year follow-up when compared with the other groups. Children with either subsyndromal scores on the CBCL anxiety/depression scale at baseline alone (n = 22) or parental mood disorders alone (n = 172) had intermediate outcomes. CONCLUSION: The CBCL anxiety/depression scale was useful in identifying children at high risk for the development of major depressive disorder and anxiety disorders at the 10-year prospective follow-up. Furthermore, our results emphasized the importance of familial psychiatric history in youth with subthreshold symptoms of depression. Parental mood disorder and subthreshold anxiety/depressive symptoms were predictive of developing depression.

Childhood trauma and increased peripheral cytokines in young adults with major depressive: Population-based study.

OBJECTIVE: The aim of this study was to evaluate the effect of childhood trauma in cytokine serum levels of individuals with MDD. METHODS: This was a cross-sectional study population-based, with people aged 18 to 35. The Mini International Neuropsychiatric Interview (M.I.N.I) measured to current major depressive disorder (MDD). To evaluate traumatic experiences during childhood, the Childhood Trauma Questionnaire (CTQ) was applied. Serum TNF- α, IL-6 and IL-10 levels were measured by ELISA using a commercial kit. RESULTS: The total sample comprised 166 young adults, of these: 40.4% were subjects with MDD and childhood trauma and 59.6% were diagnosed with MDD without childhood trauma. In relation to serum interleukin levels, subjects with childhood trauma showed a significantly higher serum IL-6 (p = 0.013) and IL-10 levels (p = 0.022) to compare no childhood trauma. Subjects with childhood trauma was observed positive correlation between serum IL-6 and physical abuse (r = 0.232, p = 0.035) and emotional abuse (r = 0.460, p ≤ 0.001). Moreover, IL-10 were positive correlation with physical abuse (r = 0.258, p = 0.013). TNF- α was not associated with childhood trauma. CONCLUSION: Childhood maltreatment may result higher inflammation dysregulation in individuals with depression than individuals that no has childhood maltreatment.