First-time administration of the Sydney Melancholia Prototype Index (SMPI) to non-English-speaking patients: a study from Brazil.

OBJECTIVE: The Sydney Melancholia Prototype Index (SMPI) is a scale that uses a non-conventional strategy to assess melancholia status based on prototypic symptoms and illness course variables. This study aimed to evaluate the performance of the first translation of this instrument in a non-English-speaking population. METHODS: A sample comprising 106 Brazilian outpatients with depression was evaluated simultaneously with the Brazilian version of the self-rated SMPI (SMPI-SR) and clinician-rated SMPI (SMPI-CR). The kappa coefficient and t test were used to evaluate concurrent validity vs. DSM-IV, CORE system, Hamilton Depression Rating Scale-6 item (HAM-D6), and HAM-D17 assignments to a melancholic or non-melancholic class. The prevalence of melancholia as well as sensitivity and specificity were calculated across instruments. RESULTS: The prevalence of melancholia was highest using DSM-IV criteria (56.6%). The kappa agreement between SMPI-CR and DSM-IV melancholia assignment was moderate (kappa 0.44, p ≤ 0.001). SMPI-CR-assigned melancholic patients had significantly higher CORE, HAM-D17, and HAM-D6 scores. The test-retest consistency values for the SMPI were modest at best, and somewhat superior for the CR version. CONCLUSION: The Brazilian SMPI-CR presented satisfactory psychometric properties (which were superior to those of the SMPI-SR), and therefore appears to be a useful option for identifying melancholia and studying its causes and optimal treatments.

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients.

Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.

Sydney Melancholia Prototype Index (SMPI): translation and cross-cultural adaptation to Brazilian Portuguese.

INTRODUCTION: Depression is possibly not a single syndrome but rather comprises several subtypes. DSM-5 proposes a melancholia specifier with phenotypic characteristics that could be associated with clinical progression, biological markers or therapeutic response. The Sydney Melancholia Prototype Index (SMPI) is a prototypic scale aimed to improve the diagnosis of melancholia. So far, there is only an English version of the instrument available. The aim of this study is to describe the translation and adaptation of the English version of the SMPI into Brazilian Portuguese. METHODS: Translation and cross-cultural adaptation of the self-report (SMPI-SR) and clinician-rated (SMPI-CR) versions into Brazilian Portuguese were done following recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). This guideline includes the following steps: preparation, forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, debriefing results review, proofreading and final report. RESULTS: The Brazilian Portuguese versions of the SMPI were well-accepted by respondents. Changes in about two-thirds of the items were considered necessary to obtain the final Brazilian Portuguese version of the SMPI. CONCLUSIONS: Both versions of the SMPI are now available in Brazilian Portuguese. The instrument could become an important option to enhance studies on melancholia in Portuguese-speaking samples.

Sydney Melancholia Prototype Index (SMPI): translation and cross-cultural adaptation to Brazilian Portuguese

Abstract Introduction Depression is possibly not a single syndrome but rather comprises several subtypes. DSM-5 proposes a melancholia specifier with phenotypic characteristics that could be associated with clinical progression, biological markers or therapeutic response. The Sydney Melancholia Prototype Index (SMPI) is a prototypic scale aimed to improve the diagnosis of melancholia. So far, there is only an English version of the instrument available. The aim of this study is to describe the translation and adaptation of the English version of the SMPI into Brazilian Portuguese. Methods Translation and cross-cultural adaptation of the self-report (SMPI-SR) and clinician-rated (SMPI-CR) versions into Brazilian Portuguese were done following recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). This guideline includes the following steps: preparation, forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, debriefing results review, proofreading and final report. Results The Brazilian Portuguese versions of the SMPI were well-accepted by respondents. Changes in about two-thirds of the items were considered necessary to obtain the final Brazilian Portuguese version of the SMPI. Conclusions Both versions of the SMPI are now available in Brazilian Portuguese. The instrument could become an important option to enhance studies on melancholia in Portuguese-speaking samples.

Perceived barriers, benefits and correlates of physical activity in outpatients with Major Depressive Disorder: A study from Brazil.

OBJECTIVES: To evaluate the barriers, benefits and correlates of physical activity (PA) in outpatients with Major Depressive Disorder (MDD). METHODS: Data were collected from outpatients under treatment for MDD at Hospital de Clínicas de Porto Alegre. Barriers and benefits were assessed with the Exercise Barriers/Benefits Scale (EBBS). Objective and self-reported PA were assessed with pedometers and the International Physical Activity Questionnaire (IPAQ), respectively. RESULTS: The sample consisted of 65 outpatients (82% female; mean age = 50.9 years; SD = 10.1). Improvement in physical performance was the most reported benefit (mean = 3.00; SD = 0.3) while the most reported barrier was physical exertion (mean = 2.95; SD = 0.4). Depression symptom severity was negatively correlated with life enhancement (r = -0.337; p = 0.009), physical performance (r=-0.348; p = 0.007), psychological outlook (r=-0.364; p = 0.005), social interaction (r=-0.317; p = 0.015) and preventive health (r=-0.352; p = 0.007). CONCLUSION: Physical exertion is the most perceived barrier for PA in people with MDD. Symptom severity is associated with higher barrier levels, whilst higher current PA levels are associated with more benefits and lesser barriers. Interventions targeting PA promotion should consider the identified benefits and barriers when developing PA programs for people with MDD in outpatient settings.