La depresión atípica se asocia con el síndrome metabólico: una revisión sistemática / Atypical depression is associated with metabolic syndrome: a systematic review

Introducción: La depresión y el síndrome metabólico (SM)son problemas importantes de salud pública, esta revisiónsistemática evaluó si el subtipo atípico de depresión está asociadocon el SM, en comparación con otros subtipos depresivos.Metodología. Dos revisores independientes realizaronbúsquedas en las bases de datos de Medline, Lilacs, PsycInfo,Scopus y Web of Science, hasta mayo de 2021, sin restricciónde idioma, incluidos estudios transversales, de casos ycontroles y de cohortes, que evaluaban a adultos. La calidadmetodológica de los estudios se evaluó mediante la escalade Newcastle-Ottawa. Se adoptaron las directrices PRISMA yesta revisión tiene registró en PROSPERO (CRD42018109762).Resultados. La búsqueda en las bases de datos identificó96 artículos y 6 se incluyeron en esta revisión. Los puntajesde calidad metodológica variaron de 7 a 10 puntos. Laasociación entre depresión atípica y SM se demostró entodas las publicaciones, así como la falta de asociacióncon melancólico y otros subtipos. La prevalencia de SM fuesignificativamente mayor entre las personas con depresiónatípica. Vale la pena señalar que hasta el momento solo sehan realizado pocos estudios que evalúen esta comorbilidad.Conclusiones. SM se asocia con depresión atípica, perono con melancólico u otros subtipos. La identificación decaracterísticas clínicas depresivas distintas parece crucialpara comprender mejor su comorbilidad con SM y dilucidarsus vías fisiopatológicas, ambas necesarias para orientarmejor las estrategias de prevención y tratamiento. (AU)

Introduction: Depression and metabolic syndrome (MetS)are important public health problems. This systematic reviewevaluated whether the atypical subtype of depression isassociated with MetS, when compared to other depressivesubtypes.Methods. Two independent reviewers searched inMedline, Lilacs, PsycInfo, Scopus and Web of Sciencedatabases, up to May 2021, without language restriction,including cross-sectional, case-control, and cohort studies,assessing adults. The methodological quality of the studieswas assessed using the Newcastle-Ottawa Scale. The PRISMAguidelines were adopted and this review was registered inPROSPERO (CRD42018109762).Results. The databases search identified 96 articles and 6was included in this review. The methodological quality scoresranged from 7 to 10 points. The association between atypicaldepression and MetS was demonstrated in all publications,as well as the lack of association with melancholic and othersubtypes. The prevalence of MetS was significantly higheramong individuals with atypical depression. It is worthnoting that only few studies assessing this comorbidity wereconducted so far.Conclusions. MetS is associated with atypical depression,but not with melancholic or other subtypes. The identificationof distinct depressive clinical features seems crucial to betterunderstand its comorbidity with MetS and elucidate itspathophysiological pathways, both necessary to better guideprevention and treatment strategies. (AU)

COVID-19: depressão e consequências alimentares no distanciamento social / COVID-19: depression and eating consequences in the social distancing

O novo coronavírus (Sars-Cov-2) impôs novos desafios para a adoção e a manutenção de uma alimentação saudável que, na presença de transtornos mentais, como a depressão, poderão desempenhar um papel deletério na interação entre as necessidades impostas pela pandemia e a capacidade de adotar estratégias de enfrentamento adequadas, e na incorporação de medidas protetivas, como hábitos de vida saudáveis. Dentre a sintomatologia para diagnóstico de depressão incluem-se sintomas específicos que podem impactar diretamente hábitos de vida, como alteração de peso, apetite, mudanças no padrão habitual de sono, além de fadiga e redução da energia. Assim, o presente estudo tem como objetivo discursar sobre a relação entre depressão e consequências alimentares. No contexto atual a vigência de depressão impacta negativamente a saúde geral, a capacidade de autocuidado e a manutenção de estilos de vida saudáveis, e pode, ainda, amplificar as dificuldades de adaptação às demandas impostas pelo distanciamento social e pela necessidade de prevenção da disseminação e da infecção pelo Sars-Cov-2..(Au)

The new coronavirus (Sars-Cov-2) imposed new challenges for the adoption and maintenance of a healthy diet that in the presence of mental disorders, such as depression, may play a deleterious role in the interaction between the needs imposed by the pandemic and the ability to adopt appropriate coping strategies, and the incorporation of protective measures, such as healthy lifestyle habits. The diagnosis of depression includes specific symptoms that can directly impact lifestyle habits, such as changes in weight, apetite and in the usual sleep pattern, besides that fatigue and decresead energy. Thus, this study aimed to present the relationship between depression and eating consequences. In the current context, the presence of depression impacts negatively the general health, the ability to self-care and the maintenance of healthy lifestyles, and can also amplify the difficulties of adapting to the demands imposed due to social distancing and the need to prevent spread and infection by Sars-Cov-2..(Au)

Perceived helpfulness of treatment for posttraumatic stress disorder: Findings from the World Mental Health Surveys.

BACKGROUND: Perceived helpfulness of treatment is an important healthcare quality indicator in the era of patient-centered care. We examine probability and predictors of two key components of this indicator for posttraumatic stress disorder (PTSD). METHODS: Data come from World Mental Health surveys in 16 countries. Respondents who ever sought PTSD treatment (n = 779) were asked if treatment was ever helpful and, if so, the number of professionals they had to see to obtain helpful treatment. Patients whose treatment was never helpful were asked how many professionals they saw. Parallel survival models were estimated for obtaining helpful treatment in a specific encounter and persisting in help-seeking after earlier unhelpful encounters. RESULTS: Fifty seven percent of patients eventually received helpful treatment, but survival analysis suggests that it would have been 85.7% if all patients had persisted in help-seeking with up to six professionals after earlier unhelpful treatment. Survival analysis suggests that only 23.6% of patients would persist to that extent. Odds of ever receiving helpful treatment were positively associated with receiving treatment from a mental health professional, short delays in initiating help-seeking after onset, absence of prior comorbid anxiety disorders and childhood adversities, and initiating treatment before 2000. Some of these variables predicted helpfulness of specific treatment encounters and others predicted persistence after earlier unhelpful encounters. CONCLUSIONS: The great majority of patients with PTSD would receive treatment they considered helpful if they persisted in help-seeking after initial unhelpful encounters, but most patients whose initial treatment is unhelpful give up before receiving helpful treatment.

How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys.

Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.

Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey.

BACKGROUND: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. METHODS: Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. RESULTS: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. LIMITATIONS: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. CONCLUSIONS: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.