Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study.

OBJECTIVE: To evaluate the effect of psychotherapies on ego defense mechanisms and the reduction of depressive symptoms in a 12-month follow-up period. METHODS: This longitudinal and quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. Two models of psychotherapy were used: Supportive Expressive Dynamic Psychotherapy (SEDP) and Cognitive Behavioral Therapy (CBT). Defense Style Questionnaire 40 was used to analyze defense mechanisms and the Beck Depression Inventory was used to measure the depressive symptoms. RESULTS: The total sample comprised 195 patients (113 SEDP and 82 CBT), with the mean age was 35.63 (11.44) years. After adjustments, increased mature defenses was significantly associated with reduced depressive symptoms at all follow-up times (p < 0.001) and the decrease in immature defenses was significantly associated with the reduction of depressive symptoms at all follow-up times (p < 0.001). While neurotic defenses were not associated with a reduction in depressive symptoms at any time of follow-up (p > 0.05). CONCLUSION: Both models of psychotherapy were effective in increasing mature defenses and decreasing immature ones, as well as decreasing depressive symptoms at all evaluation times. With this, it is understood that a greater understanding of these interactions will allow a more adequate diagnostic and prognostic evaluation and the design of useful strategies that adapt to the patient's reality.

Comparison of Clinical Significance of Cognitive-Behavioral Therapy and Psychodynamic Therapy for Major Depressive Disorder: A Randomized Clinical Trial.

The aim of this study was to evaluate the effect of two brief psychotherapy models for major depressive disorder (MDD). This is a randomized clinical trial with 247 individuals diagnosed with MDD. Supportive-expressive dynamic psychotherapy (SEDP) (18 sessions) and cognitive-behavioral therapy (CBT) (16 sessions) were the two models used in this study. Participants were evaluated at baseline, during treatment, and postintervention (last session). Clinically significant changes were found in both psychotherapy models, and CBT showed higher response rates. Regarding the Beck Depression Inventory-II [F(1,120) = 4.07, p = 0.046] and Outcome Questionnaire 45.2 [F(1.114) = 7.99, p = 0.006], CBT had a better effect than SEDP. Hence, the results obtained have contributed to literature, served to corroborate the importance and effectiveness of psychodynamic psychotherapy, as well as explored the mechanisms of change, remission, and response in the treatment of MDD, which have been ignored to a large extent.

Pro-inflammatory cytokines and psychotherapy in depression: Results from a randomized clinical trial.

Depression is a serious condition that is associated with great psychic suffering and major impairments on the patient's general health, quality of life, and social and occupational activities. In some cases, it may lead to suicide. Regardless of the innumerous research works that have already addressed depression in wide and specific facets, there is still a lot to grasp in order to effectively help preventing and treating depression. This work presents data from a randomized clinical trial that sought to evaluate the effectiveness of two brief psychotherapeutic for Depression: Cognitive Behavioral Therapy (CBT) and Supportive-Expressive Dynamic Psychotherapy (SEDP). This was a convenience sample composed of 46 individuals that were evaluated using a structured diagnostic interview and then randomly allocated to the SEDP group. We examined baseline and post-intervention serum levels of the Interleukin-6 (IL-6) and the Tumor Necrosis Factor (TNF-α) in addition to the severity of depressive symptoms according to the Outcome Questionnaire - 45.2 (OQ-45.2) and the Beck Depression Inventory (BDI). Results show that serum IL-6 and TNF-α levels, as well as the scores from the OQ-45.2 and the BDI significantly decreased after 16 sessions of SEDP (p < 0.001), except for the Interpersonal Relationship domain from the OQ-45. Despite the reduction of serum cytokines levels and OQ-45 and BDI scores, they were only significantly correlated regarding the social role domain from the OQ-45. Nonetheless, our data suggests an effective role of brief psychodynamic psychotherapy in the reduction of depressive symptoms and serum inflammatory levels that are associated with depression.

Relationship between maternal depression as a risk factor for childhood trauma and mood disorders in young adults / Relação entre depressão materna como fator de risco para trauma na infância e transtornos de humor em jovens

Background Maternal depression may be a risk factor for childhood trauma (CT), with resultant offspring development of mood disorders (MD) in adult life. Objective To verify the relationship between maternal depression (as a risk factor for childhood trauma) and mood disorders in young adults. Methods The sample was composed of 164 young adults and their mothers. Maternal depression was identified through the Mini International Neuropsychiatric Interview (M.I.N.I.). Mood Disorders in the young adults were confirmed with the Structured Interview for the DSM-IV (SCID), whereas the CT was evaluated using the Childhood Trauma Questionnaire (CTQ). Results In the group of young adults with MD, individuals who had depressed mothers presented higher mean scores of CT in comparison to the ones who did not have mothers with Depression (p < 0.005). Childhood trauma was also associated with lower social classes (p < 0.005). In the group of young adults without MD, the only variable that was associated with CT was the young adult’s (not) current work (p < 0.005). Discussion Maternal depression was considered to be a risk factor for CT and MD in young adults. Thus, preventing and treating maternal psychiatric disorders may diminish the risk of offspring childhood trauma, and, consequently, avoid negative effects in the offspring’s adult life.

Contexto Depressão materna pode ser um fator de risco para trauma na infância (TI), com consequente desenvolvimento de transtornos de humor (TH) em seus filhos na vida adulta. Objetivo Verificar a relação entre depressão materna (como fator de risco para TI) e TH em jovens. Métodos A amostra foi composta de 164 jovens adultos e suas mães. A depressão materna foi identificada por meio do Mini International Neuropsychiatric Interview (M.I.N.I.). Transtornos de humor nos jovens foram confirmados pela entrevista estruturada para o DSM-IV (SCID), enquanto o TI foi avaliado pelo Questionário de Trauma na Infância (CTQ). Resultados No grupo de jovens com TH, indivíduos que tiveram mães deprimidas apresentaram escores médios de TI mais altos em comparação aos que não tinham mães com depressão (p < 0,05). Trauma na infância também esteve associado com classes sociais desfavorecidas (p < 0,05). No grupo de jovens sem TH, a única variável associada ao TI foi o (não) trabalho do jovem (p < 0,05). Conclusões A depressão materna foi considerada fator de risco para TI e TH nos jovens. Portanto, prevenir e tratar transtornos psiquiátricos maternos pode diminuir o risco de trauma infantil no filho e, por consequência, evitar efeitos negativos na vida adulta da prole.

Childhood trauma and suicide risk in a sample of young individuals aged 14-35 years in southern Brazil.

Suicide is among the main causes of death of people aged between 15 and 44 years old. Childhood trauma is an important risk factor for suicide. Hence, the objective of this study was to verify the relationship between childhood trauma and current suicide risk (suicidal behavior and ideation) in individuals aged 14-35 years, in the city of Pelotas, Brazil. This is a cross-sectional, population-based study. Sample selection was performed by clusters. Suicide risk was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Moreover, the participants responded to a questionnaire concerning socioeconomic status, work, and substance use. The sample was composed of 1,380 individuals. The prevalence of suicide risk was 11.5%. The prevalence figures of childhood trauma were 15.2% (emotional neglect), 13.5% (physical neglect), 7.6% (sexual abuse), 10.1% (physical abuse), and 13.8% (emotional abuse). Suicide risk was associated (p<.001) with gender, work, alcohol abuse, tobacco use, and all types of childhood trauma. The odds of suicide risk were higher in women (OR=1.8), people who were not currently working (OR=2.3), individuals who presented alcohol abuse (OR=2.6), and among tobacco smokers (OR=3.4). Moreover, suicide risk was increased in all types of trauma: emotional neglect (OR=3.7), physical neglect (OR=2.8), sexual abuse (OR=3.4), physical abuse (OR=3.1), and emotional abuse (OR=6.6). Thus, preventing early trauma may reduce suicide risk in young individuals.

Burden and related factors in caregivers of young adults presenting bipolar and unipolar mood disorder.

BACKGROUND: Caregiver burden has been associated with caregivers' mental disorders and need for support and information. However, the lack of quantitative studies and formal interventions aiming to lower burden levels in this population reflect the current negligence regarding this important issue. AIM: To identify burden levels and associated factors in caregivers of young adults with bipolar and unipolar mood disorder. METHOD: This is a cross-sectional study nested within a population-based cross-sectional study with young adults. Caregiver burden was assessed through the Burden Interview. Information about caregiver mental disorders (Axis I) and alcohol abuse were obtained through the Mini International Neuropsychiatric Interview (MINI) and the Cut-Down, Annoyed, Guilty and Eye-Opener (CAGE) questionnaire, respectively. RESULTS: Caregiver burden was associated to caregiver's mood and anxiety disorders, suicide risk and being the caregiver of young adults with depression disorder and bipolar disorder. Also, burden was higher among caregivers of bipolar individuals. When excluding the control group from the analysis, only mood and anxiety disorders remained associated to caregiver burden. CONCLUSIONS: Caregivers are affected by the young adult's disorder even before a diagnosis has been given, with serious impairments in their lives. Thus, this is a subject in need of designing relevant strategies aiming to provide them with care.