Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report.

BACKGROUND: Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS: Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS: Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS: Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.

Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys.

BACKGROUND: Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation. METHODS: Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months. RESULTS: 10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation. CONCLUSION: Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.

Fatores associados à depressão e ansiedade em nutricionistas na pandemia por COVID-19 / Factors associated with depression and anxiety in nutritionists in the COVID-19 pandemic

O objetivo foi investigar os fatores associados à depressão e/ou ansiedade em nutricionistas durante a pandemia por COVID-19. Estudo transversal com aplicação das escalas GAD-7 e PHQ-9. Dos 1.018 participantes 60,2% manifestaram rastreio positivo para depressão e/ou ansiedade, com maior força de associação para conflitos muito frequentes nas relações (OR = 11,11; IC95% 6,61;18,67), uso de medicação para dor (OR = 7,42; IC95% 4,67;11,79) e pensar sempre sobre a pandemia (OR = 6,5; IC95% 4,14;10,32). Não estar em tratamento psicoterápico (OR = 0,39; IC95% 0,27;0,560) e não estar em uso de medicamento psicotrópico (OR = 0,40; IC95% 0,26;0,60) foram associados a menores chances de rastreio positivo. O estudo resulta em conhecimento epidemiológico aplicável a ações de vigilância, prevenção e controle da ansiedade e depressão entre nutricionistas.

The objective was to investigate the factors associated with depression and/or anxiety and depression in nutritionists during the COVID-19 pandemic. Cross-sectional study with the application of the GAD-7 and PHQ-9 scales. 1,018 participated, of which 60.2% showed positive screening for depression and/or anxiety, with a greater strength of association for very frequent conflicts in relationships (OR = 11.11; 95%CI 6.61;18.67), use of pain medication (OR = 7.42; 95%CI 4.67;11.79) and always thinking about the pandemic (OR = 6.5; 95%CI 4.14;10.32). Not being under psychotherapeutic treatment (OR = 0.39; 95%CI 0.27;0.560) and not using psychotropic medication (OR = 0.40; 95%CI 0.26;0.60) were associated with lower odds of positive screening. This study results in epidemiological knowledge applicable to surveillance, prevention and control of anxiety and depression among nutritionists.

Prevalence and variability of depressive symptoms in Europe: update using representative data from the second and third waves of the European Health Interview Survey (EHIS-2 and EHIS-3).

BACKGROUND: Assessing the prevalence of clinically relevant depressive symptoms and their possible variation by country and over time could be a valuable resource to inform the development of public health policies and preventive resources to reduce mental health burden. We aimed to assess cross-national differences in the point prevalence of clinically relevant depressive symptoms in Europe in 2018-20, and to evaluate point prevalence differences between countries and over time between 2013-15 and 2018-20. METHODS: In this population-based study, data from participants in the second and third waves of the European Health Interview Survey (EHIS-2 from 2013 to 2015 and EHIS-3 from 2018 to 2020) from 30 European countries were used (n=542 580). From the total sample, 283 692 participants belonging to EHIS-3 were included in the study (52·4% women and 47·5% men). The non-response in EHIS-3 ranged by country, from 12% to 78%. Point prevalence of clinically relevant depressive symptoms was evaluated using a cutoff score of 10 or more for the 8-item version of the Patient Health Questionnaire. Crude prevalence ratios and adjusted prevalence ratios (aPRs) were obtained to assess differences in the prevalence between countries and over time within countries. FINDINGS: The point prevalence of clinically relevant depressive symptoms in Europe in 2018-20 was 6·54% (95% CI 6·34-6·73), ranging across countries from 1·85% (1·53-2·17) in Greece to 10·72% (10·04-11·40) in Sweden. Compared with the other European countries, those with the lowest aPRs were Greece, Serbia, and Cyprus and those with the highest aPRs were Belgium, Slovenia, and Croatia. A small but significant increase in the prevalence between EHIS-2 and EHIS-3 was observed (aPR 1·11 [1·07-1·14]). A wide variability over time in the point prevalence within countries was observed, ranging from an aPR of 0·63 (0·54-0·74) in Hungary to 1·88 (1·53-2·31) in Slovenia. INTERPRETATION: This study, based on large and representative datasets and a valid and reliable screening tool for the assessment of depression, indicates that the point prevalence of clinically relevant depressive symptoms in Europe from 2013 to 2020 remains relatively stable, with wide variability between countries. These findings could be considered a baseline for monitoring the prevalence of clinically relevant depressive symptoms in Europe, and could inform policy for the development of preventive strategies for depression both at a country and European level. FUNDING: Center for Biomedical Research in Epidemiology and Public Health Network and AGAUR.

The performance of K6 as a screening tool for mood disorders: A population-based study of the São Paulo metropolitan area.

AIM: The use of screening instruments allows the detection of psychological and behavioural manifestations there are often not identified in users of health services. We evaluated the performance of the Kessler Psychological Distress Scale (K6) in identifying mood disorders (MD), using the Composite International Diagnostic Interview (CIDI) as gold-standard, in a population-based sample (n = 5037) of adult residents of metropolitan São Paulo. METHODS: Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated to assess the performance of K6 in detecting 30-day CIDI MD. All cut-points for each disorder were analysed using the Youden index and the area under the receiver operating characteristic curve (AUC), and the best cut-points were identified. Cronbach's alpha was calculated to assess internal consistency. RESULTS: In total, 5.5% respondents screened positive for any MD (95% IC 4.84-6.14). A good detection performance was observed for all MD, with AUC values for any MD of 0.91 (95% IC 0.89-0.92), ranging from 0.80 (95% CI 0.71-0.98) for minor depression to 0.93 (95% CI 0.87-0.98) for bipolar I disorder. Best cut-points for each MD were identified, with overall sensitivity and specificity of 88.8% and 80.2%, respectively. Cronbach's alpha was 0.83. CONCLUSIONS: K6 is a good screening tool for MD in the Brazilian population. It is a brief and easy to use instrument that can promote the early identification and treatment of MD, reducing the burden of mental illness.

Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil.

BACKGROUND: Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. METHODS: A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. RESULTS: Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). CONCLUSIONS: This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.

Potentially inappropriate medications and cognitive performance: cross-sectional results from the ELSA-Brasil study.

OBJECTIVES: Potentially inappropriate medications (PIM), especially those with potential effects on the central nervous system, can increase the risk of cognitive impairment. We investigated the association of the use of PIM and PIM that may impair cognition (PIM-Cog) with cognitive performance among older adults. METHODS: In this cross-sectional study with 2,626 participants, PIM and PIM-Cog were defined by the 2019 American Geriatrics Society Beers criteria. We calculated global cognition and memory, verbal fluency, and Trail Making Test B version (TMT-B) z-scores. Linear regression models adjusted for sociodemographic and clinical variables were used to investigate the association between PIM and cognition. RESULTS: 27% and 7% of the sample (mean age = 65.1 ± 4.1 years old, 54% women, and 61% White) used at least one PIM and PIM-cog, respectively. PIM was associated with poor performance in the TMT-B (ß = -0.17, 95% Cl = -0.29; -0.05, p = 0.007). PIM-Cog was also associated with poor TMT-B performance (ß = -0.08, 95% Cl = -0.15; -0.01, p = 0.025). CONCLUSION: The use of PIM and PIM-Cog was associated with poor executive function among older adults. The review of PIM use and the deprescription of these drugs may be an effective way to improve cognitive function.

Prevalence of depressive symptoms and its association with social support among older adults: The Brazilian National Health Survey.

BACKGROUND: The study aimed to assess the association between depressive symptoms and social support measures among non-institutionalized Brazilian older adults. METHODS: A cross-sectional study was carried out with data from the last National Health Survey, conducted in 2019. A descriptive analysis of the study variables was performed, followed by a multiple regression analysis to teste the association between the dependent variable (depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9) and independent variables (household arrangement, marital relationship, leisure activities, voluntary activity, religious activity, activities in associations/leaderships, work and receiving social support (friends and family). RESULTS: The sample comprised 22,723 older adults and 13.1 % had depressive symptoms. There was a positive relationship between the number of people in the household and the prevalence of depressive symptoms. Individuals with support from family members only (PR 0.69; 95 % CI 0.51; 0.92) and those with support from family and friends (PR 0.53 95 % CI 0.40; 0.70) had a lower prevalence of depressive symptoms than those without support. Participation in leisure and religious activities was inversely associated with depressive symptoms. A negative association was found between work and the presence of depressive symptoms (PR 0.83; 95 % CI 0.70; 0.99). LIMITATIONS: The cross-sectional design limits causal inferences and the survey did not include institutionalized individuals. CONCLUSIONS: The lower prevalence of the outcome among older adults with social support highlights the importance of evaluating these measures and practicing activities that allow personal and social interactions among this age group.

Instrumentos de rastreio e diagnóstico de transtornos depressivos utilizados na atenção primária: uma revisão integrativa / Screening and diagnostic tools for depressive disorders used in primary care: an integrative review / Instrumentos de rastreo y diagnóstico de trastornos depresivos utilizados en atención primaria: una revisión integradora

Introdução: A prevalência de transtornos depressivos na população em geral é significativa, e a Atenção Primária à Saúde (APS) desempenha um papel crucial na abordagem dessas questões. A implementação de instrumentos de rastreamento e diagnóstico desses transtornos na APS é uma das estratégias propostas para aprimorar a qualidade do atendimento. No entanto, há uma lacuna de conhecimento em relação à eficácia dessas abordagens. Objetivo: Identificar os instrumentos de rastreamento e entrevistas diagnósticas mais empregados em pesquisas envolvendo pacientes que procuram assistência em serviços de APS devido a sintomas depressivos. Métodos: Este estudo constitui uma revisão integrativa da literatura, que abordou as bases de dados LILACS e MEDLINE no período compreendido entre outubro e dezembro de 2020. A seleção dos artigos incorporou pesquisas realizadas na APS, as quais empregaram um ou mais instrumentos para rastreamento e/ou diagnóstico de transtornos depressivos. A análise dos títulos, resumos e textos completos foi realizada por pelo menos dois pesquisadores, que extraíram os dados por meio de uma planilha padronizada. Os resultados são apresentados de forma descritiva e narrativa. Resultados: Após a aplicação dos critérios de elegibilidade, foram selecionados 413 artigos. Foram identificados 22 instrumentos empregados no rastreamento e diagnóstico da depressão em estudos realizados na APS. O instrumento de rastreamento mais mencionado é o Patient Health Questionnaire e a entrevista diagnóstica mais utilizada foi a Mini International Neuropsychiatric Interview. Predominam os estudos publicados após 2011, realizados na Europa, com população adulta não idosa, visando identificar a prevalência de depressão em diferentes grupos sociais. A maioria dos estudos utilizou instrumentos longos, com critérios analíticos complexos, sem validação e/ou adaptação para a APS, além de apresentarem restrições quanto aos problemas de saúde analisados, tornando-os limitados para uso geral na APS. Conclusões: O emprego de instrumentos de rastreamento e diagnóstico para depressão na APS pode representar uma estratégia relevante para aprimorar os cuidados oferecidos a essa população. Contudo, é crucial conduzir pesquisas adicionais a fim de analisar tanto os benefícios quanto as potenciais desvantagens dessa abordagem. Além disso, é imperativo um esforço mais substancial na seleção criteriosa dos instrumentos mais adequados para aplicação.

Introduction: The prevalence of depressive disorders in the general population is high, and primary health care (PHC) is essential in dealing with these issues. The introduction of screening and diagnostic tools for these disorders in PHC is one of the suggested strategies to enhance the quality of care. Nevertheless, there is limited understanding regarding their effectiveness. Objective: To identify the screening instruments and diagnostic interviews that have been widely used in studies involving users with depressive symptoms seeking help at PHC. Methods: This was an integrative literature review. For the period from October to December 2020, searches were conducted in the LILACS and MEDLINE databases. Research articles carried out in PHC that utilized one or more screening and/or diagnostic instruments for depressive disorders were included. At least two researchers analyzed titles, abstracts, and full texts, extracting data using a standardized spreadsheet. The results were presented in a descriptive and narrative manner. Results: After using eligibility criteria, 413 articles were selected. There were 22 screening instruments used for screening and diagnosis of depression in studies carried out in PHC. The most cited screening instrument was the Patient Health Questionnaire, and the most used diagnostic interview was the Mini International Neuropsychiatric Interview. Studies published after 2011, carried out in Europe, with a non-elderly adult population and with the purpose of identifying the prevalence of depression in different social groups predominated. Most studies used long instruments, with complex analytical criteria, without validation/adaptation for PHC, and with restrictions on the analyzed health problems, making them limited for general use in PHC. Conclusions: The use of screening and diagnostic instruments for depression in PHC can be a relevant strategy to improve the care provided to this population. Nevertheless, additional research is required to analyze the benefits and harms of this approach, as well as a greater effort to select the best instruments to be used.

Introducción: La prevalencia de los trastornos depresivos en la población general es alta y la Atención Primaria de Salud (APS) ocupa una posición central en el abordaje de estos problemas. La introducción de instrumentos para el rastreo y diagnóstico de estos trastornos en la APS es una de las estrategias sugeridas para mejorar la calidad de la atención pero poco se sabe sobre su eficacia. Objetivo: Identificar los instrumentos de rastreo y entrevistas diagnósticas que más han sido utilizados en estudios con usuarios que buscan atención en los servicios de APS con síntomas depresivos. Métodos: Esta es una revisión integradora de la literatura, se realizaron búsquedas en las bases de datos LILACS y MEDLINE de octubre a diciembre de 2020. Se incluyeron artículos de investigación realizados en la APS y que utilizaron uno o más instrumentos para el rastreo y/o diagnóstico de los trastornos depresivos. Al menos dos investigadores analizaron títulos, resúmenes y textos completos, extrayendo datos mediante una hoja de cálculo estandarizada. Los resultados se presentan de forma descriptiva y narrativa. Resultados: Después de aplicar los criterios de elegibilidad, se seleccionaron 413 artículos, fueron descritos 22 instrumentos utilizados en el rastreo y diagnóstico de la depresión en estudios realizados en APS. El instrumento de rastreo más utilizado fue el Cuestionario de Salud del Paciente y la entrevista diagnóstica más utilizada fue la Mini Entrevista Neuropsiquiátrica Internacional. Predominan los estudios publicados después de 2011, realizados en Europa, con población adulta no anciana con el propósito de identificar la prevalencia de depresión en diferentes grupos sociales. La mayoría de los estudios utilizaron instrumentos extensos, con criterios analíticos complejos, sin validación y/o adaptación para la APS, y con restricciones sobre los problemas de salud analizados, limitándolos para uso general en la APS. Conclusiones: El uso de instrumentos de rastreo y diagnóstico de depresión en la APS puede ser una estrategia relevante para mejorar la atención brindada a esta población. Sin embargo, se necesitan más estudios para analizar los beneficios y dificultades de esta estrategia, así como un mayor esfuerzo para seleccionar los mejores instrumentos a utilizar.

A pandemic toll in frail older adults: Higher odds of incident and persistent common mental disorders in the ELSA-Brasil COVID-19 mental health cohort.

INTRODUCTION: We aimed to investigate the association of frailty with persistent and incident common mental disorders (CMD) in older adults during the pandemic. METHODS: We included 706 older adults who participated in the onsite wave of the ELSA-Brasil study (2017-2019) and the online COVID-19 assessment (May-July 2020). CMD were assessed in both waves by the Clinical Interview Schedule-Revised. Frailty was defined according to the physical phenotype and Frailty Index in the 2017-2019 wave. Logistic regression was used to investigate the association of frailty with persistent and incident CMD, adjusted for sociodemographics. RESULTS: Frailty according to both definitions were associated with persistent CMD (Frailty Index: OR = 8.61, 95 % CI = 4.08-18.18; physical phenotype: OR = OR = 23.67, 95 % CI = 7.08-79.15), and incident CMD (Frailty Index: OR = 2.79, 95 % CI = 1.15-6.78; physical phenotype OR = 4.37, 95 % CI = 1.31-14.58). The exclusion of exhaustion (that overlaps with psychiatric symptoms) from the frailty constructs did not change the association between frailty and persistent CMD, although the associations with indent CMD were no longer significant. LIMITATIONS: Fluctuations in CMD status were not captured between both assessments. CONCLUSION: Frailty status before the COVID-19 outbreak was associated with higher odds of persistent and incident CMD in older adults during the pandemic first wave. Identifying individuals at higher risk of mental burden can help prioritize resources allocation and management.

Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 mental health cohort.

BACKGROUND: There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the coronavirus disease 2019 (COVID-19) pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA-Brasil) São Paulo Research Center. METHODS: Between pre-pandemic ELSA-Brasil assessments in 2008-2010 (wave-1), 2012-2014 (wave-2), 2016-2018 (wave-3) and three pandemic assessments in 2020 (COVID-19 waves in May-July, July-September, and October-December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders (CMDs) were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders. RESULTS: In 2117 participants (mean age 62.3 years, 58.2% females), rates of CMDs and depressive disorders did not significantly change over time, oscillating from 23.5% to 21.1%, and 3.3% to 2.8%, respectively; whereas rate of anxiety disorders significantly decreased (2008-2010: 13.8%; 2016-2018: 9.8%; 2020: 8%). There was a decrease along three wave-COVID assessments for depression [ß = -0.37, 99.5% confidence interval (CI) -0.50 to -0.23], anxiety (ß = -0.37, 99.5% CI -0.48 to -0.26), and stress (ß = -0.48, 99.5% CI -0.64 to -0.33) symptoms (all ps < 0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk. CONCLUSION: No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.

Depression is a risk factor for metabolic syndrome: Results from the ELSA-Brasil cohort study.

INTRODUCTION: Metabolic Syndrome (MetS) and depression comorbidity has been recognized, but its directionality is still uncertain. The aims of this study was to assess the association between depression (diagnosis and severity) and MetS (components, diagnosis and trajectory) in the baseline and over a 4-year follow-up period. MATERIAL AND METHODS: Baseline and follow-up data from 13,883 participants of the Brazilian Longitudinal Study of Adult Health were analyzed. The Clinical Interview Schedule Revised assessed depressive episode and its severity. MetS components and diagnosis were assessed according to the National Cholesterol Education Program Adult Treatment Panel III. Participants were grouped according to MetS trajectory as recovered, incident and persistent MetS. Logistic regression analysis was conducted estimating odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Baseline depression was positively associated with recovered (OR = 1.59, 95%CI 1.18-2.14), incident (OR = 1.45, 95%CI 1.09-1.91) and persistent (OR = 1.70, 95%CI 1.39-2.07) MetS. Baseline depression was also associated with large waist circumference (OR = 1.47, 95%CI 1.23-1.75), high triglycerides (OR = 1.23, 95%CI 1.02-1.49), low high-density lipoprotein cholesterol (OR = 1.30, 95%CI 1.08-1.56), and hyperglycemia (OR = 1.38, 95%CI 1.15-1.66) at follow-up. Having three or more MetS components at follow-up was associated with baseline depression, with a positive dose-response effect (OR = 1.77, 95%CI 1.29-2.43; OR = 1.79, 95%CI 1.26-2.54; OR = 2.27, 95%CI 1.50-3.46, respectively). The magnitude of associations was greater in severe depression, when compared to moderate and mild. DISCUSSION: These results support that depression is a risk factor for the development of MetS and highlights the need to follow metabolic and cardiovascular alterations in the presence of depression.

Correlates and prevalence of post-traumatic stress disorders in the São Paulo metropolitan area, Brazil.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors. METHODS: Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas. RESULTS: Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to "interpersonal violence" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38). CONCLUSION: Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.

Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort.

AIM: Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories. METHODS: We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories. RESULTS: Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life. LIMITATIONS: Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative. CONCLUSION: More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.

The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys.

AIM: Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time. METHODS: Data come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: "exposure to organised violence"; "participation in organised violence"; "interpersonal violence"; "sexual-relationship violence"; "other life-threatening events"; and those involving loved ones ("network traumas"). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset. RESULTS: Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years. CONCLUSION: Sexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.

Consumption of Omega-3 and Maintenance and Incidence of Depressive Episodes: The ELSA-Brasil Study.

Depression affects 264 million persons in the world, accounting for some 4.3% of the global burden of disease. Current studies indicate that the decrease in the consumption of omega-3 food sources is associated with the increasing incidence of depression. The study aims to assess the association between the consumption of omega-3 and the maintenance and incidence of depressive episodes in adults (39−64 years) and elderly adults (>65 years). This was a longitudinal study using data from the baseline and first follow-up wave of the Longitudinal Study of Adult Health (ELSA-Brasil). Depressive episodes were obtained with the Clinical Interview Schedule Revised (CIS-R), and food consumption was measured with the Food Frequency Questionnaire (FFQ). Logistic regression was used to analyze associations between the consumption of omega-3 and depressive episodes. Fatty acids from the omega-3 family showed a protective effect against the maintenance of depressive episodes. In relation to incidence, the estimates suggest that the higher the consumption of omega-3 acids, the lower the risk of developing depressive episodes, and significant associations were found between the consumption of omega-3 and alpha-linolenic acid. Dietary consumption of omega-3, DHA, EPA, DPA, and alpha linolenic fatty acids may have a protective effect against the maintenance and incidence of depressive episodes.

Prevalence of self-reported depression in Brazil: National Health Survey 2019 and 2013. / Prevalência de depressão autorreferida no Brasil: Pesquisa Nacional de Saúde 2019 e 2013.

OBJECTIVE: To describe the prevalence of self-reported depression among Brazilian adults in the 2019 National Health Survey (PNS) and compare to the 2013 PNS. METHODS: Cross-sectional study of Brazilian adults using data from the 2019 and 2013 PNS. Prevalence and 95% confidence intervals (95%CI) of self-reported depression were estimated by region and demographic characteristics. Bivariate analyses were conducted using chi-squared tests. RESULTS: There were 90,846 participants aged ≥ 18 years in 2019, and 60,202 in 2013. Between 2013 and 2019, prevalence of self-reported depression increased from 7.6% (95%CI 7.2;8.1) to 10.2% (95%CI 9.9;10.6) and of individuals who sought healthcare, from 46.4% (95%CI 43.8;49.1) to 52.8% (95%CI 50.7;55.0). Private clinics were the main source of healthcare. CONCLUSION: Depression is highly prevalent in Brazil. Prevalence of diagnosis of depression and use of health services increased in the studied period. The predominance of care in private clinics suggests inequalities in the improvement of mental healthcare coverage.

Anticholinergic burden and cognitive performance: cross-sectional results from the ELSA-Brasil study.

OBJECTIVES: Using multiple drugs with anticholinergic properties is common and might lead to cumulative anticholinergic toxicity and increased risk of cognitive impairment. Therefore, we sought to investigate the association between the Anticholinergic Cognitive Burden (ACB) Scale and cognitive performance among middle-aged and older adults. METHODS: In this cross-sectional study with 13,065 participants from the baseline visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), mean age was 51.7 ± 9.0 years old, 55% women, and 53% white. The ACB was calculated based on the medications in use. We investigated the association of ACB with global cognition and memory, verbal fluency (VF), and trail-making test version B (TMT-B) z-scores, using multiple linear regression models adjusted for sociodemographic and clinical variables. RESULTS: Overall, 16% of participants had an ACB score greater than 0. ACB was associated with poor cognitive performance in all tests in crude analysis. After adjustment for sociodemographic characteristics, the association remained significant for the global cognitive score, as well as the memory and the TMT-B z-scores. However, after further adjustments for clinical variables, only trend associations of ACB with poor memory (ß = - 0.02, 95% Cl = - 0.05, 0.00, p = 0.056) and the TMT-B z-scores (ß = - 0.02, 95% Cl = - 0.04, 0.00, p = 0.054) were found. In stratified analyses by age groups, ACB was associated with poor cognitive performance on the TMT-B (ß = - 0.03, 95% Cl = - 0.05, - 0.01, p = 0.005) in individuals aged less than 65 years old. CONCLUSION: Although the ACB was associated with poor executive function only among middle-aged adults in adjusted analysis, residual confounding may partly explain our results.

Retest effects in a diverse sample: sociodemographic predictors and possible correction approaches.

Repeated cognitive assessment in longitudinal studies favors the occurrence of retest effects, usually increasing the scores obtained at the follow-up assessments when compared to baseline. Therefore, retest effects can compromise the evaluation of cognitive decline in older adults. Objectives: We aimed to verify the occurrence of the retest effect and the impact of sociodemographic characteristics on the follow-up scores in a sample of 5,592 participants with a diverse sociodemographic profile, who were assessed twice during 4 years of follow-up. Methods: We tested two possible approaches to correct the retest effect and calculated the Reliable Change Index. Results: We observed increased scores at the follow-up assessment after 4 years, but the results indicate a modest occurrence of retest effects. The regression difference correction successfully generated follow-up corrected scores, while the mean difference did not provide effective corrections. Sociodemographic characteristics had a minor impact on the retest. Conclusions: We recommend the regression difference correction for retest effects. The absence of this methodological approach might lead to biased results using longitudinal cognitive scores.

Avaliações cognitivas repetidas em estudos longitudinais favorecem a ocorrência de efeitos de retestagem ou de prática, geralmente aumentando os escores obtidos nas avaliações de acompanhamento quando comparados aos da primeira avaliação. Sendo assim, os efeitos do retestagem podem comprometer a verificação do declínio cognitivo em idosos. Objetivos: Objetivamos verificar a ocorrência do efeito de prática e o impacto das características sociodemográficas nos escores de seguimento em uma amostra de 5.592 participantes com perfil sociodemográfico diverso, avaliada duas vezes durante quatro anos de seguimento. Métodos: Testamos duas abordagens possíveis para corrigir o efeito de prática e calculamos o índice de mudança confiável. Resultados: Observamos escores sutilmente maiores na avaliação de seguimento após quatro anos, o que sugere a ocorrência de efeitos de retestagem. A correção pela diferença da regressão gerou escores corrigidos de acompanhamento satisfatórios, enquanto a correção pela diferença média não forneceu correções eficazes. As características sociodemográficas tiveram impacto mínimo no efeito de prática. Conclusões: Recomendamos a forma de correção pela diferença da regressão para efeitos de retestagem. A ausência dessa abordagem metodológica, quando utilizamos escores cognitivos longitudinais, pode levar a resultados enviesados.