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1.
Cochrane Database Syst Rev ; 10: CD011589, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637526

RESUMO

BACKGROUND: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback  on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES: To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS: Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS: We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS: PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether   many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.

2.
Int J Ment Health Addict ; : 1-11, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34602912

RESUMO

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

3.
J Affect Disord ; 296: 198-207, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34610514

RESUMO

BACKGROUND: We estimate work loss and economic costs due to mental and substance use disorders in the economically active population of the São Paulo Metropolitan Area, Brazil. METHODS: The São Paulo Megacity Mental Health Survey assessed a population-based sample of 3,007 economically active residents using the Composite International Diagnostic Interview 3.0 and the World Health Organization Disability Assessment Schedule 2 to investigate, respectively, 12-month psychiatric disorders, work performance, and economic costs. RESULTS: Absenteeism over the past 12 months was reported by 12.6%, and presenteeism by 14.7% (qualitative loss) and 13.1% (quantitative loss). Having any mental disorder was associated with 17.6 days of absenteeism and 37.7 days of reduced-qualitative and/or quantitative functioning. Fourteen mental disorders were significantly associated with work loss, with odds ratios ranging from 2.3 for adult separation anxiety to 40.4 for oppositional defiant disorder. At a population-level, oppositional defiant disorder, panic disorder, attention deficit disorder, and dysthymia contributed to the largest costs. The total annual economic costs were USD $83.2 billion/year, representing 6.1% of Brazil's Gross Domestic Product in 2007. LIMITATIONS: Diagnosis of mental disorders was based on self-reported symptoms. Work loss assessment was restricted to 30 days before the interview and may not fully represents the annual real experience and symptoms of the respondents which would lead to an overestimation of the burden. CONCLUSIONS: Mental disorders impose a great negative impact on work performance and functioning, with a consequent high economic burden, pointing to the need of implementing cost-effective interventions to prevent work loss.

4.
J Affect Disord ; 295: 578-586, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34509073

RESUMO

BACKGROUND: To determine the incidence of Treatment-Resistant Depression (TRD) in Spain and to estimate its economic burden, using real world data. METHODS: A retrospective, observational-study was carried out using data from the BIG-PAC database®. Patients aged ≥18 years with a diagnosis of major depressive-disorder (MDD) who initiated a new antidepressant treatment in 2015-2017 were included. The patients were classified as TRD and non-TRD. Patients were classified as TRD if they had, during the first year of antidepressant treatment: a) failure with ≥2 antidepressants including the prescription of ≥3 antidepressants (N06A) or ≥2 antidepressant and ≥1 antipsychotic (N05A; including lithium) b) antidepressants administered for ≥ 4 weeks each, and c) the time between the end of one treatment and the initiation of the next was ≤ 90 days. Inherent limitations of data collection from databases should also be considered in this analysis (e.g., lack of information about adherence to treatment). Follow-up period: 18 months. The incidence rate was calculated as the number of TRD patients per 1,000 persons-year divided by the population attended. OUTCOMES: direct healthcare and indirect costs. Two sensitivity analyses were performed varying the index date and the period used to define TRD patients (6 vs.12 months). RESULTS: 21,630 patients with MDD aged ≥ 18 years (mean age: 53.2 years; female: 67.2%) were analyzed, of whom 3,559 met TRD criteria, yielding a 3-year cumulative incidence of 16.5% (95%CI: 16%-17%) among MDD patients. The annual population incidence rate of TRD in 2015-2017, was 0.59, 1.02 and 1.18/1,000 person-years, respectively (mean: 0.93/1,000 person-year). Overall, mean total costs per MDD patient were €4,147.9, being higher for TRD than for non-TRD patients (€6,096 vs. €3,846; p<0.001): a) direct costs (€1,341 vs. €624; p<0.001), b) lost productivity (€1,274 vs. €821; p<0.001) and c) permanent disability (€3,481 vs. €2,401; p<0.001, adjusted). Sensitivity analyses showed no differences with the reported results. CONCLUSIONS: The population based TRD incidence in Spain was similar to recent data from other European countries. TRD is associated with greater resource use and higher costs compared with non-TRD patients.

5.
Health Qual Life Outcomes ; 19(1): 189, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332613

RESUMO

INTRODUCTION: The Diabetes Health Profile (DHP-18), structured in three dimensions (psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE)), assesses the psychological and behavioural burden of living with type 2 diabetes. The objectives were to adapt the DHP-18 linguistically and culturally for use with patients with type 2 DM in Ecuador, and to evaluate its psychometric properties. METHODS: Participants were recruited using purposive sampling through patient clubs at primary health centres in Quito, Ecuador. The DHP-18 validation consisted in the linguistic validation made by two Ecuadorian doctors and eight patient interviews. And in the psychometric validation, where participants provided clinical and sociodemographic data and responded to the SF-12v2 health survey and the linguistically and culturally adapted version of the DHP-18. The original measurement model was evaluated with confirmatory factor analysis (CFA). Reliability was assessed through internal consistency using Cronbach's alpha and test-retest reproducibility by administering DHP-18 in a random subgroup of the participants two weeks after (n = 75) using intraclass correlation coefficient (ICC). Convergent validity was assessed by establishing previous hypotheses of the expected correlations with the SF12v2 using Spearman's coefficient. RESULTS: Firstly, the DHP-18 was linguistically and culturally adapted. Secondly, in the psychometric validation, we included 146 participants, 58.2% female, the mean age was 56.8 and 31% had diabetes complications. The CFA indicated a good fit to the original three factor model (χ2 (132) = 162.738, p < 0.001; CFI = 0.990; TLI = 0.989; SRMR = 0.086 and RMSEA = 0.040. The BA dimension showed the lowest standardized factorial loads (λ) (ranging from 0.21 to 0.77), while λ ranged from 0.57 to 0.89 and from 0.46 to 0.73, for the PD and DE dimensions respectively. Cronbach's alphas were 0.81, 0.63 and 0.74 and ICCs 0.70, 0.57 and 0.62 for PD, BA and DE, respectively. Regarding convergent validity, we observed weaker correlations than expected between DHP-18 dimensions and SF-12v2 dimensions (r > -0.40 in two of three hypotheses). CONCLUSIONS: The original three factor model showed good fit to the data. Although reliability parameters were adequate for PD and DE dimensions, the BA presented lower internal consistency and future analysis should verify the applicability and cultural equivalence of some of the items of this dimension to Ecuador.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Equador , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Psicometria , Reprodutibilidade dos Testes
6.
Artigo em Inglês | MEDLINE | ID: mdl-34424350

RESUMO

PURPOSE: To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students. METHODS: Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency. RESULTS: Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs. CONCLUSION: Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB.

7.
BMC Psychiatry ; 21(1): 392, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372811

RESUMO

BACKGROUND: Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. METHODS: Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. RESULTS: The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. CONCLUSIONS: The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.


Assuntos
Transtornos de Ansiedade , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Inquéritos Epidemiológicos , Humanos , Prevalência , Inquéritos e Questionários
8.
Curr Psychol ; : 1-12, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34429573

RESUMO

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

10.
Artigo em Inglês | MEDLINE | ID: mdl-34068945

RESUMO

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.


Assuntos
Alcoolismo , Alcoolismo/diagnóstico , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Estudantes , Inquéritos e Questionários , Universidades
11.
Psychol Med ; : 1-12, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34140062

RESUMO

BACKGROUND: Although non-suicidal self-injury (NSSI) is an issue of major concern to colleges worldwide, we lack detailed information about the epidemiology of NSSI among college students. The objectives of this study were to present the first cross-national data on the prevalence of NSSI and NSSI disorder among first-year college students and its association with mental disorders. METHODS: Data come from a survey of the entering class in 24 colleges across nine countries participating in the World Mental Health International College Student (WMH-ICS) initiative assessed in web-based self-report surveys (20 842 first-year students). Using retrospective age-of-onset reports, we investigated time-ordered associations between NSSI and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) mood (major depressive and bipolar disorder), anxiety (generalized anxiety and panic disorder), and substance use disorders (alcohol and drug use disorder). RESULTS: NSSI lifetime and 12-month prevalence were 17.7% and 8.4%. A positive screen of 12-month DSM-5 NSSI disorder was 2.3%. Of those with lifetime NSSI, 59.6% met the criteria for at least one mental disorder. Temporally primary lifetime mental disorders predicted subsequent onset of NSSI [median odds ratio (OR) 2.4], but these primary lifetime disorders did not consistently predict 12-month NSSI among respondents with lifetime NSSI. Conversely, even after controlling for pre-existing mental disorders, NSSI consistently predicted later onset of mental disorders (median OR 1.8) as well as 12-month persistence of mental disorders among students with a generalized anxiety disorder (OR 1.6) and bipolar disorder (OR 4.6). CONCLUSIONS: NSSI is common among first-year college students and is a behavioral marker of various common mental disorders.

12.
J Affect Disord ; 293: 71-72, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34174473

RESUMO

Suicide is a major public health problem worldwide and continues to be one of the main causes of death. Implementing surveillance strategies for suicidal thoughts and behaviours would make it possible to identify individuals at high risk of ending their lives by suicide. While a universal screening would be controversial, the increasing use of the 9-item version of the Patient Health Questionnaire (PHQ-9) in different healthcare settings, such as primary care or hospital emergency departments, offers an opportunity for testing its performance for suicide surveillance. Beyond being a screening of depression, the PHQ-9 has shown merit as a marker of suicidal thinking, thoughts of self-harm, and suicide. Implementing systematic surveillance strategies for suicide in different healthcare settings including data from the PHQ-9 might be an effective way to improve case detection. This could help to enhance the identification of highest risk population groups and, consequently, to avoid potentially preventable suicides.


Assuntos
Comportamento Autodestrutivo , Suicídio , Humanos , Programas de Rastreamento , Questionário de Saúde do Paciente , Ideação Suicida , Suicídio/prevenção & controle
13.
Artigo em Inglês | MEDLINE | ID: mdl-34127211

RESUMO

INTRODUCTION: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.


Assuntos
COVID-19 , Pessoal de Saúde , Transtornos Mentais/epidemiologia , Saúde Mental , Doenças Profissionais/epidemiologia , Adolescente , Adulto , COVID-19/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Prevalência , Espanha/epidemiologia , Adulto Jovem
15.
J Psychiatr Res ; 140: 329-336, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34126428

RESUMO

We examined the manifestation of major depressive disorder, generalized anxiety disorder, substance use disorder, post-traumatic stress disorder, and panic attacks among health care professionals during the first COVID-19 wave (n = 6409) by means of mental disorder screening instruments. Logistic regressions were used to gauge individual risk factors; population attributable risk proportions (PARP) were inferred to identify the most important risk factors at the societal level. Data were weighted to represent general profiles of Belgian health care professionals. Lifetime, pre-pandemic emotional problems and work-related factors during the first wave of COVID-19 were strongly associated (mean adjusted odds ratios of 3.79 and 1.47, respectively) with positive screens for current mental disorders (occurrence of 29.3%). Most prominently, the data suggest that disruptions of work-life balance account for more than a quarter of the observed mental health problems due to the combination of widespread occurrence and strong association.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Transtornos Mentais , Bélgica/epidemiologia , Atenção à Saúde , Pessoal de Saúde , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , SARS-CoV-2
16.
J Affect Disord ; 292: 139-141, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34119869

RESUMO

BACKGROUND: The COVID-19 pandemic might increase suicide behaviors. However, results are still limited and inconclusive, especially in adolescents. METHODS: To provide a preliminary evidence of the effects of the COVID-19 pandemic on suicide attempts (SA), we compared data from the Catalonia Suicide Risk Code (CRSC), during the first 12 months of Spain COVID-19 pandemic (March 2020 to March 2021) with data of the previous 12 months (March 2019 to March 2020). The CRSC is a well-established population-based registry of suicide attempts (SA) which allows monitoring of the dynamic changes that COVID-19 may produce in a Spanish region. RESULTS: SA among adolescents increased 25% during the COVID-year, whatever, SA among adults decreased 16,5% in the same period. The increase of SA in girls was especially prominent in the starting school period in the COVID-year (September 2020-March 2021), where the increase reached 195%. LIMITATIONS: This study did not evaluate other individual risk factors of SA in the context of the COVID-19 pandemic, so is unable to make concrete causal inferences. CONCLUSIONS: These finding suggest that SA increased in adolescent girls during the last period of the COVID-19 pandemic, underscoring the need to implement effective preventive measures by public health systems and stakeholders into response during this public health crisis.


Assuntos
COVID-19 , Pandemias , Adolescente , Adulto , Feminino , Humanos , Fatores de Risco , SARS-CoV-2 , Espanha/epidemiologia , Tentativa de Suicídio
17.
J Affect Disord ; 292: 464-470, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34146897

RESUMO

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association. OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown. METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables. RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.


Assuntos
COVID-19 , Transtorno Depressivo , Adulto , Ansiedade , Controle de Doenças Transmissíveis , Depressão/epidemiologia , Humanos , SARS-CoV-2 , Apoio Social
18.
Eur Neuropsychopharmacol ; 50: 93-103, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34058711

RESUMO

Depressive Disorders are the most common psychiatric diagnoses in the general population. To estimate the frequency, costs associated with Depressive Disorders in usual clinical practice, and in the whole Spanish population, a longitudinal, retrospective, observational study was carried out using data from the BIG-PAC database®. Study population: all patients aged ≥ 18 years with a diagnosis of a Depressive Disorder in 2015-2017. Prevalence was computed as the proportion of Depressive Disorder cases in the adult general population, and the incidence rate, as the number of new Depressive Disorder cases diagnosed per 1,000 person-years in the population using health services, during 2015-2017. We collected demographic variables, comorbidity, direct health costs, and indirect costs (temporary and permanent disability). Health costs related to Depressive Disorders were estimated according to the annual resource use rate (resource/patient/year). Indirect costs were calculated according to the human capital method. Using the study data and information from the Spanish National Institute of Statistics, we estimated the cost of Depressive Disorders corresponding to the Spanish adult population, including premature mortality. 69,217 Depressive Disorder patients aged ≥ 18 years who met the inclusion/exclusion criteria were studied (mean age: 56.8 years; female: 71.4%). Prevalence of Depressive Disorders in the general population was 4.73% (95% CI: 4.70-4.76%). Annual incidence rates (2015-2017) were 7.12, 7.35 and 8.02 per 1,000 person-years, respectively. Total costs observed in our Depressive Disorder patients were € 223.9 million (corresponding to a mean of € 3,235.3; mean/patient/year), of which, 18.4% were direct health care costs and 81.6%, non-health indirect costs (18% temporary occupational disability, 63.6% permanent disability). Considering also the cost of premature death, the mean cost per patient/year was € 3,402 and the estimated societal costs of Depressive Disorders in Spain were € 6,145 million. The prevalence and incidence of Depressive Disorders are consistent with other series reviewed. Resource use and total costs (especially non-health costs) were high.

19.
Lancet Public Health ; 6(10): e729-e738, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33961802

RESUMO

BACKGROUND: We aimed to estimate the prevalence of current depressive disorder in 27 European countries, and to explore differences in prevalence between European countries and by gender. METHODS: In this population-based study, we analysed data from respondents living in 27 European countries who were included in the second wave of the European Health Interview Survey, collected between 2013 and 2015. We assessed the prevalence of current depressive disorder using the eight-item Patient Health Questionnaire (PHQ-8), with depressive disorder defined as a PHQ-8 score of 10 or higher. Prevalence estimates and 95% CIs were calculated for all 27 countries overall and for each country individually. We assessed variation in prevalence (country vs the rest of Europe) using crude and adjusted prevalence ratios obtained from negative binomial regression models. We did all analyses for the total sample and stratified by gender. FINDINGS: Our analysis sample comprised 258 888 individuals, of whom 117 310 (weighted proportion 47·8%) were men and 141 578 (52·2%) were women. The overall prevalence of current depressive disorder was 6·38% (95% CI 6·24-6·52) with important variation across countries, ranging from 2·58% (2·14-3·02) in the Czech Republic to 10·33% (9·33-11·32) in Iceland. Prevalence was higher in women (7·74% [7·53-7·95]) than in men (4·89% [4·71-5·08]), with clear gender differences for all countries except Finland and Croatia. Compared with the other European countries in our sample, those with the highest adjusted prevalence ratios were Germany (1·80 [1·71-1·89]) and Luxembourg (1·50 [1·35-1·66]), and those with the lowest adjusted prevalence ratios were Slovakia (0·28 [0·24-0·33]) and the Czech Republic (0·32 [0·27-0·38]). INTERPRETATION: Depressive disorders, although common across Europe, vary substantially in prevalence between countries. These results could be a baseline for monitoring the prevalence of current depressive disorder both at a country level in Europe and for planning health-care resources and services. FUNDING: UK Medical Research Council and CIBER Epidemiology and Public Health (CIBERESP).

20.
J Affect Disord ; 288: 199-209, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33940429

RESUMO

BACKGROUND: Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS: Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS: 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS: Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS: Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.


Assuntos
Transtornos Mentais , Transtornos Fóbicos , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Fóbicos/terapia , Estudos Retrospectivos , Inquéritos e Questionários
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