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2.
Artigo em Inglês | MEDLINE | ID: mdl-29337928

RESUMO

Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of a larger study of psychological autopsies conducted in Nunavut, Canada. The objective of this secondary analysis was to identify protective factors in the Inuit population of Nunavut by comparing people who died by suicide, people from the general population who attempted suicide, and people from the general population who never attempted suicide. This case-control study included 90 participants, with 30 participants in each group who were paired by birth date, sex, and community. Content analysis was first conducted on the clinical vignettes from the initial study in order to codify the presence of protective variables. Then, inferential analyses were conducted to highlight differences between each group in regards to protection. Findings demonstrated that (a) people with no suicide attempt have more protective variables throughout their lifespan than people who died by suicide and those with suicide attempts within the environmental, social, and individual dimensions; (b) people with suicide attempts significantly differ from the two other groups in regards to the use of services; and (c) protective factors that stem from the environmental dimension show the greatest difference between the three groups, being significantly more present in the group with no suicide attempt. Considering these findings, interventions could focus on enhancing environmental stability in Inuit communities as a suicide prevention strategy.


Assuntos
Inuítes/estatística & dados numéricos , Suicídio , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Nunavut/epidemiologia , Prevalência , Fatores de Proteção , Suicídio/etnologia , Suicídio/psicologia , Adulto Jovem
4.
Int J Neuropsychopharmacol ; 20(8): 619-623, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28520926

RESUMO

Background: Major depressive disorder is a debilitating illness, which is most commonly treated with antidepressant drugs. As the majority of patients do not respond on their first trial, there is great interest in identifying biological factors that indicate the most appropriate treatment for each patient. Studies suggest that microRNA represent excellent biomarkers to predict antidepressant response. Methods: We investigated the expression of miR-1202, miR-135a, and miR-16 in peripheral blood from 2 cohorts of depressed patients who received 8 weeks of antidepressant therapy. Expression was quantified at baseline and after treatment, and its relationship to treatment response and depressive symptoms was assessed. Results: In both cohorts, responders displayed lower baseline miR-1202 levels compared with nonresponders, which increased following treatment. Conclusions: Ultimately, our results support the involvement of microRNA in antidepressant response and suggest that quantification of their levels in peripheral samples represents a valid approach to informing treatment decisions.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/tratamento farmacológico , MicroRNAs/sangue , Biomarcadores/sangue , Citalopram/uso terapêutico , Tomada de Decisão Clínica , Transtorno Depressivo Resistente a Tratamento/sangue , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Succinato de Desvenlafaxina/uso terapêutico , Cloridrato de Duloxetina/uso terapêutico , Humanos , Escalas de Graduação Psiquiátrica , Curva ROC , Resultado do Tratamento
5.
Neuropsychopharmacology ; 42(10): 2043-2051, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28079059

RESUMO

MicroRNAs are short non-coding molecules that play a major role in regulating gene expression. Peripheral levels of miR-1202 have been shown to predict and mediate antidepressant response. However, it is not clear to what extent these peripheral measures reflect central neural changes in vivo. We approached this problem with the combined use of peripheral miR-1202 measures and neuroimaging. At baseline and after 8 weeks of desvenlafaxine (50-100 mg die), 20 patients were scanned with 3T magnetic resonance imaging, first at rest then during the Go/NoGo task, a classical test of response inhibition. Blood samples were collected at both time points. During resting state, lower baseline miR-1202 levels were predictive of increased connectivity from T0 to T8 between the posterior cingulate and the prefrontal, parietal, and occipital cortices. Changes in miR-1202 levels following desvenlafaxine treatment were negatively correlated with changes in activity in right precuneus within the default-mode network, and in connectivity between the posterior cingulate and the temporal and prefrontal cortices, and the precuneus. During the Go/NoGo task, baseline miR-1202 levels and changes in these levels were correlated with activity changes in different regions, including bilateral prefrontal, insular, cingulate, and temporal cortices, and left putamen and claustrum. Finally, secondary analyses in a subset of patients showed a trend for a significant correlation between miR-1202 levels and glutamate levels measured by spectroscopy. Changes in peripheral miR-1202 levels were therefore associated with changes in brain activity and connectivity in a network of brain regions associated with depression and antidepressant response. These effects may be mediated by the glutamatergic system.


Assuntos
Antidepressivos/uso terapêutico , Encéfalo/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/fisiopatologia , Succinato de Desvenlafaxina/uso terapêutico , MicroRNAs/sangue , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Mapeamento Encefálico , Transtorno Depressivo Maior/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/efeitos dos fármacos , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Descanso , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Resultado do Tratamento
6.
Can J Psychiatry ; 60(6): 268-75, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26175324

RESUMO

OBJECTIVE: The Inuit population in Canada's North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period. METHODS: We identified all suicides by Inuit (n = 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits. RESULTS: Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder (P = 0.002) and suicide completion (P = 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits (P < 0.001). CONCLUSIONS: At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/estatística & dados numéricos , Transtorno Depressivo Maior/etnologia , Inuítes/etnologia , Transtornos da Personalidade/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Suicídio/etnologia , Adulto , Feminino , Humanos , Masculino , Territórios do Noroeste/etnologia , Fatores de Risco , Adulto Jovem
7.
Suicide Life Threat Behav ; 45(2): 141-56, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25255825

RESUMO

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.


Assuntos
Inuítes , Delitos Sexuais/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias , Ideação Suicida , Suicídio , Adolescente , Estudos Transversais , Assistência à Saúde Culturalmente Competente/métodos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Inuítes/psicologia , Inuítes/estatística & dados numéricos , Modelos Logísticos , Masculino , Prevalência , Fatores de Proteção , Quebeque/epidemiologia , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Suicídio/etnologia , Suicídio/prevenção & controle , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adulto Jovem
8.
World J Biol Psychiatry ; 15(7): 570-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25050453

RESUMO

OBJECTIVES: Deep transcranial magnetic stimulation (DTMS) has been shown to be efficacious and relatively safe for major depressive disorder (MDD). However, its clinical utility as an augmenting strategy for treatment-resistant depression (TRD) remains unexplored. METHODS: In an open label trial, 17 outpatients with severe TRD received 4 weeks of daily high frequency DTMS over the left dorsolateral prefrontal cortex. Depressive and anxious symptoms, suicidality and quality of life (QOL) were measured at baseline (i.e., in the week prior to the start of the DTMS treatment) and at week 5 (i.e., in the week following the end of the DTMS treatment). Primary outcome measures were rates of response and remission at week 5 using an intention-to-treat approach. RESULTS: Response and remission rates at week 5 were 70.6 and 41.2%, respectively. Also, depression, anxiety, and suicidality ratings were significantly improved by week 5 (with Hedges' g estimates ranging from 0.6 to 1.72), as well as four of the five QOL domain scores (i.e., global, psychological, environmental and social). Finally, two patients dropped out of the study at week 1 because of significant scalp discomfort during stimulation. CONCLUSIONS: Our study suggests that DTMS, when used as an augmenting strategy for antidepressants in severe TRD, is efficacious, safe and relatively well tolerated. However, controlled studies with larger samples are needed to confirm and expand our preliminary findings.


Assuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Córtex Pré-Frontal/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Antidepressivos/uso terapêutico , Ansiedade/terapia , Terapia Combinada , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Ideação Suicida , Estimulação Magnética Transcraniana/efeitos adversos , Estimulação Magnética Transcraniana/instrumentação , Resultado do Tratamento
9.
Neurosci Lett ; 563: 144-8, 2014 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-24486892

RESUMO

BACKGROUND: Prognostication is poor in repetitive transcranial magnetic stimulation (rTMS) treatment for major depressive disorder (MDD). Personality traits, particularly extraversion and neuroticism, have attracted increasing attention for both trait- and state-dependent characteristics in predicting response to pharmacotherapy, psychotherapy, and more recently to therapeutic neuromodulation for MDD. The advent of deep rTMS (DTMS) allows stimulation of deeper cortical regions, and we aimed to prospectively characterize personality dimensions and antidepressant response to DTMS in treatment-resistant MDD. METHODS: A convenience sample of 15 patients with treatment-resistant MDD received four weeks of daily sessions of DTMS (20 Hz, 3000 pulses/session) of the left dorsolateral prefrontal cortex (DLFPC). At baseline and at the conclusion of treatment, patients completed the Big Five Inventory, a five-factor assessment of major personality dimensions. Clinical response was measured using the 21-item Hamilton Depression Rating Scale. RESULTS: Four weeks of DTMS treatment were not associated with changes in personality measures. Clinical remission was associated with higher baseline levels of agreeableness (score ≥ 29:100% sensitive and 72.7% specific) and conscientiousness (score ≥ 30:75% sensitive and 81.8% specific). Levels of agreeableness and extraversion were linearly associated with antidepressant response. Neuroticism was not associated with the antidepressant effects of DTMS in this cohort. CONCLUSIONS: Five-factor personality assessment may have prognostic value in DTMS for resistant MDD. Agreeableness, extraversion, and conscientiousness are associated with decreases in depressive symptoms during treatment with DTMS.


Assuntos
Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Personalidade , Estimulação Magnética Transcraniana , Adulto , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroticismo , Determinação da Personalidade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
10.
Int J Circumpolar Health ; 72: 20078, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23539438

RESUMO

INTRODUCTION: The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country. OBJECTIVE: This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method. METHOD: A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed. RESULTS: The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.


Assuntos
Ética em Pesquisa , Projetos de Pesquisa , Suicídio/psicologia , Regiões Árticas/epidemiologia , Relações Familiares , Humanos , Relações Interpessoais , Saúde Mental , Modelos Psicológicos , Motivação , Nunavut/epidemiologia , Estudos Retrospectivos , Apoio Social , Fatores Socioeconômicos , Suicídio/etnologia
11.
J Psychiatr Res ; 47(2): 141-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23069651

RESUMO

This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.


Assuntos
Pesquisa Biomédica/métodos , Transtornos Mentais/diagnóstico , Modelos Estatísticos , Pesquisa Biomédica/normas , Comparação Transcultural , Feminino , Humanos , Masculino , Transtornos Mentais/fisiopatologia
12.
Pain Med ; 13(11): 1425-35, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23036076

RESUMO

OBJECTIVE: Catastrophizing is a maladaptive response to pain and is one of the factors that contribute to the chronicity of some pain syndromes. The Pain Catastrophizing Scale (PCS) assists both treatment planning and outcome assessment. Its use is limited in Portuguese-speaking countries because of the lack of a validated translated version. We conducted the validation of the Brazilian Portuguese (BP)-PCS and explored its psychometric properties. This study reports the internal consistency, factor structure, and its capability to discriminate pain reported by patients with specific chronic pain conditions. METHODS: Three hundred eighty-four patients, 317 women (82.55%), aged 18-79 years with chronic nonmalignant pain attending an outpatient multidisciplinary pain center participated in this cross-sectional study. The instruments were the BP-PCS, pain intensity, pain interference in functional capacity, and a sociodemographic questionnaire. One subsample with chronic tensional headache (CTH) according to the criteria of the International Headache Society (N = 19), and another with a diagnosis of fibromyalgia according to the American College of Rheumatology criteria (N = 50) were selected to assess the discriminative properties of BP-PCS. RESULTS: We observed good internal consistency (Cronbach's α values of 0.91 for the total BP-PCS, and 0.93 [helplessness], 0.88 [magnification], and 0.86 [rumination] for the respective subdomains). The item-total correlation coefficients ranged from 0.91 to 0.94. Confirmatory factor analysis (CFA) supported the three factors structure, with the comparative fit index = 0.98, root mean square error of approximation = 0.09, and normed fit index = 0.98. Significant correlations were found for pain intensity, pain interference, and patient's mood (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). No significant gender difference was observed for BP-PCS scores. When comparing scores of BP-PCS scale and subscales between the selected control group (patients with pain scores on visual analog scale equal or lower than 40 mm in the most part of the day in the last 6 months) and patients with fibromyalgia or CTH, we observed lower scores for the former group. CONCLUSION: Our findings support the validity and reliability of the BP-PCS. The scale showed satisfactory psychometric properties. CFA provides support for the three-factor structure reported in previous studies. This factor structure presented good discriminative properties to identify catastrophizers who present with mild chronic pain, fibromyalgia, and CTH. The BP-PCS is a valuable tool for use in scientific studies and in the clinical setting in patients with chronic pain in Brazilian Portuguese-speaking countries.


Assuntos
Catastrofização/diagnóstico , Medição da Dor/métodos , Dor/psicologia , Psicometria/métodos , Adolescente , Adulto , Idoso , Brasil , Catastrofização/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Adulto Jovem
13.
Alcohol ; 46(6): 529-36, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22579734

RESUMO

Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.


Assuntos
Agressão/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Suicídio/psicologia , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Autopsia , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Comportamento Impulsivo/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos da Personalidade/epidemiologia , Quebeque/epidemiologia , Tentativa de Suicídio/psicologia
14.
Int J Psychol ; 47(4): 279-86, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22124478

RESUMO

There is evidence that subjective health is an important variable in general health outcomes. It can be an indicator of the individual's overall health status, creating a reliable and valid estimate about health. Quality of life (QoL) assessment can be associated with the individuals' subjective assessment of their own health status. The aim of the present study was to investigate variables associated with subjective perception of health in older inpatients. Ninety elderly inpatients over 60 years old were interviewed. The perception of health assessment (healthy/unhealthy) allocated elders in either of two groups. All the elders answered sociodemographic questions, the WHOQOL-100 and the Beck Depression Inventory (BDI). Comparing the group that considered themselves unhealthy to the other group, the former showed a tendency of worse QoL assessments in five out of six domains investigated. Significant differences were found for the physical and level of independence domains, as well as overall QoL. There was a significant association between health perception and lower intensity of depressive symptoms, as well as better QoL perception in the level of independence domain. This study shows the existence of an association between depressive symptoms and health assessment. It also suggests that the independence dimension is important in the elders' perception of their health status. These findings can help identify cause-effect relations between variables in aging studies involving health indicators and bring new intervention proposals for the elderly.


Assuntos
Envelhecimento/psicologia , Atitude Frente a Saúde , Qualidade de Vida/psicologia , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Brasil , Comparação Transcultural , Depressão/diagnóstico , Depressão/psicologia , Escolaridade , Feminino , Indicadores Básicos de Saúde , Hospitais Universitários , Humanos , Masculino , Morbidade , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Classe Social , Estatística como Assunto
15.
BMC Womens Health ; 11: 21, 2011 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-21627812

RESUMO

BACKGROUND: With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. METHODS: Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. RESULTS: Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. CONCLUSION: The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões/ética , Médicos/ética , Técnicas de Reprodução Assistida/ética , Adulto , Biologia/ética , Brasil , Comparação Transcultural , Estudos Transversais , Feminino , Alemanha , Grécia , Soronegatividade para HIV , Soropositividade para HIV , Homossexualidade Feminina , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pré-Seleção do Sexo , Pessoa Solteira
16.
Psychooncology ; 20(2): 155-64, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20878828

RESUMO

OBJECTIVE: The purpose of this study was to determine the psychosocial adjustment congruence within couples through the first year of prostate cancer experience, and to explore the personal variables that could predict congruence within couples. METHOD: Eighty-one couples were interviewed at the time of diagnosis; 69 participated at 3 months and 61 at 12 months. Paired t-tests were used to examine dyadic congruence on seven domains of psychosocial adjustment. Repeated Measures ANOVAs were used to examine the congruence over time. Multiple regressions were used to determine whether mood disturbance, urinary and sexual bother, sense of coherence, and social support were predictors of congruence within couples on each of the adjustment domains. RESULTS: At time 1, couples had incongruent perceptions in 3 of 7 domains: health care, psychological, and social adjustment. Three months later, health care, psychological, and sexual domains showed incongruence within couples. One year after the diagnosis, there were incongruent perceptions only in sexual and psychological domains. There was little variation of the congruence within couples over time. Husbands and wives' mood disturbance, urinary and sexual bother, sense of coherence, and social support accounted for 25-63% of variance in couple congruence in the adjustment domains in the study periods. CONCLUSION: The findings suggested that there is couple congruence. Domains in which incongruence was observed are important targets for clinical interventions. Greater attention needs to be directed to assisting couples to recognize the differences between their perceptions, especially the ones related to the sexual symptoms and psychological distress.


Assuntos
Adaptação Psicológica , Neoplasias da Próstata/psicologia , Cônjuges/psicologia , Estresse Psicológico/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Fatores Sexuais , Ajustamento Social , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo
17.
J Obstet Gynecol Neonatal Nurs ; 39(5): 557-65, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20920002

RESUMO

OBJECTIVE: To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL). DESIGN: Cross-sectional prospective study. Quality of life was measured as a multidimensional construct. SETTING: Assisted reproduction clinic of a university hospital. PARTICIPANTS: One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts. METHODS: Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression. RESULTS: Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed. CONCLUSION: Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.


Assuntos
Atitude Frente a Saúde , Infertilidade/psicologia , Qualidade de Vida , Cônjuges/psicologia , Adulto , Brasil , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Estudos Prospectivos
18.
Psychol Health Med ; 15(5): 596-606, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20835969

RESUMO

Depressive symptoms are the most prevalent mental health condition in older adults. Since it cannot be measured directly, the use of instruments is mandatory. The 15-item Geriatric Depression Scale (GDS) is one of the most widely used scales to measure depression in the elderly. It is recognized that the cultural context is a major determinant of the instrument's psychometric performance. Up to the present, this scale has mainly been investigated through classical psychometric approaches. The present study aims to explore whether the 15-item GDS is a suitable instrument in a Brazilian sample. In addition, it explores the potential improvement in the psychometric performance by item refinement. Four hundred twenty-four elderly adults selected through convenience sampling completed the 15-item GDS. Data were analyzed by the Rasch Measurement Model. The Rasch analysis is a powerful modern approach to explore psychometric performance of instruments in health sciences. It examines both the scale and the individual item performance in depth. The 15-item GDS proved not to be suitable in a Brazilian sample. Item misfit and differential item functioning were responsible for considerable misperformance. Scale reduction led to a 10-item structure. This refined format presented adequate psychometric performance and no differential item functioning. The present study offers an alternative and more adequate version of the GDS to be applied in Brazilian subjects. It is also in line with the need for shorter, valid scales in clinical settings. Further investigations are needed to develop a set of cultural-invariant items, which could then be applied in transcultural investigations free of bias.


Assuntos
Depressão/diagnóstico , Avaliação Geriátrica/métodos , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Entrevistas como Assunto , Masculino , Modelos Psicológicos , Psicometria/instrumentação
19.
J Psychosom Obstet Gynaecol ; 31(2): 101-10, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20443659

RESUMO

OBJECTIVE: To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples. DESIGN: Systematic review. METHODS: Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Quality of life and health-related quality of life. RESULTS: Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men. CONCLUSIONS: Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.


Assuntos
Infertilidade Feminina/psicologia , Infertilidade Masculina/psicologia , Qualidade de Vida/psicologia , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Depressão/diagnóstico , Depressão/psicologia , Emoções , Feminino , Fertilização In Vitro/psicologia , Identidade de Gênero , Humanos , Relações Interpessoais , Masculino , Inventário de Personalidade , Adulto Jovem
20.
Reprod Health ; 7: 3, 2010 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-20459694

RESUMO

BACKGROUND: Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility. METHODS: 162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added. RESULTS AND DISCUSSION: Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity. CONCLUSION: Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.

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