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1.
J Pak Med Assoc ; 71(6): 1618-1622, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34111084

RESUMO

OBJECTIVE: To estimate the burden of antenatal and postpartum depression, and to explore possible predictors of perinatal depression. METHODS: The longitudinal study was conducted at the Department of Obstetrics and Gynaecology, Shifa International Hospital and its Community Healthcare centre in Islamabad, Pakistan, from October 2018 to May 2019, and comprised women in their third trimester of pregnancy. Socioeconomic and obstetrical history was recorded on a proforma, and the Edinburgh Postnatal Depression Scale was used for screening of depression. Data was analysed using SPSS version 23. RESULTS: Of the 200 women, 71(35.5%) were primigravida and 129(64.5%) were multigravida. The overall mean age was 27.1±5.08 years. Further, 64(32%) women belonged to the low-income group, 99(49.5%) middle-income and 37(18.5%) to upper-income group. Women in postnatal period had higher depression scores than women in antenatal period (p<0.05). Antenatal depression increased the risk of postpartum depression (p<0.05). In women having unplanned pregnancies, or being multigravida, or belonging to middle and lower socioeconomic classes, the chances of perinatal depression were higher (p<0.05). CONCLUSIONS: Antenatal depression was strongly associated with postpartum depression, indicating that the former was a significant predictor of the latter. Social class and parity were also found to be directly linked with perinatal depression.


Assuntos
Depressão Pós-Parto , Complicações na Gravidez , Adulto , Depressão/epidemiologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Paquistão/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Adulto Jovem
2.
Dan Med J ; 68(6)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34060459

RESUMO

INTRODUCTION: During the first wave of the COVID-19 pandemic, it was established that otorhinolaryngologists were at a high risk of contracting the infection due to examinations of the upper airways. The aim of this study was to evaluate the impact of the COVID-19 pandemic on mental health among healthcare workers (HCWs) in primary ear-nose-throat (ENT) practices. METHODS: This was a cross-sectional questionnaire study among HCWs assessing symptoms of anxiety (Generalized Anxiety Disorder, ten-item scale) and depression (Patients Health Questionnaire, nine-item scale). The survey targeted otolaryngologists and staff in primary private practices in the Capital Region of Denmark during the COVID-19 lock-down in May 2020. RESULTS: For 30% of the participants, signs were observed of depressive symptoms and 13% had signs of anxiety symptoms. Seventy percent felt sufficiently protected by their available personal protective equipment. Fifty-two percent worried about becoming infected in relation to their work and 56% feared infecting their families. CONCLUSIONS: HCWs in Danish primary ENT practices did not display extraordinary stress reactions during the first wave of the pandemic. Noticeably, participants were concerned about acquiring the infection or transmitting it to their household. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
/psicologia , Pessoal de Saúde/psicologia , Saúde Mental , Otolaringologia , Pessoal Administrativo/psicologia , Instituições de Assistência Ambulatorial , Ansiedade/etiologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Otorrinolaringologistas/psicologia , Equipamento de Proteção Individual , Prática Privada , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
3.
Med J Malaysia ; 76(3): 284-290, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34031324

RESUMO

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) has dramatically affected global healthcare systems. We aimed to determine the response of our paediatric surgical fraternity to a disease that overwhelmingly affects adults. MATERIALS AND METHODS: We conducted a cross-sectional questionnaire-based study over 6 weeks during a federally mandated lockdown. Using snowball sampling, we recruited paediatric surgeons, trainees and medical officers from paediatric surgical units in Malaysia. The anonymous online questionnaire covered sociodemographic information, changes in patient care, redeployment, concerns regarding family members, and impact on training. Mental well-being was assessed using the Depression, Anxiety and Stress Scale (DASS-21). Kruskal-Wallis, ANOVA and multiple regression analysis was used, with significance level 0.05. RESULTS: Of the 129 eligible participants, 100(77%) responded. Junior doctors had clinically higher levels of depression, anxiety, and stress. Age <30 years was significantly associated with anxiety. Junior doctors believed that redeployment led to loss of surgical skills (p<0.001) and trainees felt that clinical application of knowledge had reduced (p<0.020). CONCLUSION: Specific to our paediatric surgical community, this study highlights areas of concern, particularly among junior doctors. It is likely that recurrent cycles of the pandemic will occur soon. These issues must be addressed to preserve the mental and emotional well-being of all health care workers.


Assuntos
Transtornos Mentais/etiologia , Doenças Profissionais/etiologia , Pediatras/psicologia , Pediatria/tendências , Especialidades Cirúrgicas/tendências , Cirurgiões/psicologia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Atitude do Pessoal de Saúde , /prevenção & controle , Criança , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Saúde Mental , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Saúde do Trabalhador , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/etiologia , Pandemias , Pediatras/educação , Pediatras/tendências , Pediatria/educação , Padrões de Prática Médica , Escalas de Graduação Psiquiátrica , Especialidades Cirúrgicas/educação , Cirurgiões/educação , Cirurgiões/tendências , Inquéritos e Questionários
4.
Psychosom Med ; 83(4): 368-372, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951724

RESUMO

OBJECTIVE: Infectious diseases can cause psychological changes in patients. This study aimed to evaluate the prevalence and related risk factors for anxiety and depression in patients with COVID-19. METHODS: A cross-sectional study was performed on patients with COVID-19 admitted to the Sino-French New City branch of Wuhan Tongji Hospital from January to February 2020. The Zung Self-Rating Anxiety and Depression Scales were used to evaluate the prevalence of anxiety and depression. Demographic, clinical, and sociological data were also collected. Multivariable logistic regression analysis was used to identify independent risk factors of anxiety and depression in patients with COVID-19. RESULTS: In the current study, 183 patients were enrolled (mean age = 53 ± 9 years; 41.1% women). The prevalences of anxiety and depression were 56.3% and 39.3%, respectively. Logistic regression analysis revealed that older age, female sex, being divorced or widowed, COVID-19 disease duration, renal disease, and depression were identified as independent risk factors for anxiety in patients with COVID-19. Factors that were associated with depression were female sex, being widowed, COVID-19 disease duration, and anxiety. CONCLUSIONS: This study demonstrates a high prevalence of anxiety and depression in patients with COVID-19 at the peak of the epidemic in Wuhan, China. The identification of demographic, clinical, and social factors may help identify health care professionals to provide psychological care as part of treatment for patients with COVID-19 and other life-threatening infectious diseases.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Ansiedade/etiologia , China/epidemiologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco
5.
Georgian Med News ; (312): 57-61, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33964827

RESUMO

The spread of depressive disorders is extra high nowadays. Depressive disorders are widespread mental disorders in the structure of mental pathology, both causes of psychiatrists' visit, and causes of medical aid. The presence of depressive syndrome in patients with cardiovascular system leads to deterioration patient's condition and adaptive abilities and aggravates somatic abnormality. Adequate therapy causes their reduction, prevention of recurrence and decompansation of comorbid somatic pathology, and eliminates severe medical and prevents social consequences. The study of clinical aspects of depressive conditions which are accompanied with pathology is one of the direction not only psychiatric, but also common pharmacotherapeutic investigations. The aim of the investigation was to determine clinical, pharmacotherapeutic and biorhythmic peculiarities of depressive disorders in patients with comorbid cardiac pathology. And also assessment of efficacy of complex therapy based on chronotherapy principle was used. 50 patients (female patients) with depressive disorders were involved in this investigation. This was performed based on "Depressive disorders of organic genesis, characterized by somatic pathology" (F 06.35), "Somatoform disorder" of heart and cardiovascular system (F 45.30), "Mild depressive episode" (F 32.00), and also comorbid arterial hypertension confirmed by physician. Clinical, laboratory, clinical and psychopathological investigations using psychodiagnostic scales (scale HAMD-21, CGI-S, CGI-І) were used. Individual biorhythmic status was established and it requires medicamentous therapy. Comparing patients of both groups, it has been detected a group of patients in whom principles of chronotherapy, especially antihypertensive and antidepressive therapy were prescribed, dynamics of patient's improvement was better than in the investigated group where the principle of chronotherapy was observed.


Assuntos
Transtorno Depressivo , Comorbidade , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Escalas de Graduação Psiquiátrica , Psicoterapia , Transtornos Somatoformes
6.
Ann Glob Health ; 87(1): 43, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33981590

RESUMO

Background: Feelings of isolation, insecurity, and instability triggered by COVID-19 could have a long-term impact on the mental health status of individuals. Objectives: The aim of this study was to examine the prevalence of mental health symptoms (anxiety, depression, and stress) in Bangladesh and the factors associated with these symptoms during the COVID-19 pandemic. Methods: From 1 to 30 April 2020, we used a validated self-administered questionnaire to conduct a cross-sectional study on 10,609 participants through an online survey platform. We assessed mental health status using the Depression, Anxiety, and Stress Scale (DASS-21). The total depression, anxiety, and stress subscale scores were divided into normal, mild, moderate, severe, and multinomial logistic regression was used to examine associated factors. Findings: The prevalence of depressive symptoms was 15%, 34%, and 15% for mild, moderate, and severe depressive symptoms, respectively. The prevalence of anxiety symptoms was 59% for severe anxiety symptoms, 14% for moderate anxiety symptoms, and 14% for mild anxiety symptoms, while the prevalence for stress levels were 16% for severe stress level, 22% for moderate stress level, and 13% for mild stress level. Multivariate analyses revealed that the most consistent factors associated with mild, moderate, and severe of the three mental health subscales (depression, anxiety, and stress) were respondents who lived in Dhaka and Rangpur division, females, those who self-quarantined in the previous seven days before the survey, and those respondents who experienced chills, breathing difficulty, dizziness, and sore throat. Conclusion: Our results showed that about 64%, 87%, and 61% of the respondents in Bangladesh reported high levels of depression, anxiety, and stress, respectively. There is a need for mental health support targeting women and those who self-quarantined or lived in Dhaka and Rangpur during the pandemic.


Assuntos
/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Bangladesh/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Prevalência , Escalas de Graduação Psiquiátrica , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
7.
BMC Med Inform Decis Mak ; 21(1): 162, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016112

RESUMO

BACKGROUND: Heterogeneity among patients' responses to treatment is prevalent in psychiatric disorders. Personalized medicine approaches-which involve parsing patients into subgroups better indicated for a particular treatment-could therefore improve patient outcomes and serve as a powerful tool in patient selection within clinical trials. Machine learning approaches can identify patient subgroups but are often not "explainable" due to the use of complex algorithms that do not mirror clinicians' natural decision-making processes. METHODS: Here we combine two analytical approaches-Personalized Advantage Index and Bayesian Rule Lists-to identify paliperidone-indicated schizophrenia patients in a way that emphasizes model explainability. We apply these approaches retrospectively to randomized, placebo-controlled clinical trial data to identify a paliperidone-indicated subgroup of schizophrenia patients who demonstrate a larger treatment effect (outcome on treatment superior than on placebo) than that of the full randomized sample as assessed with Cohen's d. For this study, the outcome corresponded to a reduction in the Positive and Negative Syndrome Scale (PANSS) total score which measures positive (e.g., hallucinations, delusions), negative (e.g., blunted affect, emotional withdrawal), and general psychopathological (e.g., disturbance of volition, uncooperativeness) symptoms in schizophrenia. RESULTS: Using our combined explainable AI approach to identify a subgroup more responsive to paliperidone than placebo, the treatment effect increased significantly over that of the full sample (p < 0.0001 for a one-sample t-test comparing the full sample Cohen's d = 0.82 and a generated distribution of subgroup Cohen's d's with mean d = 1.22, std d = 0.09). In addition, our modeling approach produces simple logical statements (if-then-else), termed a "rule list", to ease interpretability for clinicians. A majority of the rule lists generated from cross-validation found two general psychopathology symptoms, disturbance of volition and uncooperativeness, to predict membership in the paliperidone-indicated subgroup. CONCLUSIONS: These results help to technically validate our explainable AI approach to patient selection for a clinical trial by identifying a subgroup with an improved treatment effect. With these data, the explainable rule lists also suggest that paliperidone may provide an improved therapeutic benefit for the treatment of schizophrenia patients with either of the symptoms of high disturbance of volition or high uncooperativeness. TRIAL REGISTRATION: clincialtrials.gov identifier: NCT 00,083,668; prospectively registered May 28, 2004.


Assuntos
Antipsicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Inteligência Artificial , Teorema de Bayes , Humanos , Isoxazóis/uso terapêutico , Seleção de Pacientes , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Esquizofrenia/tratamento farmacológico , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-33947149

RESUMO

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants' language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21-2.19)), intermediate (aOR 1.68 (95% CI 1.16-2.42)), and limited (aOR 2.55 (95% CI 1.64-3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.


Assuntos
Depressão Pós-Parto , Depressão , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Idioma , Período Pós-Parto , Gravidez , Escalas de Graduação Psiquiátrica
9.
BMJ ; 373: n972, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972268

RESUMO

OBJECTIVE: To evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems. DESIGN: Systematic review and individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018). REVIEW METHODS: Eligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results. RESULTS: Individual participant data were obtained from 101 of 168 eligible studies (60%; 25 574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10 664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included. CONCLUSIONS: When screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels. TRIAL REGISTRATION: PROSPERO CRD42015016761.


Assuntos
Transtorno Depressivo Maior/psicologia , Hospitalização , Psicometria , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Escalas de Graduação Psiquiátrica , Sensibilidade e Especificidade
10.
Epilepsy Behav ; 118: 107943, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33839449

RESUMO

OBJECTIVE: Recent epilepsy quality measure recommendations for depression and anxiety screening endorse ultra-brief screeners, the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Thus, it is important to assess how symptom detection may be affected using ultra-brief screeners compared with slightly longer, well-validated instruments: Neurological Disorders Depression Inventory-Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7). The objective was to compare symptom detection by brief versus ultra-brief depression and anxiety screeners in a large real-world epilepsy clinic sample. METHODS: This was a prospective, cross-sectional assessment of consecutive patients in an adult tertiary epilepsy practice who completed the GAD-7 and NDDI-E with embedded ultra-brief scales (GAD-2; GAD-Single Item: GAD-SI; NDDI-E 2 item: NDDIE-2) on a tablet and had clinic staff administered ultra-brief PHQ-2 (yes/no version) documented in the medical record at the same visit. Prevalences of positive anxiety and depression screens were calculated for each instrument overall, and by epilepsy status. Concordance correlation coefficients (CCC) were calculated comparing the ultra-brief with brief anxiety and depression instruments, and receiver operating curves (ROC) were calculated using the longer instruments as alternative standards. RESULTS: Among N = 422 individuals the prevalence of positive anxiety screen by GAD-7 was 24% and positive depression screen by NDDI-E was 20%. Positive anxiety and depression screens were significantly less prevalent among seizure-free individuals than those with continued seizures. The verbally administered yes/no PHQ-2 had only 1 positive screen (0.2%). Other than poor concordance between the PHQ-2 and NDDI-E, the screener pairs had acceptable concordance (CCC 0.79 to 0.92). Areas under the ROC curves were acceptable for the NDDIE-2, GAD-2 and GAD-SI (0.96, 0.98, and 0.89, respectively). SIGNIFICANCE: In this sample, clinic staff interview-administered yes/no PHQ-2 had exceedingly low sensitivity compared with the NDDI-E self-reported on a tablet. Further investigation is warranted to assess if poor detection is due to characteristics of this PHQ-2 in epilepsy samples, or method of administration in this clinic. The other ultra-brief anxiety and depression instruments demonstrated good concordance with the longer, well-validated instruments and may be useful in clinical practice.


Assuntos
Depressão , Epilepsia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Humanos , Programas de Rastreamento , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes
11.
Ann Clin Psychiatry ; 33(2): 101-107, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33878284

RESUMO

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.


Assuntos
Pessoal de Saúde , Estresse Ocupacional , Estresse Psicológico , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , /psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Michigan/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/etiologia , Estresse Ocupacional/psicologia , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Traumático/etiologia , Transtornos de Estresse Traumático/prevenção & controle , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
12.
Wiad Lek ; 74(2): 257-262, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813482

RESUMO

OBJECTIVE: The aim: Our study aimed at evaluating the relationships between sleep disorders (SD), cognitive impairment (CI), anxiety and depression in patients with relapsing-remitting multiple sclerosis (RRMS). PATIENTS AND METHODS: Materials and methods: One hundred and five patients with RRMS (80 females and 25 males) aged from 22 to 67 years (mean age: 41,8±10,7; EDSS:3,5±1,6; disease duration (DD): 10,3±8,5 years) were enrolled into the study. All participants completed questionnaires on sleep (the Pittsburgh Sleep Quality Index /PSQI), cognitive functions (The Montreal Cognitive Assessment /MoCA), anxiety (Hamilton Anxiety Rating Scale /HAM-A), depression (Beck Depression Inventory/ BDI). RESULTS: Results: According to PSQI score the patients were divided into two groups: with (n=42) and without SD (n=63). The patients with SD were older (45,36±1,66 vs 39,41±1,27, p=0.005), had higher EDSS score (3,98±0,26 vs 3,14±0,19, p=0,008), BDI (13,79±1,14 vs 8,96±0,86, p=0,0009) and HAM-A (24,52±1,42 vs 16,56±0,99, p<0,0001) scales compared with patients without SD. The frequency of anxiety (p=0,0034) and depression (p=0,038) was significantly higher in RRMS patients with compared to those without SD. No significant difference was found in gender, DD and MoCA score. In patients with SD significant negative correlation between MoCA and BDI score (r = -0,42, p<0,005) was found. In the group of patients without SD significant negative correlation between MoCA and EDSS (r = -0,27, p=0,03), MoCA and BDI (r = -0,26, p=0,043),) MoCA and HAM-A (r = -0,25, p=0,041) score was detected. CONCLUSION: Conclusions: Insomnia type SD in RRMS patients were associated with older age, higher EDSS score and presence of anxiety and depression.


Assuntos
Disfunção Cognitiva , Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Transtornos do Sono-Vigília , Adulto , Idoso , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Escalas de Graduação Psiquiátrica , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia
13.
Psychiatr Danub ; 33(1): 36-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33857038

RESUMO

BACKGROUND: Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. SUBJECTS AND METHODS: All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. RESULTS: In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow-up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. CONCLUSIONS: In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Adolescente , Adulto , Anedonia , Humanos , Escalas de Graduação Psiquiátrica , Psicopatologia , Transtornos Psicóticos/epidemiologia , Qualidade de Vida , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-33804879

RESUMO

(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03-91.52) and 95.54% (95% CI = 94.42-96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation.


Assuntos
Questionário de Saúde do Paciente , Ideação Suicida , Depressão/diagnóstico , Humanos , Aprendizado de Máquina , Programas de Rastreamento , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
15.
BMC Pregnancy Childbirth ; 21(1): 277, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33823838

RESUMO

BACKGROUND: There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. METHODS: This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. RESULTS: Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported 'local' women who speak English as their primary language (Group L), another of socially supported 'migrant' women who speak a language other than English as their primary language (Group M), another of socially stressed 'local' women who speak English as their primary language (Group Ls), and socially stressed 'migrant' women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms. respectively). CONCLUSIONS: The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.


Assuntos
Depressão Pós-Parto/prevenção & controle , Programas de Rastreamento/organização & administração , Saúde Materna/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Alocação de Recursos para a Atenção à Saúde , Humanos , Recém-Nascido , Análise de Classes Latentes , Programas de Rastreamento/métodos , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Autorrelato/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 21(1): 281, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836676

RESUMO

BACKGROUND: Pregnancy distress is a combination of anxiety, stress, and depression during pregnancy. The first step in preventing pregnancy distress is to identify women at risk. The present study assessed adaptation and psychometric adequency of the Persian Adapted Version of Tilburg Pregnancy Distress Scale (P-TPDS). METHODS: By Brislin's translation guidelines, TPDS was translated to Persian. This was followed by determining the face validity of P-TPDS and evaluating construct validity using exploratory and confirmatory factor analyses. The Cronbach's alpha coefficients and intra-class correlation coefficient (ICC) were used to estimate reliability. RESULTS: A final 16-item scale was loaded on four distinct constructs jointly accounting for 59.62% of variance. The factors were labelled as delivery-related worries, partner involvement, pregnancy-related worries, and social-related worries. The alpha coefficients for P-TPDS subscales ranged from 0.85 to 0.91 and ICC ranged from 0.70 to 0.77. All comparative indices of the model including CFI, IFI, NFI, and NNFI were above 0.9 showing the goodness of fit for the data with a RMSEA of 0.04, lower bound: 0.038. CONCLUSIONS: The Persian adapted version of TPDS (P-TPDS) is a reliable and valid scale for assessing pregnancy distress among pregnant women in Iran.


Assuntos
Complicações na Gravidez/diagnóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Angústia Psicológica , Psicometria/métodos , Traduções , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Gravidez , Complicações na Gravidez/psicologia , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Classe Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 21(1): 292, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838663

RESUMO

BACKGROUND: India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women's mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae. METHODS: We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. RESULTS: Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention. CONCLUSIONS: Understanding factors contributing to women's suffering related to reproductive challenges in this pronatalist context is critically important for women's wellbeing.


Assuntos
Depressão Pós-Parto/epidemiologia , Pesar , Morte do Lactente , Mães/psicologia , Natimorto/psicologia , Adolescente , Adulto , Estudos Transversais , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/prevenção & controle , Depressão Pós-Parto/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/organização & administração , Pobreza , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Pesquisa Qualitativa , Normas Sociais , Natimorto/epidemiologia , Adulto Jovem
18.
BMC Psychiatry ; 21(1): 197, 2021 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874939

RESUMO

BACKGROUND: The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents. METHODS: We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data. RESULTS: Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia. LIMITATIONS: Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure. CONCLUSIONS: A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.


Assuntos
Depressão , Grupos Étnicos , Adolescente , Adulto , Idoso , Ásia , Depressão/diagnóstico , Depressão/epidemiologia , Estudos Epidemiológicos , Análise Fatorial , Humanos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
19.
BMC Psychiatry ; 21(1): 200, 2021 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879130

RESUMO

BACKGROUND: Perinatal common mental disorders are associated with significant adverse outcomes for women and their families, particularly in low- and middle-income settings. Early detection through screening with locally-validated tools can improve outcomes. METHODS: We searched MEDLINE, Embase, PsycINFO, Global Health, Cochrane Library, Web of Science and Google Scholar for articles on the validation of screening tools for common mental disorders in perinatal women in India, with no language or date restrictions. Quality was assessed using the QUADAS-2 tool. We used bivariate and hierarchical summary receiver operating characteristic models to calculate pooled summary estimates of sensitivity and specificity. Heterogeneity was assessed by visualising the distance of individual studies from the summary curve. RESULTS: Seven studies involving 1003 women were analysed. All studies assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS) in identifying perinatal depression. No validation studies of any other screening tools were identified. Using a common threshold of ≥13 the EPDS had a pooled sensitivity and specificity of 88·9% (95%CI 77·4-94·9) and 93·4 (95%CI 81·5-97·8), respectively. Using optimal thresholds (range ≥ 9 to ≥13) the EPDS had a pooled sensitivity and specificity of 94·4% (95%CI 81·7-98·4) and 90·8 (95%CI 83·7-95·0), respectively. CONCLUSION: The EPDS is psychometrically valid in diverse Indian settings and its use in routine maternity care could improve detection of perinatal depression. Further research is required to validate screening tools for other perinatal common mental disorders in India.


Assuntos
Depressão Pós-Parto , Serviços de Saúde Materna , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Índia , Programas de Rastreamento , Período Pós-Parto , Gravidez , Escalas de Graduação Psiquiátrica
20.
Medicine (Baltimore) ; 100(14): e25273, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832092

RESUMO

BACKGROUND: The optimal dose (number of pulses per session) of repetitive transcranial magnetic stimulation (rTMS), using the H-coil, in major depressive disorder (MDD) has not previously been reported. OBJECTIVE: To explore the relationship between rTMS dose and antidepressant effect, and collect data for the design of a definitive trial. METHODS: This was a double-blind, three-arm parallel-group, randomized [1:1:1], pilot trial conducted in Stockholm, Sweden (September 2014 to September 2016). The primary outcome was change in depression severity measured with the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks. Participants (n = 29) with MDD were randomized to 1000, 2000, or 4000 pulses of rTMS for 20 sessions during 4 weeks. RESULTS: At 4 weeks, the 3 treatment groups reduced the mean MADRS (95% CI) by 11.6 (4.0-19.2), 9.1 (5.0-13.3), and 11.3 (4.1-18.5) points respectively. Eleven participants met criteria for response and 10 for remission. No serious adverse events occurred. Ratings of subjective memory improved in all groups. Exploring the effect of dose and time, 4000 pulses had the largest reduction in MADRS during the first 2 weeks. A comparison of change in MADRS between 2000 and 4000 pulses after 2 weeks will require a sample size of 66 patients at power .80 and alpha .05. CONCLUSIONS: It is feasible to conduct a definitive trial investigating whether a higher number of magnetic pulses per treatment session gives a more rapid antidepressive response.


Assuntos
Transtorno Depressivo Maior/terapia , Estimulação Magnética Transcraniana/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escalas de Graduação Psiquiátrica
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