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1.
Schizophr Res ; 241: 187-196, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35139458

RESUMO

Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature of these episodes is less well understood than the more common, non-psychotic periods of illness and hence their management is also less sophisticated. This is a concern because the risk of suicide is particularly high in this subtype of mood disorder and comorbidity is far more common. In some cases psychotic symptoms may be signs of a comorbid illness but the relationship of psychotic mood to other forms of psychosis and in particular its interactions with schizophrenia is poorly understood. Therefore, our targeted review draws upon extant research and our combined experience to provide clinical context and a framework for the management of these disorders in real-world practice - taking into consideration both biological and psychological interventions.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Transtornos Psicóticos , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/etiologia , Transtornos do Humor/terapia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia
2.
J Med Internet Res ; 24(5): e30907, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35594137

RESUMO

BACKGROUND: Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China's public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. OBJECTIVE: This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app-based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. METHODS: Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. RESULTS: Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). CONCLUSIONS: Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD.


Assuntos
Transtorno Depressivo Maior , Aplicativos Móveis , Distúrbios do Início e da Manutenção do Sono , China/epidemiologia , Estudos de Coortes , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Humanos , Saúde Mental
3.
BMJ Open ; 12(5): e051887, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534066

RESUMO

PURPOSE: The Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia. PARTICIPANTS: 1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties. FINDINGS TO DATE: Prevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3. FUTURE PLANS: We are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Violência por Parceiro Íntimo , Refugiados , Adulto , Austrália/epidemiologia , Criança , Estudos de Coortes , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Violência por Parceiro Íntimo/psicologia , Masculino , Saúde Mental , Pandemias , Gravidez , Estudos Prospectivos , Refugiados/psicologia
4.
Zhonghua Yi Xue Za Zhi ; 102(19): 1437-1444, 2022 May 24.
Artigo em Chinês | MEDLINE | ID: mdl-35599408

RESUMO

Objective: To analyze the gender differences of genetic etiology in the incidence of major depression disorder among Han freshmen. Methods: A 1-year follow-up survey was carried out among 8 079 Han freshmen from Jining, Rizhao and Weifang without lifetime major depressive disorder (MDD) at baseline (April to October 2018) and 4 828 venous blood samples were also collected. After extracting DNA, Sequenom Mass Array time-of-flight mass spectrometry biochip technology was used to detect the genotypes of 17 single nucleotide polymorphisms (SNPs) MDD-related loci. Logistic regression was used for univariate analysis. Generalized multifactor dimension reduction was used to analyze gene-gene interactions. Composite International Diagnostic Interview (CIDI) 3.0 was used for MDD diagnosis. Results: The 1-year incidence of MDD among Han freshmen was 2.23% (95%CI: 1.91%-2.60%) and the gender difference of incidence between males (1.97%, 95%CI: 1.52%-2.56%) and females (2.39%, 95%CI: 1.98%-2.90%) was not statistically significant (P>0.05). AG genotype of rs768705 (nearby gene: TMEM161B) was a risk factor for MDD (OR=1.98, 95%CI: 1.24-2.83). The TC genotype of rs17727765 (nearby gene: CRYBA1) was only a risk factor for MDD in males (OR=9.61, 95%CI: 2.04-45.30). An 8-loci interaction model (PMFBP1, OLFM4, LHPP, ENOX1, TMEM161B, SPPL3, FBXL4 and L3MBTL2) could predict MDD in women with an accuracy rate of 60.05%. No effective prediction model was found for MDD in men. Conclusions: There might be gender differences in the genetic etiology of MDD. Further researches on the genetic causes of MDD in men should be explored.


Assuntos
Transtorno Depressivo Maior , Estudos de Casos e Controles , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/genética , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Masculino , Polimorfismo de Nucleotídeo Único , Fatores Sexuais
5.
Eur J Psychotraumatol ; 13(1): 2059999, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35599978

RESUMO

Background: Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumatic events in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Traumatic events often lead to increased mental health burdens in affected communities. Objective: To assess if the number of traumatic events experienced by residents of Fort McMurray correlates with the prevalence and severity of mental health issues experienced. Methodology: A cross-sectional study using an online survey questionnaire was used to gather demographic, trauma (wildfire, flooding, and COVID-19), and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardised rating scales. Data were analyzed with SPSS version 26 using Chi-Square tests and multivariate regression analysis. Results: Respondents who experienced COVID-19 and either flood or wildfire traumas (N = 101) were eleven times more likely to have GAD symptoms (OR: 11.39; 95% CI: 1.43-91.04), four times more likely to have likely MDD, (OR: 3.85; 95% CI: .995-14.90), ten times more likely to have likely PTSD (OR: 10.47; 95% CI: 1.28-85.67), and low resilience (OR: 10.56; 95% CI: 1.21-92.17). Respondents who experienced COVID-19, flooding, and wildfire traumas (N = 47) were eighteen times more likely to express GAD symptoms (OR: 18.30; 95% CI: 2.20-152.45) and more than eleven times likely to have likely PTSD (OR: 11.41; 95% CI: 1.34-97.37) in comparison to the respondents who experienced COVID-19 only trauma (N = 19). Conclusion: Measures to reduce climate change and associated natural disasters could reduce the impact of cumulative trauma and associated mental health burden in vulnerable populations. It is essential that more mental health resources are mobilised to support communities impacted by multiple natural disasters. HIGHLIGHTS: The number of traumatic disasters experienced in residents of Fort McMurray five years after the 2016 wildfires, a year after the 2020 flooding, and during the COVID-19 pandemic correlates with the prevalence and severity of the mental health conditions reported in this study.


Antecedentes: Fort McMurray es una ciudad en el norte de Alberta, Canadá, que ha experimentado múltiples eventos traumáticos en los últimos cinco años, incluyendo el incendio forestal del 2016, las inundaciones del 2020 y la pandemia por la COVID-19. Los eventos traumáticos con frecuencia conducen a una mayor carga de salud mental en las comunidades afectadas. Objetivo: Evaluar si el número de eventos traumáticos experimentados por los residentes de Fort McMurray se correlacionan con la prevalencia y la severidad de los problemas de salud mental experimentados. Métodos: Se realizó un estudio transversal utilizando un cuestionario en línea para recolectar información demográfica relacionada con el trauma (incendio forestal, inundación y COVID-19) y con la información clínica de los residentes de Fort McMurray entre el 24 de abril y el 2 de junio del 2021. Se midió la probabilidad del trastorno de ansiedad generalizada (TAG), del trastorno depresivo mayor (TDM), del trastorno de estrés postraumático (TEPT) y de una baja resiliencia utilizando escalas de medición estandarizadas. Los datos fueron analizados con el programa SPSS versión 26 utilizando las pruebas de Chi cuadrado y el análisis multivariado de regresión. Resultados: Los encuestados que experimentaron la COVID-19 y los traumas por las inundaciones o los incendios forestales (N=101) tenían once veces más probabilidad de tener síntomas de TAG (OR: 11.39; 95% CI: 1.43­91.04), cuatro veces más probabilidad de tener un TDM (OR: 3.85; 95% CI:.995­14.90), diez veces más probabilidad de tener TEPT (OR: 10.47; 95% CI: 1.28­85.67) y una baja resiliencia. Los encuestados que experimentaron traumas tanto por la COVID 19, por las inundaciones y por los incendios forestales (N=47) tenían dieciocho veces más probabilidad de expresar síntomas de TAG (OR: 18.30; 95% CI: 2.20­152.45) y más de once veces la probabilidad de tener TEPT (OR: 11.41; 95% CI: 1.34­97.37) en comparación con los encuestados que experimentaron a la COVID-19 como su única experiencia traumática (N=19). Conclusiones: Las medidas para reducir el cambio climático y los desastres naturales asociados podrían reducir el impacto acumulativo de las experiencias traumáticas y la carga de salud mental asociada en poblaciones vulnerables. Es esencial que se movilicen más recursos de salud mental para brindar apoyo a las comunidades afectadas por múltiples desastres naturales.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Incêndios Florestais , Alberta/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Humanos , Saúde Mental , Pandemias
6.
Math Biosci Eng ; 19(6): 5380-5392, 2022 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-35603360

RESUMO

Bereavement exclusion (BE) is a criterion for excluding the diagnosis of major depressive disorder (MDD). Simplistically, this criterion states that an individual who reports MDD symptoms should not be diagnosed as suffering from this mental illness, if such an individual is grieving a sorrowful loss. BE was introduced in 1980 to avoid confusing MDD with normal grief, because several cognitive and physical symptoms of grief and depression can look similar. However, in 2013, BE was removed from the MDD diagnosis guidelines. Here, this controversial topic is computationally investigated. A virtual population is generated according to the Brazilian data of death rate and MDD prevalence and its five kinds of individuals are clustered by using a Kohonen's self-organizing map (SOM). In addition, by examining the current guidelines for diagnosing MDD from an analytical perspective, a slight modification is proposed. With this modification, an adequate clustering is achieved by the SOM neural network. Therefore, for mathematical consistency, unbalanced scores should be assigned to the items composing the MDD diagnostic criteria. With the proposed criteria, the co-occurrence of normal grief and MDD can also be satisfactorily clustered.


Assuntos
Luto , Transtorno Depressivo Maior , Depressão/diagnóstico , Depressão/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Pesar , Humanos , Prevalência
7.
BMC Psychiatry ; 22(1): 317, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35509005

RESUMO

BACKGROUND: This study aimed to examine the potential independent association of functional disability with major depression and moderating effects of social support variables including marital status, living arrangement and social participation in such associations. METHODS: Data for the study were drawn from the Longitudinal Ageing Study in India (LASI) wave 1 that was collected during 2017-18 including a sample of 31,464 individuals aged 60 years and above. Descriptive statistics and results from bivariate analysis have been reported. Further, moderated multivariable logistic regression models were used to fulfil the study objective. Major depressive disorder was assessed using the scale of the Short Form Composite International Diagnostic Interview (CIDI-SF). RESULTS: It was found that 8.67% of older participants were depressed in this study. Older adults who had difficulty in basic activities of daily living (BADL) (15.34%), difficulty in instrumental activities of daily living (IADL) (12.06%), unmarried (10.13%), separate living (9.67%) and socially inactive (10.09) were having higher prevalence of major depression compared to their respective counterparts. The adjusted model-1 revealed that older adults who had difficulty in BADL and IADL were 2.53 times [AOR: 2.53, CI: 2.17-2.95] and 2.27 times [AOR: 2.27, CI: 1.97-2.64] more likely to have major depression than those with no difficulty in BADL and IADL respectively. Further, interaction analyses found that currently unmarried status, separate living and being socially inactive have moderation effects in the observed associations and exacerbate the likelihood of major depression among older adults who are functionally impaired. CONCLUSIONS: The findings highlight the importance of integrating social participation in the daily life of older adults and developing initiatives that promote a healthy surrounding such as social connectedness, co-residential living and special care for those who are physically disabled to protect against late-life depression.


Assuntos
Transtorno Depressivo Maior , Pessoas com Deficiência , Atividades Cotidianas , Idoso , Envelhecimento , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Humanos , Vida Independente , Índia/epidemiologia , Apoio Social
8.
Epidemiol Psychiatr Sci ; 31: e26, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35465862

RESUMO

AIMS: Sleep disturbance is an important factor in the pathophysiology and progression of psychiatric disorders, but whether it is a cause, or a downstream effect is still not clear. METHODS: To investigate causal relationships between three sleep-associated traits and seven psychiatric diseases, we used genetic variants related to insomnia, chronotype and sleep duration to perform a two-sample bidirectional Mendelian randomisation analysis. Summary-level data on psychiatric disorders were extracted from the Psychiatric Genomics Consortium. Effect estimates were obtained by using the inverse-variance-weighted (IVW), weights modified IVW, weighted-median methods, MR-Egger regression, MR pleiotropy residual sum and outlier (MR-PRESSO) test and Robust Adjusted Profile Score (RAPS). RESULTS: The causal odds ratio (OR) estimate of genetically determined insomnia was 1.33 (95% confidence interval (CI) 1.22-1.45; p = 5.03 × 10-11) for attention-deficit/hyperactivity disorder (ADHD), 1.31 (95% CI 1.25-1.37; p = 6.88 × 10-31) for major depressive disorder (MDD) and 1.32 (95% CI 1.23-1.40; p = 1.42 × 10-16) for post-traumatic stress disorder (PTSD). There were suggestive inverse associations of morningness chronotype with risk of MDD and schizophrenia (SCZ). Genetically predicted sleep duration was also nominally associated with the risk of bipolar disorder (BD). Conversely, PTSD and MDD were associated with an increased risk of insomnia (OR = 1.06, 95% CI 1.03-1.10, p = 7.85 × 10-4 for PTSD; OR = 1.37, 95% CI 1.14-1.64; p = 0.001 for MDD). A suggestive inverse association of ADHD and MDD with sleep duration was also observed. CONCLUSIONS: Our findings provide evidence of potential causal relationships between sleep disturbance and psychiatric disorders. This suggests that abnormal sleep patterns may serve as markers for psychiatric disorders and offer opportunities for prevention and management in psychiatric disorders.


Assuntos
Transtorno Depressivo Maior , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/genética , Estudo de Associação Genômica Ampla , Humanos , Análise da Randomização Mendeliana , Sono , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/genética , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/genética
9.
JAMA ; 327(16): 1566-1576, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35471512

RESUMO

Importance: Tobacco use is highly concentrated in persons with mental illness. Objectives: To assess trends in past-month prevalence of cigarette smoking among adults with vs without past-year depression, substance use disorders (SUDs), or both, using nationally representative data. Design, Setting, and Participants: Exploratory, serial, cross-sectional study based on data from 558 960 individuals aged 18 years or older who participated in the 2006-2019 US National Surveys on Drug Use and Health. Exposure: Past-year major depressive episode (MDE) and SUD using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. Main Outcomes and Measures: Past-month self-reported cigarette use, adjusted for sociodemographic characteristics. Results: Of the sampled 558 960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of -3.2 (95% CI, -3.5 to -2.8; P < .001), adults with SUD from 46.5% to 35.8% for an average annual percent change of -1.7 (95% CI, -2.8 to -0.6; P = .002), and adults with co-occurring MDE and SUD from 50.7% to 37.0% for an annual average annual percent change of -2.1 (95% CI, -3.1 to -1.2; P < .001). The prevalence declined significantly for each examined age, sex, and racial and ethnic subgroup with MDE and with SUD (all P < .05), except for no significant changes in American Indian or Alaska Native adults with MDE (P = .98) or with SUD (P = .46). Differences in prevalence of cigarette smoking between adults with vs without MDE declined significantly for adults overall from 11.5% to 6.6%, for an average annual percent change of -3.4 (95% CI, -4.1 to -2.7; P < .001); significant average annual percent change declines were also seen for men (-5.1 [95% CI, -7.2 to -2.9]; P < .001); for women (-2.7 [95% CI, -3.9 to -1.5]; P < .001); for those aged 18 through 25 years (-5.2 [95% CI, -7.6 to -2.8]; P < .001); for those aged 50 years or older (-4.7 [95% CI, -8.0 to -1.2]; P = .01); for Hispanic individuals (-4.4 [95% CI, -8.0 to -0.5]; P = .03), and for White individuals (-3.6 [95% CI, -4.5 to -2.7]; P < .001). For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without MDE during 2006-2012 but was significantly higher for those with MDE during 2013-2019 (difference, 11.3%; 95% CI, 0.9 to 21.7; P = .04). Differences among those with vs without SUD declined for women for an average annual percent change of -1.8 (95% CI, -2.8 to -0.9; P = .001). Conclusions and Relevance: In this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019. However, continued efforts are needed to reduce the prevalence further.


Assuntos
Fumar Cigarros , Transtorno Depressivo Maior , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Fumar Cigarros/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
10.
Epidemiol Psychiatr Sci ; 31: e28, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35485802

RESUMO

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.


Assuntos
COVID-19 , Transtorno Depressivo Maior , COVID-19/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Pessoal de Saúde , Humanos , Estudos Longitudinais , Pandemias
11.
Artigo em Inglês | MEDLINE | ID: mdl-35457746

RESUMO

There is growing recognition in research and policy of a mental health crisis among Canada's paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service's peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates-a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Transtornos de Estresse Pós-Traumáticos , Pessoal Técnico de Saúde , COVID-19/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Humanos , Ontário/epidemiologia , Pandemias , Transtornos de Estresse Pós-Traumáticos/psicologia
12.
J Affect Disord ; 309: 172-177, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35487437

RESUMO

BACKGROUND: This study evaluated associations of PE with symptomatic status in mood and anxiety disorder subjects, and considered many other associated factors so as to expand on comparable previous studies. METHODS: Consenting adults at a mood disorder center were assessed for associations of PE frequency ([never, past only, ≤once/week] vs. regularly at 2-3- or >3-times/week) with standard psychometric measures of depression and anxiety symptoms, selected demographic, clinical factors, using bivariate and multivariate methods. RESULTS: Of 2190 subjects (58.8% women; mean age 42.6 years; 44.8% with major depressive, 40.6% bipolar, and 14.6% anxiety disorders), 22.5% currently engaged in regular PE. Such engagement was associated with lower morbidity ratings, youth, male sex, being unmarried, more education, higher socio-economic status (SES), less religious practice, less early abuse, younger age at illness onset and at intake, fewer years ill, lower BMI, fewer siblings, hyperthymic temperament, less time depressed before intake, and living at higher population density. Greater PE-frequency was associated with lower ratings of depression (but not anxiety), male sex, younger age, and lower BMI. Factors independently associated with PE in multivariate modeling ranked by significance: older age at intake ≥ lower BMI > more education > higher SES > male sex. LIMITATIONS: PE assessment did not include type, intensity or duration. Some information provided may be subject to recall bias, though it should not affect comparisons among subjects. CONCLUSION: Regularly repeated PE again appeared to be beneficial for patients with depression or anxiety and should be included in their treatment interventions.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Adolescente , Adulto , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno Bipolar/psicologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Exercício Físico , Feminino , Humanos , Masculino , Transtornos do Humor/epidemiologia
13.
Adv Clin Exp Med ; 31(4): 355-358, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35394125

RESUMO

Depressive and anxiety disorders often comorbid, which causes more severe impairments. The high comorbidity and shared genetic and psychological factors between the 2 disorders have brought arguments about whether they represent a common construct, and whether the current classification is meaningful. In this editorial, a state-of-the-art overview of recent studies on the underlying mechanism of such comorbidity, and the association between and differentiation of the 2 disorders is provided. Recent studies employing data-driven approaches such as latent class analysis (LCA) and network analysis to investigate the symptomatology of depression and anxiety have indicated unique characteristics and bridging symptoms of their comorbidity. Whereas previous neurobiological and neuroendocrinological studies reported common alterations in prefrontal-limbic pathways, serotonergic projections and the hypothalamic-pituitary-adrenal (HPA) axis, recent research suggests that distinct neural circuits and heterogeneous changes in HPA activity may exist in depression when compared to anxiety. Lastly, both depression and anxiety have been long associated with decision-making deficits; however, emerging evidence from computational psychiatry demonstrate that there may be unique neurocognitive and computational alterations in each disorder. By investigating the common and unique symptomatic characteristics and underlying neurobiological and neurocomputational mechanisms of the 2 disorders as well as their comorbidity, it can be concluded that recent studies have greatly advanced our understanding of the etiology and neuropathophysiology of these disorders.


Assuntos
Transtorno Depressivo Maior , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo
14.
BMJ Open ; 12(4): e052718, 2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35440447

RESUMO

OBJECTIVE: The present study aimed to examine the associations of several indicators of food insecurity with depression among older adults in India. DESIGN: A cross-sectional study was conducted using country-representative survey data. SETTING AND PARTICIPANTS: The present study uses data of the Longitudinal Aging Study in India conducted during 2017-2018. The effective sample size for the present study was 31 464 older adults aged 60 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome variable was major depression among older adults. Descriptive statistics along with bivariate analysis was presented. Additionally, binary logistic regression analysis was used to establish the association between the depression and food security factors along with other covariates. RESULTS: The overall prevalence of major depression was 8.4% among older adults in India. A proportion of 6.3% of the older adults reduced the size of meals, 40% reported that they did not eat enough food of their choice, 5.6% mentioned that they were hungry but did not eat, 4.2% reported that they did not eat for a whole day and 5.6% think that they have lost weight due to lack of enough food in the household. Older adults who reported to have reduced the size of meals due to lack of enough food (adjusted OR (AOR): 1.76, CI 1.44 to 2.15) were hungry but did not eat (AOR: 1.35, CI 1.06 to 1.72) did not eat food for a whole day (AOR: 1.33; CI 1.03 to 1.71), lost weight due to lack of food (AOR: 1.57; CI 1.30 to1.89) had higher odds of being depressed in reference to their respective counterparts. CONCLUSION: The findings suggest that self-reported food insecurity indicators were strongly associated with major depression among older Indian adults. The national food security programmes should be enhanced as an effort to improve mental health status and quality of life among older population.


Assuntos
Depressão , Transtorno Depressivo Maior , Idoso , Estudos Transversais , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Insegurança Alimentar , Abastecimento de Alimentos , Humanos , Índia/epidemiologia , Qualidade de Vida
15.
J Affect Disord ; 308: 432-441, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35398107

RESUMO

BACKGROUND: Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. METHODS: Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. RESULTS: A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LIMITATIONS: Self-report data were used; external validation of the multivariable prediction models is needed. CONCLUSION: MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.


Assuntos
Transtorno Depressivo Maior , Adolescente , Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Criança , Estudos de Coortes , Depressão/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Estudantes/psicologia , Universidades
16.
J Affect Disord ; 309: 123-130, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35429521

RESUMO

BACKGROUND: Subthreshold depression is highly prevalent in adolescence, but compared to major depressive disorder, the clinical impact is under-researched. The aim of this review was to compare subthreshold depression and major depressive disorder in adolescents by reviewing available literature on epidemiology, risk factors, illness trajectories, brain anatomy and function, genetics, and treatment response. METHODS: We conducted a scoping review of papers on subthreshold depression and major depressive disorder in adolescence published in English. Studies in adults were included when research in adolescence was not available. RESULTS: We found that individuals with subthreshold depression were similar to individuals with major depressive disorder in several regards, including female/male ratio, onset, functional impairment, comorbidity, health care utilization, suicidal ideation, genetic predisposition, brain alterations, and treatment response. Further, subthreshold depression was about two times more common than major depressive disorder. LIMITATIONS: The definition of subthreshold depression is highly variable across studies. Adolescent-specific data are limited in the areas of neurobiology and treatment. CONCLUSIONS: The findings of the current review support the idea that subthreshold depression is of clinical importance and provide evidence for a spectrum, versus categorical model, for depressive symptomatology. Given the frequency of subthreshold depression escalating to major depressive disorder, a greater recognition and awareness of the significance of subthreshold depression in research, clinical practice and policy-making may facilitate the development and application of early prevention and intervention.


Assuntos
Transtorno Depressivo Maior , Adolescente , Adulto , Comorbidade , Depressão , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco
17.
J Affect Disord ; 308: 289-297, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35429529

RESUMO

BACKGROUND: The glutamate N-methyl-d-aspartate (NMDA) receptor antagonist ketamine rapidly ameliorates posttraumatic stress disorder (PTSD) and depression symptoms in individuals with comorbid PTSD and major depressive disorder (MDD). However, concerns over ketamine's potential neurocognitive side effects have yet to be assessed in this population. The current study investigated 1) changes in neurocognitive performance after a repeated ketamine dosing regimen and 2) baseline neurocognitive performance as a predictor of ketamine treatment effect. METHOD: Veterans with comorbid PTSD and MDD (N = 15) received six infusions of 0.5 mg/kg ketamine over a 12-day period. Neurocognitive and clinical outcomes assessments occurred at baseline and within 7 days of infusion-series completion using the CogState battery. RESULTS: Repeated ketamine infusions did not significantly worsen any measures of cognition. Rather, significant improvement was observed in working memory following completion of the infusion series. In addition, greater improvements in PTSD and MDD symptoms were associated with lower working memory, slower processing speed and faster set shifting at baseline. Lower verbal learning was also predictive of improvement in depression. LIMITATIONS: This study applied an open-label design without a placebo control. As such, it is not known to what extent the correlations or improvement in neurocognitive performance may have occurred under placebo conditions. CONCLUSION: This is the first study to examine the neurocognitive effects of repeated ketamine in participants with comorbid PTSD and MDD. Our findings suggest potential baseline neurocognitive predictors of ketamine response for comorbid PTSD and MDD symptoms.


Assuntos
Transtorno Depressivo Maior , Ketamina , Transtornos de Estresse Pós-Traumáticos , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/epidemiologia
18.
J Korean Med Sci ; 37(14): e108, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35411728

RESUMO

BACKGROUND: The effect of coronavirus disease 2019 (COVID-19) pandemic on public mental health has been increasing. Additionally, the underlying psychological stressors remain unexplored, and few studies have been conducted nationally on the social distancing measures. Therefore, the present study aimed to identify the psychological impacts of the implementation of social distancing measures by analyzing the Internet search trends of major depressive disorder (MDD) symptoms. METHODS: Using Naver® Trends' relative search volumes (RSVs), we analyzed the average search volumes and trend changes of 16 terms, adopted from the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for diagnosing MDD. An interrupted time-series analysis was performed using the data from January 1, 2016 to December 31, 2020. Furthermore, changes in RSVs, according to the intensity of the social distancing measures implemented from January 1 to December 31, 2020, were determined using Wilcoxon rank sum tests. RESULTS: Of the 16 terms, the search trends of 'feeling guilty' (P < 0.001) and 'wanting to die' (P = 0.002) showed a significant increase as of February 29, 2020, when the social distancing measures were officially implemented. Additionally, the average search volumes for 'hopelessness' (P = 0.003), 'sexual desire' (P < 0.001), 'insomnia' (P = 0.002), 'hypersomnia' (P < 0.001), 'restlessness' (P < 0.001), and 'feeling lethargic' (P < 0.001) increased significantly. Moreover, gender analysis showed that the average search volume of 'depressed mood' (P = 0.033) and the trend of 'impaired concentration' (P < 0.001) increased in males only. However, the average search volume of 'feeling lethargic' (P = 0.001) and the trend of 'feeling guilty' (P = 0.001) increased in females only. The average search volumes for 'depressed mood' (P < 0.001), 'impaired concentration' (P = 0.038), and 'indecisiveness' (P < 0.001) were significantly higher during the enforcement of level 2 or higher social distancing measures. CONCLUSION: Our results reported the negative effect of COVID-19 preventive measures on public mental health in South Korea, especially for MDD symptoms. Moreover, the findings suggested the utility of Naver Trends as a feasible big data source to assess future mental health crises.


Assuntos
COVID-19 , Transtorno Depressivo Maior , COVID-19/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Internet , Masculino , Pandemias , Saúde Pública
19.
Vertex ; XXXIII(155): 36-49, 2022 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-35438684

RESUMO

Treatment-Resistant Depression (TRD) prevalence varies considerable between regions and epidemiology of TRD in Argentina is lacking. Based on the Treatment-Resistant Depression in America Latina (TRAL) study, epidemiology and burden of TRD in MDD patients from Argentina is reported in this paper. A sample of adult MDD patients (n=396) from 5 sites in Argentina, with clinical diagnosis were included. Patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial were excluded. Patient reported outcomes and clinical assessment scales were used as outcomes. The prevalence of TRD in MDD patients in Argentina is 33.2%, based on TRAL data. Patients in TRD are older compared to those without TRD, and was more evident in married/consensual union MDD patients. Higher suicidality, greater comorbidity based on MINI, and worse scores in MADRS and PHQ-9 were identified in TRD patients. The prevalence identified in TRAL study for Argentina is substantial comparing with other Latin American countries and worldwide prevalence. TRD represents a disproportional burden to society, and efforts should be placed on reducing the burden of MDD and TRD in Argentina by improving early diagnosis, therapeutic management and ensuring that all patients have better access to mental healthcare.


Assuntos
Transtorno Depressivo Maior , Adulto , Argentina/epidemiologia , Depressão , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Humanos , América Latina/epidemiologia , Estudos Retrospectivos
20.
J Clin Psychiatry ; 83(3)2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35452197

RESUMO

Objective: Mood disorders often co-occur with attention-deficit/hyperactive disorder (ADHD), disruptive behavior disorders (DBDs), and aggression. We aimed to determine if polygenic risk scores (PRSs) based on external genome-wide association studies (GWASs) of these disorders could improve genetic identification of mood disorders.Methods: We combined 6 independent family studies that had genetic data and diagnoses for mood disorders that were made using different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). We identified mood disorders, either concurrently or in the future, in participants between 6 and 17 years of age using PRSs calculated using summary statistics of GWASs for ADHD, ADHD with DBD, major depressive disorder (MDD), bipolar disorder (BPD), and aggression to compute PRSs.Results: In our sample of 485 youths, 356 (73%) developed a subthreshold or full mood disorder and 129 (27%) did not. The cross-validated mean areas under the receiver operating characteristic curve (AUCs) for the 7 models identifying participants with any mood disorder ranged from 0.552 in the base model of age and sex to 0.648 in the base model + all 5 PRSs. When included in the base model individually, the ADHD PRS (OR = 1.65, P < .001), Aggression PRS (OR = 1.27, P = .02), and MDD PRS (OR = 1.23, P = .047) were significantly associated with the development of any mood disorder.Conclusions: Using PRSs for ADHD, MDD, BPD, DBDs, and aggression, we could modestly identify the presence of mood disorders. These findings extend evidence for transdiagnostic genetic components of psychiatric illness and demonstrate that PRSs calculated using traditional diagnostic boundaries can be useful within a transdiagnostic framework.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Depressivo Maior , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Criança , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/genética , Estudo de Associação Genômica Ampla , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/genética , Herança Multifatorial/genética , Fatores de Risco
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