The role of stress and life events in the onset of depression in the elderly / O papel do estresse e de acontecimentos cotidianos no desenvolvimento da depressão na terceira idade

The prevalence of major depressive episode in the elderly leads to impairment on several aspects of daily life, including life quality, morbid - mortality and increases rates of suicide risks. Stress and life events are frequent triggers of depressive episode in elderly. The present review aimed to explore the aspects related to the onset of depression in old age, focusing on psychosocial and stress. In order to achieve that, we systematically reviewed papers published in the Medline database from 2003-2013. From this study, we verify that depression in the elderly is a complex disorder, more often associated to psychosocial aspects and chronic stress than to genetic and biomarkers. Loneliness, daily and chronic stress, lack of social support, mourning and economical aspects such as retirement and job loss are major risk factors for depression. Generally, negative life events were noticed to cause poorer mental health in advanced age and cumulative stressful events or traumas untreated too. Furthermore, cognitive functions may be affected negatively by lifelong chronic stressors. These events can cause quite a few different impacts in distinct cultures and lifestyles. The consequences also depend on the duration, or on the life period that these episodes occur. The treatment of depression in the elderly should target both medication and psychotherapy in order to account for psychological aspects, especially treatments based on life review. These perspectives are important due to the possibility of development of specific target strategies in order to prevent those risk factors and improve quality of life in elderly. Many points were contradictorily related, overdue the papers had noticed different conclusions about the same studied points. Face of this, we grouped relevant articles with the same results. Notwithstanding, there were points that require more studies, considering the relevance of the theme.

A prevalência de episódios de depressão em idosos leva a prejuízos em vários aspectos da vida diária, incluindo qualidade de vida, morbimortalidade e, também aumento da taxa de suicídio. O estresse e eventos cotidiano são, frequentemente, gatilhos para a depressão que se afloram na idade avançada. A revisão que se segue objetivou explorar os aspectos relacionados ao início da depressão na terceira idade, com foco psicossocial e no estresse. Para tanto, nós sistematicamente revisamos artigos publicados na base de dados Medline (2003-2013). A partir disso, verificou-se que a depressão nos idosos é um distúrbio complexo que está associado mais prevalentemente a aspectos psicossociais e ao estresse crônico do que a características genéticas e biomarcadores. Solidão, estresse diário e crônico ao longo da vida, falta de apoio social, luto e aspectos econômicos, tais como aposentadoria e perda de emprego, são os principais riscos para se desenvolver sintomas depressivos. Ademais, acontecimentos considerados negativos, eventos estressantes que se acumularam ou traumas não tratados durante a vida foram relacionados à piora da saúde mental na idade avançada. Tais eventos podem causar diferentes impactos em culturas e estilos de vida distintos. As consequências também dependem da duração ou do período da vida em que os episódios ocorreram. O tratamento da depressão no idoso deve ser baseado em medicações e psicoterapia, a fim de tratar aspectos psicológicos. Nesse sentido, destaca-se a terapia com base na revisão e análise de vida. Estas perspectivas de tratamento são importantes devido a possibilidade de desenvolver estratégias alvo específicas, a fim de prevenir esses fatores de risco e melhorar a qualidade de vida do idoso. Muitos pontos foram contraditoriamente relacionados, ou seja, artigos que estudaram os mesmos fatores divergiram nas conclusões. Diante disso, nós agrupamos os artigos mais relevantes com convergência de conclusões.

Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD) to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018). Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%). Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders. .