Self-reported depression and anxiety among COPD patients. A case-control study

Abstract BACKGROUND: Anxiety and depression are the most prevalent mental disorders worldwide. However, the exact mechanisms linking chronic obstructive pulmonary disease (COPD) with depression and anxiety have not been identified. OBJECTIVES: To compare self-reported depression and anxiety among patients diagnosed with COPD in relation to healthy controls. DESIGN AND SETTING: Case control study at a public hospital institution in Spain. METHODS: We designed a case-control study. Patients were recruited using a consecutive sampling method from a single institution. Two groups were created: COPD and healthy controls. Data on medical history and demographic background were collected from the medical records. Self-reported depression levels were assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured using the State-trait anxiety inventory (STAI). RESULTS: Fifty-two patients with COPD and fifty healthy patients were included in this study. BDI scores were higher for COPD patients (10.23 ± 6.26) than in the control group (5.2 ± 6.56). STAI-state scores were higher for COPD patients (41.85 ± 12.55) than for controls (34.88 ± 9.25). STAI-trait scores were higher for COPD patients (41.42 ± 10.01) than for controls (34.62 ± 9.19). CONCLUSIONS: This study showed that there were higher levels of depression and anxiety among COPD patients than among healthy controls.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Funcionalidade familiar e associações com medidas sociodemográficas e psicológicas em idosos da comunidade / Funcionalidad familiar y asociaciones con medidas sociodemográficas y psicológicas en personas mayores de la comunidad / Family Functionality and associations with sociodemographic and psychological measures in elderly people in the community

O objetivo deste estudo foi verificar associações entre funcionalidade familiar com medidas sociodemográficas e psicológicas em idosos da comunidade. Na pesquisa de abordagem quantitativa, descritiva e transversal, foram investigados 58 idosos (M= 69,33 anos; DP=±6,86), residentes em Brasília-DF, Brasil. Foram avaliadas medidas sociodemográficas (idade, sexo, escolaridade, estado civil e classificação socioeconômica), de funcionalidade familiar (APGAR), qualidade de vida (WHOQOL-OLD), desenvolvimento pessoal (EDEP), ansiedade (BAI) e depressão (EDI). Foram analisados os dados descritivos, realizado Kruskal-wallis para a comparação entre os grupos e proposto um modelo de regressão logística múltipla (Forward Stepwise de Wald). O nível de significância das análises foi de p ≤0,05. Os resultados indicaram que o grupo de idosos com elevada disfuncionalidade familiar apresentou menor qualidade de vida geral em autonomia, atividades passadas, presentes e futuras, participação social, intimidade e maior presença de sintomas depressivos e ansiedade. O modelo de regressão logística múltipla indicou que apenas o domínio Atividades Passadas, Presentes e Futuras (p=0,001) manteve-se significativamente associado ao APGAR. Concluindo-se que o investimento nas relações familiares constitui um elemento importante para a qualidade de vida e saúde mental na velhice.

El objetivo de este estudio fue verificar la asociación entre la funcionalidad familiar y las medidas sociodemográficas y psicológicas en personas mayores de la comunidad. En la investigación cuantitativa, descriptiva y transversal, se investigaron 58 ancianos (M = 69,33 años; DT = ± 6,86), residentes en Brasília-DF, Brasil. Se evaluaron medidas sociodemográficas (edad, sexo, educación, estado civil y clasificación socioeconómica), funcionamiento familiar (APGAR), calidad de vida (WHOQOL-OLD), desarrollo personal (EDEP), ansiedad (BAI) y depresión (EDI). Se analizaron datos descriptivos, se realizó Kruskal-wallis para la comparación entre grupos y se propuso un modelo de regresión logística múltiple (Forward Stepwise de Wald). El nivel de significación de los análisis fue p ≤0,05. Los resultados indicaron que el grupo de personas mayores con alta disfuncionalidad familiar tenía una calidad de vida general más baja en autonomía, actividades pasadas, presentes y futuras, participación social, intimidad y mayor presencia de síntomas depresivos y de ansiedad.. El modelo de regresión logística múltiple indicó que solo el dominio de Actividades Pasadas, Presentes y Futuras (p=0,001) permaneció asociado significativamente con APGAR. En conclusión, la inversión en las relaciones familiares es un elemento importante para la calidad de vida y la salud mental en la vejez. Palabras claves: ancianos, familia, calidad de vida, ansiedad, depresión

This study aimed to verify associations between family functionality and sociodemographic and psychological measures among the elderly in the community. A quantitative, descriptive and cross-sectional research included 58 older adults (M = 69.33 years; SD = ± 6.86) living in Brasília-DF. Sociodemographic measures, family functioning, quality of life, personal development, anxiety and depression were evaluated. Descriptive data were analysed, Kruskal-Wallis was performed for comparison between groups, and a multiple logistic regression model (Forward Stepwise de Wald) was proposed. The results indicated that elderly with high family dysfunctionality had a lower overall quality of life in some domains. The multiple logistic regression model indicated that only the Past, Present and Future Activities domain remained significantly associated with APGAR. In conclusion, investment in family relationships is an essential element for the quality of life and mental health in old age.

Factores asociados a bajo rendimiento cognitivo en adultos con sospecha de apnea obstructiva del sueño / Factors associated with low cognitive performance in adults with suspected obstructive sleep apnea

La apnea obstructiva del sueño (AOS) se ha asociado a deterioro cognitivo. OBJETIVO: Identificar factores asociados a bajo rendimiento cognitivo (BRC) en adultos con sospecha de AOS. MÉTODO: Se realizó evaluación cognitiva empleando la Evaluación Cognitiva de Montreal (MoCA); se consideró BRC un puntaje inferior a 21. El diagnóstico de AOS fue mediante poligrafía respiratoria de 5 canales, según índice de apnea-hipopnea (IAH). Se evaluó también calidad de sueño, síntomas depresivos, entre otros. RESULTADOS: En 91,5% de 320 pacientes consecutivos se confirmó el diagnóstico de AOS. El promedio de MoCA fue 20,6 puntos. El grupo con BRC tenía mayor edad, menor escolaridad; mayor frecuencia de hipertensión arterial y diabetes mellitus, y desaturaciones de la oxihemoglobina de mayor magnitud. No hubo diferencias de gravedad según IAH entre ambos grupos. COMENTARIO: Los pacientes con BRC presentan factores de riesgo asociados a deterioro cognitivo, y mayor magnitud de desaturaciones de la oxihemoglobina.

Obstructive sleep apnea (OSA) has been associated with cognitive decline. OBJECTIVE: To identify factors associated with low cognitive performance (LCP) in adults with suspected OSA. MATHOD: Cognitive evaluation was performed using Montreal Cognitive Assessment (MoCA), and scores lower than 21 were considered LCP. The diagnosis of OSA was made using 5-channel respiratory polygraphy, according to the apnea-hypopnea index (AHI). Sleep quality, depressive symptoms, among others, were also evaluated. RESULTS: In 91.5% of 320 consecutive patients the diagnosis of OSA was confirmed. The MoCA average was 20.6 points. The group with LCP was older, less educated, were more likely to have hypertension and diabetes mellitus, and with more severe oxyhemoblobin desaturations. There were no differences in severity according to AHI between both groups. COMMENT: Patients with LCP have risk factors associated with cognitive impairment, besides more severe oxyhemoglobin desaturations.

Calidad de vida en personas mayores con depresión y dependencia funcional: validez del cuestionario SF-12 / Quality of life of older people with depression and dependence: validity of the SF-12 (short form health survey) questionnaire

Background: Depression and dependence have a great impact on the quality of life of older people. Aim: To validate the SF-12 (short-form) health related quality of care questionnaire (HRQOL) as an alternative of the SF-36 to estimate health-related quality of life (HRQoL) and its association with depression and dependence in Chilean older people living in the community. Material and Methods: The questionnaire was answered by 4,124 Chilean older people (61% women). HRQoL was evaluated with the SF-36 questionnaire. The SF-12 questionnaire includes 12 items from the SF-36. Results: The internal consistency of the SF-12 questionnaire was high (0.88). The effect size of the differences in the averages of the SF-12 and SF-36 scales was small (0.06-0.41). Good agreement was found between the physical and mental components of the SF-12 and SF-36 (0.94 and 0.89). Logistic regressions determined that people with dependence and depression have a higher risk of poor HRQoL. The figures for the physical component were, mild depression: odds ratio (OR) (95% confidence intervals (CI) = 3.28 (2.74-3.93), severe depression: OR (IC95%CI) = 4.66 (3.55-6.11), mild to moderate dependence: OR (95CI%) = 3.67 (2.97-4.54), severe dependence: OR (95%CI) = 13.06 (7.23-23.61). For the mental component, the figures were: mild depression: OR (95CI%) = 6.11(5.05-7.38), severe depression: OR (95CI%) = 22.01(14.47-33.49), mild to moderate dependence: OR (95CI%) = 1.59 (1.28-1.97), severe dependence: OR (95CI%) = 1.60 (1.04-2.47), adjusting for sociodemographic and health-related variables. Conclusions: The validity of the SF-12 for measuring HRQoL was demonstrated. People with depression and dependence have a worse physical and mental quality of life.

Rastreamento de depressão em idosos residentes em instituições de longa permanência / Tracking depression in institutionalized older adults

Objetivo: rastrear indícios de depressão em idosos residentes em instituições de longa permanência (ILPI's). Método: estudo quantitativo, exploratório e descritivo, realizado em duas ILPI's, situadas no estado de São Paulo, no ano de 2017. Para a coleta de dados, empregou dois instrumentos, sendo: um para traçar o perfil dos idosos e o outro, a Escala de Depressão Geriátrica (EDG-15) pelas propriedades psicométricas e facilidade de aplicação. O tratamento e análise dos dados foram realizados pela estatística descritiva. Aprovado pelo CEP sob CAAE 65985917.2.0000.5431. Resultados: participaram 31 idosos, detectou-se que: 16 (94%) residentes na ILPI A e seis (43%) da ILPI B apresentaram escore igual ou superior a seis pontos, caracterizando-se assim, indícios para depressão, e tendo como maior predisposição, os idosos do sexo masculino (68%) e os divorciados (36%). Conclusão: torna-se necessário o desenvolvimento de estratégias no enfrentamento dos indícios de depressão e melhoria da qualidade de vida nas ILPI's. (AU)

Objective: to track depression in institutionalized older adults. Method: quantitative, exploratory and descriptive study, carried out in two nursing home, located in the state of São Paulo, in the year 2017. For data collection, two instruments were used: one to trace the profile of the elderly and the other, the Geriatric Depression Scale (GDS-15), for its psychometric properties and ease of application. Data treatment and analysis were performed using descriptive statistics. Approved by CEP under CAAE 65985917.2.0000.5431. Results: 31 elderly people participated, it was found that: 16 (94%) residents in nursing home A and six (43%) of B had a score equal to or greater than six points, thus characterizing signs of depression, and having male (68%) and divorced (36%) older adults were more likely to be predisposed. Conclusion: it is necessary to develop strategies to deal with signs of depression and improve the quality of life in nursing homes.(AU)

Objetivo: detectar indicativos de depresión en ancianos institucionalizados. Método: estudio cuantitativo, exploratorio y descriptivo, realizado en dos asilos de ancianos, ubicados en el estado de São Paulo, en el año 2017. Para la recolección de datos se utilizaron dos instrumentos: uno para trazar el perfil del anciano y otro, la Escala de Depresión Geriátrica (GDS-15), por sus propiedades psicométricas y facilidad de aplicación. El tratamiento y análisis de los datos se realizó mediante estadística descriptiva. Aprobado por CEP bajo CAAE 65985917.2.0000.5431. Resultados: participaron 31 ancianos, se encontró que: 16 (94%) residentes del asilo A y seis (43%) del B tenían una puntuación igual o superior a seis puntos, caracterizando así signos de depresión, y tener (68%) y los adultos mayores divorciados (36%) tenían más probabilidades de estar predispuestos. Conclusión: es necesario desarrollar estrategias para enfrentar los signos de depresión y mejorar la calidad de vida en los hogares de ancianos.(AU)

La depresión y su impacto en la salud pública / Depression and its impact in public health

La prevalencia de la depresión ha aumentado en las últimas décadas debido al enfoque en la detección de enferme- dades psiquiátricas. El propósito de esta revisión bibliográfica fue definir la depresión y exponer el impacto que causa a nivel global. Se iniciará definiendo la depresión, se enlistará los principales factores predisponentes, se expondrá la posible sintomatología que se encontrará en los diferentes grupos etarios y se continuará con el impacto en la economía mundial. Se revisó diversos artí- culos encontrados en las bases de datos de la Biblioteca Virtual de Salud de Honduras (BVS), PubMed, ResearchGate, JAMA, ElServier, SciELO; concomitantemente se utilizaron actas de con- gresos, reportes técnicos, tesis, normas y estándares donde se define el trastorno depresivo mayor, para el periodo 2000 ­ 2021. Se concluye que la depresión mantiene alta prevalencia global- mente, afectando principalmente a la población en situaciones de subdesarrollo socioeconómico, con sintomatología variable de- pendiendo diferentes factores de riesgo, generando incapacidad laboral e impactando negativamente la economía mundial...(AU)

Depresión en ancianos graves con neumonía adquirida en la comunidad / Depression in seriously-ill elder people with community-acquired pneumonia

RESUMEN Introducción: aquellos países con alto grado de envejecimiento poblacional muestran asociaciones importantes con diferentes enfermedades, por ejemplo, la neumonía adquirida en la comunidad y la depresión en los ancianos. Objetivos: relacionar la depresión con la mortalidad y evaluar efectos de los antidepresivos, en los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos del Hospital Militar Central "Dr. Carlos J. Finlay". Materiales y métodos: se realizó un estudio analítico, longitudinal prospectivo, con todos los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos Emergentes, del Hospital Militar "Dr. Carlos J. Finlay". Periodo correspondiente a enero del 2018 hasta abril del 2019 que cumplieron con los criterios de inclusión. El universo lo constituyó 160 pacientes. Resultados: existieron 55 pacientes con síntomas de depresión previos al ingreso, (34 %). El 78 % de fallecidos presentaron depresión al ingreso. La edad media de los no deprimidos fue de 74, la más alta de los deprimidos fue de 80,80. No presentaron signos de depresión 93 pacientes vivos y 43 que la presentaron y fallecieron con una gran significación estadística p 0,000. RR 6,8. Se observó una marcada relación entre la mortalidad y el no recibir tratamiento para la depresión, (37) p 0,000. Conclusiones: la neumonía y la depresión son enfermedades que tienen una relación íntima. Esta asociación cuenta con una elevada mortalidad, así como el impacto del tratamiento antidepresivo en la evolución del paciente es definitorio en el ámbito de los cuidados intensivos (AU).

ABSTRACT Introduction: those countries with a high level of population ageing show important associations to different diseases, for example, community acquired pneumonia and depression in elder people. Objectives: to establish the relationship of depression with mortality and to evaluate the effect of antidepressants in patients with community-acquired pneumonia admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay". Materials and methods: a prospective, longitudinal, analytic study was carried out with all patients with community-acquired pneumonia, admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay" in the period from January 2018 until April 2019, who fulfilled the inclusion criteria. The universe were 160 patients. Results: there were 55 patients with depression symptoms before the admission. 78 % of the deceased showed depression at the admittance. The medium age of the non-depressed ones was 74 years; the highest age of the depressed ones was 80.80 years. 93 living patients did not present depression signs, and 43 presented them and died with a great statistical significance p: 0.000 RR: 6.8. A remarked relation was observed between mortality and not receiving treatment for depression (37) p 0,000. Conclusions: pneumonia and depression are diseases having a tight relationship. This association yields a high mortality, and the impact of the anti-depression treatment on the patient's evolution is defining in the intensive care settings (AU).

Quality of life and psychometric evaluation of patients diagnosed with irritable bowel syndrome: an observational cohort study

ABSTRACT BACKGROUND: Very few data are available for evaluating health-related quality of life among people with irritable bowel syndrome (IBS) and even fewer data are available in relation to anxiety and depression status among these patients. OBJECTIVES: To evaluate the quality of life, anxiety and depression status of patients with IBS. DESIGN AND SETTING: Observational cohort study conducted in a tertiary-care university hospital. METHODS: Patients who had recently been diagnosed with IBS and who had been followed up for IBS-specific treatment for at least three months were included. A quality of life (QoL) survey, the Beck Anxiety Index (BAI) and the Hamilton Depression Index (HAM-D) were applied to the patients. RESULTS: In total, 274 patients with IBS were included in the study cohort. These patients presented very high baseline scores for anxiety and depression, and very poor QoL results. CONCLUSION: Our study showed that IBS had a very high impact on these patients, regarding their anxiety and depression levels, alongside very poor results relating to quality of life.

Soledad social en ancianos hospitalizados en el servicio de Geriatría. Hospital "Comandante Faustino Pérez" / Social loneliness in elder people hospitalized in the Geriatrics service. Clinical Surgical Hospital "Comandante Faustino Pérez"

RESUMEN Introducción: la soledad social se define como la experiencia subjetiva de insatisfacción frente a la sociedad en la que se vive; en términos de estilos de vida, de valores y de uso de nuevas tecnologías, entre otros aspectos. Objetivo: caracterizar la soledad social en los adultos mayores hospitalizados. Materiales y método: se realizó un estudio observacional, descriptivo, transversal en pacientes que ingresaron en el servicio de Geriatría del Hospital Clínico Quirúrgico "Comandante Faustino Pérez", provincia Matanzas, desde octubre 2015 - 2016. El universo estuvo constituido por 212 pacientes que vivían en compañía y no padecían de demencia, confusión mental ni enfermedades graves. Para la recogida de la información se aplicó al universo de estudio la Escala ESTE II de soledad social, validada a nivel nacional e internacional para identificar el nivel de soledad social. Se utilizaron métodos de estadística descriptiva. Los resultados se presentaron en tablas. Resultados: alto nivel de soledad social en los ancianos estudiados, en el grupo atareo de 60-70 años, sin pareja, de bajo nivel de escolaridad y con enfermedades crónicas. Insuficiente percepción de apoyo y participación social, así como un limitado uso de las nuevas tecnologías. Conclusiones: predominó alto nivel de sentimiento de soledad en los ancianos, asociado a insuficiente percepción de apoyo y participación social, más un bajo acceso a las nuevas tecnologías (AU).

ABSTRACT Introduction: social loneliness is defined as the subjective experience of dissatisfaction toward society in which one lives, in terms of lifestyles, values ​​and use of new technologies among others. Objective: to characterize social loneliness in hospitalized elder adults. Material and Method: a cross-sectional, observational, descriptive, study was conducted in patients admitted to the Geriatrics Service of the Clinical Surgical Hospital "Comandante Faustino Pérez", province of Matanzas, in the period October 2015 - 2016. The universe was formed by 212 patients who lived accompanied and did not suffer from dementia, mental confusion nor serious illnesses. For collecting the information of the studied universe, the authors used the ESTE II Scale of social loneliness validated at national and international level to identify the level of social loneliness. Descriptive statistical methods were used and the results were shown in tables. Results: high level of social loneliness in studied elder people of the 60-70 years-old group, without a partner, with a low level of scholarship and with chronic diseases. They had an insufficient perception of support and social participation, as well as made a limited use of the new technologies. Conclusions: a high level of the loneliness feeling predominated in elder people, associated to an insufficient perception of support and social participation, plus a low access to the new technologies (AU).

Niveles de estrés, ansiedad y depresión en la primera fase del brote del COVID-19 en una muestra recogida en el norte de España / Níveis de estresse, ansiedade e depressão na primeira fase do surto de COVID-19 em uma amostra no norte da Espanha / Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain

En marzo de 2020, el virus SARS-CoV-2 procedente de China ha llegado a España y desde el 14 de marzo se ha declarado el estado de alarma en todo el Estado español, llevando al confinamiento a toda la población. La presente investigación se contextualiza en la Comunidad Autónoma Vasca (situada al norte de España). Se han analizado los niveles de estrés, ansiedad y depresión a la llegada del virus y se han estudiado los niveles de sintomatología psicológica según edad, cronicidad y confinamiento. Se ha recogido una muestra de 976 personas y la medición de las variables ansiedad, estrés y depresión se ha hecho mediante la escala DASS (Escala de Depresión, Ansiedad y Estrés). Los resultados demuestran que, aunque los niveles de sintomatología han sido bajos en general al principio de la alarma, la población más joven y con enfermedades crónicas ha referido sintomatología más alta que el resto de población. También se ha detectado un mayor nivel de sintomatología a partir del confinamiento, donde las personas tienen prohibido salir de sus casas. Se prevé que la sintomatología aumentará según vaya transcurriendo el confinamiento. Se defienden intervenciones psicológicas de prevención y tratamiento para bajar el impacto psicológico que pueda crear esta pandemia.

Em março de 2020, o vírus SARS-CoV-2, procedente da China, chegou à Espanha e desde 14 de março está declarado estado de emergência em todo o país, forçando toda a população ao confinamento. O presente estudo foi conduzido no País Basco (norte da Espanha). Foram analisados os níveis de estresse, ansiedade e depressão desde a introdução do vírus e os níveis de sintomas psicológicos segundo idade, comorbidades e confinamento. A amostra foi composta de 976 indivíduos e a medição das variáveis ansiedade, estresse e depressão foi realizada a partir do intrumento DASS (Escala de Depressão, Ansiedade e Estresse). Os resultados mostram que, ainda que os níveis de sintomas tenham sido baixos no início do confinamento, os indivíduos mais jovens e com comorbidades referiram mais sintomas que o restante da população. Também se detectou maior nível de sintomas desde o confinamento, quando a população foi proibida de sair de suas casas. Se prevê aumento dos sintomas conforme o confimaneto continuar. Intervenções psicológicas de prevenção e tratamento são necessárias para diminuir o impacto psicológico causado pela pandemia.

The SARS-CoV-2 virus reached Spain in March 2020, and a nationwide state of alert was declared on March 14th, leading to the confinement of the entire population. The current study was conducted in the Basque Autonomous Community in northern Spain. The authors analyzed stress, anxiety, and depression with the arrival of the virus and the levels of symptoms according to age, comorbidity, and confinement. Levels of anxiety, stress, and depression were measured in a sample of 976 adults, using the DASS scale (Depression Anxiety, and Stress Scale). Although levels of symptoms were generally low at the start of the alert, younger individuals with chronic diseases reported more symptoms than the rest of the population. The study also detected higher levels of symptoms after the stay-at-home order was issued. Such symptoms are predicted to increase as the confinement continues. The authors propose psychological interventions for prevention and treatment in order to mitigate the pandemic's psychological impacts.

Depressão em idosos de uma região rural do Sul do Brasil / Depression in the elderly of a rural region in Southern Brazil

Resumo O objetivo deste estudo é estimar a prevalência de depressão e seus fatores associados em idosos residentes da zona rural do município de Rio Grande/RS. Neste estudo transversal de base populacional realizado com 994 idosos (≥ 60 anos), cuja amostragem foi baseada no Censo Demográfico de 2010, utilizou-se o "Patient Health Questionnaire 9" (PHQ-9) para o rastreio de Episódio Depressivo Maior (EDM). Foram realizadas análises descritiva, bivariada e multivariável, com uso de regressão logística. A prevalência geral para o rastreio de Episódio Depressivo Maior foi de 8,1%. As variáveis independentemente associadas com depressão foram: sexo feminino, uso contínuo de medicamentos, doenças crônicas, índice de massa corporal e pior percepção de saúde. A criação de programas de atendimento direcionados aos idosos da área rural, visando rastreamento, diagnóstico precoce de depressão e manutenção do tratamento, englobando diversos fatores relacionados à saúde, são ações importantes que devem ser fomentadas pelo sistema de saúde.

Abstract The aim of this study is to estimate the prevalence of depression and its associated factors in elderly residents of the rural area of Rio Grande/RS. In this cross-sectional population-based study performed with 994 elderly (≥ 60 years), whose sampling was based on the 2010 Demographic Census, the Patient Health Questionnaire 9 (PHQ-9) was used for Major Depressive Episode (EDM) screening. Descriptive, bivariate and multivariate analyses were performed using logistic regression. The overall prevalence for Major Depressive Episode screening was 8.1%. The variables independently associated with depression were: female gender, continuous use of medications, chronic diseases, body mass index and worse health perception. The creation of programs target at the elderly in the rural area, aimed at screening, early diagnosis of depression and maintenance of treatment, encompassing several factors related to health, are important actions that must be fostered by the health system.

Relationship between quality of life, self-esteem and depression in people after kidney transplantation / Relación entre calidad de vida, autoestima y depresión en personas después de trasplante de riñón / Relação entre qualidade de vida, autoestima e depressão em pessoas após transplante renal

ABSTRACT Objective: to assess the relationship between health-related quality of life with depression and self-esteem of people after kidney transplantation. Method: a cross-sectional study of 47 outpatients from October 2016 to February 2017. The following tools were applied: The Medical Outcomes Study 36-Item Short-Form Health Survey, Beck Depression Inventory and Rosenberg Self-Esteem Scale. Descriptive statistics and Spearman correlation were used. Results: women had lower scores for health-related quality of life. Young adults, people with up to one and a half years of transplantation and those who had dialysis for more than one year had higher scores. Conclusion: the health-related quality of life of people with chronic kidney disease after transplantation ranged from good to excellent. The presence of depression was not identified. The relationship of data indicates that the higher the quality of life, the better the self-esteem assessment.

RESUMEN Objetivo: evaluar la relación entre calidad de vida relacionada con salud, con depresión y autoestima en personas después del trasplante de riñón. Método: estudio transversal de 47 personas en seguimiento ambulatorio de octubre de 2016 a febrero de 2017. Se aplicaron los instrumentos: The Medical Outcomes Study 36-Item Short-Form Health Survey, Inventario de Depresión de Beck e Escala de Autoestima de Rosenberg. Utilizó estadística descriptiva y correlación de Spearman. Resultados: mujeres obtuvieron puntuaciones más bajas en la calidad de vida relacionada con la salud. Los adultos, las personas con hasta un año y medio de trasplante y las que se sometieron a diálisis durante más de un año obtuvieron puntuaciones más altas. Conclusión: calidad de vida relacionada con la salud después del trasplante varió de buena a excelente. La relación de los datos indica que cuanto mayor sea la calidad de vida, mejor será la evaluación de la autoestima.

RESUMO Objetivo: avaliar relação entre qualidade de vida relacionada à saúde com depressão e autoestima em pessoas após transplante renal. Método: estudo transversal, com 47 pessoas em acompanhamento ambulatorial, de outubro de 2016 a fevereiro de 2017. Foram aplicados os instrumentos: The Medical Outcomes Study 36-Item Short-Form Health Survey, Inventário de Depressão de Beck e Escala de Autoestima de Rosenberg. Foi utilizada estatística descritiva e correlação de Spearman. Resultados: mulheres apresentaram pontuações mais baixas para qualidade de vida relacionada à saúde. Adultos jovens, pessoas com até um ano e meio de transplante e as que realizaram diálise por mais de um ano apresentaram pontuações mais altas. Conclusão: a qualidade de vida relacionada à saúde de pessoas com doença renal crônica após o transplante variou de boa a excelente. Não se identificou a presença de depressão. A relação dos dados indica que quanto maior a qualidade de vida, melhor avaliação de autoestima.

Impacto do afastamento do trabalho por doenças inflamatórias intestinais no Brasil / Impact of work disability due to inflammatory bowel diseases in Brazil

As doenças inflamatórias intestinais (DII) podem ter impactos sociais e econômicos no Brasil, onde sua prevalência aumentou recentemente. Este estudo tem como objetivo principal avaliar a incapacidade por DII na população brasileira, descrevendo proporções com fatores demográficos e como objetivo secundário, a avaliação de possíveis fatores de risco de afastamento do trabalho por Doença de Crohn (DC) em um centro de referência em DII da Universidade do Estado do Rio de Janeiro (UERJ), cujo resultado pode refletir outras regiões do país. A análise foi realizada utilizando-se a plataforma do Sistema Único de Informações sobre Benefícios da Previdência Social, com um primeiro cruzamento de dados de auxílios doença e aposentadorias por invalidez com DC e Retocolite Ulcerativa (RCU) entre 2010-2014. Dados adicionais como valores médios de benefícios, duração do benefício, idade, sexo e região foram obtidos através da mesma plataforma. Um segundo cruzamento entre auxílios doença e aposentadorias por invalidez foi feito somente para DC entre 2010-2018 no estado do Rio de Janeiro e foram pesquisados os mesmos dados adicionais. Uma subanálise foi realizada nos casos de incapacidade em comum com os pacientes com DC da UERJ, para avaliação das características que teriam maior chance de atuar como fator de risco para afastamento do trabalho, se comparando com a população de DC desse ambulatório que não teve afastamento pelo Instituto Nacional do Seguro Social (INSS). No Brasil, a incapacidade temporária ocorreu com maior frequência na RCU enquanto a permanente na DC. A DC afastou pacientes mais jovens que a RCU e ambas mais mulheres que homens. As ausências temporárias do trabalho por DC e RCU foram maiores no Sul e as menores ausências por DC foram observadas no Norte e Nordeste. A média de dias de incapacidade foi longa, de quase um ano, sendo maiores na DC em comparação à RCU, porém ambos tenderam a diminuir de 2010 à 2014. O valor dos benefícios pagos pelas DII representou aproximadamente 1% de todos os benefícios da mesma natureza no país, sendo 51% dos gastos com DC. No RJ, a prevalência da DC foi de 26 por 100.000/habitantes, com custo indireto de 0,8% dos benefícios totais, apresentando taxa de 16,6% de incapacidade, similar a encontrada no grupo de pacientes da UERJ. Os fatores de risco de incapacidade por DC na UERJ foram idade menor que 40 anos a época do diagnóstico, tempo de duração da doença, cirurgia intestinal prévia e fístula anovaginal. Dos afastados, 19% apresentaram depressão ou ansiedade associados. A média de tempo entre o diagnóstico de DC e a incapacidade foi de 3 anos. No Brasil, as DII frequentemente causam incapacidade prolongada e podem gerar aposentadorias precoces, com programas de reabilitação profissional ainda pouco explorados. As tendências de redução das taxas de incapacidade no Brasil podem refletir melhorias no acesso a cuidados de saúde e a medicamentos. Os custos indiretos baseados apenas no absenteísmo em empregos foram significativos e a demonstração desse impacto socioeconômico e de fatores de risco de incapacidade podem auxiliar no planejamento de políticas públicas para o país.

Inflammatory bowel diseases (IBD) can lead to Brazil's social and economic impacts, where their prevalence has recently increased. This study's main objective is to evaluate the disability due to IBD in the Brazilian population describing proportions with demographic factors. Secondly, it assesses possible risk factors of absence from work due to Crohn's disease (CD) in a referral center of IBD of the State University of RJ (UERJ), which results may reflect other regions of the country. The analysis was performed using the Unified Social Security Benefits Information System platform, with the first crossing of data on sickness benefits and disability pensions with CD and Ulcerative Colitis (UC) between 2010- 2014. Additional data, such as average benefit values, benefit duration, age, sex, and region of the country, were obtained through the same platform. A second crossing between sickness benefits and disability pensions was made only for CD between 2010-2018 in the state of Rio de Janeiro (RJ) for the evaluation of the same additional data. A subanalysis was made in cases of CD disability in common with patients at UERJ, to assess the characteristics that would have a greater chance as a risk factor for absence from work, compared to the population of CD of this clinic that had no disability by the Institute National Social Security (INSS). In Brazil, temporary disability occurred more frequently in the UC while the permanent one in CD. Disability occurred in patients with CD younger than UC and both more in women than in men. Temporary absences from work due to CD and UC were more significant in the South, and the lowest absences due to CD were observed in the North and Northeast. The average number of days of disability was long, almost one year, being higher in CD than in UC, but both tended to decrease from 2010 to 2014. IBD's benefits represented approximately 1% of all the benefits of sickness in the country, with 51% of DC spending. In RJ, the prevalence of CD was 26 per 100,000 / inhabitants, with an indirect cost of 0.8% of total benefits, with a rate of 16.6% of disability, similar to that found in the group of patients at UERJ. The risk factors for CD disability in UERJ were age under 40 at the time of diagnosis, duration of the disease, previous intestinal surgery, and anovaginal fistula. Of those on absence from work 19% had associated depression or anxiety. The average time between the diagnosis of CD and disability was three years. In Brazil, IBDs often cause prolonged disability and can lead to early retirements, with professional rehabilitation programs still little explored. Trends in the reduction of disability rates in Brazil may reflect improvements in access to healthcare and medicines. The indirect costs with IBD in Brazil, based only in absenteeism, were significant, and demonstrating this socioeconomic impact and risk factors for disability can help plan public policies for the country.

La depresión: un desafío en la práctica médica general / La depresión: un desafío en la práctica médica general

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)

Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)

Vulnerabilidade e fatores associados em idosos atendidos pela Estratégia Saúde da Família / Vulnerability and associated factors among older people using the Family Health Strategy

Resumo Este estudo teve por objetivo analisar a prevalência de vulnerabilidade e fatores associados em idosos atendidos pelas Estratégias Saúde da Família do município de Várzea Grande (MT). Estudo transversal realizado com 377 idosos. A variável dependente, vulnerabilidade, foi investigada através do The Vulnerable Elders Survey. As variáveis independentes foram as sociodemográficas e as condições de saúde, avaliadas através dos instrumentos validados: Miniexame do Estado Mental, Escala de Katz, Escala de Lawton, Escala de Depressão Geriátrica e Miniavaliação Nutricional Reduzida. Foi realizada análise descritiva das variáveis categóricas e numéricas, análise bivariada calculando-se as Razões de Prevalência, utilizando o teste do χ2 de Mantel Haenszel e a análise múltipla usando a regressão de Poisson. Dos idosos, 49% são vulneráveis, sendo que a maior prevalência de vulnerabilidade esteve associada com a dependência em AIVD (RP = 4,43), apresentar sintomas depressivos (RP = 1,34) e estar na faixa etária de 80 anos e mais (RP = 1,34). A prevalência de vulnerabilidade encontrada no presente estudo foi alta ao se comparar com outros estudos realizados com idosos da comunidade, enquanto que o VES-13 demonstrou-se um instrumento de fácil aplicação na atenção primária em saúde e bastante prático na triagem de idosos vulneráveis.

Abstract The objective of this study was to analyze the prevalence of vulnerability and associated factors among older people using family health strategies in Várzea Grande, Brazil. A cross-sectional study was performed with 377 community-dwelling older people. The dependent variable, vulnerability, was assessed using the Vulnerable Elders Survey. The independent variables included sociodemographic characteristics and the health status of the study population assessed using the following validated instruments: the Mini-Mental State Examination; Katz ADL scale and Lawton and Brody IADL scale; Geriatric Depression Scale; and Mini Nutritional Assessment Short-Form. Bivariate analysis was conducted using the Mantel-Haenszel chi-squared test with prevalence ratios and multivariate analysis was performed using Poisson regression. The data showed that 49% of the study population were vulnerable. The variables that showed the strongest association with vulnerability were dependence in IADLs (PR = 4.43), presence of depressive symptoms (PR = 1.34), and being aged 80 and over (PR = 1.34). The prevalence of vulnerability found by the present study was high when compared to other studies with community-dwelling older people. The VES-13 was shown to be easy to use in primary healthcare settings and particularly practical for screening vulnerability among older people.

Prevalence of depression among patients with presumptive pulmonary tuberculosis in Rio de Janeiro, Brazil

Objective: To estimate the prevalence of major depressive episode (MDE) in patients with presumptive pulmonary tuberculosis (pre-PTB, defined by cough lasting ≥ 3 weeks) and compare it between patients with pulmonary tuberculosis (PTB) and without PTB. Methods: Patients with pre-PTB (n=260) were screened for depression using the Patient Health Questionnaire (PHQ-9). Those individuals with scores ≥ 10 were subsequently assessed with the depression module of the Mini International Neuropsychiatric Interview (MINI-Plus) to confirm diagnosis. Associations of categorical variables with PTB and MDE were calculated using the chi-square test and OR. Results: PTB was confirmed in 98 patients (37.7%). A high proportion of both groups (active PTB and no PTB) screened positive for depression (60.2 vs. 62.1%, respectively). Among 159 patients who screened positive for depression, a subset of 97 (61.0%) were further evaluated with the MINI-Plus; current MDE was confirmed in 54.6% (53/97). On univariate and multivariate analysis, female sex was the only factor associated with the diagnosis of current MDE (p = 0.04). Conclusion: The prevalence of MDE was high among individuals with prolonged respiratory symptoms, independent of PTB diagnosis. This is consistent with other studies of depression in primary care in Brazil.