Association between frailty and depression among hemodialysis patients: a cross-sectional study

ABSTRACT BACKGROUND: Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle. OBJECTIVE: To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis. DESIGN AND SETTING: Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil. METHODS: This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79). CONCLUSION: Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.

Burden, family functioning, and psychological health of older caregivers of older adults: a path analysis / Sobrecarga, funcionalidade familiar e saúde psicológica de idosos cuidadores de idosos: uma path analysis

Objectives: To evaluate an explanatory model of direct and indirect associations regarding the psychological health of older caregivers of functionally dependent older adults. Methods: This is a cross-sectional study performed with older caregivers recruited in contexts of outpatient and home care. We collected information on sociodemographic characteristics, duration of caregiving, physical and cognitive function indicators of the older care recipients, perceived burden, family functioning, and psychological health measures (psychological need satisfaction and depressive symptoms). Results: We evaluated 133 caregivers (76% female, 69.5 ± 6.98 years). Variables that were significantly correlated with psychological health were selected to form an association model to be tested by structural equation modeling via path analysis. Depressive symptom variability was best explained by this model. Caregiver burden remained in the model as a mediator of indirect associations between physical function for instrumental activities of daily living and indicators of family functioning and psychological health. Three associative paths between caregiver burden and depressive symptoms were found ­ one of them was direct and the other two were mediated whether by family functioning or by the level of psychological need satisfaction. Conclusion: Depressive symptoms were the psychological health indicator best explained by the model involving instrumental functional demands that generate burden. Clinical consequences suggested by the model indicate interventions aimed at family functioning and opportunities of psychological need satisfaction as strategies for promoting caregivers' psychological health.

Objetivos: Avaliar um modelo de associações diretas e indiretas explicativo de saúde psicológica de idosos cuidadores de outros idosos funcionalmente dependentes. Metodologia: Estudo transversal realizado com idosos cuidadores recrutados em contexto ambulatorial e de atenção domiciliar. Foram levantadas informações sociodemográficas, tempo de exercício do cuidado, indicadores funcionais físicos e cognitivos dos idosos que recebem os cuidados, percepção de sobrecarga, funcionalidade familiar e medidas de saúde psicológica (satisfação de necessidades psicológicas e sintomatologia depressiva). Resultados: Foram avaliados 133 cuidadores (76% feminino, 69,5 ± 6,98 anos). As variáveis correlacionadas significativamente à saúde psicológica foram escolhidas para a composição do modelo de associações testado por análise de equações estruturais via path analysis. A variabilidade em sintomatologia depressiva foi melhor explicada pelo modelo. Sobrecarga permaneceu no modelo como mediadora das associações indiretas entre funcionalidade física para atividades instrumentais da vida diária e os indicadores de funcionalidade familiar e de saúde psicológica. Três caminhos associativos entre sobrecarga e sintomatologia depressiva foram encontrados ­ um direto e dois mediados, ora pela funcionalidade familiar, ora pelo nível de satisfação de necessidades psicológicas. Conclusão: Sintomatologia depressiva foi o indicador de saúde psicológica mais bem explicado pelo modelo que envolve a presença de demandas funcionais instrumentais geradoras de sobrecarga. Desdobramentos clínicos sugeridos pelo modelo apontam para intervenções com alvo em funcionalidade familiar e de oportunidades de satisfação de necessidades psicológicas como estratégias para promover a saúde psicológica do cuidador.

Depressão em pacientes com doença renal crônica em hemodiálise e transplante renal / Depression in patients with chronic renal disease on hemodialysis and renal transplantation

O desenvolvimento de pesquisas, diante da relevância do tema, propicia suporte teórico, favorecendo a atuação da assistência multidisciplinar, no intuito de fortalecer o vínculo terapêutico, a relação com a família e o cuidado de modo integral. O objetivo deste estudo foi revisar os principais aspectos clínicos da depres- são entre pacientes com doença renal crônica em hemodiálise e transplantados renais com base nas evidências científicas atuais. O aumento da expectativa de vida acarreta a elevação da inci- dência das doenças crônicas não transmissíveis ­ dentre elas a doença renal crônica ­, que são vistas como fatores que afetam o paciente, tanto no âmbito físico como no psicológico, gerando a associação de doenças crônicas com distúrbios psicoafetivos. Estudos prévios mostram que a depressão é três a cinco vezes mais prevalente no estágio avançado da doença renal crôni- ca do que na população em geral. A prevalência de depressão nos pacientes em hemodiálise está em torno de 20% a 40%, re- presentado uma questão de saúde pública. Apesar de sua alta prevalência, a depressão é subdiagnosticada e subtratada, pois os profissionais de saúde assemelham os sintomas depressivos com os das doenças crônicas, focalizando apenas nos aspectos físicos da enfermidade. É essencial que os profissionais da saúde estejam qualificados para reconhecer as manifestações iniciais para o diagnóstico correto da depressão, posto que esse distúrbio possui ligação direta com o sucesso terapêutico.

The development of research, given the relevance of the theme, provides theoretical support favoring the performance of multi- disciplinary care, to strengthen the therapeutic bond, the rela- tionship with the family, and care in an integral way. The objective of this study was to review the main clinical aspects of depression among patients with chronic kidney disease on hemodialysis and with kidney transplantation based on current scientific evidence. The increase in life expectancy leads to an increase in the inciden- ce of noncommunicable chronic diseases, among them chronic kidney disease, which are seen as factors that affect the patient both physically and psychologically, leading to the association of chronic diseases with psycho-affective disorders. Previous studies show that depression is five to three times more prevalent in the advanced stage of chronic kidney disease than in the general po- pulation. The prevalence of depression in hemodialysis patients is around 20% to 40%, representing a public health issue. Despite its high prevalence, depression is underdiagnosed and undertrea- ted, because health professionals relate depressive symptoms to those of chronic diseases, focusing only on the physical aspects of the disease. It is essential that health care professionals are qualified to recognize the initial manifestations for the correct diagnosis of depression, since this disorder has a direct connec- tion with therapeutic success.

Frecuencia de ansiedad y depresión en pacientes coordinados para cirugía electiva en el Hospital de Clínicas Manuel Quintela / Frequency of anxiety and depression in patients coordinated for elective surgery at the Hospital de Clínicas Manuel Quintela

Los trastornos depresivos y de ansiedad son más frecuentes en pacientes que se encuentran a la espera de un acto anestésico-quirúrgico. Estos se consideran factores de riesgo de complicaciones posoperatorias de allí el interés de detectarlos en la consulta preoperatoria. El objetivo del trabajo fue determinar la frecuencia de ansiedad y depresión en pacientes pre-quirúrgicos en el Hospital de Clínicas utilizando la Escala de Ansiedad y Depresión Hospitalaria (Hospital Anxiety and Depression Scale) validada en español mediante un estudio observacional, descriptivo y transversal. Se realizó una encuesta a una muestra tomada al azar, de pacientes prequirúrgicos obtenida de la consulta externa o de las consultas provenientes de salas de internación quirúrgica del Hospital de Clínicas entre julio y septiembre de 2019. La prevalencia global de ansiedad y depresión fue de 44% y 14,5%, respectivamente. Un mayor nivel de depresión fue asociado al sexo femenino, no encontrándose asociación entre otras variables como edad, tipo de cirugía u hospitalización, y la mayor frecuencia de cualquiera de los trastornos. Se concluye que los niveles de ansiedad son relativamente elevados y, junto a la depresión, pueden ser detectados en la consulta preoperatoria de manera sencilla utilizando el instrumento propuesto.

The depressive and anxiety disorders are more frequent in patients who are waiting a surgical procedure. These are risk factors of postoperative complications. The objective of this work was to determine the incidence of anxiety and depression in the preoperative period at the University Hospital using the Hospital Anxiety and Depression Scale validated in spanish through an observational, descriptive and cross-sectional study. A socio-demographic characterization of patients was carried out and aspects related to imminent surgery were described. The study was conducted in a random sample of pre-surgical patients who attended an outpatient clinic or were hospitalized at the Hospital de Clínicas, between July and September 2019. The global incidence of anxiety and depression was 44% and 14.5% respectively. A mayor level of depression was observed in females, no other statistically significant evidence was found to support an association between the other variables (age, type of surgery, hospitalization) and the higher prevalence of any of the disorders. We concluded that the level of anxiety is high in our population and deserves to be detected, through the implementation of a simple instrument.

Efecto de la pandemia por COVID-19 en la salud mental de los otorrinolaringólogos en Hispanoamérica / COVID-19 pandemic effects on otolaryngologist's mental health in Hispanoamerica

Introducción: la pandemia puede generar compromiso en la salud mental y los otorrinolaringólogos son los especialistas con mayor riesgo de exposición y contagio por SARS-CoV-2. Materiales y métodos: estudio de corte transversal en otorrinolaringólogos de Hispanoamérica, donde se evaluaron variables socioeconómico/demográficas y su asociación con las escalas PHQ-9 y GAD-7. Resultados: se estudiaron 256 otorrinolaringólogos de dieciséis países de Hispanoamérica. La escala PHQ-9 presentó una media de 5,45 (DE 4,22). La escala GAD-7 presentó una media de 4,55 (DE 3,457). La prevalencia de depresión mayor y ansiedad fue del 14,8 % y 7 %, respectivamente. En el análisis multivariado, los otorrinolaringólogos a los que se les ha realizado prueba con hisopado nasofaríngeo tienen una predicción significativa para presentar una puntuación alta en la escala PHQ-9 (coeficiente ß = 2,350; p=0.027). En la puntuación de la escala GAD-7, los individuos con mayor edad tienen una predicción significativa de menor puntuación en la escala (coeficiente ß = -0,144; p=0,002). Los otorrinolaringólogos con más años de experiencia (coeficiente ß = 0,909; p=0,037) y aquellos a los que les han realizado prueba de RT-PCR con hisopado nasofaríngeo para SARS-CoV-2 tienen una predicción significativa para presentar una puntuación alta en la escala GAD-7 (coeficiente ß = 2,370; p=0,027). Conclusión: en el transcurso de la pandemia, los otorrinolaringólogos de Hispanoamérica han presentado cambios drásticos de sus condiciones sociales y económicas y experimentado sus potenciales efectos en la salud mental. La exposición a al hisopado nasofaríngeo para el diagnóstico de COVID-19 fue la única variable independiente que se asoció con aumento de las puntuaciones en las escalas GAD-7 y PHQ-9.

Introduction: The COVID-19 pandemic could affect the mental health, especially to the health workforce directly exposed to the virus. ENT surgeons have one of the highest risks of exposure and infection by SARS-CoV-2. Methods: Cross-sectional study in otolaryngologists from Hispanoamerica. Socioeconomic and demographic variables were evaluated with the PHQ-9 and GAD-7 score. Results: 256 ENT surgeons from sixteen Hispanoamerican countries were studied. The PHQ-9 scale presented an average of 5.45 (SD 4.22). The GAD-7 score presented an average of 4.55 (SD 3.457). The prevalence of major depression and generalized anxiety disorders were 14.8 % and 7 %, respectively. In the multivariate analysis, the otolaryngologists who have been tested by nasopharyngeal swab have a significant prediction to present a higher score on the PHQ-9 score (coefficient ß = 2.350, p=0.027), while on the GAD-7 score, older individuals have a significant prediction of lower score (coefficient ß = -0.144, p=0.002). Otolaryngologists with more years of experience (coefficient ß = 0.909, p=0.037) and those who have undergone RT-PCR testing with nasopharyngeal swab have a significant prediction to present a higher GAD-7 (coefficient ß = 2.370, p = 0.027). Conclusion: During the pandemic, otolaryngologists in Hispanoamerica have presented drastic changes in their social and economic conditions, and their potential effects on mental health. Exposure to the nasopharyngeal swab test for the diagnosis of COVID-19 was the only independent variable that was associated with higher scores on GAD-7 and PHQ-9.

Sintomas Depressivos estão Associados a Níveis Séricos Elevados de Colesterol de Lipoproteína de Baixa Densidade em Idosos com Diabetes Mellitus Tipo 2 / Depressive Symptoms are Associated with High Levels of Serum Low-Density Lipoprotein Cholesterol in Older Adults with Type 2 Diabetes Mellitus

Resumo Fundamento O Diabetes Mellitus Tipo 2 (DMT2) é comum nos idosos, que também apresentam um nível elevado de fatores de risco para doenças cardiovasculares (DCVs), tais como dislipidemia. Entretanto, o papel da depressão nos pacientes com DMT2 e sua relação com fatores de risco para DCV são pouco estudados. Objetivo O objetivo do presente estudo foi investigar a relação entre sintomas depressivos (SDs) e fatores de risco cardiovascular conhecidos em idosos comunitários portadores de DMT2. Métodos Trata-se de um estudo transversal, no qual foram incluídos 85 idosos comunitários com DMT2. Os SDs foram avaliados através da Escala de Depressão Geriátrica de Yesavage, em versão reduzida (GDS-15). Os seguintes fatores de risco cardiovascular foram avaliados: pressão arterial sistólica (PAS) e diastólica (PAD), glicose plasmática em jejum (GPJ), perfil lipídico (triglicerídeos séricos (TG), colesterol total sérico (CT), colesterol sérico de lipoproteína de baixa densidade (LDL-C) e colesterol sérico de lipoproteína de baixa densidade (HDL-C)) e índice de massa corporal (IMC). A análise de regressão múltipla de Poisson foi utilizada para avaliar a associação entre os SDs e cada fator de risco cardiovascular ajustado por sexo, idade, tempo em atividades físicas moderadas e status funcional. O nível de significância adotado para a análise foi de 5%. Resultados Dentre todos os fatores de risco analisados, apenas o aumento de LDL-C apresentou uma correlação com níveis elevados de SD (RP=1,005; IC95% 1,002-1,008). Foi observada uma associação significativa entre os níveis de HDL-C (RP=0,99; IC95% 0,98-0,99) e a PAS (RP=1,009; IC95% 1,004-1,014). Conclusão Nos idosos com DMT2, a presença de SD foi associada a níveis de LDL-C, HDL-C e PAS, mesmo após o ajuste por sexo, idade, nível de atividade física e capacidade funcional. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Type 2 Diabetes Mellitus (T2DM) is common in older adults, who also present a high level of risk factors for cardiovascular disease (CVD), such as dyslipidemia. However, the role of depression in T2DM patients and its relationship with CVD risk factors are understudied. Objective The present study aimed to investigate the relationship between depressive symptoms (DS) and known cardiovascular risk factors in community dwelling older adults with T2DM. Methods This is a cross sectional study, in which 85 community-dwelling older adults with T2DM were assessed. DS was assessed using the Yesavage Geriatric Depression Scale - short version (GDS-15). The following cardiovascular risk factors were evaluated: systolic (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), lipid profile (serum triglycerides - TG, serum total cholesterol - TC, serum low-density lipoprotein cholesterol - LDL-C, and serum high-density lipoprotein cholesterol - HDL-C) and body mass index (BMI). Poisson multiple regression was performed to test the association between DS and each cardiovascular risk factor adjusted by sex, age, time spent in moderate physical activity, and functional status. The significance level adopted for the analysis was 5%. Results Among all the analyzed risk factors, only high levels of LDL-C were related to high DS (PR=1.005, CI 95% 1.002-1.008). A significant association was observed between HDL-C levels (PR=0.99, CI 95% 0.98-0.99) and SBP (PR=1.009, CI 95% 1.004-1.014). Conclusion In older adults with T2DM, the presence of DS was associated with LDL-C, HDL-C levels and SBP, even after adjusting for sex, age, physical activity level and functional capacity. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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).

Prevalência de sonolência diurna excessiva e fatores associados em adolescentes da coorte RPS, em São Luís (MA) / Prevalence of excessive daytime sleepiness and associated factors in adolescents of the RPS cohort, in São Luís (MA), Brazil

RESUMO: Objetivos: Estimar a prevalência de sonolência diurna excessiva (SDE) e os fatores associados a ela em adolescentes da coorte de nascimentos de São Luís (MA). Método: Estudo transversal realizado com 2.514 adolescentes com idade de 18 e 19 anos. Utilizou-se abordagem hierarquizada e calculou-se a razão de prevalências utilizando regressão de Poisson com ajuste robusto da variância. Foram estudadas características sociodemográficas (sexo, cor, classe econômica, ocupação), hábitos de vida (lazer, fumo, álcool, uso de drogas ilícitas, consumo de café e de bebidas energéticas, prática de atividade física, adiposidade corporal, tempo de tela, depressão) e fatores relacionados ao sono. Resultados: A prevalência de SDE foi de 36,8%. Sexo feminino (razão de prevalência - RP = 1,33; intervalo de confiança de 95% - IC95% 1,19 - 1,49), alto risco de consumo de bebidas alcoólicas (RP = 1,26; IC95% 1,09 - 1,46), episódio depressivo maior atual (RP = 1,26; IC95% 1,08 - 1,46), escore de 10 a 18 de alterações do sono (RP = 1,43; IC95% 1,10 - 1,85) e escore de 5 a 7 da disfunção durante o dia (RP = 2,51; IC95% 2,06 - 3,07) foram os fatores de risco para SDE. A classe econômica D/E foi fator de proteção para SDE (RP = 0,47; IC95% 0,27 - 0,85). Conclusão: Mais de um terço dos adolescentes apresentou SDE, e aqueles com maiores riscos precisam melhorar seus hábitos de vida e de sono para que não tenham mais SDE, visando melhorar sua qualidade de vida.

ABSTRACT: Objectives: To estimate the prevalence and factors associated with excessive daytime sleepiness (EDS) in adolescents from the São Luís, Maranhão birth cohort. Method: Cross-sectional study conducted with 2,514 adolescents aged 18 and 19 years old. A hierarchical approach was used, and prevalence ratios were calculated using Poisson regression with robust variance adjustment. Sociodemographic characteristics (gender, race, economic class, and occupation), lifestyle (leisure activities, smoking, alcohol, illicit drug use, coffee and energy consumption, physical activity, body adiposity, screen time, and depression), and factors related to sleep were studied. Results: The prevalence of EDS was 36.8%. The female gender (PR = 1.33; 95%CI 1.19 - 1.49), high risk for alcohol consumption (PR = 1.26; 95%CI 1.09 - 1.46), current major depressive episode (PR = 1.26; 95%CI 1.08 - 1.46), sleep alteration score from 10 to 18 (PR = 1.43; 95%CI 1.10 - 1.85), and sleep score from 5 to 7 of daytime dysfunction (PR = 2.51; 95%CI 2.06 - 3.07) were risk factors for EDS. Economic class D/E was a protective factor for EDS (PR = 0.47; 95%CI 0.27 - 0.85). Conclusion: More than one-third of adolescents had EDS. Adolescents at higher risk need to improve their sleeping habits and lifestyle so that they no longer have EDS and can improve their quality of life.

Association between depression and quality of life among Brazilian older adults in long-term care facilities / Asociación entre depresión y calidad de vida entre adultos mayores brasileños en centros de atención a largo plazo / Associação entre depressão e qualidade de vida entre idosos brasileiros em instituições de longa permanência

This study aims to test the association between geriatric depression and the quality of life of older adults in long-term care facilities in Brazil. Results showed that there was a significant correlation among four of the six domains that were measured in the WHOQOL-OLD questionnaire of those demonstrating symptoms and those without. In conclusion, higher depression scores were reported by participants who had lower quality of life scores. Mental health care should be carefully addressed among institutionalized older adults in long-term facilities.

Lo objectivo es probar la asociación entre la depresión geriátrica y la calidad de vida de los adultos mayores en centros de cuidados a largo plazo en Brasil. Los resultados mostraron que hubo una correlación significativa entre cuatro de los seis domínios que se midieron em el cuestionario WHOQOL-OLD de aquellos que muestram sintomas y los que no. En conclusión, los participantes que tenían puntuaciones de calidad de vida más bajas informaron puntuaciones de depresión más altas. La atención de la salud mental debe abordarse cuidadosamente entre los adultos mayores institucionalizados en instalaciones a largo plazo.

Este estudo tem como objetivo testar a associação entre depressão geriátrica e qualidade de vida de idosos em instituições de longa permanência no Brasil. Os resultados mostraram que houve uma correlação significativa entre quatro dos seis domínios que foram medidos no questionário WHOQOL-OLD daqueles que demonstraram sintomas e aqueles sem. Em conclusão, escores mais altos de depressão foram relatados pelos participantes que apresentaram escores mais baixos de qualidade de vida. Os cuidados de saúde mental devem ser cuidadosamente tratados entre idosos institucionalizados em instalações de longo prazo.

Does psychotherapy improve alexithymia? A comparison study among patients with mild or moderate depression

Abstract Background Alexithymia is reported to be a risk factor for depression. Psychotherapy is efficient for treatment of depression. Yet, the effect of psychotherapies on alexithymia is poorly understood. Objectives We aimed to compare Cognitive Behavioral Therapy (CBT), Existential Psychotherapy (ExP) and Supportive Counseling (SUP) for therapeutic efficacy and effect on alexithymia in depression. Methods There were 22 patients for each patient group. Sessions were performed as eight consecutive weekly and following two monthly boosters. Sixty six healthy controls were added. Prior to the sessions, patients received Sociodemographic Data Form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Hamilton Depression Rating Scale (HDRS) and 20-item Toronto Alexithymia Scale (TAS-20). The control group received Sociodemographic Data Form, SCID-1 and TAS-20. Patients additionally received HDRS and TAS-20 after their weekly and booster sessions. Results Patients' mean TAS-20 score was greater than of controls, however, it did not have a significant change throughout the study. Mean HDRS scores of ExP and CBT groups were lower than SUP group at the end. Discussion Alexithymia did not improve with psychotherapy. The exception was effect of ExP on externally oriented thinking. Psychotherapies all improved depression. CBT and ExP were more helpful than SUP.

Is there a correlation between depressive symptoms and motor skills in post-stroke patients? / Existe correlação entre sintomas depressivos e habilidades motoras em pacientes pós-AVC?

ABSTRACT Deficits in motor skills and depressive symptoms are common effects observed after stroke, so it is necessary to understand how these variables interact with each other. Therefore, the aim of this study was to investigate the relationship between these two variables in post-ischemic stroke patients. We evaluated 135 patients with a mean age of 60 years (± 15). The Fugl-Meyer assessment of motor function was used to assess motor skills in the upper limbs, lower limbs, balance, and sensitivity and the Beck Depression Inventory was applied to evaluate depressive symptoms. To assess the relationship between both components, Spearman's correlation was performed. Depressive symptoms were negatively correlated with all variables of motor skills. This study suggests that higher motor skills in post-stroke patients may be associated with fewer depressive symptoms. Thus, a better understanding of how post-stroke symptoms are interrelated may improve patient treatment and care, contributing to a better quality of life.

RESUMO Déficits na habilidade motora e presença de sintomas depressivos são comuns em pacientes pós-AVC. Assim, é necessário compreender como estas variáveis interagem entre si. O objetivo deste trabalho foi verificar esta relação em pacientes pós-AVC isquêmico. Participaram 135 sujeitos, com idade média de 60 anos (± 15). Foi utilizado o protocolo de desempenho motor Fugl Meyer para verificar a habilidade motora dos membros superiores, inferiores, equilíbrio e sensibilidade e o Inventário de Depressão de Beck para verificar os sintomas depressivos. Foi realizada a análise de Spearman para verificar a relação entre os dois componentes. Os sintomas depressivos se correlacionaram negativamente com todas as variáveis da habilidade motora. Assim, a maior habilidade motora implicou em menores sintomas depressivos. Portanto, compreender como as sequelas pós-AVC se relacionam auxilia no melhor tratamento e atendimento ao paciente, contribuindo para melhorar sua qualidade de vida.

The effect of music therapy on hemodialysis patients' quality of life and depression symptoms / O efeito da musicoterapia na qualidade de vida e nos sintomas de depressão de pacientes em hemodiálise

ABSTRACT Introduction: The sources of stress involved in chronic kidney disease (CKD) can lead to depressive states, directly affecting the hemodialysis patient's quality of life (QOL). There are few reports and studies on therapeutic interventions that aim to minimize depressive symptoms in these patients and an even greater shortage of studies using music therapy. Objective: This study evaluated the effect of music therapy on QOL and depressive symptoms in hemodialysis patients. Method: This was a music therapy intervention study in which 23 patients were evaluated regarding QOL and depression symptoms at two distinct stages - before and after the intervention. Eight sessions of music therapy were conducted, with two weekly sessions and an average duration of 75 minutes. The intervention was conducted by the music therapist herself, using specific music therapy techniques, besides voice and guitar to conduct harmonic and rhythmic support for the groups' sound-music production. Results: The patients showed a significant reduction in depression symptoms (p < 0.001) and better QOL results, with significant differences in the following dimensions: functional capacity (p = 0.011), pain (p = 0.036), general health (p = 0.01), vitality (p = 0.004), mental health (p = 0.012), symptom and problem list (p = 0.01), and overall health (p = 0.01). Conclusions: Intervention with music therapy constitutes an effective option in the treatment and prevention of depressive symptoms and improved QOL of HD patients.

RESUMO Introdução: Fontes de estresse representadas pela doença renal crônica (DRC) podem gerar estados de depressão, interferindo diretamente na qualidade de vida (QV) dos pacientes em hemodiálise (HD). Poucos são os relatos e estudos de intervenção terapêutica visando minimizar os sintomas depressivos nesses pacientes, com maior escassez de trabalhos utilizando a musicoterapia. Objetivo: O presente estudo avaliou o efeito da musicoterapia na QV e nos sintomas depressivos em pacientes em HD. Método: Estudo de intervenção musicoterapêutica, no qual 23 pacientes foram avaliados quanto à QV e sintomas de depressão em duas fases distintas: pré e pós-intervenção. Foram realizadas duas sessões em grupo por semana, com duração de 75 minutos, em um período de quatro semanas. A intervenção foi realizada por um musicoterapeuta, que utilizou técnicas específicas da musicoterapia, além da voz e do violão para conduzir apoio rítmico e harmônico na produção sonoro-musical dos grupos. Resultados: Os pacientes apresentaram redução significativa dos sintomas de depressão (p<0,001) e melhores resultados na QV, com diferenças estatísticas significantes nas dimensões: capacidade funcional (p=0,011), dor (p=0,036), estado geral de saúde (p=0,01), vitalidade (p=0,004), saúde mental (p=0,012), lista de sintomas e problemas (p=0,01) e saúde global (p=0,01). Conclusões: A intervenção com musicoterapia constitui-se opção efetiva no tratamento e prevenção de sintomas depressivos e na melhora da QV de pacientes em HD.

Factors associated with depression symptoms in women after breast cancer

ABSTRACT OBJECTIVE: To analyze the factors associated with the presence of depression symptoms in women after breast cancer. METHODS: Cross-sectional study with 181 women with breast cancer, aged 57.0 years (SD = 9.5), who were undergoing treatment or after treatment in the Oncology Research Center in Florianópolis, state of Santa Catarina, Brazil. The questionnaire comprised items addressing general and health information, economic level, anthropometric measures, depression symptoms (Beck Depression Inventory), self-esteem (Rosenberg Self-Esteem Scale), and body image (Body Image After Breast Cancer Questionnaire). Descriptive and inferential statistical analysis were performed by chi-square and Fisher's exact tests to verify association, Mann-Whitney U test to compare the groups and Poisson regression to identify the prevalence ratio of the factors associated with presence of depression symptoms (p < 0.05). RESULTS: We found an association between the presence of depression symptoms and the group of younger women (aged 40-60 years), those who had another disease besides cancer, those who had mastectomy surgery, those who suffered from lymphedema, and those who presented low-medium self-esteem. Less educated women presented more depressive symptoms, as did women with worse body image on the subscales of limitations, transparency, and arm concerns. CONCLUSIONS: Age, educational attainment, diagnosis of other diseases, type of surgery, lymphedema, self-esteem, and body image were factors associated with the presence of depression symptoms in Brazilian women after breast cancer. Health professionals should be aware of these relationships and try to detect depression symptoms earlier and improve the care they provide to these women.

Association between diabetes mellitus and depressive symptoms in the Brazilian population

ABSTRACT OBJECTIVE To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease. METHODS Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals. RESULTS Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62). CONCLUSIONS Interventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education.

Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms / Ancianos cuidadores de ancianos: fragilidad, solidon y sintomas depresivos / Idosos cuidadores de idosos: fragilidade, solidão e sintomas depressivos

ABSTRACT Objective: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. Method: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried's frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). Results: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. Conclusion: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

RESUMEN Objetivo: investigar la asociación entre fragilidad, soledad y síntomas depresivos de ancianos que cuidan de ancianos. Método: estudio transversal, realizado con 341 ancianos cuidadores catastrados en Unidades de Salud de la Familia de un municipio del interior paulista. Las entrevistas fueron domiciliarias e incluyeron cuestionario para caracterización del cuidador, fenotipo de fragilidad de Fried, APGAR de familia (funcionalidad familiar), Escala de Depresión Geriátrica (síntomas depresivos) y ítem 3 de la Escala de Esperanza de Herth (soledad). La regresión logística fue utilizada para analizar la asociación entre síntomas depresivos y soledad (variables independientes), y fragilidad y pre-fragilidad (variables dependientes). Resultados: hubo asociación entre fragilidad, soledad y síntomas depresivos. Los ancianos cuidadores solitarios tuvieron posibilidades aumentadas en el 158% de tener pre-fragilidad, y el 360% de fragilidad. Los ancianos cuidadores con síntomas depresivos tuvieron posibilidades aumentadas en un 242% de tener fragilidad. Conclusión: los ancianos cuidadores solitarios y que presentan síntomas depresivos tienen más probabilidades de ser frágiles y pre-frágiles.

RESUMO Objetivo: investigar a associação entre fragilidade, solidão e sintomas depressivos de idosos que cuidam de idosos. Método: estudo transversal, realizado com 341 idosos cuidadores cadastrados em Unidades de Saúde da Família de um município do interior paulista. As entrevistas foram domiciliares e incluíram questionário para caracterização do cuidador, fenótipo de fragilidade de Fried, APGAR de família (funcionalidade familiar), Escala de Depressão Geriátrica (sintomas depressivos) e item 3 da Escala de Esperança de Herth (solidão). A regressão logística foi utilizada para analisar a associação entre sintomas depressivos e solidão (variáveis independentes), e fragilidade e pré-fragilidade (variáveis dependentes). Resultados: houve associação entre fragilidade, solidão e sintomas depressivos. Idosos cuidadores solitários tiveram chances aumentadas em 158% de apresentar pré-fragilidade, e 360% de fragilidade. Idosos cuidadores com sintomas depressivos tiveram chances aumentadas em 242% de apresentar fragilidade. Conclusão: idosos cuidadores solitários e que apresentam sintomas depressivos têm mais chances de serem frágeis e pré-frágeis.

Sintomas depressivos em cuidadores familiares de pacientes com insuficiência cardíaca: revisão integrativa / Síntomas depresivos en cuidadores familiares de pacientes con insuficiencia cardíaca: una revisión integradora / Depressive symptoms in the family caregivers of patients with heart failure: an integrative review

Resumo OBJETIVOS Identificar a ocorrência de depressão em cuidadores familiares de pacientes com insuficiência cardíaca e a correlação de outras variáveis com a depressão. MÉTODO A busca bibliográfica foi realizada nas bases de dados Web of Science, Medline, LILACS e PubMed, em março de 2017. Artigos publicados entre 2004 e 2016, escritos em inglês, espanhol ou português, utilizando os descritores saúde, insuficiência cardíaca, depressão, cuidadores e familiares foram incluídos. RESULTADOS Foram selecionados 26 trabalhos. 6% a 64% reportaram sintomas depressivos. Os sintomas depressivos foram associados com as características dos pacientes e cuidadores. Em sua maioria, os sintomas depressivos foram maiores entre os cuidadores familiares que a população em geral e se relacionou principalmente com a sobrecarga do cuidado e a qualidade de vida. CONCLUSÃO Os estudos identificaram sintomas depressivos nos cuidadores de pacientes com insuficiência cardíaca.

Resumen OBJETIVOS Identificar la ocurrencia de síntomas depressivos en los cuidadores familiares de pacientes con insuficiencia cardíaca y la correlación de otras variables con los síntomas depressivos. MÉTODO La búsqueda bibliográfica se realizó en las bases de datos Web of Science, Medline, LILACS y PubMed en marzo de 2017. Se incluyeron artículos publicados entre 2004 y 2016, escritos en inglés, español o portugués, utilizando los descriptores de salud, insuficiencia cardíaca, depresión, cuidadores y familia. RESULTADOS Se seleccionaron 26 trabajos. De 6% a 64% reportaron síntomas depresivos. Los síntomas depressivos se asociaron a características de pacientes y cuidadores. En la mayoría de los casos, los síntomas depresivos fueron mayores entre los cuidadores familiares que en la población general y se relacionaron principalmente con la carga asistencial y la calidad de vida. CONCLUSIONES Los estudios identificaron síntomas depresivos en los cuidadores de pacientes con insuficiencia cardiaca.

Abstract AIMS Identify the occurrence of depressive symptoms in family caregivers of patients with heart failure and the correlation of other variables with depressive symptoms. DESIGN/METHOD The literature review was conducted in the Web of Science, Medline, LILACS and PubMed databases in March 2017. Papers published between 2004 and 2016, written in English, Spanish or Portuguese were included. The descriptors used were health, heart failure, depression, caregivers, and family. RESULTS 26 papers were selected. 6% to 64% reported depressive symptoms. Depressive symptoms were associated with patients' and caregivers' characteristics. In most cases, depressive symptoms were greater among family caregivers than in the general population and were mainly associated with care burden and quality of life. CONCLUSIONS The studies report depressive symptoms in caregivers of patients with heart failure.

Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction / Diferenças por Sexo na Ansiedade e Depressão após Infarto Agudo do Miocárdio

Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.

Resumo Fundamento: Os pacientes com doença cardíaca, depressão e transtornos de ansiedade são altamente prevalentes e persistentes. A depressão e a ansiedade desempenham um papel significativo na progressão da doença cardiovascular e são reconhecidas como fatores de risco independentes. No entanto, há muito pouca análise relacionada ao gênero em relação às doenças cardiovasculares e transtornos emocionais. Objetivo: Avaliar os níveis de depressão e ansiedade em pacientes com infarto do miocárdio (IM) no primeiro mês após o IM e avaliar a relação entre os fatores de risco para doença cardiovascular, indicadores demográficos e distúrbios emocionais, bem como determinar se existem diferenças ou semelhanças baseadas no sexo do paciente. Métodos: Esta pesquisa incluiu questões demográficas, características clínicas, questões sobre fatores de risco de doença cardiovascular e a Escala Hospitalar de Ansiedade e Depressão [HADS]. Todos os testes estatísticos foram bilaterais, e valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Determinou-se que 71,4% dos pacientes do sexo feminino e 60,4% dos pacientes do sexo masculino apresentavam sintomatologia concomitante de ansiedade e/ou depressão (p = 0,006). Utilizando os homens como o ponto de referência, as mulheres mostraram um risco elevado de apresentar qualquer distúrbio psiquiátrico (odds ratio, 2,86, p = 0,007). O escore da HADS-D foi notavelmente maior nas mulheres (8,66 ± 3,717) do que nos homens (6,87 ± 4,531, p = 0,004). Foi determinado que os pacientes do sexo masculino que desenvolveram depressão eram em média mais jovens do que aqueles sem depressão (p = 0,005). Conclusões: As mulheres demonstraram risco mais elevado de apresentar distúrbio de ansiedade e/ou depressão em comparação aos homens. Além disso, a gravidade da depressão aumentou com a idade entre os homens, enquanto o gravidade da ansiedade diminuiu. Em contraste, a gravidade da depressão e ansiedade foram semelhantes para mulheres de todas as idades após o IM. Um maior escore de depressão foi associado com diabetes e inatividade física, e o maior escore de ansiedade foi associado ao tabagismo nos homens. A hipercolesterolemia foi associada tanto aos maiores escores de ansiedade e depressão, enquanto um maior escore de depressão foi associado à inatividade física entre mulheres.

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias: revisión de la literatura / Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families: literature review

La diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complica ciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pue den reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Suicidal ideation, anxiety, and depression in patients with multiple sclerosis / Ideação suicida, ansiedade e depressão em pacientes com esclerose múltipla

ABSTRACT Psychiatric disorders frequently occur in patients with multiple sclerosis (MS); however, limited reports are available on these comorbidities. We aimed to investigate the relationships among MS, anxiety, depression, and suicidal ideation. Methods: One hundred and thirty two patients with relapsing-remitting MS were evaluated using the Expanded Disability Status Scale, Beck Depression Inventory-II (BDI-II), Beck Scale for Suicide Ideation (BSI), and Hospital Anxiety and Depression Scale. Results: A hierarchical regression analysis was performed to evaluate the variables. The regression equation significantly predicted the BSI score (R2 = 0.306; adjusted R2 = 0.273; F (9, 125) = 9.18; p < 0.0005), and the BDI-II score was the only variable that contributed significantly to this model (p < 0.0005). Conclusions: A high prevalence of depression and anxiety, and a higher rate of suicidal ideation were identified in MS patients compared to the general population. The presence of depressive symptoms appeared to have a direct influence on the risk of suicide.

RESUMO Transtornos psiquiátricos frequentemente ocorrem em pacientes com esclerose múltipla (EM). No entanto, os artigos sobre estas comorbidades são limitados. Pretendemos investigar as relações entre EM, ansiedade, depressão e ideação suicida. Métodos: Cento e trinta e dois pacientes com EM remitente-recorrente foram avaliados usando a Escala de Estado de Incapacidade Expandida, Inventário de Depressão de Beck-II (IDB-II), Escala de Beck para Ideação de Suicídio (BSI) e Escala de Ansiedade e Depressão. Resultados: Uma análise de regressão hierárquica foi realizada para avaliar as variáveis. A equação de regressão previu significativamente o escore BSI (R2 = 0,306; R2 ajustado = 0,273; F (9,125) = 9,18; p < 0,0005) e o escore no IDB-II foi a única variável que contribuiu significativamente para este modelo (p < 0,0005). Conclusões: Uma alta prevalência de depressão e ansiedade e uma maior taxa de ideação suicida foram identificadas em pacientes com EM em comparação com a população em geral. A presença de sintomas depressivos pareceu ter uma influência direta no risco de suicídio.