Emotional eating in women with generalized anxiety disorder

Abstract Introduction Individuals diagnosed with generalized anxiety disorder (GAD) seek pleasurable foods to avoid their negative emotional experiences. Ineffective regulation of negative emotions may be a risk factor for emotional eating (EE), leading to suffering, dysfunctional behaviors, and weight gain. Objectives The aim of this study is to understand the relationship between emotional dysregulation and EE, investigating potential mediators such as the intensity of the worry, avoidance of internal experiences, mindfulness, and self-compassion in female patients with anxiety. Methods In this cross-sectional study, participants from a randomized clinical trial diagnosed with GAD answered the following instruments at baseline: the Difficulties in Emotion Regulation Scale (DERS), the Three Factor Eating Questionnaire (TFEQ-R21), the Penn State Worry Questionnaire (PSWQ), the Action and Acceptance Questionnaire (AAQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Self-Compassion Scale (SCS). We estimated Pearson correlation coefficients and performed mediation analyses. Results We evaluated 51 female individuals, 34 of whom completed all the questionnaires. Our data showed that EE was positively correlated with emotional dysregulation (r = 0.593; p < 0.001), worry trait (r = 0.402; p = 0.018), and avoidance of internal experiences (r = 0.565; p < 0.001), whereas it was negatively correlated with self-compassion (r = -0.590; p < 0.001) and mindful state (r = -0.383; p = 0.026). Moreover, we demonstrated that self-compassion mediates the relationship between emotional dysregulation and EE (ab product estimate = 0.043, 95% confidence interval [95%CI] 0.003-0.084). Conclusion Our findings contribute to the literature by identifying psychological factors that could mediate the association between emotional dysregulation and EE, enabling identification of more effective eating behavior intervention targets for patients with GAD.

Validation and clinical application of the Metacognitions Questionnaire in a sample of Brazilian generalized anxiety disorder patients: the effects of different treatment interventions

Abstract Introduction Metacognitive beliefs about worry may trigger anxiety. However, the effect of generalized anxiety disorder (GAD) treatment on metacognition has not yet been investigated. Objectives To validate the Metacognitions Questionnaire (MCQ-30) in a Brazilian GAD sample and verify whether different interventions reduce metacognitive beliefs. Method We recruited 180 GAD individuals and randomized them to Body in Mind Training (BMT), Fluoxetine (FLX), or an active control group (Quality of Life [QoL]) for 8 weeks. The MCQ-30 was assessed for internal consistency, was evaluated with confirmatory and exploratory factor analyses, and was tested for convergent validity with the Penn State Worry Questionnaire (PSWQ). Generalized estimating equations (GEE) were employed to analyze differences after the interventions. Results The MCQ-30 demonstrated good internal consistency and acceptability; the original five-factor model was supported. There was a positive moderate correlation between MCQ-30 scores and worry. GEE showed a significant group x time interaction (p < 0.001). Both BMT (mean difference [MD] = -6.04, standard error [SE] = -2.39, p = 0.034) and FLX (MD = -5.78, SE = 1.91, p = 0.007) reduced MCQ-30 scores. FLX was superior to QoL, but not BMT, at weeks 5 and 8. There were no differences between BMT and QoL. Conclusion The Brazilian-Portuguese version of MCQ-30 showed good psychometric properties. Furthermore, the positive effect of FLX and BMT on metacognition suggests it may represent a potential therapeutic target.

Psychiatric outcomes and overall functioning in healthcare students during the first wave of the COVID-19 pandemic: a cross-sectional study

Abstract Introduction There is evidence that the coronavirus disease 2019 (COVID-19) pandemic impacted students on health care courses, including evidence of associations between anxiety or depression and inadequate coping mechanisms or unhealthy habits. However, little is known about possible predictors of mental health or psychiatric symptoms in Brazilian health care students during this period. Objective To evaluate possible factors associated with anxiety and depressive symptoms, used to measure psychiatric outcomes, and quality of life, used as a parameter of overall functionality, in Brazilian students on health care courses during the COVID-19 pandemic. Methods A cross-sectional study was conducted with Brazilian students on health care courses from May to December 2020. Participants were recruited through social media and answered a 71-item open online questionnaire exploring demographic characteristics and personal behavior during the pandemic, anxiety, depression, and quality of life. We searched for variables potentially associated with psychiatric symptoms and mental health in these individuals using Poisson regression models. Results Multivariate models showed depression and anxiety were associated with poor quality of life and medication abuse was associated with greater anxiety and poor quality of life. Psychotherapy was an effective coping strategy for anxiety and meditation or mindfulness practice and physical activity improved the students' quality of life. Conclusions Our study presents important information about the factors associated with psychological impacts of the COVID-19 pandemic and strategies for coping with them that should be helpful to reflect on and for designing appropriate interventions.

Comorbidity of psychiatric and dermatologic disorders with skin picking disorder and validation of the Skin Picking Scale Revised for Brazilian Portuguese

Objective: Skin picking disorder (SPD) affects up to 5.4% of the population. Less than half of patients are correctly diagnosed and treated. Developing tools to recognize SPD can help professionals and patients alike. This trial aimed to validate the Skin Picking Scale-Revised (SPS-R) for the Brazilian population and assess the psychiatric and dermatological comorbidities of patients with SPD. Methods: Brazilians with a primary diagnosis of SPD, 18 years or older, were recruited from a community sample by media advertising and evaluated by a dermatologist and a psychiatrist. Self-report instruments were used: SPS-R, Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed to evaluate the SPS-R, and Pearson correlation (r) was used to assess the relationship between instruments. Results: Overall, 124 patients were included. The SPS-R demonstrated good internal consistency (Cronbach's coefficient = 0.84). CFA found a good fit to the model according to all indices (χ2 = 29.67; degrees of freedom [df] = 19; p = 0.056; root mean square error of approximation [RMSEA] = 0.067; comparative fit index [CFI] = 0.969; non-normed fit index [NNFI] = 0.954). SPS-R correlated with DLQI (r = 0.73), GAD-7 (r = 0.51), and PHQ-9 (r = 0.43). The sample had a high prevalence of psychiatric disorders, mainly generalized anxiety disorder (62.1%) and current (32.3%) and past (37.1%) depressive episodes. Conclusion: The Brazilian version of the SPS-R presents good psychometric properties. The severity of SPD is related to severity of depression, anxiety, and impairment in quality of life. Clinical trial registration: ClinicalTrials.gov, NCT04731389

Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause

Objective: Vasomotor symptoms affect 60-80% of women during the menopausal transition. Anxiety, depression, and anxiety sensitivity can have an important role in the distressful experience of vasomotor symptoms. Our aim was to evaluate the prevalence and association of vasomotor and negative affect symptoms. Methods: A cross-sectional study was conducted with 89 perimenopausal women aged 45-55 years. Broad psychiatric and clinical evaluations were carried out. The primary outcome was the vasomotor symptom problem rating and the main study factor was anxiety sensitivity. Linear regression analyses were conducted to examine the associations between the study factors and the primary outcome, and a multiple regression model was created to assess which variables were independently associated with vasomotor symptom problem rating. Results: The prevalence of anxiety, depression, and vasomotor symptoms were 58, 62, and 73%, respectively. Negative affect symptoms were positively associated with vasomotor symptom problem rating. The association of anxiety sensitivity and vasomotor symptom problem rating remained significant after controlling for perimenopausal stage, thyrotropin, follicle-stimulating hormone levels, and psychotropic medication use (β = 0.314, p = 0.002). Conclusion: A better understanding of the experience of vasomotor symptoms is needed, especially the role of negative affect symptoms and anxiety sensitivity. New strategies focusing on related thoughts and behaviors could improve the quality of life of perimenopausal women.

Impulsivity influences food intake in women with generalized anxiety disorder

Objective: Eating behavior is affected by psychological and neurocognitive factors. However, little is known about this relationship in anxious patients. Our aim was to investigate the associations between impulsivity, inhibitory control, energy-dense food consumption, and body mass index (BMI) in women with generalized anxiety disorder (GAD). Methods: In this cross-sectional study, 51 adult females with GAD answered the Barratt Impulsiveness Scale (BIS-11) and participated in a go/no-go task using food images. Anthropometric measurements were evaluated. A food frequency questionnaire and a snack test were used to study eating behavior. Pearson correlation and multiple linear regression were performed to analyze the variables of interest, adjusted by age. Results: Impulsivity predicted intake of sugar (p = 0.016, 95%CI 0.67-6.05), total fat (p = 0.007, 95%CI 0.62-3.71), and saturated fat (p = 0.004, 95%CI 0.30-1.48). The snack test showed a positive correlation between presence of impulsivity and intake of biscuits (R = 0.296; p = 0.051). Response inhibition to food images in the go/no-go task paradigm did not predict BMI or food intake. Conclusion: Impulsivity was predictive of higher sugar and saturated fat intake in women diagnosed with GAD. Our findings add to the literature regarding the association between neuropsychological factors and food consumption in this specific population.

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention

Objective: Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students. Methods: In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention. Results: Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001). Conclusion: UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study

Objectives: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study. Methods: Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children's clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors. Results: The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder. Conclusion: Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias

Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study / Desempenho em tarefas de atenção, memória, habilidades visuoconstrutivas e funções executivas em adolescentes com transtornos de ansiedade: um estudo comunitário caso-controle

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

Estrutura fatorial, fidedignidade e parâmetros de itens da versão em português brasileiro do questionário GAD-7 / Factor structure, reliability, and item parameters of the brazilian-portuguese version of the GAD-7 questionnaire / Estructura factorial, confiabilidad, y ítems parámetros de la versión de portugués brasileño del cuestionario GAD-7

This study examined the psychometric properties of the Brazilian-Portuguese version of the Generalized Anxiety Disorder GAD-7 questionnaire in a community sample (n = 206) of Brazilian adults. The sample was 41% female, with a mean age of 21.10 (SD = 4.49),75.6% from colleges/universities. Results of a confirmatory factor analysis provided support to the original unidimensional model of the GAD-7 in the Brazilian context. Analyses of Variance (ANOVA) showed that the GAD-7 scores were significantly different between males and females, with females scoring higher than males. The scale demonstrated good reliability evidence; both Cronbach's alpha coefficient (α = .916) and rho composite reliability coefficient (ρ= .909) were adequate. Item parameter analysis showed items 5 and 7 presented the highest severity thresholds for the generalized anxiety latent trait, whereas item 1 presented the lowest ones. Our findings suggest that the Brazilian-Portuguese version of the GAD-7 is suitable for assessing Generalized Anxiety Disorder symptoms in Brazilian adults in community settings.

Este estudo analisou as propriedades psicométricas da versão em Português Brasileiro do questionário de "Transtorno de Ansiedade Generalizada - GAD-7 em uma amostra de comunidade (n = 206) da população adulta brasileira. A amostra foi composta por de 41% de participantes do sexo feminino, com idade média de 21,10 (DP = 4,49), e 75,6% em instituições de ensino superior. Os resultados da análise fatorial confirmatória forneceram apoio para o modelo unidimensional original do GAD-7 no contexto brasileiro. As análises de variância (ANOVA) mostraram que os escores do GAD-7 foram significativamente diferentes entre homens e mulheres, com as mulheres apresentando maiores escores que os homens. A escala demonstrou uma boa fidedignidade; sendo que tanto o coeficiente de Cronbach alfa (α = 0,916) e rho coeficiente de confiabilidade composta (ρ = 0,909) foram adequados. A análise dos parâmetros dos itens mostrou itens 5 e 7 apresentaram os limiares mais elevados de severidade para o traço-latente de ansiedade generalizada, enquanto que o item 1 apresentou as menores. Nossos resultados sugerem que a versão Português Brasileiro do GAD-7 é adequada para avaliar os sintomas do transtorno de ansiedade generalizada em adultos brasileiros em ambientes comunitários.

Este estudio examinó las propiedades psicométricas de la versión de portugués brasileño del cuestionario de Desorden de Ansiedad Generalizada GAD-7, en una muestra comunitaria (n = 206) de adultos brasileños. La muestra se compone de 41% de mujeres, con una edad media de 21,10 (SD = 4,49), y 75,6% estudiantes universitarios. El análisis factorial confirmatorio proporcionó evidencias que soportan el modelo unidimensional original del GAD-7 en el contexto brasileño. El análisis de variancia (ANOVA) mostró que las puntuaciones fueron significativamente diferentes entre hombres y mujeres, siendo que las mujeres obtuvieron puntuaciones más altas que los hombres. La escala demostró tener una buena confiabilidad; el coeficiente de alpha de Cronbach (α= .916) y el coeficiente rho de fiabilidad (ρ = .909) fueron adecuados. El análisis de datos mostró los ítems 5 y 7 tuvieron los umbrales de gravedad más altos en el trazo de ansiedad generalizada, mientras el ítem 1 tuvo el más bajo. Nuestros hallazgos sugieren que la versión en portugués brasileño de GAD-7 es adecuado para la evaluación de síntomas de trastorno de ansiedad generalizada en adultos brasileños en contextos comunitarios.

Measuring child maltreatment using multi-informant survey data: a higher-order confirmatory factor analysis / Dados de levantamento com múltiplos informantes para a mensuração de maus-tratos na infância: uma análise fatorial confirmatória de segunda ordem

Objective To investigate the validity and reliability of a multi-informant approach to measuring child maltreatment (CM) comprising seven questions assessing CM administered to children and their parents in a large community sample. Methods Our sample comprised 2,512 children aged 6 to 12 years and their parents. Child maltreatment (CM) was assessed with three questions answered by the children and four answered by their parents, covering physical abuse, physical neglect, emotional abuse and sexual abuse. Confirmatory factor analysis was used to compare the fit indices of different models. Convergent and divergent validity were tested using parent-report and teacher-report scores on the Strengths and Difficulties Questionnaire. Discriminant validity was investigated using the Development and Well-Being Assessment to divide subjects into five diagnostic groups: typically developing controls (n = 1,880), fear disorders (n = 108), distress disorders (n = 76), attention deficit hyperactivity disorder (n = 143) and oppositional defiant disorder/conduct disorder (n = 56). Results A higher-order model with one higher-order factor (child maltreatment) encompassing two lower-order factors (child report and parent report) exhibited the best fit to the data and this model's reliability results were acceptable. As expected, child maltreatment was positively associated with measures of psychopathology and negatively associated with prosocial measures. All diagnostic category groups had higher levels of overall child maltreatment than typically developing children. Conclusions We found evidence for the validity and reliability of this brief measure of child maltreatment using data from a large survey combining information from parents and their children.

Objetivo Investigar a validade e confiabilidade de uma abordagem de múltiplos informantes para a mensuração de maus-tratos na infância, composta por sete questões avaliando maus-tratos na infância respondidas pelas crianças e seus pais em uma ampla amostra comunitária. Métodos A amostra foi composta por 2.512 crianças com idades entre 6 e 12 anos e seus pais. Maus-tratos na infância foram avaliados com três questões respondidas pelas crianças e quatro respondidas pelos seus pais, investigando violência física, negligência física, violência emocional e violência sexual. Análises fatoriais confirmatórias foram utilizadas para comparar os índices de ajuste de diferentes modelos. Validade convergente e divergente foi testada utilizando escores de relato parental e de relato dos professores no Strengths and Difficulties Questionnaire. Validade discriminante foi investigada utilizando a entrevista Development and Well-Being Assessment para dividir os participantes em cinco grupos diagnósticos: controles com desenvolvimento típico (n = 1.880), transtornos do medo (n = 108), transtornos do estresse (n = 76), transtorno de déficit de atenção-hiperatividade (n = 143) e transtorno opositivo-desafiador/conduta (n = 56). Resultados Um modelo de segunda ordem com um fator de segunda ordem (maus-tratos na infância) englobando dois fatores de primeira ordem (relato da criança e relato parental) demonstrou o melhor ajuste aos dados, e os resultados de confiabilidade desse modelo foram aceitáveis. Como esperado, maus-tratos na infância estiveram positivamente associados a medidas de psicopatologia e negativamente associados a medidas pró-sociais. Todos os grupos de categorias diagnósticas tiveram níveis mais altos de maus-tratos na infância do que as crianças com desenvolvimento típico. Conclusões Foram encontradas evidências de validade e confiabilidade dessa medida breve de maus-tratos na infância utilizando dados de um grande levantamento combinando o relato de pais e seus filhos.

Executive functions as a potential neurocognitive endophenotype in anxiety disorders: A systematic review considering DSM-IV and DSM-5 diagnostic criteria classification / Funções executivas como um potencial endofenótipo neurocognitivo nos transtornos de ansiedade: uma revisão sistemática da literatura considerando os critérios diagnósticos do DSM-IV e do DSM-5

Evidence in the literature indicates that neurocognitive impairments may represent endophenotypes in psychiatric disorders.Objective:This study aimed to conduct a systematic review on executive functions as a potential neurocognitive endophenotype in anxiety disorder diagnosis according to the DSM-IV and DSM-5 classifications.Methods:A literature search of the LILACS, Cochrane Library, Index Psi Periódicos Técnico-Científicos, PubMed and PsycInfo databases was conducted, with no time limits. Of the 259 studies found, 14 were included in this review.Results:Only studies on obsessive-compulsive disorder (OCD) were found. The executive function components of decision-making, planning, response inhibition, behavioral reversal/alternation, reversal learning and set-shifting/cognitive flexibility were considered to be a neurocognitive endophenotypes in OCD.Conclusion:Further studies on executive functions as a neurocognitive endophenotype in other anxiety disorders are needed since these may have different neurocognitive endophenotypes and require other prevention and treatment approaches.

Evidências na literatura indicam que déficits neurocognitivos podem representar endofenótipos nos transtornos psiquiátricos.Objetivo:Esse estudo teve como objetivo realizar uma revisão sistemática das funções executivas como um potencial endofenótipo neurocognitivo nos transtornos de ansiedade de acordo com as classificações diagnósticas do DSM-IV e do DSM-5.Métodos:Uma pesquisa na literatura nas bases de dados LILACS, Cochrane Library, Index Psi Periódicos Técnico-Científicos, PubMed and PsycInfo foi conduzida, sem limite de tempo. Dos 259 estudos encontrados, 14 foram incluídos nessa revisão.Resultados:Somente foram encontrados estudos sobre o transtorno obsessivocompulsivo (TOC). Os componentes das funções executivas como a tomada de decisão, planejamento, inibição de resposta, inversão comportamental/alternância, aprendizagem reversa e mudança de foco/flexibilidade cognitiva foram considerados endofenótipos neurocognitivos no TOC.Conclusão:É necessário o desenvolvimento de estudos sobre funções executivas como um endofenótipo neurocognitivo em outros transtornos de ansiedade, pois eles podem apresentar diferentes endofenótipos neurocognitivos e podem exigir abordagens de prevenção e tratamento distintas.

Internalizing disorders and quality of life in adolescence: evidence for independent associations

Objective: To investigate whether internalizing disorders are associated with quality of life (QoL) in adolescents, even after accounting for shared risk factors. Methods: The sample comprised 102 adolescents from a community cross-sectional study with an oversampling of anxious subjects. Risk factors previously associated with QoL were assessed and divided into five blocks organized hierarchically from proximal to distal sets of risk factors. Results: Multiple regression analysis yielded a hierarchical model accounting for 72% of QoL variance. All blocks were consistently associated with QoL (p < 0.05), accounting for the following percentages of variance: 12% for demographics; 5.2% for family environment; 37.8% for stressful events; 10% for nutritional and health habits; and 64.2% for dimensional psychopathological symptoms or 22.8% for psychiatric diagnoses (dichotomous). Although most of the QoL variance attributed to internalizing symptoms was explained by the four proximal blocks in the hierarchical model (43.2%), about 21% of the variance was independently associated with internalizing symptoms/diagnoses. Conclusions: QoL is associated with several aspects of adolescent life that were largely predicted by our hierarchical model. Our findings reinforce the hypothesis that internalizing disorders and internalizing symptoms in adolescents have a high impact on QoL and deserve proper clinical attention. .

Dysfunctional family environments and childhood psychopathology: the role of psychiatric comorbidity / Ambientes de famílias disfuncionais e psicopatologia infantil: o papel da comorbidade psiquiátrica

Introduction: The study of the association between specific characteristics of family environments and different types of psychopathology may contribute to our understanding of these complex disorders and ultimately inform therapeutics. Objective: To compare the family characteristics of four groups: typically developing children; children with anxiety disorders only; children with externalizing disorders only; and children with both anxiety and externalizing disorders. Methods: This study enrolled 115 individuals from the community. Child psychiatrists made psychiatric diagnoses using a structured clinical interview. The Family Environment scale was used to evaluate six domains of family function. Results: The group with both anxiety and externalizing disorders had higher levels of conflict in family environment and lower levels of organization when compared with typically developing children. In addition, internalizing and externalizing symptoms were positively associated with conflict and negatively with organization. Maternal depressive and anxious symptoms were also associated with higher conflict and lower organization scores. Conclusion: An important between-group difference in comorbid cases of anxiety and behavioral disorders suggests that children with this comorbidity are potential candidates for family interventions to address family conflicts and organizational aspects (AU)

Introdução: O estudo da relação entre características específicas do ambiente familiar e os diferentes tipos de psicopatologias pode contribuir para o nosso entendimento desses complexos transtornos e possivelmente gerar informações para seu tratamento. Objetivo: Comparar as características familiares de quatro grupos: Crianças com desenvolvimento típico; crianças com transtornos de ansiedade apenas; crianças com transtornos de externalização apenas; e crianças com transtornos de ansiedade e de externalização. Métodos: Cento e quinze indivíduos foram recrutados na comunidade. Psiquiatras pediátricos usaram uma entrevista clínica estruturada para estabelecer os diagnósticos psiquiátricos. A Escala do Ambiente Familiar (Family Environment) foi usada para avaliar os seis domínios de funcionamento da família. Resultados: O grupo que apresentava tanto transtornos de ansiedade quanto de externalização apresentou níveis mais altos de conflito e níveis mais baixos de organização quando comparados com as crianças com desenvolvimento típico. Além disso, os sintomas de externalização e internalização estavam positivamente relacionados a conflitos e negativamente a organização. Sintomas depressivos e de ansiedade da mãe também se mostraram relacionados a resultados mais altos para conflito e mais baixos para organização. Conclusão: Uma importante diferença entre grupos em casos de comorbidades de transtornos de ansiedade e de comportamento sugerem que as crianças com esta comorbidades são candidatos em potencial para intervenções familiares que abordem conflitos familiares e aspectos organizacionais (AU)

Associations between child disciplinary practices and bullying behavior in adolescents / Associações entre práticas de disciplina infantil e comportamento de bullying em adolescentes

OBJECTIVE: to investigate associations between different types of child disciplinary practices and children and adolescents' bullying behavior in a Brazilian sample. METHODS: cross-sectional study, with a school-based sample of 10-to 15-year-old children and adolescents. Child disciplinary practices were assessed using two main subtypes: power-assertive and punitive (psychological aggression, corporal punishment, deprivation of privileges, and penalty tasks) and inductive (explaining, rewarding, and monitoring). A modified version of the Olweus Bully Victim Questionnaire was used to measure the frequency of bullying. RESULTS: 247 children and adolescents were evaluated and 98 (39.7%) were classified as bullies. Power-assertive and punitive discipline by either mother or father was associated with bullying perpetration by their children. Mothers who mostly used this type of discipline were 4.36 (95% CI: 1.87-10.16; p < 0.001) times more likely of having a bully child. Psychological aggression and mild forms of corporal punishment presented the highest odds ratios. Overall inductive discipline was not associated with bullying. CONCLUSIONS: bullying was associated to parents' assertive and punitive discipline. Finding different ways of disciplining children and adolescents might decrease bullying behavior. .

OBJETIVO: investigar a associação entre práticas parentais de disciplina e comportamento de bullying entre adolescentes brasileiros. MÉTODOS: estudo transversal, com alunos de 10 a 15 anos. Práticas parentais de disciplina foram avaliadas utilizando duas subclassificações principais: autoritárias e punitivas (agressão psicológica, punição corporal, retirada de privilégios e penalidades) e indutivas (explicações, recompensa e monitoramento). Uma versão modificada do Olweus Bully Victim Questionnaire foi utilizada para verificar a frequência de bullying. RESULTADOS: foram avaliados 247 adolescentes, e 98 (39,7%) deles foram classificados como agressores. Práticas parentais de disciplina autoritárias e punitivas, utilizadas tanto pela mãe como pelo pai, apresentaram associação com a prática de bullying pelos filhos. Mães que mais utilizavam este tipo de disciplina apresentaram chance 4,36 (IC95%: 1,87-10,16; p < 0,001) vezes maior de ter um filho agressor. Agressão psicológica e formas brandas de punição corporal apresentaram os maiores odds ratio. Disciplina indutiva como um todo não apresentou associação. CONCLUSÕES: a prática de bullying apresentou associação com a disciplina parental autoritária e punitiva. A utilização de diferentes formas de disciplinar os adolescentes podem diminuir o comportamento de bullying. .

Propriedades psicométricas da versão brasileira do behavioral inhibition instrument (BII) e associações com sintomas psicopatológicos / Psychometric properties of the brazilian version of the behavioral inhibition instrument (BII) and associations with psychopathological symptoms / Propiedades psicométricas de la versión brasileña del behavioral inhibition instrument (BII) e sus asociaciones con síntomas psicopatológicos

Os objetivos desse estudo foram investigar propriedades psicométricas da versão brasileira do Behavioral Inhibition Instrument (BII) e suas associações com sintomas de ansiedade e depressão em crianças e adolescentes. Participaram 838 estudantes com idades entre 9-18 anos (M=12,89; DP=2,10) de uma amostra comunitária respondendo a versão brasileira do BII e questionários de autorrelato de sintomas de ansiedade e depressão. Os resultados demonstraram que a prevalência de crianças e adolescentes na categoria de alta inibição comportamental foi de 16,6%. O BII apresentou propriedades psicométricas satisfatórias com maiores níveis de inibição comportamental correlacionados a maiores níveis de sintomas de ansiedade e depressão, especialmente para sintomas de fobia social. Além disso, participantes com altos escores de inibição comportamental tiveram maior probabilidade de apresentar sintomas de ansiedade em um espectro clínico ou subclínico, especialmente para fobia social. Implicações para intervenções preventivas precoces são brevemente discutidas...

The aims of this study were to investigate psychometric properties of the Behavioral Inhibition Instrument (BII) and their association with depression and anxiety symptoms in children and adolescents. Eight hundred and thirty-eight students aged 9-18 years (M=12.89, SD=2.10) from a community sample answered the Brazilian-Portuguese version of the BII and self-report questionnaires of depression and anxiety symptoms. Results showed the prevalence of children and adolescents in the high behavioral inhibition (BI) category was 16.6%. The BII presented satisfactory psychometric properties with higher levels of BI being correlated to higher levels of depression and anxiety symptoms, especially social phobia symptoms. Also participants with higher BI scores were more likely to present anxiety symptoms in a subclinical or clinical range, especially for social phobia. Implications for early preventive interventions are briefly discussed...

Los objetivos de este estudio fueron investigar las propiedades psicométricas de la versión brasileña del Behavioral Inhibition Instrument (BII) y sus asociaciones con los síntomas de ansiedad y depresión en niños y adolescentes. Ochocientos treinta y ocho (838) estudiantes con edades entre 9 y 18 años (M=12,89; DP=2,10) de una muestra comunitaria respondieron a la versión brasileña del BII y a cuestionarios auto-aplicables de síntomas de ansiedad y depresión. Los resultados demuestran que el predominio de niños y adolescentes en la categoría de alta inhibición conductual fue de 16,6%. El BII presentó propiedades psicométricas satisfactorias con mayores niveles de inhibición conductual correlacionándose a mayores niveles de síntomas de ansiedad y depresión, especialmente para fobia social. Además, los participantes con altos puntajes de inhibición conductual tuvieron mayor probabilidad de presentar síntomas de ansiedad en un espectro clínico o subclínico, especialmente para fobia social. Algunas implicancias para realizar intervenciones preventivas precoces son brevemente discutidas...

Revisão sistemática de instrumentos para avaliação de ansiedade na população brasileira / Systematic review of instruments to evaluate anxiety in Brazilian population / Revisión sistemática de los instrumentos de evaluación de ansiedad en la población brasileña

O objetivo deste estudo foi realizar uma revisão sistemática dos instrumentos para a avaliação de sintomas ansiosos e Transtornos de Ansiedade (TA) disponíveis no Brasil. Foi realizada uma revisão nas bases Index Psi, PePSIC, SciELO, LILACS, PsycINFO e PUBMED com auxílio de estratégias extras. Foram incluídos 99 estudos, contemplando 69 instrumentos de avaliação. A maioria dos instrumentos é composta por adaptações transculturais, de estilo psicométrico e autoaplicados. Sete categorias emergiram dos resultados, evidenciando o caráter multifacetado do construto ansiedade. Há alternativas para investigação de TA em diferentes faixas etárias e contextos. A maioria dos estudos apresentou boas evidências de validade e fidedignidade para os instrumentos avaliados, embora alguns ainda careçam de maiores investigações. O avanço e o contínuo monitoramento dos estudos acerca da avaliação de TA oferecem subsídios teóricos e empíricos para o desenvolvimento do construto ansiedade e para a prevenção e tratamento dos TA...

The aim of this study was to conduct a systematic review of the instruments for the assessment of Anxiety Disorders (AD) available in Brazil. A literature review was conducted in Index Psi, PePSIC, SciELO, LILACS, PsycINFO, and PUBMED databases complemented by extra strategies. The review included 99 studies about 69 assessment instruments. Most of the instruments were cross-cultural adaptations, psychometric-based and self-reported. Results were divided into seven categories of instruments, supporting the multifaceted characteristics of the anxiety construct. Alternatives for the assessment of AD in different age ranges and contexts were found. Most of the studies presented good validity and reliability evidences of the instruments evaluated, although some still need further investigations. The progress and continuous monitoring of the studies about AD assessment provide theoretical and empirical support for the development of the anxiety construct and for the prevention and treatment of AD...

El objetivo de este estudio fue realizar una revisión sistemática de los instrumentos para evaluación de los síntomas y Trastornos de Ansiedad (TA) disponibles en Brasil. Fue realizada una revisión en las bases Index Psi, PePSIC, SciELO, LILACS, PsycINFO y PUBMED con auxilio de estrategias extras. Fueron incluidos 99 estudios, contemplando 69 instrumentos de evaluación. La mayoría de los instrumentos fue compuesta por adaptaciones transculturales, de estilo psicométrico y auto-aplicables. Siete categorías surgieron de los resultados, poniendo en evidencia el carácter multifacético del constructo de la ansiedad. Hay alternativas para investigar los TA en diferentes grupos etarios y contextos. La mayoría de los estudios presentó buenas evidencias de validez y confiabilidad para los instrumentos evaluados, aunque algunos aún necesiten mayores investigaciones. El avance y continuo monitoreo de los estudios acerca de la evaluación de TA ofrecen subsidios teóricos y empíricos para el desarrollo del constructo ansiedad y para la prevención y tratamiento de los TA...