A magnetic resonance imaging-based morphometric and structural covariance network study of Brazilian adolescents stratified by depression risk

Objectives: To explore differences in regional cortical morphometric structure between adolescents at risk for depression or with current depression. Methods: We analyzed cross-sectional structural neuroimaging data from a sample of 150 Brazilian adolescents classified as low-risk (LR) (n=50) or high-risk (HR) for depression (n=50) or with current depression (n=50) through a vertex-based approach with measurements of cortical volume (CV), surface area (SA), and cortical thickness (CT). Differences between groups in subcortical volume and in the organization of networks of structural covariance were also explored. Results: No significant differences in brain structure between groups were observed in whole-brain vertex-wise CV, SA, or CT. Also, no significant differences in subcortical volume were observed between risk groups. In relation to the structural covariance network, there was an indication of an increase in the hippocampus betweenness centrality index in the HR group network compared to the LR and current depression group networks. However, this result was only statistically significant when applying false discovery rate correction for nodes within the affective network. Conclusion: In an adolescent sample recruited using an empirically based composite risk score, no major differences in brain structure were detected according to the risk and presence of depression.

Identifying Depression Early in Adolescence: assessing the performance of a risk score for future onset of depression in an independent Brazilian sample

Objective: The Identifying Depression Early in Adolescence Risk Score (IDEA-RS) was recently developed in Brazil using data from the Pelotas 1993 Birth Cohort to estimate the individualized probability of developing depression in adolescence. This model includes 11 sociodemographic variables and has been assessed in longitudinal studies from four other countries. We aimed to test the performance of IDEA-RS in an independent, community-based, school-attending sample within the same country: the Brazilian High-Risk Cohort. Methods: Standard external validation, refitted, and case mix-corrected models were used to predict depression among 1442 youth followed from a mean age of 13.5 years at baseline to 17.7 years at follow-up, using probabilities calculated with IDEA-RS coefficients. Results: The area under the curve was 0.65 for standard external validation, 0.70 for the case mix-corrected model, and 0.69 for the refitted model, with discrimination consistently above chance for predicting depression in the new dataset. There was some degree of miscalibration, corrected by model refitting (calibration-in-the-large reduced from 0.77 to 0). Conclusion: IDEA-RS was able to parse individuals with higher or lower probability of developing depression beyond chance in an independent Brazilian sample. Further steps should include model improvements and additional studies in populations with high levels of subclinical symptoms to improve clinical decision making.

Physical activity and depressive symptoms among adolescents in a school-based sample

Objective: To explore associations between self-reported weekly physical activity and depressive symptomatology among adolescents in a school-based sample from Brazil. Methods: We surveyed 7,405 adolescents aged 14 to 16 years in 101 public schools in Porto Alegre, Brazil. We assessed physical activity using an adapted version of the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition - Adolescent Physical Activity Measure (PACE+), and depressive symptoms using the Brazilian Portuguese version of the Patient Health Questionnaire - Adolescent Version. We compared the depressive symptom scores among adolescents with varying levels of physical activity. Results: Of the overall sample, 84.4% exercised less than the recommended frequency of 60 minutes/day, at least 5 days/week, of moderate to intense physical activity (PACE+ score ≥ 5). Adolescents whose physical activity levels fell below that threshold had higher median depression scores (8 [IQR = 10] vs. 7 [IQR = 9], W = 4060461, p < 0.001). A similar pattern was observed for depression scores in those with PACE+ < 1 (median of 10 [IQR = 11]) and ≥ 1 (7 [IQR = 9], W = 7457608, p < 0.001). Conclusion: In this large sample of Brazilian adolescents, those who exercised less frequently and vigorously than their peers reported more depressive symptoms.

The research output on child and adolescent suicide in Brazil: a systematic review of the literature

Objective: Suicide is the third leading cause of death among Brazilians aged 10 to 24 years. We aimed to review and describe the research output on suicide in children and adolescents in Brazil and to identify strengths and gaps in this literature. Methods: PubMed/MEDLINE was searched for studies on suicide of children and adolescents (aged 0-19 years) in Brazil, published from inception to December 31, 2017. Results: Our search identified 1,061 records, of which 146 were included. A large proportion (134 studies; 90.4%) were original articles classified as observational epidemiological studies. Fifty-two articles (35.6%) used primary data. Of those, 18 (12.3%) evaluated prevalence of suicidal behaviors in population-based samples. Seventy studies (47.9%) addressed death by suicide, and the remainder reported other phenomena, such as ideation, planning, or suicide attempt. Only 37 publications (25.3%) studied children and/or adolescents exclusively. Most of the studies (53.5%) were conducted with samples from the South and Southeast regions of Brazil. Conclusion: Our findings indicate that the body of evidence on suicide among children and adolescents in Brazil is limited. The scientific output is of low quality, and there is a complete lack of interventional studies specifically designed for the youth population.

Neuroimaging adolescents with depression in a middle-income country: feasibility of an fMRI protocol and preliminary results

Objective: To test the feasibility and to present preliminary results of a neuroimaging protocol to evaluate adolescent depression in a middle-income setting. Methods: We assessed psychotropic medication-free adolescents (age range 14-16 years) with a diagnosis of major depressive disorder (MDD). Participants underwent a comprehensive clinical evaluation and both structural and functional magnetic resonance imaging (fMRI). In this pilot study, a preliminary single-group analysis of resting-state fMRI (rs-fMRI) data was performed, with a focus on the default mode network (DMN), cognitive control network (CCN), and salience network (SN). Results: The sample included 29 adolescents with MDD (mean age 16.01, SD 0.78) who completed the protocol. Only two participants were excluded due to MRI quality issues (head movement), and were not included in the analyses. The scans showed significant connectivity between the medial prefrontal cortex and posterior cingulate cortex (DMN), the ACC and anterior insula (SN), and the lateral prefrontal cortex and dorsal parietal cortex (CCN). Conclusion: We demonstrated the feasibility of implementing a complex neuroimaging protocol in a middle-income country. Further, our preliminary rs-fMRI data revealed patterns of resting-state connectivity consistent with prior research performed in adolescents from high-income countries.

Self-perceived body image, dissatisfaction with body weight and nutritional status of Brazilian adolescents: a nationwide study / Auto-imagem corporal, insatisfação com o peso corporal e estado nutricional deadolescentes brasileiros: um estudo nacional

Abstract Objectives The purpose of this study was to evaluate the agreement and risk factors for underestimation and overestimation between nutritional status and self-perceived body image and to assess the prevalence and associated factors for dissatisfaction with body weight among Brazilian adolescents. Methods Students aged 12-17 years participating in the Study of Cardiovascular Risk in Adolescents ("ERICA"), a multicenter, cross-sectional, school-based country-wide study, were included (n = 71,740). Variables assessed as covariates were sex, age, skin color, socioeconomic status, and common mental disorders (screened by the General Health Questionnaire, GHQ-12). Multinomial logistic regression was used to explore the association between covariates and combinations between self-perceived body image and body mass index (agreement, underestimation and overestimation). The associations between dissatisfaction with body weight and exposure variables were investigated using multivariable Poisson regression models. Results Approximately 66% students rightly matched their body mass index with self-perceived weight (kappa coefficient was 0.38 for boys and 0.35 for girls). Agreement was higher among younger students and adolescents from low income households. Male sex, older age, and GHQ-12 score ≥3 were associated with weight overestimation. Prevalence of dissatisfaction with body weight was 45.0% (95% CI: 44.0-46.0), and higher among girls, older adolescents, those with underweight or overweight/obesity, as well as those who were physically inactive and with GHQ-12 ≥3. Conclusions Most of the sample rightly self-perceived their body image according to body mass index. Students with body image misperception and those dissatisfied with their weight were more likely to present a positive screening for common mental disorders.

Resumo Objetivos A finalidade deste estudo foi avaliar a concordância e os fatores de risco para subestimação e superestimação entre o estado nutricional e a autoimagem corporal e para avaliar a prevalência e os fatores associados à insatisfação com o peso corporal entre adolescentes brasileiros. Métodos Foram incluídos estudantes entre 12 e 17 anos que participavam do Estudo de Riscos Cardiovasculares em Adolescentes ("ERICA"), um estudo multicêntrico, transversal, nacional e de base escolar (n = 71.740). As variáveis analisadas como covariáveis foram sexo, idade, cor da pele, situação socioeconômica e transtornos mentais comuns (triados pelo Questionário de Saúde Geral, QSG-12). A regressão logística multinomial foi usada para explorar a associação entre as covariáveis e as combinações entre a autoimagem corporal e o índice de massa corporal (concordância, subestimação e superestimação). As associações entre a insatisfação com o peso corporal e as variáveis de exposição foram investigadas com os modelos multivariáveis de regressão de Poisson. Resultados Aproximadamente 66% dos estudantes associaram corretamente seu índice de massa corporal com o peso autopercebido (o coeficiente kappa foi 0,38 para meninos e 0,35 para meninas). A concordância foi maior entre jovens e adolescentes de baixa renda. Sexo masculino, adolescentes mais velhos e um escore QSG 12 ≥ 3 foram associados à superestimação do peso. A prevalência de insatisfação com o peso corporal foi 45,0% (IC de 95%: 44,0-46,0), maior entre meninas, adolescentes mais velhos, aqueles abaixo do peso ou com sobrepeso/obesidade, fisicamente inativos e com QSG-12 ≥ 3. Conclusões A maior parte da amostra associou corretamente sua imagem corporal de acordo com o índice de massa corporal. Estudantes com distorção da autoimagem corporal e aqueles insatisfeitos com seu peso foram mais propensos a apresentar rastreamento positivo para transtornos mentais comuns.

Mental disorders and suicide risk in emerging adulthood: the 1993 Pelotas birth cohort

ABSTRACT OBJECTIVE To assess the prevalence of some mental disorders and suicide risk, and the association between them in youths. METHODS Data from the 1993 Pelotas Birth Cohort (Brazil) was used. The prevalence of mental disorders at 22 years [major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), attention-deficit/ hyperactivity disorder (ADHD), bipolar disorders type 1 and 2 (BD1; BD2), post-traumatic stress disorder (PTSD), and antisocial personality disorder (APD)] and of suicide risk were assessed using the Mini International Neuropsychiatric Interview (n = 3,781). Comorbidity between disorders was also assessed. Association of each mental disorder and the number of disorders with suicide risk was assessed using Poisson regression. RESULTS The prevalence of any mental disorder was 19.1% (95%CI 17.8-20.3), and GAD was the most prevalent (10.4%; 95%CI 9.5-11.4). The prevalence of current suicide risk was 8.8% (95%CI 5.9-9.7). All disorders (except APD) and the suicide risk were higher among women. Mental disorders were associated with a higher suicide risk, with the highest risks being observed for MDD (RR = 5.6; 95%CI 4.1-7.8) and PTSD (RR = 5.0; 95%CI 3.9-6.3). The higher the number of co-occurring mental disorders, the higher the risk of suicide. CONCLUSIONS Our findings showed that about 20% of the youths had at least one mental disorder. However, this prevalence is underestimated since other relevant mental disorders were not assessed. Mental disorders were associated with higher suicide risk, especially the comorbidity between them.

Mental health information online: what we have learned from social media metrics in BuzzFeed's Mental Health Week / Informações de saúde mental on-line: o que aprendemos com as métricas de mídias sociais na Semana de Saúde Mental do BuzzFeed

Abstract Introduction The Internet has seen rapid growth in the number of websites focusing on mental health content. Considering the increased need for access to accurate information about mental health treatment, it is important to understand the promotion of this information online. Objective To analyze BuzzFeed's Mental Health Week (BFMHW) interactions on its own website and in related social media platforms (Facebook, Twitter and YouTube) using metrics of information delivery in mental health topics. Methods We extracted social media metrics from the 20 posts with the highest number of BuzzFeed interactions on the BFMHW website and from 41 videos available on the BFMHW playlist created by the BuzzFeed Video profile on YouTube. We analyzed the format and content used in BuzzFeed's publishing methods as well as the following social media metrics: exposure (presence online, views and time online), influence (likes) and engagement (comments, shares, replies and BuzzFeed interactions). Results Analysis of the variables revealed that audience engagement is associated with the number of medias in which the content is published: views on YouTube and shares on Facebook (0.71, p<0.001), total interactions on Facebook (0.66, p<0.001) and BuzzFeed number of total interactions (0.56, p<0.001). Conclusions Our results suggest that videos on YouTube may be an important information channel, including activity and engagement on other medias such as Facebook. Information may be more effective in reaching the audience if it is delivered in more than one media and includes personal experiences, some humor in content and detailed information about treatment.

Resumo Introdução O número de sites com foco em conteúdo de saúde mental vem crescendo rapidamente. Considerando a necessidade crescente de acesso a informações precisas sobre tratamento em saúde mental, é importante entender a promoção dessas informações on-line. Objetivo Analisar as interações da Semana de Saúde Mental do BuzzFeed (BuzzFeed's Mental Health Week - BFMHW) em seu próprio site e em plataformas de mídia social relacionadas (Facebook, Twitter e YouTube) usando métricas de entrega de informações em tópicos de saúde mental. Métodos Extraímos métricas de mídias sociais das 20 postagens com o maior número de interações no site da BFMHW e de 41 vídeos disponíveis na playlist da BFMHW criada pelo perfil BuzzFeed Video no YouTube. Analisamos o formato e o conteúdo usados nos métodos de publicação do BuzzFeed, bem como as seguintes métricas de mídias sociais: exposição (presença on-line, visualizações e tempo on-line), influência (curtidas) e engajamento (comentários, compartilhamentos, respostas e interações do BuzzFeed). Resultados A análise das variáveis revelou que o envolvimento do público está associado ao número de mídias em que o conteúdo é publicado: visualizações no YouTube e compartilhamentos no Facebook (0,71, p <0,001), interações totais no Facebook (0,66, p <0,001) e número de interações totais no BuzzFeed (0,56, p <0,001). Conclusões Nossos resultados sugerem que o YouTube pode ser um importante canal de informações, incluindo atividades e envolvimento em outras mídias, como o Facebook. As informações podem alcançar o público de forma mais eficaz se forem exibidas em mais de uma mídia e incluírem experiências pessoais, algum humor no conteúdo e informações detalhadas sobre o tratamento.

Translation and cross-cultural adaptation into Brazilian Portuguese of the Mood and Feelings Questionnaire (MFQ) - Long Version / Tradução e adaptação transcultural para o português brasileiro do instrumento Mood and Feelings Questionnaire (MFQ) - Versão Longa

Abstract Introduction Major depressive disorder (MDD) is prevalent among young people, with a high incidence during adolescence. It is, therefore, important to have reliable instruments to capture the construct of depression in this population. The objective of the present work is to describe the process of translation and cultural adaptation of the Mood and Feelings Questionnaire (MFQ) - Long Version, into Brazilian Portuguese. Method We followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines for translation and cultural adaptation, including the steps of preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing results and finalization, proofreading and final report. Cognitive debriefing was conducted in a sample of adolescent patients and their respective caregivers at mental health clinics affiliated with the Brazilian public health system. Results Results suggest that the items were well understood and that the MFQ seems to be an appropriate instrument for use with Brazilian adolescents and caregivers. Conclusions The Brazilian Portuguese MFQ - Long Version constitutes an adequate tool for the assessment of depression among adolescents. Future studies are required to evaluate psychometric properties of the instrument.

Resumo Introdução O transtorno depressivo maior (TDM) é prevalente em jovens, com alta incidência durante a adolescência. Portanto, é importante que instrumentos confiáveis estejam disponíveis para avaliar o construto da depressão nessa população. O objetivo do presente trabalho é descrever o processo de tradução e adaptação cultural do Mood and Feelings Questionnaire (MFQ) - Versão Longa para o português brasileiro. Método Foram utilizadas as diretrizes da International Society for Pharmacoeconomics and Outcomes Research (ISPOR) para tradução e adaptação cultural, incluindo as etapas de preparação, tradução, reconciliação, retrotradução, revisão da retrotradução, harmonização, estudo piloto, revisão dos resultados do estudo piloto, revisão final e relato final. A etapa de estudo piloto foi conduzida em uma amostra de pacientes adolescentes e seus respectivos cuidadores em clínicas de saúde mental afiliadas ao Sistema Único de Saúde. Resultados Os resultados sugeriram que os itens foram bem compreendidos, e que o MFQ parece ser um instrumento apropriado para uso com adolescentes e cuidadores brasileiros. Conclusões A versão traduzida para o português brasileiro do MFQ - Versão Longa constitui um instrumento adequado para a avaliação da depressão em adolescentes. Futuros estudos são necessários para avaliar as propriedades psicométricas da escala.

Mood disorders in childhood and adolescence

The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.

Developments and challenges in the diagnosis and treatment of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, often associated with other psychiatric comorbidities, functional impairments, and poor long-term outcomes. The objective of this selected review is to describe current advances and challenges in the diagnosis and treatment of ADHD. The disorder is associated with neurobiological underpinnings and is highly heterogeneous in various aspects, such as symptom profiles, cognitive impairments, and neurobiological and genetic features. The efficacy and safety of short-term pharmacological treatments across the life cycle is well studied, but further research investigating long-term treatment, impact of treatment in preschoolers, and non-pharmacological interventions is needed. Future research is also needed to better characterize the neurodevelopmental pathways of the disorder, linking clinical and neurobiological information, less investigated populations, and new interventions.

Setting priorities for mental health research in Brazil / Agenda de prioridades de pesquisa para saúde mental no Brasil

BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) "matrix support", c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.

INTRODUÇÃO: O principal objetivo desse estudo foi revisar a agenda de prioridades em pesquisa em saúde mental no Brasil. MÉTODO: Foram selecionados 28 especialistas (22 pesquisadores, cinco legisladores e o coordenador) de diferentes regiões. Responderam ao que consideravam mais relevante em pesquisa para a saúde mental para os próximos 10 anos. Dezessete responderam e configuraram 110 questões, que foram reavaliadas por eles, com atribuição de escore, a partir de 15 itens distribuídos segundo grau de responsividade, eficácia, aplicabilidade, equidade e impacto na redução da carga da doença mental. 35 questões, e dentre elas as 10 mais bem pontuadas, foram destacadas. RESULTADOS: Prevaleceram indicações para estudos de efetividade das intervenções, matriciamento, comparação entre modelos de intervenção e detecção e tratamento de transtornos mais prevalentes na Estratégia da Saúde da Família. Avaliação de serviços quanto às barreiras ao tratamento; custo-efetividade dos antipsicóticos, intervenções contra efeitos do álcool e outras drogas, e aplicação de tecnologias (telemedicina) para educação e supervisão dos generalistas foram outros. CONCLUSÃO: Apontou-se para necessidade de investimentos na saúde mental na atenção primária à saúde; avaliação do sistema de serviços de cuidados de saúde mental, e pesquisas para romper barreiras ao acesso e à equidade no tratamento dos transtornos mentais.

The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings / Avaliação multidimensional e tratamento da ansiedade em crianças e adolescentes: marco teórico, desenho, métodos e resultados preliminares

OBJECTIVE: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8 percent), social anxiety disorder (n = 57; 41.3 percent) and separation anxiety disorder (n = 49; 35.5 percent) were the most frequent disorders. CONCLUSION: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

OBJETIVO: o objetivo deste estudo é descrever o desenho, os métodos e as características amostrais da Avaliação Multidimensional e Tratamento da Ansiedade em Crianças e Adolescentes - Projeto PROTAIA. MÉTODO: Escolares entre 10 e 17 anos de todas as escolas pertencentes à área de abrangência da unidade de atenção primária do Hospital de Clínicas de Porto Alegre foram incluídos no projeto. O projeto compreende cinco fases: 1) triagem comunitária; 2) diagnóstico psiquiátrico; 3) avaliação multidimensional, incluindo fatores ambientais, neuropsicológicos, nutricionais e marcadores biológicos; 4) tratamento; e 5) fase translacional. RESULTADOS: Um total de 2.457 sujeitos foram triados para transtornos de ansiedade na comunidade. Dos indivíduos que compareceram à avaliação diagnóstica, 138 foram detectados com ao menos um transtorno de ansiedade (excluindo fobia específica) e 102 indivíduos sem nenhum transtorno de ansiedade. Dentre os casos de ansiedade, o transtorno de ansiedade generalizada (n = 95; 68,8 por cento), transtorno de ansiedade social (n = 57; 41,3 por cento) e o transtorno de ansiedade de separação (n = 49; 35,5 por cento) foram os mais frequentes. CONCLUSÃO: O projeto PROTAIA é um projeto de pesquisa promissor que pode contribuir para o entendimento da relação entre transtornos de ansiedade e fenótipos relacionados à ansiedade com vários fatores de risco, tanto genéticos quanto ambientais.