Ansiedade e Depressão: rastreio entre profissionais da estratégia de saúde da família na Amazônia / Anxiety and Depression: screening among family health strategy professionals in the Amazon / Ansiedad y Depresión: tamizaje entre profesionales de estrategias de salud familiar en la Amazonía

Objetivo: realizar rastreamento de depressão e transtorno de ansiedade generalizada entre profissionais da Estratégia de Saúde da Família em um município no interior da Amazônia. Método:estudo transversal desenvolvido com 63 profissionais atuantes em 12 equipes de ESF na cidade de Santarém, Pará, Brasil. Foram utilizadas ferramentas validadas e adaptadas transculturalmente: o Patient ́s Health Questionaire ­9 e o Generalizes Anxiety Disorder ­7. Os dados foram analisados a partir de ferramentas da estatística descritiva (frequências absolutas e relativas) a partir do software Microsoft Excel 2018. Resultados:Houve predomínio de indivíduos do sexo feminino, na idade de 40 a 44 anos e raça/cor pardo. O estado civil predominante foi casado, a categoria profissional mais representada na amostra foram os agentes comunitários de saúde e o a maioria dos participantes possuía nível superior completo. 57.1% tiveram rastreamento positivo para depressão e 42.1% para ansiedade. Conclusão:Observou-se elevada frequência de ansiedade e depressão entre os profissionais incluídos na amostra. Nossos dados reforçam a necessidade de ações preventivas na área de saúde mental visando reduzir os impactos dos fatores de risco. Além disso, é fundamental a realização de grandes estudos voltados à investigação dos fatores associados à saúde mental dos trabalhadores da saúde no Brasil

Objective: To screen for depression and generalized anxiety disorder among Family Health Strategy professionals in a municipality in the interior of the Amazon. Method:A cross-sectional study was carried out with 63 professionals working in 12 FHS teams in the city of Santarém, Pará, Brazil. Cross-culturally adapted and validated tools were used: the Patient's Health Questionnaire -9 and the Generalized Anxiety Disorder -7. The data was analyzed using descriptive statistics tools (absolute and relative frequencies)using Microsoft Excel 2018 software. Results:There was a predominance of females, aged between 40 and 44 and of brown race/color. The predominant marital status was married, the most represented professional category in the sample were community health agents and the majority of participants had completed higher education. 57.1% were screened positive for depression and 42.1% for anxiety. Conclusion:There was a high frequency of anxiety and depression among the professionals included in the sample. Our data reinforces the need for preventive action in the area of mental health in order to reduce the impact of risk factors. In addition, it is essential to carry out large-scale studies investigating the factors associated with the mental health of health workers in Brazil.

Objetivo: Detectar depresión y ansiedad generalizada en profesionales de la Estrategia Salud de la Familia de un municipio del interior de la Amazonia. Método:Se realizó un estudio transversal con 63 profesionales que trabajan en 12 equipos de la ESF en la ciudad de Santarém, Pará, Brasil. Se utilizaron instrumentos validados y adaptados transculturalmente: el Cuestionario de Salud del Paciente -9 y el Trastorno de Ansiedad Generalizada -7. Los datos se analizaron mediante herramientas de estadística descriptiva (frecuencias absolutas y relativas) utilizando el software Microsoft Excel 2018. Resultados:Hubo un predominio de mujeres, con edades comprendidas entre 40 y 44 años y de raza/color moreno. El estado civil predominante fue casado, la categoría profesional más representada en la muestra fue la de agentes de salud comunitarios y la mayoría de los participantes habían completado estudios superiores. El 57,1% dieron positivo en depresión y el 42,1% en ansiedad. Conclusión:Hubo una elevada frecuencia de ansiedad y depresión entre los profesionales incluidos en la muestra. Nuestros datos refuerzan la necesidad de acciones preventivas en el área de la salud mental para reducir el impacto de los factores de riesgo. Además, es fundamental la realización de grandes estudios dirigidos a investigar los factores asociados a la salud mental de los trabajadores de la salud en Brasil

Higher IL-6 and IL-4 plasma levels in depressed elderly women are influenced by diabetes mellitus

Abstract Objective This study aimed at investigating a set of peripheral cytokines in elderly female patients with MDD, comparing them to controls, and assessing the potential influence of clinical comorbidities on inflammatory markers. Methods Twenty-five elderly female patients diagnosed with MDD and 19 age-matched female controls were enrolled on this study. Plasma levels of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were evaluated with commercially-available assays. Results Elderly female patients with MDD exhibited higher plasma IL-6 and IL-4 levels when compared to controls. In a logistic regression model taking cytokine levels, comorbidities, and age into account, only type 2 diabetes mellitus (DM2) remained associated with MDD. Conclusion Diabetes influences the association between MDD and higher levels of cytokines in elderly female patients. Future studies should take this evidence into account in order to mitigate confounding factors.

An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS)

Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. Conclusions: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials. Registration number: PROSPERO CRD42022296246.

Factores asociados con intento suicida en pacientes económicamente activos con diagnóstico de depresión mayor

Introducción: En el mundo, cada 40 segundos una persona se quita la vida; el suicidio se considera un problema de salud pública, y el intento de suicidio previo es uno de los factores de riesgo relacionados con suicidio consumado. A pesar de las estrategias implementadas y los estudios realizados, en Colombia las cifras de suicidio van en ascenso, de manera más marcada en la población económicamente activa. Objetivo: Identificar los factores sociodemográficos, familiares, personales, económicos y religiosos asociados con el intento suicida en pacientes con trastorno depresivo en edad productiva (18-62 arios), en una institución de salud mental en Bogotá, Colombia. Métodos: Se realizó un estudio de prevalencia analítica en la Clínica de Nuestra Señora de la Paz, de Bogotá; para explorar la relación entre los factores descritos y el intento suicida, se realizó una revisión de 350 historias clínicas de la población seleccionada. Resultados: El 37,7% de la muestra presentó intento de suicidio. Se encontraron asociaciones entre el intento de suicidio y la formación superior a primaria (RP = 0,47 [0,23-0,97]), no recibir ingresos (RP = 1,72 [1,13-2,61]), no tener pareja (RP = 2,10 [1,33-3,32]), el consumo de alcohol (p = 0,045), el consumo de alucinógenos (RP = 2,39 [0,97-3,43]) y la presencia de trastorno de personalidad (RP = 1,93 [1,11-3,34]). Conclusiones: Los resultados del estudio son similares a los descritos previamente en el mundo. Es necesario reconocer y abordar diversos factores asociados con el intento de suicidio en pacientes depresivos para desplegar acciones de promoción y prevención, identificación temprana e intervenciones específicas que impacten en las cifras de suicidio consumado en el país.

Introduction: Every 40 seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. Objective: To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. Methods: An analytical prevalence study was conducted at the Nuestra Señora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. Results: In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR = 0.47 [0.23-0.97]), no economic income (PR = 1.72 [1.13-2.61]), no partner (PR = 2.10 [1.33-3.32]), alcohol consumption (p = 0.045), hallucinogen use (PR = 2.39 [0.97-3.43]) and the presence of personality disorder (PR= 1.93 [1.11-3.34]). Conclusions: The results of the study are similar to those previously described in other studies around the world. There is a need to recognize and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Mapping the modulating effect of transcutaneous auricular vagus nerve stimulation on voxel-based analyses in patients with first-episode major depressive disorder: a resting-state functional magnetic resonance imaging study

Introduction: Seed-based analysis has shown that transcutaneous auricular vagus nerve stimulation (taVNS) can modulate the dysfunctional brain network in patients with major depressive disorder (MDD). However, the voxel-based neuropsychological mechanism of taVNS on patients with first-episode MDD is poorly understood. The objective of this study was to assess the effects of an 8-week course of taVNS on patients with first-episode MDD. Methods: Twenty-two patients with first-episode MDD accepted an 8-week course of taVNS treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment. Voxel-based analyses were performed to characterize spontaneous brain activity. Healthy controls (n=23) were recruited to minimize test-retest effects. Analysis of covariance (ANCOVA) was performed to ascertain treatment-related changes. Then, correlations between changes in brain activity and the Hamilton Depression Rating Scale (HAM-D)/Hamilton Anxiety Scale (HAM-A) remission rate were estimated. Results: Significant group-by-time interactions on voxel-based analyses were observed in the inferior ventral striatum (VSi) and precuneus. Post-hoc analyses showed that taVNS inhibited higher brain activity in the VSi, while upregulating it in the precuneus. Functional connectivity (FC) between the VSi and precuneus decreased. Positive correlations were found between the HAM-D remission rate and changes in brain activity in the VSi. Conclusion: taVNS reduced the FC between VSi and precuneus by normalizing the abnormal spontaneous brain activity of VSi in first-episode MDD patients.

Gravidade da depressão, resposta ao tratamento e PRO (incapacidade e QoL) em pacientes com DRT em um ano de acompanhamento com tratamento padrão: análise do subgrupo brasileiro do estudo observacional multinacional TRAL / Depression severity, treatment response and PRO (disability and QoL) in TRD patients over a 1-year follow-up with standard of care: Analysis of the Brazilian subset of the multicenter, observational TRAL study

Objetivo: A depressão resistente ao tratamento (DRT) é uma preocupação primária no Brasil devido à sua natureza onerosa e complexa, enquanto o diagnóstico e o tratamento geralmente são desafiadores. O presente manuscrito apresenta os resultados clínicos de um ano de acompanhamento em pacientes com DRT em tratamento padrão (SOC) no subgrupo brasileiro do estudo de Depressão Resistente ao Tratamento na América Latina (TRAL). Métodos: Essa fase longitudinal do estudo TRAL tinha como meta caracterizar alterações nos resultados clínicos e outras variáveis de interesse (p. ex., qualidade de vida, incapacidade) em um ano de acompanhamento em pacientes com DRT em 10 centros no Brasil. Os pacientes incluídos tinham diagnóstico clínico de DRT com base nos critérios DSM-5 e confirmado por MINI. A Escala de Depressão de Montgomery-Asberg (MADRS) era usada para avaliar a gravidade da doença e os resultados clínicos. Outras escalas de depressão e instrumentos classificados pelo paciente eram usadas para medir resultados correlacionados. Resultados: Cento e cinquenta e oito pacientes com DRT, na maioria mulheres (84,4%) com idade média de 48,55 anos, foram incluídos na análise. Apenas 31,4% dos pacientes apresentaram uma resposta clinicamente significativa, 10,3% tiveram recidiva e 26,7% alcançaram remissão, conforme medido pela MADRS no final do estudo (EOS). Aproximadamente 55% dos pacientes apresentavam depressão grave/moderadamente grave no EOS. Problemas de mobilidade, cuidados pessoais, problemas nas atividades usuais e dor e desconforto foram relatados pela maioria dos pacientes no EOS, assim como comprometimento marcado/extremo das atividades no trabalho/escola e da vida social/das atividades de lazer no EOS. Conclusões: Os resultados clínicos alcançados atualmente ainda são notavelmente insatisfatórios para DRT. Portanto, o envolvimento de todas as partes interessadas é essencial para implementar protocolos de tratamento mais eficazes no Brasil.

Objective: Treatment-resistant depression (TRD) is a primary concern in Brazil due to its burdensome and complex nature, while diagnosis and treatment is often challenging. The current manuscript presents the clinical outcomes in a one-year follow-up of TRD patients under Standard-of-care (SOC) in the Brazilian subset of the Treatment-Resistant Depression in America Latina (TRAL) study. Methods: This longitudinal phase of TRAL aimed to characterize changes in the clinical outcomes and other variables of interest (e.g. quality of life, disability) in a one-year follow-up of TRD patients in 10 centers in Brazil. Included patients were clinically diagnosed with TRD based on DSM-5 criteria and confirmed by MINI. Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess disease severity and clinical outcomes. Other depression scales and patient rated instruments were used to measure correlated outcomes. Results: One hundred fifty-eight TRD patients, mostly female (84.4%), averaging 48.55 years, were included in the analysis. Only 31.4% of the patients showed a clinically significant response, 10.3% had a relapse and 26.7% achieved remission, as measured through MADRS at end-of-study (EOS). Almost 55% of the patients showed moderately severe/severe depression at EOS. Mobility issues, self-care, problems with usual activities and pain and discomfort were reported by the majority of the patients at EOS, as well as marked/extreme disruption of school/work and social life/leisure activities at EOS. Conclusions: Currently achieved clinical outcomes are still remarkably unsatisfactory for TRD. Therefore, the involvement of all relevant stakeholders is essential to implement more effective treatment protocols in Brazil.

Positive screening for major depressive disorder in high-risk pregnant women / Triagem positiva para transtorno depressivo maior em gestantes de alto risco

ABSTRACT Objective: To estimate the frequency of positive screening for major depressive disorder and associated factors in high-risk pregnant women at a reference hospital of the Brazilian Public Health System. Methods: Cross-sectional study with 184 high-risk pregnant women at the Maternity at the Hospital Regional de São José , SC, Brazil. Positive screening for major depressive disorder using the Edinburgh Postpartum Depression Scale was selected as the dependent variable. Socio-demographic and pregnancy-related variables were also collected. Data were analyzed using Poisson regression with a robust estimator, including all variables that presented a p-value < 0.20 in the bivariate analysis. Statistically significant differences were considered when p ≤ 0.05. Results: The frequency of positive screening for major depressive disorder was 37.5%. Non-white skin color, income of less than USD 572,56 per month and maternal age of less than 18 years or greater than or equal to 35 years were statistically and independently associated with positive screening for major depressive disorder in high-risk pregnant women. Conclusion: The frequency of positive screening for major depressive disorder in the high-risk pregnant women studied was 37.5%. The frequency was statistically associated with skin color, family income and extremes in the maternal age.

RESUMO Objetivo: Estimar a frequência de rastreio positivo de transtorno depressivo maior e fatores associados em gestantes de alto risco em uma maternidade de referência do Sistema Único de Saúde. Métodos: Estudo transversal envolvendo 184 gestantes de alto risco da Maternidade do Hospital Regional de São José, SC, Brasil. A variável dependente foi o rastreio de transtorno depressivo maior por meio da aplicação da Escala de Depressão Pós-parto de Edimburgo. Foram coletadas ainda variáveis sociodemográficas e relacionadas à gestação. Os dados foram analisados por meio da regressão de Poisson com estimador robusto, incluindo todas as variáveis que apresentaram valor de p < 0,20 na análise bivariada. Consideraram-se diferenças estatisticamente significativas quando p ≤ 0,05. Resultados: A frequência de rastreio positivo para transtorno depressivo foi de 37,5%. Cor da pele não branca, renda mensal inferior a USD 572,56 e idade materna inferior a 18 anos ou superior ou igual a 35 anos foram estatística e independentemente associadas ao rastreamento positivo para transtorno depressivo maior em gestantes de alto risco. Conclusão: A frequência de rastreio positivo de transtorno depressivo maior em gestantes de alto risco estudadas foi de 37,5%. A frequência mostrou-se estatisticamente associada com cor de pele, renda familiar e extremos de idade materna.

Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression / Transtorno depressivo maior como fator de risco para ideação suicida em alunos de instituições educacionais: uma metanálise e metarregressão

Abstract Objective: This study aimed to analyze the effect of major depressive disorder (MDD) as a risk factor for suicidal ideation in individuals whose ages varied from 11 to 24 years and who were attending educational institutions. Data source: A systematic review was carried out by searching in PubMed and Biblioteca Virtual em Saúde (BVS). Original studies conducted in educational institutions, including individuals whose age varied from 11 to 24 years, in English, Spanish, or Portuguese were included. Data synthesis: Eight studies were selected for the meta-analysis, including 35,443 youths, with an average age of 16.8 years, predominantly female (51.2%), and from middle-income Asian countries (91.6%). An odds ratio of MDD of 3.89 (95%CI 2.46-6.17) for suicide ideation in youth was found. Subgroup analysis showed higher effects in Asia (OR=4.71; 95%CI 3.22-6.89) than Americas (OR=1.71; 95%CI 1.44-2.03). The meta-regression model indicated that younger adolescents (coef=-0.63; 95%CI 1.09--0.18; p<0.01) and older studies (coef=-0.23; 95%CI 0.039--0.08; p<0.01) presented higher effects of MDD on suicidal ideation. Conclusions: Early detection and treatment of MDD in youth patients are of utmost importance for preventing suicidal ideation. Educational institutions could play an important role in the early detection and intervention.

Resumo Objetivo: Analisar o efeito do transtorno depressivo maior (TDM) como fator de risco para a ideação suicida em indivíduos com idades entre 11 e 24 anos que frequentam instituições de ensino. Fontes de dados: Revisão sistemática realizada até agosto de 2020 por meio de buscas nas bases United States National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS), sem limitações quanto à data de publicação. Síntese dos dados: Oito estudos foram selecionados para a metanálise, incluindo 35.443 jovens com idade média de 16,8 anos, predominantemente do sexo feminino (51,2%) e de países asiáticos de renda média (91,6%). Foi encontrado odds ratio (OR) de TDM de 3,89 (intervalo de confiança — IC95% 2,46-6,17) para a ideação suicida em jovens. A análise de subgrupo mostrou efeitos maiores na Ásia (OR=4,71; IC95% 3,22-6,89) do que nas Américas (OR=1,71; IC95% 1,44-2,03). O modelo de metarregressão demonstrou que adolescentes mais jovens (coef=-0,63; IC95% -1,09--0,18; p＜0,01) e estudos mais antigos (coef=-0,23; IC95% -0,039--0,08; p＜0,01) apresentaram maiores efeitos do TDM sobre a ideação suicida. Conclusões: Observou-se relação entre TDM e ideação suicida no continente asiático, entre adolescentes mais jovens e em estudos mais antigos.

Alterações de sono em pacientes depressivos adultos: uma revisão integrativa / Sleep changes in adult depressive patients: an integrative review / Cambios del sueño en pacientes depresivos adultos: una revisión integradora

Esta é uma revisão da literatura que tem como objetivo elucidar as alterações do sono em pacientes adultos com depressão, principalmente sem outras comorbidades ou condições especiais, e estabelecer a relação entre distúrbios do sono e depressão, com foco no Transtorno Depressivo Maior. A metodologia envolve uma revisão integrativa da literatura dos últimos 15 anos (2009-2023) nas bases de dados Biblioteca Virtual em Saúde (BVS) e Pubmed, utilizando as palavras-chave "distúrbios do sono", "depressão" e "adultos". Os resultados mostram um total de 240 artigos, dos quais 26 foram selecionados e 12 foram incluídos na análise. A discussão destaca o interesse recente em estudar as associações entre distúrbios do sono e transtornos depressivos, bem como a natureza global da pesquisa. A relação entre sono e saúde mental, bem como a classificação e relação entre distúrbios do sono, também são discutidos. Os achados indicam que distúrbios do sono são prevalentes em pacientes com depressão, sendo a insônia um fator de risco significativo para o desenvolvimento da depressão. A relação bidirecional entre sono e depressão é destacada, com a depressão afetando o sono e o sono afetando a depressão. A importância de estudar os mecanismos por trás dessa relação é enfatizada, pois pode ajudar os psiquiatras a gerenciar de forma mais eficaz a comorbidade de depressão e distúrbios do sono. O tratamento adequado dos distúrbios do sono também pode desempenhar um papel vital na melhoria do prognóstico e na prevenção da recorrência da depressão.

This is a literature review that aims to elucidate the sleep alterations in adult patients with depression, primarily without other comorbidities or special conditions, and establish the relationship between sleep disturbances and depression, with a focus on Major Depressive Disorder. The methodology involves an integrative review of the literature from the last 15 years (2009-2023) on the databases Biblioteca Virtual em Saúde (BVS) and Pubmed, using the keywords "sleep disorders," "depression," and "adults." The results show a total of 240 articles, 26 of which were selected and 12 of which were included in the analysis. The discussion highlights the recent interest in studying the associations between sleep disturbances and depressive disorders, as well as the global nature of the research. The relationship between sleep and mental health, as well as the classification and relationship between sleep disturbances, are also discussed. The findings indicate that sleep disturbances are prevalent in patients with depression, with insomnia being a significant risk factor for the development of depression. The bidirectional relationship between sleep and depression is highlighted, with depression affecting sleep and sleep affecting depression. The importance of studying the mechanisms behind this relationship is emphasized, as it can help psychiatrists manage the comorbidity of depression and sleep disturbances more effectively. Adequate treatment of sleep disturbances may also play a vital role in improving the prognosis and preventing the recurrence of depression.

Esta es una revisión de la literatura que tiene como objetivo dilucidar las alteraciones del sueño en pacientes adultos con depresión, principalmente sin otras comorbilidades o condiciones especiales, y establecer la relación entre las alteraciones del sueño y la depresión, con un enfoque en el Trastorno Depresivo Mayor. La metodología consiste en una revisión integradora de la literatura de los últimos 15 años (2009-2023) en las bases de datos Biblioteca Virtual em Saúde (BVS) y Pubmed, utilizando las palabras clave "sleep disorders," "depression," y "adults." Los resultados muestran un total de 240 artículos, de los cuales 26 fueron seleccionados y 12 incluidos en el análisis. La discusión destaca el reciente interés por estudiar las asociaciones entre las alteraciones del sueño y los trastornos depresivos, así como el carácter global de la investigación. También se analiza la relación entre el sueño y la salud mental, así como la clasificación y la relación entre los trastornos del sueño. Los resultados indican que las alteraciones del sueño son prevalentes en pacientes con depresión, siendo el insomnio un factor de riesgo significativo para el desarrollo de la depresión. Se destaca la relación bidireccional entre sueño y depresión, en la que la depresión afecta al sueño y el sueño a la depresión. Se subraya la importancia de estudiar los mecanismos que subyacen a esta relación, ya que puede ayudar a los psiquiatras a gestionar la comorbilidad de la depresión y los trastornos del sueño de forma más eficaz. El tratamiento adecuado de los trastornos del sueño también puede desempeñar un papel vital en la mejora del pronóstico y la prevención de la recurrencia de la depresión.

Effects of neurofeedback on major depressive disorder: a systematic review

ABSTRACT Background Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated. Objective We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies. Methods We searched for experimental studies published between 1962-2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria. Results We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results. Conclusion Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Brain-derived neurotrophic factor serum levels following ketamine and esketamine intervention for treatment-resistant depression: secondary analysis from a randomized trial

Abstract Objectives Evidence suggests that ketamine's influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels - neither with ketamine nor esketamine - despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Internet addiction and depressive symptoms: a dose-response effect mediated by levels of physical activity

Abstract Introduction There are several negative impacts on the physical and mental health of people presenting internet addiction, including development of mood disorders, such as depression. Objective The aim of the study was to evaluate the association between internet addiction and depressive symptoms, as well as to test the mediating role of physical activity in this association. Methods A cross-sectional study was conducted with undergraduate students from three universities (one private and two public institutions) in southern Brazil. Depressive symptoms were measured with the Beck Depression Inventory (BDI-21), internet addiction with the Internet Addiction Test (IAT-20), and physical activity with the International Physical Activity Questionnaire (IPAQ - short version). Poisson regression and the Karlson-Holm-Breen mediation method were used for statistical analyses. Results We observed a dose-response relationship between internet addiction and depressive symptoms. Levels of physical activity mediated the association between moderate internet addiction and depressive symptoms, accounting for 10.7% of the effect observed. Conclusion Internet addiction can be detrimental to individuals' health, contributing to development of depressive symptoms. Along with psychological and pharmacological therapies, prescription of physical activities is recommended.

Transtorno depressivo em mulheres no período pós-parto: análise segundo a raça/cor autorreferida / Trastorno depresivo en mujeres en el período posparto: análisis según raza/color autodeclarado / Depressive disorder among postpartum women: an analysis according to self-reported race/color

Resumo Objetivo Identificar a raça/cor autorreferida por mulheres com 60 dias de pós-parto; identificar a prevalência do indicativo de transtorno depressivo nessas mulheres e verificar a associação entre o indicativo de transtorno depressivo e o quesito raça/cor autorreferida. Métodos Estudo transversal desenvolvido em um município do interior paulista. Foram utilizados, para a coleta de dados, um instrumento com dados sociodemográficos e a Escala de Depressão Pós-Natal de Edimburgo. Os dados foram analisados utilizando-se o Statistical Package for Social Sciences, SPSS, versão 17.0. Resultados Participaram deste estudo 186 mulheres, 60,8% referiram ser da cor parda, 24,2% apresentaram indicativo de transtorno depressivo e, entre estas, 81,7% eram da raça negra. O indicativo de transtorno depressivo associou-se às variáveis: número de filhos (p=0,006), gestação planejada (p=0,04) e tipo de parto (p< 0,001). Conclusão Os resultados deste estudo contribuem para maior visibilidade da temática da saúde mental das mulheres, especificamente das mulheres negras, pois, mesmo que não tenha sido identificada associação significativa dentre aquelas que apresentaram indicativo de transtorno depressivo, a maioria era da raça negra.

Resumen Objetivo Identificar la raza/color autodeclarado por mujeres con 60 días de posparto, identificar la prevalencia de indicios de trastorno depresivo en esas mujeres y verificar la relación entre los indicios de trastorno depresivo y el ítem raza/color autodeclarado. Métodos Estudio transversal realizado en un municipio del interior paulista. Para la recopilación de datos, se utilizó un instrumento con datos sociodemográficos y la Escala de Depresión Posnatal de Edimburgo. Para analizar los datos se utilizó el Statistical Package for Social Sciences, SPSS, versión 17.0. Resultados Participaron en el estudio 186 mujeres, el 60,8 % declararon ser de color pardo, el 24,2 % presentó indicios de trastorno depresivo y, entre ellas, el 81,7 % era de raza negra. Los indicios de trastorno depresivo se relacionaron a las variables: número de hijos (p=0,006), embarazo planeado (p=0,04) y tipo de parto (p< 0,001). Conclusión Los resultados de este estudio contribuyen para una mayor visibilidad del tema de salud mental de las mujeres, específicamente de mujeres negras, ya que, aunque no se haya identificado una relación significativa entre las que presentaron indicios de trastorno depresivo, la mayoría era de raza negra.

Abstract Objective To identify the race/color self-reported by women 60 days postpartum; to identify the prevalence of signs of depressive disorder among these women and to verify the association between signs of depressive disorder and the self-reported race/color. Methods Cross-sectional study carried out in a noncapital city in the state of São Paulo. An instrument with sociodemographic data and the Edinburgh Postnatal Depression Scale were used for data collection. Data was analyzed using the Statistical Package for Social Sciences, SPSS, version 17.0. Results A total of 186 women participated in this study, 60.8% reported being brown, 24.2% had signs of depressive disorder and, among these, 81.7% were black. Signs of depressive disorder were associated with the variables: number of children (p=0.006), planned pregnancy (p=0.04) and type of delivery (p< 0.001). Conclusion The results of this study contribute to greater visibility of the issue of women's mental health, specifically of black women, because even though no significant association was identified among those who showed signs of depressive disorder, most were black.

COVID-19: Impacto na Saúde Mental de Trabalhadores de Enfermagem / COVID-19: Impact on Mental Health of Nursing Workers

O contexto prolongado de pandemia pelo novo Coronavírus agravou o desgaste físico e emocional dos trabalhadores de saúde, impactando negativamente na saúde mental. Os objetivos do estudo foram verificar as prevalências de Transtorno de Depressão Leve (TDL) e de Transtorno de Ansiedade Leve (TAL) e os fatores associados. Estudo transversal, realizado com trabalhadores de enfermagem de hospital privado da cidade de São Paulo (SP), Brasil. A amostra por adesão foi composta por 184 trabalhadores de enfermagem, que responderam um formulário do Google Forms®, divulgado por grupo de mídia social (WhatsApp®), restrita a funcionários e gerentes dos setores. Foram obtidos dados demográficos, ocupacionais, clínicos e indicadores de TDL e TAL por meio da Escala Hospitalar de Ansiedade e Depressão. Foi utilizada estatística descritiva e teste de associação entre variáveis independentes e dependentes. Houve predomínio de mulheres (88%), na função de técnico e/ou auxiliar de enfermagem (63,6%); e que trabalhavam em unidades especificas de pacientes com COVID-19 (58,7%). A prevalência de TDL foi 43,5% (IC 95%: 36,4% - 50,7%) e de TAL foi 46,2% (IC 95%: 39,1% ­ 53,4%). Houve associação estatisticamente significativa entre TAL, idade entre 25 e 35 anos (p=0,01) e unidade de internação não especifica para COVID-19 (p=0,04). A prevalência dos transtornos leves de depressão e ansiedade foi considerada alta. O transtorno leve de ansiedade obteve maior prevalência entre trabalhadores mais jovens e atuando em unidades não especificas para COVID-19.

The prolonged pandemic context by the new Coronavirus aggravated the physical and emotional strain of healthcare workers, negatively impacting mental health. The objectives of this study were to verify the prevalence of Mild Depression Disorder (MDD) and Mild Anxiety Disorder (MAD) and their associated factors. A cross-sectional study was conducted with nurses and nursing assistants from a private hospital in the city of Sao Paulo, Brazil. The sample consisted of 184 nursing workers, who answered a form using Google Forms®, released by the social media group (WhatsApp®), restricted to employees and managers of the sectors. Demographic, occupational, clinical data, and indicators of MDD and MAD were obtained through the Hospital Anxiety and Depression Scale. Descriptive statistics and association tests between independent and dependent variables were used. There was a predominance of women (88%), in the role of nurse technicians and/or assistants (63.6%), and those who worked in specific units of patients with COVID-19 (58.7%). The prevalence of MDD was 43.5% (95% CI: 36.4% - 50.7%) and MAD was 46.2% (95% CI: 39.1% ­ 53.4%). There was a statistically significant association between MAD, age between 25 and 35 years (p=0.01) and hospital unit not specific for COVID-19 (p=0.04). The prevalence of mild depression and anxiety disorders was considered high. Mild anxiety disorder had a higher prevalence among younger workers and those working in units not specific to COVID-19

Development of Questionnaire for Parental Acceptability of School based Depression Symptom Screening / 中国学校卫生

Objective@#The study aimed to develop Questionnaire for Parental Acceptability of School based Depression Symptom Screening by Delphi method, so as to provide a reference and suggestions for promoting screening adolescents depression.@*Methods@#The study was conducted through the literature review and two rounds of the Delphi expert consultation. The initial construction of scale dimension and item was conducted through the literature search. A survey of 12 experts from 6 different provinces, cities and regions in China was conducted, and the Delphi technique was used to collect and analyze expert opinions data about the importance and feasibility of questionnaire content. The dimensions and specific items of the questionnaire were finally determinded.@*Results@#The response rates were 100% in both rounds of Delphi consultation. Kendall coordination degree W =0.22 ( χ 2=63.72, P <0.01), which showed the agreement of expert opinions. The initial scale consisted of 4 dimensions and 17 items, including parental cognition of school based depression screening, parental cognition of school depression screening results feedback and management, parental attitude of school based depression screening, parental utilization of mental health services. After two rounds of expert consulattion, the final scale consisted of 3 first grade dimensions including parental cognition of depression symptom, parental attitude of school based depression symptom screening and parental mental health promotion behaviour, and also cinsisted of 4 second grade dimensions including parental knowledge of depression symptom, parental attitude of school based depression symptom screening, parental choice preference of school based depression symptom screening, parental utilization of mental health services, which had a total of 25 items.@*Conclusion@#The questionnaire is developed for assessing parental acceptability of school based depression screening and associated factors. The finding will facilitate mental health services providers in the screening implementation, but further empirical research is still needed.

Analysis of regional homogeneity and functional connectivity among the depression and bipolar disorder with mixed features patients / 中华放射学杂志

Objective:To investigate the regional homogeneity (ReHo) among the major depressive disorder patients without mixed features (MDD noMF), major depressive disorder with mixed features (MMF), bipolar disorder with mixed features (BMF) and bipolar disorder patients without mixed features (BD noMF) patients, and to explore the brain activity and functional connectivity patterns of the MMF and BMF patients. Methods:This was a cross-sectional study. The MDD noMF patients (MDD noMF group), MMF patients (MMF group), BMF patients (BMF group), BD noMF patients (BD noMF group), and age-and gender-matched healthy controls (HC group) were recruited from Beijing Anding Hospital, Capital Medical University between April, 2021 and June, 2022. All the participants underwent resting-state functional MRI scanning. The ReHo values was computed with the DPABI software based on the MATLAB. Firstly, the difference in ReHo among the patients with MDD noMF, MMF, BMF, BD noMF and HC group were estimated by the analysis of covariance and the post-hoc method (LSD or Games-Howell). And then, the brain regions with significant different ReHo values were selected as the seeds to calculate the functional connectivity with the whole brain. Results:A total of 29 cases in the MDD noMF group, 24 cases in the MMF group, 26 cases in the BMF group, 29 cases in the BD noMF group, and 42 in the HC group were included. The differences in ReHo values in the left fusiform and the left precuneus of the 5 groups were statistically significant ( P<0.05). Among of them, the ReHo values of the left fusiform were lower in the MMF, BMF and BD noMF groups compared with the HC group ( P<0.05), while the ReHo values of the left precuneus in MDD noMF, MMF, BMF and BD noMF groups were higher than that in the HC group ( P<0.05). The ReHo value of the left fusiform was lower in the MMF group compared with the MDD noMF group ( P=0.001); the ReHo value of the left fusiform was lower in the BMF group compared with the MDD noMF and BD noMF groups ( P<0.05). The functional connectivity between the left fusiform and vermis, left insula, right putamen, and left medial superior frontal gyrus, and functional connectivity between the left precuneus and right superior frontal gyrus (dorsolateral) showed significant difference among the MDD noMF, MMF, BMF, BD noMF and HC groups ( P<0.05). Compared with HC group, MDD noMF, MMF, BD noMF groups showed higher functional connectivity between the left fusiform and the vermis, and MDD noMF, MMF, BMF, BD noMF group showed higher functional connectivityy between the the left fusiform and the left insula, left medial superior frontal gyrus and right putamen ( P<0.05). Compared with the MDD noMF group, the MMF, BMF and BD noMF groups showed higher functional connectivity between the left fusiform and the left insula ( P<0.05). Compared with the MDD noMF group, the BMF and BD noMF groups had higher functional connectivity between the left fusiform and the left medial superior frontal gyrus ( P<0.05). The BMF group showed higher functional connectivity of the left fusiform with the right putamen than the MDD noMF and BD noMF groups. Additonally, the BMF and BD noMF groups showed higher functional connectivity between the left precuneus and the right superior frontal gyrus (dorsolateral) than HC, MDD noMF and MMF groups ( P<0.05). Conclusions:MMF and BMF patients have local abnormalities of functional activity synchronization in the left fusiform and precuneus and abnormal functional connectivity patterns with multiple brain regions. MMF and BMF patients have specific neuroimaging features compared to MDD noMF or BD noMF patients and also share similar neuroimaging pathogenesis.

Effect of self-help cognitive behavioral therapy for insomnia combined with trazodone hydrochloride on elderly patients with depression and insomnia / 中国医师杂志

Objective:To observe the efficacy of self-help cognitive behavioral therapy for insomnia (CBTI), trazodone hydrochloride and their combination in the treatment of depression and insomnia comorbidity in the elderly.Methods:90 elderly patients with insomnia and depression admitted to the 901th Hospital of the Joint Logistic Support Force from October 2019 to October 2021 were selected as the study subjects. They were divided into trazodone group, CBTI group and trazodone combined with CBTI group(combination group), with 30 cases in each group. Trazodone group was treated with oral trazodone hydrochloride, CBTI group was treated with self-help CBTI, and the combination group was treated with oral trazodone hydrochloride combined with self-help CBTI. All three groups were treated for 4 weeks. The sleep latency, total sleep time and sleep efficiency of each group were compared at the time of admission and after 4 weeks of treatment. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used for sleep assessment before and after treatment, and Self-Rating Depression Scale (SDS) was used for depression assessment.Results:Before treatment, there was no significant difference among the three groups in terms of sleep latency, total sleep time, sleep efficiency, PSQI, ESS and SDS (all P>0.05). After treatment, the sleep latency of the three groups was shorter than that before treatment, and the total sleep time was longer than that before treatment (all P<0.05). The sleep efficiency of the trazodone group and the combination group was higher than that before treatment, with statistically significant difference (both P<0.05). The indexes of the combined group were better than those of the trazodone group and the CBTI group (all P<0.05). The sleep latency of the trazodone group was shorter than that of the CBTI group, and the total sleep time was longer than that of the CBTI group (all P<0.05), with statistically significant difference (all P<0.05). After treatment, the PSQI, except for the SDS of CBTI group, the ESS and SDS of the three groups were lower than those before treatment (all P<0.05). The PSQI, ESS and SDS of the combined group were lower than those of the trazodone group and the CBTI group, and the ESS and SDS of the trazodone group were lower than those of the CBTI group, with statistically significant difference (all P<0.05). Conclusions:For the elderly patients with depression and insomnia, the combination of self-help CBTI and trazodone can not only improve insomnia but also relieve depression symptoms, and the effect is better than that of trazodone and self -help CBTI alone.

Bioinformatics analysis of regulatory network of long non-coding RNA LOC107987438 in depressive disorder / 中华行为医学与脑科学杂志

Objective:To investigate the regulatory role of defferentially expressed LOC107987438 in the pathogenesis of depressive disorder and provide a theoretical basis for its clinical application in depressive disorder.Methods:Differential expression of LOC107987438 was verified by quantitative real-time polymerase chain reaction(qRT-PCR)in peripheral blood monocular cells(PBMCs)of 60 patients with depressive disorder and 60 health controls. In addition, its diagnostic value was assessed by receiver operating characteristic(ROC)curves. Based on the ceRNA mechanism of lncRNA, the miRDB database was applied to predict the target miRNAs of LOC107987438, and the miRNAs with target score ≥ 80 among them were screened out.The screened miRNAs were then used to predict their potential target mRNAs through four databases which were TargetScan 8.0, miRTarBase, mirDIP and miRPathDB. Moreover, the predicted target mRNAs were annotated for gene ontology(GO)function annotation and tokoyo encyclopedia of genes and genomes(KEGG) pathway enrichment analysis via ClusterProfiler 4.0.5 package of R 4.1.1. Finally, a protein-protein interaction network was constructed using the STRING 11.5 platform to retrieve the interacting genes.Results:The qRT-PCR results showed that normalized expression of LOC107987438 in PBMCs of patients with depressive disorder was higher than that in health controls(depressive disorder: 2.084±1.357, health controls: 1.000±0.660, P<0.001). The ROC curve results showed that the area under curves(AUC)of LOC107987438 was 0.759(95% CI: 0.675-0.842, P<0.05), indicating its high potential diagnostic value. Bioinformatics analysis showed that hsa-miR-4670-3p, hsa-miR-619-3p, hsa-miR-6721-5p and hsa-miR-297 were the miRNAs with high bindings to LOC107987438. The results of KEGG signaling pathway enrichment revealed that hypoxia-inducible factor 1(HIF-1)signaling pathway, phosphatidylinositol 3-kinase-AKT(PI3K-Akt) signaling pathway and erythroblastic oncogene B(ErbB) signaling pathway were closely associated with depressive disorder. Among the top ten key genes screened by the protein-protein interaction network, kirsten rats arcomaviral oncogene homolog(KRAS), androgen receptor(AR), cyclic-AMP response binding protein1(CREB1), insulin-like growth factor 1(IGF1), cyclin-dependent kinase inhibitor 1B(CDKN1B) and calcium/calmodulin-dependent protein kinase type Ⅱ alpha(CAMK2A)were strongly associated with depressive disorder. Conclusion:The establishment of ceRNA regulatory network of LOC107987438 provides a theoretical basis for exploring the pathophysiology of depressive disorders.

The association of obesity with depressed severity in adolescent patients with first-episode untreated major depressive disorder / 中华行为医学与脑科学杂志

Objective:To investigate the characteristics of obesity in adolescents with major depressive disorder (MDD) and its association with the depressed severity.Methods:A total of 278 adolescents with MDD were recruited according to the inclusion and exclusion criteria. Their demographic data were collected and 24-item Hamilton depression scale (HAMD-24) was used to evaluate their severity of depression. According to the body mass index (BMI) classification standard of adolescents in China, all subjects were classified into four groups(wasting group, normal BMI group, overweight group and obesity group). SPSS 26.0 statistical software was used for data analysis. The Kruskal-Wallis test and the Chi-square test were separately used for the comparison of the four groups.Spearman correlation was used to explore the relationship between BMI and HAMD-24 scores and severity.Results:Among 278 adolescents with MDD, the prevalence of body abnormality was 32.4% (90/278), among which wasting, overweight and obesity were 9.0% (25/278), 14.4% (40/278) and 9.0% (25/278) respectively. There were statistically differences in gender ( χ2=17.018, P<0.001), HAMD-24 scores ( H=9.427, P=0.024) and depressed severity( H=8.508, P=0.037) among the four groups. Multiple comparisons showed that there were only statistically differences between obesity group and normal BMI group, that was the prevalence of obesity in males was higher than that in females ( χ2=13.631, P<0.001), and the level in HAMD-24 scores ( Z=2.956, P=0.003) and depressed severity ( Z=2.832, P=0.005) was lower in obesity group than that in normal BMI group.Spearman correlation analysis showed that BMI was negatively correlated with HAMD-24 scores ( r=-0.162, P=0.007). Conclusion:There is gender difference in obesity rates among the adolescent patients with first-episode untreated MDD. And the obese patients are less depressed than those with normal BMI.