Trastorno del espectro autista en mujeres: A propósito de un caso clínico / Autism spectrum disorder in women: About a clinical case

El diagnóstico de trastorno del espectro autista (TEA) en mujeres presenta importantes complejidades, desafíos y particularidades. Históricamente se ha planteado que este trastorno es más frecuente en hombres, existiendo, además, un sesgo hacia el género masculino en el screening y criterios diagnósticos. Objetivo: Presentar un caso clínico a fin de revisar las dificultades y particularidades asociadas al proceso diagnóstico de TEA en mujeres. Discusión: Las investigaciones a la fecha han planteado que muchas niñas no encajan en el perfil tradicional de TEA. Se han descrito características específicas del cuadro clínico en el sexo femenino, varias de las cuales se evidencian en el caso clínico presentado. Por otro lado, existen altas tasas de comorbilidades, tanto con patologías médicas como psiquiátricas, las cuales son siempre relevantes de evaluar. Conclusiones: Como en muchos otros aspectos, las mujeres también han sido invisibilizadas en lo que respecta al TEA. Es relevante que se continúe estudiando el tema para lograr un diagnóstico e intervención precoces en esta población.

The diagnosis of autism spectrum disorder (ASD) in women presents with significant complexities and challenges. It has been mentioned that the disorder is more prevalent in males, and there is also a bias towards the male gender in screening and diagnostic criteria. Objectives: To present a clinical case in order to review difficulties and peculiarities associated with the diagnostic process of ASD in women. Discussion: It has been suggested that many girls do not fit the traditional profile of ASD. Specific characteristics of the female gender phenotype have been described, several of which are illustrated in the clinical case presented. On the other hand, there are high rates of comorbidities, both with medical and psychiatric conditions, which are always relevant to assess and recognize. Conclusions: As in various other aspects, women have also been unrecognized and misdiagnosed when it comes to ASD. It is relevant that we keep understanding this issue, in order to achieve an early diagnosis and provide proper interventions to this population.

Sedentary behavior, screen time and mental health of college students: a Meta-analysis / 中华流行病学杂志

Objective: To evaluate the effects of sedentary behavior/screen time on mental health of college students by Meta-analysis based on the results of literature retrieval and provide theoretical basis for the improvement of college students' mental health. Methods: The original research literatures about sedentary behavior (including screen time) and college students' mental health published as of 14 July 2022 were retrieved from PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang data. Data were extracted from the included studies and scored by one author in accordance with the proposed programme, and quality score was reviewed by another author. The literature that met the inclusion criteria was systematically reviewed and Meta-analysis was carried out by software Stata 14.2 based on the data from the literatures. Results: A total of 36 studies met the inclusion criteria, including 35 observational studies and 1 interventional study. There are 4 papers about the effects of sedentary behavior and 9 papers about the effects of screening time on depression in college students and 4 papers about the effects of sedentary behavior/screening time on anxiety in college students were used for a Meta-analysis, and the other studies were also analyzed. The Meta-analysis on the effects of sedentary behavior on depression in college students showed that there was a significant positive correlation between higher level sedentary behavior and increased risk for depression (OR=1.07,95%CI:1.05-1.10). Subgroup analysis indicated that there was no significant correlation between higher level sedentary behavior and depression (OR=1.74, 95%CI:0.93-3.25) in the unadjusted confounding factor model, but there was significance positive correlation after adjusting confounding factors (OR=2.15, 95%CI:1.18-3.90). Meta-analysis on the effects of screen time on depression in college students showed that longer screen time were significantly positively correlated with higher depression level (OR=1.03, 95%CI: 1.02-1.05). The results of subgroup analysis showed that in both unadjusted confounding factor model and adjusted confounding factor model, longer screen time was significantly positively correlated with depression (OR=1.27, 95%CI: 1.13-1.42; OR=1.45, 95%CI: 1.18-1.79) , respectively. Meta-analysis on the effects of sedentary behavior on anxiety showed that longer screen time was significantly positively correlated with increased anxiety risk (OR=1.44, 95%CI: 1.31-1.58). The results of subgroup analysis showed that in both unadjusted confounding factor model and adjusted confounding factor model, there was a significant positive correlation between longer screen time and anxiety (OR=1.47, 95%CI: 1.31-1.65; OR=1.38, 95%CI:1.17-1.62). The analysis for the literatures which were not eligible for Meta-analysis found that sedentary behavior/screen time was significantly associated with stress and other mental health in college students. Conclusions: Sedentary behavior or screen time is significantly negatively correlated with college students' mental health, in particular, resulting in depression and anxiety. These effects might be be different between weekdays and weekend days.

Ideação suicida e risco de depressão entre idosos residentes em instituições de longa permanência / Ideación suicida y riesgo de depresión entre adultos mayores residentes en establecimientos de larga estadía / Suicidal ideation and risk of depression among older adults residing in long-stay institutions

Objetivo: identificar o estado depressivo e ideação entre idosos em Instituições de Longa Permanência dos municípios da região do Seridó/RN, Brasil. Método: estudo transversal e descritivo, desenvolvido entre os meses de agosto a novembro de 2020, nas Instituições de Longa Permanência para Idosos. Resultados: a amostra final foi composta por 45 idosos, predominando idosos do sexo feminino, com idade maior ou igual a 80 anos, solteiros, não alfabetizados, brancos, aposentados e com tempo de institucionalização maior do que 1 ano. Observou-se um maior quantitativo do sexo feminino, 64,4% com idade maior ou igual a 80 anos. Quanto ao estado depressivo, visto que houve significância e as variáveis "grau de depressão" e "ideação suicida" com p-valor < 0,1 (p-valor = 0,07). Considerações finais: observa-se uma considerável ocorrência de graus de depressão e ideação suicida na população estudada.

Objetivo: identificar el estado depresivo y la ideación entre las personas mayores residentes en los Establecimientos de Larga Estadía de los municipios de la región de Seridó/RN, Brasil. Método: estudio transversal y descriptivo, desarrollado entre los meses de agosto y noviembre de 2020, en los Establecimientos de Larga Estadía para Adultos Mayores. Resultados: la muestra final fue compuesta por 45 adultos mayores, predominantemente del sexo femenino, con edad igual o superior a 80 años, solteros, analfabetos, blancos, jubilados y con tiempo de institucionalización superior a 1 año. Se observó un mayor número de mujeres, 64,4%, con 80 años o más. En cuanto al estado depresivo, hubo significación y las variables "grado de depresión" e "ideación suicida" con p-valor < 0,1 (p-valor = 0,07). Consideraciones finales: se observa una considerable ocurrencia de grados de depresión e ideación suicida en la población estudiada.

Objective: to identify the depressive state and ideation among older adults in Long-Stay Institutions in the cities of the Seridó/RN region, Brazil. Method: cross-sectional and descriptive study, developed between the months of August and November 2020, in the Long Stay Institutions for Older Adults. Results: the final sample was composed of 45 older adults, predominantly females, aged 80 years old or more, single, non-literate, white, retired and with a time of institutionalization longer than 1 year. We observed a higher number of females, 64.4%, aged 80 years or older. As for the depressive state, there was significance and the variables "degree of depression" and "suicidal ideation" with p-value < 0.1 (p-value = 0.07). Final considerations: a considerable occurrence of degrees of depression and suicidal ideation is observed in the population studied

Prevalence and factors associated with depression and anxiety among medical students in an inland university in Brazil / Prevalência e fatores associados à depressão e ansiedade entre estudantes de medicina de uma universidade do interior do Brasil

Medical schools are known to be stressful environments for students, and hence medical students have been believed to experience greater incidences of depression and anxiety than the general population or students from other spe-cialties. The present study investigates the prevalence of anxiety and depressive symptoms together with factors as-sociated with them among medical students in a federal public university in the south of Brazil. A descriptive study was performed using self-administered questionnaires to access socio-demographic, institutional, and health variables in association with two scales - Beck's Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) - designed to assess depressive and anxiety symptoms, respectively. The research sample consisted of 152 subjects. The depres-sive symptoms prevalence was 65.1% (BDI > 9), state-anxiety was 98.6%, and trait-anxiety was 97.4% (STAI > 33). Among women, 37.8% demonstrated moderate/severe depressive symptoms. High levels of state-anxiety symptoms and trait-anxiety symptoms were found in 44.7% of students under the age of 20. In the group with the lowest month-ly income, it was observed the highest distributions for moderate/severe depressive symptoms, high state and high trait-anxiety symptoms, corresponding to 47.4%, 57.9%, and 47.4%, respectively. Students attending the third term of medical school had the highest percentage of moderate/severe depressive symptoms (62.5%) and high state-anxiety symptoms (50%). In addition, students who had both financial aid programs presented the highest percentages of moderate/severe depressive symptoms (46.2%), highstate-anxiety symptoms (61.5%), and high trait-anxiety symptoms (46.2%). We also observed a correlationbetween depression and trait-anxiety symptoms (P = 0.037). In conclusion, it was identified as risk factors for depressive symptoms the previous depression diagnosis, previous search for health service due to psychological symptoms, being in financial aid programs, dissatisfaction with the medical school, and inadequate psychological help offered by it. For state-anxiety symptoms and trait-anxiety outcome, there is an increased risk among low-income or students who have financial help from financial aid programs and younger age students. (AU)

Objetivo: Investigar a prevalência de sintomas de ansiedade e depressão e fatores associados a eles entre es-tudantes de medicina de uma universidade pública do sul do Brasil. Métodos: Foi realizado um estudo descritivo através de questionários autoaplicáveis para avaliar variáveis sociodemográficas, institucionais e de saúde, associa-das a duas escalas - Inventário de Depressão de Beck (BDI) e Inventário de Traço-Estado de Ansiedade (STAI) - para avaliar os sintomas de depressão e ansiedade, respectivamente. Resultados: A prevalência de sintomas depres-sivos foi de 65,1% (BDI > 9), estado de ansiedade foi de 98,6% e traço de ansiedade de 97,4% (STAI > 33). Uma correlação significativa foi encontrada entre depressão e traço de ansiedade. Diagnóstico prévio de depressão, busca prévia por serviços de saúde, insatisfação com o curso de medicina e ter auxílio de baixa renda e bolsa de iniciação científica foram identificados como fatores de risco para depressão. Estudantes com baixa renda mensal e menores de 25 anos apresentaram maior risco para estado de ansiedade. Idade, ano da faculdade de medicina e programa de ajuda financeira provaram ser um fator de risco para traço de ansiedade. Conclusão: Esses resultados mostram fatores significativos relacionados à saúde mental de estudantes de uma faculdade de medicina recém-fundada no interior do Brasil. (AU)

Detección temprana de deterioro cognitivo leve en personas mayores durante la pandemia: protocolo cribado online / Early detection of mild cognitive impairment in older people during the pandemic: online screening protocol

Introducción: la pandemia COVID-19 ha tenido un gran impacto en la vida y en especial en las personas mayores. El objetivo del presente estudio fue explorar un protocolo de cribado online para detectar tempranamente Deterioro Cognitivo Leve en personas mayores. Métodos: fue de tipo cuantitativo y cualitativo. La muestra fue de 22 personas mayores de las comunas de Coronel y Lota, Región del Bio-bio. El protocolo estaba compuesto por: Cuestionario sociodemográfico, Test del Reloj Versión Cacho, Moca versión validada en Chile, Escala Depresión Yesavage y Test Acentuación de Palabras. El procedimiento consistió en la aplicación del protocolo a través de un Tablet o Laptop. Resultados: se encontró que la mayoría no presentaba deterioro cognitivo, pero si depresión. Conclusiones: se discute sobre la aplicación de un protocolo de diagnóstico online en personas mayores y los indicadores de depresión que podrían estar dado por la situación actual de pandemia.

The COVID-19 pandemic has had a great impact in the world, more so in the lives of elderly people. The objective of this study was to explore an online screening protocol to detect early Mild Cognitive Impairment. The method was both quantitative and qualitative, the sample included 22 elderly people from the Coronel y Lota, Biobio region. The protocol was integrated with a sociodemographic questionnaire, the Clock Drawing Test (Cacho Version), MOCA (validated in Chile version), Yesavage Depression Scale (Reduced version) and the Word Accentuation Test. The evaluation involved applying the protocol online in a tele neuropsychological assessment. The results showed that most of the elder people evaluated did not present cognitive impairment but did have depression. The application of an online diagnostic protocol in older people and the indicators of depression that could be given by the current pandemic situation are discussed.

Antecedente de depresión, síntomas de estrés postraumático, apoyo social percibido: prediciendo la depresión posparto / History of depression, post-traumatic stress symptoms, perceived social support: predicting postpartum depression

Objetivo: Describir y analizar si el apoyo social percibido modera la relación entre antecedente de depresión (AD) o síntomas de trastorno de estrés postraumático (TEPT) y desarrollo de síntomas de depresión posparto (SDPP), evaluado prospectivamente. Método: Diseño longitudinal de tres tiempos: antes del parto (n = 458), primer mes posparto (n = 406) y tercer mes posparto (n = 426). Se utilizaron la Escala de Depresión Posparto de Edimburgo (EPDS), la Escala de Síntomas de Estrés Postraumático (PCL-C) y la Escala de Apoyo Social Percibido (MOS). Se realizó un análisis de ocho modelos jerárquicos de regresión lineal múltiple, por cada tiempo de evaluación en el estudio. Resultados: Se encontró una asociación significativa entre síntomas de TEPT y puntaje de SDPP en los tres tiempos. El apoyo social percibido es un factor protector significativo para los SDPP en los tiempos 1 y 2, mientras que el AD es un factor de riesgo significativo en los tiempos 2 y 3. Los resultados no apoyan las hipótesis de interacción. Conclusiones: El apoyo social es un factor protector significativo, que puede disminuir los SDPP; sin embargo, disminuye con el tiempo. El apoyo social no logra revertir la asociación de los síntomas de TEPT con el puntaje en SDPP.

Objective: Describe and analyze if the perceived social support moderates the relationship between depression history or post-traumatic stress disorder symptoms and the development of symptoms of postpartum depression, prospectively evaluated. Method: Longitudinal design of three times: before partum (n = 458), one month (n = 458) and 3 months postpartum (n = 458). The version of the Edinburgh Postnatal Depression Scale (EPDS), the version of the PTSD Checklist-Civilian Version (PCL-C), and the version of the Medical Outcomes Study Social Support Survey (MOS) were used. Analysis of eight hierarchical multiple linear regression models. Results: A significant association was found between symptoms of post-traumatic stress and postpartum depression, in the three times measured. The perceived social support variable was found to be a significant protective factor for perinatal depression in times 1 and 2, and history of depression was significant in times 2 and 3. The results do not support the interaction hypothesis. Conclusions: Social support is a significant protective factor, which can reduce the symptoms of postpartum depression, nevertheless the significance decreases over time. However, social support fails to reverse the association of post-traumatic stress disorder symptoms with symptoms of postpartum depression score.

Validez del cuestionario PHQ-2 para la detección de depresión en personal sanitario colombiano durante Covid-19 / Validity of the PHQ-2 questionnaire for the detection of depression in Colombian health personnel during Covid-19

RESUMEN: Introducción: La sintomatologia depresiva en profesionales de la salud asociado a crisis virales es de alta prevalencia a nivel global, siendo su detección una prioridad por lo cual, el objetivo de esta investigación fue analizar la validez convergente y consistencia interna del cuestionario de salud del paciente-2 (PHQ-2) en profesionales sanitarios. Método: Estudio eSalud donde se recopilaron datos transversales en línea (n=725), de 281 médicos generales, 237 médicos especialistas y 207 enfermeras durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Edad promedio 41,3 años (± 8,76). El 38,4% eran hombres (278) y el 61.6% mujeres (447). El 66.1% del personal sanitario atendió pacientes contagiados por coronavirus y el 33,9% no prestó estos servicios. Se administró la versión de 9 ítems del PHQ, validada en población colombiana junto a la versión de 2 ítems del PHQ. Resultados: Se encontró una alta correlación entre las escalas (r=.860, P<0.001), demostrando la validez convergente del PHQ-2 para medir la sintomatología depresiva. La consistencia interna del PHQ-2 fue adecuada, con un Alpha de Cronbach de 0.80 (I.C.= 0.76 - 0.83). Conclusiones: El PHQ-2 presenta adecuados estándares psicométricos de confiabilidad y validez, por lo que su rápida administración, fácil calificación e interpretación, lo convierte en un instrumento confiable y valido para la detección rápida, sin sobrecargas laborales, de los síntomas depresivos en médicos y enfermeras que atiendan o no pacientes en condiciones de brotes virales.

ABSTRACT Background: Depressive symptomatology in health professionals associated with viral crises is highly prevalent globally, being its detection a priority. Therefore, the objective of this research was to analyze the convergent validity and internal consistency of the Patient Health Questionnaire (PHQ-2) in healthcare professionals. Method: E-Health study where cross-sectional data was collected online (n = 725), from 281 general practitioners, 237 specialist doctors and 207 nurses during the Colombian quarantine, between April 20 and August 10, 2020. Average age 41.3 years (± 8.76). 38.4% were men (278) and 61.6% women (447). 66.1% of health personnel treated patients infected with coronavirus and 33.9% did not provide these services. The 9-item version of the PHQ was administered, validated in the Colombian population together with the 2-item version of the PHQ. Results: A high correlation was found between the scales (r = .860, P <0.001), demonstrating the convergent validity of the PHQ-2 to measure depressive symptomatology. The internal consistency of the PHQ-2 was adequate, with a Cronbach's Alpha of 0.80 (I.C. = 0.76 - 0.83). Conclusions: The PHQ-2 has adequate psychometric standards of reliability and validity, so its rapid administration, easy qualification and interpretation, makes it a reliable and valid instrument for the rapid detection, without work overload, of depressive symptoms in doctors and nurses whether or not they care for patients with viral outbreaks.

Producción científica sobre validación y adaptación de instrumentos de tamizaje de la depresión en población peruana / Scientific output on validation and adaptation of depression screening instruments in peruvian population

RESUMEN: El objetivo de la investigación fue describir la producción científica sobre estudios psicométricos de instrumentos de tamizaje para la depresión en población peruana. Para ello, se realizó un estudio descriptivo de la literatura científica en Scopus, Web of Science, PubMed y SciELO, con descriptores para depresión, propiedades psicométricas y Perú. Luego del proceso de revisión se incluyeron 22 estudios. Se encontraron validaciones de instrumentos de tamizaje en adultos mayores, adultos, adultos con depresión, mujeres adultas, mujeres embarazadas, profesionales de salud, estudiantes universitarios, estudiantes de secundaria y niños. El Patient Health Questionnaire (PHQ-9) fue el instrumento más estudiado. A pesar de que los estudios psicométricos cubren la mayoría de las poblaciones, quedan pendientes los pueblos originarios y poblaciones clínicas. El PHQ-9, por sus características, podría implementarse en las políticas de salud mental del Perú.

ABSTRACT The aim of the research was to describe the scientific output of psychometric studies on screening instruments for depression in the Peruvian population. We carried out a descriptive study of the scientific literature in Scopus, Web of Science, PubMed and SciELO, with descriptors for depression, psychometric properties, and Peru. After the review process, we included 22 studies. We found validations of screening instruments for older adults, adults, adults with depression, adult women, pregnant women, health professionals, university students, high school students and children. The Patient Health Questionnaire (PHQ-9) was the most widely used instrument. Psychometric studies cover most populations; however, native people and clinical populations remain to be studied. The PHQ-9, due to its characteristics, could be implemented in mental health policies in Peru.

Depression and Cardiovascular Disease in Women

Abstract The prevalence of depression varies from 1 to 17% in different geographic regions, and its incidence is 70% higher in women than men. Today, depression affects more than 300 million people worldwide, affecting twice as many women from adolescence to adulthood. In addition to this earlier onset, depression in women tends to be more severe. Cardiovascular disease and depression are chronic diseases that have a major impact on cardiovascular and all-cause morbidity and mortality, with evidence of a two-way relationship between them, in which depression is a predictor of cardiovascular disease and vice versa. In females, the degree of illness and prognosis are more severe when both diseases are present, than when diagnosed alone. In patients with acute or chronic cardiovascular disease, especially women, a systematic screening for depression should be considered as a preventive strategy of cardiovascular events, aiming to reduce the risk of future events. There are still no clinical studies designed to assess the impact of antidepressant treatment on cardiovascular outcomes in women.

Combinación de datos de la Encuesta Nacional de Salud con notificaciones GES de depresión para mejorar la estimación de la prevalencia de depresión en Chile / Combining the national health survey with GES notifications to improve the depression prevalence estimation in Chile

BACKGROUND: Major Depressive Disorder (MDD) is a public health problem of increasing severity in Chile. However, prevalence studies of MDD yield discordant results. Reconciling these discordances, at least in part, requires improving the estimate of MDD prevalence in Chile. AIM: To improve the estimate of MDD prevalence in Chile, by combining data from the 2016/17 Chilean National Health Survey (ENS) with data from the mandatory notifications of users of the Explicit health guaranties (GES acronym in Spanish) program of the Ministry of Health for MDD treatment. MATERIAL AND METHODS: The 2016/17 ENS, applied a Composite International Diagnostic Interview (CIDI) module (n = 3,403), to diagnose individuals with MDD. This article presents an approach that combines the CIDI/ENS diagnoses with GES depression notifications for this period. This dataset combination was applied first to individual macro-zones, then at a national level. RESULTS: The analysis with ENS 2016/17 data only, yields a prevalence of MDD in subjects 18 years or older of 6.19% (95% CI: 4.51-8.43). However, the analysis of the combined data sources yields a prevalence that increases to 6.65% (95% CI: 4.63-8.67). In terms of number of cases, this prevalence increase translates into 63,474 additional MDD cases per year. CONCLUSIONS: The MDD prevalence that results from combining ENS 2016/17 and GES data is greater than the prevalence reported by the ENS 2016/17 alone. This increase in cases allows policymakers to improve budgeting and implementation of public policies concerning the prevention and treatment of MDD.

Relationships between worry and depressive symptoms during two group therapies for generalized anxiety disorder / A inter-relação entre preocupações e sintomas depressivos em adultos com ansiedade generalizada

OBJECTIVE: Generalized anxiety disorder (GAD) is a chronic and disabling disorder associated with various impairments and shows a significant prevalence in the worldwide and Brazilian populations. This study aimed to investigate the longitudinal relationship of two symptoms relevant to the disorder (worry and depressive symptoms) in the context of a randomized clinical trial (RCT) by using a cross-lagged panel model (CLPM) analysis. METHODS: A total of 92 adult patients with GAD were randomized to receive ten sessions of either acceptance­based group behavioral therapy (ABBT) or nondirective supportive group therapy (NDST). Treatment had four time-point measures. Worries were measured using the Penn State Worry Questionnaire (PSWQ), and depression was measured using the Depression Anxiety Stress Scales (DASS-D). RESULTS: The NDST model revealed significant paths from worry to depression (first wave) and from depression to worry (second wave). There was no other significant cross-lagged effect. These data show that there was an influence between symptoms only during one of the treatment groups, and without a homogeneous and constant pattern in any of the cross-lagged routes. CONCLUSION: A supportive group psychotherapy potentially interferes with the pattern of the direct relationship between worries and depressive symptoms in adults with GAD.

OBJETIVO: O transtorno de ansiedade generalizada (TAG) é um diagnóstico crônico e incapacitante, associado a diversos prejuízos e com relevante prevalência na população mundial e na brasileira. Este estudo tem por objetivo investigar a relação longitudinal de duas manifestações relevantes para o transtorno (preocupação e sintomas depressivos), utilizando uma análise cross-lagged panel model (CLPM) por meio de dados de um ensaio clínico randomizado (ECR). MÉTODOS: Um total de 92 pacientes adultos com TAG foi randomizado para duas psicoterapias em grupo: terapia comportamental baseada em aceitação (TCBA) ou terapia de apoio não diretiva (TAND). Cada grupo teve duração de 10 sessões, distribuídas em 14 semanas. O tratamento teve quatro tempos de medida: linha de base, meio do tratamento, pós-tratamento e seguimento de três meses. As variáveis investigadas foram: preocupações, medidas pelo Penn State Worry Questionnaire (PSWQ), e sintomas depressivos, medidos pela Depression Anxiety Stress Scales (DASS-D). Os modelos CLMP foram gerados pelo programa Mplus. RESULTADOS: O modelo do grupo TAND revelou duas rotas significativas: preocupação para sintomas depressivos (primeira onda) e sintomas depressivos para preocupação (segunda onda). Não houve outro efeito cross-lagged que obteve significância estatística. Esses dados mostram que houve influência alternada entre os sintomas somente durante o período de um dos dois tratamentos testados, configurando um padrão heterogêneo das rotas cross-lagged. CONCLUSÃO: A psicoterapia suportiva em grupo potencialmente interfere no padrão da relação direta entre preocupação e sintomas depressivos em adultos com TAG.

Assessment of quality of life in patients with inflammatory bowel disease / Avaliação da qualidade de vida em pacientes com doença inflamatória intestinal

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, occurring main-ly in the young, socioeconomically active age group. Both the recurrent-remitting course of symptoms and the chronicity of the disease impact patients' quality of life (QoL). Objective: determine the contributing factors asso-ciated with QoL in IBD patients in a tertiary service. Methods: a cross-sectional study of patients seen at the IBD outpatient clinic of the Federal University of Pelotas from January to November 2020, with clinical and laboratory data collection. Disease assessment was performed using Crohn's Disease Activity Index for Crohn's disease and Mayo score for ulcerative colitis and quality of life through the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: the presence of a history of depression resulted in a significant impact on the overall QoL (p = 0.005) and mainly in the systemic symptoms (p = 0.04), social (p <0.001), and emotional (p = 0.008) domains. Regarding disease activity, statistical significance was evidenced in the intestinal symptoms domain (p <0.001) and overall QoL (p <0.001). Conclusion: a history of psychiatric illness and IBD disease activity were predictors of poorer QoL assessed by the IBDQ (AU)

A doença inflamatória intestinal (DII) é um distúrbio inflamatório crônico do trato gastrointestinal ocorrendo prin-cipalmente na faixa etária jovem socioeconomicamente ativa. Tanto o curso recorrente-remitente dos sintomas quanto a cronicidade da doença impactam a qualidade de vida (QoL) dos pacientes. Objetivo: avaliar a qualidade de vida de pacientes com DII em um serviço terciário. Métodos: estudo transversal de pacientes atendidos no ambulatório de DII da Universidade Federal de Pelotas no período de janeiro a novembro de 2020, com coleta de dados clínicos e laboratoriais. A atividade de doença foi avaliada pelo Crohn's Disease Activity Index para os casos de Doença de Crohn e escore de Mayo para os casos de retocolite ulcerativa e QoL por meio do Inflammatory Bowel Disease Questionnaire (IBDQ). Resultados: a presença de história de depressão resultou em impacto significativo na QoL (p = 0,005) e principalmente nos domínios sintomas sistêmicos (p = 0,04), social (p < 0,001) e emocional (p = 0,008). Em relação à atividade da doença, evidenciado significância estatística nos domínios sintomas intes-tinais (p < 0,001) e qualidade global (p < 0,001). Conclusão: há evidências de que os pacientes com história de depressão e não remissão da DII apresentam maior impacto na qualidade de vida avaliados pelo IBDQ (AU)

Association between social capital indicators and depressive symptoms among Brazilian university students / Associação entre indicadores de capital social e sintomas depressivos entre estudantes universitários brasileiros

Abstract The study aimed to investigate the association between social capital indicators and depressive symptoms among university students from Brazil. The study drew on a sample of 579 randomly selected university students, from a greater crossnational study conducted in 2018. Students completed a self-administered questionnaire assessing depressive symptoms, indicators of social capital and lifestyle behaviors. Data were analyzed using multivariate logistic regression models. Indicators of social capital included trust, group membership and frequency of meeting friends. Four social capital indicators were significantly associated with clinically relevant depressive symptoms. Students who agreed that people are likely to take advantage of one another were more likely to report depressive clinically relevant symptoms (OR: 1.80, 95%CI: 1.00 - 3.23) as well as students who agreed that people are not willing to help in case needed (OR: 2.11, 95%CI: 1.02 - 4.36). Perceived stress, smoking and hazardous alcohol consumption were not associated with clinically relevant depressive symptoms. Social capital plays an important role in explaining depressive symptoms among Brazilian university students. The study suggests that creating trust and enhancing participation in social networks can be an important strategy for promoting mental health among university students investigated in this study.

Resumo O estudo investigou a associação entre indicadores de capital social e sintomas depressivos entre estudantes universitários do Brasil. Um estudo transversal foi conduzido com uma amostra de 579 estudantes universitários selecionados randomicamente em 2018. Os estudantes completaram questionários auto-administrados para avaliar sintomas depressivos, indicadores de capital social e comportamentos de estilos de vida. Os dados foram analisados usando modelos de regressão logística multivariada. Indicadores de capital social incluíam confiança, associações em grupos, frequência de encontrar com os amigos, entre outros. Quatro indicadores de capital social se associaram significativamente com relevantes sintomas clínicos de depressão. Estudantes que disseram que as pessoas tendem a tirar mais vantagens umas das outras eram mais propensas a relatar sintomas clínicos relevantes de depressão (OR: 1.80, 95%CI: 1.00 - 3.23), assim como estudantes que relataram que as pessoas não estão dispostas a ajudar caso precise de ajuda (OR: 2.11, 95%CI: 1.02 - 4.36). A autopercepção de estresse, o consumo de álcool e o fumo não se associaram aos sintomas clínicos de depressão. O capital social desempenha um papel importante na explicação dos sintomas depressivos entre os universitários brasileiros. O estudo sugere que promover confiança e aumentar a participação nas redes sociais pode ser uma estratégia importante para a promoção da saúde mental entre os universitários investigados neste estudo.

Prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease: a review / Prevalência de manifestações clínicas sugestivas de depressão em pacientes portadores de doença falciforme: uma revisão

OBJECTIVE: To assess the prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease. METHODS: A systematic search was performed in the electronic databases PubMed® , LILACS and SciELO, with the following inclusion criteria: cross-sectional studies that assessed the prevalence of depression in patients with sickle cell disease, published in English or Portuguese in the last 10 years. The selection of the articles was performed in two stages by two independent researchers following the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) recommendations. The first stage consisted on screening the titles and abstracts, and in the second stage the full text was appraised, both following the pre-defined inclusion and exclusion criteria. RESULTS: From the 42 articles available, nine were included in this review. Seven instruments were used to screen for depression with different cutoff points, and the Patient Health Questionnaire-9 (PHQ-9) was the most used instrument. The worldwide prevalence of clinical manifestations suggestive of depression ranged from 11 to 40%, according to several variables. CONCLUSION: The prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease is higher compared to the prevalence of depression in the general population. Thus, the multidisciplinary follow-up for these people, with a focus on mental health, is of great importance.

OBJETIVO: Avaliar a prevalência mundial de manifestações clínicas sugestivas de depressão em portadores de doença falciforme. MÉTODOS: Realizou-se uma busca sistemática nas bases de dados eletrônicas PubMed® , LILACS e SciELO, para identificação dos estudos transversais, publicados em inglês ou português nos últimos 10 anos, que avaliaram a prevalência de depressão em portadores de doença falciforme. A seleção dos artigos foi realizada em duas etapas e por dois pesquisadores independentes seguindo a recomendação PRISMA (Preferred reporting items for systematic reviews and meta-analyses). A primeira etapa consistiu na triagem dos títulos e resumos e na segunda etapa foi realizada a análise completa do artigo, ambas seguindo os critérios de inclusão e exclusão predefinidos. RESULTADOS: Dos 42 artigos disponíveis, nove foram incluídos na revisão. Foram utilizados sete instrumentos diferentes para rastreio de depressão com diferentes pontos de corte, sendo The Patient Health Questionnaire-9 (PHQ-9) o instrumento mais utilizado. A prevalência mundial de manifestações clínicas sugestivas de depressão variou de 11% a 40%, conforme diversas variáveis verificadas. CONCLUSÃO: A prevalência de manifestações clínicas sugestivas de depressão encontrada para os portadores de doença falciforme é superior à prevalência de depressão descrita na população geral. Desse modo, é de suma importância o acompanhamento multidisciplinar para essas pessoas, com enfoque na saúde mental.

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

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

Psychological well-being in patients undergoing stem cell transplantation

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

Evaluation of psychological symptoms in patients before and after simultaneous pancreas-kidney transplantation: a single-center cross-sectional study

Purpose: Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking. Methods: Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT. Results: Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002). Conclusions: These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.

Measurement of depression in the Brazilian population: validation of the Patient Health Questionnaire (PHQ-8) / Mensuração da depressão na população brasileira: validação do Questionário de Saúde do Paciente (PHQ-8) / Medición de la depresión en la población brasileña: validación del Cuestionario de Salud del Paciente (PHQ-8)

We aimed to evaluate the psychometric properties of the Brazilian version of the Patient Health Questionnaire (PHQ-8). A study with a sample of 4,170 individuals (≥ 15 years old) from the urban area. Conglomerate sampling was adopted in two stages (census sectors and streets), with weighting of estimates by sample weights. A structured questionnaire with sociodemographic data, the PHQ - the modules for depression, generalized anxiety disorder and panic disorder - and the Self-Reporting Questionnaire (SRQ-20) were used. In the evaluation of the PHQ-8, we verified the construct validity by analyzing the dimensional structure, convergent validity and internal consistency. We found a linear disorder without losses to maintain the four response categories. The factor analysis found unidimensionality of the depression construct, with strong factor loads, low residual variances, low residual correlation between items, good fit of the model, internal consistency and satisfactory convergent factorial validity (high loads and correlations with other tests/scales of similar constructs). The PHQ-8 has a one-dimensional structure with evidence of good validity and reliability, being suitable for use in the Brazilian population.

O objetivo deste estudo foi avaliar as propriedades psicométricas da versão brasileira do Questionário de Saúde do Paciente (Patient Health Questionnaire; PHQ-8). Realizamos um estudo com uma amostra de 4.170 indivíduos (≥ 15 anos) em área urbana. A amostragem por conglomerado foi adotada em duas etapas (setores censitários e ruas) com ponderação das estimativas por pesos amostrais. Foi utilizado questionário estruturado com dados sociodemográficos, o PHQ - com módulos para depressão, transtorno de ansiedade generalizada e transtorno do pânico - e o Questionário de Autorrelato (Self-Reporting Questionnaire; SRQ-20). Uma desordem linear sem perdas foi encontrada para manter as quatro categorias de resposta. A análise fatorial revelou unidimensionalidade do construto depressão com cargas fatoriais fortes, baixas variâncias residuais, baixa correlação residual entre os itens, bom ajuste do modelo, consistência interna e validade fatorial convergente satisfatória e altas correlações com outros instrumentos de construtos semelhantes. O PHQ-8 possui estrutura unidimensional com evidência de boa validade e confiabilidade, sendo adequado para uso na população brasileira.

El objetivo de este estudio fue evaluar las propiedades psicométricas de la versión brasileña del Cuestionario de Salud del Paciente (Patient Health Questionnaire; PHQ-8). Se trata de un estudio con una muestra de 4.170 individuos (≥ 15 años) en un área urbana. El muestreo por conglomerados fue adoptado en dos etapas (sectores censuales y calles) con ponderación de las estimaciones por pesos muestrales. Los instrumentos utilizados fueron un cuestionario estructurado con datos sociodemográficos, el PHQ -con módulos para depresión, trastorno de ansiedad generalizada y trastorno de pánico- y el Cuestionario de Autoinforme (Self-Reporting Questionnaire; SRQ-20). Al evaluar el PHQ-8 se verificó la validez de su construcción a través de su estructura dimensional, validez convergente y consistencia interna. Se encontró un desorden lineal sin pérdidas para mantener las cuatro categorías de respuesta. El análisis factorizado encontró unidimensionalidad del constructo depresión con fuertes cargas factoriales, bajas varianzas residuales, baja correlación residual entre ítems, buen ajuste del modelo, consistencia interna y satisfactoria validez factorial convergente (altas cargas y correlaciones con otras pruebas/escalas de constructos similares). El PHQ-8 tiene una estructura unidimensional con evidencia de buena validez y confiabilidad, y es adecuado para su uso en la población brasileña.

Limites e possibilidades de agentes comunitários de saúde na identificação de sintomas depressivos / Límites y posibilidades de los agentes comunitarios de salud en la identificación de síntomas depresivos / Limitations and possibilities of community health workers in identifying depressive symptoms

RESUMO Objetivo: avaliar o conhecimento de agentes comunitários de saúde sobre identificação de sintomas depressivos na comunidade. Método: trata-se de pesquisa qualitativa, realizada em Unidade Básica de Saúde, em Teresina, Piauí, Brasil, com 15 agentes comunitários de saúde. Utilizou-se o método da Pesquisa-Ação. A produção dos dados aconteceu em janeiro e fevereiro de 2019, por meio de dois seminários temáticos, pautados no Método Criativo Sensível. Os discursos foram submetidos à análise temática. Resultados: agentes comunitários de saúde reconhecem os sintomas depressivos por tristeza, choro, isolamento, anedonia e solidão, manifestados pelos indivíduos. Os limites para essa identificação, relatados pelos profissionais, foram dificuldade de acesso aos usuários e às famílias e estigma e preconceito com a depressão. Quanto às possibilidades, destacaram-se acesso à informação sobre a temática pela mídia, diálogo/conversa estabelecido entre usuário e profissional e acesso à rede de apoio. Considerações finais: conclui-se que o reconhecimento, as limitações e as possibilidades de identificação de sintomas depressivos por esses profissionais refletem no diagnóstico, planejamento e implementação de ações no cuidado em saúde mental de forma precoce e segura.

RESUMEN Objetivo: evaluar el conocimiento de agentes comunitarios de salud sobre identificación de síntomas depresivos en la comunidad. Método: se trata de investigación cualitativa, realizada en Unidad Básica de Salud, en Teresina, Piauí, Brasil, con 15 agentes comunitarios de salud. Se utilizó el método de Investigación-acción. La producción de los datos tuvo lugar en enero y febrero de 2019, a través de dos seminarios temáticos, de acuerdo con el Método Creativo-sensible. Los discursos fueron sometidos al análisis temático. Resultados: Los agentes comunitarios de salud reconocen los síntomas depresivos por tristeza, llanto, aislamiento, anhedonia y soledad, manifestados por los individuos. Los límites para esa identificación, relatados por los profesionales, fueron dificultad de acceso a los usuarios y a las familias y estigma y prejuicio con la depresión. En cuanto a las posibilidades, se destacaron acceso a la información sobre la temática por los medios, diálogo/conversación establecido entre usuario y profesional y acceso a la red de apoyo. Consideraciones finales: se concluye que el reconocimiento, las limitaciones y las posibilidades de identificación de síntomas depresivos por parte de estos profesionales reflejan en el diagnóstico, la planificación e implementación de acciones en el cuidado en salud mental de forma precoz y segura.

ABSTRACT Objective: to evaluate the knowledge of community health workers about the identification of depressive symptoms in the community. Method: this is a qualitative research, conducted in a Primary Health Care Unit in Teresina, Piauí, Brazil, with 15 community health workers. We used the Action-Research method. Data production took place in January and February 2019, through two thematic seminars, guided by the Creative Sensitive Method.The speeches were submitted to thematic analysis. Results: community health workers recognize the depressive symptoms by means of sadness, crying, isolation, anhedonia and loneliness, manifested by individuals. The limitations to this identification, reported by professionals, were difficulty of access to users and families, as well as stigma and prejudice against depression. As for the possibilities, access to information about the theme through the media, dialogue/conversation established between users and professionals, besides access to a support network, were highlighted. Final considerations: we conclude that the recognition, limitations and possibilities of identification of depressive symptoms by these professionals are reflected in the diagnosis, planning and implementation of actions in mental health care in an early and safe way.