DSM-5 latent classes of alcohol users in a population-based sample: results from the São Paulo Megacity Mental Health Survey, Brazil.

BACKGROUND: We aimed to identify different categorical phenotypes based upon the DSM-V criteria of alcohol use disorders (AUD) among alcohol users who had at least one drink per week in the past year (n=948). METHODS: Data are from the São Paulo Megacity Mental Health Survey collected in 2005-2007, as part of the World Mental Health Survey Initiative. A latent class analysis of the 11 DSM-5-AUD criteria was performed using Mplus, taking into account complex survey design features. Weighted logistic regression models were used to examine demographic correlates of the DSM-5-AUD latent classes. RESULTS: The best latent-class model was a three-class model. We found a "non-symptomatic class" (69.7%), a "use in larger amounts class" (23.2%), defined by high probability (>70%) of the "use in larger amounts" criterion only, and a "high-moderate symptomatic class" (7.1%), defined by high-moderate probability of all the 11 AUD criteria. Compared to those in the non-symptomatic class, individuals in the "high-moderate symptomatic class" were more likely to have been married, have lower educational attainment and to be unemployed or in non-regular/informal employment. Those on the "use in larger amounts class" were more likely to have been married or never married. CONCLUSION: The two symptomatic classes clearly represented the dimensionality of the new proposed AUD criteria, and could be more specifically targeted by different prevention or treatment strategies. DSM-5-AUD has the advantage of shedding light on risky drinkers included in the "use in larger amounts class", allowing for preventive interventions, which will reach a large number of individuals.

Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey.

BACKGROUND: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. METHODS: Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. RESULTS: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. LIMITATIONS: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. CONCLUSIONS: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.

Does ragging play a role in medical student depression - cause or effect?

BACKGROUND: Medical students experience a lot of stress what may contribute to symptoms of depression. In this study we set out to look at the environmental factors which may be contributing in one medical school in Brazil. METHODS: We assessed depressive symptoms using Beck's Depression Inventory in 465 and 267 medical students in 2001 and 2006 respectively. We explored possible social and environmental causes using qualitative data. RESULTS: Nearly 15% scored above the cut off for depression in both the samples. Males in the pre-clinical stage in 2006 showed an increase in depressive symptoms than males in the same cycle in 2001 (aOR=7.36 [95% CI=0.85-63.5] p=0.07). Qualitative data confirmed that factors such as ragging and low social involvement were correlated with depressive symptoms in pre-clinical stage males. LIMITATIONS: The sample size was small both for quantitative and qualitative aspects of the study. CONCLUSIONS: It appears that ragging plays an important role in the genesis of depressive symptoms in medical students.

Mental disorders in megacities: findings from the São Paulo megacity mental health survey, Brazil.

BACKGROUND: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. METHODS AND RESULTS: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. DISCUSSION: Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Psychiatry: life events and social support in late life depression.

OBJECTIVES: To examine the association of life events and social support in the broadly defined category of depression in late life. INTRODUCTION: Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil. METHODS: We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. ''Old age symptomatic depression'' was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed ''late subthreshold depression''. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE) inventory. RESULTS: ''Old age symptomatic depression'' occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, ''old age symptomatic depression'' was associated with a perceived lack of social support in men and life events in women. DISCUSSION: Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance. CONCLUSIONS: We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.

Psychiatry: life events and social support in late life depression

OBJECTIVES: To examine the association of life events and social support in the broadly defined category of depression in late life. INTRODUCTION: Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil. METHODS: We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. ''Old age symptomatic depression'' was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed ''late subthreshold depression''. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE) inventory. RESULTS: ''Old age symptomatic depression'' occurred in 18.8 percent of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, ''old age symptomatic depression'' was associated with a perceived lack of social support in men and life events in women. DISCUSSION: Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance. CONCLUSIONS: We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.

Suicidal ideation among students enrolled in healthcare training programs: a cross-sectional study / Ideação suicida entre estudantes da área da saúde: um estudo transversal

Objective: We aimed to assess the presence of suicidal ideation, depressive symptoms and symptoms of hopelessness in three healthcare training programs. Method: The study's population comprised all students enrolled at the Medical School of the Fundação do ABC, Brazil, from 2006 to 2007 compared to students enrolled in nursing and pharmacy programs. We applied the Beck Scale for Suicidal Ideation, the Beck Depression Inventory and the Beck Hopeless Scale to assess psychiatric symptomatology. The general response rates of the medical, nursing, and pharmacy students were 56 percent, 56 percent and 61 percent, respectively. Results: There was no difference regarding the presence of suicidal ideation among medical, nursing and pharmacy students. There was also no difference regarding the presence of either depression or hopelessness in medical students in comparison to nursing and pharmacy students. In comparison to nursing and pharmacy students, significantly higher severity rates in terms of hopelessness were observed only among medical students. Conclusion: Although we did not observe significant differences regarding suicidal ideation and depression among the three healthcare programs, our findings suggest that the presence of suicidal ideation is indeed a source of concern. Early identification of these symptoms is crucial in order to offer appropriate support and treatment and prevent deaths by suicide.

Objetivo: Objetivou-se avaliar a presença de ideação suicida, sintomas depressivos e sintomas de desesperança entre três cursos da área da saúde. Método: A população do estudo consistiu de todos os estudantes de medicina matriculados na Faculdade de Medicina da Fundação do ABC, Brasil, durante 2006 e 2007, comparados com os alunos matriculados nos cursos de enfermagem e farmácia. Aplicamos a Escala de Ideação Suicida de Beck, o Inventário de Depressão de Beck e a Escala de Desesperança de Beck para avaliar sintomatologia psiquiátrica. A taxa de resposta entre os estudantes de medicina, enfermagem e farmácia foi de 56 por cento, 56 por cento e 61 por cento, respectivamente. Resultados: Não houve diferença em relação à presença de ideação suicida entre os estudantes de medicina, enfermagem e farmácia. Também não houve diferença em relação à presença de depressão ou desesperança nos estudantes de medicina em comparação com os alunos de enfermagem e farmácia. Taxas de gravidade significativamente mais elevadas foram observadas apenas em desesperança entre os estudantes de medicina em comparação com os alunos de enfermagem e farmácia. Conclusão: Embora não tenhamos observado diferenças significativas entre os três cursos da área da saúde com relação à ideação suicida e depressão, a presença de ideação suicida é um achado preocupante. A identificação precoce destes sintomas é fundamental, de modo a se oferecer apoio e tratamento adequados e prevenir mortes por suicídio.

Suicidal ideation among students enrolled in healthcare training programs: a cross-sectional study.

OBJECTIVE: We aimed to assess the presence of suicidal ideation, depressive symptoms and symptoms of hopelessness in three healthcare training programs. METHOD: The study's population comprised all students enrolled at the Medical School of the Fundação do ABC, Brazil, from 2006 to 2007 compared to students enrolled in nursing and pharmacy programs. We applied the Beck Scale for Suicidal Ideation, the Beck Depression Inventory and the Beck Hopeless Scale to assess psychiatric symptomatology. The general response rates of the medical, nursing, and pharmacy students were 56%, 56% and 61%, respectively. RESULTS: There was no difference regarding the presence of suicidal ideation among medical, nursing and pharmacy students. There was also no difference regarding the presence of either depression or hopelessness in medical students in comparison to nursing and pharmacy students. In comparison to nursing and pharmacy students, significantly higher severity rates in terms of hopelessness were observed only among medical students. CONCLUSION: Although we did not observe significant differences regarding suicidal ideation and depression among the three healthcare programs, our findings suggest that the presence of suicidal ideation is indeed a source of concern. Early identification of these symptoms is crucial in order to offer appropriate support and treatment and prevent deaths by suicide.

Hypotension caused by therapeutic doses of venlafaxine: case report and proposed pathophysiological mechanisms.

Although venlafaxine is usually associated with modest increases in blood pressure and not so often clinical hypertension, there are a few reported cases of hypotension related to overdoses of this specific antidepressant. The case study of a young female patient with a history of Major Depressive Disorder who initiated treatment with venlafaxine 75 mg/day and developed hypotension when the dosage was titrated up to 225 mg/day is described. The patient did not present comorbid diseases nor use other medication. A temporal association and a dose-dependent relationship between the hypotension and the use of venlafaxine is shown. To the best of the knowledge of the authors,this is the first case report that specifically associates regular doses of venlafaxine with the presence of hypotension. A pathophysiological mechanism is proposed, involving the participation of presynaptic alpha2-adrenergic receptors and the presence of a possible genetic polymorphism of cytochrome P4502D6, which is associated with lower drug metabolization, to explain the relationship between venlafaxine in regular dosage and development of hypotension.