Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population.

OBJECTIVES: To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population. METHODS: Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated. RESULTS: The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity. CONCLUSION: The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

Abstract Objectives To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population. Methods Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated. Results The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity. Conclusion The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

Possibilidades de focos de intervenção na saúde mental da população oncológica durante a pandemia da Covid-19 / Possibilities of intervention focuses on the mental health of the oncology population during the Covid-19 pandemic

A pandemia da Covid-19 trouxe uma série de problemas envolvendo a saúde pública. Dentre essas, a saúde mental de populações específicas ficaram prejudicadas, fazendo com que se tornasse analisar focos de intervenções específicas para as mesmas. Dentre estas, os pacientes oncológicos se mostram mais vulneráveis ao desenvolvimento de problemas em saúde mental durante a pandemia, necessitando que sejam pensadas intervenções efetivas e focais para o seu cuidado. Essa carta tem como objetivo alertar os profissionais de saúde mental a respeito do tema e dar uma breve orientação sobre o foco necessário de cuidado.(AU)

The Covid-19 pandemic brought a series of problems involving public health. Among these, the mental health of specific populations was impaired, making it necessary to analyze foci of specific interventions for them. Among these, cancer patients are more vulnerable to the development of mental health problems during the pandemic, requiring effective and focused interventions for their care. This letter aims to alert mental health professionals about the topic and give brief guidance on the necessary focus of care.(AU)

La pandemia de Covid-19 trajo una serie de problemas relacionados con la salud pública. Entre estos, la salud mental de poblaciones específicas se vio afectada, por lo que fue necesario analizar focos de intervenciones específicas para ellos. Entre estos, los pacientes con cáncer son más vulnerables al desarrollo de problemas de salud mental durante la pandemia, lo que requiere intervenciones efectivas y enfocadas para su atención. Esta carta tiene como objetivo alertar a los profesionales de la salud mental sobre el tema y brindar una breve guía sobre el enfoque necesario de la atención.(AU)

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19.

The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.

A behavioral economic risk aversion experiment in the context of the COVID-19 pandemic.

We investigated what degree of risk of infection with COVID-19 is necessary so that people intend to stay home, even when doing so means losing their salary. We conducted an online survey across Brazil during the initial outbreak, in which 8,345 participants answered a questionnaire designed to identify the maximum tolerated risk (k') necessary for them to disregard social distancing recommendations and guarantee their salaries. Generalized linear mixed models, path analysis structural equation, and conditional interference classification tree were performed to further understand how sociodemographic factors impact k' and to establish a predictive model for the risk behavior of leaving home during the pandemic. We found that, on average, people tolerate 38% risk of infection to leave home and earn a full salary, but this number decreased to 13% when the individual risk perception of becoming ill from severe acute respiratory syndrome coronavirus-2 is considered. Furthermore, participants who have a medium-to-high household income and who are older than 35 years are more likely to be part of the risk-taking group who leave home regardless of the potential COVID-19 infection level; while participants over 45 years old and with good financial health are more likely to be part of the risk-averse group, who stay home at the expense of any salary offered. Our findings add to the political and public debate concerning lockdown strategies by showing that, contrary to supposition, people with low socioeconomic status are not more likely to ignore social distancing recommendations due to personal economic matters.

Aspectos do luto em familiares de mortos em decorrência da Covid-19 / Aspects of grief in family members of the dead as a result of Covid-19

A pandemia de Covid-19 tem gerado efeitos nocivos na saúde mental da população. Isso pode ser especialmente preocupante em pessoas que perderam familiares em decorrência da doença. Este estudo teve como objetivo compreender as particularidades do processo de luto diante da crise ocasionada pela Covid-19. Trata-se de uma pesquisa documental qualitativa que analisou reportagens publicadas entre março e abril de 2020 - período posterior a primeira morte registrada no Brasil - em cinco mídias de grande circulação. Os materiais foram selecionados por dois pesquisadores, e a análise de conteúdo foi realizada pelo método de Bardin. Cinco categorias de análise foram identificadas: Desafios de uma experiência nova e urgente, preconceito decorrente do contato com doentes, sentimentos, formas de enfrentamento e rituais funerários. Manifestações de revolta diante da minimização da doença por autoridades foram frequentes, bem como queixas relacionadas a organização do sistema de saúde, inexistência de fluxos e desinformação dos profissionais. Diante da disseminação de Fake News, foram observados relatos de hostilizações em redes sociais e o afastamento de pessoas conhecidas, gerando solidão. O medo de estar contaminado e de transmitir para outras pessoas também foi recorrente. Ainda, notou-se que a impossibilidade de acompanhar o familiar morto durante a internação e as limitações dos rituais foram associados a culpa e tristeza. É possível que a experiência do luto seja intensificada diante das peculiaridades que permeiam o processo de morte decorrente da Covid-19, sobretudo nos primeiros meses da pandemia. Tendo em vista que os efeitos na saúde mental da população podem ser mais duradouros do que a pandemia, é fundamental que investigações sejam realizadas e estratégias de suporte desenvolvidas.(AU)

The Covid-19 pandemic has had harmful effects on the populations mental health. This can be worrisome in people who have lost family members to Covid-19. This study aims to understand the particularities of the mourning process during the crisis caused by Covid-19. This is a qualitative documentary research that analyzed reports published between March and April 2020 - a period after the first recorded death in Brazil - in five large-circulation media. The materials were selected by two researchers, and content analysis was performed using the Bardin method. Five categories of analysis were identified: Challenges of a new and urgent experience, prejudice resulting from contact with patients, feelings, forms of confrontation and funeral rituals. Manifestations of anger at the authorities minimization of the disease were frequent, as well as complaints related to the organization of the health system, lack of flows and lack of information from professionals. Faced with the spread of Fake News, reports of harassment on social networks and the removal of known people were observed, generating loneliness. The fear of being contaminated and of transmitting it to other people was also recurrent. Furthermore, it was noted that the impossibility of accompanying the deceased family member during hospitalization and the limitations of the rituals were associated with guilt and sadness. It is possible that the experience of grief is intensified given the peculiarities that permeate the process of death resulting from Covid-19, especially in the first months of the pandemic. Considering that the effects on the populations mental health can be more lasting than the pandemic, it is essential that investigations are carried out and support strategies developed.(AU)

La pandemia de Covid-19 ha tenido efectos nocivos en la salud mental de la población. Esto puede ser preocupante en personas que han perdido a familiares a causa de Covid-19. Este estudio tuvo como objetivo comprender las particularidades del proceso de duelo ante la crisis provocada por el Covid-19. Se trata de uma investigación documental cualitativa que analizó informes publicados entre marzo y abril de 2020, un período posterior a la primera muerte registrada en Brasil. Los materiales fueron seleccionados y el análisis de contenido se realizó mediante el método Bardin. Se identificaron cinco categorías de análisis: Desafíos de una experiência nueva y urgente, Prejuicios derivados del contacto con los pacientes, Sentimientos, Formas de enfrentamiento y Ritos funerarios. Fueron frecuentes las manifestaciones de enfado por la minimización de la enfermedad por las autoridades, así como las quejas relacionadas con el sistema de salud, la falta de flujos y la falta de información por parte de los profesionales. Ante la difusión de Fake News, se observaron denuncias de hostigamiento en redes sociales y el alejamiento de personas conocidas, generando soledad. Además, se observó que la imposibilidad de acompañar al familiar fallecido durante la hospitalización y las limitaciones de los rituales se asociaron con la culpa y la tristeza. Es posible que la experiencia del duelo se intensifique dadas las peculiaridades que permean el proceso de muerte resultante del Covid-19, especialmente en los primeros meses de la pandemia. Considerando que los efectos en la salud mental de la población pueden ser más duraderos que la pandemia, es fundamental que se realicen investigaciones y se desarrollen estrategias de apoyo.(AU)

Features of Immunosenescence in Women Newly Diagnosed With Breast Cancer.

Adults exposed to childhood maltreatment have increased stress reactivity. This profile is associated with dysregulation of the immune system, including enhanced inflammatory reactions and accelerated senescence. Subjects exposed to ear stress have increased risk for several age-related diseases, including cardiovascular disease, type II diabetes, and cancer. Although previous studies have reported immune changes in advanced cancer, very little information is available regarding early stage breast cancer. Here, 29 patients with breast cancer were recruited: 15 with history of childhood maltreatment (CM+) and 14 without history (CM-). Twenty-seven healthy women without CM were selected as the control group. Peripheral blood was collected and lymphocyte subsets phenotyped by multi-color flow cytometry (B cells, CD4+ T, CD8+ T, natural killer cells, activated T cells, regulatory T cells, and senescence-associated T cells). Because human cytomegalovirus (CMV) was associated with signatures of early senescence, the CMV serology was determined by ELISA. None of the subjects had IgM reactivity to CMV, excluding acute viral infection. There was a higher proportion of patients with increased CMV IgG levels in the CM+ group as compared to CM- or controls. Different stages of T-cell differentiation can be determined based on the cell-surface expression of the costimulatory molecules CD27 and CD28: ear (CD27+CD28+), intermediate-differentiated (CD27-CD28+), and late-differentiated or senescent T cells (CD27-CD28-). After adjusting for age and education, ear T cells (CD27+CD28+) were found reduced in CM+ and CM- patients (p < 0.0001). In contrast, intermediate-differentiated T cells (CD27-CD28+; p < 0.0001), senescent T cells (CD27-CD28-; p < 0.0001), and exhausted T cells (CD8+CD27-CD28-PD1+; p < 0.0001) were found expanded in both CM+ and CM- groups. Our data suggest that features of immunosenescence are associated with newly diagnosed breast cancer, regardless of the CM history.

The childhood maltreatment influences on breast cancer patients: A second wave hit model hypothesis for distinct biological and behavioral response.

Stress and cancer are two complex situations involving different biological and psychological mechanisms. Their relationship have long been studied, and there is evidence of the impact stress has on both, development and disease progression. Furthermore, early stress has been studied as an important factor associated to this relationship, since its impacts on the immune, endocrine and cognitive development throughout life is already known. Therefore, understanding early stress as a first wave of stress in life is necessary in order to explore a possible second wave hit model. From this perspective, we believe that breast cancer can be understood as a second wave of stress during development and that, in addition to the first wave, can cause important impacts on the response to cancer treatment, such as increased chances of disease progression and distinct behavioral responses. In this article we propose a second wave hit hypothesis applied to breast cancer and its implications on the immune, endocrine and cognitive systems, through mechanisms that involve the HPA axis and subsequent activations of stress responses.

Avaliação da tomada de decisão de pais frente ao tratamento oncológico pediátrico / Evaluation of parents' decision-making in oncologic pediatric treatment / Evaluación del toma de decisiones de los padres en tratamiento pediátrico oncológico

Introdução: A tomada de decisão frente a um tratamento oncológico pediátrico merece um foco de atenção vista a quantidade de decisões que os pais enfrentam durante esse processo, podendo gerar muitas vezes desconfortos emocionais, dúvidas, incertezas e angústias. Dessa forma, avaliar como a equipe de saúde influencia na decisão dos pais se apresenta como fator importante para poder se entender o quanto de autonomia eles possuem para poderem escolher diante das inúmeras possibilidades advindas do tratamento. Objetivo: Avaliar o processo de tomada de decisão de pais frente ao tratamento oncológico de seus filhos, analisando a percepção de coerção, nível de desenvolvimento psicológico moral e outras dificuldades existentes. Métodos: Foram selecionados dez participantes por conveniência para realizar uma entrevista semiestruturada individual e foram aplicadas a Escala de Percepção de Coerção em Assistência e a Escala de Desenvolvimento Psicológico-Moral. Utilizou-se o método da análise de conteúdo de Bardin para se realizar a categorização das falas dos participantes. Resultados: Nove mães e um pai foram entrevistados (n=10), com média de idade de 33,1 anos. Foram identificadas seis categorias a partir da análise de conteúdo oriundas da temática central. Verificou-se não haver percepção de coerção pelos pais e todos demonstraram nível psicológico-moral adequado para tomarem decisões. Conclusão: Observou-se que, apesar de dificuldades emocionais, os pais se mostraram capazes de decidir questões relacionadas ao tratamento de seus filhos, tendo autonomia o suficiente para a tomada de decisão.

Introduction: Decision-making when facing a pediatric cancer treatment deserves a spotlight due to the amount of decisions that parents must deal with during this process, which may often generate emotional stress, doubts, uncertainties and anxieties. Thus, assessing how the health team influences the decision of parents is an important factor to evaluate how much autonomy they have to be able to choose on the numerous possibilities resulting from the treatment. Objective: To evaluate parents' decision-making process in oncologic pediatric treatments and to analyze the perception of coercion, the level of moral-psychological development and other difficulties. Method: 10 participants were selected by convenience to conduct individual semi-structured interviews, applying the Scale of Perception of Coercion in Assistance and the Moral-Psychological Scale. Results: Nine mothers and one father were interviewed (n = 10), with an average age of 33.1 years. Six categories were identified from the analysis of content originated from the central theme. There was no perception of coercion by parents and all have shown psychological and moral levels suitable for decision-making. Conclusion:It was observed that, in spite of emotional difficulties, parents have proved ableto decide on issues related to the treatment of their children, having enough autonomy for decision-making.

El frente de la toma de decisiones a un tratamiento de cáncer pediátrico merece un foco de atención a la cantidad de decisiones que enfrentan los padres durante este proceso y con frecuencia puede generar malestares emocionales, dudas, incertidumbres y ansiedades. Por lo tanto, para evaluar el equipo de salud influye en la decisión de los padres se presenta como un factor importante para entender el grado de autonomía que tienen que ser capaces de elegir en las numerosas posibilidades que resultan del tratamiento. Objetivo: Evaluación de toma de decisiones de los padres sobre sus hijos el tratamiento pediátrico oncológico, Evaluación de la percepción de la coacción, el nivel de desarrollo psicológico moral y otras dificultades existentes. Método: Por conveniencia, diez participantes fueron seleccionados para responder a la entrevista semiestructurada individual, aplicando la escala de percepción de coerción de Asistencia y la Escala de Desarrollo moral psicológica. Resultados:Se entrevistaron a nueve madres y un padre (n = 10), con una edad media de 33,1 años. Se identificaron seis categorías de contenido de origen a partir del análisis temático central. Había la percepción de coacción por parte de los padres y todo a nivel psicológico y moral Mostró apropiado tomar decisiones. Conclusión:Se observó que, a pesar de las dificultades emocionales, los padres han demostrado ser capaces de decidir cuestiones relacionadas con el tratamiento de sus hijos, que tienen la suficiente autonomía para la toma de decisiones.