ABSTRACT
PURPOSE: Depression currently affects 350 million people, and its prevalence among adolescents is 4% to 8%. Adolescents who abandon antidepressant treatment or drop out of clinical trials are less likely to recover or experience a remission of symptoms because they are not being followed up by a medical team. The objective of this study was to analyze the dropout rates of randomized clinical trials of depressed adolescents receiving treatment with antidepressant drugs and the factors associated with nonadherence by summarizing this information in a systematic review and meta-analysis. METHODS: Articles were retrieved from MEDLINE, EMBASE, Cochrane, Clinical Trial, PsycINFO, and Web of Science using the MeSH terms "depressive disorder," "randomized trials," and "adolescents." The evaluation of study quality was performed by using the Cochrane Handbook for Systematic Reviews of Interventions and the Jadad scale. FINDINGS: The final sample included 50 articles, of which 44 presented dropout rates. The overall dropout prevalence was 23% (95% CI, 20-27; P < 0.0001). Participants aged ≥16 years, those treated with serotonin norepinephrine reuptake inhibitors, and those receiving medication only exhibited the highest dropout prevalence, respectively (33% [95% CI, 27-39], 45% [95% CI, 31-64], and 15% [95% CI, 13-17]). The adverse effects most associated with dropout were attempted suicide followed by mania, skin rash, and headache. Problems relating to clinical trials and family arbitration were also related with dropout. IMPLICATIONS: Serotonin/norepinephrine reuptake inhibitor treatment, adolescent age >16 years, and receiving medication were the only factors demonstrating a higher association with dropout rates. Selective serotonin reuptake inhibitors were linked to the lowest prevalence, probably due to fewer perceived problems with related adverse effects and higher efficacy in adolescents. Cognitive-behavioral therapy combined with pharmacotherapy produced a lower nonadherence prevalence; this approach can be an alternative to avoid dropouts and relapse. Prospero identifier: CRD42014013475.
Subject(s)
Antidepressive Agents/therapeutic use , Depression/therapy , Patient Dropouts/statistics & numerical data , Randomized Controlled Trials as Topic , Adolescent , Antidepressive Agents/adverse effects , HumansABSTRACT
A relação entre drogas e suicídio é apontada como causal, porém alguns autores defendem a perspectiva que a presença de substância é um fator de risco. Portanto é importante nos serviços voltados aos dependentes químicos explorar o risco de suicídio para medidas preventivas. Pensando nisso foi realizado um estudo transversal no Ligue 132, para descrever as informações disponível relacionadas a situações de suicídio e a disponibilidade de serviços públicos para o atendimento desses casos. Em 2011 foi encontrado 77 casos com menções de suicídio. A substância mais envolvida foi o álcool. Entre os sujeitos que identificaram o município de onde estavam falando 64% possuía algum formato de CAPS. Ha necessidade de mais estudos para investigar o uso de telemedicina para o atendimento de casos de suicídio assim como uma descrição mais detalhada desses casos para compreensão melhor das causas.(AU)
The relationship between drugs and suicide is pointed out as causal, but some authors defend the perspective that the presence of substance is a risk factor. Therefore, it is important in services for the dependents to explore the risk of suicide for preventive measures. With this in mind, a cross-sectional study was carried out in Ligue 132, to describe the available information related to suicide situations and the availability of public services to attend these cases. In 2011, 77 cases of suicide were found. The most involved substance was alcohol. Among the subjects that identified the municipality where they were speaking 64% had some form of CAPS. There is a need for further studies to investigate the use of telemedicine for the treatment of suicide cases as well as a more detailed description of these cases for a better understanding of the causes.(AU)
Subject(s)
Humans , Telemedicine , Substance-Related Disorders , Suicidal Ideation , Suicide , Drug Users , Mental Health ServicesABSTRACT
Usuários de drogas tendem a ser mais depressivos do que não usuários. O objetivo deste estudo foi investigar os fatores de risco para episódios e sintomas depressivos em usuários de álcool e ou cocaína/crack que procuraram um serviço de telemedicina. Realizou-se um estudo transversal (n=838) com aplicação do Inventário de Depressão de Beck para mensuração dos sintomas depressivos e o Mini-International Neuropsychiatric Interview para episódio depressivo atual nos usuários no acompanhamento telefônico para cessação do consumo de drogas. O principal fator de risco entre os usuários para sintomas depressivos foi baixa escolaridade (OR=1,4 IC 95%:1,1-2,2). Para o episódio depressivo atual o maior risco entre os usuários foi ser do sexo feminino (OR=1,5 IC 95%:1,0-2,4). O consumo de crack estava associado a episódio depressivo atual (p=0,014). O uso do telefone é viável para detecção de fatores de risco para episódios e sintomas depressivos nos usuários de álcool e ou cocaína/crack. (AU)
Drug users tend to be more depressed than non-users. The aim of this study was to investigate the risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack that called for the telemedicine service. We conducted a cross- sectional study (n = 838) with application of the Beck Depression Inventory to Measure depressive symptoms and the Mini International Neuropsychiatric Interview for current depressive episode in users on the telephone follow-up to cessation of drug use. The main risk factor among users for depressive symptoms was lower education (OR = 1.4; 95% CI: 1.1-2.2). For the current depressive episode the greatest risk among users was being female (OR = 1.5; 95% CI: 1.0-2.4). The crack use was associated with current depressive episode (p = 0.014). The use of the phone is feasible to detect risk factors for episodes and depressive symptoms in users of alcohol and or cocaine/crack.(AU)
Subject(s)
Humans , Telemedicine , Substance-Related Disorders , Depression , Drug Users , Crack Cocaine , Depressive Disorder , AlcoholismABSTRACT
Death by suicide is now the third most frequent cause of death in the population 15-44 years old. This self-inflicted death has meaning that requires understanding and attention. The objective of this study was to understand the experiences and feelings of cocaine users within the relationship of addiction and suicide. This is a qualitative study conducted from August 2012 to February 2013. The 18 individuals who met criteria for a depressive episode responded to the semi-structured interview for suicide risk, the Mini International Neuropsychiatric Interview. During the analysis of the narrated content, there were three categories established: previous history, previous suicide attempts, and depression. The results were evaluated seeking to reflect and understand the experiences exposed by users. This study helps to understand the meaning of the experiences and feelings of crack/cocaine users who are at the risk for suicide...
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Middle Aged , Depression , Suicide , Opioid-Related DisordersABSTRACT
Death by suicide is now the third most frequent cause of death in the population 15-44 years old. This self-inflicted death has meaning that requires understanding and attention. The objective of this study was to understand the experiences and feelings of cocaine users within the relationship of addiction and suicide. This is a qualitative study conducted from August 2012 to February 2013. The 18 individuals who met criteria for a depressive episode responded to the semi-structured interview for suicide risk, the Mini International Neuropsychiatric Interview. During the analysis of the narrated content, there were three categories established: previous history, previous suicide attempts, and depression. The results were evaluated seeking to reflect and understand the experiences exposed by users. This study helps to understand the meaning of the experiences and feelings of crack/cocaine users who are at the risk for suicide.(AU)
A morte por suicdio passou a ocupar a terceira posio entre as mais frequentes na populao de 15 a 44 anos de idade. A morte autoinfligida possui significados que requerem compreenso e ateno. O objetivo deste estudo foi conhecer as vivncias e os sentimentos dos usurios de cocana dentro da relao dependncia qumica e suicdio. Este um estudo qualitativo, realizado de agosto de 2012 a fevereiro de 2013. Os 18 indivduos que preencheram os critrios para episdio depressivo responderam entrevista semiestruturada para risco de suicdio, pelo Mini International Neuropsychiatric Interview. Na anlise dos contedos narrados, estabeleceram-se trs categorias: histria pregressa, tentativas de suicdio e depresso. Os resultados foram avaliados procurando refletir e compreender as vivncias expostas pelos usurios. Este estudo auxilia a compreenso dos significados das vivncias e sentimentos dos usurios de cocana/crack ante o risco de suicdio.(AU)
La muerte por suicidio paso a ocupar la tercera posicin entre las causas mas frecuentes en la poblacin de 15 a 44 aos de edad. La muerte autoinflingida posee significados que requieren comprensin y atencin . El objetivo de este estudio fue conocer las vivencias y los sentimientos de los usuarios de cocana dentro de la relacin de dependencia qumica y suicidio. Este es un estudio cualitativo, realizado entre agosto del 2012 y febrero del 2013. Los 18 individuos que cumplieron con los criterios para episodio depresivo respondieron a una entrevista semiestructurada para el riesgo de suicidio, por el Mini International Neuropsychiatric Interview. En el anlisis de los contenidos narrados, se establecieron tres categoras: historia anterior, tentativas de suicidio y depresin. Los resultados fueron evaluados procurando reflexionar y comprender las vivencias expuestas por los usuarios. Este estudio apoya la comprensin de significados de las vivencias y sentimientos de los usuarios de cocana/crack ante el riesgo de suicidio.(AU)
