ABSTRACT
BACKGROUND: Major Depressive Disorder is a long-term, recurring, and very common illness that is associated with a significant decline in functional ability. The gold-standard method of treating depression is pharmacotherapy, which involves the use of antidepressant medications either alone or in various combinations. However, approximately 30% of Major Depressive Disorder patients suffer from Treatment Resistant Depression, a more severe condition that has a profound impact on patients' lives. Our study aims to conduct the first comprehensive review and meta-analysis to assess the effectiveness and safety of adding Dialectical Behavior Therapy to antidepressant medications compared to groups using pharmacotherapy alone as an intervention for adults with Treatment Resistant Depression. MATERIALS AND METHODS: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Lilacs, Web of Science, and PsycINFO. We will manually review the reference lists of the included studies to identify potentially relevant studies. There will be no restrictions on the language or publication date. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aims to determine the effectiveness and safety of Dialectical Behavior Therapy as an intervention for Treatment Resistant Depression in adults. ETHICS AND DISSEMINATION: Ethical approval was not required as individual patient data was not obtained. Our intention is to publish the systematic review in a medical journal that offers open access upon completion of the process. TRIAL REGISTRATION: PROSPERO registration number CRD42023406301. Registered on March 24, 2023.
Subject(s)
Depressive Disorder, Treatment-Resistant , Dialectical Behavior Therapy , Meta-Analysis as Topic , Systematic Reviews as Topic , Humans , Depressive Disorder, Treatment-Resistant/therapy , Adult , Dialectical Behavior Therapy/methods , Depressive Disorder, Major/therapy , Antidepressive Agents/therapeutic use , Treatment OutcomeABSTRACT
Introduction: Major Depressive Disorder (MDD) is a chronic, recurrent, and highly prevalent disease that is associated with significant functional disability. During pregnancy, the prevalence of the disease is approximately 20%, with 12% of these, requiring treatment to avoid important negative consequences for the mother-baby binomial. Risk-benefit assessment of the use of antidepressants during pregnancy is mandatory, in addition to knowledge of the long-term effects of prenatal exposure to these drugs in the offspring. In this study, we will perform an updated systematic review and meta-analysis to explore the treatment of depression during pregnancy, along with its effectiveness, safety, and possible harm to women and children. Materials and methods: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, Scopus, Lilacs, and PsycINFO. The reference lists of the included studies will be manually reviewed to identify potentially relevant studies. There will be no restrictions on language or date of publication. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias (RoB2) instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aimed to ascertain the efficacy and safety of antidepressants in pregnant women and children. Ethics and dissemination: Ethical approval was not required as individual patient data were not collected. Dissemination: Plan to publish a systematic review in an open-access medical journal at the end of the process. Systematic Review Registration: PROSPERO, CRD42023447694.
ABSTRACT
To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.
CONCLUSÕES: O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.
Subject(s)
Hospitalization/statistics & numerical data , Mental Disorders/epidemiology , Mental Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Brazil/epidemiology , Female , Humans , Male , Mental Disorders/therapy , Time FactorsABSTRACT
Resumo Conclusões O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.
Abstract To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.
