Personality dimensions, resilience, and depression during COVID-19 pandemic: A one-year longitudinal study.

BACKGROUND: The onset of the COVID-19 pandemic has brought to light a significant surge in depression across diverse populations. While a considerable body of research has linked this upswing to lockdowns and restrictive measures, it is crucial to recognize that lockdowns alone cannot fully elucidate the observed increase in mental health disorders, given the vast array of individual psychological responses. OBJECTIVE: This study aims to test e whether personality dimensions (Extroversion, Neuroticism, and Psychoticism) and resilience play a role in shielding individuals from developing depression during the COVID-19 pandemic, as observed in a sample of Brazilian adults. METHODS: This research employed a one-year longitudinal naturalistic study involving the general population. It utilized a web-based questionnaire administered in three waves during the COVID-19 pandemic: April 2020, September 2020, and May 2021. The research protocol contains the Patient Health Questionnaire-9 - PHQ-9, the Connor-Davidson Resilience Scale - CD-RISC, and the Eysenck Personality Questionnaire Revised-Abbreviated - EPQR-A. RESULTS: Our study encompassed 455 participants, of which 35.6 % met the criteria for depression in the first wave, and this figure decreased to 18.5 % in the second and third waves (p = 0.001). Resilience levels in the non-depressed group (consistently exhibited higher means across all three waves when compared to the depressed group (first wave: x¯= 27.98; second wave: x¯= 37.26; third wave: x¯= 36.67; p = 0.001). Furthermore, resilience exhibited an overall protective effect against depression in all waves (PR = 0.93, p = 0.000). Neuroticism and Psychoticism emerged as predictors of depression across all waves (PR = 1.346; p = 0.0001 and PR = 1.157; p = 0.030), while the Extroversion dimension showed no significant effect. CONCLUSION: The decline in depression rates during the first year of the COVID-19 pandemic was influenced by levels of resilience, which acted as a protective factor against the development of depressive symptoms. Notably, Neuroticism and Psychoticism predicted the risk of developing depressive symptoms. Implications for practical intervention in future crisis scenarios suggest the need for public health policy programs featuring personalized interventions that prioritize enhancing resilience.

Serum cytokine variations among inpatients with major depression, bipolar disorder, and schizophrenia versus healthy controls: a prospective 'true-to-life' study.

Background: There is increasing evidence of the association between chronic low-grade inflammation and severe mental illness (SMI). The objective of our study was to assess serum cytokine levels (SCLs) at admission and discharge in a true-to-life-setting population of inpatients with major depression (MD), bipolar disorder (BD), and schizophrenia (Sz), as well as of healthy controls. Methods: We considered MD, BD, and Sz to be SMIs. We evaluated 206 inpatients [MD, N = 92; BD, N = 26; mania (Ma), N = 44; Sz, N = 44). Generalized estimating equations were used to analyze variations in SCL [interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17] at hospital admission and discharge. Results of 100 healthy controls were compared with those of SMI patients at both time points. We evaluated patients' improvement during in-hospital treatment in terms of general psychiatric symptoms, global clinical impression, functionality, and manic and depressive symptoms with validated scales. Results: In all, 68.9% of patients completed the study. Overall, SMI inpatients had higher SCL when compared with controls regardless of diagnosis. There was a significant decrease in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity Scale (CGI-S) scores, and an increase in Global Assessment of Functioning (GAF) scores for all disorders evaluated (p < 0.001), as well as a significant decrease in HDRS-17 scores among MD inpatients (p < 0.001) and in YMRS scores among Ma inpatients (p < 0.001). IL-2 and IL-6 levels decreased significantly between admission and discharge only among MD inpatients (p = 0.002 and p = 0.03, respectively). We found no further statistically significant changes in SCL among the remaining disorders (BD, Ma, and Sz). There was no significant decrease in IFN-γ (p = 0.64), TNF-α (p = 0.87), IL-4 (p = 0.21), IL-10 (p = 0.88), and IL-17 (p = 0.71) levels in any of the evaluated diagnoses. Conclusion: MD inpatients had a decrease in IL-2 and IL-6 levels during hospitalization, which was accompanied by clinical improvement. No associations were found for the remaining SMIs (BD, Ma, and Sz).

The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A): psychometric properties of the Brazilian Portuguese version.

INTRODUCTION: The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A) consists of 24 items for assessment of the three fundamental personality traits (psychoticism, extraversion, and neuroticism) and a validity scale (lie scale). Our objectives were to assess the psychometric properties of a version of this instrument culturally adapted for Brazil. METHOD: 321 participants were recruited using a non-probabilistic method. RESULTS: Internal consistencies ranged from minimally acceptable to respectable, except for the psychoticism domain. Higher neuroticism scores were associated with higher depression and anxiety scores, higher extraversion scores were associated with lower levels of depression symptoms, and higher psychoticism scores were associated with higher levels of depression symptoms. CONCLUSION: Our findings describe sustainable psychometric properties for the Brazilian Portuguese version of EPQR-A.

The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A): psychometric properties of the Brazilian Portuguese version

Abstract Introduction The Eysenck Personality Questionnaire Revised - Abbreviated (EPQR-A) consists of 24 items for assessment of the three fundamental personality traits (psychoticism, extraversion, and neuroticism) and a validity scale (lie scale). Our objectives were to assess the psychometric properties of a version of this instrument culturally adapted for Brazil. Method 321 participants were recruited using a non-probabilistic method. Results Internal consistencies ranged from minimally acceptable to respectable, except for the psychoticism domain. Higher neuroticism scores were associated with higher depression and anxiety scores, higher extraversion scores were associated with lower levels of depression symptoms, and higher psychoticism scores were associated with higher levels of depression symptoms. Conclusion Our findings describe sustainable psychometric properties for the Brazilian Portuguese version of EPQR-A.

Structural magnetic resonance imaging findings in severe mental disorders adult inpatients: A systematic review.

In severe presentations, major depressive disorder (MDD), schizophrenia (SZ), and bipolar disorder (BD) can be categorized as severe mental disorders (SMD). Our aim is to evaluate structural magnetic resonance imaging and computed tomography findings in adult inpatients diagnosed with SMD and hospitalized at psychiatric wards. PubMed, Embase, PsycInfo, Cochrane Library, and Web of Science were searched up to May 27th, 2021. Articles were screened and extracted by two independent groups, with third-party raters for discrepancies. Quality of evidence was evaluated with the Newcastle-Ottawa Scale. Synthesis was made by qualitative analysis. This study was registered on PROSPERO (CRD42020171718) and followed the PRISMA protocol. 35 studies were included, of which none was considered to likely introduce bias in our analyses. Overlapping areas in MDD, SZ, and Affective Psychosis (AP) patients, that include BD and MDD with psychotic features, are presented in the inferior temporal and cingulate gyri. MDD and SZ had commonly affected areas in the inferior and middle frontal gyri, transverse temporal gyrus, insula, and hippocampus. SZ and AP had commonly affected areas in the temporal pole. Overlapping affected areas among SMD patients are reported, but the heterogeneity of studies' designs and findings are still a limitation for clinically relevant guidelines.

Resilience in severe mental disorders: correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia.

PURPOSE: To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life. METHODS: Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). RESULTS: Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; rs = - 0.163). The scores in the resilience scale's personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = - 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306-0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience. CONCLUSION: Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients' quality of life with severe mental disorders.

Positive Association Between Therapeutic Alliance and Quality of Life in Psychodynamic Psychotherapy, Cognitive Behavior Therapy, and Interpersonal Therapy: The Patient's Perspective.

BACKGROUND: The therapeutic alliance (TA) is considered a common psychotherapeutic factor associated with positive results in psychotherapies. There are no studies relating the TA with quality of life (Qol). OBJECTIVES: Our objective was to evaluate whether there is an association between the TA and Qol across three different psychotherapies. METHODS: A cross-sectional study, which included outpatients undergoing individual psychotherapeutic treatment was conducted. When analyzing the total sample, the correlation of the TA with Qol domains did not present statistical significance. When considering only the sample of patients who were undergoing treatment in psychodynamic psychotherapy (PP), there was a statistically significant association between the TA and the psychological domain of Qol (p < 0.05). When using a regression model for adjusting for confounding factors, the association between psychological domain with the TA on the PP patients sample lost significance (p = 0.221). DISCUSSION: These findings suggest that the TA seems to be more strongly related to better QoL in PP.

Brain-derived neurotrophic factor (BDNF) and inflammatory markers: Perspectives for the management of depression.

BACKGROUND: Mood disorders, including major depressive disorder, are among the main causes of disability and early mortality and constitute an important public health problem. Despite the search for a neurobiological explanation for these disorders, diagnosis and treatment are still based on subjective symptoms and psychometric assessments. Biomarkers, used as indicators of normal biological and pathological processes or pharmacological responses to a clinical intervention, may be useful in improving the current classification of psychiatric disorders, which can help understand the role of biological information in diagnosis, prognosis, and assessment of responses to intervention. OBJECTIVES: This review aims to analyze the existing literature on Brain-Derived Neurotrophic Factor (BDNF) and inflammatory markers related to depression and to assess the advances and perspectives of their applicability in the diagnosis, prognosis, and assessment of responses to intervention in order to understand the importance of these biomarkers for the management of depression. RESULTS: Evidence shows that BDNF is an important biomarker for the pathogenesis of depression; reduced levels are linked to reduced synaptic plasticity and neuronal atrophy, while elevated levels are associated with survival and neuronal differentiation, which is compatible with the neurogenic hypothesis of depression. Although the use of this biomarker is not yet established, literature shows that the concentration of BDNF is a useful measure for the differentiation between healthy and depressed individuals. Based on the inflammatory theory of depression, studies have found higher levels of inflammation in depressed individuals when compared to healthy ones, as well as an association between chronic inflammation and depressive symptoms. Studies have also found anti-inflammatory agents with anti-depressant effects. Markers such as IL-6, IL-1ß, TNFα, and C-reactive protein (CRP) are potential markers of depression, but the role of cytokines in human brain activity is still insufficiently established. CONCLUSIONS: Despite the large number of potential biological markers not yet fully established in the pathophysiology of depression, which is a challenge for psychobiology, it is clear that the concentrations of these substances are altered in psychiatric diagnoses related to the disease activity. Thus, although more research is needed, the current body of knowledge on biomarkers allows us to predict their use in the management of depression.

The Effects of Individual Psychotherapy in BDNF Levels of Patients With Mental Disorders: A Systematic Review.

BACKGROUND: Brain-derived Neurotrophic Factor (BDNF) is considered the main cerebral neurotrophin and is produced in the central neural system and peripherals. Its levels are reduced in patients with several psychiatric disorders, but it is unclear if the response to psychotherapy can alter its concentration. OBJECTIVE: To carry out a systematic review evaluating the effects of individual psychotherapy in BDNF levels in patients with mental disorders. METHODS: The databases PubMed, EMBASE, PsycArticles, SciELO, Web of Science, and CENTRAL; the last search was performed on October 2019 for trials evaluating the effects of individual psychotherapy in BDNF levels in adults with mental disorders. PROSPERO registration: CRD42018108144. RESULTS: Eight of 293 studies were included. A rise in BDNF levels was observed in depressive patients when psychotherapy was combined with medication. Patients with post-traumatic stress disorder (PTSD) who responded to therapy presented a raise in BDNF levels mostly when combined with physical activity. There was a rise in BDNF levels in those who responded to psychotherapy in patients with bulimia, in borderline patients, and in insomniacs. CONCLUSIONS: The BDNF seems to present variations after psychotherapy especially in patients with bulimia, PTSD, insomnia, and borderline. These subjects also have symptom reduction. Thereby, BDNF could be a supplemental tool to analyze the success to psychotherapy. BDNF levels in patients with major depression after therapy are still controversial and the short follow-up of most studies is a limiting factor.

Interpersonal Psychotherapy for Gender Dysphoria in a Transgender Woman.

We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment.

Increased Levels of Brain-Derived Neurotrophic Factor Are Associated With High Intrinsic Religiosity Among Depressed Inpatients.

Recognition of the importance of religion and spirituality in psychiatry is increasing, and several studies have shown a predominantly inverse relationship between religiosity and depression. Brain-derived neurotrophic factor (BDNF) is a widely studied brain neurotrophin responsible for synaptic plasticity, dendritic and neuronal fiber growth, and neuronal survival. The objective of the present study was to evaluate BDNF levels across high and low intrinsic religiosity (IR) in depressed inpatients. Serum BDNF levels were evaluated from 101 depressed inpatients at hospital admission and 91 inpatients at discharge. Religiosity was assessed using a validated version of the Duke University Religion Index. High IR patients had significantly higher serum BDNF at discharge than do low IR (52.0 vs. 41.3 ng/mL, P = 0.02), with a Cohen's d effect size difference of 0.56. High IR patients had a statistically significant increase in BDNF levels from admission to discharge (43.6 ± 22.4 vs. 53.8 ± 20.6 ng/mL, -1.950 (paired t-statistic), P = 0.05). The relationship between IR and BDNF levels (F = 6.199, P = 0.00) was controlled for the effects of depressive symptoms (â€…ß = 2.73, P = 0.00) and psychiatric treatments, including selective serotonin reuptake inhibitors (SSRIs) (ß = 0.17, P = 0.08), serotonin and norepinephrine reuptake inhibitors (SNRIs) (â€…ß = -0.23, P = 0.02), tricyclic antidepressants (TCAs) (â€…ß = -0.17, P = 0.10), lithium (â€…ß = 0.29, P = 0.00), anticonvulsants (â€…ß = 0.22, P = 0.03), antipsychotics (â€…ß = -0.05, P = 0.61), and electroconvulsive therapy (â€…ß = 0.00, P = 0.98). The current findings suggest a potential pathway to help understand the protective effect of religiosity in depressive disorders.

Longitudinal Investigation of Psychotherapy Outcomes (LIPO): Description of the Study Protocol.

Background: Despite extensive research in the field of psychotherapies, few studies have compared the primary psychotherapies of naturalistic design, which represents real-life situations. Objective: The objectives of this study were to evaluate three modalities of evidence-based psychotherapy for clinical, psychosocial, and biological outcomes and to identify the mediators and confounders of this process. Our primary hypothesis is that all psychotherapies will improve clinical and psychosocial outcomes and will increase BDNF levels. Methods: Design: longitudinal, naturalistic. Participants: One hundred twenty-six patients who underwent one of three evidence-based modalities of individual psychotherapy [psychodynamic psychotherapy (PDT), interpersonal psychotherapy (IPT), and cognitive-behavioral psychotherapy (CBT)] were included. Measure: Primary outcomes are divided into three domains of variables: clinical (general psychiatric symptoms), biological (serum BDNF levels), and psychosocial (resilience, quality of life, coping strategies, social support, and quality of life-adjusted years of life). Confounding/mediator variables included clinical (personality traits, type of psychotherapy, number of sessions, concomitant use of pharmacological treatment, history of previous psychotherapeutic treatment, medical and psychiatric comorbidities, and psychiatric diagnosis), psychosocial (psychosocial stressors, therapeutic alliance, and defense mechanism style), and other (religiosity) factors. Procedure: The follow-up period will be baseline and 6 months and 1 year after entering the study. The study will include 42 controls for biological variables only. Sample size calculation considered a significance level of 5% and a power of 80% to detect a difference of 0.22 with a standard deviation of 0.43, assuming losses of 20-30% of patients. The comparison between the modalities of psychotherapy will be by generalized estimating equations (GEE) model, the analysis of mediators by the Hayes method, and confounders by multivariate logistic regression. Discussion: The findings of this study are intended to demonstrate the outcomes of evidence-based psychotherapies for clinical, psychosocial, and biological parameters and to understand the mediators and confounders of this process in a real-life setting for patients with severe mental illness, thus contributing to the establishment of evidence-based public health policies in the field of psychological interventions.

Can Religious Coping and Depressive Symptoms Predict Clinical Outcome and Quality of Life in Panic Disorder? A Brazilian Longitudinal Study.

Few studies have investigated the relationship between spiritual/religious coping (S/R coping) and panic disorder (PD). This Brazilian longitudinal study evaluated if S/R coping and depressive symptoms can predict PD remission and improved quality of life (QoL). There were 101 outpatients with PD who were followed up for 12 to 16 weeks. The prevalence ratio (PR) between positive S/R coping and negative S/R coping and PD remission was assessed, as well as the association between positive S/R coping and negative S/R coping and QoL. After adjusting for confounding factors, positive S/R coping presented an inverse PR with PD remission, which was not statistically significant (0.88; p = 0.075). There was no association between S/R coping and QoL. Depressive symptoms were negatively associated with PD remission (PR = 0.97; p < 0.01) and were not predictive of a better QoL.

Readmission in psychiatry inpatients within a year of discharge: The role of symptoms at discharge and post-discharge care in a Brazilian sample.

INTRODUCTION: Readmission into inpatient psychiatric beds is a useful outcome for patients, care providers, and policymakers. This study aims to investigate the role of level of symptoms at discharge and type of post-discharge care in determining readmissions after a year before a psychiatric admission. METHODS: We performed a prospective and observational study in a general hospital psychiatric facility. Patients were assessed at admission, discharge, and one year after discharge. We used a multivariable logistic regression to determine predictors of readmission. RESULTS: In total, 488 patients were included at admission, and 401 (82,17%) were accessed in the follow-up period. Psychiatric readmissions occurred in 29.17% of the followed patients. The number of previous admissions represents a 38% higher chance of being readmitted (OR 1.38; CI 1.16-1.60). For patients admitted in a depressive episode, not being in remission at discharge increases 140% the chance to be readmitted (OR 2.40; CI 1.14-5.07) as well as the follow-up at primary (OR 5.27; CI 1.06-26.15). For those with Schizophrenia and related disorders, higher scores in BPRS at discharge increases the chance to be readmitted (OR 1.28, CI 1.11-1.48). CONCLUSION: Level of symptoms at discharge was related to higher chance to be readmitted in patients admitted in a depressive episode and those with schizophrenia and related disorders. Findings of the type of care raise the need for further investigation. Also, this finding confirms the importance of the history of previous admissions in predicting future admissions.

Remission of depression following electroconvulsive therapy (ECT) is associated with higher levels of brain-derived neurotrophic factor (BDNF).

INTRODUCTION: Research on the association between electroconvulsive therapy (ECT) and increased brain derived neurotrophic factor (BDNF) levels has produced conflicting result. There have been few studies which have evaluated BDNF levels in clinical contexts where there was remission following treatment. The objective of this study was to investigate whether remission of depression following ECT is associated with changes in BDNF levels. METHODS: Adult inpatients in a psychiatric unit were invited to participate in this naturalistic study. Diagnoses were made using the Mini-International Neuropsychiatric Interview (MINI) and symptoms were evaluated at admission and discharge using the Hamilton Rating Scale for Depression (HDRS-17). Thirty-one patients who received a diagnosis of depression and were subjected to ECT were included retrospectively. Clinical remission was defined as a score of less than eight on the HDRS-17 at discharge. Serum BDNF levels were measured in blood samples collected at admission and discharge with a commercial kit used in accordance with the manufacturer's instructions. RESULTS: Subjects HDRS-17 scores improved following ECT (t = 13.29; p = 0.00). A generalized estimating equation (GEE) model revealed a remission × time interaction with BDNF levels as a dependent variable in a Wald chi-square test [Wald χ(2) = 5.98; p = 0.01]. A post hoc Bonferroni test revealed that non-remitters had lower BDNF levels at admission than remitters (p = 0.03), but there was no difference at discharge (p = 0.16). CONCLUSION: ECT remitters had higher serum BDNF levels at admission and the level did not vary during treatment. ECT non-remitters had lower serum BDNF levels at admission, but levels increased during treatment and were similar to those of ECT remitters at discharge.

Quality of life in caregivers of children and adolescents with Osteogenesis Imperfecta.

BACKGROUND: Osteogenesis imperfecta (OI) is a group of genetic disorders of collagen biosynthesis, characterized by low bone density leading to fractures. Most patients exhibit functional impairment and require the aid of a caregiver. The aim of this study is to assess the quality of life (QoL) of caregivers of patients with OI. METHODS: In this cross-sectional study, a convenience sampling strategy was used to enroll adult caregivers of children and adolescents with OI who attended a referral center in southern Brazil. The WHOQOL-BREF instrument was used to assess QoL. RESULTS: Twenty-four caregivers of 27 patients (10 with type I, 4 with type III, and 13 with type IV OI) were included in the study. Eighteen caregivers were the patients' mothers, two had OI, and 22 cared for only one patient. Mean WHOQOL-BREF scores were 14.59 for the physical health domain, 13.80 for the psychological domain, 15.19 for the social relationships domain, and 12.87 for the environmental domain; the mean total QoL score was 14.16. QoL scores did not differ significantly according to patients' OI type or number of fractures. Economic status was not correlated significantly with QoL scores. CONCLUSIONS: QoL appears to be impaired in caregivers of patients with OI. Additional studies are required to confirm these findings and to ascertain which factors account for this phenomenon.

Intrinsic religiosity, resilience, quality of life, and suicide risk in depressed inpatients.

BACKGROUND: Religiosity is inversely related to depression and is directly associated with positive psychological outcomes. Nonetheless, there is no consensus on whether or how religiosity could impact and protect against depression. The present study evaluated the association between intrinsic religiosity and resilient psychological characteristics in depressed inpatients. METHODS: A sample of 143 depressed patients was prospectively evaluated in an inpatient psychiatric treatment in South Brazil. High Intrinsic Religiosity (HIR) and Low Intrinsic Religiosity (LIR) patients were compared across socio-demographic information, clinical measures, religiosity, resilience and quality of life. A linear regression model was used to evaluate the association between intrinsic religiosity and resilience, and the Cohen d test was utilized to assess effect sizes. RESULTS: At admission, HIR patients showed higher HAM-D (p=0.05), BPRS (p=0.02), GAF (p=0.02), and CGI (p=0.03) scores, lower educational levels (p=0.04), higher social support (p=0.05), and fewer previous suicide attempts (p=0.05). At discharge, HIR patients showed higher quality of life (p=0.001) and higher resilience (p=0.000), with a large effect size difference between groups (1.02). Based on a linear regression model (adjusted r=0.19, p=0.000), intrinsic religiosity was associated with resilience, controlling for covariates. CONCLUSION: In a sample of depressed inpatients, intrinsic religiosity was found to be associated with resilience, quality of life, and fewer previous suicide attempts. These findings support the relevance of religiosity assessments in mental health practice and support the hypothesis that resilient psychological characteristics may mediate the positive effects of intrinsic religiosity in depression.

Quality of life of brazilian patients with Gaucher disease and fabry disease.

OBJECTIVE: To evaluate QoL in a sample of Brazilian patients with Gaucher (GD) and Fabry (FD) disease using the SF-36 survey. METHOD: Observational cross-sectional study. The SF-36 survey was administered to cognitively able patients 12 years or older, who were seen in the Medical Genetics Service of Hospital de Clínicas de Porto Alegre, Brazil. RESULTS: Thirty-five patients were included in the study (GD = 21, FD = 14), mean age was 29.8 ± 14.2 years and 29 (82.9%) were receiving ERT. Patients with GD receiving ERT had better scores in the general health (p = 0.046) domain of the SF-36 than patients with FD receiving ERT. Comparison of patients with GD naive to ERT and those receiving ERT revealed differences only in the bodily pain domain (p = 0.036). The Zimran score showed a moderate negative correlation with the following domains of the SF-36: physical functioning (p = 0.035), role-physical (p = 0.036), general health (p = 0.023) and role emotional (p = 0.021). DISCUSSION AND CONCLUSION: Although limited because of the small number of patients included, findings suggest that patients with GD receiving ERT have a better QoL than patients with FD or with GD not receiving ERT. Imiglucerase has a beneficial effect against pain for patients with GD. Further studies should be conducted to confirm our findings.

An introduction to Rasch analysis for Psychiatric practice and research.

This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.

The EUROHIS-QOL 8-item index: comparative psychometric properties to its parent WHOQOL-BREF.

OBJECTIVES: To test the psychometric properties of the EUROHIS-QOL 8-item index, a shortened version of the World Health Organization Quality of Life Instrument-Abbreviated Version (WHOQOL-BREF). METHODS: The sample consisted of 2359 subjects identified from primary care settings, with 1193 having a confirmed diagnosis of depression. Data came from six countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in a large international study, the Longitudinal Investigation of Depression Outcomes. The structure of the EUROHIS-QOL 8-item index follows that of the WHOQOL-BREF assessment. Internal consistency was measured by using Cronbach's alpha. Convergent validity was assessed by using correlations with different measures for mental health (Symptom Checklist 90), physical health (self-evaluation), and quality of life (WHOQOL-BREF and short form 36 health survey). Discriminant group validity was assessed between diagnosed depressed and nondepressed patients. Differential item functioning and unidimensionality were analyzed by using Rasch analysis. Factor structure was assessed with structural equation modeling analyses. RESULTS: Internal consistency was acceptable (ranged between 0.72 and 0.81 across countries), and the index discriminated well between depression (t = 6.31-20.33; P < 0.001) across all countries. Correlations between the EUROHIS-QOL 8-item index and different measures--Symptom Checklist 90 (r = -0.42), physical health (r = -0.42), WHOQOL-BREF domains (r = 0.61-0.77), and short form 36 health survey (r = 0.58)--were all significant (P < 0.001). The index is unidimensional with desired item fit statistics. Two items ("daily living activities" and "enough money to meet your needs") had residuals exceeding 4. Differential item functioning was observed with general quality of life, general health, relationships, and home items for age. A common one-factor structure with acceptable fit was identified in three out of six countries (comparative fit index = 0.85, root mean square error of approximation = 0.11). CONCLUSIONS: The EUROHIS-QOL 8-item index showed acceptable cross-cultural performance and a satisfactory discriminant validity and would be a useful measure to include in studies to assess treatment effectiveness.