Beyond frequency: Evaluating the validity of assessing the context, duration, ability, and botherment of depression and anxiety symptoms in South Brazil.

Assessment tools for depression and anxiety usually inquire about the frequency of symptoms. However, evidence suggests that different question framings might trigger different responses. Our aim is to test if asking about symptom's context, ability, duration, and botherment adds validity to Patient Health Questionnaire-9, General Anxiety Disorder-7, and Patient-Related Outcome Measurement Information Systems depression and anxiety. Participants came from two cross-sectional convenience-sampled surveys (N = 1,871) of adults (66% females, aged 33.4 ± 13.2), weighted to approximate with the state-level population. We examined measurement invariance across the different question frames, estimated whether framing affected mean scores, and tested their independent validity using covariate-adjusted and sample-weighted structural equation models. Validity was tested using tools assessing general disability, alcohol use, loneliness, well-being, grit, and frequency-based questions from depression and anxiety questionnaires. A bifactor model was applied to test the internal consistency of the question frames under the presence of a general factor (i.e., depression or anxiety). Measurement invariance was supported across the different frames. Framing questions as ability (i.e., "How easily …") produced a higher score, compared with framing by context (i.e., "In which daily situations …"). Construct and criterion validity analysis demonstrate that variance explained using multiple question frames was similar to using only one. We detected a strong overarching factor for each instrument, with little variances left to be explained by the question frame. Therefore, it is unlikely that using different adverbial phrasings can help clinicians and researchers to improve their ability to detect depression or anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The interplay between ADHD and school shift on educational outcomes in children and adolescents: A cross-sectional and longitudinal analysis.

Many countries implement a double-shift schooling system, offering morning or afternoon shifts, driven by diverse factors. Young people with ADHD may face educational problems attending morning shifts compared to afternoon shifts. To investigate this, we used data from a Brazilian school-based cohort (n = 2.240, 6-14 years old, 45.6% female; 50.2% in the morning shift; 11.2% with ADHD). ADHD was determined by child psychiatrists using semi-structured interview. Educational outcomes were measured cross-sectionally and three years later (80% retention) and included reading and writing ability, performance in school subjects, and any negative school events (repetition, suspension, or dropout). Generalized regression models tested the interaction between ADHD and school shift and were adjusted for age, sex, race/ethnicity, intelligence, parental education, socioeconomic status, and site. Attrition was adjusted with inverse probability weights. We used two dimensional measures of attentional problems as sensitivity analysis. ADHD and morning shift were independently associated with lower reading and writing ability and with higher odds for negative school events cross sectionally. ADHD independently predicted lower performance in school subjects and higher negative school events at follow-up. Interaction was found only at the cross-sectional level in a way that those studying in the afternoon present better educational outcomes compared with those studying in the morning only if they have lower ADHD symptom. Thus, ADHD was not associated with poorer educational outcomes among those studying in the morning. However, participants studying in the afternoon with lower levels of attentional problems presented better educational, despite these associations fade away over time.

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br).

OBJECTIVES: There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). METHODS: The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. RESULTS: EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. CONCLUSION: The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br)

Abstract Objectives There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusion The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Gender inequality and depression among medical students: A global meta-regression analysis.

Depression is a serious mental health problem with a high prevalence among medical students. It is unclear whether a gender disparity of depression exists in this population, and whether gender inequality influences depression estimates by gender. We conducted a systematic search for published systematic reviews or meta-analyses in six databases and primary studies were obtained from those records. Studies were included if they contained original data on the prevalence of depression among male and female medical students. The Gender Inequality Index (GII) and the Human Development Index (HDI) were obtained from the United Nations Development Programme website. A random effects meta-analysis of the odds ratio for depression between females and males was conducted. Meta-regression analyses were conducted to assess the association of GII and prevalence of depression. The HDI was later incorporated in a multivariable model. We included a total of 106 studies and 84,119 students from 32 different countries. Female medical students are at higher odds of depression (OR = 1.30, 95% CI 1.17-1.44, p < 0.01). A significant correlation was found between GII and prevalence of depression for female (ß = 0.24, p = 0.02) medical students, but not for male medical students. This association remained significant after adjusting for HDI. The female gender was associated with higher prevalence of depression in this population. The gender disparity in depression may be explained by the effect of gender inequality.

Doenças respiratórias em crianças e adolescentes: um perfil dos atendimentos na atenção primária em Vitória/ES / Respiratory diseases in children and adolescents: profiling primary care visits in Vitória/ES / Enfermedades respiratorias en niños y adolescentes: un perfil de asistencia en la atención primaria en Vitória/ES

Objetivo: Identificar las principales causas de enfermedades respiratorias en la atención primaria, en Vitória, ES, para residentes de edades entre 0 y 19 años, relacionar su gravedad con la edad y el estatus socioeconómico y verificar la variación temporal en la frecuencia de estas visitas. Métodos: Estudio descriptivo transversal de las visitas realizadas en el 2014 en las 30 unidades básicas de salud de la ciudad de Vitória, con datos del sistema de registros electrónicos Rede Bem Estar. Se realizó un análisis descriptivo de las variables sociodemográficas, grupos diagnósticos y mes de atención y regresión logística entre la topografía del tracto respiratorio y las variables sociodemográficas. Resultados: De los 113.252 casos de 0 a 19 años de edad, las enfermedades respiratorias fueron las más frecuentes (28.810, 25,43% del total, 40,18% de las visitas por enfermedad), especialmente las "Infecciones agudas de las vías respiratorias superiores" (61,35%), las "Enfermedades crónicas de las vías respiratorias inferiores" (14,60%) y "Otras enfermedades de las vías aéreas superiores" (8,69%). La proporción de asistencias disminuyó con la edad y fue mayor entre los residentes de los vecindarios de ingresos promedios más bajos. Las vías aéreas superiores fueron más afectadas en todos los grupos de edad, especialmente en los más avanzados, y entre los residentes de los barrios de ingreso familiar promedio más alto. Sin embargo, sólo el 6% de la varianza de la distribución según la topografía del aparato respiratorio se explicó por grupo de edad y estado socioeconómico. Se observó un aumento de las asistencias en los meses de marzo a noviembre. Conclusiones: Las enfermedades respiratorias tienen un gran impacto en la población pediátrica de Vitória. Se recomiendan medidas de prevención primaria y secundaria que tengan en cuenta la multi-causalidad implicada en la determinación de estas enfermedades.

Objective: To identify the main reasons for visiting a primary health care facility among 0-19 year old residents with respiratory diseases, as well as their frequency, and to associate the severity of those diseases with age and socioeconomic status. Methods: A descriptive cross-sectional study was conducted on all visits to any of the 30 basic health units of the city of Vitória, ES in 2014, using the electronic database Rede Bem Estar. A descriptive analysis was carried out on sociodemographic variables, diagnostic groups and the month of these visits, in addition to logistic regression between the topography of the impairment of the respiratory system and sociodemographic variables. Results: Respiratory diseases were the most frequent reason for visiting the primary health care facility among all 113,252 0-19 years old participants included in the study (28,810, corresponding to 25.43% of the total and 40.18% of visits due to illness), particularly "acute upper respiratory infections" (61.35%), "chronic lower respiratory diseases" (14.60%), and "other diseases of the upper airways" (8.69%). The months of March to November showed higher frequency of visits, and the visit rates decreased with age, proving to be higher among residents of neighborhoods with lower average income. The upper airways were more affected in all age groups, especially in the older ones, and in residents of higher average income neighborhoods. However, only 6% of the variance of the distribution based on the topography of the impairment of the respiratory system was explained by age group and socioeconomic status. Conclusions: Respiratory diseases have a major impact on the pediatric population in Vitória. Primary and secondary prevention measures are recommended, taking into account the multi-causality involved in determining these diseases.

Resumo Objetivo: Identificar as principais causas de atendimento por doenças respiratórias na atenção primária, em Vitória, ES, nos residentes de 0­19 anos, relacionando a gravidade das mesmas com idade e nível socioeconômico, e verificar a variação temporal de frequência desses atendimentos. Métodos: Estudo transversal descritivo dos atendimentos realizados em 2014 nas 30 unidades básicas de saúde do município de Vitória, com dados do sistema de registros eletrônicos Rede Bem Estar. Realizou-se análise descritiva das variáveis sociodemográficas, grupos de diagnóstico e mês de atendimento e regressão logística entre topografia de acometimento do aparelho respiratório e variáveis sociodemográficas. Resultados: Dos 113.252 atendimentos de 0­19 anos, doenças respiratórias constituíram as causas mais frequentes (28.810, 25,43% do total, 40,18% dos atendimentos por doença), destacando-se "Infecções agudas das vias aéreas superiores" (61,35%), "Doenças crônicas das vias aéreas inferiores" (14,60%) e "Outras doenças das vias aéreas superiores" (8,69%). A proporção de atendimentos caiu com a idade e foi maior entre residentes em bairro de menor renda domiciliar média. As vias aéreas superiores foram mais acometidas em todas as faixas etárias, principalmente nas mais avançadas, e nos residentes em bairros de maior renda domiciliar média. Porém, apenas 6% da variância da distribuição segundo topografia de acometimento do aparelho respiratório foi explicada por faixa etária e nível socioeconômico. Observou-se crescimento dos atendimentos nos meses de março a novembro. Conclusões: Doenças respiratórias são agravos de grande impacto na população pediátrica em Vitória. Recomendam-se medidas de prevenção primária e secundária que levem em consideração a multicausalidade envolvida na determinação dessas doenças.