The effect of age on the relationship between negative life events and current and new depressive episodes: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: There is scarce data concerning the relationship between negative life events (NLEs)* and current and new depressive episodes by age. METHODS: Cross-sectional (baseline) and prospective analyses (4-year/8-year follow-ups) were performed in 15,105 civil servants in 6 cities in Brazil classified according to age strata at baseline: 1st(35-44), 2nd(45-54), 3rd(55-64), and 4th(65-74) years. The independent variable was NLEs in the last year (robbery, hospitalization, death of a relative, financial hardship, and rupture of a love relationship) collected at baseline. The dependent variable was depressive episodes assessed at baseline (current), and 4-year/8-year follow-ups (new). We built logistic (Odds Ratio[OR];95 % Confidence Interval[CI]) in the cross-sectional analysis and Poisson regression models (Relative Risk[RR], [CI]) in the prospective analysis. RESULTS: Robbery, hospitalization, financial hardship, rupture of a relationship were associated with current depressive episodes concentrated in the 35-44 age range, while for new depressive episodes, the association of hospitalization, death of a relative, and financial hardship were concentrated in the 45-54 age stratum. Financial hardship was associated with current depressive episodes in all age-strata: 1st: OR, 2.77(CI, 1.83-4.19); 2nd: OR, 1.71(CI, 1.26-2.34); 3rd: OR, 1.68(CI,1.15-2.46); 4th, OR, 4.07(CI, 1.24-13.34), and new depressive episodes: 1st: RR, 1.45(CI, 1.09-1.93); 2nd RR, 1.46(CI: 1.15-1.84); 3rd: RR, 1.97(CI, 1.38-2.82). Rupture of a relationship was associated only with current depressive episode, while death of a relative only with new depressive episode. LIMITATION: We cannot rule out the possibility of recall bias, since NLEs` information was self-reported. CONCLUSION: The association between NLEs with depressive episodes was concentrated in youngers.

Interaction of Val66Met BDNF and 5-HTTLPR polymorphisms with prevalence of post-earthquake 27-F PTSD in Chilean population.

Post-traumatic stress (PTSD) disorder is a mental health condition that can occur after experiencing or witnessing a traumatic event. The 27-F earthquake that struck Chile in 2010 was one such event that had a significant impact on the mental health of the population. A study was conducted to investigate the prevalence of PTSD and its associated factors among survivors of this earthquake. The study was a longitudinal design, involving a sample of 913 patients aged 18 to 75 years who attended 10 Primary Care Centers in Concepción, Chile. The Composite International Diagnostic Interview (CIDI) was used to assess both depressive episodes (DE) and PTSD before and after the earthquake. The study also involved genotyping studies using saliva samples from the participants, specifically focusing on the Val66Met and 5-HTTLPR polymorphisms. Statistical analysis was performed to examine the association between different variables and the presence of PTSD. These variables included demographic factors, family history of psychiatric disorders, DE, childhood maltreatment experiences, and critical traumatic events related to the earthquake. The results showed that the incidence of post-earthquake PTSD was 11.06%. No significant differences were found between the groups of participants who developed post-earthquake PTSD regarding the Val66Met or 5-HTTLPR polymorphisms. However, a significant association was found between the concomitant diagnosis of DE and the development of post-earthquake PTSD. The presence of DE doubled the risk of developing post-earthquake PTSD. The number of traumatic events experienced also had a statistically significant association with an increased risk of developing post-earthquake PTSD. The study's limitations include the potential interference of different DE subtypes, the complexity of quantifying the degree of earthquake exposure experienced by each individual, and events entailing social disruption, such as looting, that can profoundly influence distress. In conclusion, the study found that PTSD following the 27-F earthquake in Chile was associated with a concomitant diagnosis of DE and the number of traumatic events experienced. The study did not find a significant association between PTSD and the Val66Met or 5-HTTLPR polymorphisms. The researchers recommend that mental health professionals should prioritize the detection and treatment of concomitant depressive episodes and exposure to critical traumatic events in survivors of disasters. They also suggest that further research is needed to better understand the relationship between genetic factors and post-disaster PTSD.

Neuropsychiatric and sleep study in autosomal dominant dopa-responsive dystonia.

Introduction: Although the diurnal fluctuation of motor dysfunction, reversible with small doses of dopamine, is a cornerstone for the phenotype of the autosomal dominant Segawa syndrome, the non-motor symptoms of this neurotransmitter deficiency have still received limited attention. Objective: This study aims to evaluate non-motor symptoms of this dopa-responsive dystonia through an intrafamilial comparative cross-sectional study. Methods: Seventeen individuals with a c.IVS5 + 3insT (c.626 + 3insT) variation in the GTP cyclohydrolase-1 gene (GCH1, HGNC: 4193) and 34 intrafamilial controls were studied using the Beck Depression Inventory-II, the Wiener Matrizen Test 2, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the MINI/MINI PLUS Questionnaires, the World Health Organization Quality of Life - BREF Instrument and a drug use assessment questionnaire. Results: No significant difference was found between the groups in the prevalence of sleep disorders and in cognitive function. Nevertheless, generalized anxiety disorder (p = 0.050) and attention-deficit/hyperactivity disorder in childhood (p = 0.011) were observed only in individuals without the molecular variation. The group with the GCH1 variation presented a worse perception about how safe they feel in their daily lives (p = 0.034), less satisfaction with themselves (p = 0.049) and with their relationships (p = 0.029), and a higher prevalence of past major depressive episodes before use of L-Dopa (p = 0.046). Conclusion: Low dopamine could have been protective against generalized anxiety disorder and attention-deficit/hyperactivity disorder in childhood in Segawa group individuals. The prevalence of depression was higher in individuals with the molecular variant prior to the L-Dopa treatment. Considering it, the penetrance estimates for the variant carriers increased from 58.8% to up to 88% in this large studied family. Additionally, neuropsychiatric tests of all individuals with a molecular diagnosis in an affected family are a valuable instrument for its clinical management.

Guía de práctica clínica para el tamizaje y manejo del episodio depresivo leve en el primer nivel de atención del Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud)

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

Factores asociados a irritabilidad en adultos con episodio depresivo en Lima Metropolitana / Factors associated to irritability in adults with depressive episode in Metropolitan Lima

Objetivo: Determinar factores sociodemográficos y clínicos asociados a la presencia de irritabilidad en adultos con episodio depresivo (ED) en Lima Metropolitana. Materiales y Métodos: Estudio observacional, correlacional, transversal, utilizando la base de datos de adultos desde los 18 años del Estudio Epidemiológico de Salud Mental de Lima Metropolitana y Callao del año 2012, en una muestra probabilística multietápica de 4445 adultos. Los instrumentos usados fueron una ficha de datos sociodemográficos, MINI (Entrevista Neuropsiquiátrica Internacional), Cuestionario de Salud Mental de Colombia (modificado), Índice de Calidad de Sueño de Pittsburgh, EMBU modificado y Cuestionario de Experiencias Tempranas Adversas. Se utilizó estadística descriptiva, regresión simple y multivariada para estimar la prevalencia de adultos con irritabilidad en episodio depresivo (IED) y determinar la asociación entre IED y variables independientes. Resultados: La prevalencia de IED fue de 34,9%. Se halló asociación estadísticamente significativa con: menor edad de inicio del ED, mayor severidad del ED, presencia de trastorno de ansiedad generalizada, abuso/dependencia de alcohol, algunos síntomas depresivos (autorreproches, problemas de concentración e indicadores suicidas), conductas violentas, menor calidad de sueño, estilos de crianza de sobreprotección y favoritismo, y presencia de eventos adversos antes de los 18 años. Conclusiones: Varias características y factores diferencian la depresión con irritabilidad de la que carece de este síntoma. La posibilidad de que la irritabilidad llegue a ser considerada como un especificador del episodio depresivo, contribuiría a desarrollar estrategias para su más precisa identificación y manejo clínico.

Objective: To determine factors associated to the presence of irritability in adults with depressive episode (DE) in Metropolitan Lima in 2012. Materials and methods: Database of the Epidemiological Study of Metropolitan Lima and Callao, carried out in 2012, was used to make an observational, correlational, cross-sectional study. A multistage probabilistic sample of 4445 adults of 18 years and older. The instruments were: MINI (International Neuropsychiatric Interview), Mental Health Questionnaire of Colombia (modified), modified brief EMBU, a questionnaire of adverse early experiences, Pittsburgh Sleep Quality Index and a sociodemographic data sheet. Descriptive statistics, simple and multivariate regression were used to estimate prevalence of adults with irritability in depressive episode (IDE) and to determine the association between IDE and independent variables. Results: The prevalence of IDE was 34.9%. A statistically significant association was found with: early age of onset of DE, greater severity of DE, presence of generalized anxiety disorder (GAD), abuse/dependence on alcohol, some depressive symptoms (such as self-reproach, concentration problems and suicidal indicators), violent behaviors, a lower quality of sleep, parenting styles of overprotection and favoritism, and the presence of adverse events before the age of 18. Conclusions: The possibility that irritability may be considered as a specifier of the depressive episode, would contribute to the development of strategies for its identification and clinical management.

Interleukin-10 promoter gene polymorphisms are associated with the first major depressive episode in chronic hepatitis C patients.

AIMS: To investigate the association of IL10 SNPs in chronic hepatitis C (CHC) patients with and without the first major depressive episode (MDE), as well as their association with plasma levels of target cytokines. METHODS: A hundred and thirty two CHC patients (32 with and 100 without first MDE) and 98 controls were prospectively enrolled in this cross-sectional study. MDE was diagnosed by a psychiatrist, using the Mini International Neuropsychiatric Interview Plus 5.0. IL10 polymorphisms (-1082 G/A, -819C/T and -592C/A IL10 SNPs) were evaluated by Taqman SNP genotyping assay. Plasma concentrations of IL-2, IL-6, IL-10, IFN-γ and TNF-α were determined using the Human Th1/Th2 Cytometric Bead Array kit. The associations were investigated by logistic models. RESULTS: The frequencies of the studied IL10 SNPs did not differ between the CHC patients and controls. The first MDE was positive and independently associated with the IL10-1082*A, IL10-819*T and IL10-592*A (ATA) low producer haplotype (OR = 1.50; 95% CI = 1.11-2.04; P = 0.009) and current alcohol misuse (OR = 4.29; 95% CI = 1.22-15.05; P = 0.02), and inversely associated with increasing age (OR = 0.94; 95% CI = 0.91-0.98; P = 0.006). In addition, plasma level of TNF-α was significantly higher in the carriers than in the non-carriers of the IL10 ATA haplotype in patients with the first MDE. The IL-10 and IL-2 plasma levels were significantly higher in the carriers than in non-carriers of the IL10 GCC high producer haplotype, demonstrating the functionality of the studied IL10 polymorphisms. CONCLUSIONS: This is the first study to demonstrate that the IL10 low producer ATA haplotype is associated with the first MDE in patients with CHC.

Functional impairment and cognitive performance in mood disorders: A community sample of young adults.

The aim of this study was to compare the global functioning and cognitive performance in a community sample of young adults with mood disorders versus community controls. This was a cross-sectional study nested in a cohort study with a community sample. Data was collected from February 2012 to June 2014; specifically, at a mean of five years after the first phase, all young adults were invited to participate in a re-evaluation. Mini International Neuropsychiatric Interview - PLUS (MINI-PLUS) was used for the diagnosis of mood disorders. The Functional Assessment Short Test (FAST) and the Montreal Cognitive Assessment (MoCA) were used to assess the global functioning, and cognitive performance, respectively. Were included 1258 subjects. Functional impairment was greater in subjects with bipolar disorder when compared to community controls, and there were no differences between major depressive disorder and community controls. There were no significant differences in cognitive performance between young adults with mood disorders when compared to community controls. Functional impairment is a marker for bipolar disorder in young adults; however, gross cognitive impairment assessed by a screening test is not, possibly because cognition is impaired in more advanced stages of the disorder.

Patient Health Questionnaire-9 versus Edinburgh Postnatal Depression Scale in screening for major depressive episodes: a cross-sectional population-based study.

BACKGROUND: Major depressive episodes (MDE) are frequent at the population level and are generally associated with severe symptoms that impair performance of activities of daily living of individuals suffering from this condition. The aim of this study was to compare the accuracy of two tests that separately showed suitable properties in screening for MDE: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). METHODS: In a previous study, the sensitivity and specificity of the PHQ-9 and the EPDS in screening for MDE were compared with a structured diagnostic interview conducted by psychiatrics and psychologists using the Mini International Neuropsychiatric Interview as the gold standard. In a sample of adults living in the community in Pelotas, Brazil, the PHQ-9 and EPDS were applied at the same interview and the gold standard on a median of 17 days later. The interviews were carried out at the participant's home. RESULTS: 447 Individuals (191 men and 256 women) were assessed. The PHQ-9 and the EPDS results were concordant in 87.5% of the respondents, with a moderate agreement beyond what was expected by chance alone (kappa = 0.61). The areas below the ROC curves were not statistically different (82.1% for PHQ-9 and 83.5% for EPDS) (p = 0.291), thus indicating that the two tests had similar moderate accuracy. CONCLUSIONS: PHQ-9 and EPDS may be applied with equal confidence in screening for MDE in the community.

Patient health questionnaire-9 versus Edinburgh postnatal depression scale in screening for major depressive episodes: a cross-sectional population-based study.

BACKGROUND: Major depressive episodes (MDE) are frequent at the population level and are generally associated with severe symptoms that impair performance of activities of daily living of individuals suffering from this condition. The aim of this study was to compare the accuracy of two tests that separately showed suitable properties in screening for MDE: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh postnatal depression scale (EPDS). METHODS: In a previous study, the sensitivity and specificity of the PHQ-9 and the EPDS in screening for MDE were compared with a structured diagnostic interview conducted by psychiatrics and psychologists using the Mini International Neuropsychiatric Interview as the gold standard. In a sample of adults living in the community in Pelotas, Brazil, the PHQ-9 and EPDS were applied at the same interview and the gold standard on a median of 17 days later. The interviews were carried out at the participant's home. RESULTS: 447 individuals (191 men and 256 women) were assessed. The PHQ-9 and the EPDS results were concordant in 87.5 % of the respondents, with a moderate agreement beyond what was expected by chance alone (kappa = 0.61). The areas below the ROC curves were not statistically different (82.1 % for PHQ-9 and 83.5 % for EPDS) (p = 0.291), thus indicating that the two tests had similar moderate accuracy. CONCLUSIONS: PHQ-9 and EPDS may be applied with equal confidence in screening for MDE in the community.

Fatores de risco para episódios e sintomas depressivos em usuários de álcool e/ou cocaína / Risk factors for depressive episodes and symptoms in alcohol and/or cocaine users

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)

Discovery of a Partner Affair and Major Depressive Episode in a Probability Sample of Married or Cohabiting Adults.

Prior research has found that humiliating marital events are associated with depression. Building on this research, the current study investigated the association between one specific humiliating marital event-discovering that one's partner had an affair-and past-year major depressive episode (MDE) in a probability sample of married or cohabiting men and women who were at high risk for depression based on the criterion that they scored below the midpoint on a measure of marital satisfaction (N = 227). Results indicate that (i) women were more likely than men to report discovering their partner had an affair in the prior 12 months; (ii) discovering a partner affair was associated with a higher prevalence of past-year MDE and a lower level of marital adjustment; and (iii) the association between discovering a partner affair and MDE remained statistically significant when holding constant demographic variables and marital adjustment. These results support continued investigation into the impact that finding out about an affair has on the mental health of the person discovering a partner affair.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Trastornos de la alimentación en hombres: cuatro subtipos clínicos / Eating Disorders in Males: Four Clinical Subtypes

Introducción: los trastornos de la alimentación, inicialmente considerados como prioritariamente femeninos, se encuentran igualmente en hombres. Su presentación, comorbilidades y evolución, parecen ser bastante similares a las descritas en muestras femeninas. Métodos: este trabajo presenta una serie de 21 casos con distintos cuadros de trastornos de la conducta alimentaria (TCA) y fobia a la comida. Resultados: se identifican variables comunes que pueden ayudar a la caracterización de por lo menos cuatro subtipos clínicos, tendientes a facilitar la evaluación y la intervención. Se plantean cuatro subtipos clínicos: restrictivo, impulsivo, evitativo y secundario a otras psicopatologías. Conclusiones: se discuten las implicaciones de este planteamiento.

Introduction: Eating disorders have been considered as essentially feminine, but they appear in men as well. Their presentation, comorbidities and evolution seem to be very similar to the ones in women. Methods: 21 cases of eating disorders and food phobia are described. Results: Common variables are identified that could be helpful in the characterization of at least four clinical subtypes, in order to facilitate clinical evaluation and treatment. Four clinical subtypes are presented: restrictive, impulsive, avoidant and secondary to other psychopathology. Conclusion: the implications of this outline are discussed.