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INTRODUCTION: Recent guidelines on depressive disorders suggest a combination of antidepressants and psychotherapy in case of moderate to severe symptomatology. While cognitive behavioral therapy and interpersonal therapy are the most investigated interventions, psychodynamic psychotherapies have been less explored. OBJECTIVE: The aim of this paper is to systematically review literature data on the efficacy of shortterm psychodynamic psychotherapy (STPP) in combination with antidepressants in the treatment of depressive disorders, focusing both on short and on long-term results and on potential moderators that could influence its effectiveness. METHODS: The systematic review was conducted using the PRISMA guidelines. Databases searched were PubMed, Ovid, Scopus, and Cochrane Library, from inception to August 2023. RESULTS: Adding STPP to medications in the first six months of treatment didn't influence remission rates, but improved acceptability, work adjustment, interpersonal relationships, social role functioning, hospitalization rates and cost-effectiveness. After 12 months, a significant difference in remission rates arised, favouring combined therapy. In a long-term perspective, adding STPP to pharmacotherapy reduced the recurrence rate by almost 50%. STPP has proven to be more effective in longer depressive episodes, in more severe depressions and in patients with a childhood abuse history. Instead, STPP had no impact on major depressive disorder with comorbid Obsessive-Compulsive Disorder (OCD). CONCLUSIONS: Combining STPP with antidepressants appeared to be helpful both in a short-term and in a long-term perspective. Still, there are few rigorous studies with large samples and further research is needed to identify which subgroups of patients may benefit more from STPP.

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Locus of control has been highlighted as a variable related to mental health and well-being, as well as being indicated as a predictor for psychopathologies such as depression and anxiety. To verify these relationships, the aim of this study was to present two path analysis models related to the associations between locus of control, depression, anxiety, and emotional dysregulation. A sample of 327 participants (M age = 38.3 years, SD = 12.8), of both genders (Fem. = 75.2%), completed a sociodemographic questionnaire, the Locus of Control Scale (ELOCUS), the Baptista Depression Scale (EBADEP-A), the Emotional Dysregulation Scale (EDEA), and the Cognitive Anxiety Scale (ECOGA). Spearman correlations and path analyses were performed for the two proposed models. In the first model, the locus of control was a predictor of emotional dysregulation, symptoms of depression and anxiety. In the second model, the locus of control mediated the relationship between factors of emotional dysregulation (seeking strategies and pessimism) in relation to depression and anxiety. It was concluded that the locus of control is an important construct in the direct or indirect prediction of psychopathological symptoms.

El locus de control se ha señalado como una variable relacionada con la salud mental y el bienestar, además de estar indicado como un predictor de psicopatologías como la depresión y la ansiedad. Para verificar estas relaciones, el objetivo de este estudio fue presentar dos modelos de path analysis relacionados con las asociaciones entre locus de control, depresión, ansiedad y desregulación emocional. Una muestra de 327 participantes (M= 38.3 años, DE= 12.8), de ambos sexos (Fem. = 75.2 %), respondió un cuestionario sociodemográfico, la Escala de Locus de Control (ELOCUS), la Escala Baptista de Depresión (EBADEP-A), la Escala de Desregulación Emocional (EDEA) y la Escala de Ansiedad Cognitiva (ECOGA). Se realizaron correlaciones de Spearman y path analyses para los modelos propuestos. En el primer modelo, el locus de control fue un predictor de desregulación emocional, síntomas de depresión y ansiedad. En el segundo modelo, el locus de control medió la relación entre factores de desregulación emocional (búsqueda de estrategias y pesimismo) en relación con la depresión y la ansiedad. Se concluye que el locus de control es un constructo importante en la predicción directa o indirecta de síntomas psicopatológicos.

O locus de controle tem sido apontado como uma variável relacionada a saúde mental e bem-estar, além de ser indicado como um preditor para psicopatologias como depressão e ansiedade. No intuito de verificar essas relações, o objetivo deste estudo foi apresentar dois modelos de path analysis relacionados às associações entre locus de controle, depressão, ansiedade e desregulação emocional. Uma amostra de 327 participantes (M = 38,3 anos, DP = 12,8), ambos os sexos (Fem. = 75,2%), responderam um questionário sociodemográfico, a Escala de Locus de Controle (ELOCUS), a Escala Baptista de Depressão (EBADEP-A), a Escala de Desregulação Emocional (EDEA) e a Escala Cognitiva de Ansiedade (ECOGA). Foram realizadas correlações de Spearman, além de path analyses dos modelos propostos. No primeiro modelo, o locus de controle foi preditor da desregulação emocional, sintomatologia de depressão e ansiedade. Já, no segundo modelo, o locus de controle mediou a relação entre fatores da desregulação emocional (busca por estratégias e pessimismo) em relação a depressão e ansiedade. Conclui-se que o locus de controle é um construto importante na predição direta ou indireta de sintomas psicopatológicos.

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Background: The Behavioral Inhibition System (BIS) comprises limbic circuitry implicated in avoidance behaviors. Its increased activation has been identified as a risk factor for anxiety and depressive disorders. In addition, both Catechol-O-Methyltransferase (COMT) and Brain Derived Neurotrophic Factor (BDNF) have been postulated as candidate genes that constitute a vulnerability for the onset of anxiety and depressive disorders. The aim of this study was to evaluate the possible association between the rs4680 polymorphism of the COMT gene and the rs6265 polymorphism of the BDNF gene with the BIS and the Behavioral Activation System (BAS) in a population sample from Colombia. Methods: Genetic information was obtained by extracting DNA from blood samples of 80 participants and using Taqman probes designed for each polymorphism. In addition, participants completed a BIS/BAS scale in order to establish a neuropsychological classification. Results: The frequency of the Met allele of the BDNF gene was greater in the group with BIS sensitivity compared to the group with BAS sensitivity. On the contrary, the frequency of the Met allele of the COMT gen did not show a significant association with the BIS. Conclusions: The rs6265 polymorphism of BDNF gene is associated with the BIS which in turn constitutes a risk factor for anxiety and depression.

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The use of antidepressants during pregnancy benefits the mother's well-being, but the effects of such substances on neurodevelopment remain poorly understood. Moreover, the consequences of early exposure to antidepressants may not be immediately apparent at birth. In utero exposure to selective serotonin reuptake inhibitors (SSRIs) has been related to developmental abnormalities, including a reduced white matter volume. Several reports have observed an increased incidence of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) after prenatal exposure to SSRIs such as sertraline, the most widely prescribed SSRI. The advent of human-induced pluripotent stem cell (hiPSC) methods and assays now offers appropriate tools to test the consequences of such compounds for neurodevelopment in vitro. In particular, hiPSCs can be used to generate cerebral organoids - self-organized structures that recapitulate the morphology and complex physiology of the developing human brain, overcoming the limitations found in 2D cell culture and experimental animal models for testing drug efficacy and side effects. For example, single-cell RNA sequencing (scRNA-seq) and electrophysiological measurements on organoids can be used to evaluate the impact of antidepressants on the transcriptome and neuronal activity signatures in developing neurons. While the analysis of large-scale transcriptomic data depends on dimensionality reduction methods, electrophysiological recordings rely on temporal data series to discriminate statistical characteristics of neuronal activity, allowing for the rigorous analysis of the effects of antidepressants and other molecules that affect the developing nervous system, especially when applied in combination with relevant human cellular models such as brain organoids.

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Introdução: A depressão é um transtorno incapacitante e causa prejuízos funcionais, além de altos custos para o sistema de saúde e previdência social. No Brasil, os Centros de Atenção Psicossocial são serviços de base comunitária, prioritários para o cuidado, a fim de possibilitar a reinserção social dos sujeitos adoecidos mentalmente. Objetivos: Investigar os custos diretos e indiretos da depressão no Brasil entre 2010 e 2018, e a oferta de cuidados em saúde dos CAPS a indivíduos com depressão, entre 2013-2019. Métodos: Estudo de custo da doença baseado na prevalência, com abordagem top-down, sob a perspectiva da sociedade, e estudo descritivo, ecológico, de série temporal, com dados secundários de bancos de dados nacionais, com adultos de 18 anos ou mais de idade, com diagnóstico de depressão. Foram incluídos custos diretos (hospitalares e ambulatoriais), provenientes dos Sistemas de Informação Hospitalar e Ambulatorial, e indiretos (absenteísmo), do Instituto Nacional de Seguro Social, além dos atendimentos efetuados nos CAPS, provenientes dos Registros das Ações Ambulatoriais de Saúde (RAAS psicossocial). Os custos foram calculados por ano, de 2010 a 2018. A cobertura presumida de CAPS foi calculada para 2013 e 2019, com base nos serviços cadastrados e ativos. Resultados: O custo da depressão foi de Int$ 2.288.511.607,39 no período analisado, com custo médio anual de Int$ 254.279.067,49. De 2014 a 2018, houve queda acentuada no custo da depressão (-44,24%), principalmente nos custos indiretos (-55,83%). No período investigado, os custos indiretos representaram 74,85% do custo total. Com o tempo, o ambulatório superou o custo hospitalar. Em 2017 e 2018, os custos ambulatoriais representaram, respectivamente, 43,22% e 39,57% dos custos totais. Em todos os anos analisados, predominaram os custos e atendimentos nos CAPS para o sexo feminino (77%). Houve um aumento de 107% no número de pacientes com depressão atendidos nos CAPS entre 2013 e 2019. Prevaleceram, entre os atendidos, aqueles de cor/raça branca (38%) e parda (34%), na faixa etária de 41-60 anos (49%). Foram mais frequentes o diagnóstico de episódios depressivos (65%) e o atendimento individual (75%). A cobertura presumida dos CAPS foi de 71% e 87% no país em 2013 e 2019, respectivamente, embora com disparidades acentuadas entre os estados. Conclusões: A depressão é uma doença com elevada carga econômica para o sistema de saúde. Foram identificados avanços na implementação dos CAPS no país, no período 2013-2019. No entanto, ainda são necessários investimentos, tal como maior cobertura dos serviços, pois ainda permanecem desigualdades entre as unidades federativas, além de serem reduzidos os atendimentos em grupos e familiares, sendo necessária a capacitação de equipes multiprofissionais e de profissionais de saúde aptos para a atenção psicossocial.

Introduction: Depression is a disabling disorder and it causes functional damages, in addition to high costs to the health system and social previdence. In Brazil, the Psychosocial Atention Centers are services of communitarian base intented to care and enable the social reinsertion of mentally diseased individuals. Objectives: To investigate depression's direct and indirect costs in Brazil between 2010 and 2018, and CAPS' offer of medical care to individuals with depression, between 2013-2019. Methods: Study of cost based on prevalence, with top-down approach, under the perspective of society, and descriptive, ecological study of temporal series, with secondary data from national data banks, with adults over 18 years old or more, diagnosed with depression. Direct costs (hospital and outpatient) that came from Hospital and Outpatient Information Systems and indirect ones (absenteeism) that came from the National Institute of Social Security were included, in addition to the performed medical cares in CAPS, which can be found on the Records of Outpatient Health Actions (psychosocial RAAS). The costs were calculated by year, from 2010 to 2018. CAPS' presumed coverage was calculated for 2013 and 2019, based on registered and active services. The cost of depression was from Int$ 2.288.211.607,39 in the analyzed period, with an average annual cost of Int$ 254.279.067,49. From 2014 to 2018, there was an elevated decrease in the cost of depression (-44,24%), mainly in indirect costs (-55,83%). In the investigated period, the indirect costs represented 74,85% of the total cost. With time, the outcare overcame the hospital cost. In 2017 and 2018, outcare costs represented, respectively, 43,22% and 39,57% of total costs. During all the analyzed years, the costs and medical cares in CAPS were mostly for the feminine sex (77%). There was an increase of 107% in the number of patients with depression that received medical care in CAPS between 2013 and 2019. Those that received medical cares the most were of white color-race (38%) and brown (34 %), between the ages of 41 and 60 years old (49%). The diagnose of depressive episodes (65%) and the individual medical care (75%) were most frequent. The presumed CAPS' coverage was of 71% and 87% in the country, respectively, although with accentuated disparities between the states. Conclusion: Depression is a disease with elevated economical charge to the health system. Advancements were identified in the implementation of CAPS in the country, during 2013-2019. However, investments are still necessary, just as a bigger coverage of the services, because there are still inequalities bwtween the federative unities, in addition to reduced medical cares for groups and families, making the training of multi-professional and professional health teams that are able to pychosocial attention, necessary.

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Background: Cognitive retraining or remediation approaches dispense high levels of stimulation and new learning tasks, leading to an increased neural connections, which facilitate rapid recovery in patients with neurological as well as psychiatric conditions. Objectives: The current study aimed to investigate the effect of cognitive retraining (CR) in depressive disorders. We assigned 40 patients with mild to moderate depression to two sample groups, with 20 participants each: CR alone and CR with medicine. A 6-week CR module was delivered, and participants' scores on measures such as the Beck Depression Inventory-II, Metacognition Questionnaire 30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning were compared. Results: Analysis using Stata/IC version 16 included descriptive statistics, paired and independent t-tests, analysis of covariance, and propensity score matching. Cohen's d was computed to determine the effect size. Within-group analysis revealed statistically significant differences in pre-post scores of the outcome measures (p < .05) and large effect size (d = 3.41; d = 3.60) in both groups. The difference in scores of outcome measures between the groups was not significant (p > .05) even when covariates were controlled, or nearest neighbor match analysis was carried out. CR is effective in alleviating symptoms and dysfunctional metacognitive beliefs in addition to enhancing functioning and quality of life. Conclusions: CR-based interventions may be essential mental health services owing to growing research in psychotherapy via virtual modes such as tele- and video-conferencing. These interventions can substantiate both prevention and remedy. (AU)

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The high prevalence of mental health problems among university students poses a challenge when developing effective interventions, with digital technologies emerging as a potential resource to address this problem. The inclusion of student input in the design and development of such interventions is critical to improving their impact. This study contributed to the initial phase of a research project that aims to adapt and evaluate the feasibility and acceptability of an early intervention for anxiety and depression based on digital technologies for university students. Three participatory workshops were conducted with 13 university students in Chile to inquire about the features and content that a mental health mobile app should include to meet their needs and preferences. The workshop transcripts were analysed using inductive thematic analysis. The results of this study highlight the value of modifications such as the personalisation of some features of the app. The students recommended incorporating topics related to university life and the possibility of contacting a mental health professional, as well as the inclusion of peer interaction or other forms of support.

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Background: The mild cognitive impairment (MCI) stage among elderly individuals is very complex, and the level of diagnostic accuracy is far from ideal. Some studies have tried to improve the 'MCI due to Alzheimer's disease (AD)' classification by further stratifying these patients into subgroups. Depression-related symptoms may play an important role in helping to better define the MCI stage in elderly individuals. Objective: In this work, we explored functional and structural differences in the brains of patients with nondepressed MCI (nDMCI) and patients with MCI with depressive symptoms (DMCI), and we examined how these groups relate to AD atrophy patterns and cognitive functioning. Methods: Sixty-five participants underwent MRI exams and were divided into four groups: cognitively normal, nDMCI, DMCI, and AD. We compared the regional brain volumes, cortical thickness, and white matter microstructure measures using diffusion tensor imaging among groups. Additionally, we evaluated changes in functional connectivity using fMRI data. Results: In comparison to the nDMCI group, the DMCI patients had more pronounced atrophy in the hippocampus and amygdala. Additionally, DMCI patients had asymmetric damage in the limbic-frontal white matter connection. Furthermore, two medial posterior regions, the isthmus of cingulate gyrus and especially the lingual gyrus, had high importance in the structural and functional differentiation between the two groups. Conclusion: It is possible to differentiate nDMCI from DMCI patients using MRI techniques, which may contribute to a better characterization of subtypes of the MCI stage.

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SUMMARY OBJECTIVE: This study aimed to analyze the epidemiological profile and psychological disorder of the suicide attempt cases in Francisco Beltrão, Paraná. METHODS: This is an epidemiological descriptive/qualitative study of suicide attempts conducted between 2017 and 2020. This study used data from the Brazilian Information system for notifications involving suicide attempts (Sistema de Informação de Agravos de Notificação, SINAN) and 447 notifications were obtained. An analysis of the electronic medical record of these patients was performed in order to investigate the mental disorders, using a questionnaire. RESULTS: Of the 447 notifications, 382 were eligible for the study. Using the 95% confidence interval, there was a higher frequency of females with 71.7% aged between 18 and 35 years representing 48.4%, with 77.2% white race/color, the singles appeared in the majority with 47.6% with a history of previous suicide attempts, using exogenous intoxication as a method in the attempt with 67.5%. Regarding mental health, 66.5% of the patients had some mental disorders, with the highest prevalence of recurrent depressive disorder found in 40.6%. CONCLUSION: It was observed that there is a need for training of health professionals and implementation of programs and preventive measures aimed primarily at females aged between 18 and 35 years with mental disorders, especially with recurrent depressive disorder and with a history of previous suicide attempt.

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Introducción: la enfermedad renal crónica avanzada se define como la presencia de daño renal y se caracteriza por alteraciones estructurales y funcionales que disminuyen la tasa de filtración glomerular. Esta enfermedad constituye un punto de cambio en la vida de las personas que la padecen, pues los obliga a diseñar estrategias mediante las cuales puedan reestructurar sus sueños, aspiraciones y proyectos de vida debido a que esta es una condición que cambia los estilos de vida y ocasiona otras entidades que afectan los niveles físico, psicológico y social. Objetivo: determinar los factores asociados a la depresión en personas con enfermedad renal crónica avanzada en población del departamento de Boyacá, Colombia. Materiales y métodos: se realizó un estudio transversal en 201 pacientes con enfermedad renal crónica en fases avanzadas y que estuvieran en manejo con terapia dialítica. Para la obtención de los datos se aplicó el cuestionario de depresión de Beck, además se incluyeron variables demográficas, sociales y clínicas. Resultados: la edad promedio de los participantes fue 58,5 años, el 76,11 % eran varones y la prevalencia de depresión fue de 40,29 %. Las personas con pareja estable y que cuentan con apoyo familiar y buena atención por parte del personal de salud tienen menos probabilidad de presentar depresión, mientras que los mayores de 50 años de edad, quienes llevan más dos años en terapia dialítica y aquellos que presentan otras enfermedades como diabetes mellitus y enfermedad pulmonar obstructiva crónica tienen probabilidades más altas de desarrollar depresión. Conclusiones: se considera prudente crear grupos de apoyo en las unidades de diálisis, donde se incluya a los pacientes y sus familiares, con el fin de detectar tempranamente problemas de salud mental y darles un manejo temprano, buscando de esta forma una adecuada adherencia al tratamiento de las patologías de base.

Introduction: Renal insufficiency is defined as the presence of renal damage and is characterized by structural and functional alterations with decreased glomerular filtration rate. This disease constitutes a turning point in the lives of people who suffer from it, since it requires elaborate forms or methods by which they can structure their dreams, aspirations and life projects additionally changing lifestyles, and generates other entities that affect the physical, psychological and social level. With this project they were determined the factors associated with depression in people with advanced chronic kidney disease in population of the department of Boyacá. Materials and methods: A cross-sectional study was conducted, which included patients with chronic kidney disease in advanced stages who were managed with dialysis therapy. Demographic, social and clinical variables were included. Where the Beck depression questionnaire was applied. Results: A total of 201 people participated. The average age was 58.5 years and 76.11 % were male. The prevalence of depression was 40.29 %. People with a stable partner, who have family support and good care from health personnel are less likely to have depression, while people over 50 years of age, with more than two years in dialysis therapy and the presence of Diseases such as diabetes mellitus and chronic obstructive pulmonary disease are more likely to develop depression. Conclusions: It is considered prudent to create support groups in dialysis units, where patients and their families are included, this in order to detect mental health problems early and give early management, thus seeking an adequate to the adherence of the underlying pathologies.

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Abstract Objective To assess the most common psychological disturbances in women with deep endometriosis and bowel involvement who are waiting surgical treatment and to evaluate what forms of coping are used to solve the problem. Methods This was a cross-sectional observational study of 40 women diagnosed with deep endometriosis and intestinal symptoms. They completed two questionnaires: one for anxiety and depression (Hospital Anxiety and Depression Scale [ HADS]) and the Scale of Mode of Confronting Problems (EMEP, in the Portuguese acronym). Results We found that 77.1% of the patients had anxiety and depression, with anxiety being the most prevalent (87.5% of the patients); 90% of the patients used problem focused and religious introspection as their main modes of confronting problems. Conclusion In the use of the HADS questionary, two psychological aspects were the most present in women with deep endometriosis awaiting surgical treatment: anxiety and depression. The most used forms of coping to solve the problem were problem coping and religious practices.

Resumo Objetivo Avaliar os distúrbios psicológicos mais comuns em mulheres com endometriose profunda e acometimento intestinal que aguardam tratamento cirúrgico e avaliar as formas de enfrentamento que são usadas para resolver o problema. Métodos Estudo observacional transversal com 40 mulheres com diagnóstico de endometriose profunda e acometimento intestinal. As pacientes responderam dois questionários: para ansiedade e depressão (Hospital Anxiety and Depression Scale [HADS, na sigla em inglês) e outro para enfrentamento dos problemas (EMEP). Resultados Constatamos que 77% das pacientess apresentaram ansiedade e depressão, sendo a ansiedade a mais prevalente (87,5%); 90% das pacientes usaram a forma religiosa e focada no problema como sua principal estratégia de enfrentamento. Conclusão Os aspectos psicológicos mais encontrados em mulheres com endometriose profunda e intestinal que aguardam tratamento cirúrgico são ansiedade e depressão. As formas mais usadas de enfrentamento para resolver o problema foram práticas religiosas e focada no problema.

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ABSTRACT BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

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ABSTRACT Background: The importance of foods or food constituents in mental health is increasingly recognized, and "nutritional psychiatry" is a growing discipline. Objective: This narrative review aims to present work supporting associations between food or food constituents and mental health, specifically depressive disorders. Methods: The data presented is derived from preclinical and clinical work, including in vitro and in vivo assays, as well as observational studies and randomized clinical trials of dietary interventions. The focus of the review is the mediation of inflammatory processes and oxidative stress by dietary constituents that are an integral part of a healthy diet, such as the Mediterranean diet and similar. Results and Discussion: We present evidence for the role of the diet in prevention and management of depressive disorders, beyond the effect of individual nutrients. The findings indicate that among the dietary components with higher degree of evidence to influence depressive disorders are long chain n-3 polyunsaturated fatty acids (EPA and DHA), and various dietary bioactive compounds, especially plant-derived secondary metabolites represented by polyphenols such as flavonoids and resveratrol. Conclusion: Diet exerts an important role on mental health, and evidence indicates that some dietary constituents contribute to the prevention of depressive disorders.

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BACKGROUND: Posterior segment eye diseases, such as glaucoma and retinal diseases (such as diabetic retinopathy, age-related macular degeneration, and retinal detachment), are chronic diseases that are among the major causes of visual impairment. OBJECTIVE: We investigated the prevalence of anxiety disorders, depressive disorders, and common mental disorders in these patients and also the incidence of depression. METHODS: We examined baseline (2008-2010) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used the Clinical Interview Schedule-Revised (CIS-R) to perform International Classification of Diseases-10-based diagnoses of anxiety and depressive disorders. Common mental disorder was defined as a Clinical Interview Schedule-Revised >11. We used multinomial logistic regression models to investigate associations between eye diseases and mental disorders, adjusted by age, gender, educational level, self-reported ethnicity, cardiovascular conditions, and self-reported quality of vision. RESULTS: Out of 10,775 subjects, 249 (2.3%), 303 (2.8%), and 30 (0.3%) reported having retinal diseases, glaucoma, or both, respectively. Patients with retinal diseases and those with glaucoma and retinal diseases presented a higher prevalence of common mental disorders (relative-risk ratios of 1.7 and 3.7, respectively, P < 0.001). These patients also presented a higher incidence of depression at follow-up (relative-risk ratios of 3.0 and 5.9, respectively, P < 0.001). Patients with glaucoma presented neither a higher prevalence nor a higher incidence of mental disorders or depression. CONCLUSIONS: Retinal diseases but not glaucoma were associated with mental disorders, indicating that patients with posterior segment eye diseases require distinct management of psychiatric morbidity according to the underlying pathology.

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Objective: Examine the Strengths and Difficulties Questionnaire (SDQ) responses of parents and teachers for children with ADHD comorbid with major depressive disorder (MDD), with an emphasis on determining how well the respondent groups' responses correlate, and how well the results obtained perform as predictors of clinical diagnosis. Method: The SDQ was completed by parents and teachers of (n = 215 participants, 7-12 years old) in ADHD, MDD, ADHD + MDD, and healthy control groups. Agreement between parent and teacher SDQs and their concordance with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnoses were assessed. Receiver operating characteristic (ROC) and Kappa concordance analyses were used to compare the groups with the health control group. Results: The comorbid group presented greater impairments than the ADHD, MDD, and control groups (p < .001). Conclusion: The presence of psychiatric comorbidity causes greater impairment for school children with ADHD. The SDQ has good sensitivity for detecting these children and correlates well with DSM diagnosis.

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BACKGROUND: Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. METHODS: We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. RESULTS: In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (- 9.01%, - 11.66 to - 6.31). The highest proportion of YLD was observed in the age range of 15-64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil's, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. CONCLUSIONS: Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

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OBJECTIVE: The authors investigated the associations between polygenic liability and progression to bipolar disorder or psychotic disorders among individuals diagnosed with unipolar depression in early life. METHODS: A cohort comprising 16,949 individuals (69% female, 10-35 years old at the first depression diagnosis) from the iPSYCH Danish case-cohort study (iPSYCH2012) who were diagnosed with depression in Danish psychiatric hospitals from 1994 to 2016 was examined. Polygenic risk scores (PRSs) for major depression, bipolar disorder, and schizophrenia were generated using the most recent results from the Psychiatric Genomics Consortium. Hazard ratios for each disorder-specific PRS were estimated using Cox regressions with adjustment for the other two PRSs. Absolute risk of progression was estimated using the cumulative hazard. RESULTS: Patients were followed for up to 21 years (median=7 years, interquartile range, 5-10 years). The absolute risks of progression to bipolar disorder and psychotic disorders were 7.3% and 13.8%, respectively. After mutual adjustment for the other PRSs, only the PRS for bipolar disorder predicted progression to bipolar disorder (adjusted hazard ratio for a one-standard-deviation increase in PRS=1.11, 95% CI=1.03, 1.21), and only the PRS for schizophrenia predicted progression to psychotic disorders (adjusted hazard ratio=1.10, 95% CI=1.04, 1.16). After adjusting for PRSs, parental history still strongly predicted progression to bipolar disorder (adjusted hazard ratio=5.02, 95% CI=3.53, 7.14) and psychotic disorders (adjusted hazard ratio=1.63, 95% CI=1.30, 2.06). CONCLUSIONS: PRSs for bipolar disorder and schizophrenia are associated with risk for progression to bipolar disorder or psychotic disorders, respectively, among individuals diagnosed with depression; however, the effects are small compared with parental history, particularly for bipolar disorder.

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BACKGROUND: According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience. AIMS: Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster. METHOD: Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003-2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD. RESULTS: Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08-1.37, and OR = 1.16, 95% CI 1.06-1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52-5.04), and a dose-response relationship between pre-disaster stressors and post-disaster MDD was found. CONCLUSIONS: In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.

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Resumen Objetivo: determinar el efecto de un programa de rehabilitación en los puntajes de ansiedad y depresión de pacientes con enfermedad cardiovascular. Materiales y métodos: se analizó la información de una cohorte retrospectiva de pacientes con enfermedad cardiovascular, admitidos a un programa de rehabilitación cardiaca. La ansiedad y depresión fueron medidas con la escala HADS (Hospital Anxiety and Depression Scale) y se categorizaron según el tratamiento de base recibido (médico o quirúrgico). Se comparó el cambio en los puntajes de ansiedad y depresión al ingreso y al final de la rehabilitación cardiaca mediante la prueba de Wilcoxon para muestras pareadas y la prueba de McNemar para evaluar el cambio de los porcentajes en cada subescala. Resultados: se incluyeron 1.221 pacientes. La mediana de edad fue 61 años, 68,30% eran hombres. Al ingreso, la mediana del puntaje de ansiedad y depresión fue 3, de los cuales 141 pacientes presentaron un trastorno de ansiedad (11,55%) y 67 un trastorno depresivo (5,49%). Al final de la rehabilitación cardiaca se obtuvo una mejoría en los puntajes de ansiedad y depresión tanto en pacientes en tratamiento médico (promedio -1,87 puntos 95% IC -2,14 a -1,60 p<0,01 y -1,46 puntos 95% IC -1,72 a -1,21 p<0,01 respectivamente) como quirúrgico (promedio -1,48 puntos 95% IC -1,78 a -1,18 p<0,01 y -1,83 puntos 95% IC -2,12 a -1,57 p<0,01). Conclusiones: los puntajes de ansiedad y depresión, en pacientes con enfermedad cardiovascular en tratamiento médico o quirúrgico, mejoraron luego de un programa integral de rehabilitación cardíaca.

Abstract Objective: To determine the effects of a rehabilitation program on the anxiety and depression scores of patients with cardiovascular disease. Materials and methods: An analysis was performed on the information collected from a retrospective cohort of patients with cardiovascular disease, admitted to a cardiac rehabilitation program. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and were classified according to the baseline treatment (medical or surgical) received. A comparison was made between the anxiety and depression scores on admission and at the end of the cardiac rehabilitation program using Wilcoxon test for paired samples and the McNemar test to evaluate the change in the percentages in each sub-scale. Results: A total of 1,221 patients were included. The median age was 61 years, and 68.3% were males. On admission, the median score was 3 on the anxiety and depression scale, with 141 (11.55%) patients having an anxiety disorder, and 67 (5.49%) with depressive disorder. An improvement was observed in the anxiety and depression scores at the end of the end of the cardiac rehabilitation, both in patients on medical treatment (mean difference minus 1.87 points, 95% CI; -2.14 to -1.60: P<.01, and -1.46 points, 95% CI; -1.72 to -1.21: P<.01, for anxiety and depression, respectively) and on surgical treatment (mean difference -1.48 points, 95% CI; -1.78 to -1.18, P<.01 and -1.83 points, 95% CI -2.12 to -1.57, P<.01, respectively). Conclusions: The anxiety and depression scores in patients with cardiovascular disease on medical or surgical treatment improved after an integrated cardiac rehabilitation program.

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Objective: The main purpose of this study was to investigate the factor structure of the Beck Depression Inventory - Second Edition (BDI-II) in a sample of adults. Specifically, we evaluated the BDI-II based on confirmatory factor analysis of different measurement models, and compared the optimal factor structure of the BDI-II by gender using measurement invariance analysis. Method: A cross-sectional survey with 717 community-dwelling adults was conducted. The Brazilian Portuguese version of the BDI-II was administered. Seven different models (one-, two-, three-factor models and their bifactor structures) were tested through CFA. CFA and multigroup analysis were executed with the software MPLUS (Weighted Least Squares Estimator - WLSMV). Results: Four bifactor models reached acceptable fit indices. A bifactor model with two specific factors (Cognitive-Affective, and Somatic-Affective) provided the best fit to the data. The multigroup analysis of this model demonstrated invariance by gender. Conclusions: Our findings support the use of the total BDI-II score to identify depressive symptoms, including gender comparisons. Since a bifactor structure fit the data better, the scores of the specific factors should not be used as the first choice, or at least should be used with caution. The analysis of the severity of depression, based on a total score, seems to be the most appropriate option.