La calidad de vida de las madres de niños trabajadores en las calles de São Paulo, Brasil

The present study evaluated the perceived quality of life of the mothers of street children and investigated the association with their history of childhood violence, the occurrence of current domestic violence, their current mental states and that of their children, and family functioning. the applied instruments were as follows: Strengths and Difficulties Questionnaire, WorldSAFECore Questionnaire, Instrument for the Assessment of Quality of Life of the WHO, Global Assessment of Relational Functioning Scale, Childhood Trauma Questionnaire and a socio-demographic questionnaire. the sample of convenience consisted of 79 low-income mothers who raised their children alone, and most of whom had a positive screening for mental illness. the multiple regression analysis showed that the perception of quality of life of these women was associated with the presence of psychopathology either in themselves or their children and family dysfunction. Thus any program aimed at improving the quality of life of such mothers should consider addressing their mental problems as well as those of their children, besides offering educational and psychotherapeutic approaches to these families to improve the social environment.Universidade Federal de São Paulo, Dept Psiquiatria, BR-04038020 São Paulo, SP, BrazilUniv São Paulo, Inst Matemat & Estat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psiquiatria, BR-04038020 São Paulo, SP, BrazilWeb of Scienc

Validation of the Brazilian-Portuguese version of the Clinician Administered Post Traumatic Stress Disorder Scale-5

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987–0.997), p < 0.001]. Cohen’s Kappa for individual items ranged between 0.759 and 1. Cronbach’s alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835)

A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression

Background: A history of child sexual abuse (CSA) is related to higher suicide rates and poor treatment outcomes in depressed adult patients. Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the CSA effects on this emerging treatment. Here, we assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD). Methods: A directed acyclic graphic (DAG) was designed to identify clinical confounders between CSA and esketamine predictors of response. The confounders were applied in a statistical model to predict depression symptom trajectory in a sample of 67 TRD outpatients. Results: The patient sample had a relatively high prevalence rate of CSA (35.82%). Positive family history of first-degree relatives with alcohol use disorder and sex were clinical mediators of the effects of esketamine in a CSA adult population. Overall, the presence of at least one CSA event was unrelated to esketamine symptom reduction. Conclusions: Unlike responses to conventional antidepressants and psychotherapy, CSA does not appear to predict poor response to esketamine.publishedVersio

A paradigm for understanding and treating psychiatric illness

Institute of Psychiatry Departament of Psychological Medicine Section of Neurobiology of Mood DisordersUniversity of London King's College Stress, Psychiatry and Immunology LabNational Institute of Mental Health Section on Neuroendocrine ImmunologyUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Stress, hypothalamic-pituitary-adrenal axis(HPA and depression

BV UNIFESP: Teses e dissertaçõe

Global assessment of relational functioning scale(GARF) vality study whith depressive patients

Neste trabalho a autora realize tini estudo de validacao da Escala de Avaliacao Global de Funcionamento nas Relacoes (GARF) para tini grupo de pacientes portadores de depressao recorrente. Urna amostra de 34 pacientes, corri diagnostico de depressao recorrente confirmado atraves da Structured Clinical Interview (SCID), foi submetida a urna entrevista familiar semi-estruturada e a aplicacao da GARF. A entrevista foi considerada padrao ouro. Os dados obtidos na entrevista e na escala foram comparados para obtencao do ponto de corte da GARE para dividir familias entre funcionamento satisfatorio ou insatisfatorio. Foram entao calculados os coeficientes de sensibilidade, especificidade, valores preditivos positivo e negativo e taxa de classificacao incorreta. O estudo do ponto de corte da escala foi tambem realizado utilizando curvas ROC examinadas para o escore geral da GARE e para suas tres subescalas; resolucao de problemas, organizacao e clima emocional. Foi observado o comportamento do ponto de corte de acordo corri variaveis sociodernograficas e clinicas. A influencia do conjunto das variaveis sociodemograficas e clinicas rios escores da GARE foi avaliada atraves da regressao multipla. Os resultados mostram que o melhor ponto de corte para a GARF e 70, corri sensibilidade de 78 por cento, especificidade de 86 por cento, valor preditivo positivo de 95 por cento, valor preditivo negativo de 50 por cento e taxa de classificacao incorreta de 20 por cento. Nao ha variacao significativa do ponto de corte para as tres subescalas da GARF. O modelo de regressao multipla explica 41 por cento da variabilidade do escore da GARF e envolve as variaveis, escolaridade do paciente, gravidade do episodio depressivo atual e papel relacional do individuo que responde as questoes para o preenchimento da escala aumentam os escores da GARF. Sao discutidas algumas hipoteses para estes achados apoiados na dinamica do funcionamento familiar, em questoes socioculturais e metodologicas. Conclui-se que a versao em portugues da GARF apresenta bom desempenho no estudo com pacientes com diagnostico de depressao recorrente. Deve-se destacar que o escore da GARF sofre influencia da escolaridade do paciente, da gravidade do episodio depressivo atual e do papel relacional de quem fornece as informacoes sobre o funcionamento familiarBV UNIFESP: Teses e dissertaçõe

Meta-analysis of the effect of racial discrimination on suicidality

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there have been reports that minorities and marginalized groups exposed to RD are at a higher risk of suicide. Given that RD negatively impacts mental health and that suicide is a major public health concern, we meta-analytically reviewed the literature to investigate whether RD is associated with suicidal ideation (SI) and suicide attempt (SA). We identified 43 eligible articles investigating the association between RD and suicidality through PubMed, Embase, PsycINFO and Scopus, from which we pooled 39 effect sizes for SI (58,629 individuals) and 15 for SA (30,088 individuals). Results demonstrated that RD has a small but significant effect both on SI (r = 0.16, 95% CI: 0.12 to 0.19; p < 0.0001) and on SA (r = 0.13, 95% CI: 0.02 to 0.23; p = 0.018). We found no indication of publication bias, and fail-safe tests confirmed the robustness of the results. Furthermore, we tested the moderating effects of several study characteristics (e.g., age, race, RD and SI time frame assessment, and categorization of RD measures). The only study characteristic to moderate the effect of RD on SI was SI time frame assessment (r = 0.07; 95% CI: 0.015 to 0.12; p = 0.01). Our findings suggest that SI and SA are phenomena that may be influenced by exposure to RD. Thus, individuals that are discriminated based on race may develop more suicidal thoughts and an increased likelihood of attempting suicide. These findings underscore the need for more prevention and intervention efforts to attenuate the effect of RD on suicidality

Subjective and objective sleep quality in young women with posttraumatic stress disorder following sexual assault: a prospective study

Background: Most posttraumatic stress disorder (PTSD) sleep disturbances reports have been conducted in male combat veteran populations, usually decades after the disorder’s onset. Given the increase in the prevalence of violence against women and the fact that women are at greater risk for developing PTSD, it is critical to examine sleep abnormalities in this population. Objectives: To examine subjective and objective sleep quality in young women with PTSD following sexual assault compared with a control group at baseline and after one year of treatment. Methods: Seventy-four women with PTSD following sexual assault and 64 healthy controls with no history of sexual assault were assessed using the Clinician-Administered PTSD Scale (CAPS-5), the Beck Depression Inventory, the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index (PSQI), the Modified Fatigue Impact Scale, and the Insomnia Severity Index. Subjects also underwent full in-lab polysomnography. PTSD participants received pharmacological and/or psychological therapy between baseline and one-year follow-up. Results: The PTSD group had significantly higher scores in the clinical and sleep measurements than the control group. Although the PTSD group reported poorer subjective sleep quality than healthy controls, there were few between-group differences in objective sleep. Analysis of the PTSD group at baseline and one-year follow-up showed that the PSQI global score was a significant predictor of PTSD improvement. Conclusions: Sleep quality is impaired in young women with PTSD and may impact long-term treatment responses. Better sleep quality is significantly associated with PTSD improvement, independent of depression and anxiety