Depressive disorder burden: global epidemiological issues and information needs in Portugal

INTRODUCTION Modern societies at present are heavily burdened by depressive disorders but a further increment of negative impact is predictable in years to come. Though there are effective treatments available these disorders are infrequently recognised and managed. OBJECTIVES To review depressive disorders burden focusing the epidemiological information gap in Portugal. METHODOLOGY Bibliographic search using Medline, the Index of Portuguese Medical Journals and the National Library, as well as other sources, with particular focus for review studies and cross-references. RESULTS Burden of depressive disorders is well established worldwide with increasing accuracy allowing for better health planning and treatment access. In Portugal, in spite of the need, scarcity of data and methodological inadequacy are the rule, with no precise prevalence data available. CONCLUSIONS The true dimension of depression burden issues in Portugal will only be globally and scientifically assessed through epidemiological studies in various settings with representative national populations.publishersversionpublishe

A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial

PURPOSE: This study aimed to assess the efficacy of a staff-training intervention to improve service users’ engagement in activities and quality of care, by means of a cluster randomised controlled trial. METHOD: All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit’s manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users’ level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users’ quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). RESULTS: Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. CONCLUSIONS: The intervention increased the level of knowledge of staff without leading to an improvement in service users’ engagement in activities, quality of life, or quality of care in the units

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5–20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson’s disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations. © 2019, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply