The research output on child and adolescent suicide in Brazil : a systematic review of the literature

Objective:Suicide is the third leading cause of death among Brazilians aged 10 to 24 years.We aimed to review and describe the research output on suicide in children and adolescents in Braziland to identify strengths and gaps in this literature.Methods:PubMed/MEDLINE was searched for studies on suicide of children and adolescents (aged0-19 years) in Brazil, published from inception to December 31, 2017.Results:Our search identified 1,061 records, of which 146 were included. A large proportion (134studies; 90.4%) were original articles classified as observational epidemiological studies. Fifty-twoarticles (35.6%) used primary data. Of those, 18 (12.3%) evaluated prevalence of suicidal behaviors inpopulation-based samples. Seventy studies (47.9%) addressed death by suicide, and the remainderreported other phenomena, such as ideation, planning, or suicide attempt. Only 37 publications(25.3%) studied children and/or adolescents exclusively. Most of the studies (53.5%) were conductedwith samples from the South and Southeast regions of Brazil.Conclusion:Our findings indicate that the body of evidence on suicide among children andadolescents in Brazil is limited. The scientific output is of low quality, and there is a complete lack ofinterventional studies specifically designed for the youth population

Depression dimensions : integrating clinical signs and symptoms from the perspectives of clinicians and patients

Background Several studies have recognized that depression is a multidimensional construct, although the scales that are currently available have been shown to be limited in terms of the ability to investigate the multidimensionality of depression. The objective of this study is to integrate information from instruments that measure depression from different perspectives–a self-report symptomatic scale, a clinician-rated scale, and a clinician-rated scale of depressive signs–in order to investigate the multiple dimensions underlying the depressive construct. Methods A sample of 399 patients from a mood disorders outpatient unit was investigated with the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS), and the Core Assessment of Psychomotor Change (CORE). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate underlying dimensions of depression, including item level analysis with factor loadings and item thresholds. Results A solution of six depression dimensions has shown good-fit to the data, with no cross-loading items, and good interpretability. Item-level analysis revealed that the multidimensional depressive construct might be organized into a continuum of severity in the following ascending order: sexual, cognitive, insomnia, appetite, non-interactiveness/motor retardation, and agitation.Conclusion An integration of both signs and symptoms, as well as the perspectives of clinicians and patients, might be a good clinical and research alternative for the investigation ofmultidimensional issues within the depressive syndrome. As predicted by theoretical models of depression, the melancholic aspects of depression (non-interactiveness/motor retardation and agitation) lie at the severe end of the depressive continuum

Factors associated with adherence to sports and exercise among outpatients with major depressive disorder

Introduction: Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. Methods: In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. Results: MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. Conclusion: Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients

Relação entre qualidade de vida e prevalencia de ideação suicida em pacientes atendidos no programa de transtorno de humor : HCPA

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Interpersonal psychotherapy as add-on for treatment-resistant depression : a pragmatic randomized controlled trial

Background Treatment-resistant depression (TRD) is an extremely prevalent clinical condition. Although Interpersonal Psychotherapy (IPT) is an established treatment for uncomplicated depression, its effectiveness has never before been studied in patients with TRD in real-world settings. We investigate IPT as an adjunct strategy to treatment as usual (TAU) for TRD patients in a pragmatic, randomized, controlled trial. Methods A total of 40 adult patients with TRD (satisfying the criteria for major depressive disorder despite adequate antidepressant treatment) were recruited from a tertiary care facility for this pragmatic trial and blinded to the evaluator. Patients were randomized to one of two treatment conditions: (1) TAU – pharmacotherapy freely chosen by the clinician (n=23) and (2) TAU+IPT (n=17). Assessments were performed at weeks 8, 12, 19 and 24. Changes in the estimated means of the Hamilton Depression Rating Scale score were the primary outcome measure. Secondary outcomes included patient-rated scales and quality of life scales. We used a linear mixed model to compare changes over time between the two groups. Results Both treatments lead to improvements in depressive symptoms from baseline to week 24 with no significant between group differences in either primary: TAU (mean difference: 4.57; CI95%: 0.59–8.55; d=0.73) vs. IPT+TAU (mean difference: 5.86, CI95%: 1.50–10.22; d=0.93) or secondary outcomes. Limitations Our relatively small sample limits our ability to detect differences between treatments. Conclusions Both treatments lead to equal improvements in depressive symptoms. We found no evidence to support adding IPT to pharmacotherapy in patients with TRD