Serum cytokine variations among inpatients with major depression, bipolar disorder, and schizophrenia versus healthy controls : a prospective ‘true-to-life’ study

Background: There is increasing evidence of the association between chronic low-grade inflammation and severe mental illness (SMI). The objective of our study was to assess serum cytokine levels (SCLs) at admission and discharge in a true-to-life-setting population of inpatients with major depression (MD), bipolar disorder (BD), and schizophrenia (Sz), as well as of healthy controls. Methods: We considered MD, BD, and Sz to be SMIs. We evaluated 206 inpatients [MD, N=92; BD, N=26; mania (Ma), N=44; Sz, N=44). Generalized estimating equations were used to analyze variations in SCL [interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17] at hospital admission and discharge. Results of 100 healthy controls were compared with those of SMI patients at both time points. We evaluated patients’ improvement during in-hospital treatment in terms of general psychiatric symptoms, global clinical impression, functionality, and manic and depressive symptoms with validated scales. Results: In all, 68.9% of patients completed the study. Overall, SMI inpatients had higher SCL when compared with controls regardless of diagnosis. There was a significant decrease in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression–Severity Scale (CGI-S) scores, and an increase in Global Assessment of Functioning (GAF) scores for all disorders evaluated (p<0.001), as well as a significant decrease in HDRS-17 scores among MD inpatients (p<0.001) and in YMRS scores among Ma inpatients (p<0.001). IL-2 and IL-6 levels decreased significantly between admission and discharge only among MD inpatients (p=0.002 and p=0.03, respectively). We found no further statistically significant changes in SCL among the remaining disorders (BD, Ma, and Sz). There was no significant decrease in IFN-γ (p=0.64), TNF-α (p=0.87), IL-4 (p=0.21), IL-10 (p=0.88), and IL-17 (p=0.71) levels in any of the evaluated diagnoses. Conclusion: MD inpatients had a decrease in IL-2 and IL-6 levels during hospitalization, which was accompanied by clinical improvement. No associations were found for the remaining SMIs (BD, Ma, and Sz)

Protective factors against depressive symptoms among Brazilian healthcare workers during the initial stages of the COVID-19 pandemic : a cross-sectional study

Objectives This study aims to assess the prevalence of depressive symptoms among healthcare workers and possible factors associated with this outcome (resilience, spirituality, social support, quality of life, among other individual variables). Our hypothesis is that some of these factors can have a protective effect on depressive symptoms. Design Web-based cross-sectional survey. Setting Participants were recruited online from 16 April to 23 April 2020. Participants 1043 healthcare workers, predominantly Brazilians, aged 18 years or older. Primary and secondary outcome measures Depression was the primary outcome, measured using the Patient Health Questionnaire-9 (PHQ-9). Possible protective factors were measured in the following ways: social support was assessed by the modified Medical Outcomes Study Social Support Survey (mMOS-SS); spirituality, religiousness and personal beliefs (SRPB) were evaluated using the 9-item SRPB module of the brief WHO Quality of Life instrument (WHOQoL-SRPB-bref); quality of life was assessed using the brief EUROHIS instrument for Quality of Life (EUROHISQoL 8-item); resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Results 23% met the criteria for depression according to the PHQ-9 scale. Quality of life (B=−3.87 (−4.30 to −3.43), β=−0.37, p<0.001), social support (B=−0.32 (−0.59 to −0.05), β=−0.04, p=0.022), resilience (B=−0.19 (−0.23 to −0.15), β=−0.20, p<0.001), SRPB (B=−0.03 (−0.05 to −0.02), β=−0.01, p<0.001) and physical exercise (B=−0.95 (−1.40 to −0.51), β=−0.08, p<0.001) demonstrated protective effects against depression. Conclusion Healthcare workers have a high risk of developing depressive symptoms during the COVID-19 pandemic, especially those working in the front line. However, there are factors that seem to work as protective mechanisms against depression, notably perceived quality of life

Avaliação da adesão terapêutica em idosos atendidos na atenção primária

OBJETIVO: Identificar a prevalência de não adesão à terapia medicamentosa dos idosos atendidos na atenção primária de Blumenau, SC, Brasil. MÉTODOS: Estudo epidemiológico observacional, seccional, de base populacional com amostra aleatória de usuários que compareceram às farmácias de 14 unidades de atenção primária à saúde e responderam o questionário com as variáveis de estudo. A prevalência de não adesão foi medida por meio de um questionário autorrelatado. A associação entre variáveis de estudo e não adesão foi estimada pelo odds ratio por meio de modelo de regressão logística. RESULTADOS: Dos 151 idosos entrevistados, 84,1% referiram utilizar medicação contínua. A média de idade foi de 69,04 anos. Com relação às características médico-assistenciais, a média de medicamentos utilizados foi de 4,3, e patologias do aparelho circulatório apareceu como destaque (43,3%) entre as doenças de base. A prevalência de não adesão foi de 35,4%. As variáveis "interrupção prévia por falta de medicamento"e "uso de medicamentos com prescrição inadequada"se mostraram associadas à não adesão (p < 0,005). CONCLUSÃO: os resultados reforçam a necessidade de melhorar as políticas públicas e os processos gerenciais que visem garantir o acesso da população aos medicamentos essenciais, bem como qualificar o processo de prescrição dos profissionais de saúde como forma de melhorar a adesão terapêutica em idosos

Potential predictors of depressive symptoms during the initial stage of the COVID-19 outbreak among Brazilian adults

Background: In early 2020, Sars-Cov-2 was identified in China as a new coronavirus. Due to its transmission, Sars-Cov-2 has spread rapidly across the world. In the early stage of the disease outbreak, psychiatric symptoms have been reported, including depressive symptoms. In this study, we assessed the prevalence of depressive symptoms in quarantine and its association with sociodemographic variables and known protective factors for depression, such as spirituality, social support, resilience, and quality of life. Methods: A cross-sectional web-based questionnaire was distributed via social media. The instruments consisted of the 8-item EUROHIS-QOL, PHQ-9, Social Support Questionnaire, WHOQoL-SRPB, and CD-RISC. Results: A total of 3,274 participants were included in this study. 23.67% of the participants met the criteria for a depressive episode. Higher age, spirituality, social support, resiliency, and quality of life were associated with less depressive symptoms. Quarantine length; mental health treatment; chronic disease; age; sex; lower levels of spirituality, social support, resilience, quality of life, physical exercise, and education; and unpaid occupation were found to be predictors of depressive symptoms during COVID-19 quarantine. Limitations: The data are limited to the pandemic initial period, the sample isn’t random and the use of self- reported questionnaires are some limitations of our study. Conclusions: During the initial phase of the COVID-19 outbreak in Brazil, quarantine time, treatment for mental health, chronic illness, lower levels of education, and unpaid occupation were positively associated with depressive symptoms. Age, sex, spirituality, social sup- port, resilience, quality of life, and physical exercise showed a negative relationship with depressive symptoms