Relative impact of diagnosis and clinical stage on response to electroconvulsive therapy: a retrospective cohort

OBJECTIVES: Electroconvulsive therapy (ECT) is commonly indicated for refractory psychiatric disorders. However, little research has compared response across diagnoses. Here, we aimed to evaluate the relative impact of diagnosis and clinical staging as response predictors in a cross-diagnostic sample. METHODS: In a retrospective cohort of adult inpatients (n=287) who underwent at least six sessions of ECT, we investigated predictors of complete response (a clinical global impression of 1) to ECT. We use adjusted regression models to estimate the impact of clinical diagnosis and staging on complete response and dominance analysis to assess the relative importance of these predictors. RESULTS: Those for whom a depressive episode was a primary indication for treatment were the most likely to have complete improvement, while those with psychosis were the least likely; clinical stage had a significant influence on outcome in all diagnoses. A diagnosis of psychosis was the strongest predictor of non-response. CONCLUSIONS: A diagnosis of psychosis (mainly schizophrenia) was the strongest predictor of non-response. We also found that clinical staging can aggregate information on ECT response that is independent of clinical diagnosis

Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: A systematic review and meta-analysis

BackgroundImplementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are.MethodsWe conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6–18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems.ResultsWe found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37–0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = −0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = −0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = −0.47 to 2.07). For CD the sample size was very small, so the results are imprecise.ConclusionA significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376]

Translating measurement into practice: Brazilian norms for the Patient Health Questionnaire (PHQ-9) for assessing depressive symptoms

OBJECTIVES: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. METHODS: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde - 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. RESULTS: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. CONCLUSION: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings

Telomere length and epigenetic age acceleration in adolescents with anxiety disorders

Evidence on the relationship between genetics and mental health are flourishing. However, few studies are evaluating early biomarkers that might link genes, environment, and psychopathology. We aimed to study telomere length (TL) and epigenetic age acceleration (AA) in a cohort of adolescents with and without anxiety disorders (N = 234). We evaluated a representative subsample of participants at baseline and after 5 years (n = 76) and categorized them according to their anxiety disorder diagnosis at both time points: (1) control group (no anxiety disorder, n = 18), (2) variable group (anxiety disorder in one evaluation, n = 38), and (3) persistent group (anxiety disorder at both time points, n = 20). We assessed relative mean TL by real-time quantitative PCR and DNA methylation by Infinium HumanMethylation450 BeadChip. We calculated AA using the Horvath age estimation algorithm and analyzed differences among groups using generalized linear mixed models. The persistent group of anxiety disorder did not change TL over time (p = 0.495). The variable group had higher baseline TL (p = 0.003) but no accelerated TL erosion in comparison to the non-anxiety control group (p = 0.053). Furthermore, there were no differences in AA among groups over time. Our findings suggest that adolescents with chronic anxiety did not change telomere length over time, which could be related to a delay in neuronal development in this period of life

Beyond frequency: Evaluating the validity of assessing the context, duration, ability and botherement of depression and anxiety symptoms in south Brazil

Assessment tools for depression and anxiety usually inquire about frequency of symptoms. However, evidence suggests that different question framings might trigger different responses. Our aim is to test if asking about symptom’s context, ability, duration and botherement adds validity to PHQ-9, GAD-7 and PROMIS depression and anxiety. Participants came from two cross-sectional convenience-sampled surveys (N=1,871) of adults (66% females, aged 33.4 ± 13.2), weighted to approximate with the state-level population. We examined measurement invariance across the different question frames, estimated whether framing affected mean scores, and tested their independent validity using covariate-adjusted and sample-weighted structural equation models. Validity was tested using tools assessing general disability, alcohol use, loneliness, well-being, grit, and frequency-based questions from depression and anxiety questionnaires. A bifactor model was applied to test the internal consistency of the question-frames under the presence of a general factor (i.e., depression or anxiety). Measurement invariance was supported across the different frames. Framing questions as ability (i.e., “how easily…”) produced a higher score, compared with framing by context (i.e., “in which daily situations…”). Construct and criterion validity analysis demonstrate that variance explained using multiple question frames were similar to using only one. We detected a strong overarching factor for each instrument, with little variances left to be explained by the question frame. Therefore, it is unlikely that using different adverbial phrasings can help clinicians and researchers to improve their ability to detect depression or anxiety.Key words: PHQ-9, GAD-7, PROMIS, mental health questionnaire, question frame.<br/

Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil

Background Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. Methods For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6–14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010–11, and 1917 were assessed 8 years later (2018–19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. Findings DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20–2·18; CBCL 1·66, 1·19–2·30), but only CBCL independently predicted poor life chances (1·56, 1·19–2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. Interpretation Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes

Utilisation and costs of mental health-related service use among adolescents

BACKGROUND: The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. METHODS: Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. RESULTS: Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44–4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27–3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69–5.36, p<0.001]), higher impact of symptoms on adolescent’s life (OR = 1.32, 95%CI = 1.19–1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05–1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12–0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02–0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04–1.07, p = 0.036). CONCLUSION: The impact of mental health problems on adolescents’ daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs

Development and validation of the Brazilian Portuguese version of the Reported and Intended Behaviour Scale (RIBS-BP)

The object of the study was to translate and validate the Reported and Intended Behaviour Scale (RIBS) into Brazilian Portuguese. A native Brazilian speaker fluent in English translated the RIBS into Brazilian Portuguese. Comprehensibility and face validity were assessed through discussions with mental health professionals and volunteers recruited from the community. Brazilian Portuguese version of the questionnaire was back-translated into English by another Brazilian researcher fluent in English and the researcher who developed the original RIBS was consulted to check the adequacy of the questionnaire translation, and approved the final translated version. RIBS-BP was administered to 1,357 caregivers from a community-based cohort. Internal consistency and factor loading were assessed through confirmatory factor analysis (CFA). Differential item functioning was examined using Multiple Indicator Multiple Causes for subgroups of gender, socioeconomic status, and caregiver education. To assess external validity, we examined whether responses in RIBS-BP varied among these subgroups, considering respondents’ previous contact with people with mental illness. CFA fit indices were good to excellent (root mean square error of approximation [RMSEA] = 0.07; 90% confidence interval, CI [0.04, 0.10]; comparative fit index [CFI] = 1.00; Tucker-Lewis Index [TLI] = 1.00). All loadings were above 0.4 (0.73 to 0.89), indicating that intended behavior items are related to the same unidimensional latent factor. In the latent model, higher socioeconomic status was associated with less intended stigma-related behavior (β = 0.20, p <.001), adjusted for education and gender. RIBS-BP has good internal consistency, demonstrate measurement invariance among subgroups, and appears to be a valid measure of stigma, representing a suitable tool to assess reported and intended stigma-related behaviors in Brazil. (PsycInfo Database Record (c) 2020 APA, all rights reserved

Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire

This project aim to perform factor analysis to understand factor structure and reliability of the NHS Community Mental Health Service User Survey (2017)

Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: a systematic review and meta-analysis

BackgroundImplementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are.MethodsWe conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6–18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems.ResultsWe found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37–0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = −0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = −0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = −0.47 to 2.07). For CD the sample size was very small, so the results are imprecise.ConclusionA significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376]