Revista Brasileira de Psiquiatria最新文献

Objective: To test the efficacy of a dissonance-based (DB) intervention in targeting risk factors for eating disorders (EDs) and predisposing factors for muscle dysmorphia (MD) symptoms in body-dissatisfied Brazilian men over 1 year of follow-up and evaluate whether reductions in body-ideal internalization would mediate the intervention's impact on ED and MD symptoms.

Methods: Participants were randomized to a two-session DB intervention (n=89) or assessment-only control (AOC) (n=91), and completed validated measures assessing body-ideal internalization, body dissatisfaction, ED, and MD symptoms at baseline, post-intervention, 1-month, 6-month, and 1-year follow-ups.

Results: The DB condition showed significantly greater reductions in MD symptoms and body dissatisfaction compared with the AOC group over a 1-year follow-up, while significant differences were not observed for body-ideal internalization and ED symptoms. Changes in body-ideal internalization from baseline to 1-month follow-up completely mediated the relationship between condition and the changes observed in both ED and MD symptoms.

Conclusion: These results provide further evidence of the efficacy of the tested intervention through 1-year follow-up in reducing body dissatisfaction and MD symptoms, but no such result was observed for body-ideal internalization and EDs. Our findings provide support for theoretical models of eating pathology and MD symptoms in Brazilian men.

Objective: To conduct a thorough examination of the current understanding of the effect of maternal depression exposure on the executive functions (EFs) of offspring.

Methods: Following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement, a comprehensive search for peer-reviewed cohort studies was performed on the MEDLINE (via PubMed), ScienceDirect, LILACS, PsycINFO, and SciELO databases. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation framework.

Results: Thirty-three cohort studies from different countries, enrolling a total of 38,981 participants, were analyzed. Twenty-four studies confirmed the hypothesis of a harmful effect of maternal depressive symptoms on offspring EF. However, high heterogeneity among studies was found, and meta-analysis was not feasible. Fetal programming, genetics, and parental practices have been identified as potential mechanisms that can affect the EFs of children born to mothers who have experienced depressive symptoms.

Conclusion: Our findings suggest a negative association between maternal depressive symptoms and offspring EF. Further studies on the effects of chronicity/severity of maternal symptoms and changes in EFs in different sensitive periods are needed.

Objective: To compare the prevalence of postpartum depression (PPD) symptoms between high-income countries (HIC) and low- and middle-income countries (LMIC) during the COVID-19 pandemic.

Methods: The PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO, and CINAHL databases were searched until October 2022 for studies that collected data during the pandemic. The metaprop command was used in the Stata statistical software version 12.0 to run a random-effects meta-analysis.

Results: A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of PPD symptoms was 31% (95%CI 21.85-40.99). The pooled prevalence of PPD symptoms among women from HIC (30.5% [95%CI 16.95-46.02]) did not differ significantly from that of women from LMIC (31.5% [95%CI 19.26-45.15]). However, studies that analyzed women up to 1 month after childbirth reported a lower prevalence of PPD symptoms (17.5% [95%CI 9.85-26.62]) compared to those that observed them up to 1 year after childbirth (38.3% [95%CI 33.96-42.83]).

Conclusions: The prevalence of PPD symptoms was high across countries, regardless of human development index. This condition must be regularly tracked worldwide to assess, discuss, and recommend more assertive steps that may be implemented to address it based on the particular characteristics of each country.

Patients with schizophrenia represent a group heterogeneous in clinical presentation and severity. Although severity has been operationalized in different ways, mostly on a gradient between symptom severity and functional impairment, such approaches are limited in capturing real-world functioning. We suggest adopting the severity model proposed by DSM-5 for autism spectrum disorders. The model defines three levels of severity based on the support required, directly addressing two barriers from previous models: real-world functioning and ease of implementation. Our adapted model includes three new features: first, this severity specifier is global, rather than for each symptom domain; second, the centrality of occupational functioning is emphasized to define the level of support; third, we propose a 1-month timeframe for severity appraisal, standardizing the assessment process. Considering practical utility, we indicate how severity assessment can guide clinical practice towards rehabilitation. Additionally, we outline operational definitions for severity and functioning in schizophrenia, aligned with the premises of our model. Finally, we acknowledge potential limitations, the most relevant being the need for empirical validation. The model is presented to foster discussion. Additional studies will follow to investigate inter-rater reliability and convergent validation with standard measures of symptom and functioning severity.

Objective: To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness.

Methods: This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed.

Results: Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39).

Conclusion: Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person's state of general mental health.

Objective: From a preventive perspective, this study reviewed the literature on protective factors against depressive symptoms in high-risk children and adolescents.

Methods: We conducted a thorough search of the PubMed, APA, EMCare, and Embase databases for studies published between 1946 and August 25, 2023. We included only longitudinal studies that analyzed protective factors for depressive symptoms in high-risk children or adolescents, excluding cross-sectional studies, reviews, and pre-clinical studies.

Results: A total of 29 studies with 62,405 participants were analyzed and 38 protective factors were identified. Positive individual characteristics, family factors, peer relationships, school-related aspects, neighborhood characteristics, and intrinsic religiosity were associated with improved depression outcomes.

Conclusion: These findings have important implications for preventive strategies in this population. Addressing protective factors can help prevent depression and enhance lifetime mental health.