Trends in Psychiatry and Psychotherapy最新文献

Introduction: Causal inference from observational data remains a significant challenge for scholars and policymakers, particularly in assessing the impact of public health policies where randomization is often infeasible.

Objective: To evaluate the impact of the Yellow September campaign on suicide rates in Brazil using the synthetic control method (SCM).

Methods: A quasi-experimental design was applied using annual suicide rate data from 2000 to 2019. Socioeconomic and demographic variables were obtained from the World Bank and WHO datasets. The SCM was employed to construct a counterfactual scenario simulating suicide rates in the absence of the campaign, using Latin American countries as control units.

Results: The synthetic control model demonstrated a strong alignment between Brazil and its synthetic counterpart in the pre-intervention period. However, post-2015 analysis revealed a 9.2% increase in suicide rates in Brazil compared to the synthetic control. Brazil exhibited a post-/pre-intervention RMSPE ratio of 4.18, the highest among all countries in the donor pool. However, placebo tests indicated that this observed increase was not statistically significant, suggesting the difference may reflect random variation or other factors unrelated to the campaign.

Conclusions: The Yellow September campaign had no statistically significant impact on reducing suicide rates in Brazil. While the observed increase in suicide rates may reflect improved case reporting or contextual influences, these findings underscore the complexity of evaluating mental health policies. Complementary strategies and further research are needed to better understand the campaign's effects and address the multifaceted nature of suicide prevention.

The relationship between physical fitness and mental health is recognized, with evidence suggesting that physical fitness components may offer added protection against mental health issues. However, whether this applies to university students, who commonly experience anxiety and depression, is less clear. This cross-sectional study explores the association of physical fitness with anxiety and depression symptoms in ≥18-year-old students from seven Brazilian universities. Mental health was evaluated using the Diagnostic and statistical manual of mental disorders (DSM-5), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Physical fitness was assessed via handgrip strength, vertical jump, and the 20m Shuttle-Run test, with students classified into low or high fitness based on genderspecific medians. Poisson regression with robust variance was used to analyze the relationship between physical fitness, anxiety, and depression. The sample included 199 students (52.6% women; median age=21). Those scoring above the median in 2 or 3 physical fitness tests had lower rates of depressive symptoms (PR= 0.53; 95%Confidence Interval (CI): 0.33 - 0.84) compared to those with 0 or 1 tests. Higher jump height also corresponded with reduced depression risk (PR=0.65; 95%CI: 0.44-0.97) and lower co-occurrence of depression and anxiety (Adjusted PR = 0.55; 95%CI = 0.31 - 0.99). 2 or 3 tests above the median corresponded to a decreased likelihood of co-ocurrence of anxiety and depressive symptoms (PR= 0.43; 95%CI: 0.26 - 0.71). No significant association was found between physical fitness and anxiety alone. Thus, higher physical fitness was associated with fewer depressive symptoms among university students.

Background: The COVID-19 pandemic has impacted global mental health, affecting mortality from suicide. This study evaluated the impact of COVID-19 on suicide mortality in Brazil from 2000 to 2022.

Methods: Study of temporal events with data of events by suicide of the Mortality Information System (MIS). Mortality were calculated per 100,000 inhabitants. Differences before and during the pandemic were evaluated with the Wilcoxon Signed-Rank Test and Prais-Winsten regression. Interrupted Temporal Series (ITS) analysis was performed.

Results: Between 2000 and 2022, there were 243,143 cases of suicide in Brazil. During the pandemic, the median monthly mortality increased from 0.4 to 0.6 per 100,000 inhabitants, with a trend of an increase of 0.78% per month.

Limitations: Because it is an ecological study, it is not possible to have individual conclusions. Secondary data and population estimates may be inaccurate.

Conclusions: The COVID-19 pandemic has increased suicide mortality in Brazil, highlighting the need for more effective mental health policies.

Introduction: This study represents the first clinical descriptive study on opioid use disorder (OUD) in Brazil.

Methods: This comparative cross-sectional study involved 314 adult patients at the Addiction Outpatient Clinic of Instituto Perdizes, São Paulo, from April 2023 to August 2024. Data were collected through interviews, using the validated Brazilian Portuguese version of the Addiction Severity Index (ASI-6) and the Structured Clinical Interview for DSM-5 (SCID). Statistical analysis included descriptive statistics, chi-square tests for categorical variables, and the Kruskal-Wallis test for continuous variables.

Results: Patients were evaluated and divided in two groups: OUD group (OUDG) with 45 (14.3%) and non-opioid use disorder group (NOUDG) with 269 (85,87%). In the OUDG, 26.7% were healthcare professionals (p < 0.001; 95%CI 3.34 - 7.92), and there was a high incidence of chronic pain (55.6%) (p < 0.001; 95%CI 2.60 - 4.13). Healthcare utilization was notably higher among OUD patients, with 73.3% attending healthcare services in the past six months (p < 0.001; 95%CI 1.14 - 4.97).

Discussion: Emerging data reveal a growing trend in opioid use in low- and middle-income countries, with Brazil witnessing a notable rise in opioid prescriptions.

Conclusion: Developing effective preventive strategies for OUD is crucial to mitigating its significant public health risks. Chronic pain conditions and healthcare professionals may represent vulnerable groups with an elevated risk of developing OUD.

Objectives: Empathy is crucial in patient-centered care, enabling shared decision-making, better satisfaction, and clinical outcomes. We examined the association between empathy and personality in a sample of medical students from Brazil.

Methods: The sample comprised medical students from the first to sixth year at a private university in Sao Paulo. Empathy was evaluated cross-sectionally using the Interpersonal Reactivity Index. The NEO Five-Factor Inventory was used to assess personality domains. A multivariate linear regression analysis modeled the association between personality and empathy.

Results: The final sample consisted of 227 subjects. The mean age was 24.2 (SD 4.3) years, and the sample was predominately female (75%). Higher levels of Neuroticism (β = 2.11, 95% CI 0.84-3.38, P = 0.001) and Agreeableness (β = 2.50, 95% CI 1.46-3.53, P < 0.001) were associated with higher empathy scores. Extraversion (β = 0.00, 95% CI -1.26-1.26, P = 0.998); Openness to Experience (β = 0.85, 95% CI -0.28-1.98, P = 0.138), and Conscientiousness (β = -0.80, 95% CI -1.95-0.35, P = 0.173) did not show significant associations with empathy scores. Female gender, year in the program, and sociodemographic characteristics did not show significant associations with empathy.

Conclusion: Both Neuroticism and Agreeableness were found to be associated with higher empathy. We review available interventions to enhance empathy and identified potential medical education curricular changes that could foster empathy development.

Objective: This study aimed to investigate the clinical outcomes and mortality risk factors associated with alcohol use disorder (AUD) in hospitalized COVID-19 patients.

Methods: We analyzed a national database containing information on the clinical and sociodemographic aspects of patients hospitalized with severe acute respiratory syndrome between February 2020 and February 2023 in Brazil, including those aged > 18 years with laboratory-confirmed COVID-19. The primary exposure of interest was a history of AUD before admission and the primary outcome was in-hospital mortality.

Results: Among the 2,124,285 patients, 11,433 (0.53 %) had AUD. The in-hospital mortality rate was higher in the patients with AUD (46.2%) than in those without AUD (31.9%). After adjusting for confounding covariates, individuals with AUD had twice the risk of death (Odds Ratio [OR]= 1.94, 95% confidence interval [CI] 1.85-2.03) compared with non-AUD patients. Among individuals with AUD, the covariates independently associated with the primary outcome were age > 60 years, male sex, hospitalization in the Central-West, Northeast and North regions, symptoms of dyspnea and reduced oxygen saturation at admission, presence of comorbidities, and year of admission.

Conclusion: In this population-based study, we found that patients with AUD had twice the risk of fatal outcomes than those without AUD.

Objective: We aim to create a web-based calculator for assessing depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9), utilizing IRT-based standardized scores, to improve measurement precision, standardization, and practical application in clinical practice.

Methods: This study developed a web-based calculator using a graded response IRT model for assessing depressive symptoms with the PHQ-9, using data from the Brazilian National Health Survey 2019 (n = 90,846, aged 15 to 107 years old, 52.8% female). The tool calculates latent depressive symptoms and converts them into T-scores, with stratification by sex and age groups. The application respects patient confidentiality by deleting sensitive information postcalculation.

Results: Estimated models resulted in a mean sample size of 3244.5 participants in each group (SD: 1066). The calculator can be accessed at https://mheg.shinyapps.io/phq9-score.

Discussion: The development of an IRT-based web calculator for the PHQ-9 represents an advancement in depressive symptoms' assessment, offering precision and potential clinical utility. By standardizing scores into a common metric, this tool facilitates the interpretation of depressive symptoms and comparison across different instruments. The study's scope is limited to the Brazilian population and external validity for other contexts is warranted. Future studies should evaluate the clinical validity and the threshold of the tool for predicting real life problems.

Background: Drug overdose deaths remain a significant and understudied public health concern in Brazil. This study aimed to examine drug overdose death records from 2000 to 2020, focusing on the relationship between mood disorders and intentionality, along overall sociodemographic characteristics.

Methods: Data from the Brazilian Mortality Information System from 2000-2020 were analyzed. Records with causes of death coded as X40-X45 (accidental poisoning), X60-X65 (intentional poisoning), or Y10-Y15 (undetermined intentionality poisoning) were included. The dataset comprised 21,410 deaths, including 933 subjects with mood disorders (ICD-10 codes F30-F39). A descriptive analysis of sociodemographic variables, stratified by mood disorders, was conducted. Logistic regression models identified independent associations with intentional overdose deaths.

Results: People who died of a drug overdose were mostly men (61.55%), non-white (52.45%), and single (59.33%). Most drug overdose deaths were intentional (44.70%). Compared to overall overdoses, the subset with mood disorders included a higher share of women (67.95%), whites (63.88%), and intentional overdoses (75.24%). Female gender (OR 1.30), mood disorder (OR 2.0), non-white race (OR 0.56), high school graduates (OR 0.93), some college education (OR 1.28), and divorced or widowed (OR 0.73) were independently associated with intentional overdose deaths.

Conclusion: The sociodemographic characteristics of people who died of overdoses must guide national public policies. Strategies might involve conducting screenings for mental health disorders and drug-related problems in primary care.

Introduction: Alzheimer's disease (AD) is the leading cause of dementia in the elderly and involves pathophysiological events which results in progressive cognitive impairment and functional disabilities. Loneliness is a unique condition in which an individual perceives themselves as socially isolated, even when they are among other people. It is also a worldwide public health challenge associated with higher mortality, and risk of cardiovascular and psychiatric diseases. The aim of this study is to investigate the impacts of loneliness on the development of AD in women.

Methods: Systematic Review registered in PROSPERO (CDCRD42024521068) and adherent to PRISMA and Cochrane guidelines. In November 2025, systematic searches conducted by independent reviewers were carried out in international databases. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the Downs and Black Checklist.

Results: A significant association is suggested between loneliness and the development of AD. Possible causal mechanisms were identified, namely chronic stress associated with loneliness, lack of social and emotional support, and reduced cognitive and social activity. The organization of studies allows for an analysis of the incidence of AD, the progression of cognitive decline, and the relationship with neurobiological changes associated with loneliness.

Conclusion: Despite being a complex and barely understood relationship, Loneliness may play a relevant role in the development of AD among women. Psychosocial factors must be considered in the context of aging and women's mental health, emphasizing its role in increasing the risk and progression of the disease.

Background: The offspring of parents with bipolar disorder (BD) and with attention deficit hyperactivity disorder (ADHD) have a higher risk of having the same condition. Both disorders also share psychopathological symptoms; however, little is known about their genetic overlap. To examine whether the offspring of parents with BD have a greater chance of being affected by ADHD, we conducted a systematic review.

Methods: From inception to August 12, 2024, we searched the PubMed, SciELO, PsycInfo and Cochrane databases. We included studies if they investigated the association of parental bipolar disorder with offspring outcomes and made a proper investigation of disorders using validated instruments based on the Diagnostic Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) criteria. Studies were excluded if: parents were under 18 years old or over 70; did not report original data; systematic reviews; in vitro studies; with an animal model; offspring older than 17 years of age or with any comorbid diagnosis with ADHD. To assess risk of bias, two authors independently used the Newcastle-Ottawa Scale quality assessment tool.

Results: 23 articles met the inclusion criteria. The majority of the studies reported that the offspring of parents with BD were at higher risk for ADHD. Particularly, in all case‒control studies, the risk of ADHD was higher in the case group than the control group.

Conclusion: The current studies are yet heterogeneous and literature did not uncover the biological correlation of these disorders regarding genetic, biochemical, neuroimaging and neuropsychological aspects.