Search

Background: Simple and brief questionnaires with adequate psychometric properties are useful for the early detection of depressive disorders., Aim: To analyze the psychometric behavior of the Patient Health Questionnaire (PHQ-9) in Chile., Material and Methods: Data were collected from 1,738 adult patients, consulting in primary health care centers. The values obtained in the PHQ-9 were compared with those of the Composite International Diagnostic Interview (CIDI)., Results: The mean score of PHQ-9 was 4.85 ± 5.57. Internal consistency indices were high. McDonald's ω coefficient of was 0.90 and Cronbach alpha 0.89. A confirmatory factor analysis showed a good fit of the one-dimensional model. Using a cutoff score of seven determined with the receiver operating characteristic (ROC) curve, the sensitivity and specificity of the instrument were 0.8 and 0.7, when compared with CIDI diagnoses., Conclusions: PHQ-9 is a useful instrument for the screening of depressive disorders in primary health care centers in Chile.

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Background: Depression is considered the second leading cause of disability worldwide., Aim: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE)., Material and Methods: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied., Results: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features., Conclusions: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.

Background: Screening instruments are required for the detection of depressive disorders by primary care practitioners., Aim: To develop a screening instrument to detect depression, based on data gathered interviewing patients attending primary health care settings., Material and Methods: The instrument was constructed with data about factors associated or triggering a depressive disorder obtained from 3,000 patients consulting for general morbidity. All patients answered the Composite International Diagnostic Interview, (version 2.1, section depression) and an inventory containing 39 risk factors for depression, obtained from the literature. A multiple imputation method using chained equations was carried out. Using a binary logistic regression with backward selection, an equation for depression screening was obtained. The c-index was calculated to estimate discriminating power of the model. A shrinkage factor was estimated to adjust the predictive model., Results: Estimations were carried out with data from 2,552 patients with a median age of 47 years (73% women). Fifty five percent lived with a partner and 45% had basic studies. The method selected 14 significant predictors, with a shrinkage value of 0.861 and a c-index of 0.838 (95% confidence intervals 0.82-0.86)., Conclusions: The instrument has adequate psychometric properties as a screening tool for depression in primary health care.

Background: Serotonin plays a central role regulating mood and on the development of depressive disorders., Aim: To study whether 5HTTLPR functional polymorphisms in the serotonin transporter gene or the Monoamine oxidase A gene (uMAOA) were risk markers for depression., Material and Methods: The Composite International Diagnostic Interview (CIDI) was applied to 1,062 consultants in primary health care centers aged between 18 and 75 years to establish the diagnosis of depression. A sample of saliva was obtained for DNA extraction and genetic analyses., Results: No association between the presence of depressive disorders and 5HTTLPR (ss) or uMAOA (3/3) risk genotypes was found. Psychological abuse and the presence of two or more life events were found to be predictors of depression in the studied sample., Conclusions: In this study, 5HTTLPR and uMAOA polymorphisms were not risk factors for depression. However, psychological abuse and the presence of two or more life events were risk factors for depressive disorders.

Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers' methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered.

Background: The reduction of major depression incidence is a public health challenge., Aim: To develop an algorithm to estimate the risk of occurrence of major depression in patients attending primary health centers (PHC)., Material and Methods: Prospective cohort study of a random sample of 2832 patients attending PHC centers in Concepción, Chile, with evaluations at baseline, six and twelve months. Thirty nine known risk factors for depression were measured to build a model, using a logistic regression. The algorithm was developed in 2,133 patients not depressed at baseline and compared with risk algorithms developed in a sample of 5,216 European primary care attenders. The main outcome was the incidence of major depression in the follow-up period., Results: The cumulative incidence of depression during the 12 months follow up in Chile was 12%. Eight variables were identified. Four corresponded to the patient (gender, age, depression background and educational level) and four to patients' current situation (physical and mental health, satisfaction with their situation at home and satisfaction with the relationship with their partner). The C-Index, used to assess the discriminating power of the final model, was 0.746 (95% confidence intervals (CI = 0,707-0,785), slightly lower than the equation obtained in European (0.790 95% CI = 0.767-0.813) and Spanish attenders (0.82; 95% CI = 0.79-0.84)., Conclusions: Four of the factors identified in the risk algorithm are not modifiable. The other two factors are directly associated with the primary support network (family and partner). This risk algorithm for the incidence of major depression provides a tool that can guide efforts towards design, implementation and evaluation of effectiveness of interventions to prevent major depression.

Background: Suicidal behavior ranges from ideation to consummation of suicide. In Chile, rates of suicide increased from 4.8 to 12.7/100,000 in the period 1992-2009., Aim: To evaluate the prevalence of suicidal behavior and its relationship with sociodemographic factors and psychiatric diseases., Material and Methods: The Composite International Diagnostic Interview (CIDI), was applied to a representative sample of 2,978 Chilean participants. The prevalence of four suicidal behaviors (thinking about or wishing death, suicide ideation and suicide attempts) and of psychiatric diseases according to the revised third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), was calculated., Results: The lifetime prevalence of suicidal conception was 14.3% and the suicide attempt 7.7%, the latest associated with sex, age, school years, smoking habits, being married or having a relationship, depressive disorders, dysthymia, and alcohol, drug and tobacco dependence., Conclusions: Rates founded exceed international prevalence data and extrapolated to current rates of completed suicide, higher levels of suicidal behavior should be expected. Considering the associated disorders we can infer that it is essential a correct diagnosis and treatment of mood disorders and substance consumption to any other specific interventions.

Background: Psychiatric disorders that appear during childhood or adolescence should be a public health priority., Aim: To report the results of a national representative survey in the Latin American region examining the prevalence of DSM-IV psychiatric disorders in children and adolescents., Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family risk factors, socioeconomic status and service use., Results: A sample of 1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses., Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.

Background: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care., Aim: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile., Material and Methods: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use., Results: A sample of 272 children and adolescents was evaluated, obtaining 93,4% of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8%, being 16.5% in boys and 17.1% in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7% and 16.8% respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired., Conclusions: The prevalence of psychiatric disorders in Cautín is high in children and adolescents.

Background: The Diagnostic and Statistic Manual (DSM) solved the problem of diagnostic criteria for psychiatric diseases. Highly structured interviews such as Composite International Diagnostic Interview (CIDI) allow the evaluation of psychiatric disorders in large samples, with great accuracy., Aim: To report the prevalence rates of psychiatric disorders in a representative sample of Chilean individuals., Material and Methods: The CIDI was administered to 2978 Chilean individuals coming form four provinces. Lifetime and prevalence rates of psychiatric disorders, based in the third revision of the DSM, were calculated., Results: Thirty six percent of the population had a psychiatric disorder at least once in their lifetime and 23% had a disorder in the last six months. The most common lifetime diagnoses were agoraphobia in 11%, major depressive disorders in 9%, dysthymia in 8% and alcohol dependence in 6%. Only 49% of those with a psychiatric disorder sought medical care, while 4% of those individuals considered devoid of psychiatric illnesses, consulted in a mental health facility., Conclusions: The prevalence of psychiatric disorders in the Chilean population is similar to that of other Spanish speaking populations in Latin or North America.