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Introduction: Digital psychiatry holds promise for expanding accessibility to mental health treatment, but concerns exist regarding its inclusivity and the potential for exacerbation of digital exclusion among vulnerable populations. This study aims to evaluate the inclusivity of digital psychiatry research and interventions, and to explore their potential to worsen digital exclusion., Methods: We conducted a cross-sectional analysis of sociodemographic data from two clinical trials that utilize psychiatric online treatment modalities in Brazil. Participants were recruited nationwide through digital media platforms., Results: The sample comprised 224 individuals, predominantly female (95.1%) and Caucasian (71.87%) participants, with an average of 15.12 years of schooling. It was observed that White individuals were overrepresented compared to national averages (42.8%). Additionally, participants had a higher average number of years of schooling compared to the national average (10.1 years). Our analysis revealed a clear profile among psychiatric patients with access to and interest in digital interventions, predominantly younger, White, educated, and female individuals., Discussion: As digital therapeutic solutions advance, ensuring their inclusivity and accessibility for vulnerable individuals is crucial. Initiatives to promote digital inclusion and reassess participant recruitment strategies are needed to effectively address digital exclusion. By adopting multifaceted approaches, digital mental health care can be made more effective and accessible to all., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Background: Intimate partner violence (IPV) increased extensively around the world during the pandemic, causing severe women's mental health damages. However, there are no studies showing these effects in Brazil., Purpose: To assess the perpetration of IPV and the presence of depression and suicidal ideation in women living in Brazil during the pandemic., Methods: Cross-sectional online survey including women living in Brazil from July 2020 to Jun 2021. Participants answered a 43-item self-applied questionnaire exploring their characteristics and life changes due to the pandemic (CoRonavIruS Health Impact Survey), IPV (World Health Organization Violence Against Women) and depressive symptoms or suicidal ideation (Patient Health Questionnaire-9). We used multiple Poisson regression analyses with robust variance to model associations between IPV and mental health outcomes, considering as covariates aspects of social vulnerability., Results: We found a high frequency of IPV (33.3%), depression (36.1%) and suicidal ideation (19.8%) among the participants. IPV was significantly associated with depression (PR=1.502, p=0.001 for one type of IPV; PR=2.702, p<0.001 for two or three types of IPV) and suicidal ideation (PR=2.264, p<0.001 for one type of VPI; PR=3.272, p<0.001 for two or three types of IPV). Food insecurity, being black, lower educational levels and being in a relationship with a person of the same gender were associated with one or both mental health outcomes., Conclusions: We demonstrated an association of IPV with higher frequencies of depression and suicidal ideation in women living in Brazil during the COVID-19 pandemic, highlighting the urgency of strengthening strategies to protect women during adversities., Competing Interests: Angelica Cerveira de Baumont received a Coordination for the Improvement of Higher Education Personnel (CAPES) postdoctoral scholarship, and Gisele Gus Manfro received a Brazilian National Council for Scientific and Technological Development CNPq senior scholarship (306249/2017-0). No other conflicts of interest declared concerning publication of this article.

Introduction: Metacognitive beliefs about worry may trigger anxiety. However, the effect of generalized anxiety disorder (GAD) treatment on metacognition has not yet been investigated., Objectives: To validate the Metacognitions Questionnaire (MCQ-30) in a Brazilian GAD sample and verify whether different interventions reduce metacognitive beliefs., Method: We recruited 180 GAD individuals and randomized them to Body in Mind Training (BMT), Fluoxetine (FLX), or an active control group (Quality of Life [QoL]) for 8 weeks. The MCQ-30 was assessed for internal consistency, was evaluated with confirmatory and exploratory factor analyses, and was tested for convergent validity with the Penn State Worry Questionnaire (PSWQ). Generalized estimating equations (GEE) were employed to analyze differences after the interventions., Results: The MCQ-30 demonstrated good internal consistency and acceptability; the original five-factor model was supported. There was a positive moderate correlation between MCQ-30 scores and worry. GEE showed a significant group x time interaction (p < 0.001). Both BMT (mean difference [MD] = -6.04, standard error [SE] = -2.39, p = 0.034) and FLX (MD = -5.78, SE = 1.91, p = 0.007) reduced MCQ-30 scores. FLX was superior to QoL, but not BMT, at weeks 5 and 8. There were no differences between BMT and QoL., Conclusion: The Brazilian-Portuguese version of MCQ-30 showed good psychometric properties. Furthermore, the positive effect of FLX and BMT on metacognition suggests it may represent a potential therapeutic target., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Introduction: Individuals diagnosed with generalized anxiety disorder (GAD) seek pleasurable foods to avoid their negative emotional experiences. Ineffective regulation of negative emotions may be a risk factor for emotional eating (EE), leading to suffering, dysfunctional behaviors, and weight gain., Objectives: The aim of this study is to understand the relationship between emotional dysregulation and EE, investigating potential mediators such as the intensity of the worry, avoidance of internal experiences, mindfulness, and self-compassion in female patients with anxiety., Methods: In this cross-sectional study, participants from a randomized clinical trial diagnosed with GAD answered the following instruments at baseline: the Difficulties in Emotion Regulation Scale (DERS), the Three Factor Eating Questionnaire (TFEQ-R21), the Penn State Worry Questionnaire (PSWQ), the Action and Acceptance Questionnaire (AAQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Self-Compassion Scale (SCS). We estimated Pearson correlation coefficients and performed mediation analyses., Results: We evaluated 51 female individuals, 34 of whom completed all the questionnaires. Our data showed that EE was positively correlated with emotional dysregulation (r = 0.593; p < 0.001), worry trait (r = 0.402; p = 0.018), and avoidance of internal experiences (r = 0.565; p < 0.001), whereas it was negatively correlated with self-compassion (r = -0.590; p < 0.001) and mindful state (r = -0.383; p = 0.026). Moreover, we demonstrated that self-compassion mediates the relationship between emotional dysregulation and EE (ab product estimate = 0.043, 95% confidence interval [95%CI] 0.003-0.084)., Conclusion: Our findings contribute to the literature by identifying psychological factors that could mediate the association between emotional dysregulation and EE, enabling identification of more effective eating behavior intervention targets for patients with GAD., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Introduction: There is evidence that the coronavirus disease 2019 (COVID-19) pandemic impacted students on health care courses, including evidence of associations between anxiety or depression and inadequate coping mechanisms or unhealthy habits. However, little is known about possible predictors of mental health or psychiatric symptoms in Brazilian health care students during this period., Objective: To evaluate possible factors associated with anxiety and depressive symptoms, used to measure psychiatric outcomes, and quality of life, used as a parameter of overall functionality, in Brazilian students on health care courses during the COVID-19 pandemic., Methods: A cross-sectional study was conducted with Brazilian students on health care courses from May to December 2020. Participants were recruited through social media and answered a 71-item open online questionnaire exploring demographic characteristics and personal behavior during the pandemic, anxiety, depression, and quality of life. We searched for variables potentially associated with psychiatric symptoms and mental health in these individuals using Poisson regression models., Results: Multivariate models showed depression and anxiety were associated with poor quality of life and medication abuse was associated with greater anxiety and poor quality of life. Psychotherapy was an effective coping strategy for anxiety and meditation or mindfulness practice and physical activity improved the students' quality of life., Conclusions: Our study presents important information about the factors associated with psychological impacts of the COVID-19 pandemic and strategies for coping with them that should be helpful to reflect on and for designing appropriate interventions., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Introduction Children with anxiety disorders have been suggested to possess deficits in verbal fluency, shifting and attention, with inconsistent results regarding working memory and its subcomponents. This study extends previous findings by analyzing the performance of children with anxiety disorders in a wide range of neuropsychological functions. Methods We evaluated 54 children with a primary diagnosis of an anxiety disorder according to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) using subtests of a neuropsychological battery. The severity of anxiety disorders was assessed using the Pediatric Anxiety Rating Scale (PARS). We calculated the frequency of neuropsychological impairments (-1.5 standard deviation of the normative sample). Comparisons between groups were performed based on the severity of anxiety symptoms, as well as in the presence of one vs. more diagnoses of anxiety disorder. Results We found higher impairment in visuospatial working memory (23.1%), semantic memory (27.8%), oral language (35.4%) and word writing (44.4%) in anxious children. Moreover, children with higher anxiety severity presented lower performance in visuospatial working memory, inferential processing, word reading, writing comprehension, copied writing, and semantic verbal fluency (d = 0.49 to 0.96 [Cohen's d]). The higher the number of anxiety diagnoses, the lower the performance in episodic memory and oral and written language (d = 0.56 to 0.77). Conclusion Our data suggested the presence of memory (visuospatial working memory and semantic memory) and language deficits (oral and writing) in some children with an anxiety disorder. Severity and number of anxiety diagnoses were associated with lower performance in memory and language domains in childhood.

Objective:: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders., Methods:: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions., Results:: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11)., Conclusions:: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Introduction: Previous studies have implicated impaired verbal fluency as being associated with anxiety disorders in adolescents., Objectives: To replicate and extend previously reported evidence by investigating whether performance in phonemic verbal fluency tasks is related to severity of anxiety symptoms in young children with anxiety disorders. We also aim to investigate whether putative associations are independent from co-occurring attention deficit hyperactivity disorder (ADHD) symptoms., Methods: Sixty children (6-12 years old) with primary diagnoses of anxiety disorders participated in this study. Severity of symptoms was measured using clinician-based, parent-rated and self-rated validated scales. Verbal fluency was assessed using a simple task that measures the number of words evoked in 1-minute with the letter F, from which we quantified the number of isolated words, number of clusters (groups of similar words) and number of switches (transitions between clusters and/or between isolated words)., Results: There was a significant association between the number of clusters and anxiety scores. Further analysis revealed associations were independent from co-occurring ADHD symptoms., Conclusion: We replicate and extend previous findings showing that verbal fluency is consistently associated with severity in anxiety disorders in children. Further studies should explore the potential effect of cognitive training on symptoms of anxiety disorders.

Objective: To investigate the validity and reliability of a multi-informant approach to measuring child maltreatment (CM) comprising seven questions assessing CM administered to children and their parents in a large community sample., Methods: Our sample comprised 2,512 children aged 6 to 12 years and their parents. Child maltreatment (CM) was assessed with three questions answered by the children and four answered by their parents, covering physical abuse, physical neglect, emotional abuse and sexual abuse. Confirmatory factor analysis was used to compare the fit indices of different models. Convergent and divergent validity were tested using parent-report and teacher-report scores on the Strengths and Difficulties Questionnaire. Discriminant validity was investigated using the Development and Well-Being Assessment to divide subjects into five diagnostic groups: typically developing controls (n = 1,880), fear disorders (n = 108), distress disorders (n = 76), attention deficit hyperactivity disorder (n = 143) and oppositional defiant disorder/conduct disorder (n = 56)., Results: A higher-order model with one higher-order factor (child maltreatment) encompassing two lower-order factors (child report and parent report) exhibited the best fit to the data and this model's reliability results were acceptable. As expected, child maltreatment was positively associated with measures of psychopathology and negatively associated with prosocial measures. All diagnostic category groups had higher levels of overall child maltreatment than typically developing children., Conclusions: We found evidence for the validity and reliability of this brief measure of child maltreatment using data from a large survey combining information from parents and their children.

Introduction: Anxiety disorders (AD) share features of both anxiety and fear linked to stress response. The hypothalamic-pituitary-adrenal (HPA) axis is considered the core biological pathway of the stress system and it is known that an inappropriate response to environmental stimuli may be related to individual genetic vulnerability in HPA-linked genes. Despite the biological plausibility of a relationship between the HPA axis and AD, few studies have investigated associations between genetic polymorphisms linked to the HPA axis and this complex disorder., Objective: To investigate whether AD are associated with genetic polymorphisms in HPA-linked genes in adolescents., Methods: Our study consisted of a cross-sectional evaluation of a community sample comprising a total of 228 adolescents (131 cases of AD). We extracted DNA from saliva and genotyped polymorphisms in HPA-linked genes (FKBP5: rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916; NR3C1: rs6198; CRHR1: rs878886; and SERPINA6: rs746530) with real time polymerase chain reaction (PCR). The instruments used to diagnose and assess the severity of AD were the Schedule for Affective Disorder and Schizophrenia for School-Age Children - Present and Lifetime (K-SADS-PL) and the Screen for Child and Anxiety related Emotional Disorders (SCARED)., Results: We failed to detect any associations between AD and genetic polymorphisms in HPA-linked genes (p > 0.05)., Conclusion: To our knowledge, this is the first study evaluating these specific polymorphisms in relation to AD in adolescents, which encourages us to design further research on the subject.

Introduction: The study of the association between specific characteristics of family environments and different types of psychopathology may contribute to our understanding of these complex disorders and ultimately inform therapeutics., Objective: To compare the family characteristics of four groups: typically developing children; children with anxiety disorders only; children with externalizing disorders only; and children with both anxiety and externalizing disorders., Methods: This study enrolled 115 individuals from the community. Child psychiatrists made psychiatric diagnoses using a structured clinical interview. The Family Environment scale was used to evaluate six domains of family function., Results: The group with both anxiety and externalizing disorders had higher levels of conflict in family environment and lower levels of organization when compared with typically developing children. In addition, internalizing and externalizing symptoms were positively associated with conflict and negatively with organization. Maternal depressive and anxious symptoms were also associated with higher conflict and lower organization scores., Conclusion: An important between-group difference in comorbid cases of anxiety and behavioral disorders suggests that children with this comorbidity are potential candidates for family interventions to address family conflicts and organizational aspects.

Background: Anxiety disorders are highly prevalent, affecting approximately 10% of individuals throughout life; its onset can be detected since early childhood or adolescence. Studies in adults have shown that anxiety disorders are associated with alcohol abuse, but few studies have investigated the association between anxiety symptoms and problematic alcohol use in early ages., Objective: To evaluate if anxiety symptoms are associated with problematic alcohol use in young subjects., Methods: A total of 239 individuals aged 10-17 years were randomly selected from schools located in the catchment area of Hospital de Clínicas de Porto Alegre. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was used to evaluate the presence of anxiety symptoms, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), to evaluate alcohol use., Results: One hundred twenty-seven individuals (53.1% ) reported having already used alcohol. Of these, 14 individuals showed problematic alcohol use (5.8% ). There was no association between lifetime use of alcohol and anxiety symptoms, but mean SCARED scores in individuals with problematic alcohol use was higher if compared to those without problematic use, even after adjustment for age and gender (29.9±8.5 vs. 23.7±11.8, p < 0.001)., Conclusions: Despite the limitation of a cross-sectional design, our study suggests that anxiety symptoms are associated with problematic alcohol use early in life.

Objective: To describe the cross-cultural adaptation of the Affective Reactivity Index (ARI) to Brazilian Portuguese and to investigate preliminary psychometric properties of the adapted version., Methods: Cross-cultural adaptation was based on the investigation of the theoretical and operational equivalences of the original ARI in the Brazilian context, followed by a process of translation, back-translation, and review by a committee of experts. Data analysis was carried out in a community sample of 133 schoolchildren aged 8 to 17 years to investigate the following characteristics of the ARI: 1) factor structure; 2) internal consistency; 3) construct validity comparing differential relationships between irritability and anxiety dimensions and impairment; and 4) item response theory (IRT) parameters., Results: A final Brazilian Portuguese version of the instrument was defined and is presented. Internal consistency was good, and our analysis supported the original single-factor structure of the ARI. Correlations of the ARI with distress-related anxiety dimensions were higher than with phobic-related anxiety dimensions, supporting its construct validity. In addition, higher ARI scores were associated with higher irritability-related impairment. IRT analysis underscored frequency of loss of temper as essential to inform about pathological states of irritability., Conclusion: The Brazilian Portuguese version of the ARI seems to be very similar to the original instrument in terms of conceptual, item, semantic, and operational equivalence. Our preliminary analysis replicates and extends previous evidence confirming promising psychometric properties for the ARI.

Objective: To describe the cross-cultural adaptation of the Spence Children's Anxiety Scale (SCAS) for use in Brazil., Methods: Cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. All these procedures were carried out for both the child and the parent versions of the SCAS., Results: A final Brazilian version of the instrument, named SCAS-Brasil, was defined and is presented., Conclusion: The SCAS-Brasil instrument seems to be very similar to the original SCAS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of childhood anxiety symptoms in community, clinical, and research settings.