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Objectives. Deep transcranial magnetic stimulation (DTMS) has been shown to be efficacious and relatively safe for major depressive disorder (MDD). However, its clinical utility as an augmenting strategy for treatment-resistant depression (TRD) remains unexplored. Methods. In an open label trial, 17 outpatients with severe TRD received 4 weeks of daily high frequency DTMS over the left dorsolateral prefrontal cortex. Depressive and anxious symptoms, suicidality and quality of life (QOL) were measured at baseline (i.e., in the week prior to the start of the DTMS treatment) and at week 5 (i.e., in the week following the end of the DTMS treatment). Primary outcome measures were rates of response and remission at week 5 using an intention-to-treat approach. Results. Response and remission rates at week 5 were 70.6 and 41.2%, respectively. Also, depression, anxiety, and suicidality ratings were significantly improved by week 5 (with Hedges' g estimates ranging from 0.6 to 1.72), as well as four of the five QOL domain scores (i.e., global, psychological, environmental and social). Finally, two patients dropped out of the study at week 1 because of significant scalp discomfort during stimulation. Conclusions. Our study suggests that DTMS, when used as an augmenting strategy for antidepressants in severe TRD, is efficacious, safe and relatively well tolerated. However, controlled studies with larger samples are needed to confirm and expand our preliminary findings. [ABSTRACT FROM AUTHOR]

Introduction. The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country. Objective. This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method. Method. A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed. Results. The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations. [ABSTRACT FROM AUTHOR]

Depressive symptoms are the most prevalent mental health condition in older adults. Since it cannot be measured directly, the use of instruments is mandatory. The 15-item Geriatric Depression Scale (GDS) is one of the most widely used scales to measure depression in the elderly. It is recognized that the cultural context is a major determinant of the instrument's psychometric performance. Up to the present, this scale has mainly been investigated through classical psychometric approaches. The present study aims to explore whether the 15-item GDS is a suitable instrument in a Brazilian sample. In addition, it explores the potential improvement in the psychometric performance by item refinement. Four hundred twenty-four elderly adults selected through convenience sampling completed the 15-item GDS. Data were analyzed by the Rasch Measurement Model. The Rasch analysis is a powerful modern approach to explore psychometric performance of instruments in health sciences. It examines both the scale and the individual item performance in depth. The 15-item GDS proved not to be suitable in a Brazilian sample. Item misfit and differential item functioning were responsible for considerable misperformance. Scale reduction led to a 10-item structure. This refined format presented adequate psychometric performance and no differential item functioning. The present study offers an alternative and more adequate version of the GDS to be applied in Brazilian subjects. It is also in line with the need for shorter, valid scales in clinical settings. Further investigations are needed to develop a set of cultural-invariant items, which could then be applied in transcultural investigations free of bias. [ABSTRACT FROM AUTHOR]

Objective. To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples. Design. Systematic review. Methods. Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures. Interventions. None. Main Outcome Measures. Quality of life and health-related quality of life. Results. Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men. Conclusions. Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples. [ABSTRACT FROM AUTHOR]