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BACKGROUND: The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES: To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING: Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS: The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS: Two studies were identified: one on adolescents in the remote Yup’ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS: The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS: The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.

IntroductionThere are more than 370 million indigenous people from 5000 cultures living in 90 countries worldwide. Although they make up 5% of the global population, they account for 15% of the extreme poor. Youth suicide is the second leading cause of mortality among 15–29 years old and disproportionately affects indigenous youth. This research protocol pertains to a systematic review of studies that use a comparator/control group to evaluate the effectiveness of suicide interventions targeting indigenous adolescents (aged 10–19 years).Methods and analysisWe will conduct a systematic search on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO from inception to September 2019 to identify articles that compare mental health interventions for suicide prevention among indigenous adolescents. Two reviewers will independently determine the eligibility of each study. Studies will be assessed for methodological quality using the risk of bias tool to assess non-randomised studies of interventions. We will conduct a meta-analysis if possible and use established statistical methods to identify and control for heterogeneity where appropriate.Ethics and disseminationThis systematic review will use published data and does not require ethics approval. However, this review is in preparation of a feasibility study that will examine how best to support the physical and mental health of indigenous adolescents in Brazil. Ethics approval for the feasibility study was obtained from National Research Ethics Commission. Findings will be disseminated through a peer-reviewed publication and will be made available to key decision-makers with authority for indigenous health and other relevant stakeholders.PROSPERO registration numberCRD42019141754.

Depression is a mental disorder that affects millions of people around the world. However, depressive symptoms can be seen in other psychiatric and medical conditions. Here, we investigate the effect of DHEA treatment on depressive symptoms in individuals with depression and/or other clinical conditions in which depressive symptoms are present. An electronic search was performed until October 2019, with no restrictions on language or year of publication in the following databases: Medline, EMBASE, LILACS, and Cochrane Library. Randomized controlled trials comparing DHEA versus placebo were included if the depressive symptoms were assessed. Fifteen studies with 853 female and male individuals were included in this review. To conduct the meta-analysis, data were extracted from 14 studies. In comparison with placebo, DHEA improved depressive symptoms (standardized mean difference [SMD] -0.28, 95% (CI) -0.45 to -0.11, p =.001, 12 studies, 742 individuals (375 in the experimental group and 367 in the placebo group), I2 = 24%), very low quality of evidence, 2 of 14 studies reporting this outcome were removed in a sensitivity analysis as they were strongly influencing heterogeneity between studies. No hormonal changes that indicated any risk to the participants' health were seen. Side effects observed were uncommon, mild, and transient, but commonly related to androgyny. In conclusion, DHEA was associated with a beneficial effect on depressive symptoms compared to placebo. However, these results should be viewed with caution, since the quality of evidence for this outcome was considered very low according to the GRADE criteria.

Faced with the growing interest about the action of dehydroepiandrosterone (DHEA) and its benefits, as well as the negative impacts that sexual dysfunctions have on people's quality of life, this systematic review was undertaken with the objective of evaluating the effect of DHEA use on aspects of sexual function.An electronic search was conducted in the databases of PubMed, ISI Web of Science and Virtual Health Library (VHL) combining the terms 'DHEA treatment' and 'DHEA use' with terms such as 'sexual dysfunction', 'sexual frequency' and 'libido'. No limits on time and language were imposed. Clinical studies were considered eligible where individuals for any reason made use of DHEA and if they had any aspect of sexual function assessed. Preclinical studies and systematic reviews were considered ineligible.The search identified 183 references and 38 were considered eligible. DHEA improved aspects such as sexual interest, lubrication, pain, arousal, orgasm and sexual frequency. Its effect was better in populations with sexual dysfunction, especially in perimenopausal and postmenopausal women.Considering the studies currently published, DHEA is effective in improving several aspects of sexual function, but this effect did not reach all the populations studied.

Background: Depression is a mental disorder that affects a large part of the world's population. DHEA is a hormone that has long been attributed to the ability to improve depressive symptoms. However, few studies were conducted with depression individuals not resulting from other medical conditions. Objective: To investigate whether DHEA is more effective than placebo in the treatment of depressive symptoms in subjects with depression not resulting from other psychiatric or medical comorbidities. Methods: An electronic search was carried out using the keywords Dehydroepiandrosterone (Mesh) AND Depression (Mesh) in the following databases: Medical Literature databases Analysis and Retrieval System Online (Medline), Excerpta Medical Database (EMBASE), Latin American and Caribbean Health Sciences (LILACS) and the Cochrane Library through their website for relevant publications until June 2018. Only randomized clinical trials were included. The critical appraisal of the articles was performed using the Risk of Bias Tool from Cochrane Collaboration. Results: The meta-analysis applied in this review pointed to a significant effect in favor of treatment with DHEA compared to placebo. Conclusion: DHEA may be one more effective alternative between the drugs used in the treatment of depression.

Twenty patients with DSM5 schizophrenia were comprehensively and formally assessed by an experienced psychiatrist. All subjects were assessed for: positive and negative psychotic symptoms; social anxiety; panic anxiety; obsessive compulsive disorder, atypical depression; major depression; suicide risk; and global assessment of functioning. Different profiles of clinical presentation and symptom evolution emerged for patients with schizophrenia who had co-morbid depression (15%), OCD (15%), panic or limited symptom attacks (55%) and social anxiety (5%). At least eighty percent of the sample had one or more of these co-morbidities. Summing up, the data support our previous finding that panic is highly prevalent in Schizophrenia with Auditory Hallucinations (>73% here, versus 100% before), and panic was paroxysmally concurrent with voice onset. Moreover, characteristic clinical findings may help point clinicians to five specific co-morbidity psychosis subtypes. Moreover, co-morbidity dissection of psychotic diagnoses recalls and parallels the historical psychopharmacologic dissection of non-psychotic anxiety and depressive subtypes diagnoses. Larger studies should further test and explore these preliminary findings.

Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.

International interest on the benefits of using the steroid hormone Dehydroepiandrosterone (DHEA) on various aspects of human health, including the regulation of mood, is increasing. This study aimed to review the scientific literature on the use of DHEA in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses. PubMed, ISI Web of Knowledge and Virtual Health Library (VHL) databases were independently searched by two researchers using the following terms: depression, treatment, DHEA, and mood. Clinical studies were considered eligible when subjects were treated with DHEA and psychological assessments of depression were conducted. No time limits or language for this research were imposed. One 183 references were identified, and 22 references were selected to compose this review. Significant improvements related to the use of DHEA in patients with depression were observed, in addition to improvements in depressive symptoms in patients with schizophrenia, anorexia nervosa, HIV and adrenal insufficiency. No significant improvements were observed regarding depressive symptoms in patients with fibromyalgia; the results observed in patients with autoimmune diseases and healthy individuals remain contradictory. Although the selected studies demonstrated good methodological applications, most studies consisted of small samples, and only 3 studies were conducted in a young population. Therefore, we concluded that the studies published to date indicate promising results regarding the use of DHEA in the treatment of depression and depressive symptoms, especially in depression that is mild or resistant to conventional therapy.

Objective To assess the relationship between sexual hormones, sexual function and quality of life in postmenopausal women. Method A cross-sectional study was conducted with a convenience sample of 36 postmenopausal women between the ages of 45 and 65 in follow-up at a climacteric outpatient clinic. Mood, quality of life, sexual function and hormonal profile were assessed. Results With regard to sexual hormones and sexual function, a relationship was found between orgasm and luteinizing hormone (r=0.37), orgasm and sex hormone-binding globulin (SHBG) (r=0.39), SHBG and less pain (r=0.44), dehydroepiandrosterone (DHEA) and desire (r=-0.45), as well as between prolactin and lubrication (r=0.33). Sexual hormones and quality of life were related as follows: progesterone and limitations due to physical aspects (r=0.35), SHBG and social aspects (r=0.35), cortisol and pain (r=0.46), DHEA and social aspects (r=-0.40). Finally, the following relationships were found between sexual function and quality of life: sexual desire and vitality, social aspects, state of general health and mental health (r=0.46, r=0.51, r=0.35, and r=0.38, respectively). Arousal, orgasm and satisfaction with sexual life showed a relationship with less physical pain (r=0.40, r=0.42, and r=0.43, respectively). Satisfaction with sexual life was correlated with vitality (r=0.33). Conclusion Different correlations than expected were found in this study regarding the effect of some hormones on sexual function and some aspects of the quality of life of postmenopausal women. Resumo Objetivo Avaliar a relação entre hormônios sexuais, função sexual e qualidade de vida em mulheres na pós-menopausa. Métodos Estudo transversal com amostra de conveniência de 36 mulheres na pós-menopausa, com idades entre 45 e 65 anos, em seguimento ambulatorial de climatério. Humor, qualidade de vida, função sexual e perfil hormonal foram avaliados. Resultados Entre hormônios sexuais e função sexual, foi encontrada relação entre orgasmo e hormônio luteinizante (r=0,37), orgasmo e globulina ligadora de hormônios sexuais (SHBG) (r=0,39), SHBG e menos dor (r=0,44), desidroepiandrosterona (DHEA) e desejo (r=-0,45), bem como entre prolactina e lubrificação (r=0,33). Entre hormônios sexuais e qualidade de vida: progesterona e limitações por aspectos físicos (r=0,35), SHBG e aspectos sociais (r=0,35), cortisol e dor (r=0,46), DHEA e aspectos sociais (r=-0,40). Por fim, entre função sexual e qualidade de vida: desejo sexual e vitalidade, aspectos sociais, estado geral de saúde e saúde mental (r=0,46, r=0,51, r=0,35 e r=0,38, respectivamente). Excitação, orgasmo e satisfação com a vida sexual mostraram uma relação com menos dor física (r=0,40, r=0,42 e r=0,43, respectivamente). A satisfação com a vida sexual foi correlacionada com a vitalidade (r=0,33). Conclusão Correlações diferentes das esperadas foram encontradas neste estudo em relação ao efeito de alguns hormônios sobre a função sexual e alguns aspectos da qualidade de vida de mulheres na pós-menopausa.