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Importance: Owing to its anti-inflammatory properties and antiviral “in vitro” effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a ...

The objective was to compare the mental health indicators of health workers providing care to individuals with COVID-19 in Brazil, considering sociodemographic and occupational variables and the risk perception of contamination by the Sars-CoV-2 of workers from different professions, identifying risk and protective factors. A sample of 916 health workers was assessed: physicians, nursing workers, and workers from other professions (psychologists, physical therapists, nutritionists, speech therapists, occupational therapists, dentists, pharmacists, and social workers). REDCAP software was used to collect data online, using standardized instruments to assess anxiety, depression, posttraumatic stress, and insomnia, and one questionnaire addressed risk and protective variables. Statistical techniques for comparing groups were used along with logistic regression analysis. The results revealed that all the groups presented indicators of significant mental health problems (>36%), especially the nursing group. A larger percentage of participants, regardless of the profession, presented a high rate of insomnia disorders, while posttraumatic stress was the least expressive. Occupational variables stand out as risk factors for mental health, with specificities among the different groups. A protective factor for all the groups was having positive professional prospects. The protective factors for the physicians group included support provided by co-workers, being older and a man, while being satisfied with physical protective measures implemented by the employing institution was a protective factor for the groups composed of nursing workers and other professionals. These findings are relevant for devising mental health care strategies.

Importance Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. Objective To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. Design, setting, and participants This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirao Preto Medical School University Hospital in Sao Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. Interventions Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. Main outcomes and measures The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Results A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. Conclusions and relevance In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. Trial registration ClinicalTrials.gov Identifier: NCT04504877.

Importance The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data sources MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study selection Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data extraction and synthesis Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%). Conclusions and relevance In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.

Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores >= 10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 >= 10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Study Design and Setting: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. Results: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 >= 10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 >= 10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 >= 14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 >= 14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). Conclusion: PHQ-9 >= 10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. (C) 2020 Elsevier Inc. All rights reserved.

BackgroundItem 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

This systematic review and meta-analysis examines whether physician depressive symptoms are associated with the risk for perceived or observed medical errors., Key Points Question What are the magnitude and direction of associations between physician depressive symptoms and medical errors? Findings In this systematic review and meta-analysis of 11 studies involving 21 517 physicians, physicians with a positive screening for depression were highly likely to report medical errors. Examination of longitudinal studies demonstrated that the association between physician depressive symptoms and medical errors is bidirectional. Meaning This study found that physician depressive symptoms were associated with medical errors, highlighting the relevance of physician well-being to health care quality and underscoring the need for systematic efforts to prevent or reduce depressive symptoms among physicians., Importance Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature. Objective To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors. Data Sources A systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science was performed from database inception to December 31, 2018. Study Selection Peer-reviewed empirical studies that reported on a valid measure of physician depressive symptoms associated with perceived or observed medical errors were included. No language restrictions were applied. Data Extraction and Synthesis Study characteristics and RR estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Main Outcomes and Measures Relative risk estimates for the associations between physician depressive symptoms and medical errors. Results In total, 11 studies involving 21 517 physicians were included. Data were extracted from 7 longitudinal studies (64%; with 5595 individuals) and 4 cross-sectional studies (36%; with 15 922 individuals). The overall RR for medical errors among physicians with a positive screening for depression was 1.95 (95% CI, 1.63-2.33), with high heterogeneity across the studies (χ2 = 49.91; P

BackgroundDifferent diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.MethodData collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.ResultsA total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).ConclusionsThe MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

BACKGROUND: Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. METHODS: We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. RESULTS: 16,742 participants (2,097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0·996 (95% confidence interval 0·996 to 0·996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0·02 (−0·06 to 0·00) and more specific by 0·01 (0·00 to 0·01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0·00 to 0·05 (0·03 at cutoff 10), and specificity was within 0·01 for all cutoffs (0·00 to 0·01). CONCLUSIONS: PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Aim The Structured Clinical Interview for the DSM is one of the most used diagnostic instruments in clinical research worldwide. The current Clinician Version of the instrument (SCID-5-CV) has not yet been assessed in respect to its psychometric qualities. We aimed to assess the clinical validity and different reliability indicators (interrater test-retest, joint interview, face-to-face vs telephone application) of the SCID-5-CV in a large sample of 180 non-prototypical and psychiatric patients based on interviews conducted by raters with different levels of clinical experience. Methods The SCID-5-CV was administered face-to-face and by telephone by 12 psychiatrists/psychologists who took turns as raters and observers. Clinical diagnoses were established according to DSM-5 criteria and the longitudinal, expert, all data (LEAD) procedure. We calculated the percentage of agreement, diagnostic sensitivity and specificity, and the level of agreement (kappa) for diagnostic categories and specific diagnoses. Results The percentage of positive agreement between the interview and clinical diagnoses ranged between 73% and 97% and the diagnostic sensitivity/specificity were >0.70. In the joint interview, the levels of positive agreement were high (>75%) and kappa levels were >0.70 for most diagnoses. The values were less expressive, but still adequate, for interrater test-retest interviews. Conclusion The SCID-5-CV presented excellent reliability and high specificity as assessed with different methods. The clinical validity of the instrument was also confirmed, which supports its use in daily clinical practice. We highlight the adequacy of the instrument to be used via telephone and the need for careful use by professionals with little experience in psychiatric clinical practice.

Purpose To identify the predictive effect of multiple variables of risk and resilience on the behavior of school-age children living with maternal depression. Design and methods In a cross-sectional predictive study, the influence of maternal depression, cumulative stressors, and resilience on the behavior of children was analyzed. Findings In the univariate analysis, maternal depression and cumulative stressors were considered as risks, and resilience as protection for the children. In the multivariate analysis, resilience was a predictor of fewer problems in the presence of maternal depression and risks. Practice implications The degree of resilience was an indicator for the relevance of developmental actions involving effective coping skills for cumulative stressors, including maternal depression.

Objective: To examine association of sociodemographic characteristics, personality traits, social skills, and work variables with anxiety, depression, and alcohol dependence in medical residents. Methods: A total of 270 medical residents completed the following self-report instruments: sociodemographic and work questionnaire, Patient Health Questionnaire-4 (PHQ-4), Alcohol Use Disorders Identification Test-3 (AUDIT-3), Revised NEO-Five Factor Inventory (NEO-FFI-R), and Social Skills Inventory (SSI-Del-Prette). Data were analyzed using descriptive statistics and univariate and multivariate logistic regression analyses. Results: Multivariate analysis showed an association of neuroticism (odds ratio [OR] 2.60, p < 0.001), social skills (OR 0.41, p < 0.01), and number of shifts (OR 1.91, p = 0.03) with anxiety or depression, and of male sex (OR 3.14, p = 0.01), surgical residency (OR 4.40, p = 0.001), extraversion (OR 1.80, p < 0.01), and number of shifts (OR 2.32, p = 0.04) with alcohol dependence. Conclusion: The findings support a multidetermined nature of mental health problems in medical residents, in addition to providing data that may assist in the design of preventive measures to protect the mental health of this group.

Este é um estudo transversal realizado na cidade de Ribeirão Preto, que tem como objetivo sistematizar indicadores clínicos associados à gravidade da depressão recorrente em mães de crianças em idade escolar e avaliar o impacto desses indicadores para o comportamento dos filhos, bem como, identificar se há interferência de determinantes sociais associados às condições sociodemográficas das famílias. A coleta de dados considerou o período de 2007 a 2013, avaliando-se 100 mães com filhos em idade escolar, divididos em Grupo Depressão e Grupo Comparação com 50 díades cada. Utilizou-se Questionário sociodemográfico, Questionário sobre a Saúde do Paciente-9, Entrevista Clínica Estruturada e, Questionário de Capacidades e Dificuldades. Verificou-se que, independente de vulnerabilidades sociais, a gravidade da depressão se configurou como fator de risco para mais problemas de comportamento das crianças no geral (p

Background Genetic and epigenetic variations of the serotonin transporter gene (SLC6A4) have been related to the etiology of depression. The 5-HTTLPR polymorphism at the SLC6A4 promoter region has two variants, a short allele (S) and a long allele (L), in which the S allele results in lower gene transcription and has been associated with depression. The short S-allele of 5-HTTLPR polymorphism of this gene has been associated with depression. In addition to molecular mechanisms, exposure to early life risk factors such as maternal depression seems to affect the development of depression in postnatal life. The present study investigated the association of 5-HTTLPR polymorphism and CpG DNA methylation (5mC) levels of an AluJb repeat element at the SLC6A4 promoter region in mother–child pairs exposed to maternal depression. Methods We analyzed DNA samples from 60 subjects (30 mother–child pairs) split into three groups, with and without major depression disorder (DSM-IV) among children and mothers. The genotyping of 5-HTTLPR polymorphism and quantification of 5mC levels was performed by qualitative PCR and methylation-sensitive restriction enzyme digestion, and real-time quantitative PCR (MSRED-qPCR), respectively. Results The sample analyzed presented a higher frequency of S allele of 5-HTTLPR (67.5%). Despite the high frequency of this allele, we did not find statistically significant differences between individuals carrying at least one S allele between the depression and healthy control subjects, or among the mother–child pair groups with different patterns of occurrence of depression. In the group where the mother and child were both diagnosed with depression, we found a statistically significant decrease of the 5mC level at the SLC6A4 promoter region. Limitations The limitations are the relatively small sample size and lack of gene expression data available for comparison with methylation data. Conclusion In this study, we demonstrated a repeat element specific 5mC level reduction in mother–child pairs, concordant for the diagnosis of depression.

The prevalence of anxiety and depression disorders in undergraduate students is high and several variables can be influential. The aim is to verify the predictive value of social skills, sociodemographic variables, and course characteristics for depression and anxiety. A total of 1282 students of a public university, of both sexes and from different years and courses, participated in this study. Screening instruments for depression and anxiety were applied, as well as an instrument investigating social skills and a questionnaire covering socio demographic indicators and course characteristics. The data were analyzed using univariate analysis followed by multiple binary Original Research Article

The medical residency is recognized as a risk period for the development of burnout and mental health problems, such as anxiety and depression, which have impact on the physician and clientele alike. There is a need for studies that address conditions of risk and protection for the development of such problems. This study aimed to verify the rates of burnout, anxiety, and depression presented by resident physicians, as well as the associations of these problems with social skills, as potential protective factors. The hypothesis was defined that the problems (burnout, anxiety, and depression) would be negatively associated with social skills. A total of 305 medical residents, of both genders, of different specialties, from clinical and surgical areas of a Brazilian university hospital were evaluated using the following standardized self-report instruments: Burnout Syndrome Inventory, Social Skills Inventory, and the Patient Health Questionnaire-4. High rates of burnout and mental health problems were verified and social skills were negatively associated with burnout dimensions such as emotional exhaustion, emotional detachment, and dehumanization, but positively associated with personal accomplishment. Furthermore, residents with indicators of problems presented significantly lower social skills means than those of residents without indicators of burnout, anxiety, or depression. More studies are needed, which include other types of instruments in addition to self-report ones and evaluate not only social skills but also social competence in the professional practice. These should adopt intervention and longitudinal designs that allow the continuity or overcoming of the problems to be verified. Since social skills can be learned, the results of the study highlight the importance of developing the interpersonal skills of the professionals during the training of resident physicians in order to improve their practice.

Given the recognition of the influence of maternal depression on the family environment, this study aimed to compare and verify the possible associations between the sociodemographic profile, stressor events and social support perceived by women/mothers with recurrent depression (G1), compared to women/mothers without psychiatric disorders (G2). The participants were 100 women with biological school-age children. The women responded to the instruments: General Questionnaire, Structured Clinical Interview for DSM-IV, Adverse Events Scale, Chronic Adversity Scale and Semi-Structured Interview - Social Support. It was found that G1 presented significantly more stressor events and less perceived social support. In linear regression analysis, the depression was a significant condition for most of the stressful events, independent of the sociodemographic variables. However, schooling was the only condition that influenced the perceived social support. In mental health actions for women/mothers with depression, it is necessary to consider the coexistence of multiple stressor conditions and low perceived social support. Resumo Dado o reconhecimento da influência da depressão materna para o ambiente familiar, objetivou-se comparar e verificar as possíveis associações entre o perfil sociodemográfico, eventos estressores e suporte social percebido por mulheres/mães com depressão recorrente (G1), em relação a mulheres/mães sem transtornos psiquiátricos (G2). Participaram 100 mulheres, com filhos biológicos em idade escolar. As mulheres responderam aos instrumentos: Questionário Geral, Entrevista Clínica Estruturada para DSM-IV, Escala de Eventos Adversos, Escala de Adversidade Crônica e Entrevista Semiestruturada - Suporte Social. Verificou-se que G1 apresentou significativamente mais eventos estressores e menos suporte social percebido. Na análise de regressão linear, detectou-se que a depressão foi condição significativa para maioria dos eventos estressores, independentemente das variáveis sociodemográficas. Entretanto, a única condição que influenciou a percepção de suporte social foi a escolaridade. Nas ações em saúde mental para mulheres/mães com depressão, faz-se necessário considerar a convivência com condições de múltiplos estressores e baixo suporte social percebido. Resumen Considerando la influencia de la depresión materna en el ambiente familiar, el objetivo de este estudio fue comparar y verificar las posibles asociaciones entre el perfil sociodemográfico, acontecimientos estresantes y apoyo social percibido por mujeres/madres con depresión recurrente (G1), con relación a las mujeres/madres sin trastornos psiquiátricos (G2). Participaron 100 mujeres, con hijos biológicos en edad escolar. Las mujeres respondieron a los instrumentos: Cuestionario General, Entrevista Clínica Estructurada para DSM-IV, Escala de Eventos Adversos, Escala de Adversidad Crónica y Entrevista Semiestructurada - Apoyo Social. Se verificó que G1 presentó significativamente más acontecimientos estresantes y menos apoyo social percibido. En el análisis de regresión lineal, se detectó que la depresión fue condición significativa para la mayoría de los acontecimientos estresantes, independientemente de las variables sociodemográficas. Mientras tanto, la única condición que influyó en la percepción del apoyo social fue la escolaridad. En las acciones en salud mental para mujeres/madres con depresión, es necesario considerar la convivencia con condiciones de múltiples factores de éstres y bajo apoyo social percibido.

OBJECTIVE: To adapt the trait version of the Self Statements during Public Speaking (SSPS) scale to a state version (SSPS-S) and to assess its discriminative validity for use in the Simulated Public Speaking Test (SPST). METHOD: Subjects with and without social anxiety disorder (n = 45) were assessed while performing the SPST, a clinical-experimental model of anxiety with seven different phases. RESULTS: Alterations in negative self-assessment occurred with significant changes throughout the different phases of the procedure (p = .05). Non-cases presented significantly higher mean values of the SSPS-S in all phases of the procedure than cases (p < .01). CONCLUSION: Cases assessed themselves in a less positive and more negative manner during the SPST than did non-cases. SSPS-S is adequate for this assessment, especially its negative subscale, and shows good psychometric qualities.

The objective of this article is to present a critical analysis of the research outlines used in empirical studies published between the years 2000 and March of 2007 about social anxiety disorder and its associations with social skills. Seventeen papers were identified and grouped into two classes for analysis, namely: Characterization of Social Skills Repertoire (N = 10) and Therapeutical Modalities – Application and Comparison of Clinical Intervention (N = 7). The critical analysis of the research outlines pointed to the necessity of new studies with clinical and non-clinical samples, with random allocation of individuals, with the proposition of contextualized interaction tasks, in order to support the generalization as to the association of the social skills and social anxiety disorder, and to demonstrate the functionality and process by which anxiety interferes with social performance.

O Questionário de Capacidades e Dificuldades (Strengths and Difficulties Questionnaire) é um instrumento amplamente pesquisado, de uso livre, que visa avaliar a saúde mental de crianças e adolescentes. Dada a relevância do uso de instrumentos aferidos para a avaliação de indicadores de saúde mental, este trabalho objetivou analisar a produção científica relacionada às propriedades psicométricas do Questionário. Procedeu-se a um levantamento bibliográfico de estudos indexados nas bases de dados MedLine, PsycINFO e Lilacs, a partir da publicação original do instrumento, abrangendo o período de 1997 a 2010, utilizando-se as seguintes palavraschave: Strengths and Difficulties Questionnaire and psychometric properties; e Strengths and Difficulties Questionnaire and validity or reliability. Foram selecionados e analisados 51 estudos psicométricos. Os resultados indicaram índices positivos de validade e fidedignidade em 21 países, incluindo o Brasil, caracterizando seu alcance transcultural e sua aplicabilidade na área de saúde mental infanto-juvenil . The Strengths and Difficulties Questionnaire is a broadly investigated tool, available for use free of charge, with the aim of assessing the mental health of children and adolescents. Given the importance of using standardized instruments for assessing mental health indicators, the aim of this study was to review scientific literature related to the psychometric properties of the Strengths and Difficulties Questionnaire. A search in MedLine, PsycINFO and Lilacs databases was performed, starting from year of the original publication of the questionnaire, from 1997 to 2010, using the keywords: Strengths and Difficulties Questionnaire and psychometric properties, and Strengths and Difficulties Questionnaire and validity or reliability. Fifty-one psychometric studies were selected and analyzed. The results indicated positive levels of validity and reliability in 21 countries, including Brazil, highlighting its crosscultural range and applicability in the area of mental health for children and adolescents.

The objectives of the present study were to adapt the Liebowitz Social Anxiety Scale from the clinician administered to the self-report version (LSAS-SR) and to perform the initial psychometric studies concerning internal consistency and item analysis.The phase of adaptation was performed by two specialists in the Mental Health area and the face validity was tested by a group of 30 university students. As part of the psychometric study of the LSAS-SR, the internal consistency was assessed and the items were analyzed by applying the scale to 682 university students.The LSAS-SR proved to be easy to understand by the group studied, with no need to make any changes in the instructions for application. The scale showed adequate internal consistency (α = 0.96) as well as an acceptable correlation between items and total score (0.38-0.72).The initial psychometric studies of the LSAS-SR presented adequate indicators, stimulating the continuation of studies involving the validation and reliability of the scale not only when applied to a sample of the general population, but also when applied to clinical groups.

PURPOSE: The study aims to conduct a psychometric study of the Fagerstrom Test for Nicotine Dependence (FTND) and to assess the prevalence, sociodemographic profile, and psychiatric comorbidities of smokers in a general hospital. DESIGN AND METHODS: Two hundred sixty-four inpatients were elegible for inclusion in the study and assessed with Structured Clinical Interview for the DSM-IV (Module E), Patient Health Questionnaire, Fast Alcohol Screening Test, and FTND. FINDINGS: The cut-off note two of the FTND is the most adequate to identify tobacco abuse/dependence (sensibility: 0.59–0.76). The reliability was estimated to be 0.68–0.96. A 44% rate of tobacco abuser/dependent patients was detected, with a 28% rate of psychiatric comorbidity. PRACTICE IMPLICATIONS: Detection of the smoking habits at the time of hospitalization can be opportune, favoring the planning and the beginning of treatment.

The objective of the present study was to evaluate the response of social anxiety disorder (SAD) patients to threat scenarios. First-choice responses to 12 scenarios describing conspecific threatening situations and mean scores of defensive direction and defensive intensity dimensions were compared between 87 SAD patients free of medication and 87 matched healthy controls (HC). A significant gender difference in the first-choice responses was identified for seven scenarios among HCs but only for two scenarios among SAD patients. A significantly higher proportion of SAD patients chose "freezing" in response to "Bush" and "Noise" scenarios, whereas the most frequent response by HCs to these scenarios was "check out". SAD males chose "run away" and "yell" more often than healthy men in response to the scenarios "Park" and "Elevator", respectively. There was a positive correlation between the severity of symptoms and both defensive direction and defensive intensity dimensions. Factorial analysis confirmed the gradient of defensive reactions derived from animal studies. SAD patients chose more urgent defensive responses to threat scenarios, seeming to perceive them as more dangerous than HCs and tending to move away from the source of threat. This is consistent with the hypothesis that the physiopathology of anxiety disorders involves brain structures responsible for defensive behaviors.

PURPOSE: To carry out a systematic review of the association between maternal and school-age children depression and covariate factors. DESIGN AND METHODS: The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004–2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used. FINDINGS: Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis. PRACTICE IMPLICATIONS: Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression.

Depression is the most common psychiatric comorbidity in Parkinson's disease (PD), but is often under-diagnosed and under-recognized.To evaluate and compare the psychometric qualities of the Patient Health Questionnaire (PHQ-2) and the depression item of the Unified Parkinson's Disease Rating Scale (UPDRS).Cross-sectional study conducted at a movement disorders outpatient clinic. One hundred ten patients with a diagnosis of PD without dementia were evaluated. A neurologist administered the PHQ-2 and the UPDRS, and the diagnosis of major depression was performed using the structured clinical interview for DSM disorders - clinical version. Two self-rating scales (Zung Self-rating Depression Scale and 15-item Geriatric Depression Scale) were also used.The prevalence of current depression in the sample was 25.5% (n = 28). The scores of the PHQ-2 discriminated between subjects with and without depression, with an area under the receiver operating characteristic curve of 0.90. The sensitivity and specificity for a cut-off score of three were 75% and 89%, respectively. The values for the depression item of the UPDRS were slightly lower.The PHQ-2 is a valid tool for screening depression in PD.

O Desenho da Figura Humana (DFH) é uma das técnicas de avaliação psicológica mais conhecidas e utilizadas no Brasil, podendo informar sobre características da imagem corporal do indivíduo, tema relevante na atualidade, quando a representação do corpo tem assumido grande destaque social. Neste contexto, objetivou-se avaliar a representação da imagem corporal expressa no DFH (proposta de Machover) de adultos de diferentes índices de massa corporal (IMCs). Participaram do estudo 120 voluntários, de idades entre 18 e 55 anos, dos sexos masculino e feminino, saudáveis, residentes em Ribeirão Preto (SP), distribuídos em quatro grupos de IMC (abaixo do peso, peso normal, sobrepeso e acima do peso). Os desenhos foram classificados por juízes independentes, adotando-se o sistema proposto por Van Kolck. Os resultados indicaram poucas diferenças significativas entre os itens avaliativos do DFH e os diferentes grupos de IMC, apontando limites informativos na investigação da imagem corporal de adultos por meio desta técnica. The Human Figure Drawing (HFD) is one of the most known and employed techniques of psychological evaluation in Brazil, informing body image characteristics of individuals, a currently relevant issue in which body image representation has assumed a great social importance. In this context, body image representation, expressed through the HFD (proposed by Machover), was evaluated in adults with distinct body mass indexes (BMI). Participants included 120 healthy volunteers, from 18 to 55 years of age, males and females, resident in Ribeirão Preto (SP), and classified in four groups of BMI (underweight, normal weight, overweight and obese). The drawings were classified by independent judges, by adopting the system proposed by Van Kolck. The results indicate few meaningful differences among the evaluated items of the HFD and the distinct groups of BMI, indicating informative limits in the investigation of body image of adults through this technique. El Dibujo de la Figura Humana (DFH) es una de las técnicas de evaluación psicológica más conocidas y utilizadas en Brasil que puede informar sobre características de la imagen corporal del individuo, tema relevante en la actualidad cuando la representación del cuerpo ha asumido gran destaque social. En este contexto, se buscó evaluar la representación de la imagen corporal, expresa en el DFH (propuesta de Machover), de adultos de diferentes índices de masa corporal (IMC). Participaron del estudio 120 voluntarios, de 18 a 55 años, de los sexos femenino y masculino, saludables, residentes en Ribeirão Preto (SP), distribuidos en cuatro grupos de IMC (abajo del peso, peso normal, sobrepeso y exceso de peso). Los dibujos fueron clasificados por jueces independientes, adoptándose el sistema propuesto por Van Kolck. Los resultados indicaron pocas diferencias significativas entre los ítems evaluadores del DFH y los diferentes grupos de IMC, señalando límites informativos en la investigación de la imagen corporal de adultos por medio de esta técnica.

PURPOSE. The purpose of this study was to further assess the psychometric qualities of the Mini-Social Phobia Inventory (MS) to screen for social anxiety disorder (SAD). DESIGN AND METHODS. The MS and other self- and clinician-rated scales for anxiety and social anxiety were applied in 2,314 university students and in samples of SAD patients (n = 88) and nonpatients (n = 90). FINDINGS. The MS revealed adequate discriminative validity, internal consistency (α= 0.49–0.73), convergent validity with the Social Phobia Inventory, Brief Social Phobia Scale, and Self-Statements During Public Speaking Scale and convergent and divergent validity with the Beck Anxiety Inventory. PRACTICE IMPLICATIONS. The MS has shown to be a fast and efficient screening instrument for SAD in different cultures and contexts.

O objetivo do presente estudo foi comparar pedidos de interconsulta psiquiátrica realizados para dois hospitais gerais universitários brasileiros e avaliar a aplicabilidade de um protocolo de registro de interconsulta psiquiátrica (PRISMe). Foi realizada análise dos pedidos de interconsulta, do PRISMe anexado a eles e o número total de pedidos de interconsulta incluídos na amostra foi 541 (438 pedidos de interconsulta do HCFMRP-USP e 103 pedidos de interconsulta do HU-UFSC). Observou-se maior freqüência de solicitação para pacientes do sexo feminino, caucasianos, entre 31 a 60 anos e casados. Os diagnósticos psiquiátricos mais freqüentes foram depressão, transtornos de adaptação e de personalidade. Os resultados estão de acordo com a literatura nacional e internacional e as diferenças encontradas podem ser atribuídas às diferenças na infra-estrutura das instituições e nos contextos sócio-econômicos nos quais estão inseridas. Achados do presente estudo demonstram a aplicabilidade do PRISMe e sugerem que podem facilitar a sistematização da obtenção de achados clínico-demográficos e a comparabilidade entre as diferenças. The objective of the present report was to compare consultative psychiatric services in two Brazilian university hospitals and to evaluate the applicability of a standardized protocol (PRISMe) for recording psychiatric liaison consultations. Analyses of psychiatric consultations and the attached protocol were performed. 541 consecutive liaison consultations were included in the final sample (438 consecutive consultations from the Federal university hospital in São Paulo and 103 from the Federal university hospital in Santa Catarina). In both hospitals, the majority of patients were female, married, white, and 31 to 60 years of age. Depression and adjustment and personality disorders were the most common psychiatric diagnoses, which could explain the higher referral of female patients. The results are consistent with the Brazilian and international literature, and the differences between the two hospitals could be related to both logistical differences between the consultative psychiatric services and the socioeconomic contexts. The findings confirm the applicability of the PRISMe and suggest that systematization of clinical and demographic information is important for future comparative studies.

Introduction: Although anxiety is a common psychiatric complication of Parkinsons disease (PD), it has received little attention compared to depression in PD, being still an under-recognized and under-diagnosed condition in clinical practice. Objective: To review general aspects of the association between anxiety and PD concerning prevalence, etiopathogenesis, clinical characteristics, comorbidities, and treatment. Method: The basic and clinical literature on anxiety and PD was reviewed via the Pubmed, Lilacs and Scielo indexing services, using the keywords anxiety, etiology, prevalence, treatment, Parkinson, and Parkinsons disease. Moreover, complementary information was extracted from the reference lists of the articles found in the search. Results: Up to 67% of PD patients present clinically significant anxiety levels. Oscillations in anxious symptoms may be related to the use of anti-Parkinson drugs and motor fluctuations. The association between anxiety in PD and depressive disorders sleep disturbances, and cognitive impairment has also been proposed as a possible explanation for this psychiatric complication. Thus far, few data on the treatment of anxiety disorders in PD are available. Conclusions: More studies investigating aspects such as prevalence, etiopathogenesis, comorbidities, impact on life quality, and treatment are necessary and opportune in order to facilitate the recognition and diagnosis of anxiety disorders in PD.

PURPOSE. This article evaluates the comparability of the telephone and in-person Structured Clinical Interview for DSM–IV (SCID) interviews in assessing patients with social anxiety disorder (SAD) as an independent anxiety diagnosis. DESIGN AND METHODS. One hundred subjects were randomly selected and interviewed with the SCID, once by telephone and once in person (1–3 months later). FINDINGS. The prevalence of SAD assessed with the telephone interviews was 56%, whereas the in-person prevalence was 52%, with no statistically significant difference. The test–retest kappa for the 200 interviews was .84, indication of excellent agreement. PRACTICE IMPLICATIONS. These findings, along with the existing evidence of their validity, should encourage the use of SCID by telephone for SAD diagnostic interviews.

A pesquisa foi realizada no contexto da disciplina de odontopediatria em uma clínica-escola. Objetivou-se caracterizar os problemas comportamentais das crianças atendidas e as manifestações de estresse das crianças, dos seus acompanhantes e dos alunos de odontologia, além de identificar o medo diante do tratamento odontológico dos acompanhantes e as possíveis associações entre as manifestações de estresse e a colaboração das crianças em face dos procedimentos odontológicos. Participaram do estudo 110 crianças, 110 acompanhantes e 70 alunos. Procedeu-se à aplicação dos seguintes instrumentos: Escala de Estresse Infantil; Escala Comportamental A2 de Rutter; Inventário de Sintomas de Estresse de Lipp; Dental Fear Survey. Constatou-se que o atendimento odontopediátrico mostrou-se permeado de manifestações de estresse por parte das crianças, acompanhantes e alunos, condição pouco favorecedora da aprendizagem dos alunos e de comportamentos de colaboração com o atendimento por parte das crianças, o que se fez presente em procedimentos de diferentes níveis de invasão. Current study, carried out at the Pediatric Dentistry Clinic, characterizes behavioral problems and stress manifestations in children undergoing dental treatment and identifies possible links between children's cooperation in dental procedures. Manifestations of stress in the accompanying person and in the dental student practicing the treatment were identified, showing the manner they influence the child behavior during the procedure. One hundred and ten children, 110 accompanying persons and 70 students participated in the study. The following instruments were applied: Child Stress Scale, Rutter Parent Scale A2, Lipp Stress Symptoms Inventory, and Dental Fear Survey. Since dental treatment was permeated with stress manifestations by children, accompanying persons and dentistry students, such conditions did not favor the dentistry students' learning or the children's cooperative behavior. Manifestations were present regardless of the invasiveness degree of the procedure. La investigación fue realizada en el contexto de la disciplina de odontopediatría en una clínica escuela. Tuvo como objetivo caracterizar los problemas comportamentales de los niños asistidos y las manifestaciones de estrés de los niños, de sus acompañantes y de los alumnos de odontología, además de identificar el miedo ante el tratamiento odontológico de los acompañantes y las posibles asociaciones entre las manifestaciones de estrés y la colaboración de los niños ante a los procedimientos odontológicos. Participaron del estudio 110 niños, 110 acompañantes y 70 alumnos. Se hizo la aplicación de los siguientes instrumentos: Escala de Estrés Infantil; Escala Comportamental A2 de Rutter; Inventario de Síntomas de Estrés de Lipp; Dental Fear Survey. Se constató que en la asistencia odontopediátrica hubo manifestaciones de estrés, en los niños, acompañantes y alumnos, condición poco favorecedora del aprendizaje de los alumnos y hubo, también, comportamientos de colaboración con la asistencia por parte de los niños, lo que se hizo presente en procedimientos de diferentes niveles de invasión.

Introduction Communication apprehension is defined as "an individual's level of fear or anxiety associated with either real or antecipated communication with another person or persons" (McCroskey, 1984). McCroskey & Richmond (1987) identify four types of communication apprehension: trait-like, context-based, receiver-based and situational. The extent to which this condition is experienced has an inhibitory or facilitating influence on the development of communication competence and communication skill. Studies have shown high communicaton apprehension can have an impact on a person's behavior, relationships, perceptions of others, occupational choice and employment opportunities and education (Richmond, 1984; McCroskey & Richmond, 1987).This topic has attracted the interest of researchers in the areas of Psychology and Education because of the relevance of these indicators for the study of behavior, as demonstrated by the large number of papers published in this area (Payne & Richmond, 1984) and by the delimitation of specific conditions. Particularly important within this context is the fear of public speaking. Epidemiological studies have demonstrated that public speaking fear is the most prevalent fear in the general population (Geer, 1995; Stein, Walker & Forde, 1996), with its prevalence not depending on gender, ethnic group or age (Phillips, Jones, Rieger & Snell, 1997), a fact that has stimulated studies for the evaluation and dimensioning of this specific situation. Public speaking is also considered to be a powerful psychosocial stressor (Saab, Mattheus, Stoney & McDonald, 1989; Gerder, Turner, Sherwood & Light, 1990), eliciting great anxiety and negative affects, in addition to neuroendocrine, metabolic, immunological, cardiovascular and electrodermal responses (Gonzalez-Bono et al, 2002). Because of these characteristics, public speaking has been also considered to be the most prevalent fear in social anxiety disorder (SAD) (Stein, Walker & Forde, 1994; Furmark et al, 1999). Since the evaluation of subjective experiences and of emotional states is hampered by the characteristics of these constructs, it is necessary to develop procedures that will permit to evaluate and measure such constructs in an objective, reliable and systematic manner so that the data can be replicated and the situation can be validated as a source of information. In addition, it is well-known that the anxiety and other subjective states presented in the fear of public speaking can be modified by diverse therapeutical approaches, such as pharmacotherapy and cognitive/behavior therapy. These strategies act upon a variety of measurable states such as physiological responses (heart rate, blood pressure, peripheral pulse volume) and electrodermal activity (skin conductance level, number of spontaneous fluctuation) , among others. Regarding the evaluation of anxiety experiences, we should emphasize the importance of experimental models that permit the exploration of diverse behavioral correlates such as the "psychological" one, in which stimuli and situations external to the individual are employed in order to provoke anxiety, and the "biological" one, in which anxiety is induced by the administration of drugs. Among the psychological experimental models, four are particularly outstanding because of their importance and extensive use in clinical-experimental contexts and will be briefly commented upon below. The first, denoted "Aversive Noise Conditioning" (Vila & Beech, 1977), evaluates the activity of the sweat glands of the palms of the hands by means of skin conductance responses, which, when increased, can be regarded as an autonomic measure of the response to fear. The model evaluates this physiological response before and after the presentation of a blue light stimulus paired with white noise of aversive intensity. The second model consists of the "Stroop-Color Word Test", which is based on the induction of a cognitive conflict. …

ObjectiveThis study aimed to evaluate the discriminative validity of MINI-SPIN (MS) as a screening tool for social anxiety disorder (SAD) in a group of Brazilian university students.MethodSPIN was collectively applied to 2320 university students. Among them, 656 individuals who fulfilled the criteria for positive MS (N = 473) and negative MS (N = 183) were selected and divided into two groups. The selected subjects were interviewed by telephone using the SAD module of the SCID-IV, used as the gold standard. In order to check interrater reliability, a group of university students (N = 57) was reinterviewed by telephone by a second rater, and another group (N = 100) participated in a face-to-face interview.ResultsThe Kappa coefficient among the telephone interviews was 0.80, and a coefficient of 0.84 (P < 0.001) was obtained between the telephone interview and the face-to-face one. For a cut-off score of 6, suggested in the original English version of the instrument, sensitivity was 0.94, specificity 0.46, the positive predictive value (PPV) was 0.58, and the negative predictive value (NPV) was 0.92. For a cut-off score of 7, we observed an increase in the specificity and in the PPV (0.68 and 0.65) while the sensitivity and NPV (0.78 and 0.80) remained high.Discussion/ConclusionMS showed quite satisfactory psychometric qualities. The cut-off score of 6 seemed to be the most suitable to attest the tracking value of the tool. However, the cut-off score of 7 was the most suitable as a minimum parameter for the studied group, with psychometric values more similar to those of the original study.

The aim of this study is to investigate mental health problems in children born small for gestational age (SGA) and those born appropriate for gestational age (AGA) and to assess the association of these problems with child and family characteristics. Six hundred and seventy-seven children, belonging to a birth cohort from 1994 in Ribeirão Preto/SP (southeastern Brazil), were evaluated (140 SGA and 537 AGA). They were later reevaluated at school age (2004/2005) by means of the Strengths and Difficulties Questionnaire for mental health assessment (parent report). Results showed that children born SGA presented greater frequency of behavioral problems and emotional symptoms compared to children born AGA. Variables associated with mental health problems in the univariate model were: male sex, children born SGA, low educational level of parents, socioeconomic disadvantage, and belonging to families with many members. However, in multivariate analysis, two factors - being born SGA and father's low educational level - lost their statistical significance, and the other sociodemographic variables remained significant (male sex, low-level of maternal education, low socioeconomic level, families with many members). It has been concluded that being born SGA was not independently associated with mental health problems, but sociodemographic factors proved to be the predictors of this type of problem in the cohort studied. Este estudo objetivou investigar problemas de saúde mental em crianças nascidas pequenas para a idade gestacional (PIG) e adequadas para a idade gestacional (AIG), além de verificar também as possíveis associações destes problemas com variáveis biológicas e sociodemográficas. Foram avaliadas 677 crianças (140 PIG e 537 AIG), pertencentes a uma coorte de nascimento do ano de 1994, em Ribeirão Preto/SP (sudeste do Brasil), reavaliadas na idade escolar (2004/2005), por meio do Questionário de Dificuldades e Capacidades (versão dos pais). Os resultados mostraram que as crianças nascidas PIG apresentaram maior frequência de problemas comportamentais e sintomas emocionais, em comparação às crianças nascidas AIG. As variáveis associadas a problemas de saúde mental, no modelo univariado, foram o sexo masculino, crianças nascidas PIG, baixa escolaridade materna e paterna, desvantagem socioeconômica e famílias mais numerosas. Entretanto, na análise multivariada, a condição de nascimento PIG e a escolaridade paterna perderam sua significância estatística, permanecendo somente associadas às demais variáveis sociodemográficas (sexo masculino, baixa escolaridade materna, nível socioeconômico mais baixo e famílias mais numerosas). Conclui-se que a condição de nascimento PIG não foi independentemente associada a problemas de saúde mental, tendo os fatores sociodemográficos se mostrado como melhores preditores deste tipo de problema na coorte estudada.

The Strengths and Difficulties Questionnaire (SDQ) was designed to screen for behavioral problems in youths based on cutoff points that favor the instrument's diagnostic sensitivity. The present study aimed to analyze the discriminative validity of the SDQ to identify behavioral difficulties and prosocial resources in school-age children compared with the diagnostic data collected by the corresponding sections of the Development and Well-being Assessment (DAWBA). In addition, new cutoff points that value specificity were defined for the SDQ scales, exploring its diagnostic potential. This study was conducted in Brazil and assessed a community convenience sample that consisted of 120 children aged 6–12 years who were not under psychological/psychiatric treatment. The mothers of the participants also completed a sociodemographic questionnaire. Descriptive statistics were used to clinically characterize the sample. A ROC curve was used to assess the discriminant validity of the SDQ, and new cutoff points were established to maximize the instrument's specificity. The new cutoff points enabled a significant increase in specificity without a significant loss of sensitivity, which favors approaches based on measures of screening and diagnosis yet does not damage the instrument's screening capacity. The following increases were observed: 100% for the depressive disorder scale (cutoff point = 7), 95.1% for the generalized anxiety disorder scale (cutoff point = 7), 46.6% for the conduct disorder scale (cutoff point = 6), 19.2% for the hyperactive disorder scale (cutoff point = 8), and 27.6% for the antisocial personality disorder scale (cutoff point = 6). A cutoff point of 8 was applied to the prosocial behavior scale, which exhibited a 62.1% increase in specificity. The use of more specific cutoff points generated more accurate results and favored SDQ's use, particularly in contexts of care that require more precise and faster procedures for identification of problems.

The aim of the present study was to critically analyze 15 empirical articles produced during a 30-year period (1972 - 2003) and indexed in the PsycINFO, Medline, Lilacs and SciELO databases; the selected articles focused on Chagas disease and its effects on the cognitive and psychosocial functioning of infected patients. The analysis indicates that cognitive damage and psychosocial stress are related to the Chagas disease. Major critical points are the small number of papers on psychosocial variables over the covered period and the diversity of the studied variables, suggesting the need for research that investigate more profoundly the impact of the disease on the patient, with personal as well as contextual variables so as to find out the combined effect of such conditions in order to implement successful health education policies and practices.

The objective of the present study was to evaluate the factor structure of Bech's version of the Brief Psychiatric Rating Scale (BPRS), translated into Portuguese. The BPRS was administered to a heterogeneous group of psychiatric inpatients (N = 98) and outpatients (N = 62) in a University Hospital. Each patient was evaluated from one to eight times. The interval between consecutive interviews was one week for the inpatients and one month for the outpatients. The results were submitted to factorial analysis. The internal consistency of the total scale and of each factor was also estimated. Factorial analysis followed by normalized orthogonal rotation (Varimax) yielded four factors: Withdrawal-Retardation, Thinking Disorder, Anxious-Depression and Activation. Internal consistency measured by Cronbach's alpha coefficient ranged from 0.766 to 0.879. The data show that the factor structure of the present instrument is similar to that of the American version of the BPRS which contains 18 items, except for the absence of the fifth factor of the latter scale, Hostile-Suspiciousness.

Munksgaard 2001.Objective: To assess the beneficial impact of a structured interview on thereliability of BPRS ratings in raters with low clinical experience.Method: Each patient was rated once a week in two separate interviews,conducted on the same day. The first interview was conducted by a raterwith low clinical experience (recruited from a group of five residents inpsychiatry and one clinical psychologist in training). All secondinterviews were conducted by the same highly experienced psychiatrist.Results: The number of items with full agreement between observersincreased with the use of SIG. The value of intraclass correlationcoefficients for individual items and the total score also increased,approaching reported studies with experienced raters.Conclusion: These results suggest that the use of SIG reduces variabilityof information gathering in reliability testing of BPRS with lessexperienced raters.J.A.S. Crippa, R.F. Sanches,J.E.C. Hallak, S.R. Loureiro,A.W. Zuardi

O objetivo deste trabalho foi detectar indicadores de potencial cognitivo de crianças com queixa de dificuldade de aprendizagem escolar, utilizando procedimento combinado de avaliação psicométrica (Raven) e avaliação assistida (Jogo de Perguntas de Busca com Figuras Diversas - PBFD). Foram avaliadas 20 crianças de oito a 11 anos, encaminhadas para atendimento psicológico na área da Saúde com queixa de dificuldade de aprendizagem. O PBFD foi delineado em fases e realizado antes (avaliação) e após (reavaliação) uma intervenção psicopedagógica de curta duração. Houve variações de desempenho na avaliação psicométrica, com tendência à classificação "definidamente abaixo da média". Na avaliação assistida, nos momentos da avaliação e da reavaliação, houve variações nos perfis de desempenho cognitivo, indicando diferenças individuais quanto às dificuldades e recursos cognitivos. Discriminou-se um subgrupo de crianças que precisaram de pouca ajuda e monitoramento, daquele de crianças que precisaram de mais assistência para implementar estratégias eficientes na resolução de problemas. This research intended to detect indicators of cognitive potential of children with school learning disability complaints, employing combined procedures of psychometric assessment (Raven) and assisted assessment (Constraint-seeking questions game with several figures -- PBFD). Twenty children with learning disability complaints, aged from eight to 11 years, were assessed, all referred for psychological evaluation in Health Services. PBFD was delineated by phases and carried out before (assessment) and after (re-assessment) a short duration psychopedagogic intervention. There was a variation in the performance of children in the psychometric assessment, with a tendency of predominance of the classification "definitely below the average". In the assisted assessment, there was variation in the cognitive performance profile, showing individual differences in cognitive difficulties and resources, both assessment and re-assessment moments. A subgroup of children needing few help and monitoring was distinguished, in contrast with a group that needed more assistance to implement efficient strategies for problem resolution.

This study aims to translate and validate Early Trauma Inventory Self Report -Short Form (ETISR-SF) to Brazilian Portuguese. 253 adult subjects answered the ETISR-SF, Beck Anxiety Inventory (BAI), Fagerström Test for Nicotine Dependence (FTND), Patient Health Questionnaire (PHQ-9) and Fast Alcohol Screening Test (FAST). The instrument showed good internal consistency (0.83). Correlations with the PHQ-9 and BAI were moderate (r=0.26-0.47) and showed the expected associations with psychiatric constructs. No associations were found for FTND and FAST. Confirmatory Factor Analysis revealed that a correlated four-factor model as well as a second order model subsuming four lower order components presented the best model fit. Test-retest reliability was also excellent (ICC=0.78-0.90). ETISR-SF is suitable for assessing traumatic experiences in a Brazilian community sample. Given the importance of trauma as a public health problem, tools such as ETISR-SF may help clinicians/ researchers to better evaluate and measure such events and further advance clinical care of trauma victims.

Social Anxiety Disorder (SAD) is prevalent and rarely diagnosed due to the difficulty in recognizing its symptoms as belonging to a disorder. Therefore, the evaluation/screening scales are of great importance for its detection, with the most used being the Liebowitz Social Anxiety Scale (LSAS). Thus, this study proposed to evaluate the psychometric properties of internal consistency and convergent validity, as well as the confirmatory factorial analysis and reliability of the self-reported version of the LSAS (LSAS-SR), translated into Brazilian Portuguese, in a sample of the general population (N = 413) and in a SAD clinical sample (N = 252). The convergent validity with specific scales for the evaluation of SAD and a general anxiety scale presented correlations ranging from 0.21 to 0.84. The confirmatory factorial analysis did not replicate the previously indicated findings of the literature, with the difficulty being in obtaining a consensus factorial structure common to the diverse cultures in which the instrument was studied. The LSAS-SR presented excellent internal consistency (α = 0.90–0.96) and test-retest reliability (Intraclass Correlation Coefficient = 0.81; Pearson’s = 0.82). The present findings support those of international studies that attest to the excellent psychometric properties of the LSAS-SR, endorsing its status as the gold standard.

The epidemiological dimension of mental health problems in childhood and its impact warrant new studies. Knowledge about the predictors of mental health in children is scant in developing countries. The present study estimated the prevalence of psychiatric disorders in Brazilian school-age children based on a community sample from primary health care services, with the aim of verifying the predictive value of biological, social, and familial risk factors in children's mental health. The study was performed with 120 children of both genders identified through their mothers. The children's mental health was evaluated by sociodemographic factors and a diagnostic interview conducted with parents. Biological, social, and familial risk factors were evaluated by the Supplemental Questionnaire and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Of the 120 children, 45.8 % were diagnosed with at least one mental health disorder. Children with diagnoses of depressive disorder and generalized anxiety disorder presented evidence of greater exposure to risk factors compared with children without these psychiatric diagnoses. Children with more risk factors throughout their lifetime had greater comorbidities compared with children with a lower number of risk factors. The identification of groups exposed to interconnected risk factors represents a priority when planning mental health practices. The strong role of chronic familial risk factors needs to be emphasized because they are a possible target for the prevention of depressive and anxiety disorders.

The Interactive Observation Scale for Psychiatric Inpatients (IOSPI) is characterized by the necessity of interaction between the rater and the patient during the evaluation process. The reliability, validity and factor structure of the IOSPI were evaluated by using a total of 186 sets of ratings accomplished by 2 nursing aides on 34 adult psychiatric inpatients submitted to weekly evaluations during the 3 first weeks of hospitalization. The patients were observed by the 2 nursing aides simultaneously during the morning shift (5 h). In the afternoon of the same day, they were interviewed by two psychiatrists who filled in separately the Brief Psychiatric Rating Scale (BPRS). Factor analysis of the 16 IOSPI items revealed 5 distinct clusters of items, which represented higher-order constructs of social interest, psychomotor agitation, psychoticism, neatness and irritability. It was found that the IOSPI has significant interrater reliability, estimated by an intraclass correlation coefficient of total score and factor score. The total scores of the IOSPI showed a significant correlation with the total scores of the BPRS, meeting the criteria of concurrent validity. The criteria of predictive validity were also met, since the patients who could be discharged presented IOSPI scores significantly lower than the patients who could not be discharged. In conclusion, the IOSPI met the requirements of an evaluation scale and can stimulate therapeutic attitudes of the nursing staff by its characteristics of interactive observation.

Great progress has been observed in the literature over the last decade regarding the validation of instruments for the assessment of Social Anxiety Disorder in the Brazilian context. Particularly outstanding in this respect is the production of a group of Brazilian investigators regarding the psychometric study of the following instruments: Liebowitz Social Anxiety Scale, Social Phobia Inventory, Brief Social Phobia Scale, Disability Profile, Liebowitz Self-Rated Disability Scale, Social Phobia Safety Behaviors Scale and Self-Statements During Public Speaking Scale, which have proved to be appropriate and valid for use in the adult Brazilian population, representing resources for the assessment of social anxiety in clinical and experimental situations.