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Introduction: The Temperament & Personality Questionnaire (T&P) is a self-report instrument designed to evaluate personality styles overrepresented in patients with depression. This report briefly describes the translation and adaptation of the T&P into Brazilian Portuguese., Methods: The procedures, which included 10 steps, followed guidelines for the adaptation of self-report instruments defined by the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) Task Force for Translation and Cultural Adaptation., Results: The author of the original T&P questionnaire authorized and participated in the translation conducted by the authors and independent native speakers. Evaluation of the translated questionnaire indicated that only minor adjustments were required in the Portuguese version., Conclusions: The Brazilian version of T&P, translated and adapted following a rigid standardized process, is available for use free of charge and may be especially useful in pursuing links between personality styles and depressive conditions.

Exercise can be an effective treatment for depression. Although the efficacy of exercise is well established, little is known concerning the biological changes associated with the antidepressant effects of exercise. A randomized, controlled trial was conducted to evaluate the effects of adding exercise to the usual treatment on the thiobarbituric acid-reactive substances (TBARS) and brain-derived neurotrophic factor (BDNF) serum levels of severely depressed inpatients. Twenty-six participants were randomized to an exercise group (n=15, exercise+treatment as usual) or a control group (n=11, treatment as usual). The participants in the exercise group completed a targeted dose of 16.5 kcal/kg/week of aerobic exercise, three times per week, throughout their hospitalizations. The control group did not exercise during their hospitalizations. The mean hospitalization length was of 21.63 (4.5)×23.82 (5.7) days for exercise and control groups, respectively. The exercise group performed a median of nine sessions. After adjusting for previous tobacco use, a significant group×time interaction was found for TBARS serum levels (p=0.02). A post hoc Bonferroni test revealed differences between the exercise and control groups at discharge. A significant time effect (p<0.001) but no group×time interaction was found (p=0.13) for BDNF serum levels. Adding exercise to the usual treatment of severely depressed inpatients decreases the TBARS serum levels of severely depressed inpatients after 3 weeks. Adding exercise had no additional effects on BDNF serum levels.

Objective: To investigate whether internalizing disorders are associated with quality of life (QoL) in adolescents, even after accounting for shared risk factors., Methods: The sample comprised 102 adolescents from a community cross-sectional study with an oversampling of anxious subjects. Risk factors previously associated with QoL were assessed and divided into five blocks organized hierarchically from proximal to distal sets of risk factors., Results: Multiple regression analysis yielded a hierarchical model accounting for 72% of QoL variance. All blocks were consistently associated with QoL (p < 0.05), accounting for the following percentages of variance: 12% for demographics; 5.2% for family environment; 37.8% for stressful events; 10% for nutritional and health habits; and 64.2% for dimensional psychopathological symptoms or 22.8% for psychiatric diagnoses (dichotomous). Although most of the QoL variance attributed to internalizing symptoms was explained by the four proximal blocks in the hierarchical model (43.2%), about 21% of the variance was independently associated with internalizing symptoms/diagnoses., Conclusions: QoL is associated with several aspects of adolescent life that were largely predicted by our hierarchical model. Our findings reinforce the hypothesis that internalizing disorders and internalizing symptoms in adolescents have a high impact on QoL and deserve proper clinical attention.

Objective: To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities., Methods: There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test., Results: The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found., Conclusions: The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.

Previous studies have shown that chronic conditions have a negative impact on quality of life. Furthermore, this impact appears to be different in males and females, but it is not yet clear what factors may mediate this relationship. Females with chronic health conditions had poorer quality of life in the physical and psychological domains as compared to males with chronic health conditions. The difference between male and female patients in the psychological domain disappeared when the analysis was adjusted for confounding factors such as age, presence of a chronic health condition, socioeconomic status, and depressive symptoms., (© The Author(s) 2013.)

Background: The number of people with disabilities in Brazil and worldwide has grown substantially in recent decades. Cross-cultural quality of life instruments can be helpful in the development of interventions designed to meet the needs of this population and contribute to rational allocation of resources. This study sought to provide evidence of validity and reliability the Brazilian Portuguese version of WHOQOL-Dis-D (a cross-cultural, multicentre instrument developed by the WHOQOL-Group for the assessment of quality of life in persons with physical disability - PD) and WHOQOL-Dis-ID (for persons with intellectual disability - ID)., Methods: Classical psychometric methods were used to conduct independent analyses of the PD and ID samples. Criterion groups were established for analysis of construct validity. Concurrent validity was assessed in relation to SWLS and BDI-II scores; discriminant validity, in relation to WHODAS-II. Cronbach alpha was used to test the instrument scales and subscales for reliability. The ID subgroup was retested, and test-retest reliability assessed by means of intraclass correlation coefficients and paired Student's t-test., Results: A total of 162 (98 females) people with PD and 156 (55 females) people with ID participated in the study. Cronbach alpha was satisfactory across practically all domains and factors in the PD subsample. In IDs, most factors or domains had coefficients higher than 0.70, but four subscales exhibited less satisfactory performance. Evidence of construct and concurrent validity and reliability were obtained., Conclusions: The analyses presented herein provide satisfactory evidence of the validity and reliability of the instrument and corroborated the factor structure revealed during cross-cultural research. Further studies with larger sample sizes are required to obtain additional evidence of validity and reliability.

Background: Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis., Methods: We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes., Results: Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=-1.89 [95% CI=-2.64 to -1.15, p<0.0001]). Also, there was a significant decrease in depression scores between 3 and 6 months (Hedges׳ g=-0.27, p=0.003), but no significant changes from months 6 to 12. Finally, dropout rates at 12 months were 10.8% (95% CI=4.3% to 24.4%)., Limitations: Small number of included studies (most of which were open label), and limited long-term effectiveness data., Conclusions: DBS applied to the SCC seems to be associated with relatively large response and remission rates in the short- and medium- to long-term in patients with severe TRD. Also, its maximal antidepressant effects are mostly observed within the first 6 months after device implantation. Nevertheless, these findings are clearly preliminary and future controlled trials should include larger and more representative samples, and focus on the identification of optimal neuroanatomical sites and stimulation parameters., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Prognostication is poor in repetitive transcranial magnetic stimulation (rTMS) treatment for major depressive disorder (MDD). Personality traits, particularly extraversion and neuroticism, have attracted increasing attention for both trait- and state-dependent characteristics in predicting response to pharmacotherapy, psychotherapy, and more recently to therapeutic neuromodulation for MDD. The advent of deep rTMS (DTMS) allows stimulation of deeper cortical regions, and we aimed to prospectively characterize personality dimensions and antidepressant response to DTMS in treatment-resistant MDD., Methods: A convenience sample of 15 patients with treatment-resistant MDD received four weeks of daily sessions of DTMS (20 Hz, 3000 pulses/session) of the left dorsolateral prefrontal cortex (DLFPC). At baseline and at the conclusion of treatment, patients completed the Big Five Inventory, a five-factor assessment of major personality dimensions. Clinical response was measured using the 21-item Hamilton Depression Rating Scale., Results: Four weeks of DTMS treatment were not associated with changes in personality measures. Clinical remission was associated with higher baseline levels of agreeableness (score ≥ 29:100% sensitive and 72.7% specific) and conscientiousness (score ≥ 30:75% sensitive and 81.8% specific). Levels of agreeableness and extraversion were linearly associated with antidepressant response. Neuroticism was not associated with the antidepressant effects of DTMS in this cohort., Conclusions: Five-factor personality assessment may have prognostic value in DTMS for resistant MDD. Agreeableness, extraversion, and conscientiousness are associated with decreases in depressive symptoms during treatment with DTMS., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Given that mental symptoms might interfere with the quality of life (QOL) of people living with HIV/AIDS (PLHAs), the goal of this paper was to examine the correlation between depression, anxiety, and QOL in a sample of HIV-positive Brazilians. A cross-sectional study was designed to analyze the correlations between the presence of mental symptoms and the QOL scores of PLHAs. Depression and anxiety symptoms were measured using the Beck Depression Inventory and the State-Trait Anxiety Inventory, respectively. The QOL was assessed using the World Health Organization Quality of Life instrument - HIV module. A convenience sample of 308 men and women living with HIV (131 asymptomatic, 91 symptomatic, and 86 with AIDS) in Porto Alegre/RS-Brazil was selected. The depression scores were higher in patients with AIDS compared with asymptomatic and symptomatic patients, yet there were no differences in the anxiety scores between the stages of infection. Better QOL scores were observed in the earlier stages of infection (asymptomatic and symptomatic groups). In the correlation between mental symptoms and QOL scores, the Pearson's coefficient values were of a moderate (r = .47) to a large (r = .65) magnitude for depressive symptoms, and the scores for the anxiety symptoms were small to moderate (r ≤ .35). After adjusting for the disease stage and clinical and sociodemographic variables in a multiple regression model (using QOL as the dependent variable), the depressive symptoms showed significantly higher beta-coefficient values compared with the remaining variables. The data obtained from this study indicate that the QOL of PLHAs is primarily affected by depression. Thus, it has been strongly recommended that treatment programs dedicated to PLHAs assess depressive symptoms, providing subsequent referrals and treatments. Treating depression might be effective for PLHAs and might potentially improve both the overall QOL and the health outcomes.

The best classification of depressive disorders is still to be established. A melancholic subtype has a lengthy history, and recent research demonstrates its relevance. This study compares the prevalence of psychotic symptoms in nonmelancholic and melancholic depression and assesses whether there is a dimensional pattern in the severity of symptoms among the subtypes. Patients with unipolar depression were assessed for melancholic status, psychotic symptoms, and severity of depression. The diagnosis of melancholia was made by both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), criteria and CORE measure. The DSM criteria assigned a much higher percentage of patients as melancholics (67.4%) than did the CORE (24.9%). Prevalence of psychosis was distinctly higher in the melancholics. Symptoms severity was higher among the melancholics when compared with the nonmelancholics. The presence of psychotic symptoms was not associated with an increase in the intensity of depressive symptoms. Psychotic symptoms are more frequently associated with the melancholic subtype of depression. This suggests clinical contiguity between the melancholic and psychotic subtypes and the clinical relevance of identifying melancholia.

This work redeems, contextualizes and features the social, historical and cultural aspects of the deaf community that uses the Brazilian Sign Language focusing on the social and anthropological model. The scope of this study was to conduct a bibliographical review in scientific textbooks and articles available in the Virtual Health Library, irrespective of the date of publication. 102 articles and 53 books were located, including 33 textbooks and 26 articles (four from the Lilacs database and 22 from the Medline database) that constituted the sample. Today, in contrast with the past, there are laws that guarantee the right to communication and attendance by means of the Brazilian Sign Language. The repercussion, acceptance and inclusion in health policies of the decrees enshrined in Brazilian laws is a major priority.

Objective: To use principal component analysis (PCA) to test the hypothesis that the items of the Hamilton Depression Scale (HAM-D₁₇) have been selected to reflect depression disability, whereas some of the items are specific for sub-typing depression into typical vs. atypical depression., Method: Our previous study using exploratory factor analysis on HAM-D₁₇ has been re-analyzed with PCA and the results have been compared to a dataset from another randomized prospective study., Results: PCA showed that the first principal component was a general factor covering depression disability with factor loadings very similar to those obtained in the STAR*D study. The second principal component was a bi-directional factor contrasting typical vs. atypical depression symptoms. Varimax rotation gave no new insight into the factor structure of HAM-D₁₇., Conclusion: With scales like the HAM-D₁₇, it is very important to make a proper clinical interpretation of the PCA before attempting any form of exploratory factor analysis. For the HAM-D₁₇, our results indicate that profile scores are needed because the total score of all 17 items in the HAM-D₁₇ does not give sufficient information.

The objectives of this study were to investigate: (a) multiple relations between socio-demographic, psychosocial, and health variables and quality of life in the elderly and (b) the model's validity through correlation with depressive symptoms. The sample included 339 elderly individuals from 60 to 98 years of age (M = 73.4; SD = 8.3), who answered a socio-demographic questionnaire, WHOQOL-100, and BDI. Cluster analysis of the sample distributed the elders into two groups according to self-perceived quality of life (better versus worse), and logistic regression analysis identified variables that explained better quality of life. Social class, self-rated health status, volunteer work, use of medication, and data collection setting were associated with quality of life (predictive capacity for correct classification 72.3%, specificity 73.6%, and sensitivity 71.1%). The inverse correlation between the model's variables and BDI scores provided evidence of the model's validity. The model can help support public policies aimed at promoting quality of life in the elderly.

The objective of this study was to provide normative SF-36 scores in a general population sample in Brazil and to describe differences in mean scores according to socio-demographic characteristics. The SF-36 questionnaire was distributed to a randomly selected sample of the general population of Porto Alegre in the State of Rio Grande do Sul. The response rate was 68% and 755 subjects were included (38% male, 62% female). Lower health status was revealed among females in the 30 to 44 year age bracket, from the lower income class, with less education and self-reported chronic medical conditions. The results and percentiles of scores of the SF-36 are reported as normative data for the general population. The SF-36 was an acceptable and practical instrument for measuring health-related quality of life in a sample of Brazilians. The results of this study can be useful for researchers using the SF-36 questionnaire in other groups to compare the scores with normative data. The SF-36 may prove a valuable tool for discovering vulnerable groups in epidemiological studies due to the ability to discriminate between different population subgroups.

Objective: To construct versions of the WHOQOL-BREF and WHOQOL-DIS instruments in Brazilian sign language to evaluate the Brazilian deaf population's quality of life., Methods: The methodology proposed by the World Health Organization (WHOQOL-BREF and WHOQOL-DIS) was used to construct instruments adapted to the deaf community using Brazilian Sign Language (Libras). The research for constructing the instrument took placein 13 phases: 1) creating the QUALITY OF LIFE sign; 2) developing the answer scales in Libras; 3) translation by a bilingual group; 4) synthesized version; 5) first back translation; 6) production of the version in Libras to be provided to the focal groups; 7) carrying out the Focal Groups; 8) review by a monolingual group; 9) revision by the bilingual group; 10) semantic/syntactic analysis and second back translation; 11) re-evaluation of the back translation by the bilingual group; 12) recording the version into the software; 13) developing the WHOQOL-BREF and WHOQOL-DIS software in Libras., Results: Characteristics peculiar to the culture of the deaf population indicated the necessity of adapting the application methodology of focal groups composed of deaf people. The writing conventions of sign languages have not yet been consolidated, leading to difficulties in graphically registering the translation phases. Linguistics structures that caused major problems in translation were those that included idiomatic Portuguese expressions, for many of which there are no equivalent concepts between Portuguese and Libras. In the end, it was possible to create WHOQOL-BREF and WHOQOL-DIS software in Libras., Conclusions: The WHOQOL-BREF and the WHOQOL-DIS in Libras will allow the deaf to express themselves about their quality of life in an autonomous way, making it possible to investigate these issues more accurately.

This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles., Methods: A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables., Results: The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups., Limitations: The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study., Conclusion: Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To test some psychometric properties of the Brazilian-Portuguese version of the Youth Quality of Life Instrument-Research (YQOL-R) in a community sample of Brazilian adolescents., Methods: This is a cross-sectional community study conducted in six schools of the catchment area of a family health unit. From an original population of 2,754 students from 10 to 17 years old, we randomly selected 419 to answer the Brazilian-Portuguese version of the YQOL-R. We tested reliability, known group differences (using anxiety symptoms and bullying involvement), and factor structure., Results: The YQOL-R showed a good internal consistency and had an adequate and expected known group differences with both bullying and anxiety. The factor structure of the conceptual model was partially supported by our analysis., Conclusions: The Brazilian-Portuguese version of the YQOL-R showed sufficiently good psychometric properties. Further studies are needed in order to better investigate alternative configurations of the factor structure.

Objectives: To test the psychometric properties of the EUROHIS-QOL 8-item index, a shortened version of the World Health Organization Quality of Life Instrument-Abbreviated Version (WHOQOL-BREF)., Methods: The sample consisted of 2359 subjects identified from primary care settings, with 1193 having a confirmed diagnosis of depression. Data came from six countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in a large international study, the Longitudinal Investigation of Depression Outcomes. The structure of the EUROHIS-QOL 8-item index follows that of the WHOQOL-BREF assessment. Internal consistency was measured by using Cronbach's alpha. Convergent validity was assessed by using correlations with different measures for mental health (Symptom Checklist 90), physical health (self-evaluation), and quality of life (WHOQOL-BREF and short form 36 health survey). Discriminant group validity was assessed between diagnosed depressed and nondepressed patients. Differential item functioning and unidimensionality were analyzed by using Rasch analysis. Factor structure was assessed with structural equation modeling analyses., Results: Internal consistency was acceptable (ranged between 0.72 and 0.81 across countries), and the index discriminated well between depression (t = 6.31-20.33; P < 0.001) across all countries. Correlations between the EUROHIS-QOL 8-item index and different measures--Symptom Checklist 90 (r = -0.42), physical health (r = -0.42), WHOQOL-BREF domains (r = 0.61-0.77), and short form 36 health survey (r = 0.58)--were all significant (P < 0.001). The index is unidimensional with desired item fit statistics. Two items ("daily living activities" and "enough money to meet your needs") had residuals exceeding 4. Differential item functioning was observed with general quality of life, general health, relationships, and home items for age. A common one-factor structure with acceptable fit was identified in three out of six countries (comparative fit index = 0.85, root mean square error of approximation = 0.11)., Conclusions: The EUROHIS-QOL 8-item index showed acceptable cross-cultural performance and a satisfactory discriminant validity and would be a useful measure to include in studies to assess treatment effectiveness., (Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objective: To explore the concepts of quality of life (QOL), quality of care (QOC), and attitudes toward disabilities in Porto Alegre, Brazil, from the perspective of people living with disabilities, including their relatives and caregivers., Methods: This was a qualitative study that interviewed a total of 23 participants in five focus groups, during May-August 2006. After an open discussion about QOL, the WHOQOL-Bref, a generic questionnaire for the assessment of QOL, was presented to participants. The study was performed simultaneously in 15 international centers. Analysis was based on Bardin's content analysis., Results: Regarding QOL, important themes that emerged were: work, education, leisure, universal accessibility, integration in the society, and social inclusion. Concerning QOC, professional qualifications, disabilities-related training for health and education professionals, and access to health services were considered important. Regarding attitudes toward disabilities, the participants perceived the attitudes of others, especially of caregivers, to significantly impact the QOL of people with disabilities., Conclusions: People living with disabilities value many of the same themes considered important by the general public; however, several additional themes specific to disabilities and specific to these groups of participants emerged. This information highlights the importance of taking into account the unique perceptions and cultural traits of the target population when measuring QOL, QOC, and attitudes toward disabilities.

Objectives: To investigate the effect of cognitive support (an associative orienting instruction at encoding) on contextual memory in depressed patients., Methods: Seventeen patients (age 20-40 years, 14 women) diagnosed with major depressive disorder (MDD) and 22 healthy controls matched for age, gender and education completed a recognition memory task for item (object) and context (location), with or without an incidental binding cue at encoding. In addition, participants completed the vocabulary subtest of the Wechsler Adult Intelligence Scale (WAIS III) and the Wisconsin Card Sorting Test (WCST). Salivary samples were collected at 7 AM, 4 PM and 10 PM on the day of testing for cortisol and DHEA level measurement., Results: Depressed patients showed a deficit in contextual memory in the absence of a binding cue but did not differ from healthy controls in item memory or when a binding cue was present. Cortisol and cortisol/DHEA ratios were lower in depressed patients compared to healthy controls and correlated with memory deficits., Conclusions: Contextual memory deficits in MDD patients can be reduced by providing cognitive support at encoding., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: The Rasch model prescribes procedures to ensure that a scale constructed from multiple items conforms to fundamental requirements of interval scales of measurement., Objective: To test the Rasch properties of the domains of the World Health Organization Quality of Life Instrument-abbreviated version (WHOQOL-BREF) in depressed patients from primary care settings., Design: Cross-sectional, cross-national study., Setting: Primary care., Patients: The sample consisted of 1193 patients having a confirmed diagnosis of depression from 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the Longitudinal Investigation of Depression Outcomes (LIDO) study., Measurements: The Composite International Diagnostic Interview (CIDI) diagnosed depression, whereas the Center for Epidemiological Studies Depression Scale (CES-D) assessed severity of depression. The WHOQOL-BREF measured generic quality of life (QOL)., Results: Three of the 4 WHOQOL-BREF domains (physical, psychological, and environment) conform to the Rasch model expectations, following adjustments required mainly because of individual item misfit or differential item functioning (DIF) due to age or country. The social domain showed relatively poor psychometric properties, as observed in previous studies., Conclusions: The Rasch analysis demonstrated that, with some modifications, all domains of the WHOQOL-BREF, except for the social domain, provide an interval scale measure of generic subjective QOL in the context of depressed primary care patients in 6 countries worldwide.

Background: Physical exercise has been extensively researched as a therapeutic option for treatment of major depression., Methods: In a randomized controlled trial, we analyze the effects of aerobic physical exercise as an add-on strategy for treatment of severe depressed inpatients. The exercise has a "Dose" of 16.5 kcal/kg/week, three times a week during all the hospitalization., Results: Our preliminary results show that there is no significant difference in scores of Hamilton in the second week between groups (Mean[SD]=8.2[5.96] × 11.18[5.03], p=0.192). However, there is a significant reduction in Hamilton scores of patients in exercise group at discharge (Mean[SD]=5.93[4.46] × 9.45[3.56], p=0.041). Regarding Quality of Life (QoL), no significant difference were found between groups in the second week in physical domain (Mean[SD]=56.98[8.96] × 54.54[9.18], p=0.511) and psychological domain (Mean[SD]=50.88[13.88] × 42.04[12.42], p=0.106). However, there is a significant difference in psychological domain (Mean[SD]=55.88[9.92] v 41.66[13.04], p=0.004) and a trend but no statistical significance in the physical (Mean[SD]=58.80[9.14] × 52.12[8.70], p=0.07) at discharge., Limitations: Many patients receive different treatment strategies, like ECT (1 patient at exercise group × 3 at control group). Other limitation is the small number of participants included until this moment., Conclusion: Our preliminary results suggest that physical exercise could be a feasible and effective add-on strategy for treatment of severe depressed inpatients, improving their depressive symptoms and QoL., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Purpose: Normative data for WHOQOL-bref are scarce in the literature and unavailable in Latin American countries. The main objective of this study was to provide normative scores of WHOQOL-bref in a general population sample in Brazil and to describe differences in mean scores according to some socio-demographic characteristics., Methods: WHOQOL-bref was applied to a randomly selected sample of the general population of Porto Alegre. Participants were literate people aged 20 to 64 years. The questionnaires were self-administered in the presence of an interviewer in the respondent's home., Results: The response rate was 68%, and the final sample contained 751 respondents (38% men, 62% women). Low quality of life was observed in the following subgroups: female gender, lower economic class, lower educational level, and the subgroup reporting a chronic medical condition. The mean scores of the WHOQOL-bref and percentiles of scores are reported as normative data for the general population., Conclusion: Our results can be useful to researchers using the WHOQOL-bref to compare their results with normative data from a randomly selected sample of general population. Additionally, the ability of WHOQOL-bref to discriminate different population subgroups makes it an important tool to identify vulnerable groups in epidemiological surveys.

Objective: To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers., Method: A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires., Results: The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures., Conclusion: This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

Objectives: SF-6D is a preference-based measure of health developed to estimate utility values from the SF-36. The aim of this study was to estimate a weighting system for the SF-6D health states representing the preferences of a sample of the Southern Brazilian general population., Methods: A sample of 248 health states defined by the SF-6D was valued by a sample of the southern Brazilian population using the standard gamble. Mean and individual level multivariate regression models were fitted to the standard gamble valuation data to estimate preference weights for all SF-6D health states. The models were compared with those estimated in the UK study., Results: Five hundred twenty-eight participants were interviewed, but 58 (11%) were excluded for failing to value the worst state. Data from 469 subjects producing 2696 health states valuations were used in the regression analysis. In contrast to the best performing model for the UK data, the best performing model for the Brazilian data was a random effects model using only the main effects variables, highlighting the importance of adopting a country-specific algorithm to derive SF-6D health states values. Inconsistent coefficients were merged to produce the final recommended model, which has all significant coefficients and a mean absolute difference between observed and predicted standard gamble values of 0.07., Conclusions: The results provide the first population-based value set for Brazil for SF-6D health states, making it possible to generate quality-adjusted life years for cost-utility studies using regional data. Besides, utility weights derived using the preferences of a sample from a southern Brazilian population can be derived from existing SF-36 data sets., (Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objective: To deal with the question of whether a 5-point response Likert scale should be changed to a 3-point scale when used in the field testing of people with intellectual disabilities (IDs), which was raised after the pilot study of World Health Organization Quality of Life (WHOQOL)-DIS, a module being developed with the World Health Organization measure of quality of life for disabilities., Methods: Three possible ways were used to generate hypothetical data by merging a 5-point scale into a 3-point scale. The analyses were based on both item response theory and classical measurement theory. The partial credit model for polytomous response was performed for item evaluation; the confirmatory factor analysis was used to check construct validity, the Cronbach's alpha for domain reliability, and correlation analyses for the relationship between the 5-point scale and the generated 3-point scale., Results: Most items with a 5-point response scale had disordered response options and/or unequal-length intervals between successive response options; these deficiencies were removed or improved without decline of validity and reliability in the hypothetical data of 3-point scales., Conclusion: Instead of the 5-point scale, a 3-point scale could be used for IDs in the field test of developing the module WHOQOL-DIS., (© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.)

Objective: Melancholic depression is a lifetime diagnosis, typically with recurrent episodes. Melancholia, a syndrome with a long history and distinctive psychopathological features, is differentiated from major depression by the DSM-IV specifiers and partly described in the International Classification of Diseases - 10th edition. Within the present classification, it is frequently seen in severely ill patients with major depression and bipolar disorder. Nevertheless, it has a distinctive psychopathology and biological homogeneity in clinical experience and laboratory test markers, and it is differentially responsive to specific treatment interventions according to international studies. The objective of this study is to review the literature published by Latin American authors about Melancholia., Method: We conducted a systematic search to identify scientific literature published by Latin American authors gathering information relevant to the revision of the classification of mental and behavioral disorders in patients with melancholic depression of the International Classification of Diseases - 10th edition. The review was specifically focused on literature from Brazil and Latin America in order to examine the specific Latin American contribution for the study of melancholia as a distinct entity., Results and Conclusion: Melancholia can be identified as a separate mood disorder with unique psychopathology and psychoneuroendocrinology, worthy of separate attention in the classification systems. We therefore suggest that melancholia be positioned as a distinct, identifiable mood disorder that requires specific treatment.

The condition of a 42-year-old woman with drug-refractory major depression, severe headache, and progressive visual impairment was diagnosed as idiopathic intracranial hypertension (IICH). Idiopathic intracranial hypertension is a relative contraindication to electroconvulsive therapy (ECT), chiefly due to the theoretical risk of brain herniation. Although the diagnosis of IICH was unequivocal, the patient's headache was interpreted as being unassociated with IICH. Nine ECT sessions were performed, and both depression and headache improved dramatically. People with IICH are at an increased risk of depression and report more physical complains, including headache. Cases of IICH may be considered for ECT if depression is drug-refractory. In this case, cerebrospinal fluid open pressure should be closely monitored.

Objective: To analyze the psychometric properties of the World Health Organization's Quality of Life Instrument--Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB)., Methods: The WHOQOL-SRPB, the Brief Spiritual/Religious Coping Scale (Brief-SRCOPE Scale), the WHOQOL-BREF and the Beck Depression Inventory (BDI) were consecutively applied in a convenience sample of 404 patients and workers of a university hospital and workers of a university, in the city of Porto Alegre, Southern Brazil, between 2006 and 2009. The sample was stratified by sex, age, health status and religion/belief. The retest of the two first instruments was conducted with 54 participants. Exploratory factorial analyses of the WHOQOL-SRPB with the method of main components were performed, without limiting the number of factors, and requiring eight factors concomitantly with the WHOQOL-BREF items., Results: The Brazilian Portuguese version of the WHOQOL-SRPB (General SRPB-Domain) showed construct validity, with a discriminatory validity between believers and non-believers (t = 7.40; p = 0.0001); concurrent criterion-related validity, distinguishing depressed individuals from non-depressed ones (t = 5.03; p = 0.0001); convergent validity with the WHOQOL-BREF (physical r = 0.18; psychological r = 0.46; social r = 0.35; environmental r = 0.29; global r = 0.23; p = 0.0001) and with the SRPB-Domain of the WHOQOL-100 (r = 0.78; p = 0.0001); and convergent/discriminatory validity with the brief SRCOPE Scale (with positive SRCOPE r = 0.64; p = 0.0001/negative SRCOPE r = -0.03; p = 0.554). Excellent test-retest reliability (t = 0.74; p = 0.463) and internal consistency (α = 0.96; intrafactorial correlation 0.87 > r > 0.60; p = 0.0001) were observed. The exploratory factorial analyses performed corroborated the eight-factor structure of the WHOQOL-SRPB multicenter study., Conclusions: The Brazilian Portuguese version of the WHOQOL-SRPB showed good psychometric qualities and use valid and reliable in Brazil. It is suggested that new studies be conducted with specific populations, such as different religions, cultural groups and/or diseases.

Background: Depressive symptoms are associated with impaired quality of life (QOL). However, there are scarce data comparing the magnitude of depression on QOL among persons with different chronic diseases in developing countries. This study aimed to evaluate the impact of depression on QOL in patients with ischemic heart disease (IHD) and end-stage renal disease (ESRD) in hemodialysis., Methods: Cross-sectional survey conducted in 173 patients: 103 with IHD and 70 in hemodialysis. Depression was diagnosed by the Mini International Neuropsychiatric Interview-5.0 and depressive symptoms measured by Beck Depression Inventory. QOL was assessed through the Short-Form-36 (SF-36) and World Health Organization Quality of Life Instrument-brief (WHOQOL-brief). Multivariate analyses were performed to assess the association between variables and QOL., Results: Depression prevalence was 14.3% among IHD patients and 9.9% in the hemodialysis group, and depressive symptoms were present in 39 and 36%, respectively. Regardless of the chronic condition, depressed patients presented lower QOL scores than non-depressed ones in all domains, and the most affected were role emotional, mental health and social functioning of SF-36, and psychological domain of WHOQOL-brief. In linear regression analysis, depressive symptoms were predictive for lower QOL in all domains, with the highest standardized beta coefficients (ranging from -0.26 to -0.64)., Conclusion: Depression is an independent factor associated with worse QOL in IHD and ESRD patients. Among the priorities aiming at improving QOL must be evaluation and management of depressive symptoms.

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.

Objective: To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL)., Design: Cross-sectional prospective study. Quality of life was measured as a multidimensional construct., Setting: Assisted reproduction clinic of a university hospital., Participants: One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts., Methods: Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression., Results: Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed., Conclusion: Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other., (© 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To describe the translation and adaptation methodology for the Measure of Parental Style, a self-report instrument developed originally in English, following the International Society for Pharmacoeconomics and Outcomes Research guidelines, comparing this to other methodologies used for the same purposes., Method: Translation and Cultural Adaptation group International Society for Pharmacoeconomics and Outcomes Research guidelines were followed (preparation, first forward translation, reconciliation, back translation, revision of back translation, harmonization, cognitive debriefing, revision of debriefing results, syntax and orthographic revision, final report)., Conclusion: A careful and qualified cross-cultural translation and adaptation of an instrument contribute for measuring what it is designed to measure across cultures. Presenting this process, besides its final product, provides the opportunity that this experience could be replicated for adaptation of other instruments.

Objective: The negative impact of depressive symptoms on quality of life has been the focus of increasing attention, yet this relation remains unstudied in samples from developing countries. The objective of this study was to determine whether the occurrence of depressive symptoms is associated with impaired quality of life and whether this association remains significant after adjustment for some variables., Method: A convenience sample was selected and the measures used were the WHOQOL-100, to assess quality of life, the Beck Depression Inventory, to screen for depressive symptoms, and the Economic Classification Criterion - Brazil, to evaluate socioeconomic status., Results: One hundred nineteen healthy adults (community) and 122 adult patients (tertiary hospital) from Brazil were assessed. Depressive symptoms were negatively correlated with all the domains of quality of life, even after statistical control for age, socioeconomic status, and presence of chronic health conditions. Socioeconomic status was positively correlated with the social relationships and environmental domains of quality of life., Conclusion: Our findings indicate that depressive symptoms and socioeconomic status are important elements affecting the relationship between chronic health conditions and quality of life in Brazil.

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.

Background: Previous studies found that depression is associated with a broad impairment in quality of life (QOL). This finding might be associated to a measurement overlap., Methods: The objective of this study was to verify whether the items of the World Health Organization Quality of Life Instrument-Abbreviated version (WHOQOL-BREF), a measure of generic QOL, are invariant among patients having a current major depressive episode who come from primary care services. We investigated data from primary care services from the 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the baseline sample of the Longitudinal Investigation of Depression Outcomes. The Rasch model was used to analyze items exhibiting differential item functioning (DIF) as a way of assessing invariance in relation to a depression factor defined by the diagnosis of depression using the Composite International Diagnostic Interview. In addition, the Center for Epidemiological Studies-Depression Scale (CES-D) score was correlated with the item and domain scores of the WHOQOL-BREF using the Pearson coefficient., Results: The sample consisted of 2359 subjects, of which 1193 had a confirmed diagnosis of a current major depressive episode. Of the 26 items of the WHOQOL-BREF, 11 showed DIF due to the depression factor, and the physical domain presented more items displaying DIF. All Pearson coefficients between the WHOQOL-BREF item and domain scores and the CES-D score were weak and moderate (r = -0.13 to r = 0.43)., Conclusions: Our findings indicate that most WHOQOL-BREF items do not exhibit DIF for a current major depressive episode and the variance associated with depression in this generic QOL measure is restricted to some facets of this construct. Thus, we recommend this restricted adjustment for depression in future analyses of this measure. Furthermore, our study indicates that researchers must measure QOL regardless of depression severity.

This study aimed to assess the validity and reliability of World Health Organization Quality of Life Instrument (WHOQOL)-brief and SF-36 in patients with coronary artery disease (CAD). Considering that depression is known to be associated with bad outcomes in CAD and it is highly associated with poor Quality of Life (QOL), we tested the correlation between WHOQOL and SF-36 and an instrument to screen depressive symptoms. It is a cross-sectional survey conducted in 103 patients with documented CAD. QOL was measured through WHOQOL-brief and SF-36 and depressive symptoms were assessed by the Beck Depression Inventory (BDI). To evaluate convergent validity, the correlations between both QOL assessment instruments were examined; discriminant validity was assessed through BDI and QOL instruments correlations. Coefficient Cronbach's alpha was used to test reliability. Percentages of floor and ceiling effects were higher in SF-36 scores than the WHOQOL-brief ones. Although WHOQOL-brief showed a maximum of 1% of floor effect and 9% of ceiling effect, SF-36 presented 40 and 32%, respectively. Internal consistency reliability ranged from 0.65 to 0.85 for the WHOQOL-brief and 0.57 to 0.89 for the SF-36. Correlations between subscales of WHOQOL-brief and BDI ranged from -0.74 to -0.61 and correlations between subscales of SF-36 and BDI ranged from -0.68 to -0.26. SF-36 and WHOQOL-brief seem to be valid and consistent QOL measures in patients with CAD. Researchers should define the aims of their studies before choosing which instrument to use, because they appear to measure different constructs of QOL.

This paper aims at identifying symptoms of depression in primary health care service users, assessing the association between sociodemographic characteristics and the impact of those symptoms on the quality of life. It is a transversal study with a consecutive sampling of ninety-five patients of a primary health care unit, Beck Depression Inventory (BDI) and WHOQOL-Bref were used to measure depressive symptoms and quality of life, respectively. No significant association was found among sociodemographic data, depression symptoms, and quality of life. Nevertheless, forty-four patients (46%) had depression symptoms associated to a significantly worse quality of life in all areas (p < 0.001). This finding shows the importance of being aware of the presence of depression, even in primary health care service users, considering the negative impact that depression symptoms have on the quality of life.

Purpose/objectives: To assess differences in ways women with breast cancer evaluate their own quality of life (QOL) compared to perceptions of their partners and to identify factors that influence dissimilarities in QOL perceptions., Design: Cross-sectional study., Setting: Breast unit in southern Brazil., Sample: 73 women with stage I-III breast cancer and their partners. Most participants were middle-aged, with partners of long-term cohabitation., Methods: QOL was evaluated with the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF), Beck Depression Inventory, and WHOQOL-BREF adapted for a third person., Main Research Variables: Demographic and clinical features, QOL, partners' perceptions, and depression., Findings: No differences were found between the perceptions of QOL in different domains between the patients and their partners. Depression in women seemed to be the only variable that interfered in a consistent manner with the congruity of the QOL assessments made by patients and their partners., Conclusions: Partners of women with breast cancer may be viewed as reliable surrogates to assess patients' QOL., Implications for Nursing: Partners' judgments of patients' QOL may be important in some circumstances, particularly when patients are not able to answer questions about their own QOL because of cognitive or functional limitations. Nurses must be aware that partners are the most frequent informal caregivers and should be included in the entire treatment process.

Objective: Depression is a frequent, recurrent and chronic condition with high levels of functional disability. The Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present a review of the Guidelines Published in 2003 incorporating new evidence and recommendations., Method: This review was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. The Brazilian Medical Association proposed this methodology for the whole project. The review was developed from new international guidelines published since 2003., Results: The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Strategies for different phases of treatment are also discussed., Conclusion: The Guidelines are an important tool for clinical decisions and a reference for orientation based on the available evidence in the literature.

Objective: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice., Method: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients' perception, mechanism of action, technique and cognitive impairment., Results: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment., Conclusion: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.