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Objective: To present the protocol and methods for the prospective longitudinal assessments-including clinical and digital phenotyping approaches-of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study, which comprises Brazilian adolescents stratified at baseline by risk of developing depression or presence of depression., Method: Of 7,720 screened adolescents aged 14 to 16 years, we recruited 150 participants (75 boys, 75 girls) based on a composite risk score: 50 with low risk for developing depression (LR), 50 with high risk for developing depression (HR), and 50 with an active untreated major depressive episode (MDD). Three annual follow-up assessments were conducted, involving clinical measures (parent- and adolescent-reported questionnaires and psychiatrist assessments), active and passive data sensing via smartphones, and neurobiological measures (neuroimaging and biological material samples). Retention rates were 96% (Wave 1), 94% (Wave 2), and 88% (Wave 3), with no significant differences by sex or group ( p > .05). Participants highlighted their familiarity with the research team and assessment process as a motivator for sustained engagement., Discussion: This protocol relied on novel aspects, such as the use of a WhatsApp bot, which is particularly pertinent for low- to-middle-income countries, and the collection of information from diverse sources in a longitudinal design, encompassing clinical data, self-reports, parental reports, Global Positioning System (GPS) data, and ecological momentary assessments. The study engaged adolescents over an extensive period and demonstrated the feasibility of conducting a prospective follow-up study with a risk-enriched cohort of adolescents in a middle-income country, integrating mobile technology with traditional methodologies to enhance longitudinal data collection., (© 2023 The Authors.)

Importance: The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups., Objective: To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study., Design, Setting, and Participants: Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023., Exposure: Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years., Main Outcomes and Measures: Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs., Results: Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years., Conclusions and Relevance: An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives.

Objective: Although there is a general perception that adolescent social media use is a global phenomenon, there is a scarcity of data on patterns and preferences of social media use among youth in low- and middle-income countries (LMICs). We here describe self-reported prevalence and perceived effects of social media use in a school-based sample of Brazilian adolescents., Methods: We analyzed cross-sectional data on 7,113 adolescents aged 14 to 16 years enrolled at 101 public state schools between 2018 and 2019 in Porto Alegre, state of Rio Grande do Sul, Brazil., Results: Of the 7,113 adolescents with complete data for analyses, 54.9% were female, and 60.6% reported their skin color as white. At least one social media platform was used by 97.7% of adolescents every day, and 64.7% reported being online "almost constantly." YouTube and WhatsApp were the most popular platforms. Most participants perceived the effect on their lives of social media use as neutral., Conclusion: The pattern of social media use by adolescents in Porto Alegre, Brazil, is similar to that reported for samples from high income countries. Also, we found that those who reported being constantly online were also more likely to report socializing with their friends offline., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Background: Mental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment., Objective: This study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents' mood., Methods: The IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp's default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study., Results: The adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot's final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively)., Conclusions: The IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development., (©Anna Viduani, Victor Cosenza, Helen L Fisher, Claudia Buchweitz, Jader Piccin, Rivka Pereira, Brandon A Kohrt, Valeria Mondelli, Alastair van Heerden, Ricardo Matsumura Araújo, Christian Kieling. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.08.2023.)

Objective: To explore associations between self-reported weekly physical activity and depressive symptomatology among adolescents in a school-based sample from Brazil., Methods: We surveyed 7,405 adolescents aged 14 to 16 years in 101 public schools in Porto Alegre, Brazil. We assessed physical activity using an adapted version of the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition - Adolescent Physical Activity Measure (PACE+), and depressive symptoms using the Brazilian Portuguese version of the Patient Health Questionnaire - Adolescent Version. We compared the depressive symptom scores among adolescents with varying levels of physical activity., Results: Of the overall sample, 84.4% exercised less than the recommended frequency of 60 minutes/day, at least 5 days/week, of moderate to intense physical activity (PACE+ score ≥ 5). Adolescents whose physical activity levels fell below that threshold had higher median depression scores (8 [IQR = 10] vs. 7 [IQR = 9], W = 4060461, p < 0.001). A similar pattern was observed for depression scores in those with PACE+ < 1 (median of 10 [IQR = 11]) and ≥ 1 (7 [IQR = 9], W = 7457608, p < 0.001)., Conclusion: In this large sample of Brazilian adolescents, those who exercised less frequently and vigorously than their peers reported more depressive symptoms.

Competing Interests: Declaration of interests HH reports her role as President of the World Psychiatric Association during the period of preparing and submitting the Commission for publication, and support from an Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship. VP reports being a co-founder of Librum, a mental health consulting firm, and has consulted with Johnson & Johnson, with no fees received related to the submitted work. His research on depression is supported by the National Institute of Mental Health (NIMH) and the Wellcome Trust. CK is a researcher from Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil, and a UK Academy of Medical Sciences Newton Advanced Fellow. MB reports grants from the NHMRC as Senior Principal Research Fellow, during the conduct of the study; personal fees from Servier, Lundbeck, Livanova, Grunbiotics, Otsuka, RANZCP, ANZJP, and Medisquire India, outside of the submitted work; and three issued patents (Modulation of Physiological processes and agents useful for same, Modulation of diseases of the central nervous system and related disorders, and Xanthone-rich plant extracts or compounds therefrom for modulating diseases of the central nervous system and related disorders issued). CB reports travel support from the Wellcome Trust and personal fees from the University of Melbourne and the World Psychiatric Association, during the conduct of the study. PC reports support for unrelated grants from the European Commission and ZonMw, and receives royalties for books and for occasional workshops and invited addresses. TAF reports grants and personal fees from Mitsubishi-Tanabe and Shionogi, and personal fees from Sony, outside of the submitted work. TAF also has a patent 2020-548587 concerning smartphone cognitive behavioural therapy applications pending, and intellectual properties for Kokoro-application licensed to Tanabe-Mitsubishi. RCK was a consultant for Datastat, Holmusk, RallyPoint Networks, and Sage Pharmaceuticals. He has stock options in Cerebral, Mirah, PYM, and Roga Sciences. CFR reports consultant fees from the Depression and Bipolar Support Alliance, Weill Cornell School of Medicine, UpToDate, The University of Maryland School of Public Health, Psychopharmacology Institute, and Merck; and an honorarium from the American Association for Geriatric Psychiatry, outside of the submitted work; and royalties from the University of Pittsburgh and Oxford University Press. Since 2018, MMW has received research funding from NIMH, Brain and Behavior Foundation, Templeton Foundation, and the Sackler Foundation, and has received book royalties from Perseus Press, Oxford University Press, and APA Publishing and royalties on the social adjustment scale from Multihealth Systems. DC is funded by the African Academy of Sciences and is a founder of Friendship Bench, which is supported by Boehringer Ingelheim, Draper Richards Kaplan Foundation, Mulago Foundation, Africa Visionary Fund, David Weekley Foundation, Grand Challenges Africa, Grand Challenges Canada, Schooner Foundation and Zoom Cares. CD reports grants from National Institute for Health and Social Care (England), personal fees from World Organisation of Family Doctors, personal fees from iheed—Accredited Medical Education Online (Ireland), outside of the submitted work; and as Chair of the Working Party for Mental Health of the World Organisation for Family Doctors, CD advocates for the central role of family doctors in the assessment and management of depression in primary care settings. LMH reports funding from the South London and Maudsley NHS Foundation Trust/King's College London Biomedical Research Centre; the UKRI Collaborative Mental Health Network plus: Violence, Abuse and Mental Health: Opportunities for change (ES/S004424/1); National Institute for Health Research (NIHR) HS&DR ESMI II: The Effectiveness and cost effectiveness of community perinatal Mental health services (17/49/38); and salary support from the South London NIHR Applied Research Collaboration. CWH reports funding from NIMH, National Institute of Drug Abuse, National Heart, Lung, and Blood Institute, Fogarty International Center, and Centers for Disease Control and Prevention–National Institute for Occupational Safety and Health. HSM reports personal fees from Abbott Laboratories, outside of the submitted work; and a patent US 2005/0033379A1 licensed to Abbott Laboratories. BWJHP reports grants from Jansen Research and Boehringer Ingelheim, outside of the submitted work. MT reports personal fees from Acadia Pharmaceuticals, Allergan, Alto Neuroscience, Axsome Therapeutics, Engage Health Media, GreenLight VitalSign6, Janssen, Merck Sharp & Dohme, Myriad Neuroscience, Navitor Pharmaceutical, Otsuka, Perception Neuroscience, SAGE Therapeutics, Signant Health, Academy Health, Akili Interactive, Health Research Associates, Jazz Pharmaceutical, Lundbeck Research USA, Perception Neuroscience Holdings, and Pharmerit International, outside of the submitted work. All other authors declare no competing interests.

Purpose: The goal of this study was to explore the perspectives of different stakeholders regarding the experiences of adolescent depression in Porto Alegre, Brazil., Methods: We conducted 54 key-informant interviews with adolescents, parents, social workers, health workers, educators, and policy makers and two focus group discussions with 5 adolescents and 6 parents. Data were analysed using a framework approach and guided by the adolescents' personal narratives, with adult stakeholders' views supplementing these perspectives., Results: Four main themes emerged, creating a relational model of adolescent depression that highlights isolation as a central component of the experience. In relation to the self, the experience of depression led to a feeling of detachment from others resulting from the sensation that usual interactions did not have the same meaning as before. This disruption of interactions is perceived as self-isolation and is described in relation to coping mechanisms., Conclusion: These findings shed light on important aspects of the identification and management of adolescent depression in Brazil. Since social interaction was a core component of the descriptions and experiences of depression, we speculate that promising interventions are those that could enhance the promotion of a supportive environment and interpersonal relationships.

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS). Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers. Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample. Results: A total of 7,720 adolescents aged 14-16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group. Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence., Competing Interests: VM has received research funding from Johnson & Johnson, a pharmaceutical company interested in the development of anti-inflammatory strategies for depression, but the research described in this paper is unrelated to this funding. LAR has received grant or research support from, served as a consultant to, and served on the speakers' bureau of Bial, Medice, Novartis/Sandoz, Pfizer, and Shire/Takeda in the last 3 years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him have received unrestricted educational and research support from the following pharmaceutical companies: Novartis/Sandoz, and Shire/Takeda. He has received travel grants from Shire/Takeda to take part in the 2018 American Psychiatric Association congress. He also receives authorship royalties from Oxford Press and ArtMed. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kieling, Buchweitz, Caye, Manfro, Pereira, Viduani, Anés, Battel, Benetti, Fisher, Karmacharya, Kohrt, Martini, Petresco, Piccin, Rocha, Rohde, Rohrsetzer, Souza, Velazquez, Walsh, Yoon, Zajkowska, Zonca, Swartz and Mondelli.)

Objective: To formulate strategic recommendations to strengthen primary health care (PHC) in Brazil's Unified Health System (SUS) based on expert consultation., Method: The present qualitative study, developed from March to August, 2018, included administration of an open questionnaire followed by consensus building among 20 participants representing the five Brazilian regions, selected using the criterion of recognized professional expertise in the field of PHC. Participants answered an online questionnaire created by the authors. The findings were systematized as recommendations, which were submitted for priority ranking by the expert group using a one-round Delphi technique. The final recommendations were discussed in a face-to-face workshop., Results: Of 20 experts, 18 answered the open questionnaire, generating 84 themes for analysis, which were systematized into 44 proposals. Evaluation of these proposals resulted in 20 recommendations, emphasizing expansion of the Family Health Strategy (FHS); enhanced access to PHC; training of professionals for multidisciplinary work in the PHC setting; allocation of technologies to ensure PHC resolvability; improvement of regulation/coordination of services to strengthen a foundational role of PHC in the SUS; human resources, provision of professionals, and support/stimulus for teams; production and dissemination of knowledge; transparency in PHC initiatives; and mediating role of PHC in the healthcare system., Conclusions: The findings support the FHS as the best model to ensure a strong PHC in the SUS, combined with policies that prioritize essential PHC attributes, especially through innovation in care, management, and communication technologies., Competing Interests: Conflitos de interesse. Nada declarado pelos autores.

Objective: To evaluate the impact of SciELO and MEDLINE indexing on the number of articles submitted to Jornal de Pediatria., Methods: Analysis of total article submission, submission of articles from foreign countries and acceptance figures in the following periods: stage I - pre-website (Jan 2000-Mar 2001); stage II - website (Apr 2001-Jul 2002); stage III - SciELO (Aug 2002-Aug 2003); stage IV - MEDLINE (Sep 2003-Dec 2004)., Results: There was a significant trend toward linear increase in the number of submissions along the study period (p = 0.009). The number of manuscripts submitted in stages I through IV was 184, 240, 297, and 482, respectively. The number of submissions was similar in stages I and II (p = 0.148), but statistically higher in Stage III (p < 0.001 vs. Stage I and p = 0.006 vs. Stage II) and Stage IV (p < 0.001 vs. stages I and II, and p < 0.05 vs. stage III). The rate of article acceptance decreased during the study period. The number of original articles published has been stable since the 2001 March/April issue (n = 10), when the journal reached a printed page limit, leading to stricter judgment criteria and a relative decrease in acceptance rate. The number of foreign submissions in stages I through IV was 1, 2, zero and 17, respectively, with p < 0.001 for the comparison of stage IV with previous stages., Conclusions: SciELO indexing was associated with an increase in Brazilian manuscript submissions to Jornal de Pediatria, whereas MEDLINE indexing led to an increase in both Brazilian and foreign submissions.