Prevalência do autorrelato de depressão no Brasil: resultados da Pesquisa Nacional de Saúde, 2013

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms

OBJECTIVE

Few studies have focused on medical students and residents' mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD).

METHODS

The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance.

RESULTS

515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD.

CONCLUSION

The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

Depression in Brazilian farmers: prevalence and associated factors

BACKGROUND

The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression.

AIMS

To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers.

METHODS

A cross-sectional epidemiological study involving 784 farmers of the state of Espírito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors.

RESULTS

The prevalence of depression symptoms among farmers was 16.8% (n = 132). Of those experiencing symptoms, 6.1% (n = 48) we're currently experiencing a depressive episode, and 10.7% (n = 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04-2.54), not owning the land (OR 1.79; 95% CI 1.11-2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18-3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45-5.67), complex multimorbidity (OR 1.95; 95% CI 1.15-3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39-21.99).

CONCLUSIONS

A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population.

Self-Reported Chronic Back Pain and Current Depression in Brazil: A National Level Study

There is limited literature investigating the association between chronic back pain (CBP) and depression in Brazil. This study evaluates the association between CBP, CBP-related physical limitations (CBP-RPL), and self-reported current depression (SRCD), in a nationally representative sample of Brazilian adults. The data for this cross-sectional study came from the 2019 Brazilian National Health Survey (n = 71,535). The Personal Health Questionnaire depression scale (PHQ-8) was used to measure the SRCD outcome. The exposures of interest were self-reported CBP and CBP-RPL (none, slight, moderate, and high limitation). Multivariable weighted and adjusted logistic regression models were used to investigate these associations. The weighted prevalence of SRCD among CBP was 39.5%. There was a significant weighted and adjusted association between CBP and SRCD (weighted and adjusted odds ratio (WAOR) 2.69 (95% CI: 2.45-2.94). The WAOR of SRCD among individuals with high, moderate, and slight levels of physical limitation was significantly greater than for those without physical limitation due to CBP. Among Brazilian adults with high levels of CBP-RPL, there was over a five-fold increased risk of SRCD compared to those without CBP-RPL. These results are important for increasing awareness of the link between CBP and SRCD and for informing health services policies.

Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil

BACKGROUND

To evaluate the short-term impact of COVID-19 pandemic on low back pain (LBP) outcomes in southern Brazil.

METHODS

Data from the PAMPA Cohort were analyzed. Adults were recruited between June and July 2020 in the Rio Grande do Sul state using online-based strategies. Participants responded a self-reported, online questionnaire on LBP with two timepoints: before (retrospectively) and during COVID-19 pandemic. We assessed LBP experience, LBP-related activity limitation (no/yes), and LBP intensity (0 to 10 [strongest pain]).

RESULTS

From a total sample of 2,321 respondents (mean age: 37.6 ± 13.5; 75.4% women), the prevalence of LBP did not change significantly from before (74.7% [95%CI 72.3; 76.9]) to the first months of pandemic (74.2% [95%CI 71.9; 76.3]). However, an increased pain levels (β: 0.40; 95%CI 0.22; 0.58) and a higher likelihood for activity limitation due to LBP was observed (PR 1.14; 95%CI 1.01; 1.29). Longitudinal analyzes showed that age, gender, BMI, chronic diseases, physical activity, and anxiety and depression symptoms, were associated with LBP in the first pandemic months.

CONCLUSION

Although the prevalence of LBP did not change at the first months of COVID-19 pandemic, LBP-induced impairment in daily activities and pain intensity was higher when compared to before the pandemic.

Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis

Depression is a major global health burden and there are stark socioeconomic inequalities in both the prevalence of depression and access to treatment for depression. In Brazil, racial/ethnic inequalities are of particular concern, but the factors contributing to these inequalities remain mostly unknown. This paper firstly explores determinants of depression and the treatment gap (i.e., untreated afflicted individuals) in Brazil and identifies if socio-economic and health system factors explain changes over time. Secondly, it analyses income and racial/ethnic inequalities in depression and the treatment gap and identifies factors explaining inequalities through decomposition methods. Data from two waves (2013 and 2019) of a representative household-based survey are used. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Black or brown/mixed Brazilians were more likely to have untreated depression, and region of residence was the most important determinant of these racial/ethnic inequalities. Notably, 44.6% of the difference in the treatment gap between white individuals and black and brown/mixed individuals was not explained by differences in observables, which could potentially be due to discrimination or difficulties in accessing treatment due to other non-observable characteristics. Employment, age, exposure to violence and physical activity are the main contributing factors to income inequalities in depression. These results suggest that policies aimed at improving the levels of exposure of lower-income individuals to risk factors may positively impact mental health and mental health inequalities, while addressing inequalities in service provision and resourcing for mental health and tackling barriers to access stemming from discrimination are essential to bridge the treatment gap equitably.

Psychometric properties of the PHQ-9 measure of depression among Brazilian older adults

Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire - 9 (PHQ-9, one of the most extensively used tools for assessing depression) in the Brazilian older population.Method: Data on 3,356 Brazilian adults aged 60+ years living in Guarulhos, São Paulo state were used. The factor structure of the questionnaire was analysed using a factor analysis approach. The questionnaire's measurement equivalence was tested across gender, age, personal income, and education level groups. The scores were compared across groups based on the highest level of equivalence achieved. The questionnaire's internal consistency was analysed considering its factor structure.Results: A one-factor solution was identified as the most adequate factor structure, with the factor explaining 57.6% of the items' variance. The correlation of the resulting latent score with the overall raw sum score in the PHQ-9 was r = 0.96. Measurement equivalence regarding thresholds and loadings was achieved for all tested groups. On average, women, older, less educated, and poorer people had higher latent scores on the depression factor. The measure showed a good internal consistency with Revelle's omega total ω_t=0.92.Conclusion: The results suggest that, among Brazilian older adults living in Guarulhos, São Paulo state, the PHQ-9 measures depressive symptomatology equivalently across different sociodemographic subgroups. Moreover, it can be scored using the raw sum of the item scores to adequately reflect different levels of depressive symptomatology.

Physical activity and the incidence of depression during the COVID-19 pandemic in Brazil: Findings from the PAMPA cohort

We examined the longitudinal association between physical activity (PA) and the incidence of self-reported diagnosed depression in adults in southern Brazil during the COVID-19 pandemic. Data from the PAMPA (Prospective Study About Mental and Physical Health) cohort was used. Data collection for baseline was carried out on June-July 2020, with two follow-up assessments taking place six months apart. An online, self-reported questionnaire assessed depression and PA. Depression was assessed by asking participants whether they were ever diagnosed with depression. We included 441 participants (women: 75.9%; mean age [SD]: 38.0 [13.5]) in southern Brazil. Over the follow-up, 21.8% (95% confidence interval [CI]: 18.1%-25.9%) were diagnosed with depression. Insufficiently active (<150 min per week of physical activity) (Incidence rate [IR]: 61.9; 95%CI: 39.5-102.4; p = 0.047) and active (≥150 min per week of physical activity) (IR: 50.4; 95%CI: 31.9-84.0; p = 0.015) participants had reduced IR of depression per 1000 persons-year at risk compared to inactive ones (0 min per week of physical activity) (IR: 99.9; 95%CI: 79.7-126.8). In the adjusted analyses, participants in the insufficient active (hazard ratio [HR]: 0.58; 95%CI: 0.34-0.98) and active (HR: 0.53; 95%CI: 0.31-0.93) group had a lower risk of developing depression than the inactive group. PA both at and out of home reduced the risk of incident depression (HR: 0.49; 95%CI: 0.25-0.98) compared to no physical activity. Endurance (HR: 0.52; 95%CI: 0.28-0.97) and endurance plus strengthening (HR: 0.40; 95%CI: 0.17-0.95) PA reduced the risk of incident depression compared to none. Being physically active during pandemic, regardless of the amount of PA practiced, reduced the incidence of depression in adults in southern Brazil.

Prevalence of self-reported depression in Brazil: National Health Survey 2019 and 2013

OBJECTIVE

To describe the prevalence of self-reported depression among Brazilian adults in the 2019 National Health Survey (PNS) and compare to the 2013 PNS.

METHODS

Cross-sectional study of Brazilian adults using data from the 2019 and 2013 PNS. Prevalence and 95% confidence intervals (95%CI) of self-reported depression were estimated by region and demographic characteristics. Bivariate analyses were conducted using chi-squared tests.

RESULTS

There were 90,846 participants aged ≥ 18 years in 2019, and 60,202 in 2013. Between 2013 and 2019, prevalence of self-reported depression increased from 7.6% (95%CI 7.2;8.1) to 10.2% (95%CI 9.9;10.6) and of individuals who sought healthcare, from 46.4% (95%CI 43.8;49.1) to 52.8% (95%CI 50.7;55.0). Private clinics were the main source of healthcare.

CONCLUSION

Depression is highly prevalent in Brazil. Prevalence of diagnosis of depression and use of health services increased in the studied period. The predominance of care in private clinics suggests inequalities in the improvement of mental healthcare coverage.

Measurement of depression in the Brazilian population: validation of the Patient Health Questionnaire (PHQ-8)

We aimed to evaluate the psychometric properties of the Brazilian version of the Patient Health Questionnaire (PHQ-8). A study with a sample of 4,170 individuals (≥ 15 years old) from the urban area. Conglomerate sampling was adopted in two stages (census sectors and streets), with weighting of estimates by sample weights. A structured questionnaire with sociodemographic data, the PHQ - the modules for depression, generalized anxiety disorder and panic disorder - and the Self-Reporting Questionnaire (SRQ-20) were used. In the evaluation of the PHQ-8, we verified the construct validity by analyzing the dimensional structure, convergent validity and internal consistency. We found a linear disorder without losses to maintain the four response categories. The factor analysis found unidimensionality of the depression construct, with strong factor loads, low residual variances, low residual correlation between items, good fit of the model, internal consistency and satisfactory convergent factorial validity (high loads and correlations with other tests/scales of similar constructs). The PHQ-8 has a one-dimensional structure with evidence of good validity and reliability, being suitable for use in the Brazilian population.

Depression underdiagnosis: Prevalence and associated factors. A population-based study

Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil.

METHOD

We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors.

RESULTS

The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%).

CONCLUSION(S)

depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.

Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon

BACKGROUND

The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon.

METHODS

Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors.

RESULTS

Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05).

LIMITATIONS

Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population.

CONCLUSION

Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.

Determinants of increased frequency of depressive and anxiety symptoms in exercise professionals during the COVID-19 pandemic

BACKGROUND

The coronavirus disease (COVID-19) pandemic has affected workers in different health services including exercise professionals (EP). The urgent need to adapt in-person to online activities might have led to increased frequency of anxiety and depressive symptoms.

OBJECTIVE

We aimed to identify the determinants of aggravated depressive and anxiety symptoms in EP in southern Brazil during social distancing from the COVID-19.

METHODS

A cross-sectional study was conducted with EP who worked at fitness centers, sports clubs, private schools, or at a public exercise program offered by the municipal council. We used an online-based, self-administered, adapted version of the Hospital Anxiety and Depression scale to compare symptoms of depression and anxiety pre- and during social distancing.

RESULTS

Participants (n = 201) had a mean age of 32.7±8.0 years, with more than half being male, white, and having an university degree. We observed that 81%and 71%of respondents reported higher frequency in anxiety and depression symptoms, respectively, during social distancing than in the period before it. Physical education teachers, women, non-white professionals, and those with chronic disease were more likely to worsen anxiety symptoms. Women had higher odds to increased frequency in depressive symptoms. Physical activity and previous experience with internet-based tools for working activities reduced the risk of increased depressive symptoms.

CONCLUSIONS

Sex, ethnicity, chronic diseases, educational level, physical activity, and experience with online tools were determinants for increased frequency of depression and anxiety symptoms in EP.

Association between specific types of physical activity during the COVID-19 pandemic and the risk of subjective memory decline: findings from the PAMPA Cohort

OBJECTIVES

This study aimed to identify the effects of different physical activities practised during the time period when COVID-19 social distancing measures were in place on the risk of subjective memory decline in adults.

STUDY DESIGN

Retrospective cohort study.

METHODS

Data from the Prospective Study about Mental and Physical Health (PAMPA), a state-level (Rio Grande do Sul, Brazil), online-based cohort study, were analysed. Respondents were asked to rate their memory before COVID-19 social distancing measures were implemented (retrospectively) and on the day that the survey was completed. Subjective memory decline was defined as a perceived worsening of memory function during COVID-19 social distancing compared with the pre-pandemic period. The types of physical activity practised before and during COVID-19 social distancing measures were assessed.

RESULTS

Data from 2319 adults were included. Out-of-home endurance, muscle strengthening, combined endurance and muscle strengthening, and stretching activities reduced the risk of subjective memory decline during the pandemic. In terms of physical activities practised at home, only muscle strengthening did not protect against subjective memory decline. Participants who sustained any type of physical activity at home during the COVID-19 pandemic showed a reduced risk for subjective memory decline.

CONCLUSIONS

Physical activity, regardless of the type of activity and location performed, during the time period when COVID-19 social distancing measures were in place can mitigate the effects of the pandemic on subjective memory decline.

Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis

AIMS

The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations.

METHODS

Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression.

RESULTS

Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes.

CONCLUSIONS

Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.

Women's alcohol consumption in a Primary Health Care service

OBJECTIVE

To identify alcohol consumption patterns in people cared by a Primary Health Care service and verify the association between the patterns and the variables of the sample.

METHOD

Our observational study used both the Alcohol Use Disorders Identification Test instrument and a questionnaire with socio-demographic, clinical, and behavioral questions for data collection. We carried out the descriptive and univariate analysis with Kendall and Kruskal-Wallis correlation tests. We introduced variables with p ≤ 0.2 values in the multiple logistic regression - Mann-Whitney test.

RESULTS

The sample of the study was constituted by 561 women. The analysis results indicated relevant influence for higher patterns of consumption: not having a partner, not having a religion, smoking and drug habits, and having arterial hypertension. Besides that, within each additional year in women's age, the alcohol consumption decreases.

CONCLUSION

We endorsed data that female alcohol consumption is presenting a tendency to increase especially among younger women, this information is essential for the promotion of Primary Health Care.

Depressive symptoms as an independent risk factor for mortality

OBJECTIVE

To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil.

METHODS

Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index.

RESULTS

The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40).

CONCLUSION

Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.

Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the “virtual snowball” sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems—sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents’ emotional status throughout the COVID-19 pandemic.

Association of Selenium Intake and Development of Depression in Brazilian Farmers

Introduction: Depression and deficiency in the consumption of micronutrients are a public health problem, especially in the rural population. The deficiency in selenium consumption affects mental health, contributing to the development of major depressive disorders. Thus, this study aimed to evaluate selenium intake and its association with depressive symptoms in farmers in southeastern Brazil. Material and Methods: Epidemiological, cross-sectional, and analytical study with 736 farmers aged between 18 and 59. A semistructured questionnaire was used to collect sociodemographic, lifestyle and clinical condition data. For evaluation of food intake, three 24-h recalls were applied, and for identification of depressive episodes, the Mini-International Neuropsychiatric Interview was conducted. Results: A total of 16.1% (n = 119) of the farmers presented symptoms of major depressive episodes, 5.8% (n = 43) presented symptoms of current depressive episodes, and 10.3% (n = 76) presented symptoms of recurrent major depressive episodes. Sociodemographic factors associated with depression were gender (p < 0.001), marital status (p = 0.004), and socioeconomic class (p = 0.015). The consumption of high doses of selenium was associated with a reduction of ~54% in the chances of occurrence of depression (OR = 0.461; 95% CI = 0.236-0.901). Conclusion: High selenium intake is associated with a lower prevalence of depression even after adjusting for sociodemographic variables, lifestyle, and pesticide intoxication. The findings of this study contributed to highlighting the high prevalence of depression in rural areas and its relationship with selenium intake.

Association between physical activity and subjective memory decline triggered by the COVID-19 pandemic: Findings from the PAMPA cohort

Implementation of social distancing reduced the incidence of coronavirus disease (COVID-19) cases. Nevertheless, this strategy has other undesirable effects such as physical inactivity and psychological distress, which are associated with cognitive impairment. We aimed to examine whether physical activity during social distancing restrictions could reduce the risk of subjective memory decline in adults. Participants (n=2321) completed the baseline assessment of PAMPA cohort (Prospective Study About Mental and Physical Health), a ambispective cohort study conducted in southern Brazil. An online-based, self-administered questionnaire assessed physical activity and self-rated memory in two different periods: before and during social distancing. Data collection was executed from June 22nd to July 23rd 2020. Adjusted Poisson regression models were performed and values reported in prevalence ratio (PR) with 95% confidence interval (CI). Participants presented with a mean age of 38.2 (95%CI: 37.5, 38.9) years. Most were women (76.6%), had at least a university degree (66.7%), and were overweight or obese (53.3%). Subjective memory decline was reported by 30.0% (95%CI: 27.7%, 32.4%) of respondents. Most individuals with subjective memory decline reported being physically inactive during the pandemic of COVID-19. Participants were less likely to experience subjective memory decline if they either became (PR: 0.56; 95%CI: 0.36, 0.89) or remained (PR: 0.68; 95%CI: 0.49, 0.93) physically active compared to inactive respondents. Physical activity participation during social distancing reduced the likelihood of subjective memory decline in adults. Physical activity should be highlighted as a potential alternative to reduce the burden of the COVID-19 pandemic on cognitive function and mental health.

Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis

Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.

Sharp increase in depression and anxiety among Brazilian adults during the COVID-19 pandemic: findings from the PAMPA cohort

OBJECTIVES

We aimed to compare the prevalence of depression and anxiety symptoms before and during the pandemic and identify factors associated with aggravated mental health symptoms.

STUDY DESIGN

Retrospective cohort study.

METHODS

We identified the proportion of normal, mild, moderate, and severe symptoms of depression and anxiety before and during the social distancing restrictions in adults from southern Brazil. An online, self-administered questionnaire was delivered for residents within the state of Rio Grande do Sul. Depressive and anxiety symptoms were examined by the Hospital Anxiety and Depression Scale.

RESULTS

Most of the participants (n = 2314) aged between 31 and 59 years (54.2%), were women (76.6%), White (90.6%) with a university degree (66.6%). Moderate-to-severe symptoms of depression and anxiety were reported in 3.9% and 4.5% of participants, respectively, before COVID-19. During the pandemic (June-July, 2020), these proportions increased to 29.1% (6.6-fold increase) and 37.8% (7.4-fold increase), respectively. Higher rates of depressive and anxiety symptoms were observed among women, those aged 18-30 years, diagnosed with chronic disease and participants who had their income negatively affected by social restrictions. Remaining active or becoming physically active during social distancing restrictions reduced the probability of aggravated mental health disorders.

CONCLUSIONS

Depressive and anxiety symptoms had a 6.6- and 7.4-fold increase since the COVID-19 pandemic. Public policies such as physical activity promotion and strategies to reduce the economic strain caused by this pandemic are urgently needed to mitigate the impact of the pandemic on mental health.

A collaborative care psychosocial intervention to improve late life depression in socioeconomically deprived areas of Guarulhos, Brazil: the PROACTIVE cluster randomised controlled trial protocol

BACKGROUND

The elderly population has been growing in most low- and middle-income countries (LMIC), and depression is a common condition among these populations. The lack of integration between mental health and primary healthcare services and the shortage of mental health specialists in the public health system contribute to underdiagnosis and undertreatment of depression. One of the strategies to reduce this gap is task shifting and collaborative care treatments. This study therefore aims to evaluate the effectiveness and cost-effectiveness of a collaborative care psychosocial intervention to improve the clinical management of depression among elderly people in poor neighbourhoods in Guarulhos, Brazil.

METHODS

Two-arm, cluster randomised controlled trial with Basic Health Units as the clusters and a 1:1 allocation ratio. Twenty Basic Health Units have been randomly selected and randomised to control or intervention arms. We aim to recruit 1440 adults (72 per cluster) aged 60 years or over identified with depression (9-item Patient Health Questionnaire (PHQ-9) score ≥ 10). The control arm participants will receive an enhanced usual care, while the intervention arm participants will receive an enhanced usual care and a 17-week psychosocial intervention programme delivered at home by community health workers with the help of an application installed on tablet computers. The primary outcome is the proportion with depression recovery (PHQ-9 < 10) at 8 months' follow-up. We will also assess the maintenance of any earlier clinical gains and the cost-effectiveness of the intervention at 12 months.

DISCUSSION

This is the first randomised trial to investigate a collaborative care intervention to treat depression among poor elderly in LMIC/Latin America. This is a major public health problem worldwide, but in these countries, there are no locally tested, evidence-based interventions available to date.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number ISRCTN57805470 . Registered on 25 April 2019.

Influência do nível socioeconômico, idade, gordura corporal e sintomas depressivos na frequência de atividade física em adultos: uma análise de caminhos

Resumo A atividade física é um comportamento complexo e influenciado por variáveis sociodemográficas e clínicas. A melhor compreensão desses fatores possibilita considerar a associação deles com a atividade física. O objetivo deste estudo foi estimar os efeitos do nível socioeconômico, idade, gordura corporal e sintomas depressivos na frequência de atividade física entre adultos. Trata-se de um estudo transversal de base populacional conduzido com 808 indivíduos. Foram avaliadas as inter-relações entre as variáveis nível socioeconômico, idade, gordura corporal e sintomas depressivos no nível de atividade física total, por meio da técnica “path analysis”. Observou-se efeito direto negativo e significativo da idade (β = -0,113; p < 0,004) nos níveis de atividade física. A idade (β = 0,376; p < 0,001) influenciou a gordura corporal, com efeito positivo e significativo. Os sintomas de depressão foram influenciados negativamente pelo nível socioeconômico (β = -0,126; p < 0,001) e positivamente pela idade (β = 0,244; p < 0,001) e gordura corporal (β = 0,169; p < 0,004). O nível socioeconômico, a gordura corporal e os sintomas depressivos não influenciaram diretamente os níveis de atividade física. Concluindo, os resultados mostraram que o avançar da idade contribui para a redução da prática de atividade física.

Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017

BACKGROUND

Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017.

METHODS

We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared.

RESULTS

In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (- 9.01%, - 11.66 to - 6.31). The highest proportion of YLD was observed in the age range of 15-64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil's, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI.

CONCLUSIONS

Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

Managing noncommunicable diseases during the COVID-19 pandemic in Brazil: findings from the PAMPA cohort

The objective was to identify the impact of social distance in the management of noncommunicable diseases (NCD) in the adult population from the state of Rio Grande do Sul, southern Brazil. This is an ambispective, population-based cohort study. Descriptive analysis and Poisson regression models were used and the results were reported as prevalence ratio and 95% confidence intervals. From a total of 1,288 participants, 43.1% needed medical care and 28.5% reported impaired management of NCDs during social distance. Female sex, age between 18 and 30 years old, living in the Serra region (central region of the state), people with depression and multimorbidity were more likely to have impaired management of NCDs. Being physically active reduced the probability of having impaired management of NCD by 15%. Reduced monthly income was associated with the difficulty in accessing prescription medicine and avoidance of seeking in-person medical assistance. Depression was associated with difficulties in accessing medications, while avoidance of seeking in-person medical assistance was more likely for people with multimorbidity, arthritis/arthrosis/fibromyalgia, heart disease, and high cholesterol.

Depressive symptoms among healthcare undergraduate students

OBJECTIVE

to identify the intensity of depressive symptoms and their associated factors in healthcare undergraduate students.

METHOD

cross-sectional study developed with undergraduate health students from a public higher education institution using the Beck Depression Inventory-version II and a student characterization questionnaire. The study involved 792 participants. For data analysis, we used descriptive statistics, chi-squared test and Poisson regression.

RESULTS

the intensity of depressive symptoms was moderate to severe in 23.6% of the students, associated with the non-performance of physical and leisure activities and with speech therapy and nursing courses.

CONCLUSION

several factors may be associated with depression, thus, further investigation into the related factors that cause its emergence in this period of life is necessary, as well as raising institutional awareness and developing strategies at the personal and group level to promote well-being, improve time management and interpersonal relationships, in order to achieve better academic results and personal development.

Major depressive episode among university students in Southern Brazil

INTRODUCTION

Depression is the leading cause of disability around the world, and it has been increasingly affecting young people. This study evaluates the prevalence and factors associated with major depression in university students, with emphasis on the influence of the academic field, chosen study area and the environment they are inserted.

METHODS

A census of students who entered the university in the first semester of 2017 was held at a university in Southern Brazil. The outcome of major depressive episode was evaluated using the Patient Health Questionnaire-9, considered when the individual had five or more depressive symptoms for at least one week. Its prevalence was estimated, and the associated factors were examined by the hierarchical multivariable analysis using the Poisson regression model.

RESULTS

A total of 32% (95% confidence interval 29.9–34.2) of university students presented a major depressive episode, and the problem was more frequent among women (prevalence ratio [PR] = 1.59); people aged 21 to 23 years (PR = 1.24); those with a family history of depression (PR = 1.27); minorities’ sexual orientation (homosexuals, PR = 1.64, and bisexuals, PR = 1.69); who lived with friends or colleagues (PR = 1.36); students in the area of applied social and human sciences (PR = 1.28), and linguistics, language and literature, and art (PR = 1.25). The worst academic performance (PR = 2.61), alcohol abuse (PR = 1.25), and illicit drug use (PR = 1.30) were also positively associated with major depressive episode.

CONCLUSION

In addition to individual, family, and behavioral aspects, already described as risk factors for major depressive episodes in the general population, academic aspects also influence the occurrence of depression among university students. Considering the high prevalence of major depressive episode and its negative impact on health, public and institutional policies are necessary to focus on students’ mental health promotion and care.

Prevalência de sintomas de depressão em agentes comunitários de saúde

Resumo Os agentes comunitários de saúde são imprescindíveis e considerados atores importantes para a organização do Sistema Único de Saúde. Este estudo teve como objetivo avaliar a prevalência de sintomas de depressão relacionada aos fatores ocupacionais, sociodemográficos e de estilo de vida dos agentes. Realizou-se um estudo transversal com 400 agentes comunitários, por meio de entrevistas individuais em unidades básicas de saúde de um município situado em Minas Gerais, entre 2015 e 2017. A variável dependente foi a prevalência de sintomas de depressão (Patient Health Questionnaire), e as variáveis independentes foram estresse psicossocial no trabalho (modelo demanda-controle); apoio social; perfil socioeconômico e demográfico; autopercepção de saúde; atividade física; características e condições de trabalho; capacidade para o trabalho e qualidade de vida. A prevalência de sintomas depressivos entre os agentes foi de 20,6%. Na análise multivariada, a prevalência de depressão se associou à baixa ou moderada capacidade para o trabalho, ao baixo apoio social, às classes econômicas C, D e E e aos domínios físico e psicológico da qualidade de vida. Sugere-se a criação de espaços para discussão sobre saúde mental relacionada com o trabalho.

Post-stroke depression and cognitive impairment: Study design and preliminary findings in a Brazilian prospective stroke cohort (EMMA study)

BACKGROUND

Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study).

METHODS

Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time.

RESULTS

Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI.

LIMITATIONS

Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness.

CONCLUSIONS

Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.

A dança dos números: aferindo experiências de discriminação em grupos multiplamente marginalizados

Resumo: O objetivo deste estudo foi analisar a Escala de Discriminação Explícita (EDE), buscando identificar sua capacidade em refletir experiências de discriminação interseccionais sob a perspectiva do cruzamento entre cor/raça, sexo/gênero e posição socioeconômica. Trata-se de estudo baseado em dados de uma pesquisa realizada com uma amostra representativa de estudantes (n = 1.023) da Universidade Federal de Santa Catarina, regularmente matriculados no primeiro semestre de 2012. A análise estatística incluiu estimação das frequências relativas de cada um dos 18 itens da EDE, bem como de suas principais motivações, estratificadas por sexo/gênero, cor/raça e posição socioeconômica. Modelos de regressão binomial negativa possibilitaram avaliar se sexo/gênero, cor/raça e posição socioeconômica constituem preditores do escore de discriminação obtido com o instrumento, mesmo após o ajuste para covariáveis que potencialmente afetam as relações de interesse. Os resultados da análise de cada um dos 18 itens do instrumento sugerem que a EDE possibilita a mensuração da discriminação dentro de um quadro interseccional, uma vez que traz à tona as experiências discriminatórias vivenciadas por subgrupos minoritários, tais como mulheres negras e de posição socioeconômica baixa. Contudo, tal tendência não foi observada no escore global do instrumento, sugerindo que ele não permite situar os respondentes num espectro de variação de discriminação, que inclui graus menos e mais intensos do fenômeno. Pesquisas futuras são necessárias a fim de enfrentar a limitação observada e, assim, dar maior visibilidade às experiências de discriminação de grupos multiplamente marginalizados.

Prevalência de depressão e fatores associados em mulheres atendidas pela Estratégia de Saúde da Família

RESUMO Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária.

The association between physical activity and depression among individuals residing in Brazil

PURPOSE

There is very limited literature investigating the association between physical activity (PA) and depression in South American countries such as Brazil. The purpose of the current study was to evaluate the prevalence of depression and its association with PA in a very large, representative sample of young adults (ages 18-39 years) (YA), middle-aged adults (ages 40-59 years) (MAA) and older adults (ages ≥ 60 years) (OA) residing in Brazil.

METHODS

The sample for this cross-sectional study was based on the Brazilian National Health Survey conducted in 2013. The Personal Health Questionnaire depression scale (PHQ-8) was applied to measure current (past 2 weeks) depression as the outcome of interest, and the exposure was self-reported PA for leisure. Multivariable weighted logistic regression models were conducted to investigate the association between PA and depression while adjusting for socio-demographic characteristics and number of health comorbidities among YA, MAA and OA.

RESULTS

The final study sample size was 59,399 (33,480 females; 25,919 males). After adjusting for the covariates of interest, the lack of PA for leisure was associated with a significant increase in depression only among males (YA: OR 1.45, 95% CI 1.02-2.06; MAA: OR 2.38, 95% CI 1.40-4.03; OA: OR 5.35, 95% CI 2.14-13.37). There was no significant association between PA for leisure and depression among females of all age groups.

CONCLUSIONS

Although PA for leisure is not associated with depression among Brazilian females, the obtained results suggest that this association is significant among Brazilian males, who may be able to benefit from PA for leisure to reduce their symptoms of depression.

Does volume of physical exercise have an effect on depression in patients with fibromyalgia?

BACKGROUND

Fibromyalgia Syndrome (FMS) is a musculoskeletal disorder frequently associated with depression. We aimed to investigate the association between physical exercise (PE) and depression in patients with FMS, and to evaluate the effect of the weekly volume of PE on depression.

METHODS

A total of 215 FMS patients with depression were evaluated with the Beck Depression Inventory, and were also classified as inactive, insufficiently active, or active. We performed binary logistic regression, with PE as the dependent variable and the level of depression as an independent variable. We also used the Mann-Whitney U test. An alpha value of 0.05 was determined to have significance (p<0.05).

RESULTS

Inactive patients with FMS have a higher rate of moderate to severe depression (29.1%) and major depression (25%) when compared with active patients. In comparing the depression index between inactive, insufficiently active, and active FMS patients according to the reported weekly volume of PE, we observed differences between inactive and active patients (p=0.035). The level of depression was positively associated with physical inactivity in FMS, and FMS patients with severe depression had 3.45 1.23-9.64) times the likelihood of being inactive than patients without depression or with minimal depression.

LIMITATIONS

The classification of PE does not distinguish between types of PE, or whether differences in activity can have different results in depression.

CONCLUSION

There was an association between PE and lower values of depression in patients with FMS, and the level of depression was positively and significantly associated with physical inactivity.