Abstract Objectives To assess alcohol use and perceived change in alcohol consumption (before and during the pandemic) in Brazilians during the COVID-19 pandemic, their correlates, and their associations with depressive, anxiety and co-occurring depressive and anxiety symptoms (D&A). Methods This is a cross-sectional study comprising 992 individuals in self-isolation. A self-report questionnaire was used to assess whether participants were drinking during self-isolation and whether they changed their drinking behavior (drinking less, more, or no change) from before to during the pandemic. D&A symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI). Results A total of 68.5% of participants reported alcohol consumption during the pandemic, and 22.7% of these reported increased alcohol use. Smoking was positively associated with alcohol consumption during the pandemic. Alcohol consumption was associated with anxiety (OR = 1.40, 95%CI 1.06-1.85, p < 0.01) and D&A (OR = 1.38, 95%CI 1.02-1.87, p = 0.033) symptoms. Conclusions Drinking during self-isolation was prevalent and was associated with risk factors for alcohol use disorders. The long-term effects of high drinking rates and increased consumption should be proactively monitored and assessed.

Abstract Introduction High rates of early hospital discharge are often observed in crack cocaine users and are related to adverse outcomes and increased public spending. This study evaluated clinical and sociodemographic factors associated with early treatment discharge among crack users. Methods The sample comprised 308 men diagnosed with crack cocaine use disorder (crack only), aged 18 to 65 years, admitted between 2013 and 2017 to a male-only hospital unit to treat substance use disorders. Sociodemographic and clinical data were obtained using the Addiction Severity Index, 6th version, and a Sociodemographic Questionnaire. Results Early discharge (within 7 days) was significantly associated with lack of own income, insufficient family support, being single, and recent homelessness. Regarding drug use, lower treatment retention was related to younger age of crack use onset, recent alcohol use, and nicotine use. Factors such as age, skin color, and educational level showed no relation to the outcome. Conclusion Our findings suggest that presence of characteristics verifiable at the time of admission may be related to crack users’ treatment retention. Identification of these factors can contribute to target interventions in order to improve treatment adherence in crack cocaine users.

Abstract Introduction Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. Objectives To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. Methods Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). Results Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). Discussion Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

ABSTRACT Objectives. To characterize how physical activity and sedentary behavior have been measured in national health surveys in South American countries. Methods. An extensive search was made for national health surveys from all 12 South American countries through health websites, national statistical offices, and contact with researchers and policy-makers. The following eligibility criteria were used to select surveys: conducted in a South American country; used a nationally representative sample ≥ 18 years; coordinated by the public, private or mixed private–public sector; and assessed physical activity and/or sedentary behavior. Data were extracted on general information about the surveys, specific details about the physical activity and sedentary behavior assessment, and additional questions related to activity behavior. Results. In total, 36 surveys were included, two of which were multicountry surveys; all surveys assessed physical activity and 27 assessed sedentary behavior. Most surveys (23/36; 64%) were based on previously validated international questionnaires, but 13 (57%) of these deviated from the reference tools, introducing changes and adaptations. Sedentary behavior was assessed mostly through questions on screen time and/or daily sitting time in the same physical activity questionnaires. No survey used device-based measures to generate data on these behaviors. Conclusions. Differences between instruments used and modifications limit the comparability of data across countries. This highlights the importance of standardizing assessment within South America for physical activity and sedentary behavior sections in national surveys, with the broader aim of contributing to establishing a standardized strategy for the surveillance of physical activity and sedentary behavior in South America.

RESUMO Objetivos. Caracterizar como a atividade física e o comportamento sedentário têm sido medidos em pesquisas nacionais de saúde em países sul-americanos. Métodos. Foi realizada uma busca extensa de pesquisas nacionais de saúde de todos os 12 países sul-americanos em sites de saúde e órgãos nacionais de estatística, e pelo contato com pesquisadores e formuladores de políticas. Foram usados os seguintes critérios de elegibilidade para selecionar as pesquisas: conduzida em um país sul-americano; que tenha usado uma amostra nacionalmente representativa ≥ 18 anos; coordenada pelo setor público, privado ou público-privado; e que tenha avaliado a atividade física e/ou o comportamento sedentário. Os dados extraídos eram sobre informações gerais das pesquisas, detalhes específicos sobre a avaliação da atividade física e do comportamento sedentário e questões adicionais relacionadas ao comportamento na atividade. Resultados. Ao todo, 36 pesquisas foram incluídas, duas das quais foram conduzidas em vários países. Todas as pesquisas avaliaram a atividade física e 27 avaliaram o comportamento sedentário. A maioria das pesquisas (23/36; 64%) baseou-se em questionários internacionais previamente validados e 13 (57%) delas se desviaram das ferramentas de referência, introduzindo mudanças e adaptações. O comportamento sedentário foi avaliado principalmente por meio de perguntas sobre tempo de tela e/ou tempo diário sentado nos mesmos questionários sobre atividade física. Nenhuma pesquisa utilizou medições realizadas por dispositivos para gerar dados sobre esses comportamentos. Conclusões. As diferenças entre os instrumentos usados e as modificações limitam a comparabilidade dos dados entre os países, o que destaca a importância de padronizar a avaliação na América do Sul para as seções de atividade física e comportamento sedentário em pesquisas nacionais, com o objetivo mais amplo de contribuir para o estabelecimento de uma estratégia padronizada para a vigilância da atividade física e do comportamento sedentário na América do Sul.

RESUMEN Objetivos. Describir cómo se han medido la actividad física y el sedentarismo en las encuestas nacionales de salud en los países de América del Sur. Métodos. Se llevó a cabo una extensa búsqueda de encuestas nacionales de salud de los doce países sudamericanos en sitios web de salud, oficinas nacionales de estadística y mediante el contacto con investigadores y responsables de formular políticas. Para escoger las encuestas se emplearon los siguientes criterios de selección: realizada en un país sudamericano; muestra representativa a nivel nacional de ≥ 18 años; coordinada por el sector público, el sector privado o mixto público-privado; y evaluación de la actividad física o el sedentarismo. Se extrajeron datos como información general de las encuestas, detalles específicos de la evaluación de la actividad física y el sedentarismo, y otras preguntas relacionadas con la actividad física. Resultados. En total, se incluyeron 36 encuestas, dos de las cuales se realizaron en varios países. Todas las encuestas evaluaron la actividad física; 27, el sedentarismo. La mayoría de las encuestas (23/36; 64%) se basaron en cuestionarios internacionales anteriormente validados, de los cuales 13 (57%) se desviaron de las herramientas de referencia al tener cambios y adaptaciones. El sedentarismo se evaluó principalmente en los mismos cuestionarios de actividad física mediante preguntas sobre el tiempo invertido delante de pantallas o el tiempo diario sentado. Ninguna encuesta aplicó medidas basadas en dispositivos para obtener datos sobre estos comportamientos. Conclusiones. Las diferencias entre los instrumentos empleados y las modificaciones limitan la comparabilidad de los datos en todos los países. Esto pone de relieve la importancia de estandarizar la evaluación en América del Sur de las secciones dedicadas a la actividad física y al sedentarismo en las encuestas nacionales, con el objetivo general de contribuir a la creación de una estrategia estandarizada para la vigilancia de la actividad física y el sedentarismo en América del Sur.

Objective: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association. Methods: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses. Results: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association. Conclusion: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.

Objective: The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness. Methods: The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil. Results: Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency. Conclusion: Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

Objective: The field of food addiction has attracted growing research attention. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a screening tool based on DSM-5 criteria for substance use disorders. However, there is no validated instrument to assess food addiction. Methods: The mYFAS 2.0 has been transculturally adapted to Brazilian Portuguese. The data for this study was obtained through an anonymous web-based research platform: participants provided sociodemographic data and answered Brazilian versions of the the mYFAS 2.0 and the Barratt Impulsivity Scale (BIS-11). Analysis included an assessment of the Brazilian mYFAS 2.0’s internal consistency reliability, factor structure, and convergent validity in relation to BIS-11 scores. Results: Overall, 7,639 participants were included (71.3% females; age: 27.2±7.9 years). The Brazilian mYFAS 2.0 had adequate internal consistency reliability (Cronbach’s alpha = 0.89). A single factor solution yielded the best goodness-of-fit parameters for both the continuous and categorical version of the mYFAS 2.0 in confirmatory factor analysis. In addition, mYFAS 2.0 correlated with BIS-11 total scores (Spearman’s rho = 0.26, p < 0.001) and subscores. Conclusion: The Brazilian mYFAS 2.0 demonstrated adequate psychometric properties in our sample; however, future studies should further evaluate its discriminant validity.

Objective: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. Methods: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted. Results: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities. Conclusion: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.