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Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9)
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Damiano, Rodolfo Furlan

; Hoffmann, Maurício Scopel

; Gosmann, Natan Pereira

; Pan, Pedro Mario

; Miguel, Eurípedes Constantino

; Salum, Giovanni Abrahão

Brazilian Journal of Psychiatry

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aug 2023, Volume 45 N. 4 Pages 310 - 317

Abstract: En | Text: En | PDF: En

Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde – 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.

https://doi.org/10.47626/1516-4446-2022-2945

Grief, interpersonal disputes, and role transitions: the breadth of interpersonal telepsychotherapy as a strategy to reduce mental health suffering due to the COVID-19 pandemic among health professionals
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Fleck, Marcelo Pio

; Spanemberg, Lucas

; de Souza, Livia Hartmann

; Salum Junior, Giovanni Abrahão

Brazilian Journal of Psychiatry

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apr 2023, Volume 45 N. 2 Pages 197 - 198

Abstract: En | Text: En | PDF: En

https://doi.org/10.47626/1516-4446-2022-2867

Translating measurement into practice: Brazilian norms for depressive symptom assessment with the Patient Health Questionnaire (PHQ-9)
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Damiano, Rodolfo Furlan

; Hoffmann, Maurício Scopel

; Gosmann, Natan Pereira

; Pan, Pedro Mario

; Miguel, Eurípedes Constantino

; Salum, Giovanni Abrahão

Brazilian Journal of Psychiatry

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2023, N. ahead

Abstract: En | Text: En | PDF: En

https://doi.org/10.47626/1516-4446-2022-2945

Identifying Depression Early in Adolescence: assessing the performance of a risk score for future onset of depression in an independent Brazilian sample
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Cunha, Graccielle R.

; Caye, Arthur

; Pan, Pedro

; Fisher, Helen L.

; Pereira, Rivka

; Ziebold, Carolina

; Bressan, Rodrigo

; Miguel, Eurípedes Constantino

; Salum, Giovanni A.

; Rohde, Luis Augusto

; Kohrt, Brandon A.

; Mondelli, Valeria

; Kieling, Christian

; Gadelha, Ary

Brazilian Journal of Psychiatry

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2023, Volume 45 N. 3 Pages 242 - 248

Abstract: En | Text: En | PDF: En

Objective: The Identifying Depression Early in Adolescence Risk Score (IDEA-RS) was recently developed in Brazil using data from the Pelotas 1993 Birth Cohort to estimate the individualized probability of developing depression in adolescence. This model includes 11 sociodemographic variables and has been assessed in longitudinal studies from four other countries. We aimed to test the performance of IDEA-RS in an independent, community-based, school-attending sample within the same country: the Brazilian High-Risk Cohort. Methods: Standard external validation, refitted, and case mix-corrected models were used to predict depression among 1442 youth followed from a mean age of 13.5 years at baseline to 17.7 years at follow-up, using probabilities calculated with IDEA-RS coefficients. Results: The area under the curve was 0.65 for standard external validation, 0.70 for the case mix-corrected model, and 0.69 for the refitted model, with discrimination consistently above chance for predicting depression in the new dataset. There was some degree of miscalibration, corrected by model refitting (calibration-in-the-large reduced from 0.77 to 0). Conclusion: IDEA-RS was able to parse individuals with higher or lower probability of developing depression beyond chance in an independent Brazilian sample. Further steps should include model improvements and additional studies in populations with high levels of subclinical symptoms to improve clinical decision making.

https://doi.org/10.47626/1516-4446-2022-2775

Inflammation and damage-associated molecular patterns in major psychiatric disorders
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Valiati, Fernanda Endler

; Feiten, Jacson Gabriel

; Géa, Luiza Paul

; Silveira Júnior, Érico de Moura

; Scotton, Ellen

; Caldieraro, Marco Antonio

; Salum, Giovanni Abrahão

; Kauer-Sant’Anna, Marcia

Trends in Psychiatry and Psychotherapy

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2023, Volume 45 elocation e20220576

Abstract: En | Text: En | PDF: En

Abstract Background Emerging evidence indicates that inflammation plays an important role as a mechanism underlying mental disorders. However, most of the research on inflammatory mechanisms focuses on serum levels of interleukins and very few studies have investigated molecules that initiate and expand innate immune pathways such as damage-associated molecular patterns (DAMPs). Objectives This study investigated the levels of DAMPs among patients diagnosed with major depressive disorder (MDD), bipolar disorder (BD) I and II, schizophrenia (SCZ), and generalized anxiety disorder (GAD). We quantified serum levels of heat shock proteins (HSPs) 70 and 60 and of S100 calcium-binding protein B (S100B). Methods Serum levels of HSP70, HSP60, and S100B were assessed in a sample of participants with psychiatric disorders (n = 191) and a control group (CT) (n = 59) using enzyme-linked immunosorbent assay (ELISA). Results Serum HSP70 concentrations were significantly higher in the MDD group compared to the CT, SCZ, and BD groups. The GAD group had higher concentrations of HSP70 than the SCZ group. Exploring associations with medications, lithium (p = 0.003) and clozapine (p = 0.028) were associated with lower HSP70 levels. Approximately 64% of the sample had DAMPs levels below the limits of detection indicated by the respective ELISA kit. Conclusion This was the first study to assess DAMPs levels in a transdiagnostic sample. Our preliminary findings suggest that HSP70 may be associated with MDD pathophysiology. Medications such as lithium and clozapine were associated with lower HSP70 levels in BD and SCZ groups, respectively. Therefore, it is worth mentioning that all participants were medicated and many psychotropic drugs exert an anti-inflammatory effect, possibly reducing the signs of inflammation.

https://doi.org/10.47626/2237-6089-2022-0576

Is the 9-item Patient Health Questionnaire sufficiently sensitive to detect clinical risk of suicide in essential workers seeking emotional support during the COVID-19 pandemic?
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Motta, Luis Souza

; Costa, Marianna de Abreu

; Spanemberg, Lucas

; Dreher, Carolina Blaya

; Salum, Giovanni Abrahão

Brazilian Journal of Psychiatry

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dec 2022, Volume 44 N. 6 Pages 676 - 677

Abstract: En | Text: En | PDF: En

https://doi.org/10.47626/1516-4446-2022-2666

Implementation of Group Interpersonal Psychotherapy in primary care
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Mattos, Maria Isabel Perez

; Mosqueiro, Bruno Paz

; Stuart, Scott

; Salum, Giovanni

; Duzzo, Rosana de Lima

; Souza, Laura Wolf de

; Chini, Ariane

; Fleck, Marcelo Pio de Almeida

Revista de Saúde Pública

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2022, Volume 56 elocation 23

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

https://doi.org/10.11606/s1518-8787.2022056003731

Implementation of Group Interpersonal Psychotherapy in primary care
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Mattos, Maria Isabel Perez

; Mosqueiro, Bruno Paz

; Stuart, Scott

; Salum, Giovanni

; Duzzo, Rosana de Lima

; Souza, Laura Wolf de

; Chini, Ariane

; Fleck, Marcelo Pio de Almeida

Revista de Saúde Pública

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2022, Volume 56 elocation 23

Abstract: En | Text: En | PDF: En

https://doi.org/10.11606/s1518-8787.2022056003731

Translating science into policy: mental health challenges during the COVID-19 pandemic
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Mari, Jair J.

; Gadelha, Ary

; Kieling, Christian

; Ferri, Cleusa P.

; Kapczinski, Flavio

; Nardi, Antonio E.

; Almeida-Filho, Naomar

; Sanchez, Zila M.

; Salum, Giovanni A.

Brazilian Journal of Psychiatry

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dec 2021, Volume 43 N. 6 Pages 638 - 649

Abstract: En | Text: En | PDF: En

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.

https://doi.org/10.1590/1516-4446-2020-1577 2 downloads

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Predictors of gaming disorder in children and adolescents: a school-based study
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Ferreira, Felipe de M.

; Bambini, Beatriz B.

; Tonsig, Gabriela K.

; Fonseca, Lais

; Picon, Felipe A.

; Pan, Pedro M.

; Salum, Giovanni A.

; Jackowski, Andrea

; Miguel, Eurípedes C.

; Rohde, Luis A.

; Bressan, Rodrigo A.

; Gadelha, Ary

Brazilian Journal of Psychiatry

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jun 2021, Volume 43 N. 3 Pages 289 - 292

Abstract: En | Text: En | PDF: En

Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.

https://doi.org/10.1590/1516-4446-2020-0964 336 downloads

11.

Distinct correlates of empathy and compassion with burnout and affective symptoms in health professionals and students
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Romani-Sponchiado, Aline

; Jordan, Matthew R.

; Stringaris, Argyris

; Salum, Giovanni A.

Brazilian Journal of Psychiatry

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apr 2021, Volume 43 N. 2 Pages 186 - 188

Abstract: En | Text: En | PDF: En

Objective: The causes of high rates of psychological distress among health professionals and students are largely unknown. Health professionals respond to those who are in distress with empathy (feeling what others feel) or compassion (caring about what others feel). This study aims to investigate whether empathy and compassion are distinct traits and how both traits are associated with negative affect (burnout, depression, anxiety and anger symptoms) in undergraduate students and professionals in medicine, psychology and nursing. Methods: A sample of 464 students and professionals filled out an online protocol with a sociodemographic data questionnaire and self-report questionnaires covering the variables of interest. Results: The findings indicate that empathy is associated with higher negative affect, while compassion is associate with lower negative affect, which suggests that they are different traits. Conclusion: Our findings provide new evidence that the well-being of health professionals might be affected differently depending on socioemotional traits relevant to emotional connection.

https://doi.org/10.1590/1516-4446-2020-0941

12.

Differentiating irritable mood and disruptive behavior in adults
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Knackfuss, Ana Cláudia U.

; Leibenluft, Ellen

; Brotman, Melissa A.

; de Moura Silveira Júnior, Érico

; Simioni, André

; Teixeira, Lorenna S.

; Gerchmann, Luciana

; Fijtman, Adam

; Trasel, Andrea R.

; Sperotto, Daniela

; Manfro, Arthur G.

; Kapczinski, Flávio

; Sant’Anna, Márcia K.

; Salum, Giovanni A.

Trends in Psychiatry and Psychotherapy

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dec 2020, Volume 42 N. 4 Pages 375 - 386

Abstract: En | Text: En | PDF: En

Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.

https://doi.org/10.1590/2237-6089-2019-0078 641 downloads

13.

Art, science and the mental health we need in a pandemic
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Salum, Giovanni Abrahão

; Eduardo Filho, Carlos

; Evans-Lacko, Sara

; Fleck, Marcelo Pio de Almeida

; Baeza, Fernanda Lucia Capitanio

Trends in Psychiatry and Psychotherapy

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sep 2020, Volume 42 N. 3 Pages 217 - 218

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/2237-6089-2020-0068 559 downloads

14.

Supporting people with severe mental health conditions during the COVID-19 pandemic: considerations for low- and middle-income countries using telehealth case management
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Salum, Giovanni A.

; Rehmenklau, Jaqueline F.

; Csordas, Michele C.

; Pereira, Flavia P.

; Castan, Juliana U.

; Ferreira, Anderson B.

; Delgado, Vera B.

; Bolzan, Liana de M.

; de Lima, Miguel A.

; Blauth, Juarez H.

; dos Reis, José R.

; Rocha, Paula B.

; Guerra, Tadeu A.

; Saraiva, Izabela M.

; Gramz, Bruna de C.

; Ronchi, Bruna R.

; Ribeiro, Bruna L.

; Konig, Dienifer F.

; Grevet, Eugênio H.

; de Pinho, Leandro B.

; Schneider, Jacó F.

; Eustáquio, Paula R.

; Ramos, Márcia Z.

; Marques, Myriam F.

; Axelrud, Luiza K.

; Baeza, Fernanda L.

; Lacko, Sara E.

Brazilian Journal of Psychiatry

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aug 2020, Volume 42 N. 4 Pages 451 - 452

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2020-1078 1141 downloads

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Precision non-implantable neuromodulation therapies: a perspective for the depressed brain
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Borrione, Lucas

; Bellini, Helena

; Razza, Lais Boralli

; Avila, Ana G.

; Baeken, Chris

; Brem, Anna-Katharine

; Busatto, Geraldo

; Carvalho, Andre F.

; Chekroud, Adam

; Daskalakis, Zafiris J.

; Deng, Zhi-De

; Downar, Jonathan

; Gattaz, Wagner

; Loo, Colleen

; Lotufo, Paulo A.

; Martin, Maria da Graça M.

; McClintock, Shawn M.

; O’Shea, Jacinta

; Padberg, Frank

; Passos, Ives C.

; Salum, Giovanni A.

; Vanderhasselt, Marie-Anne

; Fraguas, Renerio

; Benseñor, Isabela

; Valiengo, Leandro

; Brunoni, Andre R.

Brazilian Journal of Psychiatry

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aug 2020, Volume 42 N. 4 Pages 403 - 419

Abstract: En | Text: En | PDF: En

Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.

https://doi.org/10.1590/1516-4446-2019-0741 1546 downloads

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