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.

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.

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.

Abstract Introduction We assessed the impact of polythetic conceptualizations of mental disorders on the validity and reliability of psychiatric diagnosis, with a specific focus on two levels of heterogeneity: phenomenological and pathophysiological. Objective We investigated this issue using attention deficit hyperactivity disorder (ADHD) as an example. Method We examined individuals from two samples enriched for psychopathology (n = 1 255 children in Porto Alegre and 1 257 children in São Paulo, Brazil). We conducted a series of data analyses to investigate phenomenological heterogeneity, including confirmatory factor analysis. We also investigated pathophysiological heterogeneity using symptom-level regressions between ADHD symptoms and four neurocognitive processes consistently linked to ADHD (working memory, inhibitory control, intra-subject variability in reaction times, and temporal processing). Lastly, we assessed the performance of polythetic systems for reliability testing inter-rater and test-rest reliability of two well-known symptomatic scales. Results Among the 116 200 possible combinations of symptoms to achieve DSM symptomatic threshold for categorical ADHD diagnosis, we found 173 combinations in the two independent samples, and only four were replicated in both samples (2.3%). We also found that the number of ADHD symptoms is a poor indicator of variation in the general ADHD latent trait. Overall, symptoms did not have specific profiles of associations with any of the neurocognitive processes. Reliability analyses revealed that increasing the number of items augments overall reliability of measurements. Discussion and conclusion Our findings illustrate both potential benefits and problems inherent to the polythetic system for ADHD. Implications for the search of mechanisms underlying psychiatric disorders are discussed.

Resumen Antecedentes Evaluamos el impacto de las conceptualizaciones politécnicas de los trastornos mentales en la validez y la fiabilidad del diagnóstico psiquiátrico, con un enfoque específico en dos niveles de heterogeneidad: fenomenológico y fisiopatológico. Objetivos Investigamos este problema utilizando el trastorno por déficit de atención e hiperactividad (TDAH) como ejemplo. Método Examinamos individuos de dos muestras enriquecidas por psicopatología (n = 1 255 niños en Porto Alegre y 1 257 niños en São Paulo, Brasil). Llevamos a cabo una serie de análisis de datos para investigar la heterogeneidad fenomenológica, incluido el análisis factorial confirmatorio. También investigamos la heterogeneidad fisiopatológica utilizando regresiones al nivel de síntomas entre los síntomas del TDAH y cuatro procesos neurocognitivos consistentemente vinculados al TDAH (memoria de trabajo, control inhibitorio, variabilidad intrasujeto en tiempos de reacción y procesamiento temporal). Por último, evaluamos el rendimiento de los sistemas politéticos para la prueba de confiabilidad interevaluador y la confiabilidad test-rest de dos escalas sintomáticas bien conocidas. Resultados Entre las 116 200 posibles combinaciones de síntomas para alcanzar el umbral sintomático del DSM para el diagnóstico categórico de TDAH, encontramos 173 combinaciones en las dos muestras independientes y sólo cuatro se replicaron en ambas muestras (2.3%). También encontramos que la cantidad de síntomas de TDAH no es un buen indicador de la variación en el rasgo latente general del TDAH. En general, los síntomas no tenían perfiles específicos de asociaciones con ninguno de los procesos neurocognitivos. Los análisis de confiabilidad revelaron que aumentar el número de artículos aumenta la confiabilidad general de las mediciones. Discusión y conclusión Nuestros hallazgos ilustran tanto los beneficios potenciales como los problemas inherentes al sistema politécnico para el TDAH. Se discuten las implicaciones para la búsqueda de mecanismos subyacentes a los trastornos psiquiátricos.

Resumo Objetivo Descrever a adaptação transcultural da Escala de Ruminação de Raiva (Anger Rumination Scale, ARS) para uso no Brasil. Método A adaptação transcultural seguiu um processo de quatro etapas baseado em literatura especializada: 1) investigação da equivalência conceitual e dos itens; 2) tradução e retrotradução; 3) pré-teste; e 4) investigação da equivalência operacional. Resultados Uma versão final brasileira do instrumento, denominada ARS-Brasil, foi obtida e é apresentada. Os resultados do pré-teste demonstraram que a escala foi predominantemente bem entendida entre adultos, e indicaram algumas modificações que foram incluídas na versão final. Conclusão A versão da ARS adaptada para o português brasileiro mostra-se muito similar à versão original da ARS no que diz respeito à equivalência conceitual e dos itens, semântica e equivalência operacional, sugerindo que futuros estudos transculturais poderiam se beneficiar desta primeira versão. Como resultado, um novo instrumento está agora disponível para a avaliação de sintomas de ruminação da raiva e da irritabilidade para adultos, em contextos comunitário, clínico e de pesquisa.

Abstract Objective To describe the cross-cultural adaptation of the Anger Rumination Scale (ARS) for use in Brazil. Methods The cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. Results A final Brazilian version of the instrument (ARS-Brazil) was defined and is presented. Pretest results revealed that the instrument was generally well understood by adults as well as indicated a few modifications that were included in the final version presented here. Conclusion The Brazilian Portuguese version of the ARS seems to be very similar to the original ARS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of rumination symptoms of anger and irritability for adults in community, clinical, and research settings.

Resumo Objetivo: Este estudo objetivou avaliar crianças e adolescentes com transtornos de ansiedade leve e moderada nas funções neuropsicológicas de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global, comparando o seu desempenho ao de crianças com desenvolvimento típico. Métodos: Participaram do estudo 68 crianças e adolescentes com idade de 10 a 17 anos (41 com diagnósticos clínicos atuais de transtornos de ansiedade e 27 controles), selecionados de uma amostra transversal mais ampla de adolescentes da comunidade. Os adolescentes com diagnóstico foram divididos ainda em dois grupos com base na gravidade dos transtornos (leve ou moderado). Todos os participantes realizaram uma avaliação neuropsicológica individual das funções de atenção, memória episódica verbal, memória de trabalho, habilidades visuoconstrutivas, funções executivas e cognição global. Resultados: Nenhum dos testes neuropsicológicas demonstrou diferenças significativas, sendo a única exceção a tarefa de span de dígitos ordem inversa, na qual o grupo com ansiedade leve apresentou desempenho superior ao do grupo com ansiedade moderada e também ao dos controles (p = 0.041; η2 = 0.11). Conclusão: Os resultados sugerem que não só os transtornos de ansiedade podem preservar as principais funções cognitivas durante a adolescência, mas que podem até melhorar certos processos de memória de trabalho.

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Resumo Introdução: Estudos prévios sugerem que déficits na fluência verbal estariam associados a transtornos de ansiedade em adolescentes. Objetivo: Replicar e estender os resultados prévios investigando se o desempenho em uma tarefa de fluência verbal fonêmica está relacionado com a gravidade dos sintomas de ansiedade em crianças com transtorno de ansiedade. Pretendemos, também, investigar se essa associação é independente da coocorrência de sintomas de déficit de atenção e hiperatividade (TDAH). Métodos: Participaram desse estudo 60 crianças (6-12 anos) com diagnóstico primário de transtorno de ansiedade. A gravidade dos sintomas foi medida utilizando escalas validadas baseadas para avaliação clínica, resposta dos pais ou responsáveis e resposta da criança. A fluência verbal foi avaliada utilizando uma tarefa simples que mede o número de palavras evocadas em 1 minuto com a letra F, a partir da qual foram quantificados o número de palavras isoladas, o número de clusters (agrupamentos de palavras semelhantes) e o número de switches (transições entre os agrupamentos e/ou entre palavras isoladas). Resultados: Encontramos uma associação significativa entre o número de clusters e os escores de ansiedade. Uma análise posterior revelou que essas associações foram independentes dos sintomas coocorrentes de TDAH. Conclusões: Replicamos e estendemos os resultados anteriores mostrando que a fluência verbal está consistentemente associada com a gravidade dos transtornos de ansiedade em crianças. Novos estudos são incentivados com o objetivo de investigar potenciais efeitos de treinamentos cognitivos sobre os sintomas ansiosos em indivíduos com transtornos de ansiedade.

Abstract Introduction: Previous studies have implicated impaired verbal fluency as being associated with anxiety disorders in adolescents. Objectives: To replicate and extend previously reported evidence by investigating whether performance in phonemic verbal fluency tasks is related to severity of anxiety symptoms in young children with anxiety disorders. We also aim to investigate whether putative associations are independent from co-occurring attention deficit hyperactivity disorder (ADHD) symptoms. Methods: Sixty children (6-12 years old) with primary diagnoses of anxiety disorders participated in this study. Severity of symptoms was measured using clinician-based, parent-rated and self-rated validated scales. Verbal fluency was assessed using a simple task that measures the number of words evoked in 1-minute with the letter F, from which we quantified the number of isolated words, number of clusters (groups of similar words) and number of switches (transitions between clusters and/or between isolated words). Results: There was a significant association between the number of clusters and anxiety scores. Further analysis revealed associations were independent from co-occurring ADHD symptoms. Conclusion: We replicate and extend previous findings showing that verbal fluency is consistently associated with severity in anxiety disorders in children. Further studies should explore the potential effect of cognitive training on symptoms of anxiety disorders.

The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

Objetivo: Descrever a adaptação transcultural do Affective Reactivity Index (ARI) para o português do Brasil e investigar propriedades psicométricas preliminares da versão adaptada. Método: A adaptação transcultural foi baseada na investigação das equivalências teórica e operacional da versão original do ARI no contexto brasileiro, seguida do processo de tradução, retrotradução e revisão por comitê de especialistas. A análise dos dados foi realizada em uma amostra comunitária de 133 escolares com idade entre 8 e 17 anos para investigar as seguintes características do ARI: 1) estrutura fatorial; 2) consistência interna; 3) validade do construto, comparando as relações diferenciais entre irritabilidade e as dimensões de ansiedade e prejuízo; e 4) parâmetros de teoria da resposta ao item (TRI). Resultados: Uma versão final em português do Brasil do instrumento foi definida e é apresentada. A consistência interna foi boa, e nossa análise confirmou a estrutura unifatorial original do ARI. As correlações do ARI com as dimensões de ansiedade relacionadas a sofrimento foram maiores do que com as dimensões de ansiedade relacionadas a fobias, reforçando a validade do construto. Além disso, escores mais altos no ARI foram associados a maior prejuízo relacionado à irritabilidade. A análise do TRI enfatizou a frequência de perda de controle como essencial para determinar estados patológicos de irritabilidade. Conclusão: A versão em português do Brasil do ARI parece ser muito semelhante ao instrumento original em termos de equivalência conceitual, de itens, semântica e operacional. Nossa análise preliminar reproduz e estende evidências anteriores que confirmam propriedades psicométricas promissoras para o ARI.

Objective: To describe the cross-cultural adaptation of the Affective Reactivity Index (ARI) to Brazilian Portuguese and to investigate preliminary psychometric properties of the adapted version. Methods: Cross-cultural adaptation was based on the investigation of the theoretical and operational equivalences of the original ARI in the Brazilian context, followed by a process of translation, back-translation, and review by a committee of experts. Data analysis was carried out in a community sample of 133 schoolchildren aged 8 to 17 years to investigate the following characteristics of the ARI: 1) factor structure; 2) internal consistency; 3) construct validity comparing differential relationships between irritability and anxiety dimensions and impairment; and 4) item response theory (IRT) parameters. Results: A final Brazilian Portuguese version of the instrument was defined and is presented. Internal consistency was good, and our analysis supported the original single-factor structure of the ARI. Correlations of the ARI with distress-related anxiety dimensions were higher than with phobic-related anxiety dimensions, supporting its construct validity. In addition, higher ARI scores were associated with higher irritability-related impairment. IRT analysis underscored frequency of loss of temper as essential to inform about pathological states of irritability. Conclusion: The Brazilian Portuguese version of the ARI seems to be very similar to the original instrument in terms of conceptual, item, semantic, and operational equivalence. Our preliminary analysis replicates and extends previous evidence confirming promising psychometric properties for the ARI.

OBJETIVO: Testar algumas propriedades psicométricas da versão brasileira do Youth Quality of Life Instrument-Research (YQOL-R) em uma amostra comunitária de adolescentes brasileiros. MÉTODOS: Este é um estudo transversal comunitário realizado em seis escolas localizadas na área de abrangência de uma unidade de saúde da família. De uma população original de 2.754 estudantes com idade entre 10 e 17 anos, selecionamos aleatoriamente 419 para responder à versão brasileira do YQOL-R. Testamos a confiabilidade, as diferenças já conhecidas entre os grupos (utilizando sintomas de ansiedade e envolvimento em episódios de bullying) e a estrutura fatorial. RESULTADOS: O YQOL-R apresentou boa consistência interna, e as diferenças já conhecidas entre os grupos mostraram-se adequadas e estiveram dentro do esperado tanto com relação ao bullying quanto à ansiedade. A estrutura fatorial do modelo conceitual foi em parte fundamentada por nossa análise. CONCLUSÕES: A versão brasileira do YQOL-R apresentou propriedades psicométricas suficientemente boas. São necessários mais estudos a fim de melhor investigar configurações alternativas da estrutura fatorial.

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