Objective: This study investigated the association between childhood family adversity and depression in a cohort of Brazilian adults over three visits. Methods: A total of 12,636 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), baseline (2008-2010) and followed up in 2012-2014 and 2017-2019, were included. Five types of family dysfunction and the childhood family dysfunction score (0, 1, and ≥ 2 dysfunctions) were used. The Clinical Interview Schedule-Revised was used to assess depression in visits 1 and 2 or 3. Multinomial logistic regression models estimated crude and adjusted OR and 95%CI. Results: The mean age of the sample was 59.6 (SD, 8.8) years, 7.4% presented depression in one visit, and 2.2% presented it in two or three visits. After adjustment, compared to no family dysfunction, mental disorder (OR = 3.91; 95%%CI 2.94-5.21), substance abuse (OR = 2.14; 95%CI 1.65-2.77), and parental separation/divorce (OR = 1.55; 95%CI 1.12-2.15) increased the odds of depression in two or three visits. Exposure to ≥ 2 types of family dysfunction increased the odds of depression in one, and two or three visits in a dose-response gradient. Conclusion: Exposure to childhood family dysfunction contributes to the occurrence and recurrence of depression in adults. Interventions to prevent dysfunctional family environments and their repercussions on children can reduce the burden of depression.

Objective: To evaluate whether attitudes toward drug use, as well as decision-making, communication, and alcohol resistance skills, act as predictors of alcohol use and binge drinking initiation among Brazilian students, considering sex differences. Methods: In a longitudinal sample of 1,103 seventh-grade students from 15 Brazilian public schools, we explored if attitudes toward drug use and decision-making, communication, and alcohol resistance skills at baseline predicted alcohol outcomes 9 months later. Results: Lower levels of resistance skills (i.e., ORboys = 0.29; 95%CI 0.12-0.70) and positive attitudes toward drugs (i.e., ORgirls: = 1.41; 95%CI 1.02-1.94) were predictors of alcohol use onset and binge drinking, independently of sex. Decision-making predicted binge drinking initiation, but only for girls (OR = 0.73; 95%CI 0.59-0.91). Negative attitudes toward drugs were a risk factor for alcohol use initiation, but only for boys (OR = 0.78; 95%CI 0.64-0.95). Conclusion: Our findings highlight the importance of understanding the predictors of alcohol initiation in adolescents, to inform which key components preventive programs should address in their activities to achieve the expected preventive outcomes.

Objective: The practice of using drugs to modulate experiences is a well-documented phenomenon worldwide, particularly among men who have sex with men (MSM). This study aims to describe patterns of drug combinations used by Brazilian MSM, embracing a detailed examination of the Brazilian context, which may inspire research elsewhere while enriching the global panorama on MSM drug use. By focusing on Brazilian MSM, the study sheds light on specific drug use combinations, which may help in the development of effective, culturally sensitive public health strategies. Methods: This investigation was conducted within the Latin American MSM Internet Survey, a pioneer online study addressing psychosocial and sexual health of MSM in the region. Conducted from January to May 2018, the survey garnered responses from over 18,139 Brazilian MSM. Using exploratory factor analysis through maximum likelihood estimation, the study identified distinct sub-groups of drug users among 15,499 participants after exclusion due to discrepant responses (Kaiser-Meyer-Olkin measure = 0.94 and Bartlett’s test ≤ 0.01), indicating adequate sampling and suitability for factor analysis across all substances. Results: The factor analysis revealed four primary drug combination groups among participants: Group One (Heavy Drug Users), Group Two (Party Drug Users), Group Three (Conservative Users), and Group Four (Classic Chemsex Users). Each group represents unique drug use patterns and preferences, from the use of potent stimulants to more socially accepted substances like tobacco and cannabis. Notably, Group One, identified as “heavy” drugs users, used particularly risky substances, including mephedrone, crack, crystal meth, heroin, and other synthetic stimulants. Conclusion: The findings reveal diverse and complex drug use patterns among MSM in Brazil. Understanding these patterns is essential for developing targeted interventions and support mechanisms for various sub-groups among MSM. Future research should focus on the health outcomes associated with these patterns and the social and psychological contexts of drug use.

Objective: To explore the association of 75 candidate genes previously reported in subjects with anxiety symptoms (AS) and depressive symptoms (DS) with such symptomatology in a Mexican cohort. Methods: The sample included 2,012 individuals from the Mexican Genomic Database for Addiction Research (MxGDAR/Encodat) cohort: 198 with AS, 266 with DS, 66 with both anxiety and depressive symptoms (ADS), and 1,482 healthy controls. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) screening questionnaire was used to evaluate lifetime AS and DS. The sample was genotyped with the commercial microarray PsychArray BeadChip. We identified 707 single nucleotide polymorphisms (SNPs) of 75 genes previously associated with AS and DS. The PLINK logistic regression approach was performed to analyze the association between these SNPs and AS, DS, and ADS. Results: The analysis identified significant associations of LAMA SNP rs2437092 (p = 3.89 × 10-5) and MYO1H SNP rs11066591 (p = 4.06 × 10-5) with anxiety and depressive symptoms. Additionally, MBD5 SNPs rs7578002 and rs1234428 were associated with DS (p = 7.9 × 10-6 and p = 1.94 × 10-5, respectively). However, after adjustment for age, sex, and the three genetic principal components, only the associations of rs7578002 and rs1234428 with DS remained (p = 5.85 × 10-5 and p = 8.15 × 10-5, respectively). Conclusions: Our study replicated the association between MBD5 and DS. The MBD5 protein is involved in gene silencing, suggesting its potential implication in the development of DS in the Mexican population.

Objective: To evaluate the effect of narrative therapy on post-traumatic stress disorder (PTSD) symptoms, perceived stress, anxiety, and depression in nurses. Methods: A total of 92 clinical nurses with positive PTSD symptom screening results were randomly assigned (1:1) to the intervention or control group. The intervention group received narrative therapy and a psychological stress leaflet, while the control group received only a psychological stress leaflet. PTSD, perceived stress, anxiety, and depression were measured before and after the intervention to assess the effect of narrative therapy. Results: After the intervention, the intervention group showed significantly lower PTSD symptom levels (p = 0.025), perceived stress (p = 0.033), anxiety (p = 0.004), and depression (p = 0.015) than the control group. Regarding the dichotomous PTSD, anxiety, and depression outcomes, there was a statistically significant decrease in the number of positive cases of PTSD (p = 0.030) and anxiety (p = 0.002), but no significant change in the number of positive cases of depression (p = 0.060). Conclusion: Narrative therapy is expected to alleviate PTSD symptoms, stress, anxiety, and depression among frontline clinical nurses, and healthcare managers should consider narrative therapy interventions to improve the mental health of their nursing staff. Clinical trial registration: ChiCTR2200058472. Registration date: April 09, 2022. Date of first recruitment: June 1, 2022.

Objective: Suicide represents 1% of all deaths in the world, and it is more prevalent in developing countries. Because suicide mortality has been growing in recent years in Brazil, we investigated whether patients who committed suicide in 2022 in Fortaleza sought care in the state’s only psychiatric emergency service before the act. Methods: This retrospective cross-sectional study used data from electronic psychiatric emergency records and reports from the state department of forensics. Results: A total of 292 deaths (25% women) were identified, representing almost 2% of mortality in Fortaleza that year. Only 2.7% of those who committed suicide during this period requested an emergency psychiatric evaluation in the 3 months prior to death. Of these individuals, 75% mentioned suicidal ideation. Most deaths (70%) were due to hanging. Conclusion: The majority of patients who committed suicide in Fortaleza in 2022 did not seek care from the psychiatric emergency service prior to the event; further studies are needed to investigate the causes of this behavior.

Objective: To assess longitudinal patterns of anxiety, depression, and posttraumatic stress symptoms, as well as their predictors, among workers at a referral hospital during the first two waves of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. Methods: Data were collected between July 2020 and June 2021 (n=1,078). Anxiety, depression, and posttraumatic stress symptoms were assessed using three self-report scales: the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Impact of Event Scale-Revised (IES-R). Predictor analysis included COVID-19-related events, fear of COVID-19, and institutional support. Statistical analysis involved linear mixed models (LMM) and local polynomial regressions. Results: Anxiety and depression trended towards increased reactivity, while posttraumatic stress presented a downward trend over follow-up, with less fluctuation. Predictor analysis showed that higher levels of institutional support were associated with a reduced risk of all adverse mental health outcomes; conversely, greater fear of COVID-19 was positively associated with all such outcomes. Conclusion: Our findings underscore the importance of allocating enhanced attention and resources to effectively addressing personal health challenges among the health workforce, emphasizing the significance of organizational support and continuous monitoring of emotional distress.

Objective: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, they have some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia; in recent years, interest in its use in patients with psychotic disorders has been increasing. This meta-analysis aims to evaluate the effectiveness of CBT-I for sleep problems in patients with psychotic disorders. Methods: A systematic search of the PubMed, Scopus, and EBSCO (MEDLINE) databases was conducted to identify relevant studies. The inclusion criteria were randomized controlled trials (RCTs) and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had had sleep problems for at least 1 month, and who were receiving treatment. The initial search yielded 246 studies, of which eight were ultimately selected for meta-analysis after screening and applying inclusion and exclusion criteria. Statistical analysis was conducted in the R software environment. Results: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders in both the short and long term. Additionally, CBT-I leads to significant improvement in psychotic symptoms in the short-term period and contributes significantly to improvement in mental well-being in both short- and long-term follow-up. Conclusions: CBT-I is an effective, valuable method for sleep problems in patients with psychotic disorders. Its widespread use for this purpose is recommended.

Objective: In this population-based cohort study, we compared the risks of incident hyperopia, myopia, astigmatism, and strabismus between children with autism spectrum disorder (ASD) and those without ASD. Methods: This study included children who were born in Taiwan at any time between 2004 and 2017, using data from the Taiwan Maternal and Child Health Database (TMCHD). We included 20,688 children with ASD and 2,062,120 matched controls to estimate the risks of incident hyperopia, myopia, astigmatism, and strabismus. Cox proportional hazards regression models were conducted for risk assessment. Models were adjusted for sex, calendar year of birth, and gestational age at birth. Statistical significance was determined through adjusted hazard ratios (aHRs) and 95%CIs. Results: Children with ASD had higher risks of incident hyperopia (aHR: 1.78; 95%CI 1.70-1.86), myopia (aHR: 1.27; 95%CI 1.24-1.30), astigmatism (aHR: 1.51; 95%CI 1.46-1.56), and strabismus (aHR: 2.18; 95%CI 2.05-2.32) compared to children without ASD. Conclusion: Clinicians should screen children with ASD for potential eye conditions. Further studies are required to elucidate the mechanisms linking ASD with eye diseases. In addition, studies should explore how the type and severity of ASD symptoms influence the detection of these eye conditions.

Objective: To study the impacts of maternal depressive symptoms trajectories and harsh parenting and explore if the maternal quality of life (QoL) mediates this association. Methods: We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal study from Pelotas, Brazil (n=3,285 mothers, complete cases analysis). We used the Edinburgh Postnatal Depression Scale (EPDS) to assess maternal depressive symptoms and calculated their trajectories from 3 months until the 11-year follow-up using a group-based modeling approach. Psychological and physical aggression were measured using the Parent-Child Conflict Tactics Scale (CTSPC). Maternal QoL was measured by the question “How is your quality of life?” Data were analyzed using path models in Mplus. Results: All maternal depressive symptoms trajectories increased the frequency of psychological and physical aggression at early adolescence when compared to the reference group. Mediation analysis indicated that maternal depressive symptoms led to low levels of perceived maternal QoL, which in turn was associated with increased use of harsh parenting. The proportion of total effect explained by maternal QoL ranged from 4.04% (0.00-5.58%) to 16.31% (10.88-19.10%). Conclusion: Our findings, within a longitudinal framework from a middle-income country, support existing evidence that maternal depressive symptoms are associated with harsh parenting. Our results also suggest that one mechanism underlying this association is lower perceived maternal QoL.

Objective: We investigated whether a wide range of baseline mental disorders among university students predict Internet gaming disorder (IGD) 1 to 3 years later. Methods: This prospective cohort study was conducted in six Mexican universities and had a 1- to 3-year follow-up period (September 2018 to June 2022). Participants were 1st-year university students (n=2,144) free of symptoms indicative of IGD at entry (baseline). Ten mental disorders (bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences, and attention deficit hyperactivity disorder) at baseline were investigated as risk factors for IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate. Results: Any baseline mental disorder was associated with a 2.33 times (1.26-4.31) higher rate of IGD 1 to 3 years later. Several individual disorders were associated with rates of IGD in multiple models, with comorbid conditions diminishing most of these associations. Conclusion: Only major depressive disorder and bipolar disorder remained associated with new cases of IGD. The discrepant results of longitudinal studies on the role of specific mental disorders in the development of IGD should be further investigated.

Objective: This study investigated whether moral harassment contributes to anxiety, depression, and burnout among medical residents. Methods: This three-stage longitudinal study involved 218 1st-year residents, of whom 76 (34.9%) participated in all stages. The questionnaire covered demographics, mental health (using the Patient Health Questionnaire-4), burnout (using the Maslach Burnout Inventory Human Services Survey), and harassment experiences. Mental health outcomes and harassment were analyzed using logistic regression. Results: Anxiety and depression scores varied significantly, including a notable decrease in the personal accomplishment dimension of burnout. The prevalence of harassment was above 90%, and most victims were disturbed by the harassment they suffered. While a direct correlation between harassment victimization and reduced mental health was not found, seeking help exacerbated suffering, and depression and emotional exhaustion increased less among surgical residents. Conclusion: To the extent of our knowledge, this is the first longitudinal study on mental health and harassment among medical residents. The mental suffering experienced after taking action against harassment suggests that safe environments for addressing these issues are lacking in medical residencies. Further studies concerning surgical residents could shed light on their lower levels of suffering. Institutional changes are needed to support victims and create a healthy environment.

Objective: Patients at risk of psychosis present a variety of symptoms, and identifying the most discriminative symptoms is essential for efficient detection and treatment. Methods: This cross-sectional online study analyzed individuals from the general population to better assess their risk of symptoms classified as clinical high risk (CHR) for psychosis. The 16-item Prodromal Questionnaire was applied as a self-report screening tool. Item response theory with a graded response model was used to assess the discrimination and difficulty of the questionnaire’s criteria. Results: The analysis included 936 participants (mean age: 21.5 years; 71.9% women). “Déjà vu” stood out for its high discriminative power, while the “voices or whispers” and “seeing things” items had greater precision than the other CHR-related symptoms. Conversely, the “smell or taste” and “changing faces” items were associated with the most severe cases. Conclusion: This study identified the most indicative CHR-related symptoms for accurate assessment of psychosis severity, which can be used to guide targeted preventative interventions.

Objective: Functionality and quality of life levels were measured in caregivers of patients with bipolar disorder, investigating the associations between them and with clinical and sociodemographic data. Method: A cross-sectional study was conducted between 2020 and 2022 with caregivers of patients with bipolar disorder treated in a university hospital’s outpatient clinic. The following instruments were applied: a clinical and sociodemographic questionnaire, the World Health Organization Disability Assessment Schedule 2.0, the 36-Item Short Form Health Survey, the Mini International Neuropsychiatric Interview Plus, and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results: The median World Health Organization Disability Assessment Schedule 2.0 score was < 20, and the median score on the 36-Item Short Form Health Survey domains was > 60. Caregivers with greater functional impairment had lower quality of life. Being younger, being a parent, having non-psychiatric clinical conditions, and having mental disorders were associated with lower quality of life and functionality. Conclusion: These results indicate less functional impairment and better perceived quality of life than what has been reported in the literature, demonstrating that there is a subgroup of caregivers who perform their role without significant compromise to these health aspects. Exploring other factors associated with functionality and quality of life, such as resilience, psychological support, etc., may allow for more targeted public health interventions, optimizing comprehensive bidirectional care for patients and caregivers.