Publications by authors named "Luciana de Avila Quevedo"

44 Publications

Brief cognitive behavioral therapy in pregnant women at risk of postpartum depression: Pre-post therapy study in a city in southern Brazil.

J Affect Disord 2021 Jul 30;290:15-22. Epub 2021 Apr 30.

Catholic University of Pelotas, Brazil; PQ CNPq, Brazil.

Background: Postpartum depression (PPD) affects a high number of women, often the first manifestation of a mood disorder that will occur later in life, bringing serious consequences for the patient and her offspring. Depression today is the leading cause of disability worldwide. The aim of this study was to evaluate the effectiveness of a preventive cognitive behavioral therapy (CBT) for PPD.

Methods: Pre-post therapy study, as part of a population-based cohort study. Pregnant women without a diagnosis of depression participated, who were divided into two groups: risk of depression (CBT) and a control group (without therapy). The preventive therapy consisted of six sessions of CBT, administered weekly. The Outcome Questionnaire (OQ-45) was used in all sessions. The Mini International Neuropsychiatric Interview and Beck Depression Inventory-II were used on three occasions. The final statistical analyses were performed by Poisson regression.

Results: The prevalence of PPD in the risk group was 5.5% and in the control group 2.2%, with no difference between the groups (PR 1.66 95% CI 0.44-6.18). The OQ-45 averages gradually reduced during the therapy sessions, indicating therapeutic progress. Schooling was an associated factor, both with the manifestation of PPD and with the greater effectiveness of the therapy.

Limitations: Rate of 40.5% refusal to preventive treatment and absence of a group with similar characteristics in another therapy model.

Conclusions: Brief cognitive behavioral therapy applied by mental health professionals with basic training was effective in preventing the manifestation of PPD.
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http://dx.doi.org/10.1016/j.jad.2021.04.031DOI Listing
July 2021

Maternal-fetal attachment and perceived parental bonds of pregnant women.

Early Hum Dev 2021 Mar 22;154:105310. Epub 2021 Jan 22.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 373 - 411 C, 96015-560 Pelotas, RS, Brazil. Electronic address:

Background: The parental bond is characterized by the perception of care and protection received by parental figures throughout human development. During the gestational period, the intensity in which the woman manifests behaviors and feelings for the fetus was denominated maternal-fetal attachment (MFA). In this perspective, the literature indicates that there is association between MFA and the pregnant woman's perception about the bond established with her parents.

Aims: This study aimed to evaluate the association between MFA and perceived parental bonds of pregnant women in the city of Pelotas/RS (Brazil).

Study Design: This is a cohort study with 839 women during their gestational period. All women answered to the Parental Bonding Instrument to investigate the perceived parental bonds, and the MFA was assessed through the Maternal-Fetal Attachment Scale.

Results: The main results showed that perceived paternal overprotection was associated with a higher MFA after adjustment (B 2.00 CI95% 0.30; 3.70). Additionally, the pregnant women who were in the first trimester of pregnancy (p < 0.001), who did not live with a partner (p = 0.018), and who did not feel supported by the baby's father during pregnancy (p = 0.014) presented lower scores of MFA.

Conclusion: This study showed the importance of the paternal role in the women's life, considering the perception of the bond with their father during their development, an adequate support by the father of the baby, and the presence of a partner during pregnancy. As a result, the paternal role may influence the feelings and behaviors of greater affection, care, and concern regarding the fetus.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910275PMC
March 2021

Maternal-fetal attachment and perceived parental bonds of pregnant women.

Early Hum Dev 2021 Mar 22;154:105310. Epub 2021 Jan 22.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 373 - 411 C, 96015-560 Pelotas, RS, Brazil. Electronic address:

Background: The parental bond is characterized by the perception of care and protection received by parental figures throughout human development. During the gestational period, the intensity in which the woman manifests behaviors and feelings for the fetus was denominated maternal-fetal attachment (MFA). In this perspective, the literature indicates that there is association between MFA and the pregnant woman's perception about the bond established with her parents.

Aims: This study aimed to evaluate the association between MFA and perceived parental bonds of pregnant women in the city of Pelotas/RS (Brazil).

Study Design: This is a cohort study with 839 women during their gestational period. All women answered to the Parental Bonding Instrument to investigate the perceived parental bonds, and the MFA was assessed through the Maternal-Fetal Attachment Scale.

Results: The main results showed that perceived paternal overprotection was associated with a higher MFA after adjustment (B 2.00 CI95% 0.30; 3.70). Additionally, the pregnant women who were in the first trimester of pregnancy (p < 0.001), who did not live with a partner (p = 0.018), and who did not feel supported by the baby's father during pregnancy (p = 0.014) presented lower scores of MFA.

Conclusion: This study showed the importance of the paternal role in the women's life, considering the perception of the bond with their father during their development, an adequate support by the father of the baby, and the presence of a partner during pregnancy. As a result, the paternal role may influence the feelings and behaviors of greater affection, care, and concern regarding the fetus.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910275PMC
March 2021

Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation.

Int J Soc Psychiatry 2020 Dec 9:20764020981107. Epub 2020 Dec 9.

Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil.

Background: Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA).

Aims: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient.

Method: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR).

Results: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them ( = .011). The obsessions associated with higher levels of family accommodation were: contamination ( < .001), hoarding/saving ( = .001), symmetry/exactness ( = .001), religious ( = .019), and diverse ( = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation ( < .05).

Conclusion: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
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http://dx.doi.org/10.1177/0020764020981107DOI Listing
December 2020

Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation.

Int J Soc Psychiatry 2020 Dec 9:20764020981107. Epub 2020 Dec 9.

Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil.

Background: Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA).

Aims: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient.

Method: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR).

Results: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them ( = .011). The obsessions associated with higher levels of family accommodation were: contamination ( < .001), hoarding/saving ( = .001), symmetry/exactness ( = .001), religious ( = .019), and diverse ( = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation ( < .05).

Conclusion: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
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http://dx.doi.org/10.1177/0020764020981107DOI Listing
December 2020

Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation.

Int J Soc Psychiatry 2020 Dec 9:20764020981107. Epub 2020 Dec 9.

Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil.

Background: Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA).

Aims: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient.

Method: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR).

Results: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them ( = .011). The obsessions associated with higher levels of family accommodation were: contamination ( < .001), hoarding/saving ( = .001), symmetry/exactness ( = .001), religious ( = .019), and diverse ( = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation ( < .05).

Conclusion: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
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http://dx.doi.org/10.1177/0020764020981107DOI Listing
December 2020

How sex differences in schooling and income contribute to sex differences in depression, anxiety and common mental disorders: The mental health sex-gap in a birth cohort from Brazil.

J Affect Disord 2020 09 26;274:977-985. Epub 2020 May 26.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil. Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro - Pelotas, RS. Cep: 96020-220 - Caixa Postal 464. Phone: +55 (53) 3284 - 1300. Electronic address:

Background: Reasons for the higher rates of depression, anxiety and common mental disorders among women are unclear. We investigated the mediating effect of schooling and personal income and the effect modification of maternal schooling and family income at baseline.

Methods: In 1982, the maternity hospitals of Pelotas (Southern Brazil) were daily visits and those livebirths whose family lived in the urban area of the city were examined and their mothers interviewed. At 30 years, the presence of major depression (MD) and generalized anxiety disorder (GAD) was assessed using the Mini-International Psychiatric Interview, and common mental disorders (CMD) with the self-rated questionnaire. We used Mantel-Haenszel test to assess effect modification and a counterfactual framework using inverse probability weights (IPW) and G-computation to analyze mediation.

Results: Income at 30 years captured part of the association of sex with MD (16.5%), GAD (14.2%), and CMD (18.0%). Schooling at 30 years was higher in women (p<0.001), and therefore inversely mediated the association with MD (-5.4%), GAD (-4.8%), and CMD (-6.7%). If we fixed the mediator to earning more than 3 minimum salaries, the effect of sex, was reduced in 64.9%, 56.7% and 31.4%, for MD, GAD and CMD, respectively, and 62.4%, 13.6% and 23.8%, if fixed to 12 or more years of schooling.

Limitations: We were not able to evaluate mental health and socioeconomic changes, or assess a bidirectional effect CONCLUSION: Personal income and schooling at 30 years, are important mediators and effect modifiers of the association between sex and MD, GAD, and CMD.
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http://dx.doi.org/10.1016/j.jad.2020.05.033DOI Listing
September 2020

Generalized Anxiety Disorder, Depressive Symptoms and the Occurrence of Stressors Events in a Probabilistic Sample of Pregnant Women.

Psychiatr Q 2021 03;92(1):123-133

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil.

The aim of the study is to verify the association between GAD, the severity of depressive symptoms and stressors in pregnant women between the first and second trimester. Cross-sectional study, part of a cohort that followed 980 women during the gestational period of a city in southern Brazil. We performed bivariate analysis using the t-test and chi-square. The variables that presented p ≤ 0.20 were taken for multivariate analysis, through logistic regression, in order to control possible confounding factors. The Mini International Neuropsychiatric Interview Plus was used to evaluate GAD, the severity of depressive symptoms was investigated through the Beck Inventory of Depression II, and stress events according to the Social Readjustment Assessment Scale of Holmes e Rahe. The sample consisted of 980 women. Women with mild depression symptoms had 9.8 (IC95% 4.6;21.0) times more GAD, those with moderate symptoms had 27.5 (IC95% 12.5;60.0) times more GAD, and those with severe symptoms had 52.9 (IC95% 19.1;146.5) times more GAD when compared to pregnant women with no symptoms or minimal symptoms. Regarding the stressful events, the pregnant women who presented GAD had an increase of 1.0 (IC95% 1.0;1.1) point in the mean of occurrence of stressor events when compared to those without GAD. These findings highlight the need for prevention strategies and interventions to promote maternal mental health, which benefit the development of infants in the long term.
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http://dx.doi.org/10.1007/s11126-020-09763-0DOI Listing
March 2021

Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort.

Rev Bras Enferm 2020 10;73(1):e20180162. Epub 2020 Feb 10.

Universidade Federal de Pelotas. Pelotas, Rio Grande do Sul, Brazil.

Objective: To describe the association between common mental disorders and socio-demographic variables, smoking habits and stressful events among the 30-year-old members of a 1982 cohort.

Method: Mental disorder was analyzed by the Self-Reporting Questionnaire (SRQ-20). Poisson regression was used to analyze the unadjusted and adjusted associations.

Results: Low level of education and stressful events increased the prevalence of mental disorders for both genders. Lower income for women and unemployment for men also remained associated with CMD.

Conclusion: It was possible to describe the association between contemporary factors and mental disorders in a young population, to which prevention and control measures, through public policies proposed to the areas of Primary Care, Mental Health and Education, can represent a better quality of life and health.
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http://dx.doi.org/10.1590/0034-7167-2018-0162DOI Listing
November 2020

Thimerosal-containing vaccines and deficit in child development: Population-based study in southern Brazil.

Vaccine 2020 02 31;38(9):2216-2220. Epub 2020 Jan 31.

Postgraduate Programme in Health and Behavior - Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C - 96015-560, Pelotas, RS, Brazil.

Background: The discussion on the safety of thimerosal-containing vaccines (TCVs) and their impact on child development it́s very relevant.

Methods: This is a cohort study with mother-child dyads who received prenatal care in the Unified Health System. The domains of motor, cognitive and language development were evaluated in children between 24 and 36 months of age. Data on vaccination were obtained through the child's immunization record. A linear regression analysis was carried out considering possible confounders.

Results: In bivariate analyses, motor and language development were associated with TCVs (p < 0.05). However, in the multivariate analysis, this association was not maintained (p > 0.05). These results indicate that the use of TCVs is not associated with child development. The importance of this study is summarized in transmitting relevant information regarding public health, based on reliable data.
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http://dx.doi.org/10.1016/j.vaccine.2019.12.044DOI Listing
February 2020

Changes in young children's oral health-related behaviours and caregiver knowledge: A cluster randomized controlled trial in Brazil.

Community Dent Oral Epidemiol 2020 02 15;48(1):81-87. Epub 2019 Dec 15.

Graduate School of Dentistry, Pelotas Federal University, Pelotas, Brazil.

Objective: To evaluate the effectiveness of an intervention to improve young children's oral health-related behaviours and caregiver knowledge.

Methods: This paper reports on findings from a cluster randomized controlled trial, 12 months after of baseline, conducted in Pelotas, Southern Brazil. Two Primary Healthcare Centers (PHCs) and 170 caregiver-child dyads were assigned to an intervention group, and two PHCs and 174 dyads were assigned to a control group. Children's oral hygiene behaviours, sugar consumption and use of dental services were the outcomes analysed as well as changes in caregiver knowledge. The impact of the intervention was assessed using multilevel mixed-effects model regressions and the change rate ratios (IRR) were expressed.

Results: There were positive and significant changes in favour of the intervention group in children's oral hygiene behaviours, use of dental services, and caregivers' knowledge of oral health. For example, children in the intervention group were more likely to have brushed with fluoride toothpaste at least two times a day (IRR 1.43, 95% CI 1.06-1.92), to have brushed their teeth before bedtime (IRR 1.37, 95% CI 1.02-1.84), and to have used dental services for preventive care (IRR 2.54, 95% CI 2.02-3.19) than children in the control group.

Conclusion: This intervention had positive effects on children's oral health-related behaviours and caregivers' oral health knowledge.
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http://dx.doi.org/10.1111/cdoe.12507DOI Listing
February 2020

Childhood trauma and depressive symptoms in pregnant adolescents in Southern Brazil.

Int J Public Health 2020 Mar 19;65(2):197-205. Epub 2019 Nov 19.

Postgraduate Programme in Health and Behavior, Catolic University of Pelotas-UCPel, Pelotas, RS, Brazil.

Objectives: This study aimed to investigate the association between child maltreatment and depressive symptomatology during gestation in adolescents.

Methods: This was a cross-sectional study with pregnant adolescents aged 12 to 19 years. Data were collected with the Beck Depression Inventory, Childhood Trauma Questionnaire, and Mini International Neuropsychiatric Interview.

Results: Compared to adolescents who did not experience each type of neglect or abuse, experiencing them was associated with a higher proportion of depressive symptoms: emotional neglect PR = 1.4 (95% CI 1.1; 1.8); physical neglect PR = 1.7 (95% CI 1.3; 1.7); emotional abuse PR = 1.8 (95% CI 1.4; 2.2); and physical abuse PR = 1.3 (95% CI 1.1; 1.7).

Conclusions: This study demonstrates the association between childhood experiences and mental health in adolescence, especially in vulnerable samples, such as pregnant adolescents. This finding reveals the importance of studying early trauma in life and enabling preventive help, especially in adolescents. High-quality evidence of perinatal mental health problems should be generated to make pregnancy safer for women in low- and middle-income countries.
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http://dx.doi.org/10.1007/s00038-019-01311-3DOI Listing
March 2020

Prevalence of mental health problems in preschoolers and the impact of maternal depression.

Eur Child Adolesc Psychiatry 2020 May 7;29(5):605-616. Epub 2019 Aug 7.

Postgraduate Programme in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.

A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4-5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2-3 years old and 4-5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4-5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4-5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.
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http://dx.doi.org/10.1007/s00787-019-01381-xDOI Listing
May 2020

The influence of therapeutic alliance in the quality of life of obsessive-compulsive disorder patients: An intervention study.

Gen Hosp Psychiatry 2020 May - Jun;64:112-114. Epub 2019 Jun 15.

Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Gonçalves Chaves, 377 - 411 C, 96015-560, Pelotas, RS, Brazil.

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http://dx.doi.org/10.1016/j.genhosppsych.2019.06.007DOI Listing
May 2021

The perception of parental bonding in pregnant adolescents and its association with generalized anxiety disorder.

Eur Psychiatry 2018 10 24;54:51-56. Epub 2018 Aug 24.

Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil.

Background: The parental bonding is influenced by two dimensions: care and control or protection over the child of both parents. The lack of care during childhood may make the individual more susceptible to the onset of psychiatric disorders when adult. These psychiatric disorders when present during pregnancy may have a negative impact on the health of pregnant women and children. The aim of this study was to assess the association between generalized anxiety disorder (GAD) in pregnant adolescents and the perception of parental bonding.

Methods: This is a cross-sectional study with 871 pregnant women under the age of 19, receiving prenatal care in 47 Basic Health Units in the one city, Brazil. The generalized anxiety disorder was measured using the Mini International Neuropsychiatric Interview (MINI) and the perception of parental bonding in childhood using the Parental Bonding Instrument (PBI).

Results: The prevalence of GAD was 8.5%. Among all the parental bonding dimensions, only a perceived lack of maternal care under 16 years was associated with GAD.

Conclusions: The results showed that only the perception of maternal bonding was associated with later GAD. It suggests that an adequate maternal bond is an essential component of psychological health.
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http://dx.doi.org/10.1016/j.eurpsy.2018.07.011DOI Listing
October 2018

A Randomized, Controlled Trial of the Effectiveness of a Psychoeducational Intervention on Family Caregivers of Patients with Mental Disorders.

Community Ment Health J 2018 02 25;54(2):211-217. Epub 2017 Apr 25.

Postgraduate Programme in Health and Behavior, Universidade Católica de Pelotas-UCPel, Gonçalves Chaves, 377-411 C, Pelotas, CEP 96015-560, Brazil.

The present study aimed to investigate the effectiveness of a psychoeducational intervention on caregivers of patients assisted by the Center for Psychosocial Health Care (CPHC) focusing on the patient's psychopathology. This was a randomized clinical trial with 130 caregivers with higher mean burden scores assessed using the Zarit Burden Interview Scale (ZBI) (66 caregivers in the intervention group and 64 in the control group). The intervention included six home visits of psychoeducational interventions according to each mental disorder identified in the CPHC records. The intervention group had a reduction of 4.8 points in ZBI mean score (p = 0.008) and in the control group, the reduction was 1.9 points, which was not significant (p = 0.305). It is possible to think that psychoeducation may have served to inform about the disease and how to deal with it, to give emotional support to caregivers and to implement coping strategies and stress management.
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http://dx.doi.org/10.1007/s10597-017-0126-7DOI Listing
February 2018

[Quality of life with Obsessive-Compulsive Disorder: a study among Primary Care users].

Cien Saude Colet 2017 Apr;22(4):1353-1360

Programa de Pós-Graduação em Saúde e Comportamento da Universidade Católica de Pelotas (UCPel). R. Gonçalves Chaves 373/prédio C/411, Centro. 96015-560 Pelotas RS Brasil.

Quality of life (QOL) can be affected by the presence of mental disorders, like Obsessive-Compulsive Disorder (OCD). Thus, the evaluation and monitoring of QOL in patients with mental disorders enables the identification of priorities, making it possible to implement actions to improve QOL among health system users. The scope of this article is to measure QOL in OCD patients in primary health care. It involves a cross-sectional study with a convenience sample including all users of three Basic Health Units of Pelotas in the State of Rio Grande do Sul, Brazil. The quality of life was measured with the WHOQOL-Bref and the OCD was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.) This study included 1081 individuals. The prevalence of OCD was 3.9%. OCD patients had a lower average in all domains of QOL when compared to individuals without OCD (p < 0.001). The findings of this study emphasize the importance of using QOL as a monitoring tool of the disorder in basic health care.
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http://dx.doi.org/10.1590/1413-81232017224.02062015DOI Listing
April 2017

Maternal Depression Increases Childhood Dental Caries: A Cohort Study in Brazil.

Caries Res 2017 30;51(1):17-25. Epub 2016 Nov 30.

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.

Aim: To investigate the relationship between maternal depression and childhood caries in a cohort of adolescent mothers.

Methods: This cross-sectional study nested in a cohort evaluated a sample of 538 mother/child dyads. When the children were 24-36 months of age, data regarding oral health from children and mothers were collected by clinical dental examination. A mother's major depressive disorder was assessed by using the Mini International Neuropsychiatric Interview (MINI [Plus]), at the current moment. Independent variables were obtained by using questionnaires. The outcome on dental caries experience was dichotomized by using 2 cut points: dmfs ≥1 and dmfs ≥3. Poisson regression analysis, using a hierarchical approach, was applied to assess the association between major depressive disorder in mothers with and those without caries experience and the outcome.

Results: The prevalence of dental caries in children was 15.1% (n = 82). The mean dmfs index was 1.12 (SD = 3.72). The prevalence of major depressive disorder was 32.6% (n = 168). An interaction between caries status and depressive disorder was found, and after adjusted analysis, children from mothers with major depressive disorder with negative caries experience presented a higher caries prevalence (prevalence ratio 4.00, 95% confidence interval 1.29-12.41).

Conclusion: Our findings suggest that maternal psychiatric disorders could have a negative impact on children's oral health.
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http://dx.doi.org/10.1159/000449040DOI Listing
January 2018

Genomic ancestry and the social pathways leading to major depression in adulthood: the mediating effect of socioeconomic position and discrimination.

BMC Psychiatry 2016 09 5;16(1):308. Epub 2016 Sep 5.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro. Cep: 96020-220, Caixa Postal 464, Pelotas, RS, Brazil.

Background: Evidence suggests that there is an association between ethnicity/skin color and depression; however, many contextual and individual variables, like sense of discrimination and socioeconomic position (SEP), might influence the direction of this association. We assessed the association between African ancestry and major depression among young adults that have been followed-up since birth in a Southern Brazilian city, and the mediating effect of SEP and discrimination.

Methods: In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n = 5914). In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for major depression diagnosis. In addition, DNA samples were genotyped for approximately 2.5 million single nucleotide polymorphisms (SNPs) using Illumina (CA, USA) HumanOmni2.5-8v1 array. Genomic ancestry estimation was based on approximately 370 000 single nucleotide polymorphisms (SNPs) mutually available for the Pelotas cohort and selected samples (used as reference panels) of the HapMap and Human Genome Diversity (HGDP). We estimated prevalence ratios (PR) using Poisson regression models and evaluated the association between percentage of African ancestry and major depression. We used G-computation for mediation analysis.

Results: At 30 years, 3576 individuals were evaluated for major depression (prevalence = 7.9 %). Only individuals in the highest SEP, who had a percentage of African ancestry between >5-30 % and >30 % had a prevalence of major depression 2.16 (PR = 2.16 95 % CI [1.05-4.45]) and 2.74 (PR = 2.74 95 % CI [1.06-7.06]) times higher, than those with 5 % or less, respectively. Among these subjects, sense of discrimination by skin color, captured 84 % of the association between African ancestry and major depression.

Conclusion: SEP is an important effect modifier of the positive association between African ancestry and major depression. In addition, this association is predominantly mediated by the sense of feeling discriminated by skin color.
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http://dx.doi.org/10.1186/s12888-016-1015-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011949PMC
September 2016

Breastfeeding and mental health in adulthood: A birth cohort study in Brazil.

J Affect Disord 2016 Sep 26;202:115-9. Epub 2016 May 26.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil.

Background: Breastfeeding is negatively associate with behavioral and internalization problems, psychological stress, and depressive/anxiety symptoms. However, studies evaluating specific mental health disorders are scarce. We aimed to assess the association between breastfeeding and mental health outcomes in young adults.

Methods: In 1982, hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n=5914). Information on breastfeeding was collected in early childhood. In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of major depression (MD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD). In addition, we used the Beck Depression Inventory (BDI-II) and the Self-reported Questionnaire (SRQ-20), to evaluate depressive symptoms severity and common mental disorders (CMD), respectively. We used multivariable regression models to evaluate the association between breastfeeding and mental health outcomes.

Results: We evaluated 3657 individuals. Prevalence of CMD, MD, GAD and SAD was 24.3%, 7.9%, 12.7% and 3.6%, respectively. In multivariable models the odds of having a more severe case of depression (BDI-II) was smaller among those breastfed for 6 or more months (OR=0.69 95%CI [0.53-0.89]). We observed a similar pattern for MD and CMD, however, confidence intervals included the reference.

Limitations: We had no information on home environment characteristics during childhood. Lack of power and a small effect size could explain why we did not detect an association between breastfeeding and MD.

Conclusion: Breastfeeding reduced the odds of having more severe depressive symptoms.
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http://dx.doi.org/10.1016/j.jad.2016.05.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957542PMC
September 2016

[Effects of social mobility on adult mental health:a systematic review of the literature].

Cien Saude Colet 2016 Feb;21(2):443-8

Universidade Federal de Pelotas, Pelotas, RS, Brasil.

The scope of this study was to identify longitudinal studies evaluating the relationship between social mobility and mental disorders in adults. An electronic review of the literature was conducted in the PubMed/Medline and PsycINFO databases. The bibliographic references of the articles selected for analysis were also examined for eligibility. Cohort studies were selected taking social mobility as exposure category and mental health-related disorders as the outcome. Seven studies were reviewed and their definition and categorization of exposure and outcome were found to be heterogeneous, thus rendering analysis and comparison of the results found in the various studies difficult. Mental health-related disorders were more common in individuals belonging to lower socio-economic classes, regardless of having upward, stable or downward social mobility. Moreover, the influence of individual socio-economic conditions, assessed in adulthood, appears to be greater than the effect of parental economic status on the mental health of individuals. This review indicates that it is possible to find a relationship between socio-economic status during the course of life and mental health in adulthood. However, the direction taken by this relationship remains unclear.
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http://dx.doi.org/10.1590/1413-81232015212.17942014DOI Listing
February 2016

Trends in burnout syndrome and emotional factors: an assessment of anesthesiologists in Southern Brazil, 2012.

Psychol Health Med 2016 Jun 28;21(4):413-423. Epub 2016 Jan 28.

a Postgraduate Program in Health and Behavior , Universidade Católica de Pelotas , Pelotas , Brazil.

Burnout syndrome (BOS) is the result of chronic stress at work, and is characterized by emotional exhaustion (EE), depersonalization (DP), and low professional accomplishment. Anesthesiologyis a stressful profession. The aim of this study was to assess the prevalence of burnout as well as the sociodemographic and working characteristics associated with this syndrome's emotional factors, in anesthesiologists from Southern Brazil. We assessed burnout severity, depressive symptoms, and self-esteem using the Maslach burnout inventory, the Beck depression inventory, and the Rosenberg self-esteem scale, respectively. Of the 198 anesthesiologists included in this study, 48.7% were positive for burnout, 26.9% for EE, 41.3% for DP and 32.7% for low personal accomplishment. Trends in BOS was associated with a younger age, difficulty to conciliate family and work demands, low self-esteem, and depressive symptoms.
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http://dx.doi.org/10.1080/13548506.2016.1139143DOI Listing
June 2016

Cognitive and language performance in children is associated with maternal social anxiety disorder: A study of young mothers in southern Brazil.

Early Hum Dev 2015 Dec 16;91(12):707-11. Epub 2015 Nov 16.

Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Background: It has been shown that maternal mental health is associated with poorer skills development in the offspring. However, the evidence evaluating the association between social anxiety disorder (SAD) and cognitive or language development, is scarce.

Aim: To evaluate the association between maternal SAD and performance in cognitive and language tests in 30-month old children.

Study Design: This was a cohort study involving young women evaluated since pregnancy.

Subjects: We evaluated 520 mother-child dyads who received prenatal medical assistance through the National Public Health System in a southern Brazilian city, from October 2009 to March 2011.

Outcome Measures: We used the Mini Neuropsychiatric Interview Plus (MINI Plus) to assess SAD among young mothers. Cognitive and language performance in their offspring was analyzed using the Bayley Scales of Infant and Toddler Development - 3rd Edition.

Results: We found an association between maternal SAD and performance in cognitive and language tests. Children of mothers with SAD had in average 4.5 less points in the Bayley scale, when compared to those with mothers without SAD: in the cognitive (β=-4.53 [95% CI -7.8; -1.1] p=0.008) and language subscales (β=-4.54 [95% CI -9.0; -0.5] p=0.047).

Conclusions: Our findings suggest that children with mothers suffering from SAD have poorer cognitive abilities and language skills.
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http://dx.doi.org/10.1016/j.earlhumdev.2015.10.002DOI Listing
December 2015

The Effect of Fetal and Childhood Growth over Depression in Early Adulthood in a Southern Brazilian Birth Cohort.

PLoS One 2015 15;10(10):e0140621. Epub 2015 Oct 15.

Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Background: Poor nutrition and growth during fetal life and childhood might be associated with depression in adulthood; however, studies evaluating these associations present controversial results, especially when comparing studies using different proxies for fetal growth. We evaluated the association of fetal and childhood growth/nutrition with depression, in adulthood, using different approaches and measurement methods.

Method: In 1982, hospital births (n = 5914) in Pelotas, southern Brazil, were examined and have been prospectively followed. At 30 years, the presence of major depression and depressive symptoms severity was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). The present study assessed their association with birth weight, premature birth, small for gestational age (SGA), stunting and conditional growth during childhood.

Results: At 30 years, 3576 individuals were evaluated and 7.9% had major depression. Low birth weight (PR = 1.01 95%CI [0.64-1.60]), having been born SGA (PR = 0.87 95%CI [0.64-1.19]) and premature birth (PR = 1.22 95%CI [0.72-2.07]) were not associated with major depression in multivariable models. However, those born SGA who were also stunted in childhood had a higher prevalence of major depression (PR = 1.87 95%CI [1.06-3.29]) and greater odds of scoring a higher level of depression in the BDI-II (OR = 2.18 95%CI [1.34-3.53]).

Conclusion: In this Brazilian cohort of young adults, those born SGA who were also stunted during childhood had a higher risk of depression in adulthood. Our results show that the effect of growth impairment on depression is cumulative.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140621PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607416PMC
June 2016

Social Mobility and Mental Disorders at 30 Years of Age in Participants of the 1982 Cohort, Pelotas, Rio Grande Do Sul - RS.

PLoS One 2015 8;10(10):e0136886. Epub 2015 Oct 8.

Graduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil.

This study aimed to evaluate the relationship between mental disorders at 30 years of age and social mobility by formally testing three hypotheses: Risk Accumulation; Critical Period; and Social Mobility. The study was performed using data from the 30-year follow-up of the Pelotas Birth Cohort Study, conducted in 1982, and data from previous follow-ups. The tool used to evaluate mental health was the Self Report Questionnaire (SRQ-20). For the statistical analysis, the chi-square test with the Yates correction was used to estimate the prevalence of mental disorder, and the Poisson regression with robust variance was used to formally test the hypotheses according to the Risk Accumulation, Critical Period and Social Mobility Models. The analyses were stratified by gender. The prevalence of Common Mental Disorders (CMDs) was 24.3% (95% CI 22.9-25.7) when the whole sample was considered. The highest prevalence, 27.1% (95% CI 25.1-29.2), was found in women, and the difference between genders was significant (p < 0.001). CMDs were more frequent in participants who remained "poor" in the three follow-ups. In both men and women, the best fit was obtained with the Risk Accumulation Model, with p = 0.6348 and p = 0.2105, respectively. The results indicate the need to rethink public income maintenance policies. Finally, we suggest further studies to investigate the role of different public policies in decreasing the prevalence of mental disorders and thus contribute proposals of new policies that may contribute to the prevention of these disorders.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136886PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598184PMC
June 2016

[Stressor events in the family environment that are indicative of mental health problems in children of school age].

Cien Saude Colet 2015 Jul;20(7):2157-63

Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brasil,

The scope of this article is to evaluate the relationship between stressor events that occurred last year in the family of children and adolescents that are indicative of mental health problems in a sample of students from two schools in a city in southern Brazil. It involved a cross-sectional study with 1,075 students enrolled in two public elementary schools. The Strengths and Difficulties Questionnaire was used to assess emotional and behavioral factors of the child and the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe (1967) to assess stressor events. The chi-square and Poisson regression test with robust variance adjustment for expressing the results in the prevalence ratio (PR) and confidence intervals of 95% were used. The chances of presenting problems of hyperactivity were 1.42 (95% CI 1.10 to 1.83) times higher in the intermediate tercile and 1.37 (95% CI 1.06-1.78) in the higher tercile compared with the lower tercile. With respect to relationship problems the chances were of 1.49 (95% CI 1.15 to 1.93) times higher in the higher tercile when compared with the lower tercile. The results suggest that environmental factors may be strongly related to the etiology of mental disorders in childhood and adolescence.
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http://dx.doi.org/10.1590/1413-81232015207.17452014DOI Listing
July 2015

The Met allele of BDNF Val66Met polymorphism is associated with increased BDNF levels in generalized anxiety disorder.

Psychiatr Genet 2015 Oct;25(5):201-7

aPost Graduation in Health and Behavior, Catholic University of Pelotas, Pelotas, RS bCellular and Molecular Biology, Pontifical Catholic University of Rio Grande do Sul cEndocrinology Service dDepartment of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Generalized anxiety disorder (GAD) is a common psychiatric disorder characterized by long-term worry, tension, nervousness, fidgeting, and symptoms of autonomic system hyperactivity. The neurobiology of this disorder is still unclear, although it has been shown consistently that the environment and the genetic profile could increase its risk. We examined whether a polymorphism in the brain-derived neurotrophic factor (BDNF) gene, which plays a role in neuroplasticity and memory, could increase the vulnerability to this disorder.

Participants And Methods: In our study, 816 participants from a population-based study were genotyped by qPCR for the BDNF functional variant rs6265 (Val66Met) and the BDNF serum levels were measured by ELISA.

Results: Our results showed a significant association between the Met allele and risk for GAD (P=0.014), but no differences were observed in the serum levels of BDNF according to diagnosis (P=0.531) or genotype distribution (P=0.197). However, after stratification according to the GAD diagnosis, the Met allele was associated significantly with an increase in serum BDNF levels compared with the Val/Val genotype in GAD participants (F=3.93; P=0.048). The logistic regression analysis confirmed the independent association of Met allele as a risk factor for development of GAD after adjusting for confounder variables (β=0.528; 95% confidence interval: 0.320-0.871; P=0.012).

Conclusion: These results suggest that BDNF could be involved in the neurobiology of GAD and might represent a useful marker associated with the disease.
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http://dx.doi.org/10.1097/YPG.0000000000000097DOI Listing
October 2015

[Work overload faced by caregivers assisting frequenters of a psychosocial care center for children and adolescents in the south of Brazil].

Cien Saude Colet 2014 Dec;19(12):4819-27

Universidade Católica de Pelotas, Pelotas, RS, Brasil,

The scope of this article is to compare the work overload averages among caregivers assisting frequenters of a Psychosocial Care Center for children and adolescents (CAPSi) in Pelotas-Brazil in relation to the mental health of the children and adolescents and the caregivers themselves. It involved a cross-sectional study conducted with the primary caregiver of CAPSi frequenters. The work overload was evaluated using the Zarit Burden Interview scale and the mental health problems of frequenters were assessed using the Strengths and Difficulties Questionnaire (SDQ). To verify the presence of common potential mental disorders of caregivers, a Self-Report Questionnaire (SRQ-20) was used. T-test and ANOVA was used for data analysis. The average work overload was significantly higher in caregivers of frequenters with behavioral problems (p = 0.000), hyperactivity (p = 0.001) and relationship problems with peers (p = 0.001). IT was also significantly higher among those classified as potential cases of common mental disorders (p = 0.000); women caregivers (p = 0.032) and those with past problems with the Judiciary and/or Guardianship Council involving a frequenter (p = 0.039). The importance of work geared to caregivers to enhance the quality of care and quality of life of the caregivers themselves should be highlighted.
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http://dx.doi.org/10.1590/1413-812320141912.19182013DOI Listing
December 2014

Low birth weight, preterm birth and small for gestational age association with adult depression: systematic review and meta-analysis.

Br J Psychiatry 2014 Nov;205(5):340-7

Christian Loret de Mola, MD, MSc, Giovanny Vinícius Araújo de França, MSc, Postgraduate Programme in Epidemiology, Federal University of Pelotas; Luciana de Avila Quevedo, PhD, Postgraduate Programme in Health and Behaviour, Catholic University of Pelotas; Bernardo Lessa Horta, MD, PhD, Postgraduate Programme in Epidemiology, Federal University of Pelotas, Brazil.

Background: There is no consensus on the effects that low birth weight, premature birth and intrauterine growth have on later depression.

Aims: To review systematically the evidence on the relationship of low birth weight, smallness for gestational age (SGA) and premature birth with adult depression.

Method: We searched the literature for original studies assessing the effect of low birth weight, premature birth and SGA on adult depression. Separate meta-analyses were carried out for each exposure using random and fixed effects models. We evaluated the contribution of methodological covariates to heterogeneity using meta-regression.

Results: We identified 14 studies evaluating low birth weight, 9 premature birth and 4 SGA. Low birth weight increased the odds of depression (OR = 1.39, 95% CI 1.21-1.60). Premature birth and SGA were not associated with depression, but publication bias might have underestimated the effect of the former and only four studies evaluated SGA.

Conclusions: Low birth weight was associated with depression. Future studies evaluating premature birth and SGA are needed.
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http://dx.doi.org/10.1192/bjp.bp.113.139014DOI Listing
November 2014

The impact of anxious symptoms in the remission of depressive symptoms in a clinical trial for depression: follow-up of six months.

J Affect Disord 2014 Oct 21;168:331-6. Epub 2014 Apr 21.

Universidade Católica de Pelotas-Programa de pós-graduação em Saúde e Comportamento, Rua Gonçalves Chaves, 373, Sala 416C, Centro CEP 96015-560, Brazil. Electronic address:

Background: Studies show high comorbidity between anxiety disorder and depression. Little is known regarding how anxiety symptoms affect prognosis in depression treatment, suggesting the importance of studying the impact of anxiety symptoms in the treatment of depression. We evaluated the impact of anxiety symptoms in the remission of depressive symptoms after brief psychotherapies for depression.

Methods: This randomized clinical trial of 18-29-year-old adults included individuals who met the diagnostic criteria for depression as assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD); anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HARS). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP). Both treatments included seven sessions. At the end of the treatment and six-month follow-up, an evaluation was made with the HRSD and HARS. The sample included 97 patients divided between the protocols of psychotherapy.

Results: There was a significant, positive, moderate correlation between the severity of anxiety symptoms at baseline and the remission of depressive symptoms at post-intervention (r=0.38 p<0.001) as well as a significant, positive, low correlation at follow up (r=0.20 p=0.049). We found remission of anxiety symptoms and depressive symptoms after brief psychotherapies, and the remission persisted at follow up.

Limitation: We did not evaluate the diagnosis of anxiety disorders.

Conclusion: The severity of anxiety symptoms did not compromise the treatment focused primarily on depressive symptoms.
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http://dx.doi.org/10.1016/j.jad.2014.03.034DOI Listing
October 2014