Publications by authors named "Ricardo Azevedo da Silva"

119 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

Cognitive complaints in individuals recently diagnosed with bipolar disorder: A cross-sectional study.

Psychiatry Res 2021 Jun 21;300:113894. Epub 2021 Mar 21.

Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Aim: To assess the differences in subjective cognitive dysfunction between major depressive disorder (MDD) and recently diagnosed Bipolar Disorder (BD) across euthymia and mood episodes.

Methods: This is a cross-sectional study corresponding to the second wave of a longitudinal study. The first wave consisted of subjects aged between 18 and 60 diagnosed with MDD. In the follow up after three years (second wave), conversion from MDD to BD diagnosis was assessed by qualified psychologists using the Mini International Neuropsychiatric Interview (MINI-Plus). Subjects were categorized in four diagnostic groups: euthymic MDD, MDD in a current mood episode, euthymic BD, and BD in a current mood episode. All subjects completed the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), an instrument specifically designed for detecting subjective cognitive deficits in BD.

Results: The total sample (n = 468) included 410 subjects with MDD and 58 individuals recently diagnosed with BD. We subdivided the 2 groups based on their current mood state, and found a significant difference in COBRA total scores between euthymic BD individuals (median 17.00 [IQR: 8.75 - 20.75]) and euthymic MDD subjects (median 8.00 [IRQ: 5.00 - 14.00], p = 0.002), showing higher subjective cognitive dysfunction in individuals recently diagnosed with BD. The differences remained significant after adjusting for the presence of lifetime psychotic symptoms. We found no differences between MDD and BD during an acute mood episode.

Limitation: The small sample size of individuals with BD.

Conclusion: The findings suggest a higher presence of subjective cognitive complaints among individuals recently diagnosed with BD in comparison to individuals with MDD during euthymia.
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http://dx.doi.org/10.1016/j.psychres.2021.113894DOI Listing
June 2021

Sleep alterations in individuals recently diagnosed with bipolar disorder across different mood stages.

Psychiatry Res 2021 May 25;299:113824. Epub 2021 Feb 25.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brasil. Electronic address:

Objectives: To assess the differences in sleep impairments in major depressive disorder (MDD) and individuals recently diagnosed with bipolar disorder (BD) across different mood stages.

Methods: This is a cross-sectional study corresponding to the second wave of a prospective clinical cohort of a sample of outpatients. The first wave included subjects diagnosed with MDD aged 18 to 60 years. Averaging 3 years after the first phase (second wave), conversion from MDD to BD diagnosis was assessed using the Mini International Neuropsychiatric Interview. The total sample was divided into four groups: euthymic MDD, MDD in a current episode, euthymic BD, and BD in a current mood episode. The sleep alterations were assessed using the Pittsburgh Sleep Quality Index.

Results: The sample included 468 subjects (261 euthymic MDD, 149 MDD currently depressed, 16 euthymic BD, and 42 BDs currently in a (hypo)manic or depressive episode). Euthymic BD differed from euthymic MDD only in the domains of sleep efficiency and sleep disturbances, showing lower sleep efficiency (PR 4.91 [95%CI 1.94 - 12.42]) and higher sleep disturbances (PR 3.38 [95%CI 1.32 - 8.67]) in subjects recently diagnosed with BD during euthymia. These differences remained significant after adjusting for the potential confounding factors.

Conclusions: The findings point out the relevance of regular sleep assessments in individuals recently diagnosed with BD, since the differences in sleep quality observed could provide insights regarding prognosis, treatment, and the extent to which these individuals display significant subsyndromal symptomatology, even in the absence of a mood episode.
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http://dx.doi.org/10.1016/j.psychres.2021.113824DOI Listing
May 2021

Children's eating behaviour traits and dental caries.

J Public Health Dent 2021 Mar 15. Epub 2021 Mar 15.

Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.

Objectives: This cross-sectional study aimed to assess eating behavior traits in children with or without dental caries.

Methods: A sample of 580 children aged 8 years enrolled in 20 public schools in the city of Pelotas, Brazil were included. Parents/caregivers provided sociodemographic information and answered the Children's Eating Behavior Questionnaire (CEBQ) to assess eating behavior traits. This instrument possesses the subscales: food responsiveness, enjoyment of food, satiety responsiveness, slowness in eating, food fussiness, emotional overeating, emotional undereating, and desire to drink. To assess the presence of decayed, missing or filled teeth (DMFT/dmft), the World Health Organization (WHO) criteria were adopted. WHO criteria were used to evaluate presence of overweight and obesity. Analysis of variance (ANOVA) was used to compare the mean score in each CEBQ subscale according to the different exposure variables. Linear regression was used to assess the association between dental caries and CEBQ subscales means.

Results: Approximately half of the children were male (51.03 percent) and 66.73 percent had low/middle socioeconomic status. The mean DMFT/dmft was 2.41, ranging from 0 to 13, and 63 percent of the children showed DMFT/dmft > 0. After adjustments for potential confounders, children with dental caries showed higher scores on the subscales desire to drink (P = 0.03), and satiety responsiveness (P = 0.04).

Conclusion: The present study showed that some aspects of eating behaviors differ in children with or without caries. Such knowledge adds to the understanding of the multifactorial etiology of caries and may help in the development of nutritional interventions to promote healthy eating behaviors, with benefits for oral health.
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http://dx.doi.org/10.1111/jphd.12449DOI Listing
March 2021

Predictors of conversion from major depressive disorder to bipolar disorder.

Psychiatry Res 2021 Mar 18;297:113740. Epub 2021 Jan 18.

Graduate Program in Health and Behavior, Universidade Católica de Pelotas (UCPEL), Pelotas, RS, Brazil. Electronic address:

The present study has two main aims: (1) To assess whether childhood trauma helps to differentiate Major Depressive Disorder (MDD) from Bipolar Disorder (BD) in a cross-sectional design; and (2) Describe the rate of conversion from MDD to BD, as well as the clinical and demographic predictors of conversion from MDD to BD in a prospective cohort design. We conducted a prospective cohort study in two phases, in the city of Pelotas, RS, Brazil. In the first phase, 565 subjects diagnosed with MDD, and 127 with BD according to the Mini International Neuropsychiatric Interview were included. In the second phase, only individuals with MDD were reevaluated for potential conversion to BD. The rate of conversion from MDD to BD in 3 years was 12.4%. Predictors of conversion from MDD to BD included lower educational level, use of illicit substances, younger age of the first depressive episode, and family history of BD. Childhood trauma was not a significant risk factor for conversion to BD in our prospective study. Our findings can contribute to the prevention and identification of conversion from MDD to BD, as well as to the establishment of more targeted therapeutic interventions, improving the prognosis of these individuals.
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http://dx.doi.org/10.1016/j.psychres.2021.113740DOI Listing
March 2021

Effects of depression and excess body weight on cognition and functioning in young adults: A population-based study.

J Affect Disord 2021 03 27;282:401-406. Epub 2020 Dec 27.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Objectives: The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults.

Methods: This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA).

Results: The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p<0.001) as well as FAST total (p=0.010), work (p=0.002), cognition (p=0.023), finances (p=0.032) and relationships domains (p=0.008).

Conclusions: The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.
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http://dx.doi.org/10.1016/j.jad.2020.12.083DOI Listing
March 2021

Effects of depression and excess body weight on cognition and functioning in young adults: A population-based study.

J Affect Disord 2021 03 27;282:401-406. Epub 2020 Dec 27.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Objectives: The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults.

Methods: This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA).

Results: The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p<0.001) as well as FAST total (p=0.010), work (p=0.002), cognition (p=0.023), finances (p=0.032) and relationships domains (p=0.008).

Conclusions: The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.
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http://dx.doi.org/10.1016/j.jad.2020.12.083DOI Listing
March 2021

A closer look at the epidemiology of schizophrenia and common mental disorders in Brazil.

Dement Neuropsychol 2020 Jul-Sep;14(3):283-289

Department of Health and Behavior, Universidade Católica de Pelotas - Pelotas, RS, Brazil.

Schizophrenia and common mental disorders are noteworthy social and economic concern worldwide. Epidemiologic studies on the impact of specific mental disorders in emerging countries are scarce.

Objectives: We aimed to characterize the demographic, social, and economic burden of schizophrenia and common mental disorders patients in the health system in Brazil.

Methods: Data on these conditions in Brazil between 2008 and 2019 were collected through the website of the Departamento de Informática do Sistema Único de Saúde (Information Technology Department of the Unified Health System - DATASUS) maintained by the Brazilian Ministry of Health. Mean annual hospital admissions were 154,009.67, and cumulative incidence of 77.44 admissions per 100,000 inhabitants.

Results: Average annual hospital expenses were US$ 67,216,056.04, with an average admission cost of US$ 432.58. The most affected age groups were older adults albeit younger individuals showed a trend towards increase of occurrences in recent years. There were a higher number of admissions in men compared to women.

Conclusions: We consider the results obtained important to assist in evaluating and guiding public policies regarding the prevention and treatment in health systems.
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http://dx.doi.org/10.1590/1980-57642020dn14-030009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500820PMC
September 2020

A closer look at the epidemiology of schizophrenia and common mental disorders in Brazil.

Dement Neuropsychol 2020 Jul-Sep;14(3):283-289

Department of Health and Behavior, Universidade Católica de Pelotas - Pelotas, RS, Brazil.

Schizophrenia and common mental disorders are noteworthy social and economic concern worldwide. Epidemiologic studies on the impact of specific mental disorders in emerging countries are scarce.

Objectives: We aimed to characterize the demographic, social, and economic burden of schizophrenia and common mental disorders patients in the health system in Brazil.

Methods: Data on these conditions in Brazil between 2008 and 2019 were collected through the website of the Departamento de Informática do Sistema Único de Saúde (Information Technology Department of the Unified Health System - DATASUS) maintained by the Brazilian Ministry of Health. Mean annual hospital admissions were 154,009.67, and cumulative incidence of 77.44 admissions per 100,000 inhabitants.

Results: Average annual hospital expenses were US$ 67,216,056.04, with an average admission cost of US$ 432.58. The most affected age groups were older adults albeit younger individuals showed a trend towards increase of occurrences in recent years. There were a higher number of admissions in men compared to women.

Conclusions: We consider the results obtained important to assist in evaluating and guiding public policies regarding the prevention and treatment in health systems.
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http://dx.doi.org/10.1590/1980-57642020dn14-030009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500820PMC
September 2020

Resilience as a mediator factor in the relationship between childhood trauma and mood disorder: A community sample of young adults.

J Affect Disord 2020 09 1;274:48-53. Epub 2020 May 1.

Translational Science on Brain Disorders, Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, RS, Brasil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil. Electronic address:

Background: Studies on the field of mood disorders has mainly focusing on the risk factors associated to develop the illness or the clinical factors associated with the clinical progression. Less attention was given to factors such as resilience that may be associated with better outcomes in the course of mood disorders. In this study, we assessed the mediation effect of resilience on the relationship between childhood trauma and mood disorders, as well as the severity of depressive symptoms in a population-based sample.

Methods: This is a cross-sectional study with a community sample of young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls without any mood disorder. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and to assess the resilience was used the Resilience Scale (RS-25).

Results: All subtypes of trauma were associated with both MDD and BD, however, only physical and emotional abuse differentiated BD from MDD subjects. Bootstrapping-enhanced mediation analyses indicated that resilience partly mediated the association of childhood trauma to both mood disorder and severity of depression.

Limitation: The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality.

Conclusions: The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of childhood trauma. This study provides important information regarding the relationships among childhood trauma, resilience, and mood disorder.
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http://dx.doi.org/10.1016/j.jad.2020.04.011DOI Listing
September 2020

Temperament traits moderate the relationship between Childhood Trauma and Interleukin 1β profile in young adults.

Psychoneuroendocrinology 2020 06 16;116:104671. Epub 2020 Apr 16.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil. Electronic address:

Early life stressors, such as childhood trauma, have been associated to alterations in immune response that can last until adulthood. In this context, interleukin 1β (IL-1β) emerges as a pro-inflammatory cytokine with a pivotal role. Also, considering the temperament differences in stress susceptibility, and even immune dysfunction, studies investigating the complex interaction between these factors are scarce. Thus, the aim of the present study was to evaluate the moderating role of temperament traits in the relationship between childhood trauma and serum IL-1β levels. This cross-sectional study consisted of 325 individuals, men and women, aged 18-35, enrolled from a population-based study in the city of Pelotas, Southern Brazil. Our main results indicate that higher serum levels of IL-1β were associated with trauma severity (p < 0.01), and the variance of anger could explain 29% of IL-1β increase in individuals who suffered severe trauma (p < 0.05). The effect of anger was considerably stronger in men than in women (46% and 25%, respectively). Moreover, the variance of sensitivity also explained 15% of IL-1β increase (p < 0.05) as well as the variance of volition explained 11% of IL-1β decrease (p < 0.05) in individuals who suffered severe trauma in the general population. Our results indicate that emotional individual differences can moderate the impact of childhood trauma on low-grade inflammation in young adults.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104671DOI Listing
June 2020

Social, emotional, and behavioral problems and parent-reported sleep bruxism in schoolchildren.

J Am Dent Assoc 2020 05 26;151(5):327-333. Epub 2020 Mar 26.

Background: A number of theories associate emotional factors with the triggering of sleep bruxism (SB). Few studies have used validated instruments to assess psychological characteristics and SB in children. In this study, the authors aimed to assess the prevalence of parent-reported SB in children and its association with social, emotional, and behavioral problems.

Methods: The authors conducted a cross-sectional study with a school-based sample at 20 public schools in Brazil. Parents or caregivers provided information related to tooth-grinding sounds during sleep and about children's social, emotional, and behavioral problems by using the Strength and Difficulties Questionnaire. Analyses were carried out considering each subscale of the Strength and Difficulties Questionnaire and the total score. The authors estimated prevalence ratios by using a Poisson regression model. Statistical inferences were based on 95% confidence intervals.

Results: A total of 556 children aged 8 years were included. Prevalence of SB was 30.83%. Results of an adjusted analysis showed a significant association of SB with higher scores on total difficulties (overall score) (P < .001) and emotional symptoms (P < .001) and peer relationship problems (P = .010) subscales.

Conclusions: Parental reports of emotional and behavioral problems were associated with a higher prevalence of SB in schoolchildren.

Practical Implications: This study's results contribute to those of previous investigations about the association between psychological characteristics and SB. Interdisciplinary research involving dentistry and psychology may improve the understanding of bruxism.
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http://dx.doi.org/10.1016/j.adaj.2020.01.025DOI Listing
May 2020

The role of CACNA1C gene and childhood trauma interaction on bipolar disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2020 07 10;101:109915. Epub 2020 Mar 10.

Laboratory of Clinical Neuroscience, Post-graduation Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Studies on gene x environment interaction (GxE) have provided vital information for uncovering the origins of complex diseases. When considering the etiology of bipolar disorder (BD), the role of such interactions is unknown. Here, we tested whether trauma during childhood could modify the effect of two polymorphisms in the CACNA1C gene (rs1006737 and rs4765913) in terms of susceptibility to BD. The study enrolled 878 Caucasian young adults in a cross-sectional population-based survey. BD diagnosis was performed using a clinical interview MINI 5.0, and trauma was assessed with the childhood trauma questionnaire (CTQ). Binary logistic regression models were employed to test the main effects of polymorphisms, haplotypes, and GxE interactions using sex as a confounder. We did not observe an association between the polymorphisms and diagnosis of BD. However, we noted that childhood trauma modified the effect of the rs4765913 polymorphism (p = .018) and the AA haplotype (rs1006737 - rs4765913) (p = .018) on BD susceptibility. A allele carriers of the rs4765913 polymorphism or the AA haplotype exposed to childhood trauma are more likely to develop BD compared to the individuals without a genetic risk. Thus, this study showed that the risk of developing BD in individuals exposed to childhood trauma was influenced by the individual's genetic background, varying according to the CACNA1C genotypes.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109915DOI Listing
July 2020

The role of CACNA1C gene and childhood trauma interaction on bipolar disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2020 07 10;101:109915. Epub 2020 Mar 10.

Laboratory of Clinical Neuroscience, Post-graduation Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil. Electronic address:

Studies on gene x environment interaction (GxE) have provided vital information for uncovering the origins of complex diseases. When considering the etiology of bipolar disorder (BD), the role of such interactions is unknown. Here, we tested whether trauma during childhood could modify the effect of two polymorphisms in the CACNA1C gene (rs1006737 and rs4765913) in terms of susceptibility to BD. The study enrolled 878 Caucasian young adults in a cross-sectional population-based survey. BD diagnosis was performed using a clinical interview MINI 5.0, and trauma was assessed with the childhood trauma questionnaire (CTQ). Binary logistic regression models were employed to test the main effects of polymorphisms, haplotypes, and GxE interactions using sex as a confounder. We did not observe an association between the polymorphisms and diagnosis of BD. However, we noted that childhood trauma modified the effect of the rs4765913 polymorphism (p = .018) and the AA haplotype (rs1006737 - rs4765913) (p = .018) on BD susceptibility. A allele carriers of the rs4765913 polymorphism or the AA haplotype exposed to childhood trauma are more likely to develop BD compared to the individuals without a genetic risk. Thus, this study showed that the risk of developing BD in individuals exposed to childhood trauma was influenced by the individual's genetic background, varying according to the CACNA1C genotypes.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109915DOI Listing
July 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

Leptin polymorphism rs3828942: risk for anxiety disorders?

Eur Arch Psychiatry Clin Neurosci 2019 Aug 16. Epub 2019 Aug 16.

Institute of Health Sciences, Department of Health and Behavior, Catholic University of Pelotas - UCPel, Rua Gonçalves Chaves 373, Sala 324, Pelotas, RS, 96010-280, Brazil.

Leptin is an anorexigenic hormone well recognized by its role in mediating energy homeostasis. Recently, leptin has been associated with psychiatric disorders and interestingly, leptin treatment has shown antidepressant and anxiolytic effects. We examined the association of leptin levels and leptin (LEP) gene rs3828942 polymorphism with anxiety disorders considering sex differences. A cross-sectional population-based study, including 1067 young adults, of whom 291 presented anxiety disorders diagnosed by the Mini International Neuropsychiatric Interview (MINI 5.0). The rs3828942 polymorphism was genotyped by real-time PCR and ELISA measured leptin levels. Leptin levels were not associated with anxiety disorders after adjusting for sex and body mass index (BMI) [ß = - 0.009 (- 0.090-0.072); p = 0.832]. The distribution of rs3828942 genotypes was not associated with anxiety disorders. However, in a sex-stratified sample, the A-allele of rs3828942 polymorphism was associated with risk for GAD in women even when adjusting for confounding variables [OR = 1.87 (1.17-2.98); p = 0.008]. In a subsample of 202 individuals with GAD and control matched by sex and BMI, results suggest an interaction between genotypes and GAD diagnosis based on leptin levels only in the male group [F (1, 54) = 6.464; p = 0.0139]. Leptin is suggested to be related with the neurobiology of anxiety disorders in a sex-dependent manner since women carrying the A-allele of LEP rs3828942 present a higher risk for GAD, while leptin levels seem to be lower in men with GAD carrying A-allele. Studies on the relationship between leptin polymorphisms and levels are scarce and, therefore, further research is necessary.
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http://dx.doi.org/10.1007/s00406-019-01051-8DOI Listing
August 2019

Emotional and behavioral problems: a school-based study in southern Brazil.

Trends Psychiatry Psychother 2019 1;41(3):211-217. Epub 2019 Aug 1.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil.

Introduction: Mental health assessment in childhood needs to be carried out within a broader context that includes different factors.

Objective: To assess the prevalence of emotional and behavioral problems in schoolchildren and associated factors.

Method: A cross-sectional study was conducted with a school-based sample at 20 schools selected by systematic random sampling. Participants consisted of children aged 7-8 year old and their parents or primary caregivers. The Strengths and Difficulties Questionnaire (SDQ) was used to screen for the presence of emotional and behavioral problems in children.

Results: A total of 596 dyads were evaluated. The prevalence of emotional and behavioral problems was 30.0% among boys and 28.2% among girls. Hyperactivity/inattention were more prevalent among boys (p=0.015). Belonging to economically disadvantaged strata increased the likelihood of emotional and behavioral problems among schoolchildren by 71% (p=0.001), while having parents or caregivers with mental disorder increased by 2.2 times that probability (p<0.001). Conclusion: Our findings showed a high prevalence of emotional and behavioral problems among schoolchildren, as well as the influence of economic conditions and of the mental health of parents and caregivers on child mental health.
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http://dx.doi.org/10.1590/2237-6089-2017-0119DOI Listing
March 2020

Cognitive performance and salivary cortisol levels in school children.

Psychiatry Clin Neurosci 2019 Sep 20;73(9):596-597. Epub 2019 Jul 20.

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

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http://dx.doi.org/10.1111/pcn.12904DOI Listing
September 2019

Cognitive performance and salivary cortisol levels in school children.

Psychiatry Clin Neurosci 2019 Sep 20;73(9):596-597. Epub 2019 Jul 20.

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

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http://dx.doi.org/10.1111/pcn.12904DOI Listing
September 2019

Clinical outcomes and childhood trauma in bipolar disorder: A community sample of young adults.

Psychiatry Res 2019 05 21;275:228-232. Epub 2018 Dec 21.

Department of Health and Behavior, Catholic University of Pelotas, 373 Goncalves Chaves, 416C room, Zip code 96015-560, Pelotas, RS, Brazil. Electronic address:

Childhood trauma is a complex experience, much reported by subjects with bipolar disorder. There are still few studies that assess its consequences in a community sample of bipolar in early stage. The aim of the present study is to assess the association between childhood trauma and clinical outcomes, including the global functioning, in a community sample of young adults with bipolar disorder. This is a cross-sectional study with a community sample of subjects with bipolar disorder, from 23 to 30 years old, with and without childhood trauma. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The functioning was assessed by Functioning Assessment Short Test (FAST). Ninety subjects with bipolar disorder were included in the study (30 with childhood trauma and 60 without childhood trauma). Young adults with bipolar disorder and childhood trauma showed higher prevalence of current suicide risk, higher severity of depressive symptoms, and higher functioning impairment as compared to subjects with bipolar disorder without childhood trauma. The childhood trauma experiences appear to be an environmental risk factor for worse clinical outcomes and higher functional impairment.
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http://dx.doi.org/10.1016/j.psychres.2018.12.114DOI Listing
May 2019

Persistence of symptoms after cognitive therapies is associated with childhood trauma: A six months follow-up study.

Psychiatry Res 2019 05 20;275:177-180. Epub 2019 Feb 20.

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, 373 Goncalves Chaves, 416C room, Zip code 96015-560. Pelotas-RS, Brazil. Electronic address:

This study aims to assess the effect of childhood trauma on the outcomes of brief cognitive therapies for major depressive disorder. This is a follow-up clinical study nested in a randomized clinical trial of cognitive therapies. Sixty-one patients were assessed at baseline, post-intervention and six-month follow-up. The study showed that brief cognitive therapies improved depressive and anxious symptoms at post-intervention and six-month follow-up. Higher childhood trauma scores at baseline were significantly associated with higher severity of depressive and anxious symptoms at six-month follow-up. Longer courses of psychotherapy may be needed to improve the long-lasting effects of traumatic experiences.
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http://dx.doi.org/10.1016/j.psychres.2019.02.044DOI Listing
May 2019

Biological Rhythm Disruption Associated with Obesity in School Children.

Child Obes 2019 04 29;15(3):200-205. Epub 2019 Jan 29.

Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.

Background: Biological rhythm is the daily metabolic cycle of mammals that involves the sleep-wake cycles, hormone release, eating habits and digestion, body temperature, and other important bodily functions that are repeated daily. Thus, greater difficulty in maintaining the circadian rhythms may be involved in the increased risk of obesity. This study assessed the association between biological rhythm disruption and childhood obesity among school children.

Methods: This is a cross-sectional study with 7-8-year-old school children enrolled in a public school in the city of Pelotas-RS. The sample was drawn through multistage sampling. The Biological Rhythms Interview of Assessment in Neuropsychiatry-Kids (BRIAN-Kids) was used to assess the degree of difficulty maintaining the biological rhythm. BMI was calculated as weight/height (kg/m).

Results: A total of 596 children and their caregivers participated in this study. The prevalence of obesity was 24% among school children, 28.9% for girls, and 19.4 for boys (p = 0.009). Obese children had greater difficulties in maintaining the biological rhythm compared to nonobese children (p = 0.007). Some of these difficulties included sleep (p = 0.008), overall activities (p = 0.027), social rhythm (p = 0.033), and eating (p = 0.032) pattern.

Conclusion: Approximately one-quarter of children were obese. This finding was associated with the caregiver characteristics and some difficulties in maintaining the biological rhythm.
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http://dx.doi.org/10.1089/chi.2018.0212DOI Listing
April 2019

Salivary cortisol levels and biological rhythm in schoolchildren with sleep bruxism.

Sleep Med 2019 02 28;54:48-52. Epub 2018 Oct 28.

Department of Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.

Objective: Salivary cortisol levels and biological rhythms could be hypothesized as part of the multifactorial framework that explains bruxism etiology. The objective of this study was to examine salivary cortisol levels and biological rhythms in schoolchildren with sleep bruxism (SB).

Methods: This is a cross-sectional study with a school-based sample. The Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K) was used to evaluate biological rhythms. Salivary samples were collected by the spitting method. The salivary cortisol level was measured by electrochemiluminescence. The criteria proposed by the American Academy of Sleep Medicine (AASM) were used to evaluate SB.

Results: The SB prevalence was 16%. The SB presence was associated with belonging to families of lower economic status (p = 0.003). In addition, children with SB showed greater difficulty in maintaining biological rhythm (p = 0.002) and had higher levels of salivary cortisol (p = 0.034) compared with children without SB.

Conclusions: Higher levels of cortisol and disruption of biological rhythm was associated with SB in schoolchildren.
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http://dx.doi.org/10.1016/j.sleep.2018.09.031DOI Listing
February 2019

Metabolic syndrome, depression and anhedonia among young adults.

Psychiatry Res 2019 01 7;271:306-310. Epub 2018 Aug 7.

Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil; Department of Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.

The aim of this study was to assess the association between anhedonia and metabolic syndrome (MetS) in a well-characterized community sample of individuals with a current depressive episode. This is a cross-sectional study with young adults aged 24-30 years old. Depressive episode and the presence of anhedonia was assessed using the Mini International Neuropsychiatric Interview - Plus version (MINI Plus). The MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). The sample included 931 subjects, being 22 had depression without anhedonia, whereas 55 had depression with anhedonia. MetS was more prevalent among subjects with depression and anhedonia (43.6%) when compared to individuals without anhedonia and population control group. Moreover, subjects with depression and anhedonia have a significant increase of levels of glucose, triglycerides, total-cholesterol and LDL-cholesterol, as well as significant decreased in the HDL-cholesterol level. The present study showed that individuals with depression and anhedonia present higher prevalence of MetS. Our study suggests that the use of the concept of anhedonia may contribute to a better understanding of the complex relationship between depression and metabolic syndrome.
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http://dx.doi.org/10.1016/j.psychres.2018.08.009DOI Listing
January 2019

Biological rhythm and emotional and behavioral problems among schoolchildren in Southern Brazil.

Chronobiol Int 2019 03 3;36(3):353-359. Epub 2018 Dec 3.

a Health and Behavior , Universidade Católica de Pelotas , Pelotas , Brazil.

Emotional and behavioral problems have been considered an indicative of mental disorder in children. Mental health problems affect 10-20% of children and adolescents living in low-income and middle-income countries. Evidence suggests that disruptions in the biological rhythm may be a primary cause of emotional and behavioral changes, which affects several psychological functions and moods. Thus, this study aimed at verifying the association between biological rhythm and emotional and behavioral problems in schoolchildren living in Southern Brazil. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016. The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ), parents' version. This is a 25-item assessment questionnaire used to screen mental health problems in children and adolescents (from 4 to 17 years of age) in the last 6 months. The Biological Rhythm Interview of Assessment in Neuropsychiatry-Kids (BRIAN-K) was used to measure the degree of biological rhythm disruption. The BRIAN-K consists of 20 items; from among these, 17 items are added to generate a quantitative measure, with greater scores indicating more biological rhythm disruption. The final score can also be divided into four subscales: sleep, social rhythm, eating pattern and overall activities. A total of 609 children responded to the assessment instruments. With regard to parents or primary caregiver, 596 completed the assessment and 13 (2%) were not located or refused to participate in the study. Thus, 596 dyads were included in the analysis. Children with emotional and behavioral problems presented higher scores in all domains of BRIAN-K: sleep, social, activity, eating pattern and total score (p < 0.001). The following variables remained associated with emotional and behavioral problems after adjusted analysis: BRIAN-K total score (p < 0.001) and all subscales sleep (p < 0.001), social (p < 0.001), activity (p < 0.001) and eating pattern (p < 0.001). Children with emotional and behavioral problems presented higher biological rhythm disruption when compared with children without emotional and behavioral problems. Our study emphasizes the importance of biological rhythm and its influence on emotional and behavioral problems in schoolchildren. Early detection of any biological rhythm disruption may enhance further assessment of any eventual emotional and behavioral problem and even a psychopathology.
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http://dx.doi.org/10.1080/07420528.2018.1545781DOI Listing
March 2019

Impact of genetic variations in ADORA2A gene on depression and symptoms: a cross-sectional population-based study.

Purinergic Signal 2019 03 3;15(1):37-44. Epub 2018 Dec 3.

Department of Life and Health Sciences, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

Genetic variants involved in adenosine metabolism and its receptors were associated with increased risk for psychiatric disorders, including anxiety, depression, and schizophrenia. Here, we examined an association between a single nucleotide polymorphism in A receptor gene (ADORA2A, rs2298383 SNP) with current depressive episode and symptom profile. A total of 1253 individuals from a cross-sectional population-based study were analyzed by the Mini International Neuropsychiatric Interview 5.0. Our data showed that the TT genotype of ADORA2A rs2298383 SNP was associated with reduced risk for depression when compared to the CC/CT genotypes (p = 0.020). This association remained significant after adjusting for confounding variables such as smoking, gender, socioeconomic class, and ethnicity (OR = 0.631 (95% CI 0.425-0.937); p = 0.022). Regarding the symptoms associated with depression, we evaluated the impact of the ADORA2A SNP in the occurrence of sad/discouraged mood, anhedonia, appetite changes, sleep disturbances, motion changes, energy loss, feelings of worthless or guilty, difficulty in concentrating, and presence of bad thoughts. Notably, the TT genotype was independently associated with reduced sleep disturbances (OR = 0.438 (95% CI 0.258-0.743); p = 0.002) and less difficulty in concentrating (OR = 0.534 (95% CI 0.316-0.901; p = 0.019). The cross-sectional design cannot evaluate the cause-effect relationship and did not evaluate the functional consequences of this polymorphism. Our data support an important role for ADORA2A rs2298383 SNP in clinical heterogeneity associated with depression. The presence of the TT genotype was associated with decrease risk for current depression and disturbances in sleep and attention, two of the most common symptoms associated with this disorder.
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http://dx.doi.org/10.1007/s11302-018-9635-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439088PMC
March 2019

Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies.

Bipolar Disord 2019 08 14;21(5):437-448. Epub 2018 Dec 14.

Department of Psychiatry, University Hospital of Lausanne, Prilly, Switzerland.

Objectives: Although clinical evidence suggests important differences between unipolar mania and bipolar-I disorder (BP-I), epidemiological data are limited. Combining data from nine population-based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP-I with both manic and depressive episodes with respect to demographic and clinical characteristics in order to highlight differences.

Methods: Participants were compared for gender, age, age at onset of mania, psychiatric comorbidity, temperament, and family history of mental disorders. Generalized linear mixed models with adjustment for sex and age as well as for each study source were applied. Analyses were performed for the pooled adult and adolescent samples, separately.

Results: Within the included cohorts, 109 adults and 195 adolescents were diagnosed with M/Md and 323 adults and 182 adolescents with BP-I. In both adult and adolescent samples, there was a male preponderance in M/Md, whereas lifetime generalized anxiety and/panic disorders and suicide attempts were less common in M/Md than in BP-I. Furthermore, adults with mania revealed bulimia/binge eating and drug use disorders less frequently than those with BP-I.

Conclusions: The significant differences found in gender and comorbidity between mania and BP-I suggest that unipolar mania, despite its low prevalence, should be established as a separate diagnosis both for clinical and research purposes. In clinical settings, the rarer occurrence of suicide attempts, anxiety, and drug use disorders among individuals with unipolar mania may facilitate successful treatment of the disorder and lead to a more favorable course than that of BP-I disorder.
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http://dx.doi.org/10.1111/bdi.12732DOI Listing
August 2019

Impact of resilience on the improvement of depressive symptoms after cognitive therapies for depression in a sample of young adults.

Trends Psychiatry Psychother 2018 Jul-Sep;40(3):226-231

Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil.

Introduction: Few studies have evaluated positive measures for therapeutic response. Thus, the objective of this study was to assess the effects of resilience on severity of depressive and anxious symptoms after brief cognitive psychotherapy for depression.

Methods: This was a clinical follow-up study nested in a randomized clinical trial of cognitive therapies. The Resilience Scale was applied at baseline. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used at baseline, post-intervention, and at six-month follow-up.

Results: Sixty-one patients were assessed at baseline, post-intervention and at six-month follow-up. Resilience scores were significantly different between baseline and post-intervention assessments (p<0.001), as well as at baseline and at six-month follow-up (p<0.001). We observed a weak negative correlation between baseline resilience scores and HDRS scores at post-intervention (r=-0.295, p=0.015) and at six-month follow-up (r=-0.354, p=0.005). Furthermore, we observed a weak negative correlation between resilience scores and HARS scores at post-intervention (r=-0.292, p=0.016).

Conclusion: Subjects with higher resilience scores at baseline showed a lower severity of symptoms at post-intervention and at six-month follow-up.
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http://dx.doi.org/10.1590/2237-6089-2017-0047DOI Listing
November 2018

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults.

J Affect Disord 2019 01 11;243:103-107. Epub 2018 Sep 11.

Federal University of Pelotas, RS, Brazil.

Introduction: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

Objective: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

Methods: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

Results: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

Limitations: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

Conclusion: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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http://dx.doi.org/10.1016/j.jad.2018.09.007DOI Listing
January 2019

Clinical features of differential diagnosis between unipolar and bipolar depression in a drug-free sample of young adults.

J Affect Disord 2019 01 11;243:103-107. Epub 2018 Sep 11.

Federal University of Pelotas, RS, Brazil.

Introduction: Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.

Objective: To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.

Methods: This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.

Results: The characteristics associated with bipolar depression were being male (p < 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p < 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p < 0.001), and diurnal preference (p = 0.028).

Limitations: The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.

Conclusion: Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.
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http://dx.doi.org/10.1016/j.jad.2018.09.007DOI Listing
January 2019