Publications by authors named "Ricardo Tavares Pinheiro"

88 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

Obesity and ADHD: Exploring the role of body composition, BMI polygenic risk score, and reward system genes.

J Psychiatr Res 2021 04 22;136:529-536. Epub 2020 Oct 22.

Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil. Electronic address:

The association between obesity and attention-deficit hyperactivity disorder (ADHD) has been extensively reported in the literature. However, the potential mechanisms underlying this association are not completely understood. This study aimed to evaluate the association between body composition and ADHD and explore the possible genetic mechanisms involved. We used data from the 1982 Pelotas (Brazil) Birth Cohort at age 30-year follow-up (N = 3630). We first used logistic regression analysis to test whether body mass index (BMI), fat mass (FM), and fat-free mass (FFM) were associated with ADHD. We further tested the association between BMI polygenic risk score (BMI-PRS) and ADHD and the role of the genes upregulated in the reward system using a gene-set association approach. BMI (odds ratio [OR] = 1.05; 95% confidence interval [CI], 1.00-1.09; p = 0.038) and FM (OR = 1.04; 95% CI, 1.00-1.07; p = 0.043) were associated with ADHD. The BMI-PRS was associated with ADHD (using p-value threshold (P) = 0.4; OR = 1.65; 95% CI, 1.02-2.65) at a nominal level. In gene-set analysis, the reward system genes were associated with BMI in subjects with a high BMI-PRS score, considering P = 0.4 (p = 0.014). The results suggest that BMI genetic components, especially those genes related to the reward system, may be involved in this association.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.026DOI Listing
April 2021

Obesity and ADHD: Exploring the role of body composition, BMI polygenic risk score, and reward system genes.

J Psychiatr Res 2021 04 22;136:529-536. Epub 2020 Oct 22.

Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil. Electronic address:

The association between obesity and attention-deficit hyperactivity disorder (ADHD) has been extensively reported in the literature. However, the potential mechanisms underlying this association are not completely understood. This study aimed to evaluate the association between body composition and ADHD and explore the possible genetic mechanisms involved. We used data from the 1982 Pelotas (Brazil) Birth Cohort at age 30-year follow-up (N = 3630). We first used logistic regression analysis to test whether body mass index (BMI), fat mass (FM), and fat-free mass (FFM) were associated with ADHD. We further tested the association between BMI polygenic risk score (BMI-PRS) and ADHD and the role of the genes upregulated in the reward system using a gene-set association approach. BMI (odds ratio [OR] = 1.05; 95% confidence interval [CI], 1.00-1.09; p = 0.038) and FM (OR = 1.04; 95% CI, 1.00-1.07; p = 0.043) were associated with ADHD. The BMI-PRS was associated with ADHD (using p-value threshold (P) = 0.4; OR = 1.65; 95% CI, 1.02-2.65) at a nominal level. In gene-set analysis, the reward system genes were associated with BMI in subjects with a high BMI-PRS score, considering P = 0.4 (p = 0.014). The results suggest that BMI genetic components, especially those genes related to the reward system, may be involved in this association.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.026DOI Listing
April 2021

Obesity and ADHD: Exploring the role of body composition, BMI polygenic risk score, and reward system genes.

J Psychiatr Res 2021 04 22;136:529-536. Epub 2020 Oct 22.

Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil. Electronic address:

The association between obesity and attention-deficit hyperactivity disorder (ADHD) has been extensively reported in the literature. However, the potential mechanisms underlying this association are not completely understood. This study aimed to evaluate the association between body composition and ADHD and explore the possible genetic mechanisms involved. We used data from the 1982 Pelotas (Brazil) Birth Cohort at age 30-year follow-up (N = 3630). We first used logistic regression analysis to test whether body mass index (BMI), fat mass (FM), and fat-free mass (FFM) were associated with ADHD. We further tested the association between BMI polygenic risk score (BMI-PRS) and ADHD and the role of the genes upregulated in the reward system using a gene-set association approach. BMI (odds ratio [OR] = 1.05; 95% confidence interval [CI], 1.00-1.09; p = 0.038) and FM (OR = 1.04; 95% CI, 1.00-1.07; p = 0.043) were associated with ADHD. The BMI-PRS was associated with ADHD (using p-value threshold (P) = 0.4; OR = 1.65; 95% CI, 1.02-2.65) at a nominal level. In gene-set analysis, the reward system genes were associated with BMI in subjects with a high BMI-PRS score, considering P = 0.4 (p = 0.014). The results suggest that BMI genetic components, especially those genes related to the reward system, may be involved in this association.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.026DOI Listing
April 2021

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

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

Development and psychometric validation of Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) in a Brazilian sample.

Addict Behav 2020 04 10;103:106191. Epub 2019 Dec 10.

Fundação Universidade do Rio Grande, Brazil.

Objectives: The aim of this study was to develop and examine the psychometric properties of the IGDS9-SF in a sample of Brazilian gamers and to find the best cut-off point for this instrument using a normative and clinically diagnosed sample of gamers.

Methods: A total of 610 participants were recruited to the present study. Construct validity was assessed through Exploratory and Confirmatory Factor Analysis (EFA, CFA). Criterion-related validity was established through the associations with Game Addiction Scale (GAS) and weekly gameplay. Reliability analysis was performed using the Cronbach's alpha (α) as the indicator of internal consistency. A cut-off point was estimated using the Receiver Operating Characteristics Curve (ROC curve) where the results of a clinical assessment was used as the gold standard.

Results: EFA and CFA findings confirmed the single-factor structure of the IGDS9-SF. Positive correlations indicated adequate criterion-related validity, and the scale was shown to be reliable (α=0.82). Finally, the optimal cut-off point for risky gaming was found to be >16 points and for diagnosis to be >21 points.

Conclusions: This study provides validity and reliability evidence for the use of the Brazilian version of the IGDS9-SF in the assessment of Internet Gaming Disorder, further supporting its usefulness as a robust psychometric tool that can be employed in clinical and research settings in Brazil.
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http://dx.doi.org/10.1016/j.addbeh.2019.106191DOI Listing
April 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

People living with HIV/AIDS: body image and its important associations with mental health and BMI.

Psychol Health Med 2020 09 18;25(8):1020-1028. Epub 2019 Nov 18.

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

Patients on antiretroviral therapy face new challenges, such as bodily changes. We conducted a cross-sectional study with people living with HIV/AIDS. We investigate the self-perception of body image and its associations. Most of the patients reported negative self-perception of body image (NSPBI), being mostly women, up to 40 years old and with changes in BMI. NSPBI was associated with depressive symptoms and punctual alterations in the redistribution of body fat: face, abdomen and legs, subjects still little elucidated. Assessing neglected aspects can improve the way these patients see themselves, and come to understand the disease as only a part of their lives.
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http://dx.doi.org/10.1080/13548506.2019.1691244DOI Listing
September 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

MicroRNAs expressed in depression and their associated pathways: A systematic review and a bioinformatics analysis.

J Chem Neuroanat 2019 10 22;100:101650. Epub 2019 May 22.

Depression is a debilitating mental illness, one of the most prevalent worldwide. MicroRNAs have been studied to better understand the biological mechanisms that regulate this disease. This study review systematically the literature to identify which microRNAs are currently being associated with depression and their related pathways. The electronic search was conducted in PubMed, Scopus, Scielo, ISI Web of Knowledge, and PsycINFO databases, using the search terms "Depressive Disorder" or "Depression" and "MicroRNAs". After, microRNAs that were up and down-regulated in depression were analyzed by bioinformatics. We observed that among the 77 microRNAs cited by included studies, 54 had their levels altered in depressed individuals compared to controls, 30 being up-regulated and 24 down-regulated. The bioinformatics analysis revealed that among the up-regulated microRNAs there were 81 total and 43 union pathways, with 15 presenting a significant difference. Among the down-regulated microRNAs, 67 total and 45 union pathways were found, with 14 presenting a significant difference. The miR-17-5p and let-7a-5p were the most frequently found microRNAs in the statistically significant pathways. In this study a panel of altered microRNAs in depression was created with their related pathways, which is a step towards understanding the complex network of microRNAs in depression.
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http://dx.doi.org/10.1016/j.jchemneu.2019.101650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996133PMC
October 2019

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

Early-life events and developmental defects of enamel in the primary dentition.

Community Dent Oral Epidemiol 2018 10 6;46(5):511-517. Epub 2018 Aug 6.

Postgraduate Programs in Dentistry and Epidemiology, Federal University of Pelotas, Pelotas, Brazil.

Objective: To investigate the occurrence of developmental defects of enamel (DDE) in the primary teeth of children aged 24-36 months and their association with early-life events.

Methods: This study was undertaken with children aged 24-36 months in Pelotas, Southern Brazil. Information on demographic and socioeconomic characteristics, events occurring during pregnancy and neonatal events was collected previously. In this study, information on the health-related behaviours of mothers and children was collected using questionnaires and information about children's oral health was achieved through clinical oral examination. The outcome, the prevalence of DDE (≥1), was determined using the DDE index (FDI). Bivariate and multivariate logistic regression analyses were performed.

Results: Five hundred and three mother/child dyads were evaluated, and 13.1% of the children had DDE. Multivariate analysis showed that children with Apgar scores less than 7 had around 2.5-fold higher odds of developing DDE than children with Apgar scores between 7 and 10 (OR = 2.78; 95% confidence interval [CI], 1.35-5.73). The analysis of different types of enamel defects shows that the presence of hypoplasia (OR 3.13; 95% CI, 1.35-7.27) and diffuse opacities (OR 3.95; 95% CI, 1.68-9.27) remained associated in adjusted analysis with Apgar scores.

Conclusion: Early-life events may cause DDE. A lower Apgar score was associated with a higher prevalence of enamel defects.
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http://dx.doi.org/10.1111/cdoe.12408DOI Listing
October 2018

Are Maternal Factors Predictors for Early Childhood Caries? Results from a Cohort in Southern Brazil.

Braz Dent J 2017 May-Jun;28(3):391-397

Graduate Program in Dentistry, UFPel - Universidade Federal de Pelotas, Pelotas, RS, Brazil.

This study aimed to determine the influence of maternal factors on the early development of dental caries in Brazilian preschoolers. This cross-sectional study was nested in a cohort of adolescent mothers. The current wave was performed when the children were aged 24 to 42 months. The questionnaire-based survey targeted adolescent mothers and included demographic and socioeconomic variables as well as the maternal education level. In addition, clinical examinations were performed on the mothers and their children. Mothers were assessed for decayed, missing and filled teeth in the permanent dentition (DMFT index) and gingival assessment; their children were assessed for decayed, missing and filled teeth in the deciduous dentition (dmft index). Poisson regression with robust variance was used to estimate the prevalence ratio, risk ratio and 95% confidence intervals. This data was also used to identify the maternal risk factors associated with the outcomes (prevalence and severity of childhood caries). A total 538 mother-child dyads were evaluated; the prevalence of early childhood caries was 15.1% and maternal caries was 74.4%. After the adjustment, the children that exhibited a greater incidence of dental caries were from mothers of low socioeconomic status, or from those presenting decayed teeth and higher rates of gingival bleeding. The results of this study suggest that the oral health of mothers is a potentially important risk factor for the development of early childhood dental caries. Public health planners should consider this information when planning interventions in order to prevent the occurrence of early dental caries.
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http://dx.doi.org/10.1590/0103-6440201601047DOI Listing
September 2018

Maternal depression and anxiety associated with dental fear in children: a cohort of adolescent mothers in Southern Brazil.

Braz Oral Res 2017 Nov 6;31:e85. Epub 2017 Nov 6.

Universidade Federal de Pelotas - UFPel, Post-Graduate Program in Dentistry, Pelotas, RS, Brazil.

Exposure to maternal symptoms of depression/anxiety has long-term negative consequences for child development, regardless of the contextual risk. The objective of this study was to investigate the relationship of the symptomatology of persistent maternal depression and anxiety with child dental fear. This study was nested in a cohort of adolescent mothers in southern Brazil. Symptomatology of maternal depression and anxiety was assessed during pregnancy and postpartum, when the mothers' children were 24-36 months old, using Beck Depression Inventory and Beck Anxiety Inventory. The mothers answered a questionnaire to assess dental fear in their children, and to obtain socioeconomic and demographic data. Both mothers and their children were submitted to clinical oral examination (n= 540 dyads) to obtain oral health data. Multivariate hierarchical Poisson regression analysis was used to determine associations (p < 0.05). At data collection, the prevalence of maternal depressive symptoms was 39.1%, and anxiety was observed in 27.8% of the mothers, whereas 21.6% of the children presented dental fear. In the adjusted analysis, children's dental fear was positively associated with mothers' presenting depressive symptomatology and caries experience. The depression symptomatology trajectory was not associated with dental fear, whereas mothers with persistent symptoms of anxiety reported higher prevalence of dental fear toward their offspring. The findings of symptomatology of maternal depression observed at data collection and persistence of anxiety may negatively impact the child's perception of dental fear. Mothers are the main caregivers and primary models responsible for transmitting health-related behaviors; consequently, mental disorders affecting mothers may negatively impact their children.
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http://dx.doi.org/10.1590/1807-3107BOR-2017.vol31.0085DOI Listing
November 2017

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil.

Am J Orthod Dentofacial Orthop 2017 Nov;152(5):613-621

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil. Electronic address:

Introduction: Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth.

Methods: This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion).

Results: The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02-3.24) or were still using it (PR = 3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34-0.73).

Conclusions: Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.
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http://dx.doi.org/10.1016/j.ajodo.2017.03.022DOI Listing
November 2017

Do maternal depression and anxiety influence children's oral health-related quality of life?

Community Dent Oral Epidemiol 2017 10 17;45(5):398-406. Epub 2017 Apr 17.

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

Objective: This study aimed to investigate the influence of depressive and anxiety symptoms in young mothers on their perception in relation to their children's oral health-related quality of life (COHRQoL).

Methods: This cross-sectional study was carried out in Pelotas, Southern Brazil, and it was nested in a cohort of adolescent mothers having their prenatal care in public health service, starting in 2008. When the children were aged 24-36 months, they and their mothers were interviewed and submitted to clinical examination by a trained team. Socioeconomic, educational, behavioural and psychological assessments were collected in the interview and oral examination investigated caries and gingival bleeding (in mothers) and caries and dental trauma (in children). Maternal perception of impact on COHRQoL was evaluated by Early Childhood Oral Health Impact Scale (ECOHIS). The outcome in the present study was the occurrence of impact on COHRQoL (ECOHIS≥2), that is the presence of at least one ECOHIS item reported as occasionally (score 2), often (score 3) or very often (score 4). Analysis was conducted using Poisson regression with robust variance and obtained prevalence ratios (PR) and respective 95% confidence intervals (CI).

Results: This study comprised 537 mother-child dyads. After adjustment, higher scores of COHRQoL remained significantly associated with depressive symptoms (PR=1.80, 95% CI: 1.36-2.38) and maternal anxiety symptoms (PR=2.28, 95% CI: 1.72-3.00). Mothers with anxiety symptoms or depressive symptoms had a prevalence of impact 91% higher when compared with mothers without any symptoms (PR=1.91; CI 95% 1.35-2.68), and mothers with both symptoms had almost 2.5 times higher risk of perception of negative impact on COHRQoL (PR=2.48; CI 95% 1.78-3.45).

Conclusion: Poorer COHRQoL was associated with maternal depression and anxiety symptoms.
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http://dx.doi.org/10.1111/cdoe.12303DOI Listing
October 2017

Influence of maternal psychological traits on sleep bruxism in children.

Int J Paediatr Dent 2017 Nov 24;27(6):469-475. Epub 2017 Jan 24.

Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.

Background: Sleep bruxism (SB) is a sleep disorder with high incidence in toddlers and may perpetuate to adulthood. The multifactorial etiology of bruxism includes pathophysiologic and psychological factors.

Aim: To investigate the relationship between depression, stressful events, and the presence of symptoms of anxiety and depression with SB in children of adolescent mothers.

Design: This cross-sectional study nested in a cohort evaluated a sample of 536 mothers and their children aged 24-36 months. Interviews were conducted with mothers. Maternal report of SB was collected. Mother's major depressive disorder was assessed using the Mini International Neuropsychiatric Interview (MINI Plus); Life Events Scale assessed the stressful events; Beck Depression Inventory and Beck Anxiety Inventory investigated the symptoms of depression and anxiety. Poisson regression analysis was applied to assess the association of maternal psychological disorders and stressful events with SB on children.

Results: Prevalence of SB was 25.93% (95% CI 22.2-29.7). After adjustments, maternal major depression disorder [PR 1.43 (95% CI 1.06-1.92)] and the presence of stressful events mainly environmental changes [PR 1.47 (95% CI 1.08-2.00)] showed significant association with bruxism in children.

Conclusion: This study showed a positive association between mother's psychological traits and SB development in their toddlers.
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http://dx.doi.org/10.1111/ipd.12285DOI Listing
November 2017

Associations of Linear Growth and Relative Weight Gain in Early Life with Human Capital at 30 Years of Age.

J Pediatr 2017 03 4;182:85-91.e3. Epub 2017 Jan 4.

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

Objective: To assess the associations of birthweight, nutritional status and growth in childhood with IQ, years of schooling, and monthly income at 30 years of age.

Study Design: In 1982, the 5 maternity hospitals in Pelotas, Brazil, were visited daily and 5914 live births were identified. At 30 years of age, 3701 subjects were interviewed. IQ, years of schooling, and income were measured.

Results: On average, their IQ was 98 points, they had 11.4 years of schooling, and the mean income was 1593 reais. After controlling for several confounders, birthweight and attained weight and length/height for age at 2 and 4 years of age were associated positively with IQ, years of years of schooling, and income, except for the association between length at 2 years of age and income. Conditional growth analyses were used to disentangle linear growth from relative weight gain. Conditional length at 2 years of age ≥1 SD score above the expected value, compared with ≥1 SD below the expected, was associated with an increase in IQ (4.28 points; 95% CI, 2.66-5.90), years of schooling (1.58 years; 95% CI, 1.08-2.08), and monthly income (303 Brazilian reais; 95% CI, 44-563). Relative weight gain, above what would be expected from linear growth, was not associated with the outcomes.

Conclusion: In a middle-income setting, promotion of linear growth in the first 1000 days of life is likely to increase adult IQ, years of schooling, and income. Weight gain in excess of what is expected from linear growth does not seem to improve human capital.
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http://dx.doi.org/10.1016/j.jpeds.2016.12.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323242PMC
March 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

Aging, neurocognitive impairment and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals.

Braz J Infect Dis 2016 Nov - Dec;20(6):599-604. Epub 2016 Oct 24.

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

Background/objective: There is an increasing number of older patients with human immunodeficiency virus infection due to the success of antiretroviral therapy, the improved prognosis and life expectancy of patients, and the higher number of new infections among older individuals. The main objective of the present study was to compare the characteristics of older human immunodeficiency virus patients with those of younger patients.

Materials And Methods: We conducted a cross-sectional study with human immunodeficiency virus-infected patients who were treated at the Specialized Care Service (Serviço de Assistência Especializada) for human immunodeficiency virus/AIDS in the city of Pelotas, South Brazil. Sociodemographic information as well as data on human immunodeficiency virus infection and treatment were collected. All participants underwent psychiatric and neurocognitive assessments, and their adherence to antiretroviral therapy was evaluated.

Results: A total of 392 patients participated in the study, with 114 patients aged 50 years and older. The characteristics showing significant differences between older and younger human immunodeficiency virus-infected patients included race/ethnicity, comorbidities, duration and adherence to antiretroviral therapy, currently undetectable viral load, and cognitive impairment. Compared to younger patients, older patients were at higher risk of exhibiting cognitive impairment [OR 2.28 (95% CI: 1.35-3.82, p=0.002)] and of having increased adherence to antiretroviral therapy [OR 3.11 (95% CI: 1.67-5.79, p<0.001)].

Conclusions: The prevalence of neurocognitive impairment remained high in human immunodeficiency virus-infected patients despite antiretroviral therapy. In the present study, the prevalence of this type of impairment was significantly higher in patients aged ≥50 years, most likely due to aging, human immunodeficiency virus infection, and a possible synergistic effect between these factors. Despite this higher prevalence, older patients exhibited higher rates of adherence to antiretroviral therapy and of undetectable human immunodeficiency virus viral load.
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http://dx.doi.org/10.1016/j.bjid.2016.09.006DOI Listing
July 2017

Maternal perception of the occurrence of traumatic dental injuries in children: a cohort study of south Brazil.

Int Dent J 2016 Jun 28;66(3):163-8. Epub 2016 Jan 28.

Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.

Background: Adolescent mothers may have an inaccurate perception and awareness of dental trauma occurrence in children, which may influence whether or not they seek treatment.

Objective: This study evaluated maternal perception of traumatic dental injury (TDI) occurrence and related factors in children, 24-36 months of age, of adolescent mothers from a cohort in the city of Pelotas/RS, Brazil.

Methods: Clinical data from 508 children were collected through physical examination; demographic variables (including socio-economic status) and maternal perception of trauma occurrence were collected through interviews with the children's mothers. Statistical analysis was performed using STATA 12.0.

Results: The prevalence of dental trauma was 12.6% (64). A total of 291 (57.9%) mothers reported that their child had hit his or her teeth/mouth at least once. Only 69 (24.8%) mothers who perceived a TDI sought care. The maternal perception of dental trauma experienced by children showed no relationship with diagnosis on clinical examination. Enamel fracture was the most prevalent type of trauma (71.6%), and the maxillary central incisors were the teeth most affected.

Conclusions: Owing to lack of awareness about TDI, the adolescent mothers in this study sample did not seek treatment for their children. Awareness campaigns for parents and caregivers about the possible consequences of TDI and the importance of follow up after dental trauma are required.
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http://dx.doi.org/10.1111/idj.12215DOI 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

Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

Lancet Glob Health 2015 Apr;3(4):e199-205

Postgraduate Programme in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil.

Background: Breastfeeding has clear short-term benefits, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists.

Methods: A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula.

Findings: From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20-5·33), more years of education (0·91 years, 0·42-1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8-588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income.

Interpretation: Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.

Funding: Wellcome Trust, International Development Research Center (Canada), CNPq, FAPERGS, and the Brazilian Ministry of Health.
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http://dx.doi.org/10.1016/S2214-109X(15)70002-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365917PMC
April 2015

Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in Southern Brazil.

J Affect Disord 2015 May 3;177:95-100. Epub 2015 Feb 3.

Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas. Electronic address:

Introduction: Depression during pregnancy in adolescents is increasing significantly. However, instruments for early depression screening during prenatal care are scarce. Faced this fact, the objective of this research is to identify the best cutoff points for the Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) in a sample of pregnant adolescents.

Method: 807 pregnant adolescents, with a mean age of 17 years, met in public antenatal services were evaluated. Two screening scales for depression were analyzed, EPDS and the BDI. These scales had their accuracy measured by AUC of their ROC curve, as well as their respective sensitivity and specificity.

Results: In the analysis, the best cutoff for the EPDS was≥10, in which the sensitivity was 81.1% and specificity 82.7%. For the BDI, it was with recognized the cutoff ≥11, sensitivity 86.7% and specificity 73.8%. In the analysis of the ROC AUC, values of 0.89 (CI 0.87-0.92) for the EPDS and BDI for 0.87 (CI 0.84-0.89) were identified compared to the MINI.

Limitations: The sample was composed majority by middle and low income adolescent and the study was performed only with pregnant women in the second trimester.

Conclusions: The results indicate that both scales have good accuracy in screening of depression in adolescent mothers. However, the EPDS scale shows higher AUC ROC and also better sensitivity and specificity values, the latter being more precise and effective for screening for depression in this population.
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http://dx.doi.org/10.1016/j.jad.2015.01.051DOI Listing
May 2015

[Stressful life events and mood disorders: a community sample].

Cien Saude Colet 2014 Sep;19(9):3941-6

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

Mood disorders are a consequence of the interaction between environmental and biological factors. The objective of this study was to identify associations between stressful life events (LEs) and mood disorders in a community sample of young people in southern Brazil. It is a cross-sectional population-based study on young people between 18 and 24 years of age. The selection of the sample was conducted via conglomerates. Mini International Neuropsychiatric Interviews were used to evaluate mood disorders, and the Social Readjustment Rating Scale to assess stressful life events. The sample included 1172 young people. Of the total sample, the proportion of stressful life events in the last year in each category was: 53.8% work, 42.4% loss of social support, 63.8% family, 50.9% environmental changes, 61.1% personal difficulties, and 38.7% finances. A significant relationship was found between categories of stressful life events and mood disorder episodes. A higher incidence of stressful life events was found among young people in a mixed episode compared to young people in a depressive, (hypo)maniac episode with controls. This finding suggests a psychosocial interaction between stressful life events and the occurrence of mood disorders.
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http://dx.doi.org/10.1590/1413-81232014199.12932013DOI Listing
September 2014