Prevalência do medo de quedas em idosos e sua associação com fatores clínicos,funcionais e psicossociais: Estudo FIBRA-RJ

Introdução: Com o expressivo aumento da população idosa, as quedas são eventos comuns e levam a desfechos adversos à saúde. As consequências do medo de quedas podem ser tão incapacitantes como as quedas. Objetivo: O presente estudo teve como objetivo estimar a prevalência do medo de quedas em idosos e sua associação com fatores clínicos, funcionais e psicossociais. Métodos: Utilizaram-se os dados do Estudo FIBRA-RJ, que avaliou clientes de uma operadora de saúde, residentes na Zona Norte do município do Rio de Janeiro. A seleção desta amostra foi realizada através de amostragem aleatória inversa, de acordo com estratos de faixa etária e sexo do cadastro oferecido pela operadora. As entrevistas foram realizadas face a face no domicilio. O medo de quedas, variável dependente, foi avaliado através da FES-I-BR. As seguintes variáveis clínicas, funcionais e psicossociais foram avaliadas como variáveis independentes: histórico de quedas, fratura pós-queda, número de comorbidades, número de medicamentos, internação no último ano, uso de dispositivo de auxílio à marcha, dependência funcional nas atividades básicas e instrumentais de vida diária, dificuldade visual e auditiva, força de preensão palmar, velocidade de marcha, autopercepção de saúde, sintomas depressivos, alteração cognitiva, morar só, apoio social instrumental e nível de atividade. As associações foram avaliadas através de regressão logística. Resultados: Dentre os 742 idosos avaliados, 51,9% apresentaram medo de quedas, sendo esta prevalência maior no sexo feminino e nos mais idosos. Na análise logística multivariada, houve associação com histórico de 1 ou 2 quedas (OR=2,18; IC95%1,42-3,36), 3 ou mais quedas (OR=2,72; IC95% 1,10-6,70), usar 7 ou mais medicamentos (OR=1,70; IC95%1,04-2,80), dificuldade auditiva (OR=1,66; IC95% 1,10-2,49), ter dependência funcional nas atividades de vida diária (AVDs) (OR=1,73; IC95%1,07-2,79), velocidade de marcha diminuída (OR=1,64; IC95%1,04-2,58), autopercepção de saúde regular (OR=1,89; IC95%1,30-2,74) e ruim/muito ruim (OR=4,92; IC95%1,49-16,27) e sintomas depressivos (OR=1,68; IC95%1,07-2,63). Conclusão: Os resultados obtidos mostram a prevalência elevada de medo de quedas. Destaca-se a necessidade de avaliação desta condição nos idosos. Identificar os fatores associados é útil para desenvolver estratégias efetivas de intervenção dos possíveis fatores modificáveis.

细胞因子对大鼠抑郁样行为的影响

Depression is one of the most important psychological diseases to threaten human health. “Cytokine theory of depression” suggests that cytokines may play an important role in depression, which provided a new perspective in the study the mechanism and the therapy of depressive symptoms. This view is supported by various findings. Administration of pro-inflammatory cytokine or lipoposaccharide in animal induces depressive-like behavior such as anhedonia and low locomotion, which is very similar to the behavioral symptoms of depression in humans. However, the earlier researches may only pay attention to the short-time behavior effects; the effects of long-time behavior changes have not been clearly reported. In addition, there are few reports about the effects of pro-inflammatory cytokine or anti-inflammatory cytokine on the depressive-like behavior induced by chronic stressors. To further understand the role of cytokines in depression, the purpose of the present study is to investigate the dose and time effects of pro-inflammatory cytokines induced by lipoposaccharide on depressive-like behavior, sensitization effect of pro-inflammatory and blockage effect of anti-inflammatory on depressive-like behavior induced by chronic cold swimming stress. The behavioral observation was carried out using sacharin preference test, open field test and elevated-plus maze. The results indicated that: 1) The activated immunity induced by LPS i.p administration could induce significant depressive-like behavior, but these behaviors had no long-term effect; 2)The depressive-like behaviors induced by stress could be elicited earlier and kept longer by the activated immunity induced by LPS ip ; 4) The chronic activated immunity induced by LPS icv administration could provoke significant depressive-like behavior, and the depressive-like behaviors induced by stress could be enhanced by icv LPS, LPS and stress had certain interact-sensitization effect on depressive-like behavior； 5) Anti-inflammatory cytokines IL-10 icv reversed the depressive-like behaviors induced by the stress. In conclusion, cytokines play an important role in the depressive-like behavior. Both peripheral and central administration of LPS induced a certain depressive-like behavior and enhanced stress-induced depressive behavior. The anti-inflammatory cytokine IL-10 icv could reverse the depressive-like behaviors induced by the stress. Keywords: lipoposaccharide, depressive-like behavior, anhedonia, locomotion, chronic cold swimming stress

金融工作者的抑郁症状的影响因素及其形成机制研究

Ill-health prevails in the workplace. A key problem encountered in the area of stress management is a lack of research into the way job burnout turns into mental problems, especially depressive symptoms, the most prevalent and costly psychiatric condition in the workplace. This research belongs to a cross-discipline area of industrial psychiatry and organizational behavior, which has seldom been investigated before. This research will contribute to the theoretical development of organizational behavior, especially to stress management and industrial psychiatry. This study aims to explore etiological factors and mechanisms of depressive symptoms of workers in the financial industry. By using literature review, semi-structured interviews and surveys as the major research methods, this Ph.D. study systematically investigated the risk factors of workers’ depressive symptoms within and outside of the work area. These risk factors are worker-work environment fits, work family conflicts, and workers’ psychological vulnerabilities to depression. A thorough literature review and 20 semi-structured interviews of brokers in different kinds of financial markets show the feasibility and necessity of this Ph.D. study when it comes to the issue of financial workers’ depressive symptoms. Two surveys of workplace-etiological factors of depressive symptoms were conducted among 244 financial workers and 1024 financial workers. This cross-sample verification showed that worker-work environment fit was a good framework to study risk factors of workers’ depressive symptoms. Results revealed that job demands-abilities misfit could lead to job burnout which in turn contributed to worker’s depressive symptoms; besides this, work effort-reward imbalance could directly cause workers’ depressive symptoms. Emotional labor enhanced the positive effect of job burnout on workers’ depressive symptoms. In the third study, a prominent risk factor outside of the work area, namely work family conflict, and workers’ psychological vulnerabilities of depression were included with workplace etiological factors to investigate the overall predictive model of depressive symptoms of financial workers. The survey was conducted among the same 1024 financial workers. Results indicated that work effort-reward imbalance, job burnout and work interfering in family life were three external etiological factors of workers’ depressive symptoms. Neuroticism, autonomy and low emotional intelligence were three individual etiological factors which had a positive effect on workers’ depressive symptoms. Moreover, neuroticism enhanced the relationship between job burnout and depressive symptoms as well as between work interfering in family life and depressive symptoms. Autonomy aggravated the relationship between job burnout and depressive symptoms. However, emotional intelligence attenuated the relationship between job burnout and depressive symptoms as well as between work effort-reward imbalance and depressive symptoms. Besides, workers’ dysfunctional attitudes played a partial mediating role in the relationships between above etiological factors and depressive symptoms. In the same sample, research evidence of impairments of workers’ depressive symptoms to their work-life quality was also obtained. Specifically, depressive symptoms could predict workers’ presenteeism, absenteeism and turnover intention. Their subjective well-being was also lowered when suffering more severe depressive symptoms. This research provides a theoretical basis to management practices targeted to set up the Employee Assistance Program or even more specilised rehabilitation programs for workers with depressive symptoms so as to improve their work-life quality and and establish a harmonious enterprise.

Promoção da Adesão à Terapêutica e da Qualidade de Vida na Epilepsia

Tese apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Doutor em Ciências Sociais, especialidade em Psicologia

Vulnerability or resilience? Psycho-social factors associated with deliberate self-harm among adolescents

Background: Deliberate self-harm (DSH) is common among adolescents in Ireland and internationally. Psychological factors, negative life events and lifestyle factors have been found to be associated with self-harm in this group. However, large scale population-based studies of adolescent selfharm and its correlates have been lacking, and internationally a standardised methodology was needed to facilitate comparative studies. The focus on vulnerability which has been prevalent in this field has meant that research has failed to examine resilient adaptation among at-risk adolescents. Method: Data were obtained from a cross-sectional school-based study conducted in Ireland and in each of the six other centres which participated in the Child and Adolescent Self-harm in Europe (CASE) study. In Ireland, 3,881 adolescents in 39 schools in completing the anonymous questionnaire, while across all 7 centres, over 30,000 young people participated. Data were gathered on health and lifestyle, self-harm thoughts and behaviour, a wide range of life events, psychological characteristics (anxiety and depressive symptoms, self-esteem, impulsivity and coping style), and support available to young people. Results: This thesis reports the findings of the Irish CASE centre as well as one international study. The factors associated with DSH among Irish adolescents differed by gender, but among both genders drug use and knowing a friend who had engaged in self-harm were associated with DSH. Among Irish boys, strong associations were found between bullying and poor mental health and DSH. Among boys who had been bullied, psychological and school factors were associated with DSH, while family support was protective. Links between stressful life events, psychological characteristics and DSH within the international CASE sample were examined. Increased history of self-harm thoughts and acts was associated with greater depression, anxiety and impulsivity, lower self esteem and an increased prevalence of ten different negative life events, supporting the hypothesis of a “dose-response” relationship between these risk factors and the self-harm process. Associations between coping style, mental health factors (depressive symptoms, anxiety and self-esteem) and self-harm were examined among Irish adolescents. Emotion-oriented coping was strongly associated with poorer mental health and self-harm thoughts and acts. A mediating effect of emotion-oriented coping on associations between mental health factors and DSH was found for both genders and between problem-oriented coping and mental health factors for girls. Similar mediating effects of coping style were found when risk of self-harm thoughts was examined. Resilient adaptation among adolescents exposed to suicidal behaviour of others was examined. Self-harm thoughts were common in these adolescents. Among those exposed to suicidal behaviour of others, vulnerability factors were drug use and higher levels of anxiety among boys, while for girls drug use, bullying and abuse were vulnerability factors, while resilience was associated with higher self-esteem and use of problem-oriented coping. Conclusion: These findings can aid in the identification of young people at risk of self-harm in the school setting and highlight the importance of mental health, peer-related and lifestyle factors in the development of DSH. High-risk groups of young people such as bullying victims and those exposed to suicidal behaviour of others have distinctive profiles of risk factors which differ from those of their peers. Findings relating to the importance of positive coping skills can inform positive mental health programmes, many of which aim to enhance life skills and build resilience among young people. Knowledge of the factors associated with positive adaptation among at-risk adolescents can inform prevention efforts among this group.

Substance misuse in young people in Ireland - a focus on benzodiazepines

Benzodiazepines are a class of drugs that are prescribed for the treatment of anxiety and insomnia. Due to the powerful tolerance that can develop as a result of sustained use, benzodiazepines can also be dependence-forming. Benzodiazepine dependence can occur from prescribed and from recreational use, and is a significant issue for young people. The consequences of benzodiazepine dependence include cognitive and learning impairment, depressive symptoms, and increased suicide risk. Despite these risks, the nature of youth benzodiazepine use has not been explored to the same extent as other drugs. A review of existing Irish literature revealed that benzodiazepines are one of the five most recreationally-used drugs among young people. Analyses of young people attending a treatment centre indicated that young attendees from urban areas were more likely to be referred to the centre because of benzodiazepines than rural attendees. Further examination of the centre’s attendees showed that regular benzodiazepine users experienced more paranoia, loss of interest in sport, and pallor than non-regular users. Analysis of benzodiazepine prescribing to young people revealed that approximately one in seven young people were prescribed benzodiazepines for periods greater than recommended by national guidelines. Young benzodiazepine users discussed in interviews that they took benzodiazepines to escape from negative feelings and that they are generally taken in a social setting. Further interviews with youth counsellors and general practitioners highlighted that both family and community attitude to benzodiazepine use can impact on a young person’s benzodiazepine usage. Suggestions for reducing benzodiazepine use such as psychological alternatives to medication, public awareness campaigns and prescribing restrictions are provided. Future research can elaborate upon this work to determine other methods of reducing youth benzodiazepine use and the damage that it causes to the young people themselves, but also to their families, their community, and society at large.

Research into the potential of short interventions in promoting well-being among adolescents

The present research examines the issue of universal interventions designed to enhance wellbeing among a community-based adolescent population. The first phase saw a cross-sectional survey conducted among Transition Year students in 13 secondary schools in Cork city and county, Republic of Ireland, with a view towards identifying dimensions linked with wellbeing (operationalised as subjective happiness, life satisfaction, and depressive symptoms) and which might prove effective in informing intervention approaches. Arising from this, mindfulness, gratitude, and cognitive-behavioural dimensions emerged as predictors of wellbeing, and short interventions (four sessions/four weeks) informed by each were conducted with participant groups in three secondary schools, one intervention in each school. Results from statistical analysis showed that the mindfulness and cognitive-behavioural interventions facilitated significant reductions in depressive symptoms among active condition participants at post-test, but that these benefits were not sustained over time, while no statistically significant changes were detected on subjective happiness and life satisfaction. The gratitude intervention was found to have had no effect on the three outcome variables. The findings are discussed in the context of theory and past research, while limitations, implications, and possible future directions are also addressed.

Hippocampus shape analysis and late-life depression.

Major depression in the elderly is associated with brain structural changes and vascular lesions. Changes in the subcortical regions of the limbic system have also been noted. Studies examining hippocampus volumetric differences in depression have shown variable results, possibly due to any volume differences being secondary to local shape changes rather than differences in the overall volume. Shape analysis offers the potential to detect such changes. The present study applied spherical harmonic (SPHARM) shape analysis to the left and right hippocampi of 61 elderly subjects with major depression and 43 non-depressed elderly subjects. Statistical models controlling for age, sex, and total cerebral volume showed a significant reduction in depressed compared with control subjects in the left hippocampus (F(1,103) = 5.26; p = 0.0240) but not right hippocampus volume (F(1,103) = 0.41; p = 0.5213). Shape analysis showed significant differences in the mid-body of the left (but not the right) hippocampus between depressed and controls. When the depressed group was dichotomized into those whose depression was remitted at time of imaging and those who were unremitted, the shape comparison showed remitted subjects to be indistinguishable from controls (both sides) while the unremitted subjects differed in the midbody and the lateral side near the head. Hippocampal volume showed no difference between controls and remitted subjects but nonremitted subjects had significantly smaller left hippocampal volumes with no significant group differences in the right hippocampus. These findings may provide support to other reports of neurogenic effects of antidepressants and their relation to successful treatment for depressive symptoms.

A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults.

This research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms.

Effects of chronic mild traumatic brain injury on white matter integrity in iraq and afghanistan war veterans

Mild traumatic brain injury (TBI) is a common source of morbidity from the wars in Iraq and Afghanistan. With no overt lesions on structural MRI, diagnosis of chronic mild TBI in military veterans relies on obtaining an accurate history and assessment of behavioral symptoms that are also associated with frequent comorbid disorders, particularly posttraumatic stress disorder (PTSD) and depression. Military veterans from Iraq and Afghanistan with mild TBI (n = 30) with comorbid PTSD and depression and non-TBI participants from primary (n = 42) and confirmatory (n = 28) control groups were assessed with high angular resolution diffusion imaging (HARDI). White matter-specific registration followed by whole-brain voxelwise analysis of crossing fibers provided separate partial volume fractions reflecting the integrity of primary fibers and secondary (crossing) fibers. Loss of white matter integrity in primary fibers (P < 0.05; corrected) was associated with chronic mild TBI in a widely distributed pattern of major fiber bundles and smaller peripheral tracts including the corpus callosum (genu, body, and splenium), forceps minor, forceps major, superior and posterior corona radiata, internal capsule, superior longitudinal fasciculus, and others. Distributed loss of white matter integrity correlated with duration of loss of consciousness and most notably with "feeling dazed or confused," but not diagnosis of PTSD or depressive symptoms. This widespread spatial extent of white matter damage has typically been reported in moderate to severe TBI. The diffuse loss of white matter integrity appears consistent with systemic mechanisms of damage shared by blast- and impact-related mild TBI that involves a cascade of inflammatory and neurochemical events. © 2012 Wiley Periodicals, Inc.

Art, adolescence and Social Work: Anja, the invisible manager

This article has been written with the intention of being able to analyse the contributions of art —theatre, in this case— to the practice of social work. For this purpose, we have chosen to read the social reality in which we intervene through the lens of social constructionism. This helps us to rescue the social and subjective side of art, and, moreover, to recover the depathologization of the subject in professional intervention. Thus, using a practical case taken from work with adolescents in the German FSJ programme, hand-in-hand with a young girl called Anja we trace the developmental and sociological aspects of adolescence in order to later address certain common points of art and psychosocial work. Art will hence be redefined as a transitional object allowing questions to be addressed relating to (self-) perception, attachment, communication and changes in conduct as the ultimate goal of professional action. Lastly, we note the limitations and risks of art-based intervention, in order to conclude with a final synopsis.

Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence

Objectives: This study examined: (i) the prevalence of trauma in a bipolar disorder (BD) sample, and (ii) how trauma histories mediated by interpersonal difficulties and alcohol dependence impact on the severity of BD. The prevalence of posttraumatic stress disorder (PTSD) and its relationship to outcomes in BD were also examined.

Methods: Sixty participants were recruited from a geographically well-defined mental health service in Northern Ireland. Self-reported trauma histories, PTSD, interpersonal difficulties and alcohol dependence and were examined in relation to illness severity.

Results: A high prevalence of trauma was found. Trauma predicted the frequency of hospital admissions (R-2 = 0.08), quality of life (R-2 = 0.23) and inter-episode depressive symptoms (R-2 = 0.13). Interpersonal difficulties, but not alcohol dependence, appeared to play an important role in mediating these adverse effects. While only 8% of the sample met criteria for active PTSD, this comorbid disorder was associated with BD severity.

Conclusions: This study indicates that awareness of trauma is important in understanding individual differences in bipolar presentations. The theoretical and clinical implications of evidence that trauma is related to more adverse outcomes in BD are discussed. The finding that interpersonal difficulties mediate the relationship between trauma and BD severity is novel. The need for adjunctive evidence-based treatments targeting interpersonal difficulties is considered.

Rates of childhood trauma in a sample of patients with schizophrenia as compared with a sample of patients with non-psychotic psychiatric diagnoses

Despite strong evidence of high rates of childhood and adult trauma in schizophrenia, the area remains under-researched. Our objectives in the study were first, to examine the rates of exposure to childhood, adult and lifetime (child plus adult) trauma in a population with schizophrenia and a population with non-psychotic psychiatric diagnoses and second, to examine the effect of trauma on the symptoms of schizophrenia. Two groups, those with schizophrenia (n = 40), and those with a non-psychotic diagnosis (n = 30), were recruited. Data were collected for demographic, psychiatric and trauma histories for all participants and on psychosocial functioning and psychiatric symptomatology for the patients with schizophrenia. Childhood exposure to trauma was significantly more common in the schizophrenia group (t = 5.196, df = 68, p <0.001, Eta squared = 0.28), with the strongest relationship being childhood physical assault. In the schizophrenia group a history of trauma was significantly related to poor communication skills (r = -0.529, p <0.001) and depressive symptoms (r = 0.443, p = 0.004). Evidence that childhood exposure to trauma is more common in a population with schizophrenia is consistent with other studies and raises the possibility that such trauma is of etiological importance. Further research is required to replicate those findings, to elucidate possible pathways by which the experience of trauma may contribute to the development of schizophrenia, and to explore the relationship between a history of childhood trauma and the experience of depressive symptoms in schizophrenia.

The Association Between Childhood Trauma and Memory Functioning in Schizophrenia

Objective: Both neurocognitive impairments and a history of childhood abuse are highly prevalent in patients with schizophrenia. Childhood trauma has been associated with memory impairment as well as hippocampal volume reduction in adult survivors. The aim of the following study was to examine the contribution of childhood adversity to verbal memory functioning in people with schizophrenia. Methods: Eighty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of chronic schizophrenia were separated into 2 groups on the basis of self-reports of childhood trauma. Performance on measures of episodic narrative memory, list learning, and working memory was then compared using multivariate analysis of covariance. Results: Thirty-eight (45%) participants reported moderate to severe levels of childhood adversity, while 47 (55%) reported no or low levels of childhood adversity. After controlling for premorbid IQ and current depressive symptoms, the childhood trauma group had significantly poorer working memory and episodic narrative memory. However, list learning was similar between groups. Conclusion: Childhood trauma is an important variable that can contribute to specific ongoing memory impairments in schizophrenia.

Bereavement Adjustment and Support among Caregivers

The objective of this study was to examine the influence of health status, demographics, duration of bereavement, caregiving experience, and the use of formal services on bereavement adjustment for caregivers. Participants were 151 bereaved family caregivers who participated in a telephone survey. The most frequently reported symptoms by caregivers were sleeplessness, followed by depression, and loss of appetite. One hundred thirty-five respondents (89%) felt that things were going reasonably well for themselves at the time of the interview, and 91 respondents (60%) had come to terms with their loved one's death. Hierarchical regression models revealed that being a younger caregiver, reporting poorer mental health status, and being the spouse of the care recipient were predictive of a greater number of reported depressive symptoms in bereavement. Poorer mental health status, being a spousal caregiver, and reporting negative consequences of caregiving on caregiver's health were predictive of poorer recovery in bereavement. Study results also revealed that relatives and friends played an important role in assisting the bereaved to manage the bereavement process. This article identifies factors associated with poor reactions in bereavement and that bereavement as a social process where family and friends play an important role in the recovery process.