Qualidade subjetiva do sono, sintomas depressivos, sentimentos de solidão e institucionalização em pessoas idosas

RESUMO Objetivos: A presente investigação teve como principais objetivos descrever a qualidade subjetiva do sono e as perturbações do sono e analisar a intensidade dos sintomas depressivos e dos sentimentos de solidão em idosos institucionalizados; comparar estes dados com um grupo de idosos não institucionalizados e analisar a relação entre estas variáveis nos dois grupos. Métodos: Este estudo insere-se no Projeto Trajetórias do Envelhecimento de Idosos em Resposta Social de onde foi retirada uma amostra de cento e quarenta idosos sem défice cognitivo, com 70 institucionalizados e 70 não institucionalizados emparelhados por idade, sexo, escolaridade e estado civil. A média de idades foi de 76,58 (DP = 6,10), incluindo 104 mulheres e 36 homens. Como instrumentos foram utilizados um Questionário Sociodemográfico, o Questionário sobre o Sono na Terceira Idade, a Escala Geriátrica de depressão e a Escala de Solidão da Universidade da Califórnia, Los Angeles. Resultados: Verificou-se que os idosos institucionalizados apresentavam mais sentimentos de solidão do que os não institucionalizados. Contudo, não se verificaram diferenças entre os dois grupos em relação aos sintomas depressivos, qualidade subjetiva do sono ou perturbações do sono, com algumas exceções: os idosos residentes na comunidade mostraram ter a perceção de demorar mais tempo a adormecer, de acordar mais cedo e de ter mais pesadelos. Através de uma análise correlacional verificou-se, na amostra global, que quanto pior a qualidade subjetiva do sono mais sintomas depressivos se observavam e quanto mais sintomas depressivos, mais sentimentos de solidão, não havendo, contudo, relação entre o sono e a solidão. Conclusões: Concluímos que a situação de institucionalização se acompanha de mais sentimentos de solidão, mas não de sintomas depressivos ou de pior qualidade de sono. Por esse motivo, sugere-se que se desenvolvam programas de intervenção dirigidos à solidão em idosos institucionalizados. ABSTRACT Aims: The main objectives of this investigation were to describe the subjective quality of sleep and sleep disorders and analyze the intensity of depressive and loneliness symptoms in institutionalized elderly people; compare these data against a non-institutionalized elderly people subsample and analyze the relationship between these variables in both subsamples. Method: This study is part of Trajectories of Elderly Aging in Social Response Project from which a sample of one hundred and forty elderly people with no cognitive impairment was taken, with 70 institutionalized and 70 non-institutionalized matched by age, sex, education, and marital status. The average age was 76.58 (SD = 6.10), including 104 women and 36 men. The tools used for this analysis were a sociodemographic questionnaire, the Questionnaire About Sleep in the Older Adults, Geriatric Depression Scale, and the Loneliness Scale of the University of California, Los Angeles. Results: The study confirmed that institutionalized elderly people had more feelings of loneliness than those non-institutionalized. However, there were no differences between the two subsamples regarding depressive symptoms and subjective sleep quality or sleep disturbances, with some exceptions: Elderly people living in the community showed to have the perception of taking more time to fall asleep, waking up earlier, and having more nightmares. Through a correlational analysis it was found, in both subsamples, that the worse the subjective sleep quality the more depressive symptoms were observed; and the more depressive symptoms, the more feelings of loneliness, despite of not existing a relation between sleep and loneliness. Conclusions: We concluded that institutionalization is linked to more feelings of loneliness but not to depressive symptoms nor to worse quality of sleep. For this reason, it is suggested that intervention programs are developed with a focus on elderly institutionalized populations.

Cultural influences on positive affect and reward processing in depressed youth

Thesis (Ph.D.)--University of Washington, 2016-07

Parental influences and mothers’ experiences on infant and young child feeding practices

The objective of this thesis was to better understand how parental factors influence feeding practices, how mothers experience feeding and what factors mothers perceive influencing feeding in different contexts. This study is largely based on STEPS Study (Steps to Healthy Development of Children), which is a longitudinal cohort of 1797 families. In addition, qualitative data was collected among mothers in Finland and Solomon Islands. The results of this study show that different parental determinants associate with infant and young child feeding behavior and practices. Mothers with high cognitive restraint of eating introduced complementary foods earlier and neophobic mothers’ breastfed exclusively for a shorter time than mothers who ranked lower in these behaviors. Fathers’ poor diet quality associated with shorter total breastfeeding duration. Mothers’ postnatal depressive symptoms associated with shorter duration of exclusive breastfeeding, earlier introduction of complementary foods and lower compliance of feeding recommendations. The higher amount of marital distress associated with longer duration of exclusive breastfeeding and better compliance with feeding recommendations. Mothers, who participated in qualitative interviews, described how complex interplay of individual perceptions, significant others and socio-cultural environment influenced feeding practices and behavior. This study showed that several parental factors influence infant and young child feeding practices as well as compliance with the feeding recommendations. Maternal experiences and perceptions on child feeding relate to the context where mother-infant pair lives in. These results highlight the importance of targeting feeding support and, if needed, specific interventions to mothers and families who are in risk of poor feeding practices.

Sintomatologia depressiva e sono

Os comportamentos depressivos são cada vez mais evidentes na sociedade atual e ocorrem normalmente, a partir da adolescência, sendo a sua incidência maior nas mulheres. Esses comportamentos, que se traduzem em sintomatologia depressiva interferem com vários aspetos do ser humano, desde a sua imagem corporal, aos seus estados nutricional e psicológico, até ao seu estado de saúde em geral, e ao seu padrão de sono. Este trabalho procura explorar as relações entre os hábitos e a qualidade do sono e a sintomatologia depressiva. Foram avaliados 100 profissionais de saúde com horários de trabalho irregulares e com idades compreendidas entre os 20 e os 65 anos : 54 do sexo feminino e 46 do sexo masculino. Aplicou-se um questionário onde se recolheram os seguintes dados: IMC, horário de trabalho, alimentação, consumo de substâncias estimulantes, sintomatologia depressiva, sonolência diurna e qualidade do sono. Relativamente ao IMC verificou-se que 44% dos inquiridos apresenta excesso de peso e 2% já se encontra em Obesidade grau I. Relativamente ao horário de trabalho, 74 % dos inquiridos referiu o turno da manhã como sendo o seu preferencial e 59% disse que o trabalho por turnos que não era vantajoso. Na avaliação da interferência do horário de trabalho por turnos nas diversas atividades extra profissionais verificou-se que quanto ao tempo de lazer 72 % dos inquiridos disse que interfere muito, na vida social e familiar 78 % dos inquiridos diz que interfere muito, nas atividades pessoais 60 % dos inquiridos disse que interfere muito e na alimentação 83 % dos inquiridos diz que interfere muito. Ainda na alimentação, verificou-se que 52% dos inquiridos acha que o tempo que tem disponível não é adequado a uma boa refeição pelo que se verificou uma frequência das refeições irregular nomeadamente ao pequeno almoço, que apenas 47% disse sempre tomar. Relativamente ao consumo de substâncias estimulantes a mais consumida é o café, uma vez que mais de metade (53%) dos inquiridos diz tomar sempre, segue-se o consumo de tabaco, o qual 44% dos inquiridos disse consumir sempre. Quanto ao exercício físico 68% dos inquiridos disse não praticar. Na presença de sintomatologia depressiva, verifica-se que a maior parte dos inquiridos (68%; n=68) apresenta uma sintomatologia depressiva mínima, 24% apresenta depressão ligeira e 8% (n=8) apresenta depressão moderada. A determinação da sonolência diurna, verifica-se que 28% (n=28) dos inquiridos apresenta pouca sonolência diurna, 65% apresenta moderada sonolência diurna e 7% apresenta Sonolência diurna excessiva. Quanto á qualidade do sono, verifica-se que 18 % dos inquiridos tem uma boa qualidade de sono, 53 % tem sono de má qualidade e 29% dos inquiridos apresenta distúrbio de sono. Estas evidências levaram a concluir que existe uma forte relação ente o sono e a sintomatologia depressiva, e que o horário de trabalho por turnos interfere na qualidade de vida dos indivíduos, sendo que a única forma de intervir está na prevenção, incentivando os trabalhadores a hábitos de vida saudáveis e a um controlo periódico do seu estado de saúde.

Adolescent depression in schools: + Contigo Project

epidemiological data. It involves a high degree of mortality, namely by suicide, which is the third leading cause of death in the 15-24 age group. Objectives: To assess the presence and severity of depressive symptoms in a non-clinical population of adolescents. Methodology: This is a quantitative, descriptive and cross-sectional study, using the Portuguese version of the Beck Depression Inventory (BDI-II). The sample was composed of 741 adolescents. Results: The results show that 31.2% of the adolescents have depression and, of these, 17.7% have moderate to severe depressive symptoms. Girls have higher levels of depression (p=.00). The total mean score in the BDI-II was 12. Conclusion: Given the adolescents' high vulnerability to depression and suicide, it is essential to implement prevention programs in schools to promote the early detection of depression and suicidal behaviors, and the referral to mental health services.

Mental health and suicidal behaviors in adolescents from a Portuguese island

Background: Adolescent suicidal behaviors are a public health priority. Objectives: Suicidal behavior is an understudied field in the Azores, and the few existing research studies with Portuguese adolescents only include young people from Mainland Portugal. This study aims at analyzing the adolescent student population from this island region so as to describe the current situation and plan community intervention projects in this area to meet the identified needs. Methodology: This is a non-experimental, quantitative and descriptive-correlational study with the purpose of describing phenomena and finding associations between variables. Results: The results showed that 17.9% of the 484 sampled adolescents reported self-harm behaviors, with 12.7% reporting self-cutting and 5.2% medication overdose or ingestion of toxic substances. Around 15.5% of the adolescents reported suicidal ideation. Additionally, they showed high levels of depressive symptoms (19.9%), ranging from moderate (12%) to severe (7.9%). Conclusion: Adolescents had more self-harm behaviors, more severe depressive symptoms, a lower self-concept and fewer coping strategies than similar populations in mainland Portugal.

Individual Differences in Reactions to Peer Victimization: The Moderating Role of Temperament and Sex

This study examined whether temperamental traits and sex moderate the effects of peer victimization on children’s adjustment over a year to identify factors that put victimized children at heightened risk for adjustment difficulties. Children (N = 282; M age = 7.94 years, SD = 0.32) and teachers reported on exposure to peer victimization. Parents provided ratings of children’s temperament (i.e., inhibitory control and negative emotionality) and depressive symptoms, and teachers provided ratings of children’s aggression. Results revealed that overt victimization predicted aggression in girls with low levels of inhibitory control. Results also revealed that total victimization predicted depressive symptoms in girls with high levels of negative emotionality and in boys with low levels of negative emotionality. This research identifies temperament and sex as contributors to individual differences in children’s reactions to peer victimization. The findings are discussed in the context of temperament x environment and diathesis-stress frameworks.

Atividade física e saúde:benefícios de um programa combinado de exercício com visualização mental em doentes com Parkinson

Projeto de Investigação apresentado para a obtenção do grau de Mestre em Psicologia do Desporto e do Exercício

The relationship of early social, mental, and behavioral experiences with adult obesity and Alcohol Use Disorder

Stressful life events early in life, including symptoms of mental disorders or childhood maltreatment, may increase risk for worse mental and physical health outcomes in adulthood. The purpose of this dissertation was to examine the effects of childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms and maltreatment experience on two adult outcomes: obesity and alcohol use disorder (AUD). Mediational effects of adolescent characteristics were explored. This dissertation used Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health. In Paper 1 (Chapter 3), we investigated the association between multiple types of child maltreatment and adult objective (body mass index; BMI) and subjective (self-rated) obesity, as well as mediating effects by adolescent characteristics including depressive symptoms and BMI. Results showed that after adjusting for sex, race/ethnicity, and maternal education, physical maltreatment was moderately associated with adulthood obesity as measured by BMI and self-reported obesity, while sexual maltreatment was more strongly associated with the objective measure but not the subjective measure. The indirect effects of mediation of adolescent BMI and depressive symptoms were statistically significant. In Paper 2 (Chapter 4), the objective was to examine mediation by adolescent depressive symptoms, alcohol consumption, peer alcohol consumption, and delinquency in the relationship between ADHD symptoms and adult AUD. The indirect effects of mediation of adolescent delinquency, alcohol consumption, and peer alcohol consumption were statistically significant in single and multiple mediator models. In Paper 3 (Chapter 5), the objective was to assess the joint effects of maltreatment/neglect on adult AUD. After adjusting for sex, race/ethnicity, child maltreatment, and parental AUD, ADHD symptoms were significantly associated with increased odds of AUD. There was no strong evidence of multiplicative interaction by maltreatment. This association was stronger for males than females, although the interaction term was not statistically significant. This dissertation adds to the literature by examining relationships between several major public health problems: ADHD symptoms, childhood maltreatment, AUD, depressive symptoms, and obesity. This project has implications for understanding how early life stress increases risk for later physical and mental health problems, and identifying potential intervention targets for adolescents.

Atividade física e saúde:benefícios de um programa combinado de exercício com visualização mental em doentes com Parkinson

Projeto de Investigação apresentado para a obtenção do grau de Mestre em Psicologia do Desporto e do Exercício

The role of psychological inflexibility in Beck's cognitive model of depression in a sample of undergraduates

Beck's cognitive model of depression proposes that depressogenic schemas have an effect on depressive symptoms by increasing the frequency of negative automatic thoughts in response to negative life events. We aimed to test a moderated, serial mediation model where psychological inflexibility, a core concept of the Acceptance and Commitment Therapy (ACT) model of psychopathology, both mediates and moderates the relationship between depressogenic schemas and the frequency of negative automatic thoughts. A cross-sectional design was used in which 210 undergraduates responded to questionnaires assessing the constructs of interest. Results supported the proposed moderated mediation model. Both psychological inflexibility and negative automatic thoughts were significant mediators of the relationship between depressogenic schemas and depressive symptoms, and psychological inflexibility also moderated the effect of depressogenic schemas on negative automatic thoughts. We conclude that the role of psychological inflexibility in the cognitive model of depression deserves more attention.

The pathophysiology of CADASIL: studies in a Scottish cohort

Since identification that mutations in NOTCH3 are responsible for cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) in the early 1990s, there has been extensive characterisation of the clinical and radiological features of the disease. However therapeutic interventions remain elusive, partly due to a limited understanding of the vascular pathophysiology and how it leads to the development of strokes, cognitive decline and disability. The apparent rarity and heterogenous natural history of CADASIL potentially make conducting any longitudinal or therapeutic trials difficult. The role of disease biomarkers is therefore of some interest. This thesis focuses on vascular function in CADASIL and how it may relate to clinical and radiological markers of disease. Establishing the prevalence of CADASIL in the West of Scotland was important to assess the impact of the disease, and how feasible a trial would be. A mutation prevalence of 10.7 per 100,000 was demonstrated, suggesting significant under diagnosis of the disease across much of Scotland. Cerebral hypoperfusion is thought to be important in CADASIL, and it has been shown that vascular abnormalities precede the development of brain pathology in mouse models. Investigation of vascular function in patients, both in the brain and systemically, requires less invasive measures. Arterial spin labelling magnetic resonance imaging (MRI) and transcranial Doppler ultrasound (TCD) can both be used to obtain non-invasive and quantifiable indices of vascular function. Monitoring patients with MRI whilst they receive different concentrations of inspired oxygen and carbon dioxide can provide information on brain function, and I reviewed the practicalities of this technique in order to guide the design of the studies in this thesis. 22 CADASIL patients were recruited to a longitudinal study. Testing included peripheral vascular assessment, assessment of disability, neurological dysfunction, mood and cognition. A CO2 reactivity challenge during both TCD and arterial spin labelling MRI, and detailed MRI sequences were obtained. I was able to demonstrate that vasoreactivity was associated with the number of lacunes and brain atrophy, as were carotid intima-media thickness, vessel stiffness, and age. Patients with greater disability, higher depressive symptoms and poorer processing speed showed a tendency to worse cerebral vasoreactivity but numbers were small. This observation suggests vasoreactivity may have potential as a therapeutic target, or a biomarker. I then wished to establish if arterial spin labelling MRI was useful for assessing change in cerebral blood flow in CADASIL patients. Cortical grey matter showed the highest blood flow, mean (SD), 55 (10) ml/100g/min and blood flow was significantly lower within hyperintensities (19 (4) ml/100g/min; p <0.001). Over one year, blood flow in both grey matter (mean -7 (10) %; p = 0.028) and deep white matter (-8 (13) %; p = 0.036) declined significantly. Cerebrovascular reactivity did not change over one year. I then investigated whether baseline vascular markers were able to predict change in radiological or neuropsychological measures of disease. Changes in brain volume, lacunes, microbleeds and normalised subcortical hyperintensity volume (increase of 0.8%) were shown over one year. Baseline vascular parameters were not able to predict these changes, or those in neuropsychological testing. NOTCH3 is found throughout the body and a systemic vasculopathy has been seen particularly affecting resistance vessels. Gluteal biopsies were obtained from 20 CADASIL patients, and ex vivo myography investigated the response to vasoactive agents. Evidence of impairment in both vasodilation and vasoconstriction was shown. The addition of antioxidants improved endothelium-dependent relaxation, indicating a role for oxidative stress in CADASIL pathology. Myography measures were not related to in vivo measures in the sub-group of patients who had taken part in both studies. The small vessels affected in CADASIL are unable to be imaged by conventional MR imaging so I aimed to establish which vessels might be responsible for lacunes with use of a microangiographic template overlaid onto brain images registered to a standard brain template. This showed most lacunes are small and associated with tertiary arterioles. On the basis of this thesis, it is concluded that vascular dysfunction plays an important role in the pathophysiology of CADASIL, and further assessment of vascular measures in longitudinal studies is needed. Arterial spin labelling MRI should be used as it is a reliable, non-invasive modality that can measure change over one year. Furthermore conventional cardiovascular risk factor prevention should be undertaken in CADASIL patients to delay the deleterious effects of the disease.

Diagnóstico de la relación entre el uso excesivo de las TICs y síntomas depresivos y ansiedad en estudiantes de medicina, Universidad de Cuenca, Ecuador

Se trata de un estudio descriptivo de corte transversal entre estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca1, para determinar la magnitud del uso excesivo de Tecnologías de Información y Comunicación (TICs), su variación en función de la edad, sexo, estado civil y la carrera; así como su asociación con síntomas depresivos y de ansiedad. En el cuestionario previamente validado que fue aplicado a muestra aleatoria por conglomerados de 333 estudiantes, se integraron preguntas de información demográfica, test de uso excesivo de TICs y de síntomas depresivos y de ansiedad. El concepto de Riesgo Relativo y su Intervalo de Confianza al 95% fue utilizado para el análisis estadístico. Los resultados nos revelan que la edad promedio de la muestra de la población fue de 22 años, 37,2% con uso excesivo de TICs, el 18,3% presentan síntomas depresivos y 39,8% de ansiedad. Entre las variables asociadas de manera significativa con el uso excesivo de TICs están: la edad menor de 19 años (RR 2,04; IC 95% 1,31-3,20), el género masculino (RR 1,36; IC 95% 1,03-1,80) y la carrera de Tecnología Médica (RR 1,83; IC 95% 1,28-2,63). El uso excesivo de las TICs no está asociado con el estado civil. Sin embargo, el análisis estadístico nos muestra la existencia de una correlación positiva entre el uso excesivo de las TICs y la frecuencia de estudiantes con síntomas depresivos (RR 1,88; IC 95% 1,45-2,44) y de ansiedad (RR 2,61; IC 95% 1,64-4,15).

Navegando a tempestade num copo de álcool: locus de controlo de saúde e depressão em alcoólicos em tratamento

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

RISK FACTORS FOR NONMEDICAL PRESCRIPTION ANALGESIC USE AMONG COLLEGE STUDENTS: RESULTS OF A PROSPECTIVE STUDY

Purpose—Nonmedical Prescription Analgesic (NPA) use is a serious public health concern and studies on risk factors for NPA use are lacking. This investigation used preexisting data from a landmark longitudinal, prospective study of college students, the College Life Study (CLS), to examine the longitudinal relationship between four suspected risk factors—affective dysregulation, conduct problems, depressive symptoms, and general psychological health—and NPA use. Methods—The sample was comprised of 1,253 young adults originally recruited as first-year college students from a large, mid-Atlantic university. Results—10.5% (n=103) of the participants during year 3 of the study reported past year NPA use, of which 55.3% (n=57) were male and 81.6% (n=84) were white. Affective dysregulation and conduct problems were found to be significantly and longitudinally (baseline to year 3) associated with incident NPA use after controlling for gender, parents’ education, and race/ethnicity. Conclusions—Affective dysregulation and conduct disorder are longitudinally associated with NPA use among college students. These findings might aid in prevention efforts to reduce NPA use among college students.