Studies have shown that 70 – 80% of a product's life cycle costs are committed by the end of the product design phase (Anderson, 2014; National Research Council, 1991; Swift, 1987). This supports the general claim that decision making in the conceptual stage drives the cost throughout the life cycle. The use of concurrent engineering has been viewed as the answer to this problem, offering the Design for Excellence (DFX) as one approach for evaluating product designs across specific disciplines. This research focuses on a subset of DFX referred to as Design for Manufacturability to develop a means to assess manufacturing risk and cost impacts in the conceptual design phase while exploring some of the challenges associated with its implementation. First, the use of design for manufacturing methods typically occurs late in the design phase, where the detection of product deficiencies increases life cycle costs as teams work to mitigate the impacts to cost, quality, and production implementation schedules. Second, implementing methods and tools in the conceptual stage involves the need for decision-making at a point where the least amount of design and manufacturing information is available. Lastly, implementation of new methods requires a commitment of time for personnel to gain the familiarity needed to effectively use these methods to benefit product development activities. In response to this problem, this research introduces the House of Manufacturability (HOM) assessment method, heavily influenced by the House of Quality. This research synthesizes the results of a comprehensive literature review and the insight gained from a stakeholder evaluation involving individuals from the product development community to develop an early life cycle manufacturability assessment. The proposed HOM method utilizes an assessment matrix of manufacturability indicators (MIs) and stakeholder requirements (SRs) to arrive at manufacturability risk numbers (MRNs) that represent the concerns of the manufacturing enterprise. A pilot case study of a notional UAV design concept is explored to illustrate the application of the method and capture observations critical to the research. The results of the case study are compared to the stakeholder input to confirm alignment with the stakeholders’ expectations.

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Parents can have large effects on their offspring by influencing the early developmental environment. In birds, a major way that parents can influence the early developmental environment is through egg incubation. Not only is incubation necessary for hatching success, but small changes of <1C in average incubation temperature have large effects on post-hatch offspring morphology and physiology. However, incubation is energetically costly and time-consuming for parents, and thus parents must allocate resources between incubation and self-maintenance. This can lead to differences in parental incubation behavior and egg temperatures among and within populations. Understanding which factors influence incubation, and the subsequent effects for offspring, is crucial for understanding parental effects, non-genetic drivers of phenotypic variation, and how environmental changes affect avian populations. I used wood ducks (Aix sponsa) as a study species to investigate how factors (disturbance, clutch size, ambient temperature) that influence parental demands may affect parental incubation behavior, physiology, and egg temperatures, and subsequently how egg temperatures affect offspring behavior and physiology. In a field experiment, I found that nest disturbance (i.e., capture) reduced both parent prolactin concentrations and the amount of time that parents spent incubating (Chapter 1). Further, ambient temperature was positively and clutch size negatively related to egg temperatures. Notably, in large clutches, differences in average incubation temperature among eggs within nests were large enough (i.e., >1C) to lead to different offspring phenotypes within broods (Chapter 2). Then, in a series of experiments in which I controlled incubation temperature, I provided evidence that lower average incubation temperatures lead to a reduced ability of ducklings to exit the nest cavity (Chapter 3), a more proactive behavioral phenotype (Chapter 4), a smaller body size, and a reduced efficiency in food consumption (Chapter 5), compared to those incubated at higher temperatures. Together, my dissertation illustrates how disturbances, clutch size, and ambient temperature can influence an important aspect of avian parental care, which has wide-ranging effects on offspring traits and fitness. This has broad implications for understanding the evolution of clutch size, development of behavior, and the effects of anthropogenic changes on wildlife. / Doctor of Philosophy / Animal parents can have large effects on the development of their offspring. In birds, an important way that parents affect their offspring is through incubation, where parents physically warm their eggs to stimulate embryo development. Eggs must be incubated in order to hatch, but recent research has shown that small changes (<1C/2F) in average incubation temperature have major consequences for the quality (e.g., size, ability to thermoregulate) of offspring after they hatch. However, parents must balance how they spend their time and energy between incubation and other important activities (e.g., eating, avoiding predators), and thus incubation behavior and temperature can vary among birds. Understanding which factors affect incubation, and the consequences of altered incubation temperatures for the offspring, will help us to better understand how animals care for their offspring and how environmental changes may influence offspring development. I investigated how human disturbance, environmental temperature, and the number of eggs in the nest influenced parental incubation behavior and egg temperatures, and subsequently how egg temperatures affected offspring behaviors. By studying wood ducks (Aix sponsa) in the wild, I found that parents spent less time incubating after a human disturbance (i.e., capture) than before (Chapter 1), egg temperatures increased as environmental temperatures increased, and egg temperatures decreased as the number of eggs in the nest increased (Chapter 2). Further, in nests with many eggs (>12), some eggs experienced much lower average incubation temperatures (>1C/2F difference) than others in the same nest (Chapter 2). Then, by studying wood duck ducklings in an aviary, I found that ducklings incubated at lower temperatures were less successful at exiting a nest (Chapter 3), exhibited bolder and more exploratory behaviors (Chapter 4), were smaller, and consumed less food (Chapter 5), than those incubated at a higher temperature. Together, my dissertation shows that the number of eggs in a nest, environmental temperatures, and human disturbances can influence parental behaviors, which then affect offspring. This has broad implications for understanding why birds lay the number of eggs that they do, how animal behaviors develop, and how environmental changes (including those caused by humans) can affect wildlife.

Methanogens are supposed to be one of the first life forms that emerged and evolved on early Earth inan environment of high depths and pressure utilizing the chemical energy provided by serpentinization.Serpentinization is a geological process that involves the transformation of low-silica ultramafic rocks,which are present in the lower oceanic crust and upper mantle. During this transformation minerals arereacting with water producing H2. Methanogens that can utilize this H2 to reduce the available CO2(hydrogenotrophs) can thrive in an environment like that, taking advantage of the substrate and energyflow that exists and thrive at these ecosystems. Methanobacterium oryzae is a hydrogenotrophicmethanogen that belongs to the order Methanobacteriales and has been isolated from a rice field inPhilippines. Methanobacterium oryzae strain FPi and a strain (wild strain) similar to that, isolated froman ophiolitic outcrop in an active serpentine site in Chimaera, Antalya, Turkey in 2017, have been usedin this study and have been tested for their survivability and adaptation abilities in different iron and O2concentrations. The two strains were cultivated in mediums with 4 different iron and 2 different O2concentrations for a duration ranging from 9 to 21 weeks. Gas chromatography was used to analyzeweekly gas samples for CH4 and CO2 concentrations that have been used as growth indicators. Scanningelectron microscope pictures have been taken to assess cell presence and contamination as well asidentify mineral precipitates. The results indicate the importance of iron for these species showinglimited or no growth when treated with no iron and enhanced growth at higher concentrations of iron.Furthermore, O2 has hindered or inhibited growth in most of the samples, but lower oxygenconcentrations seem to be tolerated by some specimens throughout the experimental time. Furtherresearch for the detection of the mechanisms behind the survivability of the methanogens with no ironand with oxygen in the medium is needed to further reveal the limits of life and provide moreinformation about the organisms that might have been the first ones that inhabited our planet.

Yes / To identify maternal factors that influence physical activity behaviour in 2 year old children.

Introdução: A depressão é uma condição frequente, de curso crônico e recorrente, usualmente associada à incapacitação funcional e comprometimento significativo no desempenho das atividades diárias. Assim, o desempenho ocupacional do paciente depressivo pode ser prejudicado, ocorrendo desorganização da rotina diária, dificuldades para desempenhar papéis ocupacionais, sociais e tarefas que possuem como objetivo a automanutenção, a produtividade e o lazer. Estudos estimam que 30 a 50% dos pacientes depressivos não apresentam resposta terapêutica adequada aos tratamentos antidepressivos disponíveis atualmente, sendo estes considerados pacientes depressivos resistentes ao tratamento. Além disso, investigações científicas indicam que pacientes com estresse precoce (EP) possuem risco aumentado de desenvolver episódio depressivo recorrente e resistente, sintomas mais graves, mais tentativas de suicídio e maior probabilidade de apresentar comorbidades psiquiátricas associadas, o que dificultaria a resposta terapêutica. Objetivos: O primeiro estudo objetivou examinar a influência do EP na resposta terapêutica de pacientes depressivos, bem como, identificar qual a melhor abordagem terapêutica para esses pacientes a partir dos achados da literatura. O segundo estudo teve como objetivo analisar a relação entre os subtipos de EP de pacientes psiquiátricos adultos tratados em um programa de semiinternação psiquiátrica em Hospital Dia (HD), além de investigar as chances de ocorrência de depressão de acordo com as características sociodemográficas e clínicas desta amostra. O terceiro estudo objetivou avaliar o impacto do EP na gravidade dos sintomas psiquiátricos e no desempenho ocupacional de pacientes depressivos adultos. O quarto estudo teve como propósito avaliar a influência de fatores sociodemográficos, clínicos, do EP e do desempenho ocupacional na resposta terapêutica de pacientes depressivos adultos tratados em um programa de semi-internação psiquiátrica em HD. E o quinto estudo objetivou descrever uma intervenção grupal de terapia ocupacional para pacientes depressivos adultos com EP inseridos em um programa de semi-internação psiquiátrica em HD. Métodos: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura, utilizando as palavras chaves: early life stress, childhood maltreatment, child abuse childhood trauma, childhood neglect, depression, major depression, depressive, treatment response, treatment outcome, prediction nas seguintes bases de dados: PubMed, WEB OF KNOWLEDGE, PsycINFO e Scopus, publicados em inglês, sem limitação de tempo. O segundo estudo foi desenvolvido com a avaliação de n=81 pacientes psiquiátricos divididos em duas amostras: com EP (n=58) e sem EP (n=23) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Nesta avaliação foram utilizados os seguintes instrumentos: Mini Entrevista Neuropsiquiátrica Internacional (MINI-PLUS) para avaliação do diagnóstico psiquiátrico; Questionário Sobre Traumas na Infância (CTQ) para avaliação do EP; Inventário de Depressão de Beck II (BDI-II), Inventário de Ansiedade de Beck (BAI), Escala Hospitalar de Ansiedade e Depressão (HAD), Escala de Ideação Suicida de Beck (BSI), Escala de Desesperança de Beck (BHS), Escala de Impulsividade de Barratt (BIS-11), para avaliação dos sintomas psiquiátricos, além de uma ficha sóciodemográfica e clínica para coleta de dados do paciente. O terceiro estudo foi desenvolvido com n=91 pacientes em episódio depressivo atual divididos em duas amostras: com EP (n=62) e sem EP (n=25) em regime de semiinternação psiquiátrica na mesma instituição. Os participantes também responderam os questionários citados anteriormente, além da Escala de Avaliação de Depressão GRID de Hamilton (GRID-HAM-D21) para avaliação da gravidade da sintomatologia depressiva e a Medida Canadense do Desempenho Ocupacional (COPM) para avaliação da auto-percepção do cliente sobre o desempenho ocupacional. O quarto estudo foi desenvolvido com n=73 pacientes em episódio depressivo atual divididos em dois grupos de acordo com a resposta terapêutica na Escala de Avaliação para Depressão de Montgomery-Asberg (MADRS): respondedores (n=40) e não respondedores ao tratamento (n=33), em regime de semiinternação psiquiátrica na mesma instituição. Além dos questionários já citados anteriormente, os participantes também responderam a MADRS para avaliação da resposta terapêutica. Vale mencionar que o protocolo de avaliação psicométrica foi aplicado na admissão hospitalar e 60 dias após. O quinto estudo foi desenvolvido com 10 pacientes em episódio depressivo atual submetidos a um protocolo de 8 sessões de grupo de Terapia Ocupacional, utilizando-se de atividades expressivas e reflexivas para ressignificação das histórias de EP. Resultados: Na revisão sistemática foram incluídos 21 estudos sobre a temática estudada, sendo que a maioria dos estudos aponta que os diferentes subtipos de EP podem desencadear psicopatologias mais graves e mais incapacitantes no adulto, como a depressão. Além disso, o EP influencia no curso clínico e na resposta terapêutica de pacientes depressivos crônicos. Não há consenso na literatura sobre a abordagem terapêutica que apresenta maior eficácia para o paciente depressivo com EP, embora abordagens combinadas demonstrem eficácia superior. No segundo estudo foi evidenciado que a ocorrência de depressão na idade adulta está relacionada à situações de abuso emocional e sexual e negligência física na infância. Pacientes com abuso emocional na infância possuem uma prevalência 4.38 maior de depressão em comparação com aqueles sem história de EP. Os resultados do terceiro estudo indicaram que na amostra avaliada, 70.4% dos pacientes depressivos sofreram algum tipo grave de EP, comparados a 29.6% sem EP. Além disso, os pacientes depressivos com EP apresentaram maior impulsividade do que os sem EP. Foram observadas ainda correlações significativas entre a gravidade do EP e os sintomas depressivos, ansiosos e ideação suicida no grupo com EP. Os pacientes com EP apresentaram pior desempenho ocupacional quando comparados com os sem EP, apresentando prejuízos principalmente no trabalho. Os resultados do quarto estudo indicam que 45.3% dos pacientes depressivos não responderam ao tratamento, comparados a 54.7% respondedores ao tratamento. Verificamos ainda que o EP desempenhou um papel importante na resposta terapêutica dos pacientes depressivos, sendo que 60 dias após o tratamento pacientes depressivos com EP apresentaram sintomas graves de ideação suicida quando comparados aos sem EP 60 dias após a admissão. Os resultados do estudo cinco indicaram que o grupo dentro dos princípios da Terapia Ocupacional é uma estratégia importante para ressignificação das histórias traumáticas na infância e adolescência de pacientes em episódio depressivo atual. As atividades terapêuticas forneceram subsídios para o paciente exteriorizar e reelaborar as vivências do EP. Conclusões: A integração destes dados destaca a importância da influência do EP no desencadeamento de transtornos psiquiátricos, de modo especial na depressão, no seu curso clínico e resposta terapêutica, além da necessidade de novas formas de intervenções terapêuticas, como às desenvolvidas pela Terapia Ocupacional para a ressignificação das vivências de EP. Ressalta-se a necessidade de novos estudos para o aprimoramento da compreensão dos efeitos nocivos do EP nas psicopatologias depressivas no adulto. / Introduction: Depression is a common condition, chronic and recurrent course, usually associated with functional impairment and significant depletion in performing daily activities. Thus, the occupational performance of the depressive patient may be impaired, occurring disruption of daily routine, difficulty of playing occupational roles, and social tasks, which aims are self-maintenance, productivity and leisure. Studies estimate that 30 to 50% of the depressed patients don\'t have adequate therapeutic response to antidepressant treatments currently available, which are considered depressed patients resistant to treatment. Moreover, scientific research indicates that patients with early life stress (ELS) present increased risk of developing recurrent and resistant depressive episodes, more severe symptoms, more suicide attempts and are more likely to have associated psychiatric comorbidities, which would hinder the therapeutic response. Aims: The first study aimed to examine the influence of ELS in therapeutic response of depressed patients, as well as identify the best therapeutic approach for these patients from the literature findings. The second study aimed to analyze the relationship between ELS subtypes in adult psychiatric patients from psychiatric semihospitalization program in Day Hospital (DH), and to investigate the chances of occurrence of depression according to the sociodemographic and clinical characteristics of this sample. The third study aimed to evaluate the impact of the ELS on the severity of psychiatric symptoms and occupational performance in depressed adults. The fourth study aimed to evaluate the influence of sociodemographic and clinical factors, ELS and occupational performance in the treatment of adult patient\'s depressive response treated in a psychiatric semi-hospitalization program in DH. The fifth study aimed to describe an intervention group of occupational therapy for depressive adult patients with ELS treated in a psychiatric semi-hospitalization program in DH. Methods: The first study was developed through a systematic review of literature using the key words: early life stress, childhood maltreatment, child abuse childhood trauma, childhood neglect, depression, major depression, depressive, treatment response, treatment outcome, prediction, in the following databases: PubMed, WEB OF KNOWLEDGE, PsycINFO e Scopus, published in English, without time limitation. The second study was developed with the assessment of n= 81 psychiatric patients divided into two samples: with ELS (n= 58) and without ELS (n= 23), at the Clinics Hospital of Medical School of Ribeirão Preto. In this evaluation, the following instruments were applied: Mini International Neuropsychiatric Interview (MINI-Plus) for evaluation of psychiatric diagnosis; Childhood Trauma Questionnaire (CTQ) for evaluation of ELS; Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Beck Scale for Suicidal Ideation (BSI), Barratt Impulsiveness Scale (BIS-11), Hospital Anxiety and Depression Scale (HAD), for evaluation of psychiatric symptoms, as well as a social record for collecting demografic and clinic patients\' data. The third study was conducted with n=91 patients with current depressive episode divided in two samples: with ELS (n=62) and without ELS (n=25), in psychiatric semi-hospitalization regime at the same institution. Participants also answered the questionnaires mentioned previously, as well as GRID Hamilton Depression Rating Scale (GRID-HAM-D21) to assess the severity of depressive symptoms and the Canadian Occupational Performance Measure to evaluate the selfperception of the customer about his/her occupational performance. The fourth study was conducted with n= 73 patients with current depressive episode divided into two groups according to the therapeutic response for Montgomery-Asberg Depression Rating Scale (MADRS): responders (n=40) and non-responders to treatment (n=33) in psychiatric semihospitalization regime at the same institution. In addition to the questionnaires previously mentioned, participants also answered MADRS for evaluation of therapeutic response. It is worth mentioning that the psychometric assessment protocol was applied at admission and 60 days later. The fifth study was conducted with n=10 patients with current depressive episode submitted to a protocol of 8 Occupational Therapy group sessions, using expressive and reflective activities to reframe the stories of ELS. Results: Systematic review included 21 trials on the subject matter, and most studies indicate that different subtypes of ELS can trigger more severe and disabling psychopathologies in adults, such as depression. Furthermore, ELS influences the clinical course and in therapeutic response in chronic depressive patients. There is no consensus in the literature on therapeutic approach that is more effective for depressed patients with ELS, although combined approaches demonstrate superior effectiveness. In the second study, it was shown that the occurrence of depression in adulthood is related to situations of emotional abuse, sexual and physical neglect in childhood. Patients with history of emotional abuse in childhood have 4.38 times higher prevalence of depression when compared to those without ELS. The third study results indicated that from the sample studied, 70.4% of depressive patients experienced a severe type of ELS, compared to 29.6% without ELS. Furthermore, depressive patients with ELS presented greater impulsivity than those without ELS. Significant correlations were observed between the severity of ELS and depressive symptoms, anxiety and suicidal ideation in the group with ELS. Patients with ELS showed worse occupational performance when compared to those without ELS, especially at work. The results of fourth study indicate that 45.3% of depressed patients don\'t respond to treatment, compared to 54.7% that responds to treatment also we found that ELS performed an important role in therapeutic response of depressive patients, as after 60 days depressed patients with ELS showed severe symptoms of suicidal ideation compared to without ELS 60 days after admission. The results of the fifth study indicated that the group of occupational therapeutic approach is an important strategy to reframe the stories of traumatic childhood and adolescence in patients with current depressive episode. Therapeutic activities provided resources to patient for externalizing and reworking experiences of ELS.Conclusions: The integration of these data highlights the importance of the influence of ELS in the onset of psychiatric disorders, especially depression, in its clinical course and therapeutic answer, and the need for new forms of therapeutic interventions, such as those developed by the Occupational Therapy for reframing experiences of ELS. It is noteworthy the need for further studies to improve understanding of the harmful effects of ELS in depressive disorders in adults.

Introdução: A depressão é uma condição frequente, de curso crônico e recorrente, usualmente associada à incapacitação funcional e comprometimento significativo no desempenho das atividades diárias. Assim, o desempenho ocupacional do paciente depressivo pode ser prejudicado, ocorrendo desorganização da rotina diária, dificuldades para desempenhar papéis ocupacionais, sociais e tarefas que possuem como objetivo a automanutenção, a produtividade e o lazer. Estudos estimam que 30 a 50% dos pacientes depressivos não apresentam resposta terapêutica adequada aos tratamentos antidepressivos disponíveis atualmente, sendo estes considerados pacientes depressivos resistentes ao tratamento. Além disso, investigações científicas indicam que pacientes com estresse precoce (EP) possuem risco aumentado de desenvolver episódio depressivo recorrente e resistente, sintomas mais graves, mais tentativas de suicídio e maior probabilidade de apresentar comorbidades psiquiátricas associadas, o que dificultaria a resposta terapêutica. Objetivos: O primeiro estudo objetivou examinar a influência do EP na resposta terapêutica de pacientes depressivos, bem como, identificar qual a melhor abordagem terapêutica para esses pacientes a partir dos achados da literatura. O segundo estudo teve como objetivo analisar a relação entre os subtipos de EP de pacientes psiquiátricos adultos tratados em um programa de semiinternação psiquiátrica em Hospital Dia (HD), além de investigar as chances de ocorrência de depressão de acordo com as características sociodemográficas e clínicas desta amostra. O terceiro estudo objetivou avaliar o impacto do EP na gravidade dos sintomas psiquiátricos e no desempenho ocupacional de pacientes depressivos adultos. O quarto estudo teve como propósito avaliar a influência de fatores sociodemográficos, clínicos, do EP e do desempenho ocupacional na resposta terapêutica de pacientes depressivos adultos tratados em um programa de semi-internação psiquiátrica em HD. E o quinto estudo objetivou descrever uma intervenção grupal de terapia ocupacional para pacientes depressivos adultos com EP inseridos em um programa de semi-internação psiquiátrica em HD. Métodos: O primeiro estudo foi desenvolvido por meio de uma revisão sistemática da literatura, utilizando as palavras chaves: early life stress, childhood maltreatment, child abuse childhood trauma, childhood neglect, depression, major depression, depressive, treatment response, treatment outcome, prediction nas seguintes bases de dados: PubMed, WEB OF KNOWLEDGE, PsycINFO e Scopus, publicados em inglês, sem limitação de tempo. O segundo estudo foi desenvolvido com a avaliação de n=81 pacientes psiquiátricos divididos em duas amostras: com EP (n=58) e sem EP (n=23) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Nesta avaliação foram utilizados os seguintes instrumentos: Mini Entrevista Neuropsiquiátrica Internacional (MINI-PLUS) para avaliação do diagnóstico psiquiátrico; Questionário Sobre Traumas na Infância (CTQ) para avaliação do EP; Inventário de Depressão de Beck II (BDI-II), Inventário de Ansiedade de Beck (BAI), Escala Hospitalar de Ansiedade e Depressão (HAD), Escala de Ideação Suicida de Beck (BSI), Escala de Desesperança de Beck (BHS), Escala de Impulsividade de Barratt (BIS-11), para avaliação dos sintomas psiquiátricos, além de uma ficha sóciodemográfica e clínica para coleta de dados do paciente. O terceiro estudo foi desenvolvido com n=91 pacientes em episódio depressivo atual divididos em duas amostras: com EP (n=62) e sem EP (n=25) em regime de semiinternação psiquiátrica na mesma instituição. Os participantes também responderam os questionários citados anteriormente, além da Escala de Avaliação de Depressão GRID de Hamilton (GRID-HAM-D21) para avaliação da gravidade da sintomatologia depressiva e a Medida Canadense do Desempenho Ocupacional (COPM) para avaliação da auto-percepção do cliente sobre o desempenho ocupacional. O quarto estudo foi desenvolvido com n=73 pacientes em episódio depressivo atual divididos em dois grupos de acordo com a resposta terapêutica na Escala de Avaliação para Depressão de Montgomery-Asberg (MADRS): respondedores (n=40) e não respondedores ao tratamento (n=33), em regime de semiinternação psiquiátrica na mesma instituição. Além dos questionários já citados anteriormente, os participantes também responderam a MADRS para avaliação da resposta terapêutica. Vale mencionar que o protocolo de avaliação psicométrica foi aplicado na admissão hospitalar e 60 dias após. O quinto estudo foi desenvolvido com 10 pacientes em episódio depressivo atual submetidos a um protocolo de 8 sessões de grupo de Terapia Ocupacional, utilizando-se de atividades expressivas e reflexivas para ressignificação das histórias de EP. Resultados: Na revisão sistemática foram incluídos 21 estudos sobre a temática estudada, sendo que a maioria dos estudos aponta que os diferentes subtipos de EP podem desencadear psicopatologias mais graves e mais incapacitantes no adulto, como a depressão. Além disso, o EP influencia no curso clínico e na resposta terapêutica de pacientes depressivos crônicos. Não há consenso na literatura sobre a abordagem terapêutica que apresenta maior eficácia para o paciente depressivo com EP, embora abordagens combinadas demonstrem eficácia superior. No segundo estudo foi evidenciado que a ocorrência de depressão na idade adulta está relacionada à situações de abuso emocional e sexual e negligência física na infância. Pacientes com abuso emocional na infância possuem uma prevalência 4.38 maior de depressão em comparação com aqueles sem história de EP. Os resultados do terceiro estudo indicaram que na amostra avaliada, 70.4% dos pacientes depressivos sofreram algum tipo grave de EP, comparados a 29.6% sem EP. Além disso, os pacientes depressivos com EP apresentaram maior impulsividade do que os sem EP. Foram observadas ainda correlações significativas entre a gravidade do EP e os sintomas depressivos, ansiosos e ideação suicida no grupo com EP. Os pacientes com EP apresentaram pior desempenho ocupacional quando comparados com os sem EP, apresentando prejuízos principalmente no trabalho. Os resultados do quarto estudo indicam que 45.3% dos pacientes depressivos não responderam ao tratamento, comparados a 54.7% respondedores ao tratamento. Verificamos ainda que o EP desempenhou um papel importante na resposta terapêutica dos pacientes depressivos, sendo que 60 dias após o tratamento pacientes depressivos com EP apresentaram sintomas graves de ideação suicida quando comparados aos sem EP 60 dias após a admissão. Os resultados do estudo cinco indicaram que o grupo dentro dos princípios da Terapia Ocupacional é uma estratégia importante para ressignificação das histórias traumáticas na infância e adolescência de pacientes em episódio depressivo atual. As atividades terapêuticas forneceram subsídios para o paciente exteriorizar e reelaborar as vivências do EP. Conclusões: A integração destes dados destaca a importância da influência do EP no desencadeamento de transtornos psiquiátricos, de modo especial na depressão, no seu curso clínico e resposta terapêutica, além da necessidade de novas formas de intervenções terapêuticas, como às desenvolvidas pela Terapia Ocupacional para a ressignificação das vivências de EP. Ressalta-se a necessidade de novos estudos para o aprimoramento da compreensão dos efeitos nocivos do EP nas psicopatologias depressivas no adulto. / Introduction: Depression is a common condition, chronic and recurrent course, usually associated with functional impairment and significant depletion in performing daily activities. Thus, the occupational performance of the depressive patient may be impaired, occurring disruption of daily routine, difficulty of playing occupational roles, and social tasks, which aims are self-maintenance, productivity and leisure. Studies estimate that 30 to 50% of the depressed patients don\'t have adequate therapeutic response to antidepressant treatments currently available, which are considered depressed patients resistant to treatment. Moreover, scientific research indicates that patients with early life stress (ELS) present increased risk of developing recurrent and resistant depressive episodes, more severe symptoms, more suicide attempts and are more likely to have associated psychiatric comorbidities, which would hinder the therapeutic response. Aims: The first study aimed to examine the influence of ELS in therapeutic response of depressed patients, as well as identify the best therapeutic approach for these patients from the literature findings. The second study aimed to analyze the relationship between ELS subtypes in adult psychiatric patients from psychiatric semihospitalization program in Day Hospital (DH), and to investigate the chances of occurrence of depression according to the sociodemographic and clinical characteristics of this sample. The third study aimed to evaluate the impact of the ELS on the severity of psychiatric symptoms and occupational performance in depressed adults. The fourth study aimed to evaluate the influence of sociodemographic and clinical factors, ELS and occupational performance in the treatment of adult patient\'s depressive response treated in a psychiatric semi-hospitalization program in DH. The fifth study aimed to describe an intervention group of occupational therapy for depressive adult patients with ELS treated in a psychiatric semi-hospitalization program in DH. Methods: The first study was developed through a systematic review of literature using the key words: early life stress, childhood maltreatment, child abuse childhood trauma, childhood neglect, depression, major depression, depressive, treatment response, treatment outcome, prediction, in the following databases: PubMed, WEB OF KNOWLEDGE, PsycINFO e Scopus, published in English, without time limitation. The second study was developed with the assessment of n= 81 psychiatric patients divided into two samples: with ELS (n= 58) and without ELS (n= 23), at the Clinics Hospital of Medical School of Ribeirão Preto. In this evaluation, the following instruments were applied: Mini International Neuropsychiatric Interview (MINI-Plus) for evaluation of psychiatric diagnosis; Childhood Trauma Questionnaire (CTQ) for evaluation of ELS; Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Beck Scale for Suicidal Ideation (BSI), Barratt Impulsiveness Scale (BIS-11), Hospital Anxiety and Depression Scale (HAD), for evaluation of psychiatric symptoms, as well as a social record for collecting demografic and clinic patients\' data. The third study was conducted with n=91 patients with current depressive episode divided in two samples: with ELS (n=62) and without ELS (n=25), in psychiatric semi-hospitalization regime at the same institution. Participants also answered the questionnaires mentioned previously, as well as GRID Hamilton Depression Rating Scale (GRID-HAM-D21) to assess the severity of depressive symptoms and the Canadian Occupational Performance Measure to evaluate the selfperception of the customer about his/her occupational performance. The fourth study was conducted with n= 73 patients with current depressive episode divided into two groups according to the therapeutic response for Montgomery-Asberg Depression Rating Scale (MADRS): responders (n=40) and non-responders to treatment (n=33) in psychiatric semihospitalization regime at the same institution. In addition to the questionnaires previously mentioned, participants also answered MADRS for evaluation of therapeutic response. It is worth mentioning that the psychometric assessment protocol was applied at admission and 60 days later. The fifth study was conducted with n=10 patients with current depressive episode submitted to a protocol of 8 Occupational Therapy group sessions, using expressive and reflective activities to reframe the stories of ELS. Results: Systematic review included 21 trials on the subject matter, and most studies indicate that different subtypes of ELS can trigger more severe and disabling psychopathologies in adults, such as depression. Furthermore, ELS influences the clinical course and in therapeutic response in chronic depressive patients. There is no consensus in the literature on therapeutic approach that is more effective for depressed patients with ELS, although combined approaches demonstrate superior effectiveness. In the second study, it was shown that the occurrence of depression in adulthood is related to situations of emotional abuse, sexual and physical neglect in childhood. Patients with history of emotional abuse in childhood have 4.38 times higher prevalence of depression when compared to those without ELS. The third study results indicated that from the sample studied, 70.4% of depressive patients experienced a severe type of ELS, compared to 29.6% without ELS. Furthermore, depressive patients with ELS presented greater impulsivity than those without ELS. Significant correlations were observed between the severity of ELS and depressive symptoms, anxiety and suicidal ideation in the group with ELS. Patients with ELS showed worse occupational performance when compared to those without ELS, especially at work. The results of fourth study indicate that 45.3% of depressed patients don\'t respond to treatment, compared to 54.7% that responds to treatment also we found that ELS performed an important role in therapeutic response of depressive patients, as after 60 days depressed patients with ELS showed severe symptoms of suicidal ideation compared to without ELS 60 days after admission. The results of the fifth study indicated that the group of occupational therapeutic approach is an important strategy to reframe the stories of traumatic childhood and adolescence in patients with current depressive episode. Therapeutic activities provided resources to patient for externalizing and reworking experiences of ELS.Conclusions: The integration of these data highlights the importance of the influence of ELS in the onset of psychiatric disorders, especially depression, in its clinical course and therapeutic answer, and the need for new forms of therapeutic interventions, such as those developed by the Occupational Therapy for reframing experiences of ELS. It is noteworthy the need for further studies to improve understanding of the harmful effects of ELS in depressive disorders in adults.