Background: For decades, researchers have been striving to better understand the complex mix of factors underlying post-combat mental illness, in the hope of enabling better outcomes for military personnel. This study focuses on investigating the behavior and possible interaction of two risk factors for poor mental health post-deployment to a combat mission: adverse childhood experience (ACE) and deployment-related stressful experience (DRSE). Methods: A longitudinal dataset linking data from 3302 military personnel at recruitment to data collected post-deployment to Canada’s mission in Afghanistan was analysed, using novel scoring systems for exposure classification. Results: Significant ACE-DRSE interaction terms were found in relation to SF-36 MCS, depression and suicidal ideation: the negative effect DRSE had on mental health outcomes was amplified as ACE levels increased. Conclusion: Individuals with a history of childhood adversity are more susceptible to the negative mental health impacts of stressful experiences during deployment to a combat zone.

Orientador: Maria Elena Guariento / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T02:26:04Z (GMT). No. of bitstreams: 1 Biasoli_TiagoRodrigo_M.pdf: 825455 bytes, checksum: 6d0f70441461706b304a0a416c486bed (MD5) Previous issue date: 2015 / Resumo: Em decorrência do aumento significativo de pessoas acima de 60 anos com transtornos mentais, é necessário conhecer as características destes sujeitos, com o intuito de promover uma melhor assistência em saúde, assim como identificar os possíveis fatores de risco associados à incidência destas doenças. Em função disso, esta pesquisa teve como o objetivo principal a caracterização sociodemográfica (gênero, idade, escolaridade, estado conjugal) e clínica (número de consultas, tempo de tratamento, número de ambulatórios frequentados e óbitos) de 318 idosos com algum tipo de transtornos de humor, entre os 1131 idosos atendidos em Ambulatórios Especializados na atenção ao idoso, do Hospital de Clínicas da Unicamp no período de 2008 a 2013. Os dados foram coletados dos prontuários do Serviço Digital de Arquivo Médico. A análise dos dados foi realizada utilizando-se os testes Qui-Quadrado (para valores esperados menores que 5). Para avaliar a associação dos transtornos de humor com as demais variáveis, foram realizadas análises de regressão logística univariada, para a verificação de associações isoladas. Em seguida, foram realizadas com os mesmos desfechos análises de regressão logística multivariada pelo método de entrada manual (enter) das variáveis independentes. Para todas as análises foram adotadas um valor de p menor ou igual a 0,05 e utilizando-se, para isso, o software Statistical Package for the Social Sciences (SPSS®), versão 20. Verificou-se, que a amostra total era composta predominantemente por mulheres (59,8%), por idosos na faixa etária entre 70-79 anos (38,8%) e casados (50,8%). Os Transtornos Mentais Orgânicos estavam presentes em 62,3% dessa população, seguidos por 23,6% relacionado aos Transtornos de Humor, sendo que 67,6% da amostra submetiam-se a tratamento por período superior a dois anos, 39% tinham realizado mais de 6 consultas e 34,1% tinham registro de comorbidades associadas. Em relação ao perfil por Especialidade, novamente se constatou um predomínio de mulheres idosas em todos os segmentos, já em relação à faixa etária, percebe-se uma diferença significativa entre as Especialidades, já que os indivíduos mais novos predominavam na Área de Psiquiatria e os mais idosos (acima de 80 anos), são mais evidentes na Área de Geriatria. Quanto às características clínico-psicológicas, verificou-se predomínio dos Transtornos Mentais Orgânicos nos Ambulatórios relacionados da Geriatria e Neurologia, sendo que os Transtornos de Humor tiveram maior registro na Psiquiatria com 44,4% dos diagnósticos. Em relação ao número de comorbidades registradas, verificou-se que 76,3% dos idosos atendidos na Geriatria apresentavam comorbidades associadas, sendo que o maior tempo de tratamento foi encontrado nos pacientes da Psiquiatria, que também registrou o maior número de consultas por paciente, e foi o único local com pacientes acompanhados em três ou mais ambulatórios. Em relação aos idosos com Transtornos de Humor, evidenciou-se que os sujeitos com menos de 80 anos, do sexo feminino, analfabetos, sem companheiros, e que comparecimento a maior número de consultas associaram-se positivamente com a presença desses Transtornos / Abstract: As a consequence of the significant increase in people over 60 with mental disorders, it is necessary to know the characteristics of this population in order to promote better health care, and to identify possible risk factors associated with the incidence of these diseases. This research has as main objective to describe the socio-demographic characteristics (gender, age, education, marital status) and clinical characteristics (number of counsel, treatment time and deaths) of 318 elderly people with some kind of disorder mood among 1131 elderly patients from outpatient clinics of Clinic Hospital of the State University of Campinas, during the period of 2008-2013. The data were collected from medical records of Digital Medical Archive Service. Data analysis was performed using the chi-square test (expected to lower values than 5) to compare categorical variables. To evaluate the association of mood disorders with the other variables, analyzes were performed univariate logistic regression, for the verification of individual associations. They were then held to the same outcomes multivariate logistic regression analysis by manual input method (enter) the independent variables. For all analyzes were adopted a p-value lesser than or equal to 0.05. It was used the Statistical Package for the Social Sciences software (SPSS), version 20. It was found that the total sample was consisted in the majority of women (59.8%). people aged between 70-79 years (38.8%) and married (50.8%). The Organic Mental Disorders were present in 62.3% of the population, followed by 23.6% related to Mood Disorders; 67.6% of the sample were undergoing treatment for longer than two years, 39% had conducted over 6 consultations and 34.1% had associated comorbidities registration. Regarding the profile for Specialty, again we found a predominance of older women in all segments. In terms of age, a significant difference between the specialties was evident, as the younger individuals predominated in Psychiatry Area and older (over 80) are more evident in Geriatrics Area. As for the clinical and psychological characteristics, there was predominance of Organic Mental Disorders related to outpatient clinics Geriatrics and Neurology, and the Mood Disorders had greater occurrence more record in Psychiatry with 44.4% of diagnoses. Regarding the number of registered comorbidities, it was found that 76.3% of the elderly seen in Geriatrics had more comorbidities, and the longer treatment was found in patients of Psychiatry, who also recorded the highest number of visits per patient and was the only place with patients followed for three or more clinics. Regarding the elderly with Mood Disorders, it became clear that individuals under 80 years, female, illiterate, without companions, and that attendance at more consultations were positively associated with the presence of these disorders / Mestrado / Gerontologia / Mestre em Gerontologia

Background: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed the relation of FSH levels with depression in multivariable linear and logistic models adjusting for age, body mass index, estradiol, antidepressant use, and other factors, and evaluated effect modification by age. In adjusted analyses of all participants, higher FSH levels were associated with lower prevalence of depression (OR comparing ≥50 vs/L = 0.50, P = 0.02). Each 10-unit increase in FSH was associated with a 17% lower prevalence of depression (95% CI 0.70-0.99). Regression coefficients for Quartiles (Q) 2-4 vs. Q1 of FSH were 0.208, -0.170, -0.472, respectively (P = 0.14). Associations were mainly observed in older women (OR 0.47, P = 0.05; ages 64-73 years). Higher FSH levels in older postmenopausal women were associated with lower prevalence of depression and depressive symptoms, independent of estradiol, adiposity measures, and other factors. Further research is warranted to evaluate mechanisms underlying these associations, including effects of FSH on immune function.

ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored. The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a moderating variable between ACEs and mental health outcomes. A secondary data analysis utilizing data from the 2018 National Survey of Children’s Health (NSCH) was used to examine the proposed aims. The study population consisted of children between the ages of 3 and 17. Chi-square analyses were utilized, and logistic regression models were constructed. Weighted prevalence estimates were calculated. 8.6%, 6.9%, 8.0% and 3.7% currently had ADHD, behavioral disorders, anxiety and depression. The prevalence of each disorder was higher for older age, Whites, public insurance, single parent homes or homes without parents, caregivers with mental health problems and non-users of medical home. Children exposed to 4 or more ACEs had greater odds of ADHD (adjusted odds ratio [aOR]= 2.03; 95% confidence interval [CI], 1.52-2.72), behavioral disorders (aOR: 2.47; CI: 1.81-3.37), anxiety (aOR: 2.66; CI: 2.00-3.53) and the strongest relationship was seen with depression (aOR: 4.53; CI: 3.13-6.54). Individual resilience, family resilience and community resilience were associated with decreased odds of mental health outcomes and the strongest relationship was seen with individual resilience. There were significant interactions between exposure to ACEs and child resilience for ADHD (aOR: 0.14; CI: 0.08-0.23), current behavioral disorders (aOR: 0.10; CI: 0.06-0.16), anxiety and (aOR: 0.21; CI: 0.13-0.35) depression (aOR: 0.24; CI: 0.13-0.43) as well as significant interactions between ACE exposure and community resilience for depression (aOR: 0.25; CI: 0.10-0.61). The findings of this research have implications for the improvement of mental health diagnosis, promotion of resilient measures and future research.

Background: The care for patients with mental disorders have changed and this has led to higher demands on nurses. Research is conducted globally within the subject and studies have shown that nurses enquire more theoretical knowledge and practical training. In the Gambia, nursing education is conducted by five different schools and the country has one psychiatric hospital. Purpose: To explore nurses’ experiences and challenges while caring for patients with mental disorders in the Gambia. Method: The study was conducted using a quantitative cross-sectional design. Result: The result showed that the respondents enquire more education, that the work is challenging and that the majority of respondents have experience of working with patients with mental disorders. Conclusions:  There is a need for internal education for nurses on their workplaces and more research within the subject.

This thesis examines the motivation of players of video games for their playing, and the strategy of these players for overcoming feelings of depression, using the methods of grounded theory. The first part deals with the approach of sociology and selected studies towards the issue of video games and mental disorders, to which I then relate the findings of my own research at the final chapter. In the second part of this work I present what methodology has been used and how. In the final part I lead a discussion about the findings and outcomes of my research.

Background. As part of a longitudinal study, prevalence findings of DSM-IV disorders are presented for a random sample of 3021 respondents aged 14 to 24, with response rate 71%. Method. Assessment included various subtypes of disorders, subthreshold conditions and disorders that have only rarely been studied in other epidemiological surveys. The computer-assisted Munich-Composite International Diagnostic Interview (M-CIDI) was used to derive DSM-IV diagnoses. Results. Substance disorders were the most frequent (lifetime 17·7%; 12-month 11·4%), with abuse being considerably more frequent than dependence. Other mental disorders had a lifetime prevalence of 27·5% (12-month, 17·5%) with depressive disorders (16·8%) being more frequent than anxiety disorders (14·4%). Eating disorders (3·0%) and threshold somatoform disorders (1·2%) were rare disorders. Subthreshold anxiety and somatoform disorders, however, were more frequent than threshold disorders. Prevalence of disorders was equally high for males and females, although specific disorder prevalence varied significantly by gender. The co-occurrence of disorders (co-morbidity) was substantial and was significantly related to greater reductions in work productivity and increased rates of professional helpseeking behaviour. Conclusions. Findings underline that mental disorders in young adults are frequent and impairing, limiting work and education ability and social interaction. Given the fact that adolescents and young adults are in a key phase of socialization in terms of professional career and interpersonal relationships, our findings indicate a considerable risk potential for an accumulation of complicating factors and future chronicity. This paper is the first report of this ongoing longitudinal study about early developmental conditions of mental disorders.

An abundance of research has implicated socioeconomic disadvantage as a major risk factor for increased rates of morbidity and mortality worldwide. While advances in science, medicine, and technology have enabled a positive trend in health outcomes over the previous two decades, individuals of lower socioeconomic status have experienced negligible improvements in health and longevity. Furthermore, individuals of lower socioeconomic status face higher risks of mental health disorders than their higher socioeconomic status counterparts. In order to improve methods of intervention, it is important to understand how the roots of these issues are cultivated during childhood. Socioeconomic status is operationalized in multiple ways, including objective measures at both the household and neighborhood levels such as income, education, occupation, employment status, and single-parent status, as well as subjective measures such as perceived social status. This work explores the relationships between exposure to childhood socioeconomic disadvantage and the development of psychopathology. It reviews the literature for impacts of lower socioeconomic status during childhood on both internalizing (mood and anxiety) and externalizing (behavioral and substance use) disorders. Overall, mental health disorders constitute a significant proportion of the worldwide health burden, affecting one in four adults across the global population, including one in five adults and one in two adolescents in the United States. These staggering prevalence rates illuminate the importance of better understanding the mechanisms by which mental health illnesses emerge. Childhood exposure to socioeconomic deprivation has been identified as a robust contributing factor to the increased risk of psychopathology development. Exposure to socioeconomic disadvantage increases the risk for mood disorders such as major depressive disorder, dysthymic disorder, bipolar I and II disorder, cyclothymic disorder; anxiety disorders such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias; behavioral disorders such as oppositional defiant disorder, conduct disorder, antisocial personality disorder, and attention-deficit/hyperactivity disorder; and substance use disorders such as alcohol and tobacco use. These conditions can disrupt normal growth and development; cause significant impairment in social, academic, and occupational environments; and create tremendous distress in important areas of daily functioning. An ecobiodevelopmental model reveals how the interplay of biological factors, such as genetic inheritance and physiological adaptations/disruptions, with ecological factors, such as the social and physical environment, occurs continuously across the entire life span from the prenatal period through infancy, childhood, adolescence, and adulthood to drive development and the evolution of individual health and disease. Application of this approach helps to explain how genetic predispositions interact with exposure to poverty to cultivate an environment more prone to adverse childhood experiences. Adverse childhood experiences are stressors occurring prior to the age of 18 that can be threatening or harmful emotionally or physically, which can include traumatic or potentially traumatic experiences such as neglect and abuse. Examples include socioeconomic hardship, racial/ethnic discrimination, parental death, separation from parents, divorce, neighborhood violence, parental mental illness, abuse, neglect, parental substance abuse, violence and criminality in the home, and life-threatening physical illness. Adverse childhood experiences promote toxic stress, which occurs from distressing situations high in magnitude, duration, or frequency without protective, buffering adult relationships to help the child cope. Toxic stress is characterized by an overloading of the body’s normal physiologic response mechanisms, which can have adverse long-term consequences through brain circuitry alterations and physiologic disruptions of the hypothalamic-pituitary-adrenocortical axis occurring during sensitive, critical periods of development. Toxic stress-induced alterations can occur in brain regions such as the hippocampus, amygdala, and prefrontal cortex, which are important in mood control, anxiety, stress coping, decision-making, and self-regulation. Self-regulation is a critical mediator in the link between childhood deprivation and subsequent psychopathology, as deficits in self-regulation increases the risk of both internalizing and externalizing disorders. In summation, the ecobiodevelopmental model is a multi-disciplinary approach that integrates developmental science constructs of toxic stress and self-regulation with ecology, neuroscience, and life course sciences to supply promising explanations for the underlying mechanisms linking childhood poverty to mental illnesses.

Den psykiska ohälsan ökar i Sverige och utgör en av de vanligaste orsakerna till sjukfrånvaro från arbetsplatser. Att hantera anställdas psykiska ohälsa är en krävande uppgift och ett stort ansvar som åläggs chefer, men trots detta saknas chefsperspektivet inom forskningsområdet. Det övergripande syftet med studien är att undersöka hur operativa chefer med personalansvar konkret arbetar med sina medarbetares psykiska ohälsa och vilka organisatoriska förutsättningar som finns för detta. Psykisk ohälsa som fenomen är ett omfattande begrepp och används i studien tillsammans med begreppet CMD (Common Mental Disorders), vilket är ett vedertaget begrepp i internationell litteratur på området. I studien genomfördes fem semistrukturerade intervjuer med operativa chefer som var verksamma i en stor organisation inom byggbranschen. Intervjuerna analyserades genom kvalitativ innehållsanalys och för att karaktärisera chefernas psykosociala situation har resultatet har diskuterats utifrån krav, kontroll och stödmodellen. Studien har visat att arbetsuppgiften att som personalansvarigchef hantera medarbetares psykiska ohälsa är komplicerad och krävande. Psykisk ohälsa har bekräftats vara svårt att hantera på grund av komplexiteten i problemet och organisatoriskt stöd beskrevs som en nödvändighet för att som personalansvarig chef hantera medarbetare psykisk ohälsa. Resultatet visadeäven att det fanns vissa brister i förutsättningarna för att hantera detta, då mer konkret stöd och kunskap för dessa typer av situationer efterfrågades.