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.

While the importance of assessing the occupational consequences of insomnia and other sleep disorders is emphasised in clinical nosologies and research guidelines, there is little consensus on which aspects of occupational performance should be assessed, how such impairment should be measured, and how outcomes should be reported. The research programme described in this thesis aimed to address this issue. Chapter 1 presents a systematic review and methodical critique of studies reporting those aspects of occupational performance most impacted by (or most frequently associated with) insomnia symptoms and degraded sleep quality. Equivocal results, wide variations in reporting conventions, and the overall lack of comparability among studies, strongly indicated the need to develop a standardised metric able to quantify sleep related occupational performance and serve as an assessment and outcome instrument suitable for use in research and clinical settings. Informed by the literature review, Chapters 2-4 describe the development and validation of the Loughborough Occupational Impact of Sleep Scale ( LOISS ), a unidimensional 19 item questionnaire that captures sleep-related occupational impairment across a number of workplace domains over a 4-week reference period. Chapters 5-7 describe LOISS outcomes from: i) surveys in a random population sample; ii) a representative sample of the UK workforce; and iii) a clinical sample of patients with obstructive sleep apnoea (before and after treatment with CPAP). Overall, the scale showed strong internal consistency (Cronbach s alpha range=0.84-0.94) and test-retest reliability (r=0.77, r2=0.59, p<0.001), high levels of criterion validity (significantly discriminating between good and poor sleepers), and proved an effective outcome measure in OSA. From the survey data reported in Chapters 2-7, LOISS score distributions showed no consistent gender difference but did show a significant ageing gradient, with sleep-related occupational impairment declining with increasing age. In conclusion, the work presented here supports the usability, validity and reliability of the LOISS as an assessment and outcome instrument, and also demonstrates the utility of this instrument in exploring the dynamics of sleep-related occupational performance

Made available in DSpace on 2014-06-11T19:24:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-07Bitstream added on 2014-06-13T20:52:52Z : No. of bitstreams: 1 abe_pb_me_mar.pdf: 1091660 bytes, checksum: 63cf0317e8dcdb377606b1427ca9fae7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A análise do nível de participação escolar é fundamental para avaliar qualitativamente a inclusão de crianças com Necessidades Educacionais Especiais (NEE) em classe regular de ensino. Para essa avaliação é preciso dirigir a atenção para a funcionalidade do aluno perante as demandas ambientais específicas, tendo-se como recurso para a coleta de informações um instrumento de medida padronizado. Nessa direção, o presente estudo investigou a participação escolar de alunos com registro de matrícula constando NEE, por meio da aplicação da School Function Assessment (SFA) tendo como objetivos: a identificação dos níveis de auxílio oferecidos a essas crianças e o levantamento da opinião dos professores sobre a importância do referido instrumento. Participaram deste estudo oito professoras de nove crianças com NEE matriculadas em classe regular do primeiro ciclo do ensino fundamental de escolas municipais. Os resultados indicaram que a participação dos alunos é próxima das expectativas de desempenho para as demais crianças da série nos ambientes de classe regular, pátio de recreio, transporte, banheiro, deslocamento e hora do lanche. As áreas de maior dificuldade foram: participação em classe regular e participação no pátio durante o recreio e intervalo. Nota-se a existência de altos níveis de assistência de terceiros, durante a execução de tarefas, havendo pouca ou nenhuma adaptação. Segundo a opinião das professoras, o instrumento (SFA) deixou mais claro o entendimento quanto ao desempenho e à participação do aluno na escola, mas, não agregou imediato valor para o trabalho cotidiano em sala de aula. Esses dados sugerem que o diagnóstico descritivo da funcionalidade é algo a ser destacado nos registros escolares, uma vez que as necessidades educacionais especiais devem ser identificadas na interação do sujeito com o seu ambiente... / The analysis of the level of participation in school is essential to understand the quality of inclusion of children with special needs in the general education classrooms. For this evaluation it is important to focus attention on the student functionality before the demands of the environment, using as a resource for collecting information it is used a standardized criterion-referenced assessment. This work investigated the performance of students identified in school records as having special needs, the instrument used for this task was the School Function Assessment (SFA) which has as its objectives the identification of levels of aid offered to the children and the understanding of the views of teachers about the importance of that instrument. A group of eight teachers participated in this work evaluating nine students with special needs enrolled on the basic education in regular public schools. The results indicated that the participation performance of those students is close to what is expected from a typical student in each one of the school environments: regular classrooms, playground/recess, transportation, bathroom/toileting, transitions, meal time/snack time. The environments presenting greatest difficulty were: participation in the regular classroom and participation in the playground/recess. It was noticed the presence of high levels of assistance by other people during the tasks having little or none adaptation. In the view of the teacher, the instrument (SFA) brings a clearer understanding about the performance and participation of students in the school, but it does not bring immediate added value to the daily work in the classroom. This data suggests that the descriptive diagnostic of the functionality is something to be carefully posted on the school records as the special needs must be identified by the relationship of the student with the school environment... (Complete abstract click electronic access below)

Introdução: A dor crônica pélvica É uma das doenças mais frequentes entre mulheres na idade reprodutiva, e como a maioria delas, tem impacto direto na vida conjugal, social e profissional da mulher. O impacto da dor no desempenho ocupacional das mulheres afeta diretamente a atividade econômica domiciliar, visto que, atualmente, a mulher representa uma parte considerável da renda familiar. A terapia ocupacional pelo Modelo Canadense de Desempenho Ocupacional as dimensões holísticas do individuo nas 3 áreas de desempenho ocupacional: autocuidado, produtividade e lazer; e do ponto de vista do estudo da dor, os procedimentos da terapia ocupacional incluem a avaliação da multiplicidade de fatores físicos, psicossociais e ambientais agravados pela dor, nos diversos contextos de desempenho do indivíduo. Objetivo: Caracterizar o desempenho ocupacional de mulheres portadoras de DPC atendidas em um serviço terciário e verificar a associação entre as limitações ocupacionais com a presença de dor pélvica crônica, o grau de cinesiofobia e os sintomas psicológicos. Casuística e Métodos: Estudo transversal qualitativo descritivo. Foram coletadas 150 mulheres, sendo 75 mulheres com DPC (grupo: dor) e 75 mulheres saudáveis (grupo: saudáveis), todas as participantes receberam o termo de consentimento livre e esclarecido. O cálculo do tamanho da amostra foi realizado sobre proporções com margem de erro relativo em populações infinitas através da seguinte expressão: n=(z2 · q)/(2 p). As avaliações e escalas utilizadas foram: Visual analogue scale VAS (Escala visual analógica),Escala de faces, Questionários de saúde do paciente: PHQ-4 (Patient Health Questionnaire), SRQ (Self-reportQuestionnaire), Escala Tampa de Cinesiofobia, Medida Canadense de Desempenho Ocupacional (COPM). Os dados obtidos foram registrados em formulário próprio. Foi avaliada a distribuição normal das variáveis através do teste de DAgostino e Pearson. Para verificar a associação entre grupos e variáveis qualitativas nós utilizamos o teste exato de Fisher, ou o Qui-quadrado quando mais pertinente. Resultado: Mulheres com DPC estão inseridas em menor número no mercado de trabalho em relação a mulheres saudáveis, e apresentam mais alterações no sono e histórico de cirurgia abdominal, além de terem pontuações acima da média nos testes PHQ-4, SRQ e Tampa, o tempo de dor (M) foi de 108 meses e o VAS (M) 74. As mulheres com DPC se preocupam menos com o autocuidado, nas 3 subcategorias de autocuidado as mulheres com DPC ressaltam menos importância. Na categoria produtividade o nível de 8 importância é homogêneo, mas apesar de mulheres com DPC estarem em menor número no mercado de trabalho, na subcategoria trabalho ambos os grupos apresentam preocupações em suas atividades de trabalho, em relação à tarefas domésticas mulheres com DPC se preocupam mais do que mulheres com saudáveis, e o inverso ocorre em deveres. Na ultima categoria analisada ambos os grupos revelam o lazer e suas 3 subcategorias importantes de forma homogenia. O desempenho e satisfação de mulheres com DPC é menos do que a média do grupo de mulheres Saudáveis. Conclusão: O desempenho e a satisfação de mulheres com DPC são prejudicados devido, principalmente, a DPC. Alterações no sono e cirurgia abdominais anteriores, podem estar relacionadas diretamente com DPC. Essas mulheres apresentam um comportamento como a perda de identidade, isolamento social, coping e dor social. O questionário TAMPA sugere que mulheres com DPC apresentam medo ao realizar suas atividades. Nosso trabalho tenta preencher uma lacuna na literatura sobre o desempenho ocupacional em mulheres portadoras de dor pélvica crônica, pois pouco se sabe sobre a doença e o quanto interfere no desempenho ocupacional dessas mulheres. / Introduction: Pelvic chronic pain is one of the most common disease among women of reproductive age, and like most of them, have a direct impact on marital life, social and professional woman. The impact of pain on work performance of women directly affects household economic activity, since, currently, the woman is a substantial part of household income. Occupational therapy by the Canadian Model of Occupational Performance holistic dimensions of the individual in the three areas of occupational performance: self-care, productivity and leisure; and from the viewpoint of the pain study, occupational therapy procedures include the evaluation of the multitude of physical, environmental and psychosocial factors aggravated by pain in many contexts individual\'s performance. Objective: To characterize the occupational performance of women with DPC met in a tertiary center and the association between occupational limitations with the presence of chronic pelvic pain, the degree of kinesiophobia and psychological symptoms. Methods: Qualitative descriptive cross-sectional study. 150 women were collected, of which 75 women with CPP (group: pain) and 75 healthy women (group: healthy), all participants were given free and informed consent form. The calculation of sample size was performed on proportions with margin of error relative in infinite populations by the following expression: n = (z 2 q) / (2 · p). Reviews and scales used were: Visual analogue scale VAS (visual analogue scale), Face Scale, Health Questionnaires patient: PHQ-4 (Patient Health Questionnaire), SRQ (Self-report Questionnaire), Scale Tampa kinesiophobia, Measurement Canada Occupational Performance (COPM). Data were recorded on a specific form. The normal distribution was evaluated variables by D\'Agostino and Pearson test. To investigate the association between groups and qualitative variables we used Fisher\'s exact test or chi-square when more relevant. Result: Women with DPC are inserted into fewer in the labor market compared to healthy women, and have more sleep disturbances and history of abdominal surgery, and have above average scores on the PHQ-4 tests, SRQ and Tampa, time of pain (M) was 108 months and the VAS (M) 74. Women with DPC care less about the \"self-care\" in the three subcategories of \"self-care\" women with DPC emphasize less important. In the category \"productivity\" the level of importance is homogeneous, but despite women with CPP are outnumbered in the labor market, in the subcategory \"work\" both groups have concerns about their work activities, regarding the \"housekeeping\" women with CPP are more concerned than women with healthy and the opposite occurs in \"duties\". In the last category analyzed both groups reveal the \"leisure\" and its 10 three major subcategories of homogeneous manner. The performance and satisfaction of women with CPP is less than the average of the group Healthy women. Conclusion: The performance and satisfaction of women with CPP are harmed due mainly to DPC. Changes in previous abdominal surgery and sleep, can be directly related to DPC. These women exhibit behavior such as loss of identity, social isolation, coping and social pain. The CAP survey suggests that women with CPP have fear when performing their activities. Our work tries to fill a gap in the literature on occupational performance in women with chronic pelvic pain, because little is known about the disease and how much interferes with the work performance of those women.

It is the responsibility of professions to provide evidence of the demonstrable value and quality of service delivery. Occupational therapists in mental health care settings find it difficult to produce convincing evidence of the demonstrable value and their contribution to health care. Currently no effective outcome measure for occupational therapists in mental health practices exists for the South African context . The development of an outcomes measuring system is much needed in these crucial times of cost-cutting, rendering quality of care with the minimum resources and the quest for evidence of the effect of intervention. The purpose of this study was to fill the outcome measurement gap by developing a system that is clinically tested and user-friendly for occupational therapists in mental health care settings. Such a system had to represent the outcomes in the occupational therapy programmes, meet the needs of the therapist in terms of purpose of the tool, be easily administered and be standardised. It was also important that the outcome measure was grounded in the theoretical framework that guides intervention programmes, namely Vona du Toit’s Model of Creative Ability. This theoretical framework is widely used in South African mental health care settings and was found suitable to be transformed into a rating scale for the outcome measure. A participatory approach combined with a mixed method exploratory design, specifically the instrument development model, was selected to guide the study. The development of the outcome measure happened in three phases. Domains for the outcome measure emerged after participation from occupational therapy clinicians and mental health care users in Phase 1. The operationalisation of the domains and the development of the rating scale happened during Phase 2. The third phase was the piloting of the outcome measure to identify issues to be optimised for the final implementation of the outcome measure. Eight domains with 52 representative items emerged from Phase 1. The domains were Process skills, Communication and Interaction skills, Lifeskills, Role performance, Balanced lifestyle, Motivation, Self-esteem and Affect. Clinicians were satisfied that these domains represented the service that they deliver and compared well with the mental health care users’ need for occupational therapy. The involvement of mental health care users in confirming relevant domains for the outcome measure ensured a client-centred approach in the research process. The outcome measure, named as the Activity Participation Outcome Measure (APOM), has a unique feature of generating reports and spider graphs for every mental health care user. The APOM was piloted in three mental health care settings. In spite of good intentions from clinicians to apply the measure, it was clear that measuring outcomes is neither a priority, nor a routine task in clinical settings. The preliminary investigation into the psychometric properties yielded positive results. However, the sample sizes for the validity and reliability samples were not optimal and further data collection needs to continue for confirmation. It is recommended that investigations into the psychometric properties of the instrument continue to eventually market it as a valid and reliable outcome measure for occupational therapists in mental health care settings. / Thesis (PhD)--University of Pretoria, 2010. / Occupational Therapy / unrestricted

Magister Scientiae (Occupational Therapy) - MSc(OT) / Street gangs have become a permanent feature of the social landscape in the Western Cape, South Africa. Various strategies have been developed to address the issue of gangsterism. The study focused on one strategy, disengagement. Disengagement is regarded as the process in which active gang members withdraw from their affiliated gangs and re-integrate into society. Much of the research that has been conducted in the area of disengagement has been done internationally, and there is very little research that explores how youth leave gangs within the South African context. Therefore, the current study explored young men’s perceptions and experiences of disengaging from gangs and how occupations facilitate and sustain the disengagement process. In the present study, occupation is defined as activities and tasks of everyday living that give meaning or value to one’s life. Occupation is associated with health and well-being, but occupations can also be unhealthy and dangerous. A qualitative approach, using an explorative research design, was adopted in order to explore the topic within a South African context, namely the townships of Nyanga and Langa, which are located on the Cape Flats. Through the use of purposive and convenience sampling, ten members of two groups, namely, the Peace Team and Project Playground, were invited to participate in the study. The Peace Team was established in 2013 by former gang members in response to the conflict amongst the youth of Nyanga and to encourage gang members to leave gangs. Project Playground is a Non-Governmental Organisation that services the areas of Langa and Gugulethu through a variety of community development projects and after school programmes. An initial focus group was conducted with some of the participants. Thereafter, semi structured interviews were conducted with each of the ten participants (until data saturation was reached). After the individual interviews were completed, a second focus group was conducted with some of the participants to discuss and explore issues that were uncovered during the individual interviews. All focus groups and interviews were voice recorded and transcribed verbatim, and transcriptions were then compared to the recordings to assure accurate reflections thereof. Thematic analysis was used to identify codes, categories and themes. Once transcription was completed coding was commenced. Through the use of codes, the researcher was able to reorganize data in a way that facilitated the interpretation and enabled the researcher to organize data into categories that were analytically useful to the study. Categories were then grouped in sub-themes and finally themes, based on similarities and patterns. Rigor and trustworthiness was ensured through various means including triangulation of data sources (multiple participants), data gathering methods (focus groups and individual interviews), member checking, keeping an audit trail and reflexivity. Ethical clearance was obtained from the Senate Research Committee of the University of the Western Cape, registration number 15/7/86. From the data five themes emerged to form the findings. These themes were: (1) The reason why, (2) The price of gang life… the fine print, (3) Time to get out… I didn’t sign up for this, (4) Getting out and staying out, and (5) The price of my freedom. The study contributed to current knowledge in occupational therapy and occupational science regarding how engagement in meaningful occupations promotes health and well-being. In understanding these occupations and what meaning they hold, it assists occupational therapists in planning, implementing and evaluating appropriate interventions to help gang members to disengage from gangs and engage in meaningful and healthy occupations that support their reintegration into the community in pro-social ways.

"September 2008" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Elysa Roberts Occupational justice recognizes that all people have the right to occupational engagement because it is through occupational engagement that people experience well-being. Occupational injustice occurs when outside forces prevent people from engaging in occupation, require participation in activities that they find meaningless, or prevent people from making choices about their occupations. People with developmental disabilities in a day program are at risk for occupational injustice because they require environmental support in order to engage in occupation. This phenomenological study explored occupational engagement of adults with moderate to severe disabilities in a day program by examining what the staff members and consumers found meaningful within the program activities and capturing how the consumers exhibited occupational engagement. This study understood occupational engagement in terms of meaning, self-choice, and motivation leading to involvement in occupation. The methods involved phenomenological interviews with 10 staff members regarding satisfying and dissatisfying experiences working with the consumers, interviews with 10 consumers with moderate to severe developmental disabilities regarding the activity groups using visual supports to enable participation, and four observations of consumers in preferred and less preferred activity groups using the Volitional Questionnaire. Strategies were employed to ensure trustworthiness of the data and analysis including dense description, data triangulation, member checks, peer review, reflexive journaling, and the use of a structured observation tool with demonstrated reliability and validity. Thematic analysis demonstrated that staff members found meaning in the day program activities through Consumer Engagement in Program Activities and Reciprocal Interaction, and the consumers found meaning in the day program activities through Doing/Active Engagement and Respectful Interaction. The consumers demonstrated occupational engagement through the following themes: Doing Activity/Initiating Action, Positive Affect, and Focused Attention. The findings demonstrated the influence of a supportive environment, choice, and relationships between consumers and staff members that may be reflective of co-occupation on occupational engagement. This information is important in order to build the body of knowledge regarding occupational engagement in an infrequently studied population, understand the implications related to such persons' occupational justice, and include the perspectives of people with moderate to severe cognitive disabilities in the study of occupation.

Inledning och Bakgrund: Vid arbete tillsammans med personer som drabbats av stroke är det vanligt att arbetsterapeuter använder sig av både funktionsbedömningar och av aktivitetsbaserade bedömningar. Flera studier belyser vikten av att sätta mål tillsammans med patienten, men det finns faktorer som hindrar eller möjliggör att målformulering utförs.  Syfte: Syftet var att beskriva hur arbetsterapeuter på strokeenheter i Sverige arbetar med utredning och målformulering tillsammans med personer som drabbats av stroke. Metod: Designen är en beskrivande, kvalitativ intervjustudie med induktiv ansats. Avsiktligt urval användes för att rekrytera deltagare. Datainsamling utfördes genom semistrukturerade intervjuer av nio arbetsterapeuter. Dataanalys utfördes genom kvalitativ innehållsanalys. Resultat: Resultatet kunde sammanfattas i den övergripande huvudkategorin Aktivitetsförmåga bedöms med olika tillvägagångssätt. Den bestod av fyra kategorier: Lära känna patienten, Funktions- eller aktivitetsbedömning?, Hinner inte sätta mål, MEN... samt Kliniskt resonemang.  Slutsats: Genom angreppsättet True top-down får arbetsterapeuten verktyg att skapa sig en bättre helhetsbild av den strokedrabbade personens aktivitetsförmåga. Motor and Process Skills Rating Form kan erbjuda ett stöd i att beskriva och dokumentera vad som observerats i en aktivitetsbedömning. För att målformulering ska utföras i större utsträckning på strokeenheter, behöver rutiner utarbetas. / Introduction: When working with individuals suffering from stroke, it is common that occupational therapists use both function-based and occupation-based assessments. Several studies highlight the importance of goal-setting together with the patient, but there are factors that either prevent or enable goal-setting to be carried out. Aim: The aim was to describe how occupational therapists at stroke units in Sweden work with evaluation and goal setting together with persons who has suffered a stroke. Method: The study was performed using a descriptive, qualitative interview design with an inductive approach.  Purposive sampling was used to recruit participants. Data was collected using semi-structured interviews with nine occupational therapists. The collected data was analysed in line with qualitative content method.   Results: The results was summarized in the overarching main category Occupational capacity is assessed using different approaches. The main category contained four categories: Getting to know the patient, Function- or activity assessment?, Not having the time for goal-setting, BUT... and Clinical reasoning.   Conclusions: Through the True top-down approach, the occupational therapist gets tools to create a better overall picture of the occupational capacity of the stroke patient. The Motor and Process Skills Rating Form can offer support in describing and documenting an observation. An elaborate process and routines need to be carried out to enable goal-setting in a greater extent at stroke units in Sweden.

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem. The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence. The first purpose of this dissertation was to explore the MAM dimension of condition-related factors to determine the Quick Disabilities of the Arm Shoulder and Hand (QDASH) minimal clinical important difference (MCID) for three distal upper extremity conditions. The second purpose was to explore the MAM dimension of personal factors to learn from individuals who expressed incongruence between their QDASH and GROC scores; how they described their perceived change in therapy. The third purpose was to explore the MAM dimension of therapy-related factors to examine the effect of patient-therapist collaborative goal setting on patient adherence to treatment and QDASH outcomes. Results demonstrated in the first study that diagnosis specific MCID’s differed from the global MCID using multiple diagnoses. In the second study results demonstrated that patients expect to have a dedicated therapist who they can trust to work collaboratively with them to establish goals and spend time with them to achieve these goals. In the third study, our first hypothesis was not supported for all three measures of adherence. The median for home exercise program diary adherence was found to trend towards significance by 8.7 percent favoring the experimental group Mann-Whitney U (p < .100). Our second hypothesis was not supported. The experimental group receiving collaborative goal setting intervention had similar QDASH mean change scores 45.9±27.6 compared to the control group 46.1±23.8, Mann-Whitney U (p < .859).