Objetivo: El objetivo de este estudio fue determinar la asociación entre hipertensión arterial (HTA) y síntomas depresivos, así como estimar la prevalencia de HTA y de síntomas depresivos en la población peruana. Métodos: Estudio transversal, analítico de base poblacional. Se incluyó a individuos de 18 años a más, residentes habituales de las áreas seleccionadas. La presencia de síntomas depresivos fue medida con la escala PHQ-9, mientras que la HTA se midió utilizando el promedio de dos mediciones realizadas durante la entrevista o el auto-reporte de diagnóstico previo. Se usaron modelos de regresión de Poisson con errores estándar robustos para estimar las razones de prevalencia (RP) y los intervalos de confianza al 95% (IC95%) de la asociación de interés. Resultados: Los datos de 25699 individuos fueron analizados, media de edad 44,1 (DE: 17,7) años, 54,0% de mujeres. La prevalencia de síntomas depresivos e HTA fue de 2,7% (IC95%: 2,5%-3,0%) y 21,9% (IC95%: 21,1%-22,9%), respectivamente. En el análisis multivariable, HTA no estuvo asociado a la presencia de síntomas depresivos (PR=1.16; IC95%: 0,90-1,50) después de controlar por potenciales confusores y el diseño del estudio. Conclusión: Este estudio no encontró asociación entre la presencia de HTA y de síntomas depresivos. / Objective: This study aimed to determine the association between hypertension and depressive symptoms, as well as to estimate the prevalence of both hypertension and depressive symptoms in the Peruvian population. Methods: Data from a population-based study was utilized. People aged ≥18 years and current residents of selected areas were included. The presence of depressive symptoms was measured using the PHQ-9 scale while hypertension was estimated using the mean of two measurements made during the interview. Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and confidence intervals at 95% (95% CI) for the association of interest. Results: Data from 25699 individuals were analyzed, mean age was 44.1 (DE: 17.7) years, 54.0% were females. The prevalence of depressive symptoms and HTA were 2.7% ((IC95%: 2.5%-3.0%) and 21.9% (IC95%: 21.1%-22.9%), respectively. In the multivariable analysis, HTA was not associated with the presence of depressive symptoms (PR=1.16; IC95% 0.90-1.50) after adjusting for confounders and the study design. Conclusion: This study found no association between hypertension and the presence of depressive symptoms.

Generaliserat ångestsyndrom (GAD) innebär överdriven eller icke befogad oro. För att mäta GAD utvecklades skalan GAD-7, som med sina sju frågor identifierar diagnosen enligt kriterierna från DSM-IV. Borg centiMax-skalan avser att tillföra ett förhållande mellan olika känslouttryck genom att ta fram ett exakt numeriskt värde. Skalan bygger på kvotdata, så upplevelsen av exempelvis GAD kan beskrivas som “dubbelt så stark” som en annan, jämfört med svarsalternativen i en Likertskala. Syftet med denna studie är därför att validera Borg centiMax-skalan (GAD-7-cMax) för mätning av GAD vid validering med GAD-7, samt se hur divergent validitet ser ut i Borg centiMax-skalan genom jämförelse mellan depression och ångest. Datan samlades in via bekvämlighetsurval med hjälp av en digital enkät (N = 107). GAD-7-cMax påvisade även hög intern konsistens när den används för mäta intensiteten av GAD (α = 0,916). Den övergripande korrelationen mellan den ursprungliga skalan GAD-7 och GAD-7-cMax visades vara starkt positiv (r = 0.809). En positiv korrelation återfanns mellan deltagarnas genomsnittliga poäng inom GAD samt depression på Borg centiMax-skalan (r = 0,75). Gränsvärde i resultatet låg på cirka 60 cM baserat utifrån totalpoäng för svår ångest (≥15 av 21) för GAD-7. Sammanfattningsvis visade denna studie avsevärt positiv konvergent validitet. Borg centiMax-skalan fungerar väl för mätning av ångest. Detta resultat indikerar ökad möjlighet till mer noggranna mätningar av ångest i framtiden, genom att patienter kan besvara var exakt deras känsla ligger mellan dessa siffror i Borg centiMax-skalan.

Bakgrund: Psykisk ohälsa är ett brett spektrum av olika diagnoser och studier visar på att den åldersgrupp som är hårdast drabbad är 16-29 åringar, inte minst studenter. Tidigare forskning visar också att det finns ett samband mellan fysisk aktivitet och psykisk hälsa, men även att kvinnor engagerar sig mindre i fysiska aktiviteter jämfört med män. Siffror visar också att kvinnor upplever mer psykisk ohälsa än män. Syfte: Studien syftade till att undersöka sambandet mellan självskattad fysisk aktivitetsnivå och psykisk hälsa hos studenter vid Luleå Tekniska Universitet, samt att undersöka skillnader mellan könen. Metod: En kvantitativ enkätundersökning tillämpades genom att sammanställa de två formulären, IPAQ-SF (fysisk aktivitetsnivå) och PHQ-9 (psykisk hälsa). Enkäten distribuerades via en facebookgrupp för studenter vid Luleå Tekniska Universitet och var tillgänglig i två veckor innan bearbetning av den insamlade empirin. Empirin analyserades i JASP och variablerna som användes var självskattad fysisk aktivitetsnivå i MET-minuter och PHQ-9 poäng (0-27). Resultat: Totalt 23 deltagare varav 15 kvinnor och 6 män. Mann-Whitney U-testet visade ingen signifikant skillnad mellan könen i självskattad psykisk hälsa och fysisk aktivitetsnivå, med p-värden på 1,0 (PHQ-9) och 0,97 (IPAQ-SF). Vidare visade Spearman’s korrelationstest en mycket svag negativ korrelation mellan psykisk hälsa och fysisk aktivitet. En korrelationskoefficient på -0,037, p=0,875, vilket innebär att det inte fanns något signifikant samband mellan de två variablerna. Konklusion: Studenterna som deltog i denna studie visade inget signifikant samband mellan variablerna självskattad fysisk aktivitetsnivå, mätt i MET-minuter och psykisk hälsa (0-27). Ytterligare sågs ingen skillnad mellan könen. / Background: Mental health issues is a wide spectrum of different diagnosis and studies indicate that the age group that is most affected are individuals between 16-29 years old, particularly students. Previous research also demonstrates a correlation between physical activity and mental health, as well as a lower level of physical engagement among women in comparison to men. Additionally, statistics show that women experience more mental health problems than men. Purpose: The study aimed to investigate the correlation between self-rated mental health and physical activity among students at Luleå University of Technology, as well as to investigate gender differences. Method: A quantitative survey was conducted by compiling the two forms, IPAQ-SF (physical activity) and PHQ-9 (mental health). The survey was distributed through a Facebook group for students at Luleå University of Technology and was available for two weeks before processing the collected data. The collected data were analyzed using JASP, with the variables of self-reported physical activity level in MET-minutes and PHQ-9 scores (ranging from 0-27). Results: A total of 21 participants, 15 women and 6 men. The Mann-Whitney U-test showed no significant difference between genders in self-rated mental health and physical activity level, with p-values of 1.0 (PHQ-9) and 0,97 (IPAQ-SF). Furthermore, spearman’s correlation test showed a very weak negative correlation between mental health and physical activity. A correlation coefficient of -0,037, p=0,875, which means that there was no significant correlation between the two variables. Conclusion: The students who participated in the study showed to have no significant correlation between the variables self-reported level of physical activity, measured in MET-minutes and mental health (scored from 0-27). Furthermore, no difference was seen between genders.

Personer som drabbats av depression återfaller/återinsjuknar ofta en eller flera gånger i livet. Forskning har visat att b la demografiska faktorer, residualsymtom och insomni är prediktorer för återfall. Syftet med studien var därför att undersöka betydelsen av demografiska faktorer, residualsymtom och insomni för nivån av depression 6-12 månader efter avslutad behandling på en psykiatrisk specialistmottagning. Urvalet var alla patienter som diagnosticerats med depression eller recidiverande depression och genomgått KBT-terapi under perioden 2008 – september 2013, och som hade uppföljningsdata vid sex eller tolv-månader, vilket sammanlagt var 111 patienter. Beroendevariabel var resultat på formuläret Patient Health Questionnaire (PHQ-9). Resultaten visade att patienter med residualsymtom inte försämrades signifikant mellan eftermätningen och uppföjningsmätningen, ett fynd som inte överensstämmer med forskning på området. Regressionsanalyser visade ingen signifikant påverkan av kön, ålder och utbildningsnivå på senare nivå av depression vid uppföljningsmätning. Däremot visade regressionsanalyser att sömnbesvär, mätt med formuläret Insomnia Severity Index (ISI), vid framför allt eftermätning hade ett samband med senare nivå av depression vid uppföljningsmätningen. Resultaten indikerade att kvarstående sömnbesvär då behandlingen avslutades predicerade senare nivå av depression. Slutsatsen är att ett tillägg av en sömnintervention för de patienter som har insomni då behandlingen avslutas kan minska sannolikheten för återfall i depression. Då många patienter saknade uppföljningsdata kunde inga säkra slutsatser dras.

Esta dissertação analisa os impactos de fatores socioeconômicos e psicossociais sobre a prevalência da depressão no Brasil através de modelos probit e da decomposição de Oaxaca-Blinder aplicados às bases de dados dos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD Saúde) e da Pesquisa Nacional de Saúde 2013 (PNS 2013). Neste trabalho, foram usados dois critérios básicos de identificação de indivíduos deprimidos: os que referiram ter recebido o diagnóstico de depressão de algum profissional de saúde e os que obtiveram um escore superior a 4 no teste PHQ-9 (cujas perguntas constam na PNS 2013). Foram obtidos resultados estatisticamente significativos, evidenciando a maior probabilidade da depressão entre mulheres e a relação inversa do transtorno com as variáveis renda domiciliar, desemprego, escolaridade e idade. Fatores como doenças físicas, doenças mentais e deficiências demonstraram uma relação direta com a depressão, embora as quantificações de suas magnitudes tenham sido sensíveis à especificação dos modelos. Também mostraram uma relação direta com o transtorno depressivo variáveis associadas a traumas e estresse emocional (como ter perdido um filho, ter sofrido algum tipo de violência, ter um filho com problemas de saúde, etc.). Outras variáveis como raça e região geográfica apresentaram resultados ambivalentes, também sensíveis às diferentes especificações de modelo. Ainda, variáveis referentes ao mercado de trabalho como o tipo de vínculo empregatício e setor de atividade apresentaram resultados inconclusivos. Por fim, outra conclusão importante foi que o critério de identificação dos indivíduos com depressão é determinante nos resultados. / This dissertation analyses the impacts of socioeconomic and psychosocial factors over the prevalence of depression in Brazil through probit models and the Oaxaca-Blinder decomposition applied to the data in Brazilian National Household Survey Health Supplement (PNAD Saúde) and the National Health Survey (PNS 2013). In this dissertation, two basic criteria were used to identify individuals with depression: those who declared to have received a depression diagnosis from a health professional and those who scored more than 4 in the PHQ-9 depression test (whose questions are included in PNS 2013). Statistically significant results were found, showing a higher probability of depression among women and an inverse relationship between the disorder and household income, unemployment, education and age. Factors such as chronic physical diseases, mental illnesses and deficiencies have showed a direct relationship with depression, although the quantification of such effects had a rather high sensitivity to model specification. Also, variables associated with emotional stress (such as having lost a child, being victim of some sort of violence, having a child with health problems) showed a direct relationship with depressive disorder. Other variables such as race and geographic region showed ambivalent results also very sensitive to different model specifications. Furthermore, labor market variables like type of work contract and activity sector show inconclusive results. Finally, another important finding is that the criteria for identifying individuals with depression were determinant for the results and conclusions.

Abstract The prevalence of diabetes in the United States in 2015 was 30.3 million people; which is the equivalent of 9.4% of the population. It is a major contributor to morbidity and mortality. Depression is often underdiagnosed in these patients, which contributes to poor self-management and poor health outcomes. In a large primary-care practice on the East Coast, there is no guideline for depression screening in the diabetic population. Focusing on this specific primary care setting, the research question addressed the underdiagnoses of depression in diabetic patients. The project evaluated the prevalence of depression among patients diagnosed with diabetes by using the U.S. Preventative Services Task Force (USPSTF) depression screening tool called the Patient Depression Questionnaire. The Grove Model for Implementing Evidence-Based Guidelines in Practice Framework was used in systematically integrating the new practice guideline of screening all diabetes patients for depression. The framework involves identifying the practice problem, locating, and collecting the most well-founded evidence, and evaluating the quality of the evidence-based guideline of screening all diabetes patients for depression. To answer the project question, 135 diabetic patients in a primary care outpatient setting completed the Patient Depression Questionnaire. Descriptive statistics was used to describe the sample and determine the frequency of scores throughout the sample of patients. Ranges of scores and percentages were computed using frequency distribution. Of these 135 diabetic patients, 63.7% showed some level of depression ranging from mild to severe, which was undiagnosed prior to the administration of the screening tool. As a result of the project, recommendations were made to the site to implement the use of the depression screening tool as policy.

Esta dissertação analisa os impactos de fatores socioeconômicos e psicossociais sobre a prevalência da depressão no Brasil através de modelos probit e da decomposição de Oaxaca-Blinder aplicados às bases de dados dos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD Saúde) e da Pesquisa Nacional de Saúde 2013 (PNS 2013). Neste trabalho, foram usados dois critérios básicos de identificação de indivíduos deprimidos: os que referiram ter recebido o diagnóstico de depressão de algum profissional de saúde e os que obtiveram um escore superior a 4 no teste PHQ-9 (cujas perguntas constam na PNS 2013). Foram obtidos resultados estatisticamente significativos, evidenciando a maior probabilidade da depressão entre mulheres e a relação inversa do transtorno com as variáveis renda domiciliar, desemprego, escolaridade e idade. Fatores como doenças físicas, doenças mentais e deficiências demonstraram uma relação direta com a depressão, embora as quantificações de suas magnitudes tenham sido sensíveis à especificação dos modelos. Também mostraram uma relação direta com o transtorno depressivo variáveis associadas a traumas e estresse emocional (como ter perdido um filho, ter sofrido algum tipo de violência, ter um filho com problemas de saúde, etc.). Outras variáveis como raça e região geográfica apresentaram resultados ambivalentes, também sensíveis às diferentes especificações de modelo. Ainda, variáveis referentes ao mercado de trabalho como o tipo de vínculo empregatício e setor de atividade apresentaram resultados inconclusivos. Por fim, outra conclusão importante foi que o critério de identificação dos indivíduos com depressão é determinante nos resultados. / This dissertation analyses the impacts of socioeconomic and psychosocial factors over the prevalence of depression in Brazil through probit models and the Oaxaca-Blinder decomposition applied to the data in Brazilian National Household Survey Health Supplement (PNAD Saúde) and the National Health Survey (PNS 2013). In this dissertation, two basic criteria were used to identify individuals with depression: those who declared to have received a depression diagnosis from a health professional and those who scored more than 4 in the PHQ-9 depression test (whose questions are included in PNS 2013). Statistically significant results were found, showing a higher probability of depression among women and an inverse relationship between the disorder and household income, unemployment, education and age. Factors such as chronic physical diseases, mental illnesses and deficiencies have showed a direct relationship with depression, although the quantification of such effects had a rather high sensitivity to model specification. Also, variables associated with emotional stress (such as having lost a child, being victim of some sort of violence, having a child with health problems) showed a direct relationship with depressive disorder. Other variables such as race and geographic region showed ambivalent results also very sensitive to different model specifications. Furthermore, labor market variables like type of work contract and activity sector show inconclusive results. Finally, another important finding is that the criteria for identifying individuals with depression were determinant for the results and conclusions.

Esta dissertação analisa os impactos de fatores socioeconômicos e psicossociais sobre a prevalência da depressão no Brasil através de modelos probit e da decomposição de Oaxaca-Blinder aplicados às bases de dados dos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD Saúde) e da Pesquisa Nacional de Saúde 2013 (PNS 2013). Neste trabalho, foram usados dois critérios básicos de identificação de indivíduos deprimidos: os que referiram ter recebido o diagnóstico de depressão de algum profissional de saúde e os que obtiveram um escore superior a 4 no teste PHQ-9 (cujas perguntas constam na PNS 2013). Foram obtidos resultados estatisticamente significativos, evidenciando a maior probabilidade da depressão entre mulheres e a relação inversa do transtorno com as variáveis renda domiciliar, desemprego, escolaridade e idade. Fatores como doenças físicas, doenças mentais e deficiências demonstraram uma relação direta com a depressão, embora as quantificações de suas magnitudes tenham sido sensíveis à especificação dos modelos. Também mostraram uma relação direta com o transtorno depressivo variáveis associadas a traumas e estresse emocional (como ter perdido um filho, ter sofrido algum tipo de violência, ter um filho com problemas de saúde, etc.). Outras variáveis como raça e região geográfica apresentaram resultados ambivalentes, também sensíveis às diferentes especificações de modelo. Ainda, variáveis referentes ao mercado de trabalho como o tipo de vínculo empregatício e setor de atividade apresentaram resultados inconclusivos. Por fim, outra conclusão importante foi que o critério de identificação dos indivíduos com depressão é determinante nos resultados. / This dissertation analyses the impacts of socioeconomic and psychosocial factors over the prevalence of depression in Brazil through probit models and the Oaxaca-Blinder decomposition applied to the data in Brazilian National Household Survey Health Supplement (PNAD Saúde) and the National Health Survey (PNS 2013). In this dissertation, two basic criteria were used to identify individuals with depression: those who declared to have received a depression diagnosis from a health professional and those who scored more than 4 in the PHQ-9 depression test (whose questions are included in PNS 2013). Statistically significant results were found, showing a higher probability of depression among women and an inverse relationship between the disorder and household income, unemployment, education and age. Factors such as chronic physical diseases, mental illnesses and deficiencies have showed a direct relationship with depression, although the quantification of such effects had a rather high sensitivity to model specification. Also, variables associated with emotional stress (such as having lost a child, being victim of some sort of violence, having a child with health problems) showed a direct relationship with depressive disorder. Other variables such as race and geographic region showed ambivalent results also very sensitive to different model specifications. Furthermore, labor market variables like type of work contract and activity sector show inconclusive results. Finally, another important finding is that the criteria for identifying individuals with depression were determinant for the results and conclusions.

Syftet med denna uppsats var att undersöka behandlingseffekten av studentledd psykoterapi på Umeå Universitets psykologmottagning gällande depressions- och ångestsymptom. Mer specifikt var syftet även att jämföra de två behandlingsmetoder som praktiseras på mottagningen; kognitiv beteendeterapi (KBT) och psykodynamisk terapi (PDT), samt jämföra de självskattningsinstrument för depression och ångest som ingår i mottagningens testbatteri (Patient Health Questionnaire 9-items, PHQ-9; Hospital Anxiety and Depression scale, HADS; General Anxiety Disorder 7-item scale, GAD-7). Ett ytterligare delsyfte var att beskriva mottagningens klientpopulation. Stickprovet bestod av 61 deltagare (72.1 procent kvinnor, 49.2 procent studenter, medianålder 23 år) som behandlats med antingen KBT eller PDT. För att undersöka effekterna av behandling jämfördes deltagarnas symptomskattningar före och efter behandling uppdelat på behandlingsmetod med hjälp av två-vägs variansanalys (ANOVA). Resultaten visade stora effektstorlekar för behandling gällande depression och ångest. Inga signifikanta skillnader observerades mellan behandlingsmetoder, vilket kan bero på bristande power. Diskrepans mellan instrumentens förmåga att identifiera deltagare med symptom på depression och ångest kunde ses, i synnerhet gällande depressionssymptom. I linje med rådande forskning visar studiens resultat att studentledd behandling har effekt på depression och ångest. Validiteten för de instrument som används på Psykologmottagningen bör dock undersökas närmare. Sammantaget belyser resultaten i denna studie vikten av att välja mätinstrument anpassade för den tilltänkta populationen för att kunna utvärdera behandlingseffekt.

Obesity in the United States has increased to epidemic numbers over the last decade. Practitioners need to reverse the trend. To address the problem of depression in obesity, a practice guideline from a bariatric clinic for under-served populations was proposed to an expert panel. The Spell Out on First Use (PHQ-9) screening is a valid and reliable self-screening tool to assist the practitioner in determining the level of depression if any. The PHQ-9 has nine questions. No formal screening existed at the bariatric clinic, and the practice guideline (with algorithm and revised workflow) was proposed for use at the clinic. The expert panel consisted of the medical director, a surgeon, a psychiatrist, and a nurse practitioner at the clinic. The expert panel reviewed the materials and made one recommendation: to implement the PHQ-9 upon intake when the patient is being admitted to the program, and the panel recommends administering PHQ-9 prior to assessment by practitioners All panel members were in agreement about full implementation of the practice guideline, provided that an educational program on the revised workflow in the clinic was first presented. The expert panel also reviewed and approved the algorithm and the treatment pathways identified for patients to use in the practice after the results of the PHQ-9 are compiled. It is expected that use of the depression screening tool and recommended guidelines in the bariatric clinic will result in more effective treatment for the patients and thus better outcomes-a significant positive social change.