nÃo hà / A doenÃa periodontal (DP) à descrita como enfermidade inflamatÃrio-imunolÃgica de natureza multifatorial, resultante da interaÃÃo de microorganismos patogÃnicos e defesa do hospedeiro, cujo desenvolvimento pode ser modificado por fatores locais, doenÃas sistÃmicas ou fatores genÃticos. Eventos psicossociais como o estresse, ansiedade e depressÃo, citam-se como fatores que podem contribuir para o agravamento do prognÃstico clÃnico de vÃrias doenÃas, inclusive a periodontite crÃnica (PC), por causar desequilÃbrio imunolÃgico, podendo diretamente aumentar a produÃÃo de citocinas prÃ-inflamatÃrias. Estresse oxidativo (EO) tambÃm à relacionado à DP e à depressÃo, por causar danos Ãs estruturas celulares, alÃm de comprometer a competÃncia imunolÃgica. Este estudo avaliou os efeitos da venlafaxina, um antidepressivo, e da vitamina E, um antioxidante, na periodontite experimental induzida por ligadura em ratos (PE). Observaram-se o estado de ansiedade, depressÃo e a perda Ãssea alveolar (POA). Foram utilizados Ratos Wistar (180-220g). Os animais foram divididos em dez grupos: falso-operado (FO); EP (veÃculo-Ãgua); FO e PE + venlafaxina (10 mg/kg e 50 mg/kg); FO e PE (veÃculo-Ãleo); FO e PE + vitamina E 500 mg/kg. A PE foi induzida pela inserÃÃo de um fio de sutura de nÃilon 3.0, em torno do segundo molar superior esquerdo, o qual permaneceu por 11 dias. A venlafaxina (10 e 50 mg/kg) e a vitamina E (500 mg/kg) foram administradas diariamente, por via oral, gavagem) durante nove dias. A avaliaÃÃo comportamental foi realizada no 10 dia da induÃÃo da PE pelos testes de labirinto em cruz elevado (ansiedade) e do nado forÃado (depressÃo). Os animais foram mortos por deslocamento cervical no 11 dia da induÃÃo da PE e suas maxilas removidas, para avaliaÃÃes posteriores. A anÃlise morfomÃtrica mostrou que os animais submetidos à PE tiveram POA significativa (p<0,001) comparado aos falso-operados (FO). A venlafaxina (10 mg/kg)) diminuiu a POA, mas nÃo estatisticamente significativa, por outro lado, verificou-se maior POA no grupo de animais submetidos à PE e tratados com venlafaxina (50 mg/kg). A anÃlise histopatolÃgica mostrou no grupo submetido à PE e tratado com veÃculo (Ãgua) infiltraÃÃo mononuclear acentuada (linfÃcitos e macrÃfagos) reabsorÃÃo do processo alveolar (restando apenas fragmento Ãsseo) e destruiÃÃo do cemento, escore 2 (2-3). O grupo submetido à PE e tratado com venlafaxina (10 mg/kg) mostrou tambÃm alteraÃÃo do osso alveolar e cemento, escore 2 (1-3), entretanto, nÃo houve diferenÃa estatÃstica. O grupo FO apresentou pequeno infiltrado inflamatÃrio, escore 0 (0-0). Estresse oxidativo tambÃm foi objeto de estudo nesta pesquisa. A peroxidaÃÃo lÃpidica (TBARS) mostrou-se aumentada no grupo de animais submetido à PE. A venlafaxina (10 mg/kg) inibiu esse aumento, demonstrando papel antioxidante. Foram realizados ensaios de imuno-histoquÃmica (TNF-&#945; e iNOS) nos tecidos gengival e periodontal dos animais. Observou-se aumento da imunomarcacÃo de ambos nos tecidos periodontais dos animais submetidos à PE, comparado ao grupo FO. O tratamento com venlafaxina nÃo inibiu essa marcaÃÃo. Os resultados envolvendo o tratamento com a vitamina E (500 mg/kg) mostraram na anÃlise morfomÃtrica das maxilas dos animais submetidos à PE e tratados com vitamina E que nÃo houve proteÃÃo quanto a POA, quando comparado ao grupo submetido à PE (p>0,05). A anÃlise histopatolÃgica mostrou infiltrado mononuclear menos acentuado no grupo submetido à PE e tratado com vitamina E, escore 2 (0-3) comparado ao grupo PE, 3 (2-3). A avaliaÃÃo oxidativa foi observada mediante mensuraÃÃo da peroxidaÃÃo lipÃdica (TBARS) e da atividade da enzima superÃxido dismutase (SOD). Os animais submetidos à PE apresentaram aumento significativo na concentraÃÃo de MDA (ÂM). O tratamento com vitamina E (500 mg/kg) inibiu esse efeito (p< 0,05). Em relaÃÃo à SOD, observou-se um decrÃscimo da atividade nos animais submetidos à PE e tratados com vitamina E. A avaliaÃÃo para TNF-&#945; e iNOS mostrou que a PE aumentou a imunomarcaÃÃo de ambos; o tratamento com vitamina E diminuiu a imunomarcacÃo para iNOS. A avaliaÃÃo comportamental mostrou que a PE nÃo estava associada a ansiedade ou depressÃo. Nos animais submetidos à PE houve perda de massa corpÃrea nos primeiros dias da induÃÃo da PE. Os tratamentos com venlafaxina e vitamina E nÃo alteraram esse resultado. A venlafaxina e a vitamina E nÃo foram capazes de inibir a POA. AlÃm disso, a venlafaxina (IRSNs) à suscetÃvel de agravar a POA na PE, quando usada em dose mais elevada. AtenÃÃo, tambÃm, deve ser dada para o uso indiscriminado de antioxidantes. O uso de vitamina E demonstrou efeito ansiogÃnico. / The periodontal disease is described as an inflammatory/imunological disease of multifactorial nature that results from an interaction between pathogenic microorganisms and host defense, whose development can be modified by local factors, systemic diseases or genetic factors. Psychosocial events such as stress, anxiety and depression, are few factors which can contribute for the aggravation of the clinical prognostic of many illnesses, including the chronic periodontitis, once it causes an immunological disequilibrium, being able to increase directly the production of proinflammatory cytokines. Oxidative stress has also been related to PD and depression, because of the damages caused to the cellular structures and for compromising the immunological competence. In order to have a greater insight, the present study evaluated the effects of venlafaxine, an antidepressant, and of vitamin E, a known antioxidant, in rat model of ligature-induced experimental periodontitis (EP). The state of anxiety, depression and alveolar bone loss were assessed. Wistar Rats (180-220g) were divided into ten groups: false-operated (SO); EP (vehicle-water); SO and EP + venlafaxine (10 mg/kg e 50 mg/kg); SO and EP (vehicle-oil); SO and EP + vitamin E (500 mg/kg). EP was induced by the insertion of a nylon wire 3.0, around the second upper left molar which remained there for 11 days. Venlafaxine (10 and 50 mg/kg) and vitamin E (500 mg/kg) were administered daily, orally, during 9 days. The behavioral evaluation was made in the 10th day of EP induction by tests of labyrinth in high cross (anxiety) and of immobility in forced swim (depression). The animals were killed by cervical dislocation on day-11 and their jaws removed, for later evaluations. The morphometric analysis showed that the animals submitted to the EP had significant alveolar bone loss (ABL, p<0.001) when compared to the false-operated ones (SO). Venlafaxine (10 mg/kg) attenuated ABL, but it was not statistically significant; on the other hand, it was observed a greater ABL in the group of animals submitted to EP and treated with venlafaxine (50 mg/kg). The histopathological analysis showed in the group submitted to the EP and treated with vehicle (water), significant mononuclear infiltrate (lymphocytes and macrophages), reabsorption of alveolar process (with only bone fragment left) and cement destruction score of 2 (2-3). The group submitted to the EP and treated with venlafaxine (10 mg/kg) also showed similar alterations of the alveolar bone and cementum, with a score of 2 (1-3), otherwise there was no statistical difference. The group SO showed a small or negligible inflammatory infiltrate, score 0 (0-0). Oxidative stress was also the object of evaluation in this study. Increased lipid peroxidation (TBARS) was evident in the group submitted to EP. Venlafaxine (10 mg/kg) reverted it, showing an antioxidant role. Immuno-histochemmical tests were performed (TNF-&#945; and iNOS) in the gingival and periodontal tissues of the animals revealed an increased immunoreactivity scores in the group of animals submitted to EP, compared to SO group. Venlaflaxine treatment did not reduce these scores. Morphometric analysis of the jaws from EP rats treated with vitamin E (500mg/kg) showed no protection from ABL, when compared to EP controls. The histopathological analysis showed less mononuclear infiltrate in the group submitted to the EP and treated with vitamin E, score 2(0-3) when compared with the group EP, 3 (2-3). The oxidant stress evaluation through the measurement of lipid peroxidation (TBARS) and the activity of the enzyme superoxide dismutase (SOD) showed a significant increase in the concentration of MDA (ÂM) as well as SOD in animals on EP. Treatment with vitamin E (500 mg/kg) prevented the lipid peroxidation (p<0.05), and also showed a small decrease in SOD activity. The evaluation for TNF-&#945; and iNOS immunoreactivities, EP rats showed an increased immunoreactivity scores for both TNF-&#945; and iNOS, treatment with vitamin E reduced the immunoscores for iNOS only. The behavioral evaluation demonstrated that EP was not associated with anxiety or depression. As regards to body weight changes, rats on EP gained less body weights in the first days of induction of EP. Venlafaxine and vitamin E treatments did not change these results. These data allow us to conclude that venlafaxine as well as vitamin E treatments do not prevent ABL. Venlafaxine (IRSNs) is susceeptible to exarcerbate the ABL in EP when used in high dose. Attention should also be given to the indiscriminate use of antioxidants. The use of vitamin E showed anxiogenic effect.

O mundo vive uma epidemia de obesidade, isto significa que o número de pessoas que tem o peso excessivo aumentou e atingiu proporções preocupantes e de risco à saúde. Alterações emocionais podem estar associadas à obesidade. É importante que os tratamentos para obesidade não estejam voltados apenas para melhora da qualidade de vida relacionada à saúde física, mas também à saúde mental. Sendo assim, esta pesquisa teve como objetivo geral, verificar o estado emocional (ansiedade e depressão) dos pacientes com sobrepeso e obesidade que participaram de grupos de reeducação alimentar nas Unidades de Saúde da Família (USF) em Pindamonhangaba e como objetivos específicos, caracterizar a amostra estudada (aspectos sócio demográficos e clínicos) e verificar as relações entre o estado emocional (ansiedade de depressão) da amostra estudada e as variáveis pesquisadas. Para a coleta de dados foi utilizado um instrumento para caracterização sócio demográfica/clínica da amostra e o questionário Self Reporting Questionnaire (SRQ-20) desenvolvido para rastreamento da ansiedade e depressão (Transtorno Mental Comum - TMC). Foram sujeitos deste estudo 56 pacientes. Quanto à caracterização sócio demográfica, houve predomínio do sexo feminino (98,2%), com média de faixa etária de 51,08 anos, com companheiro (80%) e com 2º grau completo (44,6%). Com relação à ocupação, a maioria relatou ser do lar. A média da renda familiar foi de R$ 780,88. Referente ao tempo de participação nos grupos de reeducação alimentar, a maioria apresentou frequência de 1 mês a 11 meses (33,9%). Quanto à caracterização clínica, os sujeitos apresentaram médias de: peso (82,77 kg), altura (1,57m); Índice de Massa Corpórea (IMC = 33,33 Kg/m2) e Circunferência Abdominal (CA) 101,79 cm. Com relação às comorbidades, 53,6% relatou Hipertensão Arterial Sistêmica (HAS), 17,9% Diabetes Mellitus (DM), 7,1% problemas de tireoide e 14,3% outras doenças. No que se refere ao número de refeições diárias, 37,5% relatou que realiza quatro refeições/dia. Vinte e quatro (44,4%) pacientes apresentaram o hábito de beliscar e 18 (33,3%) apresentaram compulsão alimentar. Quanto ao consumo de alimentos, 94,6% dos pacientes relatou o consumo de verduras e legumes, 92,9% frutas, 51,8% doces e 51,8% refrigerantes. Quanto à atividade física, 69,6% praticavam alguma atividade, com 25% realizando-a duas vezes na semana e 42,1% relataram caminhada. Trinta e cinco (62,5%) pacientes não apresentaram TMC e 21 (37,5%) apresentaram TMC. Comparando os pacientes com e sem TMC e as variáveis, não houve diferença significativa estatisticamente nas variáveis: idade, sexo, estado civil, tempo de participação no grupo de reeducação alimentar, peso, altura, IMC, CA, classificação do IMC, HAS, DM, ato de beliscar e consumo de verduras, legumes, frutas, doces e refrigerantes. Houve diferença estatisticamente significativa nas variáveis: renda familiar (p=0,027); escolaridade (p=0,044); atividade física (p= 0,030); número de refeições realizadas diariamente p (=0,027) e compulsão alimentar (p=0,027) e a ausência de transtorno mental comum. Conclui-se que, respeitando as individualidades de cada paciente, o grupo de reeducação alimentar é um recurso importante para a melhora da qualidade de vida dos pacientes com sobrepeso e obesidade, proporcionando a possibilidade de diminuição dos TMC e práticas de promoção e prevenção à saúde. / The world is experiencing an obesity epidemic, this means that the number of people who have excessive weight increased and reached worrying proportions and health risk. Emotional changes may be associated with obesity. It is important that treatments for obesity be not only aimed to improve quality of life related to physical health but also mental health. Thus, this research aimed to check the emotional state (anxiety and depression) of patients with overweightness and obesity in nutritional education groups at the Family Health Units (USF) in Pindamonhangaba and, as specific objectives, to characterize the studied sample (socio-demographic and clinical) and to examine relationships between emotional state (depression anxiety) of the studied sample and the researched variables. To collect data, was used a tool for socio-demographic / clinical characterization of the sample and the Self Reporting Questionnaire (SRQ-20) developed for the tracking of anxiety and depression (mental health problems - TMC). Fifty-six patients participated in this study. As regards the socio-demographic, there was a female predominance (98.2%), with an average age of 51.08 years, with a partner (80%) and high-school degree (44.6%). Regarding occupation, the majority reported being housewives. The average family income was R$ 780,88. Regarding length of participation in the nutritional education group, most of them presented frequency from 1 month to 11 months (33.9%). As for the clinical characterization, the subjects showed averages of: weight (82.77 kg), height (1.57 m), Body Mass Index (BMI = 33.33 kg/m2) and waist circumference (WC) 101.79 cm. With regard to comorbidities, 53.6% reported high blood pressure (hypertension), 17.9% diabetes mellitus (DM), 7.1% thyroid problems and 14.3% other diseases. With regard to the number of meals per day, 37.5% reported having four meals per day. Twenty-four (44.4%) patients had the habit of nibbling and 18 (33.3%) had binge eating disorder. As for food consumption, 94.6% of the patients reported consumption of vegetables, 92.9% fruits, 51.8% sweets and 51.8% soft drinks. As for physical activity, 69.6% practiced some activity, with 25% doing it twice a week and 42.1% reported to walk. Thirty-five (62.5%) patients did not have TMC and 21 (37.5%) had TMC. Comparing patients with and without TMC and the variables, there was no statistically significant difference in the variables: age, sex, marital status, length of participation in group nutritional education, weight, height, BMI, WC, BMI classification, hypertension, DM, act of nibbling and consumption of vegetables, fruit, sweets and soft drinks. There was a statistically significant difference in the variables: family income (p = 0.027), education (p = 0.044), physical activity (p = 0.030), number of meals per day (p = 0.027) and binge eating (p = 0.027) and absence of common mental disorder. We conclude that, while respecting the individuality of each patient, the nutritional education group is an important resource for improving the quality of life of overweight and obese patients, providing the possibility of reducing the TMC and practicing health promotion and prevention.

Orientador: Maria Beatriz Duarte Gavião / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T00:18:21Z (GMT). No. of bitstreams: 1 Bonjardim_LeonardoRigoldi_D.pdf: 1358611 bytes, checksum: bbf0d5ab4fe7ac931ef56547e0edf065 (MD5) Previous issue date: 2004 / Resumo: Estudos epidemiológicos demonstram que sinais e sintomas de disfunção temporomandibular são comuns em adultos, constatando-se também, sua presença em crianças e adolescentes. O propósito deste estudo foi verificar a prevalência de sinais clínicos e sintomas de disfunção emporomandibular (DTM) em 217 adolescentes entre 12 e 18 anos, pertencentes a escolas da rede pública da cidade de Piracicaba e, também, as associações existentes com gênero (masculino e feminino), ansiedade, depressão e força de mordida. Os sinais clínicos foram avaliados através do Craniomandibular Index (CMI), o qual é composto de duas sub-escalas: Dysfunctional Index (DI) e Palpation Index (PI). Os sintomas subjetivos foram avaliados através de questionário. A escala Hospital Anxiety and Depression Scale (HADS) foi utilizada para avaliação dos níveis de ansiedade (HADSa) e depressão (HADSd). A força de mordida foi determinada em 40 voluntários, que apresentavam valores extremos (mínimo e máximo) para o CMI, os quais foram distribuídos em dois grupos: Grupo I ¿ 20 adolescentes sem DTM (valores extremos mínimos do CMI e ausência de sintoma) e Grupo II ¿ 20 adolescentes com DTM (valores extremos máximos do CMI e presença de pelo menos 1 sintoma). Para a obtenção da força de mordida foi utilizado um tubo pressurizado de fibra reforçada, conectado a um sensor de pressão. Os resultados para os sinais clínicos mostraram que (1) para sensibilidade à palpação dos músculos da cabeça e pescoço ocorreu grande variação na amostra total (0,9%-32,25%); (2) 10,6%, 10,6% e 7,83% dos adolescentes apresentaram sensibilidade à palpação nas regiões superior, dorsal e lateral da articulação temporomandibular, respectivamente; (3) 19,8% e 14,7% da amostra apresentaram ruído articular durante a abertura e fechamento bucal, respectivamente. Ruído articular (26,72%) e dor de cabeça (21,65%) foram os sintomas subjetivos mais prevalentes nos adolescentes. Não foram encontradas diferenças entre os gêneros na prevalência de sinais e sintomas de DTM, exceção feita à sensibilidade à palpação do pterigóideo lateral. As correlações entre os valores dos índices (DI, PI, CMI) e HADSa e HADSd foram estatisticamente significativas apenas entre CMI, PI e HADSa (p<0,01). O número de sintomas subjetivos associou-se significativamente tanto com HADSa quanto para o HADSd (p<0,01). A força de mordida foi estatisticamente maior no grupo I (325,90 N) do que no grupo II (301,51 N), sendo que as meninas deste grupo apresentaram valores significativamente menores. Ocorreu correlação negativa significativa entre CMI e PI e a magnitude da força de mordida (p<0,01). Não houve correlações significativas nas variáveis corporais e etárias com a força de mordida. Concluiu-se que os sinais e sintomas de DTM, presentes em indivíduos jovens, podem ser influenciados pela ansiedade e depressão, bem como comprometer as funções do sistema estomatognático, como se comprovou com a redução da força de mordida, principalmente no gênero feminino / Abstract: Epidemiologic studies have demonstrated that signs and symptoms of temporomandibular dysfunction (TMD) are common in adults, evidencing also its presence in children and adolescents. The aim of this study was to verify the prevalence of clinical signs and subjective symptoms of TMD in 217 adolescents aged from 12 to 18 years old from public schools in the city of Piracicaba and the associations with gender, anxiety, depression and bite force magnitude. The clinical signs were evaluated using the Craniomandibular Index (CMI), which is divided into two sub-scales: Dysfunction Index (DI) and Palpation Index (PI). The subjective symptoms were evaluated through a questionnaire. The levels of anxiety (HADSa) and depression (HADSd) were verified using the Hospital Anxiety and Depression Scale (HADS). Bite force was determined in 40 volunteers with lower and upper extremity values of CMI who were distributed in two groups: Group I ¿ 20 adolescents without TMD (lower extremes values of CMI and absence of subjective symptoms) and Group II ¿20 adolescents with TMD (upper extremes values of CMI and at least one subjective symptom) Bite force was obtained with a transducer, which consisted of a pressurized rubber tube connected to a sensor element. The results for clinical signs showed that (1) tenderness in head and neck muscles, demonstrated a great variability (0.9%-32.25%); (2) temporomandibular joint tenderness, in the superior, dorsal and lateral condyle regions, occurred in 10.6%, 10.6% and 7.83% respectively, (3) the percentage of joint sounds in mouth opening and closing was 19.8% and 14.7% respectively. Joint sounds (26.72%) and headache (21.65%) were the most prevalent symptoms in the total sample. Gender differences were not found in the prevalence of TMD signs and symptoms, except for the lateral pterygoid muscle tenderness. The correlations between indexes values (DI, PI, CMI) and HADSa and HADSd were statistically significant only with CMI, PI and HADSa (p<0.01). The number of subjective symptoms showed a significant association with HADSa and HADSd (p<0.01). Bite force was statistically higher in group I (325.90 N) than in group II (301.51 N). Girls in Group II had the smallest bite force values (p<0.05). There was a significant negative correlation between CMI and PI and bite force magnitude. There were not significant correlations between bite force and body variables and age. It was concluded that clinical signs and symptoms of TMD present in adolescents, can be influenced by anxiety and depression, decreasing the stomathognatic system functions as demonstrated by bite force reduction, primarily in girls / Doutorado / Fisiologia Oral / Doutor em Odontologia

Anxiety and depression are common in children and adolescents, and involve individual suffering, risk of future psychiatric problems, and high costs to society. However, only a limited number of children experiencing debilitating anxiety and depression are identified and receive professional help. One approach that could possibly reduce the prevalence of these conditions is universal school-based prevention aimed at reducing the impact of risk factors and strengthening protective factors involved in the development of anxiety and depression. The current thesis aimed to contribute to the literature on universal prevention of anxiety and depression in children. Study I involved a meta-analysis of earlier randomized, and cluster-randomized trials of universal prevention of anxiety and depression. Overall, the meta-analysis showed small but significant effects of universal preventive interventions, meaning that lower levels of anxiety and depression were evident after intervention completion and partially evident at follow-up assessments. No variables were found to significantly enhance the effects, however, there was a tendency for larger effects to be associated with mental health professionals delivering the interventions. In Study II, a widely adopted prevention program called Friends for Life was evaluated in a large school-based cluster-randomized effectiveness trial. The results showed no evidence of an intervention effect for the whole sample. However, children with elevated depressive symptoms at baseline and children with teachers who highly participated in supervision, seemed to benefit from the intervention in the short term. Study III involved a 3-year follow-up of Study II and an examination of the effects of sample attrition. The results showed no long-term effects for the whole sample and no maintenance of the short-term subgroup effects observed in Study II. Finally, to increase our understanding of the development of anxiety in children and to assist future improvements of universal prevention, Study IV evaluated different trajectories of overall anxiety together with related patterns of disorder-specific symptoms in a school-based sample over 39 months. Evidence favored a model of three different developmental trajectories across age. One trajectory was characterized by increasing levels of overall anxiety, but fluctuating disorder-specific symptoms arguably related to the normal challenges of children’s developmental level, which warrants an increased focus on age-relevant challenges in universal prevention. The four studies provide further understanding of the overall effectiveness of universal prevention of anxiety and depression in children, the short- and long-term effects of universal prevention in a Swedish context, and ideas for further development of preventive interventions.

Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. This paper deals with a topic not yet explored in Czech Republic - (especially) psychological factors affecting the response to trauma in order to identify patients with worse response, who require more attention of experts. The theoretical part of the paper describes burn injury as an extremely stressful event and presents factors that co- determine the individual's response to the trauma. It also describes the most common mental problems observed in people with burns. The theoretical part serves as a basis for the empirical part of the paper which presents our own research of exploratory character. The aim of the research was to identify the factors related to depression, anxiety and patient's perception of health, in a research sample of 52 adult patients shortly before hospital discharge. Minority of patients in our sample reported moderate and severe depression and anxiety symptoms. Health perception of most patients corresponded to average values in normal population while depression was found as its predictor and it also correlated with the personality traits neuroticism, introversion and consciousness. We found the predictors of depression to be the personality traits...

Anxiety and depressive disorders are common mental disorders in general population, imposing tremendous burden on both affected persons and society. Moreover, comorbidity between anxiety and depressive conditions is high, leading to substantial disability and functional impairment. Findings consistently suggest that anxiety disorders are primary to depression in the majority of comorbid cases. Yet, the question of whether anxiety disorders are risk factors for depression, and potentially even causal risk factors for the first onset of depression, remains unresolved. Recent results have shown that anxiety disorders increase the risk for subsequent depression, and also affect the course of depression, resulting in a poorer prognosis. Further, some results suggest a dose–response-relationship in revealing that a higher number of anxiety disorders and more severe impairment associated with anxiety disorders additionally increase the risk for subsequent depression. The goal of this paper is to review recent literature, summarize implications of previous findings, and suggest directions for future research regarding preventive and intervention strategies.

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Most studies on online self-help groups for healthcare contexts have explored the content of social support. However, very little research has shed light on the communicative behaviors and language use of participants in online self-help groups for mental illness. This thesis studies the communication of social support in online self-help groups for anxiety and depression (OSGADs) to reveal their characteristics as communities of practice (CofPs) and how the predominant communicative acts of the participants contribute to social support communication. The data of the present study is a self-compiled corpus of 120 threads collected from six selected OSGADs. Mixed methods discourse analysis (MMDA) is used as a research method to conduct three empirical studies (i.e., Chapters 4, 5, and 6), in which both qualitative and quantitative approaches of discourse analysis are utilized, including content analysis, textual analysis, and interaction analysis. Different analytical frameworks are employed in the analyses. The data analysis begins by investigating the main communicative patterns of the interactions (Chapter 5) and then examines two predominant communicative acts (Chapters 5 and 6). Issues closely related to the analysis are also discussed in each of the analytical chapters. Using conversation analysis (Jefferson & Lee, 1992) and Social Support Behavior Code (Coulson, 2005), Chapter 4 reveals the sequential structures and main content of the interactions. The results show that self-disclosure and advice-giving are the most predominant communicative acts in the interactions. This chapter argues that the optimal matching theory (Cutrona & Russell, 1990) is probably inadequate to elucidate that the support proffered by respondents aids the support seekers. Chapter 5 investigates the multiple functions of self-disclosure in personal, textual, and interactional layers. The functions are examined through textual analysis and interaction analysis in tandem with frameworks including cognitive discourse analysis (Tenbrink, 2015) and rhetorical structure theory (Mann & Thompson, 2009). The findings show that self-disclosure enables support providers to distance themselves from problems, release their emotions, and increase reliability/persuasiveness. Self-disclosure facilitates the disclosure of other participants and support recipients may perceive it as advice, mitigation, and normalization. Chapter 6 conceptualizes the politeness of advice messages. Viewing advice as a speech event, textual analysis is conducted to explore the discursive moves and relational strategies (Locher, 2006) in advice messages, and shows that the advice messages contain many emphatic moves and relational strategies, including sharing own experience, empathizing, and assessment. The notions of contextualization (Gumperz, 1987) and relational work (Watts, 2003) are used to argue that empathy is a contextualization cue to make the advice messages appropriate and politic. Based on the three empirical studies, this thesis suggests three main characteristics of OSGADs as CofPs, including an emphasis on supportiveness, participants' performance of multiple identities, and frequent self-disclosure and advice. This thesis argues that self-disclosure is particularly crucial in the social support communication due to its multi-functionality. Self-disclosure is also an act that contextualizes an empathetic interactional context wherein advice is often politic and appropriate. This thesis concludes by discussing implications for interpersonal communication and online support groups in Hong Kong

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