Computerised Cognitive Behavioural Therapy (CCBT) has been recommended for patients in the National Health Service (NHS) Primary Care across the United Kingdom for management of mild to moderate anxiety and depression. This approach also promises financial savings, and may fill the gap between demand and supply of face-to-face therapy. Studies have shown that CCBT is feasible and effective. However, dropout rates can be as high as 86%, but the reasons remain unclear and the information available is limited. This thesis explores factors that may impact on the usability and user experience of this computer-mediated therapy. Espousing the “real world” research philosophy and widely used methods in the Human-Computer Interaction (HCI) field for usability evaluations, four studies using a mixed-methods design were conducted. Study I was an online usability survey, which investigated if usability evaluations had been conducted for CCBT applications. Two versions of questionnaires were sent to four CCBT software developers and ten authors of randomised controlled trials. The categories and responses of the questionnaires gathered from five respondents were reviewed and summarised. The findings suggested that usability evaluations for CCBT were still in their infancy when compared to other healthcare interventions to which HCI approaches have been widely applied. Study II was a usability Heuristic Evaluation (HE) conducted with four expert evaluators to assess two different CCBT applications’ interfaces (MoodGYM and Living Life to the Full) against the self-designed usability heuristics for their compliance. The findings revealed numerous usability issues. Major problems related to navigation and inconsistency of the interfaces were identified. These could be rectified to enhance the user experience. Study III focused on other factors besides usability that might have an influence on the effective use of CCBT. Perceptions of service providers who were involved in both decision-making about CCBT availability and supporting its use were gathered. Nine service providers at different NHS organisations were interviewed. The interviews were analysed using techniques from Grounded Theory (GT). The findings suggested that the practitioners’ attitudes towards CCBT might have affected its service delivery. Four categories from the data analysis were identified: (1) shaping behaviour, (2) implementing and delivering, (3) making an appropriate referral, and (4) technology/CCBT packages - advancing with time. A conceptual model was also generated, “building support around CCBT”: a road-map that could address some of these issues. Study IV examined patients’ perceptions and acceptance of a CCBT application (Beating the Blues), its usability and the user experience, and also whether the user characteristics (e.g. computer experience (CE) and computer self-efficacy (CSE)) had any influence on patients’ use of this technology. A mixed-methods approach was utilised with a sample of 33 participants. Face-to-face and email interviews were conducted. Feedback was also gathered from a usability questionnaire and think-aloud protocol with seven participants selected from the sample. The data were analysed using Thematic and Saliency Analysis to uncover themes. Descriptive statistics were used to describe data from questionnaires. Two overarching themes from the interviews were identified: (1) access to CCBT services, and (2) perceptions and attitudes towards CCBT. Both themes revealed issues which might have significantly impacted on patients’ engagement with CCBT. Numerous flaws were also discovered in the application’s design and functionality (e.g. navigation, aesthetics, relevance of content, and inflexibility). However, the results from CE and CSE questionnaires suggested that participants were confident in using this technology. The four studies provided an in-depth understanding of factors that affect the usability and user experience of CCBT and possible reasons for the high attrition rates. The implications of this research point to the need for health policymakers to focus on the current implementation issues and on how best to deploy this treatment therapy to patients. Further development of CCBT is pivotal to its success, in particular, expanding contexts of use and increasing usability evaluations. Keeping users interested and engaged will improve treatment efficiency, completion rates and will achieve better clinical outcomes.

This thesis explored whether haemodynamic responses to psychological stress test predict future blood pressure (BP) levels: the Reactivity Hypothesis. The research included a systematic review and two prospective cohort studies in the UK and Thai samples. In addition, the Blunted Reactivity Hypothesis, which posits that cardiovascular reactivity is inversely related to symptoms of anxiety and depression, was examined in cross-sectional analyses. A systematic review with meta-analysis and meta-regression with 41 prospective cohort studies (from 1950 to 2012) examined whether cardiovascular responses to psychological stress tests predict future BP levels, hypertension status, preclinical coronary heart disease (CHD) and cardiac events. Three possible moderators were included in analyses: type of task (active versus passive coping), age group (children versus adults), and duration of follow-up (short versus long-term follow-up). The review found that systolic BP reactions to psychological stress tests predict future systolic BP levels and that there was better prediction in child samples with shorter follow-up periods. Similarly, diastolic BP reactions to psychological stress predicted future diastolic BP levels. Cardiovascular reactions to psychological stress tests did not predict hypertension, preclinical CHD, or cardiac events. Cross-sectional analysis of two studies conducted in the UK and Thailand provided some evidence that anxiety and depressive symptoms were negatively associated with cardiovascular reactivity: these findings supported the Blunted Cardiovascular Hypothesis. However, these relationships were observed in the UK sample, but not in the Thai sample. Further, Thai participants responded to psychological stress task with large cardiovascular reactions, of a similar magnitude to the UK participants and observed in previous studies of Europeans and North Americans. Finally, prospective analyses revealed that systolic BP responses to mental arithmetic predict future systolic BP levels after one year of follow-up in both UK and Thai individuals, after controlling for baseline cardiovascular activity and traditional risk factors. In contrast, haemodynamic responses did not predict future BP. These results provide support for the “Reactivity Hypothesis” although the effect sizes were relatively small. However, responses to only one of the three stressors, mental arithmetic, predicted future BP implicating beta-adrenergically mediated cardiovascular responses. However, there was no physiologic evidence (i.e., cardiac output responses) that suggested beta-adrenergic mechanisms. Accordingly, future studies should examine alternate mechanisms (e.g., platelet aggregation and endothelial function) and cardiovascular responses in larger samples with a longer follow-up to further clarify the predictive value of reactivity in the development of hypertension, along with potential mechanisms.

This study aimed to examine the association between specific maternal characteristics (i.e., parents&rsquo / personality, depression, anxiety, affective state, and coping strategies) and childhood ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) symptoms in children with and without the diagnosis of ADHD. Method: Data was obtained from 231 subjects including mothers of 77 children who were just diagnosed by Child Mental Health Departments of Hacettepe University or IMGE Child Mental Health Center and 154 children without any psychiatric diagnosis, who were receiving education from Nebahat Keskin Elementary School. Among 154 non-diagnosed subjects the ones who match best with the 77 ADHD group participants were chosen, considering ages of the children, income of the family, and education of the mother. Results and Discussion: (1) Psychometric Characteristics of the TBFI and CARSS were examined. The internal consistency coefficients of the TBFI varied from .51 (for Agreeableness) to .75 (for Neuroticism) and all subscales of CARSS had moderate to high degree of internal consistencies ranging from .65 (Conduct Disorder) to .92. (e.g., Attention Deficit). Additionally, concurrent validity of TBFI and criterion validity of CARSS were studied. Results revealed that TBFI had sufficient internal consistency and validity, and also revealed that CARSS was a highly reliable and valid measure, successfully differentiating the diagnosed group from the non-diagnosed group on each subscale. (2) Group differences on maternal characteristics were examined. Compared to non-diagnosed children, children with ADHD had mothers with higher Depression symptoms, higher Negative Affect, higher Neuroticism, lower Positive Affect. (3) Regression analyses, which were conducted separately for each group and the whole group, revealed that different maternal characteristics were associated with symptoms of diagnosed and non-diagnosed children. In general while symptom levels of children, who have ADHD diagnosis, was associated with higher maternal Negative and lower Positive Affect and higher Depression and Anxiety symptoms, and lower Extraversion scores / symptom level of Comparison children was associated more with Conscientiousness. These differences were explained by means of the fit between maternal characteristics and vulnerability, lower tolerance, lower adaptation, and compensation skills of children with ADHD (when compared to Comparison group). Results addressed the importance of maternal factors regarding its association with presence, and the severity of ADHD and comorbid symptoms of children.

Made available in DSpace on 2014-12-17T15:36:42Z (GMT). No. of bitstreams: 1 RodrigoPAF_TESE.pdf: 1146990 bytes, checksum: e87dcca3a2082ed00e0523d76a6a9042 (MD5) Previous issue date: 2013-09-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome of unknown etiology, with symptoms of diffuse musculoskeletal pain and presence of specific anatomic sites called tender points. The symptoms are often associated with fatigue, sleep disturbances, morning stiffness, alterations in pain perception, anxiety and depression. Fibromyalgia exhibits a correlation between physical and behavioral symptoms, which have a negative influence on the quality of life of patients. Emotional skills are important factors since they are related to subjective well-being, personal productivity, social interaction and interpersonal relationships. We aim to describe the physical and psychosocial interactions in women with FM, showing the association between perceived social support and affect with symptoms of pain, functionality and mood. We will also describe a body representation of pain in women with FM. Data were collected over 3 years and the sample size ranged between studies. This is an exploratory cross-sectional study conducted with a convenience sample of 63 women with FM and 42 healthy women as a control group (CT), aged 20-76 years, recruited through spontaneous demand at Onofre Lopes University Hospital (HUOL) and the Clinical School of Physiotherapy of Universidade Potiguar (UNP). The Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Social Support Scale (MOS), Hamilton Anxiety Scale and Scale of Positive and Negative Affect Schedule (PANAS), in addition to pressure algometry were used. For data analysis, we used parametric and non-parametric tests and a general linear model with adjustment variables and analysis of variance. A significant difference was found between pain threshold and tolerance, functionality, depression, anxiety, social support, and positive and negative affect between the groups. Affective states and social support were associated with anxiety, depression and functionality. A body was drawn representing pain with higher incidences in trapeze, supraspinatus and second ribs. The reason for studying sensory aspects, affective behavior and social support in FM patients opens perspectives for scientific and clinical research of this syndrome. Women with chronic pain such as FM appear to have altered mood states, less social support and affective dysfunctions, influencing the other symptoms of the syndrome / A fibromialgia (FM) ? uma s?ndrome reum?tica n?o inflamat?ria, de etiologia desconhecida, apresentando sintomas de dor musculoesquel?tica difusa e presen?a de s?tios anat?micos espec?ficos dolorosos ? palpa??o, denominados tender points. Dentre os sintomas frequentemente associados est?o a fadiga, dist?rbios do sono, rigidez matinal, altera??es na percep??o da dor, ansiedade e depress?o. Existe na FM uma correla??o entre os sintomas f?sicos e comportamentais que influenciam negativamente na qualidade de vida dos pacientes. As habilidades emocionais aparecem como fatores importantes por estarem relacionadas com o mecanismo de bem estar subjetivo pessoal, produtividade, intera??o social e de relacionamento interpessoal. Objetivou-se descrever as intera??es f?sicas e psicossociais em mulheres com FM apresentando poss?veis associa??es entre a percep??o de apoio social e afetividade com os sintomas de dor, funcionalidade e estado de humor. Objetivo-se tamb?m, descrever um tipo de representa??o corporal da dor em mulheres com FM. Os dados foram coletados ao longo de 3 anos e o n?mero amostral variou entre os estudos. A partir de um estudo explorat?rio descritivo transversal, foi composta uma amostra por conveni?ncia de 63 mulheres com FM e 42 mulheres saud?veis como grupo controle (CT), com faixa et?ria de 20 a 76 anos, recrutadas mediante demanda espont?nea no setor de Fisioterapia do Hospital Universit?rio Onofre Lopes (HUOL) e na Cl?nica Escola de Fisioterapia da Universidade Potiguar (UNP). Foi aplicado o Question?rio de Impacto da Fibromialgia (FIQ), Invent?rio de Depress?o de Beck (IDB), Escala de Apoio Social (MOS), Escala de Ansiedade de Hamilton e Escala de Afeto Positivo e Negativo (PANAS). A seguir foi realizada a avalia??o da dor atrav?s da algometria de press?o. Para a an?lise dos dados, foram utilizados testes param?tricos e n?o param?tricos e de an?lise de vari?ncia. Foi encontrada diferen?a significativa quanto ao limiar e toler?ncia ? dor, funcionalidade, depress?o, ansiedade, apoio social e afetividade positiva e negativa. Os estados afetivos e o apoio social apresentaram associa??o com ansiedade, depress?o e funcionalidade. Foi elaborada uma representa??o corporal da dor que apresentou maiores incid?ncias em trap?zio, supraespinhal e segunda costela. A raz?o de se estudar a FM integrando os aspectos sensoriais, afetivo-comportamentais e sociais amplia os horizontes para investiga??o cient?fica e cl?nica dessa s?ndrome. Mulheres com FM apresentam estados de humor alterados, menor apoio social e express?o disfun??es de afetividade que influenciam os demais sintomas da s?ndrome

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

Objective: We aimed to assess psychological distress in patients with intracranial neoplasia, a group of patients who suffer from severe functional, neurocognitive and neuropsychological side effects, resulting in high emotional distress. Methods: We conducted a cross-sectional study, including inpatients with brain tumours. Eligible patients completed validated self-report questionnaires measuring depression, anxiety, distress, symptoms of posttraumatic stress disorder (PTSD), fear of progression and health-related quality of life. The questionnaire set was completed after brain surgery and receiving diagnosis and before discharge from hospital. Results: A total of n = 31 patients participated in this survey. Fourteen of them suffered from malignant (n = 3 metastatic neoplasia) and 17 from benign brain tumours. Mean values of the total sample regarding depression (M = 9.28, SD = 6.08) and anxiety (M = 6.00, SD = 4.98) remained below the cut-off ≥ 10. Mean psychosocial distress (M = 16.30, SD = 11.23, cut-off ≥ 14) and posttraumatic stress (M = 35.10, SD = 13.29, cut-off ≥ 32) exceeded the clinically relevant cut-off value in all the patients with intracranial tumours. Significantly, more patients with malignant (79%) than benign (29%) brain tumours reported PTSD symptoms (p = 0.006). Conclusion: Distress and clinically relevant PTSD symptoms in patients with intracranial neoplasia should be routinely screened and treated in psycho-oncological interventions immediately after diagnosis. Especially, neuro-oncological patients with malignant brain tumours or metastases need targeted support to reduce their emotional burden.

Hintergrund: Knochensarkome sind eine Gruppe sehr seltener maligner Tumoren. Es existieren nur wenige Studien zur psychischen Belastung der betroffenen Patienten. Ziel war es, die Prävalenz erhöhter psychischer Belastung in dieser Gruppe zu ermitteln, damit assoziierte Faktoren zu untersuchen und die Inanspruchnahme psychoonkologischer Angebote zu erfassen. Methode: Die Kohortenstudie PROSa (Krankheitslast und Versorgungssituation bei Sarkomen) wurde zwischen 2017 und 2020 in 39 deutschen Studienzentren durchgeführt. Für die vorliegende Analyse wurden Baseline-Querschnittsdaten von erwachsenen Knochensarkompatienten ausgewertet. Die psychische Belastung wurde mit dem Patient Health Questionnaire (PHQ-4) evaluiert. Sozioökonomische und klinische Faktoren wurden als mögliche Prädiktoren erhöhter psychischer Belastung mit multivariablen logistischen Regressionsmodellen exploriert. Resultate: Bei den 194 eingeschlossenen Patienten betrug die Prävalenz von Ängsten 18%, die von Depressivität 22%. Insgesamt waren 29% der Patienten überschwellig psychisch belastet. 23% hatten eine psychoonkologische Betreuung in Anspruch genommen. Im vollen Modell waren arbeitslose Patienten (Odds Ratio [OR] 5,7; 95%- Konfidenzintervall [CI] 1,6–20,0) und Patienten mit Erwerbsminderungsrente (OR 3,6; 95%-CI 1,03–12,9) im Vergleich zu solchen in Beschäftigung häufiger belastet, Patienten mit Altersrente, in Vorruhestand oder in Altersteilzeit dagegen weniger häufig (OR 0,2; 95%-CI 0,05–0,9). Die Häufigkeit psychischer Belastung war bei Patienten 5 Jahre nach Diagnose (Vergleich Diagnose <6 Monate) geringer (OR 0,1; 95%-CI 0,04–0,4). Konklusion: Die Prävalenz erhöhter psychischer Belastung bei Knochensarkompatienten ist hoch. Arbeitslose Patienten, solche mit Erwerbsminderungsrente sowie neu diagnostizierte Patienten sind besonders vulnerabel. Das Behandlungsteam sollte sich dieser Faktoren bewusst sein und auch diese sozialen Aspekte der Erkrankung berücksichtigen.

<p>Uvod: Hronična HCV infekcija je povezana sa nizom ekstrahepatičnih manifestacija, uključujući pojavu depresivnih i anksioznih simptoma, zamora, bolova u mi&scaron;ićima i zglobovima koji su povezani sa smanjenjem kvaliteta života u vezi sa zdravljem (HRQOL). Ciljevi istraživanja: Proceniti različite aspekte kvaliteta života bolesnika sa hroničnim hepatitisom C koji nisu na terapijskom tretmanu interferonom; Sagledati učestalost određenih psihosocijalnih obeležja (depresivnost, anksioznost, radni status, stepen obrazovanja) i njihovu povezanost sa kvalitetom života bolesnika sa hroničnim hepatitisom C koji nisu na terapijskom tretmanu, kao i ispitati povezanost osnovnih demografskih obeležja (starost, pol, bračno stanje) i kvaliteta života bolesnika sa hroničnim hepatitisom C; Ispitati povezanost osnovnih medicinskih obeležja vezanih za oboljenje (način prenosa infekcije, dužna infekcije, prisustvo ciroze) i kvaliteta života bolesnika sa hroničnim hepatitisom C. Materijal i metode: Istraživanje je sprovedeno kao prospektivna studija u periodu od aprila 2013. do aprila 2015. godine na Klinici za infektivne bolesti Kliničkog centra Vojvodine u Novom Sadu, Infektivnom odeljenju i u Službi za transfuziju krvi Op&scaron;te bolnice ,,Dr Radivoj Simonović&rdquo; u Somboru. Ispitano je 150 osoba, oba pola, obolelih od hroničnog hepatitisa C koji su činili studijsku grupu obolelih. U kontrolnoj grupi ispitano je ukupno 150 zdravih osoba, oba pola, uzrasta iznad 18 sličnih socio-demografskih karakteristika. Kvalitet života ispitan je pomoću upitnika: SF-36, CLDQ i HADS. Putem op&scaron;teg upitnika prikupljni su socio-demografski podaci o ispitanicima, kao i odeđena obeležja vezana za oboljenje. Rezultati: Sagledavanjem skorova upitnika SF-36 razlika u kvalitetu života između obolelih od hroničnog hepatitis C i kontrolne grupe je statistički značajna na svakom od pojedinačnih domena, ukupnom skoru SF-36 upitnika, Fizičkom kompozitnom skoru i Mentalnom kompozitnom skoru (p&lt; 0,000). Oboleli od hroničnog hepatitisa C pokazuju statistički značajno izraženiju depresivnost (t=3,37; p&lt;0,01) i anksioznost (t=2,35; p&lt;0,05) u odnosu na kontrolnu grupu. Multiplom regresionom analizom utvrđeno je da se visok procenat depresivnosti (72%) može objasniti sa skupom prediktora koji su činili domeni kvaliteta života sa upitnika SF-36. Najveći parcijalni doprinos pojavi depresivnosti imaju tri domena kvaliteta života: Fizičko funkcionisanje, Vitalnost i Mentalno zdravlje. Univarijantnom analizom utvrđen je nezavisan efekat bračnog statusa na promene u kvalitetu života kod obolelih od HHC. Lo&scaron;iji kvalitet života kod osoba koje boluju od hroničnog hepatitisa C če&scaron;će je prisutan kod onih koji žive u braku ili vanbračnoj zajednici i onih starosti 30-50 godina, dok oni koji su zaposleni imaju bolji kvalitet. Zaključak: S obzirom na lo&scaron;iji kvalitet života osoba obolelih od hroničnog hepatitisa C i če&scaron;će prisustvo depresivnih i anksioznih obeležja potrebno je proceniti kvalitet života obolelih nakon postavljanja dijagnoze, kao i tokom kliničkog praćenja i lečenja.</p> / <p>Background: Chronic HCV infection is associated with a variety of extrahepatic manifestations, including the occurrence of depressive and anxiety symptoms, fatigue, muscle pain and joint pain associated with a reduction in quality of life related to health (HRQOL). Objectives: Assess the different aspects of quality of life in patients with chronic hepatitis C who are not on interferon therapy treatment; Consider the frequency of certain psychosocial characteristics (depression, anxiety, employment status, education level) and their association with the quality of life of patients with chronic hepatitis C who have not on therapeutic treatment, as well as examine the relationship between basic demographic characteristics (age, sex, marital status) and quality of life in patients with chronic hepatitis C; To analyze the association of basic medical characteristics related to disease (mode of transmission of infection, responsible for the infection, the presence of cirrhosis) and quality of life of patients with chronic hepatitis C. Materials and Methods: The study was conducted as a prospective study from April 2013 to April 2015 at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina in Novi Sad, Department of Infectious Diseases and the Blood Transfusion General Hospital ,,Dr Radivoj Simonovic&ldquo; Sombor . The study has included 150 patients with chronic hepatitis C who have done a study group, both sexes. In the control group, has included 150 healthy subjects of both sexes, aged over 18 years, similar socio-demographic characteristics. Quality of life was tested using a questionnaire SF-36, HADS and CLDQ. Through a general questionnaire have collected the socio-demographic data on the respondents, as well as the diseases characteristics. Results: By reviewing the scores of SF-36 difference in quality of life between patients with chronic hepatitis C and control group was statistically significant in each of the individual domains, the total score of the SF-36 questionnaire, Physical and Mental composite score (p &lt;0.000). Patients with chronic hepatitis C show significantly more pronounced depression (t = 3.37; p &lt;0.01) and anxiety (t = 2.35; p &lt;0.05) compared to the control group. Multiple regression analysis showed that a high percentage of depression (72%) can be explained by a set of predictors consisted of the domain of quality of life questionnaire SF-36. The greatest partial contribution occurs depression have three domains of quality of life: Physical functioning, Vitality and Mental health. Univariate analysis identified the independent effect of marital status on changes in the quality of life in patients with HHC. Worse quality of life in patients suffering from chronic hepatitis C often present in those living in married or common-law marriage and those aged 30-50 years, while those who are employed have better quality. Conclusion: Due to the inferior quality of life of patients suffering from chronic hepatitis C and frequent presence of depressive and anxiety traits it is necessary to assess the quality of life of patients after diagnosis and during clinical follow-up and treatment.</p>

Introdução: O traumatismo cranioencefálico (TCE) é o maior problema de saúde pública nos países ocidentais. A lesão axonial difusa (LAD) é uma das mais importantes causas de sequelas neurológicas e resultam do comprometimento da substância branca causada por forças rotacionais e/ou aceleração/ desaceleração no parênquima encefálico que tensiona e lesa os axônios. Apesar dos doentes com TCE apresentarem déficits neurológicos transitórios, as mudanças cognitivas podem ser persistentes, especialmente em lesões moderadas e severas. Até o momento poucos estudos analisaram aspectos neuropsicológicos de doentes com LAD. Método: Estudo unicêntrico, prospectivo, exploratório, com braço único e três níveis de medidas repetidas. Quarenta doentes com LAD de ambos os sexos, com idade entre 18 e 55 anos foram avaliados na fase 1 (até 3 meses após o trauma), fase 2 (6 meses) e fase 3 (12 meses). Na fase 1 avaliou-se os sintomas depressivos (BDI), ansiosos (IDATE), qualidade de vida (QV SF-36) e sobrecarga do cuidador (Zarit Burden Interview). Na fase foram avaliadas as mesmas variáveis, acrescida da avaliação cognitiva (QI, memória episódica verbal e visuoespacial, processos atencionais, funções executivas, coordenação motora). Na fase 3 repetimos o procedimento da fase 2. Resultados: Não houve diferença significativa dos sintomas depressivos, de ansiedade, sobrecarga do cuidador nas fases 1, 2 e 3. Constatamos melhora significativa na memória episódica verbal e visuoespacial (p < 0,05), dos processos atencionais (p < 0,05). O QI e a idade do doente foram preditores para desempenho dos doentes em diversos testes, o mesmo não foi observado em relação a gravidade do trauma. Conclusão: O estudo mostrou melhora espontânea da memória episódica e dos processos atencionais em doentes com LAD no primeiro ano após o trauma. Esses resultados foram independentes da gravidade do trauma e dos sintomas depressivos, ansiosos e da QV dos doentes. Esses achados podem estar associados à neuroplasticidade, evidenciando-se janela terapêutica importante no primeiro ano após o trama / Introduction: Traumatic brain injury (TBI) is a major public health problem in Western countries. Diffuse axonal injury (DAI) is one of the most important causes of neurological damage and result of white matter impairment caused by rotational forces and / or acceleration / deceleration in the brain parenchyma tenses and damages the axons. Although patients with TBI present transient neurological deficits, cognitive changes may be persistent, especially in moderate and severe injuries. To date few studies have examined neuropsychological aspects of patients with DAI. Method: single-center study, prospective, exploratory, with one arm design and three levels of repeated measures. Forty patients with LAD, both sexes, aged 18 to 55 were evaluated in phase 1 (up to 3 months after the trauma), phase 2 (6 months) and phase 3 (12 months). In phase 1 we evaluated depressive symptoms (BDI), anxiety (STAI), quality of life (QoL SF-36) and caregiver burden (Zarit Burden Interview). In phase 2 were evaluated the same variables, plus the cognitive assessment (IQ, verbal and visuospatial episodic memory, attentional processes, executive functions, motor coordination). In phase 3 we repeat the procedure from step 2. Results: No significant differences in depressive symptoms, anxiety, and caregiver burden in phases 1, 2 and 3. We found significant improvement in verbal and visuospatial episodic memory (p < 0.05), of the attentional processes (p < 0.05). The IQ and patient age were predictors for performance of patients in several tests, the same was not observed for the severity of the trauma. Conclusion: The study showed spontaneous improvement of episodic memory and attentional processes in patients with LAD in the first year after the trauma. These results were independent of the severity of the trauma and depressive symptoms, anxiety and QoL of the patients. These findings may be associated with neuroplasticity, demonstrating important therapeutic window in the first year after the trauma

Loneliness occurs in the absence of belonging or social connectedness and has been linked to many physical and mental health problems. Among these conditions are depression, anxiety, sleep disturbance, and stress. College students report these four conditions as the largest barriers to good academic performance. For as much is known about loneliness, much less is known about belonging and health or the role loneliness plays in these relationships prompting a need for investigation. Using a sample of 301 university students, we replicated previous findings that loneliness predicts depression, anxiety, sleep disturbance, and stress. Next we replicated and contributed new findings for the relationship between social connectedness and the same health outcomes of interest. Previous research has found gender to be a moderator in the relationship between loneliness and social connectedness. The current study found no evidence of moderation. Based upon the available literature, it was hypothesized that loneliness would mediate the relationship between social connectedness and the health outcomes of interest. Using conditional process modeling, loneliness was found to be a mediator in every case. These findings validate previous findings on the effects of loneliness on health. They also highlight the significance of social connectedness as a factor in health. Future research should investigate the effectiveness of social connectedness as focal point for treatment of mental and physical health conditions.