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Objective: To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness. Methods: This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed. Results: Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39). Conclusion: Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person’s state of general mental health.

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Objective: To adapt the Mind-Wandering Questionnaire (MWQ) for the Brazilian context and present evidence of validity based on its internal structure. Methods: A total of 2,682 Brazilian adults from different regions of the country took part in this study. Confirmatory factor analyses and multigroup confirmatory factor analyses (MGCFA) were performed to assess the factor structure of the MWQ. McDonald’s omega (ω) was generated to provide reliability indexes. Results: The analyses demonstrated an adequate factor structure for the MWQ adapted to the Brazilian context, corroborating the original article’s single-factor model and other adaptation studies. Furthermore, the results demonstrated the instrument’s reliability in a Brazilian population (ω = 0.88). Conclusion: The MWQ is thus an adequate, reliable, and quickly administered instrument for those whose aim is to measure deliberate and spontaneous MW in Brazil.

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Objective: Evidence on the relationship between depression and clinical dimensions of schizophrenia remains limited. This cross-sectional study investigated the association between depression and Positive and Negative Syndrome Scale (PANSS) dimensions in people with schizophrenia spectrum disorders. Methods: Trained assessors administered the PANSS to measure symptoms of schizophrenia and the Calgary Depression Scale for Schizophrenia to measure depression. The association of depression with overall PANSS score and related dimensions was investigated in multiple logistic regression analyses. Results: We included 231 inpatients with schizophrenia spectrum disorders (mean age: 42.4 (SD: 12.9) years; men: 58.9%; mean overall PANSS score: 82.5 (SD: 20.1); drug-free or naïve: 39.3%), including 78 (33.8%) with clinically significant depressive symptoms. Depression was associated with higher overall (regression coefficient, SE: 0.029, 0.008; p < 0.001) and general psychopathology (regression coefficient, SE: 0.118, 0.023; p < 0.001) PANSS scores. We found an inverse relationship between depression and positive symptoms (regression coefficient, SE: -0.088, 0.028; p = 0.002). No association between depression and negative symptoms was found. Conclusion: Despite some limitations, our study shows that people affected by schizophrenia spectrum disorders with depression are likely to show more overall and general psychopathology symptoms but lower positive symptoms. Additional studies are needed to explore the generalizability of our findings.

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Objective: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). Methods: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization – suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension – in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. Results: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). Conclusion: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. Clinical trial registration: NCT02846662 (São Paulo, Brazil – SP), NCT03026426 (Lima, Peru – LI). Funded by the U.S. National Institute of Mental Health (grant U19MH098780).

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Objective: The advancement of neuroimaging and genetic research has revealed the presence of morphological abnormalities and numerous risk genes, along with their associations. We aimed to estimate magnetic resonance imaging-derived cortical thickness across multiple brain regions. Methods: The cortical thickness of 129 schizophrenia patients, 42 of their unaffected siblings, and 112 healthy controls was measured and the candidate genes were sequenced. Comparisons were made of cortical thickness (including 68 regions of the Desikan-Killiany Atlas) and genetic variants (in 108 risk genes for schizophrenia) among the three groups, and correlation analyses were performed regarding cortical thickness, clinical symptoms, cognitive tests (such as the N-back task and the logical memory test), and genetic variants. Results: Schizophrenia patients had significantly thinner bilateral frontal, temporal, and parietal gyri than healthy controls and unaffected siblings. Association analyses in target genes showed that four single nucleotide variants (SNVs) were significantly associated with schizophrenia, including thioredoxin-related transmembrane protein 2-catenin, cadherin-associated protein, delta 1 (SNV20673) (positive false discovery rate [PFDR] = 0.008) and centromere protein M (rs35542507, rs41277477, rs73165153) (PFDR = 0.030). Additionally, cortical thickness in the right pars triangularis was lower in carriers of the SNV20673 variant than in non-carriers (PFDR = 0.048). Finally, a positive correlation was found between right pars triangularis cortical thickness and logical memory in schizophrenia patients (r = 0.199, p = 0.032). Conclusions: This study identified regional morphological abnormalities in schizophrenia, including the right homologue of Broca’s area, which was associated with a risk variant that affected delta-1 catenin and logical memory. These findings suggest a potential association between candidate gene loci, cortical thickness, and schizophrenia.

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Objective: To evaluate the prevalence of attention-deficit/hyperactivity disorder (ADHD), comorbidity rates with disruptive behavior disorders and main negative outcomes in primary school students in Nampula, Mozambique. Methods: We selected a random sample of 748 students for ADHD screening from a population of around 43,000 primary school students. The Swanson, Nolan, and Pelham Rating Scale version IV was applied to both parents and teachers. All students who screened positive (n=76) and a propensity score-matched random subset of students who screened negative (n=76) were assessed by a child psychiatrist. Results: The prevalence of ADHD was estimated at 13.4% (95%CI 11.5-19.2), and 30.6% of those with ADHD presented comorbid disruptive behavior disorders. Students with ADHD (n=36) had significantly higher rates of both substance use (alcohol, marijuana) (p < 0.001), and school failures than controls (n=96; p < 0.001). Comorbidity between ADHD and disruptive behavior disorders increased the chance of substance use (p < 0.001). Secondary analyses with more restrictive ADHD diagnostic criteria revealed a lower prevalence rate (6.7%; 95%CI 5.2-12.9) with similar patterns of associated factors and negative outcomes. Conclusion: Our findings demonstrated that ADHD is a prevalent mental disorder in Mozambique, and it is associated with similar comorbid profiles, predisposing factors, and negative outcomes, as in other cultures.

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Objective: The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles. Methods: An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility. Results: Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger’s coefficient of 0.49 was found, indicating an acceptable level of scalability. Conclusion: The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed.

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Objective: Bipolar disorder (BD) is a major cause of disability-adjusted life years in young adults. Pregnancy complications have previously been associated with BD. The current study aimed to examine the association between perinatal factors and BD. Methods: We included 3,794 subjects from the 1993 Pelotas population-based birth cohort study. We assessed 27 variables at birth and modeled BD onset at 18 and 22 years. Bivariate analysis was performed by means of binomial logistic regression models. The variables with p-values less than 0.05 were included in a multiple regression with confounders. Results: Maternal smoking was associated with a 1.42-fold increased risk of BD at 18 or 22 years old (95%CI 1.091-1.841), and maternal passive exposure to tobacco with a 1.43-fold increased risk (95%CI 1.086-1.875). No association was found between other perinatal factors and BD after controlling for confounders. Conclusion: The results of the present cohort study corroborate previous reports in the literature indicating a negative effects of maternal smoking during pregnancy. These findings can be further tested and support the development of strategies to prevent the onset development of BD.

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Objective: To evaluate the factor structure, reliability, and validity of the Brazilian version of the Suicide Crisis Inventory-2 (SCI-2) among Brazilian adults. Methods: The SCI-2 was cross-culturally adapted into Portuguese and administered to 2,265 Brazilian participants. Confirmatory factor analysis (CFA) was used to assess factor structure, internal consistency, convergent validity, and criterion validity by using measures such as suicidal narratives, stressful life events, suicidal ideation, and suicide attempts. Results: The revised one-factor model of the SCI-2 demonstrated an adequate, although not optimal, model fit (χ2[1539] = 31,442.79, p < 0.001, comparative fit index [CFI] = 0.99, Tucker-Lewis index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.09, standardized root mean residual [SRMR] = 0.05). The revised five-factor model, on the other hand, demonstrated good fit (χ2[1529] = 14,174.86, p < 0.001, CFI = 1.00, TLI = 1.00, RMSEA = 0.06, SRMR = 0.04). Comparison of these two models indicated that the five-factor model had a better fit than the one-factor model. Both the total and subscale scores of the SCI-2 showed strong internal consistency and good convergent and criterion validity in relation to stressful life events, suicidal narratives (excluding the goal disengagement subscale), suicidal ideation, and suicide attempts. Conclusion: Our findings suggest that the Brazilian version of the SCI-2 is a valid tool for assessing symptoms of suicidal crisis syndrome.

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Objective: To report on suicide plans and attempts among Brazilian physicians and to investigate the associated risk factors. Methods: From January 2018 to January 2019, a nationwide online survey was conducted among Brazilian physicians using the Tool for Assessment of Suicide Risk and the Satisfaction with Life Scale. Multivariate exploratory associations of demographic, psychological, and work-related factors were performed on reports of suicide plans and attempts. Results: Of the 4,148 participants, 1,946 (53.5%) were male, 2,527 (60.9%) were 30 to 60 years old, 2,675 (64.5%) had two to four jobs, and 1,725 (41.6%) worked 40 to 60 hours a week. The overall prevalence of suicide plans was 8.8% (n=364), and suicide attempts were reported by 3.2% (n=133) of participants. Daily emotional exhaustion (ORadj = 7.857; 95%CI 2.282-27.051, p = 0.002), weekly emotional exhaustion (ORadj = 7.953; 95%CI 2.403-26.324, p = 0.001), daily frustration at work (ORadj = 3.093; 95%CI 1.711-5.588, p < 0.001), and bisexuality (ORadj = 5.083; 95%CI 2.544-10.158, p < 0.001) were significantly associated with higher odds of suicide. Extremely dissatisfied physicians reported suicide plans and attempts in 38.3% of cases, whereas extremely satisfied physicians reported suicide plans and attempts in only 2.8% of cases (p < 0.001). Conclusion: Brazilian physicians with a history of suicide plans and attempts express emotional exhaustion and frustration at work. There is an urgent need for actions to promote professional safeguards and resilience.

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Objective: To evaluate the direct, indirect, and total prospective effects of serum concentrations of 25-hydroxycholecalciferol (25[OH]D) on depressive symptoms in older adults. Methods: Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (≥ 60 years) were analyzed. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale. 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph was constructed to identify the minimum set of adjustments. Structural equation modeling analysis was used to determine the effects of 25(OH)D on depressive symptoms. Results: Data from 574 older adults (63.1% female) were analyzed. In the follow-up (n=390), 16.2% of them presented severe depressive symptoms (≥ 6 points). Structural equation modeling analysis revealed that 25(OH)D had a small direct negative effect (β = -0.11, p < 0.05) and an overall negative effect (β = -0.13; p < 0.05) on depressive symptoms in wave 3 (increased 25[OH]D led to decreased depressive symptoms). No direct or indirect effect on depressive symptoms was found in wave 2. Conclusion: Our findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.

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Objective: This study investigated the relationship between impulsivity and early trauma through a network analysis in individuals diagnosed with different substance use disorders. Methods: In a cross-sectional design, the sample included 556 men with substance use disorders (195 with alcohol use, 157 with cocaine/crack use, and 214 with polysubstance use). Early trauma and impulsive behavior were assessed using the Childhood Trauma Questionnaire and the Barratt Impulsiveness Scale, respectively. The connection between trauma and impulsivity was assessed using network analysis through a fused graphical lasso algorithm. Results: No connection was observed between impulsivity and trauma networks in individuals with alcohol use disorder. In those with cocaine use disorder, networks were linked through the motor domain and sexual abuse nodes. Inverse connections were observed between the emotional neglect node and perseverance, but not the non-planning node. In polysubstance use, the connection between impulsivity and trauma networks was weak, with the cognitive complexity node connecting to the trauma network through physical abuse. There connections were inversely proportional between the motor domain and emotional neglect nodes, as well as between cognitive instability and physical neglect. Conclusion: Our results suggest that the relationship between the type of early (childhood) trauma and the expression of impulsivity could lead to different substance use profiles.

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Objective: To test the factor structure, reliability, and validity of the Brazilian version of the Abbreviated Suicidal Narrative Inventory (SNI-38). Methods: We used an anonymous online questionnaire of the SNI-38 and self-report measures administered between November 2020 and October 2021 in the Brazilian community. Participants were recruited through social media advertisements. Confirmatory factor analysis (CFA) was performed to test the factor structure of the SNI-38. In addition, we assessed internal consistency and convergent validity against stressful life events, suicide crisis syndrome, suicidal ideation, and suicide attempts. Results: A total of 2,660 participants were included. The eight-factor model of the SNI-38 had a good model fit (χ2[637] = 7,473.98, p < 0.001, comparative fit index [CFI] = 0.99, Tucker-Lewis index [TLI] = 0.99, root mean squared error of approximation [RMSEA] = 0.07, standardized root mean residual [SRMR] = 0.06). Notably, all items were significantly and positively loaded onto their respective factors (factor loadings ≥ 0.45). The reliability of all subscales except for goal disengagement ranged from good to high. Furthermore, all subscales except goal disengagement showed positive correlations with variables such as suicide crisis syndrome, stressful life events, lifetime/past month suicidal ideation, and lifetime suicide attempts. Conclusion: These findings provide preliminary support for the validity of the Brazilian version of the SNI-38 as an appropriate, valid instrument for measuring suicidal narratives in Brazilian individuals.

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Objective: To assess nuclear distribution element-like 1 (Ndel1) enzyme activity following acute administration of sodium nitroprusside (sNP) in a rodent model of schizophrenia (SCZ) and in a cohort of chronic SCZ patients. Methods: Ndel1 activity was measured following sNP infusions in spontaneously hypertensive rats (SHR) (2.5 or 5.0 mg/kg) and in a double-blind randomized trial with 15 SCZ patients (0.5 μg/kg/min). Patients were randomized into two groups (group I: n=7; group II: n=8), with one group receiving placebo and the other sNP in phase A. In phase B, the groups switched treatments. sNP was administered as an infusion of 0.5 μg/kg/min, for 4 h, while placebo was a 5% glucose solution infused under the same conditions. The infusions were administered once weekly over 4 weeks. Psychopathology was assessed using the 18-item figure 5 (BPRS-18 – Bech’s version) and the negative subscale of the Positive and Negative Syndrome Scale. Results: Ndel1 activity was significantly reduced after sNP infusion in SHR and in patients receiving sNP (t = 7.756, degrees of freedom [df] = 97, p < 0.0001, dcohen=1.44) compared to placebo. Reduced Ndel1 activity from baseline to the end of infusion was only seen in patients after treatment with sNP. Conclusion: SCZ patients may benefit from adjunctive therapy with sNP and that the Ndel1 enzyme is a candidate biomarker of psychopathology in the disorder. Future research should look into the role of Ndel1 in SCZ and the potential effects of sNP and drugs with similar profiles of action in both animals and patients.

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Objective: Post-traumatic stress disorder (PTSD) is triggered by traumatic events, but genetic vulnerability and a history of childhood trauma may also increase the risk of PTSD onset. Thus, we investigated the interaction between genetic susceptibility according to polygenic risk score (PRS), and traumatic events. Methods: We evaluated 68 women with PTSD who had been sexually assaulted and 63 healthy controls with no history of sexual assault. DNA was genotyped using the Infinium Global Screening Array (Illumina, San Diego, CA, USA), and PRS analysis was performed using PRSice. Logistic regression models were also used to determine the interaction between childhood trauma, traumatic life events, and PRS and how they contribute to PTSD risk. Results: We found a significant association between PRS, childhood trauma (p = 0.03; OR = 1.241), and PTSD. There was also an interaction between PRS, traumatic life events, and childhood trauma, particularly physical and emotional neglect (p = 0.028; OR = 1.010). When examining neglect separately, we found a modest association between emotional neglect and PTSD (p = 0.014; OR = 1.086). Conclusion: Our findings highlight the importance of considering genetic vulnerability and traumatic experiences in understanding the etiology of PTSD.

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Objective: To evaluate the effectiveness of online group cognitive behavioral therapy (CBT) based on the CAMALEO TOC manual in the treatment of adolescents with obsessive-compulsive disorder (OCD). Methods: This is a quasi-experimental study with a single-group pretest-posttest intervention. Over a 12-week period, 11 adolescents aged 11 to 17 years with OCD participated in weekly online group CBT sessions based on the CAMALEO TOC manual. We used several assessment tools, including the Children’s Yale-Brown Obsessive-Compulsive Scale to assess the severity of OCD symptoms, the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated to measure family accommodation, the Children’s Depression Inventory to assess depression symptoms, the Revised Children’s Manifest Anxiety Scale to assess anxiety, and the Multidimensional Students’ Life Satisfaction Scale to measure satisfaction with life. Results: OCD symptoms decreased significantly (d = -1.55) after online group CBT, and a strong effect size (d = -1.03) was found for family accommodation. After controlling for variables (e.g., engagement in psychotherapeutic treatment, medication use, or psychiatric comorbidities), no significant differences were found for OCD symptoms and family accommodation scores. In addition, there was insufficient evidence to support the effectiveness of online group CBT in reducing symptoms of depression or anxiety or improving overall quality of life. Conclusion: Our study demonstrates the feasibility of short-term online group CBT as an effective therapeutic approach for adolescents with OCD.

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Objective: The present study combined transcriptomic data and computational techniques based on gene expression signatures to identify new bioactive compounds or Food and Drug Administration-approved drugs for the treatment of bipolar disorder (BD). Methods: Five transcriptomic datasets containing 165 blood samples from individuals with BD were selected from the Gene Expression Omnibus (GEO). The number of participants varied from six to 60, with a mean age between 35 and 48 years and a gender difference between them. Most of these patients were receiving pharmacological treatment. Master regulator analysis (MRA) and gene set enrichment analysis (GSEA) were performed to identify genes that were significantly different between patients with BD and healthy controls and their associations with mood states in patients with BD. In addition, molecules that could reverse the transcriptomic profiles of BD-altered regulons were identified from the Library of Network-Based Cellular Signatures Consortium (LINCS) and the Broad Institute Connectivity Map Drug Repurposing Database (cMap) databases. Results: MRA identified 59 candidate master regulators (MRs) that modulate regulatory units enriched with BD-altered genes. In contrast, GSEA identified 134 enriched genes and 982 regulons whose activation state was determined. Both analyses revealed genes exclusively associated with mania, depression, or euthymia, and some genes were shared among these three mood states. We identified bioactive compounds and licensed drug candidates, including antihypertensives and antineoplastic agents, as promising candidates for the treatment of BD. However, experimental validation is essential to confirm these findings in further studies. Conclusion: Although our data are still preliminary, they provide some insights into the biological patterns of different mood states in patients with BD and their potential therapeutic targets. The strategy of transcriptomics plus bioinformatics offers a way to advance drug discovery and personalized medicine by using gene expression information.

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Objective: To investigate the trajectory of positive attributes from childhood to early adulthood and how these trajectories might be modified by environmental factors. Methods: We enrolled 2,511 participants aged 6 to 14 years from a large prospective school-based community cohort of Brazilian children and adolescents, 45% of whom were girls. They were assessed and followed for up to 3 years (with 80% retention) or 6 years (with 71% retention). Positive attributes were assessed by using the Youth Strength Inventory (YSI). A composite measure using several indicators was used to assess childhood exposure to threats and deprivations. Results: The trajectories of YSI scores were nonlinear for male and female participants, being high in childhood, decreasing in adolescence, and being high again in early adulthood. Exposure to threat and deprivation presented a negative linear association with YSI over time. Furthermore, exposure to threat and deprivation early in life, but not later, presented an additional effect on decreasing positive attributes during the life course. Conclusion: Our findings provide new evidence on the trajectories of positive attributes in children and adolescents and show how early life adversity affects not only mental disorders but also positive aspects of mental health.

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Objective: To investigate attention deficit and hyperactivity disorder (ADHD) symptoms and impulsivity among individuals diagnosed with opioid use disorder (OUD) who also exhibit symptoms of problematic internet use (PIU). Methods: The study involved the participation of 360 patients with OUD enrolled at an alcohol and drug addiction treatment center (ADATC) from October to December 2022. Various assessment tools were administered, including Young’s Internet Addiction Scale (YIAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS), and Adult ADHD Self-Report Scale (ASRS). PIU was identified by YIAS scores equal to or exceeding 50. Results: Most participants diagnosed with OUD had comorbid PIU, with high levels of depression, anxiety, and ADHD symptoms. Both BDI and BAI scores were significantly increased in the PIU group compared to the non-PIU group (p < 0.001). Significant differences were observed in BIS Motor Impulsivity, Attentional Impulsivity, and total scores, indicating higher impulsivity in the PIU group (all p < 0.001). Additionally, higher ASRS scores were found in the PIU group (p < 0.001). Conclusion: These findings highlight the importance of addressing PIU and comorbidities in OUD treatment. Interventions targeting ADHD symptoms and emotional well-being may benefit PIU management.

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Objective: The risk of suicide is higher among health care workers than other workers. This study investigated the association between social support and suicidal ideation and behavior during the COVID-19 pandemic among Brazilian health care workers. Methods: This study used data from 10,885 respondents to the first (time point 1 – between May and June of 2020) and second (time point 2 – between December 2020 and February 2021) cross-sectional online surveys about mental health and quality of life among Brazilian health care workers during the COVID-19 pandemic. The relationship between social support as the independent variable (time point 1) and suicidal ideation and behavior as the outcomes (time point 2) was investigated through logistic regression analysis. Results: Greater social support was associated with a significantly lower risk of reporting suicidal ideation and behavior in the month prior to follow-up assessment (adjusted OR: 0.71, 95%CI 0.66-0.76 and adjusted OR 0.61, 95%CI 0.54-0.68, respectively). These associations were independent of sex, age, feelings of loneliness, and self-reported psychiatric disorders. Conclusion: Social support is associated with a lower risk of suicidality among health care workers, and its protective role appears more closely related to suicidal behavior.

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Objective: To investigate Brazilian psychiatrists’ knowledge of and perceived confidence in diagnosis and evidence-based treatment recommendations for eating disorders. Methods: In this cross-sectional study, 259 psychiatrists filled out an online form including sociodemographic data and questions about the diagnosis and treatment of eating disorders based on standard guidelines. The sample’s knowledge level and perceived confidence regarding eating disorders were characterized using descriptive statistics. Results: The sample, which was predominantly women (65.64%), had a mean age of 42.86 years, was from southeastern Brazil (56.37%), worked predominantly in private practice (59.85%), and had less than 10 years of experience in psychiatry (51.74%). We found that 33.21% of the participants correctly identified the diagnostic criteria for anorexia nervosa, 29.73% for bulimia nervosa, and 38.22% for binge eating disorders. Correct answers for therapeutic options were similar for bulimia nervosa and binge eating disorder (20.8%) but were considerably lower for anorexia nervosa (2.7%). The participants’ training about eating disorders occurred during medical school (15.1%), medical residency/graduate study (59.8%), or as continuing education (58.7%). Only 8.89% felt satisfied with their training about eating disorders, 50.97% felt confident diagnosing eating disorders, and 37.07% felt confident about treating patients with eating disorders. Conclusion: These results show an important knowledge gap about eating disorders among Brazilian psychiatrists, which affects their confidence and competence in treating patients with eating disorders.

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Objective: To determine clinical outcomes and mortality risk factors related to mental disorders in a cohort of hospitalized patients with Covid-19 in Brazil. Methods: This retrospective cohort study used a Brazilian database called the Sistema de Vigilância Epidemiológica da Gripe (Influenza Epidemiological Surveillance System) to analyze patients aged ≥ 18 years who were hospitalized with Covid-19 between 2020 and 2022. The exposure of interest was mental disorders (anxiety, depression, schizophrenia, and bipolar disorder) identified through self-report. The primary outcome was in-hospital mortality. Covariates included demographic and clinical characteristics. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data. Results: A cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) self-reporting mental disorders, of which depression was the most prevalent (52.3%). The mortality rate of patients with mental disorders was 30.8%. Age, sex, region, dyspnea, low oxygen saturation, and comorbidities were associated with a higher mortality risk, as was schizophrenia (adjusted OR: 1.68; 95%CI 1.54-1.81). Conclusions: Individuals with schizophrenia had a greater likelihood of Covid-19-related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on Covid-19 mortality.

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Objective: Panic disorder (PD) is a common disabling condition characterized by recurrent panic attacks. Emotional and behavioral impairments are associated with functional connectivity (FC) and network abnormalities. We used whole-brain FC, modular networks, and graph-theory analysis to investigate extensive network profiles in PD. Methods: Functional magnetic resonance imaging (fMRI) data from 82 subjects with PD and 97 healthy controls were included. Intrinsic FC between each pair of 160 regions, six intra-network, and 15 inter-network FCs were analyzed. Topological properties were explored. Results: PD patients showed altered FCs within the right insula, between frontal cortex-posterior cingulate cortex (PCC), frontal cortex-cerebellum, and PCC-occipital cortex (corrected p < 0.001). Lower connections within the sensorimotor network (SMN) and SMN-occipital network (OCN) were detected (p < 0.05). Various decreased global and local network features were found in PD (p < 0.05). In addition, significant correlations were found between PD symptoms and nodal efficiency (Ne) in the insula (r = -0.273, p = 0.016) and intra-insula FC (r = -0.226, p = 0.041). Conclusion: PD patients present with abnormal functional brain networks, especially decreased FC and Ne within the insula, suggesting that dysfunction of information integration plays an important role in PD.

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Objective: Few pandemic studies have explored positive aspects of mental health employing an intersectional perspective. Our intersectional investigation aimed to identify mental illness and well-being differences between groups identified as psychologically vulnerable during the pandemic by the World Health Organization (immigrants, minorities, and people with psychiatric diagnoses) and people without pre-existing risk factors while controlling for sociodemographic variables. Methods: This cross-sectional survey included 1,134 participants (76.1% women) aged 18 to 76 years. We used the Depression, Anxiety, and Stress Scales to assess mental disorders and the Satisfaction with Life Scale and the Positive and Negative Affect Schedules to assess well-being. Results: Through a variable-centered approach, multivariate analysis revealed significant mental health differences between the groups: depression (F2.1131 = 72.7, p < 0.001), anxiety (F2.1131 = 78.0, p < 0.001), stress (F2.1131 = 85.9, p < 0.001), and subjective well-being (F2.1131 = 53.6, p < 0.001). The groups also differed when a person-centered approach was used to analyze the variables jointly through latent profile analysis. We identified six mental profiles consisting of different levels of depression, anxiety, stress, and well-being. The risk and intersectional groups were more likely to be characterized by the generalized suffering (ORrisk = 0.85, ORintersec = 0.93) and profound anguish (ORrisk&intersec = 0.97) profiles. After controlling for demographic variables, mental health disparities were partially attributed to participant risk conditions. Conclusions: Based on our results, we emphasize the urgent need for public health policies that consider the specificities and vulnerabilities of minority and risk groups.

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Objective: Galectins (Gal), which have been linked with inflammatory response in the central nervous system, may play an important role in the pathogenesis of bipolar disorder. In this study, we investigated whether serum Gal-1 and Gal-3 levels are related to bipolar disorder. Methods: Thirty-six patients diagnosed with bipolar disorder were included. C-reactive protein, Gal-1, Gal-3 serum concentrations were evaluated on the first day of hospitalization and the third week of treatment and were compared with 41 healthy controls. Illness severity was evaluated with the Young Mania Rating Scale. Results: Upon hospitalization, the C-reactive protein levels of bipolar disorder patients were significantly higher than in the third week of treatment or in healthy controls. Gal-1 levels on the first day of hospitalization and the third week of treatment were higher than those of healthy controls.There was no significant difference between patient Gal-3 levels upon hospitalization and those of healthy controls; at the end of the third week of treatment, Gal-3 levels were significantly higher than on the first day of hospitalization. Conclusion: Our study is the first to show a change in Gal levels after treatment and to evaluate the role of Gal in bipolar disorder. Gal-1 may play a role in the pathophysiology of bipolar disorder. Gal-3 could be a biomarker candidate for assessing treatment response.

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Objective: To investigate the association between depressive symptoms and social support among a representative sample of the Brazilian population aged 50 years or older. Methods: Cross-sectional study of 8,074 participants of the second wave of the Brazilian Longitudinal Study on Aging (ELSI-Brasil). Depressive symptoms were screened with the Center for Epidemiologic Studies Depression Scale (CES-D8) instrument, and social support was investigated in its structural and functional dimensions. Sociodemographic variables and health conditions were considered for adjustment in investigating the association between social support and depressive symptoms using the Poisson regression model. Results: The prevalence of depressive symptoms was estimated at 19.1% (95%CI 16.7-21.7). In the analysis adjusted for possible confounding factors, depressive symptoms were independently associated with negative social support in the items “not married” (prevalence ratio [PR] = 1.24; 95%CI 1.07-1.44), “not having someone to trust” (PR = 1.31; 95%CI 1.10-1.56) and “not having someone to borrow money or an object from, in case of need” (PR = 1.46; 95%CI 1.21-1.75). Conclusion: The present findings highlight the importance of social relations in determining the presence of depressive symptoms and reinforce the need to implement public policies aimed at strengthening social networks to minimize this public health problem.

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Objective: To analyze the related influencing factors of major depressive disorder (MDD) in adolescents, focusing on suicidal and self-injurious behavior (SSIB). Methods: A total of 299 adolescents with MDD who were admitted to the psychiatric department of our hospital between February 2022 and July 2023 were selected by using convenience sampling. Participants were divided into the SSIB group (n=110) and the non-SSIB group (n=189) according to the presence of SSIB. Related indicators were collected and compared. Results: Participants’ age at first SSIB ranged from 10 to 18 years old, with a mean age of 13.30±1.74 years. The most injured parts were lower arm and wrist (42.13%). Cutting was the most common type of injury, accounting for 40% of all participants. The most common type of self-injury differed by sex (χ2 = 17.798, p = 0.006): for men, hitting was the most common; for women, cutting was the most common. In 51.41% of participants, the time between the first thought and the actual SSIB was less than 5 minutes. Scores on the Eysenck Personality Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire Chinese version, the Symptom Checklist-90 (all p < 0.001), and the Health Risk Behavior Scale (67.47±12.59 vs. 41.58±11.36, t = 9.587, p < 0.001) were significantly higher in the SSIB group than in the non-SSIB group. In addition, the total score of quality of life (QoL) (11.36±4.32 vs. 16.43±5.64, t = 5.496, p < 0.001) was lower in the SSIB group than in the non-SSIB group. Conclusion: The SSIB of adolescents with MDD relates to various factors, including impulsiveness, aggressiveness, personality traits, QoL, and mental health level.

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Objective: To investigate the associations of symptoms of attention deficit hyperactivity disorder (ADHD) with binge eating spectrum conditions (BESC) (binge eating disorder [BED], bulimia nervosa [BN], and recurrent binge eating [RBE]), psychiatric and somatic comorbidity, and healthcare utilization in a representative sample of a Brazilian city. Methods: A household survey of 2,297 adult residents of the city of Rio de Janeiro was conducted. The Adult Self-Rating Scale Screener (ASRS-6) was used to assess ADHD symptoms. BESC was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) and confirmed by telephone interview. Standardized questionnaires were used to assess psychiatric comorbidity. Closed-ended questions investigated somatic comorbidity and healthcare utilization. Results: ADHD symptoms were highly associated with BESC (BED: OR = 13.2, 95%CI 4.3-40.6; BN: OR = 27.5, 95%CI 5.9-128.7; RBE: OR = 5.8, 95%CI 2.9-11.4). However, with further adjustment for psychiatric comorbidity (depression, anxiety, alcohol use, and impulsivity), the ORs were no longer significant. Healthcare resource utilization was significantly higher in participants with ADHD and BESC but lost significance after controlling for psychiatric comorbidity. Conclusion: ADHD was associated with an increased prevalence of BESC and greater healthcare utilization. Nonetheless, there was an essential interplay among psychiatric comorbidity in the associations of ADHD and BESC.

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Objective: Verbal communication contains key information for mental health assessment. Researchers have linked psychopathology phenomena to certain counterparts in natural language processing. We characterized subtle impairments in the early stages of psychosis, developing new analysis techniques, which led to a comprehensive map associating features of natural language processing with the full range of clinical presentation. Methods: We used natural language processing to assess spontaneous and elicited speech by 60 individuals with at-risk mental states and 73 controls who were screened from 4,500 quota-sampled Portuguese speaking residents of São Paulo, Brazil. Psychotic symptoms were independently assessed with the Structured Interview for Psychosis-Risk Syndromes. Speech features (e.g., sentiments and semantic coherence), including novel ones, were correlated with psychotic traits (Spearman’s-ρ) and at-risk mental state status (general linear models and machine-learning ensembles). Results: Natural language processing features were informative for classification, presenting a balanced accuracy of 86%. Features such as semantic laminarity (as perseveration), semantic recurrence time (as circumstantiality), and average centrality in word repetition graphs carried the most information and were directly correlated with psychotic symptoms. Grammatical tagging (e.g., use of adjectives) was the most relevant standard measure. Conclusion: Subtle speech impairments can be detected by sensitive methods and can be used in at-risk mental states screening. We have outlined a blueprint for speech-based evaluation, pairing features to standard psychometric items for thought disorder.

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Objective: Single-session interventions are an effective strategy for reducing emotional distress. Enhanced psychoeducation, which includes empathic listening, risk stratification, symptom monitoring, and habit modification is particularly suitable for single-session interventions. We investigated predictors of response to an online enhanced psychoeducation intervention among essential service professionals during the COVID-19 pandemic in Brazil. Methods: The TelePSI Project, financed by the Brazilian Ministry of Health, was a nationwide initiative that served more than 3,300 individuals in various psychotherapeutic modalities. Data were collected from April 2020 to December 2021. We included all participants with high levels of emotional distress who received single-session interventions. The final sample included 460 individuals (89.1% women, 81.1% health professionals). After 1 month, 300 participants were reassessed. Results: Overuse of social media, use of social networks to contact family and friends, playing video games, smoking, drinking alcohol, and spending time with pets were associated with less improvement in symptoms, whereas playing an instrument and previous psychological treatment were associated with greater symptom improvement. This highlights the impact of lifestyle factors on the efficacy of single-session interventions. Conclusion: These results underscore the importance of considering individual lifestyle factors when implementing single-session interventions and contribute to a growing body of evidence that supports tailored application of psychoeducational strategies in mental health interventions, particularly in high-stress environments.

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Generalized anxiety disorder is a highly prevalent mental disorder. Previous data indicate that more than 18 million Brazilians suffer from this condition. Traditionally, generalized anxiety disorder has been considered a mild mental health disorder, despite its links to lower life expectancy, cardiovascular disease, and suicide. The aim of this article is to combine elements of systematic and critical reviews to produce a synthesis of the best evidence about generalized anxiety disorder treatment. Systematic reviews, meta-analyses, and randomized controlled trials were included. The descriptor used in the search was “generalized anxiety disorder,” which resulted in 4,860 articles and seven other studies, of which 59 were selected. Antidepressants and benzodiazepines were indicated, as was pregabalin, and atypical antipsychotics, such as quetiapine, have been studied. Individual cognitive behavior therapy (third wave) has proven effective. There is extensive literature on many effective treatments for generalized anxiety disorder. The present review summarizes the therapeutic possibilities, emphasizing those available in Brazil. Further studies are needed to compare other available medications, assess psychotherapies and new treatments in greater depth, as well as to assess the ideal duration of therapy. Registration number: PROSPERO CRD42021288323.

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An integral part of Brazil’s public health system, psychiatric emergency services have been instrumental in improving qualified support for crisis situations involving mental disorders in an equitable, universally accessible, and humanized way. The purpose of this article is to present a systematic review and consensus on the infrastructure and the ideal team for psychiatric emergencies services in Brazil. The authors searched electronic databases including MEDLINE (PubMed), SciELO, and Cochrane, in addition to documents from the World Health Organization, the Brazilian Ministry of Health, and other authorities. Of the 6839 manuscripts found, 46 were included. The content analysis summarized consensus statements through the Delphi method, and, after a series of interactive versions, a final report was produced. Models for changing psychiatric emergency services are assessed. It was determined that the emergency care network must be supervised by qualified management, and all health equipment and units must be effectively integrated. Psychiatric emergency services need adequate infrastructure, qualified staff (including a psychiatrist), sufficient consultation and observation space, tools and resources for differential diagnosis, training for all staff members, and communication with the health care network to facilitate referrals following patient discharge. Standardized models should be available to public health managers to guide the development of new services and adjust existing ones, always seeking improvement. The authors propose a model of psychiatric emergency services.

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This is the first of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of emerging mental disorders throughout the life course. By utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote the health and safety of their student population, paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

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This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the use of digital health in mental health care, the implementation of interventional psychiatry, and the design of innovative mental health systems that integrate principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients in general hospitals, where their mental health and physical needs are addressed, should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that can advance innovation, uphold human rights, and strive for the highest standards in mental health care.

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Bipolar disorder (BD) is a neuropsychiatric illness characterized by recurrent episodes of mania and depression, leading to significant cognitive and functional impairments, psychiatric and metabolic comorbidities, and substantial healthcare costs. The complex nature and lack of specific biomarkers for BD make it a daily challenge for clinicians. Therefore, advancing our understanding of BD pathophysiology is essential to identify novel diagnostic biomarkers and potential therapeutic targets. Although its neurobiology remains unclear, circadian disruption and lipid alterations have emerged as key hallmarks of BD. Lipids are essential components of the brain and play a critical role in regulating synaptic activity and neuronal development. Consequently, alterations in brain lipids may contribute to the neuroanatomical changes and reduced neuroplasticity observed in BD. Lipid droplets, which regulate the storage of neutral lipids, buffer the levels of toxic lipids within cells. These dynamic organelles adapt to cellular needs, and their dysregulated accumulation has been implicated in several pathological conditions. Notably, lipid droplets and different classes of lipids exhibit rhythmic oscillations throughout the 24-hour cycle, suggesting a link between lipid metabolism, circadian rhythms, and lipid droplets. In this review, we explore the impairment of circadian rhythms and lipid metabolism in BD and present evidence that circadian clocks regulate lipid droplet accumulation. Importantly, we propose the “hypothesis of lipid droplets for BD,” which posits that impaired lipid metabolism in BD is closely linked to alterations in lipid droplet homeostasis driven by circadian clock disruption.

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Patients with schizophrenia represent a group heterogeneous in clinical presentation and severity. Although severity has been operationalized in different ways, mostly on a gradient between symptom severity and functional impairment, such approaches are limited in capturing real-world functioning. We suggest adopting the severity model proposed by DSM-5 for autism spectrum disorders. The model defines three levels of severity based on the support required, directly addressing two barriers from previous models: real-world functioning and ease of implementation. Our adapted model includes three new features: first, this severity specifier is global, rather than for each symptom domain; second, the centrality of occupational functioning is emphasized to define the level of support; third, we propose a 1-month timeframe for severity appraisal, standardizing the assessment process. Considering practical utility, we indicate how severity assessment can guide clinical practice towards rehabilitation. Additionally, we outline operational definitions for severity and functioning in schizophrenia, aligned with the premises of our model. Finally, we acknowledge potential limitations, the most relevant being the need for empirical validation. The model is presented to foster discussion. Additional studies will follow to investigate inter-rater reliability and convergent validation with standard measures of symptom and functioning severity.

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Objectives: Evidence from diffusion tensor imaging (DTI) and postmortem studies has demonstrated white-matter (WM) deficits in bipolar disorder (BD). Changes in peripheral blood biomarkers have also been observed; however, studies evaluating the potential relationship between brain alterations and the periphery are scarce. The objective of this systematic review is to investigate the relationship between blood-based biomarkers and WM in BD. Methods: PubMed, Embase, and PsycINFO were used to conduct literature searches. Cross-sectional or longitudinal studies reporting original data which investigated both a blood-based biomarker and WM (by neuroimaging) in BD were included. Results: Of 3,750 studies retrieved, 23 were included. Several classes of biomarkers were found to have a significant relationship with WM in BD. These included cytokines and growth factors (interleukin-8 [IL-8], tumor necrosis factor alpha [TNF-α], and insulin-like growth factor binding protein 3 [IGFBP-3]), innate immune system (natural killer cells [NK]), metabolic markers (lipid hydroperoxidase, cholesterol, triglycerides), the kynurenine (Kyn) pathway (5-hydroxyindoleacetic acid, kynurenic acid [Kyna]), and various gene polymorphisms (serotonin-transporter-linked promoter region). Conclusion: This systematic review revealed that blood-based biomarkers are associated with markers of WM deficits observed in BD. Longitudinal studies investigating the potential clinical utility of these specific biomarkers are encouraged. Systematic review registration: PROSPERO CRD42021279246.

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Objectives: To estimate the prevalence of antidepressant use in Brazil. Methods: We conducted a systematic review with searches in MEDLINE, Embase, Scopus, LILACS, and SciELO up to May 2023. Two researchers independently selected studies, extracted data, and assessed the methodological quality. We pooled the prevalence of antidepressant use using meta-analyses of proportions (Freeman-Tukey transformation) and estimated heterogeneity by the I2 statistic. OR meta-analyses of antidepressant use by sex were calculated (men as reference) and between-study variation was explored by meta-regressions. Results: Out of 3,299 records retrieved, 23 studies published in 28 reports were included, with a total of 75,061 participants. The overall prevalence of antidepressant use was 4.0% (95%CI 2.7-5.6%; I2 = 98.5%). Use of antidepressants in the previous 3 days was higher in women (12.0%; 95%CI 9.5-15.1%; I2 = 0%) than men (4.6%; 95%CI 3.1-6.8%; I2 = 0%) (p < 0.001; OR = 2.82; 95%CI 1.72-4.62). Gender differences were particularly higher for antidepressant use in the previous year (women: 2.3%; 95%CI 1.6-3.1; I2 = 37.6% vs. men: 0.5%; 95%CI 0.2-1.0%; I2 = 0%, p < 0.001; OR = 4.18; 95%CI 2.10-8.30). Between-study variation in the overall prevalence of antidepressant use significantly increased with mean participant age (p = 0.035; residual I2 = 0%; regression coefficient = 0.003). Conclusion: Four out of every 100 Brazilians used antidepressants in this 3-decade assessment. Use increased with age and was more prevalent in women compared to men. Registration number: PROSPERO CRD42022345332.

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Objective: To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic. Methods: A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms. Results: Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR. Conclusion: Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis. Registration number: PROSPERO CRD42022332037.

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Objective: To conduct a thorough examination of the current understanding of the effect of maternal depression exposure on the executive functions (EFs) of offspring. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement, a comprehensive search for peer-reviewed cohort studies was performed on the MEDLINE (via PubMed), ScienceDirect, LILACS, PsycINFO, and SciELO databases. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation framework. Results: Thirty-three cohort studies from different countries, enrolling a total of 38,981 participants, were analyzed. Twenty-four studies confirmed the hypothesis of a harmful effect of maternal depressive symptoms on offspring EF. However, high heterogeneity among studies was found, and meta-analysis was not feasible. Fetal programming, genetics, and parental practices have been identified as potential mechanisms that can affect the EFs of children born to mothers who have experienced depressive symptoms. Conclusion: Our findings suggest a negative association between maternal depressive symptoms and offspring EF. Further studies on the effects of chronicity/severity of maternal symptoms and changes in EFs in different sensitive periods are needed. Registration number: PROSPERO CRD42020221193.

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Objective: To compare the prevalence of postpartum depression (PPD) symptoms between high-income countries (HIC) and low- and middle-income countries (LMIC) during the COVID-19 pandemic. Methods: The PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO, and CINAHL databases were searched until October 2022 for studies that collected data during the pandemic. The metaprop command was used in the Stata statistical software version 12.0 to run a random-effects meta-analysis. Results: A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of PPD symptoms was 31% (95%CI 21.85-40.99). The pooled prevalence of PPD symptoms among women from HIC (30.5% [95%CI 16.95-46.02]) did not differ significantly from that of women from LMIC (31.5% [95%CI 19.26-45.15]). However, studies that analyzed women up to 1 month after childbirth reported a lower prevalence of PPD symptoms (17.5% [95%CI 9.85-26.62]) compared to those that observed them up to 1 year after childbirth (38.3% [95%CI 33.96-42.83]). Conclusions: The prevalence of PPD symptoms was high across countries, regardless of human development index. This condition must be regularly tracked worldwide to assess, discuss, and recommend more assertive steps that may be implemented to address it based on the particular characteristics of each country. Registration number: PROSPERO CRD42022346861.

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Objective: From a preventive perspective, this study reviewed the literature on protective factors against depressive symptoms in high-risk children and adolescents. Methods: We conducted a thorough search of the PubMed, APA, EMCare, and Embase databases for studies published between 1946 and August 25, 2023. We included only longitudinal studies that analyzed protective factors for depressive symptoms in high-risk children or adolescents, excluding cross-sectional studies, reviews, and pre-clinical studies. Results: A total of 29 studies with 62,405 participants were analyzed and 38 protective factors were identified. Positive individual characteristics, family factors, peer relationships, school-related aspects, neighborhood characteristics, and intrinsic religiosity were associated with improved depression outcomes. Conclusion: These findings have important implications for preventive strategies in this population. Addressing protective factors can help prevent depression and enhance lifetime mental health.

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Objective: To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for attention deficit/hyperactivity disorder (ADHD). Methods: Randomized sham-controlled trials were identified in major databases from January 1990 to January 2023. The primary outcome was overall improvement in ADHD symptoms. Subgroup analysis focused on the efficacy of rTMS in different brain regions. Secondary outcomes were the association of rTMS with improvement in different ADHD symptoms. Outcomes were expressed as effect size based on standardized mean difference (SMD)(continuous data), and ORs with 95%CI (categorical data). Results: A meta-analysis of six randomized sham-controlled trials involving 169 participants demonstrated no difference in overall ADHD symptoms between those treated with rTMS and sham controls (SMD = -0.24, p = 0.17). Subgroup analysis revealed that rTMS was more efficacious than sham treatment when targeting the right prefrontal cortex (SMD = -0.49, p = 0.03) but not the left prefrontal cortex (SMD = 0.01, p = 0.67). rTMS treatment was correlated with greater improvement in inattention (SMD = -0.76, p = 0.0002), but not hyperactivity (p = 0.86), impulsivity (p = 0.41), or depression symptoms (p = 0.95). The apparently higher risk of dropout in the rTMS group than the sham control group was not statistically significant (OR = 1.65, p = 0.26). Conclusion: This review found that rTMS only had therapeutic efficacy for ADHD symptoms (particularly inattention) when targeting the right prefrontal cortex. Further large-scale randomized sham-controlled trials are required to verify our findings. Registration number: PROSPERO CRD42023393713.

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Objective: To identify the effects of amygdala neuromodulation on disruptive behavior and quality of life changes in patients and its relationship with epilepsy. Methods: The MEDLINE, OVID, WoS, Central Cochrane, and Scopus databases were systematically searched up to March 2023 for studies with at least six months of follow-up on extremely aggressive patients who underwent ablative surgeries or deep brain stimulation of the amygdala as the unique therapeutic target. Results: The search yielded 1,352 studies after excluding duplicates. However, only 11 case series and three case reports met the inclusion criteria. The studies were published between 1963 and 2023 and included 1,033 patients, mostly male, aged between 5 and 61 years. All of the studies performed amygdalotomy except one, which performed deep brain stimulation. Behavior improved in > 70% of the patients, and seizures occurred in approximately 30%, of whom 40% presented improvement. Two studies reported worsening behavior. Conclusions: Although we found that amygdalotomy has a positive effect on patient behavior and seizure control, new studies with greater power are needed. Future studies should investigate deep brain stimulation and the role of connectomics regarding this brain structure.

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Objective: Depression is a major public health problem. Many complementary and alternative medicine (CAM) interventions have been suggested as potential treatments. This umbrella review aimed to assess the efficacy and safety of CAM interventions for treating depression. Methods: We comprehensively searched for relevant systematic reviews and meta-analyses in the MEDLINE (via PubMed), EMBASE, Web of Science, and Cochrane Library databases. We assessed effectiveness (based on efficacy and changes in depression assessment scale scores) and safety (based on adverse events). Results: A total of 22 eligible articles were included. Yueju antidepressant and electro-acupuncture (EA) improved depression symptoms better than conventional antidepressants. In addition, omega-3 fatty acids (n-3PUFAs), exercise, manual acupuncture (MA), Hypericum mono-preparations, relaxation, and vitamin D showed superior efficacy to placebo and controls. Guipi decotion (GPD) as adjunctive therapy has higher efficacy than conventional antidepressants, and MA and Yueju have a better safety profile than conventional antidepressants. Conclusion: 10 CAMs can effectively improve the condition of patients with clinical depression.

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Objectives: To study the impact of coronavirus disease 2019 on the routine of patients with obsessive-compulsive disorder (OCD) and changes in symptoms and suicidal-related behavior, mainly in those with cleaning symptoms. Methods: In this cross-sectional study, 58 patients completed an online self-report questionnaire that included the Obsessive-Compulsive Inventory-Revised, Coronavirus Stress and Traumatic Events Scale, Coronavirus Health Impact Survey, Beck Anxiety and Beck Depression inventories, and Suicide-Related Behaviors Questionnaire. Comparisons were made with another pre-pandemic sample (n=524) regarding the last three measures. Results: During the pandemic, the patients spent more days inside their homes (χ2 = 33.39, p = 0.007), changed their alcohol consumption patterns (χ2 = 87.6, p < 0.001), and increased social media usage (χ2 = 68.83, p < 0.001). Participants with cleaning symptoms did not significantly differ from the others in relation to stress, anxiety/depressive symptoms, or suicidal-related behaviors. Finally, our sample did not differ from an equivalent OCD sample assessed before the pandemic in terms of anxiety and depressive symptom severity or suicidal-related behaviors. Conclusion: Overall, patients with OCD showed no lifestyle changes associated with higher stress levels during the pandemic. Patients with and without cleaning symptoms and patients before and during the pandemic presented similar results.

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Objective: To test the efficacy of a dissonance-based (DB) intervention in targeting risk factors for eating disorders (EDs) and predisposing factors for muscle dysmorphia (MD) symptoms in body-dissatisfied Brazilian men over 1 year of follow-up and evaluate whether reductions in body-ideal internalization would mediate the intervention’s impact on ED and MD symptoms. Methods: Participants were randomized to a two-session DB intervention (n=89) or assessment-only control (AOC) (n=91), and completed validated measures assessing body-ideal internalization, body dissatisfaction, ED, and MD symptoms at baseline, post-intervention, 1-month, 6-month, and 1-year follow-ups. Results: The DB condition showed significantly greater reductions in MD symptoms and body dissatisfaction compared with the AOC group over a 1-year follow-up, while significant differences were not observed for body-ideal internalization and ED symptoms. Changes in body-ideal internalization from baseline to 1-month follow-up completely mediated the relationship between condition and the changes observed in both ED and MD symptoms. Conclusion: These results provide further evidence of the efficacy of the tested intervention through 1-year follow-up in reducing body dissatisfaction and MD symptoms, but no such result was observed for body-ideal internalization and EDs. Our findings provide support for theoretical models of eating pathology and MD symptoms in Brazilian men. Clinical Trial Registration: Brazilian Registry of Clinical Trials (ReBEC): RBR-27dc264.

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Objective: We investigated whether social skills are impaired in patients with obsessive-compulsive disorder (OCD), whether they changed over the course of treatment, and whether OCD severity, age of onset, and illness duration were associated with social skills deficit. Methods: A total of 41 treatment-naïve patients with OCD and 34 healthy controls were assessed using the Social Skills Inventory. Patients were reevaluated 12 weeks after standardized treatment. Group differences and the effects of treatment on OCD symptomatology over time were analyzed with independent and paired tests, respectively. OCD severity, age at illness onset, and illness duration were tested as predictors of social skills. Results: The patient group had lower overall social skill scores than controls (p < 0.001). After treatment, although OCD symptomatology (p < 0.001) improved, there was no significant difference in social skills (p = 0.673). Earlier age of symptom onset predicted lower social skill scores (p = 0.016). Conclusion: Our results suggest that, despite improved OCD symptoms, social skills did not change after treatment. Subsequent investigations with larger sample sizes and longer follow-up periods could determine whether social skills are likely to increase over time.

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Objective: We investigated whether manipulating levels of uncertainty would influence performance in a decision-making task in people with obsessive-compulsive disorder. Methods: This case-control study compares Beads Task (measuring reflection/decisional impulsivity) performance and trait impulsivity (Short Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency [UPPS-P] Impulsive Behavior Scale) in patients with obsessive-compulsive disorder (n = 65) and non-clinical controls (n = 45). Differences between groups were assessed with the Mann Whitney U test. Results: The obsessive-compulsive disorder group had significantly fewer draws to decision (U = 1,845, p = 0.019) and less subjective decision-certainty (U = 1,518, p = 0.00) in the low uncertainty (85:15) condition, and higher negative urgency scores (U = 2,163, p ≤ 0.001) and lower sensation-seeking scores (U = 907.5, p = 0.001) in UPPS-P. However, differences in Beads Task performance did not survive correction for multiple comparisons. Conclusion: Patients with obsessive-compulsive disorder engage in more impulsive decision-making in the lower uncertainty condition than healthy controls, despite low subjective certainty of the decision. They also had higher scores for the trait impulsivity factor of negative urgency. Future studies should explore the contribution of trait impulsivity, as well as symptom severity, anxiety, and decision-certainty, to impulsivity in obsessive-compulsive disorder.