Tesi sul tema "Depression"

Introdução: Depressão ou morbidade depressiva, é uma doença mental complexa que inclui diferentes fenótipos e sintomas, com desfechos negativos na saúde. Os diferentes distúrbios psiquiátricos, assim como a presença de sintomas depressivos, têm sido associados a dieta e hábitos alimentares. Objetivos: Investigar a associação entre sintomas depressivos e aspectos relacionados ao estado nutricional e alimentação, em idosos residentes na da Zona Oeste do município de São Paulo. Métodos: O presente estudo é epidemiológico, transversal, de base comunitária, com 2.643 idosos com idade igual ou superior a 60 anos. Foram consideradas como variáveis: a- Dependente: Sintomas Depressivos pela escala proposta pelo Centro de Estudos Epidemiológicos para identificação de sintomas depressivos (CES-D); Variáveis independentes (preditores): Estado nutricional a partir das medidas antropométricas (peso e altura com posterior cálculo do IMC, e circunferência da cintura); Respostas a algumas questões relacionadas ao hábito de consumir determinados alimentos ou grupos de alimentos, e hábito de fazer as refeições diárias. Foram ainda avaliadas as variáveis relacionadas a presença de doenças crônicas (hipertensão, diabetes e hipercolesterolemia); características sócio econômicas e demográficas (critério de Classificação Econômica Brasileira (CCEB). As variáveis foram analisadas por regressão logística binária, adotando significativos os valores de p <0,05. Resultados: Foi encontrada uma prevalência elevada de sintomas depressivos (38%); associaram-se positivamente aos sintomas depressivos o hábito em consumir frutas, feijões, leites e derivados, azeite, água e vinho. Após ajustes pelas variáveis clínicas, socioeconômicas e demográficas, permaneceram significantes no modelo final o hábito em consumir leites e derivados, azeite e vinho; o hábito em realizar o almoços e jantar; relatar a presença de HAS; pertencer ao sexo feminino e estar divorciado ou separado. Conclusões: O presente estudo mostrou a existência de associações significativas entre sintomas depressivos e o hábito em consumir determinados alimentos (leite e derivados, azeite e vinho). Porém tais dados ainda não são totalmente conclusivos para a população brasileira. Novos estudos fazem-se necessários para esclarecer a relação entre o hábito em consumir determinados grupos de alimentos e a chance em desenvolver sintomas depressivos em idosos.
Background: Depression or depressive morbidity is a complex mental disease that includes different phenotypes and symptoms, with negative health outcomes. The different psychiatric disorders, as well as the presence of depressive symptoms, have been associated with diet and eating habits. Aims: To investigate the association between depressive symptoms and aspects related to nutritional status and feeding, of elderly residents from the West Zone of the city of São Paulo. Methods: The present study is a cross-sectional, community-based epidemiological study with 2,643 elderly individuals aged 60 or over. The following variables were considered: a-) Depedemt: Depressive Symptoms by the scale proposed by the Center for Epidemiological Studies to identify depressive symptoms (CES-D); Independent (predictors): Nutritional status from anthropometric measures (weight and height with subsequent calculation of BMI, and waist circumference); Answers to some questions related to the habit of consuming certain foods or food groups, and habit of making daily meals (Brazil, 2006). The variables related to the presence of chronic diseases (hypertension, diabetes and hypercholesterolemia) were also evaluated; Socioeconomic and demographic characteristics (Brazilian Economic Classification, CCEB) (ABEP, 2011). The variables were analyzed by binary logistic regression, adopting significant values of p <0.05. Results: There was found a high prevalence of depressive symptoms (38%); The habit of consuming fruits, beans, milks and derivatives, olive oil, water and wine were positively associated with depressive symptoms. After adjusting for the clinical, socioeconomic and demographic variables, the habit of consuming milk and derivatives, olive oil and wine remained significant in the final model; The habit of holding lunch and dinner; Have HAS; Belong to the female sex and be divorced or separated. Conclusions: The present study showed the existence of significant associations between depressive symptoms and eating habits (milk and dairy products, olive oil and wine). However, these data are not yet fully conclusive for a Brazilian population. New studies are needed to define a relationship between the habit and consumption of food groups and a chance to develop depressive symptoms in the elderly.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Esta dissertação pretende estimar a prevalência de sintomas depressivos em idosos segundo três níveis de complexidade de atenção à saúde e estudar a co-ocorrência de sintomas depressivos e incapacidade funcional. No Brasil, a transição demográfica ocorreu de forma rápida e explosiva. À medida que o número de idosos cresce ocorre o aumento da prevalência de doenças crônicas e suas complicações. A habilidade funcional pode ser vista como uma medida de resumo do impacto geral das condições médicas no contexto do ambiente e do sistema de apoio social do indivíduo, e deve ser uma consideração importante em qualquer planejamento de saúde. Uma enfermidade associada a elevado grau de incapacidade funcional é a depressão. Entre os agravos de saúde mental, a depressão é um dos mais comuns e importantes problemas psiquiátricos entre indivíduos idosos. Trata-se de estudo transversal com tamanho amostral de 643 idosos com idade de 65 ou mais anos selecionados aleatoriamente e usuários de três serviços públicos de saúde com níveis crescentes de complexidade (primário, secundário e terciário). A prevalência de sintomas depressivos foi estimada a partir da EDG-15, já traduzida e validada para uso no Brasil. O nível de estado funcional foi definido conforme os escores dos instrumentos SF-36 e HAQ. A prevalência de sintomas depressivos na amostra total foi de 45,2% (IC=41,1 49,3). Estratificando por unidade, a prevalência foi de 35,3% no nível primário, 47,6% no nível secundário e 51,7% no nível terciário (p=0,004). As prevalências encontradas foram altas nos três níveis de complexidade de atendimento, inclusive na população de idosos da unidade básica de saúde, apesar de serem idosos mais independentes e mais saudáveis. A prevalência geral de sintomas depressivos aumentou à medida que o grau de incapacidade funcional também aumentou. A busca ativa por idosos com sintomas depressivos é importante em todos os níveis de complexidade de atendimento do sistema de saúde.
This dissertation aims to estimate the prevalence of depressive symptoms in the elderly according to three levels of complexity of health care and to study the co-occurrence of depressive symptoms and levels of functional capacity. In Brazil, the demographic transition occurred quickly and explosive. As the number of elderly grows there is an increase in the prevalence of chronic diseases and their complications. The functional ability can be seen as a summary measure of overall impact of medical conditions in the context of environment and social support system of the individual, and should be an important consideration in any planning of health. A condition associated with a high degree of disability is depression. Among the grievances of mental health, depression is one of the most common and important psychiatric problems among the elderly. This is cross-sectional study with a sample size of 643 elderly aged 65 or over, randomly selected, and users of three public health services with increasing levels of complexity (primary, secondary and tertiary). The prevalence of depressive symptoms was estimated from the EDG-15, already translated and validated for use in Brazil. The level of functional status was defined as the scores of instruments SF-36 and HAQ. The prevalence of depressive symptoms in the total sample was 45.2% (CI = 41.1 to 49.3). Stratified by unit, the prevalence was 35.3% at primary level, 47.6% at secondary level and 51.7% at the tertiary level (p = 0.004). Prevalence rates were high in the three levels of complexity of care, including the elderly population in primary care unit, although the elderly are more independent and healthier. The overall prevalence of depressive symptoms increased as the degree of disability has also increased. The active search for elderly patients with depressive symptoms is important at all levels of complexity of care in the health system.

Previous research has found little support for cognitive vulnerability factors in depression. I argue that this lack of support is due to the use of tasks that tap into effortful processes, as seen in previous research. I propose that support for cognitive vulnerability factors would be found by using tasks which tap into automatic processes. Depressive automatic processes were assessed by three tasks: dichotic listening, probe detection, and implicit memory tasks. For the dichotic listening task, subjects shadowed brief neutral passages while depression- and positive-content words were played in the unattended channel. Concurrently, subjects were required to detect the word "press" presented intermittently on a computer screen. Detection latencies were recorded. For the probe detection task, pairs of words were briefly presented on a computer screen, one appearing in the upper half of the screen, and one appearing in the bottom half. Three types of word pairs were used: neutral-neutral, depression-neutral, and positive-neutral. Subjects were asked to read the top word aloud. They were also required to detect the presence of a "+", which sometimes appeared in either location of the words. Detection latencies were recorded. For the implicit memory task, half of the subjects were presented with a list of words and were required to rate each word on how much they liked each word. Four types of words were used: depression-related, happiness-related, types of flowers, and types of diseases. These subjects were then asked to generate eight exemplars for each word type. The other half of the subjects were simply asked to generate eight exemplars for the word types. Depressive effortful processes were defined as self-report of cognitions. This was assessed by three self-report questionnaires: Dysfunctional Attitude Scale, Automatic Thoughts Questionnaire, and the Hopelessness Scale. Three groups of subjects were used: currently depressed patients (n=20), remitted depressed individuals (n=20), and nondepressed individuals (n=20). The currently depressed group consisted of 13 women and 7 men, the remitted depressed group consisted of 16 women and 4 men, whereas the nondepressed group consisted of 13 women and 7 men. Their ages ranged from 23 to 65 years, with an overall average of 39.9 (SD = 11.28) years. Subjects were tested individually on each of the tasks. Three months after testing, they were asked to complete the Beck Depression Inventory. Four main hypotheses were examined: (a) currently depressed individuals would show a bias for depression-related stimuli on the automatic tasks; (b) remitted depressed individuals' pattern of performance on the automatic tasks would resemble that of the currently depressed patients; (c) remitted depressed individuals' pattern of performance on the effortful tasks would resemble that of the nondepressed individuals; and (d) measures of depressive automatic processes would be predictive of follow-up depressive symptoms. Analyses of variance and regression analyses were used. The first hypothesis was not supported. The second hypothesis was only supported for the dichotic listening task. The third hypothesis was supported, whereas the fourth hypothesis was not supported. Implications of the results to schema theory, vulnerability methodology, and clinical assessment procedures were dlscussed.
Arts, Faculty of
Psychology, Department of
Graduate

In einer Reihe neuerer epidemiologischer Studien wurde ein Zuwachs in der Prävalenz der Major Depression in jüngeren Geburtskohorten und ein sinkendes Ersterkrankungsalter dieser Störung beobachtet (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). Gleichzeitig wurden bei älteren Personen auffallend niedriege Depressionsraten gefunden. Der vorliegende Beitrag gibt einen Überblick über die diesen Beobachtungen zugrundeliegenden Studien. Die Validität der Befunde und ihre Bedeutsamkeit für die Ätiologie der Major Depression sowie mögliche Alternativerklärungen der zeitlichen Effekte werden diskutiert. Während der Befund eines Zuwachses depressiver Störungen in jüngeren Geburtskohorten empirisch gut belegt ist, sind die niedrigen Depressionsraten bei älteren Personen zumindest teilweise auf einen Artefakt der Forschungsmethodologie zurückzuführen
The findings of a number of recent major epidemiological studies in different countries document an increase in the cumulative lifetime prevalence estimates of major depression with each successively younger birth cohort and a decrease in the age of onset of this disorder (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). At the same time comparably low depression estimates are found for the elderly. The paper presents an overview of the major studies conducted in this area in recent years. The validity of the findings, their significance for the aetiology of Major Depression and possible alternative explanations for the temporal trends are discussed. While much valid empirical evidence confirms the increase of Major Depression in recent birth cohorts, the low prevalence estimates in the elderly seen to represent at least in part an artifact of the research methodology

Depressive symptoms in pregnancy are common, reported by approximately 20% of pregnant women worldwide. Of these, around 4-7% fulfill the criteria for major depressive episode (MDE). The prevalence rates of MDE seem no different from those in non-pregnant women of childbearing ages, or may even be lower. Further, the clinical presentation of depressive symptoms in women of childbearing age does not differ depending on whether women are pregnant, postpartum or outside the peripartum period. For this reason, some researchers argue that peripartum depression is just another depression, merely occurring at a stressful point in life.   Antenatal depression and antidepressant treatment have been associated with an increased risk of poor pregnancy outcomes, such as preterm birth, impaired placental function, decreased fetal body and head growth. Nevertheless, little is known about the biological mechanisms behind these complications and more research is needed to elucidate the underlying pathways. In this thesis we have studied 1) attentional bias in antenatal and postpartum depression, with or without antidepressant treatment and 2) peripheral inflammatory markers in pregnancy (depressed, SSRI-treated, healthy controls). The title for this thesis is: Is peripartum depression just another depression? Based on the findings we have obtained thus far, the answer would be no. One argument would be that, as presented in study I, women who suffer from antenatal and postpartum depression do not display the typical attentional bias to negative words that is characteristic of depressive states in the non-pregnant population. Whether this is due to protective mechanisms of pregnancy or due to features that distinguish antenatal and postpartum depression from non-peripartum depression remains to be demonstrated. Secondly, study II describes that women with antenatal depression had significantly lower levels of peripheral inflammatory markers than healthy pregnant controls. Hypothetically, this could be due to dysregulated switch to the antiinflammatory pro-M2 milieu that characterizes normal third trimester pregnancy. These findings are clearly at odds with the literature in non-pregnant samples, where depression has been associated with increased levels of proinflammatory cytokines, but should be interpreted in the context of pregnancy-induced changes in inflammatory response. Moreover, treatment for antenatal depression is not as straightforward as it is in non-pregnant patients. When considering treatment, the expecting mother has to be aware of the risk-benefit profile for herself and the child. While antidepressant therapy clearly improves the mood of treated women, our findings do not indicate that antidepressant treatment has any positive impact on their inflammatory profile.

Introdução. A depressão é uma síndrome clínica heterogênea caracterizada por perfis sintomatológicos distintos. Contudo, raros são os estudos que investigaram subtipos depressivos na comunidade e seus correlatos sociodemográficos e clínicos, diferenciando-os quanto à apresentação de acordo com o gênero. Métodos. Utilizou-se o banco de dados do Estudo São Paulo Megacity. Entraram na análise 1.212 sujeitos (869 mulheres e 343 homens) que responderam sobre a presença ou ausência dos sintomas constantes no módulo de depressão do questionário WMH-CIDI. Foi usado o método de análise de classes latentes (ACL). Critérios estatísticos (como o Critério de Informação Bayesiano [BIC] e a entropia) foram empregados para a determinação do número de classes que melhor classificava os sujeitos. Após a obtenção dos modelos mais adequados, as classes foram validadas por correlatos sociodemográficos e clínicos, utilizando-se regressão logística multinomial. Posteriormente, examinou-se a associação entre os subtipos depressivos e a utilização dos serviços de saúde ao longo da vida. Todas as análises foram realizadas no programa Mplus 6.12. Resultados. O melhor modelo de ACL para a amostra geral foi o de 3 classes denominadas Melancólica (37,8%), Atípica (17,83%) e Leve (44,37%). Os sujeitos da classe Atípica apresentaram elevada probabilidade de irritabilidade (81,8%) e ansiedade (90,7%). No modelo final ajustado, pertencer à classe Melancólica associou-se significativamente com: transtorno do espectro bipolar; transtorno de ansiedade; dependência de álcool e drogas; maior incapacitação; e maior escolaridade. Mulheres na classe Atípica foram mais propensas a ter maior escolaridade e comorbidade com transtorno do espectro bipolar e transtorno de ansiedade. Na análise da subamostra de mulheres, o melhor modelo de ACL foi o de 3 classes, semelhantes ao modelo da amostra total: Melancólica (39,34%), Atípica (19,53%) e Leve (41,13%). No modelo final ajustado para o sexo feminino, a classe Melancólica associou-se significativamente com: transtorno do espectro bipolar; transtorno de ansiedade; dependência de álcool e drogas; transtorno disfórico pré-menstrual; e maior incapacitação. Mulheres desta classe, comparadas com às das outras classes, foram mais propensas a ter maior escolaridade e estarem separadas, divorciadas ou viúvas. A classe Atípica associou-se significativamente com: transtorno do espectro bipolar; transtorno de ansiedade; dependência de álcool e drogas; e maior escolaridade. Para o sexo masculino, o melhor modelo de ACL foi também o de 3 classes: Melancólica (40,37%), Agitada (19,56%) e Leve (40,07%). Praticamente todos os homens pertencentes à classe Agitada apresentaram agitação e ansiedade, e uma grande proporção (ao redor de 84%), irritabilidade. Ainda, os sujeitos desta classe apresentaram as maiores proporções de pensamento acelerado (43,9%), aumento de energia (10,6%) e tentativa de suicídio (10,5%), em um perfil de sintomas semelhante aos estados mistos. A classe Agitada associou-se significativamente com os transtornos do espectro bipolar, embora esta associação não tenha permanecido no modelo ajustado. A classe Melancólica entre os homens associou-se com transtorno de ansiedade e dependência de nicotina. Mesmo os sujeitos das classes mais sintomáticas relataram baixo uso de serviços ao longo da vida. Conclusões. Nosso estudo confirma que subtipos depressivos, como melancólico, atípico e agitado podem ser identificados em amostras da população geral, corroborando a heterogeneidade sintomatológica do construto de depressão das classificações atuais. Tanto os perfis sintomatológicos, como as comorbidades com outros transtornos psiquiátricos, como espectro bipolar, ansiedade e dependência de substâncias, têm implicações na escolha do tratamento. Estes resultados podem também contribuir para a determinação de melhores critérios e especificadores dos subtipos depressivos nas próximas edições do DSM e da CID
Introduction. Depression is a heterogeneous clinical syndrome characterized by distinct symptom profiles. However, few studies have investigated depressive subtypes in the community and their sociodemographic and clinical correlates, differentiating them on the presentation according to gender. Methods. Data comes from the São Paulo Megacity Mental Health Survey. One thousand two hundred and twelve subjects (869 women and 343 men) entered in the analysis and responded to the presence or absence of symptoms of the depression module of the WMH-CIDI questionnaire. Latent class analysis (LCA) was used. Statistical criteria (such as the Bayesian Information Criteria [BIC] and entropy) were applied to the determination of the number of classes that best classified the subjects. After obtaining the most suitable models, the classes were validated by clinical and sociodemographic correlates, using multinomial logistic regression. We also later examined the association between depressive subtypes and lifetime health service utilization. All analyses were performed in the program Mplus 6.12. Results. The best LCA model for the overall sample was a 3-class model, which were named Melancholic (37.8%), Atypical (17.83%) and Mild (44.37%). Those in the Atypical class had a high probability of irritability (81.8%) and anxiety (90.7%). In the final adjusted model, being in the Melancholic class was significantly associated with: having a bipolar spectrum disorder; an anxiety disorder; alcohol and drug dependence; greater disability; and higher education. Women in the Atypical class were more likely to have higher education and comorbidity with bipolar spectrum disorder and anxiety disorder. In the analysis of the subsample of women, the best LCA model was a 3-class model, with classes similar to the model of the overall sample: Melancholic (39.34%), Atypical (19.53%) and Mild (41.13%). In the final adjusted model for females, the Melancholic class was significantly associated with: bipolar spectrum disorder; anxiety disorder; alcohol and drug dependence; premenstrual dysphoric disorder; and greater disability. Women in this class, as compared to those in other classes, were more likely to have higher education and be separated, divorced or widowed. The Atypical class was significantly associated with: bipolar spectrum disorder; anxiety disorder; alcohol and drug dependence; and higher education. For males, the best LCA model was also a 3-class model: Melancholic (40.37%), Agitated (19.56%) and Mild (40.07%). Virtually all men belonging to Agitated class endorsed agitation and anxiety, and a large proportion (around 84%), irritability. In addition, respondents belonging to this class presented the highest proportions of racing thought (43.9%), increased energy (10.6%), and suicide attempt (10.5%), in a symptom profile similar to mixed states. The Agitated class was significantly associated with bipolar spectrum disorders, although this association did not remain in the adjusted model. The Melancholic class among men was associated with anxiety disorder and nicotine dependence. Even subjects of more symptomatic classes reported low lifetime use of services. Conclusions. Our study confirms that depressive subtypes such as melancholic, atypical and agitated can be identified in samples from the general population, corroborating the symptomatologic heterogeneity of the construct of depression of current classifications. Both symptom profiles and comorbidity with other psychiatric disorders, such as bipolar spectrum, anxiety and substance dependence, have implications for the choice of treatment. These results may also contribute to establishing better criteria and specifiers of depressive subtypes in future editions of DSM and ICD

In einer Reihe neuerer epidemiologischer Studien wurde ein Zuwachs in der Prävalenz der Major Depression in jüngeren Geburtskohorten und ein sinkendes Ersterkrankungsalter dieser Störung beobachtet (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). Gleichzeitig wurden bei älteren Personen auffallend niedriege Depressionsraten gefunden. Der vorliegende Beitrag gibt einen Überblick über die diesen Beobachtungen zugrundeliegenden Studien. Die Validität der Befunde und ihre Bedeutsamkeit für die Ätiologie der Major Depression sowie mögliche Alternativerklärungen der zeitlichen Effekte werden diskutiert. Während der Befund eines Zuwachses depressiver Störungen in jüngeren Geburtskohorten empirisch gut belegt ist, sind die niedrigen Depressionsraten bei älteren Personen zumindest teilweise auf einen Artefakt der Forschungsmethodologie zurückzuführen.
The findings of a number of recent major epidemiological studies in different countries document an increase in the cumulative lifetime prevalence estimates of major depression with each successively younger birth cohort and a decrease in the age of onset of this disorder (Cross-National Collaborative Group, 1992; Klerman & Weissman, 1989). At the same time comparably low depression estimates are found for the elderly. The paper presents an overview of the major studies conducted in this area in recent years. The validity of the findings, their significance for the aetiology of Major Depression and possible alternative explanations for the temporal trends are discussed. While much valid empirical evidence confirms the increase of Major Depression in recent birth cohorts, the low prevalence estimates in the elderly seen to represent at least in part an artifact of the research methodology.

Bakgrund:Var fjärde svensk drabbas någon gång i livet av sjukdomen depression, 25% kvinnor och 15% män. Uppskattningsvis lider 300 miljoner människor i hela världen av depression och antalet växer. Diagnosen depression är den mest återkommande och kostsamma diagnosen av psykiatriska sjukdomar som behandlas inom primärvården. Depression kan utvecklas till ett allvarligt hälsotillstånd vilket kan leda till att personen som drabbats av depression tar sitt liv. Syfte: Syftet med litteraturstudien var att beskriva vilken betydelse fysisk aktivitet har som omvårdnadsåtgärd vid depression och depressiva symptom. Vidare var syftet att granska den metodologiska aspekten för litteraturstudiens ingående artiklar och beskriva deras urvalsmetod. Metod: Deskriptiv litteraturstudie med systematisk litteraturöversikt, vetenskapliga artiklarna söktes via CINAHL och Medline via PubMed, även en manuell sökning genomfördes. Totalt ingick 16 antal artiklar i litteraturstudien. Huvudresultat: Fysisk aktivitet har en god förebyggande effekt samt symtomreducerande effekt vid depressiva symtom/depression. Fysisk aktivitet kan även bidra till förbättring i kognitiva funktioner. Slutsatser: Fysisk aktivitet har en förebyggande och reducerande effekt på depressiva symtom och depression patienterna bör definieras i tid och information, motivation och uppmuntran är viktiga åtgärder för sjuksköterskan att känna till i sitt hälsofrämjande arbete.
Background: Every fourth Swede is some time in life affected by the disease depression, 25 % women and 15 % men. Approximately 300 million people in the world are suffering from depression and the number is increasing. The diagnosis of depression is the most recurrent and expensive diagnosis of psychiatric diseases treated within the primary health center. Depression can develop into a severe health condition, which can lead to that the affected individual commits sucid. Purpose: The purpose of this literary study was to describe the impact of physical activity as nursing treatment for depression and depressive symptoms. Furthermore, the aim was to examine the methodological aspect of the articles in the literary study in detail and describe their selection method. Method: Descriptive literary study with systematic literary survey, the scientific articles searched in CINHAL and Medline by PubMed. One manual search was performed. A total of 16 articles were included in the literary study. Main result: Physical activity has a good preventive and symptom reducing effect on depressive symptoms/depression. In addition, physical activity can contribute to improvement in cognitive functions. Conclusion: Physical activity has a preventive and reducing effect on depressive symptoms and the patients should be defined in time. Information, motivation and encouragement are important measures for the nurse to be acquainted with in his/her health preventing work.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
OBJECTIVES: Analyze the prevalence of the pre-operative depressive symptoms (SD) in patients who search cosmetic breast surgeries (with and without implants) in two different institutions (public and private) comparing: the types of surgeries, institutions and their sociodemographic characteristics. METHODS: This is a cross-sectional study on the prevalence of DS, among patients seeking cosmetic breast surgery using the Beck Depression Inventory (BDI-II) and questionnaire of sociodemographic datas for statistical comparison. RESULTS: 185 patients were included between 18 and 71 years and the greatest demand in the public institution was the reduction mammoplasty while in private was for breast augmentation.Among the institutions, there were statistically significant differences in socio-demographic variables: age (p=0.034), skin color (p<0.001), marital status between cohabiting and divorced (p=029 and p=0.039 respectively), schooling (p=0.002) and income (p<0.001). There were differences in the distribution of scores between institutions (p=0.03) and in the number and percentage of DS evaluation categories with a prevalence of 120% and 242% more positive depressive disorder’s risk (R+TD: ≥15 points in BDI-II) respectively with moderate to severe level in the public institution. The prevalence of R+TD in public institution was 25.8%, while the private was 11.6% (p=0.012). Among the patients with R+TD, the variables: age, schooling and income were statistically significant (p<0.001 for all), after Poisson’s regression. No patient of mastopexy without implants presented R+TD and the highest prevalence of this (51.4%) occurred in breast implant patients (breast augmentation and mastopexy with implants). The presence (p=0.12) or absence (p=0.33) of implant did not demonstrate a higher risk for depression with statistically significant. Among all patients, 7% answered positively about suicide item, with predominance within the group of implants (54.5%). CONCLUSIONS: The prevalence of DS is high (18.9%), with greater risk of 2,3 in public. Patients from public and private institutions showed different profiles. Age, less education and lower income are possible predictors of R+TD in this population. There was no statistically significant difference between R+TD and the different kinds of cosmetic breast surgeries among institutions. Patients for breast implant do not shown to have a higher significant of SD.
OBJETIVOS: Avaliar a prevalência de sintomas depressivos (SD) pré-operatórios em pacientes que buscam cirurgias mamárias estéticas (com e sem implantes) em duas instituições distintas (pública e privada) comparando: os tipos de cirurgias, instituições e suas características sociodemográficas. MÉTODOS: Trata-se de estudo transversal de prevalência de SD entre pacientes que buscam cirurgias plásticas mamárias estéticas utilizando Inventário de Depressão Beck (BDI-II) e questionário de dados sociodemográficos para comparação estatística. RESULTADOS: Foram incluídas 185 pacientes entre 18 e 71 anos onde a maior procura na instituição pública foi pela mamoplastia redutora enquanto na privada foi pela mamoplastia de aumento. Entre as instituições houve diferença estatisticamente significante nas variáveis sócio-demográficas: idade (p=0,034), cor da pele (p<0,001), estado civil entre amasiadas e divorciadas (p=029 e p=0,039 respectivamente), tempo de estudo (p=0,002) e renda (p<0,001). Houve diferença na distribuição das pontuações entre instituições (p=0,03) e do número e porcentagem das categorias de avaliação de SD com prevalência de 120% e 242% a mais de risco positivo de transtorno depressivo (R+TD: ≥15 pontos no BDI-II) respectivamente de nível moderado e grave na instituição pública. A prevalência de R+TD na instituição pública foi de 25,8%, enquanto na privada 11,6% (p=0,012). Entre as pacientes com R+TD, as variáveis: idade, tempo de estudo e renda apresentaram significância estatística (p<0,001 em todas), após regressão de Poisson. Nenhuma paciente de mastopexia sem implante apresentou R+TD enquanto que a maior prevalência deste (51,4%) ocorreu em pacientes de implante mamário (mamoplastia de aumento e mastopexia com implante). A presença (p=0,12) ou ausência (p=0,33) de implante não demonstraram maior risco para TD com significância. Dentre todas as pacientes, 7% responderam positivamente sobre o item suicídio, com predomínio no grupo com indicação de implantes (54,5%). CONCLUSÕES: A prevalência de SD é elevada (18,9%), com risco de 2,3 maior na pública. Pacientes de instituição pública e privada apresentam perfis diferentes. As variáveis: idade, menor escolaridade e baixa renda são possíveis fatores preditivos de R+TD nesta população. Não se observou diferença estatisticamente significante entre R+TD e os diferentes tipos de cirurgias mamárias estéticas entre instituições. Pacientes com indicação de implante mamário não demonstraram ter maior significância de R+TD.

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Os períodos de gestação e puerpério nem sempre são marcados por alegrias e realizações. É exatamente nesta fase que muitas mulheres experimentam alterações importantes do humor e/ou ansiedade, sendo o pós-parto o período de maior vulnerabilidade para o aparecimento de transtornos psiquiátricos. Apesar de ser hoje uma das condições clínicas mais estudadas da psiquiatria e de ser bastante conhecida na prática clínica, a depressão pós-parto ainda não apresenta consensos conceituais e metodológicos importantes para um maior grau de confiabilidade no diagnóstico e na comparação de dados de pesquisas. Assim, esta pesquisa busca minimizar a carência de uniformização e consenso a respeito deste tema tão relevante. Este estudo corresponde a uma revisão sistemática descritiva, no qual foram utilizados três bancos de dados: PubMed/MEDLINE, Scientific Electronic Library Online (SciELO) e Literatura Latino-americana e do Caribe em ciências da saúde (LILACS) e foram incluídos os artigos originais em língua inglesa, nos últimos 5 anos até 30 de junho de 2014, em humanos do sexo feminino. Foram excluídos os artigos não originais, os artigos de revisão e os relatos ou séries de casos. Após a exclusão dos artigos não pertinentes, restaram 356 que foram avaliados por dois revisores e apenas 154 artigos preencheram os critérios de inclusão. O resultado evidencia uma grande heterogeneidade nos instrumentos de pesquisa, com 38 instrumentos de triagem, diagnóstico e avaliação distintos. A verificação do instrumento principal dos estudos, registra uma predominância do Edimburg Depression Postpatum Scale (EPDS) em cerca de 65% dos artigos, apresentando pontos de corte com uma variação total de 7 a 20 e predominância entre 12 e 13. Quanto ao tempo, verifica-se que a maior parte das aferições dos instrumentos foram realizadas no primeiro trimestre do puerpério (45%), contudo foram grandes os percentuais de registros fora deste período, 43% acima de 3 meses do puerpério e 12% durante a gestação. Em relação aos períodos com maior prevalência de casos após o nascimento, constata-se que 65% encontra-se nos primeiros 3 meses após o parto e 35% após os 3 meses. Desta forma, apesar de se averiguar uma heterogeneidade significativa entre os estudos, há uma predominância do EPDS como método de triagem mais utilizado. Já em relação ao tempo, os resultados indicam que ele está muito além do que atualmente é preconizado nos manuais diagnósticos, com episódios depressivos desde a gestação até o período de um ano após o parto, relacionando-se ao nascimento do filho. Os resultados deste estudo ajudam a diminuir as discordâncias metodológicas e conceituais sobre as depressões relacionadas ao parto e podem embasar políticas em saúde para melhorar as estratégias na busca de um diagnóstico mais preciso e precoce e, desta forma, ajudar na prevenção e assistência às mães acometidas por essa enfermidade.
Periods of pregnancy and postpartum are not always marked by joys and achievements. It is precisely at this stage that many women experience major changes of mood and / or anxiety, and the postpartum period has the greatest vulnerability to the onset of psychiatric disorders. Although it is now one of the most studied clinical conditions of psychiatry and being well known in clinical practice, the postpartum depression still does not present conceptual and methodological consensus important for a greater degree of reliability in the diagnosis and the data comparison of survey. Therefore, this research seeks to minimize the lack of standardization and consensus on this issue as relevant. This study represents a descriptive systematic review, in which was used three databases: PubMed / MEDLINE, Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Literature in Health Sciences (LILACS) and original articles were included in English in the last five years until June 30, 2014, in human females. Non-original articles, review articles and reports or case series were excluded. After exclusion of irrelevant articles, remaining 356 that were evaluated by two reviewers and only 154 articles met the inclusion criteria. The result shows a great heterogeneity in research tools, with 38 screening tools, diagnostic and distinct evaluation. Verification of the main instrument of the studies, reports a prevalence of Edimburg Depression Postpatum Scale (EPDS) in about 65% of the articles, with cutoff points with a total variation 7-20 and prevalence between 12 and 13. As for the time, it appears that most of the instruments measurements were carried out in the first quarter of the puerperium (45%), however, were large percentage of the records outside of this period, 43% over 3 months postpartum and 12% during pregnancy. For periods with higher prevalence of cases after birth, it appears that 65% is the first 3 months after delivery and 35% after 3 months. Thus, although to ascertain significant heterogeneity between studies, there is a predominance of the EPDS as the most used screening method. In relation to time, the results indicate that it is far beyond what is currently recommended in the diagnostic manual, with depressive episodes from pregnancy to one year after delivery, relating to the birth of the child. The results of this study help to decrease the methodological and conceptual disagreements over the depressions related to childbirth and can to base health policies to improve the strategies in the search for a more accurate diagnosis and early and thus help prevent and assistance to affected mothers by this disease.

Depression in adolescents is a ubiquitous mental health problem presenting ambiguities, uncertainties, and diverse challenges in its conceptualization, presentation, detection, and treatment. Despite the plethora of research on adolescent depression, there exists a paucity of research in regards to obtaining information from the adolescents themselves. In a mixed method, cross-sectional study, adolescents (N= 332) in grades 8 and 11 provided their conceptions of depression. Adolescents' self-recognition of depression was examined in association with depressive symptomatology and reported pathways to talking to someone. Adolescents' social and emotional competence was also examined in association with severity of their depressive symptomatology. Developed categories and subcategories of adolescent depression were guided by the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) criteria for Major Depressive Episode (MDE) (American Psychiatric Association [APA], 2000). Adolescents' definitions of depression were dominated by subjective, holistic interpretations and add new information and depth to the previous research on adolescent depression. Depressed Mood and Social Impairment were the core categories, both contained intricate subcategories. The frequencies of these constructs provide a map of the themes and subthemes that pervade adolescents' personal philosophies regarding adolescent depression. About half of the adolescents who self-recognized depression within two weeks (45%),qualify into screened depression (Reynolds Adolescent Depression Scale -2" version [RADS-2];Reynolds, 2002) criteria based on the DSM-IV-TR for MDE (APA, 2000). However, this study's findings showed that the mean for screened Depression Total Score (RADS-2; Reynolds, 2002)was significantly higher in those adolescents who self-recognized versus those who did not self-recognize depression. The majority of lifetime self-recognizers of depression thought that they needed to talk to someone and reported that they talked to someone when feeling depressed. Poor Emotion Awareness was a strong contributor to increasing vulnerability to depressive symptomatology. This study provides new theoretical insights regarding the concept and detection of adolescent depression, and links between social and emotional competence and depressive symptomatology. These findings extend previous research (APA, 2000), provide new understanding to guide future research, and have direct implications for research, policy, and practice strategies aimed to better communicate with and help young people with and without depression.

Investigacions prèvies han sugerit que la depressió i l’agressió poden ser el resultat d’una pèrdua de posició social en animals i humans (Adler et al., 2000; Edwards & Kravitz, 1997). El propòsit d’aquest projecte de recerca va ser entendre millor els efectes del rang social en la salut mental dels adolescents, específicament estudiant l’associació entre mesures de rang com l’estat social subjectiu, el sentit de control, i la percepció de desigualtat d’ingressos econòmics en la infantesa amb els símptomes de depressió, els pensaments i comportaments suïcides, i l’agressió en una mostra clínica d’adolescents predominantment d’ètnia Afro-Americana d’una zona urbana dels Estats Units d’Amèrica. Els objectius d’aquest projecte de recerca van ser: 1- Analitzar l’associació entre el rang social i els símptomes depressius i l’agressió en una mostra clínica d’adolescents; 2- Determinar els mecanismes pels quals el rang social afecta l’estat d’ànim i l’agressió en adolescents; i 3- Determinar l’impacte del rang social en l’estat de benestar psicològic des d’una perspectiva del desenvolupament. La hipòtesi és que els adolescents amb una percepció d’estat social o sentit de control disminuïts presentaran més símptomes de depressió, pensaments i comportaments suïcides, i agressió quan les altres variables es tinguin en consideració. Aquest projecte de recerca va consistir en un estudi de mètodes mixtes (Palinkas et al., 2011) amb el propòsit d’adquirir un coneixement complex dels temes estudiats, corroborar els resultats amb diferents mètodes, i comparar nivells múltiples del sistema. L’estudi es va composar de 2 fases: Fase 1: El recull de dades qualitatives es va conduïr realitzant entrevistes en profunditat amb 23 adolescents i seguint un mètode de diseny i anàlisi fenomenològic. Les entrevistes es van realitzar fins que es va aconseguir saturació de la informació. Fase 2: El recull de dades quantitatives es va conduïr admininstrant una enquesta transversal. Cent noranta set (N=197) adolescents van completar l’enquesta per a complementar les entrevistes en profunditat. El diseny de l’enquesta es va basar en les troballes de la fase 1. Les dades qualitatives van ser analitzades per anàlisi temàtic fent servir el programa ATLAS. L’anàlisi de dades quantitatives es va realitzar conduïnt anàlisis descriptius de les variables i regressions logístiques i liniars fent servir el paquet estadístic SPSS. Els anàlisis de factors confirmatoris i modelització d’equacions estructurals es van realitzar amb el programa Mplus. Els resultats d’aquesta sèrie d’estudis mostren associacions positives entre l’estat social percebut com a baix i la depressió i la ideació suïcida, i associacions positives entre sentit de control disminuït i l’aggressió en una mostra d’adolescents reclutats en entorns clínics urbans, suggerint que la percepció d’estat social i el sentit de control com experiència en adolescents pot tenir efectes en la salut mental en aquesta edat primerenca. A més, ja a l’adolescència, varem observar individuus que feien servir habilitats d’afrontament per a intentar gestionar les reaccions relacionades amb el seu rang social. Els resultats d’aquesta recerca podrien tenir implicacions en intervencions terapèutiques individuals i grupals, donat que les interpretacions que els adolescents fan del seu entorn social poden incloure’s en el treball terapèutic. Aquests resultats també podrien tenir implicacions en salut pública, donat que intervencions a nivell de població podrien atenuar els efectes de les desigualtats o disminuir les desigualtats, i prevenir la internalització de les desigualtats en la juventut.
Investigaciones previas han sugerido que la depresión i la agresión pueden ser el resultado de una pérdida de estatus social en animales y humanos (Adler et al., 2000; Edwards & Kravitz, 1997). El propósito de este proyecto de investigación fue entender mejor los efectos del rango social en la salud mental de los adolescentes, específicamente estudiando la asociación entre medidas de rango como el estatus social subjectivo, el sentido de control, i la percepción de desigualdad de ingresos económicos en la infancia con los síntomas de depresión, pensamientos y comportamientos suicidas y agresión en una muestra clínica de adolescentes predominantemente de étnia Afro-Americana en una zona urbana de Estados Unidos de América. Los objetivos de este proyecto de investigación fueron: 1- Analizar la asociación entre el rango social y los síntomas depresivos y la agresión en una muestra clínica de adolescentes; 2- Determinar los mecanismos por los cuales el rango social afecta el estado de ánimo y la agresión en adolescentes; y 3- Determinar el impacto del rango social en el estado de bienestar psicológico des de una perspectiva del desarrollo. La hipótesis es que los adolescentes con una percepción de estatus social o sentido de control disminuidos presentarán más síntomas de depressión, pensamientos y comportamientos suicidas, y agresión cuando las otras variables se tengan en consideración. Este proyecto de investigación consistió en un estudio de métodos mixtos (Palinkas et al., 2011) con el próposito de adquirir un conocimento complejo de los temas estudiados, corroborar los resultados con diferentes métodos, y comparar niveles múltiples del sistema. El estudio estuvo compuesto de 2 fases: Fase 1: Colección de datos cualitativos que consistió en realizar entrevistas en profundidad con 23 adolescentes siguiendo un método de diseño y análisis fenomenológico. Las entrevistas se realizaron hasta que se consiguió saturación de la información. Fase 2: La colección de datos cuantitativos se condujo administrando una encuesta transversal. Ciento noventa y siete (N= 197) adolescentes completaron la encuesta para complementar las entrevistas en profundidad. El diseño de la encuesta se basó en los hallazgos de la fase 1. Los datos cualitativos fueron analizados con análisis temático utilizando el programa ATLAS. El análisis de datos cuantitativos se realizó con análisis descriptivos de las variables y regresiones logísticas y lineares utilizando el paquete estadístico SPSS. El análisis factorial confirmatorio y los modelos de ecuaciones estructurales se realizaron con el programa Mplus. Los resultados de esta serie de estudios muestran asociaciones positivas entre el estatus social percibido como bajo y la depresión y la ideación suicida, y asociaciones positivas entre el sentido de control disminuido y la agresión en una muestra de adolescentes reclutados en entornos clínicos urbanos, lo que sugiere que la percepción del estatus social y el sentido de control experimentado por los adolescentes puede tener efectos en la salud mental en esta etapa de edad temprana. Además, tan pronto como en la adolescencia, observamos que hay individuos que utilizan habilidades de afrontamiento para intentar gestionar las reacciones relacionadas con su rango social. Los resultados de esta investigación podrían tener implicaciones en interventiones terapéuticas individuales y grupales, dado que las interpretaciones que los adolescentes hacen de su entorno social pueden incluirse en el trabajo terapéutico. Estos resultados también podrían tener implicaciones en salud pública, dado que las interventiones a nivel de población pueden atenuar los efectos de las desigualdades o disminuir las desigualdades, y prevenir la internalización de las desigualdades en la juventud.
Previous research has suggested that depression and aggression can result from loss of social status in animals and humans (Adler et al., 2000; Edwards & Kravitz, 1997). The purpose of this research project was to understand better the effects of social rank on the mental health of adolescents, specifically by studying the associations between measures of rank such as subjective social status, sense of control, and perceived childhood income inequality, with depressive symptoms, suicidal thoughts and behaviors, and aggression in a clinical sample of predominantly Black adolescents from an urban area in the United States. The aims of this research project were: 1- To analyze the association between social rank and depressive symptoms and aggression in a clinical sample of adolescents; 2- To determine the mechanisms by which social rank affects mood and aggression in adolescents; and 3- To determine the impact of social rank on psychological well-being from a developmental perspective. The hypothesis is that adolescents with lower perceived social rank or sense of control will present more symptoms of depression, more suicidal thoughts and behaviors, and more aggression when adjusting for other variables. This research project consisted of a mixed methods research study (Palinkas et al., 2011) with the purpose of acquiring a more comprehensive understanding of the topics, corroborating the results with different methods, and comparing multiple system levels. The study comprised 2 phases: Phase 1: Qualitative data collection was conducted with in-depth interviews with 23 adolescents following a phenomenological method of design and analysis. The interviews were completed until information saturation was reached. Phase 2: Quantitative data collection was conducted using a cross-sectional survey. One hundred and ninety-seven (n=197) adolescents completed a survey in order to complement the in-depth interviews. The design of the survey was based on the findings from phase 1. The qualitative data were analyzed by thematic analysis using the software ATLAS. The quantitative data analyses were conducted through descriptive analysis of the variables and logistic and linear regressions using the statistical package SPSS. Confirmatory factor analyses and structural equation modeling were conducted with the program Mplus. The results of these series of studies showed positive associations between low perceived social status and depression and suicidal ideation, and positive associations between low sense of control and aggression in a sample of adolescents recruited in clinical urban settings, suggesting that perceived social rank and sense of control as experienced by adolescents can have effects on mental health at that early age. Additionally, as early as in adolescence, we observed individuals using coping skills to attempt to manage reactions related to their social rank. These research findings could have implications for individual and group therapy interventions, given that the interpretations that adolescents make of their social environment can be included in therapeutic work. These results could also have public health implications, as interventions at the population level could attenuate the effects of inequality or decrease inequalities, and prevent the internalization of inequalities in youth.
Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

Bakgrund: Depression är en ledande orsak till nedsatt allmän hälsa runt om i världen. Fysisk aktivitet har i vissa fall visat sig kunna komplettera läkemedelsbehandling och förebygga psykisk ohälsa. Det har visat sig vara svårt att motivera patienter som lider av depression eller depressiva symtom till att utföra fysisk aktivitet. Syfte: Syftet med denna studie är att undersöka vilka faktorer som påverkar motivationen för fysisk aktivitet vid depression eller depressiva symptom. Metod: Ett resultat utifrån åtta artiklar har sammanställts i en litteraturstudie. Dorothea Orems teori om egenvård är teoretisk referensram. Resultat: Resultatet visade att den inre motivationen är drivande för att utöva fysisk aktivitet och att vid depression eller depressiva symtom var denna motivationsform mindre förekommande och stöd utifrån kunde behövas. Resultatet visade också på att träningsmiljön bör vara positiv samt att aktiviteten gärna får vara njutbar och rolig för att ett frekvent utövande ska ske och en inre motivation ska byggas upp. Slutsats: Individen du möter befinner sig i olika stadier i motivationen och beroende på var hen befinner sig i sin motivationsprocess behöver hen också olika typer av stöd. Den inre motivationen är ofta sänkt hos personer med depression och av resultatet att avläsa är det den typ av motivation som är den starkaste drivkraften och därmed behöver byggas upp för att öka motivationen till fysisk aktivitet.

Att bli förälder är en viktig händelse för alla kvinnor liksom deras män. Men några kan känna sig oförberedda, känslomässigt labil, oroliga och osäkra under den första tiden efter förlossningen. Nya åtaganden och ansvar som medföljer föräldraskapet kan påverka det psykiska välbefinnandet och kan utvecklas till en postpartum depression (PPD). PPD drabbar cirka 13 procent av alla kvinnor som har fött barn. Det som kännetecknar PPD är nedstämdhet, irritabilitet, känsla av hopplöshet, orkeslöshet, sömnproblem, koncentrationssvårigheter, ångest attacker, osäkerhet, likgiltighet och suicidtankar. Litteraturstudiens syfte var att undersöka vikten av en tidig upptäckt av PPD hos kvinnor och skapa kunskap i syfte att förbättra omvårdnaden. Blivande föräldrar behöver inte bara information om själva förlossningen utan också de förändringar som sker tiden efter partus.

Databassökningen gjordes i Cinahl, PubMed, och PsycInfo. Sjutton vetenskapliga artiklar inkluderades och granskades med hjälp av SBU-granskningsmall. Analysen resulterade i tre kategorier, vikten av tidig upptäckt, hur familjens hälsa påverkas och hur vårdpersonal kan hjälpa. PPD har negativa effekter, inte bara på kvinnan själv, utan även på hela familjen. Det framkom tydligt hur viktigt kunskapsutvecklingen hos vårdpersonalen är för att kunna bryta PPD i ett tidigt skede. PPD är fortfarande ett relativt ”bortglömt tillstånd” då den nyförlösta kvinnan behöver kunnig vårdpersonal för att identifiera och förstå svårigheterna vid PPD.

PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO
Este trabalho, através de um percurso crítico das principais contribuições teóricas da psicanálise sobre a depressão, defende a importância de se delimitar a neurose depressiva, como uma das neuroses com que nos deparamos freqüentemente na clínica. O narcisismo é um conceito crucial neste quadro, e é considerado aqui como uma estrutura permanente. Nesta perspectiva é a tensão entre o ideal do eu e o eu que desbalanceada vai provocar uma quebra narcísica,abrindo as portas para o acosso da pulsão de morte, que invade o eu que é engolfado pela depressão. Valoriza-se também a recusa à perda (Verleugnung) como um operador essencial da depressão, uma vez que uma corrente do psquismo aceita a perda, mas outra, inconsciente, a recusa. Discute-se a idéia de que, diante de uma perda significativa, dois destinos são possíveis: a elaboração do luto ou a melancolia e, defende-se que são vários os destinos possíveis de um luto, incluindo-se as neuroses de angústia, depressões e compulsões. Uma vez que a depressão ocupa, em termos de incidência, o lugar que a histeria ocupava na época de Freud, considera- se os laços dessa patologia com as modificações da organização social características da atualidade e, para justificar que acontecimentos recentes dolorosos provocam parcialmente a neurose depressiva, recorre-se à teoria sobre o trauma, concebendo-o como o que provoca uma injúria narcísica capaz de causar um desinvestimento no eu.
The objective of this thesis is to provide a systematic study of the depressive neuroses by reviewing and evaluating the main theoretical psychoanalytic contributions on this subject. Narcissism is a crucial concept, and is considered here as a permanent structure. In this perspective it is the increased tension between the ego ideal and the ego that provokes a narcissistic break, and as a consequence of this, the death impulse invades the ego, which succumbs to depression. The concept of denial (Verleugnung) is considered as an essential operator for depression, for one psychic current accepts the loss but the other, unconscious, disavowels it. Facing the argument that when there is a significant loss, two outcomes are possible: the elaboration of mourning or the melancholy, we defend instead,that several outcomes are possible after a loss, including the neuroses of anguish, depressions and compulsions. Today depression occupies the place that hysteria occupied at the time of Freud, so the links between depression and the modern social changes are studied. To prove that recent painful events can also provoke, at least partially, a depressive neurosis, the theory of trauma is evoked. A major concept discussed is the capability of trauma to establish a narcissistic wound that causes a discontinuity in the ego.

Our conceptualization and empirical understanding of the course of depression is beginning to change. This is largely a result of recent epidemiological and clinical data that suggest depression has a chronic course for many individuals. Treatment studies for chronic depression have found that response rates are consistently less robust than in studies of acute, episodic depression. As is such, investigators have begun to examine factors that impede treatment response among these patients. One such factor is the presence of comorbid Axis-II personality disorders. This study examined the moderating effects of Depressive Personality Disorder (DPD) on treatment outcome among 680 outpatients with chronic depression. Results suggest that DPD did not serve as a prognostic indicator of worse outcome after 12 weeks of treatment or at last observation carried forward. This was a secondary analysis of the data presented by Keller and colleagues (Keller, McCullough, Klein, Arnow, Dunner, & Gelenberg, 2000).

Bakgrund: Depression är en utbredd folksjukdom i Sverige, trots att effektiva och kända behandlingsmetoder finns är det färre än hälften som behandlas. Den vanligaste behandlingen är antidepressiva läkemedel men tyvärr kan det medföra många biverkningar. Syfte: Syftet var att belysa interventioner med fysisk aktivitet och hur dessa kan påverka en människa med depression eller depressiva symtom. Metod: Litteraturöversikt innehållande kvantitativa artiklar som granskats och delats in i olika kategorier som berört olika interventioner av fysisk aktivitet. Resultat: Fysisk aktivitet har visats sig kunna minska depression och sänka depressiva symtom, interventioner som hade störst verkan var de som pågick under längre tid samt högintensiva aktiviteter. Fysisk aktivitet fungerade som ett bra komplement till annan behandling och i viss utsträckning som ett bra alternativ till läkemedelsbehandling. Fysisk aktivitet hade även positiv inverkan på symtom så som sömn, smärta och livskvalité. Diskussion: Sjuksköterskan ska arbeta för att motivera patienter till att vara mer fysiskt aktiv genom att informera om vilka fördelar det kan ha för patientens tillfrisknande. Slutsats: Fysisk aktivitet har visat sig kunna påverka depression och depressiva symtom positivt. Vidare forskning behövs på områden som undersöker upplevelser av att ha fysisk aktivitet som behandling vid depression.

Bakgrund:Depression ökar och beräknas globalt år 2020 vara den sjukdom som flest individer lider av. Idag behandlas depression främst med farmakologisk behandling såsom antidepressiva läkemedel, vilket ger en ökad risk för biverkningar. Fysisk aktivitet är både sjukdomsförebyggande och hälsofrämjande vid depression och en icke farmakologisk behandling utan biverkningar. Trots att fysisk aktivitet är en vetenskapligt bevisad metod som resulterar i hälsofördelar är det idag inte en vedertagen omvårdnadsåtgärd vid depression. Syfte: Syftet var att beskriva upplevelsen av fysisk aktivitet hos vuxna med depression och depressiva symptom. Metod: En litteraturöversikt med tio kvalitativa artiklar. Artiklarna analyserades utifrån Fribergs femstegsmodell. En induktiv ansats valdes. Resultat: Analysen genererade två teman och sju subteman. Temana är Psykologiska förändringar och Yttre faktorers betydelse.I resultatet framkommer positiva och negativa psykologiska upplevelser av fysisk aktivitet hos personer med depression och depressiva symptom. Stöd utifrån kan öka den positiva upplevelsen av fysisk aktivitet, däremot tenderar yttre press att förvärra depressiva symptom och göra upplevelsen negativ. Slutsats: Resultatet visade att fysisk aktivitet upplevdes olika hos olika individer med depression och depressiva symptom. Det genererade i positiva upplevelser genom bland annat stärkt motivation och känsla av kontroll, samt även negativa i form av försvagat självförtroende. Det behövs en ökad kunskap, medvetenhet och förståelse i hälso- och sjukvården, där sjuksköterskan har en central roll, för att kunna tillämpa fysisk aktivitet som en omvårdnadsåtgärd anpassad efter individens behov och livssituation.
Background: The prevalence of depression is rising and it is expected to be the most common disease by 2020. The most common treatment for depression today is pharmacological through antidepressants, which increases the risk of side effects. One type of non-pharmacologically treatment for depression is physical activity, which both promotes health and prevents the upcoming of diseases without any side-effects. Despite the fact that physical activity is scientifically proven as a treatment that leads to health benefits, it has not yet grown into an accepted treatment for depression. Aim:The purpose of this study was to describe the experience of physical activity among adults with depression or depressive symptoms. Method:A literature review based on ten qualitive articles. The articles were analyzed based on Friberg’s five-step model. An inductive approach was used. Result:The analysis generated two main themes and seven subthemes. The main themes are Psychological changes andThe importance of external factors among adults with depression and depressive symptom. The result presents the positive and negative experiences of physical activity among adults with depression and depressive symptoms. Support can increase the positive experience of physical activity, while external pressure tends to exacerbate the depressive symptoms and make the experience negative. Conclusion: The result showed that the experience of physical activity was different in different people with depression and depressive symptoms. It generated in positive experiences through, among other things, strengthened motivation and sense of control, but also negative in terms of weakened self-esteem. The health care needs more knowledge and understanding within the subject, in which the nurse has a central role, to apply physical activity as a nursing measure adapted to the individual’s needs and life situation.

Background: Depression is a condition that adversely affects an individual’s thoughts, emotional life and overall well-being. Research indicates that physical activity is beneficial for those suffering from major depression and depressive symptoms.   Purpose: To compile current research findings on human experiences of physical activity associated with major depression and depressive symptoms.   Method: Literature study of published articles in the current field. Out of 14 carefully read articles, ten were selected for quality review and included in the study. Seven of the articles used were determined to be of high quality while three were determined to be of medium-high quality.   Result: Physical activity is experienced by most as positive and that it can be an aid in the processing and management of major depression and depressive symptoms. Many experienced their mood to be improved, decreased anxiety levels and an increased level of stability and harmony due to exercise.   Conclusion: Physical activity has a positive effect on the well-being of people with major depression and depressive symptoms. The results of this literature review can offer understanding as to how people with major depression and depressive symptoms experience physical activity. It can also provide nursing tools that can improve responses and give motivation for these individuals, while helping them overcome obstacles and barriers regarding physical activity.
Bakgrund: Depression är ett tillstånd som påverkar en persons tankar, känsloliv och den allmänna hälsan negativt. Forskning tyder på att hälsovinsterna av fysisk aktivitet är stora vid depression och depressiva symtom.   Syfte: Sammanställa aktuella forskningsresultat om personers upplevelser av fysisk aktivitet i samband med diagnostiserad depression eller depressiva symtom.   Metod: Litteraturöversikt av redan publicerade artiklar inom det aktuella området. Fjorton artiklar lästes noggrant varav tio stycken valdes ut till kvalitetsgranskning som sedan inkluderades. Av de tio artiklarna bedömdes det att sju stycken hade hög- och tre stycken medelhög kvalitet.   Resultat: Fysisk aktivitet upplevdes som positivt och att det kan vara en hjälp i att bearbeta och hantera depressionen och depressiva symtom. Humöret förbättrades av träningen, oro minskade och personerna kände sig mer stabila och harmoniska både i anknytning till träningen och generellt.   Slutsats:  Fysisk aktivitet har en positiv effekt på välbefinnande för personer med depression och depressiva symtom. Denna litteraturöversikts resultat kan bidra med förståelse för hur personer upplever fysisk aktivitet vid depression och depressiva symtom. Den kan också ge sjuksköterskan verktyg i att bättre kunna bemöta dessa personer och motivera ytterligare till fysisk aktivitet samt hjälpa till att överkomma hinder och barriärer emot fysisk aktivitet.

Syftet med föreliggande empiriska studie var att undersöka och beskriva i vilken omfattning individer behandlade med hemodialys rapporterar symtom på depression. Författarna ville även redogöra för den utsträckning antidepressiva läkemedel ordinerats samt om det existerade några könsskillnader i depressionssymtom och i ordinerad antidepressiv behandling. Studien baserades på ett bekvämlighetsurval från 11 geografiskt spridda dialysenheter i Sverige. Urvalet bestod av 222 patienter som mötte inklusionskriterierna (behärska svenska språket tillräckligt bra för att förstå frågorna i enkäten, genomgått hemodialys behandling i minst 6 månader samt vara 18 år fyllda) varav 141 patienter fullföljde undersökningen. Dessa 141 deltagare fick fylla i den förkortade versionen av CES-D formuläret, ett självskattnings instrument där den egna mentala hälsan skattas. Resultatet visade att drygt en tredjedel av hemodialyspatienterna hade depressionssymtom och endast 12 patienter av 50 med depressionssymtom var ordinerade antidepressiv behandling. Emellertid visade inte föreliggande studie några signifikanta könsskillnader gällande depressionssymtom eller i ordinerad farmakologisk behandling. Författarna drar slutsatsen att depression är vanligt bland hemodialyspatienter. Därför är det viktigt att utbilda både vårdgivare och närstående för att de ska kunna se tecken på depressionssymtom i ett tidigt skede, eftersom rätt behandling kan öka dessa patienters livskvalitet och samtidigt vara kostnadsbesparande för sjukvården

The aim of the present empirical study was to investigate and describe in which extent individuals treated with hemodialysis reported symptoms of depression. The authors also wanted to describe in which extent antidepressant medicine was prescribed. Also if there existed any differences between males and females in depressive symptoms and if there was any divergence in treatment with anti depressive medicals. The study was based on a convenience sample from 11 geographical spread dialys units in Sweden. The sample consisted of 222 patients whom fulfilled the inclusion criterias (they had to have a good knowledge of the Swedish language so they could understand the questionnaire, at least six months of dialysis treatment experience and be at least 18 years old) of whom 141 carried out the study. These 141 participants filled out the short version of the CES-D form, a self report form where the mental health was estimated. The result showed that one third of the hemodialysis patients had symptoms of depression and only 12 patients of 50 had treatment with antidepressant medicine. However the study did not show any significant differences between male and female regarding depressive state and treatment with anti depressive medicine. The authors conclude that depressive symptoms are common among hemodialysis patients. That is why it is important to educate nurses and relatives so they can learn how to see signs of depressive symptoms as early as possible. Right treatment could then increase hemodialysis patients quality of life and also save money for the hospitals.

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The psychological and medical clinics have evidenced that a significant part of the women go through some form of depression after childbirth. Researches show that Puerperal depression occurs in 10-15% of women in the general population; in 60% of these women it represents the first severe form of depression. This case study intends to understand the psychodynamism in the puerperal depression, its etiology and its significance in the mother s history. The clinical material presented is from a psychological evaluation process that had continuity with a psychoanalytical clinical work. The theoretical work was based on general bibliographical research and psychoanalysis authors. We researched about the diagnosis of the puerperal depression and its etiology. We discussed about the environment and the societies (historically) interference in the intercurrences of the maternity, such as depression. We also recognized that the way each postpartum women history life constitutes would excessively influence in the childbirth and in the puerperal. The maternity reactivates the infancy experiences and, mainly, the primary of the psychic life. The puerperal depression can appear as result of imperfections in the primitive emotional development of the postpartum women, mainly with those related to the experience of the depressive position, to the primary narcissism and the constitution of superego, and, especially, to the experience had in her birth. The puerperal depression and maternity study are very important because it contributes with the clinical practice, with all professionals involved with mental health, and with the organizations that searches for general population intervention
As clínicas psicológica e médica têm constatado que uma parte significativa das mulheres passa por alguma forma de depressão decorrente da maternidade. Pesquisas mostram que a depressão puerperal afeta 10% a 15% das mulheres em geral; para 60% dessas mulheres constitui-se como o primeiro episódio de depressão. O presente estudo pretende compreender o psicodinamismo na depressão puerperal, sua etiologia e significação na história da mãe. Buscamos realizar tal objetivo, através do estudo de um caso. O material clínico aqui apresentado é oriundo de um processo de avaliação psicológica que teve continuidade com um trabalho clínico psicanalítico. A articulação teórica se realizou com o levantamento bibliográfico geral e com autores da psicanálise. Abordamos o diagnóstico da depressão puerperal e sua etiologia. Discutimos sobre a participação do ambiente e das sociedades (historicamente) nas intercorrências da maternidade, entre elas, a depressão. Também, reconhecemos que a maneira como se constitui a história de vida de cada puérpera influenciará sobremaneira nos desdobramentos do parto e puerpério. A maternidade reativa as vivências da infância e, principalmente, dos primórdios da vida psíquica. A depressão puerperal pode surgir como decorrência de falhas no desenvolvimento emocional primitivo da puérpera, principalmente com aquelas relacionadas à vivência da posição depressiva, aos desdobramentos do narcisismo primário e da constituição do superego, e, especialmente, à experiência que teve no seu próprio nascimento. As pesquisas voltadas para o estudo da depressão puerperal e da maternidade são importantes, porque podem contribuir com a prática clínica, com os demais profissionais envolvidos com saúde mental e com as organizações que buscam uma intervenção sobre a população em geral

Reliable und valide Informationen zur Häufigkeit und zu Korrelaten von Depression in der Allgemeinbevölkerung sind eine Voraussetzung für eine wissenschaftlich fundierte Gesundheitsversorgung und für Präventionsmaßnahmen. Die Vielfalt an Definitionen und die klinische Heterogenität von „Depression“ stellt eine Herausforderung für das Gesundheitsmonitoring und für die epidemiologische Forschung dar. Dies spiegelt sich in der Vielzahl an Depressionsmaßen wider. Daran anknüpfend ist das Ziel dieser kumulativen Dissertation, die Häufigkeiten und soziodemographischen und gesundheitsbezogenen Korrelate – mit einem Schwerpunkt auf der somatischen Komorbidität – eines breiten Spektrums etablierter Depressionsmaße in der erwachsenen Allgemeinbevölkerung in Deutschland zu untersuchen: von aktueller psychischer Belastung, depressiver Symptomatik und einem depressiven Syndrom über eine selbstberichtete ärztliche Depressionsdiagnose bis hin zu einer klinischen Major Depression. Datenbasis für die vier Originalarbeiten der Dissertation sind die bundesweit repräsentativen Querschnittstudien „Gesundheit in Deutschland aktuell“ (GEDA, 18 Jahre und älter) und die „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1, 19-79 Jahre) mit dem Modul Psychische Gesundheit (DEGS1-MH) des Robert Koch-Instituts (RKI). In Kapitel 1 werden Forschungshintergrund, Fragestellungen und Methoden der vier Originalarbeiten zusammengefasst und die Ergebnisse dargestellt. Es ergeben sich hohe Prävalenzen auf Basis aller Depressionsmaße. Zugleich wird deutlich, dass die jeweiligen Maße zu unterschiedlichen Prävalenzschätzungen führen und dass es nur moderate Schnittmengen der jeweils identifizierten Fallgruppen gibt. Weiterhin zeigt sich eine weitgehende, jedoch keine vollständige Übereinstimmung in assoziierten soziodemographischen und gesundheitsbezogenen Korrelaten. Dies betrifft auch die Assoziation mit chronischen somatischen Erkrankungen, für die sich teilweise unterschiedliche Muster zwischen den untersuchten Depressionsmaßen und zwischen den Altersgruppen zeigen. Es folgen eine synthetisierende Ergebnisdiskussion und die Ableitung von Implikationen für die epidemiologische Forschung, das Gesundheitsmonitoring und die klinische Praxis. Kapitel 2 enthält die vier Originalarbeiten der Dissertation.

Anxiety and depression are two disorders frequently diagnosed in adults. Given serious adverse affects such as physical health problems, interpersonal relationship difficulties, and suicide, differentiation in treatment of these often comorbid disorders is a necessity in providing appropriate care. The tripartite model of anxiety and depression (Clark & Watson, 1991) proposes that these disorders are linked by a common trait (Negative Affect) and differentiated by a trait common to depression (lack of Positive Affect) and a trait common to anxiety (Physiological Hyperarousal). The Clinical Assessment of Depression (CAD; Bracken & Howell, 2004), a recently published selfreport narrow-band measure of depression, includes a measure of anxiety related symptoms in its subscale structure. This study explores the validity of the CAD with two established measures: the Beck Depression Inventory – II (Beck, Steer, & Brown, 1996) and the Beck Anxiety Inventory (Beck, & Steer, 1993). College students of 18 to 52 years of age (n = 295) enrolled in undergraduate courses in psychology at a south central Kentucky university provided the study data. These individuals were divided into nonclinical and clinical samples based on self disclosure of a clinical diagnosis to examine differences between groups. Strong positive correlations (above r = .60) between similar CAD scales and total scores on the BAI and BDI-II supported convergent validity for the nonclinical sample. All comparisons supported convergent validity for the clinical sample except the correlation between the BDI-II Total Score and the CAD - Depressed Mood subscale (r = .56). Weak to moderate correlations (r = 0.0 to .59) between dissimilar scales supported divergent validity for all dissimilar comparisons in both samples except the correlation between the BDI-II and the CAD-Anxiety/Worry subscale in the nonclinical sample (r = .66). Hotelling-Williams t-tests were performed to compare correlations of similar and dissimilar constructs. Significant results emerged most comparisons in the nonclinical group support the use of the CAD diagnostic assessment. However, nonsignificant findings for the CAD Anxiety/Worry subscale indicate that this measure lacks the ability to aid diagnose significant levels of anxiety. Only one significant difference between correlations was found for the clinical sample with the CAD – Diminished Interest subscale evidencing significantly stronger correlations with the BDI-II than the BAI. The lack of significant differences for the other CAD scales is discussed relative to the small clinical sample size and the heterogeneity of disorders represented. Results support the use of the CAD as an adequate diagnostic tool for depression with college students. Results did not support the use of the CAD in differential diagnosis of anxiety with college students within the framework of the tripartite model. Implications of the findings are discussed to aid in practice and to suggest further research.

Includes bibliographical references.
In periods of prolonged stress and pain from strenuous exercise, the body produces chemicals called endorphins that help it endure pain. These natural analgesics are presumably only released when the level of pain intensity is at least moderately high. The PANIC/separation distress system is built on the same pathways as the physical pain system, and is responsible for the ‘mental pain’ (feelings of panic anxiety, loss and sorrow) that is associated with the loss of an attachment object, or separation from it. Given this overlap, it is reasonable to expect that endorphin release can affect depressive symptoms in a positive way. There is existing evidence that exercise has a beneficial effect on depressive symptoms, yet the underlying physiological mechanism has yet to be properly determined. The purpose of this three-armed prospective randomized control pilot study was therefore to try to establish this mechanism by investigating whether intensive exercise can improve the symptoms of moderate depression as a result of demonstrable increases in plasma β-endorphins. It has previously been established that exercise-induced β-endorphin release correlates positively with the intensity of the exercise. There were two central hypotheses for this study. The first was that the mechanism behind the improvements seen in depressive symptoms due to exercise is the same mechanism that is responsible for the established analgesic effect of exercise, namely endorphin release. The second hypothesis was that only high-intensity exercise (i.e. great that 70 of heart rate reserve) will be sufficient to produce a guaranteed endorphin release, whereas moderate-intensity exercise (just under 50% of the heart rate reserve) and very low intensive exercise would not be sufficient to release endorphins, and would therefore not result in an improvement in depressive symptoms. The main aim was therefore to investigate whether intensive exercise (greater than 70% of heart rate reserve) improves moderate depression, and if so, whether this correlates with a demonstrable increase in β-endorphins. This study therefore wished to determine which of low, moderate or high intensity exercise alleviates the symptoms of depression. It also intended to determine whether an increase in β-endorphins correlates to an improvement in the participants’ depression levels, and whether greater β- endorphin release occurs during high-intensity exercise compared to low- and moderate intensity exercise. Male participants (n = 33) with moderate levels of depression were randomly assigned to one of three experimental groups of varying exercise intensities: High-intensity (160 beats per min (bpm)), Moderate intensity ( 140bpm), and a low-intensity control group (under 120bpm). All participants underwent a six-week exercise program that involved participation for three days per week, for one hour per day (i.e.18 sessions in total). Once weekly, the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery Åsberg Depression Rating Scale (MADRS) were administered to each participant. The participants in the High-and Moderate-intensity exercise groups each had 5ml of blood drawn, once per week, before and after exercise, in order to measure their β-endorphin levels, and to track any changes in these levels over time. The participants in the Control group had blood samples taken twice – once at the start of the study (a baseline measure), before and after exercise, and once on completion of the study, before and after exercise. The results indicate that both Moderate- and High-intensity exercise improved the participants’ depression levels, while the Control group also showed some improvement, but not to the same extent as the other two groups. A significant difference (p = < 0.0001) was found when comparing the initial and final HAM-D scores between all three groups. The participants’ MADRS scores also improved between all three exercising groups. A significant difference (p = 0.0182) was found when comparing the initial scores within each of the three groups to their final MADRS scores. No significant difference was found in the serum β- endorphin levels when comparing the Moderate- with the High-intensity group. The differences between the baseline and post-exercise serum β-endorphin measurements were also not significantly different for both the Moderate- and High-intensity groups (p= 0.953 and p= 0.992 respectively), while the Control’s pre- to post levels decreased significantly (p < 0.017). A significant difference between the Control-, Moderate-, and High-intensity groups (p = <0.022) was found when comparing the three groups’ serum β-endorphin concentrations after they engaged in exercise. Overall, the results of this pilot study go against the hypothesis that only High-intensity exercise would improve symptoms of moderate depression, as both high- and moderate-intensity exercise had a clear positive impact on depression scores. However, consistent with this hypothesis, very-low intensity exercise did not seem to have as beneficial an effect. The mechanism underlying the benefit of exercise on the symptoms of depression cannot be conclusively confirmed given the overall β-endorphin results. A larger sample size and more accurate analysis methods of β-endorphin levels are required in order to test these tentative findings more rigorously.

Within the last decade a number of male specific depression rating scales have been developed. Unfortunately each of these scales encompasses significant psychometric issues, thus comprising their validity. The present dissertation reports five quantitative studies based on data from community samples with the aim of developing a psychometrically valid male specific depression rating scale. As defined by DSM-IV, Major Depressive Disorder comprises a range of internalising symptoms (e.g., sadness, worthlessness, guilt, fatigue). These internalising symptoms contravene traditional masculine role norms such as emotional stoicism, self-reliance and aggression. Given this, the masculine depression framework theorises that when depressed, some men may experience atypical depression symptoms that are more congruent with masculine role norms (e.g., substance abuse, anger, emotional suppression, risk-taking). However, as these masculine type symptoms fall outside present diagnostic criteria, it is possible that males experiencing such symptoms may not be identified as depressed in primary care settings...

Bakgrund: Depressionssjukdomar orsakar lidande och är bland samhällets vanligaste ochmest kostsamma åkommor. Fysisk aktivitet har visat sig ha förebyggande och behandlandeinverkan för människors depressiva symptom, men det saknas underlag för huruvida dennabiverkningsfria behandlingsmetod har en inverkan på depressiva symptom för personer somhar en depressionsdiagnos. Syfte: Denna litteraturöversikt ämnade belysa fysisk aktivitetsinverkan på depressiva symptom hos vuxna individer som lider av diagnosen egentligdepression. Metod: 16 studier med såväl kvantitativ som kvalitativ ansats sammanställdessom en litteraturöversikt. Resultat: I majoriteten av studierna framkom det att fysiskaktivitet kunde ha en positiv inverkan på depressiva symptom samt öka tillfrisknande hospersoner med depressionsdiagnos. Ett sekundärt resultat framkom även, där fysisk aktivitetvisade sig ha olika effekt på ett antal hälsorelaterade variabler. Diskussion: Oavsett typ avintervention, tydde resultatet på att depression kan reduceras så länge patienten fick någontyp av insats. Sjuksköterskan bör se fysisk aktivitet som en tillgång i den holistiska vården avdepressionspatienter. Slutsats: Patienter med depressionsdiagnos finns inom allavårdinstanser och allmänsjuksköterskan kan med tydliga riktlinjer få ett verktyg för att utökainsatserna för patientgruppen. Fysisk aktivitet bör inte ses som en universalkur, men hos enmajoritet kan det ha en positiv effekt för depression.

Depressiva symtom har blivit ett vanligt tecken på psykisk ohälsa hos ungdomar. Dessa kan leda till utvecklandet av depression och självmordsförsök. Syftet med arbetet var att belysa preventionsprogrammens betydelse för förebyggandet av depression hos ungdomar och insatser som sjuksköterskan kan göra i det förebyggande arbetet. En systematisk litteraturstudie gjordes, där fem artiklar analyserades. Fyra studier undersökte effektiviteten av olika preventionsprogram för depressiva symtom. En studie undersökte risk- och skyddsfaktorers betydelse för utvecklandet av depressiva symtom. I resultatet kom det fram att preventionsprogrammen var effektiva och innehållet i dessa byggde på kognitiv grund. Kognitiv grund innebar att ungdomarna fick lära sig nya sätt att hantera svåra livssituationer på. Sjuksköterskans roll kunde vara att arbeta hälsofrämjande och stärka skyddsfaktorer. Slutsats är att preventionsprogrammen är effektiva men det är sjuksköterskans hälsofrämjande arbete som har störst betydelse för att ungdomen ska återfå sin hälsa. Det förebyggande arbetet behöver utvecklas i skolorna för att nå fler ungdomar och behöver ske under enklare former.
Litteraturstudie.

BACKGROUND Few high-quality observational studies have been conducted to examine clinically relevant features of emotional distress and Major Depressive Disorder (MDD) in adults with primary cerebral glioma. Our knowledge of these important complications of glioma is currently poor. AIMS This thesis aims to answer a series of relevant clinical questions. I have studied: [1] the frequency, independent clinical associations and course of general emotional distress measured using the NCCN Distress Thermometer (DT); [2] the utility of three depression screening tools for identifying MDD; [3] the frequency, independent clinical associations and course of MDD in glioma; [4] current patterns of practice, and the apparent tolerability of antidepressant treatment of depression in glioma; and [5] barriers to the effective management of MDD in glioma. METHODS I conducted a prospective, twin-centre, observational cohort study. Adults with a new histological diagnosis of primary supratentorial glioma were enrolled and interviewed three times: shortly after starting radiotherapy (T1), three months later (T2) and six months later (T3). At each time point participants completed the DT, the Hospital Anxiety and Depression Scale (Depression subscale, HAD-D), the Patient Health Questionnaire-9 (PHQ-9) and the Structured Clinical Interview for DSMIV MDD (SCID). Barriers to depression management were studied using questionnaires completed by the patient and their named GP. RESULTS During a two-year recruitment period, 223 patients were eligible and 155 provided useable data (57.4% male, mean age = 54.2 years, 85.8% high-grade glioma, 78.1% radical radiotherapy, 55.5% chemotherapy). [1] High distress (DT score ≥ 4/10) was consistently a frequent complication, occurring in between 36.4% ± 7.6% of patients at T1 to 33.7% ± 10.2% at T3. In a logistic regression analysis, high distress at T1 was independently associated with MDD, functional impairment and younger age (χ2 for model = 39.882, p < 0.001, R Square = 0.312). Patients who reported high distress at T1 (median DT score = 8; IQR 7 - 9) remained highly distressed on follow-up (T2 median score = 8, IQR 6 - 8; T3 median score = 7, IQR 5 - 8). [2] As screening tools, the HAD-D and PHQ-9 showed good internal consistency (α = 0.769 - 0.862 at any time point). The HAD-D displayed the best operating characteristics on ROC curve analysis. At a threshold of 7+, sensitivity = 0.933, specificity = 0.907 and Positive Predictive Value (PPV) = 0.56. A threshold of 8+ displayed similar PPV, however. [3] The cross-sectional prevalence of MDD was 13.5% ± 5.4% at T1, 14.8% ± 6.7% at T2 and 6.8% ± 5.8% at T3. Inter-rater diagnostic agreement was good (κ = 0.81, 95% CI 0.60 – 1.00). MDD was independently associated with a past history of depression (OR = 3.8, 95%CI 1.5 - 9.8), and with current functional impairment (OR = 3.6, 95%CI 1.4 - 9.4). MDD persisted for at least three months in 9/17 patients who could be followed up. [4] The frequency of antidepressant prescription was 8.4% ± 4.4% at T1, 7.4% ± 4.9% at T2 and 12.6% ± 6.9% at T3. Citalopram was the most frequent antidepressant choice. Antidepressant tolerability appeared to be good among patients who could be followed up. [5] Barriers to the management of depression included 78.4% of GPs regarding major depression as a normal reaction to having glioma, and 39.2% expressing a belief that major depression did not always require treatment. In addition, most patients expressed a degree of resistance to any kind of future depression treatment. DISCUSSION This is the largest cohort study of depression in consecutively presenting adults with glioma, and the first to utilise criterion standard structured interview diagnoses in a longitudinal design. There is a degree of theoretical uncertainty about the nosological validity of MDD in glioma, although the clinical relevance of this uncertainty can be debated. Methodological limitations to the presented study include an absence of alternative potential psychiatric diagnoses to MDD, the likelihood of selection bias in recruitment, and considerable attrition. Due to these and other limitations, findings from this study are tentative and should ideally be replicated. Clinicians should have a high index of suspicion for identifying low mood in glioma patients, particularly those with functional impairment or previous depressive episodes. The HAD-D (suggested threshold 8+) can reasonably be used to screen for depression, if desired. Caution is required when prescribing antidepressants. Clinicians should be educated about the frequency and consequences of MDD in glioma. Researchers interested in psychological neuro-oncology could convene a meeting to guide future projects, particularly since multi-centre studies may be necessary to recruit sufficient sample sizes in future.

Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population. Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke. The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation. Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

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The memory of clinically depressed psychiatric patients was compared with that of anxious patients and control subjects. The depressed patients had impaired ability to learn new material and to remember past public events; they retained information in memory as well as controls and did not have a more conservative response bias. These impairments were not attributable to the psychotropic medication the patients were receiving or to the after-effects of ECT. The retarded depressed patients were most severely ill and most impaired; the neurotic patients were only impaired on the more difficult tests. The anxious patients' scores were not significantly different from those of either the depressed or control subjects. The relative effects of depression and anxiety on performance were assessed using regression analysis; depression was related to performance on the easier tests, whilst something common to both depression and anxiety was related to performance on the more difficult tests. The retarded depressed subjects reported more cognitive failures than the other subjects whilst both the depressed and anxious subjects complained of significant deterioration in memory. There were statistically significant, although modest, correlations between these self-assessments of memory and performance on the memory tests. Anxiety was related to self-assessments of memory but depression was not. The memory of depressed general practice patients for information given to them by their general practitioners was investigated directly; they did not in fact have impaired memories in this everyday situation. These results suggest that the degree of memory impairment shown in depression depends both on the severity of depression and the difficulty of the task. They are discussed In the light of the suggestion by Johnson and Magaro (1987) that memory Impairments may not be specific to depression but instead be related to the overall level of psychopathology. The working memory capacity model of memory in anxiety (Eysenck, 1982) is also discussed and extended to depression, as is a model developed by Williams and Teasdale (1982) which argues that effort expenditure is largely determined by perceived task difficulty. Finally, it is concluded that the best understanding of memory in depression will come from the concurrent use of experimental studies, metamemory questionnaires and studies of memory performance in everyday life.

Volume 1 of the thesis contains the research component. Paper one is a systematic review of longitudinal studies looking at the association between depression and diabetes complications. Paper two describes a prospective longitudinal study, examining risk factors for postnatal depression in women with gestational diabetes. Paper three is a public dissemination document. Volume 2 of the thesis contains clinical practice reports (CPRs). The reports reflect work conducted during clinical placements, as follows: 1) psychological models CPR (A cognitive-behavioural and psychodynamic formulation in the case of Samuel, a 28-year old man with phobia of falling following an acquired brain injury); 2) service-related CPR (Adherence to initial goal planning meeting clinical standard in an outpatient brain injury rehabilitation service. Factors acting as barriers and facilitators); 3) single-case experimental design CPR (Cognitive behavioural intervention in the case of Alice, a 15-year old White British female with obsessive-compulsive symptoms); 4) case study CPR (The case of Monique, a 55-year old White British female with mild learning disabilities presenting with challenging behaviour); 5) case-study CPR – abstract (The case of Martin, a 67-year old White British male presenting with hypochondriasis). Names and other identifying materials in all the reports were changed in order to protect confidentiality.

Bakgrund: Depression förutspås bli den näst största sjukdomsbördan i världen år 2020. Idag återfinns psykoterapi och läkemedel som behandlingsmetoder mot depressioner. Utöver detta har studier visat på ett samband mellan minskade depressiva symtom och fysisk aktivitet. Metod: Material för granskning har sammanställts genom sökningar i artikeldatabaserna PubMed, CINAHL, PsycINFO och granskats enligt riktlinjer av Statens beredning för medicinsk utvärdering (SBU). Genom en manifest innehållsanalys har bärande meningar identifierats och lagt grunden för resultatet. Syfte: Att med en litteraturstudie undersöka vilken inverkan fysisk aktivitet har på depressionstillstånd, samt att undersöka vilka omvårdnads-åtgärder relaterat till fysiska aktiviteter den legitimerade sjuksköterskan kan rekommendera för att främja hälsan hos patienten. Resultat: Fysisk aktivitet ger minskade symtom samt förebygger insjuknande i depression. Mängden och intensiteten har ett positivt samband med minskade depressiva symtom. Slutsats: Fysisk aktivitet ger en hälsovinst för patienter med depressiva symtom. Mer forskning krävs för att uppnå en vetenskaplig trygghet i behandlingsformen.
Background: Depression is predicted to become the second largest disease burden in the world in 2020. Present treatment options for depression include psychotherapy and pharmacotherapy. In addition, studies have linked increased physical activity with decreased depressive symptoms. Method: Material for review was compiled by searching the article databases PubMed , CINAHL , PsycINFO and reviewed in accordance to the guidelines provided by the Swedish Council on Health Technology Assessment (SBU). Meaningful sentences has been identified through a manifest content analysis and served as the foundation for the results. Aim: To, as a review, examine the impact of physical activity on depression and to examine how the. Results: Physical activity reduced symptoms and prevented the onset of depression. The amount and intensity has a positive correlation with decreased depressive symptoms. Conclusion: Physical activity provides a health benefit for patients with depressive symptoms. More research is needed to scientifically confirm the treatment form.

Although meditation-based interventions have been associated with improvement in depressive symptoms and prevention of relapse, the physiological mechanisms of meditation's therapeutic effects are unknown. At the same time, a growing body of literature has shown that meditation has profound effects on numerous physiological systems that are involved in the pathophysiology of depression. The first paper reviews many of the physiological abnormalities found in depression and the reversal or normalization of these same systems by meditation. The paper includes 1) a review of the physiological concomitants of depression, 2) a description of mindfulness meditation and its effects on mood disturbance, 3) the physiological effects of mindfulness and other related forms of meditation, and 4) suggestions for future research.The second paper summarizes the results of a randomized controlled trial of mindfulness meditation training on one of the previously identified candidate systems: sleep, as measured by overnight polysomnographic sleep studies as well as subjective reports (sleep diaries). The results indicate that mindfulness has an arousing effect on objectively measured sleep that corresponds with subjectively reported improvements in mood and sleep. This pattern is similar to the one observed in responders to antidepressant medications.

Bakgrund: Depression är en vanligt förekommande sjukdom som behandlas främst med psykoterapi och antidepressiva men det behövs fler resurser och komplementära omvårdnadsåtgärder. Yoga har blivit allt mer aktuellt inom vården. Det huvudsakliga fokuset inom yoga är att lära sig vara i nuet genom meditation, andning och rörelse. Sjuksköterskan har det yttersta ansvaret för omvårdnad och ska hålla sig uppdaterad med den senaste forskningen för omvårdnad. Syfte: Syftet var att undersöka effekten av yoga som en omvårdnadsåtgärd vid depression och depressiva symtom. Metod: Kvantitativ litteraturstudie. Resultat: Yoga har visat sig ha en positiv effekt på depression och depressiva symtom efter 4 veckor till 6 månaders intervention. Diskussion: I diskussionen presenteras tre huvudfynd: Yoga har en positiv effekt vid depression och depressiva symtom, yoga har en positiv effekt för kvinnor vid depression och depressiva symtom, yoga kan användas som en komplementär omvårdnadsåtgärd vid depression och depressiva symtom.

Syfte : Studiens syfte är att beskriva patienters upplevelser av fysisk aktivitet viddepression eller depressiva symtom.Bakgrund : Depression är en både nationellt och globalt ökande problematik.Symtombild, sjuksköterskans roll, teoretiska perspektiv på motivation och hälsasamt definition av fysisk aktivitet presenteras. Studiens behov grundas i denrelativt smala evidensen gällande patienters beskrivna upplevelser av fysiskaktivitet vid depression eller depressiva symtom. Patientens perspektiv är enviktig aspekt för att öka den personcentrerade vården.Metod : En litteraturstudie har gjorts utifrån kvalitativ innehållsanalys. Studien ärbaserad på tio artiklar med kvalitativ ansats funna i databaserna Cinahl, PubMedsamt Psycinfo, vilka blivit relevans- och kvalitetsgranskade.Resultat : Fem huvudkategorier identifierades utifrån artiklarnas material;fysiologiska, psykologiska och sociala aspekter av fysisk aktivitet, barriärer förutövande av fysisk aktivitet samt främjande aspekter till fysisk aktivitet (viddepression eller depressiva symtom).Konklusion : Depression är ett komplext tillstånd där subjektiva likheter ochskillnader i upplevelsen av fysisk aktivitet identifierats. Den fysiska aktivitetengenererade för flera deltagare i de inkluderade artiklarna ett ökat självförtroende,en distraktion från negativa tankar samt en känsla av meningsfullhet.Nyckelord : depression, depressiva symtom, fysisk aktivitet, patientupplevelse,sjuksköterska
Aim : The aim of this study is to describe experiences of physical activity inpatients with depression or depressive symptoms.Background : Depression is a growing problem both nationally and globally.Symptoms, the role of the nurse, theoretical perspectives on motivation and healthas well as a definition on physical activity is presented. This study was needed toexpand on the relatively sparse research evidence regarding patients’ experiencesof physical activity as an adjunctive therapy for depression or depressivesymptoms. Patients’ perspectives and experiences are an important aspect for theoptimization of person-centered care.Method : A literature review has been made based on qualitative content analysis.The study relies on ten qualitative articles found in the databases Cinahl, PubMedand Psycinfo, which have been assessed for relevance and quality.Results : Five main categories were identified as a result; physiological,psychological and social aspects of physical activity, barriers for exercising, andpromoting factors of physical activity (in depression or depressive symptoms).Conclusion : Depression is a complex condition in which subjective differencesand similarities in the experience of physical activity have been identified. Thephysical activity generated for several participants in the included articles anincreased self-confidence, a distraction from negative thoughts and a feeling ofmeaning.Key words : depression, depressive symptoms, nurse, patient experience, physicalactivity

Background: The Patient Health Questionnaire PHQ-9 is a widely used instrument to screen for depression in clinical research. The first aim of this study was to psychometrically test the PHQ-9 in a large sample of cancer patients. The second aim was to calculate unbiased estimates of the depression burden for several cancer groups taking into account age and gender distributions. Methods: A sample of 2,059 cancer patients with varying diagnoses were examined in this study six months after discharge from a rehabilitation clinic. A representative sample of 2,693 people from the general population served as controls. Expected PHQ-9 mean scores of the general population sample, regressed on age and gender, were calculated to enable a fair comparison of different groups of cancer patients. Results: While the reliability (Cronbach’s alpha) for the PHQ-9 scale was good (alpha ≥ 0.84), the CFA fit indices of the one-dimensional solution were unsatisfactory in the patients’ sample. The factorial analysis confirmed two factors. PHQ-9 mean scores for 15 types of cancer are given, ranging from 4.0 (prostate) to 8.2 (thyroid gland). Differences between expected mean scores (derived from the general population) and raw mean scores of the cancer subsamples are reported that provide a better estimate of the depression burden. Conclusions: The results confirmed that the PHQ-9 performs well in testing depression in cancer patients. Regression coefficients can be used for performing unbiased comparisons among cancer groups, not only for this study. The burden of patients with testis cancer and Hodgkin lymphoma is underestimated when age and gender are not taken into account.