1
|
Lebel L, Paquin V, Kenny TA, Fletcher C, Nadeau L, Chachamovich E, Lemire M. Climate change and Indigenous mental health in the Circumpolar North: A systematic review to inform clinical practice. Transcult Psychiatry 2022; 59:312-336. [PMID: 34989262 PMCID: PMC9160950 DOI: 10.1177/13634615211066698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Climate change is disproportionally impacting the Circumpolar North, with particular impacts among Indigenous populations. Environmental changes are felt in many aspects of daily life of Northern communities, including both physical and mental health. Thus, health institutions from around the Arctic must meet emerging needs, while the phenomenon remains marginal to their southern counterparts. In this systematic review, we aimed to review current scientific knowledge on the mental health impacts of climate change in Indigenous Peoples across the Circumpolar North. Seven databases were searched. Original peer-reviewed research articles were included if they addressed links between climate change and mental health in Arctic or Subarctic Indigenous Populations. After extraction, data were synthesized using thematic analysis. Of the 26 articles that met inclusion criteria, 16 focused on Canadian Inuit communities and 21 were exclusively qualitative. Being on the land was identified as a central determinant of wellbeing. Immediate impacts of climate change on mental health were felt through restricted mobility and disrupted livelihoods. Effects on mental health were further felt through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. Various ways in how communities and individuals are coping with these effects were reported. Understanding climate-related pathways of mental health risks in the Arctic is crucial to better identify vulnerable groups and to foster resilience. Clinicians can play a role in recognizing and providing support for patients affected by these disruptions. Policies sensitive to the climate-mental health relationship must be advocated for.
Collapse
Affiliation(s)
- Laurence Lebel
- Population Health and Optimal Health Practices Axis, 36896CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Social and Preventive Medicine, 4440Université Laval, Québec, QC, Canada
| | - Vincent Paquin
- Population Health and Optimal Health Practices Axis, 36896CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Douglas Mental Health Institute, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Tiff-Annie Kenny
- Department of Social and Preventive Medicine, 4440Université Laval, Québec, QC, Canada
| | - Christopher Fletcher
- Population Health and Optimal Health Practices Axis, 36896CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Social and Preventive Medicine, 4440Université Laval, Québec, QC, Canada
| | - Lucie Nadeau
- Department of Psychiatry, McGill University, Montréal, QC, Canada.,Montreal Children's Hospital, Montréal, QC, Canada
| | - Eduardo Chachamovich
- Douglas Mental Health Institute, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Mélanie Lemire
- Population Health and Optimal Health Practices Axis, 36896CHU de Québec-Université Laval Research Centre, Québec, QC, Canada.,Department of Social and Preventive Medicine, 4440Université Laval, Québec, QC, Canada
| |
Collapse
|
2
|
Belzeaux R, Gorgievski V, Fiori LM, Lopez JP, Grenier J, Lin R, Nagy C, Ibrahim EC, Gascon E, Courtet P, Richard-Devantoy S, Berlim M, Chachamovich E, Théroux JF, Dumas S, Giros B, Rotzinger S, Soares CN, Foster JA, Mechawar N, Tall GG, Tzavara ET, Kennedy SH, Turecki G. GPR56/ADGRG1 is associated with response to antidepressant treatment. Nat Commun 2020; 11:1635. [PMID: 32242018 PMCID: PMC7118175 DOI: 10.1038/s41467-020-15423-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
It remains unclear why many patients with depression do not respond to antidepressant treatment. In three cohorts of individuals with depression and treated with serotonin-norepinephrine reuptake inhibitor (N = 424) we show that responders, but not non-responders, display an increase of GPR56 mRNA in the blood. In a small group of subjects we also show that GPR56 is downregulated in the PFC of individuals with depression that died by suicide. In mice, we show that chronic stress-induced Gpr56 downregulation in the blood and prefrontal cortex (PFC), which is accompanied by depression-like behavior, and can be reversed by antidepressant treatment. Gpr56 knockdown in mouse PFC is associated with depressive-like behaviors, executive dysfunction and poor response to antidepressant treatment. GPR56 peptide agonists have antidepressant-like effects and upregulated AKT/GSK3/EIF4 pathways. Our findings uncover a potential role of GPR56 in antidepressant response.
Collapse
Affiliation(s)
- Raoul Belzeaux
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.,Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France.,Fondation FondaMental, Créteil, France
| | - Victor Gorgievski
- CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Laura M Fiori
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Juan Pablo Lopez
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julien Grenier
- INSERM UMR-S 1124 ERL 3649, Université Paris Descartes, Paris, France
| | - Rixing Lin
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Corina Nagy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - El Chérif Ibrahim
- Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France.,Fondation FondaMental, Créteil, France
| | - Eduardo Gascon
- Aix-Marseille Univ, AP-HM, CNRS, INT, Inst Neurosci Timone, Hôpital Sainte Marguerite, Pôle de psychiatrie, Marseille, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Stéphane Richard-Devantoy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marcelo Berlim
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Eduardo Chachamovich
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jean-François Théroux
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Bruno Giros
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Susan Rotzinger
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- St Michael's Hospital, Li Ka Shing Knowledge Institute, Centre for Depression and Suicide Studies, Toronto, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Jane A Foster
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Naguib Mechawar
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gregory G Tall
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Eleni T Tzavara
- Fondation FondaMental, Créteil, France.,CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sidney H Kennedy
- Centre for Mental Health, Department of Psychiatry, University Health Network, Krembil Research Institute, University of Toronto, Toronto, ON, Canada.,St Michael's Hospital, Li Ka Shing Knowledge Institute, Centre for Depression and Suicide Studies, Toronto, ON, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
| |
Collapse
|
3
|
Noal DDS, Rabelo IVM, Chachamovich E. The mental health impact on individuals affected by the Vale dam rupture. CAD SAUDE PUBLICA 2019; 35:e00048419. [PMID: 31116247 DOI: 10.1590/0102-311x00048419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Débora da Silva Noal
- Fundação Oswaldo Cruz, Brasília, Brasil.,Médicos Sem Fronteiras, Rio de Janeiro, Brasil
| | | | | |
Collapse
|
4
|
Beaudoin V, Séguin M, Chawky N, Affleck W, Chachamovich E, Turecki G. Protective Factors in the Inuit Population of Nunavut: A Comparative Study of People Who Died by Suicide, People Who Attempted Suicide, and People Who Never Attempted Suicide. Int J Environ Res Public Health 2018; 15:ijerph15010144. [PMID: 29337928 PMCID: PMC5800243 DOI: 10.3390/ijerph15010144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 12/05/2022]
Abstract
Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of a larger study of psychological autopsies conducted in Nunavut, Canada. The objective of this secondary analysis was to identify protective factors in the Inuit population of Nunavut by comparing people who died by suicide, people from the general population who attempted suicide, and people from the general population who never attempted suicide. This case-control study included 90 participants, with 30 participants in each group who were paired by birth date, sex, and community. Content analysis was first conducted on the clinical vignettes from the initial study in order to codify the presence of protective variables. Then, inferential analyses were conducted to highlight differences between each group in regards to protection. Findings demonstrated that (a) people with no suicide attempt have more protective variables throughout their lifespan than people who died by suicide and those with suicide attempts within the environmental, social, and individual dimensions; (b) people with suicide attempts significantly differ from the two other groups in regards to the use of services; and (c) protective factors that stem from the environmental dimension show the greatest difference between the three groups, being significantly more present in the group with no suicide attempt. Considering these findings, interventions could focus on enhancing environmental stability in Inuit communities as a suicide prevention strategy.
Collapse
Affiliation(s)
- Véronique Beaudoin
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada.
| | - Monique Séguin
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada.
- Mood Disorders and Related Disorders, McGill Group on Suicide Studies, Douglas Mental Health University Institute & Québec Network on Suicide, Montreal, QC H4H 1R3, Canada.
| | - Nadia Chawky
- Mood Disorders and Related Disorders, McGill Group on Suicide Studies, Douglas Mental Health University Institute & Québec Network on Suicide, Montreal, QC H4H 1R3, Canada.
| | - William Affleck
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada.
| | - Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC H3A 0G4, Canada.
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Institute, McGill University, Montreal, QC H3A 0G4, Canada.
| |
Collapse
|
5
|
El-Majzoub S, Behzadi A, Lis E, Moussaoui G, Yu C, Segal M, Looper KJ, Chachamovich E, Rej S. Self-reported psychiatric symptoms associated with anticipated close psychiatry follow-up and/or hospitalization status in geriatric psychiatry patients: a preliminary study. Psychogeriatrics 2018; 18:74-76. [PMID: 28745415 DOI: 10.1111/psyg.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/05/2017] [Accepted: 05/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Salam El-Majzoub
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Arian Behzadi
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Eric Lis
- McGill University, Dept. of Psychiatry, Perceptions of Emerging Technologies Labs, Montreal, Quebec, Canada
| | - Ghizlane Moussaoui
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Physiotherapy, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Ching Yu
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marilyn Segal
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Karl J Looper
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Eduardo Chachamovich
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Lopez JP, Pereira F, Richard-Devantoy S, Berlim M, Chachamovich E, Fiori LM, Niola P, Turecki G, Jollant F. Co-Variation of Peripheral Levels of miR-1202 and Brain Activity and Connectivity During Antidepressant Treatment. Neuropsychopharmacology 2017; 42:2043-2051. [PMID: 28079059 PMCID: PMC5561353 DOI: 10.1038/npp.2017.9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/02/2017] [Accepted: 01/08/2017] [Indexed: 12/27/2022]
Abstract
MicroRNAs are short non-coding molecules that play a major role in regulating gene expression. Peripheral levels of miR-1202 have been shown to predict and mediate antidepressant response. However, it is not clear to what extent these peripheral measures reflect central neural changes in vivo. We approached this problem with the combined use of peripheral miR-1202 measures and neuroimaging. At baseline and after 8 weeks of desvenlafaxine (50-100 mg die), 20 patients were scanned with 3T magnetic resonance imaging, first at rest then during the Go/NoGo task, a classical test of response inhibition. Blood samples were collected at both time points. During resting state, lower baseline miR-1202 levels were predictive of increased connectivity from T0 to T8 between the posterior cingulate and the prefrontal, parietal, and occipital cortices. Changes in miR-1202 levels following desvenlafaxine treatment were negatively correlated with changes in activity in right precuneus within the default-mode network, and in connectivity between the posterior cingulate and the temporal and prefrontal cortices, and the precuneus. During the Go/NoGo task, baseline miR-1202 levels and changes in these levels were correlated with activity changes in different regions, including bilateral prefrontal, insular, cingulate, and temporal cortices, and left putamen and claustrum. Finally, secondary analyses in a subset of patients showed a trend for a significant correlation between miR-1202 levels and glutamate levels measured by spectroscopy. Changes in peripheral miR-1202 levels were therefore associated with changes in brain activity and connectivity in a network of brain regions associated with depression and antidepressant response. These effects may be mediated by the glutamatergic system.
Collapse
Affiliation(s)
- Juan Pablo Lopez
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Max Planck Institute of Psychiatry, Department of Stress Neurobiology and Neurogenetics, Munich, Germany
| | - Fabricio Pereira
- Department of Radiology, Nîmes Academic Hospital, Nîmes, France & EA 2415, Montpellier University, Montpellier, France
| | - Stéphane Richard-Devantoy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada
| | - Marcelo Berlim
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada
| | - Eduardo Chachamovich
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada
| | - Laura M Fiori
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada
| | - Paola Niola
- Laboratory of Pharmacogenomics, Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada
| | - Fabrice Jollant
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal,, Québec, Canada,Department of Psychiatry, Nîmes Academic Hospital, Nîmes, France,Douglas Mental Health University Institute, Frank B. Common Building, 6875 LaSalle Boulevard, Montréal,Québec, Canada H4H 1R3, Tel: +1 514 761 6131 (ext: 3301), Fax: +1 514 888 4466, E-mail:
| |
Collapse
|
7
|
Fiori LM, Lopez JP, Richard-Devantoy S, Berlim M, Chachamovich E, Jollant F, Foster J, Rotzinger S, Kennedy SH, Turecki G. Investigation of miR-1202, miR-135a, and miR-16 in Major Depressive Disorder and Antidepressant Response. Int J Neuropsychopharmacol 2017; 20:619-623. [PMID: 28520926 PMCID: PMC5570004 DOI: 10.1093/ijnp/pyx034] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Major depressive disorder is a debilitating illness, which is most commonly treated with antidepressant drugs. As the majority of patients do not respond on their first trial, there is great interest in identifying biological factors that indicate the most appropriate treatment for each patient. Studies suggest that microRNA represent excellent biomarkers to predict antidepressant response. METHODS We investigated the expression of miR-1202, miR-135a, and miR-16 in peripheral blood from 2 cohorts of depressed patients who received 8 weeks of antidepressant therapy. Expression was quantified at baseline and after treatment, and its relationship to treatment response and depressive symptoms was assessed. RESULTS In both cohorts, responders displayed lower baseline miR-1202 levels compared with nonresponders, which increased following treatment. CONCLUSIONS Ultimately, our results support the involvement of microRNA in antidepressant response and suggest that quantification of their levels in peripheral samples represents a valid approach to informing treatment decisions.
Collapse
Affiliation(s)
- Laura M Fiori
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Juan Pablo Lopez
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Stéphane Richard-Devantoy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Marcelo Berlim
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Eduardo Chachamovich
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Fabrice Jollant
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Jane Foster
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Susan Rotzinger
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Sidney H Kennedy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Verdun, Quebec, Canada (Drs Fiori, Lopez, Richard-Devantoy, Berlim, Chachamovich, Jollant, and Turecki); Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Foster, Rotzinger, and Kennedy)
| |
Collapse
|
8
|
Wexler L, Poudel-Tandukar K, Rataj S, Trout L, Poudel KC, Woods M, Chachamovich E. Preliminary Evaluation of a School-Based Youth Leadership and Prevention Program in Rural Alaska Native Communities. School Mental Health 2016; 9:172-183. [DOI: 10.1007/s12310-016-9203-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Chachamovich E, Kirmayer LJ, Haggarty JM, Cargo M, Mccormick R, Turecki G. Suicide Among Inuit: Results From a Large, Epidemiologically Representative Follow-Back Study in Nunavut. Can J Psychiatry 2015; 60:268-75. [PMID: 26175324 PMCID: PMC4501584 DOI: 10.1177/070674371506000605] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Inuit population in Canada's North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period. METHODS We identified all suicides by Inuit (n = 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits. RESULTS Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder (P = 0.002) and suicide completion (P = 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits (P < 0.001). CONCLUSIONS At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Psychiatrist, McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Quebec; Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Laurence J Kirmayer
- Psychiatrist, James McGill Professor, and Director, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, Quebec; Senior Investigator, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec
| | - John M Haggarty
- Psychiatrist and Professor, Northern Ontario School of Medicine, Division of Clinical Sciences, Thunder Bay, Ontario
| | - Margaret Cargo
- Future Fellow, School of Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Rod Mccormick
- Counselling Psychologist, Thompson Rivers University, Aboriginal Education, Kamloops, British Columbia
| | - Gustavo Turecki
- Psychiatrist, Professor of Psychiatry, and Director, McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Quebec; Director, Quebec Network for Suicide, Mood Disorders and Comorbidities, Montreal, Quebec
| |
Collapse
|
10
|
Fraser SL, Geoffroy D, Chachamovich E, Kirmayer LJ. Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors. Suicide Life Threat Behav 2015; 45:141-56. [PMID: 25255825 DOI: 10.1111/sltb.12122] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/16/2014] [Indexed: 11/30/2022]
Abstract
Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.
Collapse
Affiliation(s)
- Sarah L Fraser
- Psychoéducation, Université de Montréal, Montreal, QC, Canada
| | | | | | | |
Collapse
|
11
|
Berlim MT, Van den Eynde F, Tovar-Perdomo S, Chachamovich E, Zangen A, Turecki G. Augmenting antidepressants with deep transcranial magnetic stimulation (DTMS) in treatment-resistant major depression. World J Biol Psychiatry 2014; 15:570-8. [PMID: 25050453 DOI: 10.3109/15622975.2014.925141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Deep transcranial magnetic stimulation (DTMS) has been shown to be efficacious and relatively safe for major depressive disorder (MDD). However, its clinical utility as an augmenting strategy for treatment-resistant depression (TRD) remains unexplored. METHODS In an open label trial, 17 outpatients with severe TRD received 4 weeks of daily high frequency DTMS over the left dorsolateral prefrontal cortex. Depressive and anxious symptoms, suicidality and quality of life (QOL) were measured at baseline (i.e., in the week prior to the start of the DTMS treatment) and at week 5 (i.e., in the week following the end of the DTMS treatment). Primary outcome measures were rates of response and remission at week 5 using an intention-to-treat approach. RESULTS Response and remission rates at week 5 were 70.6 and 41.2%, respectively. Also, depression, anxiety, and suicidality ratings were significantly improved by week 5 (with Hedges' g estimates ranging from 0.6 to 1.72), as well as four of the five QOL domain scores (i.e., global, psychological, environmental and social). Finally, two patients dropped out of the study at week 1 because of significant scalp discomfort during stimulation. CONCLUSIONS Our study suggests that DTMS, when used as an augmenting strategy for antidepressants in severe TRD, is efficacious, safe and relatively well tolerated. However, controlled studies with larger samples are needed to confirm and expand our preliminary findings.
Collapse
Affiliation(s)
- Marcelo T Berlim
- Depressive Disorders Program, Douglas Mental Health University Institute and McGill University , Montréal, Québec , Canada
| | | | | | | | | | | |
Collapse
|
12
|
McGirr A, Van den Eynde F, Chachamovich E, Fleck MP, Berlim MT. Personality dimensions and deep repetitive transcranial magnetic stimulation (DTMS) for treatment-resistant depression: A pilot trial on five-factor prediction of antidepressant response. Neurosci Lett 2014; 563:144-8. [DOI: 10.1016/j.neulet.2014.01.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/29/2013] [Accepted: 01/18/2014] [Indexed: 12/28/2022]
|
13
|
Chachamovich E, Haggarty J, Cargo M, Hicks J, Kirmayer LJ, Turecki G. A psychological autopsy study of suicide among Inuit in Nunavut: methodological and ethical considerations, feasibility and acceptability. Int J Circumpolar Health 2013; 72:20078. [PMID: 23539438 PMCID: PMC3609997 DOI: 10.3402/ijch.v72i0.20078] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country. OBJECTIVE This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method. METHOD A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed. RESULTS The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Department of Psychiatry, McGill Group for Suicide Studies, McGill University, Montreal, Quebec, Canada.
| | | | | | | | | | | |
Collapse
|
14
|
da Rocha NS, Chachamovich E, de Almeida Fleck MP, Tennant A. An introduction to Rasch analysis for Psychiatric practice and research. J Psychiatr Res 2013; 47:141-8. [PMID: 23069651 DOI: 10.1016/j.jpsychires.2012.09.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.
Collapse
Affiliation(s)
- Neusa Sica da Rocha
- Hospital de Clinicas de Porto Alegre, Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
| | | | | | | |
Collapse
|
15
|
Sehn F, Chachamovich E, Vidor LP, Dall-Agnol L, Custódio de Souza IC, Torres ILS, Fregni F, Caumo W. Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of the Pain Catastrophizing Scale. Pain Med 2012; 13:1425-35. [DOI: 10.1111/j.1526-4637.2012.01492.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Chachamovich E, Ding Y, Turecki G. Levels of aggressiveness are higher among alcohol-related suicides: results from a psychological autopsy study. Alcohol 2012; 46:529-36. [PMID: 22579734 DOI: 10.1016/j.alcohol.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023]
Abstract
Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, Quebec, Canada H4H 1R3.
| | | | | |
Collapse
|
17
|
Trentini C, Wagner G, Chachamovich E, Figueiredo M, da Silva L, Hirakata V, Fleck M. Subjective perception of health in elderly inpatients. International Journal of Psychology 2012; 47:279-86. [DOI: 10.1080/00207594.2011.626046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
18
|
Záchia S, Knauth D, Goldim JR, Chachamovich JR, Chachamovich E, Paz AH, Felberbaum R, Crosignani P, Tarlatzis BC, Passos EP. Assisted reproduction: what factors interfere in the professional's decisions? Are single women an issue? BMC Womens Health 2011; 11:21. [PMID: 21627812 PMCID: PMC3125239 DOI: 10.1186/1472-6874-11-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 05/31/2011] [Indexed: 12/02/2022]
Abstract
Background With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. Methods Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. Results Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. Conclusion The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.
Collapse
Affiliation(s)
- Suzana Záchia
- Post-Graduate Program in Medicine, Assisted Reproduction Service, Gynecology and Obstetrics Department, Hospital de Clínicas de Porto Alegre 90035-903, Porto Alegre, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth DR, Passos EP. Agreement on perceptions of quality of life in couples dealing with infertility. J Obstet Gynecol Neonatal Nurs 2011; 39:557-65. [PMID: 20920002 DOI: 10.1111/j.1552-6909.2010.01168.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL). DESIGN Cross-sectional prospective study. Quality of life was measured as a multidimensional construct. SETTING Assisted reproduction clinic of a university hospital. PARTICIPANTS One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts. METHODS Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression. RESULTS Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed. CONCLUSION Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.
Collapse
|
20
|
Ezer H, Chachamovich JLR, Chachamovich E. Do men and their wives see it the same way? Congruence within couples during the first year of prostate cancer. Psychooncology 2011; 20:155-64. [DOI: 10.1002/pon.1724] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Chachamovich E, Fleck MP, Power M. Is Geriatric Depression Scale-15 a suitable instrument for measuring depression in Brazil? Results of a Rasch analysis. PSYCHOL HEALTH MED 2010; 15:596-606. [PMID: 20835969 DOI: 10.1080/13548506.2010.487108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depressive symptoms are the most prevalent mental health condition in older adults. Since it cannot be measured directly, the use of instruments is mandatory. The 15-item Geriatric Depression Scale (GDS) is one of the most widely used scales to measure depression in the elderly. It is recognized that the cultural context is a major determinant of the instrument's psychometric performance. Up to the present, this scale has mainly been investigated through classical psychometric approaches. The present study aims to explore whether the 15-item GDS is a suitable instrument in a Brazilian sample. In addition, it explores the potential improvement in the psychometric performance by item refinement. Four hundred twenty-four elderly adults selected through convenience sampling completed the 15-item GDS. Data were analyzed by the Rasch Measurement Model. The Rasch analysis is a powerful modern approach to explore psychometric performance of instruments in health sciences. It examines both the scale and the individual item performance in depth. The 15-item GDS proved not to be suitable in a Brazilian sample. Item misfit and differential item functioning were responsible for considerable misperformance. Scale reduction led to a 10-item structure. This refined format presented adequate psychometric performance and no differential item functioning. The present study offers an alternative and more adequate version of the GDS to be applied in Brazilian subjects. It is also in line with the need for shorter, valid scales in clinical settings. Further investigations are needed to develop a set of cultural-invariant items, which could then be applied in transcultural investigations free of bias.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Department of Psychiatry, Douglas Hospital, McGill University, Montreal, Canada.
| | | | | |
Collapse
|
22
|
Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth D, Passos EP. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynaecol 2010; 31:101-10. [PMID: 20443659 DOI: 10.3109/0167482x.2010.481337] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples. DESIGN Systematic review. METHODS Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures. INTERVENTIONS None. MAIN OUTCOME MEASURES Quality of life and health-related quality of life. RESULTS Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men. CONCLUSIONS Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.
Collapse
|
23
|
Chachamovich JL, Chachamovich E, Ezer H, Cordova FP, Fleck MM, Knauth DR, Passos EP. Psychological distress as predictor of quality of life in men experiencing infertility: a cross-sectional survey. Reprod Health 2010; 7:3. [PMID: 20459694 PMCID: PMC2878292 DOI: 10.1186/1742-4755-7-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 05/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility. METHODS 162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added. RESULTS AND DISCUSSION Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity. CONCLUSION Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.
Collapse
Affiliation(s)
- Juliana Lr Chachamovich
- School of Nursing, McGill University, Wilson Hall 3506 University Street, Montreal, QC, H3A 2A7, Canadá.
| | | | | | | | | | | | | |
Collapse
|
24
|
Kaipper MB, Chachamovich E, Hidalgo MPL, Torres ILDS, Caumo W. Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach. J Psychosom Res 2010; 68:223-33. [PMID: 20159207 DOI: 10.1016/j.jpsychores.2009.09.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/22/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study evaluates the State-Trait Anxiety Inventory (STAI) structure using a Rasch psychometric approach, and a refined and shorter STAI version is proposed. METHODS A cross-sectional study was performed with 900 inpatients scheduled for elective surgery. Age varied from 18 to 60 years (American Society of Anesthesiologists physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instrument (the STAI) was applied to all patients in the afternoon before the surgery and prior to the patients receiving preoperative sedatives. RESULTS Rasch analysis of the state and trait anxiety scales was performed separately. This analysis demonstrated that the original format of state and trait scales fails to show invariance across the trait-state anxiety level, which results in the unstable performance of items. The refined scale was retested in two subsequent random samples of 300 subjects each, and the results were confirmed. The performance was adequate regardless of gender. In the analysis, some items of the state scale (items 3,4,9,10,12,15, and 20) were deleted due to poor fit statistics. The remaining 13 items showed unidimensionality, local independence, and adequate index of internal consistency. Also, the original trait scale displayed several weaknesses. First, the four-point Likert response scale proved to be inadequate, and threshold disorders were found in all 20 items. Also, the original trait scale showed insufficient item-trait interaction and several individual item misfits. Following the rescoring process, and retesting in a second random sample, items were excluded (namely Items 3, 4, 11, 13, 14, 15, 18, and 19). The refined version showed local independence, unidimensionality, and adequate fit statistics. DISCUSSION The results indicate that the application of the Rasch model led to the refinement of the classic STAI state and trait scales. In addition, they suggest that these shorter versions have a more suitable psychometric performance and are free of threshold disorders and differential item functioning problems.
Collapse
Affiliation(s)
- Márcia Balle Kaipper
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | | | | |
Collapse
|
25
|
Chachamovich E, Stefanello S, Botega N, Turecki G. [Which are the recent clinical findings regarding the association between depression and suicide?]. Rev Bras Psiquiatr 2009; 31 Suppl 1:S18-25. [PMID: 19565147 DOI: 10.1590/s1516-44462009000500004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. REVIEW Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. CONCLUSION Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada
| | | | | | | |
Collapse
|
26
|
Rabin EG, Heldt E, Hirakata VN, Bittelbrunn AC, Chachamovich E, Fleck MPA. Depression and perceptions of quality of life of breast cancer survivors and their male partners. Oncol Nurs Forum 2009; 36:E153-8. [PMID: 19403443 DOI: 10.1188/09.onf.e153-e158] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess differences in ways women with breast cancer evaluate their own quality of life (QOL) compared to perceptions of their partners and to identify factors that influence dissimilarities in QOL perceptions. DESIGN Cross-sectional study. SETTING Breast unit in southern Brazil. SAMPLE 73 women with stage I-III breast cancer and their partners. Most participants were middle-aged, with partners of long-term cohabitation. METHODS QOL was evaluated with the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF), Beck Depression Inventory, and WHOQOL-BREF adapted for a third person. MAIN RESEARCH VARIABLES Demographic and clinical features, QOL, partners' perceptions, and depression. FINDINGS No differences were found between the perceptions of QOL in different domains between the patients and their partners. Depression in women seemed to be the only variable that interfered in a consistent manner with the congruity of the QOL assessments made by patients and their partners. CONCLUSIONS Partners of women with breast cancer may be viewed as reliable surrogates to assess patients' QOL. IMPLICATIONS FOR NURSING Partners' judgments of patients' QOL may be important in some circumstances, particularly when patients are not able to answer questions about their own QOL because of cognitive or functional limitations. Nurses must be aware that partners are the most frequent informal caregivers and should be included in the entire treatment process.
Collapse
Affiliation(s)
- Eliane G Rabin
- School of Nursing, Universidade Federal das Ciencias da Saúde de Porto Alegre, Alegre, Brazil.
| | | | | | | | | | | |
Collapse
|
27
|
Chachamovich J, Chachamovich E, Fleck M, Cordova F, Knauth D, Passos E. Congruence of quality of life among infertile men and women: findings from a couple-based study. Hum Reprod 2009; 24:2151-7. [DOI: 10.1093/humrep/dep177] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
Chachamovich E, Fleck MP, Trentini C, Power M. Brazilian WHOQOL-OLD Module version: a Rasch analysis of a new instrument. Rev Saude Publica 2008; 42:308-16. [PMID: 18372982 DOI: 10.1590/s0034-89102008000200017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 05/31/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the Brazilian version of WHOQOL-OLD Module and to test potential changes to the instrument to increase its psychometric adequacy. METHODS A total of 424 older adults living in a city in Southern Brazil completed the WHOQOL-OLD instrument, in 2005. Rasch analysis was used to explore the psychometric performance of the scale, as implemented by the RUMM2020 software. Item-trait interaction, threshold disorders, presence of differential item functioning and item fit, were analyzed. RESULTS Two ("death and dying" and "sensory abilities") out of six domains showed inadequate item-trait interactions. Rescoring the response scale and deleting the most misperforming items led to scale improvement. The evaluation of domains and items individually showed that the "intimacy" domain does perform well in contrast to the findings using the classical approach. In addition, the "sensory abilities" domain does not derive an interval measure in its current format. CONCLUSIONS Unidimensionality and local independence were seen in all domains. Changes in the response scale and deletion of problematic items improved the scale's performance.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Programa de Pós-Graduação em Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | | | | |
Collapse
|
29
|
Chachamovich E, Fleck M, Laidlaw K, Power M. Impact of Major Depression and Subsyndromal Symptoms on Quality of Life and Attitudes Toward Aging in an International Sample of Older Adults. The Gerontologist 2008; 48:593-602. [DOI: 10.1093/geront/48.5.593] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Chachamovich E, Fleck MP, Power M. Literacy affected ability to adequately discriminate among categories in multipoint Likert Scales. J Clin Epidemiol 2008; 62:37-46. [PMID: 18619806 DOI: 10.1016/j.jclinepi.2008.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 02/20/2008] [Accepted: 03/02/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the effect of inability to read on a five-point Likert scale, using the WHOQOL-BREF response scale. It is hypothesized that inability to read is related to loss of discriminant power among the five-category response scale. STUDY DESIGN AND SETTING In a cross-sectional design, nonreaders (n=141) and subjects educated at a graduate level (n-907) were assessed. Statistical analyses combined classic and modern psychometric approaches (Confirmatory factor analysis and Rasch analysis). RESULTS There is a remarkable difference in the psychometric performance of items across the two subgroups. Fit indexes proved to be closer to the ideal for the graduate group, but not for the nonreader group. Reducing the number of response categories improved the model exclusively for the nonreader sample. Nonreaders do not interpret the scale as a true five-category scale, but exhibit a response pattern indicative that only three categories are in fact considered. CONCLUSION These results confirm the hypothesis that a multiple-category response scale is not suitable for nonreaders. They suggest that a simpler response scale should be adopted to achieve a more reliable and satisfactory psychometric performance in this population. This effect seems to be stronger when more abstract and subjective constructs are involved.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Post-Graduate Program on Psychiatry, University Federal of Rio Grande do Sul, Rua Florencio Ygartua, 391/308, Porto Alegre - RS, CEP 90430-010, Brazil.
| | | | | |
Collapse
|
31
|
Chachamovich E, Fleck MP, Trentini CM, Laidlaw K, Power MJ. Development and validation of the Brazilian version of the Attitudes to Aging Questionnaire (AAQ): An example of merging classical psychometric theory and the Rasch measurement model. Health Qual Life Outcomes 2008; 6:5. [PMID: 18208611 PMCID: PMC2262063 DOI: 10.1186/1477-7525-6-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 01/21/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging has determined a demographic shift in the world, which is considered a major societal achievement, and a challenge. Aging is primarily a subjective experience, shaped by factors such as gender and culture. There is a lack of instruments to assess attitudes to aging adequately. In addition, there is no instrument developed or validated in developing region contexts, so that the particularities of ageing in these areas are not included in the measures available. This paper aims to develop and validate a reliable attitude to aging instrument by combining classical psychometric approach and Rasch analysis. METHODS Pilot study and field trial are described in details. Statistical analysis included classic psychometric theory (EFA and CFA) and Rasch measurement model. The latter was applied to examine unidimensionality, response scale and item fit. RESULTS Sample was composed of 424 Brazilian old adults, which was compared to an international sample (n = 5238). The final instrument shows excellent psychometric performance (discriminant validity, confirmatory factor analysis and Rasch fit statistics). Rasch analysis indicated that modifications in the response scale and item deletions improved the initial solution derived from the classic approach. CONCLUSION The combination of classic and modern psychometric theories in a complementary way is fruitful for development and validation of instruments. The construction of a reliable Brazilian Attitudes to Aging Questionnaire is important for assessing cultural specificities of aging in a transcultural perspective and can be applied in international cross-cultural investigations running less risk of cultural bias.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Post-Graduate Program of Psychiatry, Universidade Federal do Rio Grande do Sul, Brazil.
| | | | | | | | | |
Collapse
|
32
|
Chachamovich E, Trentini C, Fleck MP. Assessment of the psychometric performance of the WHOQOL-BREF instrument in a sample of Brazilian older adults. Int Psychogeriatr 2007; 19:635-46. [PMID: 16870036 DOI: 10.1017/s1041610206003619] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 03/28/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND There has been increasing interest in the measurement of quality of life in cross-sectional investigations and in the assessment of intervention outcomes in elderly adults. Several instruments used in this measurement have not yet been adequately tested. OBJECTIVE To describe the psychometric properties of the World Health Organization's Quality of Life Instrument-Short Version (WHOQOL-BREF) in a sample of Brazilian elderly. METHOD A total of 424 elderly adults selected through convenience sampling completed the instruments WHOQOL-BREF, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS) and a sociodemographic data form. Discriminant validity, concurrent validity, criterion validity and internal consistency were analyzed. RESULTS The sample comprised predominantly women (64.2%), community-dwelling subjects (84.4%) and subjects who consider themselves healthy (67.5%). All domains in the instrument showed the ability to discriminate levels of depressive symptoms and hopelessness, as well as different perceptions of health status. The correlation coefficients among the domains and the BDI and BHS scores were statistically significant. The reliability coefficients present scores ranging from 0.614 to 0.925. CONCLUSION The WHOQOL-BREF instrument shows suitable psychometric performance in a sample of Brazilian older adults, becoming a useful alternative in the measurement of quality of life in this population.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul and Hospital de Clinicas de Porto Alegre, Brazil.
| | | | | |
Collapse
|
33
|
Chachamovich JR, Chachamovich E, Zachia S, Knauth D, Passos EP. What variables predict generic and health-related quality of life in a sample of Brazilian women experiencing infertility? Hum Reprod 2007; 22:1946-52. [PMID: 17428881 DOI: 10.1093/humrep/dem080] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Infertility is a condition associated with impairment in several areas of life. Questionnaires about quality of life (QoL) allow the examination of the impact of health conditions in a broader way, comprehending outcomes beyond symptomatology, morbidity and mortality. The aim of this study was to identify factors associated with various aspects of QoL. METHODS Cross-sectional study using the following: a socio-demographic and clinical data form, the Health Survey Short Form (SF-36) which examines health-related QoL and the WHOQOL-BREF which examines general QoL. RESULTS 177 women seeking fertility assistance were interviewed. The sample was predominantly composed of women between 30 and 40 years old (64%), who had known about their infertility for <5 years (57%) and who had had no previous attempts at assisted reproduction (79%). Logistic regression indicated the following predictor variables: age (for better general health and physical functioning), previous in vitro fertilization (for lower vitality and poor psychological health scores), previous reproductive tract surgery (for worse general health but higher environment scores), advanced education (for higher vitality, mental health and environment scores, but for worse social relationships) and perception of worse sexual life (for lower overall scores). CONCLUSIONS The identification of factors associated with better or worse QoL, in its different domains, is vital in order to propose and test scientifically based interventions on infertile women.
Collapse
Affiliation(s)
- J R Chachamovich
- Assisted Reproduction Service, Embryology and Genetics Laboratory, Gynecology and Obstetrics Department, Hospital de Clinicas de Porto Alegre, RS, and Federal University of Rio Grande do Sul, Brazil.
| | | | | | | | | |
Collapse
|
34
|
Fleck MP, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40:785-91. [PMID: 17301899 DOI: 10.1590/s0034-89102006000600007] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 03/29/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: The increasing proportion of older adults in the general population and the specific characteristics of this age group show the need for the development of specific instruments to measure quality of life in older adults. The study aimed at describing the development and validation of the Portuguese version of the World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) module. METHODS: The WHOQOL-OLD instrument was administered in a sample of 424 older adults in the city of Porto Alegre, Southern Brazil, in 2005. The questionnaire comprises 24 items divided into six facets: sensory abilities; autonomy; past, present and future activities; social participation; death and dying; and intimacy. Besides the WHOQOL-OLD module, the WHOQOL-BREF, BDI and BHS instruments were also applied. The instrument's internal consistency was assessed using Cronbach's alpha coefficient. RESULTS: The instrument showed adequate internal consistency (Cronbach's coefficients ranging from 0.71 to 0.88), discriminant validity (p<0.01), concurrent validity (correlation coefficients ranging from -0.61 to -0.50) and test-retest reliability (correlation coefficients ranging from 0.58 to 0.82). Findings concerning criterion validity need further studies. CONCLUSIONS: The WHOQOL-Old module is a useful alternative with good psychometric performance in the investigation of quality of life in older adults.
Collapse
Affiliation(s)
- Marcelo P Fleck
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, Brasil
| | | | | |
Collapse
|
35
|
Schestatsky P, Zanatto VC, Margis R, Chachamovich E, Reche M, Batista RG, Fricke D, Rieder CRM. Quality of life in a Brazilian sample of patients with Parkinson's disease and their caregivers. Rev Bras Psiquiatr 2006; 28:209-11. [PMID: 17063221 DOI: 10.1590/s1516-44462006000300013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 05/28/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Parkinson's disease is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. METHOD: A cross-sectional study was performed in which quality of life was assessed by the WHOQOL-BREF questionnaire in 21 patients with Parkinson's disease and their respective caregivers. RESULTS: Significant differences between patients and caregivers were found in physical (p < 0.001) and psychological (p = 0.002) domains. In the Parkinson's disease group there was a significant inverse correlation between the psychological domain and duration of disease (p = 0.01), as well as between social domain and severity of disease (p = 0.001). There was a positive correlation between physical domain scores and number of people living in the same house (p = 0.02). The only significant finding in the group of caregivers was an inverse correlation between the social domain and the patients´ age (p = 0.04). CONCLUSION: Duration, severity of the disease and the number of people living in the same house were the most important predictors of quality of life of Parkinson's disease patients. The age of the patients was the only significant predictor found in the caregivers' quality of life. In order to complement our findings, further short-form questionnaires should be validated for Brazilian samples of Parkinson's disease.
Collapse
Affiliation(s)
- Pedro Schestatsky
- Department of Neurology, Medical School, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2600, 90035-003 Porto Alegre, RS, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Trentini CM, Chachamovich E, Figueiredo M, Hirakata VN, Fleck MPDA. A percepção de qualidade de vida do idoso avaliada por si próprio e pelo cuidador. Estud psicol (Natal) 2006. [DOI: 10.1590/s1413-294x2006000200008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi investigar a relação entre a percepção de qualidade de vida (QV) do idoso por ele próprio e por seu cuidador. Assim, 27 pares de idosos-e-cuidadores foram avaliados. Os idosos foram convidados a responder sobre condições sociodemográficas, QV (WHOQOL-100) e sintomatologia depressiva (BDI). Os cuidadores responderam os mesmos itens com relação a sua própria pessoa e também o WHOQOL-100 adaptado. Os dados mostraram uma tendência de o cuidador apresentar pior percepção de QV do idoso do que o próprio idoso cuidado. Apesar disso, observou-se concordância nos resultados de QV percebidos pelo idoso e na opinião do cuidador sobre a QV do idoso nos domínios físico, nível de independência, meio ambiente e espiritualidade/religião. A intensidade de depressão do idoso exerceu forte influência tanto na sua própria percepção de QV quanto na percepção do cuidador.
Collapse
|
37
|
Trentini CM, Xavier FMDF, Chachamovich E, Rocha NSD, Hirakata VN, Fleck MPDA. The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI). Rev Bras Psiquiatr 2005; 27:119-23. [PMID: 15962136 DOI: 10.1590/s1516-44462005000200009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE: To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS: Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS: Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS: Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.
Collapse
|
38
|
Abstract
OBJETIVOS: O objetivo deste estudo é verificar a efetividade do tratamento psicodinâmico em grupo de pacientes com fobia social generalizada. MÉTODOS: 30 pacientes foram incluídos em um estudo randomizado, simples-cego, comparando Terapia Psicodinâmica de Grupo (TPG) com um Grupo de Controle Placebo com Credibilidade (CPC). A TPG foi conduzida em 12 sessões de terapia de orientação psicodinâmica em grupo. Os pacientes do grupo controle receberam um pacote de aulas-discussões e tratamento de apoio por 12 semanas, que foi comparado à TPG. Todos os participantes preencheram a Escala de Liebowitz para Ansiedade Social (LSAS), a Escala Hamilton de Ansiedade (HAM-A) e a Escala de Impressão Clínica Global (CGI), na entrevista inicial e na 12ª semana de tratamento. Os dados foram analisados com uma ANOVA de medidas repetidas. Pacientes em vigência de tratamento farmacológico ou psicoterápico foram excluídos. RESULTADOS: Ambos os grupos apresentaram melhora na maioria das medidas. Na LSAS, os pacientes da TPG obtiveram melhora superior aos do grupo controle, ao cabo de 12 semanas (F1,28=4.84, p=0.036). Nas medidas basais dos sujeitos que completaram o estudo, não houve diferença entre os grupos em variáveis demográficas e de desfecho. CONCLUSÃO: Neste estudo, a TPG foi superior ao tratamento placebo com credibilidade no tratamento da fobia social generalizada, em um ensaio clínico randomizado, simples-cego, de 12 semanas.
Collapse
Affiliation(s)
- Daniela Zippin Knijnik
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVES Exploring the conditions that allow satisfactory quality of life in old age is an issue of scientific and social relevance. Thus, the objective of the study was to describe a quality of life assessment method for the elderly and present the results from focus groups conducted among old people in good health and ill health, as well as their caregivers. METHODS The methodology used in the WHOQOL-OLD project is the same as utilized in the development of other WHOQOL modules. Five focus groups were conducted in Brazil. The sampling procedure was done according to convenience. Eighteen old people and five caregivers took part in the focus groups. All the focus groups followed a pre-established methodology. RESULTS A tendency towards making an association between quality of life and wellbeing and feeling well was observed. The responses spontaneously included the 6 domains proposed in WHOQOL-100, thus corroborating the multidimensional nature of this construction. Nineteen out of the 24 original facets of this instrument were cited as relevant, and the five facets not spontaneously remembered were not concentrated in a single domain. When questioned about the importance of each of the 24 facets of WHOQOL-100, the groups considered all of them to be relevant. However, suggestions for modifications to five facets were made. Additional items were also examined and considered relevant for assessing quality of life among the elderly, by both the old people and the caregivers. CONCLUSIONS The results corroborate the hypothesis that old people constitute a particular group and, as such, they have relevant specific characteristics. Thus, an appropriate instrument for assessing quality of life among the elderly needs to consider such matters.
Collapse
|
40
|
Alcantara I, Schmitt R, Schwarzthaupt AW, Chachamovich E, Sulzbach MFV, Padilha RTDL, Candiago RH, Lucas RM. Avanços no diagnóstico do transtorno do humor bipolar. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0101-81082003000400004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atualmente, vemos transformações no diagnóstico do Transtorno de Humor Bipolar (THB). A prática clínica exige conhecimento mais detalhado da correlação THB - outras doenças psiquiátricas. Nessa revisão não-sistemática, foram abordados aspectos diagnósticos do THB: a) histórico, b) Espectro Bipolar, c) Depressão Atípica (DeA) e Disforia Histeróide, d) Estados Mistos, e) relação THB-Transtornos de Ansiedade, f) relação com o diagnóstico de Transtorno de Personalidade Borderline (TPB), g) contraponto ao conceito de espectro bipolar. A doença é conhecida desde a Grécia Antiga. Os estudos baseados nas publicações de Hagop Akiskal expandem o diagnóstico para além dos critérios usualmente utilizados, criando o conceito de espectro bipolar. A alta prevalência de comorbidade entre THB e Transtornos de Ansiedade corroboram que ambos compartilham o mesmo substrato neurobiológico. O debate demonstra que não há consenso, expondo a fragilidade dos nossos métodos diagnósticos. Entretanto, a revisão mostra a utilidade de sempre considerar o THB como diagnóstico diferencial.
Collapse
|
41
|
Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica 2000; 34:178-83. [PMID: 10881154 DOI: 10.1590/s0034-89102000000200012] [Citation(s) in RCA: 761] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The need of short instruments to evaluate Quality of life determines World Health Organization Quality of Life Group (WHOQOL Group) to develop an abbreviated version of the WHOQOL-100, the WHOQOL-bref. The objective is to present the Brazilian field trial of the WHOQOL-bref. METHODS WHOQOL-bref is composed by 26 questions divided in four domains: physical, psychological, social relationships and environment. The evaliation instrument, BDI (beck depression inventory) and BHS (beck hopelessness scale) were used in a 300 subjects sample in Porto Alegre, South Brazil. RESULTS/CONCLUSIONS The instrument showed a good performance concerning internal consistency, discriminant validity, criterion validity, concurrent validity and test-retest reliability. The intrument allies good psychometric performance and practicity for use which puts it as an interesting option to evaluate quality of life in Brazil.
Collapse
Affiliation(s)
- M P Fleck
- Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | | | | | | | | | | |
Collapse
|
42
|
Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. [Application of the Portuguese version of the instrument for the assessment of quality of life of the World Health Organization (WHOQOL-100)]. Rev Saude Publica 1999; 33:198-205. [PMID: 10413938 DOI: 10.1590/s0034-89101999000200012] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The WHOQOL group have developed an instrument to evaluate Quality of Life, the WHOQOL-100, available in 20 different languages (WHOQOL Group, 1998). The field trial of the portuguese version of the instrument is presented. METHODS Two hundred and fifty patients from four main medical areas (Psychiatry, Clinical, Surgery and Ginecology) of the Hospital de Clínicas de Porto Alegre and 50 controls were evaluated with the Portuguese version of the WHO Quality of Life Instrument (WHOQOL-100), Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS) in Porto Alegre, south Brazil. RESULTS AND CONCLUSION The instrument showed a good psychometric performance with good internal consistency, discriminant validity, criterion validity, concurrent validity and reliability. The authors conclude that the intrument is ready for use in Brazil, it being important to evaluate its performance in other regions and with different samples.
Collapse
Affiliation(s)
- M P Fleck
- Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
| | | | | | | | | | | | | |
Collapse
|
43
|
Fleck MPDA, Leal OF, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos LD, Pinzon V. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100). Rev Bras Psiquiatr 1999. [DOI: 10.1590/s1516-44461999000100006] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A Organização Mundial da Saúde desenvolveu um instrumento para avaliação de qualidade de vida através de um projeto colaborativo multicêntrico. São descritas a metodologia e as diferentes etapas de desenvolvimento do instrumento original. A seguir, é apresentado o desenvolvimento da versão em português. Através de uma metodologia própria foi realizada a tradução, discussão em grupos focais com membros da comunidade, pacientes e profissionais de saúde, seguida de retrotradução. O objetivo dos grupos focais foi discutir a adequação da tradução e da seleção de itens para avaliar qualidade de vida em uma cidade brasileira (Porto Alegre). O trabalho em grupo focal mostrou que o Instrumento de avaliação de Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-100) apresenta condições para aplicação no Brasil em sua versão original em português.
Collapse
|