Sergio Luis Blay

Social support is considered a protective factor against depression, but there are inconsistent findings regarding social support and depression in older adults. We aimed to clarify the association between emotional and instrumental social support and depressive symptoms in older adults cross-sectionally and longitudinally (mean follow-up = 1.96 years). We meta-analyzed raw individual participant level data from adults in mid- and late-life (N = 23,973) who completed questionnaires about physical health, mental health, and social support and completed neuropsychological assessments. These were COSMIC (Cohort Studies of Memory in an International Consortium) cohort studies carried out in Australia, Brazil, China, Germany, Greece, India, Indonesia, Singapore, South Korea, Sweden, and the United States in mostly urban settings. After controlling for depression risk factors, emotional support (B = -0.40, 95%CI: -0.60,-0.21), but not instrumental support (B = 0.17, 95%CI: -0.26,0.59), was associated with lower depressive symptoms cross-sectionally and at follow-up [emotional support (B = -0.37, 95%CI: -0.54,-0.20); instrumental support (B = 0.09, 95%CI: -0.30,0.49)]. Emotional support was associated with lower depressive scores cross-sectionally and longitudinally, while instrumental support was not associated with depressive symptoms. Our findings can help inform the nature of interventions to prevent and reduce risk of depression among older adults.

To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox's proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.

Background Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population. Methods We included a total of 1,183 community‐dwelling older adults, divided into four groups: “neither diabetes nor depression”; “diabetes only”; “depression only,” and “both diabetes and depression,” and followed‐up for a median of 13.5 years. We evaluated the inflammatory status by the high‐sensitivity C‐reactive protein (hs‐CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs‐CRP. Results Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59–3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56–2.76 HR depression: 1.26; 95% CI: 1.03–1.54). High level of hs‐CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni‐adjusted p = 0.0116). Conclusions The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

Objectives: To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates. Design: Cross‐sectional data were collected in face‐to‐face assessments. Setting: São Paulo and Rio de Janeiro, Brazil. Participants: Individuals aged 60 to 75. Measurements: Information on elder abuse was obtained using the Brazil‐adapted, nine‐item Hwalek‐Sengstock Elder Abuse Screening Test. Sampling design–adjusted descriptive statistics and logistic regression were used in analyses. Results: The overall prevalence of abuse was 14.4% (n = 46/259, 95% confidence interval ( CI ) = 9.82–20.61) in São Paulo and 13.3% (n = 27/197, 95% CI = 8.76–19.74) in Rio de Janeiro. Unadjusted analyses indicated that poor education, low physical activity, unemployment, heart disease, and psychiatric problems were associated with abuse, but in adjusted analyses, self‐reported elder abuse was significantly associated only with psychiatric problems (São Paulo: OR = 4.48, 95% CI = 1.75–11.45; Rio de Janeiro: OR = 21.61, 95% CI = 6.39–73.14). Conclusion: Elder abuse is prevalent in São Paulo and Rio de Janeiro, but whether concomitants of abuse are cause, effect, or both is unclear because this was a cross‐sectional study. These findings highlight the importance of the problem, as well as the need to develop measures to increase awareness, facilitate prevention, and fight against abuse of elderly adults.

Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis Sergio Luís Blay,1 João Vicente Augusto Aguiar,2 Ives Cavalcante Passos3 1Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina – UNIFESP), São Paulo, SP, Brazil; 2Department of Psychiatry, Fortaleza University, Fortaleza, Ceará, Brazil; 3Laboratory of Molecular Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil Background: The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. Methods: PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive–compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. Results: Six studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.76; 95% confidence interval (CI) 1.26 to 6.02; Log OR =1.013; P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P<0.001). Conclusion: Anxiety and depression symptoms are more prevalent in patients with PCOS. Keywords: polycystic ovary syndrome, depression, anxiety, epidemiological survey, meta-analysis, systematic review

While the personal characteristics of users of psychotherapy and/or psychotropic medications have been examined, direct user comparison of these treatment approaches appears to be rare. Our aim is to ascertain extent of receipt of these services, and identify basic distinguishing characteristics of users. Information on demographics, lifetime and past 12 month use of mental health services, and presence of common mental disorders (CMD), was gathered in 2002 using a multi-stage sampling procedure that yielded a population-representative, community-resident sample (N = 2000, age 18–65) for São Paulo, Brazil. Analysis used descriptive statistics and logistic regression. Overall, 9.3 % reported receiving psychotherapy and/or psychotropic medication, 54.3 % of whom did not meet CMD criteria. Of those meeting criteria for CMD (n = 455, 22.8 %), 2.9 % reported only psychotherapy, 10.1 % reported only psychotropic medication, and 5.7 % reported both. CMD was associated with use of psychotropic medication (psychotropic medication alone, Odds Ratio (OR) 3.58, 95 % CI 2.33–5.52; together with psychotherapy, OR 4.17, 95 % CI 2.34–7.44). CMD was not associated with use of psychotherapy. Users’ distinguishing characteristics were: psychotherapy only—not married; psychotropics only—increasing age, female, not married; using both—only CMD status. Neither education nor income was associated with use. Nearly 10 % of all community residents age 18–65, but less than a fifth of the 23 % with CMD, received psychotherapy and/or psychotropic medication. Non-married status increased odds of all treatment types, but CMD presence increased only odds of psychotropic and combined psychotherapy/psychotropic use, with odds of psychotropic only use increasing with age, and for women. Use was equitable with respect to education and income.

Background: Few studies have examined the impact of the built environment (BE) on health behaviours and health outcomes in middle income countries. This study examines associations between self-assessed characteristics of the home and neighbourhood environment and health-related behaviours and health outcomes in an elderly population in Brazil Design and methods: In a community sample of 6963 community dwellers 60 years old and older living in the state of Rio Grande do Sul, Brazil, associations between self-reported BE conditions and health behaviours and health outcomes were assessed using a structured questionnaire. Multivariate analysis was conducted to investigate these associations while accounting for other relevant characteristics. Results: We found significant positive associations between adverse BE conditions and pulmonary, urinary conditions, gastrointestinal, problems, headache and depression. There were mixed associations between adverse BE conditions and musculoskeletal and sensory conditions, inverse associations with metabolic disorders. and no associations with dermatologic problems and cancer. After accounting for health related behaviours, results suggest a modest association between adverse BE conditions and hypertension, with no significant associations with other indicators of cardiovascular conditions (heart problems, stroke, varicose veins). Conclusions: The findings in this study suggest links between adverse conditions in the BE and health related behaviours in the hypothesized direction. Associations with the health conditions examined here are mixed. We find the strongest evidence for effects of adverse BE conditions for pulmonary and infectious conditions. Significant associations between the adverse BE indicators and health outcomes persist after accounting for health related behaviours, suggesting that BE conditions are linked to health pathways above and beyond the health related behaviours assessed in this study.