David Richer Araujo Coelho

This narrative review aimed to synthesize the instruments used to evaluate psychiatry resident well-being. A search was conducted across PubMed, ERIC, and PsycINFO on August 24, 2024. Studies were included if they involved psychiatry residents and reported outcomes utilizing either validated instruments or sufficient methodological detail on tools developed by the residency program. Domains of interest included mental health symptoms, stress, burnout, engagement, quality of life, social support, and behavioral risk factors. Thirteen studies from six countries met inclusion criteria. Eight used at least one validated instrument, and five employed surveys developed by their residency programs. Sixteen validated tools were identified: the Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory-II (BDI-II), Primary Care Evaluation of Mental Disorders (PRIME-MD), Kessler Psychological Distress Scale (K6), Perceived Stress Scale (PSS), Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN), Copenhagen Burnout Inventory (CBI), Oldenburg Burnout Inventory (OLBI), Utrecht Work Engagement Scale (UWES), Multicultural Quality of Life Index (MQLI), Interpersonal Support Evaluation List (ISEL), Stephenson Multigroup Acculturation Scale, Symptom Checklist-90 (SCL-90), Alcohol Use Disorders Identification Test (AUDIT), and the Fagerström Test for Nicotine Dependence. Internal consistency across instruments was generally strong (α ≥ 0.70). Surveys developed by residency programs often lacked psychometric reporting, limiting comparability. Psychiatry residency programs have access to a diverse set of validated instruments for assessing resident well-being. However, inconsistent usage, limited validation of locally developed tools, and lack of longitudinal assessments highlight the need for standardized frameworks to inform well-being assessment and institutional changes within psychiatry residency programs.

Objectives. To examine the associations between discrimination, violence, and suicidality among travestis and transgender women in Brazil. Methods. We analyzed baseline data from the Transcendendo cohort (2015–2023) in Rio de Janeiro, Brazil, which enrolled travestis and transgender women aged 18 years and older. We assessed lifetime discrimination by using an 8-item scale reflecting transgender-related mistreatment experiences. We also measured physical and sexual violence, sociodemographics, and psychosocial factors. We categorized suicidality as no ideation, ideation only, and ideation with attempts, analyzed using a multivariable ordinal regression model. Results. Among 662 participants, lifetime discrimination (adjusted odds ratio [AOR] = 1.21; 95% confidence interval [CI] = 1.11, 1.32; P < .001) and lifetime sexual assault (AOR = 1.60; 95% CI = 1.17, 2.19; P = .003) were significantly associated with increased odds of suicidality. Participants with positive body self-satisfaction, HIV, and increasing age had lower odds of suicidality. Conclusions. Our findings highlight the need for antidiscriminatory policies and health services tailored to the needs of this community to mitigate suicidality risk among travestis and transgender women in Brazil. ( Am J Public Health. Published online ahead of print December 4, 2025:e1–e9. https://doi.org/10.2105/AJPH.2025.308280 )

Public and Community Psychiatry training prepares residents to care for underserved populations, including people with severe mental illness (SMI), people

Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities (n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System (Sistema Único de Saúde–SUS), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care.

Cognitive behavioral therapy has emerged as a promising intervention to enhance antiretroviral therapy adherence among people living with HIV. Here we conducted a systematic review and meta-analysis to evaluate the efficacy of cognitive behavioral therapy to improve antiretroviral therapy adherence, HIV viral load, viral suppression and CD4 counts. A total of 20 randomized controlled trials involving 1,739 people living with HIV were included, with most of the studies categorized as having low risk of bias. We show that cognitive behavioral therapy was associated with improved antiretroviral therapy adherence, with more pronounced effects for people living with HIV with psychiatric comorbidities and in studies conducted in low- and middle-income countries. No statistically significant findings were observed for HIV viral load, viral suppression or CD4 counts. These findings support the efficacy of cognitive behavioral therapy in enhancing antiretroviral therapy adherence, particularly for those with psychiatric comorbidities and in low- and middle-income countries. However, the impact of cognitive behavioral therapy on HIV viral load, viral suppression and CD4 counts remains inconclusive.

Introduction: Bipolar disorder (BD) is frequently associated with cognitive dysfunction, which can significantly impact the quality of life and functional recovery of affected individuals. Growing evidence suggests that inflammation may contribute to the cognitive dysfunction observed in BD. Methods: We conducted a systematic review following PRISMA guidelines, searching six databases on March 23, 2023 (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, and ClinicalTrials.gov ), with the aim of identifying studies that examined the relationship between peripheral or central inflammatory markers and cognitive function in adults with BD. Studies involving animals, abstracts, protocols, reviews, and non‐English publications were excluded. The quality of included studies was assessed using the Risk of Bias in Non‐Randomized Studies—of Exposure (ROBINS‐E). A narrative synthesis was completed, stratifying results based on the associations between inflammatory markers and cognitive domains in BD. The review protocol was pre‐registered in PROSPERO (CRD42023415437). Results: Out of 2680 identified records, 25 studies involving 3567 adults with BD (mean age: 43.6 years; 1839 females and 1728 males) met the inclusion criteria. Seventeen studies were classified as low risk of bias, seven as having some concerns, and one as high risk. Elevated levels of C‐reactive protein (CRP), tumor necrosis factor‐alpha (TNF‐α), interleukin‐6 (IL‐6), and interleukin‐1 receptor antagonist (IL‐1Ra) were most commonly associated with cognitive dysfunction in domains such as executive function, processing speed, and memory. Findings for other inflammatory markers were less consistent. Most studies relied on cross‐sectional designs, which limit causal interpretations. Conclusion: This review found a consistent association between inflammation and cognitive dysfunction in BD, particularly involving CRP, TNF‐α, IL‐6, and IL‐1RA in areas such as executive function, processing speed, and memory. Targeting inflammation may offer a promising approach to mitigating these cognitive challenges. Future studies should prioritize longitudinal designs, standardized cognitive assessments, and the exploration of central inflammatory markers to better understand the neurobiological processes underlying cognitive dysfunction in BD. These findings may help inform the development of adjunctive anti‐inflammatory strategies to support cognitive health in individuals with BD.

Transcranial photobiomodulation (t-PBM) with near-infrared (NIR) light has emerged as a promising therapy for major depressive disorder (MDD). However, the dose-dependent tolerability of t-PBM has not been adequately explored. This secondary analysis of a sham-controlled clinical trial evaluated the safety and tolerability of t-PBM across varying doses in 31 subjects with MDD. Participants were randomly assigned to receive four sessions of NIR (808 nm) t-PBM (sham, low, medium, and high doses) approximately one week apart. The outcome was the emergence of side effects, assessed by the Systematic Assessment for Treatment-Emergent Effects-Specific Inquiry (SAFTEE-SI) scale. The frequency of side effects, compared to baseline or the prior week, was analyzed using Cochran’s Q test. Additionally, body weight and systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded and assessed with repeated measures ANOVA. The results showed no statistically significant changes in rates of any adverse events compared to baseline or prior week. The most notable rate increases were in “delayed or absent orgasm” for the medium dose compared to baseline among 10% of participants (Cochran’s Q = 6.231; p = 0.101), and in “ringing in ears or trouble hearing” for the high dose compared to the prior week among 13% of participants (Cochran’s Q = 6.231; p = 0.101). There were no significant changes in weight or SBP and DBP (F_{(4, 85)} = 0.277, p = 0.892; F_{(4, 87.45)} = 1.722, p = 0.152; F_{(4, 87.10)} = 1.672, p = 0.164, respectively). In conclusion, this study did not find a significant association between the dose of t-PBM sessions and rates of adverse events or changes in vital signs. The side-effect profile of t-PBM appears benign, regardless of dosimetry.

Background: Transcranial photobiomodulation (t-PBM) is a promising non-invasive therapy for Major Depressive Disorder (MDD). MDD is associated with altered brain metabolism, including changes in N-acetylaspartate (NAA), choline (Cho), and creatine (Cr). This study assessed the effects of varying t-PBM doses on neurometabolite levels in the dorsolateral prefrontal cortex (dlPFC) and their correlations with clinical outcomes. Methods: In this randomized, sham-controlled, cross-over study, 33 adults with MDD received one session of t-PBM at low, medium, and high doses and a sham treatment. Proton magnetic resonance spectroscopy (1H-MRS) measured NAA, Cho, and Cr pre- and post-treatment. Clinical outcomes were assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Symptoms of Depression Questionnaire (SDQ). Statistical analyses included paired t-tests or Wilcoxon signed-rank tests for neurometabolite changes, and linear mixed-effects regression models for t-PBM dose, neurometabolites, and time effects. Results: NAA levels increased significantly (7.52 ± 0.777 to 8.12 ± 1.05 mmol/L for one session; 7.36 ± 0.85 to 7.85 ± 0.68 mmol/L across all sessions); however, these changes were not associated with specific t-PBM doses or sham. No significant changes were observed for Cho and Cr levels. Positive correlations were found between Cho levels and MADRS scores (r = 0.59, p = 0.017), and negative correlations between Cr levels and SDQ scores at the medium dose (r = −0.91, p = 0.011). Conclusions: While NAA levels increased, and correlations between neurometabolites and clinical outcomes were observed, these findings do not suggest a specific effect of t-PBM. Larger randomized controlled trials with optimized dosing protocols, extended follow-up, and advanced spectroscopy are needed to clarify the neurometabolic therapeutic potential of t-PBM in MDD.

Importance: Obsessive-compulsive and related disorders (OCRDs) encompass various neuropsychiatric conditions that cause significant distress and impair daily functioning. Although standard treatments are often effective, approximately 60% of patients may not respond adequately, underscoring the need for novel therapeutic approaches.Objective: To evaluate improvement in OCRD symptoms associated with glutamatergic medications as monotherapy or as augmentation to selective serotonin reuptake inhibitors, with a focus on double-blind, placebo-controlled randomized clinical trials (RCTs).Data Sources: Electronic searches were conducted in PubMed, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials on October 16, 2024, without date limits.Study Selection: Two investigators independently screened records to identify double-blind RCTs comparing glutamatergic medications with placebo for patients with OCRDs regardless of age, sex, gender, or refractoriness. Abstracts, study protocols, non-English studies, and trials involving augmentation to psychotherapy were excluded.Data Extraction and Synthesis: Data were extracted and synthesized using random-effects meta-analyses. Subgroup analysis was conducted based on type of OCRD, population, refractoriness of OCRD, augmentation strategy, risk of bias, and type of glutamatergic medication. Sensitivity analysis was performed using a leave-one-out approach.Main Outcomes and Measures: Improvement in OCRD symptoms was measured by standardized mean difference (Cohen d). Improvement in obsessive-compulsive disorder (OCD) symptoms was measured by mean difference (reduction in Yale-Brown Obsessive Compulsive Scale [Y-BOCS] scores).Results: A total of 27 RCTs (1369 participants; mean [SD] age, 31.5 [7.8] years; 65.6% female) were included. Glutamatergic medications showed a large effect size in improving OCRD symptoms (Cohen d = −0.80 [95% CI, −1.13 to −0.47]; low certainty of evidence). In the 23 OCD-specific RCTs, glutamatergic medications demonstrated a significant mean reduction in Y-BOCS scores (mean difference, −4.17 [95% CI, −5.82 to −2.52]; moderate certainty of evidence).Conclusions and Relevance: These findings indicate that glutamatergic medications may be effective in treating OCRDs, particularly OCD. However, high heterogeneity and potential publication bias necessitate cautious interpretation. Further research with larger sample sizes is needed to explore dose-dependent effects, additional OCRD subtypes, and other promising glutamatergic medications.