Beatriz Franck Tavares

Prevalência do uso de drogas e desempenho escolar entre adolescentes

Correspondencia para/Correspondence to: Beatriz Franck Tavares Av. Dom Joaquim, 849 – Treptow 96020-260 Pelotas, RS, Brasil E-mail: bft@terra.com.br *Parte da dissertacao de mestrado apresentada ao Departamento de Medicina Social da Faculdade de Medicina da Universidade Federal de Pelotas, em 1999. Recebido em 27/7/2000. Reapresentado em 29/10/2000. Aprovado em 10/11/2000. Descritores Transtornos relacionados ao uso de substâncias psicoativas, epidemiologia. Adolescencia. Estudantes. Baixo rendimento escolar. Comportamento do adolescente. Prevalencia. Estudos transversais. Fatores socioeconomicos. Fatores epidemiologicos. Alcool. Tabaco. Maconha. Cocaina. Ansioliticos. – Abuso de substâncias. – Drogas. Desempenho escolar.OBJECTIVE To assess the prevalence of drug use among teenagers. METHODS A cross-sectional study was carried out in Pelotas, Southern Brazil, in 1998. An anonymous, self-administered questionnaire was answered by a sample of 2,410 students with ages ranging from 10 to 19 years old, registered in all public and private high schools of the area. The schools were visited up to three times to reach absent students. RESULTS The attrition rate was 8%. The substances mostly used by the students were alcohol (86.8%), tobacco (41.0%), marijuana (13.9%), inhalants (11.6%), anxiolytic drugs (8.0%), amphetamines (4.3%), and cocaine (3.2%). Marijuana, inhalants and cocaine were used mainly by male students, while anxiolytics and amphetamines were used mainly by female students. Alcohol consumption in the last 30 days, frequent drug use, heavy drinking and alcohol intoxication were more prevalent among males. After controlling for confounding factors, there was still an association between drug use (except for alcohol and tobacco) and evening courses, higher degree of nonattendance in the previous month and higher rate of school failure. CONCLUSIONS The prevalence of drug experimentation among high school teenagers is high, indicating the importance of early detection of risk groups and development of programs to prevent drug abuse and addiction.

Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study

The aim of this study was to evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening and diagnosis of postpartum depression. Three months after delivery, EPDS was administered to 378 mothers from the 2004 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. Up to 15 days later, mothers were re-interviewed by mental health care professionals using a semi-structured interview based on ICD-10 (gold standard). We calculated the sensitivity and specificity of each cutoff point, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening postpartum depression was > 10, with 82.6% (75.3-89.9%) sensitivity and 65.4% (59.8-71.1%) specificity. For screening moderate and severe cases, the best cutoff point was > 11, with 83.8% (73.4-91.3%) sensitivity and 74.7% (69.4-79.5%) specificity. For diagnosis, EPDS was valid only for prevalence of postpartum depression in the 20-25% range, with 60% PPV for the > 13 cutoff point (59.5% sensitivity; 88.4% specificity). The specificities and PPVs for all cutoff points were below those reported by other authors. Small numbers and the calculation of PPV in samples with overrepresentation of cases in the majority of studies appear to account for these differences.

Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral

Com o objetivo de estudar a validade do Patient Health Questionnaire-9 (PHQ-9) no rastreio de episodio depressivo maior na populacao geral, conduziu-se um estudo de base populacional em Pelotas, Rio Grande do Sul, Brasil. Os domicilios foram sorteados por amostragem em multiplos estagios, sendo os adultos (> 20 anos) convidados a participar. O padrao ouro foi a entrevista diagnostica estruturada Mini International Neuropsychiatric Interview (MINI) aplicada por psiquiatras e psicologos. Tanto o PHQ-9 quanto o MINI foram aplicados no domicilio. Em um total de 447 participantes (191 homens e 256 mulheres) a analise continua identificou o ponto de corte > 9 como de maxima sensibilidade (77,5%; 61,5-89,2) e especificidade (86,7%; 83,0-89,9). Usando o algoritmo do teste, houve diminuicao da sensibilidade para 42,5% (27,0-59,1), enquanto que a especificidade aumentou para 95,3% (92,8-97,2). O PHQ-9 mostrou-se apropriado para rastreamento de episodio depressivo maior. Pela maior sensibilidade, o PHQ-9 pontuado de forma continua mostrou-se mais adequado do que o algoritmo para rastreamento de episodio depressivo maior na comunidade.Con el objetivo de evaluar la validez del Cuestionario de Salud del Paciente-9 (PHQ-9) en la deteccion de un episodio depresivo mayor en la poblacion general, se llevo a cabo un estudio de base poblacional en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Los hogares se seleccionaron al azar a traves de muestreo multietapico, siendo solo invitados a participar los adultos (> 20 anos). El padron de primer orden fue la Mini Entrevista Neuropsiquiatrica Internacional (MINI), aplicada por psiquiatras y psicologos. Ambos instrumentos fueron aplicados en la casa del participante. De un total de 447 participantes (191 hombres y 256 mujeres), el analisis continuo mostro un punto de corte > 9 como el de maxima sensibilidad (77,5%; 61,5-89,2) y especificidad (86,7%; 83,0-89,9) para la identificacion de un episodio depresivo mayor. Al utilizar el algoritmo del test, la sensibilidad disminuyo a un 42,5% (27,0-59,1), mientras que la especificidad aumento a un 95,3% (92,8-97,2). El PHQ-9 mostro ser adecuado para el cribado de un episodio depresivo mayor. Debido a la sensibilidad mas alta, el PHQ-9 marcado como una variable continua fue mas adecuado que el algoritmo para la deteccion de episodio depresivo mayor en la comunidad.

Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population

Com o objetivo de estudar a validade do Patient Health Questionnaire-9 (PHQ-9) no rastreio de episodio depressivo maior na populacao geral, conduziu-se um estudo de base populacional em Pelotas, Rio Grande do Sul, Brasil. Os domicilios foram sorteados por amostragem em multiplos estagios, sendo os adultos (> 20 anos) convidados a participar. O padrao ouro foi a entrevista diagnostica estruturada Mini International Neuropsychiatric Interview (MINI) aplicada por psiquiatras e psicologos. Tanto o PHQ-9 quanto o MINI foram aplicados no domicilio. Em um total de 447 participantes (191 homens e 256 mulheres) a analise continua identificou o ponto de corte > 9 como de maxima sensibilidade (77,5%; 61,5-89,2) e especificidade (86,7%; 83,0-89,9). Usando o algoritmo do teste, houve diminuicao da sensibilidade para 42,5% (27,0-59,1), enquanto que a especificidade aumentou para 95,3% (92,8-97,2). O PHQ-9 mostrou-se apropriado para rastreamento de episodio depressivo maior. Pela maior sensibilidade, o PHQ-9 pontuado de forma continua mostrou-se mais adequado do que o algoritmo para rastreamento de episodio depressivo maior na comunidade.Con el objetivo de evaluar la validez del Cuestionario de Salud del Paciente-9 (PHQ-9) en la deteccion de un episodio depresivo mayor en la poblacion general, se llevo a cabo un estudio de base poblacional en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Los hogares se seleccionaron al azar a traves de muestreo multietapico, siendo solo invitados a participar los adultos (> 20 anos). El padron de primer orden fue la Mini Entrevista Neuropsiquiatrica Internacional (MINI), aplicada por psiquiatras y psicologos. Ambos instrumentos fueron aplicados en la casa del participante. De un total de 447 participantes (191 hombres y 256 mujeres), el analisis continuo mostro un punto de corte > 9 como el de maxima sensibilidad (77,5%; 61,5-89,2) y especificidad (86,7%; 83,0-89,9) para la identificacion de un episodio depresivo mayor. Al utilizar el algoritmo del test, la sensibilidad disminuyo a un 42,5% (27,0-59,1), mientras que la especificidad aumento a un 95,3% (92,8-97,2). El PHQ-9 mostro ser adecuado para el cribado de un episodio depresivo mayor. Debido a la sensibilidad mas alta, el PHQ-9 marcado como una variable continua fue mas adecuado que el algoritmo para la deteccion de episodio depresivo mayor en la comunidad.

Validation of the Edinburgh postnatal depression scale (EPDS) for screening of major depressive episode among adults from the general population

BackgroundStandardized questionnaires designed for the identification of depression are useful for monitoring individual as well as population mental health. The Edinburgh Postnatal Depression Scale (EPDS) has originally been developed to assist primary care health professionals to detect postnatal depression, but several authors recommend its use outside of the postpartum period. In Brazil, the use of the EPDS for screening depression outside the postpartum period and among non-selected populations has not been validated. The present study aimed to assess the validity of the EPDS as a screening instrument for major depressive episode (MDE) among adults from the general population.MethodsThis is a validation study that used a population-based sampling technique to select the participants. The study was conducted in the city of Pelotas, Brazil. Households were randomly selected by two stage conglomerates with probability proportional to size. EPDS was administered to 447 adults (≥20 years). Approximately 17 days later, participants were reinterviewed by psychiatrics and psychologists using a structured diagnostic interview (Mini International Neuropsychiatric Interview, MINI). We calculated the sensitivity and specificity of each cutoff point of EPDS, and values were plotted as a receiver operator characteristic curve.ResultsThe best cutoff point for screening depression was ≥8, with 80.0% (64.4 - 90.9%) sensitivity and 87.0% (83.3 - 90.1%) specificity. Among women the best cutoff point was ≥8 too with values of sensitivity and specificity of 84.4% (67.2 – 94.7%) and 81.3% (75.5 – 86.1%), respectively. Among men, the best cutoff point was ≥7 (75% sensitivity and 89% specificity).ConclusionsThe EPDS was shown to be suitable for screening MDE among adults in the community.

Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression

The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most used worldwide for screening of Post-Partum Depression (PPD). The SRQ20 questionnaire has been largely used for screening of minor psychiatric disorders. This study aimed to compare the accuracy of the two instruments in screening for PPD. At the third-month follow-up home visit to infants of the 2004 Pelotas Birth Cohort, Southern Brazil, a sub-sample of 378 mothers was selected. Among other questions, EPDS and SRQ20 were applied by trained fieldworkers. Up to 15 days later, a mental health professional re-interviewed the mother (the gold standard interview). Sensitivity and specificity of each cutoff point were calculated for EPDS and SRQ20 and the results were plotted at a ROC curve. The areas under both curves were compared. Highest sensitivity and specificity cutoff were observed for EPDS ≥ 10 (sensitivity 82.7%, 95%CI 74.0 – 89.4; specificity 65.3%, 95%CI 59.4 – 71.0) and for SRQ20 ≥ 6 (sensitivity 70.5%, 95%CI 60.8 – 79.0%; specificity 75.5%, 95%CI 70.0 – 80.5%). Shape of ROC curves and areas under both curves were virtually identical (respectively, 0.8401 ± 0.02 for EPDS and 0.8402 ± 0.02 for SRQ20; p = 0.9). In conclusion SRQ20 showed to be as valid as EPDS as a screening tool for PPD at third month after delivery.

Countertransference and therapeutic alliance in the early stage of adult psychodynamic psychotherapy

OBJECTIVES The primary objective of this study was to assess the relationship between countertransference (CT) and therapeutic alliance (TA) during the early stages of psychodynamic psychotherapy. A secondary objective is to assess associations between CT and variables related to therapist and patient and between CT and other patient variables investigated, which were defense mechanisms, symptomology and functionality. METHODOLOGY This was a cross-sectional study that enrolled 30 patients treated by 17 different therapists at the psychotherapy clinics of two psychiatry centers. Assessments of each patient-therapist pair were conducted between their fourth and 10th sessions. RESULTS The CT distance domain exhibited a moderate negative correlation with TA, particularly its sub-dimension representing the patients capacity for work in therapy. Moderate positive correlations were observed between CT distance and the splitting defense mechanism and between CT closeness and suppression defenses, in addition to moderate negative correlation between CT indifference and the fantasy defense mechanism. Another finding was higher scores for CT indifference in association with socioeconomic classes D and E. CONCLUSIONS The quality of CT may provide a source of information about TA. A high degree of CT distance represents a low level of TA, particularly with relation to the patients working capacity, although presence of the splitting defense mechanism can affect CT, to the extent that it constitutes a confounding variable. The concept of CT is useful to psychotherapists, providing a source of information about the patients internal world and about certain elements of therapy, such as the quality of TA, which is important for good treatment results.

Sensibilidad y especificidad del Cuestionario de Salud del Paciente-9 (PHQ-9) entre adultos de la población general

Com o objetivo de estudar a validade do Patient Health Questionnaire-9 (PHQ-9) no rastreio de episodio depressivo maior na populacao geral, conduziu-se um estudo de base populacional em Pelotas, Rio Grande do Sul, Brasil. Os domicilios foram sorteados por amostragem em multiplos estagios, sendo os adultos (> 20 anos) convidados a participar. O padrao ouro foi a entrevista diagnostica estruturada Mini International Neuropsychiatric Interview (MINI) aplicada por psiquiatras e psicologos. Tanto o PHQ-9 quanto o MINI foram aplicados no domicilio. Em um total de 447 participantes (191 homens e 256 mulheres) a analise continua identificou o ponto de corte > 9 como de maxima sensibilidade (77,5%; 61,5-89,2) e especificidade (86,7%; 83,0-89,9). Usando o algoritmo do teste, houve diminuicao da sensibilidade para 42,5% (27,0-59,1), enquanto que a especificidade aumentou para 95,3% (92,8-97,2). O PHQ-9 mostrou-se apropriado para rastreamento de episodio depressivo maior. Pela maior sensibilidade, o PHQ-9 pontuado de forma continua mostrou-se mais adequado do que o algoritmo para rastreamento de episodio depressivo maior na comunidade.Con el objetivo de evaluar la validez del Cuestionario de Salud del Paciente-9 (PHQ-9) en la deteccion de un episodio depresivo mayor en la poblacion general, se llevo a cabo un estudio de base poblacional en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Los hogares se seleccionaron al azar a traves de muestreo multietapico, siendo solo invitados a participar los adultos (> 20 anos). El padron de primer orden fue la Mini Entrevista Neuropsiquiatrica Internacional (MINI), aplicada por psiquiatras y psicologos. Ambos instrumentos fueron aplicados en la casa del participante. De un total de 447 participantes (191 hombres y 256 mujeres), el analisis continuo mostro un punto de corte > 9 como el de maxima sensibilidad (77,5%; 61,5-89,2) y especificidad (86,7%; 83,0-89,9) para la identificacion de un episodio depresivo mayor. Al utilizar el algoritmo del test, la sensibilidad disminuyo a un 42,5% (27,0-59,1), mientras que la especificidad aumento a un 95,3% (92,8-97,2). El PHQ-9 mostro ser adecuado para el cribado de un episodio depresivo mayor. Debido a la sensibilidad mas alta, el PHQ-9 marcado como una variable continua fue mas adecuado que el algoritmo para la deteccion de episodio depresivo mayor en la comunidad.