Diogo Frasquilho Guerreiro

Mental health outcomes in times of economic recession: a systematic literature review

BackgroundCountries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations’ health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes.MethodsLiterature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered.ResultsOne-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours.ConclusionOn the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.

Association between deliberate self-harm and coping in adolescents: a critical review of the last 10 years' literature.

Coping is commonly associated with deliberate self-harm (DSH) in adolescents. This article reviews the published literature from 2000 to 2010, aiming to highlight the current evidence supporting this association. Eighteen studies met the inclusion criteria, a total sample of 24,702 subjects was obtained and 17% were DSH cases. Emotion-focused coping style and in particular avoidant coping strategies have consistently been associated with DSH in adolescents. Problem-focused coping style seems to have a negative relation. Most studies were cross-sectional, which seriously limits our conclusions on causality. There is a clear need for more systematic studies, performed in accordance with consensual methodology.

Coping Strategies in Adolescents Who Self-Harm

BACKGROUND Adolescent self-harm (SH) is a major public health concern, associated with poor outcomes. The use of ineffective coping is often referred to in explanatory models of adolescent SH. AIMS To assess the relationship between SH and coping strategies in a large sample of school-aged adolescents. METHOD A sample of public school students (n = 1,713), aged between 12 and 20 years, were examined using an anonymously completed questionnaire. SH was defined according to strict criteria through a two-stage procedure. Study participants were divided into two groups: no self-harm and lifetime self-harm. The differences between groups were explored, including logistic regression analyses (controlling for anxiety and depression effects), to reveal which coping strategies better predicted lifetime SH. RESULTS The use of nonproductive strategies was associated with SH in both genders, particularly self-blame and tension reduction. Strategies involving consulting significant others for support were used less in the SH group, especially among male subjects. The preferential use of a productive coping style was negatively associated with the SH group in both genders. CONCLUSION The results support previous data regarding a different pattern of coping strategies used by adolescents who harm themselves. The use of self-rating instruments and the cross-sectional nature of the study limit our results.

Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal

Deliberate self-harm (DSH) among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal), using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years). The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression) in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.

Self-harm in adolescents: a self-report survey in schools from Lisbon, Portugal

The study aims to determine the prevalence of self-harm (SH) and related psychosocial factors in a large sample of Portuguese adolescents. A total of 1,713 pupils, aged 12 to 20 years, completed an anonymous questionnaire in a school setting. In all, 7.3% reported at least 1 episode of SH: rates were 3 times higher for females than males. Almost half reported repeated SH, most commonly self-cutting. Anxiety, depression, and substance abuse were linked to SH, and particularly repeated SH. Anxiety, trouble with the police, and exposure to SH or suicide of others, were independently associated with SH in both genders. These findings indicate that SH is a public health concern in Portugal as in other European countries.

Attention-deficit hyperactivity disorder in adults: implications to forensic medicine.

Attention-deficit hyperactivity disorder (ADHD) in adults has been associated to a higher probability of problems with justice. Studies in prison populations disclosed higher prevalence of this disturbance. ADHD association with personality disorders and higher substance abuse could partially help in the explanation of this phenomenon. Based in a literature review, the authors present a reflection on the possible implications of the ADHD diagnosis to Forensic Medicine. After a brief review of the clinical aspects, epidemiology, etiology and nosology of ADHD, its repercussions in the sphere of justice are analysed, namely the prevalence of associated criminality, risk factors and the co-morbidity with personality disorders and substance abuse. These elements are used as a base to the discussion of the results and to a subsequent reflection on the question of (in)imputability related with this disorder.

P02-103 Psychiatric inpatient readmission in a general hospital: Preliminary report of a two years observational study

Introduction Studying inpatient clinical populations features allows a better understanding of readmissions. Factors associated with higher levels of readmission may give clues concerning better treatment planning and follow-up. Objectives To detect psychosocial and clinic factors associated with readmissions in an inpatient general psychiatric population. Method 107 patients consecutively admitted to an inpatient unit were characterized in terms of psychosocial, clinical, treatment and discharge plan features. Readmission was defined as the number of previous admittances in the last two years. Results Patients characteristics: Average age 44 (SD: 16); 58% female; 10 (SD:5) years of education; average disease duration of 128 (SD:115) months. Main diagnosis: 30,8% schizophrenia; 14% bipolar I disorder; 13,1% major depression; 11,2% recurrent major depression; 5,6% cluster B personality; 3,8% bipolar II disorder and 2,9% schizoaffective disorder. From more to less frequent diagnosis implicated in readmissions were schizophrenia, schizoaffective disorder, recurrent major depression, bipolar I, bipolar II and major depression episode. Readmissions were not associated with inpatient treatment or disease duration, nor toxics or axis II diagnosis. Nonetheless, beginning a depot antipsychotic medication was related to an increase in previous admissions. Conclusion These are preliminary results of a small sample, but they point towards the usefulness of a systematic evaluation of inpatient populations, mainly in what concerns complex clinical situations like major pathology readmissions.