Rinaldo Artes

Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation

Objectives: To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy.Design: Longitudinal cohort study.Setting: Jundiaí city, São Paulo state, Brazil.Subjects: A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000.Methods: Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA ≤10th percentile of Williams curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models.Results: Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%.Conclusions: The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.Sponsorship: Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP (grant no. 1998/00321-0).

Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students

The psychometric properties of the Portuguese version of the Beck Depression Inventory were studied on a large Brazilian college student sample (N= 1,080; 845 women, 235 men). The BDI scores according to sociodemographic characteristics and mean individual item scores for total sample and by gender were compared. BDI scores tend to be higher for women, for those who work, and for the younger participants. The reliability of the inventory estimated by alpha coefficient was high for the total sample (.86) and subgroups. Factor analysis showed three factors for the total sample (low self-esteem, cognitive-affective, and somatic) and two for each gender. Women combined affective and low self-esteem whereas men combined somatic and low self-esteem in the same dimension. Discriminant analysis showed that BDI highly discriminates depressive symptomatology in college students and measures specific aspects of depression.

Self-reported and neuropsychological measures of impulsivity in pathological gambling.

Pathological Gambling is an impulse control disorder. Impulsivity has been investigated separately by neuropsychological tests and self-report scales. Although some studies have tried to correlate these approaches, their interaction has not been sufficiently explored among pathological gamblers (PG). In this study, we have compared 214 PG (162 with comorbidity and 52 with no comorbidity) to 82 healthy volunteers regarding the reaction time and number of errors at Go/No-go tasks, and scores on the Barratt Impulsiveness Scale (BIS). PG have committed more errors at the Go/No-go tasks and presented higher scores on the self-report scale. The neuropsychological tests and BIS composed a multinomial logistic model that discriminated PG from non-gamblers better than models having one or another type of measure. Impulsivity seems to be a multi-dimensional phenomenon, and PG a heterogeneous population in which different types of impulsivity are present.

Psychometric properties of the Portuguese version of the State-Trait Anxiety Inventory applied to college students: factor analysis and relation to the Beck Depression Inventory

The psychometric properties of the Portuguese version of the trait form of the State-Trait Anxiety Inventory (STAI-T) and its relation to the Beck Depression Inventory (BDI) were evaluated in a large Brazilian college student sample containing 845 women and 235 men. STAI-T scores tended to be higher for women, singles, those who work, and subjects under 30 years. Factor analysis of the STAI-T for total sample and by gender yielded two factors: the first representing a mood dimension and the second being related to worrying or cognitive aspects of anxiety. In order to study the relation between anxiety and depression measures, factor analysis of the combination of the 21 BDI items and the 20 STAI-T items was also carried out. The analysis resulted in two factors that were analyzed according to the tripartite model of anxiety and depression. Most of the BDI items (measuring positive affectivity and nonspecific symptoms of depression) were loaded on the first factor and four STAI-T items that measure positive affectivity. The remaining STAI-T items, all of them measuring negative affect, remained in the second factor. Thus, factor 1 represents a depression dimension and factor 2 measures a mood-worrying dimension. The findings of this study suggest that, although widely used as an anxiety scale, the STAI-T in fact measures mainly a general negative affect.

Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples

BACKGROUND Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an important measure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of the Portuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions. METHODS The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic, bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions: acutely symptomatic and in remission. RESULTS SAS overall and sub-scale scores of the normal sample were consistently lower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower level than depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in better condition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. In panic patients in remission, normalization was not achieved in overall functioning, work and marital areas. LIMITATIONS Sample size was small in some groups and the evaluation was cross-sectional. CONCLUSIONS The Portuguese version of SAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for the evaluation of different clinical conditions, recommending its use in outcome studies.

Expression of Depressive Symptoms in a Nonclinical Brazilian Adolescent Sample

Objective: This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample. Method: A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: “nondepressed,” BDI < 15; “dysphoria,” BDI 16 to 20; and “depressed,” BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items. Results: The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression. Conclusions: The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.

Premenstrual dysphoric symptoms amongst Brazilian college students: factor structure and methodological appraisal

AbstractObjectivesThe present study aims to assess the factor structure of the DSM–IV Premenstrual Dysphoric Disorder (PMDD) symptoms and its relationship with depressive symptoms.MethodsWe evaluated retrospectively PMDD symptoms in 513 female college students, through a self–reporting questionnaire based on DSM–IV criteria, in addition to the Beck Depression Inventory (BDI). Principal component analysis on PMDD symptom data was performed to assess its dimensional structure.ResultsIn this non–clinical sample, the analysis indicated a higher importance of the dysphoric dimension, but physical symptoms as well as “being out of control” or “overwhelmed” should also be viewed as major symptoms of PMDD. Behavioural symptoms are of secondary importance. The mean BDI score of PMDD group was significantly higher (p < 0.05) than non– PMDD group.ConclusionThe factor structure of the total sample was similar to the symptom structure suggested by DSM–IV diagnostic criteria. Depressive symptoms should be viewed as a confounding variable in PMDD.

Analysis of Circular Longitudinal Data Based on Generalized Estimating Equations

This paper derives estimating equations for modelling circular data with longitudinal structure for a family of circular distributions with two parameters. Estimating equations for modelling the circular mean and the resultant length are given separately. Estimating equations are then derived for a mixed model. This paper shows that the estimators that follow from these equations are consistent and asymptotically normal. The results are illustrated by an example about the direction taken by homing pigeons.

Longitudinal Data Estimating Equations for Dispersion Models

Liang & Zegers generalized estimating equation approach for analysis of longitudinal data is extended to marginal distributions of dispersion model type. This includes for example the von Mises and simplex distributions, suitable for angles and proportions, respectively. Both modelling of position and joint modelling of position and dispersion is considered, and the method is applied to a set of bird orientation data.

Spatial dependence in credit risk and its improvement in credit scoring

Credit scoring models are important tools in the credit granting process. These models measure the credit risk of a prospective client based on idiosyncratic variables and macroeconomic factors. However, small and medium sized enterprises (SMEs) are subject to the effects of the local economy. From a data set with the localization and default information of 9 million Brazilian SMEs, provided by Serasa Experian (the largest Brazilian credit bureau), we propose a measure of the local risk of default based on the application of ordinary kriging. This variable has been included in logistic credit scoring models as an explanatory variable. These models have shown better performance when compared to models without this variable. A gain around 7 percentage points of KS and Gini was observed.