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Background Machine learning methods for suicidal behavior so far have failed to be implemented as a prediction tool. In order to use the capabilities of machine learning to model complex phenomenon, we assessed the predictors of suicide risk using state-of-the-art model explanation methods. Methods Prospective cohort study including a community sample of 1,560 young adults aged between 18 and 24. The first wave took place between 2007 and 2009, and the second wave took place between 2012 and 2014. Sociodemographic and clinical characteristics were assessed at baseline. Incidence of suicide risk at five-years of follow-up was the main outcome. The outcome was assessed using the Mini Neuropsychiatric Interview (MINI) at both waves. Results The risk factors for the incidence of suicide risk at follow-up were: female sex, lower socioeconomic status, older age, not studying, presence of common mental disorder symptoms, and poor quality of life. The interaction between overall health and socioeconomic status in relation to suicide risk was also captured and shows a shift from protection to risk by socioeconomic status as overall health increases. Limitations Proximal factors associated with the incidence of suicide risk were not assessed. Conclusions Our findings indicate that factors related to poor quality of life, not studying, and common mental disorder symptoms of young adults are already in place prior to suicide risk. Most factors present critical non-linear patterns that were identified. These findings are clinically relevant because they can help clinicians to early detect suicide risk.

Background Studies on the field of mood disorders has mainly focusing on the risk factors associated to develop the illness or the clinical factors associated with the clinical progression. Less attention was given to factors such as resilience that may be associated with better outcomes in the course of mood disorders. In this study, we assessed the mediation effect of resilience on the relationship between childhood trauma and mood disorders, as well as the severity of depressive symptoms in a population-based sample. Methods This is a cross-sectional study with a community sample of young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls without any mood disorder. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and to assess the resilience was used the Resilience Scale (RS-25). Results All subtypes of trauma were associated with both MDD and BD, however, only physical and emotional abuse differentiated BD from MDD subjects. Bootstrapping-enhanced mediation analyses indicated that resilience partly mediated the association of childhood trauma to both mood disorder and severity of depression. Limitation The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality. Conclusions The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of childhood trauma. This study provides important information regarding the relationships among childhood trauma, resilience, and mood disorder.

Suicide is the second leading cause of death among young adults worldwide, and few studies have assessed the factors associated with suicidality in this specific population. Thus, the aim of this study was to assess the association between mixed episodes and suicidality in a community sample of young adults. For this aim, we compared young adults in a mixed episode with individuals in a depressive or (hypo)manic episode, and community controls.This is a cross-sectional population-based study including young adults aged 18-24 years old. Information about participants' age, sex, self-reported skin color and study status were obtained using a sociodemographic questionnaire. Mixed, (hypo)manic and depressive episodes, as well as suicide risk were assessed using the Mini International Neuropsychiatric Interview.The sample included 1560 individuals. Young adults in a mixed episode showed a 13.50 times higher probability to have suicide risk, as compared to community controls (p 0.001), 5.67 higher probability to have suicide risk as compared to individuals in a (hypo)manic episode (p 0.001), and 2.18 times higher probability to have suicide risk as compared to young adults in a depressive episode (p 0.001).The assessment of suicide risk includes both suicide attempts and ideation.Young adults in a mixed episode showed a higher rate of suicide risk than individuals with depression or mania/hypomania. Considering the already increasing prevalence of suicide among young adults, there is an urgent need for the early diagnosis and treatment of mixed episodes in this specific population.

Subjects with bipolar disorder suffering of a depressive episode are frequently misdiagnosed as unipolar depression, being important studies assessing the differential diagnosis between bipolar and unipolar depression.To assess the sociodemographic and clinical features of drug-free young adults in a depressive episode of bipolar or unipolar disorder in order to identify factors that may differentiate these psychiatric conditions.This is a cross-sectional study with 241 young adults aged between 18 and 29 years who were evaluated using the Structured Clinical Interview for DSM-IV (SCID). The sample comprised patients with BD (n = 89) and major depressive disorder (n = 152), experiencing a depressive episode and not using psychoactive drugs or illicit psychoactive substances.The characteristics associated with bipolar depression were being male (p 0.001), with a family history of BD (p = 0.013), a higher frequency of childhood traumatic experiences (p = 0.001), younger age of onset of mood disorder (p = 0.004), many previous depressive episodes (p = 0.027), greater severity of depressive symptoms (p 0.001) and day/night reversal (p = 0.013). Those with unipolar depression showed a higher frequency of biological rhythm disturbances (p 0.001), and diurnal preference (p = 0.028).The sample has not included subjects with severe suicide risk, a possible important marker in differentiate unipolar from bipolar depression.Some clinical aspects may contribute to an early differential diagnosis of both bipolar and unipolar depression even in the initial stages of the disease.

Objectives The purpose of this study is to assess the independent effects of depression and excess body weight (EBW) on cognition and functioning in a community sample of young adults. Methods This was a cross-sectional of 943 young adults. The diagnosis of a current depressive episode was performed using the Mini International Neuropsychiatric Interview (MINI). Cognition and functioning were assessed using the Montreal Cognitive Assessment (MoCA) and the Functional Assessment Short Test (FAST), respectively. The EBW was defined as BMI ≥ 25.0 kg/m2. The independent main effects of depression and EBW, as well as the analysis interaction were performed using two-way analysis of covariance (ANCOVA). Results The total sample comprised 943 adults, with 75 (8.0%) individuals diagnosed with a current depressive episode and 493 (52,6%) with EBW. Of the 75 subjects with depression, 40 were identified with EBW comorbidity. Subjects with depression and EBW comorbidity reported greater cognitive and functional impairment, as compared to individuals with depression without EBW. There was a significant interaction between depression and EBW on MoCA total (p Conclusions The adverse effects of depression and EBW are independent and cumulative with respect to cognition and functioning of individuals. The understanding of the complex interactions between cognition, functioning, EBW and depression are important for development of preventive and therapeutic strategies.

To evaluate the effect of cognitive therapy on biological rhythm and depressive and anxious symptoms in a twelve-month follow-up period. In addition, correlations between the reduction of depression and anxiety symptoms and the regulation of biological rhythm were observed.This was a randomized clinical trial with young adults from 18 to 29 years of age who were diagnosed with depression. Two models of psychotherapy were used: Cognitive Behavioral Therapy (CBT) and Narrative Cognitive Therapy (NCT). Biological rhythm was assessed with the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). Severity of depressive and anxious symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS), respectively. The sample included 97 patients who were divided within the protocols of psychotherapy.There was a significant reduction in depressive and anxious symptoms (p0.001) and an increase on regulation of biological rhythm (p0.05) at the twelve-month follow-up. Moreover, we showed a positive correlation between the reduction of depressive symptoms and regulation of biological rhythm (r=0.638; p0.001) and between the reduction of anxious symptoms and regulation of biological rhythm (r=0.438; p0.001).Both models showed that cognitive therapy was effective on the reduction of depressive and anxious symptoms and on the regulation of biological rhythm at a twelve-month follow-up evaluation. This study highlights the association between biological rhythm and symptoms of depression and anxiety.We did not assess genetic, hormonal or neurochemical factors and we did not include patients under pharmaceutical treatment or those with severe symptomatology.

Aim: To assess the functional impairment of young adults with bipolar disorder with substance abuse/ dependence comorbidity. Method: Cross-sectional study within a community sample. Bipolar Disorder was assessed by qualified psychologists using The Mini International Neuropsychiatric Interview – PLUS (MINI-PLUS). Substance abuse and dependence was assessed using the “Alcohol, Smoking and Substance Involvement Screening Test” (ASSIST). Functional impairment was assessed using the Functional Assessment Short Test (FAST). Results: The sample included 1259 young adults. The prevalence of Bipolar Disorder (BD) without Substance Abuse/Dependence (SAD) comorbidity was 5.9% (n ¼74), and the prevalence of bipolar disorder with substance abuse/dependence comorbidity was 1.4% (n¼17). Both groups showed higher impairment in overall functioning, interpersonal relationship, and leisure time as compared to controls. In addition, BDþSAD showed higher impairment in the cognitive functioning domain of FAST. Limitation: A battery of neuropsychological tests was not performed. Conclusion: Functional impairment is associated with BD, independently of substance abuse or dependence. In addition, BDþSAD present a more severe impairment in the cognitive domain of FAST as compared to controls. & 2015 Published by Elsevier B.V.

Background Postpartum depression affects parents of newborns. Major depression causes cognitive prejudice. Nothing is known about memory impairment in those affected of postpartum depression. This study has a purpose to assess working and short-term memories during the postpartum period in mothers and fathers in the city of Pelotas, RS, Brazil and also to correlate the changes in memory with postpartum depression, sociodemographic factors and possible confounding factors. Methods This cross-sectional study includes families assisted by the public health system. The sample consisted of fathers and mothers of live births, born from March to December 2008. The participants were evaluated during home visits using the Edinburg Postnatal Depression Scale (EPDS) and the word span test. The cutoff point for depression in the EPDS scores was ≥ 13, and the word span scores were evaluated as discrete variables. Results The sample consisted of 395 individuals (222 women and 173 men). The prevalence of depression was 16.2% among mothers and 5.2% among fathers. Depressed individuals performed worse on the memory test. Limitations The number of men evaluated was smaller than that of women. That's a transversal study, so we have the prevalence bias. Conclusions This study shows that postpartum depression affects both men and women, and the symptoms of depression affect the working and short-term memories of affected individuals. Given that this was a larger study than those in the literature, the results emphasize the importance of detecting and treating postpartum depression and helping affected families.

Nerve growth factor (NGF) is an important member of the neurotrophins group and their involvement in the pathophysiology of major depression disorder (MDD) and suicide risk (SR) has been recently suggested. The aim of this study is to evaluate the changes in NGF serum levels in individuals with MDD and with or without risk of suicide, in subjects from a young population-based sample. This is a paired cross-sectional study nested in a population-based study. Individuals were rated for MDD and SR by a diagnostic interview--Mini International Neuropsychiatric Interview (M.I.N.I). The total population of the sample was comprised of 141 subjects distributed in three groups: 47 healthy controls, 47 subjects with current depressive episode without SR (MDD) and 47 subjects with current depressive episode and with SR (MDD + SR). NGF serum levels were significantly reduced in the MDD and MDD + SR groups when compared with controls (p ≤ 0.001). However, there were no differences in NGF levels between the MDD and MDD + SR groups (p = 1.000). These results suggest that reduced NGF serum levels can be a possible biomarker of MDD.

Objective To evaluate the prevalence of leisure-time physical activity and episodes of mood alteration in a population-based sample of adults, and its relation with gender. Method This is a cross-sectional population-based study with young adults aged between 18 and 35 years old. Sample selection was performed by clusters. The practice of physical activity was evaluated through the International Physical Activity Questionnaire (IPAQ), whereas mood disorders were evaluated using a short structured diagnostic interview—the Mini International Neuropsychiatric Interview (MINI) for DSM-IV and ICD-10 psychiatric disorders. Limitation Causal inferences are limited due the study׳s design. Results Sample consisted of 1953 young adults. The prevalence of leisure-time physical activity and of depressive episodes in the total sample was 25.3% and 17.2%, respectively. The prevalence of activity amongst men was 1.18 (CI 95% 1.18–1.32) times higher than in the women׳s group, whereas depression was 1.87 (CI 95% 1.41–2.47) times more prevalent amongst women than men. The prevalence of physical activity was not different between women ( p =0.287), nor between men ( p =0.895) regarding the presence of mania/hypomania episode. Conclusion The prevalence of physical activity and depression was different concerning gender. The prevalence of physical activity is lower amongst women, whereas the prevalence of depression is higher amongst women when compared to men.

Studies show high comorbidity between anxiety disorder and depression. Little is known regarding how anxiety symptoms affect prognosis in depression treatment, suggesting the importance of studying the impact of anxiety symptoms in the treatment of depression. We evaluated the impact of anxiety symptoms in the remission of depressive symptoms after brief psychotherapies for depression.This randomized clinical trial of 18-29-year-old adults included individuals who met the diagnostic criteria for depression as assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD); anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale (HARS). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP). Both treatments included seven sessions. At the end of the treatment and six-month follow-up, an evaluation was made with the HRSD and HARS. The sample included 97 patients divided between the protocols of psychotherapy.There was a significant, positive, moderate correlation between the severity of anxiety symptoms at baseline and the remission of depressive symptoms at post-intervention (r=0.38 p0.001) as well as a significant, positive, low correlation at follow up (r=0.20 p=0.049). We found remission of anxiety symptoms and depressive symptoms after brief psychotherapies, and the remission persisted at follow up.We did not evaluate the diagnosis of anxiety disorders.The severity of anxiety symptoms did not compromise the treatment focused primarily on depressive symptoms.

Background Stability between internal and external biological regulators are essential to stable mood states. However, the literature needs studies investigating the effect of brief psychotherapies in the biological rhythm regularization. Objective To verify the capacity regulation of biological rhythms in two models of brief psychotherapy for the remission of depressive symptoms. Methods We conducted a randomized clinical trial with young adults aged 18–29 years old who met diagnostic criteria for depression according to the Structured Clinical Interview for DSM (SCID). In order to evaluate the biological rhythm the Biological Rhythm of assessment in Neuropsychiatry (BRIAN) interview was used; whereas the severity of depression was assessed by the Hamilton Depression Rating Scale (HDRS). The psychotherapy models consisted of two cognitive psychotherapies: Cognitive Narrative Therapy (CNT) and Cognitive-Behavioral Therapy (CBT). Results The sample consisted of 97 randomized into two models of brief psychotherapy. The patients regulated the biological rhythm from baseline to post-intervention (p=.001) and follow up (p=.003). We also found a positive moderate correlation between biological rhythm regularization and remission of the depressive symptoms (r=.594; p Conclusion The two models of brief psychotherapies were effective in the remission of depressive symptoms as well as the regulation of biological rhythms in the follow-up of 6 months. Limitations We did not assess genetic, hormonal and neurochemical factors. Also, we did not include patients in pharmaceutical treatment, and with severe symptomatology.

The objective of this report is to evaluate functioning in bipolar disorder in a population-based sample of young adults (18 to 24 years old). To this end, people with bipolar disorder were compared with matched participants with only depressive episodes and control subjects without a history of mood episodes.Case-control study nested in a population-based sample. Caseness was confirmed with the Structured Clinical Interview for DSM-IV. The Functioning Assessment Short Test was used as a measure of general functioning. A multivariate model was elaborated to account for potential confounders.The sample consisted of 231 subjects. Both bipolar disorder (coef=0.60, SE=0.14, p0.001) and major depression (coef=0.44, SE=0.14, p=0.001) were associated with functioning in the multivariate model. Current depressive symptoms appeared to influence functioning in those with major depression (Z=2.05, p=0.04), but not in those with bipolar disorder (Z=0.78, p=0.43).Neuropsychological testing was not performed and we see it as an important limitation of this study.This population-based study further reinforces the notion that functional impairment is a fundamental characteristic of bipolar illness. It is present from early stages and is not completely explained by mood symptoms.

Objective To evaluate the prevalence of episodes of mania and hypomania, as well as associated factors and comorbidities among adults 18 to 24 years old in the city of Pelotas, Brazil. Method This is a cross-sectional population-based study. The sample was selected through conglomerates, and episodes of mania and hypomania were assessed using the Mini International Neuropsychiatric. Results The sample consisted of 1560 subjects. The lifetime prevalence of manic and hypomanic episodes was 7.5% and 5.3%, respectively. Subjects with (hypo)manic episodes had a higher prevalence of anxiety disorders, substance abuse and suicidality. Limitation The high rate of (hypo)mania may to some extent reflect diagnostic error. Conclusion Such high prevalence of (hypo)mania may nonetheless be valid as it was associated with corresponding rates of comorbidity and suicidality.