In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record

Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms.

This article suggests that while mental health problems affect 10—20% of children and adolescents worldwide, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. The authors review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems.

Child and adolescent mental health worldwide: evidence for action

No health without mental health.

基因科学与亲子鉴定——国际流行病与公众健康杂志J Epidemiol Community Health

Background

Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health.

Scope and Methodology

This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database).

Findings

Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.

Annual Research Review: Secular trends in child and adolescent mental health

Objective To identify the most appropriate threshold for disruptive mood dysregulation disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community. Method Trained psychologists evaluated 3,562 preadolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in 3 stages: symptomatic, syndromic, and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item, which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture preadolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology. Results At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts, some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated nonoverlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%. Conclusion Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.

Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization.

Objective To describe the profile and performance of nutritionists in Primary Health Care. Methods A cross-sectional study was carried out, and all nutritionists in two municipalities of Paraiba, Brazil, were interviewed. Information was collected through structured interviews on demographic characteristics, professional qualification, development of food and nutrition activities, knowledge and use of essential bibliography for the work in Primary Care. Results In one municipality there were 28 teams of the Family Health Strategy and in the other, nineteen teams. In all, nineteen nutritionists were interviewed, fourteen of whom were working in the health teams and five were working exclusively in the Family Health Support Centers. All but one were women and the majority were between 20 and 39 years; the majority (n=10) had no graduate training. Nutritionists from the basic health teams developed more public health nutrition actions, such as defining nutritional care protocols and vitamin A and iron supplementation than those from the Family Health Support Centers (11 versus 1; and 13 versus 1, respectively). About half were satisfied with work in general, and dissatisfaction was related to deficiencies in the availability and quality of anthropometric equipment, physical structure and material. Conclusion Nutritionists work in food and nutrition actions in collective health, emphasizing the importance of qualification and practices that better combine the programmatic agenda of this area with Primary Care.

/pdf/profile-and-performance-of-nutritionists-in-primary-health-517mujuytk.pdf

Profile and performance of nutritionists in Primary Health Care

Given the importance of child care associated with its vulnerability, this study aimed to evaluate the child health care and analyze associated factors in the Family Health Strateg y of two municipalities of Paraiba, Brazil. It was an evaluative research about the attributes of Primary Health Care from the perspective of mothers. Data were collected using a questionnaire validated for use in Brazil. Scores were given for four dimensions of Primary Health Care. It was found that only utilization achieved satisfactory scores in two municipalities. The integration score was adequate in one of the municipalities, which also presented better behavior in all dimensions and in the general evaluation of services. Older children and from higher income families were significantly associated with the low scores.  The main  finding was the low quality of primary health child care especially in accessibility and longitudinality.

/pdf/percepcao-materna-do-cuidado-a-saude-da-crianca-na-2zj7eju46t.pdf

Percepção materna do cuidado à saúde da criança na estratégia saúde da família de dois municípios da Paraíba, Brasil

Objective The aim of this study is to identify the most appropriate threshold for Disruptive Mood Dysregulation Disorder (DMDD) diagnosis and the impact of potential changes in diagnostic rules on prevalence levels in the community. Method Trained psychologists evaluated 3,562 pre-adolescents/early adolescents from the 2004 Pelotas Birth Cohort with the Development and Well-Being Behavior Assessment (DAWBA). The clinical threshold was assessed in three stages: symptomatic, syndromic and clinical operationalization. The symptomatic threshold identified the response category in each DAWBA item which separates normative misbehavior from a clinical indicator. The syndromic threshold identified the number of irritable mood and outbursts needed to capture pre-adolescents/early adolescents with high symptom levels. Clinical operationalization compared the impact of AND/OR rules for combining irritable mood and outbursts on impairment and levels of psychopathology. Results At the symptomatic threshold, most irritable mood items were normative in their lowest response categories and clinically significant in their highest response categories. For outbursts some indicated a symptom even when present at only a mild level, while others did not indicate symptoms at any level. At the syndromic level, a combination of 2 out of 7 irritable mood and 3 out of 8 outburst indicators accurately captured a cluster of individuals with high level of symptoms. Analysis combining irritable mood and outbursts delineated non-overlapping aspects of DMDD, providing support for the OR rule in clinical operationalization. The best DMDD criteria resulted in a prevalence of 3%. Conclusion Results provide information for initiatives aiming to provide data-driven and clinically oriented operationalized criteria for DMDD.

/pdf/disruptive-mood-dysregulation-disorder-symptomatic-and-ghjuj6sqpm.pdf

Iná S. Santos

Papers

Disruptive Mood Dysregulation Disorder: Symptomatic and Syndromic Thresholds and Diagnostic Operationalization.

Profile and performance of nutritionists in Primary Health Care

Percepção materna do cuidado à saúde da criança na estratégia saúde da família de dois municípios da Paraíba, Brasil

Disruptive Mood Dysregulation Disorder: symptomatic and syndromic thresholds and diagnostic operationalization