Objective: To provide a comprehensive picture of mental health problems (MHPs) in Brazilian medical students by documenting their prevalence and association with co-factors. Methods: We systematically searched the MEDLINE/PubMed, SciELO, LILACS, and PsycINFO databases for cross-sectional studies on the prevalence of MHPs among medical students in Brazil published before September 29, 2016. We pooled prevalences using a random-effects meta-analysis, and summarized factors associated with MHP. Results: We included 59 studies in the analysis. For meta-analyses, we identified the summary prevalence of different MHPs, including depression (25 studies, prevalence 30.6%), common mental disorders (13 studies, prevalence 31.5%), burnout (three studies, prevalence 13.1%), problematic alcohol use (three studies, prevalence 32.9%), stress (six studies, prevalence 49.9%), low sleep quality (four studies, prevalence 51.5%), excessive daytime sleepiness (four studies, prevalence 46.1%), and anxiety (six studies, prevalence 32.9%). Signs of lack of motivation, emotional support, and academic overload correlated with MHPs. Conclusion: Several MHPs are highly prevalent among future physicians in Brazil. Evidence-based interventions and psychosocial support are needed to promote mental health among Brazilian medical students.

Context The prevalence of depressive symptoms among medical students has been found to be higher than among other students because of their longer studying time, higher workload and larger financial burden. Despite the availability of reviews examining this, some have focused solely on one country, whereas others used databases containing papers of solely one language; therefore, the results from reviews might not be comprehensive. Against this background, this overview aims to synthesise the results from all the published systematic reviews of depression among medical students, in order to provide a more accurate result. Methods A systematic search was conducted of online databases for published systematic reviews or meta‐analyses examining the prevalence of depressive symptoms among medical students. The findings of individual studies included in these reviews were extracted and then combined with a random‐effects model. Subgroup analysis was conducted by regions. Results A total of 10 studies were selected in this overview, involving 249 primary studies and 162 450 medical students. MEDLINE was the most popular database used in these studies. The overlapping of primary studies in these reviews was appreciably high, except for three studies that focused on specific countries. The overall pooled prevalence was 27.0% (95% CI, 24.7–29.5%). Significant subgroup differences were detected (p < 0.001). The pooled prevalence among studies in the Western Pacific Region was the lowest, 18.9% (95% CI, 11.7–29.0%), whereas that in Africa (40.9%) was the highest (95% CI, 28.8–54.4%). The top five significant factors associated with depressive symptoms were: (i) year of study; (ii) gender; (iii) personal issues; (iv) family relations or issues, and (v) health status. Conclusions Depression affected around a quarter of medical students in general and 40.9% of students in Africa. It is suggested that medical schools and health authorities should introduce preventive measures to curb the high prevalence of depressive symptoms.

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Respiratory diseases in children and adolescents: profiling primary care visits in Vitória/ES Objetivo: Identificar as principais causas de atendimento por doenças respiratórias na atenção primária, em Vitória, ES, nos residentes de 0-19 anos, relacionando a gravidade das mesmas com idade e nível socioeconômico, e verificar a variação temporal de frequência desses atendimentos. Métodos: Estudo transversal descritivo dos atendimentos realizados em 2014 nas 30 unidades básicas de saúde do município de Vitória, com dados do sistema de registros eletrônicos Rede Bem Estar. Realizou-se análise descritiva das variáveis sociodemográficas, grupos de diagnóstico e mês de atendimento e regressão logística entre topografia de acometimento do aparelho respiratório e variáveis sociodemográficas. Resultados: Dos 113.252 atendimentos de 0-19 anos, doenças respiratórias constituíram as causas mais frequentes (28.810, 25,43% do total, 40,18% dos atendimentos por doença), destacando-se "Infecções agudas das vias aéreas superiores" (61,35%), "Doenças crônicas das vias aéreas inferiores" (14,60%) e "Outras doenças das vias aéreas superiores" (8,69%). A proporção de atendimentos caiu com a idade e foi maior entre residentes em bairro de menor renda domiciliar média. As vias aéreas superiores foram mais acometidas em todas as faixas etárias, principalmente nas mais avançadas, e nos residentes em bairros de maior renda domiciliar média. Porém, apenas 6% da variância da distribuição segundo topografia de acometimento do aparelho respiratório foi explicada por faixa etária e nível socioeconômico. Observou-se crescimento dos atendimentos nos meses de março a novembro. Conclusões: Doenças respiratórias são agravos de grande impacto na população pediátrica em Vitória. Recomendam-se medidas de prevenção primária e secundária que levem em consideração a multicausalidade envolvida na determinação dessas doenças. www.rbmfc.org.br Resumo ARTIGOS DE PESQUISAS Enfermedades respiratorias en niños y adolescentes: un perfil de asistencia en la atención primaria en Vitória/ESObjective: To identify the main reasons for visiting a primary health care facility among 0-19 year old residents with respiratory diseases, as well as their frequency, and to associate the severity of those diseases with age and socioeconomic status. Methods: A descriptive cross-sectional study was conducted on all visits to any of the 30 basic health units of the city of Vitória, ES in 2014, using the electronic database Rede Bem Estar. A descriptive analysis was carried out on sociodemographic variables, diagnostic groups and the month of these visits, in addition to logistic regression between the topography of the impairment of the respiratory system and sociodemographic variables. Results: Respiratory diseases were the most frequent reason for visiting the primary health care facility among all 113,252 0-19 years old participants included in the study (28,810, corresponding to 25.43% of the total and 40.18% of visits due to illness), particularly "acute upper respiratory in...

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Background The methodological choice of aggregated estimates for meta-analysis may be notable for some common drawbacks, including variations in the cut-off values of depression, and lower statistical power for analyzing the associated factors. The study aimed to refine the precision of previous findings on the prevalence of depressive symptoms among medical students, through gathering individual participant data (IPD) as identified from our previous reviews. Material and methods In the present study, we searched MEDLINE, EMBASE, PsycINFO, WanFang, Scielo and LILACS to identify published systematic reviews and meta-analyses up to March 2018, then individual data was requested for further analysis (PROSPERO registration: CRD42018091917). The participants’ age, sex, year of study, scores for depressive symptoms, and other predictor variables were requested. To pool the prevalence from the included studies, random-effects model (two-step method) was used. Multiple linear regression was used to examine the associated factors on the depression z-scores (one-step method). Results Of the 249 studies, the datasets of 34 studies were included. The crude prevalence was 19.4% (95% CI: 18.8%, 19.9%) by one-step method and the pooled prevalence was 18.1% (95% CI: 14.1%, 22.1%) by two-step method. Multiple linear regression revealed that being a female, older age, and senior year of study were significantly associated with the z-score. Conclusion The pooled prevalence of depressive symptoms from the Individual Participant Data (IPD) meta-analysis was lower than the previous meta-analyses using aggregated data. Age, sex, and year of study were significantly associated with the depression z-score. IPD meta-analysis may provide a more accurate estimation of disease burden, and allow verification of associated factors.

Objectives: There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods: The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/ discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results: EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusion:The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per “Dead” Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.