Cross-cultural validation of the COVID-19 peritraumatic distress index (CPDI) among Spanish and Peruvian populations.

The COVID-19 pandemic has had a significant psychological impact worldwide. The COVID-19 Peritraumatic Distress Index (CPDI) is widely used to assess psychological stress during the COVID-19 pandemic. Although CPDI has been validated in Peru and Spain, no cross-cultural validation studies have been conducted. As an exploratory aim, differences in CPDI factorial scores between the most prevalent medical conditions in the two samples (arterial hypertension, respiratory diseases and anxious-depressive disorders) from a general population of Peru and Spain were investigated. We conducted secondary data analysis with data from Peru and Spain to validate the CPDI in a cross-cultural context. Exploratory factor analysis (EFA) and multigroup confirmatory factor analysis (MGCFA) were performed to evaluate the factor structure and measurement invariance of the CPDI across cultural contexts. Concerning the exploratory analysis, we performed a U-Mann-Whitney test to evaluate differences in the factorial scores in the two samples. This study revealed a two-factor solution (stress and rumination/information) for the CPDI that included 21 of the 24 original items, and consistent with previous studies. The MGCFA demonstrated measurement invariance across cultural contexts (scalar invariance), indicating that the CPDI construct has the same meaning across both groups, regardless of cultural context and language variations of Spanish. Patients with anxious-depressive disorders showed higher CPDI factorial scores for both factors, whereas patients with respiratory diseases were only associated with the stress factor. This study provides evidence for the cross-cultural validity of the CPDI, highlighting its utility as a reliable instrument for assessing psychological stress in the context of COVID-19 across different cultures. These findings have important implications for developing and validating measures to assess psychological distress in different cultural contexts.

Asociación entre años de estudio y síntomas depresivos y ansiosos durante los primeros meses de confinamiento por la pandemia COVID-19, en una muestra de estudiantes de medicina de una universidad privada en Lima, Perú / Association between study year and depressive and anxious symptoms during the first months of confinement due to COVID-19 pandemic in a sample of medical students from a private university in Lima, Peru

RESUMEN Objetivos : Determinar la relación entre años de estudio y síntomas depresivos y ansiosos durante los primeros meses de la pandemia por COVID-19, en una muestra de estudiantes de medicina de Lima, controlando en particular las covariables sexo y enfermedades médicas previas. Material y métodos : Se realizó una encuesta en línea, que recolectó información de 250 estudiantes de medicina incluyendo datos generales, historia médica previa, síntomas de depresión (PHQ-9) y de ansiedad (GAD-7). Los datos se manejaron mediante un análisis multivariado. Resultados : Se encontraron diferencias entre años de estudios y los valores combinados de PHQ-9 y GAD-7 (Lambda de Wilks = 0,86; p = 1,68 x 10-4; η2p = 0,08). La presencia de enfermedades médicas previas mostró diferencias significativas en relación a los valores combinados de PHQ-9 y GAD-7 (Lambda de Wilks = 0,94, p = 4,43 x 10-4, η2p = 0,06). Las muestras univariadas mostraron diferencias en años de estudios para PHQ-9 (F6,241 = 4,12, p = 0,001, η2p = 0,09) y GAD-7 (F6,241 = 2,81, p = 0,01, η2p = 0,07). El análisis post hoc mostró diferencias estadísticamente significativas en los primeros años de estudio. Conclusiones : Estos resultados sugieren que estudiantes de medicina de los primeros años muestran mayores niveles de síntomas depresivos y ansiosos que los participantes de años superiores. Asimismo, la ocurrencia de enfermedades médicas previas explica también los valores altos de depresión y ansiedad.

SUMMARY Objective : To determine the relationship between year levels of medical studies and depressive and anxious symptoms during the first months of the COVID-19 pandemic in a sample of medical students in Lima, controlling specifically the variables sex and presence of underlying medical conditions. Material and Methods : An online survey collected information from 250 medical students, covering general data, previous medical history and symptoms of depression (PHQ-9) and anxiety (GAD-7). Data were managed using multivariate analysis of covariance. Results : Differences were found between years of study and the combined values of PHQ-9 and GAD-7 (Wilks' Λ = 0.86; p = 1.68 x 10-4; η2p = 0.08). Underlying medical conditions also showed significant differences for the combined values of PHQ-9 and GAD-7 (Wilks' Λ = 0.94, p = 4.43 x 10-4, η2p = 0.06). The univariate test for year of study showed differences for PHQ-9 (F6.241 = 4.12, p = 0.001, η2p = 0.09) and GAD-7 (F6.241 = 2.81, p = 0.01, η2p = 0.07). The post hoc analysis showed statistically significant differences in the first years of study. Conclusions : These results suggest that medical students of the first years show higher levels of depression and anxiety symptoms than participants from more advanced years of the medical career. Likewise, the occurrence of previous medical conditions also explained high levels of depression and anxiety.

[Medical conditions, symptoms of anxiety, and depression during the COVID-19 pandemic in a population sample of Lima, Peru]. / Condiciones médicas, síntomas de ansiedad y depresión durante la pandemia por COVID-19 en una muestra poblacional de Lima, Perú.

Introduction: This study aims to determine differences between the number of underlying medical conditions, depression, and anxiety, when controlling for the covariates of age, sex, and completed education.Methods: Participants (n=484) indicated the number of medical conditions present during the survey, also including the PHQ-9 and GAD-7, to assess depression and anxiety, respectively.Results: Differences were found between groups of medical conditions and the combined values of PHQ-9 and GAD-7 after controlling for the covariates mentioned above (F4,954=5.78; Wilks' Λ=0.95; P<0.0005). The univariate tests showed differences for PHQ-9 (F2,478=8.70; P<0.0005) and GAD-7 (F2,478=11.16; P<0.0005) between the 3 groups. Finally, post-hoc analysis showed differences between participants with one medical condition and with no medical condition (PHQ-9: MD=1.82; 95%CI, 0.25-3.40; GAD-7: MD=1.73; 95%CI, 0.55-2.91), and between participants with more than one medical condition and participants with no medical condition (PHQ-9: MD=3.10; 95%CI, 1.11-5.10; GAD-7: MD=2.46; 95%CI, 0.97-3.95).Conclusions: Our results suggest that people who had a medical condition during the COVID-19 pandemic were more prone to developing severe symptoms of anxiety and depression.

Content validation using Aiken methodology through expert judgment of the first Spanish version of the Eppendorf Schizophrenia Inventory (ESI) in Peru: A brief qualitative report.

BACKGROUND: The main objective of this study was the validation through the expert judgment of the first Spanish version of the Eppendorf Schizophrenia Inventory (ESI-Sp). MATERIALS AND METHODS: A translation and cultural adaptation procedure as a first stage was carried out, which was evaluated by four psychiatrists with clinical experience. In a second stage, we recruited a group of clinical psychiatrists to evaluate the translated instrument by judging the items' clarity and relevance. Content validity was performed using the Aiken methodology (Aiken's V). RESULTS: For the first stage, we did not find any items that needed alteration during translation and adaptation. Concerning the raters' stage, 30 clinical psychiatrists (47.07±13.62 years) completed the rating of the ESI-Sp. Of them, the majority worked in an institute (10/30; 33.33%) and had "15 or more" years of experience (12/30; 40.00%). The null hypothesis was rejected for all items and demonstrated the content validity of each item. Similar results were found for the factors of the ESI. Finally, the total Aiken's V for the ESI did not include the values of the null hypothesis in the confidence intervals (V=0.78; CI95 [0.70; 0.85]), demonstrating content validity. CONCLUSIONS: ESI-Sp is a valid and representative instrument to determine subjective experiences in patients with a high risk of schizophrenia. The construct validation of the ESI-Sp is pending, which our research group will carry out after this first step.

Emotional Impact on Health Personnel, Medical Students, and General Population Samples During the COVID-19 Pandemic in Lima, Peru.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Emotional Impact on Health Personnel, Medical Students, and General Population Samples During the COVID-19 Pandemic in Lima, Peru / Impacto emocional en personal de salud, estudiantes de Medicina y población general durante la pandemia de COVID-19 en Lima, Perú

ABSTRACT Background: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. Methods: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. Results: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. Conclusions: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

RESUMEN Introducción: El objetivo del estudio es comparar los efectos emocionales de la COVID-19 entre 3 grupos diferentes, a saber: personal de salud, estudiantes de Medicina y una muestra de la población general. Métodos: Se incluyó a 375 participantes en este estudio, de los que 125 eran estudiantes de Medicina (estudios preclínicos, 59; estudios clínicos, 66), 125 eran personal de salud (personal de primera línea contra la COVID-19, 59; personal no relacionado con la COVID-19, 66) y 125 pertenecían a la población general. Las escalas PHQ-9, GAD-7 y CPDI se utilizaron para evaluar el impacto emocional. Se realizó una regresión logística multinomial para medir las diferencias entre grupos, considerando posibles factores de confusión. Resultados: Con respecto a los valores del CPDI, todos los demás grupos mostraron valores reducidos en comparación con el personal de primera línea contra la COVID-19. Sin embargo, la población general y los estudiantes de Medicina preclínica y clínica mostraron un aumento de los valores del PHQ-9 en comparación con el personal en primera línea. Por último, los factores de confusión, sexo y edad se correlacionaron negativamente con puntuaciones más altas del CPDI y el PHQ-9. Conclusiones: Ser personal de primera línea se asocia con más estrés relacionado con la COVID-19. Sin embargo, la depresión está asociada con otros grupos que no están directamente involucrados en el tratamiento de los pacientes con COVID-19. Las mujeres y los participantes más jóvenes se correlacionaron con la depresión y el estrés relacionados con la COVID-19.

Emotional Impact on Health Personnel, Medical Students, and General Population Samples During the COVID-19 Pandemic in Lima, Peru.

Background: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. Methods: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. Results: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. Conclusions: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Introducción: El objetivo del estudio es comparar los efectos emocionales de la COVID-19 entre 3 grupos diferentes, a saber: personal de salud, estudiantes de Medicina y una muestra de la población general. Métodos: Se incluyó a 375 participantes en este estudio, de los que 125 eran estudiantes de Medicina (estudios preclínicos, 59; estudios clínicos, 66), 125 eran personal de salud (personal de primera línea contra la COVID-19, 59; personal no relacionado con la COVID-19, 66) y 125 pertenecían a la población general. Las escalas PHQ-9, GAD-7 y CPDI se utilizaron para evaluar el impacto emocional. Se realizó una regresión logística multinomial para medir las diferencias entre grupos, considerando posibles factores de confusión. Resultados: Con respecto a los valores del CPDI, todos los demás grupos mostraron valores reducidos en comparación con el personal de primera línea contra la COVID-19. Sin embargo, la población general y los estudiantes de Medicina preclínica y clínica mostraron un aumento de los valores del PHQ-9 en comparación con el personal en primera línea. Por último, los factores de confusión, sexo y edad se correlacionaron negativamente con puntuaciones más altas del CPDI y el PHQ-9. Conclusiones: Ser personal de primera línea se asocia con más estrés relacionado con la COVID-19. Sin embargo, la depresión está asociada con otros grupos que no están directamente involucrados en el tratamiento de los pacientes con COVID-19. Las mujeres y los participantes más jóvenes se correlacionaron con la depresión y el estrés relacionados con la COVID-19.

Validación por expertos del Índice de Distrés Peri-traumático relacionado con la Enfermedad por Coronavirus 2019 para su uso en el Perú / Expert validation of the COVID-2019 Peri-traumatic Distress Index for use in Peru

RESUMEN Objetivo: Efectuar una validación de contenido por expertos del Índice de Distrés Peri-traumático relacionado a COVID-19 (CPDI) para su uso en el Perú. Material y Métodos: El CPDI fue traducido al castellano y luego adaptado en una primera ronda de expertos. En una segunda ronda (n = 13), se evaluó la validez del contenido mediante el uso de la V de Aiken (V). Se calculó la V para cada ítem, así como para el instrumento en su conjunto (VTOT). Resultados : De los 24 ítems originales, solo un ítem (S7) presentó valores no significativos para validez de contenido, razón por la que fue eliminado. La escala con 23 ítems no presentó alteraciones en el cálculo de la VTOT. Conclusiones : Sobre la base de su validez de contenido, el CPDI en castellano es adecuado para su aplicación en la población peruana. Quedan por definirse las características psicométricas así como la modificación propuesta del instrumento, mediante estudios cuantitativos en torno a la validez del constructo.

SUMMARY Objectives : To perform an expert validation study of COVID-19 Peritraumatic Distress Index (CPDI) for its eventual use in Perú. Material and Methods: In a first round by experts, the CPDI was translated into Spanish and then adapted. In a second round, (n = 13), the content validity was evaluated by using Aiken's V (V). The V was calculated for each item, as well as for the whole instrument (VTOT). Results : Of the 24 original items, only one (S7) presented non-significant values for content validity, reason for which it was removed. The final 23-items scale did not present any alterations for the VTOT calculation. Conclusions : On the basis of its adequate content validity, the Spanish version of CPDI is suitable for its application in the Peruvian population. The psychometric characteristics of the instrument, as well as its proposed modification remain to be defined through quantitative studies of the construct validity.

Psicosis sintomáticas / Symptomatic psychoses

En el estudio de las psicosis existe un grupo, las psicosis sintomáticas, que son comunes dentro del ámbito clínico en general y que son de relevancia fundamental para todo médico, psiquiatra o no psiquiatra. Se define a las psicosis sintomáticas como alteraciones mentales que son causadas por determinadas condiciones somáticas y que no dependen de una desviación primaria. El término sintomático alude a aquellas psicosis que son producto de una noxa que tiene un efecto sobre el cerebro independientemente del origen y etiología.

In the study of psychosis there is a group, the symptomatic psychosis, that are common in the medical field in general, and relevant for all physicians (psychiatrists and other physicians who are not psychiatrists). Symptomatic psychoses are defined as all kind of mental illnesses that are caused by somatic conditions and that do not depend from a primary deviation. The term “symptomatic” refers to that kind of psychosis that is product of an injury that has an effect on the brain, independently of the origin and ethiology.

Conocimientos y estigmas sobre salud mental en familiares de pacientes que acuden a consultorio externo del ôHospital Nacional Cayetano Herediaõ / Knowledge and prejudices about mental health in outpatients' relatives in Cayetano Heredia Hospital

Objetivos: Describir los conocimientos y estigmas sobre salud mental y evaluar la asociación entre características demográficas, conocimientos de salud y estigmas. Material y Método: Estudio descriptivo transversal. Se redactaron tres viñetas describiendo un caso típico de depresión, trastorno de pánico y esquizofrenia y se formularon preguntas sobre ellas. Las viñetas y sus preguntas se validaron por juicio de expertos. Se aplicó cada viñeta y sus preguntas a 151 familiares de pacientes no psiquiátricos de consulta externa, incluyéndose un total de 453 individuos. Resultados: Para el caso de trastorno de pánico, se prefirió que el paciente sea visto por un médico especialista no psiquiatra (76,0 %) y se consideró que podía morir de una enfermedad física no diagnosticada (57,3 %). Para el caso de depresión y esquizofrenia el profesional considerado como el más indicado para tratarlo fue el psicólogo (41,7 % y 45,0 %, respectivamente). Para el caso de esquizofrenia, se encontró asociación entre ir al psiquiatra o presentar una enfermedad mental y considerarlo una amenaza para los demás (p=0,003 y p.<.0,001, respectivamente). Conclusiones: Un alto porcentaje recomendaría que pacientes con sintomatología de esquizofrenia o depresión sean tratados por un psicólogo. Por otro lado, se considera con frecuencia, que pacientes con trastorno de pánico tienen una enfermedad física que no ha podido ser diagnosticada y deben ser tratados por un médico no psiquiatra.

Objectives: To describe knowledge and prejudices about mental health and to determine if there is any association between demographic characteristics, health knowledge and prejudices on mental health. Materials and Method: This is a cross-sectional descriptive study. Three vignettes describing typical cases of depression, panic disorder, and schizophrenia were elaborated, and questions were asked about them. Vignettes and their questions were validated by a group of experts. Each vignette and its questions were administered to 151 relatives of persons attending the outpatient clinic for conditions other than psychiatric disorders, so 453 individual vignettes were assessed. Results: For cases of panic disorder, interviewees preferred patients should be seen by a specialized non-psychiatrist physician (76,0%), and they also considered these patients might die because of an undiagnosed physical condition (57,3%). For cases of depression and schizophrenia, professionals chosen as the most adequate for managing these patients were psychologists (41,7% and 45,0%, respectively). For cases of schizophrenia, an association was found between going to the psychiatrist or having a mental disorder, and they also considered these subjects may represent a threat for their peers (p=0,003 and p<0,001, respectively). Conclusions: A high percentage of interviewees would recommend that patients with schizophrenia or depression should be treated by a psychologist. On the other hand, they also considered that patients with panic disorder may have an undiagnosed physical condition and that they should be treated by a non-psychiatrist physician.

[Depressive symptoms in primary caregivers of patients diagnosed with paranoid schizophrenia attending at a psychiatric office of a general hospital in Lima, Peru]. / Síntomas depresivos en cuidadores primarios de pacientes con diagnóstico de esquizofrenia paranoide que acuden al consultorio de Psiquiatría de un hospital general de Lima, Perú

OBJECTIVE: To determine the prevalence of depressive symptoms in caregivers of patients attending at a psychiatric office of a general hospital with diagnosis of paranoid schizophrenia and to estimate the correlation between the severity of schizophrenia and depressive symptoms in the primary caregiver. METHODS: The Zung Depression Scale (ZDS) and the Depressive Psychopathology Scale (DPS) were administered to caregivers and the severity of schizophrenia was assessed using the scale of Clinical Global Impression (CGI). RESULTS: We evaluated 61 patient-caregiver pairs. Between the patients; 63.9% were male and 88.5% were single. Of the caregivers; 77.05% were women, 47.5% married, and 42.6% were the mothers of the patients. The prevalence of probable clinic depression was 3.3% and 14.8% according to the DPS (= 25.5) and the ZDS (= 56.25). It was find correlation between the caregiver score in the ZDS and the CGI of the patient (rho = 0.317, p = 0.0013). The female caregivers had higher scores in ZDS than male caregivers (49.65 ± 8.9 vs. 42.59 ± 7.15, p = 0.009). CONCLUSIONS: Patients were mostly male and single; most caregivers were married, women and mothers of patients. Depressive symptoms (according ZDS) in caregivers were higher in female and were correlated with the severity of the patient's illness.

Depresión y síntomas depresivos en pacientes que acuden al consultorio de dermatología de un hospital general de Lima / Depression and depressive symptoms in outpatients of a dermatology´s service in a general hospital of Lima

Objetivos: Determinar la prevalencia de depresión y síntomas depresivos entre pacientes nuevos que acuden al consultorio de Dermatología del Hospital Nacional Cayetano Heredia (HNCH), así como la posible asociación entre las variables demográficas o las características de la patología dermatológica y la presencia de depresión y síntomas depresivos. Métodos: Se realizó un estudio descriptivo, transversal entre 287 pacientes nuevos que acudieron al consultorio de dermatología del HNCH. Se registraron los datos demográficos, los de la enfermedad dermatológica, y los antecedentes personales y familiares. Se aplicó el Inventario de depresión de Beck (IDB) y la Entrevista Clínica Estructurada para Trastornos del DSM-IV (SCID), apartado de depresión mayor, entre enero y agosto del año 2003. Resultados: La prevalencia de depresión fue de 20,6% y la de síntomas depresivos, de 44,9% (puntuación en el IDB de 11 ó más). Se encontró asociación estadísticamente significativa entre la ocupación del paciente y depresión (p=0,042); así como entre género (p=0,039), grado de instrucción (p=0,002) y estado civil (p=0,026), y la presencia de síntomas depresivos. Los diagnósticos dermatológicos más frecuentes entre los pacientes con depresión fueron dermatitis (11,86%), acné (8,47%), melasma (8,47%) y vitíligo (6,77%). Conclusiones: La prevalencia de depresión y síntomas depresivos fue similar a la reportada en estudios similares, siendo mayor a la reportada en la población general, confirmando la importancia del tratamiento conjunto, tanto dermatológico como psiquiátrico, para brindar mejor calidad de vida a los pacientes.

Objective: To determine the prevalence of depression and depressive symptoms among new patients attending to the outpatients Dermatology service in the Hospital Nacional Cayetano Heredia (HNCH), and to determine the posible association between demographic variables or the features of the dermatological disease and the presence of depression or depressive symptoms. Methods: A cross sectional study of 287 new patients attending to the dermatology outpatients consultation in the HNCH. We recorded demographic data, skin disease data, and personal and family history. We applied the Beck Depression Inventory (BDI) and the Structured Clinical Interview for DSM-IV (SCID), Major Depression Module, between January and August 2003. Results: The prevalence of depression was 20.6% and that of depressive symptoms 44.9% (BDI score 11 or more). There was a statistically significant association between occupation of the patient and depression (p=0.042), and between gender (p=0.039), education level (p=0.002) and marital status (p=0.026), and depressive symptoms. The most common dermatologic diagnoses among patients with depression were dermatitis (11.86%), acne (8.47%), melasma (8.47%) and vitiligo (6.77%). Conclusions: The prevalence of major depression and depressive symptoms is similar to that reported in similar studies, being greater than that founded in general population. This confirms the importance of treatment collaboration between dermatologists and psychiatrists, to provide better quality of life to patients.