The role of personal recovery and internalised stigma on the expression of symptomatology in severe mental disorders: Mediating and moderating effects.

OBJECTIVE: Given the relevance of internalised stigma in people suffering from a mental disorder, in the present study, the possible mediating and moderating role of self-stigma in the relationship between personal recovery and symptomatology has been studied. METHOD: 265 participants with severe mental disorder completed the following instruments: ISMI (self-stigma), REE (personal recovery) and HoNOS, CGI, GAF and EuroQol (symptomatology). RESULTS: both the mediation and moderation analyses show significant results, which would indicate that internalised stigma has an effect on the relationship between personal recovery and symptomatology. Also, people with lower level of personal recovery and greater self-stigma have greater symptomatology than those who are in more advanced personal recovery processes and have a lower perception of internalised stigma. DISCUSSION: the findings of this study suggest that self-stigma has an effect, and the improvement at personal recovery and symptomatology is accentuated when people with a severe mental disorder have a better management of internalised stigma. Therefore, it may be interesting to include this variable in recovery interventions.

Effects of a Multi-Component Psychological Intervention to Cultivate Mental Health in Older Adults.

Introduction: Psychological interventions to cultivate mental health in older adults are scarce and tend to focus on and use a limited number of activities. Objective: The aim of this study was to test the effects of an intervention based on Keyes' concept of positive mental health. Methods: The intervention was conducted with 24 self-selected participants, while 34 were part of the control group. Positive mental health and distress outcomes were measured at baseline and at the end of the intervention. ANCOVA analysis and effect sizes were calculated. Results: Results showed that the intervention increased mental health (F= 18.22, p<0.001, η2= 0.334, d= 1.45, power 0.986) and decreased psychiatric symptomatology in the experimental group versus the control group (F= 7.07, p= 0.011, η2= 0.16, d= 0.87, power= 0.736), which showed no change. Discussion: Despite study limitations, the intervention effectively promoted older people's well-being. Future research, should evaluate the long-term effects of the intervention with varied older adult populations.

The effects of an intervention to improve mental health during the COVID-19 quarantine: comparison with a COVID control group, and a pre-COVID intervention group.

ObjectiveThe COVID-19 pandemic has constituted an unprecedented challenge to society and science and it has provided an unexpected opportunity to explore the effects of a positive intervention in times of adversity and confinement. The goal was to evaluate the effects of a theory driven group intervention to cultivate mental health and flourishing. Design: A pre post design with three groups (151 individuals) was conducted, including an experimental group that received the intervention during the pandemic, a pre-COVID intervention group, and a COVID control group. Main Outcome Measures: Based on Keyes' concept of positive mental health, measures of subjective, psychological and social well-being were obtained, as well as an indicator of psychological distress (GHQ12). Results: Intervention groups showed an increase in well-being and the COVID control group a decrease. Change scores revealed significant differences. Overall percentage of individuals at risk of ill health in baseline was 25.2%, but after the intervention, the COVID control group reached 64.1%. Conclusions: Despite the limitations, the present findings suggest that interventions to sustain and improve mental health in times of crisis and adversity can be an effective approach.

Outcomes Assessment in Psychological Treatment: Spanish adaptation of OQ-45 (Outcome Questionnaire) / Evaluación de resultados en el tratamiento psicológico: adaptación española del OQ-45 (Outcome Questionnaire)

Abstract Introduction: The Lambert's Outcomes Questionnaire (OQ-45) is a 45-item self-administered instrument used to measure clinical outcomes in psychotherapy. It measures functioning through three areas: symptoms distress, interpersonal relations and social role. The objective of this paper is to assess the reliability and the validity of its Spanish version. Method: A sample of 639 subjects, non-clinical and clinical, completed the instrument. Results: The psychometric evidences of the questionnaire showed an adequate internal consistency (.97 and .91) and acceptable convergent validity with the BDI, STAI, PSS and SF-12. The Confirmatory Factor Analyses suggested a bifactor structure. The cut-off points have been established for the subscales and total score (54.5), considering the clinical criterion, which means, prioritizing slightly the sensibility over the specificity. The RCI was 3.80 and Minimum Change Score 17.56. Conclusion: The OQ-45 showed acceptable psychometric properties, providing support for using this version of the questionnaire to assess Spanish's functionality. Given these findings, this tool could help clinicians evaluate treatment efficacy and establish psychotherapy goals.

Resumen Introducción: El instrumento Outcome Questionnaire (OQ-45) desarrollado por Lambert, se trata de una escala auto-administrada de 45-ítems que se utiliza para medir los resultados clínicos en psicoterapia. Esta herramienta evalúa el funcionamiento por medio de tres áreas: síntomas de malestar, relaciones interpersonales y rol social. El objetivo de este artículo es evaluar la fiabilidad y la validez de la versión española. Método: Una muestra de 639 personas, clínica y no clínica, cumplimentaron dicho instrumento. Resultados: Las evidencias psicométricas del cuestionario mostraron una consistencia interna adecuada (.97 y .91) y una validez convergente aceptable con las siguientes escalas: BDI, STAI, PSS y SF-12. Los análisis factoriales confirmatorios han sugerido una estructura bifactorial. Los puntos de corte se han establecido para las subescalas y la puntuación total (54.5), teniendo en cuenta el criterio clínico, lo que significa que se ha priorizado ligeramente la sensibilidad sobre la especificidad. El RCI ha sido de 3.80 y la puntuación mínima de cambio de 17.56. Conclusión: El OQ-45 ha mostrado propiedades psicométricas aceptables, que apoyan el uso de esta versión para valorar la funcionalidad de los españoles y, como consecuencia, podría ayudar a los clínicos a evaluar la eficacia del tratamiento y establecer objetivos en psicoterapia.

Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders.

BACKGROUND: Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment. METHODS: Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program. RESULTS: Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ2 = 6.72, p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (ß = .12, p = .05), which in turn were negatively related to the derived symptomatology index (ß = -.33, p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma. CONCLUSIONS: An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.

Design and evaluation of a positive intervention to cultivate mental health: preliminary findings.

The past two decades have witnessed a proliferation of positive psychological interventions for clinical and non-clinical populations, and recent research, including meta-analyses, is providing evidence of its effectiveness. Most interventions have focused on increasing life satisfaction, positive affect, and psychological well-being. Manualized, multi-component interventions based on a comprehensive theory are scarce. Keyes' concept of mental health and flourishing (subjective, psychological, and social well-being) is an overarching theoretical framework to guide the design of a multi-component psychological intervention to cultivate well-being and personal development. Therefore, the purpose of this study was to design a theory-driven positive intervention and to pilot test the intervention. The manual presents an 8-week group program that includes homework activities. A sample of 56 young adults completed the intervention. Participants were assessed at base line, after termination, and at a 6-month follow-up session. Standardized instruments were used to assess the dimensions of mental health proposed by Keyes. Pre- and post-test measures of subjective, psychological, and social well-being showed significant differences, as did the total mental health scores. At 6-month follow-up, differences remained in subjective and psychological well-being and in positive mental health, with smaller effect sizes. Limitations of these preliminary findings as well as future lines of research and improvements in this manualized intervention are proposed in the light of current research on positive interventions.

Design and evaluation of a positive intervention to cultivate mental health: preliminary findings

Abstract The past two decades have witnessed a proliferation of positive psychological interventions for clinical and nonclinical populations, and recent research, including meta-analyses, is providing evidence of its effectiveness. Most interventions have focused on increasing life satisfaction, positive affect, and psychological well-being. Manualized, multi-component interventions based on a comprehensive theory are scarce. Keyes' concept of mental health and flourishing (subjective, psychological, and social well-being) is an overarching theoretical framework to guide the design of a multi-component psychological intervention to cultivate well-being and personal development. Therefore, the purpose of this study was to design a theory-driven positive intervention and to pilot test the intervention. The manual presents an 8-week group program that includes homework activities. A sample of 56 young adults completed the intervention. Participants were assessed at base line, after termination, and at a 6-month follow-up session. Standardized instruments were used to assess the dimensions of mental health proposed by Keyes. Pre- and post-test measures of subjective, psychological, and social well-being showed significant differences, as did the total mental health scores. At 6-month follow-up, differences remained in subjective and psychological well-being and in positive mental health, with smaller effect sizes. Limitations of these preliminary findings as well as future lines of research and improvements in this manualized intervention are proposed in the light of current research on positive interventions.

High Levels of Receptor Tyrosine Kinases in CCM3-Deficient Cells Increase Their Susceptibility to Tyrosine Kinase Inhibition.

Cerebral cavernous malformations (CCMs) are vascular malformations that can be the result of the deficiency of one of the CCM genes. Their only present treatment is surgical removal, which is not always possible, and an alternative pharmacological strategy to eliminate them is actively sought. We have studied the effect of the lack of one of the CCM genes, CCM3, in endothelial and non-endothelial cells. By comparing protein expression in control and CCM3-silenced cells, we found that the levels of the Epidermal Growth Factor Receptor (EGFR) are higher in CCM3-deficient cells, which adds to the known upregulation of Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) in these cells. Whereas VEGFR2 is upregulated at the mRNA level, EGFR has a prolonged half-life. Inhibition of EGFR family members in CCM3-deficient cells does not revert the known cellular effects of lack of CCM genes, but it induces significantly more apoptosis in CCM3-deficient cells than in control cells. We propose that the susceptibility to tyrosine kinase inhibitors of CCM3-deficient cells can be harnessed to kill the abnormal cells of these lesions and thus treat CCMs pharmacologically.

Psychometric Adequacy of Recovery Enhancing Environment (REE) Measure: CHIME Framework as a Theory Base for a Recovery Measure.

PURPOSE: The aim of this study was to assess to what extent the recovery elements of the Recovery Enhancing Environment (REE) instrument measured the dimensions proposed by the CHIME framework, (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions), so as to evaluate personal recovery in people with severe mental illness. METHODS: Two processes were conducted. Firstly, five experts matched the elements of recovery evaluated by the REE items with the CHIME domains and subdomains. Then, the resulting structure from those experts agreement was analyzed with different confirmatory factor analyses (CFA) using responses to the recovery elements dimension of the REE of 312 mental health service users. RESULTS: The percentage of agreements and the kappa coefficients were adequate taking into account the CHIME dimensions (κ = 0.57 to 0.69, total κ = 0.74); however, lower agreement was found at the subdimensions level. Some indexes of the CFA were acceptable for a second order factor analysis [χ 2 (242)= 346.03, p < 0.001, CFI= 0.931, RMSEA= 0.037 (0.028 to 0.046)] and the most adequate solution was obtained from the bi-factorial structure (χ 2 (223)=233.19, p=0.306, CFI= 0.993, RMSEA= 0.012 [0.000 to 0.027]). CONCLUSIONS: Despite the subjective and complex nature of the personal recovery construct, the REE measure can be a valid instrument to verify the existing CHIME conceptual framework, since two of the models tested have resulted in adequate indexes and were also congruent with the theoretical framework and the statistical solution. Thus, REE can be used to obtain a global index of Personal Recovery dimension, and the five indicators proposed by the CHIME framework.

Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment.

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Disorder (SMD) program users in the Mental Health Services of Biscay (n=312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric properties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account.

How is evaluated mental health recovery?: A systematic review.

There is an increasingly recognition of the concept of personal recovery in the treatment of mental illness. Recovery defined as living a fulfilling, rewarding life, even in the ongoing presence of a mental illness. Consequently, a number of different instruments have been designed to assess recovery-oriented outcomes. The objective of the study was to conduct a systematic revision of the domains and the instruments used to assess personal recovery and mental health services orientation to recovery. After the systematic review, it has been carried out a selection process of the most adequate instruments taking into account different criteria of adequacy, psychometric properties and the validation to the Spanish population. In the results have been obtained 35 instruments for measuring personal recovery and 18 for assessing the orientation of recovery in mental health services. However, many of them have been dismissed for not reaching the adequacy criteria. This review makes clear the lack of consensus on the concept of recovery, as a consequence of the high number of instruments that evaluate the same concept through different domains. In addition, few instruments offer data related to the psychometric properties and only one instrument to assess personal recovery is validated to the Spanish population.