Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis.

OBJECTIVE: The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS: We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS: A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS: Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial.

BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial.

OBJECTIVE: This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. METHOD: The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians' first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. RESULTS: Most frequently, clinicians named case-based behavioral simulations as "most helpful" and video as "least helpful" training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician's age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01-1.10; p = 0.025). CONCLUSIONS: Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

Structure of the perception of health professionals regarding the quality of health services in the context of COVID-19.

BACKGROUND: The health emergency caused by COVID-19 revealed the shortcomings of health services (HS), but little is known about how this has impacted the mental health of health professionals (HP) when perceiving these difficulties. METHODS: Data were collected through an online survey administered to HP in Lima (Peru) between May and July 2020. A questionnaire was applied to identify perceived quality of health services (PHQS). A network analysis was performed, and the centrality measures of the variables were calculated and plotted. RESULTS: A total of 507 HP completed the survey. In the network analysis of PHQS, four clusters were identified: (A) "empathy" and "recognition of competencies," (B) "logistical support," "protection," "personal early diagnosis," and "early family diagnosis"; C) "professional competence with regard to their treatment and treatment for their family," "equipment for their treatment and treatment for their family," "professional competence with regard to their treatment and treatment for their family," and "institutional support for them and their family"; and D) "fear of being infected or infecting their family," "fear of dying or death of a family member," "knowledge stability," "job burnout," and "role change." The variables of PHQS with the greatest centrality were "equipment for their treatment," "equipment for the treatment of their family," and "early family diagnosis." CONCLUSIONS: The structure of the PHQS of HP describes direct and indirect influences of different variables in the context of COVID-19.

Relationship between depression, anxiety, and perceived stress in health professionals and their perceptions about the quality of the health services in the context of COVID-19 pandemic.

BACKGROUND: The health emergency caused by COVID-19 revealed the shortcomings of health services (HS), but little is known about how this has impacted the mental health of health professionals (HP). METHODS: Data were collected through an online survey administered to HP in Lima (Peru) between May and July 2020. Instruments were applied to evaluate anxiety, depression, perceived stress (PS), and perceived quality of health services (PQHS). RESULTS: A total of 507 HP completed the survey. In the multivariate analysis, younger age and female gender were related to anxiety, depression, and PS (all with p < .001). The most relevant unfavorable PQHS associated with anxiety were competence of other HP to care for HP if infected (p = .002) and support for HP or their families in the event of becoming infected (p = .001); the most relevant unfavorable PHQS associated with depression were equipment to care for HP and their families if infected (p = .003); support for HP or their families if infected (p < .001); fear of HP and/or family members being infected or dying (p = .006); and HP' recognition of their competencies (p < .001); and the most relevant unfavorable PHQS associated with PS were support for HP or their families if infected (p < .001) and instability of knowledge (p = .027). CONCLUSIONS: There was an association between impaired mental health and PQHS scores among HP. This study shows the need for HP to express their concerns about how HS are supporting their safety and that of their family during health emergencies.

[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.

Depression and anxiety symptoms and perceived stress in health professionals in the context of COVID-19: Do adverse childhood experiences have a modulating effect?

BACKGROUND: Adverse childhood experiences (ACE) have a great impact on mental health outcomes of adults. However, little is known whether ACE may act as modulators of the mental health of health professionals caring for patients with COVID-19. METHODS: Data were collected through an online cross-sectional survey administered to health professionals in Lima (Peru) between May and July 2020. The survey included standardized self-assessment instruments for anxiety, depression, acute stress (AS) and history of ACE. RESULTS: A total of 542 health professionals completed the survey. Caring for patients with COVID-19 was significantly associated with depression and anxiety and when caring for patients with COVID-19 was combined with a history of early sexual abuse, its effect on the risk of anxiety increased (OR = 7.71, p = .010). Mental health problems were associated with female gender in almost all the analyses and with the majority of ACEs. CONCLUSIONS: Health workers in the context of the COVID-19 pandemic presented a high risk of mental health disorders. Antecedents of sexual abuse acted as a potentiating factor of anxiety in professionals providing COVID-19 care. These findings suggest that the burden of ACE modulates mental health problems in health professionals during the pandemic.

The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients.

OBJECTIVE: Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. METHODS: From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. RESULTS: Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32% sensitivity and 80% specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67% sensitivity and 72.32% specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. CONCLUSIONS: The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.

Características de la personalidad relacionadas con el proceso de mentoría / Personality characteristics related to the mentoring process

Se realiza una revisión narrativa sobre la relación entre el proceso de mentoría (o mentorazgo) y la personalidad de mentores y mentoreados. Se encontró que las condiciones que favorecen un desarrollo satisfactorio del proceso son bajo nivel de neuroticismo, conciencia elevada, alta extraversión, agradabilidad intermedia, apertura intermedia, locus de control interno, bajo narcisismo y concordancia entre los niveles de neuroticismo del mentor y del mentoreado. En el caso de la autovigilancia los resultados son contradictorios. En vista de la escasez de estudios sobre la relación entre personalidad y mentoría, se recomienda investigaciones específicas en torno a este tema, particularmente en el ámbito de la educación médica.

A narrative review about the relationship between the mentoring (mentorship) process and the personality of mentors and mentees was made. It was found that the conditions that favor a successful mentoring process are low neuroticism levels, high consciousness, high extraversion, intermediate agreeableness, intermediate openness, internal locus of control, low narcissism, and concordance between neuroticism levels of mentor and mentee. In the case of self-monitoring, the results are contradictory. In view of the scarcity of studies about the relationship between personality and mentoring, it is recommended to carry out specific research on this topic, particularly in the medical education field.

Estudios psicométricos de los instrumentos en español para la detección de trastornos mentales comunes: una revisión / Psychometric studies of instruments in Spanish for the detection of common mental disorders: A review

RESUMEN El objetivo de esta revisión es describir las características psicométricas de las versiones en español de instrumentos utilizados en la detección de trastornos mentales comunes, sobre la base de una búsqueda sistemática en PubMed y Google Académico. Se identificaron los siguientes instrumentos con información pertinente: General Health Questionnaire (GHQ-12 y GHQ-28), Hospital Anxiety and Depression Scale (HADS), Escala de Salud Personal (ESP), Self-Reporting Questionnaire (SRQ-20), Escala de Malestar Psicológico de Kessler (K-6 y K-10), Patient Health Questionnaire (PHQ), Escala de Edimburgo (EPDS), Dep5, Anx5 y Symptom Checklist (SCL-90 y SCL-90-R). Los instrumentos más estudiados fueron el GHQ y la HADS. La mayoría de estudios fueron realizados en España. En Perú se evaluaron el SRQ-20, la ESP, la K-6, la K-10 y el GHQ-28. Las propiedades psicométricas descritas incluyen: consistencia interna, estructura factorial, área bajo la curva Receiver Operating Characteristic (abcROC), sensibilidad, especificidad e índice de Youden (J). El J de los instrumentos estudiados estuvo entre 0,2389 y 0,767 y el abcROC, entre 0,758 y 0,933. Esta revisión puede asistir en la elección de instrumentos psicométricos en español para la realización de estudios y la práctica clínica, así como en la identificación de necesidades de investigación sistemática en torno al tema.

SUMMARY The objective of this review is to describe the psychometric characteristics of the Spanish versions of instruments for the detection of common mental disorders, on the basis of a systematic search carried out in PubMed and Google Scholar. The following instruments with pertinent psychometric information were identified: General Health Questionnaire (GHQ-12 and GHQ-28), Hospital Anxiety and Depression Scale (HADS), Personal Health Scale (PHS), Self-Reporting Questionnaire (SRQ -20), Kessler Psychological Distress Scale (K-6 and K-10), Patient Health Questionnaire (PHQ), Edinburgh Scale (EPDS), Dep5, Anx5 and Symptom Checklist (SCL-90 and SCL-90-R). The most studied instruments were GHQ and HADS. Most of the studies were carried out in Spain. In Peru, SRQ-20, PHS, K-6, K-10 and GHQ-28 were evaluated. The psychometric properties described include internal consistency, factorial structure, area under the Receiver Operating Characteristic curve (AUC), sensitivity, specificity and Youden index (J). J of the instruments were between 0.2389 and 0.767, and the AUC, between 0.758 and 0.933. This review could help to choose psychometric instruments in Spanish for studies and clinical practice, as well as to systematically identify research needs about this topic.

Traducción y adaptación cultural del Cuestionario sobre el Uso Problemático de Internet para la población peruana / Translation and cultural adaptation of the Questionnaire on the Problematic Use of the Internet for the Peruvian population

RESUMEN Objetivo: Adaptar el Cuestionario sobre el Uso Problemático de Internet (PIUQ) para su utilización en el Perú. Material y Métodos: La traducción al español y la adaptación cultural del PIUQ siguieron un proceso sistematizado que incluyó la traducción directa, la evaluación por juicio de expertos y la retrotraducción, y culminó con la aprobación final de los creadores de la escala. Para cada uno de los 18 ítems, un primer comité de expertos evaluó en la versión preliminar la comprensibilidad, aceptabilidad, relevancia y el conjunto de respuestas; posteriormente, un segundo comité, examinó en la versión final los rasgos de claridad, pertinencia y relevancia. Se calculó la V de Aiken para cada uno de los diferentes aspectos evaluados en los 18 ítems. Resultados: En la versión preliminar, la V de Aiken tuvo valores bajos para la comprensibilidad de los ítems 1, 3, 4, 6 y 16, y para el conjunto de respuestas del ítem 4. El análisis del primer comité de expertos produjo modificaciones en los ítems 1, 4 y 16 de la dimensión de obsesión, 5 y 8 de negligencia, y 15 de trastorno de control. La evaluación por parte del segundo comité de expertos resultó en valores adecuados de V de Aiken en todos los aspectos de los 18 ítems. Conclusiones: La versión peruana final así obtenida demostró estar alineada a los fines del cuestionario original, sin alterar el significado de los ítems.

SUMMARY Objective : To adapt the Problem Internet Use Questionnaire (PIUQ) for its utilization in Peru. Material and Methods : The translation and cultural adaptation of the PIUQ followed a systematic process that involved direct translation, evaluation and judgment by expert committees and back-translation, culminating with the final approval by the scale creators. For each of the 18 items, a first group of experts assessed comprehensibility, acceptability, relevance and quality of the response set in the preliminary version; subsequently, a second group of experts, evaluated clarity, relevance and pertinence in the final version. Aiken's V was calculated for each of the different features evaluated in the 18 items. Results : In the preliminary version, Aiken's V had low values for the comprehensibility of items 1, 3, 4, 6 and 16, and for the response set of item 4. The analysis of the first expert committee led to modifications in items 1, 4 and 16 of the obsession dimension, 5 and 8 of neglect, and 15 of control disorder. The evaluation by the second expert committee resulted in adequate Aiken V values for all aspects of the 18 items. Conclusions : The final Peruvian version thus obtained proved to be aligned to the purposes of the original questionnaire, without altering the meaning of the items.

Relación entre la presencia de síntomas premenstruales y los niveles de depresión medidos con la Escala de Depresión Postnatal de Edimburgo en mujeres con menos de un año postparto / Relation between premenstrual symptoms and levels of depression measured by the Edinburgh Postnatal Depression Scale in women within their first year postpartum year

RESUMEN Objetivo: Evaluar la relación entre cada síntoma del trastorno disfórico premenstrual (TDPM) y los niveles de depresión postparto (DPP). Método: Se realizó un análisis secundario de una base de datos de 321 mujeres evaluadas transversalmente en el primer año postparto, determinando la presencia de síntomas del TDPM según los criterios del DSM-IV, y los niveles de DPP, mediante la Escala Edimburgo de Depresión Postnatal (EPDS). Mediante un análisis bivariado se determinaron las variables relacionadas significativamente con los puntajes de la EPDS y, con un análisis multivariado, se configuró el mejor modelo predictivo. Resultados: El análisis bivariado identificó a cefalea (coeficiente=3,26; p=0,002) y sensación de agobio (coeficiente=4,95; p=0,003) como asociadas a un mayor puntaje en la EPDS, más que el TDPM (coeficiente=2,52; p<0,001) como variable única. Otras variables asociadas fueron antecedente de depresión (coeficiente=2,42; p<0,001), presencia de pareja (coeficiente=1,54; p=0,041) y aborto (coeficiente=1,44; p=0,034). El modelo multivariado que mejor predice los puntajes de la EPDS incluye sensación de agobio, cefalea, antecedente de depresión mayor, presencia de pareja, antecedente de aborto y edad. Conclusiones: Los hallazgos arriba descritos podrían utilizarse para formular encuestas de tamizaje en gestantes, considerando además factores de riesgo tales como edad y antecedentes de depresión y aborto.

SUMMARY Objective : To evaluate the relationship between each symptom of premenstrual dysphoric disorder (PMDD) and the levels of postpartum depression (PPD). Methods: A secondary analysis of a database of 321 women, evaluated cross-sectionally in the first postpartum year was conducted, determining the presence of PMDD symptoms according to the DSM-IV criteria, and the levels of PPD, using the Edinburgh Postnatal Depression Scale (EPDS). A bivariate analysis determined the variables significantly related to the EPDS scores, while a multivariate analysis helped to configure the best predictive model. Results: According to the bivariate analysis, headache (coefficient=3,26; p=0,002) and feeling overwhelmed (coefficient=4,95; p=0,003) are associated with higher scores in the EPDS, even more so than PDDS (coefficient=2,52; p<0,001) as a single variable. Other associated variables were history of depression (coefficient=2,42; p<0,001), having a partner (coefficient=1,54; p=0,041) and abortion (coefficient=1,44; p=0,034). The multivariate model that best predicts EPDS scores includes feeling overwhelmed, headache, history of major depression, having a partner, history of abortion and age. Conclusions: The above findings are significantly related to EPDS scores, which could be used to design screening scales for pregnant women, also taking into account other risk factors, such as age and past history of depression and abortion.

Lead levels and cognitive abilities in Peruvian children.

OBJECTIVE: To study the relationship between blood lead levels and cognitive abilities of children exposed to this metal. METHOD: This is a cross-sectional study that included 134 children aged 6 to 8.5 years old from 3 schools with different risks of lead exposure located in El Callao (Peru). Cognitive assessments were made by means of the Graphic Test of Reasoning (GTR) and the Kohs Block Design Test (KBDT). Blood lead levels and other laboratory tests were performed. RESULTS: Children with lead > 10 ug/dl presented greater prevalence of low scores in the Graphic Test of Reasoning (18.9% vs. 7.1%, p = 0.049) and in the Kohs Block Design Test (KBDT) (39.6% vs. 18.6%, p = 0.01) compared with those with lower lead blood levels. A deficit of 1 category in the Graphic Test of Reasoning was associated with an increase in lead blood level of 16.78 ug/dl (assuming a linear relationship) and from 1 to 5.19 ug/dl (logarithmic model). For each 10 ug/dl of increase in lead levels, the Kohs Block Design Test decreases in 6.24 units (12.91 in males and 0.216 in females) (linear model), and an increase from 1 to 10 ug/dl corresponds to a drop of 16.44 points in the Kohs Block Design Test (31.19 in males and 3.98 in females) (logarithmic model). Considering the Graphic Test of Reasoning subscales, lead levels correlated negatively with the areas of numerical problems (rho = -0.445, p < 0.001), numerical relationships (rho = -0.365, p < 0.001), inferences (rho = -0.281, p = 0.002) and similarities (rho = -0.250, p = 0.005). CONCLUSIONS: Lead levels were non-linearly associated with lower cognitive abilities, especially in males, being the numerical reasoning the most affected area.

Selección de ítems para el desarrollo de un instrumento de evaluación de severidad de trastornos mentales en pacientes sin psicosis o déficit cognitivo / Item selection for the development of a severity assessment instrument for mental disorders in patients without psychosis or cognitive deficit

Objetivo: Seleccionar los ítems más relevantes para la creación de un instrumento de evaluación global de pacientes psiquiátricos ambulatorios sin psicosis ni déficit cognitivo. Material y Métodos: Se aplicaron 60 ítems, procedentes de diferentes escalas que evalúan principalmente severidad de síntomas, discapacidad y calidad de vida, a 313 pacientes con trastornos mentales de la consulta ambulatoria de psiquiatría del Hospital Cayetano Heredia (Lima, Perú). Al mismo tiempo, se evaluó la severidad de su sintomatología mental a través de la Escala de Impresión Clínica Global de Severidad (CGI-S). Se determinaron los ítems más relevantes en base a las cargas factoriales (CF) de cada ítem producto de un análisis factorial policórico y las correlaciones policóricas entre cada ítem y la CGI-S (cCGI). Resultados: Los 11 ítems más relevantes fueron: Calidad de vida global (CF=0,7958, cCGI=-0,4275), Bienestar psicológico (CF=0,7891, cCGI=-0,4507), Tristeza (CF=0,7601, cCGI=-0,4613), Sentimientos negativos (CF=0,7595, cCGI=-0,4269), Angustia (CF=0,7501, cCGI=-0,4824), Libertad y seguridad (CF=0,7402, cCGI=-0,4011), Suicidalidad (CF=0,7147, cCGI=-0,4766), Sentido de vida (CF=0,6998, cCGI=-0,4161), Crecimiento personal (CF=0,6987, cCGI=-0,4198), Espiritualidad, religión y creencias personales (CF=0,6936, cCGI=-0,3925) y Plenitud personal (CF=0,6869, cCGI=-0,4073). Conclusiones: Los 11 ítems seleccionados podrían constituir un instrumento corto de auto-reporte para la evaluación de enfermedad mental.

Objective: To select the most relevant items for the creation of a global evaluation instrument for psychiatric outpatients without psychosis or cognitive impairment. Methods: 313 psychiatric outpatients from Hospital Cayetano Heredia (Lima, Peru) completed 60 items taken from a variety of scales focused on measuring severity of symptoms, disability, and quality of life. At the same time, the severity of their mental symptoms was assessed through the Clinical Global Impressions Scale (CGI-S). The most relevant items were chosen based on each item´s factorial loads (FL) resulting from a polychoric factorial analysis and the polychoric correlations between each item and the CGI-S (CGIc). Results: The 11 most relevant items were: Global perception of quality of life (FL=0.7958, CGIc=-0.4275), Psychological/Emotional wellbeing (FL=0.7891, CGIc=-0.4057), Sadness (FL=0.7601, CGIc=-0.4613), Negative feelings (FL=0.7595, CGIc=-0.4269), Angst (FL=0.7501, CGIc=-0.4824), Freedom and physical safety (FL=0.7402, CGIc=-0.4011), Suicidality (FL=0.7147, CGIc=-0.4766), Life meaning (FL=0.6998, CGIc=-0.4161), Personal growth (FL=0.6987, CGIc=-0.4198), Spirituality and personal beliefs (FL=0.6936, CGIc=-0.3925), and Personal fulfillment (FL=0.6869, CGIc=-0.4073). Conclusion: The 11 selected items could constitute a short self-reporting instrument for the evaluation of mental illness.

Common mental disorders in public transportation drivers in Lima, Peru.

BACKGROUND: Traffic related injuries are leading contributors to burden of disease worldwide. In developing countries a high proportion of them can be attributed to public transportation vehicles. Several mental disorders including alcohol and drug abuse, psychotic disorders, mental stress, productivity pressure, and low monetary income were found predictors of high rates of traffic related injuries in public transportation drivers. The goal of this study was to estimate the prevalence of common mental disorders in the population of public transportation drivers of buses and rickshaws in Lima, Peru. METHODOLOGY/PRINCIPAL FINDINGS: Cross sectional study. A sample of bus and rickshaw drivers was systematically selected from formal public transportation companies using a snowball approach. Participants completed self-administered questionnaires for assessing major depressive episode, anxiety symptoms, alcohol abuse, and burnout syndrome. Socio demographic information was also collected. The analyses consisted of descriptive measurement of outcomes taking into account both between and within cluster standard deviation (BCSD and WCSD). A total of 278 bus and 227 rickshaw drivers out of 25 companies agreed to participate in the study. BCSD for major depressive episode, anxiety symptoms and burnout syndrome was not found significant (p>0.05). The estimated prevalence of each variable was 13.7% (IC95%: 10.7-16.6%), 24.1% (IC95%: 19.4-28.8%) and 14.1% (IC95%: 10.8-17.4%) respectively. The estimated prevalence of alcohol abuse was 75.4% (IC95%: 69-81.7%, BCSD = 12.2%, WCSD = 41.9%, intra class correlation (ICC): 7.8%). CONCLUSION: Common mental disorders such as alcohol abuse, major depressive episode, anxiety symptoms and burnout syndrome presented higher rates in public transportation drivers than general population.

Construcción de versiones cortas de la Escala de Psicopatología Depresiva para tamizaje de depresión mayor y sus características psicométricas / Construction of short versions of the Depressive Psychopathology Scale for screening of Major Depression and its psychometric features

Objetivos: Seleccionar los mejores ítems de la Escala de Psicopatología Depresiva original de 20 ítems (EPD) para construir versiones cortas a ser usadas en la detección de depresión mayor. Métodos: Usando como estándares de oro el diagnóstico de depresión mayor según la Entrevista Clínica Estructurada para el DSM-IV (Structured Clinical Interview for DSM-IV, SCID) y el diagnóstico clínico realizado por un psiquiatra (DCP), se determinó la combinación óptima de ítems buscando los mayores valores de área bajo la curva ROC (abcROC). Resultados: El abcROC más alta para el diagnóstico de depresión mayor considerando la SCID se obtuvo con una combinación de 4 ítems (EPD-4): fatiga, reactividad del ánimo, anhedonia y tristeza (abcROC=0,9033). Tomando en cuenta el DCP se identificaron 6 ítems (EPD-6): los mismos 4 ítems de la EPD-4 más alteración del sueño y pesadez de extremidades (abcROC=0,8652). Tanto para la SCID como para el DCP, las abcROC de ambas versiones cortas (EPD-4 y EPD-6) mostraron una tendencia (no significativa) a ser superiores a las correspondientes de la EPD de 20 ítems. Conclusiones: Los resultados sugieren que la detección de depresión mayor puede hacerse con versiones más cortas de la EPD sin perder su eficacia diagnóstica

Objectives: To select the best items, out of the 20 of the original Depressive Psychopathology Scale (DPS), in order to construct shorter versions to be used for Major Depression (MD) screening. Method: Using as a gold standards the diagnosis of MD according to the Structured Clinical Interview for DSM-IV (SCID) and a psychiatrist's clinical diagnosis (PCD), the best item combination was determined searching the highest area under the ROC curve value (auROC). Results: The highest auROC value for the MD diagnosis according SCID, were obtained with a combination of 4 items (DPS-4): fatigue, mood reactivity, anhedonia, and sadness (auROC=0.9033); when considering the PCD, 6 items (DPS-6) were identified: the same 4 plus sleep disturbance and overweighed extremities (leaden paralysis) (auROC=0.8652). For SCID and PCD, the auROC of both short versions (DPS-4 and DPS-6) showed a non significant trend to be greater than those corresponding to 20-item DPS. Conclusions: The results suggest that MD screening can be done with shorter versions of DPS without losing its diagnostic efficacy.

[Psychometric assessment and development of a shorter version of a new anxiety scale in a hospital sample from Lima, Peru]. / Evaluación psicométrica y desarrollo de una versión reducida de la nueva escala de ansiedad en una muestra hospitalaria de Lima, Perú

OBJECTIVES: To assess psychometric properties and to develop a shorter version of a new anxiety scale. MATERIALS AND METHODS: The 130-item new anxiety scale (NAS-130) was administered to 254 psychiatric outpatients of a general hospital in Lima, Peru. A categorical principal component analysis (CATPCA) was performed with the 130 items and based on these results and the relation of each item with a Clinical Global Impressions Severity Scale for anxiety (CGI-S) the scale was simplified. In addition, the CGI-S was used to assess the concurrent validity of the scale. RESULTS: The NAS-130 had a Cronbach's alpha of 0.97 and a Spearman correlation coefficient (Rho) with CGI-S of 0.44 (p<0.01). After item selection, a 72-item scale was obtained (NAS-72) which had a Cronbach's alpha of 0.96 and a Rho with CGI-S of 0.47 (p<0.01). All items of NAS-72 had saturation coefficients greater than 0.4 in one dimension according to the CATPCA. NAS-130 and NAS-72 scores were significantly higher in women than in men (p<0.01). CONCLUSIONS: The NAS-72 has psychometric characteristics that suggest that it could be useful to measure anxiety in our population; however, the scores should be interpreted differently in men and women.

Construcción y propiedades psicométricas de la Escala de Ansiedad de Lima de 20 ítems (EAL-20) / Construction and psychometric properties of 20-item Lima Anxiety Scale (LAS-20)

Objetivo: Seleccionar los ítems más representativos de una escala de ansiedad de 130 ítems (Escala de Ansiedad de Lima, EAL-130) para hacer posible la construcción de una versión breve de 20 ítems (EAL-20). Métodos: A partir de los datos del estudio previo de validación de la EAL-130 en 254 pacientes, se utilizó el método de análisis de regresión múltiple para identificar los ítems que mejor predecían los puntajes totales de cada una de 5 subescalas correspondientes a 5 síndromes incluidos en la escala original (ansiedad psíquica, síntomas físicos, pánico, agorafobia y fobia social). Se condujo un análisis factorial de matriz policórica de la nueva escala así generada (EAL-20). Resultados: La EAL-20 tuvo un alfa de Cronbach de 0,8885 y sus 20 ítems cubrieron el 90,38% de la varianza del puntaje total de la EAL-130. En la EAL-20 se identificaron 4 factores correspondientes a ansiedad física, fobia social, ansiedad psíquica y agorafobia. Con un punto de corte de = 10 se obtuvo un equilibrio entre sensibilidad y especificidad para la identificación de un CGI-S= 4. Conclusiones: Los 20 ítems seleccionados para la EAL-20 permiten evaluar 4 dimensiones de ansiedad, con una mínima pérdida de información respecto a la EAL-130; se sugiere usar un punto de corte = 10 como indicador de ansiedad moderada o de severidad mayor.

Objective: To select the most representative items of a 130-item anxiety scale (Lima Anxiety Scale, LAS-130) in order to construct a shorter version of 20 items (LAS-20). Methods: Based on the data of the 254 patients included in the previous validation study of LAS-130, multiple regression analysis was used to identify the items that best predicted the total scores of each of 5 subscales corresponding to 5 syndromes included in the original scale (psychic anxiety, physical symptoms, panic, agoraphobia and social phobia). In addition, a factorial analysis of the polychoric matrix of the new scale (LAS-20) was performed. Results: LAS-20 had a Cronbach's alpha of 0.8885, and its 20 items covered 90.38% of the total score variance of LAS-130. In LAS-20, 4 factors were identified corresponding to physical anxiety, social phobia, psychic anxiety and agoraphobia. Using a cut-off score of =10, equilibrium between sensitivity and specificity was obtained for detection of a CGI-S= 4. Conclusions: The 20 items selected for the LAS-20 allow to evaluate 4 anxiety dimensions with a minimum loss of information when compared to the LAS-130. A cut-off score of = 10 is suggested as an indicator of anxiety of moderate or higher severity.

Aripiprazol en dosis bajas para somnolencia diurna excesiva asociada a uso de haloperidol: un reporte de caso / Low dose aripiprazole for excessive daytime sleepiness associated with the use of haloperidol: A case report

La somnolencia diurna es un efecto adverso frecuentemente asociado al uso de antipsicóticos en pacientes con esquizofrenia. Presentamos el caso de una mujer de 43 años con esquizofrenia y tratamiento antipsicótico desde hace 24 años, que inicialmente, presentó mala respuesta a antipsicóticos clásicos de baja potencia, llegando a lograr estabilizar los síntomas psicóticos por más de 10 años con uso de haloperidol. Sin embargo, con este tratamiento presentó somnolencia diurna que llegó a ser un efecto adverso importante limitando su funcionalidad y calidad de vida. Luego de añadirse primero 3,75 mg y luego 7,5 mg de aripiprazol, mejoró hasta un 80% la somnolencia sin exacerbación de los síntomas psicóticos

Daily somnolence is a frequent adverse event associated to the use of antipsychotic medication in patients with schizophrenia. We present the case of a 43 years old women with schizophrenia and pharmacological treatment for 24 years, who, at the start of the treatment, showed inadequate response to low potency classical antipsychotics, achieving clinical stability for more than 10 years with the use of haloperidol. However, she presented severe daily somnolence which significantly limited her functionality and quality of life. After the addition of 3.75 mg and later 7.5 mg of aripiprazole the somnolence improved in nearly 80% without exacerbation of psychotic symptoms

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study.

BACKGROUND: Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS). METHODOLOGY/PRINCIPAL FINDINGS: A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbach's alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%). CONCLUSION: Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.