Personality characteristics in specialist and generalist intimate partner violence perpetrators.

Intimate partner violence (IPV) is one of the most common types of violence against women. Although personality disorders have been associated with IPV, perpetration research regarding personality according to the classification specialist/generalist IPV perpetrators is scarce. The general aim of this study was to describe personality in a large sample of IPV Spanish male perpetrators considering their classification (specialist vs. generalist). Participants were 1093 men convicted of IPV crimes whose ages ranged from 18 to 76 years old (M = 40.15; SD = 10.32). Of them, 554 men were classified as specialist perpetrators and 539 men were classified as generalist perpetrators. Participants completed questionnaires regarding sociodemographic and violence aspects as well as the Spanish version of the Millon Clinical Multiaxial Inventory III. Generalist perpetrators showed higher means in nearly all the personality disorders scales compared to specialist perpetrators. Prevalence rates in the majority of personality disorders were lower than 5%. Higher scores on the avoidant, histrionic, and self-defeating scales and lower scores on the aggressive, borderline, and drug dependence scales were related to being a specialist perpetrator. This study contributes to a better understanding of personality among generalist and specialist perpetrators.

A Four Country Study of Strangulation-related Alterations in Consciousness in Women who have Experienced Intimate Partner Violence: Co-occurrence with Traumatic Brain Injuries and Measures of Psychological Distress.

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (N=213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, USA, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and PTSD at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann Whitney U tests and Chi square tests were conducted to examine differences between women with- versus without-experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance, and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a sub-sample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate to severe BI than those who had not sustained an S-AIC (BISA severity subscale: U=3939, p=0.006). Additionally, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared to women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries, and therefore highlight IPV-related BIs as a global issue which needs to be aggressively studied with policies established and then implemented to address find.

The role of resilience in the relationship between intimate partner violence severity and ICD-11 CPTSD severity.

Background: Resilience is a modulating factor in the development of PTSD and CPTSD after exposure to traumatic events. However, the relationship between resilience and ICD-11 CPTSD is not adequately understood in survivors of intimate partner violence (IPV).Objective: The aim of this study is to determine whether resilience has a mediating role in the relationship between severity of violence and severity of CPTSD symptoms.Method: A sample of 202 women IPV survivors completed self-rated questionnaires to assess CPTSD, severity of violence and resilience.Results: Mediation analyses indicated that there was a direct relationship between the severity of violence and the severity of CPTSD symptoms (ß = .113, p < .001) and that there was a significantly inverse relationship between levels of resilience and the severity of CPTSD symptoms (ß = -.248, p < .001). At the same time, there was no significant relationship between the severity of violence and resilience (ß = -.061, p = .254).Conclusions: These findings suggest that resilience does not mediate the relationship between violence severity and CPTSD severity. Directions for future research are discussed.

The severity of intimate partner violence (physical, sexual and/or psychological violence together or in isolation) could lead to symptoms of complex post-traumatic stress disorder in women survivors of IPV in the present sample.Lower levels of resilience are associated with higher levels of symptoms of complex post-traumatic stress disorder.Resilience does not mediate the relationship between violence severity and CPTSD severity.

Exhausted women, tough men: a qualitative study on gender differences in health, vulnerability and coping with illness in Spain.

This study analyses different perceptions by women and men, from different social backgrounds and ages, regarding their health, vulnerability and coping with illness, and describes the main models provided by both sexes to explain determinants for gender inequalities in health. The qualitative study involved in-depth interviews with women and men resident in Granada (Spain). The women rated their health worse than men, associating it with feelings of exhaustion. However, men tended to overrate their health, hiding their problems behind the 'tough guy' stereotype associated with masculinity. Both women and men shared the belief that women are more vulnerable, while men are weaker at coping with illness. The explanatory models offered for this paradox of 'weak but strong women' and 'tough but weak men' were different for each sex. Men used biological arguments more than women, centred on the female reproductive cycle. Women used more cultural models and identified determinants relating to social stratification, gender roles and power imbalances. In conclusion, gender constructions affect the health perceptions of both women and men at any social level or age. 'Exhausted' women and 'tough' men should form preferential target groups for intervention to reduce gender inequalities in health.

Structural Brain Alterations in Female Survivors of Intimate Partner Violence.

Intimate partner violence (IPV) has been related to brain alterations in female survivors. Nonetheless, few studies have used an exploratory approach, focusing on brain regions that are traditionally studied in other populations with post-traumatic stress. Traumatic brain injury (TBI), strangulation, and childhood trauma are highly prevalent among this population, and have also been associated with brain alterations and functional deterioration. As such, it is difficult to determine how different brain regions are affected by the complex interplay of these factors in female survivors. The aim of this study is to assess (a) brain alterations in female survivors of IPV as compared to non-victim females and (b) the potential causal mechanisms associated with such alterations. We hypothesized that structural brain differences would be found between female survivors of IPV and non-victims, and that these differences would be related to IPV-related TBI, strangulation, IPV severity, depression, post-traumatic stress, generalized anxiety, and childhood adverse experiences. A total of 27 non-victims and 28 survivors completed structural magnetic resonance imaging and questionnaires to measure the potential causal mechanisms for brain alterations. Structural brain differences were found between groups, principally in volumetric analyses. The brain regions in which between-group differences were found were related to attempted strangulation, IPV-related TBI, severity of IPV, adverse childhood experiences, and post-traumatic stress. These results demonstrate that a wider range of brain regions may be impacted by IPV and that various factors are implicated in the structural brain alterations found in female survivors. This study demonstrates the importance of post-traumatic stress, childhood and adult trauma, and physical violence in assessing brain alterations in IPV survivors. Further, it serves as a critical first step in assessing an extensive list of potential causal mechanisms for structural brain alterations, using a more comprehensive a whole-brain structural analysis of IPV female victims, a largely understudied and vulnerable population.

"Would You Allow Your Wife to Dress in a Miniskirt to the Party"? : Batterers Do Not Activate Default Mode Network During Moral Decisions About Intimate Partner Violence.

Moral convictions consist of assessments based on perceptions of morality and immorality, of right and wrong. There are people who, based on morality, commit crimes. For instance, social and moral norms based on inequality appear to play an important role in the batterer's behavior to commit violent acts. Research shows that batterers consider themselves to be moral persons, are defenders of their beliefs, and, if necessary, are self-delusional, enjoying a "feeling" of moral worth. The main aim of this work was to uncover the brain mechanisms underlying moral decision making related to intimate partner violence (IPV) against women. We conducted a functional magnetic resonance imaging (fMRI) study comparing moral decisions related to IPV and general violence (GV) in a sample of convicted Spanish men. The two groups of our sample were recruited from the Center for Social Insertion (CSI; Granada, Spain): batterers (BG, n = 21), people convicted for IPV, and other criminals (OCG, n = 20) convicted of violating other legal norms without violence against people. Greene's classical dilemmas were used to validate IPV and GV dilemmas. First, our results showed that IPV and GV dilemmas activate the same brain areas as those activated by Greene's dilemmas, primarily involving the default mode network (DMN), which suggests that IPV and GV dilemmas are both moral dilemmas. Second, our results showed that other criminals activated the DMN during both types of dilemmas. Nevertheless, batterers activated the DMN during the GV dilemmas but not during the IPV ones, suggesting that decisions about their female partners do not entail moral conflict. Thus, these preliminary results showed that batterers do not activate moral areas during IPV dilemmas specifically, but do so during GV dilemmas. These results suggest that intervention programs for batterers should aim to specifically modify the value system held by the abuser toward his female partner and not toward other people.

Validation of the Coin in Hand-Extended Version Among Older Adults With and Without Dementia.

OBJECTIVE: The current study aimed to validate the Performance Validity Test Coin in Hand-Extended Version (CIH-EV) in groups of healthy older adults and older adults with dementia. METHOD: Using an analog simulation paradigm, the healthy control group and the clinical group were instructed to perform to the best of their ability, whereas the feigning older adults were instructed to simulate a memory deficit to obtain allowance, financial aid, or early retirement. RESULTS: Results showed that the control and clinical groups performed more optimally than the feigning group, although the clinical group had superior response times. The CIH-EV was insensitive to sociodemographic variables and neurocognitive functioning in all groups, demonstrated good convergent validity with other performance validity measures, and showed a reduced rate of false positives. CONCLUSIONS: This study corroborates the CIH-EV's effectiveness in detecting the simulation of cognitive deficits in healthy older adults and older adults with dementia.

Characteristics of Childhood Family Violence Experiences in Spanish Batterers.

Intimate Partner Violence (IPV) constitutes a major public health problem worldwide. The existing links between childhood family violence experiences and perpetration of IPV during adulthood suggest that violence is transmitted across generations. The aims of this study were to provide new insights into characteristics of the history of childhood family violence in a sample of Spanish convicted male batterers and to examine what typology of batterer (specialist or generalist) is more likely to have had different types of childhood experiences of violence in the family context. Participants were 740 men convicted of IPV whose ages ranged from 18 to 71 years old (M = 39.74; SD = 10.01). Of them, 305 men were classified as specialist batterers, and 391 men were classified as generalist batterers. Participants completed a questionnaire made ad hoc regarding family of origin violence and sociodemographic aspects. Results showed that, in comparison with generalist batterers, specialist batterers had higher likelihood of having experienced child abuse or maltreatment during their childhood, having experienced physical punishment and child neglect, having their father as the aggressor of such experienced situations of abuse, or maltreatment. Likewise, specialist batterers had higher likelihood of having been witnesses of family violence, having witnessed physical and psychological violence in the family, having witnessed their mother and siblings being the victims and their father being the aggressor when family violence occurred. This study emphasized the need for identifying children exposed to direct and indirect family violence because they could be a vulnerable group for future IPV perpetration. Moreover, variables related to childhood family violence must be considered when developing intervention treatment programs focused on male specialist batterers.

The Coin in Hand-Extended Version: Development and Validation of a Multicultural Performance Validity Test.

The number of computerized and reliable performance validity tests are scarce. This study aims to address this issue by validating a free and computerized performance validity test: the Coin in Hand-Extended Version (CIH-EV). The CIH-EV test was administered in four countries (Colombia, Spain, Portugal, and the United States) and performance was compared with other commonly used validated tests. Results showed that the CIH-EV has at least 95% specificity and 62% sensitivity, and performance was highly correlated with scores on the Test of Memory Malingering, Victoria Symptom Validity Test, and Digit Span of the Wechsler Adult Intelligence Scale. There were no significant differences in scores across countries, suggesting that the CIH-EV performs similarly in a variety of cultures. Our findings suggest that the CIH-EV has the potential to serve as a valid validity test either alone or as a supplement to other commonly used validity tests.

[Paternity and health services. Qualitative research on men's experiences during pregnancy, delivery and postpartum of theirs partners]. / Paternidad y servicios de salud. Estudio cualitativo de las experiencias y expectativas de los hombres hacia la atención sanitaria del embarazo, parto y posparto de sus parejas.

BACKGROUND: Little research has been carried out with regards to the inclusion of men during the birth process. The objective of this paper involves exploring the needs and expectations of the health services manifested by a group of fathers as a result of their experience during the birth process. METHODS: Qualitative research was carried out in Granada in 2004 via individual interviews with fathers who showed shared responsibility in the upbringing. The profile is: employment, medium-high educational level, one or more child: 0-6 months of age. The transcript was subsequently submitted to hermeneutic analysis. RESULTS: Some semantic constructs are: 1) Health Services do not concede the women as protagonists, 2) Birth process is depending on the body. Fathers can only support and fight for the relevance of men, 3) Men seem like "invisible", 4) Health services inhibit their participation, and 5) have dealings with fathers according to their gender roles. The participants address the relationship between expectations of care during the birth process and unsatisfied demands, and the manner in which they employ the obstacles encountered within health services that inhibit their participation as arguments that confirm their separation from the process. CONCLUSIONS: This paper draws attention to the limited scope of the provision of healthcare during the birth process in terms of protagonism afforded to fathers. Indeed, despite their requisitory discourse, the interviewees manifest contradictory attitudes in the face of changes that require them to make commitments. We identify elements that could be improved to adapt services to the needs of fathers and vice versa.

Structural brain differences in emotional processing and regulation areas between male batterers and other criminals: A preliminary study.

Poor emotion processing is thought to influence violent behaviors among male batterers in abusive relationships. Nevertheless, little is known about the neural mechanisms of emotion processing in this population. With the objective of better understanding brain structure and its relation to emotion processing in male batterers, the present study compares the cortical grey matter thickness of male batterers to that of other criminals in brain areas related to emotion. Differences among these brain areas were also compared to an emotional perception task. An MRI study and an emotional perception assessment was conducted with 21 male batterers and 20 men convicted of crimes other than Intimate Partner Violence (IPV). Results demonstrated that batterers' had significantly thinner cortices in prefrontal (orbitofrontal), midline (anterior and posterior cingulate) and limbic (insula, parahipocampal) brain regions. The thickness of the dorsal posterior cingulate cortex in the batterer group correlated with scores on the emotional perception task. These findings shed light on a neuroscientific approach to analyzing violent behavior perpetrated by male batterers, leading to a better understanding of the underlying mechanisms involved in IPV.

Diagnostic mistakes of culturally diverse individuals when using North American neuropsychological tests.

Although the role of culture has increasingly gained acceptance in clinical neuropsychology, relatively minimal research exists regarding the actual impact on clinical activities. In this study, we assess how using North American neuropsychological tests affects diagnostic accuracy in cognitive disorders of culturally diverse individuals. To address this question, participants from Colombia, Morocco, and Spain were administered five commonly used neuropsychological tests and the test results were used to determine whether they would be classified as having the DSM-5 diagnostic criteria for Mild Cognitive and Major Cognitive Disorder. Results reveal that diagnostic error occurred up to 20% of the time, and that the frequency of misdiagnosis differed by nationality. These results provide evidence that using tests from one culture to assess individuals from other cultures produces significant false positives. Findings are discussed in terms of the foundations of neuropsychological assessment and its relationship to cultural variables.

Are batterers different from other criminals? An fMRI study.

Intimate partner violence (IPV) is a complex and global phenomenon that requires a multi-perspective analysis. Nevertheless, the number of neuroscientific studies conducted on this issue is scarce as compared with studies of other types of violence, and no neuroimaging studies comparing batterers to other criminals have been conducted. Thus, the main aim of this study was to compare the brain functioning of batterers to that of other criminals when they are exposed to IPV or general violence pictures. An fMRI study was conducted in 21 batterers and 20 other criminals while they observed IPV images (IPVI), general violence images (GVI) and neutral images (NI). Results demonstrated that batterers, compared with other criminals, exhibited a higher activation in the anterior and posterior cingulate cortex and in the middle prefrontal cortex and a decreased activation in the superior prefrontal cortex to IPVI compared to NI. The paired t-test comparison between IPVI and GVI for each group showed engagement of the medial prefrontal cortex, the posterior cingulate and the left angular cortices to IPVI in the batterer group only. These results could have important implications for a better understanding of the IPV phenomenon.

Validation of the cross-linguistic naming test: a naming test for different cultures? A preliminary study in the Spanish population.

BACKGROUND: Despite the consensus pointing out the importance of cultural variables in neuropsychological assessments, empirical studies within cross-cultural neuropsychology continue to be limited. The Cross-Linguistic Naming Test (CLNT) is a naming test that is supposed to have no influence from cultural variables. The aim of this paper is to determine the psychometric properties of the CLNT and its discriminatory validity (Experiment 1) and to determine the performance of the CLNT in different cultures (Experiment 2). METHOD: Three groups followed the CLNT in Experiment 1: dementia patients, individuals with subjective memory complaints, and neurologically healthy volunteers. Three groups followed the CLNT in Experiment 2: Colombians, Moroccans, and Spaniards. RESULTS: The results showed that the psychometric properties of the CLNT are appropriate and that this test obtains a high specificity but a low sensitivity. Furthermore, no differences were found in the CLNT among the three cultural groups. DISCUSSION: The CLNT may be appropriate for the screening of naming impairment in Colombian, Moroccan, and Spanish cultures.

Cultural differences in neuropsychological abilities required to perform intelligence tasks.

Different studies have demonstrated that culture has a basic role in intelligence tests performance. Nevertheless, the specific neuropsychological abilities used by different cultures to perform an intelligence test have never been explored. In this study, we examine the differences between Spaniards and Moroccans in the neuropsychological abilities utilized to perform the Beta III as a non-verbal intelligence test. The results showed that the Spaniard group obtained a higher IQ than the Moroccan group in the Beta III. Moreover, the neuropsychological abilities that predicted scores for the Beta III were dependent on the country of origin and were different for each subtest. Besides showing the cultural effect on non-verbal intelligence test performance, our results suggest that a single test may measure different functions, depending on the subject's cultural background.

Neuropsychological test performance of Spanish speakers: is performance different across different Spanish-speaking subgroups?

Even though theories and research have pointed out the importance of variables such as age, gender, or education on neuropsychological assessment, much less emphasis has been placed on language and culture. With the increasing population of Spanish speakers in North America and the limited amount of clinical and scholarly information currently available, neuropsychological assessment of this group has similarly become of increasing importance. Though several studies have been published over the last two decades, an assumption exists that all Spanish speakers, holding education and age constant, would perform similarly regardless of their origin. To address this assumption, a sample of 126 participants was tested from four different countries (Chile, Dominican Republic, Puerto Rico, and Spain). Participants were compared on the following commonly used neuropsychological tests: Verbal Serial Learning Curve, Rey- Osterrieth Complex Figure Test, Verbal Phonemic Fluency Test, the Stroop Color and Word Test, and the Trail Making Test. Analyses revealed significant differences across the groups in two of the five tests administered. Significant differences were observed in the delayed recall of the Serial Learning Test and in the Verbal Fluency Test. The findings highlight the importance of within-group differences between Spanish speakers.

Embedded gender and social changes underpinning inequalities in health: an ethnographic insight into a local Spanish context.

Despite growing interest in the social determinants of health and contributions from studies focussing on the analysis of explanations to enhance our understanding of the interactions between gender identities, embodied experiences and structural inequalities between men and women, few research papers have devoted attention to this perspective in the Spanish context. This study is an empirical exploration of lay knowledge, for an enhanced understanding of health inequalities in this context, from an ethnographic standpoint based on a phenomenological approach. Specifically, our aim is to study the lay perceptions of men and women regarding their gender identity and living conditions as health determinants within different "contexts" of their everyday lives, namely: the personal context; the home context; and the neighbourhood context. Fifty eight in-depth interviews and three focus groups were held between January 2005 and January 2007, and analysed using a hermeneutic method. Our findings show how disease-coping strategies or the perceived loss of social cohesion are linked to the gender system. They also point to how the dynamics of social change have developed around a strong division between the productive and reproductive arenas. Approaching these issues from different "contexts" provides insights into the explanations for the gendered patterning of mortality and morbidity, as well as furthering our understanding of the basis for social embodiment of gender differences and health inequalities in the context studied. In the discussion of our findings, we place emphasis on the implications that informal caring has for these processes and also take into account contributions of the "lay approach" to study and understand social determinants and health inequalities.

Perfiles psicopatológicos de obesos y desnutridos medidos con el CBCL/6-18 / Psychopathological profiles of obese children and malnourished measures Obesity; in CBCL/6-18

Los objetivos de este trabajo fueron definir los trastornos psicopatológicos más comunes asociados a la obesidad y a la desnutrición, así como establecer el grupo de referencia normativo al cual pertenece México en la escala Child Behavior Checklist 6-18 (CBCL/6-18). Este fue un estudio transversal de diseño cuasiexperiemental. Se utilizó la información de 125 niños de escuelas públicas de Ciudad Juárez, Chihuahua, México, en estados de desnutrición, obesidad y normopeso, obtenida mediante las 113 preguntas relacionadas con el comportamiento de niños, que contiene el CBCL 6-18. Por medio de análisis de varianzas se estudiaron las posibles diferencias entre los grupos. Encontramos que nuestra muestra mexicana, pertenece al grupo normativo de referencia tres; las diferencias más significativas se encuentran en el grupo de obesos en la escala de problemas internalizados específicamente en ansiedad/depresión, y en el total de problemas.

This paper sought to define the most common psychopathological disorders associated with obese and malnourished children, and establish the normative group to which Mexico belongs in the Child Behavior Checklist 6-18(CBCL/6-18). This was a cross-sectional study of cuasiexperimental design. CBCL/6-18 data from 125 children from public school in Ciudad Juárez, Chihuahua, México were categorized into obese, malnourished and normal nutrition states. The 113 questions related to the behavior of children of the CBCL 6-18 through variance analysis were used to explore the possible differences between groups. Our Mexican children sample belongs to the normative group three. We found that the major differences were in internalized problems, specifically in anxiety/depression, and on Total Problems with the obese group.

Procesamiento emocional en maltratadores de género mediante el Test de Expresiones Faciales de Ekman y la Tarea Stroop Emocional / Emotional processing in batterers as assessed by Test Ekman Facial Expressions and Emotional Stroop Task in intimate partner violence situations

La investigación actual en el campo de la violencia de pareja es escasa en lo que se refiere al papel del procesamiento emocional de los maltratadores. Sin embargo, ningún estudio ha investigado en la misma muestra la capacidad de reconocer las emociones y la influencia de las emociones en los aspectos atencionales. El objetivo de este estudio es investigar en una muestra de maltratadores la capacidad de reconocer las emociones de fotografías estandarizadas y analizar la interferencia de las palabras con contenido emocional en una tarea atencional. La muestra consistió en 90 hombres condenados por violencia de pareja y 77 hombres condenados por otros delitos. Se evaluaron las características sociodemográficas asociadas a nuestra muestra y el procesamiento emocional de las expresiones faciales con la prueba de Ekman y la Tarea Stroop Emocional, diseñada específicamente para evaluar el procesamiento emocional en situaciones de violencia contra la pareja. Los resultados mostraron un mejor reconocimiento emocional de los maltratadores en las emociones faciales de enfado y sorpresa. Para el procesamiento de palabras con contenido emocional, las diferencias no fueron estadísticamente significativas.

Current research in the field of intimate partner violence has been scarce as regards the role of emotional processing in abusers. Nevertheless, no study has investigated the ability to recognize emotions and the influence of emotions on attention-related aspects among the same sample. The aim of this study is to investigate the ability to recognize emotions in standardized photographs, and to analyze the interference that words with emotional content exert on an attention task in a sample of abusers. The sample consisted of 90 men convicted of intimate partner violence and 77 men convicted of other crimes. Demographic characteristics associated to the sample were evaluated, as were emotional processing of facial expressions with the Ekman Test and the Emotional Stroop task, specifically designed to assess emotional processing in situations of intimate partner violence. The results showed better emotional recognition among abusers in the recognition of facial emotions of anger and surprise. As for the processing of words with emotional content, differences were not statistically significant.

[Gender analysis of primary care professionals' perceptions and attitudes to informal care]. / Análisis de género de las percepciones y actitudes de los y las profesionales de atención primaria ante el cuidado informal.

OBJECTIVES: To analyze primary care professionals' perceptions and attitudes to informal care from a gender perspective. METHODS: We performed a qualitative study using interviews and a discussion group. Eighteen primary care professionals were selected in the Health District of Grenada (Spain) by means of intentional sampling. Content analysis was performed with the following categories: a) perceptions: concepts of dependency and informal care, gender differences and impact on health, b) attitudes: not in favor of change, in favor of change and the right not to provide informal care. RESULTS: The health professionals emphasized the non-professional, free and strong emotional component of informal care. These professionals assigned the family (especially women) the main responsibility for caregiving and used stereotypes to differentiate between care provided by men and by women. The professionals agreed that women had a greater psychological burden associated with care, mainly because they more frequently provide caregiving on their own than men. Three major attitudes emerged among health professionals about informal care: those who did not question the current situation and idealized the family as the most appropriate framework for caregiving; those who proposed changes toward a more universal dependency system that would relieve families; and those who adopted an intermediate position, favoring education to achieve wellbeing in caregivers and prevent them from ceasing to provide care. CONCLUSIONS: We identified perceptions and attitudes that showed little sensitivity to gender equality, such as a conservative attitude that assigned the family the primary responsibility for informal care and some sexist stereotypes that attributed a greater ability for caregiving to women. Specific training in gender equality is required among health professionals to reduce inequalities in informal care.