Anxiety and eating behaviors: Mediating effect of ethnic identity and acculturation stress.

Immigration changes the daily dynamics of migrant individuals and communities, as individuals confront new cultures and environments, including new foods and eating styles. Consequent influences on eating behaviors comprise an individual's actions in feeding themself that are conditioned by biological, social, cultural, and psychological factors. Mental health indicators such as anxiety and stress reflect negative impacts of acculturation on migrants' health, but ethnic identity is potentially protective. However, the relationship between these mental health indicators and immigrant populations' eating behaviors have not been addressed. Our objective was to analyze the mediating effects of acculturation stress and ethnic identity on the relationship between anxiety and three dimensions of eating behaviors in Colombian migrants living in Chile. A total of 959 Colombian immigrants participated. Ethnic identity only partially mediated the effect of emotional eating. The other two dimensions had direct effects but no mediating effects. Conversely, acculturation stress and emotional eating partially mediated restrained eating while external intake had a direct effect but no mediation. Anxiety had significant direct effects with all the dimensions analyzed. Ethnic identity score related to a protective effect between anxiety and emotional eating. Stress of acculturation, conversely, was a risk factor in the relationship between anxiety, emotional eating, and restrained eating.

Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries.

The relationships between stigma and quality of life in schizophrenia (QoL) have been extensively explored but have mostly focused on self-stigma and self-esteem and have never been explored in Latin-America. The objective of this study was to determine which stigma dimensions were associated with QoL in a sample of community-dwelling SZ subjects of three Latin-American countries. Stabilized outpatients with SZ were recruited in three Mental Health Services in three Latin-American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Stigma and Qol-SZ were evaluated by self-administered questionnaires, the Internalized Stigma of Mental Illness scale (ISMI-12) and the SQoL-18. 253 participants were included. In multivariate analyses, QoL has been associated with each stigma dimension (social stigma, stigma experience and self-stigma), independently of age, gender, education level, ethnicity, age at illness onset, illness symptomatology and mental health treatment. More specifically, social stigma was significantly associated with impaired psychological and physical well-being, self-esteem and friendship. Self-stigma was significantly associated with impaired psychological well-being, self-esteem and autonomy. The present results confirm the importance of stigma in QoL of SZ subjects and identify new targets to develop stigma-orientated programs. Most of the previous programs have focused on self-stigma while social stigma has shown to be associated with a wide range of impaired QoL areas. Stigma and QoL may have a bidirectional relationship and targeting some specific QoL areas (like autonomy through self-empowerment approaches) may also improve the effectiveness of these programs to reduce stigma impact on the quality of life of subjects with schizophrenia. Future studies should also explore differences across countries as subjects from Bolivia were more frequently Aymara and reported higher stigma and lower QoL than SZ subjects from other countries.

Psychiatric disorders in children and adolescents in a middle-income Latin American country.

BACKGROUND: Child and adolescent mental health has scarcely been studied in developing countries, though it is an important aspect of health. Mental health problems in youth often continue into adulthood if not diagnosed or treated in time. METHODS: The Sistema de Evaluación de Niños y Adolescentes (SENA) [Child and Adolescent Evaluation System] was used to evaluate mental health indicators in a sample of students in Northern Chile. Two age-appropriate versions of the assessment were applied to a total sample of 5043 students, which included an elementary education sample of 1953 schoolchildren from fourth grade through sixth grade (ages 8 to 13 years), and a Secondary School sample of 3090 schoolchildren from seventh grade (the last year of elementary school) through the last year of Secondary school (senior high school) (ages 12 to 19 years). For each group, the version of the assessment used was determined by the students' grade level. Both samples included municipal, government-subsidized, and private schools. RESULTS: In this student population, depression, anxiety, and behavioral disorders were the main mental health problems identified, and indicators revealed a progressive increase in cases over the years, coinciding with the global epidemiological scenario. Males showed a greater presence of externalizing behaviors related to mental health problems associated with aggression and defiant behavior. However, females showed the highest number of mental health issues overall, especially regarding problems related to internalization. There are significant differences between school types. CONCLUSIONS: Our sample population analysis indicates that early intervention is necessary for the diagnosis and treatment of youth, with the goal of reducing the probability that psychiatric disorders will be prolonged, evolving, and worsening in adulthood.

[Prevalence of anxious and depressive symptoms in Colombian migrants in Chile]. / Prevalencia de sintomatología ansiosa y depresiva en migrantes colombianos en Chile.

BACKGROUND: Migratory processes may affect mental health. Data on the health status of migrants are necessary for an adequate public health approach. AIM: To describe the prevalence of anxious and depressive symptoms in Colombian migrants living in Chile and to compare it with the Chilean population. MATERIAL AND METHODS: Beck and BDI scales for depression and BAI anxiety scale were applied to 1,932 participants living in Arica, Antofagasta and Santiago. Of these, 976 participants (51% women) aged 35 ± 10 years were first generation Colombian migrants and 956 participants aged 34 ± 14 years were Chilean. RESULTS: The scores for depressive and anxious symptoms were higher in Chileans than in Colombians. Women reported worse mental health in both groups. Chilean and Colombian respondents residing in Arica and Antofagasta had a higher degree of anxiety and depression than their counterparts residing in Santiago. CONCLUSIONS: Chileans have worse mental health indicators than Colombian migrants. There are differences by sex and city of residence.

[Cut-off points of the difficulties in Emotion Regulation Scale for the Chilean population]. / Propuesta de valores de referencia para la Escala de Dificultades de Regulación Emocional (DERS-E) en población adulta chilena.

BACKGROUND: There are no reference values for the Difficulties in Emotion Regulation Scale (DERS-E) for the Chilean population. AIM: To elaborate reference values for the interpretation of the DERS-E for the Chilean population. MATERIAL AND METHODS: The Difficulties in Emotion Regulation Scale was answered by participants from the general population (1,153 heterosexual men and women and 467 gay and lesbian individuals) and a group of 351 participants with emotional complaints. Receiver operating characteristic (ROC) curves were used to obtain the reference values. A concordance index was determined, and the odds ratio was calculated to evaluate the probability of having mental health problems comparing participants with emotional complaints with those from the general population. RESULTS: The DERS-E cut-off score was 73 points for the Chilean population. No differences were detected for emotional regulation difficulties between men and women or by sexual orientation. Age had a weak association with emotional regulation difficulties. CONCLUSIONS: DERS-E has an adequate diagnostic capacity, allowing to differentiate between those who have high or low emotional regulation difficulties.

[Mental health problems among health care workers during the COVID-19 pandemic]. / Salud mental en trabajadores de la salud durante la pandemia por COVID-19 en Chile.

BACKGROUND: COVID-19 has effects on the mental health of health care workers. AIM: To explore the presence of symptoms associated with mental health problems and associated risk factors in health workers. MATERIAL AND METHODS: The questionnaires PHQ-9 for depression, GAD-7 for anxiety, ISI-7 for insomnia and IES-R-22 for psychological distress were applied to 125 health care workers aged 18 to 67 years (32 physicians, 22 nurses and 71 of other professions) laboring in hospitals and primary care facilities along Chile. RESULTS: Sixty five percent reported depression symptoms, 74% anxiety, 65% insomnia and 57% distress. Physicians had lower median scores in all scales than nurses and other health professionals. Professionals attending patients with respiratory infections or with COVID-19 had higher median scores in the scales that their counterparts. CONCLUSIONS: The frequency of mental health problems among these professionals is high and preventive measures should be taken.

The Latin American version of the internalized stigma of mental illness scale (LA-ISMI): a multicentric validation study from three Latin American countries.

BACKGROUND: To date, no data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries. The aim of this study was to validate a Latin American version of the ISMI in people with schizophrenia. METHODS: The study included 253 stabilized outpatients with schizophrenia from 3 Mental Health Services in three Latin American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). We analyzed the psychometric properties using item response and classical test theories. An item reduction was then performed to improve the psychometric properties of the ISMI-29. The final version of the ISMI was tested for construct validity, reliability, external validity and differential item functioning (DIF). RESULTS: The five-factor structure of the ISMI-29 was not confirmed using confirmatory factor analysis (RMSEA = 0.12, CFI = 0.77, and WRMR = 2.20). Seventeen items were discarded to obtain a satisfactory psychometric version. The ISMI-12 evaluates 3 dimensions: social stigma (4 items), stigma experience (4), and self-stigma (3). The factor structure accounted for 68% of the total variance. Internal consistency was satisfactory. The scalability was satisfactory, with INFIT statistics within an acceptable range. In addition, the results confirmed the absence of DIF and supported the invariance of the item calibrations between countries. CONCLUSION: The ISMI-29 is not valid in our sample and should not be used in Latin American countries. The ISMI-12 is the first internalized stigma questionnaire with satisfactory psychometric properties available in Latin American countries. Its brevity could facilitate its dissemination and use in clinical settings.

Study protocol and rationale of the "Cogni-action project" a cross-sectional and randomized controlled trial about physical activity, brain health, cognition, and educational achievement in schoolchildren.

BACKGROUND: Education and health are crucial topics for public policies as both largely determine the future wellbeing of the society. Currently, several studies recognize that physical activity (PA) benefits brain health in children. However, most of these studies have not been carried out in developing countries or lack the transference into the education field. The Cogni-Action Project is divided into two stages, a cross-sectional study and a crossover-randomized trial. The aim of the first part is to establish the associations of PA, sedentarism, and physical fitness with brain structure and function, cognitive performance and academic achievement in Chilean schoolchildren (10-13 years-old). The aim of the second part is to determinate the acute effects of three PA protocols on neuroelectric indices during a working memory and a reading task. METHODS: PA and sedentarism will be self-reported and objectively-assessed with accelerometers in a representative subsample, whilst physical fitness will be evaluated through the ALPHA fitness test battery. Brain structure and function will be assessed by magnetic resonance imaging (MRI) in a randomized subsample. Cognitive performance will be assessed through the NeuroCognitive Performance Test, and academic achievement by school grades. In the second part 32 adolescents (12-13 year-old) will be cross-over randomized to these condition (i) "Moderate-Intensity Continuous Training" (MICT), (ii) "Cooperative High-Intensity Interval Training" (C-HIIT), and (iii) Sedentary condition. Neuroelectric indices will be measures by electroencephalogram (EEG) and eye-tracking, working memory by n-back task and reading comprehension by a reading task. DISCUSSION: The main strength of this project is that, to our knowledge, this is the first study analysing the potential association of PA, sedentarism, and physical fitness on brain structure and function, cognitive performance, and academic achievement in a developing country, which presents an important sociocultural gap. For this purpose, this project will use advanced technologies in neuroimaging (MRI), electrophysiology (EEG), and eye-tracking, as well as objective and quality measurements of several physical and cognitive health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03894241 Date of register: March 28, 2019. Retrospectively Registered.

Self-stigma in patients with schizophrenia: a multicentric study from three Latin-America countries.

The aim of this study was to describe the degree of self-stigma in patients with schizophrenia across three Latin-Americans countries (Bolivia, Chile and Peru). The study included 253 outpatients that were assessed using the Internalized Stigma of Mental Illness Scale (ISMI). The results show that 48.7% of patients from Bolivia report high internalized stigma compared to 38.6% from Chile and 28.6% from Peru. There were no statistically significant differences in ISMI mean total scores for country (p = 0.057), however, there were significant differences on two subscales: alienation and social withdrawal for which Bolivia had the highest scores. In conclusion, even though these countries share several common cultural characteristics, there are also some differences between them on patients' self-stigma.

Differences on Quality of Life of Patients with Schizophrenia: A Multicentric Study from Three Latin-America Countries.

The aim of the study is to explore the variation on patient's Quality of Life (QoL) across three Latin-Americans countries. The study included 253 stabilized outpatients with schizophrenia from three Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Patients' were assessed using Schizophrenia Quality of Life Questionnaire (SQoL18). We collected socio-demographic information and clinical data, while recognizing the cultural complexity/dynamics of each country, and the influence of cultural contexts on how people experience the health systems. There are differences in QoL according to each country. Peru reports better levels of QoL at the Total Score Index and in most of the dimensions of the SQoL18. Bolivia shows the lowest indicators of QoL, except, interestingly, for the Resilience dimension where it reaches the highest scores. Even when the studied regions in the three Latin American countries share several cultural characteristics, there are also some important differences between them on patients' QoL. Possible disparities at investment in mental health by the Governments of each country are discussed while possible influences of (inter)cultural contexts are taken into account.

Schizophrenia: Impact on Family Dynamics.

In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.

Caregiver's quality of life and its positive impact on symptomatology and quality of life of patients with schizophrenia.

BACKGROUND: Although the quality of life (QoL) experienced by patients with schizophrenia has been recognized, few studies have assessed the relationship between the caregivers' QoL and patients' QoL. METHODS: The study included 253 stabilized outpatients with schizophrenia and their caregivers from 3 Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Caregivers' and patients' QoL were respectively assessed using two specific QoL questionnaires (S-CGQoL and S-QoL 18). We collected socio-demographic information and clinical data. Multiple linear regressions were performed to determine which variables were associated with patient's QoL. We tested the following hypothesis using structural equation modeling (SEM): caregivers' QoL may have an indirect effect on patients' QoL mediated by their influence of the severity of psychotic symptoms. RESULTS: In the multivariate analysis, the caregivers' QoL was not significantly associated with the patients' QoL, except for one QoL dimension about relationship with family (Beta = 0.23). Among patients' characteristics, being a woman and Aymara, having lower educational level, unemployment and severity of symptoms was significantly associated to a lower QoL. The SEM revealed a moderate significant association between caregivers' QoL and psychotic symptoms severity (path coefficient = -0.32) and a significant association between psychotic symptoms severity and patients QoL (path coefficient = -0.40). The indirect effect of caregivers' QoL on patients' QoL was significant (mediated effect coefficient = 0.13). CONCLUSION: Improvement of caregiver's QoL may have a direct impact on the psychotic symptoms of patients and indirectly on patient's QoL, confirming the need for ongoing family interventions in these regions.

The influence of acculturation strategies in quality of life by immigrants in Northern Chile.

PURPOSE: To establish the influence of acculturation strategies on quality of life, henceforth QoL. METHODS: Using a cross-sectional design, two questionnaires were applied, the WHOQoL-BREF from the World Health Organization and Basabe's acculturation strategies. The questionnaires were applied to 853 Colombian and Peruvian immigrants living in Northern Chilean cities of Arica, Antofagasta and Santiago de Chile. RESULTS: In the psychological and social domains, as well as in the overall assessment of QoL, the most beneficial strategies are those where customs are maintained from the homeland, where "integration" then "separation" are the most beneficial. On the contrary, when the strategy for maintaining homeland customs is low, the QoL tends to be lower. The strategy of "marginalized" is associated with a lower QoL. CONCLUSIONS: Acculturation strategies mildly or moderately affect the psychological and social domains of quality of life as well as the overall assessment of QoL.

Religion involvement and quality of life in patients with schizophrenia in Latin America.

OBJECTIVE: The aim of the study was to explore the relationship between religion involvement (RI) and quality of life (QoL) in patients with schizophrenia from three countries in Latin America, while considering key confounding factors such as socio-demographic and clinical characteristics. METHODS: This cross-sectional study was conducted in the public mental health services in La Paz, Bolivia; Arica, Chile; and Tacna, Peru. The data collected included RI, socio-demographic information, clinical characteristics, type of treatment and QoL using the S-QoL 18 questionnaire. A multivariate analysis using multiple linear regressions was performed to determine variables associated with QoL levels. RESULTS: Two hundred and fifty-three patients with schizophrenia were enrolled in our study. Significant positive associations were found between RI and QoL (the S-QoL 18 index: ß = 0.13; p = 0.048; autonomy dimension: ß = 0.15; p = 0.027). Other socio-cultural and economic factors were also associated with low QoL level: being a woman, older patient, low education level and being Aymara. Severity of the psychotic symptoms was associated to a lower QoL for all the dimension (ß from 0.15 to 0.31), except for the resilience. CONCLUSION: Our study found that socio-cultural and economic factors including RI were associated with QoL in patients with schizophrenia in Latin America, suggesting that these factors may influence positively health outcome. However, these relationships were moderate in strength, especially in comparison to symptoms severity which remained the most important features associated with QoL.

[Psychometric properties of the diabetes mellitus 2 treatment adherence scale version III (EATDM-III) adapted for Chilean patients]. / Análisis preliminares de la versión adaptada en población chilena de la escala de adherencia terapéutica en diabetes mellitus tipo 2--EATDM-III.

BACKGROUND: The Diabetes Mellitus 2 treatment adherence scale version III (EATDM-III) was devised in Costa Rica. Its seven factors are family support, community organization and support, physical exercise, medical control, hygiene and self-care and assessment of physical condition. AIM: To assess the psychometric properties of the scale in Chilean patients. MATERIAL AND METHODS: The results of the EATDM-III scale, applied to 274 patients with Diabetes Mellitus 2 aged 59 ± 11 years (59% women), were analyzed. Reliability, item, exploratory and confirmatory factorial analyses were carried out both in the initial and the proposed model. RESULTS: We propose a version of 30 items grouped in six dimensions, improving the fit indices obtained with the original scale. The review of item factor loadings shows that all are appropriate both in magnitude and statistical significance, with values between 0.46 and 0.93. Internal consistency measured by Cronbach's alpha, was 0.85 for the total scale. CONCLUSIONS: The adapted EATDM-III scale is reliable and can be used to assess treatment adherence in Chilean patients.

Mental health of indigenous school children in Northern Chile.

BACKGROUND: Anxiety and depressive disorders occur in all stages of life and are the most common childhood disorders. However, only recently has attention been paid to mental health problems in indigenous children and studies of anxiety and depressive disorders in these children are still scarce. This study compares the prevalence of anxiety and depressive symptoms in Aymara and non-Aymara children. Among the Aymara children, the study examines the relations between these symptoms and the degree of involvement with Aymara culture. METHODS: We recruited 748 children aged 9 to 15 years from nine schools serving low socioeconomic classes in the city of Arica, in northern Chile. The children were equally divided between boys and girls and 37% of the children were Aymara. To evaluate anxiety and depressive symptoms we used the Stress in Children (SiC) instrument and the Children Depression Inventory-Short version (CDI-S), and used an instrument we developed to assess level of involvement in the Aymara culture. RESULTS: There was no significant difference between Aymara and non-Aymara children on any of the instrument scales. Dividing the Aymara children into high-involvement (n = 89) and low-involvement (n = 186) groups, the low-involvement group had significantly higher scores on the Hopelessness subscale of the CDI-S (p = 0.02) and scores of marginally higher significance in overall Anxiety on the SiC (p = 0.06). CONCLUSIONS: Although Aymara children have migrated from the high Andean plateau to the city, this migration has not resulted in a greater presence of anxiety and depressive symptoms. Greater involvement with the Aymara culture may be a protective factor against anxiety and depressive symptoms in Aymara children. This point to an additional benefit of maintaining cultural traditions within this population.

Scale Measurement of Health Primary Service Utilization among the Migrant International Population.

In this article, we analyze the internal structure of the scale for experience in exercising the right to health care (EERHC), based on the focus from the World Health Organization (WHO) on the right to health care, from the perspective of international migrants, in Chile. The methodology was an instrumental study (n = 563) conducted to analyze the psychometric properties of the EERHC scale. Its reliability and internal consistency were evaluated, while the exploratory structural equation modeling (ESEM) model and confirmatory factor analysis (CFA) were used to identify the structure of relationships between the variables measured. The item-dimension correlations obtained present levels of r ≥ 0.3, and the Cronbach's α and McDonald's ω presented ranges >0.9, considered to be acceptable on all models. Results: the model was selected for presenting a good fit index χ2 = 24,850, df = 300, p = 0.000; RMSEA = 0.07; CFI = 0.97; TLI = 0.95; and SRMR = 0.03. The evidence obtained lets us conclude that the scale has forty-five items and four dimensions. The findings demonstrate a good internal structure and are useful to measure primary health care service utilization based on the framework.

Optimism and Intolerance to Uncertainty May Mediate the Negative Effect of Discrimination on Mental Health in Migrant Population.

(1) Background: Migration causes effects on the people who migrate and on the societies that receive them, which can be positive or negative, depending on the characteristics of the interaction. One negative effect is the emergence of mental health disorders associated with the presence of discrimination, a relationship for which there is abundant evidence, although there is less research on factors that may alter this effect. (2) Objective: To evaluate the possible mediating role of optimism and intolerance to uncertainty in the relationship between discrimination and mental health. (3) Method: Nine hundred and nineteen adult Colombian migrants residing in Chile, 49.5% were men and 50.5% women, ages from 18 to 65 years, were evaluated. The Discrimination Experience Scale, BDI-IA Inventory, BAI, LOT-R and the Intolerance to Uncertainty Scale were applied. The effects were estimated using structural equation modeling. (4) Results: A mediating effect of both dispositional optimism and intolerance to uncertainty on the relationship between discrimination and mental symptomatology was observed. (5) Conclusions: The impact on individual suffering and the social cost of mental health problems require investigating variables on the relationship between discrimination and mental health, including mediators of this relationship, which turn out to be central elements in the development of future strategies for the reduction of anxiety and depression symptoms.

The Effects of Social Determinants and Resilience on the Mental Health of Chilean Adolescents.

The aim of this research was to evaluate the effects of social determinants (i.e., gender, educational vulnerability, and socioeconomic status) and resilience on the mental health of Chilean adolescents in pre-, during, and post-COVID-19 pandemic contexts. The study included a group of 684 students, ranging in age from 12 to 18 years, who were attending educational institutions in the city of Arica. The Child and Adolescent Assessment System (SENA) was used to measure mental health problems, the Brief Resilience Scale for Children and Youth (CYRM-12) was used to measure resilience, and the Vulnerability Index of Educational Institutions was used to measure educational vulnerability. The results suggest increases in depressive, anxious, and social anxiety symptomatologies over time (wave by year, 2018, 2020, and 2021). In addition, multiple linear regression models showed predictive effects of the COVID-19 pandemic, gender, vulnerability index, socioeconomic status, and resilient behaviors on mental health problems. The worsening of mental health indicators over time requires the greater coordination and integration of mental health experts in the most vulnerable educational centers.