Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic.

PURPOSE: To examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic. METHODS: 7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models. RESULTS: Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems. CONCLUSION: The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

Effects of socioeconomic status in cognition of people with schizophrenia: results from a Latin American collaboration network with 1175 subjects.

BACKGROUND: Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls. METHODS: We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments. RESULTS: Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology. CONCLUSIONS: Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.

Meditation focused on self-observation of the body impairs metacognitive efficiency.

In the last decade of research on metacognition, the literature has been focused on understanding its mechanism, function and scope; however, little is known about whether metacognitive capacity can be trained. The specificity of the potential training procedure is in particular still largely unknown. In this study, we evaluate whether metacognition is trainable through generic meditation training, and if so, which component of meditation would be instrumental in this improvement. To this end, we evaluated participants' metacognitive efficiency before and after two types of meditation training protocols: the first focused on mental cues (Mental Monitoring [MM] training), whereas the second focused on body cues (Self-observation of the Body [SoB] training). Results indicated that while metacognitive efficiency was stable in MM training group, it was significantly reduced in the SoB group after training. This suggests that metacognition should not be conceived as a stable capacity but rather as a malleable skill.

[Mindfulness and the clinical relationship: steps to a resilience in medicine]. / Mindfulness y la relación clínica: pasos hacia una resiliencia en medicina.

Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.

[Effects of a mindfulness intervention in Chilean high schoolers]. / Mindfulness y promoción de la salud mental en adolescentes: efectos de una intervención en el contexto educativo.

BACKGROUND: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. AIM: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. MATERIAL AND METHODS: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. RESULTS: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. CONCLUSIONS: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.

Validation of a Spanish translation of the Gratitude Questionnaire (GQ-6) with a Chilean sample of adults and high schoolers.

BACKGROUND: Recent studies have associated positive emotions with several variables such as learning, coping strategies or assertive behaviour. The concept of gratitude has been specifically defined as a tendency to recognise and respond to people or situations with grateful emotion. Unfortunately in Latin America, no validated measures of gratitude on different populations are available. The aim of this study was to analyse the psychometric properties of the Gratitude Questionnaire (GQ-6) in two Chilean samples. METHODS: Two studies were conducted: the first with 668 high school adolescents (390 women and 278 men, with ages ranging between 12 and 20, and a mean age 15.54 ± 1.22) and the second with 331 adults (231 women and 100 men, with an average age of 37.59 ± 12.6). An analysis of the psychometric properties of the GQ-6 scale to determine the validity and reliability of the instrument in Chilean adolescents and adults was performed. Bivariate correlations, multiple regression analyses, exploratory factor analysis (EFA) and Monte Carlo simulations were carried out. Finally, a confirmatory factor analysis (CFA) was performed. RESULTS: A single-factor solution was found in both studies, a 5 item version for the adolescents and 6 items for adults. This factorial solution was invariant across genders. Reliability of the GQ was adequate in both samples (using Cronbach's alpha coefficient). In addition convergent and discriminate validity were assessed. Additionally, a negative correlation between the GQ-5 and depression in adolescents and a positive correlation between the GQ-6 and happiness in adults was found. CONCLUSIONS: The GQ is a suitable measure for evaluating a person's disposition toward gratitude in Chilean adolescents and adults. This instrument may contribute to the advancement of the study of positive emotions in Latin America.

Substance Use, Bullying, and Body Image Disturbances in Adolescents and Young Adults Under the Prism of a 3D Simulation Program: Validation of MySchool4web.

BACKGROUND: The use of virtual reality or three-dimensional (3D) simulation programs has been explored in different mental health problems and contexts. One of the applications that showed evidence of a suitable assessment for behavioral and emotional problems in adolescents is the 3D questionnaire called MySchool4web. The aim of this work was to analyze the psychometric properties of a tailored version of MySchool4web. MATERIALS AND METHODS: A correlational, nonexperimental, cross-sectional study was carried out. The participants were 668 secondary students from schools in Santiago, Chile with a mean age of 15.74 years. Adolescents completed MySchool4web in the informatics classroom of each school. RESULTS: Results indicated that two of the items had to be removed, and a three-factor solution was found representing the dimensions substance use, bullying, and body image. This final model of 10 items showed acceptable internal consistency per factor, and its scores were significantly associated with other related measures in nine items. CONCLUSIONS: These outcomes suggest that this version of MySchool4web is a reliable and valid measure of a 3D instrument for the screening of risky behaviors and emotional problems in adolescents and young adults in a school context.

Psychometric evidence of the Acceptance and Action Questionnaire-II (AAQ-II): an item response theory analysis in university students from Chile.

BACKGROUND: Experiential avoidance (EA) is a psychological mechanism associated with several mental health disorders and is regarded as a relevant target by third-generation cognitive behavioral therapies. It has been mainly assessed through self-report questionnaires, and the AAQ-II is the most used tool. Its psychometric evidence has been mostly tested through the classical test theory (CTT) and very scarcely assessed through Item Response Theory (IRT). METHODS: We used the Graded Response Model to examine its psychometric properties in Spanish-speaking university students (n = 1503; women = 995 (66.2%), mean age = 19.29, SD = 2.45). We tested whether the empirical data fit the model's predictions and estimated the dispersion of persons and items along the experiential avoidance continuum. Moreover, we examined category probability curves to identify the response probability of each answer. Likewise, an item-person map was made where the measurement of persons and items, both on the same scale and along the experiential avoidance continuum, could be observed jointly. Finally, we tested the gender invariance of the scale. RESULTS: We found that the values of the individuals and the items were in the established range to be considered an adequate measure of EA. Additionally, we observed high discrimination indices for all items. The current version with seven answer options could not be optimal and should be tested in future studies. Finally, we found evidence of differential functioning by gender in one of the seven items of the instrument. CONCLUSIONS: Our results indicate that the AAQ-II is a suitable tool for measuring EA and accurately classifying and differentiating EA levels in university students.

Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial.

Background: Online psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants. Methods: A multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis. Discussion: This protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.

Effects of a Mindfulness and Physical Activity Programme on Anxiety, Depression and Stress Levels in People with Mental Health Problems in a Prison: A Controlled Study.

Recent studies in the general population have shown an inverse relationship between mindfulness and symptoms of anxiety and depression, as well as the benefits of physical activity on these symptoms. These relationships have not yet been studied in a population with severe mental disorder (SMD) in prison, where symptoms of anxiety and depression and impulsive behaviours have a high incidence. A controlled study was developed to assess the benefits of a mindfulness-based protocol whereby elements of Acceptance and Commitment Therapy were evaluated and compared to an adapted sport program. Twenty-two inmates from the "El Acebuche" prison aged between 23 and 58 years old participated in this study, which included a pre-, post-, and follow-up; the majority of participants had SMD and were distributed in both conditions. The DASS-21 was obtained for its evaluation. The results of the Mann-Whitney U test for independent samples indicated a significant reduction in the levels of stress and depression in the mindfulness intervention group compared to the control group in which no significant changes were observed, providing evidence on the effect of this practice in prison contexts.

Applying mindfulness therapy in a group of psychotic individuals: a controlled study.

BACKGROUND: There are already several existing studies that show the effectiveness of mindfulness-based approaches in varying types of disorders. Only a few studies, however, have analyzed the effectiveness of this intervention in psychosis, and without finding, up to now, significant differences from the control group. AIMS: The aim of this study is two-fold: to replicate previous studies, and to focus on analyzing the feasibility and effectiveness of applying mindfulness in a group of people with psychosis. METHOD: Eighteen patients with psychosis were randomly assigned to experimental and control groups. The experimental group received eight 1-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT), while the control group was relegated to a waiting list to receive MBCT therapy. RESULTS: The experimental group scored significantly higher than the control group in their ability to respond mindfully to stressful internal events. CONCLUSIONS: Both the usefulness and effectiveness of implementing a mindfulness-based program have been replicated in a controlled manner in patients with psychosis.

The Impact of Baseline Mindfulness Scores on Mindfulness-Based Intervention Outcomes: Toward Personalized Mental Health Interventions.

A growing body of evidence has portrayed mindfulness as a useful tool for dealing with a broad range of psychological problems and disorders. This has created the impression that mindfulness-based interventions (MBIs) can be used to treat nearly all psychological difficulties, in all cases. Nonetheless, little research has been done on how individual differences may contribute to intervention outcomes. The goal of this study was to evaluate the role of baseline mindfulness on participants' outcomes by examining three prior Randomized Controlled Trials that addressed the impact of MBIs on mental health and mindfulness measures. The participants were 164 people, aged between 12 and 45, from both clinical and non-clinical samples. Our findings indicate that at least two thirds of the change produced by these interventions in terms of mindfulness scores can be predicted by the baseline scores of the same variables. We also found that many trajectories are not only strongly influenced by the initial status of the participants, but also by the intervention performed, as attested to by the significant interactions found. These results stress the need to continue doing research in a way that considers the diversity of participants' trajectories, increasing the room for intervention improvements aligned with a more personalized health care model.

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population.

Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.

The Impact of a Yoga-Based Mindfulness Intervention versus Psycho-Educational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial.

BACKGROUND: There is a global agreement in the medical community that a significant proportion of dementia cases could be prevented or postponed. One of the factors behind this agreement comes from scientific evidence showing that mind-body interventions such as mindfulness and yoga for the elderly have been related to a range of positive outcomes, including improved cognition performance in seniors with mild cognitive impairment (MCI). OBJECTIVE: This study aims to evaluate the effectiveness of a yoga-based mindfulness intervention (YBM) versus psychoeducational sessions for older adults with MCI attending Hospital Clinic Universidad de Chile in Santiago. METHOD: Two-arm, individually randomized controlled trial (RCT) will be carried out at Clinical Hospital Universidad de Chile in Santiago. Older people over 60 years with any type of MCI using a score < 21 in the Montreal Cognitive Assessment (MoCA) test and a score of 0.05 in the Clinical Dementia Rating (CDR) Scale; and with preserved activities of daily living will be randomly assigned with an allocation ratio of 1:1 in either the yoga-based mindfulness intervention or the active control group based on the psycho-educational program. People who have performed yoga and/or mindfulness in the last 6 months or/and people with a psychiatric clinical diagnosis will be excluded from the study. Montreal Cognitive Assessment, the Lawton Instrumental Activities of Daily Living Scale (IADL), the Barthel Index (BI), the Pemberton happiness index, the Geriatric Anxiety Inventory (GAI) as well as the Geriatric Depression Scale (GDS-5) will be administered by blinded outcomes assessors before random assignment (Pre-test), the week following the last session of the intervention (post-test), and then after 3- and 6-months follow-up. RESULTS: The YBM intervention protocol based on a video recording has been adapted and designed. This is the first RCT to examine the effects of a yoga-based mindfulness intervention in improving cognitive and physical functions and mental health outcomes for Chilean elderly diagnosed with MCI. It is expected to be implemented as an acceptable and effective non-pharmacological option for older people with MCI. CONCLUSION: Providing evidence-based programs such as preventive therapy for Alzheimer's disease has relevant implications for public mental health services in Chile.

Social and Economic Factors Associated With Subthreshold and Major Depressive Episode in University Students During the COVID-19 Pandemic.

Depression is one of the most frequent mental health disorders in college students and variations according to social and economic factors have been reported, however, whether social and economic variations also exist in subthreshold depression is still unknown, especially during the COVID-19 pandemic. The aim of this study was to estimate the prevalence of subthreshold depressive episode (SDE) and major depressive episode (MDE) and to examine the association between social and economic factors with SDE and MDE in undergraduate students during the COVID-19 pandemic. The participants were 1,577 college students from a university in the south of Chile (64.6% females, 22 years old on average). The participants took an online survey in November 2020 which collected information about social and economic variables, depressive symptoms, and perceived social support. Bivariate and multinomial logistic regression analysis were used. The results showed a high prevalence of SDE (14.3%) and MDE (32.3%) in the sample. Belonging to a social group and perceiving positive social support were the only variables examined that were associated with SDE. Instead, female sex, poorer quintiles, living with other relatives but not parents, economic difficulties due to the pandemic, being a parent, and perceiving positive social support were associated with MDE. Subthreshold and threshold depressive symptoms are frequent in college students, and associations with social and economic factors differ according to the level of such symptoms. These results should be considered in the development of tailored preventive and early interventions for depression in college students.

Analysis of the multidimensionality of hallucination-like experiences in clinical and nonclinical Spanish samples and their relation to clinical symptoms: implications for the model of continuity.

Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a quasi-continuum approach and that total scores on these scales explain a state of vulnerability to general perceptual disturbance.

[Typus melancholicus from tellenbach up to the present day: a review about the premorbid personality vulnerable to melancholia]. / El Typus melancholicus de Tellenbachen la actualidad: una revisiónsobre la personalidad premórbidavulnerable a la melancolía.

The concept of Typus Melancholicus (TM) was shaped by Tellenbach to describe the premorbid and intermorbid personality vulnerable to endogenous depression. The first part of this paper aims to point out the basic principles of Tellenbach's theory ­ the method, the concept of endon, of rhythmic, of situation, of rimanence, of includence and of despair. Then, we present a systematic description of the premorbid personality features - orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity. Furthermore, we present two clinical cases, one from Tellenbach and the other from our clinical practice to underline the typical way which links the premorbid condition to melancholia. Also, we propose a review of the scientific literature from Tellenbach's work to the present day. Finally, we discuss the clinical importance of the TM construct.

Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population.

Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.