Anxiety and Depression in Family Members of Critically Ill Covid-19 Inpatients: Brief Psychological Interventions via Telephone, an Exploratory Study.

Purpose: This study aimed to assess the level of anxiety and depression in relatives of critically ill COVID-19 patients admitted to the intensive care unit (ICU), and to perform an exploratory pilot study on the implementation of telephone psychological interventions to reduce the initial levels of anxiety and depression in this population. Patients and Methods: Family members of COVID-19 inpatients at ICU answered GAD-7, PHQ-9 and questions on socio-demographic data. A brief psychological intervention was applied via telephone based on the needs of the participants (with adequate adaptation, with symptoms of anxiety, depression, or both). After intervention, participants completed the Patient Global Impression of Change Scale. Results: A total of 1307 relatives were included (66.5% female), 34% and 29% had anxiety and depressive symptoms, respectively. These symptoms were associated with female gender, unemployment, and being the parent or partner of the patient. After intervention, 57.9% reported felt better, 31.3% a little better and 6.6% much better; and with emotional regulation techniques and psychoeducation, higher percentages of feeling better or much better were reported. Conclusion: Brief interventions to reduce the psychological impact of inpatient family members could be effective but will need to be explored further in future studies.

Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic.

BACKGROUND: The mental health and medical follow-up of people living with HIV (PLWH) have been disrupted by the COVID-19 pandemic. The objectives of this study were to assess anxiety, depression and substance use in Mexican PLWH during the pandemic; to explore the association of these symptoms with adherence to antiretroviral therapy (ART), and to compare patients with and without vulnerability factors (low socioeconomic level, previous psychological and/or psychiatric treatment). METHODS: We studied 1259 participants in a cross-sectional study, PLWH receiving care at the HIV clinic in Mexico City were contacted by telephone and invited to participate in the study. We included PLWH were receiving ART; answered a structured interview on sociodemographic data and adherence to ART; and completed the psychological instruments to assess depressive and anxiety symptoms and substance use risk. Data collection was performed from June 2020 to October 2021. RESULTS: 84.7% were men, 8% had inadequate ART adherence, 11% had moderate-severe symptoms of depression, and 13% had moderate-severe symptoms of anxiety. Adherence was related to psychological symptoms (p < 0.001). Vulnerable patients were more likely to be women, with low educational level and unemployed (p < 0.001). CONCLUSIONS: It is important to address mental health of PLWH during the COVID-19 pandemic, with special attention to the most vulnerable individuals. Future studies are needed to understand the relationship between mental health and ART adherence.

Psychometric properties of the Cognitive Appraisal Inventory for Patients with Chronic Pain in Mexican population / Propiedades psicométricas del Inventario de Evaluación Cognoscitiva para pacientes con dolor crónico en población mexicana

Abstract Introduction Cognitive assessment is the process whereby individuals assess the effect an adverse circumstance has on their well-being (primary assessment) and their ability to cope with it (secondary assessment), which is closely related to the emotional and behavioral response they show as a result. Objective To determine the validity and internal consistency of the Spanish version of the Cognitive Assessment Inventory (CAI) for patients with chronic pain for Mexican population. Method A total of 191 adults with chronic pain completed the Spanish version of the CAI, as well as self-report measures of disability, daily activities, anxiety, and depression. Results The confirmatory factor analysis for each type of primary cognitive assessment included in the CAI yielded models with satisfactory goodness of fit and Cronbach's α indices (loss/damage: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; threat: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; and challenge: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Cognitive assessments of loss/harm and threat were positively associated with the degree of disability, depression, and anxiety, and negatively associated with the performance of daily activities. The opposite occurred with the cognitive assessment of challenge. Discussion and conclusion The Spanish version of the CAI is a valid, quick, easy, and reliable tool for evaluating the primary cognitive assessment of pain, a construct closely related to physical disability and emotional suffering in response to this experience, which may be modified through brief cognitive interventions.

Resumen Introducción La evaluación cognoscitiva es el proceso mediante el cual un individuo valora el efecto que ejerce una circunstancia adversa en su bienestar (evaluación primaria) junto con las capacidades con que cuenta para afrontarla (evaluación secundaria), con ello guarda una estrecha relación con la respuesta emocional y conductual que despliega en consecuencia. Objetivo Determinar la validez y consistencia interna de la versión en español del Inventario de Evaluación Cognoscitiva (IEC) para pacientes con dolor crónico en población mexicana. Método Un total de 191 adultos con dolor crónico completaron la versión en español del IEC, así como medidas de autorreporte de discapacidad, actividades cotidianas, ansiedad y depresión. Resultados El análisis factorial confirmatorio para cada tipo de evaluación cognoscitiva primaria incluida en el IEC arrojó modelos con índices de bondad de ajuste y α de Cronbach satisfactorios (pérdida/daño: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; amenaza: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; y desafío: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Las evaluaciones cognoscitivas de pérdida/daño y de amenaza se asociaron positivamente con el grado de discapacidad, depresión y ansiedad, y de forma negativa con la ejecución de actividades cotidianas. Lo contrario ocurrió con la evaluación cognoscitiva de desafío. Discusión y conclusión La versión en español de la IEC es una herramienta fácil, rápida, válida y confiable para evaluar la evaluación cognoscitiva primaria del dolor, constructo íntimamente relacionado con la discapacidad física y el sufrimiento emocional ante esta experiencia susceptible de modificación mediante intervenciones cognoscitivas breves.

Assessment of anxiety in Mexican persons living with HIV using a culturally-adapted version of the GAD-7 test.

Our aim was to assess the severity of anxiety in PLWHA in Mexico City and obtain the psychometric properties of the culturally-adapted Spanish version of GAD-7. Thirteen percent of participants presented moderate to severe symptoms. Reliability (α = 0.82) and construct validity (single-factor explained 48.9% of variance) were evaluated in 411 participants. Confirmatory Factor Analysis was performed in a second sample of 527 participants. Model fit adequately (CFI = 0.991; CMIN/DF = 1.924; RMSEA = 0.042; and SRMR = 0.026). The adapted version of GAD-7 was adequate for the assessment of anxiety in Mexican PLWHA.

Evaluación de un componente de inducción al tratamiento con adolescentes usuarios de alcohol del Distrito Federal / Evaluation of an induction component in the treatment of alcohol use among Mexico City adolescents

There are two main problems reported in the intervention programs addressing teenage substance users: 1) limited admission to treatment, 2) high drop out rates. Institutions in other countries working with teenage substance users report a dropout rate between 50 and 70% after the first session at early treatment stages. In Mexico, a study on dropout rates in a brief intervention program found rates of 53%, with teenagers dropping out between the first and second session. In the addictive behavior field, there is a factor involved in the lack of acceptance for treatment and the dropout rate during treatment. This factor is the perception of addiction treatment programs and teenagers' readiness for change their consumption. Particularly, it was proposed that the lack of agreement over the actions that the therapist and the user develop, jointly and individually, affects the admission to and permanence of users in treatment programs. In addition, Yahne & Miller consider that most of the people can be admitted to the program without any willingness or with a limited willingness to change their consumption. This suggests the need for strategies that increase teenagers' interest in modifying their substance consumption. That is why this study reports the results of an evaluation of an induction to treatment session as a part of the <> [BIPA]. This induction to treatment session uses some of the strategies from motivational interviewing that also includes the change stages of Prochaska and DiClemente. These strategies are based on four steps: a) give teenagers feedback on the impact of alcohol use on their lives according to the results of a previous evaluation, b) give direct counseling about the importance of change, c) suggest alternatives to achieve this change, d) describe the BIPA characteristics and clarify the therapist's and teenagers' role in the treatment. If they follow these steps, teenagers increase their readiness to change. In addition, this induction to treatment session may help to clarify the perception about the activities that both therapist and the teenager must develop during the intervention program. The objectives of the current study are: 1) Evaluate the impact of the induction to treatment session on the therapist and teenagers' perception, 2) Evaluate the impact of the induction to treatment session on the stage of teenagers' readiness willingness to change, and 3) Determine the effects of the induction to treatment session on teenage alcohol users' acceptance and permanence. In this study, a pre-post test design without a control group was used in a sample of 28 volunteer teenage students from Mexico City. The sample was non probabilistic and included volunteer participants meeting the following criteria: a) teenage alcohol users drinking more than 4 drinks on more than 5 occasions in the last 6 months; b) reports on alcohol-related problems without physical symptoms of alcohol dependence according to DSM-IV-TR; c) being aged between 14 to 18 years old; d) being a student. This study took place at the <> Center of Psychological Services and the Acasulco Center of the UNAM Psychology Faculty, as well as at a secondary and high school in Mexico City. The instruments used were: Initial Interview, Readiness to Change Scale, and the Perception of Therapist's and Teenager's Role Questionnaire. The principal characteristics related to teenage consumption were: the overall sample reported alcohol consumption as a preeminent substance; the majority reported moderate alcohol consumption (1-2 occasions per month) over the past 90 days, although 80% reported large amounts of alcohol (more than 5 drinks per occasion). On the other hand, the three main problems reported by teenagers were related to attending parties where alcohol was necessarily consumed, family or friend's arguments and consequences related to affective situations. Data analysis showed statistical differences before and after the induction according to perceptions about the therapist's role t(27) = -2.803, p <.05, but not about the teenagers' role t(27) = -1.793, p >.05, although the average group analysis before the induction session showed that the participants had a clear perception of the activities they perform during the program. On the other hand, the data analysis did not show significant statistical differences in the recognition t(27) = .000, p >.05 and action t(27) = -1.839, p >.05 subscales, both from the readiness for change scale. As for the acceptance and permanence percentage in the treatment, 100% of the teenagers agreed to join the treatment program after the induction session, 93% only attended the first session of treatment, and 62% finished their participation in the treatment program. Based on these results, the induction to treatment session represents a component that clarifies teenagers' perception about the therapist's actions during the treatment. Although there were no significant differences in the readiness to change scale, the induction session is thought to have helped in the teenagers' admission to treatment in addition to promoting progress to action. The induction session can also be one of the variables that contributed to acceptance of and permanence in treatment among teenagers. However, it is important to evaluate the effect that the induction to treatment session had by comparing it with a control group. It is also essential to consider the evaluation of the induction to treatment session with teenage drug users, as well as teenagers that do not go to school. Despite the limited sample, the results observed suggest the relevance of this kind of components in treatment for teenage substance users.

Entre los programas de intervención dirigidos a los adolescentes que abusan del alcohol y otras drogas se han reportado dos grandes problemas: 1. la escasa aceptación para ingresar a tratamiento y 2. las altas tasas de abandono. Instituciones de otros países que trabajan con adolescentes usuarios de sustancias, reportan una tasa de deserción después de un primer contacto de entre el 50% y el 70% en fases tempranas del tratamiento. En México, un estudio sobre la deserción de los adolescentes participantes en un programa de intervención breve determinó que el porcentaje de deserción fue del 53% y la deserción se presentó entre la primera y la segunda visita al terapeuta. Algunos de los factores implicados en la falta de aceptación del tratamiento y la deserción durante el tratamiento en el campo de las adicciones, son la etapa de disposición a cambiar su consumo en la que se encuentran los sujetos y su percepción acerca de los tratamientos de las adicciones. En este sentido, en este trabajo se reporta la evaluación de una sesión de inducción al tratamiento como parte del <> [PIBA]. La sesión de inducción al tratamiento desarrollada como parte del PIBA, utiliza algunas de las estrategias propuestas por la entrevista motivacional, las que se integran en cuatro pasos: a) retroalimentar al adolescente sobre el impacto del uso de alcohol en su vida de acuerdo a los resultados de una evaluación previa, b) dar consejo directo sobre la necesidad de cambio, c) sugerir alternativas para el cambio y d) describir las características del PIBA y aclarar las acciones que el terapeuta y el adolescente realizan en el tratamiento. Con estos pasos se busca que el adolescente avance en su etapa de disposición al cambio y aclare su percepción acerca de las actividades que él y el terapeuta realizan durante el tratamiento. De manera adicional, se planteó que la sesión de inducción al tratamiento puede resultar efectiva para promover la aceptación y permanencia en el tratamiento entre los adolescentes. Para tal efecto se utilizó un diseño de grupo pretest-postest sin grupo control, con una muestra de 28 adolescentes estudiantes voluntarios del Distrito Federal, quienes reportaron consumir alcohol y tener problemas relacionados. El análisis de los datos mostró diferencias estadísticas significativas antes y después de la sesión de inducción para la percepción del rol del terapeuta, pero no para la percepción del rol del adolescente, aunque el análisis del promedio grupal acerca de la percepción del adolescente sobre su rol en el tratamiento, antes de la sesión de inducción, arrojó que los participantes tenían una percepción clara acerca de las actividades que ellos realizan durante el tratamiento. Por otra parte, el análisis no mostró diferencias estadísticas significativas para la etapa de disposición al cambio de los adolescentes antes y después de la sesión de inducción al tratamiento, sin embargo, el análisis de las medias grupales para las dos subescalas del instrumento que midió esta variable mostró que en un inicio los adolescentes se encontraban preparados para el cambio. Finalmente, se reportó que el 100% de los jóvenes aceptaron ingresar a tratamiento, el 92% acudió por lo menos a la primera sesión del programa y el 62% lo concluyó. Se propone que la sesión de inducción al tratamiento representa una estrategia mediante la cual se puede clarificar la percepción de los adolescentes sobre las actividades que realizan los terapeutas en el tratamiento, además de que puede favorecer el avance de los adolescentes de la etapa de preparación al cambio a la etapa de acción. Finalmente se considera que puede ser una de las variables que favorezcan la aceptación y permanencia en tratamiento entre los adolescentes atendidos en el estudio.