An exploratory cross-sectional study on Mental health literacy of Spanish adolescents.

BACKGROUND: Mental health literacy (MHL) is especially important for young people, but comprehensive studies on MHL in adolescents are limited, with no nationwide studies in Spain. This research aims to study MHL among Spanish adolescents and its relationship with sociodemographic factors. METHODS: An exploratory study is carried out using stratified random sampling in Spanish adolescents (N = 1000), aged 12-16 years and balanced in terms of gender, age and territorial distribution. Data collection took place in October and November 2023 through online surveys using the CAWI methodology. Sociodemographic variables, contact with mental health and the Spanish version of the Mental Health Literacy Questionnaire (MHLq-E), a self-administered instrument of 32 Likert-type items (1-5) that assesses the dimensions of help-seeking skills, knowledge about causes and symptoms, and stigma, were evaluated. Descriptive and multivariate analyses of variance (MANOVA) were conducted. RESULTS: In general, adequate levels of literacy were observed, although some aspects related to help-seeking towards teachers, stigmatising attitudes towards people of low economic status and knowledge of severe mental health problems could be improved. The results show contact with previous mental health problems as a key variable for stigma and knowledge about symptomatology together with age. Likewise, gender and family educational level were found to be related to the ability to seek professional help. CONCLUSION: This study provides information on levels of MHL among Spanish adolescents and highlights significant socio-demographic variables. These findings pave the way for interventions aimed at improving adolescents' understanding, attitudes and skills to manage mental health problems, making possible to adapt content and focus on specific groups, thus increasing its effectiveness.

The stigma of mental health problems: A cross-sectional study in a representative sample of Spain.

BACKGROUND: Mental health stigma is a relevant phenomenon with implications for the people who suffer from it. Despite its importance, no studies have been carried out in Spain at national level with a representative sample of the population. AIMS: The aim of this research is to analyze the stigma associated with MHPs in a representative sample of the Spanish population for the first time. METHOD: A cross-sectional quantitative descriptive study was carried out with a representative sample of the population (N = 2746). Descriptive analyses and regressions are carried out on the different dimensions of stigma such as attitude, attribution and intention of social distance. RESULTS: Medium levels of stigma are obtained in stigmatizing attitudes and attributions, and medium-low levels in the intention of social distance. The best predictors of stigma in its different dimensions are attitudes, attributions and intention of social distance themselves. Progressive political ideology is related to less stigma in all dimensions. Knowing someone with mental health problems and talking openly about it together with higher education are also relevant protectors. Mixed results are obtained regarding age, gender and help-seeking. CONCLUSION: National programs and campaigns focused on attitudes, attributions and behavioral intentions are necessary to reduce the stigma still present in Spanish society.

Exploratory study on the quality of forensic assessments using the Istanbul Protocol in a virtual versus face-to-face environment.

INTRODUCTION: With the advent of the Covid-19 pandemic, most torture victim care centres had to adapt their forensic assessment methods and move to online methodologies. Therefore, it is essential to assess the advan-tages and disadvantages of this type of inter-vention, which seems to be here to stay. METHOD: Structured administered surveys were conducted with professionals (n=21) and with torture survivors (SoT) (n=21) from a sample of 21 Istanbul Protocols (IP). Compar-ing face-to-face (n=10) and remote (n=11) in-terviews in relation to the evaluation process, satisfaction, difficulties encountered, and compliance with therapeutic aspects. All as-sessments were primarily psychological. Three remote and four face-to-face interviews in-cluded a medical assessment. RESULTS: No significant problems were found in relation to the ethical requirements of the IP. Satisfaction with the process was pos-itive in both modalities. Regarding the online method, there were frequent connection prob-lems and a lack of adequate material resources in the remote assessments, requiring a signifi-cantly higher number of interviews in most cases. Survivors were more satisfied than eval-uators. Overall, the forensic experts described problems in complex cases with an under-standing of the person's emotional response, they established a bond, and they undertook psychotherapeutic interventions in the event of an emotional crisis during the assessment. In the face-to-face protocols, logistical and travel problems were frequent, which meant that fo-rensic work times had to be adapted. DISCUSSION: The two methodologies are not directly comparable but have specific issues to be studied and addressed. More invest-ment and adaptation in remote methodology is needed, especially given the poor economic situation of many SoT. Remote assessment is a valid alternative to face-to-face interviews in specific cases. However, there are very relevant human and therapeutic aspects that indicate that, whenever possible, face-to-face assess-ment should be preferred.

Implications of stigma towards mental health problems on suicide risk in people with mental health problems: a systematic review.

Stigma associated with psychological problems is a major concern that negatively affects people living with different symptomatology, sometimes with serious consequences for their health.

Mental health in a heterogeneous clinical sample. A cross-sectional study of predictors and gender differences.

Introduction: Women have been shown to be a vulnerable group in relation to mental health problems over time. Despite this, gender-focused studies are uncommon. The aim of this research is to study mental health in a sample of people with mental health problems and to analyze the differences and predictors focusing on gender. Methods: A cross-sectional study is conducted in a heterogeneous clinical sample in terms of mental health problems (N = 160). Interviews with hetero-reported standardized questionnaires to collect the data are conducted. Descriptive analyses, mean difference and a regression analysis on mental health are carried out taking into account different sociodemographic, clinical and psychosocial variables. Results: Women in the study present worse levels of mental health and subjective severity of the disorder. The main predictors of mental health are being female, followed by severity, shorter time with the diagnosis and internalized stigma. Conclusion: Being female is the most robust predictor of worse mental health and symptomatology. Recommendations according to the results found proposing a gender perspective are suggested.

Predictors of Implicit and Explicit Internalized Stigma in a Sample With Different Mental Illness Diagnoses.

ABSTRACT: This research aimed to study implicit and explicit internalized stigma and its relationship with other variables in a sample of people with distinct mental illness diagnoses ( N = 160). Descriptive analysis, mean differences, correlations, and stepwise regression models were conducted. Implicit and explicit internalized stigma was found throughout the sample with differences depending on certain sociodemographic variables. Regression models revealed symptomatology, physical environment, personality traits, references to mental illness, and the time taken to seek professional help as predictors of explicit internalized stigma. At the implicit level, only self-esteem was found as a predictor explaining a low percentage of the variance. The results obtained underline the differences between implicit and explicit stigma, suggesting different relevant variables for interventions focused on prevention and internalized stigma reduction.

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study.

BACKGROUND: This study aims to longitudinally assess the psychological impact of the COVID-19 pandemic in the general Spanish population. It uses four assessment points: two weeks after the start of confinement, one month after, two months after, and one year after the first evaluation. METHODS: Evaluations were conducted through an online survey, with a sample of 3,480 people at the first data collection and 1,041, 569, and 550 people at successive evaluation points. Depressive symptoms (PHQ-2), anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS), loneliness (UCLA-3), and discrimination (InDI-d) were evaluated. RESULTS: Significant changes were found in the variables depression and anxiety with a greater presence of this kind of symptomatology after one year (p < .01). There were also significant changes in the variable social support, which showed a substantial reduction after one year (p < .001). Similarly, there were significant variations in the variable intersectional discrimination (p < .001), with greater levels of discrimination. The temporal models show no significant differences in terms of post-traumatic symptomatology (p = .12) or loneliness (p = .19). CONCLUSIONS: The pandemic had a negative impact on mental health and these effects were further exacerbated one year later.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain.

BACKGROUND: Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization. AIMS: The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement. METHOD: Participants completed an online survey. RESULTS: Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support. CONCLUSIONS: These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.

The Role of the Sense of Belonging During the Alarm Situation and Return to the New Normality of the 2020 Coronavirus Pandemic (COVID-19) in Spain.

In this study we intend to understand the impact of the COVID-19 crisis and the subsequent stay-at-home orders, on the Spanish population's sense of belonging at three moments in time: at the beginning of the lockdown, after one month of lockdown and with the return to the "new normality". A cross-sectional study was conducted through an online survey (N0 = 3480; N1 = 1041; N2 = 569). The sense of belonging was evaluated by means of four Likert-type items. These questions included membership in different groups: work/studies, friends, family and neighborhood or community. Sociodemographic and COVID-19-related data were collected. Additionally, mental health, spiritual well-being, loneliness, social support and discrimination were assessed. Descriptive analyses were carried out and linear regression models compiled. The sense of belonging increased significantly during confinement, dropping dramatically with the start of the return to the "new normality" process. The only variable that showed interaction with time and sense of belonging was discrimination. Work condition (not working providing the lowest sense of belonging scores), social support from friends and loneliness were the main predictors of the sense of belonging. The impact caused by the pandemic and the actions adopted during the first weeks regarding the sense of belonging is evident. It has been a key variable in dealing with COVID-19. Actions are now needed to increase our sense of belonging to face the post-epidemic crisis and avoid a greater impact in other areas.

Effects of COVID-19 lockdown on perceived discrimination and internalized stigma in people with previous mental disorder diagnoses in Spain.

COVID-19 disease control efforts and consequences are likely to be complicated by the impact of fear and stigmatization of the novel coronavirus. These complications may also worsen due to the potential compounding of COVID-19 related stigma with stigmatization associated with previously diagnosed conditions. This exploratory study analyzes the experiences of the stigma associated with COVID-19 lockdown in people with different previous diagnoses 2 and 5 weeks after the beginning of the state of emergency in Spain. Gender and age were controlled as covariables and 1,052 people participated in the study. The diagnosis groups were: Psychiatry and mental health (n = 71), Cardiovascular disease (n = 42), Neurological disease (n = 23), Lung disease (n = 53), and No diagnosis (n = 863). The instruments used to measure the stigma were the Intersectional Day-to-Day Discrimination Index and two items of the Internalized Stigma of Mental Illness scale. Analysis of covariance of repeated measures and analysis of variance, including Scheffe's post hoc test, were performed. We found significant differences in stigma among the first and second evaluation. Regarding the previous diagnosis, no differences were found at Time 1, but significant differences were found at Time 2, with those having a previous psychiatric or mental health diagnosis reporting higher levels of perceived discrimination and internalized stigmatization. Our results suggest that people with previous stigmatizing conditions might be more vulnerable to experiencing stigma in a confinement situation. In order to reduce the burden of the COVID-19 stigma, health interventions should also consider the resulting intersection of effects on internalized stigma and perceived discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Network Analysis of Major Depressive Disorder Symptoms and Age- and Gender-Related Differences in People over 65 in a Madrid Community Sample (Spain).

Major depressive disorder (MDD) is one of the most prevalent conditions among mental disorders in individuals over 65 years. People over 65 who suffer from MDD are often functionally impaired, chronically physically ill, and express cognitive problems. The concordance between a clinician-assessed MDD diagnosis in a primary care setting and MDD assessed with a structured clinical interview in older adults is only approximately 18%. Network analysis may provide an alternative statistical technique to better understand MDD in this population by a dimensional approach to symptomatology. The aim of this study was to carry out a network analysis of major depressive disorder (MDD) in people over 65 years old. A symptom network analysis was conducted according to age and gender in 555 people over 65, using a sample from the MentDis_ICF65+ Study. The results revealed different networks for men and women, and for the age groups 65-74 and 75-84. While depressive mood stood out in women, in men the network was more dispersed with fatigue or loss of energy and sleep disturbances as the main symptoms. In the 65-74 age group, the network was complex; however, in the 75-84 age group, the network was simpler with sleep disturbances as the central symptom. The gaps between the networks indicate the different characteristics of MDD in the elderly, with variations by gender and age, supporting the idea that MDD is a complex dynamic system that has unique characteristics in each person, rather than a prototypical classification with an underlying mental disorder. These unique characteristics can be taken into account in the clinical practice for detection and intervention of MDD.

Mental Health Consequences of the Coronavirus 2020 Pandemic (COVID-19) in Spain. A Longitudinal Study.

Background: Covid-19 remains a pandemic that most countries in the world are still dealing with. This is study aims to report the psychological impact of Covid-19 over time on the Spanish population. Methods: A longitudinal study (N = 1041) was carried out with two measurements: after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD) was evaluated by means of screening tests. Sociodemographic data, variables about Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of belonging were collected. Results: The data showed how depressive symptomatology increased significantly over time, while anxiety and PTSD did not show statistically significant changes. Spiritual well-being and loneliness were the main predictors of psychological impact. A younger age was a significant predictor of depression and anxiety, while female gender was associated with anxiety and PTSD. Conclusions: The impact of the pandemic is sustained over time, even increasing in depression, and vulnerable groups that need greater psychological health support could be identified.

Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain.

The pandemic caused by Covid-19 has been an unprecedented social and health emergency worldwide. This is the first study in the scientific literature reporting the psychological impact of the Covid-19 outbreak in a sample of the Spanish population. A cross-sectional study was conducted through an online survey of 3480 people. The presence of depression, anxiety and post-traumatic stress disorder (PTSD) was evaluated with screening tests from 14 March. Sociodemographic and Covid-19-related data was collected. Additionally, spiritual well-being, loneliness, social support, discrimination and sense of belonging were assessed. Descriptive analyses were carried out and linear regression models compiled. The 18.7% of the sample revealed depressive, 21.6% anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic stability and the belief that adequate information had been provided about the pandemic were negatively related to depression, anxiety and PTSD. However, female gender, previous diagnoses of mental health problems or neurological disorders, having symptoms associated with the virus, or those with a close relative infected were associated with greater symptomatology in all three variables. Predictive models revealed that the greatest protector for symptomatology was spiritual well-being, while loneliness was the strongest predictor of depression, anxiety and PTSD. The impact on our mental health caused by the pandemic and the measures adopted during the first weeks to deal with it are evident. In addition, it is possible to identify the need of greater psychological support in general and in certain particularly vulnerable groups.

Proposal for an implicit stigma measure in mental illness: A multigroup study.

An Implicit Association Test was developed to assess the mental illness stigma in people from the general population, mental health professionals, people with a diagnosis, and family members. No differences were found between groups. Implicit stigma was found throughout the sample, with lower scores in the younger age group.

Time to Change's social marketing campaign for a new target population: results from 2017 to 2019.

BACKGROUND: Since 2009 Time to Change has included among its strategies a social marketing campaign to tackle the stigma surrounding mental health problems. At the start of its third phase (2016-2021) the target group of the campaign was kept as people aged between mid-twenties and mid-forties but changed to middle-low income groups and the content was focused on men. METHODS: Participants (n = 3700) were recruited through an online market research panel, before and after each burst of the campaign. They completed an online questionnaire evaluating knowledge (Mental Health Knowledge Schedule, MAKS); attitudes (Community Attitudes toward Mental Illness, CAMI); and desire for social distance (Intended Behaviour subscale of the Reported and Intended Behaviour Scale, RIBS). Socio-demographic data and awareness of the campaign were also collected. RESULTS: For each of the 3 bursts, significant pre-post awareness differences were found (OR = 2.83, CI = 1.90-4.20, p < 0.001; OR = 1.72, CI = 1.22-2.42, p = 0.002; OR = 1.41, CI = 1.01-1.97, p = 0.043), and awareness at the end of the third burst was 33%. Demographic factors associated with awareness for one or more bursts included having children, familiarity with mental illness, male sex, being Black, Asian or other ethnic minorities and living in London or the East Midlands regions. An improvement across bursts in the "living with" subscale item of the RIBS, and in the "recover" and "advice to a friend" MAKS items were found. Familiarity with mental illness had the strongest association with all outcome measures, while the awareness of the campaign was also related with higher scores in MAKS and RIBS. CONCLUSIONS: These interim results suggest that the campaign is reaching and having an impact on its new target audience to a similar extent as did the TTC phase 1 campaign. While over the course of TTC we have found no evidence that demographic differences in stigma have widened, and indeed those by age group and region of England have narrowed, those for socioeconomic status, ethnicity and sex have so far remained unchanged. By targeting a lower socioeconomic group and creating relatively greater awareness among men and in Black and ethnic minority groups, the campaign is showing the potential to address these persistent differences in stigma.

Efficacy of a combined intervention program for the reduction of internalized stigma in people with severe mental illness.

BACKGROUND: Internalized stigma (IS) is a key factor in the recovery, quality of life and functioning of people with severe mental illness (SMI), and effective intervention programs are needed to reduce IS in all its dimensions. The aim of this report was to design and evaluate the effectiveness of a new psychological intervention group program for the reduction of IS in people with SMI. METHODS: A 9-session hands-on intervention program was designed with a group format in which different therapeutic techniques were combined. To evaluate the effectiveness of the program, 80 people with SMI and high levels of IS were selected and randomly assigned to one of two groups: program (n = 41, experimental group) or conventional treatment (n = 39, control group). RESULTS: Mixed analysis of variance showed improvements in total IS and all of its dimensions (cognitive, emotional and behavioral) (p ≤ 0.01) and in depressive symptomatology (p = 0.01) in the experimental group after the treatment phase. CONCLUSION: The results indicate that the program effectively reduces IS and its dimensions as well as other relevant associated variables in a sample of people with SMI.

Study of the relationship between implicit and explicit stigmas associated with mental illness.

The emergence of the Implicit Association Test (IAT) has encouraged the study of the implicit stigma associated with mental illness in recent years, although further research is still needed in this area. A sample (n = 102) composed of psychology students and people from the general population completed explicit stigma tests: Attribution Questionnaire-9 (AQ-9), Social Distance Scale (DS) and a Spanish version of the IAT. A statistical analysis of sociodemographic measures and variables, and the relationships between explicit and implicit evidence, was carried out. The presence of implicit and explicit stigma was observed throughout the sample. Significantly lower AQ-9 scores were found in the student group. A greater desire for social distance was related to older age, belonging to the general population group and not having a diagnosed relative. In contrast, greater implicit stigma was found in people who had a family member with a diagnosis. No relationship was observed between explicit tests and IAT. An analysis of the main components revealed one implicit component and other explicit. Our study supports the existence of a stigma model with two different dimensions. These findings highlight the need to consider explicit and also implicit stigma, in future theoretical models and applied studies.

Cognitive deterioration in schizophrenia: aging and cerebrovascular disease.

Today, cognitive dysfunction is accepted as a feature of schizophrenia. As the patients age, this dysfunction is higher and harder to evaluate due to the interaction among aging, other somatic diseases, psychoactive drugs, etc.

Longitudinal Study of Cognitive Variables in Women with Schizophrenia: 31-Year Follow-Up Study.

OBJECTIVE: To longitudinally analyze the course of cognitive dimensions in schizophrenic women over a period of 31 years. METHOD: Accidental sampling. Developmental longitudinal design. Diagnosis according to the ICD-10. Thirty institutionalized women were evaluated using the WAIS on three separate occasions (in 1981, 1997, and 2012). The data were analyzed using a repeated measures split-plot method. RESULTS: Patients scored one to two standard deviations below the average on the WAIS. At all three evaluation times, they scored consistently, significantly worse on Performance IQ scales than on Verbal IQ in the following sequence: Processing Speed (PS) < Perceptual Organization (PO) < Working Memory (WM) < Verbal Comprehension (VC). Longitudinally, there was a significant, linear average trend that was stable between the first and second assessments, with a significant drop in scores at the third evaluation on Performance IQ (η2 = .586) and Verbal IQ scales (η2 = .299). The same trend was observed in PS (η2 = .655) and WM (η2 = .438), while PO decreased across the three evaluations (η2 = .509) and no difference in VC was found (η2 = .126). CONCLUSION: Patients with schizophrenia presented with a low cognitive level. Longitudinally, they had a stable, differential profile of WAIS factors until late life, when performance dropped significantly.