[Psychological consequences of amputations in work accidents]. / Consecuencias psicológicas de las amputaciones por accidente laboral.

OBJECTIVE: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them. METHODS: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied. RESULTS: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life. CONCLUSIONS: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interesting field for professional intervention.

OBJETIVO: Las amputaciones en accidente laboral son un fenómeno con gran incidencia y características peculiares. Los escasos estudios que abordan los efectos de la amputación se refieren a grandes extremidades y muestran que, más allá de las secuelas físicas, existen consecuencias importantes a nivel psicológico. El objetivo de este artículo fue mostrar el conocimiento actualizado sobre las principales consecuencias psicopatológicas de las amputaciones por accidente laboral y de las variables que pueden modularlas. METODOS: Se llevó a cabo una revisión bibliográfica de carácter no sistemático, con búsquedas variadas ad hoc para las distintas variables estudiadas. RESULTADOS: Los estudios se han centrado principalmente en la sintomatología ansiosa y depresiva, el trastorno de estrés postraumático y el dolor del miembro fantasma. También se han identificado variables moduladoras que mejoran el pronóstico: adaptación a la vida cotidiana, ejercicio físico, estrategias de afrontamiento, resiliencia y calidad de vida. CONCLUSIONES: Las distintas áreas psicológicas afectadas revisadas deben considerarse al acompañar a las personas con amputación por accidente laboral. Asimismo, potenciar las variables moduladoras cuya presencia mejora el pronóstico es un campo interesante para la intervención profesional.

Prevalence and Differential Profile of Patients with Substance Use Disorder Who Have Suffered Physical and/or Sexual Abuse.

Patients with substance use disorder (SUD) who undergo treatment present a high prevalence of lifetime physical and/or sexual abuse. Studies about this phenomenon and the specific needs of patients with a history of abuse must be carried out to tailor treatment programs. The first goal of this article was to determine the prevalence of physical and/or sexual abuse among patients with SUD, and the second goal was to analyze the specific characteristics of these patients. A sample of 418 subjects was assessed to achieve the first goal and 104 subjects (52 with and 52 without a history of physical and/or sexual abuse) were examined to reach the second goal. All patients sought treatment for SUD in two Spanish clinical centers. The results showed that 15.5% of the sample had a history of physical and/or sexual abuse (42.3% of women and 9.9% of men). Patients with a history of abuse presented a higher need for SUD treatment in family and psychiatric areas and more psychopathological symptoms than patients without a history of abuse. According to this more serious profile, a patient-centered intervention considering the history of abuse is recommended. This will allow the specific needs of these patients to be met, thus improving SUD treatment success.

Impact of a trauma intervention on reducing dropout from substance use disorder treatment.

OBJECTIVE: To evaluate the effectiveness (in terms of retention) of an intervention aimed at treating the consequences of lifetime physical and/or sexual abuse among patients who are also seeking substance use disorder treatment (SUD-T) in a clinical center. METHOD: A parallel, randomized, controlled clinical trial using an experimental design (with 1 treatment group and 1 control group) with repeated measures (pretreatment, posttreatment and six-month follow-up) was carried out. The sample consisted of 57 patients in SUD-T who had experienced lifetime physical and/or sexual abuse. All patients received a cognitive-behavioral SUD-T. In addition, the treatment group (n = 29) received physical and/or sexual abuse treatment (PSA-T). RESULTS: The treatment group presented a lower SUD-T dropout rate (37.9%; n = 11) than the control group (50.0%; n = 14), but this difference was not statistically significant (χ² = .8; p = .359; φ = .122). The main variable related to SUD-T success (therapeutic discharge after completing the 40 outpatient sessions or 12 inpatients months and maintained abstinence) was the completion of PSA-T. CONCLUSIONS: The completion of this trauma-centred treatment improved the retention rate of SUD-T in patients with histories of physical and/or sexual abuse. This is a promising result because of the high SUD-T dropout rate shown by patients with victimization. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Completers and Dropouts in a Prevention Programme for Parents of Adolescents with High-Risk Behaviours.

BACKGROUND: The main goals of this study were to determine the rate of retention/dropout in a prevention programme for parents of adolescents with risk behaviours, to compare completers and dropouts in several characteristics, and to establish the main variables related to treatment completion and dropout. METHOD: The sample was composed of 367 parents (165 men and 202 women). Information was collected on sociodemographic characteristics, adolescents' attendance at the programme, psychopathological symptoms, emotional states, educational styles, and maladjustment to everyday life. RESULTS: The retention rate was 79.29% (n = 291), with no sex differences between completers and dropouts. Completers were older, maintained the composition of the nuclear family of origin and had their children simultaneously receiving treatment in the prevention programme for adolescents at the same centre. Four groups were found in the cluster analysis. The highest dropout rates were observed among parents whose children did not participate in the programme (29.5% n = 18) and among families that had undergone changes in the composition of the nuclear family of origin (28.9% n = 26). CONCLUSIONS: This study highlights the importance of family composition and the involvement of both parents and adolescents in the effectiveness of the indicated prevention programmes.

Differential MCMI-III psychopathological profiles between intimate partner violence perpetrators with and without childhood family violence.

This study explored the differential prevalence of personality disorders (PD) and clinical syndromes between male perpetrators of intimate partner violence (IPV) with and without a history of childhood family violence (CFV). A sample of 981 perpetrators of IPV was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Comparisons of sociodemographic characteristics and MCMI-III scales' scores between perpetrators with (n = 293) and without (n = 688) CFV were carried out. Results showed that IPV perpetrators with CFV had a lower level of education, were less frequently employed, and had higher rates of previous psychiatric history than perpetrators without CFV. Statistically significant differences between groups in almost all the MCMI-III scales were found. Perpetrators with CFV presented with higher scores on most of the evaluated scales and showed a more severe psychopathological profile than perpetrators without CFV. The multivariate analysis showed that the main MCMI-III domains related to CFV were higher scores on the disclosure and alcohol dependence scales and lower scores on the passive-aggressive scale. These findings reveal that CFV is associated with a more severe psychopathological profile in perpetrators of IPV. In order to develop tailored interventions, the presence of CFV and psychopathological symptoms should be assessed in IPV perpetrators.

Gender-Based Psychosocial Differences in a Sample of Young Offenders.

This study analyzes the differential psychosocial characteristics of male and female young offenders with a judicial measure from a juvenile court in Spain. Data on origin, recidivism, criminal and psychosocial characteristics of a sample of 838 juvenile offenders were collected using the Youth Level of Service/Case Management Inventory (YLS/CMI). Most of the minors were males (n = 650; 77.6%). Regarding the type of offences committed most males committed some type of crime, while females mainly committed misdemeanours. The rates of infractions committed by large groups and belonging to a gang were higher in males than in females. Concerning psychosocial variables, females presented with higher scores than males in three areas (parenting/educational guidelines, leisure and recreation, attitudes and orientation), in the total score and in several specific variables of the YLS/CMI. Moreover, having a poor relationship with one's mother and limited participation in organized activities were related to being a female minor offender, whereas having a short attention span was related to being a male offender. These three variables correctly classified 77.6% of cases. Female minor offenders present with a more severe psychosocial profile than males. Therefore, gender-based variables should be considered and addressed in prevention and intervention programmes for minors.

Gender differences in unidirectional and bidirectional intimate partner violence in addictions.

Background: Few studies have analyzed the specific characteristics related to uni/bidirectional intimate partner violence (IPV) in patients with addiction problems. Knowing the specific profiles of these patients would allow the development of effective tailored interventions.Objective: This study assessed gender differences in unidirectional and bidirectional IPV among patients undergoing drug addiction treatment.Method: We sampled 122 patients (91 male and 31 female) who sought treatment in an addiction treatment center, and collected cross-sectional self-reported data on violent behaviors (physical, sexual and psychological violence), sociodemographic factors, distorted thoughts about women and violence, impulsiveness, and anger.Results: Ninety-one percent of participants reported experience of IPV (any type and any direction). Sixty-three percent of participants reported bidirectional violence, which was more common among women (83.9%) than men (56.1%). Unidirectional (perpetration only) IPV was reported in 28.7% of participants, and it was more common among men (34.1%) than women (12.9%). No one reported unidirectional (victimization-only) IPV. When only physical and/or sexual violence was considered, bidirectional violence affected 32.0% of the sample; 23.8% were only victims, and 3.3% were only perpetrators (all of them men). Participants who reported bidirectional violence had higher scores for impulsiveness, anger, and distorted thoughts.Conclusions: Bidirectional IPV is commonly reported among patients seeking treatment for addiction, particularly among women, and should be considered in future research and clinical practice.

Are There Gender-based Effects for an Educational Program for Parents of Adolescents With Risk Behaviors?

The goals of this study were to evaluate the gender-based effectiveness of the parental intervention of the Suspertu ("recovery" in English) prevention program for adolescents with risk behaviors in Spain. The sample included 229 parents (105 fathers and 124 mothers). One open-label trial with repeated measures was used. Parents received a family therapy and a group education. The intervention improved parents' authoritative parenting style, decreasing the degree of parental stress and reducing parent's psychopathological symptoms and maladjustment. Improvement in both groups (fathers and mothers) was mainly observed from pre- to post-intervention assessment. According to the results, prevention programs for adolescents with risk behaviors may be a suitable context both to teach parents to deal appropriately with their children's risk behaviors, and to improve parent's psychological state.

Gender Differences in Risk Factors Related to Suicidal Ideation Among Callers to Telephone Helplines in Spain.

The main goals of this study were to determine the prevalence rate of suicidal ideation among callers to a Spanish telephone general crisis helpline (Teléfono de la Esperanza) and to identify gender-based characteristics and risk factors related to suicidal ideation. A sample of 10,765 (6,868 men and 3,897 women) callers to this telephone helpline was assessed. ATENSIS, an assessment tool designed to collect information related to suicidal ideation among callers to telephone helplines, was used. Comparisons between men and women with suicidal ideation were carried out in all variables studied: sociodemographics, telephone call timing, risk factors, and suicidality. Of the total sample, 1.87% (n = 201) presented suicidal ideation, with a higher prevalence in women (2.80%) than in men (1.34%). Moreover, significant gender-based differences among callers with suicidal ideations were observed in some variables: women were older than men and showed a greater prevalence of chronic disease with pain; men showed a greater prevalence of depression, alcohol/drug abuse, helplessness, and lack of hope for the future. This study showed that telephone helplines can be used to identify suicidal ideation among callers. Moreover, gender-based differential characteristics among suicide ideators have been found. The implications for further research are discussed.

Suicidal attempts among patients with substance use disorders who present with suicidal ideation.

BACKGROUND AND AIMS: Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and to explore the differential characteristics for suicide ideators with and without suicide attempts. METHODS: A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed. MEASUREMENTS: Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained. RESULTS: In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%-47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium. CONCLUSIONS: According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.

Suicidal ideation and attempts in patients who seek treatment for substance use disorder.

Patients with substance dependence have a great risk of suicidal ideation and attempts. The study of the specific risk characteristics of patients with substance use disorders who present with suicidal ideation and/or attempts becomes a crucial clinical issue in order to develop prevention strategies. The main goals of this study were to determine the prevalence rate of both suicidal ideation and attempts among patients receiving treatment for substance use disorder and to analyse the differential characteristics between these patients with and without suicidal behaviours. A sample of 334 patients (263 men-71 women) who sought treatment for substance use disorder in a Spanish clinical centre was assessed. In total, 43.7% of the patients presented with lifetime suicidal ideation (8.7% in the last month) and 17.7% with suicide attempts (1.5% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI), and more psychopathological symptoms (assessed by the SCL-90-R). Moreover the rate of suicidal ideation and attempts was significantly higher in inpatients than in outpatients. According to these results, systematic screening of suicidal risk in patients seeking treatment for substance use disorders is recommended, especially in those with a greater addiction severity.

A protocol to prevent and deal with aggressive behavior against health workers. / Protocolo de actuación para prevenir y afrontar agresiones al personal sanitario.

Violence against health workers is a highly prevalent phenomenon with serious psychological and labour consequences among professionals. This paper aims, first, to find out the main studies undertaken to date to describe and analyse the phenomenon, as well as to present different initiatives and protocols of action carried out. The second objective is to offer a procedure of action both to prevent aggression and to intervene in the event of receiving an aggression at work. After a bibliographic search in PubMed, Scopus and SciELO databases, the impact of the aggressions suffered by health professionals, the contexts in which aggressions are more frequent, their main consequences and different strategies and protocols conducted in Spain are reviewed. Given that rigorous reviews supporting such procedures are lacking in scientific journals, different action guidelines for professionals to prevent and to deal with hostile behaviour based on available evidence are developed and proposed. Finally, an easily consultable and applicable action procedure for health workers attacked in the workplace is presented.

Searching objective criteria for patient assignment in addiction treatment.

The main aim of this study was to objectify the treatment assignment criteria used in a clinical centre for addiction treatment in Spain. A sample of 162 patients (87 inpatients and 75 outpatients) who sought treatment between 2010 and 2012 was assessed. Clinical characteristics (addiction severity, psychopathological symptoms, impulsiveness and maladjustment) of the two treatment groups (inpatient and outpatient) into which patients were assigned according to the clinical criteria of therapists were analysed to identify which variables were more relevant for patient placement. Moreover, the therapeutic progression of patients who met and did not meet the assignment criteria received was studied. According to the results, a score above 4 in the family/social support area of the European Addiction Severity Index (EuropASI), or, in cases of a score between 2 and 4 in the family/social area of EuropASI, a score above 2 in the partner subscale of the Maladjustment Scale correctly classified 73.5% of cases (96.6% of inpatients and 46.7% of outpatients). Comparisons of therapeutic results depending on matching or mismatching these assignment criteria showed a larger effect size in mismatching patient assignment criteria for outpatient treatment. The results obtained in this study provide an objective criterion for addicted patient placement. Moreover, from a cost-effective perspective, they question the necessity of inpatient treatment in most cases, demonstrating that outpatient treatment is a sufficient level of care. This study addresses the approach to assigning patients to the treatment modality that best fits them, implementing the least expensive level of care needed to achieve treatment success.

Therapeutic Progression in Abused Women Following a Drug-Addiction Treatment Program.

This study explored the prevalence of victims of abuse and the therapeutic progression among women who sought treatment for drug addiction. A sample of 180 addicted Spanish women was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual), socio-demographic factors, consumption variables, and psychological symptoms. Of the total sample, 74.4% ( n = 134) of the addicted women had been victims of abuse. Psychological abuse affected 66.1% ( n = 119) of the patients, followed by physical abuse (51.7%; n = 93) and sexual abuse (31.7%; n = 57). Compared with patients who had not been abused, the addicted women with histories of victimization scored significantly higher on several European version of the Addiction Severity Index (EuropASI) and psychological variables. Specifically, physical abuse and sexual abuse were related to higher levels of severity of addiction. Regarding therapeutic progression, the highest rate of dropout was observed among victims of sexual abuse (63.5%; n = 33), followed by victims of physical abuse (48.9%; n = 23). Multivariate analysis showed that medical and family areas of the EuropASI, as well as violence problems and suicide ideation, were the main variables related to physical and/or sexual abuse. Moreover, women without abuse and with fewer family problems presented the higher probability of treatment completion. The implications of these results for further research and clinical practice are discussed.

Gender differences in treatment progress of drug-addicted patients.

The authors of this study explored the differences in treatment progress between men and women who were addicted to drugs. The differential rate of completion of/dropout from treatment in men and women with substance dependence was established. Moreover, comparisons between completers and dropouts, accounting for gender, were carried out for several variables related to treatment progress and clinical profile. A sample of 183 addicted patients (96 male and 87 female) who sought outpatient treatment between 2002 and 2006 was assessed. Information on socio-demographic, consumption, and associated characteristics was collected. A detailed tracking of each patient's progress was maintained for a minimum period of 8 years to assess treatment progression. The treatment dropout rate in the whole sample was 38.8%, with statistically significant differences between women (47.1%) and men (31.3%). Women who dropped out of treatment presented a more severe profile in most of the psychopathologic variables than women who completed it. Moreover, women who dropped out from treatment presented a more severe profile than men who dropped out. According to these results, drug-addicted women showed worse therapeutic progress than men with similar histories. Thus, women must be provided with additional targeted intervention to promote better treatment outcomes.

Prevalence and differential profile of patients with drug addiction problems who commit intimate partner violence.

BACKGROUND AND OBJECTIVES: The objectives of this study were, first, to explore the prevalence of aggressors with lifetime intimate partner violence (IPV) among patients in the Proyecto Hombre of Navarra (Spain) addiction treatment programme; and second, to know the specific and differential characteristics of patients presenting IPV as aggressors. METHODS: A sample of 162 patients (119 men and 43 women) was assessed. Data on socio-demographic and substance consumption characteristics, IPV variables, psychopathological symptoms, and personality variables were obtained. The profiles of patients in addiction treatment with and without a history of violence towards their partners were compared. RESULTS: The results showed that 33.6% of people in treatment for addiction had committed violence against their partners. This prevalence was significantly higher (χ(2) = 15.6, p < .001) in women (63.3%) than in men (24.2%). In the 98.4% of the cases the IPV was bidirectional. Patients with a history of IPV perpetration showed greater severity in substance consumption variables, psychopathological symptoms, and personality traits. Gender, the family scale on the European version of the Addiction Severity Index (EuropASI), and the aggressive-sadistic scale on the Millon Clinical Multiaxial Inventory (MCMI-III) were the main variables related to the presence of IPV as aggressors. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: There was a differential profile in patients with IPV perpetration, showing more psychopathological and personality symptoms. Moreover, in this study being a woman was one of the main predictors of committing IPV.

Differential profiles of drug-addicted patients according to gender and the perpetration of intimate partner violence.

BACKGROUND: This study explored the differential profiles of drug-addicted patients according to gender and the perpetration of intimate partner violence (IPV). METHODS: The study assessed a sample of 127 drug-addicted patients (84 male and 43 female) who sought treatment. Information about socio-demographic and consumption characteristics, IPV, psychopathological symptoms, personality characteristics and maladjustment variables was obtained. Four groups were created according to gender and the presence or absence of the perpetration of IPV: (a) men with IPV (n=41), (b) women with IPV (n=29), (c) men without IPV (n=43), and (d) women without IPV (n=14). The four groups were compared in terms of all of studied variables. RESULTS: There were significant differences between the groups in the severity of the addiction and personality characteristics. In general, the drug-addicted patients with associated IPV perpetration exhibited greater scores for nearly all of the studied variables, independent of gender. Moreover, the differences among groups were more strongly related to perpetration of IPV than to the gender of the patients. CONCLUSIONS: According to the results obtained, treatment programs for drug addiction are a suitable context for identifying the presence of IPV, but IPV is typically unnoticed in addiction treatment programs. The implications of these results for future research and clinical practice are discussed.

Differences between Alcoholics and Cocaine Addicts Seeking Treatment.

This study explored the characteristics of a representative sample of patients who were addicted to either alcohol or cocaine, comparing the profiles of both types of drug users. A sample of 234 addicted patients (109 alcoholics and 125 cocaine addicts) who sought outpatient treatment in a Spanish clinical centre was assessed. Data on socio-demographic, consumption, psychopathological and maladjustment characteristics were collected using the European Addiction Severity Index (EuropASI), the Symptom Checklist-90-Revised (SCL-90-R) and the Millon Clinical Multiaxial Inventory (MCMI-II). Demographically, differences were observed with regard to age (alcoholics were older than cocaine addicts; t = 12.2, p = .001), employment (the alcoholic group had more labor problems; χ 2 = 6.2, p = .045) and family consequences (worse in alcoholics; t = 2.3, p = .025). The EuropASI results showed statistically significant differences in addiction severity, with alcoholics showing a greater severity than cocaine addicts. In terms of psychopathology, alcoholics presented more associated symptomatology than cocaine addicts. According to these results, patients with alcohol dependence have a different profile from patients with cocaine dependence, resulting in different repercussions for important areas of their lives. These differences should be taken into account when standard treatments for addiction are implemented.

Differential profile and treatment development of drug-addicted patients depending on violent behaviours and/or criminal acts.

This study explored the prevalence of violent and/or criminal behaviors in drug-addicted patients. A sample of 252 drug-addicted patients who sought treatment was assessed. Information was collected on violent behaviors, criminal acts, socio-demographic factors, consumption factors, psychopathological factors, and personality variables. The sample was divided into 4 groups according to the presence of violence and/or criminal behaviors. There were significant differences between the groups on some variables. In general, patients associated with both violence and criminal behaviors showed a greater severity in drug consumption and maladjustment variables, as well as a higher rate of treatment dropout and re-entry.

Psychological, physical, and sexual abuse in addicted patients who undergo treatment.

This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed.