The Emerging Adult Reasons for Substance Use (EARS): Preliminary Support for Multidimensionality, Validity and Reliability.

Introduction: Substance use peaks during the transition to adulthood, beckoning additional research on its developmental influences. This article reports initial findings on the validity and reliability of the Emerging Adult Reasons for Substance use (EARS), a new measure of substance use motives based on Arnett's (2000) proposed emerging adult dimensions. Method: Content experts in emerging adulthood theory generated EARS items and collected data from a large online sample. We completed exploratory (EFA) and confirmatory factor analyses (CFA) on split halves of the total sample (n = 750). Then, we tested for invariance across genders and age cohorts, as well as examined cross-correlations with the Inventory of Dimensions of Emerging Adulthood (IDEA), Drinking Motives Questionnaire (DMQ-Revised), and measures of substance use. Results: The EFA identified three internally consistent factors: Normative Expectancy, Developmental Strain, and Subjective Invulnerability. Confirmatory factor analyses supported the three factor model, but fit indices were slightly below published standards (RSMEA = .82, CFI = .85, TLI = .83, SRMR = .07). For Normative Expectancy and Developmental Strain, intercepts varied across age cohorts, with higher intercepts for emerging relative to older adults. The patterns of correlations generally supported the construct validity of the EARS subscales. Conclusion: The EARS is reliable and valid, and appears to measure developmentally specific motives for substance use. Additional studies may further validate this promising instrument.

Cultural adaptation and Rasch psychometrics of the Substance Addiction Consequences scale.

This study aims to adapt and evaluate the validity of the Substance Addiction Consequences scale for the Brazilian community-based addiction setting. This is a psychometric study, conducted in two stages: (1) cultural adaptation and (2) validation using the psychometric Rasch model. The Substance Addiction Consequences derived from the Nursing Outcome Classification comprises 16 items and four domains in the original instrument. We applied the original scale with 200 outpatients at two Psychosocial Care Centers for Alcohol and Drugs in São Paulo, Brazil. The four subscales are suitable for the Rasch model. In 13 of the 16 items, infits and outfits are between 0.5 and 1.5, corresponding to the model's optimal parameters. In addition, we removed one item that distorted the measurement. The psychometrics suggested that the SAC scale is valid with its 15 items and four domains. Therefore, it can be considered appropriate to use in the Brazilian community-based addiction setting.

Chatbot-Based Assessment of Employees' Mental Health: Design Process and Pilot Implementation.

BACKGROUND: Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. OBJECTIVE: The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. METHODS: A fully automated chatbot ("Viki") was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium-sized enterprise (120 employees). RESULTS: The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. CONCLUSIONS: A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews.

A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru.

BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164.

Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru.

BACKGROUND: Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. OBJECTIVE: This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). METHODS: Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. RESULTS: The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. CONCLUSIONS: The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants' depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.

Internal Consistency and Convergent Validity of the Portuguese Versions of the Global Appraisal of Individual Needs-Initial and Short Screener: Validity of the Portuguese GAIN-I and SS.

The goal of this article is to present evidence on the internal consistency and convergent validity of the Brazilian Portuguese versions of the Global Appraisal of Individual Needs-"Initial" and "Short Screener" versions. METHODS: One hundred sixty-eight individuals from an inpatient service and/or a community-based outpatient service located in São Paulo were interviewed using the Brazilian Portuguese versions of the instruments. The internal consistency of the instruments scales was computed, along with evidence for the convergent validity between corresponding subscales of the Initial and Short Screener instruments. RESULTS: Cronbach's alpha values for both instruments' total scale scores were greater than .7. The Short Screener scales showed strong-to-moderate correlations with corresponding subscales of the Initial. The General Individual Severity Scale from the Initial and Total Disorder Screener from the Short Screener have convergent validity with each other (ρ = 0.801). CONCLUSIONS: The Brazilian Portuguese instrument scales showed evidence for internal consistency and convergent validity performing similarly to the American English versions.

Rasch model of the GAIN substance problem scale among inpatient and outpatient clients in the city of São Paulo, Brazil.

INTRODUCTION: This study used the Rasch model to evaluate the psychometric properties of the Portuguese version of the Substance Problem Scale (SPS) of the "Global Appraisal of Individual Needs - Initial" for use in Brazil. The SPS measures alcohol and drug problem severity within a DSM-IV-TR framework. The goal of the Rasch analysis was to assess scale dimensionality, item severity, and differential item functioning (DIF). METHODS: Data was collected from 40 inpatients and 70 outpatients in São Paulo, Brazil. The Rasch model fit and DIF by gender and level of care were examined. RESULTS: The SPS fit the Rasch model, with no items distorting the measure. Only three of the sixteen items performed differently between men and women and three performed differently by level of care. CONCLUSIONS: The results were compatible with those from Rasch analyses of the American English and Canadian English versions of the scale. The Portuguese version of the SPS is, thus, valid for use in Brazil, both with men and women in inpatient and outpatient programs.

•Rasch analysis of the Portuguese version of the Substance Problem Scale performed•This scale has performance similar to Canadian and American versions.•None of the scale items distort the measurement.•Further differential item functioning analysis with larger sample needed.