The psychometric properties of the adolescent dissociative experiences scale (A-DES) in a sample of Portuguese at-risk adolescents.

Dissociation is a process that often occurs as a sequela of psychological trauma, and it is interrelated with psychological and behavioral problems. In the at-risk adolescent population, dissociation is often underdiagnosed and undertreated. Having reliable measures to assess this phenomenon can help in identifying adolescents at-risk and improve treatment outcomes. This study assessed the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) with a sample of 402 Portuguese adolescents recruited from three at-risk populations. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, psychological and behavioral problems, and the A-DES. A subset of the sample also completed test-retest measures. Confirmatory factor analyses revealed a best-fitting 3-factor model. Analyses revealed good internal consistencies and good agreement test-retest reliability for the scale overall and the factor-based sub-scales. Construct and predictive validity was supported with results showing that A-DES discriminates between youth reporting high versus low levels of cumulative trauma exposure and youth who meet or do not meet criteria for a probable PTSD diagnosis. Study findings replicate prior research supporting a 3-factor model of dissociation and the usefulness of A-DES to identify adolescents with dissociative symptoms. Clinical and research implications are discussed.

The impact of modes of administration on self-reports of offending: evidence from a methodological experiment with university students.

Objectives: Current knowledge about the causes of offending behavior is heavily reliant on self-reports of offending (SRO). However, methodological research on the impact of modes of administration on SRO is very scarce. Further, the existing evidence conflicts with the general knowledge about responding to sensitive questions. In this study, we aimed to test whether SRO are affected by modes of administration. Methods: We carried out a methodological experiment, with a 2 (interviewer-administered vs. self-administered surveys) × 2 (paper-and-pencil vs. computer- assisted surveys) factorial design. A total of 181 undergraduate students were randomly assigned to one of these conditions and completed the International Self-Report Delinquency 3 (ISRD3) questionnaire. Results: Findings showed an increased odds of reporting offending behavior in self-administered surveys, compared to face-to-face interviews. Paper-and-pencil and computer-assisted modes resulted in comparable estimates of offending. Conclusions: This experiment provides evidence that SRO provide more accurate estimates of offending behavior using self-administered surveys.

Post-Traumatic Stress Disorder and Identity Transformation After Experiences of Psychological Abuse: A Mixed-Methods Approach.

Psychological abuse (PA) is being associated with the development of post-traumatic stress disorder (PTSD). However, few studies have focused exclusively in this type of abuse. This study aimed to examine the relationship between PA and PTSD symptoms according to gender and understand the impact of severe PA in identity transformation, in a Portuguese university sample. Using a mixed-methods approach, 158 students answered an e-survey containing closed and open-ended questions. Results indicated a positive correlation between PA and PTSD symptoms. Women were significantly different from men concerning PA, contrarily to PTSD symptoms that did not present significant gender differences. The qualitative analysis revealed two different forms of adjustment, in both genders: positive-indicating personal growth-and negative changes-impacting relationships and emotional states. The more negative changes were described, the more PTSD symptoms were presented, regardless gender. Raising awareness can help young recognize themselves as victims and prevent the development of detrimental mental health status.

Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity.

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Different settings, different approaches: a qualitative comparison of Portuguese dietitians' beliefs, attitudes and practices about obesity in public and private settings.

OBJECTIVE: With obesity being a major public health epidemic, dietitians are charged with the difficult task to assist clients in modifying their behaviours. Since there are inconsistent data about dietitians' beliefs, attitudes and practices concerning obesity and little is known concerning differences in public and private practice, we conducted the present study to address those gaps. DESIGN: Semi-structured interviews analysed according to thematic analysis procedures. SETTING: Public primary-care and private settings. SUBJECTS: Seventeen Portuguese registered dietitians working in public primary-care (n 10) and private settings (n 7). RESULTS: Regardless of work context, 'persistence of efforts' emerged as the main characteristic of dietitians' action. Besides holding negative attitudes towards obese patients, their practices are not negatively influenced. They perceive themselves as active agents in promoting lifestyle changes, offering as many management strategies as possible to empower patients, feeling positive about the accomplishment of a successful weight loss, believing in their own efficacy and competency in helping patients. However, differences in reimbursement, work environment, perceived barriers, patient characteristics and availability of resources seem to contribute to differences in persistence according to the setting in which dietitians are working, evidenced by an increase of efforts and engagement in private practice and a decrease in public primary-care practice. CONCLUSIONS: Portuguese dietitians present a positive mindset and actions about obesity treatment outcomes; however, education in behaviour change strategies should be improved. The public health system requires reorganization to enhance effective obesity management delivery. Motivation driving dietitians' work in private settings should be addressed.

Screening Tool for Psychological Intimate Partner Violence: Portuguese Validation of the Psychological Maltreatment of Women Inventory.

BACKGROUND/OBJECTIVE: The Psychological Maltreatment of Women Inventory-Short Form (PMWI-SF) is a well-established and brief instrument for assessing psychological intimate partner violence (IPV). In the absence of a specific tool to assess psychological IPV in Portuguese women, this study sought to confirm the factor structure of the Portuguese PMWI-SF and analyze its psychometric properties. METHOD: Five hundred and six women filled out the e-survey including the assessment of IPV (Revised Conflict Tactics Scales, Psychological Abuse Survey, and PMWI-SF) and psychopathology through the Brief Symptom Inventory. Sociodemographic characteristics, construct validity, and internal consistency were analyzed, and a cutoff for the PMWI-SF was established. RESULTS: Confirmatory factor analysis for the 2-factor structure (emotional/verbal abuse and domination/isolation) showed an excellent fit for the last 6 months and across the life span. Factors possessed good internal consistency (α ≥ .70) and test-retest reliability (r ≥ .90). Pearson's correlation analysis revealed the PMWI factors were positively correlated with proximal variables. PMWI-SF scores demonstrated excellent differentiation between women with and without psychological IPV (area under the curve [AUC] = .948; confidence interval or CI [.93, .97]). The PMWI-SF cutoff score that provided the optimal balance was 32 (sensitivity = 83.8%; specificity = 91.7%). CONCLUSIONS: The PMWI-SF is a valid and reliable instrument for assessing the experience of psychological IPV in Portuguese women.

What is told when the story is retold? Consistency of victimization reports in psychiatric patients.

The use of retrospective self-reports is a major methodological concern when ascertaining the occurrence of victimization experiences, with additional concerns when assessing psychiatric patients. The test for consistency can overcome some of these concerns, increasing the confidence in the information reported. Our aim was twofold: (1) to know the consistency of victimization reports; and (2) to test the role of changes on emotional distress in predicting report discrepancies, in a sample of 34 adult psychiatric patients. Participants were assessed twice, with a year interval. Sexual abuse was the experience that presented the higher level of consistency for childhood victimization, while assault with a weapon had the higher consistency level for adolescent and adult victimization. We found that increases on emotional distress predicted report discrepancies, and more specifically, increases in the report of victimization. Our results displayed acceptable consistency levels, suggesting some stability in the reporting of victimization over time. Considering that inconsistencies tended either to increases and decreases in the reporting of victimization, it would be important to consider the impact of such experiences when intervening with psychiatric patients.

Clinically speaking, psychological abuse matters.

BACKGROUND: The adverse effects of intimate partner violence (IPV) on mental health are well-established, except in the cases of psychological abuse and men's victimization. This research study examines the prevalence and the independent contribution of psychological IPV on mental health for both genders. METHODS: The initial sample comprises 661 college students from a Portuguese public university, who completed an e-survey. Statistical analysis focused on a subsample (n=364), 23% of which were men, after removing cases of physical and/or sexual abuse. RESULTS: A total of 75% of men and 72% of women reported lifetime psychological victimization and no differences were found for sociodemographic factors, including gender. However, women reported significantly more instigations of psychological abusive acts (OR =5.41, 95% CI=1.88-15.55). Multivariate linear regression models revealed that post-traumatic stress symptoms-PTSS (ß=.51; p<.001), depression (ß=.34; p<.001) and anxiety (ß=.22; p<.001)-were predicted by psychological IPV. The strongest relationship was established between psychological IPV and PTSS, and the final model accounts for 28.6% of the variance (F(6357)=23.86, p<.001). CONCLUSIONS: This article provides an empirical basis to recognize the unique and serious impact of psychological IPV on mental health, and recommends screening psychological IPV as part of the clinical routine, developing a gender-inclusive approach, and implementing evidence-based protocols tailored to the needs of these victims.

Health Conditions Prior to Imprisonment and the Impact of Prison on Health: Views of Detained Women.

Detained women have certain health conditions prior to incarceration and these conditions can improve, worsen, or remain the same in prison, depending on the prisoner's background, the characteristics of the prison, and the arrest experience. This study investigated the health of detained women and the influence of incarceration from their perspective. Three focus groups were conducted among 15 inmates, and data were analyzed according to thematic analysis procedures. Detainer's health backgrounds varied with regard to their level of health concerns, contact with health services, and health behaviors. A positive influence of incarceration was described by patients with chronic illness, patients with drug addiction, and victims of interpersonal violence. Among women with mental illnesses or those without previous health problems, reports do not reveal benefits of imprisonment for mental health. These data emphasize the importance of specialized health care and the need to invest in mental health care in corrective institutions.

When the safe place does not protect: reports of victimisation and adverse experiences in psychiatric institutions.

Psychiatric patients report higher levels of victimisation and are at risk for further victimisation in different contexts, such as psychiatric institutions. Studies in this field tend to focus on hospital staff as victims, experiencing classic forms of victimisation (e.g. physical assault, threats, verbal abuse), through qualitative studies. This is a quantitative retrospective study that aims to know the occurrence of psychiatric victimisation and other adverse experiences in Portuguese psychiatric patients. Ninety-five psychiatric patients, between 20 and 79 years old (M - 45.18, SD - 13.06), with a history of psychiatric hospitalisation answered the Experiences in Psychiatric Institution Inventory. Participants were recruited in four psychiatric hospitals. Inpatients were approached during their hospitalisation; outpatients were approached in scheduled appointment days. Only 23 (24.2%) participants reported no victimisation. Total Experiences of Self varied from 0 to 7 (M - 1.75, SD - 1.72), Total Witnessed Experiences varied from 0 to 7 (M - 1.17, SD - 1.64), and Total Global Experiences varied from 0 to 14 (M - 2.92, SD - 3.01). These results show that victimisation and adverse experiences in psychiatric contexts are frequent and go beyond classic forms of victimisation. A deeper knowledge of these experiences and their impact in the mental health of psychiatric patients may promote quality of care provided and lead to more effective treatments, thus reducing the number and length of hospitalisations, and the financial burden for public health services.

The Strongest Correlates of PTSD for Firefighters: Number, Recency, Frequency, or Perceived Threat of Traumatic Events?

Firefighters experience a wide range of traumatic events while on duty and are at risk to develop psychopathology and posttraumatic stress disorder (PTSD). According to cognitive models, the person's interpretation of the traumatic event is responsible for the development of PTSD rather than the traumatic event itself. This cross-sectional study aimed to explore the contribution of perceived threat to explain PTSD symptoms in Portuguese firefighters, after adjusting for potential confounding factors. A sample of 397 firefighters completed self-report measures of exposure to traumatic events, psychopathology, and PTSD. Perceived threat explained unique variance in PTSD symptoms, R(2) = .40, ΔR(2) = .02, F(10, 367) = 24.55, p < .001, Cohen's f(2) =.03, after adjusting for psychopathology, number, recency, and frequency of the events, and other potential confounding variables. The association between psychopathology and PTSD was also moderated by perceived threat, R(2) = .43, ΔR(2) = .03, F(11, 366) = 25.33, p < .001, Cohen's f(2) =.05. Firefighters may benefit from interventions that focus on perceived threat to prevent PTSD symptoms.

Childhood Adversity Among Institutionalized Male Juvenile Offenders and Other High-Risk Groups Without Offense Records in Portugal.

The literature has shown that delinquent adolescents report high rates of childhood adversity and family dysfunction. However, it is important to know both the degree of adversity among delinquent adolescents in comparison with other high-risk samples and the contribution of each single form of adversity to this comparison. The purpose of this study was to evaluate childhood adversity, psychopathology, and risk behaviors among 4 high-risk groups, including incarcerated delinquent youths. The participants were 120 male youths between 13 and 19 years old (M = 16.18, SD = 1.26), including 30 youths who were arrested and held in detention centers as a consequence of violent crimes; 30 youths who were identified by Child Protective Services (CPS) and remained with their families; 30 youths who were identified by CPS, removed from their homes, and placed in child and youth residential care; and 30 youths who were randomly selected from schools. The incarcerated youths reported significantly more adversity, global psychopathology, and global index of risk behaviors. When considering each risk behavior, the incarcerated youths reported higher percentages of alcohol abuse, drug use, early smoking initiation, physical assault, carrying weapons, early initiation of sexual intercourse, sexual intercourse under the influence of drugs, and sexual intercourse without condom use. The logistic regression analyses showed that only emotional neglect was significantly associated with delinquency. This study suggests that delinquent youths are exposed to a great magnitude of adversities in childhood, with emotional neglect as an independent risk factor for delinquency. In addition, these youths have higher rates of psychopathology and risk behaviors compared to other high-risk samples.

Psychopathology among youths who were victims of documented childhood maltreatment.

BACKGROUND: There is an established relationship between childhood maltreatment and later psychopathology, but most studies have used self-reports and only consider a small number of experiences. The main aim of this study was to examine predictors of psychopathology by comparing two sources (official records vs. self-reports) of ten different childhood adversities among youths who were identified by Child Protective Services (CPS). We also used a comparison group that was not identified by CPS. This study also compared, in terms of psychopathology, three groups of respondents (under-report; agreement; and over-report) based on the discrepancy between the two sources of childhood adversity. METHOD: The sample included 136 youths, ages 14-23 years, identified by CPS prior to age 12 as being maltreated and who lived with their family for at least 5 years. The comparison group included 80 youths. RESULTS: The identified youths were not different from the comparison group in global psychopathology. Psychopathology was associated only with the total amount of self-reported adverse experiences, with depressive symptoms being predicted by both documented and self-reported sexual abuse. Females reported and had more documented adversities, presenting an increased risk for psychopathology. The under-report group had a higher mean of documented experiences and a lower mean in psychopathology. CONCLUSIONS: Despite the limitations of a self-report methodology, our findings attest to its contribution in predicting health outcomes. Professionals from CPS need to be thorough when assessing and documenting the multiple experiences that may co-occur in a household, paying particular attention when young girls are involved, as the experience of sexual abuse has been shown to be independently associated with later risk of developing depressive symptoms. This process may increase the appropriateness of the chosen interventions.

HIV Diagnosis in the Context of Stable Relationships: A Qualitative Study With Women Living in Portugal.

ABSTRACT: The purpose of this phenomenological study is to explore the acceptance of HIV diagnosis of women in stable relationships. Based on eight semistructured interviews with cisgender Portuguese women, thematic analysis identified four interrelated themes that illustrated the emotional and psychosocial dynamics involved in this journey. Following an HIV diagnosis, participants grappled with complex emotions, societal perceptions, and the internalization of stigma. Marital relationships underwent profound changes, with trust breakdown and emotional distancing. Coping mechanisms ranged from seeking support to living in secrecy, which impacted psychological well-being. Acceptance of HIV diagnosis is influenced by self-stigmatization, societal perceptions of HIV, and gender dynamics. The findings contribute to the development of tailored interventions, emphasizing the interconnected nature of physical and psychological well-being in the diagnosis acceptance process.

Assessment of the Health Status of Women in Prison: A Comparison between Drug Users versus Non-users.

This study aims to analyze the history of substances use, clinical diagnoses, contacts with healthcare, and health complaints. Also, it aims to compare the health status of substance users versus non-users. Health records of 93 detained women from a prison in northern Portugal, with a mean age of 38.02 years old, were reviewed and coded using both International Classification of Primary Care-2 and International Classification of Diseases-10th. Data revealed high percentages of detainees with a history of substance use and pre-existing clinical diagnosis. During the first month of imprisonment, on average, participants had complained to a health professional 14.63 times. Substance users were younger and presented more mental health problems and health complaints. Health policies and professional practices in prison must include immediate assessment of a woman's health concerns and foster the development of efficient protocols to address those problems, especially substance use disorder treatment.

Posttraumatic stress disorder symptoms and dissociation as serial mediators of the relationship between cumulative victimization and adjustment problems among poly-victimized at-risk youth.

INTRODUCTION: Poly-victimization (PV) has a greater adverse impact on adolescents' lives than any single victimization type, even when repeatedly experienced. Adolescents who experience PV tend to present with an array of adjustment problems, and research has begun to identify mechanisms linking PV to adjustment problems. Both posttraumatic stress disorder (PTSD) and dissociation are linked to PV and adjustment problems; however, it is unclear how these variables play a role in the pathways from PV to adjustment problems. This study assessed PTSD and dissociation as serial mediators in the PV-adjustment problems link. METHOD: Two hundred eighteen Portuguese youth identified as poly-victims (56% girls) and aged between 12 and 17 years old (M = 15.63; SD = 1.26) were recruited from three at-risk contexts' cohorts. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, dissociative symptoms, and emotional and social adjustment problems. RESULTS: The study results suggest that, among poly-victim adolescents, PTSD and dissociation may be mediators of the relationship between the cumulative extent of victimization and adjustment problems. CONCLUSION: The current study's findings highlight the importance of careful assessment of both PTSD and dissociative symptoms and indicate that targeted interventions are essential when working with poly-victimized youth with the highest scores of cumulative victimization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The mediating role of posttraumatic stress symptoms on somatization in adolescents: A two-wave longitudinal study.

OBJECTIVE: Trauma as well as adverse childhood experiences (ACEs) have been associated with increased rates of later somatization symptoms. Some evidence has proposed that posttraumatic stress symptoms (PTSS) can mediate this relationship. However, most data come from adult samples. This two-wave longitudinal study aimed to investigate the relationship between cumulative adversity (total amount of adverse and traumatic experiences), PTSS and somatization symptoms in adolescents. METHOD: The sample included 150 adolescents, mean age of 16 years old (M = 15.99, SD = 1.25) with 67 (44.7%) males and 83 (55.3%) females. All were exposed to at least one traumatic event or one childhood adversity. The interval time between the two assessments was about 1 year. RESULTS: The results showed that the PTSS Cluster E, alterations in arousal and reactivity, partially mediated the relationship between cumulative adversity and somatization symptoms (B = .09, BSE = .03, CI [.01, .15]). However, the effect size of the mediation was medium, while the direct effect was large (B = .34, BSE = .08, CI [.18, .50]). CONCLUSIONS: While arousal and reactivity symptoms seem to play a key role in adolescents suffering from somatization symptoms, cumulative adversity have their own direct and strong contribution. Clinicians should consider assessing PTSS and cumulative adversity when caring for adolescents suffering with somatic symptoms to better deliver intervention plans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

New directions for patient-centred care in scleroderma: the Scleroderma Patient-centred Intervention Network (SPIN).

Systemic sclerosis (SSc), or scleroderma, is a chronic multisystem autoimmune disorder characterised by thickening and fibrosis of the skin and by the involvement of internal organs such as the lungs, kidneys, gastrointestinal tract, and heart. Because there is no cure, feasibly-implemented and easily accessible evidence-based interventions to improve health-related quality of life (HRQoL) are needed. Due to a lack of evidence, however, specific recommendations have not been made regarding non-pharmacological interventions (e.g. behavioural/psychological, educational, physical/occupational therapy) to improve HRQoL in SSc. The Scleroderma Patient-centred Intervention Network (SPIN) was recently organised to address this gap. SPIN is comprised of patient representatives, clinicians, and researchers from Canada, the USA, and Europe. The goal of SPIN, as described in this article, is to develop, test, and disseminate a set of accessible interventions designed to complement standard care in order to improve HRQoL outcomes in SSc.

Prevalence of post-traumatic stress disorder and physical health complaints among Portuguese Army Special Operations Forces deployed in Afghanistan.

BACKGROUND: Investigations conducted with several U.S. and U.K. military veterans returning from Afghanistan and Iraq have reported the existence of mental and physical health complaints. METHODS: A total of 113 participants completed a self-report questionnaire that assessed post-traumatic stress disorder (PTSD) symptoms, physical health complaints, and reported illnesses. RESULTS: Overall, 2.7% of the participants reported symptoms compatible with a PTSD diagnosis and 8.8% have partial PTSD. The most common physical health complaints were back pain, fatigue, and muscle pain. In addition, participants experienced gastrointestinal, nervous, and respiratory diseases. PTSD symptoms further explain the variance in physical health complaints after controlling for the contribution of reported illnesses to the same variables. CONCLUSIONS: The prevalence of PTSD in the study sample is low, but PTSD symptoms are significantly related to physical health complaints and reported illnesses and explain the variance in physical symptoms. This fact should be considered by clinical support services, and military personnel with physical complaints should be screened for PTSD. These Portuguese results obtained from participants belonging to a well-prepared Special Operations Forces group contribute to a better understanding of the physical and mental impact of the war in Afghanistan.

Adverse Lifelong Experiences in Portuguese People Living With HIV: A Retrospective Study.

ABSTRACT: This study aimed to analyze the adverse life experiences encountered by people living with HIV in Portugal, analyze differences between men and women, and identify which experiences were related to HIV transmission modes-sexual activity or injection drug use. We used a sample of 328 participants with a mean age of 45.64, mostly men (79.6%), with a known diagnosis of HIV for 10.34 years. Women and persons who inject drugs reported significantly more adverse outcomes throughout life. Physical abuse during childhood was significantly associated with the sexual transmission mode, whereas having a parent sent to prison during childhood, physical violence, experiencing a life-threatening injury/illness (other than HIV) during adulthood, and injuring someone during adulthood were associated with injection drug use. Practical implications are discussed at the prevention and intervention levels.