Barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes con depresión / Barriers and facilitators to mental health help-seeking, from the perspective of adolescents with depression

La prevalencia de depresión en adolescentes es aproximadamente 7% en Chile. Sólo entre 18% y 34% de jóvenes con depresión accede a ayuda profesional. Objetivo: El objetivo de esta investigación fue analizar barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes entre 15 y 17 años con depresión en Santiago de Chile. Método: Se llevó a cabo un estudio cualitativo exploratorio y descriptivo desde el enfoque fenomenológico. Se realizaron diez entrevistas semi estructuradas a adolescentes, que fueron analizadas con teoría fundamentada. Resultados: Las principales barreras fueron estigma, minimización de síntomas y preocupación por confidencialidad. Los principales facilitadores fueron contar con red de apoyo, reconocimiento de síntomas e intervenciones escolares que favorecen la detección de síntomas. Conclusiones: Se debe trabajar de manera conjunta con adolescentes, sus familias, pares y sistema escolar brindando información sobre la depresión y su tratamiento.

The prevalence of depression in adolescents is approximately 7% in Chile. Only between 18% and 34% of young people with depression access professional help. Objective: The aim of this research was to analyze the barriers and facilitators for seeking professional help in mental health, from the perspective of adolescents between 15 and 17 years of age with depression in Santiago, Chile. Methodology: An exploratory and descriptive qualitative study was carried out from the phenomenological approach. Ten semi-structured interviews were conducted with adolescents and analyzed with grounded theory. Results: The main barriers were stigma, minimization of symptoms, and concerns about confidentiality. The main facilitators were having a support network, symptom recognition, and school interventions that favor symptom detection. Conclusions: Joint work should be done with adolescents, their families, peers, and school system providing information about depression and its treatment.

Investigaciones en salud mental infanto-juvenil en Chile durante la pandemia de COVID-19: una revisión de alcance / d and youth mental health research in Chile during the COVID-19 pandemic: a scoping review

En todo el mundo se han descrito efectos negativos de la pandemia de COVID-19 en la salud mental, especialmente en la población infanto-juvenil. Sin embargo, en Chile, la investigación disponible aún no se ha sistematizado. El objetivo de este estudio fue revisar sistemáticamente las publicaciones científicas sobre salud mental infanto-juvenil en Chile durante la pandemia de COVID-19. Se buscaron reportes de investigación en las bases de datos WoS, Scopus, SciELO y LILACS. Se incluyeron 13 estudios que cumplieron los criterios de inclusión. Los estudios son heterogéneos en cuanto a sus objetivos e instrumentos utilizados. Varios estudios coinciden en que hay un aumento de los síntomas internalizantes, externalizantes y somáticos en la población infanto-juvenil desde la pandemia. Es necesario promover investigaciones colaborativas y longitudinales e investigaciones que evalúen la eficacia de intervenciones preventivas y terapéuticas. Estos resultados pueden ser útiles para clínicos, académicos y tomadores de decisión en políticas públicas para que puedan adoptar medidas para mejorar la salud mental de esta población. Palabras Clave: Salud mental, niños, adolescentes, jóvenes, COVID-19.

Abstract. Negative effects of the COVID-19 pandemic on mental health have been described worldwide, especially in the child and youth population. However, in Chile, the available research has not yet been systematized. This study aimed to systematically review scientific publications on child and youth mental health in Chile during the COVID-19 pandemic. The WoS, Scopus, SciELO, and LILACS databases were searched for research reports. Thirteen studies that met the inclusion criteria were included. The studies are heterogeneous in terms of their objectives and instruments used. Several studies agree that there is an increase in internalizing, externalizing, and somatic symptoms in the child and youth population since the pandemic. There is a need to promote collaborative and longitudinal research, and research that evaluates the efficacy of preventive and therapeutic interventions. These results may be useful to clinicians, academics, and public policymakers so that they can take steps to improve the mental health of this population. Keywords: Mental health, children, adolescents, youth, COVID-19.

Propiedades psicométricas de la escala Generalized Anxiety Disorder 7-Item (GAD-7) en una muestra comunitaria de adolescentes en Chile / Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents

BACKGROUND: The Generalized Anxiety Disorder 7-item (GAD-7) scale is widely used for the assessment of generalized anxiety disorder. AIM: To adapt the GAD-7 to the Chilean adolescent population and to evaluate its psychometric properties. MATERIAL AND METHODS: The GAD-7 was adapted and administered to 2,022 adolescents between 13 and 19 years of age, recruited from eight schools in the northern area of Santiago, Chile. Other self-report instruments were used to assess depressive symptoms and health-related quality of life. The one factor structure and invariance by sex were examined using Confirmatory Factor Analysis. Its reliability and validity based on its relationship with other variables were assessed. RESULTS: The one-factor structure and invariance by sex were confirmed. The results showed an adequate internal reliability (Cronbach's alpha = 0.86, Spearman-Brown coefficient = 0.82). As expected, significant correlations were observed with measures of depressive symptoms and health-related quality of life. Higher scores were observed in women than in men. CONCLUSIONS: The Chilean version adapted for adolescents of the GAD-7 has good psychometric properties. Thus, it may be a useful and valid instrument for the assessment of generalized anxiety disorder in adolescents in Chile.

Salud mental en estudiantes de educación superior en Chile: una revisión de alcance con meta-análisis / Mental Health of Higher Education Students in Chile: Scoping Review and Meta-Analysis

Resumen Realizamos una revisión de alcance sobre la prevalencia de síntomas psicológicos, factores asociados a la salud mental, barreras y facilitadores para la búsqueda de ayuda, y la efectividad de intervenciones de salud mental en estudiantes de educación superior en Chile. Buscamos reportes indexados hasta el 15 de octubre de 2019 en las bases de datos CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME y Web of Science. Evaluamos la calidad de los estudios de prevalencia y exploramos la prevalencia combinada de síntomas psicológicos mediante meta-análisis. Incluimos 32 estudios publicados, 20 sobre prevalencia de síntomas - 10 con la calidad suficiente para ser incluidos en el meta-análisis. Observamos una heterogeneidad sustantiva en la exploración de prevalencia combinada de síntomas, con rangos entre 22,9% a 40,7% para malestar psicológico, 16,5% a 38,8% para síntomas depresivos, 16,5% a 23,7% para síntomas ansiosos, 19,7% a 29,7% para consumo de cannabis en los últimos 12 meses, y 84,0% a 92,6% para consumo de alcohol en los últimos 12 meses. El sexo femenino se asoció consistentemente con problemas de salud mental. Es necesario realizar más estudios que evalúen el acceso a tratamiento, facilitadores y barreras para la búsqueda de ayuda, e intervenciones para mejorar la salud mental de la población objetivo.

Abstract We conducted a scoping review on the prevalence of psychological symptoms, factors associated with mental health, barriers and facilitators to help-seeking, and effectiveness of mental health interventions in higher education students in Chile. We searched for indexed reports up to October 15, 2019, in CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME, and Web of Science databases. We assessed the quality of prevalence studies and explored the pooled prevalence of psychological symptoms using meta-analyses. We included 32 published studies, 20 on the prevalence of psychological symptoms - 10 of sufficient quality to be included in meta-analyses. We observed substantial heterogeneity in the exploration of combined prevalence of psychological symptoms, with ranges from 22.9% to 40.7% for psychological distress, 16.5% to 38.8% for depressive symptoms, 16.5% to 23.7% for anxious symptoms, 19.7% to 29.7% for cannabis use in the past 12 months, and 84.0% to 92.6% for alcohol use in the past 12 months. Female sex was consistently associated with mental health problems. More studies evaluating access to treatment, help-seeking barriers and facilitators, and interventions to improve the mental health of the target population are needed.

Factores Asociados al Autoestigma de la Depresión en Adolescentes en Santiago, Chile / Associated factors with self-stigma of depression in adolescents in Santiago, Chile

Determinar la asociación entre autoestigma de la depresión y factores sociodemográficos, historia personal y parental de depresión, sintomatología ansiosa y depresiva, y calidad de vida en adolescentes. Método: Estudio transversal correlacional, en una muestra de 192 adolescentes (8º básico a 3º medio) de tres colegios particulares subvencionados de Santiago, Chile, se aplicaron cuestionarios de factores sociodemográficos, autoestigma de la depresión, sintomatología ansiosa y depresiva, y calidad de vida. Los datos se analizaron con prueba t de Student, ANOVA, coeficiente de Pearson y Regresión Lineal. Resultados: No hubo diferencias en autoestigma de depresión entre hombres y mujeres. Fue mayor el autoestigma de la depresión en adolescentes que sospechaban que habían tenido o tenían depresión, referían que su madre o padre habían tenido depresión, tenían mayor sintomatología depresiva y/o ansiosa y menor calidad de vida. Conclusión: La presencia de depresión en los progenitores progenitores (madre y/o padre), así como el desconocimiento de los adolescentes respecto a si ellos presentan el cuadro clínico, se relaciona con mayor autoestigma de la depresión en los adolescentes, lo que inhibe la búsqueda de ayuda.

To determine the association between self-stigma of depression and sociodemographic factors, personal and parental history of depression, anxious and depressive symptomatology, and quality of life in adolescents. Methods: Non-experimental cross-sectional and correlational study. A total of 192 adolescents from 8th grade to 11th grade from three private subsidized schools in Santiago, Chile, answered questionnaires on sociodemographic factors, self-stigma of depression, anxious and depressive symptomatology, and quality of life. Data were analyzed with Student's t-test, ANOVA, Pearson's coefficient and linear regression. Results: There were no differences in self-stigma of depression between men and women. Self-stigma of depression was higher in adolescents who suspected that they had had or had depression, who reported that their mother or father had had depression, who had greater depressive and/or anxious symptomatology and lower quality of life. Conclusion: The presence of depression in the parents (mother and / or father) as well as the lack of knowledge of adolescents regarding whether they have depression is related to greater self-stigma of depression which inhibits the help-seeking in adolescents.

Impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios en Chile / Impact of the COVID-19 pandemic on the mental health of university students in Chile

La pandemia por COVID-19 ha tenido un impacto negativo en el bienestar psicológico de la población. El objetivo de este estudio fue evaluar el impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios(as) en Chile, explorando el rol de los acontecimientos adversos en el núcleo familiar y las experiencias negativas relacionadas. Contestaron una encuesta en línea 2.411 estudiantes de primer año de una universidad en Chile. Tres de cada cuatro estudiantes reportaron que su estado de ánimo era peor o mucho peor en comparación con el contexto pre-pandémico. Las estudiantes mujeres presentaron significativamente mayores niveles de sintomatología depresiva y ansiosa y reportaron de forma significativa una mayor percepción de empeoramiento del estado de ánimo. Los hallazgos de este estudio refuerzan la necesidad de implementar intervenciones y estrategias orientadas a favorecer una mejor salud mental de los(as) estudiantes universitarios(as) en Chile.

Abstract. The COVID-19 pandemic has had a negative impact on the psychological well-being of the population. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the mental health of university students in Chile, exploring the role of adverse events in the family and related negative experiences. An online survey was answered by 2,411 first-year students from a university in Chile. Three out of four students reported that their mood was worse or much worse compared to the pre-pandemic context. Female students presented significantly higher levels of depressive and anxious symptoms and reported significantly greater perception of worsening mood. The findings of this study reinforce the need to implement interventions and strategies aimed at promoting better mental health for university students in Chile.

Tamizaje de episodio depresivo en adolescentes: validación del instrumento PHQ-9 / Screening depressive episodes in adolescents: validation of the Patient Health Questionnaire-9 (PHQ-9)

Background: There is a paucity of validated instruments for screening depression in adolescent populations in Chile. Aim: To determine the diagnostic accuracy of the adolescent version of Patient Health Questionnaire-9 (PHQ-9). Material and Methods: The PHQ-9 was transculturally adapted and administered to adolescents aged 15 to 19 years residing in Santiago de Chile, who were then evaluated with a semi structured interview (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version or K-SADS-PL) and the Beck Depression Inventory. Internal validity, concurrent validity, and discriminatory power of the PHQ-9 were analyzed. Results: We evaluated 245 adolescents aged 16.2 ± 1 years (71% females). Two hundred and ten presented with a depressive episode and 35 were healthy. The sensitivity and specificity of the scale were 86.2 and 82.9% for 11 points, with a positive likelihood ratio of 5.02. Conclusions: The PHQ-9 is sensitive and specific enough to be used as a screening tool in adolescents with suspected depression. At a 11-point cut-off score as proposed, the likelihood to find a positive result in a subject with depression is five times higher.

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile / Comorbidity in people with depression seeking help at primary health care centers in Santiago, Chile

Background: International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. Aim: To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. Materials and Methods: A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. Results: Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. Conclusions: Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities.

Calidad de Vida Relacionada a la Salud en niños y adolescentes en Chile / Health-Related Quality of Life in children and adolescents in Chile

Calidad de Vida Relacionada a la Salud (CVRS), si bien, no es un concepto nuevo, ya que en 1948 la Organización Mundial de la Salud definía el estado de salud como "no solo la ausencia de enfermedad, sino como un estado completo de bienestar físico, mental y social", es últimamente que se hace evidente la necesidad de que el rol de la medicina no sea sólo el de proporcionar años de Vida, sino mejorar la calidad de la misma y tener instrumentos para que el propio paciente evalúe la calidad de los servicios. La evaluación de CVRS puede realizarse a través de: a) instrumentos genéricos; b) instrumentos específicos; o c) áreas o dimensiones de funcionamiento (ej. dolor). En esta revisión, se encontró 36 publicaciones desde el año 2001 que incluyen mediciones de CVRS en población infantil y adolescente de Chile. Hay artículos de adaptación y validación de instrumentos, estudios . observacionales y correlacionales en niños y adolescentes con patologías físicas y en población escolar general. Destaca la investigación de la Universidad de Chile "Calidad de vida de los adolescentes chilenos con énfasis en salud" que incluye una muestra representativa a nivel nacional. En general, los estudios muestran que la CVRS es peor en mujeres y en adolescentes de mayor edad. Faltan investigaciones en pacientes con psicopatología, estudios longitudinales para evaluar intervenciones que mejoren la CVRS y diseñar intervenciones diferenciadas por edad y género. Palabras claves: calidad de vida, calidad de vida relacionada a la salud, niños, adolescentes.

Health-related quality of life (HRQOL), although not a new concept, since healthy status was defined in 1948 by the World Health Organization as "not merely the absence of disease, but as a state of complete physical, mental and social well-being", it has recently become clear that the role of medicine is not only to provide years of life, but to improve its quality and have instruments that allow the patient to evaluate the quality of services. HRQOL assessment may be performed by: a) generic instruments; b) specific instruments; or c) functional areas or dimensions (eg. pain). In this review, 36 publications since 2001 including measures of HRQOL in children and adolescents in Chile were found. There are articles of adaptation and validation of instruments, correlational and observational studies in children and adolescents with physical diseases and general school population. We found the research at the University of Chile "Quality of life of Chilean adolescents with emphasis on health" which includes a nationally representative sample, to be the most relevant. In general, studies show that HRQOL is worse in women and older adolescents. Research is lacking in patients with psychopathology, longitudinal studies to evaluate interventions to improve HRQOL, and interventions designed differentially by age and gender.Key words: quality of life, health-related quality of life, children, adolescents

Intervención grupal para reducir la sintomatología depresiva y promover la sensibilidad materna en embarazadas chilenas / Group intervention for reducing depressive symptoms and promoting maternal sensitivity in pregnant Chilean women

La sintomatología depresiva es frecuente en el embarazo y repercute en el posparto y en el vínculo madre-bebé. Se reportan los resultados de una intervención grupal de 5 sesiones para reducir la sintomatología depresiva y promover una adecuada sensibilidad materna. Participaron 134 embarazadas con antecedentes de depresión (grupo experimental = 88 y grupo control = 46). Se evaluó sintomatología depresiva (Inventario para la Depresión de Beck), resolución de problemas sociales (Inventario de Resolución de Problemas Sociales Abreviado), sensibilidad materna, cooperatividad infantil y riesgo vincular (Índice Experimental de Relación Niño-Adulto) en ambos grupos. Se observó una reducción significativa de la sintomatología depresiva, así como un incremento de las habilidades para la resolución de problemas sociales en el grupo intervenido. Este grupo muestra también puntajes significativamente mayores en sensibilidad materna y cooperatividad infantil, así como menores frecuencias de riesgo vincular en la evaluación postintervención. Se discute la relevancia de desarrollar estrategias de intervención durante el embarazo, considerando su impacto en la sensibilidad materna, en la calidad de las interacciones madre-bebé y en las habilidades de las madres para resolver problemas.

Depressive symptoms are frequently observed during pregnancy, and these affect the mother and her relationship with her baby during the post-partum period. Results are reported on a 5-session group intervention for reducing depressive symptoms and promoting maternal sensitivity. The participants included 134 pregnant women with a history of depression (experimental group = 46 and control group = 88). Depressive symptoms (Beck Depression Inventory), social problem-solving strategies (Social Problem-Solving Inventory-Revised), maternal sensitivity, infant cooperativeness and bonding risk (Child-Adult Relatinoship Experimental Index) were assessed in both groups. The group intervened showed a significant reduction of depressive symptoms and an improvement of social problem-solving strategies. This group also shows significantly higher scores in maternal sensitivity, and infant cooperativeness, as well as lower frequencies of bonding risk in the post-intervention assessment. The importance of considering intervention strategies during pregnancy, including its impact on maternal sensitivity, the quality of mother-baby interactions and the problem-solving abilities of the mothers, is discussed.

Bullying y calidad de vida relacionada con la salud en adolescentes escolares chilenos / Influence of bullying on the quality of life perception of Chilean students

Background: Bullying has a negative impact on the perception of adolescents of their quality of life. Aim: To analyze the association between being bullied and health related quality of life in Chilean adolescents. Material and Methods: The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. Results: Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. Conclusions: Bullying is associated with a lower quality of life perception among Chilean students.

Prevención, detección, tratamiento o seguimiento en salud mental de adolescentes a través del uso de Internet: una revisión sistemática cualitativa / Use of Internet for mental health programs aimed at adolescents

Background: The widespread use of INTERNET by adolescents, renders it a simple and accessible means for health care campaigns Aim: To perform a systematic review of ISI publications about INTERNET use for adolescent mental health prevention, detection, treatment or follow up. Material and Methods: Systematic reviews, meta analyses and controlled clinical trials in all languages were searched. Manuscripts without an abstract or only publishing the study design were excluded. All selected articles were critically read. Results: One hundred and five papers were found and 61 were excluded because they did not address the research question. Of the resting 44, only six complied with the search criteria among then, 3 articles correspond to systematic reviews addressing early intervention programs and mental hearth treatment based on Internet; the other 3 articles correspond to controlled clinical trials addressing treatment interventions of anxiety and depression and 1 address on depression prevention program. Conclusions: INTERNET facilitates the application of mental health promotion, prevention and intervention among adolescents. However the resource is still underused.

Calidad de vida relacionada con la salud en adolescentes chilenos, según autopercepción de discapacidad, enfermedad o problemas de salud crónicos / Health-Related Quality of Life according to perceivedmorbidity in Chilean adolescents

Objetivo. Relacionar la morbilidad percibida de adolescentes chilenos con su calidad de vida relacionada con la salud. (CVRS). Método. Análisis comparativo en adolescentes chilenos con y sin morbilidad percibida, según la Clasificación Internacional de Enfermedades (CIE10). Información obtenida a través de un estudio nacional, aplicando un cuestionario de medición de calidad de vida relacionada con salud (KIDSCREEN-52), adaptado culturalmente y validado en Chile en 2009. Se analizó por las variables de sexo, edad, tipo de establecimiento escolar y zonas del país. Se analizó las 10 dimensiones de calidad de vida del KIDSCREEN que se expresan como puntajes Rasch. Para el análisis de las diferencias de medias entre las variables se utilizó la prueba de Chi2 y t de Student. Se aplicó el software STATA 10.0 y SAS 9.1 Resultados. Se determina la morbilidad autopercibida a nivel nacional, la cual es más frecuente en mujeres, adolescentes menores, estudiantes de establecimientos escolares particulares y zona norte del país. El cuestionario demuestra que los puntajes Rasch más bajos de CVRS se alcanzan en adolescentes con morbilidad percibida. Conclusión. Las peores CVRS en adolescentes con morbilidad autopercibida , fue en mujeres, adolescentes mayores, del sector público de la educación y de la zona norte del país. La información es un aporte nuevo y útil para futuros programas de salud juveniles del sector público.

Objective. To correlate Chilean adolescents’ perceived morbidity with their Health-Related Quality of Life (HRQoL). Method. Comparative analysis of Chilean adolescents with and without perceived morbidity classified according to the International Classification of Diseases (ICD10). Information was collected through a national study, applying the KIDSCREEN-52 questionnaire, adapted culturally and validated in Chile in 2009. The ten quality life dimensions, expressed as Rasch points, were analyzed by sex, age, type of school and zones of the country. To analyze the mean differences between the variables, the Chi squared and Student’s t-test were used. The software used were STATA 10.0 and SAS 9. Results. The self perceived morbidity was assessed across the country and was more frequent in women, adolescents of younger age, students from private schools and from the north zone of the country. The lowest HRQoL Rasch points were determined in adolescents with perceived morbidity. Conclusion. The worst HRQoL in adolescents was found in those with self perceived morbidity, women, higher adolescent age, students from public schools and from the north of the country. This finding is new and a useful contribution for future national public health programs concerning adolescents.

Intervenciones psicológicas perinatales en depresión materna y vínculo madre-bebé: una revisión sistemática / Psychological perinatal interventions in maternal depression and mother-child bond: a systematic review

La depresión perinatal constituye un trastorno de alta prevalencia con repercusiones negativas en la madre y en el bebé. A partir de estos antecedentes se revisa la literatura existente sobre intervenciones psicológicas focalizadas en reducir la depresión y/o favorecer un vínculo madre-infante positivo desde el embarazo hasta los dos años del niño/a. Se consideran 27 estudios publicados entre los años 1996 y 2012, que incluyen grupos experimental y control. Los resultados muestran que un mayor número de intervenciones se focalizan en la depresión perinatal como variable, distinguiendo entre intervenciones en el embarazo y postparto. Un menor número de estudios se dirige a la calidad del vínculo madre-infante y a ambas variables. Las intervenciones reportadas como exitosas, incluyen intervenciones grupales e individuales dirigidas a favorecer la sensibilidad materna y técnicas corporales.

Perinatal depression constitutes a high prevalence disorder, with negative repercussions in the mother and the baby. From these precedents, this article reviews different psychological interventions developed to reduce depression and/or to promote a mother-infant bond-quality, from pregnancy to children's second year of life. There are considered 27 studies published between 1996 and 2012, with inclusion of experimental and control groups. Results show that most of the interventions are focused in perinatal depression as a variable, differentiating between interventions during pregnancy and at postpartum. A minor number of studies focused on the mother-baby bond quality and to modify both variables in a simultaneous way. Interventions that were reported to be successful considered group and individual interventions focused on promoting maternal sensitivity and corporal techniques.

Factores que facilitan la conversación sobre sexualidad entre padres e hijos/as de primer ciclo de enseñanza básica / Factors that facilitate the talking about sexuality between parents and sons / daughters of first cycle of basic education

Objetivo: Determinar los factores que facilitan la conversación sobre sexualidad entre padres e hijos/as de primer ciclo de enseñanza básica. Método: Estudio de diseño transversal y analítico. Se estudiaron 210 padres de ambos sexos con hijos/as cursando el primer ciclo de enseñanza básica de tres colegios de la Región Metropolitana, uno municipalizado, uno particular subvencionado y uno particular pagado, los cuales contestaron una encuesta que formaba parte de un diagnóstico previo a la aplicación de un Programa de Educación Sexual destinado a niños/as del primer ciclo de enseñanza básica. Se ajustó un modelo de regresión logística múltiple para identificar aquellos factores que facilitan la conversación de sexualidad entre padres e hijos/as. Resultados: Los factores que aumentan la posibilidad de los padres de sentirse bien al conversar de sexualidad con sus hijos son: hijos que cursan 3º a 4º básico, padres que habían asistido anteriormente a un curso de educación sexual y estiman tener alto nivel de conocimiento en educación sexual. Conclusiones: Los resultados muestran la necesidad de capacitar a los padres en educación sexual para que puedan abordar estos temas con sus hijos a más temprana edad.

Objective: To determine the factors that facilitate the talking about sexuality between parents and children the first cycle of basic education. Method: This is a cross-sectional and analytical study. We studied 210 parents of either sex with sons / daughters studying the first cycle of basic education in three schools in the metropolitan region, one public, one private subsidized and one private, which answered a survey that was part of a previous diagnosis of the implementation of a sex education program aimed at children the first cycle of basic education. Multiple logistic regression model to identify factors that facilitate conversation about sexuality between parents and sons / daughters was used. Results: Factors that increase the probability of parents to feel good to talk about sexuality with their children include: children enrolled in 3rd-4th grade, parents who had previously attended a course in sex education and estimated to have high level of knowledge on sex education. Conclusions: The results show the need to train parents in sex education so that they can address these issues with their children at a younger age.

Síndrome premenstrual y trastorno disfórico premenstrual en la adolescencia / Premenstrual syndrome and premenstrual dysphoric disorder during adolescence

Hasta 85 por ciento de las mujeres en edad fértil presentan síntomas premenstruales. Sólo algunas de ellas cumplen criterios para Síndrome Premenstrual (SPM) y menos aún para Trastorno Disfórico Premenstrual (TDPM). Ambas patologías comienzan en la adolescencia y se asocian a consecuencias negativas que interfieren en el funcionamiento diario. A pesar de eso, pocas adolescentes consultan por estos síntomas y, cuando consultan, muchas veces, no reciben el diagnóstico ni el tratamiento adecuado. En este artículo se hace una revisión de la epidemiología, diagnóstico y tratamiento del SPM y del TDPM en adolescentes. Educación sobre cambios en estilo de vida, alimentación saludable y ejercicio, son las intervenciones más recomendadas en adolescentes. En cambio, en adultos habría mayor evidencia en tratamiento hormonal y con psicotrópicos.

Up to 85 percent of women of child bearing age present premenstrual symptoms. Only some of them meet criteria for Premenstrual Syndrome (PMS) and even less for premenstrual dysphoric disorder (PMDD). Both diseases begin in adolescence and are associated with negative consequences that interfere with daily functioning. Despite this, few adolescents consult for these symptoms, and when they consult, they do not get proper diagnosis and treatment. In this article we review the epidemiology, diagnosis and treatment of PMS and PMDD in adolescents. Education on lifestyle changes, healthy nutrition and exercise are the interventions most recommended in adolescents. In contrast, in adults, hormone therapy and psychotropic have greater evidence.

Ideas autolíticas, violencia autoinfligida, y síntomas depresivos en escolares chilenos / Suicidal ideation, self-directed violence and depression among Chilean school adolescents

Background: Suicidal behaviors and depression are prevalent phenomena among adolescents, and are considered a public health problem. Aim: To determine the prevalence of depressive symptoms and suicidal behaviors and the relationship between both phenomena, in a representative sample of students from ninth grade in Santiago, Chile. Material and Methods: We recruited a probability sample of 2,597 adolescents who answered a questionnaire with questions about suicidal behavior and the Beck Depression Inventory (BDI-II). Results: The lifetime prevalence of suicidal ideation and planning was 21 and 14%, respectively. The prevalence for the past two weeks was 6.7 and 4.4% for suicidal ideation and planning, respectively. Autolytic behaviors, once in lifetime and in the past week were referred by 26 and 4% of respondents, respectively. In one third of these, self-harm coincided with recent suicide ideation or planning. All levels of suicidal behavior were more frequently reported by women. Clinically significant depressive symptoms were present in 23.5% of adolescents. Females doubled male rates. Severe depressive symptoms were present in 9.4% of the sample. A higher level of suicidal behavior correlated with more severe forms of depression. Sixty percent of adolescents who reported recent self-harm, had clinically relevant depressive symptoms. Two thirds of them had severe symptoms. Conclusions: Suicidal behavior in Chilean adolescents is prevalent, and there is an association between this behavior and the level of depression. The school is a good place to identify and develop preventive measures for teenagers.

Uso de programas de terapia cognitivo conductual computarizada para la prevención y tratamiento de depresión en adolescentes / Use of computerized cognitive behavioral therapy programs for the prevention and treatment of depression in adolescents

La terapia cognitivo conductual computarizada (TCC-c) ha demostrado ser efectiva en depresión en adultos. En adolescentes la investigación en esta área es aún limitada. El objetivo de este trabajo es revisar la literatura sobre el uso de programas de TCC-c para la prevención y tratamiento de depresión en adolescentes. Se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO. Diez estudios que corresponden a seis diferentes programas fueron analizados. Los programas varían en extensión y grado de contacto con los profesionales. En general, los estudios reportaron buena aceptabilidad y reducción de la sintomatología depresiva. Sin embargo, en su mayoría hubo una alta tasa de abandono. La evidencia preliminar sugiere que la TCC-c es una alternativa útil en la prevención y tratamiento de la depresión en adolescentes. Faltan estudios que apunten a mejorar la adherencia y eficacia de programas con TCC-c.

Computerized cognitive behavioral therapy (cCBT) is a demonstrated effective therapy for depression in the adult population. In the adolescent population, however, little research has been done. The objective of this study is to review the literature about the use of cCBT programs to prevent and treat depression in adolescents. A search was done in the databases PubMed, LILACS, and SciELO. In the end, ten studies, corresponding to six different programs, were analyzed. The programs varied in length and degree of contact with professionals. In general, the studies reported good acceptance and reduced depressive symptomatology; however, the majority of the studies had a high rate of dropouts. Preliminary evidence suggests that cCBT is a useful alternative in the prevention and treatment of depression in adolescents, but additional studies must be done to show improved cCBT program adherence and efficacy.

Preliminary reliability and validity of the spanish generalized expectancies for negative mood regulation scale / Confiabilidad y validez preliminares de la versión en español de la escala de expectativas generalizadas para la regulación del ánimo negativo

OBJECTIVE: This article introduces a Spanish version of the Generalized Expectancies for Negative Mood Regulation Scale (NMR-S) and tests the reliability and the validity of the new questionnaire. METHODS: A sample of 360 students from Chile completed the NMR-S along with instruments measuring depressive symptoms, social desirability, coping, and emotion regulation. RESULTS: A factor analysis indicated that the NMR-S has a one-dimensional structure. The reliability of the new instrument was α = 0.89. The concurrent validity of the NMR-S was supported by correlations with measures of coping, emotion regulation, and depressive symptoms. Furthermore, the NMR-S predicted depressive symptoms when controlling for emotion regulation and coping. CONCLUSIONS: The findings are the first evidence to support the reliability and validity of the NMR-S.

OBJETIVO: En este artículo se presenta la versión en español de la Escala de Expectativas Generalizadas para la Regulación del Animo Negativo (NMR-S) y se evalúa la confiabilidad y la validez del nuevo cuestionario. MÉTODOS: Una muestra de 360 estudiantes de Chile completó la NMR-S junto con instrumentos dirigidos a medir síntomas depresivos, deseabilidad social, afrontamiento y regulación emocional. RESULTADOS: Un análisis factorial indicó que la NMR-S tiene una estructura unidimensional. La confiabilidad del nuevo instrumento fue de α = 0,89. La validez concurrente de la NMR-S fue avalada a través de su correlación con las mediciones de afrontamiento, regulación emocional y síntomas depresivos. Asimismo, la NMR-S predijo los síntomas depresivos cuando se controló por la regulación emocional y el afrontamiento. CONCLUSIONES: Los datos presentados son la primera evidencia para avalar la confiabilidad y la validez de la NMR-S.