Effectiveness of a group-based psychosocial program to prevent depression and anxiety in older people attending primary health care centres: a randomised controlled trial.

BACKGROUND: Evidence about the effectiveness of psychosocial interventions to reduce the incidence of depression and anxiety and promote subjective well-being in older people is limited, particularly in Latin-American countries. This study thus aims to assess a program specifically designed to address this issue in persons aged 65 to 80 and attending primary health care centres. METHOD: Older people who use primary care centres are to be randomly assigned to the program or to a control group. Only independent users will be included; those having had a major depressive disorder or an anxiety disorder in the last 6 months will be excluded. The program is group based; it includes cognitive stimulation, expansion of social support networks and cognitive behaviour strategies. Depressive and anxiety symptoms and disorders, as well as psychological well-being, will be assessed using standardised instruments, once before implementing the program and later, after 18 and 36 weeks. DISCUSSION: Primary care is a setting where interventions to improve mental health can be beneficial. Providing evidence-based programs that work with older people is a priority for public mental health. TRIAL REGISTRATION: A protocol for this study has been registered prospectively at ISRCTN registry on 25 July 2018. Identifier: ISRCTN32235611 .

[Psychometric characteristics of the Patient Health Questionnaire (PHQ-9)]. / Propiedades psicométricas del PHQ-9 (Patient Health Questionnaire) en centros de atención primaria de Chile.

BACKGROUND: Simple and brief questionnaires with adequate psychometric properties are useful for the early detection of depressive disorders. AIM: To analyze the psychometric behavior of the Patient Health Questionnaire (PHQ-9) in Chile. MATERIAL AND METHODS: Data were collected from 1,738 adult patients, consulting in primary health care centers. The values obtained in the PHQ-9 were compared with those of the Composite International Diagnostic Interview (CIDI). RESULTS: The mean score of PHQ-9 was 4.85 ± 5.57. Internal consistency indices were high. McDonald's ω coefficient of was 0.90 and Cronbach alpha 0.89. A confirmatory factor analysis showed a good fit of the one-dimensional model. Using a cutoff score of seven determined with the receiver operating characteristic (ROC) curve, the sensitivity and specificity of the instrument were 0.8 and 0.7, when compared with CIDI diagnoses. CONCLUSIONS: PHQ-9 is a useful instrument for the screening of depressive disorders in primary health care centers in Chile.

Brooding as moderator of depressive symptoms after a work accident: A longitudinal study.

This study analyzes the relationship between having experienced a work accident and developing depressive symptoms six months later, considering the subjective severity of accidents, the use of both positive and negative religious coping strategies, and brooding as predictors variables. Fifty seven women and 187 men were evaluated during the month following their accident (T1) and six months later (T2). The results show that after controlling for initial depressive symptoms, all predictors showed a statistically significant relationship with depression at six months, including the interaction between brooding and subjective severity of accident. Forty nine percent of resilient participants exhibited low symptoms at T1 and T2, 22% of recovered individuals showed high symptoms at T1 and low symptoms afterwards, 20% of depressive individuals had high symptoms at T1 and T2, and 8% exhibited high symptoms only at T2. High severity, brooding and religious coping at T1 differentiated those who exhibited stable symptoms from those who were resilient. Resilience was specifically predicted with a negative coefficient by the interaction of brooding with subjective severity of accident. We conclude that brooding is a variable that moderates the relationship between subjective severity of accident and the development and maintenance of depressive symptoms. Subjective severity of accident, brooding and negative religious coping are risk factors, while positive religious coping is not a sufficient protection factor.

PSYCHOMETRIC PROPERTIES OF THE ALABAMA PARENTING QUESTIONNAIRE ADAPTED TO FAMILIES OF CHILEAN PRESCHOOLERS.

The Alabama Parenting Questionnaire (APQ) is a well-known tool to assess empirically identified aspects of positive and negative parenting practices. This study evaluates the psychometric properties of an adapted version of the APQ for its use with parents of children between 2 and 6 years of age in Chile. The participants were 557 parents of children aged 2 to 6 years. A confirmatory factor analysis showed that the best fit was obtained by a four-factor model (positive reinforcement, parental involvement, inconsistency of disciplinary practices, and punitive practices). The invariance analysis for this model by sex and social composition was positive. Disciplinary inconsistency and punitive practices were correlated with externalized and internalized behaviors in children. Results suggest that this adaptation of the APQ may result in a useful tool for clinical and research purposes in this age group.

[Facilitators and barriers to implementation of intercultural health policy in Chile]. / Facilitadores y obstaculizadores de la implementación de la política de salud intercultural en Chile.

Objective To identify elements that either facilitate or hinder implementation of Chile's intercultural health policy. Methods A descriptive study was conducted with the participation of health services users from the Mapuche ethnic group, biomedical health professionals, intercultural facilitators, and key informants in two health facilities serving towns with a high density of Mapuche population. The information was obtained through semi-structured interviews that were analyzed thematically. Results Factors identified as facilitating the implementation of this policy include laws and regulations pertaining to the rights of indigenous peoples, the empowerment of users around their rights, the formation of implementation teams, the presence of professionals of Mapuche origin in health facilities, and the existence of processes for systematization of the work carried out. The asymmetric relationship between the Mapuche people and the state, and between the Mapuche health system and the biomedical model, constitutes a fundamental barrier. Other obstacles include the lack of theoretical and practical clarity around the concept of intercultural health and a lack of resources. Conclusions Despite the facilitators identified and the achievements to date, meaningful progress in implementation of an intercultural health policy is limited by barriers that are hard to change. These include the usual forms of government planning and the hegemony of the biomedical model.

[Suicide attempts among Chilean adolescents]. / Prevalencia de intento de suicidio adolescente y factores de riesgo asociados en una comuna rural de la provincia de Concepción.

BACKGROUND: Suicide mortality rates are increasing among teenagers. AIM: To study the prevalence and predictive factors of suicide attempts among Chilean adolescents. MATERIAL AND METHODS: A random sample of 195 teenagers aged 16 ± 1 years (53% males) answered an anonymous survey about their demographic features, substance abuse, the Osaka suicidal ideation questionnaire, Smilksten familial Apgar. Beck hopelessness scale, Beck depression scale and Coppersmith self-esteem inventory. RESULTS: Twenty five percent of respondents had attempted suicide at least in one occasion during their lives. These attempts were significantly associated with female gender, absent parents, family dysfunction, drug abuse, smoking, low self-esteem, hopelessness, depression and recent suicidal ideation. A logistic regression analysis accepted female gender, smoking and recent suicidal ideation as significant independent predictors of suicide attempt. CONCLUSIONS: Suicide attempted is common among teenagers and its predictors are female sex, smoking and previous suicidal ideation.

Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study.

Background: Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days. Method: Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms. Results: When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms. Discussion: The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.

Stigma toward people with mental disorders in mental healthcare in Chile.

OBJECTIVE: This research aimed to determine the stigma toward people with mental illness among mental health personnel and identify individual, professional, and contextual predictors. METHODS: A descriptive, cross-sectional, and correlational design was used. The sample consisted of 218 mental health personnel working in Outpatient Psychiatric Units belonging to hospitals and Community Mental Health Centers in Chile. Stigma was evaluated using a scale of humanized treatment, a scale of social distance, and a scale of attitudes in health personnel. In addition, sociodemographic and professional information was collected from mental health personnel and contextual information, particularly the type of outpatient mental health center and the technical-administrative unit that groups all the health centers in a territory. RESULTS: It was found that mental health personnel, in general terms, present low levels of stigma expressed in behaviors of comfort and support toward users, a desire for closeness and social interaction, and reduced stigmatizing beliefs and attitudes of infantilization toward individuals with MHPs. However, intimacy and trust were lower than expected.Only educational levels and health centers were related to stigma. CONCLUSIONS: The low levels of stigma may be due to the evolution of this phenomenon and the country's mental health policies.

Posttraumatic growth in people affected by an occupational accident: A longitudinal multilevel model of change.

This study analyzed a predictive model of posttraumatic growth (PTG) in a cohort of 244 workers affected by an occupational accident. A longitudinal design with three points in time (i.e., 1, 6, and 12 months after the accident) was used. PTG, posttraumatic stress symptoms (PTSS), subjective severity of the event, deliberate rumination, and seeking social support were evaluated. In addition, time since the accident, age, and gender were included as predictors in our model. Deliberate rumination and seeking social support significantly predicted PTG trajectory in a multilevel model. Practical conclusions from the results suggest that work accident victims should be encouraged to seek social support and to positively reframe their experience.

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile.

Background: This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups. Methods: We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups. Results: We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001). Conclusion: Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.

Interventions to reduce the stigma of mental health at work: a narrative review.

BACKGROUND: While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. OBJECTIVE: We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. METHOD: The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. RESULTS: These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. DISCUSSION AND CONCLUSION: Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

Social Sharing of Emotions and Communal Appraisal as Mediators Between the Intensity of Trauma and Social Well-Being in People Affected by the 27F, 2010 Earthquake in the Biobío Region, Chile.

The psychosocial impacts of natural disasters are associated with the triggering of negative and positive responses in the affected population; also, such effects are expressed in an individual and collective sphere. This can be seen in several reactions and behaviors that can vary from the development of individual disorders to impacts on interpersonal relationships, cohesion, communication, and participation of the affected communities, among others. The present work addressed the psychosocial impacts of the consequences of natural disasters considering individual effects via the impact of trauma and community effects, through the perception of social well-being, the valuation of the community and the social exchange of emotions. The aim of this study was to assess the relationship between individual reactions (i.e., intensity of trauma) and the evaluation of social and collective circumstances (i.e., social well-being) after the earthquake of 27F 2010 in Chile, through collective-type intervention variables not used in previous studies (i.e., social sharing of emotions and community appraisal). For this purpose, a descriptive, ex post facto correlational and cross-sectional methodology was carried on, with the participation of 487 people affected by the 2010 earthquake, 331 women (68%) and 156 men (32%), between 18 and 58 years old (M = 21.09; SD = 5.45), from the provinces of Ñuble and Biobío, VIII region, Chile. The measurement was carried out 4 years after the earthquake and the results show that greater individual than collective involvements were found, mainly in the coastal zone of the region. The mediation analysis showed that the relationship between the intensity of the trauma and social well-being occurs through a route that considers social sharing of emotions and community appraisal. These results indicate that the overcoming of individual affectations to achieve social well-being occurs when in the immediate post-disaster phases the affected communities activate shared emotional and cognitive processes, which allow them to jointly face subsequent threats and abrupt changes.

Parental Stress and Satisfaction in Parents With Pre-school and School Age Children.

Parenting is a transforming experience for the life of parents that brings joy and satisfaction as well as challenges, frustration, and demands. The aim of this study was to determine the relationship between "parental stress and satisfaction" and work-home conflict, perceived social support, and global satisfaction with life, and to determine the moderating role of the parent's gender. A sample of 244 participants was studied: 49.6% (121) mothers and 50.4% (123) fathers with children between 2 and 12 years of age. The data was analysed by means of multiple linear regression models and Beta regression for stress and parental satisfaction, respectively, and they were complemented with general and conditional dominance analyses to estimate the relevance of the predictors. Mothers presented higher levels of parental stress and satisfaction than fathers. Being female, having two children, and home-work conflict were predictors of a higher parental stress. Age was also a predictor, as younger parents and also those older than 37 years of age showed more parental stress. Having no partner and being male was associated to lower parental satisfaction. In conclusion, parental stress and satisfaction emerge as clearly differentiated dimensions of parenting experience. The gender gap in parental stress could be linked to the persistence of traditional roles regarding the care of the children, in agreement with the findings in other research.

Subjective Well-Being and Parenthood in Chile.

Being a parent plays an important role in people's life trajectory and identity. Though the general cultural perception is that having children is a source of subjective well-being, there is evidence that, at least in some societies, the subjective well-being of those who are parents is worse, in some aspects, than that of those who are not. This gap has been the object of interest and controversy. The aim of this study was to compare Chilean adults with and without children in a broad set of well-being indicators, controlling for other sociodemographic variables. A public national probabilistic database was used. The results show that, in terms of positive and negative affect, those who are not parents achieve greater well-being than those who have children. Other results also pointed in that direction. The implications of the social context and gender, which are aspects that pose a burden for the exercise of parenthood in Chile, are discussed.

Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente.

This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.

Psychometric Properties of the Patient Health Questionnaire-9 in Elderly Chilean Primary Care Users.

Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75-0.80] and α = 0.78 [95% CI: 0.75-0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high (r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84-0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.

Randomized cluster trial of a parenting program in Chile: Key mediators in the decrease in behavior problems in preschool children.

BACKGROUND: Parenting training is a proven strategy for the promotion of positive parenting practices and for the prevention and treatment of behavior problems in children. The processes that explain this efficacy are less clear. The aim of this study was to assess the mediating role of parenting practice modification, encouraged through the implementation of a universal parenting training program, for the decrease of behavior problems in 3- to 6-year-old children. METHOD: A cluster randomized trial was carried out in 19 educational centers in low and middle socioeconomic areas. A total of 178 families received the program and 154 of them were the control group. The following parenting practices were assessed: positive reinforcement, involvement, inconsistency, unsuitable treatment behaviors and physical punishment, as well as hostility and humiliation behaviors. Parent-child interaction was also assessed using an observational instrument. A multiple mediation analysis was carried out, identifying the indirect effects. RESULTS: Reduction of harsh discipline and physical punishment, and parental inconsistency mediated the effects observed in the reduction of child behavior problems during the program. CONCLUSION: Within Chilean families, harsh discipline, physical punishment, and parental inconsistency are important aspects to be considered in the implementation of universal parenting training programs.

Stigma towards people with a diagnosis of severe mental disorder in primary healthcare centers: perspectives of service users and health teams in Chile.

BACKGROUND: Stigma towards people diagnosed with a severe mental disorder (SMD) is one of the main obstacles for these service users to receive timely and relevant healthcare. This study was undertaken to understand how stigmatizing attitudes are demonstrated towards people with SMD in primary healthcare centers (PHC) from the perspective of those affected and primary healthcare professionals. METHODS: We used a qualitative exploratory research design to contrast the differences and similarities regarding stigmatizing attitudes towards people with SMD in primary healthcare centers (PHC) from the perspective of two groups: (i) people diagnosed with a severe mental disorder, and (ii) healthcare professionals. Data was collected through semi-structured interviews and discussion groups and subsequently analyzed using Atlas.ti software. RESULTS: Our results indicate that both service users and healthcare professionals manifest stereotypes, prejudices, and discriminatory behavior in health care. In addition, structural aspects of the health system and organizational culture appear to contribute to stigmatization. Both groups agreed that there is a need for healthcare professionals to have more education, specialization, and skill development related to mental health issues. CONCLUSIONS: Interventions to reduce the stigma towards people with SMD in PHC must consider delivery of information about mental disorders, development of skills in the healthcare professionals, and modifications in the culture of the health centers.

Adaptive Reflection on Negative Emotional Experiences: Convergences and Divergence Between the Processing-Mode Theory and the Theory of Self-Distancing Reflection.

Reflecting on negative emotional experiences can be adaptive but it can also maintain or intensify detrimental emotional states. Which factors determine whether reflection can have one consequence or another is unclear. This study focused on two research programs that have concentrated on this topic in the last decades: processing-mode theory (PMT) and self-distancing theory (SDT). The article described and contrasted both programs and their findings. The promising results that PMT and SDT have achieved in identifying the differences between the forms of adaptive and maladaptive reflection are highlighted. Likewise, the disconcerting contradictions observed between both programs that make integrating the findings difficult are indicated. The PMT states that adaptive reflection is concrete, and it is focused on the how of the experience. The SDT states that adaptive reflection is self-distanced and focused on the global meaning of the experience. The article finishes by indicating possible explanations for these apparent contradictions and outlines the challenges to be solved to improve comprehension of the topic.

An Integrative Program to Reduce Stigma in Primary Healthcare Workers Toward People With Diagnosis of Severe Mental Disorders: A Protocol for a Randomized Controlled Trial.

Background: People with severe mental disorders (SMDs) have higher disease and death rates than the general population. Stigma (negative attitudes and perceptions) contributes to limited access to health services and a lower quality of medical assistance in this population, and it is manifested as negative attitudes, social distance, and discrimination toward this social group. For these reasons, healthcare workers are a priority group for anti-stigma interventions. This study aims to assess the effectiveness of a program specifically designed to decrease negative attitudes and social distance and increase inclusive behaviors in healthcare workers toward people with SMD. Methods: The study will be a randomized clinical trial. A minimum of 210 healthcare workers from 11 primary care centers in the province of Concepción, Chile, will be randomly chosen to receive the program or be part of the control group. There will be a pre-, post-, and 4-months evaluation of social distance, attitudes, and behaviors of participants toward people with SMD using standardized scales such as the social distance scale, which is a scale of clinician attitude toward mental illness adapted from attitudes of clinicians toward mental illness, and self-reports. The intervention program will consist of education strategies, direct, and indirect contact with people diagnosed with SMD, and skill development. There will be six face-to-face sessions directly with the participants and two additional sessions with the directors of each healthcare center. The program will involve a facilitator who will be a healthcare professional and a co-facilitator who will be a person diagnosed with SMD. Discussion: This study will evaluate an intervention program especially designed to reduce stigma in healthcare workers toward people with SMD, a topic on which there is little background information, particularly in low- and middle-income countries. It is important to have interventions with proven effectiveness for this purpose to ensure equity in healthcare services. Trial Registration: This study was registered under ISRCTN.com (ISRCTN46464036).