Dual-factor Models of Mental Health: A Systematic Review of Empirical Evidence.

Objective: Dual-factor models of mental health propose that mental health includes two interrelated yet distinct dimensions - psychopathology and well-being. However, there is no systematization of the evidence following these models. This review aims to address the following research question: what evidence exists using dual-factor models? Method: The current systematic review was conducted using PRISMA guidelines on the following databases: Web-of-science, Scopus, Academic Search Complete, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, ERIC, and MEDLINE. The screening process resulted in 85 manuscripts that tested the assumptions of dual-factor models. Results: Evidence revealed psychometric substantiation on the two-dimensionality of the dual-factor model, and 85% of the manuscripts provided evidence related to classifying participants into different mental health groups. Most studies showed that the Complete Mental Health or Positive Mental Health group is the most prevalent status group, and longitudinal evidence suggests that most participants (around 50%-64%) remain in the same group across time. Regarding the factors associated with mental health status groups, studies reviewed in this manuscript focus mainly on school-related outcomes, followed by supportive relationships, sociodemographic characteristics, psychological assets, individual attributes, physical health, and stressful events. Conclusions: This review highlights the importance of considering the two dimensions of mental health when conceptualizing, operationalizing, and measuring mental health. Fostering mental health must go beyond reducing symptoms, and practitioners would be able to include well-being-related interventions in their regular practice to improve individuals' mental health outcomes.

Stressful Events During Last Year, Violence and Anxiety and Depression: A Moderated Mediation Model by Sex.

The literature suggests that being subject to a stressful life and victimization may negatively affect mental health, and that women and men seem to differ in these variables. Nevertheless, neither the mediating role of victimization experiences in the relationship between stress and mental health, nor the moderated role of sex have been explored. A sample of 826 adults, aged from 18 to 77 years old, completed a set of self-reported questionnaires (69.4% women). Results revealed significant mediation effects of psychological violence on the relationship between stress, depression and anxiety. Participants who reported more stressful life events in the previous year, also reported higher psychological abuse, which in turn predicted higher depression and anxiety. Furthermore, the moderating effects of sex were found to be statistically significant. Results suggest that interventions should be tailored to individual needs in order to prevent secondary victimization derived from biased beliefs related to stress, violence and gender in professional practice.

Why Are Men More Likely to Endorse Myths About Child Sexual Abuse Than Women? Evidence From Disposition and Situation-Based Approaches.

Research on attitudes toward Child Sexual Abuse (CSA) consistently shows that men are more likely to endorse myths about CSA events, victims and perpetrators, compared to women. Here we present two studies that examine why these gender differences occur. Study one (N = 439) followed a dispositional approach to test the mediating role of empathy, social dominance orientation (SDO) and propensity for moral disengagement in the association between gender and the endorsement of CSA myths. Male participants showed higher levels of SDO and propensity for moral disengagement, and lower empathy, which in turn were associated with greater CSA myths acceptance. Study two (N = 360) followed a situational approach to test these processes using a specific case of CSA. Male participants showed higher levels of SDO and lower empathy, which in turn were associated with lower scores of perceived assault seriousness, victim credibility, perpetrator culpability, and greater victim culpability. Overall, the results suggest that men and women may appraise CSA differently, which can be partly explained by differences in SDO, propensity to morally disengage, and empathy. Furthermore, different cognitive mechanisms may be activated with regard to general appraisals of CSA compared to specific cases of CSA.

Child Maltreatment Severity Questionnaire (MSQ) for Professionals: Development, Validity, and Reliability Evidence.

This article presents the development and validation of the child Maltreatment Severity Questionnaire (MSQ), aiming to contribute to increase the quality and efficiency of evaluation processes in the Child Protection System (CPS). To obtain a valid and reliable instrument, a set of studies was developed: Study 1-Based on two previous studies, the questionnaire was developed and the severity level of the items within maltreatment subtypes was assigned by 93 professionals from the welfare and CPS system. Consensus about the severity levels was assessed and described in terms of within-item reliability rankings; Study 2-The MSQ was filled out for 253 children and adolescents referred to the CPS. To ensure that the items within different subtypes of maltreatment were homogenous and had internal consistency, a reliability analysis was performed; Study 3-The MSQ was filled out for 1,000 children and adolescents referred to the CPS. This study involved testing validity evidence through an exploratory and a confirmatory factor analysis. We also analyzed the internal consistency, sensibility (i.e., sex and age differences) and concurrent validity of the MSQ. Findings support the adequacy and reliability of the MSQ to be used by CPS professionals in evaluating child maltreatment.

Victimization Experiences and Well-Being in Adulthood: A Systematic Review and Meta-Analysis.

Scientific research has explored the impact of violence during adulthood on psychopathology. Fewer efforts have been made from a positive theoretical framework, and no systematic evidence has been provided. This manuscript describes a literature review and meta-analysis on the relationship between victimization experiences and well-being in adulthood. A literature review was performed, and 27 studies met the inclusion criteria for the systematic review 16 for the meta-analysis. The meta-analysis yielded a medium and significant overall effect size (r = -0.309, p < .001), which indicated that greater victimization experiences partly explain lower well-being outcomes. A set of theoretical and methodological issues are discussed, specifically considering the conceptualization of victimization and well-being as well as the studies design, sample characteristics, measures, and data analysis. Derived from this integrative discussion, some recommendations are also provided for future research.

Child Sexual Abuse Myth Scale: Validity and Reliability Evidence in the Portuguese Context.

Child sexual abuse myths legitimize abusive behaviors, involving high levels of victim blame and low levels of offender liability. The present study aims to: (i) adapt a measure of endorsement of child sexual abuse myths to the Portuguese context (i.e., Child Sexual Abuse Myth Scale - CSAMS); and (ii) provide validity and reliability evidence for this measure. A total of 423 adults (66.2% female) filled out a sociodemographic questionnaire, the Ambivalent Sexism Inventory, and the CSAMS. The CSAMS validity and reliability results supported the original structure, which comprises three dimensions: Blame Diffusion (e.g., 'Adolescent girls who wear very revealing clothing are asking to be sexually abused'), Restrictive Stereotypes (e.g., 'Most children are sexually abused by strangers or by men who are not well known to the child'), and Denial of Abusiveness (e.g., 'Older children, who have a better understanding of sexual matters, have a responsibility to actively resist sexual advances by adults'). Configural and metric invariance by sex were held, and criterion validity was observed through significant associations between myths, sexism and sex. This study provided evidence in support of the validity and reliability of the Portuguese version of the Child Sexual Abuse Myth Scale.

The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies.

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.

Emergency residential care settings: A model for service assessment and design.

There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care.

USING THE PARENT-INFANT RELATIONSHIP GLOBAL ASSESSMENT SCALE TO IDENTIFY CAREGIVER-INFANT/TODDLER DYADS WITH ABUSIVE RELATIONSHIP PATTERNS IN SIX EUROPEAN COUNTRIES.

The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were recruited from community settings without known violence problems, and 51 dyads were recruited from clinical settings and already had been identified with violence problems or as being at risk for violence problems. To classify the dyads on the PIR-GAS categories, caregiver-child interactions were video-recorded and coded with observational scales appropriate for child age. To test whether the PIR-GAS allows for reliable identification of dyads with abusive relationship patterns, PIR-GAS ratings were compared with scores on the the International Society for the Prevention of Child Abuse and Neglect's (ISPCAN) Child Abuse Screening Tool-Parental Version (ICAST-P; D.K. Runyan et al., ), a questionnaire measuring abusive parental disciplinary practices. It was found that PIR-GAS ratings differentiated between the general and the clinical sample, and the dyads with abusive patterns of relationship were identified by both the PIR-GAS and the ICAST-P. Interrater reliability for the PIR-GAS ranged from moderate to excellent. The value of a broader use of tools such as the DC: 0-3R to promote early identification of families at risk for infant and toddler abuse and neglect is discussed.

Youths in Residential Care Perceptions about their Group: Psychometric Properties of a Measurement Tool.

This study aims to present the development of a scale focused on youth's perceptions about their group in residential care and to offer evidences of validity and reliability. This work is part of a national study involving 59 institutions and 360 adolescents (55% males) from 11 to 18 years old (M = 14.72; SD = 1.81). Evidences of validity were tested, as well as the reliability data and the relationship between group perceptions, individual characteristics and placement length. A structure with three components was found explaining 62% of variance: Deviant behavior, Positive Attributes and Oppositional Behavior. The CFA revealed good values of fit: CFI = .95, GFI = .90 and RMSEA = .050. Furthermore, a positive and significant correlation was found between positive attributes and life satisfaction (p < .001), and negative ones with deviant behavior (p < .01) and oppositional behavior (p < .01). Finally, a positive and significant correlation was found between Deviant behavior and youth's age (p < .05), and significant gender differences were found in this dimension (i.e., p < .001; d = .38, 95% CI [-9.97, 2.94]; males reported higher scores than females). No significant correlations were found regarding the length of placement. These results suggest that this tool reveals satisfactory psychometric properties to be used in further studies with youth in residential care.

Psychometric properties of the Portuguese version of place attachment scale for youth in residential care.

BACKGROUND: Although the significant scientific advances on place attachment literature, no instruments exist specifically developed or adapted to residential care. METHOD: 410 adolescents (11 - 18 years old) participated in this study. The place attachment scale evaluates five dimensions: Place identity, Place dependence, Institutional bonding, Caregivers bonding and Friend bonding. Data analysis included descriptive statistics, content validity, construct validity (Confirmatory Factor Analysis), concurrent validity with correlations with satisfaction with life and with institution, and reliability evidences. The relationship with individual characteristics and placement length was also verified. RESULTS: Content validity analysis revealed that more than half of the panellists perceive all the items as relevant to assess the construct in residential care. The structure with five dimensions revealed good fit statistics and concurrent validity evidences were found, with significant correlations with satisfaction with life and with the institution. Acceptable values of internal consistence and specific gender differences were found. CONCLUSIONS: The preliminary psychometric properties of this scale suggest it potential to be used with youth in care.

Capacidade discriminante do inventário de potencial de abuso na infância: dados numa amostra de progenitores portugueses / Discriminant ability of the child abuse potential inventory: data from a sample of Portuguese parents

This study aims to test discriminant ability of the Child Abuse Potential Inventory (CAP) in a sample of 641 Portuguese parents. Thirty-seven percent of the sample is composed by abusive parents reported to the Comissions for the Protection of Children and Young People and evaluated by an assessment questionnaire of maltreatment, neglect and sexual abuse. Abusive parents showed significantly higher scores on the Abuse Scale and in all of its dimensions. Considering the discriminant analysis, the Abuse Scale correctly classified 79.9% of the cases and the function of sub dimensions correctly classified 83.3% of the cases. These results reveal the capacity of CAP in identifying cases of potential child abuse in the Portuguese context. (AU)

Este estudo tem como objetivo testar a capacidade discriminante do Inventário de Potencial de Abuso na Infância (CAP), numa amostra de 641 progenitores portugueses. Trinta e sete por cento da amostra é constituída por progenitores maltratantes sinalizados às Comissões de Proteção de Crianças e Jovens e avaliados através do Questionário de Avaliação do Mau Trato, Negligência e Abuso Sexual. Os resultados indicaram que os progenitores maltratantes reportam valores significativamente superiores na Escala de Abuso e em todas as suas dimensões. Do ponto de vista da capacidade discriminante, a função da Escala de Abuso Global classificou corretamente 79,9% e a função das subdimensões da Escala classificou corretamente 83,3% dos casos. Estes resultados revelam a potencialidade do instrumento na identificação de situações de potencial abuso na infância no contexto português. (AU)

NEO-FFI: Psychometric properties of a short personality inventory in Portuguese context / NEO-FFI: Propriedades psicométricas de um inventário reduzido de personalidade no contexto português

The aim of this study was to assess the psychometric properties (validity and reliability) of the Portuguese adaptation of the NEO Five-Factor Inventory (NEO-FFI) and to compare the obtained structure to the original North American version. The methods of analysis used for cross-validation of the factorial structure were the Principal Axis Factoring (PAF) and the Confirmatory Factor Analysis (CFA). PAF reproduced the original structure of NEO-FFI and CFA revealed a satisfactory fit of single-factor models for the five dimensions. The reliability analysis showed high values of internal consistency which are congruent with previous international adaptations of the NEO-FFI. Multidimensional analysis showed significant main effects of gender and academic qualifications on personality using age as covariant. The findings suggest that the Portuguese version of the NEO-FFI is a reliable instrument to measure the five dimensions of personality. (AU)

O objetivo deste estudo foi avaliar as propriedades psicométricas (validade e fidelidade) da adaptação portuguesa do NEO-FFI e comparar a estrutura obtida com a versão original americana. Como métodos para a validação cruzada da estrutura fatorial foram usados a Análise Fatorial de Eixos Principais (PAF) e uma Análise Fatorial Confirmatória (CFA). A PAF reproduziu a estrutura original do NEO-FFI e a CFA revelou modelos uni-factoriais de ajustamento satisfatório para cada uma das cinco dimensões. A análise de fidelidade revelou elevados valores de consistência interna, congruentes com as adaptações prévias internacionais do NEO-FFI. A análise multidimensional revelou efeitos principais significativos do género e das qualificações académicas na personalidade, usando a idade como co-variante. Os resultados sugerem que a versão portuguesa do NEO-FFI é um instrumento fiável para medir as cinco dimensões da personalidade. (AU)

A latent growth model suggests that empathy of medical students does not decline over time.

Empathy is a relevant attribute in the context of patient care. However, a decline in empathy throughout medical education has been reported in North-American medical schools, particularly, in the transition to clinical training. The present study aims to longitudinally model empathy during medical school at three time points: at the entrance, final of pre-clinical phase and at the beginning of clinical training. Data collected with the adaptation to Portuguese of the Jefferson Scale of Physician Empathy (student version) were analysed with latent growth modelling, conditioned by gender, openness and agreeableness. Empathy scores at all times were higher for females than for males, but only significantly at the end of the preclinical phase. The model showed a satisfactory fit level and the primary finding was that undergraduate medical student's empathy did not decline over time. Empathy scores were significantly and positively related with Openness to Experience and Agreeableness at admission, but the empathy rate of change across time was not significant. The stability of empathy revealed by a longitudinal methodology applied for the first time to empathy studying, contradicts previous results of decline and contributes to the understanding of the empathy development of medical students.

Empathy of medical students and personality: evidence from the Five-Factor Model.

The main aim of this study was to test hypothetical associations between personality dimensions and empathy scores in medical students. The Portuguese version of NEO-FFI was administered in order to characterize participants in terms of five personality traits: Neuroticism, Extraversion, Agreeableness, Openness to Experience, and Conscientiousness. Self-reported empathy measures were obtained with the Portuguese version of the Jefferson Scale of Physician Empathy (JSPE-spv), a Likert-type questionnaire specifically developed for administration in health sciences settings that measures domains, such as compassionate care and perspective taking. Correlation analysis, multivariate analysis of covariance, and logistic regression analysis were conducted. The results confirmed positive associations between agreeableness, openness to experience and empathy, and did not support our hypothesis of negative associations between neuroticism and empathy. It is suggested that that the personality of students should be taken into account in programs to enhance empathy in undergraduate medical education.

Individual characteristics and student's engagement in scientific research: a cross-sectional study.

BACKGROUND: In light of the increasing recognition of the importance of physician scientists, and given the association between undergraduate research experiences with future scientific activity, it is important to identify and understand variables related to undergraduate students' decision to engage in scientific research activities. The present study assessed the influence of individual characteristics, including personality traits and socio-demographic characteristics, on voluntary engagement in scientific research of undergraduate medical students. METHODS: For this study, all undergraduate students and alumni of the School of Health Sciences in Minho, Portugal were invited to participate in a survey about voluntary engagement in scientific research activities. Data were available on socio-demographic, personality and university admission variables, as part of an ongoing longitudinal study. A regression model was used to compare (1) engaged with (2) not engaged students. A classification and regression tree model was used to compare students engaged in (3) elective curricular research (4) and extra-curricular research. RESULTS: A total of 466 students (88%) answered the survey. A complete set of data was available for 435 students (83%).Higher scores in admission grade point average and the personality dimensions of "openness to experience" and "conscientiousness" increased chances of engagement. Higher "extraversion" scores had the opposite effect. Male undergraduate students were two times more likely than females to engage in curricular elective scientific research and were also more likely to engage in extra-curricular research activities. CONCLUSIONS: This study demonstrated that student' grade point average and individual characteristics, like gender, openness and consciousness have a unique and statistically significant contribution to students' involvement in undergraduate scientific research activities.

Empathy in senior year and first year medical students: a cross-sectional study.

BACKGROUND: The importance of fostering the development of empathy in undergraduate students is continuously emphasized in international recommendations for medical education. Paradoxically, some studies in the North-American context using self-reported measures have found that empathy declines during undergraduate medical training. Empathy is also known to be gender dependent- (highest for female medical students) and related to specialty preference - (higher in patient-oriented than technology-oriented specialties). This factor has not been studied in Portuguese medical schools. METHODS: This is a cross-sectional study of undergraduate medical students on self-rated measures of empathy collected at entrance and at the conclusion of the medical degree, and on the association of empathy measures with gender and specialty preferences in one medical school in Portugal. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) among three cohorts of undergraduate medical students in the first (N = 356) and last (N = 120) year. The construct validity of JSPE-spv was cross-validated with Principal Component Analysis and Confirmatory Factor Analysis. Reliability was assessed using Cronbach' Alpha. Global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences (people-oriented vs technology-oriented specialties). RESULTS: The empathy scores of students in the final year were higher as compared to first year students (F (1,387) = 19.33, p < .001, ɳ2p = 0.48; π = 0.99). Female students had higher empathy scores than male students (F (1,387) = 8.82, p < .01, ɳ 2p = 0.23; π = 0.84). Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties (F (1,387) = 2.44, p = .12, ɳ 2p = 0.06; π = 0.06). CONCLUSIONS: This cross-sectional study in one medical school in Portugal showed that the empathy measures of senior year students were higher than the scores of freshmen. A longitudinal cohort study is needed to test variations in students' empathy measures throughout medical school.

Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis.

OBJECTIVE: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. METHODS: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. RESULTS: In 56.0% of patients (n=205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n=156) by the SLB, which was inconclusive in 1.4% (n=5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. CONCLUSIONS: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients.