Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders.

BACKGROUND: Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment. METHODS: Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program. RESULTS: Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ2 = 6.72, p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (ß = .12, p = .05), which in turn were negatively related to the derived symptomatology index (ß = -.33, p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma. CONCLUSIONS: An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.

A taxonomy of groups at risk based on reported and desired body mass index and its relationships with health.

This study aimed to identify groups at risk based on reported and desired Body Mass Index (BMI) and their relationships with weight satisfaction, food intake and perceived health, and to analyze gender differences. A pre-experimental observational study was conducted. 3380 individuals (mean age 20.16; 64.4% females) participated in a survey in the context of a healthy university project. Participants anonymously completed the SF-12, reported height, weight, desired weight, satisfaction and quality of intake. Reported BMI (BMI-r) and Desired BMI (BMI-d) were calculated following WHO standards. Combining BMI-r and BMI-d four groups emerged: Favorable Concordance, FC (67.40% normal weight wanting to maintain it), Unfavorable Concordance, UC (9.19% non-normal weight wanting such unhealthy condition), Favorable Discrepancy, FD (13.92% unhealthy weight wanting to move in a healthy direction), and Unfavorable Discrepancy, UD (9.49% normal or non-normal weight desiring an unhealthy condition). FD individuals showed lower levels of self-perceived physical health, poorer perception of the quality of their intake, and less satisfaction with weight. Both UD and UC groups are at risk, showing the UD group the lowest scores in mental health and healthy food intake. Higher proportions of females were found in the UD group, and wanting to lose weight. These findings suggest that health treatment, prevention and promotion programs can benefit from a taxonomy that identifies not only people at risk but the direction and adjustment (i.e. healthy vs non healthy) of their intention to change. Programs could be targeted at different groups, with specific goals and interventions, and avoid the 'one-fits-all' to foster a healthy weight in the young adult university population.

Individualized and Standardized Outcome Measures: Further Arguments in Favor of Cohabitation.

Ashworth et al. (Admin Policy Ment Health Ment Health Serv Res 46:425-428, 2019) recently published a paper in this journal making a cogent argument for the cohabitation of standardized and individualized outcome measures. In the present Point of View article, we consider additional arguments in favor of this cohabitation.

Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment.

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Disorder (SMD) program users in the Mental Health Services of Biscay (n=312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric properties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account.

Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke.

BACKGROUND: Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group. METHODS: A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups. RESULTS: At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group. CONCLUSIONS: The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.

How is evaluated mental health recovery?: A systematic review.

There is an increasingly recognition of the concept of personal recovery in the treatment of mental illness. Recovery defined as living a fulfilling, rewarding life, even in the ongoing presence of a mental illness. Consequently, a number of different instruments have been designed to assess recovery-oriented outcomes. The objective of the study was to conduct a systematic revision of the domains and the instruments used to assess personal recovery and mental health services orientation to recovery. After the systematic review, it has been carried out a selection process of the most adequate instruments taking into account different criteria of adequacy, psychometric properties and the validation to the Spanish population. In the results have been obtained 35 instruments for measuring personal recovery and 18 for assessing the orientation of recovery in mental health services. However, many of them have been dismissed for not reaching the adequacy criteria. This review makes clear the lack of consensus on the concept of recovery, as a consequence of the high number of instruments that evaluate the same concept through different domains. In addition, few instruments offer data related to the psychometric properties and only one instrument to assess personal recovery is validated to the Spanish population.

Maternal Antenatal Attachment Scale (MAAS): adaptation to Spanish and proposal for a brief version of 12 items.

The psychometric properties of the adapted Spanish version of the Maternal Antenatal Attachment Scale were examined. The main goal was to investigate the reliability and construct validity of the conceptual structure of Condon's proposal. Five hundred twenty-five pregnant women, attending maternal education classes in Bizkaia (Spain), answered the translated and back-translated version of the Maternal Antenatal Attachment Scale. This scale comprises 19 items with five answer choices divided into two subscales: quality of attachment and intensity of attachment. Participants also answered a questionnaire about the reproductive history that was developed ad hoc for the present study. The Spanish adaptation of the Maternal Antenatal Attachment Scale final version comprises 12 items: seven items have been removed due to their inadequate psychometric properties. Internal consistency of the inventory is moderate-high (.73) and it ranges from .68 (intensity of attachment) to .75 (quality of attachment) for the dimensions. Three alternative structural models were proven using a confirmatory factor analysis. Lastly, the two-related-factor model was chosen, as it obtained suitable fit indexes (χ (2) = 102.28; p < .001; goodness-of-fit index (GFI) = .92; comparative fit index (CFI) = .95; root mean square error of approximation (RMSEA) = .042, 90 % CI [.030-.054]). Due to its adequate psychometric properties, the Spanish version of the Maternal Antenatal Attachment Scale can be proposed as a suitable instrument for the purpose of measuring antenatal attachment. The study of antenatal attachment helps to detect possible difficulties for the mother in establishing an affective relationship with the foetus. This may affect the foetus growth, delivery and the future mother-child relationship.

[Use of the reliable change index to evaluate the effectiveness of clinical interventions: Application of an asthma training program]. / Uso del índice de cambio fiable en la evaluación de la efectividad de intervenciones clínicas: aplicación en un programa formativo en asma.

OBJECTIVE: To compare two methods for the evaluation of outcomes to assess effectiveness of a therapeutic intervention of a professional education program on asthma control. DESIGN: A naturalistic, intervention study in which asthmatic patients were attended by clinicians (IG group) who Had taken part in a special education program and a control group (CG) that received medical assistance from clinicians still waiting to be trained. LOCATION: Five urban Primary Care Health Centres of the same region. PARTICIPANTS: From an initial sample of 100 patients, 76 formed the final sample for analysis. The study included 37 males and 39 females, aged between 18 and 65 years (M=41.2 years). The two study groups were found to be homogeneous except for the sex variable. INTERVENTION: Training program for clinical treatment adherence. MAIN MEASUREMENTS: Peak flow as spirometric index, and structured interview. STATISTICAL ANALYSIS: The results were initially analysed using classical techniques based on robust ANOVA models, and then by calculating the Reliable Change Index (RCI). RESULTS: ANOVA models, conducted separately for each sex, showed no significant differences, due to sample size. RCI methodology showed significant differences in the percentage of patients improved in both groups, as well as clinically relevant changes being observed individually. CONCLUSIONS: The RCI method is presented as an attractive alternative as regards the classical methods of analysis that can help in the clinical decision.

The role of resilience and coping strategies as predictors of well-being in breast cancer patients.

PURPOSE: This study investigated the role of resilience and coping strategies on breast cancer patients' well-being using a structural equation model. To achieve this objective, a model previously developed by Mayordomo's group was partially replicated using a longitudinal study design in an oncological sample. METHODS: The study was a longitudinal observational survey. Patients with breast cancer were recruited (N = 166). Resilience was measured with the Mexican Resilience Measurement Scale, coping strategies with the Forms of Coping and Dimensions Scale and perception of the psychological well-being with a short-form of Ryff's Scales of Psychological Well-Being at the start and end of adjuvant chemotherapy (T1 and T2 respectively). RESULTS: The results showed stability in the variables over time and revealed differences with respect to Mayordomo's model. The best predictor of well-being at T2 was well-being at T1. In addition, the model indicated that resilience had a direct impact on well-being through problem-focused coping. Indeed, resilience and problem-focused coping best explained well-being at T2. CONCLUSIONS: Both at the start and end of adjuvant chemotherapy for breast cancer, problem-focused coping positively predicted resilience, which in turn was a positive predictor of well-being. On the other hand, emotion-focused coping showed no association with resilience or well-being. As part of the multidisciplinary cancer team, oncology nurses have a key role to play in promoting resilience and problem-focused coping as an important goal of psychosocial interventions in breast cancer patients.

The role of personal recovery and internalised stigma on the expression of symptomatology in severe mental disorders: Mediating and moderating effects.

OBJECTIVE: Given the relevance of internalised stigma in people suffering from a mental disorder, in the present study, the possible mediating and moderating role of self-stigma in the relationship between personal recovery and symptomatology has been studied. METHOD: 265 participants with severe mental disorder completed the following instruments: ISMI (self-stigma), REE (personal recovery) and HoNOS, CGI, GAF and EuroQol (symptomatology). RESULTS: both the mediation and moderation analyses show significant results, which would indicate that internalised stigma has an effect on the relationship between personal recovery and symptomatology. Also, people with lower level of personal recovery and greater self-stigma have greater symptomatology than those who are in more advanced personal recovery processes and have a lower perception of internalised stigma. DISCUSSION: the findings of this study suggest that self-stigma has an effect, and the improvement at personal recovery and symptomatology is accentuated when people with a severe mental disorder have a better management of internalised stigma. Therefore, it may be interesting to include this variable in recovery interventions.

Adaptation and analysis of psychometric features of the Caregiver Risk Screen: a tool for detecting the risk of burden in family caregivers.

BACKGROUND: There are a limited number of scales available in the Spanish language that can be used to detect burden among individuals who care for a dependent family member. The purpose of this work was to adapt and validate the Caregiver Risk Screen (CRS) scale developed by Guberman et al. (2001) (Guberman, N., Keefe, J., Fancey, P., Nahmiash, D. and Barylak, L. (2001). Development of Screening and Assessment Tools for Family Caregivers: Final Report. Montreal, Canada: Health Transition Fund). METHODS: The sample was made up of 302 informal caregivers of dependent family members (average age 57.3 years, and 78.9% were women). Scale structure was subjected to a confirmatory factor analysis. Concurrent and convergent validity were assessed by correlation with validated questionnaires for measuring burden (Zarit Burden Inventory (ZBI)) and psychological health (SCL-90-R). RESULTS: The results show a high level of internal consistency (Cronbach's alpha = 0.86), suitable fit of the one-dimensional model tested via confirmatory factor analysis (GFI = 0.91; CFI = 0.91; RMSEA = 0.097), and appropriate convergent validity with similar constructs (r = 0.77 with ZBI; and r-values between 0.45 and 0.63 with SCL-90-R dimensions). CONCLUSIONS: The findings are promising in terms of their adaptation of the CRS to Spanish, and the results enable us to draw the conclusion that the CRS is a suitable tool for assessing and detecting strain in family caregivers. Nevertheless, new research is required that explores all the psychometric features on the scale.

Patient-reported outcome measures: are they patient-generated, patient-centred or patient-valued?

BACKGROUND: In the past two decades, there has been a growing interest in the development of a more patient-centred approach to assessing treatment outcomes. This interest has resulted in the increasing use of patient-reported outcome measures (PROMs) in both clinical trials and usual clinical practice. AIMS: To briefly discuss the paucity of efficacy and effectiveness studies in the field of mental health (exemplified by schizophrenia, depression and opioid dependence) that significantly incorporate the patient's perspective. The limited concordance between the perspectives of patients and clinicians in outcome assessment is also addressed. Finally, we propose a new PROM classification system based on the degree to which these instruments incorporate the patient's perspective. CONCLUSIONS: PROMs may differ little from traditional instruments unless they truly incorporate the patient's perspective and not just the perspectives of clinicians and researchers. Efforts to develop new PROMs that provide a more patient-centred outcome assessment should use qualitative and participatory methods to capture and incorporate patient perspectives and values.

Differences in Quality of Life and Emotional Well-being in Breast, Colon, and Lung Cancer Patients During Outpatient Adjuvant Chemotherapy: A Longitudinal Study.

BACKGROUND: Adjuvant chemotherapy used at each cancer site may affect quality of life (QoL) and emotional well-being (affect) of cancer patients differently; however, these differences between groups have not been studied. OBJECTIVES: The aim of this study was to assess differences in QoL and affect by cancer site at the start of outpatient adjuvant chemotherapy, whether QoL and affect change during this treatment, and whether adverse effects influence these variables. METHODS: A multicenter longitudinal descriptive study was conducted with 247 participants with breast, colon, or lung cancer at the beginning (T1) and end of treatment (T2). We used the SF-12 Health Survey, Positive and Negative Affect Scale, and an "ad hoc" adverse effects questionnaire. RESULTS: At the start of chemotherapy, the lung group had poorer Physical Component Summary and poorer positive and negative affect ( P < .05) scores. In the end-of-treatment comparisons, breast and colon cancer patients' status had worsened, whereas lung cancer patients had tended to stabilize, although they remained the most vulnerable. Adverse effect severity was significant for Physical Component Summary ( r = -0.13, P = .035), with decreases in positive affect ( r = -0.17, ß = -.16) and increases in negative affect ( r = 0.15, ß = .14). CONCLUSIONS: Changes in QoL and emotional state differ between groups, implying a need for varying levels of follow-up and emotional support. Patients with lung cancer seem particularly vulnerable. IMPLICATIONS FOR PRACTICE: Cancer nurses could strengthen the assessment of patients undergoing chemotherapy using more sensitive instruments such as the Positive and Negative Affect Scale and considering differences by cancer site, to provide care tailored to individual patient needs and preferences.

Development of the Acoustic Comfort Assessment Scale (ACAS-12): Psychometric properties, validity evidence and back-translation between Spanish and English.

A methodological proposal of a scale for human perception assessment of acoustic environment (acoustic comfort) in urban public spaces is presented: Acoustic Comfort Assessment Scale (ACAS 12). This paper shows the process of constructing this scale and its psychometric properties and validation. The approach is based on the soundscape conceptualisation collected in ISO 12913-1:2014 (Acoustics-Soundscape: Definition and conceptual framework). The proposed scale is a 5-point semantic differential scale made up of twelve pairs of bipolar adjectives, grouped around five theoretical dimensions. It is based on previous versions of 2-point and 3-point scales. The ACAS-12 scale is the result of several empirical studies carried out by the authors on environmental and acoustic comfort assessment, beginning in 2011 in some cities of the Basque Country (Spain). Selected urban open places cover a wide variability of acoustic and non-acoustic characteristics, as well as the type of participants (real users) and activities carried out in these places. The original language of this scale is Spanish. The back-translation technique has been applied to create the English version. The results highlight the good psychometric properties of the ACAS 12 scale (Cronbach's alpha 0.91 and composite reliability 0.90) and indicate that the best factorial solution is that of a single factor composed of the 12 pairs of adjectives that would explain approximately 50% of the ACAS-12 variance (44% of extracted variance by Raykov's method or 56% by the MAP test). The absolute and incremental fit indices were above the minimum reference value of 0.90 and the residual-based indices showed values close to suitability (SRMR = 0.057; RMSEA = 0.042). This result supports the consideration of the ACAS-12 scale as a general measure of acoustic comfort.

Satisfaction with methadone as a medication: psychometric properties of the Spanish version of the treatment satisfaction questionnaire for medication.

There is a manifest lack of psychometrically sound instruments designed for specific and multidimensional assessment of satisfaction with methadone as a medication within the context of methadone maintenance treatment. Therefore, it may be worthwhile to assess the pertinence and utility of using a generic and multidimensional medication satisfaction instrument that has not been specifically developed for use in methadone maintenance treatment.The aim of this study was thus to explore the psychometric properties of the Spanish version of the Treatment Satisfaction Questionnaire for Medication (TSQM version 1.4 [Health Qual Life Outcomes. 2004;2:12]) in a sample of methadone-maintained heroin-dependent patients.Two hundred three methadone-maintained patients filled out the TSQM and other several measures related to the construct of patient satisfaction (eg, Verona Service Satisfaction Scale for methadone treatment). Dimensionality of the TSQM was assessed by means of a confirmatory factor analysis. Internal consistency was examined using the ordinal coefficient α. Spearman correlations were used to explore the relationship between the TSQM and the measures conceptually related to patient satisfaction.Regarding the dimensionality of the TSQM, its original factor structure adequately fitted the data (Satorra-Bentler χ58, 72.14 [P = 0.100]; root-mean-square error of approximation, 0.045; comparative fit index, 0.978). All but 1 of the 4 TSQM subscales showed acceptable to good internal consistency values (0.78-0.89). The dimensions of the TSQM were differentially and congruently correlated with related measures.The results strongly suggest the TSQM value as a brief, generic, and psychometrically sound instrument to assess satisfaction with methadone as a medication in a multidimensional manner. Notwithstanding, more research is needed not only to assess the generalizability of these findings but also to provide pieces of evidence for other psychometric properties, especially the TSQM predictive validity.

Commercial videogames in stroke rehabilitation: systematic review and meta-analysis.

OBJECTIVE: The aim of this article was to perform a systematic review of all studies (both observational and experimental) wherein commercial video games were used in comprehensive rehabilitation (both physical and cognitive areas) after stroke. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed, and all observational and experimental studies that met at least six PEDro scale criteria were included. A total of 50 studies were included in the Meta-Analysis. Data analysis was performed using RevMan 5.3 and the bias with JAMOVI. RESULTS: In observational studies, results favored intervention with video games in terms of functionality such as Fulg-Meyer Assessment scores [standard mean difference (SMD) = -0.45; 95% CI = -0.74 to -0.15; p = .94; I2 = 0%)] and when measured in the upper limbs using the Wolf Motor Function Test (SMD = 0.41; 95% CI = 0.07 to 0.74; p = .47; I2 = 0%). Other results showed heterogeneity. In the experimental group, most results tended to favor the experimental group and showed homogeneity, but they were not significant. Fail Safe N was calculated, and the results were not biased. CONCLUSIONS: Results tend to favor intervention with commercial video games, but the heterogeneity of the measuring instruments and small sample size do not allow for significant results to be obtained. Future research should provide the number of participants, mean, and standard deviation to facilitate future meta-analyses. Commercial video games appear to be a feasible tool in physical and cognitive stroke rehabilitation.

Cognitive behavioral therapy with and without biofeedback in fibromyalgia: Assessment of functional and clinical change.

The study compared the effectiveness of Cognitive Behavioral Therapy (CBT) with biofeedback or with emotional expression in individuals with fibromyalgia, and a waiting list control group. 88 women participated in a naturalistic study with random assignment. The Fibromyalgia Impact Questionnaire, SCL-90R, and a visual analog quality of life scale were used. Both intervention groups improved, but differed in physical and emotional control response. Using the reliable change index procedure, clinical improvement occurred in 18.8% of participants, and 4.8% achieved scores comparable with clinical recovery. Greater specificity on therapeutic objectives is warranted.

Role of resilience and emotional control in relation to mental health in people with cancer.

This study explored the relationship between emotional control, resilience, and mental health in cancer. Patients with cancer were recruited (n = 170). Courtauld Scale of Emotional Control, Connor-Davidson Resilience Scale, and the General Health Questionnaire were selected. Assuming the absence of interaction among the variables, they were analyzed separately. Four groups resulted, finding statistically significant differences (F(4, 165) = 18.03; p < 0.001). High resilience and low emotional control seem to be protective attributes, and high emotional control has demonstrated to be a risk factor for mental health. Considering differences in cancer-related psychological variables could derive in personalized psychotherapeutic interventions.

A global health model integrating psychological variables involved in cancer through a longitudinal study.

Objective: The literature has shown the relevance of certain psychological variables in adjustment to cancer. However, there is a great variability, and these features could be modified through the disease process. The aim of this study is to provide an integrated and global perspective of the importance of variables such as coping, resilience, emotional control, social support, affect, and others in cancer patients through a longitudinal study, with the objective of exploring their associations and underlying interactions. Methods: The sample was composed of 71 people diagnosed with cancer who were attending psychological support at the Spanish Association Against Cancer (Biscay). We assessed the following variables in two periods of 6 months: perceived stress (PSS), emotional control (CECS), resilience (CD-RISC), coping strategies (CERQ), personality (NEOFFI), social support (MOSS), affect (PANAS), emotional distress (GHQ), quality of life (SF-12) and visual-analogic scales (EVA). Results: Results showed predictive effects of perceived stress on physical health perception (ß = -0.22; t = -3.26; p = 0.002). Mental health perception was influenced by almost all the psychological variables. Consciousness at baseline (ßCo = 0.15; p = 0.003), change in Extraversion (ßEx = 0.16; p = 0.001) and Resilience (ßRe = 0.15; p = 0.002) had significant effects on perceived mental health. Conclusion: This study provides a global health model that integrates and explores associations between psychological variables related to cancer disease. This information could be useful for guiding personalized psychotherapeutic interventions, with the aim of increasing adjustment to disease.

Effects of a Multi-Component Psychological Intervention to Cultivate Mental Health in Older Adults.

Introduction: Psychological interventions to cultivate mental health in older adults are scarce and tend to focus on and use a limited number of activities. Objective: The aim of this study was to test the effects of an intervention based on Keyes' concept of positive mental health. Methods: The intervention was conducted with 24 self-selected participants, while 34 were part of the control group. Positive mental health and distress outcomes were measured at baseline and at the end of the intervention. ANCOVA analysis and effect sizes were calculated. Results: Results showed that the intervention increased mental health (F= 18.22, p<0.001, η2= 0.334, d= 1.45, power 0.986) and decreased psychiatric symptomatology in the experimental group versus the control group (F= 7.07, p= 0.011, η2= 0.16, d= 0.87, power= 0.736), which showed no change. Discussion: Despite study limitations, the intervention effectively promoted older people's well-being. Future research, should evaluate the long-term effects of the intervention with varied older adult populations.