Is there a case for mental health promotion in the primary care setting? A systematic review.

OBJECTIVES: To evaluate the effectiveness of mental health promotion (MHP) interventions by primary health care professionals in the adult population. METHODS: Systematic review of literature in English and Spanish for randomized controlled trials (RCTs) and observational studies evaluating the impact of interventions carried out by primary care professionals explicitly to promote and improve the overall mental health of adult patients. PubMed, PsycINFO, and Web of Science were independently searched by two investigators to identify all MHP articles from inception to October 2013 (no restrictions). RESULTS: We retrieved 4262 records and excluded 4230 by a review of title and abstract. Of 32 full-text articles assessed, 3 RCTs were selected (2 in USA, 1 in UK); two focused on the mental health of parents whose children have behavioral problems, the other on older people with disabilities. One study reported a MHP intervention that improved participants' mental health at 6-month follow-up. All studies had low-moderate quality (2 of 5 points) on the Jadad Scale. CONCLUSION: There is a lack of implementation and/or evaluation of mental health promotion activities conducted by primary care professionals. More research is needed to clearly understand the benefits of promoting mental health in this setting.

Adjustment disorders in primary care: prevalence, recognition and use of services.

BACKGROUND: Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care. AIMS: To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs). METHOD: Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories. RESULTS: The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription. CONCLUSIONS: Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

Burden of chronic physical conditions and mental disorders in primary care.

BACKGROUND: The World Health Organization (WHO) has stated that the three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depression and ischaemic heart disease. AIMS: To estimate health-related quality of life (HRQoL) and quality-adjusted life-year (QALY) losses associated with mental disorders and chronic physical conditions in primary healthcare using data from the diagnosis and treatment of mental disorders in primary care (DASMAP) study, an epidemiological survey carried out with primary care patients in Catalonia (Spain). METHOD: A cross-sectional survey of a representative sample of 3815 primary care patients. A preference-based measure of health was derived from the 12-item Short Form Health Survey (SF-12): the Short Form-6D (SF-6D) multi-attribute health-status classification. Each profile generated by this questionnaire has a utility (or weight) assigned. We used non-parametric quantile regressions to model the association between both mental disorders and chronic physical condition and SF-6D scores. RESULTS: Conditions associated with SF-6D were: mood disorders, beta = -0.20 (95% CI -0.18 to -0.21); pain, beta = -0.08 (95%CI -0.06 to -0.09) and anxiety, beta = -0.04 (95% CI -0.03 to -0.06). The top three causes of QALY losses annually per 100 000 participants were pain (5064), mood disorders (2634) and anxiety (805). CONCLUSIONS: Estimation of QALY losses showed that mood disorders ranked second behind pain-related chronic medical conditions.

Adaptation and validation of a scale of self-efficacy and social support for physical activity in Spanish patients with severe mental disorders.

BACKGROUND: People with severe mental disorders (SMDs) suffer problems of obesity, a sedentary life, and poor physical condition, mainly due to low levels of physical activity. Self-efficacy (SE) and social support (SS) are important components that influence participation in physical activity. METHODS: This study adapted a scale to assess SE and SS in promoting physical activity in Spanish people with SMDs, as well as provide preliminary evidence of its validity. One hundred Spanish patients (23% female) with SMDs, between 26 and 61 years old, completed the SE/SS assessment for SMD (SE/SS-ASMD). RESULTS: The instrument seemed to capture a four-factor structure in people with SMDs. Due to the lack of a gold standard, the scale was related to other instruments with which it might be expected to show a correlation, such as those for physical activity and its quality; however, the levels of correlation found were low (≈0.3). The Internal consistency (Cronbach's α) for the SE-ASMD, SS-ASMD staff, SS-ASMD peers, and SS-ASMD family scales were 0.76, 0.76, 0.80, and 0.80, respectively. CONCLUSIONS: The psychometric analysis of the SE/SS-ASMD supported its suitability as a new tool for researchers in the area of physical activity among people with SMDs.

Impact of mental disorders and chronic physical conditions in health-related quality of life among primary care patients: results from an epidemiological study.

PURPOSE: To estimate the comorbidity of mental disorders with chronic physical conditions and to assess their independent and combined effects on health-related quality of life (HRQOL). METHODS: Face-to-face cross-sectional survey of adult attendants to public primary care (PC) centres from Catalonia (Spain). A total of 3,815 out of 5,402 selected patients provided data for this study. We report frequency of chronic physical conditions among participants with mental disorders and the contribution of each mental disorder and chronic physical condition to HRQOL. RESULTS: Chronic pain is the most frequent condition among those with mental disorders (74.54%). The effect of chronic physical conditions on HRQOL is rather minor when compared to the effect of mental disorders (especially mood disorders). However, chronic pain plays an important role in HRQOL loss. CONCLUSIONS: Mood disorders and chronic pain negatively affect HRQOL of PC patients. Especial efforts should be made to detect and treat mental disorders and chronic pain at this level.

Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression.

Importance: To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective: To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources: A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection: A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis: Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures: Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results: Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (ß = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (ß = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance: Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.

Individual differences in self-reported thought control: the role of the repressive coping sytle.

The purpose of the present research is to assess differences between repressors and non repressors in some aspects associated with conscious thought control. Thus, Sixty-three Spanish university students with different combinations of trait anxiety and defensiveness completed the Thought Control Ability Questionnaire (TCAQ) and the White Bear Suppression Inventory (WBSI). Data analysis showed that subjects with low anxiety (repressors and low anxious) reported higher perceived ability to control unpleasant thoughts and less tendency to suppress than did subjects with high anxiety (high anxious and defensive high anxious). Implications of these results are discussed in relation to recent researches that have explored the association between repression and thought suppression.

Recognition of anxiety disorders by the general practitioner: results from the DASMAP study.

OBJECTIVES: The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. METHODS: An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. RESULTS: GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. CONCLUSION: GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.

Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study.

OBJECTIVES: The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria. METHODS: Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed. RESULTS: GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP. CONCLUSION: GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.

Analysis of the efficacy of different thought suppression strategies

Algunos estudios han demostrado que cuando alguien intenta suprimir un determinadopensamiento, paradójicamente es este pensamiento lo primero que viene a la mente. Noobstante, varios estudios posteriores sobre este tema han señalado que la supresión exitosade un pensamiento depende en gran medida de la estrategia específica de control mentalque se ha empleado. Así, el presente estudio examinó el impacto de diferentes instruccionesde supresión en la frecuencia y valoraciones realizadas sobre recuerdos de los ataquesterroristas del 11-M que tuvieron lugar en Madrid en 2004. Con este objetivo, 120 estudiantesfueron asignados aleatoriamente a las siguientes condiciones experimentales: supresión,supresión con distracción focalizada, supresión con visualización de un estímulorecordatorio, y monitorización. Los análisis estadísticos mostraron una ausencia de efectosparadójicos, es decir, no se encontró un aumento inmediato o demorado de la frecuenciade los pensamientos y/o recuerdos suprimidos. Además, aquellos participantes instruidos aemplear la distracción focalizada informaron de un menor número de intrusiones a cortoy largo plazo que los sujetos de la condición control. Finalmente, los resultados son discutidosen relación con los estudios previos sobre control del pensamiento(AU)

Some researches have demonstrated that when one wants to suppress a thought, it isparadoxically the first thing that comes to mind. However, subsequent studies on this topichave pointed out that successful thought suppression depends on the specific strategyemployed to deal with the unwanted thought. The present study examined the impact ofdifferent thought suppression instructions on the frequency and appraisals of memoriesabout the March 11 attacks that took place in 2004 in Madrid. Thus, 120 undergraduateswere randomly allocated to the following experimental conditions: thought suppression,thought suppression with focused distraction, thought suppression confronting a reminder,and monitor-only. Data analysis showed an absence of paradoxical effects, that is, neitherimmediate nor delayed frequency increases of the target thought. Furthermore, thoseparticipants instructed to use focused distraction reported less intrusions than those fromthe control condition at short and long-term. Finally, the results are discussed in relationto previous studies on thought control(AU)

Individual differences in self-reported thoght control: the role of the repressive coping style / Diferencias individuales en control del pensamiento: el papel del estilo represivo de afrontamiento

The purpose of the present research is to assess differences between repressors and non repressors in some aspects associated with conscious thought control. Thus, Sixty-three Spanish university students with different combinations of trait anxiety and defensiveness completed the Thought Control Ability Questionnaire (TCAQ) and the White Bear Suppression Inventory (WBSI). Data analysis showed that subjects with low anxiety (repressors and low anxious) reported higher perceived ability to control unpleasant thoughts and less tendency to suppress than did subjects with high anxiety (high anxious and defensive high anxious). Implications of these results are discussed in relation to recent researches that have explored the association between repression and thought suppression

El objetivo de la presente investigación es evaluar las diferencias existentes entre represores y no represores en diferentes aspectos relacionados con el control consciente del pensamiento. De este modo, 63 estudiantes universitarios españoles, con diferentes combinaciones de ansiedad rasgo y defensividad, completaron el Thought Control Ability Questionnaire (TCAQ) y el White Bear Suppression Inventory (WBSI). El análisis de los datos mostró que los sujetos con baja ansiedad rasgo (represores y bajamente ansiosos) informaron de una mayor capacidad percibida de control de pensamientos no deseados y una menor tendencia a suprimir tales pensamientos que los sujetos con alta ansiedad (altamente ansiosos y defensivos ansiosos). Las implicaciones de estos resultados son discutidas en relación con investigaciones recientes que han explorado la asociación entre represión y supresión de pensamiento