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Over the COVID-19 pandemic, the impact of enduring mental health on healthcare workers has become increasingly evident. This review focuses on post-pandemic mental health challenges faced by healthcare personnel in Latin America. This highlights the persistent burden on healthcare workers, especially women, which is exacerbated by economic disparities, inadequacies in the healthcare system, and ongoing occupational stressors. Our literature review, utilizing databases such as PubMed, Scopus, and Google Scholar, scrutinized the mental health status of healthcare professionals in the region after the pandemic's peak. The analysis indicated sustained levels of psychological distress, with frontline workers and women continuing to be affected disproportionately. These findings emphasize the urgent need for personalized interventions to effectively address the complex mental health challenges in this context. This review advocates strategic interventions, including tailored psychological support, innovative diagnostics, and technological solutions, integrated into patient-centered care models. Such approaches aim to enhance the mental resilience and overall well-being of healthcare professionals across Latin America in the post-COVID era.
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Introduction: Suicide deaths in young people have been increasing in recent decades and are considered a major public health problem worldwide, being a partially preventable event. The prevalence of suicidal ideation is high among university students, especially in health careers. The objective of this study was to measure the prevalence of high suicidal risk in this specific group and to identify associated factors, aiming to provide empirical evidence for the construction of effective suicide prevention strategies. Methods: A cross-sectional study was conducted based on an online survey directed to healthcare students near the end of the first year of the COVID-19 pandemic to learn about the frequency of suicidal risk and its associated factors. The sample consisted of 477 students (70.8% female, mean age 21.7 ± 2.5 years) from eight healthcare majors. The data were collected in January 2021. Results: 22.6% of the young people reported a high suicide risk on the Okasha scale, and 3.4% made a suicide attempt in the previous year. Factors associated with high suicidal risk were having a non-heterosexual orientation, an irregular academic trajectory, experiences of physical and/or psychological violence, higher levels of depressive and anxious symptomatology, as well as lower levels of social support from friends and family. Conclusions: Suicide risk and attempt levels are high in this group of students, and there is a group of factors that could guide more effective actions, such as support for higher-risk groups and screening to identify and provide support to young people at high suicidal risk and with mental health conditions.
Introducción: Las muertes por suicidio en jóvenes han ido en aumento en las últimas décadas y se considera un problema de salud pública prioritario a nivel mundial, siendo un evento parcialmente prevenible. La prevalencia de ideas suicidas es alta entre estudiantes universitarios, especialmente en carreras de la salud. El objetivo de este estudio fue medir la prevalencia de alto riesgo suicida en este grupo específico e identificar factores asociados, con la finalidad de aportar evidencia empírica para la construcción de estrategias efectivas de prevención del suicidio. Métodos: Se realizó un estudio transversal basado en una encuesta en línea a estudiantes de carreras de la salud, casi al final del primer año de la pandemia de COVID-19, para conocer la frecuencia del riesgo suicida y sus factores asociados. La muestra fue de 477 estudiantes (70,8% mujeres, edad promedio 21,7 ± 2,5 años), de ocho carreras de la salud. Los datos se recogieron en enero de 2021. Resultados: Un 22,6% de los jóvenes reportó un alto riesgo suicida en la escala de Okasha y 3,4% hizo un intento suicida en el año previo. Los factores asociados al alto riesgo suicida fueron: tener una orientación no-heterosexual, una trayectoria académica irregular, experiencias de violencia física y/o psicológica, mayores niveles de sintomatología depresiva y ansiosa, así como menores niveles de apoyo social de amigos y de la familia. Conclusiones: Las cifras de riesgo e intentos suicidas son elevadas en este grupo de estudiantes y existe un perfil de factores que podrían orientar acciones más efectivas, tales como apoyo a grupos de mayor riesgo y hacer tamizaje para identificar y dar ayuda a jóvenes con alto riesgo suicida y con problemas de salud mental.
Subject(s)
COVID-19 , Suicidal Ideation , Suicide, Attempted , Humans , Cross-Sectional Studies , Female , Male , Young Adult , COVID-19/epidemiology , COVID-19/prevention & control , Suicide, Attempted/statistics & numerical data , Risk Factors , Surveys and Questionnaires , Students, Health Occupations/psychology , Prevalence , Adolescent , Adult , Suicide/statistics & numerical data , Suicide/psychology , Social Support , Depression/epidemiologyABSTRACT
Introduction: Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. Methods: A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Results: Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. Conclusions: A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.
Introducción: La investigación sobre desinstitucionalización psiquiátrica ha descuidado el hecho que las reformas en este campo se anidan en un sistema de salud que se ha sometido a reformas financieras. Esta subordinación podría introducir incentivos desalineados con las nuevas políticas de salud mental. Según el Plan Nacional de Salud Mental de Chile, este sería el caso en los centros de salud mental comunitaria. El objetivo es comprender cómo el mecanismo de pago al centro de salud mental comunitaria es un potencial incentivo para la salud mental comunitaria. Métodos: Este es un estudio mixto cuantitativo-cualitativo convergente, que utiliza la teoría fundamentada. Recolectamos datos administrativos de producción entre 2010 y 2020. Siguiendo la teoría de mecanismo de pago, entrevistamos a 25 expertos de los ámbitos pagador, proveedor y usuario. Integramos los resultados a través de la codificación selectiva. Este artículo presenta los resultados relevantes de la integración selectiva mixta. Resultados: Reconocimos siete mecanismos de pago implementados heterogéneamente en los centros de salud mental comunitaria del país. Estos, responden a tres esquemas supeditados a límites de tarifa y presupuesto público prospectivo. Se diferencian en la unidad de pago. Se asocian con la implementación del modelo de salud mental comunitaria afectando negativamente a los usuarios, los servicios provistos, los recursos humanos disponibles, la gobernanza adoptada. Identificamos condiciones de gobernanza, gestión y unidad de pago que favorecerían el modelo de salud mental comunitaria. Conclusiones: Un conjunto desarticulado de esquemas de pago implementados heterogéneamente, tiene efectos negativos para el modelo de salud mental comunitaria. Es necesario y posible formular una política de financiación explícita para la salud mental complementaria a las políticas existentes.
Subject(s)
Community Mental Health Centers , Grounded Theory , Reimbursement Mechanisms , Chile , Humans , Community Mental Health Centers/economics , Community Mental Health Centers/organization & administration , Health Policy , Deinstitutionalization/economics , Health Care Reform , Community Mental Health Services/economics , Community Mental Health Services/organization & administrationABSTRACT
BACKGROUND: Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important". RESULTS: Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists. CONCLUSIONS: The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.
Subject(s)
First Aid , Mental Health , Humans , Chile , Argentina , Australia , Delphi Technique , Surveys and QuestionnairesABSTRACT
Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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Recently, the use of nanotechnology in food has gained great interest. Iron nanoparticles with unique chemical, physical and structural properties allow their potential use mainly as iron fortifiers, colorants and antimicrobial agents. However, in the market we can find only supplements and food colorants based on iron nanoparticles. Their use in food fortification has so far been focused only on in vitro and in vivo experimental studies, since the toxicological evaluation of these studies has so far been the basis for the proposals of laws and regulations, which are still in an early stage of development. Therefore, the aim of this work was to summarize the use of the different forms of iron nanoparticles (oxides, oxyhydroxides, phosphates, pyrophosphates and sulfates) as food additives and supplements and to resume the perspectives of legislation regarding the use of these types of nanoparticles in the food industry.
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BACKGROUND: Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy. CONCLUSIONS: While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.
Subject(s)
Mental Health , Psychotic Disorders , Humans , First Aid , Chile , Argentina , Delphi Technique , Psychotic Disorders/therapy , Surveys and QuestionnairesABSTRACT
Dentro de la práctica clínica, así como en la salud poblacional, es habitual utilizar cuestionarios que permiten evaluar condiciones o variables que no son directamente observables. No obstante, la construcción y validación de estos instrumentos o cuestionarios suele ser poco conocida. El objetivo de esta revisión narrativa es sintetizar de manera general el proceso de construcción y validación de estos cuestionarios, para así tener una mejor comprensión de este proceso, de los aspectos que se evalúan y de la mejor forma de utilizarlos. La validación de cuestionarios corresponde a un proceso de análisis de este, cuya finalidad es medir una variable latente o constructo, así como sus dimensiones, las que no pueden ser observadas directamente. Una variable latente puede ser inferida a través de un conjunto de atributos específicos que forman parte de ella, como los ítems de un cuestionario y que sí son observables. En este artículo se abordan de manera teórica los conceptos fundamentales de validación de cuestionarios o test, variables latentes o constructos, estudio de la confiabilidad y de la validez, así como los factores que afectan a estas dos últimas características, a través de una revisión narrativa. En el texto, se presentan ejemplos sobre estos conceptos.
In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.
ABSTRACT
In clinical practice and population health, it is common to use questionnaires to assess conditions or variables that are not directly observable. However, the construction and validation of these instruments or questionnaires are often poorly understood. This narrative review aims to summarize in a general way the process of construction and validation of these questionnaires in order to have a better understanding of this process, the aspects that are evaluated, and the best way to use them. The validation of questionnaires corresponds to a process of analysis of the questionnaire, aiming to measure a latent variable and its dimensions, which cannot be observed directly. A latent variable can be inferred through a set of specific attributes that are part of it, such as the items of a questionnaire, which are observable. Through a narrative review, this article addresses the fundamental concepts of questionnaire or test validation, latent variables or constructs, reliability and validity studies, and the factors that theoretically affect the latter two characteristics. Examples of these concepts are presented in the text.
Dentro de la práctica clínica, así como en la salud poblacional, es habitual utilizar cuestionarios que permiten evaluar condiciones o variables que no son directamente observables. No obstante, la construcción y validación de estos instrumentos o cuestionarios suele ser poco conocida. El objetivo de esta revisión narrativa es sintetizar de manera general el proceso de construcción y validación de estos cuestionarios, para así tener una mejor comprensión de este proceso, de los aspectos que se evalúan y de la mejor forma de utilizarlos. La validación de cuestionarios corresponde a un proceso de análisis de este, cuya finalidad es medir una variable latente o constructo, así como sus dimensiones, las que no pueden ser observadas directamente. Una variable latente puede ser inferida a través de un conjunto de atributos específicos que forman parte de ella, como los ítems de un cuestionario y que sí son observables. En este artículo se abordan de manera teórica los conceptos fundamentales de validación de cuestionarios o test, variables latentes o constructos, estudio de la confiabilidad y de la validez, así como los factores que afectan a estas dos últimas características, a través de una revisión narrativa. En el texto, se presentan ejemplos sobre estos conceptos.
Subject(s)
Reproducibility of Results , Humans , Surveys and QuestionnairesABSTRACT
BACKGROUND: Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. METHODS: A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels. RESULTS: Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. CONCLUSIONS: A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.
Subject(s)
Mental Health , Suicide , Adolescent , Humans , Aged , Chile , First Aid/methods , Argentina , Surveys and Questionnaires , Delphi Technique , Australia , Suicide/psychologyABSTRACT
Traditionally, research has been divided according to its methodology into quantitative and qualitative. Mixed research methodology combines both methods and has established itself as a third approach, allowing to comprehensively address high-complexity research problems. Although there are various definitions of mixed methods research, they all share aspects such as the collection and analysis of both quantitative and qualitative data and the integrated interpretation of the results within the same research. This type of research is an important tool to address the complexity of health sciences, allowing the understanding and integration of quantitative data with experience-based aspects. In this way, a broad and deep perspective of health problems is achieved, providing a solution to sanitary policies and services. During the development of mixed methods research, there are key stages where both approaches can be integrated depending on the objectives set by the investigators. Although mixed methods studies may differ widely, general models have been identified to guide the development of a single specific design. These models are classified according to the priority of each approach, the sequence in which each approach will be executed, the level and timing of data integration, and the purpose of integrating the data for the study.
Tradicionalmente la investigación se ha dividido según su metodología en cuantitativa y cualitativa. La metodología mixta de investigación, que combina ambos métodos, se ha consolidado como una tercera vía, permitiendo abordar de forma integral problemas de investigación de alta complejidad. Aunque existen diversas definiciones sobre la investigación con métodos mixtos, todas ellas comparten aspectos como la recolección y análisis de datos tanto cuantitativos como cualitativos, y la interpretación integrada de los resultados dentro de una misma investigación. Este tipo de investigación es una herramienta importante para abordar la complejidad propia del campo de la salud, permitiendo comprender e integrar los datos cuantitativos con aspectos vivenciales y experienciales. Con ello se logra una perspectiva amplia y profunda de los problemas de salud, dando respuesta a las políticas y servicios sanitarios. Durante el desarrollo de una investigación con métodos mixtos, existen etapas clave donde ambos enfoques pueden integrarse dependiendo de los objetivos planteados por los equipos de investigación. Aunque los estudios con métodos mixtos pueden ser muy diferentes, se han identificado modelos generales que guían el desarrollo de un diseño específico a utilizar. Estos modelos se clasifican según la prioridad de cada enfoque, la secuencia en la que se ejecutará cada enfoque, el nivel y momento de integración de los datos y el propósito de esta integración para el estudio en particular.
Subject(s)
Research Design , Humans , Qualitative ResearchABSTRACT
Tradicionalmente la investigación se ha dividido según su metodología en cuantitativa y cualitativa. La metodología mixta de investigación, que combina ambos métodos, se ha consolidado como una tercera vía, permitiendo abordar de forma integral problemas de investigación de alta complejidad. Aunque existen diversas definiciones sobre la investigación con métodos mixtos, todas ellas comparten aspectos como la recolección y análisis de datos tanto cuantitativos como cualitativos, y la interpretación integrada de los resultados dentro de una misma investigación. Este tipo de investigación es una herramienta importante para abordar la complejidad propia del campo de la salud, permitiendo comprender e integrar los datos cuantitativos con aspectos vivenciales y experienciales. Con ello se logra una perspectiva amplia y profunda de los problemas de salud, dando respuesta a las políticas y servicios sanitarios. Durante el desarrollo de una investigación con métodos mixtos, existen etapas clave donde ambos enfoques pueden integrarse dependiendo de los objetivos planteados por los equipos de investigación. Aunque los estudios con métodos mixtos pueden ser muy diferentes, se han identificado modelos generales que guían el desarrollo de un diseño específico a utilizar. Estos modelos se clasifican según la prioridad de cada enfoque, la secuencia en la que se ejecutará cada enfoque, el nivel y momento de integración de los datos y el propósito de esta integración para el estudio en particular.
Traditionally, research has been divided according to its methodology into quantitative and qualitative. Mixed research methodology combines both methods and has established itself as a third approach, allowing to comprehensively address high-complexity research problems. Although there are various definitions of mixed methods research, they all share aspects such as the collection and analysis of both quantitative and qualitative data and the integrated interpretation of the results within the same research. This type of research is an important tool to address the complexity of health sciences, allowing the understanding and integration of quantitative data with experience-based aspects. In this way, a broad and deep perspective of health problems is achieved, providing a solution to sanitary policies and services. During the development of mixed methods research, there are key stages where both approaches can be integrated depending on the objectives set by the investigators. Although mixed methods studies may differ widely, general models have been identified to guide the development of a single specific design. These models are classified according to the priority of each approach, the sequence in which each approach will be executed, the level and timing of data integration, and the purpose of integrating the data for the study.
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[This corrects the article DOI: 10.3389/frhs.2022.958743.].
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OBJECTIVE: To measure and understand mental wellbeing among women prisoners in Chile, as part of a larger study. RESULT: Sixty-eight sentenced prisoners in a women's prison participated in a survey, giving a response rate of 56.7%. Using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the mean wellbeing score of participants was 53.77 out of maximum score of 70. Whilst 90% of the 68 women felt useful at least some of the time, 25% rarely felt relaxed, close to others or able to make up their own minds about things. Data generated from two focus groups attended by six women offered explanations for survey findings. Thematic analysis identified stress and loss of autonomy due to the prison regime as factors which negatively affect mental wellbeing. Interestingly, whilst offering prisoners an opportunity to feel useful, work was identified as a source of stress. Interpersonal factors linked to a lack of safe friendships within the prison and little contact with family had an adverse impact on mental wellbeing. The routine measurement of mental wellbeing among prisoners using the WEMWBS is recommended in Chile and other Latin American countries to identify the impact of policies, regimes, healthcare systems and programmes on mental health and wellbeing.
Subject(s)
Mental Health , Prisoners , Humans , Female , Chile , Prisoners/psychology , Prisons , Surveys and QuestionnairesABSTRACT
BACKGROUND: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.
Subject(s)
Depression , Mental Health , Humans , Depression/diagnosis , Depression/therapy , First Aid , Argentina , Chile , Delphi Technique , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Report the prevalence of depression, resilience, and risk factors among healthcare workers (HCW) during Co-vid-19. MATERIALS AND METHODS: This is an observational cross-sectional study derived from the ongoing international, prospective multicentric study "The COVID-19 HEalth caRe wOrk-Ers Study" (HEROES). A convenience sample of 2 127 HCW was obtained from Chiapas and Jalisco between May 19th and July 24th 2020. Depression was assessed using the Patient Health Questionnaire, resilience with the Brief Resilience Scale and a Covid risk scale was developed. Model-adjusted prevalence ratios (PRs) and an additive interaction model were performed. RESULTS: Moderate-severe depression was found in 16.6% of HCW. Those from Jalisco, physicians, in hospitals, with chronic illness and mental health history were more depressed. The interaction between resilience and risk showed that, compared to those with no risk and medium/high resilience, HCW at risk with medium/high resilience had a 2.38 PR for depression while those at risk and low resilience had a PR of 5.83. CONCLUSION: This evidence points the need to develop strategies to enhance resilience and reduce the risk in HCW.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Depression/epidemiology , SARS-CoV-2 , Pandemics , Cross-Sectional Studies , Prospective Studies , Health Personnel/psychology , Risk FactorsABSTRACT
OBJECTIVE: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. METHODS: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. RESULTS: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Subject(s)
Mental Health Services , Psychotic Disorders , Male , Humans , Female , Chile , Psychotic Disorders/therapy , Social Stigma , Rehabilitation, VocationalABSTRACT
Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.
Subject(s)
Mental Disorders , Substance-Related Disorders , Humans , Chile , Cross-Cultural Comparison , Social Stigma , Primary Health CareABSTRACT
This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach.
ABSTRACT
Introducción: El trastorno depresivo mayor (TDM) constituye un problema de salud pública por su alta prevalencia y consecuencias biopsicosociales. Es un desorden clínicamente heterogéneo, complejo y de curso fluctuante. En Chile, no existen estudios sobre trayectorias terapéuticas en TDM. Objetivo: Describir las trayectorias de respuesta clínica en pacientes con TDM en tratamiento en centros de Atención Primaria de Salud (APS) en Chile. Método: Estudio de cohorte prospectiva de cinco meses de seguimiento. Se incluyeron pacientes ingresados en el Programa de Garantías Explícitas en Salud de Depresión de siete centros de APS de la Región de Valparaíso, Chile. Se realizaron cuatro evaluaciones (semanas 0, 4, 12 y 20) para describir variables clínicas y sociodemográficas relacionadas con la evolución. Se elaboraron trayectorias de respuesta en relación con el curso de los síntomas depresivos. Resultados: Se incluyeron 159 participantes (93% fueron mujeres), con un promedio de 43 años de edad. Las condiciones de riesgo para TDM más frecuentemente reportadas fueron el aislamiento social o la escasa red de apoyo y haber presenciado violencia intrafamiliar durante la infancia. Se obtuvo 12 trayectorias de respuesta de un total de 16 patrones posibles. Se observan diferencias al analizar las respuestas terapéuticas entre las semanas 0 y 12 y 0 y 20. Las trayectorias más frecuentes fueron el mantenimiento o empeoramiento de la sintomatología depresiva (37,7%). Conclusiones: Los resultados muestran una variabilidad sintomática durante el transcurso de un TDM. En este seguimiento de cinco meses, más de un tercio de las participantes no mejoraron sus síntomas depresivos.
Introduction: Major depressive disorder (MDD) is a public health problem due to its high prevalence and biopsychosocial consequences. It is a clinically heterogeneous and complex disorder with a fluctuating course. In Chile, there are no studies on clinical trajectories in MDD. Objective: To describe the clinical response trajectories in patients with MDD under treatment in primary care centers (PCC) in Chile. Method: We conducted a prospective cohort study with a five-month follow-up, including patients treated in the Explicit Guarantees in Healthcare program for depression at seven PCC in the Valparaíso Region, Chile. We carried out four evaluations (weeks 0, 4, 12 and 20) to describe various clinical and sociodemographic variables related to the therapeutic evolution. We elaborated response trajectories in relation to the course of depressive symptoms. Results: 159 participants were included (93% women), with an average age of 43 years old. The most frequently reported risk conditions for MDD were social isolation or poor support network and having witnessed domestic violence during childhood. Twelve response trajectories were obtained from a total of 16 possible patterns. Differences were observed when analyzing the therapeutic responses between weeks 0 and 12 and 0 and 20. The most frequent trajectories were the maintenance or worsening of depressive symptoms (37.7%). Conclusions: The results show a symptomatic variability during the course of MDD. In this five-month follow-up, more than a third of the participants did not improve their depressive symptoms.