Cross-cultural validation of the COVID-19 peritraumatic distress index (CPDI) among Spanish and Peruvian populations.

The COVID-19 pandemic has had a significant psychological impact worldwide. The COVID-19 Peritraumatic Distress Index (CPDI) is widely used to assess psychological stress during the COVID-19 pandemic. Although CPDI has been validated in Peru and Spain, no cross-cultural validation studies have been conducted. As an exploratory aim, differences in CPDI factorial scores between the most prevalent medical conditions in the two samples (arterial hypertension, respiratory diseases and anxious-depressive disorders) from a general population of Peru and Spain were investigated. We conducted secondary data analysis with data from Peru and Spain to validate the CPDI in a cross-cultural context. Exploratory factor analysis (EFA) and multigroup confirmatory factor analysis (MGCFA) were performed to evaluate the factor structure and measurement invariance of the CPDI across cultural contexts. Concerning the exploratory analysis, we performed a U-Mann-Whitney test to evaluate differences in the factorial scores in the two samples. This study revealed a two-factor solution (stress and rumination/information) for the CPDI that included 21 of the 24 original items, and consistent with previous studies. The MGCFA demonstrated measurement invariance across cultural contexts (scalar invariance), indicating that the CPDI construct has the same meaning across both groups, regardless of cultural context and language variations of Spanish. Patients with anxious-depressive disorders showed higher CPDI factorial scores for both factors, whereas patients with respiratory diseases were only associated with the stress factor. This study provides evidence for the cross-cultural validity of the CPDI, highlighting its utility as a reliable instrument for assessing psychological stress in the context of COVID-19 across different cultures. These findings have important implications for developing and validating measures to assess psychological distress in different cultural contexts.

Latent Class Analysis in Depression, Including Clinical and Functional Variables: Evidence of a Complex Depressive Subtype in Primary Care in Chile.

OBJECTIVE: To establish differentiated depressive subtypes using a latent class analysis (LCA), including clinical and functional indicators in a sample of depressed patients consulted in Chilean Primary Health Care. METHODS: A LCA was performed on a sample of 297 depressed patients consulted in Chilean PHC. The Mini International Neuropsychiatric Interview, the Hamilton Depression Rating Scale, the Outcome Questionnaire -social role, and interpersonal subscales were as instruments. A regression analysis of the different subtypes with sociodemographic and adverse life experiences was performed. RESULTS: In a sample characterized by 87.5% of women, two, three, and four latent class models were obtained. The three-class model likely represents the best clinical implications. In this model, the classes were labeled: "complex depression" (CD) (58% of the sample), "recurrent depression" (RD) (34%), and "single depression episode" (SD) (8%). Members of CD showed a higher probability of history of suicide attempts, interpersonal, and social dysfunction. Psychiatric comorbidities differentiated the RD from SD. According to a multinomial regression model, childhood trauma experiences, recent stressful life experiences, and intimate partner violence events were associated with the CD class (p < 0.01). Limitations. The vast majority of participants were females from Chile and the sample studied was not random. So, the results may not necessarily represent outpatient clinics. CONCLUSIONS: This study can provide additional evidence that depression, specifically in female gender, could be better understood as a complex heterogeneous disorder when clinical and functional indicators are studied. Furthermore, adverse life experiences starting in childhood could lead to a differentiated complex depressive subtype.

Remission in Depression and Associated Factors at Different Assessment Times in Primary Care in Chile.

OBJECTIVE: To determine the factors associated with remission at 3, 6, 9 and 12 months among depressive adult patients in primary care [PHC] in Chile. METHODS: This is a one-year naturalistic study that followed 297 patients admitted for treatment of depression in eight primary care clinics in Chile. Initially, patients were evaluated using: the International Mini-Neuropsychiatric Interview [MINI], a screening for Childhood Trauma Events [CTEs], the Life Experiences Survey and a partner violence scale. The Hamilton Depression Scale [HDRS] was used to follow the patients during the observation time. Associations between the factors studied and the primary outcome remission [HDRS ≤ 7] were assessed using a dichotomous logistic regression and a multivariate Poisson regression. The significance level was 0.05. RESULTS: Remission [HDRS ≤ 7] ranged between 36.7% at 3 months and 53.9% at 12 months. Factors that predicted poor remission during the observation time were: CTEs [Wald X2 = 4.88, Exp B=0.94, CI 0.90-0.92, p=0.27]; psychiatric comorbidities [Wald X2 = 10.73, Exp B=0.90, CI 0.85-0.96, p=0.01]; suicidal tendencies [Wald X2 = 4.66, Exp B=0.88, CI 0.79-0.98, p=0.03] and prior treatment for depression [Wald X2 = 4.50, Exp B=0.81, CI 0.68-0.85, p=0.03]. DISCUSSION: Almost 50% of this sample failed remission in depression at 12 months. Psychiatric comorbidities and CTEs are factors that should be considered for a poor outcome in depressed Chilean patients. These factors need more recognition and a better approach in PHC.

Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la atención primaria en Chile / Association between adverse childhood experiences with depression in adults consulting in primary care

Background: Traumatic experiences during childhood may influence the development of mental disorders during adulthood. Aim: To determine clinical and psychosocial variables that are associated with a higher frequency of adverse childhood experiences (ACE) in patients who consult for depression in Primary Health Care clinics in Chile. Material and Methods: A socio-demographic interview, the mini international neuropsychiatric interview (MINI), a screening for ACE, a questionnaire for partner violence (PV), the Life Experiences Survey (LES) and the Hamilton Rating Scale for Depression (HRDS) were applied to 394 patients with major depression (87% women). Results: Eighty two percent of patients had experienced at least one ACE and 43% of them reported three or more. Positive correlations were observed between the number of ACE and severity of depressive symptoms (r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). Conclusions: These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood.

Factors Associated With Greater Severity of Depression in Chilean Primary Care Patients.

OBJECTIVE: To determine clinical and psychosocial variables associated with increased depression severity in patients who consult public primary health care clinics (PHCs) in Chile. METHODS: The study included 394 patients diagnosed with major depressive disorder (MDD) according to ICD-10 criteria who were evaluated between February and September 2014 using a sociodemographic interview, the Mini-International Neuropsychiatric Interview (MINI), a screening for childhood trauma, a scale for partner violence, the Life Events Survey (LES), and the Hamilton Rating Scale for Depression (HRSD). RESULTS: Positive correlations were determined between greater severity of depression and more frequency of depressive episodes (r = 0.2, P < .01), psychiatric comorbidities (r = 0.36, P < .01), number of childhood traumatic events (r = 0.19, P < .01), intimate partner violence events (r = 0.155, P < .01), and stressful life events (r = 0.13, P < .05). Inverse correlation was determined with the age at first episode (r = -0.16, P < .01). The psychiatric comorbidities explained most of the variability of depressive symptoms (11.7%); addition of child abuse to the comorbidities increased the correlation to 12.7%. CONCLUSIONS: The different covariates considered in this sample showed that psychiatric comorbidity played the principal role in explaining the severity of depression.

Childhood trauma and psychiatric comorbidities in patients with depressive disorder in primary care in Chile.

Childhood trauma is associated with different psychiatric disorders during adulthood. These disorders are often presented in comorbidity with depression. OBJECTIVE: To establish the relationship between psychiatric comorbidities and childhood traumatic events in patients with depression in Chile. METHODS: Three hundred and ninety-four patients with major depression were assessed using the MINI International Neuropsychiatric Interview and a screening for childhood trauma. RESULTS: Social anxiety disorder was associated with having witnessed domestic violence during childhood (OR = 2.2, CI 1.2 - 3.8), childhood physical abuse (OR = 2.7, CI 1.6 - 4.4), physical injury associated with physical abuse (OR = 2.3, CI 1.3 - 4.7) and sexual abuse by a non-relative (OR = 2.7, CI 1.3 - 4.2). Posttraumatic stress disorder was associated with physical injury associated with physical abuse (OR = 1.9, CI 1.1 - 3.6), sexual abuse by a relative (OR = 3.2, IC 1.8 - 5.9) and sexual abuse by a non-relative (OR = 2.2, CI 1.2 - 4.1). Antisocial personality disorder was associated with traumatic separation from a caregiver (OR = 3.2, CI 1.2 - 8.5), alcohol abuse by a family member (OR = 3.1, CI 1.1 - 8.1), physical abuse (OR = 2.8, CI 1.1 - 6.9) and sexual abuse by a non-relative (OR = 4.8, CI 1.2 - 11.5). Panic disorder was associated with sexual abuse by a relative (OR = 1.9, CI 1.1 - 3.1). Generalized anxiety disorder was associated with sexual abuse by a non-relative (OR = 1.9, CI 1.1- 3.3). CONCLUSIONS: Further clinical recognition is required in patients seeking help for depression in primary care. This recognition must take into account the patient's current psychiatric comorbidities and adverse childhood experiences.

[Association between adverse childhood experiences with depression in adults consulting in primary care]. / Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la atención primaria en Chile.

BACKGROUND: Traumatic experiences during childhood may influence the development of mental disorders during adulthood. AIM: To determine clinical and psychosocial variables that are associated with a higher frequency of adverse childhood experiences (ACE) in patients who consult for depression in Primary Health Care clinics in Chile. MATERIAL AND METHODS: A socio-demographic interview, the mini international neuropsychiatric interview (MINI), a screening for ACE, a questionnaire for partner violence (PV), the Life Experiences Survey (LES) and the Hamilton Rating Scale for Depression (HRDS) were applied to 394 patients with major depression (87% women). RESULTS: Eighty two percent of patients had experienced at least one ACE and 43% of them reported three or more. Positive correlations were observed between the number of ACE and severity of depressive symptoms (r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). CONCLUSIONS: These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood.

Depresión y trauma temprano: hacia una caracterización clínica de perfiles de consulta en un servicio de salud secundario / Depression and early trauma: towards a characterization of clinical profiles of consultation in a secondary mental health service

Patients with depression maltreated during childhood differ from those depressive patients without this background. In patients with early trauma the disease emerges earlier, it is more severe and does not respond to the classical antidepressant therapy. Despite this evidence, research regarding the clinical conceptualization and approach to these patients is still limited. The above becomes relevant in Chile, considering the high prevalence of depression and history of adverse childhood events among Chilean depressive consulting health services. Based on the conceptualization of complex Post traumatic stress disorder (PTSD), the overall objective of this article is to propose a conceptualization to the clinical characteristics presented in depressive patients with early abuse, who consult in a mental health service. We propose that in all these patients it needs to inquire actively about history of early adverse events, patterns of interpersonal difficulties, psychiatric comorbidity with emphasis on PTSD features and presence of dissociative symptoms. According to which of the areas is the most important to understand the reason of consultation and considering the observation of 41 patients treated in the context of the Psychic Tauma Unit in the Curicó Hospital, we postulate the existence of the following profiles: depressive, posttraumatic and dissociative. The main clinical characteristics of each profile are presented with a therapeutic approach.

Existe suficiente evidencia que constata que los antecedentes de maltrato infantil se asocian al desarrollo de un subtipo depresivo en la vida adulta, de mayor severidad, cronicidad y peor respuesta a la terapia antidepresiva clásica. La conceptualización respecto a la clínica y al abordaje que requiere este subtipo ha sido poco sistematizada. En Chile, lo anterior adquiere relevancia dada la alta prevalencia de antecedentes de maltrato infantil en consultantes por depresión en los servicios de salud. Partiendo de la conceptualización que engloba la nosología de Estrés post-traumático (TEPT) complejo, el objetivo general de este artículo es proponer una posible caracterización de pacientes con depresión y trauma temprano en un servicio de salud secundario. Se plantea para el reconocimiento de esta clínica diferenciada, en el nivel secundario, que en la primera consulta en todos los pacientes depresivos, se indaguen activamente las siguientes variables: historia de eventos adversos tempranos, patrón de dificultades interpersonales, comorbilidad psiquiátrica con énfasis en la pesquisa activa de la clínica de cuadros ansiosos específicamente TEPT y presencia de síntomas o trastornos disociativos. Según cuál de las variables clínicas previamente expuestas, permite comprender mejor el motivo de consulta actual, y de acuerdo a la observación de 42 pacientes en la Unidad de Trauma del Hospital de Curicó postulamos la existencia de los siguientes perfiles de consulta en estos pacientes: depresivo, postraumático y disociativo. Se plantean las características clínicas centrales que pudiese caracterizar a cada uno de estos perfiles y el probable abordaje terapéutico

Evaluation of an outpatient intervention for women with severe depression and a history of childhood trauma.

OBJECTIVE: The study examined the effectiveness of a three-month structured outpatient intervention developed for women with severe depression and childhood trauma that used brief psychodynamic psychotherapy by comparing it to standard treatment recommended in clinical guidelines issued by the Chilean Ministry of Health. METHODS: Eighty-seven women who sought treatment from a public health service in Curicó, Chile, and who had severe depression and a history of childhood traumatic experiences were randomly assigned to receive either the intervention (N=44) or standard treatment (N=43). The participants were assessed at baseline and at three months (completion of the intervention) and six months with use of the Hamilton Depression Scale (Ham-D); Lambert's Outcome Questionnaire (OQ-45.2), which rates psychiatric symptoms, interpersonal relationships, and social role functioning; and the Post-traumatic Stress Treatment Outcome scale (PTO 8), which assesses symptoms of posttraumatic stress disorder. An intent-to-treat design was used with multiple analyses of variance. RESULTS: At three months significant differences were found in favor of the intervention group in Ham-D scores (p<.001) and OQ-45.2 scores (p<.05). At six months a significantly greater proportion of the intervention group had indicators of remission as measured by the OQ-45.2 (39% versus 14%, p<.05) and by the Ham-D (22% versus 5%, p<.05). Scores on the PTO 8 indicated significant improvements in posttraumatic stress disorder symptoms at six months, although there were no significant differences between the groups. CONCLUSIONS: An outpatient intervention that screened for and focused on childhood traumas and that helped patients understand current psychosocial difficulties as a repetition of past traumas was effective in reducing psychiatric symptoms and improving interpersonal relationships and social role functioning among women with severe depression and a history of childhood trauma.

[Relationship between post-traumatic stress disorder, child sexual abuse and sexual re-victimization]. / Relación entre trastorno por estrés postraumático de inicio tardío, abuso sexual infantil y revictimización sexual. Caso clínico.

There is a relationship between child sexual abuse and adult psychopathology. We report a 35 year-old woman derived to the Psychiatric Service of the Curicó Hospital due to anxiety and depressive symptoms lasting eight years, to illustrate the above mentioned relationship. At the psychiatric unit, a post traumatic stress disorder of belated onset, triggered by sexual abuse during childhood, re-edited after her daughter's birth, was diagnosed. This case illustrates different factors, which, in retrospective studies, have been associated with the morbid consequences of child sexual abuse, and allows an understanding of how different sexually traumatic events, during a person's lifetime, contribute to the development of a psychopathology. The problem was confronted by the mental health team at different levels and symptoms subsided in few interventions. An active search of the traumatic sexual background, allowed this achievement. The importance of studying and validating clinical situations as the present case, with methodologies based on evidence, is stressed.

Relación entre trastorno por estrés postraumático de inicio tardío, abuso sexual infantil y revictimización sexual: Caso clínico / Relathionship between post-traumatic stress disorder, child sexual abuse and sexual re-victimization

There is a relationship between child sexual abuse and adult psychopathology. We report a 35 year-old woman derived to the Psychiatric Service of the Curicó Hospital due to anxiety and depressive symptoms lasting eight years, to illustrate the above mentioned relationship. At the psychiatric unit, a post traumatic stress disorder of belated onset, triggered by sexual abuse during childhood, re-edited after her daughter's birth, was diagnosed. This case illustrates different factors, which, in retrospective studies, have been associated with the morbid consequences of child sexual abuse, and allows an understanding of how different sexually traumatic events, during a person's lifetime, contribute to the development of a psychopathology. The problem was confronted by the mental health team at different levels and symptoms subsided in few interventions. An active search of the traumatic sexual background, allowed this achievement. The importance of studying and validating clinical situations as the present case, with methodologies based on evidence, is stressed.