Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Translation and cross-cultural adaptation of seventeen widely-used assessment instruments for child and adolescent mental health in Greece.

BACKGROUND: In the context of Greece, many instruments measuring constructs pertinent to child and adolescent mental health lacked a locally-validated, freely-available version. As part of a nationwide survey, we translated and cross-culturally adapted a collection of seventeen brief, largely-employed assessment tools that can be used at scale. METHODS: This study is part of the Child and Adolescent Mental Health Initiative in Greece (CAMHI), a capacity-building program focusing on enhancing mental health care for children and adolescents living in Greece. We conducted a nationwide survey assessing mental health symptoms, parenting practices, service availability and quality, mental health literacy and stigma, and professional practices within the country. As part of this process, we selected outcomes and instruments after consulting the International Consortium for Health Outcomes Measurement (ICHOM) and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). From our selection, we identified 17 instruments that did not have a Greek-validated version available for use. These instruments were translated and cross-culturally adapted following a structured procedure, including independent back-and-forth translations, synthesis of versions, expert revision, and pilot testing. Some instruments were slightly modified to meet CAMHI survey purposes. RESULTS: A cross-culturally adapted version in Greek was made available for the following instruments: Pediatric Symptoms Checklist (PSC); Deliberate Self Harm Inventory (DSH) (modified); Child and Adolescent Trauma Screen-2 (CATS-2); ABCD Screen Use (modified); Swanson, Nolan, and Pelham-IV (SNAP-IV); Parent Behavior Inventory (PBI); Mental Health Literacy Scale (MHLS)-(modified); Australian Mental Health Vignettes; Reported and Intended Behavior Scale (RIBS); Barriers to Access to Care (BACE) (modified); Experience of Service Questionnaire (ESQ) (modified); and Multitheoretical List of Therapeutic Interventions (MULTI-30) (modified). CONCLUSION: A collection of these widely-used assessment tools is now adapted for the local context and freely accessible at [ https://osf.io/crz6h/ ]. Researchers and health professionals in Greece can utilize this resource to screen, evaluate, and monitor various constructs related to mental health in accordance with the most effective practices.

The science of child and adolescent mental health in Greece: a nationwide systematic review.

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population.

OBJECTIVES: To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population. METHODS: Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated. RESULTS: The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity. CONCLUSION: The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

Threat and deprivation are associated with distinct aspects of cognition, emotional processing, and psychopathology in children and adolescents.

Exposure to childhood adversity has been consistently associated with poor developmental outcomes, but it is unclear whether these associations vary across different forms of adversity. We examined cross-sectional and longitudinal associations between threat and deprivation with cognition, emotional processing, and psychopathology in a middle-income country. The sample consisted of 2511 children and adolescents (6-17 years old) from the Brazilian High-Risk Cohort for Mental Conditions. Parent reports on childhood adversity were used to construct adversity latent constructs. Psychopathology was measured by the Child Behavior Checklist (CBCL) to generate a measure of general psychopathology (the "p" factor). Executive function (EF) and attention orienting toward angry faces were assessed using cognitive tasks. All measures were acquired at two time-points 3 years apart and associations were tested using general linear models. Higher levels of psychopathology were predicted by higher levels of threat cross-sectionally and longitudinally, and by deprivation longitudinally. For EF, worse performance was associated only with deprivation at baseline and follow-up. Finally, threat was associated with attention orienting towards angry faces cross-sectionally, but neither form of adversity was associated with changes over time in attention bias. Our results suggest that threat and deprivation have differential associations with cognitive development and psychopathology. Exposure to adversity during childhood is a complex phenomenon with meaningful influences on child development. Because adversity can take many forms, dimensional models might help to disentangle the specific developmental correlates of different types of early experience. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=uEU0L8exyTM.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

Abstract Objectives To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population. Methods Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated. Results The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity. Conclusion The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

ADHD in childhood predicts BMI and body composition measurements over time in a population-based birth cohort.

BACKGROUND/OBJECTIVES: Obesity has been reported as an attention-deficit hyperactivity disorder (ADHD) comorbidity. So far, few studies have aimed to explore the potential causal relationship between ADHD and obesity, as well as used other measures of body composition like fat-free mass (FFM) and fat mass (FM) as measures of obesity. This study aimed to test the association between ADHD and body composition (body mass index [BMI] and others) and to evaluate the potential causal relationship with obesity. SUBJECTS/METHODS: Data from the 1993 Pelotas (Brazil) birth cohort at age 11-, 15-, 18-, and 22-year follow-up was used. We performed a cross-lagged panel model (CLPM) analysis between ADHD symptoms and BMI to explore the causal relationship between both traits. Finally, we tested whether ADHD, inattention, and hyperactivity symptom scales were associated with BMI, FM, and FFM at 22 years. RESULTS: In the CLPM, higher ADHD scores at age 11 predicted higher BMI at age 15 (ß = 0.055, 95% CI [0.037; 0.073]). ADHD symptoms at age 11 was also associated with a decrease in the FFM (ß = -0.16, 95% CI [-0.28; -0.05]), and an increase in the BMI (ß = 0.17, 95% CI [0.10; 0.23]) and FM (ß = 0.17, 95% CI [0.06; 0.29]) at 22 years. At 22 years of age, ADHD was associated with FFM and FM. Moreover, an increase in BMI was observed with an increase in several symptoms of ADHD in general (ß = 0.06, 95% CI [0.004; 0.12]), and hyperactivity symptoms (ß = 0.15, 95% CI [0.05; 0.25]). CONCLUSION: ADHD at 11 years predicted a higher BMI at 15 years, and body fat composition in adulthood, suggesting higher scores on ADHD symptoms in early life may be a critical point for body composition in early adulthood. The hyperactivity symptoms may play an important role in the BMI increase.

Testing the Stability and Validity of an Executive Dysfunction Classification Using Task-Based Assessment in Children and Adolescents.

OBJECTIVE: It is unclear if pediatric executive dysfunction assessed only with cognitive tasks predicts clinically relevant outcomes independently of psychiatric diagnoses. This study tested the stability and validity of a task-based classification of executive function. METHOD: A total of 2,207 individuals (6-17 years old) from the Brazilian High-Risk Cohort Study participated in this study (1,930 at baseline, 1,532 at follow-up). Executive function was measured using tests of working memory and inhibitory control. Dichotomized age- and sex-standardized performances were used as input in latent class analysis and receiver operating curves to create an executive dysfunction classification (EDC). The study tested EDC's stability over time, association with symptoms, functional impairment, a polymorphism in the CADM2 gene, polygenic risk scores (PRS), and brain structure. Analyses covaried for age, sex, social class, IQ, and psychiatric diagnoses. RESULTS: EDC at baseline predicted itself at follow-up (odds ratio [OR] = 5.11; 95% CI 3.41-7.64). Participants in the EDC reported symptoms spanning several domains of psychopathology and exhibited impairment in multiple settings, including more adverse school events (OR = 2.530; 95% CI 1.838-3.483). Children in the EDC presented higher attention-deficit/hyperactivity disorder and lower educational attainment PRS at baseline; higher schizophrenia PRS at follow-up; and lower chances of presenting a polymorphism in a gene previously linked to high performance in executive function (CADM2 gene). They also exhibited smaller intracranial volumes and smaller bilateral cortical surface areas in several brain regions. CONCLUSION: Task-based executive dysfunction is associated with several validators, independently of psychiatric diagnoses and intelligence. Further refinement of task-based assessments might generate clinically useful tools.

Gene expression changes associated with trajectories of psychopathology in a longitudinal cohort of children and adolescents.

We aimed to identify blood gene expression patterns associated to psychopathological trajectories retrieved from a large community, focusing on the emergence and remission of general psychiatric symptoms. Hundred and three individuals from the Brazilian High-Risk Cohort Study (BHRCS) for mental disorders were classified in four groups according to Child Behavior Checklist (CBCL) total score at the baseline (w0) and after 3 years (w1): low-high (L-H) (N = 27), high-low (H-L) (N = 12), high-high (H-H) (N = 34) and low-low (L-L) groups (N = 30). Blood gene expression profile was measured using Illumina HT-12 Beadchips, and paired analyses comparing w0 and w1 were performed for each group. Results: 98 transcripts were differentially expressed comparing w0 and w1 in the L-H, 33 in the H-L, 177 in the H-H and 273 in the L-L. Of these, 66 transcripts were differentially expressed exclusively in the L-H; and 6 only in the H-L. Cross-Lagged Panel Models analyses revealed that RPRD2 gene expression at w1 might be influenced by the CBCL score at w0. Moreover, COX5B, SEC62, and NDUFA2 were validated with another technique and were also differentially regulated in postmortem brain of subjects with mental disorders, indicating that they might be important not only to specific disorders, but also to general psychopathology and symptoms trajectories. Whereas genes related to metabolic pathways seem to be associated with the emergence of psychiatric symptoms, mitochondrial inner membrane genes might be important over the course of normal development. These results suggest that changes in gene expression can be detected in blood in different psychopathological trajectories.

Psychometric properties of the Brazilian version of the Cognitive Emotion Regulation Questionnaire.

INTRODUCTION: The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine cognitive strategies referring to what someone thinks after the experience of threatening or stressful events. The main purpose of this study was to evaluate the validity of the Brazilian version of the CERQ. METHODS: The adaptation process included translation, backtranslation, expert committee evaluation, and test on 30 participants from the target population. A sample of 445 university students completed the Portuguese version of the CERQ, a sociodemographic questionnaire, the Life Events Checklist (LEC-5), and the Positive and Negative Affect Schedule (PANAS) on an on-line research platform. Validity was assessed through confirmatory factor analysis of two models - a nine-factor model and a second-order model. Internal consistency was assessed through Cronbach's alpha analysis and correlations with affective variables measured by the PANAS. RESULTS: The analyses showed that the nine-factor model of the CERQ has good factorial validity and high reliability, with Cronbach's alpha values ranging between 0.71 and 0.88. The second-order model did not have a good fit to the data. CONCLUSION: The results obtained in this study are similar to the ones found previously, indicating that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, but that grouping them according to their adaptability is not recommended.

Psychometric properties of the Brazilian version of the Cognitive Emotion Regulation Questionnaire / Propriedades psicométricas da versão brasileira do Questionário de Regulação Emocional Cognitiva

Abstract Introduction: The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine cognitive strategies referring to what someone thinks after the experience of threatening or stressful events. The main purpose of this study was to evaluate the validity of the Brazilian version of the CERQ. Methods: The adaptation process included translation, backtranslation, expert committee evaluation, and test on 30 participants from the target population. A sample of 445 university students completed the Portuguese version of the CERQ, a sociodemographic questionnaire, the Life Events Checklist (LEC-5), and the Positive and Negative Affect Schedule (PANAS) on an on-line research platform. Validity was assessed through confirmatory factor analysis of two models - a nine-factor model and a second-order model. Internal consistency was assessed through Cronbach's alpha analysis and correlations with affective variables measured by the PANAS. Results: The analyses showed that the nine-factor model of the CERQ has good factorial validity and high reliability, with Cronbach's alpha values ranging between 0.71 and 0.88. The second-order model did not have a good fit to the data. Conclusion: The results obtained in this study are similar to the ones found previously, indicating that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, but that grouping them according to their adaptability is not recommended.

Resumo Introdução: O Questionário de Regulação Emocional Cognitiva (Cognitive Emotion Regulation Questionnaire [CERQ]) foi desenvolvido para medir nove estratégias cognitivas que se referem à forma como as pessoas pensam sobre a experiência de eventos ameaçadores ou estressantes. O objetivo principal deste estudo foi desenvolver e avaliar a validade da versão brasileira do CERQ. Métodos: O processo de adaptação incluiu tradução, retrotradução, avaliação de comitê de especialistas e teste em 30 participantes da população-alvo. Uma amostra de 445 universitários completou a versão em português do CERQ, um questionário sociodemográfico, a Lista de Verificação de Eventos de Vida (Life Events Checklist [LEC-5]) e a Escala de Afeto Positivo e Negativo (Positive and Negative Affect Schedule [PANAS]) em uma plataforma de pesquisa online. A validade do instrumento foi avaliada através da análise fatorial confirmatória de dois modelos: um modelo de nove fatores e um modelo de segunda ordem. A consistência interna foi avaliada por meio da análise de alfa de Cronbach e correlações com variáveis afetivas medidas pela PANAS. Resultados: As análises mostraram que o modelo de nove fatores do CERQ possui boa validade fatorial e alta confiabilidade, com valores de alfa de Cronbach variando entre 0,71 e 0,88. O modelo de segunda ordem não se ajustou bem aos dados. Conclusão: Os resultados obtidos neste estudo são semelhantes aos encontrados em estudos anteriores, indicando que o CERQ é uma ferramenta válida e confiável para avaliar as estratégias de regulação cognitiva das emoções, mas que agrupá-las de acordo com sua adaptabilidade não é recomendado.

Exposure to physical and sexual violence and suicidal ideation among schoolchildren / Exposição à violência física e sexual e ideação suicida entre escolares

ABSTRACT Objective The purpose of this study was to estimate the association between exposure to physical and sexual violence, and suicidal ideation in Brazilian Schoolchildren, accounting for confounding variables of religious practice, and problems with alcohol and other drugs. Methods This study consists of a cross-sectional analytical approach of a larger school-based study conducted in 2012 in two medium-sized municipalities in south of Brazil. Participants were 3,547 students aging 12 to 17 years old who answered an assembled questionnaire. Descriptive and Logistic Regression analyses were conducted with suicide ideation outcome testing prediction models stratified by sex. Results Suicide ideation prevalence in the sample was of 21.7%, and regression analysis indicated that girls and boys exposed to physical or sexual violence had 3.42 and 3.14 times more probability of referring suicidal ideation in the past 30 days. Adjusted analyses showed little interference of religious practice, while problems with alcohol and other drugs seemed to also explain suicidal ideation in the sample. Conclusion We highlight the importance of future longitudinal studies to investigate the mechanisms through which exposure to physical or sexual abuse influence suicidal ideation among boys and girls, as well as mediation studies that could enlighten the role of drug and alcohol use in this relationship.

RESUMO Objetivo O objetivo deste estudo foi estimar a associação entre exposição à violência física e sexual e ideação suicida em escolares brasileiros, controlando para variáveis relacionadas a prática religiosa e problemas com álcool e outras drogas. Métodos Este estudo consiste de um recorte transversal de um estudo maior realizado em 2012 em dois municípios de médio porte no sul do Brasil. No total, 3.547 alunos de 12 a 17 anos responderam a um questionário desenvolvido para o estudo em questão. Análises descritivas e de regressão logística foram conduzidas testando modelos preditores de ideação suicida estratrificados por sexo. Resultados A prevalência de ideação suicida na amostra foi de 21,7% e a análise de regressão indicou que meninas e meninos expostos à violência física ou sexual tinham 3,42 e 3,14 vezes mais probabilidade de referir ideação suicida nos últimos 30 dias. As análises ajustadas mostraram pouca interferência da prática religiosa, enquanto problemas com álcool e outras drogas também parecem explicar ideação suicida na amostra. Conclusão Destacamos a importância de futuros estudos longitudinais para investigar os mecanismos por meio dos quais a exposição ao abuso físico ou sexual influencia a ideação suicida em meninos e meninas, bem como estudos de mediação que possam esclarecer o papel do uso de drogas e álcool nessa relação.

[Conditions associated with impaired social skills in a convenience sample of crack users]. / Condições associadas a prejuízo de desempenho em habilidades sociais em uma amostra de conveniência de usuários de crack.

The article analyzes conditions associated with low scores on the Social Skills Inventory (SSI) among crack users in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, based on a cross-sectional study in a convenience sample of 519 individuals interviewed in 2011. Low SSI scores occurred in 52.8% of the sample, and there were no differences according to currently active use of crack (yes/no) or current addiction treatment. Higher likelihood of low SSI was associated with crack users in pre-contemplation or contemplation in University of Rhode Island Change Assessment - URICA (p = 0.031), high Beck Depression Inventory - BDI scores (p = 0.037), mourning a deceased child (p = 0.001), and having committed armed robbery to obtain crack (p = 0/020). Lower likelihood of low SSI was associated with 9 or more years of schooling (p = 0.001), high social support (p < 0.001), high resilience (p < 0.001), having lost contact with parents (p = 0.032), history of hospitalization due to crack (p = 0.009), and history of sex to obtain crack (p = 0.009). The findings are clinically useful and highlight the issue's importance.

Condições associadas a prejuízo de desempenho em habilidades sociais em uma amostra de conveniência de usuários de crack / Conditions associated with impaired social skills in a convenience sample of crack users / Condiciones asociadas a prejuicios sobre el desempeño en habilidades sociales dentro de una muestra de conveniencia con consumidores de crack

O artigo apresenta condições associadas a escores deficitários noInventário de Habilidades Sociais (IHS) entre usuários decrack da Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil. Estudo transversal, com amostragem de conveniência de 519 indivíduos, entrevistados em 2011. Escore deficitário no IHS ocorreu para 52,8% da amostra e não houve diferenças quanto a estar ou não em uso ativo decrack, ou quanto a estar ou não em atendimento. Apresentaram probabilidade aumentada de déficit no IHS os usuários decrack em pré-contemplação ou contemplação noUniversity of Rhode Island Change Assessment - URICA (p = 0,031), com escores elevados no Inventário de Depressão de Beck- BDI (p = 0,037) os que viveram luto de filho (p = 0,001) e os que já assaltaram para obter o crack (p = 0,020). Com probabilidade diminuída estavam os que tinham escolaridade de 9 anos ou mais (p = 0,001), apoio social elevado (p < 0,001), resiliência elevada (p < 0,001), com histórico de ter perdido o contato com seus pais (p = 0,032), já tendo sido hospitalizado em função da droga (p = 0,009) e que relataram já ter mantido atividade sexual para obter a pedra (p = 0,009). Os achados têm utilidade clínica e mostram a importância do tema.

The article analyzes conditions associated with low scores on the Social Skills Inventory (SSI) among crack users in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, based on a cross-sectional study in a convenience sample of 519 individuals interviewed in 2011. Low SSI scores occurred in 52.8% of the sample, and there were no differences according to currently active use of crack (yes/no) or current addiction treatment. Higher likelihood of low SSI was associated with crack users in pre-contemplation or contemplation in University of Rhode Island Change Assessment - URICA (p = 0.031), high Beck Depression Inventory - BDI scores (p = 0.037), mourning a deceased child (p = 0.001), and having committed armed robbery to obtain crack (p = 0/020). Lower likelihood of low SSI was associated with 9 or more years of schooling (p = 0.001), high social support (p < 0.001), high resilience (p < 0.001), having lost contact with parents (p = 0.032), history of hospitalization due to crack (p = 0.009), and history of sex to obtain crack (p = 0.009). The findings are clinically useful and highlight the issue's importance.

El artículo presenta las condiciones asociadas a marcadores deficitarios en elInventario de Habilidades Sociales (IHS) entre usuarios decrack de la Región Metropolitana de Porto Alegre, Río Grande do Sul, Brasil. Se trata de un estudio transversal, con una muestra de conveniencia de 519 individuos, entrevistados en 2011. El marcador deficitario en el IHS se produjo en un 52,8% de la muestra y no hubo diferencias en cuanto a estar o no consumiendo activamente crack, o en cuanto a estar no bajo supervisión médica. Tuvieron una probabilidad mayor de déficit en el IHS los consumidores de crack pre-contemplados o contemplados en elUniversity of Rhode Island Change Assessment - URICA (p = 0,031), con marcadores elevados en Beck Depression Inventory - BDI (p = 0,037), quienes vivieron luto por un hijo (p = 0,001) y los que ya robaron para obtener crack (p = 0,020). Con probabilidad disminuida estaban quienes tenían una escolaridad de 9 años o más (p = 0,001), apoyo social elevado (p < 0,001), resiliencia elevada (p < 0,001), con historial de haber perdido el contacto con sus padres (p = 0,032), ya habiendo sido hospitalizado por crack (p = 0,009) y que ya informaron haber mantenido relaciones sexuales para obtener crack (p = 0,009). Los hallazgos tienen utilidad clínica y muestran la importancia del tema.