A multicentric study on stigma towards people with mental illness in health sciences students.

BACKGROUND: There is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology. METHODS: A comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians' Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain. RESULTS: We found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour. CONCLUSIONS: Our study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress.

Wegner's Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a 'rebound' of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.

Pain interference in persons with spinal cord injury: classification of mild, moderate, and severe pain.

UNLABELLED: Pain intensity is commonly measured by patient ratings on numerical rating scales (NRS). However, grouping such ratings into categories may be useful for guiding treatment decisions or interpreting clinical trial outcomes. The purpose of this study was to examine pain intensity classification in 2 samples of persons with spinal cord injuries (SCI) and chronic pain. The first sample (n = 307) rated the average intensity and activity interference of pain in general, and the second sample (n = 174) rated their worst pain problem. Pain intensity was categorized as mild, moderate, or severe using 4 possible classification systems; analyses were performed to determine the classification system that best distinguished the pain intensity groups in terms of activity interference. In both samples, the optimal mild/moderate boundary was lower (mild = 1-3 on a 0-10 NRS scale) than that reported previously for individuals with other pain problems. The possibility that pain may interfere with activity at lower levels for individuals with SCI requires further exploration. The moderate/severe boundary suggested by previous research was confirmed in only one of the samples. Implications for the assessment of pain intensity and functioning in persons with SCI and pain are discussed. PERSPECTIVE: Although pain in individuals with SCI is common, more research is needed regarding its characteristics and treatment. This study sought to develop an empirically based classification system for mild, moderate, and severe pain that could be useful for applying clinical treatment guidelines and for interpreting the results of much-needed clinical trials.

Reliability and validity of a self-report FIM (FIM-SR) in persons with amputation or spinal cord injury and chronic pain.

OBJECTIVE: To evaluate the reliability and validity of a self-report FIM (FIM-SR) in two samples of adults with disabilities. DESIGN: Participants in a clinical trial of amitriptyline for pain (n = 84 with spinal cord injury [SCI], n = 38 with amputation) provided responses to the study measures via telephone interview. Reliability was estimated using Cronbach's alpha and test-retest correlation coefficients, and validity was examined by comparing FIM-SR scores with the Craig Handicap Assessment and Reporting Technique (CHART) by comparing the CHART scores between the participants with SCI and amputation, and by comparing CHART scores between subjects with different levels of SCI. RESULTS: In the SCI sample, the FIM-SR demonstrated adequate reliability, and correlational analyses supported the validity of the FIM-SR motor scales. In addition, the FIM-SR motor scales discriminated subjects with different diagnoses (SCI vs. amputation) and injury levels (paraplegia vs. tetraplegia). The psychometric properties of the entire FIM-SR in the amputation sample and of the FIM-SR cognitive scales in the SCI sample were difficult to determine due to a ceiling effect in which these scale scores were skewed toward the top end of the range. CONCLUSIONS: The FIM-SR motor scales and total FIM-SR score are reliable and valid measures of perceived functional independence in individuals with SCI. However, all of the FIM-SR scales in the amputation sample, and the FIM-SR cognitive scales in the SCI sample, seem to be less useful measures of functioning due to subjects reporting high levels of independence. The FIM-SR should be retested in amputation samples with more variable levels of functioning.

On the affective nature of chronic pain / La naturaleza afectiva del dolor crónico

The aim of the present study was to test if the Spanish Version of the McGill Pain Questionnaire (MPQ-SV) can account for differences between chronic and acute pain patients and to test the equality of Factor Structures in both samples. The sample was made up of 175 chronic pain patients and 176 acute pain sufferers. The mean scores of the Sensory, Affective and Total Subscales of the MPQ-SV, intercorrelations between subscales and reliability indexes were compared in both samples and a multisample confirmatory factor analysis was carried out. The chronic pain sample showed higher scores than the acute pain sample in all the MPQ-SV scales: affective, sensory and total. On the other side, the intercorrelations between the MPQ-SV scales and its reliability indexes were more intense in chronic than in acute patients. Finally, the factorial structure of MPQ-SV according to a tridimensional model, could not be generalized to acute and chronic pain samples. In conclusion, MPQ accounted the differences between chronic and acute pain, the emotional distress of chronic pain was translated into high scores to all the MPQ scales (AU)

El objetivo de este estudio fue contrastar si la versión española del Cuestionario de Dolor McGill (MPQ-SV) se muestra sensible a las diferencias entre pacientes con dolor agudo y pacientes con dolor crónico así como comprobar si la estructura factorial del cuestionario es generalizable a ambas muestras. La muestra estaba compuesta de 175 pacientes con dolor crónico y 176 pacientes con dolor agudo. Se llevó a cabo una comparación entre las puntuaciones medias de las subescalas (sensorial, afectiva y total), las correlaciones y los índices de fiabilidad de las mismas. También se realizó un análisis factorial confirmatorio multimuestra. Los pacientes de dolor crónico obtuvieron puntuaciones más altas que los pacientes con dolor agudo en todas las subescalas (sensorial y afectiva) y en la escala total. Por otro lado, las intercorrelaciones entre las subescalas y sus índices de fiabilidad fueron más altos cuando la muestra era de dolor crónico. Finalmente, de acuerdo con el modelo tridimensional que subyace a la creación del cuestionario, la estructura factorial del MPQ-SV no es generalizable de una muestra a otra. En conclusión, el MPQ es sensible a las diferencias entre dolor crónico y agudo. Se discute si la carga emocional del color crónico se traduce en altas puntuaciones en todas las subescalas del MPQ (AU)

Some empirical evidence regarding the validity of the Spanish version of the McGill Pain Questionnaire (MPQ-SV).

Despite the fact that the McGill Pain Questionnaire (MPQ) is a useful pain assessment tool with widespread acceptance, empirical analyses have questioned its validity because they have not consistently supported the three a priori factors that guided its construction. The Spanish version that has followed the most systematic and rigorous reconstruction process (Lázaro C, Bosch F, Torrubia R, Banos JE. The development of a Spanish Questionnaire for assessing pain: preliminary data concerning reliability and validity. Eur J Psychol Assess, 1994;10:145-151) lacks evidence to support its construct validity. In the present study, the internal structure of the Spanish version of the McGill Pain Questionnaire (Lázaro C, Bosch F, Torrubia R, Banos JE. The development of a Spanish Questionnaire for assessing pain: preliminary data concerning reliability and validity. Eur J Psychol Assess, 1994;10:145-151) was examined in a sample of 202 acute pain patients and 207 chronic pain patients. Confirmatory factor analyses were carried out to compare alternative models postulating different internal structures (one-factor model, the classic three-factor model, and the semantic model inspired by the alternative structure found by Donaldson in 1995 (Donaldson GW. The factorial structure and stability of the McGill Pain Questionnaire in patients experiencing oral mucositis following bone marrow transplantation. Pain 1995;62:101-109)). Results from the LISREL CFA analysis indicated that the semantic model fitted better than the other models. On the other hand, intercorrelations between scales were smaller than the reliability indexes. In relation to concurrent evidence, significant correlations (0.001) were found between each subscale and the criteria measurements of every pain dimension. Only the affective subscale presented discriminant validity. Evidence supports the validity of the affective and sensory subscales but not the evaluative scale.