Factor structure of the brief psychiatric rating scale-expanded among outpatients with psychotic disorders in five Southeast European countries: evidence for five factors.

The Brief Psychiatric Rating Scale (BPRS) is a useful tool for measuring the severity of psychopathological symptoms among patients with psychosis. Many studies, predominantly in Western countries, have investigated its factor structure. This study has the following aims: (a) to further explore the factor structure of the BPRS-Expanded version (BPRS-E, 24 items) among outpatients with psychotic disorders in Southeast European countries; (b) to confirm the identified model; and (c) to investigate the goodness-of-fit of the three competing BPRS-E factor models derived from previous studies. The exploratory factor analysis (EFA) produced a solution with 21 items grouped into five factors, thus supporting the existence of a fifth factor, i.e., Disorganization. A follow-up confirmatory factor analysis (CFA) revealed a 19-item model (with two items removed) that fit the data well. In addition, the stability of two out of three competing factor models was confirmed. Finally, the BPRS-E model with 5 factors developed in this cross-national study was found to include a greater number of items compared to competing models.

Psychometric Evaluation of the Farsi Version of the Surgical Anxiety Questionnaire.

PURPOSE: The aim of this study was to evaluate the psychometric properties of the Farsi version of the Surgical Anxiety Questionnaire. DESIGN: Cross-sectional study. METHODS: This study was performed on 402 patients who were candidates for elective surgery in Mashhad [East Iran) hospitals in winter 2021. After forward-backward translation, face and content validity checks were performed qualitatively. The construct validity was assessed by exploratory and confirmatory factor analysis. Data analysis was performed with SPSS 16 and AMOS 26. FINDINGS: In exploratory factor analysis, two factors were extracted: concerns about surgery and anesthesia; and postdischarge concerns, which explained 52% of the total variance. The Cronbach's alpha for the entire questionnaire was 0.91 and for the subscales ranged from 0.80 to 0.87. The final model had a good fit as determined by confirmatory factor analysis. CONCLUSIONS: The Farsi version of the surgical anxiety questionnaire has acceptable validity and reliability. The existence of this scale measuring domain-specific anxiety allows for further research in this area.

The COVID-19 fear, anxiety, and resilience among emergency nurses.

Background: Besides physical complications, COVID-19 is associated with psychological issues such as fear and anxiety. High resilience in nurses enables them to adopt positive coping mechanisms and successfully operate in the stressful environment of COVID-19 wards. The present study aimed to evaluate the correlation between COVID-19 fear and anxiety with resilience in the emergency nurses of the hospital affiliated with Kurdistan University of Medical Sciences (west of Iran) in 2021. Materials and methods: This cross-sectional study was conducted on 295 emergency nurses of selected hospitals in Kurdistan province, Iran, in 2021. Data were collected using a demographic questionnaire, Fear of COVID-19 Scale (FCV-19S), Corona Disease Anxiety Scale (CDAS), and Connor-Davidson Resilience Scale (CD-RISC). Data analysis was performed in R software version 3.6.3. Results: The mean scores of resilience, COVID-19 fear, and COVID-19 anxiety were 55.07 ± 19.82 (ranging from 0 to 100), 20 ± 7.37 (ranging from 7 to 35) and 36.48 ± 13.21 (ranging from 18 to 54) respectively. There was a negative and significant correlation between resilience with COVID-19 fear (r = -0.449, p = 0.001), COVID-19 anxiety (r = 0.458, p = 0.001). A significant correlation was observed between COVID-19 fear and anxiety, which indicated that if the other demographic variables remained unchanged, a one-unit increase in COVID-19 fear and anxiety decreased the mean resilience score by -0.66 (P = 0.008) and -0.34 (P = 0.015), respectively. Conclusion: COVID-19 fear and anxiety were significantly correlated. Therefore, providing training courses for promoting resilience could reduce the fear and anxiety of nurses during the COVID-19 pandemic.

Validation and psychometric properties of the Farsi version of the fear of COVID-19 scale among pregnant women.

OBJECTIVE: The Covid-19 epidemic, which has become the most challenging issue for health organizations and governments, has led to panic among people, especially pregnant women. The aim of this study was to investigate the psychometric properties of the Persian version of the Fear of COVID-19 Scale (FCV-19S) on a sample of Iranian pregnant women. METHODS: This cross-sectional study was performed on 500 pregnant women referred to gynecology offices in Tehran. Construct validity was performed using exploratory (with maximum likelihood method and Promax rotation) and confirmatory factor analysis. Cronbach's alpha and McDonald omega coefficients were used to examine internal consistency. RESULTS: The mean age of the women was 28.98 (SD = 5.86) years. In exploratory factor analysis, two factors were extracted-emotional response and physiological response, which together explained 65.21% of the total variance of fear of Covid-19. In the confirmatory factor analysis, the final model had a good fit: CMIN/df = 1.515, goodness of fit index (GFI) = 0.981, adjusted goodness of fit index (AGFI) = 0.956, normed fit index (NFI) = 0.979, Incremental Fit Index (IFI) = 0.993, comparative fit index (CFI) = 0.993, and root mean square error of approximation (RMSEA) = 0.045 (95% CI: 0.001-0.085). Cronbach alpha and McDonald omega coefficients for the first factor were 0.874 and 0.878, and for the second factor were 0.853 and 0.854, respectively. CONCLUSION: The FCV-19S in pregnant women has a good construct validity and can be used in various studies.

Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe.

BACKGROUND: DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders. AIMS: To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project. METHOD: Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis. RESULTS: Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention. CONCLUSIONS: Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.

Validation of the persian version of the COVID-19 prevention, recognition and home-management self-efficacy scale.

INTRODUCTION: Adopting preventive behaviors and following the guidelines for controlling the COVID-19 epidemic depend on people's self-efficacy in carrying out these behaviors and instructions. The aim of this study was to investigate the psychometric properties of the Persian version of the COVID-19 Self-Efficacy Scale (COVID-19 SES, Hernández-Padilla et al., 2020). MATERIAL AND METHODS: This cross-sectional study was performed in a group of 400 people who were residents of the city of Asadabad in western Iran from December 2020 to January 2021. The participants were selected using a convenience sampling method. Face and content validity was assessed qualitatively based on feedback from the participants and experts, and the necessary changes were applied to the final version of the questionnaire. For construct validity, exploratory factor analysis (n=200) and confirmatory factor analysis (n=200) were performed. Internal consistency was expressed as Cronbach's alpha coefficient. Relative stability was assessed using the intraclass correlation coefficient (ICC), and absolute stability was calculated through examination of standard error of measurement (SEM). RESULTS: In exploratory factor analysis, three factors of prevention, symptom recognition, and homemanagement of COVID-19 were extracted that together explained 71.35% of the total variance. The internal consistency of the whole instrument was 0.955 and its three dimensions were 0.894, 0.916 and 0.955, respectively. In addition, an ICC of 0.986 (95% CI: 0.975-0.993, p=0.001) was found. In the confirmatory factor analysis, comparative and parsimonious fit indices were excellent, and absolute fit indices were moderate. CONCLUSIONS: The Persian version of the COVID-19 SES has good validity and reliability and can be used to measure self-efficacy in prevention, symptoms recognition, and home-management of COVID-19.

Corrigendum: Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue.

[This corrects the article DOI: 10.3389/fpsyt.2021.785144.].

Non-pharmacological interventions for schizophrenia-analysis of treatment guidelines and implementation in 12 Southeast European countries.

This study aimed to analyze treatment guidelines of 12 SEE countries to identify non-pharmacological interventions recommended for schizophrenia, explore the evidence base supporting recommendations, and assess the implementation of recommended interventions. Desk and content analysis were employed to analyze the guidelines. Experts were surveyed across the 12 countries to assess availability of non-pharmacological treatments in leading mental health institutions, staff training, and inclusion in the official service price list. Most SEE countries have published treatment guidelines for schizophrenia focused on pharmacotherapy. Nine countries-Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Moldova, Montenegro, North Macedonia, and Serbia-included non-pharmacological interventions. The remaining three countries-Kosovo (UN Resolution), Romania, and Slovenia-have not published such treatment guidelines, however they are on offer in leading institutions. The median number of recommended interventions was seven (range 5-11). Family therapy and psychoeducation were recommended in most treatment guidelines. The majority of recommended interventions have a negative or mixed randomized controlled trial evidence base. A small proportion of leading mental health institutions includes these interventions in their official service price list. The interventions recommended in the treatment guidelines seem to be rarely implemented within mental health services in the SEE countries.

Factor structure and internal consistency of the Clinical Assessment Interview for Negative Symptoms (CAINS) on a sample of persons with psychotic disorders in Bosnia and Herzegovina.

The assessment of negative symptoms is crucial for development of adequate therapeutic interventions. This is a challenging task due to complex clinical presentation and lack of reliable and valid instruments. This study examined the psychometric characteristics of the Clinical Assessment Interview for Negative Symptoms (CAINS). The sample consisted of 81 persons with schizophrenia or schizoaffective disorder recruited from two health institutions in the Sarajevo Canton: the Clinical Center of the University of Sarajevo and the Psychiatric Hospital of the Sarajevo Canton. The 13 CAINS items grouped into four factors (expression, motivation and satisfaction in the recreational domain, motivation and satisfaction with social relationships, motivation and satisfaction with job and education). The four-factor solution accounted for 87.83% of the variance of manifest items. The reliabilities of extracted factors were as follows: for motivation and satisfaction with social relationships α = 0.897, for motivation and satisfaction with job and education α = 0.961, for Motivation and satisfaction in the recreation domain α = 0.981, and for expression α = 0.938. The highest correlation between factors was found between Motivation and satisfaction with recreation and Motivation and satisfaction with social relationships. On the other hand, the lowest correlation was found between motivation and satisfaction with social relations and motivation and satisfaction with job and education. In conclusion, the study showed that the latent structure of CAINS is adequate, clearly interpretable, and consisted of four factors. The measure can be used for assessment of the negative symptoms in outpatients with psychosis in Bosnia and Herzegovina.

Non-pharmacological treatments for schizophrenia in Southeast Europe: An expert survey.

BACKGROUND: Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in South-East European countries (SEE). OBJECTIVE: To explore mental health care experts' opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE. METHODS: An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo†, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received non-pharmacological interventions, type of services delivering these interventions, and expert views of availability barriers. RESULTS: In eight countries, the estimated percentage of people with schizophrenia who receive non-pharmacological treatments was below 35%. The primary explanations for the low availability of non-pharmacological treatments were: lack of human and financial resources, lack of training for clinicians, and pharmacotherapy dominance in the treatment for schizophrenia. CONCLUSION: Lack of personal and institutional resources and state support were identified as primary obstacles to staff training and delivering non-pharmacological treatments to people with schizophrenia on individual and systemic levels, respectively. This evidence can be used to improve holistic, evidence-based treatment for schizophrenia in the SEE countries.

Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue.

Background: Negative symptoms are core features of schizophrenia and very challenging to be treated. Identification of their structure is crucial to provide a better treatment. Increasing evidence supports the superiority of a five-factor model (alogia, blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS Consensus); however, previous data primarily used the Brief Negative Symptoms Scale (BNSS). This study, including a calibration and a cross-validation sample (n = 268 and 257, respectively) of participants with schizophrenia, used the Clinical Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure of negative symptoms and to test theoretical and data-driven (from this study) models of negative symptoms. Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor, and hierarchical factor) models and two EFA-derived models. Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated model from EFA consisting of five factors (expression, motivation for recreational activities, social activities, vocational, and close/intimate relationships) was an excellent fit to the data (comparative fix index = 0.97, Tucker-Lewis index = 0.96, and root mean square error of approximation = 0.07). Conclusions: This study cannot support recent data on the superiority of the five-factor model defined by the NMIH-MATRICS consensus and suggests that an alternative model might be a better fit. More research to confirm the structure of negative symptoms in schizophrenia, and careful methodological consideration, should be warranted before a definitive model can put forward and shape diagnosis and treatment of schizophrenia.

Implementing a digital mental health intervention for individuals with psychosis - a multi-country qualitative study.

BACKGROUND: Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources. METHODS: Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts. RESULTS: Six major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains. CONCLUSIONS: This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.

Examination of the psychometric properties of the persian version of the COVID-19-impact on Quality of Life Scale.

INTRODUCTION: As a result of high transmission and mortality rates, the Covid-19 pandemic has led to a worldwide health crisis, isolation, and widespread fear, therefore negatively influencing people's quality of life (QOL). The goal of the present study was to examine the psychometric properties (validity and reliability) of the Persian version of the COVID-19-Impact on Quality of Life (COV19-QoL) scale. METHODS: After translating the scale using the forward-backward method, face and content validly was qualitatively assessed. Then the scale was distributed to 488 individuals from the general population via online platforms. Construct validity was assessed using exploratory (EFA) and confirmatory (CFA) factor analysis. In addition, internal consistency was examined using Cronbach's alpha coefficient and McDonald's omega, relative stability was assessed using interclass correlation coefficient (ICC), and absolute stability was calculated through examination of standard error of measurement. RESULTS: The EFA revealed one factor that explained 55.96% of the total variance of the scale. Internal consistencies of 0.823 and 0.882 were found using Cronbach's alpha coefficient and McDonald's omega, respectively. In addition, an ICC of 0.837 (with a two-week interval) was found. Covid-19 had a greater impact on the QOL of healthy participants than that of those with underling conditions (p = 0.004), and also on the QOL of single participants than that of married ones (p = 0.032). CONCLUSION: The Persian version of the COV19-QoL is a valid and reliable instrument that can be used to examine the impact of Covid-19 on QOL.

Trends in suicide mortality in Montenegro from 2000 to 2018.

BACKGROUND: This is an ecological study that analyzes suicides committed in Montenegro during the 2000-2018 period, taking into account gender, age and methods of suicide. METHODS: Suicide rates and trends up until 2009 were obtained from the official registers of Bureau of Statistics of Montenegro (MONSTAT) while the later data were obtained from the Department of Interior's. MONSTAT also provided data on unemployment and average salary. As per statistical methods, descriptive and correlations were calculated. RESULTS: The average crude suicide rate was 21.06, for males 29.93 and for females 12.42. Crude suicide rates were not associated with unemployment rate or average salary. However, the unemployment rate was significantly correlated with lethal methods of suicide, namely suicide by firearm and by hanging. Average net salary was negatively correlated with suicide by firearm. CONCLUSIONS: The ratio of males and females who committed suicide was 2.41. In the last three years, this ratio continues to rise in favor of males (reaching 4.29 in 2018). This could be explained by specific cultural features where males are expected to be the main financial contributors to the households. The labor market of Montenegro does not offer adequate opportunities to set and maintain a stable economic situation which puts additional pressure and stress on males.