Discrimination starts with adjectives.

Discrimination starts with adjectives.

Cultural psychiatry: beyond DSM-5.

BACKGROUND: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. OBJECTIVE: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. METHOD: A narrative review was carried out of the most relevant articles in the area. RESULTS: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. CONCLUSIONS: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

Psiquiatría cultural: más allá del DSM-5 / Cultural psychiatry: beyond DSM-5

RESUMEN Introducción: La psiquiatría cultural evalúa las manifestaciones, los síntomas de sufrimiento emocional o los trastornos mentales en los distintos contextos culturales; asimismo, aborda problemas sociales como la pobreza, la violencia y las desigualdades entre grupos o clases sociales. Objetivo: Presentar una revisión narrativa de los aspectos culturales más relevantes en el contexto de la práctica clínica en psiquiatría y proponer algunas alternativas para mejorar la competencia cultural de los profesionales de la salud. Métodos: Se llevó a cabo una revisión narrativa de los artículos más relevantes en el área. Resultados: Habitualmente se utiliza la perspectiva cultural para explicar diferencias en las prevalencias que se observan en algunos trastornos mentales según el sexo y la localización geográfica. Las diferencias culturales modifican la expresión de distress o sufrimiento emocional, y esto puede reducir la precisión y afectar a la confiabilidad de las clasificaciones y la validez de los diagnósticos actuales usados en psiquiatría. La Asociación Psiquiátrica Americana, en la clasificación más reciente, revisó los trastornos asociados con la cultura pero solo incluyó un reducido número de situaciones. La formación médica y la psiquiatría deben responder a las necesidades de comunidades diversas y proporcionar un cuidado de calidad mediante el desarrollo de competencias transculturales en los currículos. Conclusiones: Se debe considerar que las diferencias culturales modifican la expresión de distress y con ello se menoscaba la validez y la confiabilidad de los diagnósticos hegemónicos en distintos contextos culturales. En un mundo cada vez más globalizado, es posible que futuras clasificaciones diagnósticas omitan los «síndromes culturales¼.

ABSTRACT Background: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method: A narrative review was carried out of the most relevant articles in the area. Results: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

Psychometric Properties of the Five-Item Francis Attitude Towards Christianity Scale in Colombian Psychiatric Outpatients.

This study aimed to know the psychometric properties of the five-item Francis scale of the attitude towards Christianity (Francis-5) by assessing psychiatric outpatients in Santa Marta, Colombia. A sample of 260 adult patients participated. The exploratory and confirmatory factor analyses revealed an excellent one-dimensional structure with high internal consistency. It was concluded that the Francis-5 exhibited good indicators of validity and reliability in Colombian psychiatric outpatients.

Review of cases, case series and prevalence studies of zoophilia in the general population. / Revisión de casos, series de casos y estudios de prevalencia de zoofilia en la población general.

BACKGROUND: Information about the frequency of zoophilic behaviour in the general population is scarce. OBJECTIVE: To review cases, case series and prevalence studies of zoophilia in adults in the general population. METHODS: A review of publications was carried out in MEDLINE via PubMed, Scopus and the Biblioteca Virtual en Salud [Virtual Health Library] ranging from January 2000 to December 2017. RESULTS: Thirteen papers were reviewed (ten case reports, two case series and one cross-sectional study). Twelve patients were described, the case series totalled 1,556 people and the cross-sectional study included 1,015 participants and reported a prevalence of zoophilic behaviour of 2%. CONCLUSIONS: Information on the prevalence of zoophilic behaviour in the general population is limited. The Internet will probably be a valuable tool for further investigating these behaviours in coming years.

Revisión de casos, series de casos y estudios de prevalencia de zoofilia en la población general / Review of cases, case series and prevalence studies of zoophilia in the general population

RESUMEN Introducción: El conocimiento de la frecuencia de comportamientos zoofílicos en la población general es escaso. Objetivo: Revisar casos, series de casos y estudios de prevalencia de zoofilia en adultos de la población general. Métodos: Se realizó una revisión en las bases de datos de MEDLINE, a través de PubMed, Scopus y la Biblioteca Virtual en Salud de publicaciones desde enero de 2000 hasta diciembre de 2017. Resultados: Se revisaron 13 trabajos (10 informes de casos, 2 series de casos y 1 estudio transversal). Entre los casos se describió a 12 pacientes; las series de casos sumaron a 1.556 personas y el estudio transversal incluyó a 1.015 participantes e informó de una prevalencia de comportamientos zoofílicos del 2%. Conclusiones: Es escasa la información sobre la prevalencia de comportamientos zoofílicos en la población general. Es probable que internet permita investigar mejor estos comportamientos en los próximos años.

ABSTRACT Background: Information about the frequency of zoophilic behaviour in the general population is scarce. Objective: To review cases, case series and prevalence studies of zoophilia in adults in the general population. Methods: A review of publications was carried out in MEDLINE via PubMed, Scopus and the Biblioteca Virtual en Salud [Virtual Health Library] ranging from January 2000 to December 2017. Results: Thirteen papers were reviewed (ten case reports, two case series and one cross-sectional study). Twelve patients were described, the case series totalled 1,556 people and the cross-sectional study included 1,015 participants and reported a prevalence of zoophilic behaviour of 2%. Conclusions: Information on the prevalence of zoophilic behaviour in the general population is limited. The Internet will probably be a valuable tool for further investigating these behaviours in coming years.

Short Homophobia Scale (SHS): desempenho em estudantes universitárias de enfermagem / Short Homophobia Scale (SHS): desempeño en estudiantes universitarias de enfermería / Homophobia Short Scale (HSS): Performance in female nursing students

Resumo Objetivo: Estimar o desempenho psicométrico da escala de homofobia Short Homophobia Scale (SHS) em estudantes de enfermagem do sexo feminino de uma universidade em Cartagena, Colômbia. Métodos: Desenhou-se um estudo de validação que incluiu 419 estudantes de enfermagem do sexo feminino cursando do primeiro ao oitavo semestre com 18 a 29 anos de idade (M=20,9; DP=2,9). As estudantes preencheram os quatro itens da SHS. Observou-se que o instrumento tem consistência interna (alfa de Cronbach e ômega de McDonald) e dimensionalidade (análise fatorial confirmatória, AFC). Resultados: Considerou-se a consistência interna aceitável (Cronbach 0,68 e McDonald 0,69). Na AFC, um fator retido explicou 51,5% da variância. Os indicadores globais de qualidade do ajuste foram aceitáveis (raiz quadrada da média do erro de aproximação = 0,08; IC = 90% 0,03 a 0,14; índice de ajuste comparativo = 0,98; índice de Tucker-Lewis = 0,94; e raiz quadrada média residual padronizada = 0,02). Os escores foram semelhantes por etnia/raça e orientação política (p >0,001) e significativamente mais elevados em estudantes cristãs que em outras afiliações religiosas (p <0,001). Conclusão: Em estudantes de enfermagem do sexo feminino, o desempenho da escala SHS foi considerado aceitável pela consistência interna e pela observância de um fator, havendo também bons indicadores de dimensionalidade. É necessário pesquisar o desempenho em alunos do sexo masculino.

Resumen Objetivo: Estimar el desempeño psicométrico de la escala de homofobia Short Homophobia Scale (SHS) en estudiantes de enfermería de sexo femenino de una universidad en Cartagena, Colombia. Métodos: Estudio de validación que incluyó 419 estudiantes de enfermería de sexo femenino, cursando desde el primer al octavo semestre, de 18 a 29 años de edad (M=20,9; DP=2,9). Las estudiantes completaron los cuatro ítems de la SHS. Se observó que el instrumento tiene consistencia interna (alfa de Cronbach y omega de McDonald) y dimensionalidad (análisis factorial confirmatorio, AFC). Resultados: La consistencia interna fue considerada aceptable (Cronbach 0,68 y McDonald 0,69). En el AFC, un factor retenido fue el motivo del 51,5 % de varianza. Los indicadores globales de calidad del ajuste fueron aceptables (raíz cuadrada del promedio del error de aproximación = 0,08; IC = 90 % 0,03 a 0,14; índice de ajuste comparativo = 0,98; índice de Tucker-Lewis = 0,94; y raíz cuadrada promedio residual estándar = 0,02). La puntuación fue semejante por etnia/raza y orientación política (p>0,001) y significativamente más elevada en estudiantes cristianas que en otras religiones (p>0,001). Conclusión: El desempeño de la escala SHS en estudiantes de enfermería de sexo femenino fue considerado aceptable por la consistencia interna y por el cumplimiento de un factor. También se observaron buenos indicadores de dimensionalidad. Es necesario estudiar el desempeño en alumnos de sexo masculino.

Abstract Objective: To estimate the psychometric performance of the Homophobia Short Scale (HSS) in female nursing students in a university in Cartagena, Colombia. Method: A validation study was designed in which 419 female nursing students from the first to the eighth semester participated, aged between 18 and 29 years (M=20.9, SD=2.9). The students completed all four items of the HSS. Internal consistency was found (Cronbach's alpha and McDonald's omega) and dimensionality (confirmatory factor analysis, CFA). Results: The internal consistency was acceptable (Cronbach of 0.68 and McDonald of 0.69) and in the CFA one factor was retained which accounted for 51.5% of the variance, with acceptable global indicators of goodness of fit (the root of the mean square error of approximation =0.08, CI=90% 0.03-0.14, Comparative Fit Index=0.98, Tucker-Lewis Index=0.94, and standardized mean square residual=0.02). The scores were similar, according to ethnic-race and political orientation (p>0.001) and significantly higher in Christians than in other religious affiliations (p<0.001). Conclusion: In female nursing students, the HSS shows an acceptable performance in internal consistency and one factor, with good dimensionality indicators. It is necessary to know this performance in male nursing students.

Dimensionalidad, validez nomológica y consistencia interna de la escala breve de Davidson para estrés postraumático en estudiantes de Santa Marta, Colombia / Dimensionality, nomological validity and internal consistency of the brief Davidson scale for post-traumatic stress in students from Santa Marta, Colombia / Dimensionalidade, validade nomológica e consistência interna da escala abreviada de Davidson para estresse pós-traumático em estudantes de Santa Marta, Colômbia

Resumen Objetivo: Conocer la dimensionalidad, la validez nomológica y la consistencia interna de la escala breve de Davidson para estrés postraumático en estudiantes de media vocacional de Santa Marta, Colombia. Metodología: En el segundo semestre de 2018, un total de 1462 estudiantes de décimo y undécimo grado, entre 13 y 17 años (M = 16,0; de = 0,8), 60,3 % de sexo femenino, diligenció la escala breve de Davidson para estrés postraumático. Se realizaron análisis factorial exploratorio y confirmatorio. Se calculó la consistencia interna de la dimensión, con los coeficientes alfa de Cronbach y omega de McDonald. Resultados: En el análisis factorial exploratorio, la escala breve de Davidson para estrés postraumático mostró Kaiser-Meier-Olkin = 0,714, chi cuadrado de Barttlet = 783,3 (gl= 6; p= 0,001), y valor propio de 1,99, que explicó el 49,7 % de la varianza. En el análisis factorial confirmatorio, chi cuadrado = 5,921; gl= 2; p= 0,052; raíz del cuadrado medio del error de aproximación = 0,037 (ic 90 % 0,000-0,072); índice comparativo de ajuste = 0,995; índice de Tucker-Lewis = 0,985 residual cuadrada media estandarizada = 0,011. El alfa de Cronbach fue 0,66, y la omega de McDonald, 0,69. Conclusiones: La escala breve de Davidson para estrés postraumático es unidimensional, con aceptable consistencia interna.

Abstract Objective: To determine the dimensionality, nomological validity and internal consistency of the brief Davidson scale for post-traumatic stress in average vocational students from Santa Marta, Colombia. Methodology: In the second semester of 2018, a total of 1,462 tenth and eleventh grade students aged between 13 and 17 years old (M = 16.0; DE = 0.8), 60.3% female, filled out the brief Davidson scale for post-traumatic stress. Exploratory and confirmatory factor analyses were performed. The internal consistency of the dimension was calculated with Cronbach's alpha and McDonald's omega coefficients. Results: In the exploratory factor analysis, the brief Davidson scale for post-traumatic stress showed Kaiser-Meier-Olkin = 0.714, Barttlet's chi square = 783.3 (gl = 6; p = 0.001), and an eigenvalue of 1.99, which explained 49.7% of the variance. In the confirmatory factor analysis, chi square = 5.921; gl = 2; p = 0.052; root of the mean square of the error of approximation = 0.037 (CI 90% 0.000-0.072); comparative adjustment index = 0.955; Tucker-Lewis index = 0.985 standardized mean square residual = 0.011. Cronbach's alpha was 0.66, and McDonald's omega was 0.69. Conclusions: The brief Davidson scale for post-traumatic stress is one-dimensional, with acceptable internal consistency.

Resumo Objetivo: Conhecer a dimensionalidade, a validade nomológica e a consistência interna da escala abreviada de Davidson para estresse pós-traumático em estudantes dos últimos dois anos do ensino médio de Santa Marta, Colômbia. Metodologia: No segundo semestre de 2018, um total de 1462 alunos dos anos 10º e 11º, entre 13 e 17 anos (M = 16,0; DE = 0,8), 60,3 % de gênero feminino, preencheram a escala abreviada de Davidson para estresse pós-traumático. Análises fatorial exploratória e confirmatória foram realizadas. A consistência interna da dimensão foi calculada, com os coeficientes alfa de Cronbach e ômega de McDonald. Resultados: Na análise fatorial exploratória, a escala abreviada de Davidson para estresse pós-traumático mostrou Kaiser-Meier-Olkin = 0,714, chi quadrado de Barttlet = 783,3 (gl = 6; p = 0,001), e valor próprio de 1,99, que explicou 49,7 % da variância. Na análise fatorial confirmatória, o chi quadrado = 5,921; gl = 2; p = 0,052; raiz do quadrado médio do erro de aproximação = 0,037 (IC 90 % 0,000-0,072); Índice comparativo de ajuste = 0,995; Índice Tucker- Lewis = 0,985 residual quadrada média estandardizada = 0,011. O alfa de Cronbach foi 0,66, e o ômega do McDonald foi 0,69. Conclusões: A escala abreviada de Davidson para estresse pós-traumático é unidimensional, com consistência interna aceitável.

Barriers to access to mental health services among Colombia outpatients.

BACKGROUND: Access barriers are all situations or conditions that limit seeking, receiving or enjoying benefits offered by the health system. This set of situations translates into underutilization of the services offered. In Colombia, there is little information about barriers to accessing medical care in general, and even less in the specific field of mental health. AIM: To determine the barriers to accessing psychiatric care in outpatients in Santa Marta, Colombia. METHODS: The authors designed a cross-sectional study with a non-probability sample of adult patients who consulted between August and December 2018. The barriers to access were measured with a 20-item version of the Barriers to Access to Care Evaluation (BACE) scale. RESULTS: A total of 247 patients participated; they were between 18 and 82 years (mean (M) = 47.5, standard deviation (SD) = 13.9). A total of 69 (27.9%) patients classified as having major attitudinal barriers; 62 (25.1%) patients, major barriers related to stigma-discrimination; and 41 (16.6%) patients, major instrumental barriers. Concerning the associated variables, age less than 45 years was related to major attitudinal barriers (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.6-5.5), major barriers related to stigma-discrimination (OR = 3.8, 95% CI 2.0-7.2) and major instrumental barriers (OR = 2.7, 95% CI 1.3-5.3). Men reported major instrumental barriers more frequently than women (OR = 2.8, 95% CI 1.3-5.8). CONCLUSION: The major attitudinal, related to stigma-discrimination and instrumental barriers to access frequently delay a consultation with mental health services. Actions are necessary to reduce barriers to accessing mental health care.

Asociación entre las tasas de homicidio y de suicidio en Colombia, 2017 / Association between homicide and suicide rates in Colombia, 2017

El contexto socioeconómico guarda relación significativa con las tasas de homicidio y de suicidio1. Por un lado, se plantea que las condiciones socioeconómicas adversas incrementan las tasas de homicidio y de suicidio en una población por el incremento de los comportamientos agresivos y violentos tanto hacia otros como contra sí mismos2. Y por el otro, se considera que el malestar socioeconómico solo incrementa los homicidios, con reducción o mantenimiento de la tasa de suicidio, lo que resulta en aumento de la proporción entre homicidios y suicidios, es decir, en países con situación socioeconómica favorable, se reducen los homicidios y se elevan los casos de suicidios porque, si no se encuentra una causa externa al malestar, como desempleo o pobreza, la violencia hacia a uno mismo se multiplica3. De la misma manera, se postula que las situaciones de conflictos armados, o guerras propiamente dichas, afectan a la tasa de suicidios; las muertes por suicidio se reducen significativamente y las muertes por la guerra se multiplican de modo exponencial.

The socio-economic context is significantly related to homicide and suicide rates1 . On the one hand, it is argued that adverse socio-economic conditions increase homicide and suicide rates in a population by increasing aggressive and violent behaviour both towards others and towards oneself2. On the other hand, it is considered that socio-economic distress only increases homicides, with a reduction or maintenance of the suicide rate, which results in an increase in the ratio between homicides and suicides, i.e. in countries with a favourable socio-economic situation, homicides are reduced and cases of suicide increase because, if no external cause of the distress is found, such as unemployment or poverty, violence towards oneself multiplies3. In the same way, it is postulated that situations of armed conflict, or wars per se, affect the suicide rate; suicide deaths are significantly reduced and war deaths multiply exponentially4.

El papel de los médicos generales en la psiquiatría en Colombia / The role of general practitioners in psychiatry in Colombia

En Colombia, según el más reciente estudio de salud mental en la población general, la frecuencia de trastornos mentales alguna vez en la vida es del 9,1%; del 4% durante el año más reciente y 1,6% en el último mes. Para una población proyectada de 50,4 millones de habitantes, se estima que durante el mes más reciente 800.000 ciudadanos colombianos presentaron alguna necesidad de atención en salud mental. Sin embargo, el país tiene entre 1500 y 2000 psiquiatras activos, de tal suerte que se cuenta con un psiquiatra por cada 25.200 a 33.600 habitantes. A lo anterior se suma que la totalidad de los psiquiatras ejercen en las grandes capitales.

Trastornos por consumo de sustancias: entre las inequidades y el estigma / Substance use disorders: Between inequities and stigma

Las personas que reúnen criterios para trastornos por consumo de sustancias (TCS) son víctimas, con frecuencia, del complejo estigma-discriminación (CED), no solo por parte de la sociedad en general, sino también por profesionales de la salud y por el autoestigma. No obstante, por la relación de los TCS con factores biológicos predisponentes y condiciones sociales adversas, se considera que estos son "autoinducidos". Asimismo, se conoce que en los TCS se presentan cambios biológicos, psicológicos o del desarrollo que menoscaban la decisión de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas físicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aún más la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario diseñar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos.

People who meet criteria for substance use disorders (SUD) are often victims of the stigma-discrimination complex (SDC) not only by the society in general, but also by health professionals and the presence of self-stigma. However, because of the relationship of the SUD with predisposing biological factors and adverse social conditions, SUD are considered 'self-induced'. Likewise, it is known that SUD presents biological, psychological or developmental changes that undermine the decision of abandonment and persistence in consumption, despite negative physical, emotional and social consequences. The SDC related to SUD is a stressor that deteriorates the quality of life of consumers and, at the same time, it is configured as a barrier to access to health services. It is necessary to design and investigate the effectiveness of strategies to reduce SDC related to SUD in different populations and settings.