Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis.

BACKGROUND: Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. METHODS: Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. RESULTS: A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. LIMITATIONS: The cross-sectional design does not allow determination of established causality. CONCLUSIONS: Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.

Psychiatric profiles in suicidal attempters: Relationships with suicide behaviour features.

BACKGROUND: Suicide constitutes a major health concern worldwide, being a significant contributor of death, globally. The diagnosis of a mental disorder has been extensively linked to the varying forms of suicidal ideation and behaviour. The aim of our study was to identify the varying diagnostic profiles in a sample of suicide attempters. METHODS: A sample of 683 adults (71.3% females, 40.10±15.74 years) admitted at a hospital emergency department due to a suicide attempt was recruited. Latent class analysis was used to identify diagnostic profiles and logistic regression to study the relationship between comorbidity profile membership and sociodemographic and clinical variables. RESULTS: Two comorbidity profiles were identified (Class I: low comorbidity class, 71.3% of attempters; Class II: high comorbidity class, 28.7% of attempters). Class I members were featured by the diagnosis of depression and general anxiety disorder, and low comorbidity; by contrast, the high comorbidity profile was characterized by a higher probability of presenting two or more coexisting psychiatric disorders. Class II included more females, younger, with more depressive symptoms and with higher impulsivity levels. Moreover, Class II members showed more severe suicidal ideation, higher number of suicide behaviours and a greater number of previous suicide attempts (p<.01, for all the outcomes), compared to Class I members. CONCLUSIONS: Psychiatric profiles may be considered for treatment provision and personalized psychiatric treatment in suicidal attempters as well as tackle suicide risk.

Clinical predictors and psychosocial risk factors of suicide attempt severity.

BACKGROUND: Suicide attempts are an important predictor of completed suicide and may differ in terms of severity of medical consequences or medical lethality. There is little evidence on serious suicide attempt (SSA) and very few studies have compared SSA with non-SSA. OBJECTIVE: The aim of this multisite, coordinated, cohort study was to analyze the role of clinical variables and the sociodemographic and psychological risk factors of SSA. METHOD: In this multisite, coordinated, cohort study, 684 participants (222 for the mild suicide attempt group, 371 for the moderate suicide attempt group and 91 for the SSA group) were included in the study. Ordinal regression models were performed to analyze the predictor variables of SSA. RESULTS: Early physical abuse (OR=1.231) and impulsivity (OR=1.036) were predictors of SSA, while depressive symptoms were associated with a lower risk of SSA. CONCLUSION: Environmental and psychological factors as physical abuse and impulsivity are related with severe suicide severity. These findings will help to develop strategies to prevent suicide and may be considered for the treatment and management of suicide.

Intervención basada en mindfulness a través de una app móvil para personas con cáncer colorrectal en espera de cirugía: ensayo clínico aleatorizado / Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial

Introducción: El cáncer colorrectal representa el tercer cáncer con mayor incidencia en ambos sexos. Un tercio de los pacientes con cáncer experimentan sintomatología ansiosa o depresiva. El objetivo de este estudio fue evaluar la eficacia de una intervención de reducción de estrés basada en mindfulness a través de una aplicación móvil (En calma en el quirófano). Método: Es un ensayo controlado, aleatorizado, con evaluador ciego y multicéntrico, que compara la eficacia de una aplicación de entrenamiento en mindfulness para móviles (rama experimental) con tratamiento habitual (rama control), en 3tiempos de medida (T0 o línea base, T1 o alta a domicilio, T2 o un mes tras cirugía). Se evaluó la sintomatología ansiosa y depresiva (HADS), la calidad de vida (WHOQOL), la escala de dolor (EVA) y la escala de satisfacción (CSQ). Resultados: Hubo un total de 270 derivaciones. Fueron analizadas 82 personas: 39 personas utilizaron la app y 43 continuaron su tratamiento habitual. No hubo cambios significativos entre grupos ni tiempos de medida. Se observó una ligera tendencia en la que el grupo experimental tuvo menos síntomas de depresión y ansiedad entre T0 y T2 (B?= −0,2; IC 95%: 8,8-9,2). Conclusiones: Nuestra población mostraba una edad media alta (65 años), niveles bajos de ansiedad y depresión, y niveles medios de calidad de vida en T0. Estos factores podrían haber interactuado y limitado la eficacia de la app. Nuevas líneas de investigación tienen que ir dirigidas a evaluar la eficacia de las apps para pacientes con enfermedades quirúrgicas en poblaciones más jóvenes. (AU)

Introduction: Colorectal cancer is the third most common cancer worldwide that occurs both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a mindfulness-based stress reduction intervention through a mobile application («en calma en el quirófano»). Method: This study is a multicenter, single-blind (evaluator), controlled, randomized trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in 3different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Hospital Anxiety and depression Scale (HADS), quality of life (WHOQOL), pain (VAS) and satisfaction (CSQ) were assessed. Results: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively; 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B=−0.2; 95% CI: 8.8-9.2). Conclusions: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies. (AU)

Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial.

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a Mindfulness-based stress reduction intervention through a mobile application ("En Calma en el Quirófano"). METHOD: This study is a multicenter, single-blind (evaluator), controlled, randomised trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in three different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Anxiety and depression symptoms (HADS), quality of life (WHOQOL), pain, (VAS) and satisfaction (CSQ) were assessed. RESULTS: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively. 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B = -0.2; 95% CI between 8.8 and 9.2). CONCLUSIONS: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies.

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte II: educación del paciente y formación de los profesionales / Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas clave, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parteII se reflejan las 12 recomendaciones, referidas a las dos últimas áreas. Conclusiones: Un buen conocimiento de la fibromialgia por el paciente mejora el afrontamiento y la aceptación de la enfermedad reduciendo la gravedad de algunas manifestaciones clínicas. Los profesionales sanitarios que tratan a los pacientes con fibromialgia deben tener una buena formación sobre esta enfermedad para mejorar los resultados del tratamiento y la relación con el paciente.(AU)

Objective: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. Methods: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment» or «reasoned judgement». Results: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. Conclusions: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.(AU)

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento / Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas claves, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parte I se reflejan las 27 primeras, referidas a las 2 primeras áreas. Conclusiones: Establecer el diagnóstico mejora el afrontamiento del paciente y reduce los costes sanitarios. Se deben evitar AINE, opioides mayores y benzodiacepinas por los efectos adversos. No existe una evidencia sólida que justifique la asociación de fármacos. Tampoco existe una buena evidencia para recomendar ningún tipo de terapia complementaria. Las cirugías muestran más complicaciones y un grado de satisfacción menor por el paciente por lo que deben evitarse si la indicación no está claramente establecida.(AU)

Objective: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques. Results: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.(AU)

Recommendations by the Spanish Society of Rheumatology on the management of patients with fibromyalgia. Part II.

OBJECTIVE: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of "formal assessment" or "reasoned judgement". RESULTS: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This part II shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.

Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and treatment.

OBJECTIVE: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment. / Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento.

OBJECTIVE: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II. / Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte II.

OBJECTIVE: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment¼ or «reasoned judgement¼. RESULTS: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.

Mindful Self-Compassion program for chronic pain patients: A randomized controlled trial.

BACKGROUND: Although evidence-based psychological treatments for chronic pain (CP) have been demonstrated to be effective for a variety of outcomes, modest effects observed in recent reviews indicate scope for improvement. Self-compassion promotes a proactive attitude towards self-care and actively seeking relief from suffering. Consequently, more compassionate people experience better physical, psychological and interpersonal well-being. METHODS: We conducted a single-blind, randomized, controlled trial to examine the effects of a Mindful Self-Compassion program (MSC) on relevant clinical outcomes in patients with CP. Patients were randomly assigned to one of the two intervention arms: MSC or cognitive-behavioural therapy (CBT). The protocols of both intervention arms were standardized and consisted of a 150-min session once a week during 8 weeks formatted to groups of no more than 20 participants. The primary outcome was self-compassion, measured with the Self-Compassion Scale (SCS). The secondary outcomes were other pain-related scores, quality-of-life measures, and anxiety and depression scores. RESULTS: In all, 62 and 61 patients were assigned to the MSC and CBT groups, respectively. The MSC intervention was more effective than CBT for self-compassion (average treatment effect [ATE] = 0.126, p < 0.05). The secondary outcomes, pain acceptance (ATE = 5.214, p < 0.01), pain interference (ATE = -0.393, p < 0.05), catastrophizing (ATE = -2.139, p < 0.10) and anxiety (ATE = -0.902, p < 0.05), were also favoured in the experimental arm (MSC). No serious adverse events were observed. CONCLUSIONS: Mindful Self-Compassion is an appropriate therapeutic approach for CP patients and may result in greater benefits on self-compassion and emotional well-being than CBT. SIGNIFICANCE: This randomized controlled trial compares the novel intervention (MSC program) with the gold standard psychological intervention for CP (CBT). MSC improves the levels of self-compassion, a therapeutic target that is receiving attention since the last two decades, and it also improves anxiety symptoms, pain interference and pain acceptance more than what CBT does. These results provide empirical support to guide clinical work towards the promotion of self-compassion in psychotherapeutic interventions for people with CP.

Diálogo con atención plena: integrando mindfulness y narrativas / Dialogue with full attention: integrating mindfulness and narratives

Se desarrolla una propuesta de integración de narrativas y mindfulness basándonos en la naturaleza lingüística del ser humano y su capacidad de apertura al campo de la conciencia. Se describen otros programas psicoterapéuticos en el mundo que han integrado mindfulness. Se aportan datos de investigación a nivel nacional e internacional. Se comparte la experiencia de nuestro grupo al trabajar en la clínica e investigar con esta perspectiva en la sanidad pública española. Se hace hincapié en la importancia de desarrollar programas de formación para los profesionales de la salud mental que sean rigurosos y profundos

A proposal to integrate narratives and mindfulness based on the linguistic nature of human beings and their ability of openness to the consciousness field is made. Other international psychotherapeutic programs that have integrated mindfulness into their practice are described. Research evidence from both national and international studies is provided. In this paper we share our experience working from this perspective both in research and in the clinical practice. The importance of developing rigorous and in-depth training programs for mental health professionals is pointed out

Arteterapia en dolor crónico / Art Therapy in chronic pain

El dolor es un fenómeno difícil de entender que comprende dimensiones sensoriales/discriminativas, afectivas/motivacionales y cognitivas/evaluativas. La arteterapia permite trabajar con aspectos corporales y cognitivo-emocionales del dolor; en este sentido resulta ser útil para desarrollar y explorar recursos para el manejo del dolor, pues al involucrar el cuerpo permite entrenar la atención dividida ampliando el campo perceptivo más allá del dolor. Dada la complejidad del dolor crónico, las intervenciones deben ser multicomponentes e interdisciplinares. El presente artículo presenta un abordaje arteterapéutico en el dolor crónico, recorriendo los mecanismos de acción y exponiendo una experiencia arteterapéutica con mujeres con dolor crónico tras haber pasado por una intervención basada en mindfulness

Pain is a phenomenon difficult to understand, which comprises sensory/discriminatory, affective/emotional and cognitive/evaluative dimensions. Art Therapy allows to work with physical and cognitive-emotional aspects of pain; in this sense, it is useful for developing and exploring resources for pain management, because involving the body allows to train the divided attention, widening the perceptive area beyond pain. Given the complexity of chronic pain, interventions must be interdisciplinary and with multiple components. This article presents an Art Therapy approach for chronic pain, going through mechanisms of action, and showing an Art Therapy experience with women in chronic pain after undergoing a mindfulness-based intervention