The 5Cs of positive youth development: their impact on symptoms of depression, anxiety, stress, and emotional distress in Chilean adolescents.

Effective approaches to addressing mental health challenges faced by adolescents require a deep understanding of the factors contributing to optimal development, well-being, and prosperity. From the perspective of Positive Youth Development (PYD), this study proposes to examine the relationship between the 5Cs of PYD (Competence, Confidence, Connection, Character, and Caring) and symptoms of depression, anxiety, stress, and emotional distress among Chilean adolescents. A quantitative, cross-sectional, non-experimental study was conducted with 425 adolescents (ages 12 to 19, M = 14.95, SD = 1.81) from three Chilean cities: Arica (23%), Alto Hospicio (32%), and Iquique (46%). Data analysis included the use of confirmatory factor analysis (CFA) and structural equation modeling (SEM). The results indicate that two of the 5Cs, Confidence and Connection, have a significant negative direct effect on the four evaluated criterion indicators. These findings contribute to the literature on positive youth development in Latin America and underscore the importance of fostering confidence and connection in interventions aimed at promoting the mental health of adolescents in Chile and in similar contexts.

Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study.

BACKGROUND: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. OBJECTIVE: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. METHODS: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. RESULTS: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. CONCLUSIONS: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. TRIAL REGISTRATION: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.

The effect of discrimination on Mental Health in the Chilean Population

Introduction: Discrimination affects the health and well-being of those who experience it. The relationship between discrimination and mental health in migrant communities and in the Chilean child and youth population has been previously studied, however, there is little evidence regarding the effects of discrimination on the general population. Objective: To analyze the relationship between discrimination and the presence of anxious and depressive symptoms in the Chilean population. Methods: Prospective cross-sectional study evaluating 927 subjects in the cities of Arica, Antofagasta, and Santiago. To evaluate discrimination the Krieger Discrimination Experience Scale is used. To asses depressive and anxious symptomatology, the Beck scales for BDI Depression and BAI Anxiety were implemented. Results: The mean age of the sample is 33.9 years (Range 18-70 years; SD=13.13). 59.5% of the participants are female. 36% of the participants reported having experienced discrimination in some aspect of their lives. The highest perception of discrimination is associated with employment (42%) and the main reported causes are level of education or income, age, and gender. Experiences of discrimination exert statistically significant positive effects of moderate magnitude (b>.30) on depressive (b=.460, p<.001) and anxious (b=.480, p<.001) symptomatology, the latter being interrelated (b=.636, p<.001). Conclusions: More than a third of the population studied reported having been discriminated in some aspect of their lives. This perception is further accentuated in relation to employment. The perception of discrimination is associated with an increase in anxious and depressive symptoms in the Chilean population.

Introducción: La discriminación afecta la salud y el bienestar de las personas que la experimentan. Se ha estudiado ampliamente la relación entre discriminación y salud mental en comunidades migrantes y en población infanto-juvenil chilena, sin embargo, existe escasa evidencia respecto a los efectos de esta en la población general. Objetivo: Analizar la relación entre discriminación y la presencia de sintomatología ansiosa y depresiva en población chilena. Material y Método: Estudio transversal prospectivo evaluando 927 sujetos en las ciudades de Arica, Antofagasta y Santiago. Para evaluar discriminación se utiliza la escala de experiencias de discriminación de Krieger. Para evaluar sintomatología depresiva y ansiosa se utilizan las escalas de Beck para Depresión BDI y Ansiedad BAI. Resultados: La edad promedio de la muestra es de 33,9 años (Intervalo de 18 a 70 años; DE=13,13). El 59,5% de los participantes son mujeres. Un 36% de los participantes declara haber experimentado discriminación en algún aspecto de su vida. La mayor percepción de discriminación se asocia al empleo (42%) siendo las principales causas reportadas el nivel educacional o de ingresos, la edad y el sexo. Las experiencias de discriminación ejercen efectos positivos estadísticamente significativos de magnitud moderada (b>.30) sobre sintomatología depresiva (b=.460, p<.001) y ansiosa (b=.480, p<.001) estando las últimas interrelacionadas entre sí (b=.636, p<.001). Conclusión: Más de un tercio de la población estudiada reporta haber sido discriminada en algún aspecto de su vida. Esta percepción se agudiza en torno a la obtención de empleo. La percepción de discriminación se asocia a incremento en sintomatología ansiosa y depresiva en la población chilena.

Development of the PREMIUM computerized adaptive testing for measuring the access and care coordination for patients with severe mental illness.

Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.

The Effects of Social Determinants and Resilience on the Mental Health of Chilean Adolescents.

The aim of this research was to evaluate the effects of social determinants (i.e., gender, educational vulnerability, and socioeconomic status) and resilience on the mental health of Chilean adolescents in pre-, during, and post-COVID-19 pandemic contexts. The study included a group of 684 students, ranging in age from 12 to 18 years, who were attending educational institutions in the city of Arica. The Child and Adolescent Assessment System (SENA) was used to measure mental health problems, the Brief Resilience Scale for Children and Youth (CYRM-12) was used to measure resilience, and the Vulnerability Index of Educational Institutions was used to measure educational vulnerability. The results suggest increases in depressive, anxious, and social anxiety symptomatologies over time (wave by year, 2018, 2020, and 2021). In addition, multiple linear regression models showed predictive effects of the COVID-19 pandemic, gender, vulnerability index, socioeconomic status, and resilient behaviors on mental health problems. The worsening of mental health indicators over time requires the greater coordination and integration of mental health experts in the most vulnerable educational centers.

Invited Commentary: Improving Instruments to Counter the Bias in Their Construction.

In this issue of the Journal, Villalonga-Olives et al. (Am J Epidemiol. 2023;192(8):1264-1273) examined the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there was differential item functioning (DIF) in social capital by race, and also when stratified by educational attainment, as a measure of socioeconomic status. The authors tested whether there is DIF in social capital items between Black and White people and found that DIF across these items was significant although not large, but they were still indicative of measurement error, which they suspected was related to the way these items were developed-that is, based on cultural assumptions tested in mainstream White America. However, some gaps remain to be fleshed out.

Defining recovery in schizophrenia: A review of outcome studies.

Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (dIG+ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (dIG+ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.

Optimism and Intolerance to Uncertainty May Mediate the Negative Effect of Discrimination on Mental Health in Migrant Population.

(1) Background: Migration causes effects on the people who migrate and on the societies that receive them, which can be positive or negative, depending on the characteristics of the interaction. One negative effect is the emergence of mental health disorders associated with the presence of discrimination, a relationship for which there is abundant evidence, although there is less research on factors that may alter this effect. (2) Objective: To evaluate the possible mediating role of optimism and intolerance to uncertainty in the relationship between discrimination and mental health. (3) Method: Nine hundred and nineteen adult Colombian migrants residing in Chile, 49.5% were men and 50.5% women, ages from 18 to 65 years, were evaluated. The Discrimination Experience Scale, BDI-IA Inventory, BAI, LOT-R and the Intolerance to Uncertainty Scale were applied. The effects were estimated using structural equation modeling. (4) Results: A mediating effect of both dispositional optimism and intolerance to uncertainty on the relationship between discrimination and mental symptomatology was observed. (5) Conclusions: The impact on individual suffering and the social cost of mental health problems require investigating variables on the relationship between discrimination and mental health, including mediators of this relationship, which turn out to be central elements in the development of future strategies for the reduction of anxiety and depression symptoms.

Pre and Post Pandemic Depressive and Anxious Symptoms in Children and Adolescents in Northern Chile.

The psychological effects of the COVID-19 pandemic still represent a focus of concern, especially in children and adolescents who are a group particularly vulnerable to the psychological consequences of the COVID-19 pandemic, mainly due to the loss of socialization and leisure spaces. The aim of the study is to determine the variation in the levels of depressive and anxious symptomatology in children and adolescents in the North of Chile. METHODS: A Repeated cross-sectional design (RCS) was used. The sample consisted of a total of 475 students aged 12 to 18 years (high school) from educational establishments in the city of Arica. To evaluate the changes in the mental health of students associated with the COVID-19 pandemic, the same mental health measures applied to students were compared in two waves (2018-2021). RESULTS: An increase in the symptomatology levels of depression, anxiety, social anxiety, and problems with the family, while a decrease in problems with school and peers was observed. CONCLUSIONS: The results show that there is an increase in mental health problems associated with the periods of time in which the COVID-19 pandemic transformed the social relation spaces and classrooms of secondary school students. The observed changes point to future challenges, which include that it may be important to improve the coordination and integration of mental health professionals in educational centers and schools.

Mental Health in Indigenous Children and Adolescents: The Contribution of Cultural Backgroud.

The purpose of this study is to describe and compare the prevalence of mental health problems in Aymara and non-Aymara children and adolescent. The study sample comprised 1839 students from 8 to 19 years, from educational institutions of Northern Chile. Forty-nine percent of students identified with the Aymara ethnic group. The Child and Adolescent Evaluation System was used to evaluate internal and external problems. In Elementary school, Aymara students showed significantly lower scores in externalized problems and in high school, there were significantly lower scores in interiorized, exteriorized and other problems than Non-Aymara students. It seems that the legacy of the Aymara culture has favored the development of protective factors in relation to the mental health of these students. In a context of growing recognition and appreciation of this culture, greater involvement with Aymara culture could promote better mental health of school children.

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis.

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

Necesidad de apoyo psicológico y etnicidad en personas diagnosticadas con Esquizofrenia: La importancia del componente subjetivo en el abordaje del estigma internalizado / Need for psychological support and ethnicity in people diagnosed with Schizophrenia: The importance of the subjective component in addressing internalized stigma

Objetivo Comparar las características socio-demográficas, la calidad de vida, el malestar psicológico y los niveles de estigma internalizado en una muestra de pacientes con Esquizofrenia pertenecientes a la región de Arica y Parinacota que reciben tratamiento en el mismo sistema de salud mental. Método Participaron 209 pacientes con un diagnóstico de Esquizofrenia usuarios de los servicios públicos ambulatorios de salud mental. Resultados La pertenencia a la etnia Aymara no determinó diferencias en las características sociodemográficas. Por otra parte, el grupo de pacientes Aymara presentó mayores niveles de Alienación en la escala de Estigma Internalizado en comparación al grupo de pacientes No-Aymara. La necesidad de apoyo psicológico es convergente a los niveles de malestar psicológico, la calidad de vida y el estigma internalizado. Conclusiones Los hallazgos refuerzan la adecuada capacidad de los usuarios con Esquizofrenia para valorar sus necesidades de apoyo psicológico durante el tratamiento en función de sus niveles de calidad de vida y malestar psicológico.

Objective The aim of this study was to compare the socio-demographic characteristics, quality of life, psychological distress and levels of internalized stigma in a sample of patients with Schizophrenia belonging to the region of Arica and Parinacota who receive treatment in the same mental health system. Methods 209 patients with a diagnosis of schizophrenia, users of public outpatient mental health services, participated in the study. Results Aymara ethnicity did not determine differences in sociodemographic characteristics. On the other hand, the group of Aymara patients had higher levels of Alienation on the Internalized Stigma Scale compared to the group of Non-Aymara patients. Need for psychological support are convergent to levels of psychological distress, quality of life and internalized stigma. Conclusions The findings emphasize the adequate capacity of users with schizophrenia to assess their psychological support needs during treatment based on their levels of quality of life and psychological distress.

Well-Being and Mental Health in Teachers: The Life Impact of COVID-19.

The impact of the pandemic on teachers' mental health has also been an important issue. The aim of the study was to analyze the vital impact of COVID-19, spirituality, and the use of social-emotional strategies on teacher well-being, mediated by mental health. The sample was non-random, inviting all teachers in a city North of Chile to participate in the study. The sample consisted of 624 teachers. A total of 74.4% were women and 25.6% were men. The mean age was 44.1 and the standard deviation was 11.9. A total of 56.4% belonged to public schools and 43.6% belonged to subsidized schools. Structural equations were used to analyze the data, finding a mental health mediating effect between the death of a close person, affected areas and family history with life satisfaction. Spirituality and the use of socio-emotional strategies self-applied by the teachers had no direct relationship with their mental health, so their mediating effect in relation to life satisfaction was discarded. Teachers who used social-emotional strategies, as well as those who reported higher levels of spirituality, obtained greater satisfaction with life, both general and specifically. Women had higher levels of depression, anxiety and stress symptomatology, but also higher levels of life satisfaction. The implications are discussed.

Predictors of Internalized Stigma in Patients with Schizophrenia in Northern Chile: A Longitudinal Study.

The study aim was to longitudinally assess internalized stigma in a sample of patients from Northern Chile with a diagnosis of schizophrenia along with indicators of patient recovery, including quality of life, psychotic symptomatology, social cognition, premorbid adjustment, and years of untreated psychosis. The 10-year follow-up of stigma measures and predictors were assessed at public outpatient mental health centers in the city of Arica, Chile, during the months of March-July 2012. A total of 26 patients successfully completed the evaluation. The results revealed that, with the exception of the self-stigma subdimension, no clinically significant changes were seen in the trajectories of internalized stigma ratings between baseline and 10-year follow-up, underscoring the importance of assessing global components such as quality of life and premorbid adjustment during the process of internalizing stigma.

Children's Mental Health: Discrepancy between Child Self-Reporting and Parental Reporting.

(1) Background: Discrepancies between children's self-reports and their parents' reports on mental health indicators are associated with measurement errors or informant bias. However, they are a valuable tool in understanding the course of child psychopathology. This study aims to determine the level of discrepancies between parents' perceptions and children's self-reports in mental health indicators in Northern Chile. (2) Methods: A System of Evaluation of Children and Adolescents self-report (Sistema de Evaluación de Niños y Adolescentes, SENA) was responded to by 408 students between 8 and 13 years old and their parents. (3) Results: Children reported a significantly higher frequency of emotional problems, defiant behavior, and executive functions as compared to their parents' responses. (4) Conclusions: There is a disjunction between the report of parents and children, which could originate in poor family communication.

Validación de la escala GEOPTE de cognición social para psicosis en pacientes con esquizofrenia en Latinoamérica / Validation of the GEOPTE scale of social cognition for psychosis in patients with schizophrenia in Latin America

El propósito de este estudio fue validar la escala GEOPTE de cognición socialpara su uso en pacientes con diagnóstico de esquizofrenia en paísesLatinoamericanos. Participaron 253 pacientes con un diagnóstico de esquizofreniay 253 cuidadores principales provenientes de los servicios públicos de salud mentalde Bolivia, Chile y Perú. Las propiedades psicométricas de la escala GEOPTE fueronobtenidas mediante análisis factoriales confirmatorios (CFA), CFA-multigrupo,coeficientes de fiabilidad y correlación de Pearson. El CFA mostró la adecuaciónentre la estructura factorial teórica original con la establecida en este estudio devalidación. La escala evidenció satisfactorios indicadores de fiabilidad, presentóasociaciones significativas con la “Escala de los síndromes positivo y negativo”(PANSS) y sólo mostró invarianza débil según el sexo. La escala GEOPTE poseepruebas de validez y fiabilidad suficiente para su uso en pacientes con diagnósticode esquizofrenia en países Latinoamericanos. (AU)

The purpose of this study was to validate the GEOPTE scale of social cognitionfor its use in patients diagnosed with Schizophrenia in Latin American countries.The participants were 253 patients with a diagnosis of Schizophrenia and 253 maincaregivers from mental health services in Bolivia, Chile and Peru. The psychometricproperties of the GEOPTE scale were obtained through confirmatory factor analysis(CFA), CFA-multigroup, reliability coefficients and Pearson's correlation. The CFAshowed the adequacy between the original theoretical factor structure and the oneestablished in this validation study. The scale showed satisfactory reliabilityindicators, presented significant associations with the Positive and NegativeSyndrome Scale (PANSS) and showed only weak invariance according to gender.The GEOPTE scale has sufficient evidence of validity and reliability for its use inpatients diagnosed with Schizophrenia in Latin American countries. (AU)

Latent Profiles of Premorbid Adjustment in Schizophrenia and Their Correlation with Measures of Recovery.

Premorbid adjustment (PA) has classically been defined as psychosocial functioning in the areas of education, occupation, social and interpersonal relationships prior to evidence of characteristic positive symptomatology. It is a concept which possesses ample evidence regarding its predictive nature for the course of Schizophrenia. The study aimed to analyze the latent profiles of premorbid adjustment and their relationship with symptomatology, functionality, subjective recovery, stigma resistance and years of untreated psychosis. Latent class analysis (LCA) was used to elaborate a solution of three premorbid adjustment profiles in a sample of 217 patients diagnosed with Schizophrenia from Public Mental Health Centers in the city of Arica, Chile. The results show that premorbid adjustment was significantly correlated with recovery indicators and that latent profiles of better premorbid adjustment predict better outcomes in subjective recovery and stigma resistance. The results show that premorbid adjustment not only has implications for the severity of the disorder, but that psychosocial functioning prior to psychosis affects the patient's subjectivity, the representation of the disorder and the recovery process.

Internalizing Problems and Resilience in Primary School Students in Low and High Socioeconomic Vulnerability Establishments in Chile.

BACKGROUND: The processes involved in this study were 2-fold. First, we analyzed the levels of resilience and internalized problems (defined as group of emotional symptoms) in children aged 9 to 12 years. Second, we examined whether the relationship between them varies according to the low or high vulnerability of school communities. METHODS: About 1460 students from schools in northern Chile participated. A total of 52.6% were girls, and 47.4% were boys. The scales of internalizing problems of the System of Evaluation of Children and Adolescents (SENA) and the short scale of resilience (CYRM-12) were applied. Correlations in each group and differences between groups were analyzed using a MANOVA. A 2-level path analysis was also performed. RESULTS: Resilience was higher in the context of low vulnerability while depression, social anxiety, and posttraumatic stress symptomatology were greater in the context of high vulnerability. A 2-level path analysis showed that the slope of gender, anxiety, and depression symptomatology varies between schools and an interaction effect between vulnerability and anxiety symptomatology. CONCLUSION: There are differences in the relationship between internalized problems and resilience according to whether the students belong to low or high vulnerability establishments. This study contributes to a better understanding of the relationship between internalizing problems and resilience.

The Mediating Role of Contextual Problems and Sensation Seeking in the Association between Substance Use and Mental Health in Adolescents from Northern Chile.

Substance use is a risk behavior that has been associated with adverse mental health outcomes in adolescence. The aim of this study was to determine the relation between behavioral problems, emotional problems, and substance use as well as the mediating role of contextual problems and sensation seeking in this relation. A cross-sectional study of 2277 adolescents from Northern Chile was conducted. The System for the Evaluation of Children and Adolescents (SENA) was used to assess substance use, contextual problems, sensation seeking, and emotional and behavioral problems. Through a mediational model, it was observed that substance use has a positive indirect effect on emotional and behavioral problems when both contextual problems and sensation seeking act as mediating variables. An indirect effect of substance use on contextual problems with sensation seeking as a mediator was also observed. The results suggests that context and sensation seeking are a relevant source of information in understanding adolescents and their propensity to use drugs. Interventions based on addressing contextual problems (problems with school, peers, and family) and enhancing personal resources should be implemented in order to reduce substance use in adolescents as well as the consequences it can generate in the short, medium, and long term.