Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A).

Introduction: There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population. Methods: 161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated. Results: The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A. Conclusion: Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

El abordaje perinatal interdisciplinar desde Atención Primaria de Salud (APS): el desarrollo de una atención bio-psico-social integrada / The interdisciplinary perinatal approach from Primary Health Care (PHC): the development of an integrated bio-psycho-social care

El Equipo de Atención Primaria (EAP) Roquetes-Canteres de Barcelona se plantea, en el marcode investigación impulsada por Bruc Salut (equipo psicoterapéutico), una intervención bio-psico-social integrada. Eneste artículo se describe la investigación desde su inicio y los diferentes programas que se están llevando a cabo desde2014 con un recorrido por todos los programas desarrollados. Se explica detenidamente cómo se han creado, llevadoa cabo, evaluado y su funcionamiento actual, gracias al trabajo coordinado del equipo interdisciplinar para atenderlos aspectos emocionales de la parentalidad, el establecimiento del vínculo y el buen desarrollo del bebé, así como lasensibilización y contención de los profesionales del equipo. Finalmente, se define la figura del profesional sanitariode enlace del EAP, que se ha creado para coordinar y guiar el equipo y fomentar la mirada bio-psico-social entre losprofesionales, vital para evitar una visión fragmentada de las familias.(AU)

The Primary Health Care Team (EAP) Roquetes-Canteres in Barcelona is considering, within theresearch framework promoted by Bruc Salut (a psychotherapeutic team), an integrated bio-psycho-social intervention.This article describes the research since its beginning and the different programmes that are being carried out since2014 with a tour of all the developed programmes. It explains thoroughly how they have been created, carried out,evaluated and their current operation, thanks to the coordinated work of the interdisciplinary team to address theemotional aspects of parenthood, the establishment of the bond and the good development of the baby, as well asthe awareness and self-restraint of the team professionals. Finally, the figure of the EAP liaison health professional isdefined, which has been created to coordinate and guide the team and to promote the bio-psycho-social view amongthe professionals, vital to avoid a fragmented view of the families.(AU)

L’Equip d’Atenció Primària (EAP) Roquetes-Canteres de Barcelona es planteja,en el marc de la investigació impulsada per Bruc Salut (equip psicoterapèutic), una intervenció biopsicosocialintegrada. En aquest article es descriuen la investigació des de l’inici i els diferents programes que s’estan duenta terme des de 2014 amb un recorregut per tots els programes desenvolupats. S’explica detingudament coms’han creat, dut a terme, avaluat i el funcionament actual, gràcies al treball coordinat de l’equip interdisciplinariper atendre els aspectes emocionals de la parentalitat, l’establiment del vincle, el bon desenvolupament del nadói també la sensibilització i contenció dels professionals de l’equip. Finalment, es defineix la figura del professionalsanitari d’enllaç de l’EAP, que s’ha creat per coordinar i guiar l’equip i fomentar la mirada biopsicosocial entreels professionals, vital per evitar una visió fragmentada de les famílies.(AU)

Measuring Changes in Social Skills Throughout an Intervention Program for Children with ASD, Contributions from Polar Coordinate Analysis.

The demand of social skills interventions for people with ASD has grown in recent years. The main goal of this research was to study social skills: "responding to interaction" and "initiating interaction", and to capture whether there were differences between an initial and a final session in a program for children with ASD. Additionally, we aimed to compare social skills patterns according to the VIQ level. The sample (N = 20) was divided into 2 subgroups depending on whether the VIQ was > 90 or < 90. We employed a mixed methods approach based on a systematic observation of social behaviors. The observational design was nomothetic, follow-up, and multidimensional. Once we confirmed inter-observer reliability for the ad hoc observational instrument we performed descriptive statistics and polar coordinate analysis using LINCE software. The results show high intragroup and intergroup variability. In general, participants with VIQ < 90 showed a better improvement in responding to interaction, whereas participants with VIQ > 90 showed more complex patterns to initiate interactions. The polar coordinate technique was useful for detecting significant relationships between autism's social micro-behaviors. Results and information obtained through observational methodology could allow professionals to understand communication and interaction of participants.

Implementation and evaluation in low intensity intervention programs from the CONNECT perspective of mixed methods: Application in a case of an autistic child.

There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities, and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway. The mixed method perspective offers a suitable framework, and observational methodology - in itself considered mixed method - is appropriate for studying the implementation and evaluation of low intensity intervention programs, allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods. In this work it was applied to a single case, in a low intensity intervention, retrieving valuable information obtained, but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner. The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy, in which we sought to identify which of the therapist's techniques stimulated actions of reciprocal social interaction in the child, and which techniques inhibited non reciprocal social interactions. The observational design was nomothetic, follow-up, and multidimensional. The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder. We used an ad hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Polar coordinate analysis was carried out using the free program HOISAN 2.0. Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories. The results provide objective evidence - backed up by the application of polar-coordinate-based data analysis - that within a framework of psychoanalytic psychotherapy, the techniques of "verbalization" and "vocalization" significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language. On the other hand, direct gaze promotes the child's withdrawal. The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism.

Talleres de salud mental para adolescentes en el aula. Experiencia transnacional / Tallers de salut mental per a adolescents a l’aula. Experiència transnacional / Mental health workshops for adolescents in the classroom. Transnational experience

Muchos problemas de salud mental suelen aparecer al final de la infancia o al inicio de la adolescencia. Según diversos estudios, tales problemas son las principales causas de morbilidad, mortalidad y discapacidad entre los más jóvenes. Por ello, la prevención en salud mental es una tarea prioritaria en este grupo etario, especialmente a nivel escolar. Los talleres de salud mental en el aula (TSMA) pretenden favorecer el manejo de las emociones y prevenir el suicidio adolescente. El artículo describe los objetivos, metodología y conclusiones preliminares de los talleres, a partir de la experiencia realizada en diversos centros educativos de Colombia y Barcelona (España).(AU)

Many mental health problems often appear at the end of childhood or the beginning of adolescence. According to various studies, such problems are the main causes of morbidity, mortality, and disability among young people. Therefore, mental health prevention is a priority task in this age group, especially at the school level. Classroom mental health workshops (TSMA) aim to promote the management of emotions and prevent adolescent suicide. The article describes the objectives, methodology, and preliminary conclusions of the workshops, based on the experience carried out in several schools in Colombia and Barcelona (Spain).(AU)

Molts problemes de salut mental apareixen al final de la infància o a l’inici de l’adolescència. Segons diversos estudis, aquests problemes són les principals causes de morbiditat, mortalitat i discapacitat entre els més joves. Per això, la prevenció en salut mental és una tasca prioritària en aquest grup, especialment en l’àmbit escolar. Els tallers de salut mental a l’aula (TSMA) pretenen afavorir el maneig de les emocions i prevenir el suïcidi adolescent. L’article descriu els objectius, metodologia i conclusions preliminars, a partir de l’experiència realitzada en diversos centres educatius de Colòmbia i Barcelona (Espanya).(AU)

Psychometric Properties of the Spanish Short Version of the Inventory of Personality Organization (IPO-18) in a Nonclinical Sample.

This report supports validation for the Spanish 18-item short version of the Inventory of Personality Organization (IPO), a self-reported instrument for the assessment of personality organization, according to Kernberg's object-relation based model. The IPO is used to depict personality structure types, using three scales: psychological defense mechanisms, degree of identity integration and reality testing. The review of the literature suggests alternatively factorial solutions. Accordingly, this study, using a nonclinical sample (N = 315), tested the fit of several factorial models (2- and 3- factor solution) via the maximum likelihood approach. Confirmatory Factor Analysis revealed a better fit for the 2-factor solution (CFI = .97, TLI = .96, RMSEA = .037, AIC = 311.06), in accordance with Kernberg's theory. Each of the 2 IPO subscales shows good levels of internal consistency, and they are associated with increased negative affect, aggressive dyscontrol as well as depression, anxiety and general level of psychopathological distress in line with theoretical expectations. Our results suggest that the Spanish short version of the IPO is a reliable and valid tool for the assessment of personality organization following Kernberg's model.

Detection of depressive-anxiety symptomatology and associated risk factors among pregnant women in a low-income neighborhood.

AIM: To determine the prevalence of anxiety-depressive symptomatology and associated risk factors in a population of pregnant women in the low-income neighborhood of Roquetes (Barcelona, Spain). DESIGN: Quasi-experimental, cross-sectional study. LOCATION: The study was carried out at the Primary Care Center, Roquetes Canteres, Barcelona. PARTICIPANTS: Between 2015 and 2017, all pregnant women who visited the Sexual and Reproductive Care Team in Primary Care (ASSIR) or their Family Physician (FP) were invited to take part in a study if they met the following criteria: (a) over 18 years old (b) able to understand in any of the 4 study languages. Of a total of 239 gestating women, 19 declined to participate, 14 moved away from the area and 16 underwent voluntary termination of pregnancy, leaving a sample of 190 subjects. MATERIAL AND METHODS: The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptomatology, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety, and a sociodemographic data questionnaire was administered. Once all descriptive demographic data from the whole sample was analyzed, baseline clinical and demographic characteristics were compared using the independent t-test for continuous variables and the chi-squared analysis for categorical variables. RESULTS: The t-test showed that 48% of pregnant women presented an at-risk degree of anxiety-depressive symptomatology, double that found in the general population. Applying a chi-squared test to the at-risk and non-risk groups revealed associated prenatal risk factors including: having a history of violence; living in a rented room, mistreatment in infancy and mental health issues. The ROC curves analysis obtained a cutoff point score of 4 Accumulated Associated Factors (AAF) (AUC 0.765, p < .001, 57% sensitivity and 79% specificity). CONCLUSIONS: Our study shows that rates of anxiety-depressive symptomatology in a population with considerable socio-economic deprivation can more than double. AAF in the population at risk of anxiety and depression were detected, highlighting the need to allocate resources to identification and prevention during pregnancy. This requires the involvement of a multidisciplinary, professional team with a biopsychosocial perspective.

La salud mental perinatal en tiempos de pandemia por COVID-19 / Perinatal mental health during COVID-19 pandemic / La salut mental perinatal en temps de pandèmia per COVID-19

El propósito de este artículo es compartir la experiencia de la atención grupal online e interdisciplinar a embarazadas y a madres con bebés (0-6 meses de vida) con la finalidad de aumentar la contención ante las consecuencias de la pandemia actual. Constatamos la importancia de la atención primaria en red durante el período perinatal, debido a la gran cantidad de profesionales que intervienen. Así mismo, observamos que las embarazadas y madres precisan de un enfoque holístico (atendiendo las necesidades físicas y emocionales), a través de la propuesta del arrullo multisensorial, que incorpora las diferentes visiones de los profesionales en los síntomas, preocupaciones y malestares. Observamos que estos dos aspectos (la red y la atención interdisciplinar holística) permiten reducir la fragmentación asistencial y favorecer la contención emocional de las familias y los profesionales

The purpose of this article is to share the experience of online and interdisciplinary group care for pregnant women and mothers with babies (0-6 months of age) in order to increase containment when facing the consequences of the current pandemic. We highlight the importance of networked primary care during the perinatal period due to the high number of professionals involved. Similarly, we realize that pregnant women and mothers require a holistic approach (attending to physical and emotional needs) through a suggested multisensory lullaby that includes various perspectives of professionals regarding symptoms, concerns and distress. We observe that these two aspects (the network and interdisciplinary holistic care) allow to reduce healthcare fragmentation and to promote emotional containment for families and professionals

El propòsit d'aquest article és compartir l'experiència de l'atenció grupal en línia I interdisciplinària a embarassades I a mares amb bebès (0-6 mesos de vida) amb la finalitat d'augmentar la contenció davant les conseqüències de la pandèmia actual. Constatem la importància de l'atenció primària en xarxa durant el període perinatal, a causa de la gran quantitat de professionals que intervenen. Així mateix, observem que les embarassades I mares necessiten un enfocament holístic (atenent les necessitats físiques I emocionals), a través de la proposta de l'embolcall multisensorial, que incorpora les diferents visions dels professionals en els símptomes, preocupacions I malestars. Observem que aquests dos aspectes (la xarxa I l'atenció interdisciplinària holística) permeten reduir la fragmentació assistencial I afavorir la contenció emocional de les famílies I els professionals

A Mixed Methods Framework for Psychoanalytic Group Therapy: From Qualitative Records to a Quantitative Approach Using T-Pattern, Lag Sequential, and Polar Coordinate Analyses.

Conducted within a mixed methods framework, this study focuses on the conversation-facilitation role of a lead therapist during group psychotherapy with adolescents. Conversation is an essential component of psychoanalytic psychotherapies and there is growing interest in describing and studying the impact of conversational techniques. One way to do this is to report on specific approaches, such as questioning, paraphrasing, and mentalization in intervention turns and to analyze their impact on the therapist-patient relationship. The main aim of this study was to investigate differences in communication strategies used by a lead therapist in the early and late stages of therapy with six adolescents aged 13-15 years. We employed a mixed methods design based on systematic direct observation supplemented by indirect observation. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified by our use of an ad hoc observation instrument for communication strategies combining a field format and a category system. We analyzed interobserver agreement quantitatively by Cohen's kappa using GSEQ5 software. Following confirmation of the reliability of the data, we analyzed the lead therapist's conversation-facilitation techniques in sessions 5 and 29 of a 30-session program by quantitatively analyzing what were initially qualitative data using T-pattern detection (THEME v.6 Edu software), lag sequential analysis (GSEQ5 software), and polar coordinate analysis (HOISAN v. 1.6.3.3.6. software and R software). The results show changes in the techniques used from the start to the end of therapy. Of the 28 communication strategies analyzed, three were particularly common: questioning and paraphrasing in session 5 and questioning and mentalization in session 29. This mixed methods study shows that combined use of T-pattern detection, lag sequential analysis, and polar coordinate analysis can offer meaningful and objective insights into group psychotherapy through the lens of the therapist.

A Psychoanalytical Perspective on the Co-therapeutic Relationship With a Group of Siblings of Children With Autism: An Observational Study of Communicative Behavior Patterns.

A child diagnosed with autism may have a negative psychological and behavioral impact on their siblings, whose participation in a group with children in the same situation is a preventive measure. Our group study was conducted by two therapists (T1 and T2) assigned to co-therapy (CT) work. Both therapists shared the theoretical bases and understanding of the group and the needs of the individual subjects, and complemented each other in terms of the direction of their interventions, given that shared impressions and continuous exchanges that integrate countertransference aspects are essential to successful co-therapy. The objectives of this study were as follows: (a) to detect patterns of clarification, confrontation, and interpretation interventions by T1 and T2 in the group; and (b) to detect patterns of clarification, confrontation and interpretation interventions considering T1 and T2 as the only focal subject of the CT. Design was mixed-methods based on systematic observation, for which we developed a qualitative ad hoc instrument that combined a field format and a categorizing system. Interobserver agreement was analyzed quantitatively using Cohen's kappa and Krippendorf's canonical concordance. Once data reliability was confirmed, lag sequential analysis using GSEQ5 software was performed to search for behavior patterns. The results show (a) different behavior patterns in the clarification, confrontation, and interpretation interventions by T1 and T2; and (b) different behavior patterns when T1 and T2 are considered as the focal subject (CT). Our study offers a new perspective on the impact of therapist interventions on participants in this kind of group.

Mixed Methods Approach to Describe Social Interaction During a Group Intervention for Adolescents With Autism Spectrum Disorders.

Over the last 20 years, researchers have been mixing qualitative and quantitative approaches, but mixed methods research represents a new movement that arose in response to the currents of qualitative and quantitative research, considered separately. Little has been published on the use of polar coordinate analysis in psychotherapy. This type of analysis can provide detailed information and integrate the qualitative-quantitative analysis. Even less has been published on the analysis of ASD children's behavior. The main aim of this study was to implement this mixed methods methodology to analyze patterns of social behaviors in a group of adolescents with ASD during a group social competence intervention program. Moreover, we wanted to see whether an observational scale could be combined fruitfully with polar coordinate analysis and to investigate whether typical ASD behaviors show similar interrelations (prospective and retrospective sequentialities) as behaviors observed in psychotherapy. We used an adaptation from the Social Skills Training Program (UC Davis, California). We observed that each participant took a unique course, increasing or decreasing the number and quality of their social behaviors. In accordance with previous literature, results suggest some increment in the amount of appropriate social conduct. We did not detect a generalized progress pattern but agreed that there were changes between the beginning and end of the intervention. Therefore, we consider that observational methodology is useful in the field of psychotherapy and ASD, offering detailed information about changes and development that cannot be obtained with other traditional measures, such as questionnaires.

Observation of Interactions in Adolescent Group Therapy: A Mixed Methods Study.

Group psychotherapy is a useful clinical practice for adolescents with mental health issues. Groups typically consist of young people of similar ages but with different personalities, and this results in a complex communication network. The goal of group psychoanalytic psychotherapy is to improve participants' mentalization abilities, facilitating interactions between peers and their therapist in a safe, containing environment. The main aim of this study was to analyze conversation turn-taking between a lead therapist, a co-therapist, and six adolescents over the course of 24 treatment sessions divided into four blocks over 8 months. We employed a mixed-methods design based on systematic observation, which we consider to be a mixed method itself, as the qualitative data collected in the initial observation phase is transformed into quantitative data and subsequently interpreted qualitatively with the aid of clinical vignettes. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified as we used an ad-hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Once we had confirmed the reliability of the data, these were analyzed by polar coordinate analysis, which is a powerful data reduction technique that provides a vector representation of relationships between categories. The results show significant relationships between the therapist and (1) the activation of turn-taking by the participants and the co-therapist and silence and (2) conversation-facilitating interventions and interventions designed to improve mentalization abilities. Detailed analysis of questions demonstrating interest in others showed how the communication changed from radial interactions stemming from the therapist at the beginning of therapy to circular interactions half way through. Repetition was found to be a powerful conversation facilitator. The results also illustrate the role of the therapist, who (1) did not facilitate interventions by all participants equally, (2) encouraged turn-taking from more inhibited members of the group, (3) stimulated conversation from the early stages of therapy, and (4) favored mentalization toward the end. Despite its complexity, polar coordinate analysis produces easy-to-interpret results in the form of vector maps.

Intervención grupal con pre-adolescentes con autismo de alto funcionamiento / Group intervention with pre-adolescents diagnosed with high functioning autism

En este artículo se presenta una intervención grupal con pre-adolescentes con diagnóstico de Trastorno del Espectro Autista (TEA) o autismo de alto funcionamiento. Se expone el proceso de un grupo terapéutico en el que, a lo largo de 24 sesiones, se trabajó la comunicación y la relación interpersonal entre sus miembros, desde una perspectiva psicoanalítica, con el propósito de modificar sus dificultades interpersonales y promover el proceso de socialización y maduración de su personalidad. La valoración pre-post de la intervención con el cuestionario CBCL de Achenbach y el test proyectivo del dibujo de la figura humana, mostró una evolución positiva de los tres participantes del grupo (AU)

This paper presents a group therapy intervention with pre-adolescents diagnosed with Autism Spectrum Disorder (ASD) or high functioning autism. It is described the group therapy process in which, over 24 sessions, communication and interpersonal relation were worked between its members, from a psychoanalytic perspective, with the propose to modify their interpersonal difficulties and promote the socialization process and their personality maturation. The pre and post intervention evaluation with the Achenbach Child Behaviour Checklist (CBCL) questionnaire and the projective test of the human figure drawing, showed a positive evolution of the 3 participants of the group (AU)