[Depression, generalized anxiety and risk of problematic substance use in high school students]. / Depresión, ansiedad generalizada y riesgo de consumo problemático de sustancias en estudiantes secundarios.

OBJECTIVE: To estimate the prevalence and comorbidity of depression, generalized anxiety, and risk of problematic substance use in adolescents, and to examine the sociodemographic variables associated with these mental health problems. SUBJECTS AND METHOD: 2,022 students from first to third year of high school (9th to 11th grade) from 8 educational establishments in the northern area of Santiago, Chile, participated in the study. The mean age was 15.2 years and 49.5% of the sample was female. Sociodemographic, measures of depression (Patient Health Questionnaire-9 [PHQ-9]), generalized anxiety (Generalized Anxiety Disorder 7-item [GAD-7]), and risk of problematic substance use (Car, Relax, Alone, Forget, Family/Friends, Trouble [CRAFFT]) data were collected. Data were analyzed using bivariate hypothesis testing and logistic and Poisson regression models. RESULTS: 52.9% met the criteria for one or more mental health problems. A total of 35.2% scored positive for depression, 25.9% for generalized anxiety, and 28.2% for risk of problematic substance use, with differences by gender in the first two and differences by gender and age in the third. A total of 26.5% scored positive for two or more mental health problems. Regression models showed differences in the associations between gender, age, and not living with both parents with the mental health problems studied. CONCLUSIONS: There is a high prevalence and comorbidity in the three mental health problems studied. The results show the importance of assessing comorbidity in clinical work with adolescents and the development of transdiagnostic preventive interventions for this population.

Growing Up with Intimate Partner Violence at Home: Adolescents' Narratives on Their Coping Strategies.

Purpose: The research on adolescents who have grown up around intimate partner violence (IPV) between their parents or caregivers has mostly focused on adolescent's victimization experiences and the negative impact of this type of violence on their mental health. More research is needed on how they respond to these experiences. The aim of this study is to understand adolescents' coping strategies regarding IPV between their parents or caregivers, from their perspectives. Methods: The participants were ten adolescents between 12 and 17 years old (4 female and 6 male), users of protection programs in Chile. Semi-structured interviews were conducted, using thematic narrative analysis afterward. Results: The results show seven coping strategies: intervention, social support seeking, protective role, positive resignification, hypervigilance, escape-avoidance, and denial. The narratives of the adolescents indicate that they face not only specific episodes of IPV but also the consequences and family dynamics that accompany this type of violence. Conclusion: Adolescents' coping strategies can be organized in a continuum of IPV integration-distancing, based on the degree and form of involvement in the experience. Growing up with IPV at home demands an early development of the sense of agency and taking a position in the face of violence, transitioning between active and victim roles.

[Disparities in the use of mental health services of adolescents in Chile]. / Disparidades en el uso de servicios de salud mental de adolescentes en Chile.

OBJECTIVE: To examine disparities in the use of mental health services (MHS) in adolescents according to sociodemographic factors. SUBJECTS AND METHOD: 2,022 adolescents aged 13-19 years in Santiago, Chile, participated in the study. Between April and May 2008, they answered a self-report survey that assessed lifetime (history of treatment for depression) and current (psychological or pharmacological treatment) use of MHS, sociodemographic variables, and psychopathology as symptoms of depression, symptoms of generalized anxiety disorder, and risk of problematic substance use. Data were analyzed using logistic regression. RESULTS: 16.5% of participants reported lifetime use of MHS due to depression, 9.7% were on current psychological treatment, and 2.7% were on current pharmacological treatment. Among those meeting criteria for a mental health problem, only 14.9% to 18.9% were currently on treatment. Males, younger participants, and those who had immigrants' parents reported lower lifetime use of MHS due to depression. Those with parents with 9 to 12 years of education and who had immigrants' parents reported lower current MHS use. Youth not living with both parents reported higher lifetime and current MHS use. CONCLUSIONS: We observe a high treatment gap in those with mental health needs as well as differences in MHS use based on socio-demographic variables. These results may be useful for planning interventions that favor access to and use of MHS, especially in the most disadvantaged groups of adolescents.

Barriers and Facilitators to Mental Health Help-Seeking and Experiences with Service Use among LGBT+ University Students in Chile.

Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.

[Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents]. / Propiedades psicométricas de la escala Generalized Anxiety Disorder 7-Item (GAD-7) en una muestra comunitaria de adolescentes en Chile.

BACKGROUND: The Generalized Anxiety Disorder 7-item (GAD-7) scale is widely used for the assessment of generalized anxiety disorder. AIM: To adapt the GAD-7 to the Chilean adolescent population and to evaluate its psychometric properties. MATERIAL AND METHODS: The GAD-7 was adapted and administered to 2,022 adolescents between 13 and 19 years of age, recruited from eight schools in the northern area of Santiago, Chile. Other self-report instruments were used to assess depressive symptoms and health-related quality of life. The one factor structure and invariance by sex were examined using Confirmatory Factor Analysis. Its reliability and validity based on its relationship with other variables were assessed. RESULTS: The one-factor structure and invariance by sex were confirmed. The results showed an adequate internal reliability (Cronbach's alpha = 0.86, Spearman-Brown coefficient = 0.82). As expected, significant correlations were observed with measures of depressive symptoms and health-related quality of life. Higher scores were observed in women than in men. CONCLUSIONS: The Chilean version adapted for adolescents of the GAD-7 has good psychometric properties. Thus, it may be a useful and valid instrument for the assessment of generalized anxiety disorder in adolescents in Chile.

State of Mental Health Research of Adolescents and Youth in Chile: An Ontological Analysis.

Knowing the state of mental health research in adolescents and youth can be an important tool for decision-making, especially in contexts of limited resources. The aim of this study is to map the scientific research on adolescent and youth mental health in Chile using an ontological framework. We have mapped the population of research articles on mental health of adolescents and youth in Chile in Scopus, Web of Science, and SciELO databases onto the ontology. The PRISMA reporting guidelines were used to screen the 1688 items based on relevance, duplication, and version. The corpus of 346 articles was coded into the ontology through an iterative process among the seven authors. This ontological mapping shows isolated research efforts that have been carried out in Chile to explain the whole state of mental health in adolescents and youth. There is a lack of coordination between the priorities established by the decision-makers and the researchers. Our results coincide with the need to strengthen mental health research in the country, and to prioritizing those topics that contribute to decision-making based on the needs of the population.

Social and Economic Factors Associated With Subthreshold and Major Depressive Episode in University Students During the COVID-19 Pandemic.

Depression is one of the most frequent mental health disorders in college students and variations according to social and economic factors have been reported, however, whether social and economic variations also exist in subthreshold depression is still unknown, especially during the COVID-19 pandemic. The aim of this study was to estimate the prevalence of subthreshold depressive episode (SDE) and major depressive episode (MDE) and to examine the association between social and economic factors with SDE and MDE in undergraduate students during the COVID-19 pandemic. The participants were 1,577 college students from a university in the south of Chile (64.6% females, 22 years old on average). The participants took an online survey in November 2020 which collected information about social and economic variables, depressive symptoms, and perceived social support. Bivariate and multinomial logistic regression analysis were used. The results showed a high prevalence of SDE (14.3%) and MDE (32.3%) in the sample. Belonging to a social group and perceiving positive social support were the only variables examined that were associated with SDE. Instead, female sex, poorer quintiles, living with other relatives but not parents, economic difficulties due to the pandemic, being a parent, and perceiving positive social support were associated with MDE. Subthreshold and threshold depressive symptoms are frequent in college students, and associations with social and economic factors differ according to the level of such symptoms. These results should be considered in the development of tailored preventive and early interventions for depression in college students.

Propiedades psicométricas de la escala Generalized Anxiety Disorder 7-Item (GAD-7) en una muestra comunitaria de adolescentes en Chile / Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents

BACKGROUND: The Generalized Anxiety Disorder 7-item (GAD-7) scale is widely used for the assessment of generalized anxiety disorder. AIM: To adapt the GAD-7 to the Chilean adolescent population and to evaluate its psychometric properties. MATERIAL AND METHODS: The GAD-7 was adapted and administered to 2,022 adolescents between 13 and 19 years of age, recruited from eight schools in the northern area of Santiago, Chile. Other self-report instruments were used to assess depressive symptoms and health-related quality of life. The one factor structure and invariance by sex were examined using Confirmatory Factor Analysis. Its reliability and validity based on its relationship with other variables were assessed. RESULTS: The one-factor structure and invariance by sex were confirmed. The results showed an adequate internal reliability (Cronbach's alpha = 0.86, Spearman-Brown coefficient = 0.82). As expected, significant correlations were observed with measures of depressive symptoms and health-related quality of life. Higher scores were observed in women than in men. CONCLUSIONS: The Chilean version adapted for adolescents of the GAD-7 has good psychometric properties. Thus, it may be a useful and valid instrument for the assessment of generalized anxiety disorder in adolescents in Chile.

[Prevalence estimation of Autism Spectrum disorders in chilean urban population]. / Estimación de la prevalencia de trastorno del Espectro Autista en población urbana chilena.

INTRODUCTION: The prevalence of Autism Spectrum Disorder has increased, varying between 0.5 and 1% around the world. The prevalence of ASD in Chile is unknown. OBJECTIVE: To estimate the prevalence of ASD in two urban communes of Santiago, Chile. SUBJECTS AND METHOD: Cross-sectional epidemiological study. 272 children aged between 18-30 months who attended well-child visits at two Family Health Centers in two urban communes of Santiago participated. Consecutive sampling was used and chil dren who were already being monitored by neurology were excluded. Screening was performed using the Modified Checklist for Autism in Toddlers (M-CHAT). Those children with altered M-CHAT were evaluated by a pediatric neurologist at the San Borja Arriarán Clinical Hospital and diagnosed with ASD according to clinical criteria. The Autism Diagnostic Observation Schedule - Second Ver sion (ADOS-2) was used as a diagnostic complement. The prevalence of ASD was estimated with a 95% confidence interval. RESULTS: 44 children had altered M-CHAT; 5 of them were clinically diagno sed with ASD. A 1.95% prevalence of ASD (95% CI 0.81-4.63) was obtained, with a sex distribution of 4 boys per 1 girl. CONCLUSIONS: This study is the first estimate of ASD prevalence in two communes of Santiago, Chile. A high prevalence of this condition was observed, which highlights the need for obtaining resources for an early multidisciplinary approach for these patients.

Growing up in the context of intimate partner violence: Experiences and meanings for adolescents in Chile.

BACKGROUND: Growing up in the context of intimate partner violence (IPV) is associated with a range of mental health problems in childhood. A recent area of research in this field considers the perspectives of children and adolescents in understanding the phenomenon of IPV. OBJECTIVE: To explore the lived experiences of adolescents growing up in the context of IPV and the meanings they construct about the phenomenon. PARTICIPANTS AND SETTING: Ten adolescents (five females and five males), between 12 and 17 years old, who were attending psychosocial programs specialized in child maltreatment in Santiago, Chile. METHODS: The data were obtained through semi-structured interviews and thematic narrative analysis. RESULTS: The results show that many of the adolescents narrate their lived experiences of severe and chronic episodes of IPV as part of their life story, and that they continue to do so even after their parents separate. It was also found that the adolescents suffered other forms of victimizations, such as physical and sexual abuse. CONCLUSIONS: Adolescents growing up in the context of IPV are demonstrated to be not only direct victims of violence but also active agents capable of reflecting on it. The implications of children and adolescents participating in such investigations for the development of effective interventions in IPV are also discussed.

The co-occurrence of intimate partner violence exposure with other victimizations: A nationally representative survey of Chilean adolescents.

BACKGROUND: Previous studies have found a high co-occurrence between Intimate Partner Violence exposure (IPVe) and other forms of victimization, such as physical and sexual abuse, yet little is known about this issue from community samples in Latin America or -in particular- Chile. OBJECTIVE: To examine the prevalence, sociodemographic correlates and co-occurrence of IPVe with other youth victimizations in Chile. PARTICIPANTS AND SETTING: A secondary data analysis of the First Poly-victimization Survey in Children and Adolescents in Chile was conducted, which had 19,684 responses from 7th to 11th grade students attending publicly-funded, subsidized and independent schools in urban areas across the country. METHODS: The Juvenile Victimization Questionnaire was applied, and sociodemographic information was collected. Multiple logistic regression models were used. RESULTS: The prevalence of lifetime IPVe was 13.0 % (95 % CI [12.4-13.6]), and 3.6 % (95 % CI [3.4-4.0]) for past-year IPVe. The factors that were positively associated with lifetime IPVe were: female, over 14 years old, indigenous ethnicity, with a disability, mother with immigrant status, living with only one parent, and attending publicly-funded and subsidized schools. Most of these associations were maintained for past-year IPVe. All victimizations studied were positively associated with lifetime and past-year IPVe. Poly-victimization, maltreatment and witnessing sibling abuse showed the strongest associations (adjusted OR > 4.0). Co-occurrence was particularly high among IPVe youth, especially for community violence (86.2 %) and any maltreatment (81.5 %) in lifetime reports. CONCLUSIONS: An integrated approach to assessing IPVe and other forms of victimizations would enrich research and clinical practice, especially early detection of IPVe occurrences.

Perspectivas de niños y niñas sobre crecer en hogares con violencia de género en la pareja / Child perspectives on growing up with gender-based intimate partner violence at home

Crecer en el contexto de violencia de género en la pareja (VGP) se ha relacionado con problemas de salud mental en los/as hijos/as, sin embargo, poco se conoce sobre los efectos de la VGP desde el punto de vista de los propios hijos/as. El objetivo de esta investigación fue comprender el impacto psicológico asociado a vivir en contexto de VGP desde la perspectiva de los/as niños/as. Se realizaron entrevistas semiestructuradas con 3 niños y 5 niñas entre 8 y 12 años, que asistían a Programas de Protección Infanto-Juvenil y que habían crecido con diferentes formas de VGP crónica en el hogar. Las entrevistas se analizaron mediante análisis narrativo. Los resultados muestran que crecer en un contexto de VGP posee un impacto psicológico en los/as niños/as, principalmente en su bienestar emocional, las relaciones familiares y, en algunos casos, en las descripciones de sí mismos/as. Se concluye que las experiencias de VGP pueden tener un impacto significativo en la vida de los/as niños/as y afectar diferentes ámbitos de sus vidas. Los hallazgos enfatizan la importancia de comprender los efectos de la VGP desde la perspectiva de los/as hijos/as, con el fin de desarrollar intervenciones clínicas de acuerdo con sus necesidades

Growing up in the context of gender-based intimate partner violence (IPV) has been associated with mental health problems in children yet little is known about IPV effects on children from their own point of view. The aim of this research was to understand the psychological impact associated with living in an environment with IPV, from the perspective of children. Semi-structured interviews were conducted with 3 boys and 5 girls, between 8 and 12 years old, who were attending psychosocial programs specialized in maltreatment and experimented different forms of chronic IPV at home. The interviews were analyzed using narrative analysis. The results show that growing up in an environment with IPV has a psychological impact on children's emotional wellbeing and family relationships, and in some cases on their self-concept. We conclude that IPV experiences had a profound impact on the participants' wellbeing, affecting various areas of the children's lives. The results highlight the importance of understanding the effects of IPV from the children's perspective, in order to develop clinical interventions in accordance with their needs

A Qualitative Account of Children's Perspectives and Responses to Intimate Partner Violence in Chile.

The literature has shown that including children's perspectives in intimate partner violence (IPV) field research will improve our understanding of this violence and its impact on the well-being of victims. Furthermore, the literature suggests that children are not passive witnesses. Rather, they use a variety of strategies to cope with IPV. The aim of this research is to understand the experiences and coping strategies of children who have lived through IPV between their parents/caregivers. The participants of this study were nine children between the ages of 8 and 12 years (five girls and four boys). These participants were recruited from a specialized program in Chile focused on the maltreatment of children. Semi-structured interviews were conducted, and a thematic narrative analysis was used to identify recurring themes from the interviews. The results showed that children used a variety of coping strategies when an episode of violence was occurring. The aim of these coping strategies included the following: (a) emotional and behavioral self-regulation, (b) seeking social support, (c) avoiding emotional reactions related to IPV episodes, (d) escaping violent episodes, and (e) intervening to stop the IPV and protect their mothers. Along with these coping mechanisms, the results reveal that children often not only have to confront IPV when it is present in their families but are also potentially subjected to other types of victimization. The findings of this study highlight that children are active subjects with agency in response to episodes of IPV and respond through a range of actions and coping mechanisms. The researchers emphasize the relevance of integrating and validating the voices of children in research, given that children are direct victims of IPV and a high-risk group for other types of child victimization.

Stigmatizing Beliefs and Attitudes to Depression in Adolescent School Students in Chile and Colombia.

Major depressive disorder (MDD) affects between 4 and 5% of adolescents. However, there is still a huge gap between adolescents who meet criteria for MDD and those who receive mental health care. Stigmatizing attitudes toward depression are among the main barriers to seeking professional help. The aim of this article is to examine the individual characteristics associated with stigmatizing attitudes toward depression in a sample of adolescent school students from Chile and Colombia, and present the adaptation and psychometric properties of the Personal Depression Stigma Scale (DSS-Personal) for both countries. A total of 2971 adolescents, aged 10-19 (M = 14.6, SD = 1.5), who were recruited from eight schools in Santiago, Chile (n = 2022), and eight schools in Medellín, Colombia (n = 949), completed the DSS-Personal, the Patient Health Questionnaire (PHQ-9), and a questionnaire of individual sociodemographic characteristics. Factor structure, internal consistency, and validity of the DSS-Personal were assessed. Multiple linear regression models were used to evaluate the association between DSS-Personal scores and sociodemographic information, depression scores, and the use of health services by country. Confirmatory factor analysis supported the unidimensional structure of the DSS-Personal, while the estimated reliability of its scores was acceptable. Results show that DSS-Personal scores were higher in adolescents in Colombia than in Chile (U = 9.36, p < 0.001). Immigrant status was the only variable significantly related to personal depression stigma in both samples. Being female was associated with lower levels of stigma in adolescents in Chile, while depressive symptoms were associated with lower levels of stigma in adolescents in Colombia. Age, having been diagnosed with depression, and being in pharmacological or psychological treatment were not related to levels of personal depression stigma in either sample. The identified associated factors of personal depression stigma should be considered in the development of anti-stigma campaigns; also, gender differences require special attention. The results of this study suggest that it is important to offer school-based programs to reduce personal stigma, and that specific anti-stigma campaigns should address personal stigma in men and immigrants.

Subthreshold depression in adolescence: Gender differences in prevalence, clinical features, and associated factors.

BACKGROUND: Subthreshold depression (SD) is an important mental health problem in adolescence given its high prevalence, comorbidity, and functional impairment. However, currently little is known about gender differences of SD in adolescence. The aim of this study was to examine gender differences in prevalence, clinical features, and associated factors in adolescents with subthreshold depressive episode (SDE). METHODS: The participants were 2,022 adolescents between 9th and 11th grades (49.5% girls, 15.2 years average age) recruited from eight state-subsidized schools located in the northern part of Santiago, Chile. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Descriptive statistics, bivariate and multinomial logistic regression analyses were used. RESULTS: The prevalence of SDE and major depressive episode were 16.5% (95% CI: 14.9-18.2) and 17.7% (95% CI: 16.1-19.4), respectively. Both mental health problems were more prevalent in females (p < 0.001). With regard to SDE, girls displayed a higher rate of depressive mood and sleep problems, while boys had greater anhedonia, problems related with concentration, and psychomotor retardation/agitation. High levels of dysfunctional thoughts and perceived social support were associated with SDE in females and males. Social problem solving and emotion regulation had a differentiated impact on SDE depending on gender. CONCLUSION: Depressive symptoms and SDE were found to be common health problems among adolescents in Chile. SDE had major gender differences in terms of prevalence, clinical features, and associated factors. These differences should be considered in the development of preventive and early interventions.