Humor Styles in Healthcare Professionals: A Correlational Study.

Using humor as a caregiving strategy can help professionals perceive daily and work-related events from a more optimistic and light-hearted perspective. The main objective of this study was to analyze humor styles among health care professionals. A cross-sectional and correlational design was employed. Data were collected using the Humor Styles Questionnaire, which measures four humor styles: affiliative, self-enhancing, aggressive, and self-defeating humor. Health care professionals scored higher in positive humor than negative humor. Age exhibited a negative correlation with positive humor. Significant differences were observed between marital status and affiliative and self-enhancing humor, professional category and hospital unit with aggressive humor, shift work and self-enhancing humor, and type of contract and experience with affiliative humor. Health care professionals employ various humor styles based on their social and work contexts. It is crucial for health care professionals to receive training in the use of positive humor to consciously avoid humor styles that can hinder well-being.

Análisis de las propiedades psicométricas de un cuestionario para medir la actitud hacia el humor en los profesionales sanitarios / Analysis of the psychometric properties of a questionnaire to measure the attitude towards humor in healthcare professionals

Objetivo principal: Analizar las propiedades psicométricas de un instrumento diseñado específicamente para evaluar la actitud ante el humor en profesionales sanitarios. Métodos: Estudio de validación, transversal. Se determinó la fiabilidad con el índice de discriminación, el coeficiente de correlación intraclase e ítem-total, el α de Cronbach y el índice de Pearson. La validez de constructo se analizó con el análisis factorial exploratorio. Resultados principales: La Escala Multidimensional del Humor en Profesionales Sanitarios (EMHUPS) consta de 35 ítems y 8 factores: humor con el paciente, en el trabajo, en los cuidados, en el entorno privado, formación en humor, en el entorno sanitario, demanda de formación en humor y humor y ocio. Presenta una varianza del 60,99% y una fiabilidad de 0,88. Conclusión principal: La escala EMHUPS presenta unas propiedades psicométricas aceptables en la medida del humor en profesionales sanitarios. (AU)

Objective: To evaluate the psychometric properties of an instrument designed specifically designed to determine attitude towards humor in health professionals. Methods: A cross-sectional and a validation study. The reliability study analysed the discrimination capacity of the items with discrimination index, the intraclass and item-total correlation coefficient, the Cronbach's α coefficient and the Pearson's correlation coefficient. In the validation study, the Exploratory Factor Analysis was carried out. Results: The Multidimensional Scale of Humor in Healthcare Professionals (EMHUPS) consists of 35 items divided into 8 factors: humor with the patient, humor at work, humor and care, humor in the private environment, training in humor, humor and the sanitary environment, demand for training in humor and humor and leisure. These factors explained a total variance of 60.99% with overall reliability of 0.88. Conclusions: EMHUPS presents acceptable psychometric properties in the measurement of humor in healthcare professionals. (AU)

Efficacy of the myofascial approach as a manual therapy technique in patients with clinical anxiety: A randomized controlled clinical trial.

BACKGROUND: To analyze the efficacy of the myofascial approach in patients with clinical anxiety and to study its relationship with associated symptoms. METHODS: Randomized placebo-controlled clinical trial. Thirty-six adult patients with clinical anxiety were randomized to receive the myofascial treatment (n = 18) or placebo (n = 18). The patients and the evaluators were blinded to this assignation. The treatment consisted of four myofascial sessions of 40 min each for four weeks. The placebo intervention consisted of four sessions of simulated myofascial intervention of the same duration and frequency as the treatment. Follow-up was at one, three and six months. The primary outcome was clinical anxiety measured using the STAI (State-Trait Anxiety Inventory). Secondary outcomes were central sensitization, general health, somatization, depression, and pain. RESULTS: There were significant differences in the behavior of the groups over time for clinical anxiety (STAI Trait-Anxiety) (p < 0.001), central sensitization (p = 0.005) and somatization (p = 0.008) in favor of the myofascial group, with a large effect size for anxiety and a medium effect size for central sensitization and somatization. Regarding clinical anxiety, after the intervention a mean difference was observed with respect to the baseline of 19.98 points in the myofascial group (p < 0.001) and 5.95 in the placebo group (p = 0.22). The intention-to-treat principle was used. There were no adverse events or side effects in either group. CONCLUSIONS: The myofascial approach is effective in improving anxiety levels and associated central sensitization processes in patients with clinical anxiety and this improvement is maintained over time. CLINICAL TRIAL REGISTRATION: NCT04826302.

Diseño de un instrumento de medida del humor en profesionales sanitarios / Design of an instrument to measure humor in health professionals

Objetivo: Diseñar un instrumento de medida del humor en los profesionales sanitarios. Método: Estudio descriptivo, observacional y transversal de metodología mixta. Se elaboró el instrumento en varias fases: revisión bibliográfica, generación de los ítems, determinación del formato, evaluación por panel de expertos, estudio piloto, reevaluación por panel de expertos y test-retest. Se analizó la pertinencia, la relevancia y el grado de comprensión de los ítems. Se calculó la validez interobservador con el índice kappa y el coeficiente de correlación intraclase, considerándose los valores ≥ 0,61. Se utilizó la t de Student para muestras relacionadas y el coeficiente de correlación de Pearson. Para todas las pruebas se aceptó un valor de p<0,05. Resultados: La Escala Tridimensional del Humor en Profesionales Sanitarios consta de 50 ítems medidos con una escala Likert de 5 puntos en función del grado de acuerdo. El panel de expertos valoró la escala global con 3,57 (0,79) puntos sobre 5. Se obtuvo una fiabilidad interobservador de 0,69 (p<0,001) en el estudio piloto, un coeficiente de correlación de Pearson de 0,71 (p=0,002) y un coeficiente de correlación intraclase de 0,69 (p=0,001) en el test-retest. No se observaron diferencias estadísticamente significativas entre las puntuaciones del test-retest. Conclusión: La Escala Tridimensional del Humor en los Profesionales Sanitarios es una herramienta innovadora en la medida del humor en el contexto sanitario, creada específicamente para profesionales sanitarios. Antes de su utilización, es necesario analizar su validez y fiabilidad en futuros estudios.(AU)

Aim: The objective of this study was to develop an instrument for measuring humor in health professionals. Methods: Observational, transversal and descriptive study of mixed methodology. The instrument was designed in several phases: literature review, item generation, determination of the scale format, review by the expert panel, pilot study, reevaluation by the expert panel, and test-retest. The pertinence, relevance and comprehension of the items were analyzed. Interobserver agreement was calculated with Kappa and the intraclass correlation coefficient considering values ≥ 0.61. Pared sample Student's t test and Pearson's correlation coefficient were used. A level of statistical significance was established at P<0,05. Results: The Three-Dimensional Scale of Humor in Health Professionals consists of 50 items measured with a 5-point Likert scale based on the degree of agreement. Experts’ panel evaluated the global scale with 3.57 (0.79) points out of 5. An interobserver reliability of 0.69 (P<0.001) was obtained in the pilot study. A Pearson correlation coefficient of 0.71 (P=0.002) and an intraclass correlation coefficient of 0.69 (P=0.001) resulted in the test-retest. No statistically significant differences were observed between test-retest scores. Conclusion: The Three-Dimensional Scale of Humor in Health Professionals is an innovative tool for measuring humor in the health context. This scale is created specifically for health professionals. It́s necessary its validation in future studies.(AU)

Validation of the humour styles questionnaire in healthcare professionals.

AIM: The aim of this study is to determine the reliability and validity of the Humour Styles Questionnaire (HSQ) in a sample of Spanish healthcare professionals. DESIGN: A cross-sectional study. METHODS: The version of HSQ translated into Spanish by Cayssials and Pérez was used to validate on a sample of healthcare professionals (N = 250). The reliability analysed the Crombach's α coefficient and Pearson's correlation coefficient between the factors and the total scale score. The Exploratory Factor Analysis was carried out with Kaiser's criteria for the extraction of factors with Varimax rotation. RESULTS: HSQ in this study sample reproduced the similar structure of the original version with four factors (affiliative, self-enhancing, aggressive and self-defeating humour). These factors explained 44.46% of the total variance and Cronbach's ranged from 0.64-0.79. Global HSQ scale reliability was 0.82. CONCLUSION: The HSQ is a valid and reliable instrument for assessing humour in healthcare professionals.

Design of an instrument to measure humor in health professionals.

AIM: The objective of this study was to develop an instrument for measuring humor in health professionals. METHODS: Observational, transversal and descriptive study of mixed methodology. The instrument was designed in several phases: literature review, item generation, determination of the scale format, review by the expert panel, pilot study, reevaluation by the expert panel, and test-retest. The pertinence, relevance and comprehension of the items were analyzed. Interobserver agreement was calculated with Kappa and the intraclass correlation coefficient considering values ≥0.61. Pared sample Student's t test and Pearson's correlation coefficient were used. A level of statistical significance was established at P < 0.05. RESULTS: The Three-Dimensional Scale of Humor in Health Professionals consists of 50 items measured with a 5-point Likert scale based on the degree of agreement. Experts' panel evaluated the global scale with 3.57 (0.79) points out of 5. An interobserver reliability of 0.69 (P < 0.001) was obtained in the pilot study. A Pearson correlation coefficient of 0.71 (P = 0.002) and an intraclass correlation coefficient of 0.69 (P = 0.001) resulted in the test-retest. No statistically significant differences were observed between test-retest scores. CONCLUSION: The Three-Dimensional Scale of Humor in Health Professionals is an innovative tool for measuring humor in the health context. This scale is created specifically for health professionals. It's necessary its validation in future studies.

Aplicación de hipnosis al miedo al contagio por COVID-19 en un cuidador de paciente oncológico / Hypnosis applied to the fear of COVID-19 in a cancer caregiver

Objetivo: Se presenta el caso de un familiar de paciente oncológico durante la situación generada por la pandemia de COVID-19, con el que se utiliza un programa multicomponente en el que se incluye la hipnosis clínica como herramienta para gestionar el miedo al contagio y la adaptación a la enfermedad oncológica en el cuidador principal. Método: Una intervención a través de hipnosis clínica para el manejo del miedo al contagio durante el proceso oncológico de su enfermedad. Resultado: Se produce la reducción de la sintomatología ansiosa, en relación con el miedo al contagio, permitiendo a PS abordar diferentes situaciones sin aplicar un afrontamiento evitativo, usando su miedo como una estrategia de protección frente al COVID-19. Ha conseguido mejorar el insomnio, reduciendo los problemas de conciliación y mejorar su autoestima y reforzar el autoconcepto. Conclusión: La hipnosis se revela como una técnica útil rápida y eficaz, que permite manejar de manera adecuada la sintomatología de carácter ansioso dentro de un programa multicomponente. (AU)

Objective: Treatment of fear of contagion during the COVID-19 pandemic and the adaptation to the oncological disease through a multicomponent program that includes clinical hypnosis, in the main caregiver. Method: An intervention using clinical hypnosis to manage the fear of contagion during the process of caring for an oncological patient. Results: There is a reduction in anxiety symptoms, in relation to the fear of contagion, which allows the patient to address different situations without applying avoidant coping, using fear as a protection strategy against COVID-19. Insomnia problems were improved, reducing problems with conciliation insomnia, improving self-esteem and reinforcing self-concept. Conclusion: Hypnosis is revealed as a useful, fast and effective technique that allows to adequately manage anxiety symptoms within a multicomponent program. (AU)

Symptom and Performance Validity Assessment in European Countries: an Update.

In 2013, a special issue of the Spanish journal Clínica y Salud published a review on symptom and performance validity assessment in European countries (Merten et al. in Clínica y Salud, 24(3), 129-138, 2013). At that time, developments were judged to be in their infancy in many countries, with major publication activities stemming from only four countries: Spain, The Netherlands, Great Britain, and Germany. As an introduction to a special issue of Psychological Injury and Law, this is an updated report of developments during the last 10 years. In that period of time, research activities have reached a level where it is difficult to follow all developments; some validity measures were newly developed, others were adapted for European languages, and validity assessment has found a much stronger place in real-world evaluation contexts. Next to an update from the four nations mentioned above, reports are now given from Austria, Italy, and Switzerland, too.

Directrices para la Redacción de Estudios de Caso en Psicología Clínica: PHYSCHOCARE Guidelines / Guidelines for writing of case studies in clinical psychology: PSYCHOCARE guidelines

La publicación continua de estudios de casos en la literatura psicológica pone de relieve la utilidad de esta alternativa para comunicar resultados entre investigadores y profesionales. Este artículo contiene recomendaciones de buenas prácticas para escribir estudios de casos clínicos, series de casos y estudios de diseños experimentales de caso único en psicología clínica, con el fin de mejorar la transparencia en la comunicación de los resultados y aumentar su posibilidad de publicación. Estas pautas sintetizan las recomendaciones de la psicología basada en la evidencia y los estudios de casos sistemáticos, así como las tendencias actuales en el análisis estadístico para este tipo de diseños. Se indican las secciones a incluir, una breve descripción del contenido a desarrollar en cada una de ellas y los aspectos éticos a tener en cuenta en la preparación de estos manuscritos

Continuous publication of case studies in the psychological literature highlights the usefulness of this alternative for communicating results between researchers and practitioners. This article covers recommendations of good practices for writing clinical case studies, case series, and single-case experimental design in clinical psychology in order to improve transparency in the communication of results and increase their odds of being published. These guidelines summarize recommendations from evidence-based psychology and systematic case studies, as well as from current trends in statistical analysis for these types of designs. Sections to be covered, a brief description of the content to be developed in each of them, and the ethical aspects to be taken into account in manuscript preparation are pointed out

Use of hypnosis for the placement of a midline catheter in a patient at the end of life.

OBJECTIVE: The case of a non-oncological patient at the end of his life, admitted to a Palliative Care Unit (PCU), is presented. After a failed attempt to place a central venous catheter (CVC) and another placement of a peripherally inserted central catheter (PICC), the patient exhibited high anxiety regarding a midline catheter (MC) and refused its placement, even though this was necessary for the administration of intravenous drugs to control dyspnea and other complex symptoms that he presented. METHOD: An intervention through clinical hypnosis for successful MC placement and symptom control is described. RESULT: Through clinical hypnosis and interdisciplinary teamwork, it was possible to place a MC, necessary for symptomatic control of a complex patient. SIGNIFICANCE OF RESULT: This case exemplifies hypnosis as a simple procedure that is easy to apply, accepted by the patient, and effective in the implementation of invasive procedures and symptom control in PCUs.

El Efecto Placebo en el Tratamiento del Dolor Musculoesquelético Cervical: un Ensayo Clínico Aleatorizado / The placebo effect in the treatment of musculoskeletal neck pain: A randomized clinical trial

Se ha estudiado el efecto placebo en el dolor musculoesquelético cervical ampliamente. Se deriva del contexto de la intervención y es común a todas ellas. Las últimas investigaciones apuntan a que Kinesio Taping podría ser una forma de efecto placebo. A través del presente estudio se prende analizar si el Kinesio Taping es una forma de efecto placebo en sujetos con dolor musculoesquelético cervical. Se comparó el efecto del Kinesio Taping con el de un placebo. Tras analizar 30 sujetos, los resultados muestran que el efecto clínico del Kinesio Taping es similar al de un placebo. Las expectativas, el condicionamiento o la sugestión pueden estar muy relacionadas con el efecto clínico en los pacientes

Placebo effect has been widely studied in musculoskeletal neck pain treatment. This effect derives from the therapeutic context and is common to all of them. Latest research suggests Kinesio Taping could be a kind of placebo effect. This clinical trial analizes if Kinesio Taping could be a kind of placebo effect in subjects with musculoskeletal neck pain. Kinesio Taping was compared with a placebo. After analyzing 30 subjects, the results show that Kinesio Taping clinical effects are similar to placebo. Expectations, conditioning, or suggestion could be very closely related to clinical effect in patients

Evaluación de la Sugestionabilidad en Trastornos Emocionales. Un Estudio Exploratorio / The assessment of suggestibility in emotional disorders: An exploratory study

La evaluación de la sugestionabilidad y la hipnotizabilidad se ha establecido como una valiosa línea de investigación. No obstante, la mayor parte de los estudios se han realizado con muestras de población general, siendo los trabajos con muestras clínicas escasos. El objetivo del presente estudio ha sido evaluar la sugestionabilidad en una muestra de pacientes (n = 147), mediante la aplicación de un inventario de sugestionabilidad y establecer una comparación con una muestra control (n = 57). Los participantes de la muestra clínica presentaron significativamente una mayor sugestionabilidad, en comparación con los participantes de la muestra control, en la puntuación total y en las escalas de absorción, implicación emocional e influenciabilidad. Al comparar grupos específicos de trastornos mentales con respecto a la muestra control, se observaron diferencias estadísticamente significativas en sugestionabilidad para los pacientes con trastorno de ansiedad social, trastorno de pánico, trastorno obsesivo-compulsivo y trastorno de estrés postraumático. Estos resultados tienen importantes implicaciones para la práctica clínica

The assessment of suggestibility and hipnotizability has become a valuable research line in the last decades. However, most studies have focused on general population, and there are limited and insufficient papers dealing with clinical simples. The aim of the present study was to evaluate general suggestibility in a sample of patients (n = 147) compared to a control (non-clinical) group (n = 57), by means of the adminitration of an inventory of suggestibility. Clinical sample participants showed higher levels of suggestibility (overall score) and higher levels of absorption, emotional suggestibility, and influence of others (subscales) than controls. By clinical groups, social anxiety, panic isorder, OCD, and PTSD groups scored higher in suggestibility than controls. These results have relevant implications for clinical practice

Sobre la Validez y Eficacia de la Hipnosis Clínica. Valoración Crítica del Documento Observatorio OMC contra las Pseudociencias, Pseudoterapias, Intrusismo y Sectas Sanitarias en relación con la Hipnoterapia / No disponible

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Psychological characteristics of dissociation in general population / Características psicológicas de la disociación en la población general

Dissociation is defined as the separation of those processes that should be accessible, considering that both somatoform and conversion symptoms may be understood as dissociative. In recent decades, psychological variables have been related to dissociation, such as suggestibility, fantasy, alexithymia, abnormal emotional processes, and also a particular personality profile. The aim of this paper is to study the profile associated with psychoform and somatoform dissociation. The sample consisted of 355 participants. University students employed the snowball sampling. The following instruments were used: the Dissociative Experiences Scale-II (DES-II), the Questionnaire Somatoform Dissociation (SDQ-20), the Inventory Suggestibility (IS), the Alexithymia Scale Toronto (TAS-20), the Scale Difficulties in Emotion Regulation (DERS), the revised NEO Personality Inventory (NEO-PI), and some ad hoc questions to evaluate sleep-related experiences. The results indicated that high dissociators showed higher scores on suggestibility, alexithymia, sleep- related experiences, neuroticism, openness to experience, and lower conscientiousness than low dissociators, the results being similar to those obtained by high somatizers. As a conclusion, the profile found in both types of dissociation indicated their existing relationship, and pointed out possible lines of future research and treatment

La disociación se define como la separación de procesos que deberían ser accesibles, considerándose que los síntomas somatomorfos y conversivos pueden entenderse como disociativos. En las últimas décadas se han encontrado variables psicológicas relacionadas con la disociación, como la sugestionabilidad, la fantasía, alexitimia, alteraciones en los procesos emocionales y un perfil concreto de personalidad. El objetivo de este trabajo es estudiar el perfil asociado a la disociación psicoforme y somaforme. La muestra estuvo compuesta por 355 participantes. El muestreo consistió en la bola de nieve por parte de estudiantes universitarios. Para su realización se utilizó la Escala de Experiencias Disociativas-II (DES-II), el Cuestionario de Disociación Somatoforme (SDQ-20), el Inventario de Sugestionabilidad (IS), la Escala de Alexitimia de Toronto (TAS-20), la Escala de Dificultades en la Regulación Emocional (DERS), el Inventario de Personalidad NEO revisado (NEO-PI) y preguntas elaboradas ad hoc para evaluar experiencias relacionadas con el sueño. Los sujetos con elevada disociación mostraron mayores puntuaciones en sugestionabilidad, alexitimia, experiencias de sueño, neuroticismo y apertura y menores en responsabilidad, de forma muy similar al grupo de sujetos de elevada somatización. Puede concluirse que el perfil hallado en ambos tipos de disociación refleja la relación existente entre ambas y señala posibles líneas de investigación y tratamiento futuros

Mindfulness, personalidad y sugestionalibilidad: estudio correlacional exploratorio / Mindfulness, personality and suggestibility: a correlational study

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The present paper aims to explore the relationship between mindfulness (measured by the Spanish version of the Five Facet Mindfulness Questionnaire -FFMQ), personality 'Big Five' (measured by the Spanish version of the NEO Five Factor Inventory) and suggestibility (measured by the Inventory of Suggestibility) in normal university population (N= 80). Main results revealed negative and significant correlations between Neuroticism and all FFMQ facets, except for the 'observe' subscale. Very low and mainly non-significant correlations were obtained regarding Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. Regarding suggestibility, there were positive and significant correlations between the Absorption subscale and the FFMQ total score, 'describe' and 'act with awareness' facets; and negative and significant correlations between the Influencing by others subscale and the FFMQ total score, 'act with awareness' and 'nonjudgment' facets. Taking into account FFMQ y IS total scores, mindfulness and suggestibility constructs appear to be relatively independent. Results are discussed regarding previous literature (AU)

Disociación, personalidad, sugestionabilidad, alexitimia y dificultades en la regulación emocional: un estudio correlacional / Dissociation, personality, suggestibility, alexithymia, and problems with emotional regulation: a correlational study

El presente estudio explora la relación entre la disociación psicológica y somática y su asociación con la sugestionabilidad, alexitimia, personalidad y dificultades en la regulación emocional. Los resultados sobre la muestra de 355 participantes indican la relación entre ambos tipos de disociación, la sugestionabilidad, las dificultades en la regulación emocional y la presencia de características diferenciadores de personalidad en ambos tipos de síntomas disociativos, mostrándose mayor neuroticismo, búsqueda de sensaciones y apertura, así como menor amabilidad y responsabilidad en la disociación psicológica. En la disociación somática, la personalidad mostró únicamente relación con la faceta de ansiedad. La edad también se relaciona de forma diferencial dependiendo de los síntomas disociativos presentes. Estos resultados ponen de manifiesto la importancia de estudiar de forma conjunta ambos tipos de síntomas disociativos, psicológicos y somáticos

The present paper explores the relationship between psychological and somatic dissociation and different personality and emotional variables, including suggestibility, alexithymia, and emotional regulation and dysregulation. The results with a sample of 355 partipants of a normal population reveal that there is a positive relationship between both types of dissociation, suggestibility and emotional dysregulation. Likewise, there were different patterns of personality associated both to psychological and somatic dissociation. Correlations found in this study put forward the importance to take into account both types of dissociactive symptoms, psychological and somatic ones

Symptom validity assessment in European countries: Development and state of the art / Evaluación de la validez de los síntomas en Europa: evolución y situación actual

In the past, the practice of symptom validity assessment (SVA) in European countries was considerably lagging behind developments in North America, with the topic of malingering being largely taboo for psychological and medical professionals. This was being changed in the course of the past decade with a growing interest in methods for the assessment of negative response bias. European estimates of suboptimal test performance in civil and social forensic contexts point at base rates similar to those obtained in North America. Symptom over-reporting and underperformance in neuropsychological examinations appear to occur in a sizable proportion of patients. Although there is considerable progress in establishing SVA as an integral and indispensable part of psychological and neuropsychological assessment in some countries, others appear to lag behind. In some countries there is still enormous resistance against SVA from part of the neuropsychological and psychiatric communities (AU)

Hasta no hace mucho tiempo la evaluación de la validez de los síntomas en Europa, tanto en su vertiente científico-académica como en la práctica profesional, estaba muy por detrás de los avances que se producían en Norteamérica y particularmente la simulación se consideraba un tema tabú entre los profesionales de la Psicología y la Medicina. En la última década las cosas parecen haber cambiado, observándose un incremento en el interés por la evaluación del sesgo de respuesta negativo. Las tasas base de prevalencia obtenidas utilizando pruebas de rendimiento subóptimo en contextos civiles y forenses son similares a las obtenidas en Norteamérica. Los fenómenos de exageración de síntomas en autoinformes y rendimiento insuficiente en pruebas neuropsicológicas parecen ocurrir en semejante proporción de pacientes. Aunque se han producido avances notables en el establecimiento de la evaluación de la validez de los síntomas como una parte integral e indispensable de la evaluación psicológica y neuropsicológica en algunos países europeos, en otros sin embargo la situación es mucho más incipiente. De hecho, en algunos países sigue existiendo una gran resistencia a la evaluación de la validez de los síntomas proveniente de algunos profesionales de la psiquiatría y la neuropsicología (AU)

Prevalencia de simulación en incapacidad temporal: percepción de los profesionales de la salud / Health professionals´ perceptions of prevalence of malingering in temporary disability in Spain

A pesar de su relevancia económica y social, apenas existen estudios en España que aborden la prevalencia de la simulación en la incapacidad temporal. El objetivo de este estudio ha sido abordar esta cuestión indagando en qué patologías se percibe que hay mayor presencia de simulación en el contexto médico-legal por parte de los profesionales que trabajan en su determinación. Para ello se ha dispuesto de una muestra incidental de 161 médicos (56% mujeres) procedentes de 26 provincias distintas, con edades comprendidas entre los 30 y los 59 años (M = 43.6, DT = 6.5) y con un promedio de 17 años de ejercicio profesional (DT = 6.3). Mediante un breve cuestionario se les pidió que indicaran qué patologías eran más simuladas, cuál creían que era el porcentaje de simulación en las mismas, cuál era el perfil sociodemográfico (edad, nivel de ingresos, profesión, etc.) y qué datos consideraban indicativos de sospecha. Los resultados mostraron que los profesionales percibían como con mayores tasas de simulación los trastornos por dolor crónico (esguince cervical, lumbalgia, cervicalgia, fibromialgia) y los afectivos y emocionales (ansiedad y depresión). El perfil sociodemográfico prototípico era el de personas de mediana edad, con trabajos poco estimulantes y bajos o moderados ingresos, que comienzan sufriendo originalmente algún tipo de lesión o trastorno y deciden prolongarlo en el tiempo para mantener los beneficios obtenidos. Estos resultados se presentan encuadrados dentro del modelo adaptativo de simulación y se asocian a la necesidad de desarrollar protocolos específicos de simulación que minimicen los posibles falsos positivos y falsos negativos en el proceso de evaluación (AU)

In spite of the economic and social relevance of the prevalence of malingering in temporary incapacity, there are very few studies in Spain dealing with this problem. The aim of the present paper is to address this matter by looking into those pathologies that according to professionals show the highest rates of malingering in the medico-legal context. For this purpose, we used an incidental sample of 161 doctors (56% of them were women) from 26 different Spanish provinces, with an age range of 30 to 59 (M = 43.6, SD = 6.5) and an average seniority on the job of 17 years (SD = 6.3). They were asked to complete a brief questionnaire indicating those pathologies in which they thought malingering was more frequent, what percentage of these conditions they thought was simulated, the sociodemographic profile of malingerers (age, income, occupation, etc.), and what data they considered to be an indication for suspicion. The results showed that the doctors perceived the highest rates of malingering to be associated with chronic pain conditions (cervical sprain, lumbago, neck and shoulder pain, fibromyalgia) and affective/emotional conditions (anxiety and depression). The prototypical sociodemographic profile was a middle-aged person, with an unstimulating job and a low or moderate income, and who once had an injury or disorder and decided to prolong it over time in order to maintain the benefits obtained. These results are presented within the frame of the adaptive malingering model and linked to the need to develop specific malingering protocols which minimize the risk of false positives and false negatives in the assessment process (AU)

Fibromialgia: ¿exageración o simulación? / Fibromyalgia: Exaggeration or malingering?

Se presenta un estudio multidimensional de la exageración de síntomas en pacientes con fibromialgia. El objetivo principal es detectar patrones discriminantes de simulación de discapacidad relacionada con el dolor con el fin de desarrollar un protocolo detallado para la evaluación de sospecha de simulación en los casos con síntomas físicos o psicológicos falsos o exagerados motivados por incentivos externos. La muestra total (N = 113) estuvo compuesta por cuatro grupos: pacientes con fibromialgia no litigantes (n = 36), pacientes con fibromialgia en situación de litigancia (n = 26), participantes análogos (n = 21) y grupo control (n = 30). Se administraron diferentes pruebas médicas y psicológicas a los participantes, incluyendo pruebas médicas complementarias, la adaptación española de la Escala de Auto–Eficacia (Baessler y Schwarzer, 1996), la Escala de Satisfacción Personal Vital (González Ordi, Santamaría y Casado Morales, 2012), la adaptación española del Cuestionario de Impacto de Fibromialgia (FIQ, Monterde, Salvat, Montull y Fernández-Ballart, 2004), la versión española de la Encuesta de Salud SF-36 (Alonso, Prieto y Antó, 1995), la adaptación española del Inventario Estructurado de Simulación de Síntomas (SIMS, González Ordi y Santamaría, 2009) y la adaptación española del Inventario de Personalidad de Minnesota- 2- Formulario Reestructurado (MMPI-2-RF, Ben-Porath y Tellegen, 2008a). Se presentan datos sobre las diferencias entre grupos y la precisión de predicción de los instrumentos utilizados. También se aborda un protocolo para la detección de la simulación en base a los resultados del perfil diferencial entre la fibromialgia no litigante y litigantes (AU)

A multidimensional study on symptom exaggeration in fibromyalgia patients is presented. The main aim is to detect discriminant patterns of malingered pain-related disability in order to develop a detailed protocol for the assessment of suspected malingering in cases of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Overall sample (N = 113) consisted of four groups: fibromyalgia patients not involved in litigation (n = 36), fibromyalgia patients involved in litigation (n = 26), analogue fibromyalgia-instructed participants (n = 21), and control group (n = 30). Several medical and psychological tests were administered to participants, including medical complementary tests, the Spanish adaptation of the General Self-Efficacy Scale (Baessler & Schwarzer, 1996), the Life Personal Self-Report Scale (González-Ordi, Santamaría, & Casado-Morales, 2012), the Spanish adaptation of the Fibromyalgia Impact Questionnarie (FIQ, Monterde, Salvat, Montull, & Fernández-Ballart, 2004), the Spanish version of the SF-36 Health Survey (Alonso, Prieto, & Antó, 1995), the Spanish adaptation of the Structured Inventory of Malingered Symptomatology (SIMS, González-Ordi & Santamaría, 2009), and the Spanish adaptation of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF, Ben-Porath & Tellegen, 2008a). Data on mean group differences and predictive accuracy of the instruments used are presented. A protocol for the detection of malingering based on the differential profile scores between fibromyalgia non-litigants and litigants are also addressed (AU)

Simulación en patología dolorosa crónica del raquis cervical (cervicalgia/esguince cervical) / Detection of malingering in chronic painful condition of the cervical spine (neck pain/whiplash injury)

Se presenta una aproximación a la situación actual de la detección de simulación en la patología dolorosa del raquis cervical, basada en la idea central de la convergencia de datos que proceden de diferentes fuentes de información. La evaluación del paciente ha de ser multimétodo, multisistema y multidisciplinar, utilizando diferentes pruebas médicas y psicológicas actualmente contrastadas. En aquéllas ocasiones en las que el clínico sospecha la existencia de simulación (por ejemplo en el caso de algunos esguinces cervicales), la dificultad radica en definir en primer lugar si existe o no un patrón de exageración de síntomas, y en segundo lugar si el paciente es o no un simulador. Se plantea un protocolo de actuación para esta sospecha en el caso de cervicalgia/esguince cervical. Cuantas más pruebas independientes entre sí evidencien un patrón similar de exageración de síntomas, mayor certeza tendrá el evaluador a la hora de expresar sus conclusiones(AU)

An updated review of the literature on detection of malingering in chronic painful condition of the cervical spine is addressed. The detection of malingering is mainly based on the convergence of different sources of information. Indeed, patient assessment must use multiple methods, examine multiple systems and be multidisciplinary oriented, by using different empirical-based medical and psychological tests, instruments and procedures. In the presence of simulation suspect by the clinician (e.g. some whiplash injury cases), two aspects must be clarified in order to determine the presence of: (1) pattern of symptom exaggeration, and (2) malingering. In order to do this, a clinical multidisciplinary protocol is presented and detailed for the assessment of malingering in cases of neck pain/whiplash injury. The key aspect that the clinician must take into account is, that the more independent the tests, strategies and procedures show patterns of symptom exaggeration, the more certain will be our conclusions(AU)