Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial.

Background: Online psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants. Methods: A multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis. Discussion: This protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.

Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic.

PURPOSE: To examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic. METHODS: 7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models. RESULTS: Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems. CONCLUSION: The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

Psychometric evidence of the Acceptance and Action Questionnaire-II (AAQ-II): an item response theory analysis in university students from Chile.

BACKGROUND: Experiential avoidance (EA) is a psychological mechanism associated with several mental health disorders and is regarded as a relevant target by third-generation cognitive behavioral therapies. It has been mainly assessed through self-report questionnaires, and the AAQ-II is the most used tool. Its psychometric evidence has been mostly tested through the classical test theory (CTT) and very scarcely assessed through Item Response Theory (IRT). METHODS: We used the Graded Response Model to examine its psychometric properties in Spanish-speaking university students (n = 1503; women = 995 (66.2%), mean age = 19.29, SD = 2.45). We tested whether the empirical data fit the model's predictions and estimated the dispersion of persons and items along the experiential avoidance continuum. Moreover, we examined category probability curves to identify the response probability of each answer. Likewise, an item-person map was made where the measurement of persons and items, both on the same scale and along the experiential avoidance continuum, could be observed jointly. Finally, we tested the gender invariance of the scale. RESULTS: We found that the values of the individuals and the items were in the established range to be considered an adequate measure of EA. Additionally, we observed high discrimination indices for all items. The current version with seven answer options could not be optimal and should be tested in future studies. Finally, we found evidence of differential functioning by gender in one of the seven items of the instrument. CONCLUSIONS: Our results indicate that the AAQ-II is a suitable tool for measuring EA and accurately classifying and differentiating EA levels in university students.

Impacto de problemas de salud mental y apoyo social en la calidad de sueño: Seguimiento longitudinal antes y durante la pandemia de COVID-19 en universitarios chilenos / Impact of mental health problems and social support on sleep quali-ty: Follow-up before and during the first eight months of the COVID-19 pandemic in Chilean university student

Introducción: Antecedentes refieren altos índices de problemas de salud mental en universitarios antes y durante la pandemia por COVID-19, con efectos sobre la baja calidad de sueño; sin embargo, el apoyo social percibido actuaría como un factor protector. Objetivo: Evaluar el impacto de la salud mental (ansiedad, depresión y estrés) sobre la calidad de sueño, de forma transversal y longitudinal, antes y durante la pandemia por COVID-19 en universitarios chilenos, verificando si el apoyo social percibido podría moderar esta relación. Material y Métodos: 1.619 universitarios en el año 2019 y 1.862 en el año 2020 respondieron cuestionarios orientados a medir depresión, ansiedad, estrés, calidad del sueño y apoyo social percibido. Con una fracción de la muestra que respondió en ambos años (n = 325) se realizó análisis longitudinal y se contrastaron los puntajes de los instrumentos entre ambos años, mediante una matriz de transición y un modelo de regresión múltiple. Resultados: Se encuentran altas prevalencias de problemas de salud mental, aumentando en el año 2020 la sintomatología moderada y grave. Se agudizan los problemas de sueño y la percepción de bajo apoyo social. Todas las variables de salud mental pueden predecir la calidad del sueño, excepto el apoyo social y longitudinalmente, aumenta la severidad de la baja calidad de sueño y la depresión. No se encuentran moderaciones significativas entre apoyo social percibido y el resto de las variables. Conclusiones: El efecto de la pandemia en la salud mental es complejo, requiriéndose acciones concretas para apoyar psicológicamente a los estudiantes.(AU)

Introduction: Research has revealed high rates of mental health problems in university students before and during the COVID-19 pan-demic, with effects on poor sleep quality; however, perceived social sup-port appears to act as a protective factor. Objective: To assess the impact of mental health (anxiety, depression, and stress) on sleep quality, cross-sectionally and longitudinally, before and during the COVID-19 pandemic in Chilean university students, verifying whether perceived social support could act as a moderatorin this relationship.Material and Methods: 1,619 university students in 2019 and 1,862 in 2020 answered questionnaires aimed at measuring depression, anxiety, stress, sleep quality, and perceived social support. Longitudinal analysis was per-formed with afraction of the sample that responded in both years (n= 325). The scores of the instruments for both years were contrasted using a transition matrix and a multiple regression model. Results: High prevalence rates of mental health problems were found, with moderate and severe symptoms increasing in 2020. Sleep problems and the perception of low social support worsened. All mental health variables were found to predict sleep quality except for social support; longitudinally, the severity of poor sleep quality and depression increased. No significant moderation effects were found between perceived social support and the rest of the variables. Conclusions: The effect of the pandemic on mental health is complex, re-quiring concrete actions to provide students with psychological suppor.(AU)

Mental health and religiosity: the role of experiential avoidance in the symptoms of depression, anxiety, and stress

Several studies have considered religiosity to be a protective factor against several mental health difficulties. However, other studies suggest the opposite, that is, that religiosity is a risk factor associated with psychological symptoms. In this context, there are no studies that evaluate this relationship considering the role of experiential avoidance, which is a predictive transdiagnostic variable of various mental health disorders. This study evaluated the relationship between experiential avoidance, attitudes toward religion, and symptoms of depression, anxiety, and stress in a sample of believers using a non-experimental cross-sectional design in the city of Valdivia, Chile. Results indicate that experiential avoidance is positively related to symptoms of depression, anxiety, and stress, being the only predictor variable of the three symptomatic dimensions. Engaging in regular religious practice was not associated with religious literalness or experiential avoidance, while religious literalism was negatively associated with stress. Finally, Evangelicals showed a more regular religious practice than Catholics, while Catholics showed a higher index of religious literality; however, these differences were not associated with mental health. The clinical implications of these results are discussed (AU)

Effects of a Mindfulness and Physical Activity Programme on Anxiety, Depression and Stress Levels in People with Mental Health Problems in a Prison: A Controlled Study.

Recent studies in the general population have shown an inverse relationship between mindfulness and symptoms of anxiety and depression, as well as the benefits of physical activity on these symptoms. These relationships have not yet been studied in a population with severe mental disorder (SMD) in prison, where symptoms of anxiety and depression and impulsive behaviours have a high incidence. A controlled study was developed to assess the benefits of a mindfulness-based protocol whereby elements of Acceptance and Commitment Therapy were evaluated and compared to an adapted sport program. Twenty-two inmates from the "El Acebuche" prison aged between 23 and 58 years old participated in this study, which included a pre-, post-, and follow-up; the majority of participants had SMD and were distributed in both conditions. The DASS-21 was obtained for its evaluation. The results of the Mann-Whitney U test for independent samples indicated a significant reduction in the levels of stress and depression in the mindfulness intervention group compared to the control group in which no significant changes were observed, providing evidence on the effect of this practice in prison contexts.

The Impact of a Yoga-Based Mindfulness Intervention versus Psycho-Educational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial.

BACKGROUND: There is a global agreement in the medical community that a significant proportion of dementia cases could be prevented or postponed. One of the factors behind this agreement comes from scientific evidence showing that mind-body interventions such as mindfulness and yoga for the elderly have been related to a range of positive outcomes, including improved cognition performance in seniors with mild cognitive impairment (MCI). OBJECTIVE: This study aims to evaluate the effectiveness of a yoga-based mindfulness intervention (YBM) versus psychoeducational sessions for older adults with MCI attending Hospital Clinic Universidad de Chile in Santiago. METHOD: Two-arm, individually randomized controlled trial (RCT) will be carried out at Clinical Hospital Universidad de Chile in Santiago. Older people over 60 years with any type of MCI using a score < 21 in the Montreal Cognitive Assessment (MoCA) test and a score of 0.05 in the Clinical Dementia Rating (CDR) Scale; and with preserved activities of daily living will be randomly assigned with an allocation ratio of 1:1 in either the yoga-based mindfulness intervention or the active control group based on the psycho-educational program. People who have performed yoga and/or mindfulness in the last 6 months or/and people with a psychiatric clinical diagnosis will be excluded from the study. Montreal Cognitive Assessment, the Lawton Instrumental Activities of Daily Living Scale (IADL), the Barthel Index (BI), the Pemberton happiness index, the Geriatric Anxiety Inventory (GAI) as well as the Geriatric Depression Scale (GDS-5) will be administered by blinded outcomes assessors before random assignment (Pre-test), the week following the last session of the intervention (post-test), and then after 3- and 6-months follow-up. RESULTS: The YBM intervention protocol based on a video recording has been adapted and designed. This is the first RCT to examine the effects of a yoga-based mindfulness intervention in improving cognitive and physical functions and mental health outcomes for Chilean elderly diagnosed with MCI. It is expected to be implemented as an acceptable and effective non-pharmacological option for older people with MCI. CONCLUSION: Providing evidence-based programs such as preventive therapy for Alzheimer's disease has relevant implications for public mental health services in Chile.

The Impact of Baseline Mindfulness Scores on Mindfulness-Based Intervention Outcomes: Toward Personalized Mental Health Interventions.

A growing body of evidence has portrayed mindfulness as a useful tool for dealing with a broad range of psychological problems and disorders. This has created the impression that mindfulness-based interventions (MBIs) can be used to treat nearly all psychological difficulties, in all cases. Nonetheless, little research has been done on how individual differences may contribute to intervention outcomes. The goal of this study was to evaluate the role of baseline mindfulness on participants' outcomes by examining three prior Randomized Controlled Trials that addressed the impact of MBIs on mental health and mindfulness measures. The participants were 164 people, aged between 12 and 45, from both clinical and non-clinical samples. Our findings indicate that at least two thirds of the change produced by these interventions in terms of mindfulness scores can be predicted by the baseline scores of the same variables. We also found that many trajectories are not only strongly influenced by the initial status of the participants, but also by the intervention performed, as attested to by the significant interactions found. These results stress the need to continue doing research in a way that considers the diversity of participants' trajectories, increasing the room for intervention improvements aligned with a more personalized health care model.

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population.

Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.

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.

Effects of socioeconomic status in cognition of people with schizophrenia: results from a Latin American collaboration network with 1175 subjects.

BACKGROUND: Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls. METHODS: We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments. RESULTS: Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology. CONCLUSIONS: Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.

Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population.

Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.

A Qualitative Study of a Mindfulness-Based Intervention in Educational Contexts in Chile: An Approach Based on Adolescents' Voices.

The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective of the children and adolescents who participate in mindfulness practice. The goal of this paper is to analyse the subjective experience of a group of adolescents following the completion of a mindfulness-based intervention developed for schools in Chile. The intervention studied is the ".b curriculum", which is part of the Mindfulness in School Project (MiSP) developed in the UK. Twenty adolescents participated in semi-structured interviews within their school, in which three key areas were explored: pedagogy, perceived effects, and mechanisms of action, each of them being analysed from the perspective of thematic analysis. The results support the view that pedagogy is a very relevant consideration in the implementation, development, and efficacy of mindfulness-based interventions within the school context. We propose that the inclusion of structure, contents, process/mindful practices, and teachers' expertise provides the pedagogical-relational framework required for students to successfully develop mindfulness skills, which enables them to experience their cognitive, emotional, and somatic effects. These effects are linked to self-regulation strategies, based on paying attention to one's somatic experience with kindness and curiosity, which works as an attentional anchor. It is hoped that these results will contribute to the spread of mindfulness research in adolescents in Latin America, thus facilitating cross-cultural and international comparisons.

[Mindfulness and the clinical relationship: steps to a resilience in medicine]. / Mindfulness y la relación clínica: pasos hacia una resiliencia en medicina.

Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.

Mindfulness y la relación clínica: pasos hacia una resiliencia en medicina / Mindfulness and the clinical relationship: steps to a resilience in medicine

Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.

Meditation focused on self-observation of the body impairs metacognitive efficiency.

In the last decade of research on metacognition, the literature has been focused on understanding its mechanism, function and scope; however, little is known about whether metacognitive capacity can be trained. The specificity of the potential training procedure is in particular still largely unknown. In this study, we evaluate whether metacognition is trainable through generic meditation training, and if so, which component of meditation would be instrumental in this improvement. To this end, we evaluated participants' metacognitive efficiency before and after two types of meditation training protocols: the first focused on mental cues (Mental Monitoring [MM] training), whereas the second focused on body cues (Self-observation of the Body [SoB] training). Results indicated that while metacognitive efficiency was stable in MM training group, it was significantly reduced in the SoB group after training. This suggests that metacognition should not be conceived as a stable capacity but rather as a malleable skill.