Development of a Multiplatform Tool for the Prevention of Prevalent Mental Health Pathologies in Adults: Protocol for a Randomized Control Trial.

BACKGROUND: The prevalence of depression and anxiety has increased in recent years, with many individuals having trouble accessing mental health support. Smartphones have become an integral part of modern life, with apps offering new ways to deliver evidence-based self-help strategies to cope with common mental health symptoms. However, most of them do not have empirical evidence of their overall effectiveness or the effectiveness of their components, which could pose a risk for users. OBJECTIVE: The aim of this study is to evaluate the effectiveness of the modules of evaluation, psychoeducation, and emotional regulation strategies in a multiplatform self-help mental health mobile app in the Maule region of Chile. METHODS: A sample of 196 adults will be selected, who will be randomly assigned to different components of the app for a fixed period to assess its ability to reduce symptomatology. RESULTS: The trial is not yet recruiting and is expected to end in October 2024. The first results are expected in April 2024. CONCLUSIONS: This is the first study in Chile to develop and test the effectiveness of a mobile app to manage anxiety and depression symptoms in adults. The intervention proposed is based on evidence suggesting that the internet or remote intervention tools and self-management of prevalent symptomatology could be the future of mental health care systems in the digital era. If the effects of the intervention are positive, wide implementation in Chile and other Spanish-speaking countries could be possible in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52324.

Propiedades Psicométricas de la Escala de Evaluación Socioemocional Breve de Infantes y Niños (BITSEA) en una muestra de niños y niñas chilenos / Psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a sample of Chilean children

Introducción: La infancia temprana es una etapa crítica para la salud mental, por lo que es fundamental contar con herramientas eficaces para detectar tempranamente conductas infantiles relacionadas con psicopatología. Objetivo: Investigar las propiedades psicométricas de la Escala de Evaluación Socioemocional Breve de Infantes y Niños (BITSEA) en una muestra de infantes chilenos. Método: 289 padres de niños y niñas de entre 12 y 36 meses de edad completaron la BITSEA y el CBCL 1½-5. Resultados: Se encontró una confiabilidad aceptable para las puntuaciones de la subescala "problema socioemocional" (ω=0.84), y una confiabilidad baja para las puntuaciones de la subescala "competencia socioemocional" (ω=0.59). La estructura factorial fue adecuada y se observó una alta validez concurrente con otras escalas. El modelo confirmatorio mostró índices aceptables (CFI= 0.94; TLI= 0.94; SRMR= 0.07; RMSEA= 0.027). Conclusión: La BITSEA en esta muestra arrojó resultados similares a otros estudios, su aplicabilidad es prometedora para la detección temprana de problema socioemocional en la infancia temprana. Se sugiere continuar su estudio en muestra nacional representativa.

Introduction: Early childhood is a critical stage for mental health, and it is necessary to have effective tools for early detection of child behaviours related to psychopathology. Objective: to assess the psychometric properties of the Brief Infant and Toddler Social-Emotional Evaluation Scale (BITSEA) in a sample of Chilean children. Methods: 289 parents of infants and toddlers aged 12-36 months completed the BITSEA and the CBCL 1½-5. Results: Acceptable reliability was found for the "socioemotional problems" dimension (ω=0.84), and low reliability for the "socioemotional competence" subscale scores (ω=0.59). The factor structure was adequate and high concurrent validity with other scales was observed. The confirmatory model showed acceptable fit indices (CFI= 0.94; TLI= 0.94; SRMR= 0.07; RMSEA= 0.027). Conclusion: The BITSEA in this sample showed similar results to other studies, its applicability is promising for the early detection of socioemotional problems in early childhood. It is suggested to continue its study in a nationally representative sample.

Propuesta de Valores de Referencia para el Cuestionario de Evaluación del Apego Adulto: Experiences in Close Relationships (ECR-12), en población adulta chilena / Reference values for the Adult Attachment Assessment Questionnaire: Experiences in Close Relationships (ECR-12) in the Chilean Adult Population

El cuestionario de Experiencias en Relaciones Cercanas (ECR) es un instrumento de auto-reporte ampliamente utilizado para evaluar el apego en la adultez, a partir de dos dimensiones: la ansiedad y la evitación asociadas al apego. Este instrumento ha sido adaptado en múltiples contextos, incluyendo el chileno, del cual existe una versión abreviada (ECR-12), objeto de análisis del presente estudio. Si bien existe consenso en que la seguridad en el apego es mejor descrita en términos dimensionales, hay ámbitos, como en la práctica clínica donde contar con valores de referencia podría ser de utilidad. El objetivo de este estudio es proveer valores de referencia para la interpretación de los valores del ECR-12 en el contexto chileno. Para ello, una muestra de 6779 participantes respondió el ECR-12. Se utilizó el método de puntuación z con normalización para obtener los valores de referencia. Los análisis realizados evidenciaron la necesidad de construir baremos diferenciados por edad. Así, para el grupo de 29 años o menos, el punto de corte en la dimensión de ansiedad es de un promedio igual o superior a 4.4 puntos, y para la evitación, el punto de corte es de un promedio igual o superior a 2.5. En cambio, para el grupo de 30 años o más, el punto de corte en la dimensión de ansiedad es de un promedio igual o superior a 4.2, y para la evitación, es de un promedio igual o superior a 2.9. Estos hallazgos pueden ser relevantes no sólo para identificar a personas que puedan presentar niveles sustancialmente altos de ansiedad y/o evitación en el apego, sino, también puede constituirse como una herramienta clínica complementaria en contextos terapéuticos.

The Experiences in Close Relationships (ECR) questionnaire is a widely used self-report measure to assess adult attachment, based on two dimensions: attachment anxiety and attachment avoidance. This instrument has been adapted in multiple contexts, including the Chilean, for which there is an abbreviated version (ECR-12), that is the object of analysis in the present study. Although there is consensus that attachment security is best described in dimensional terms, there are areas, such as clinical practice, where having reference values could be useful. The aim of this study is to provide reference values for the interpretation of ECR-12 scores in the Chilean context. To do this, a sample of 6779 participants was evaluated using the ECR-12. The z-score normalization method was used to obtain the reference values. The analyzes carried out showed the need to build scales differentiated by age. Thus, for the group of 29 years or less, the cut-off point in the anxiety dimension is an average equal to or greater than 4.4 points, and for avoidance, the cut-off point is an average equal to or greater than 2.5. On the other hand, for the group aged 30 or older, the cut-off point in the anxiety dimension is an average equal to or greater than 4.2, and for avoidance, it is an average equal to or greater than 2.9. These findings can be relevant not only for identifying people who may present substantially high levels of anxiety and/or avoidance in attachment, but also as a complementary clinical tool in therapeutic contexts.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Using Exploratory Structural Equation Modeling (ESEM) to Examine the Internal Structure of Posttraumatic Stress Disorder Symptoms.

Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC-5) and PTSD Checklist for DSM-5 (PCL-5). All six tested CFA models showed good fit indexes (RMSEA = .051-.056, CFI = .969-.977, TLI = .965-.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027-.036, CFI = .991-.996, TLI = .985-.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD.

Measuring adult romantic attachment: psychometric properties of the brief Spanish version of the experiences in close relationships.

The Experiences in Close Relationships (Brennan et al, Attachment theory and close relationships, 1998) questionnaire is one of the most widely used measures of adult romantic attachment. Despite the advantages of the ECR, the length of this measure may discourage its use in clinical and research contexts. Consequently, the goal of this study was to develop a brief Spanish version of the ECR questionnaire and to examine its psychometric properties when administered to six different Spanish-speaking samples from Chile. Confirmatory factor analyses replicated the two-dimensional structure of the ECR and its invariance across gender. Results also supported the reliability and concurrent validity of our brief Spanish version of the ECR (i.e., Spanish ECR-12), by its association with measures of emotion regulation, dyadic empathy, psychological distress and well-being, and relationship satisfaction. The Spanish ECR-12 can be used by researchers and clinical professionals as an abridged measure of adult attachment.

Using Exploratory Structural Equation Modeling (ESEM) to examine the internal structure of posttraumatic stress disorder symptoms

Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC-5) and PTSD Checklist for DSM-5 (PCL-5). All six tested CFA models showed good fit indexes (RMSEA = .051-.056, CFI = .969-.977, TLI = .965-.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027-.036, CFI = .991-.996, TLI = .985-.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD

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Measuring adult romantic attachment: psychometric properties of the brief Spanish version of the experiences in close relationships

Abstract The Experiences in Close Relationships (Brennan et al, Attachment theory and close relationships, 1998) questionnaire is one of the most widely used measures of adult romantic attachment. Despite the advantages of the ECR, the length of this measure may discourage its use in clinical and research contexts. Consequently, the goal of this study was to develop a brief Spanish version of the ECR questionnaire and to examine its psychometric properties when administered to six different Spanish-speaking samples from Chile. Confirmatory factor analyses replicated the twodimensional structure of the ECR and its invariance across gender. Results also supported the reliability and concurrent validity of our brief Spanish version of the ECR (i.e., Spanish ECR-12), by its association with measures of emotion regulation, dyadic empathy, psychological distress and well-being, and relationship satisfaction. The Spanish ECR-12 can be used by researchers and clinical professionals as an abridged measure of adult attachment.

Does the Type of Abuse Matter? Study on the Quality of Child Attachment Narratives in a Sample of Abused Children.

Child abuse has been associated with the development of insecure-disorganized patterns of attachment. However, the way in which different types of abuse relate to variations in attachment representations is not entirely clear. Thus, the objective of this study was to determine the relationship between three types of abuse (sexual abuse, physical abuse, and neglect) and the quality of child attachment representation, as assessed through attachment narratives. The results indicate that abuse in general, as well as each of its typologies in particular, is associated with insecure-disorganized attachment narratives. No differences were observed in the association between each individual type of abuse and the quality of attachment narratives, as well as between the number of abuse experiences and the quality of attachment. The findings are discussed from attachment theory and the literature on child development and maltreatment.

The effect of sexual abuse on children's attachment representations in Chile.

Child sexual abuse is associated with problems in children's emotional development, particularly increased insecurity of attachment. However, few studies have examined its effect on the organization of attachment representations in preschoolers, and the findings of those that have been conducted have not been entirely consistent. Therefore, this study aims to analyze the effect of child sexual abuse on attachment representation quality in a sample of children 3 to 7 years old in Chile. The results indicate child sexual abuse does affect children's attachment representation quality. The attachment narratives of child sexual abuse victims scored significantly higher than nonvictims on the hyperactivity and disorganization dimensions of attachment. These results are discussed in terms of attachment theory, clinical findings on child sexual abuse, and clinical implications.

Romantic attachment in Chilean adults: development of a short-form version of the experiences in close relationships.

Though the study of romantic attachment has expanded into all areas of psychology, it remains the case that there is no valid, reliable test available to measure it in Latin America. The present research objective was to adapt a Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark, & Shaver 1998) questionnaire, developing a short-form version, and to determine its factor structure in two samples of Chilean adults of different ages. A pool of 25 items was chosen to capture the two dimensions (Anxiety and Avoidance), which were obtained through principal components analysis in a sample of 477 adults. Subsequently, the short-form ECR's two-dimensional structure was confirmed using confirmatory factor analysis in a new sample (N = 296). All sub-dimensions' internal consistencies were found to be satisfactory. Evidence for the test's concurrent validity with the variables age, gender, and socioeconomic status was also obtained. The dimensions of romantic attachment showed no differences according to age or gender. However, participants of high socioeconomic status exhibited lower levels of anxious attachment than those with low socioeconomic status. It was concluded that the Chilean short-form version of the ECR has good psychometric properties and is a suitable assessment of adult attachment.

Validación chilena del cuestionario de evaluación del apego romántico experiences in close relationships (ECR): análisis de la validez de criterio / A Chilean validation of the romantic attachment questionnaire experiences in close relationships (ECR): analysis of criterion validity

El objetivo de esta investigación fue analizar la validez de criterio del cuestionario de apego romántico Experiences in Close Relationships (ECR, Brennan, Clark y Shaver, 1998) para la población chilena de adultos. Este cuestionario evalúa las dos dimensiones del apego romántico adulto: la evitación (de la intimidad) y la ansiedad (acerca de las relaciones). Los participantes fueron 549 adultos, quienes completaron el cuestionario ECR y el cuestionario de apego adulto CaMir. Se evaluó las propiedades psicométricas del cuestionario, mostrando que es un instrumento con una adecuada validez de criterio y con una estructura factorial que representa las dos dimensiones teóricas propuestas por los autores originales. Se concluye que la versión chilena del ECR es válida para examinar el apego romántico en la adultez.

The aim of this study was to analyze the criterion validity of the Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark y Shaver 1998) questionnaire in a sample of Chilean adults. This self-report questionnaire assesses two dimensions of romantic attachment: avoidance (of intimacy) and anxiety (about relationships). 549 Chilean adults completed the ECR and the Chilean version of the adult attachment questionnaire CaMir. Data analyses evaluated psychometric properties of the Chilean ECR, and showed adequate evidence of reliability, criterion validity, and a bifactorial structure similar to the original instrument. We can conclude that the Chilean version of the ECR is a reliable and valid measure to assess the romantic attachment in this population.

Romantic attachment in Chilean adults: development of a short-form version of the experiences in close relationships

Though the study of romantic attachment has expanded into all areas of psychology, it remains the case that there is no valid, reliable test available to measure it in Latin America. The present research objective was to adapt a Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark, & Shaver 1998) questionnaire, developing a short-form version, and to determine its factor structure in two samples of Chilean adults of different ages. A pool of 25 items was chosen to capture the two dimensions (Anxiety and Avoidance), which were obtained through principal components analysis in a sample of 477 adults. Subsequently, the short-form ECR’s two-dimensional structure was confirmed using confirmatory factor analysis in a new sample (N = 296). All sub-dimensions’ internal consistencies were found to be satisfactory. Evidence for the test’s concurrent validity with the variables age, gender, and socioeconomic status was also obtained. The dimensions of romantic attachment showed no differences according to age or gender. However, participants of high socioeconomic status exhibited lower levels of anxious attachment than those with low socioeconomic status. It was concluded that the Chilean short-form version of the ECR has good psychometric properties and is a suitable assessment of adult attachment (AU)

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Efecto del maltrato físico en la calidad de las representaciones de apego infantil en Chile: resultados preliminares / The effect of physical abuse on the quality of infant attachment representations in Chile: preliminary results

El objetivo de este artículo es presentar los resultados preliminares de un estudio que analiza el efecto del maltrato físico sobre la calidad de las representaciones de apego infantil. Para evaluar las representaciones del apego se utilizó la tarea de completación de historias de apego con el sistema de codificación A.S.C.T. Q-sort. El maltrato físico fue categorizado con el Sistema de Codificación de Maltrato Modificado. Los resultados indican que el maltrato físico tiene un efecto negativo en la calidad de las representaciones del apego. Los niños víctimas de maltrato físico presentan una mayor preferencia por la utilización de estrategias de hiperactivación y desorganización del apego que los niños no maltratados. Los resultados son discutidos en relación a la teoría del apego y a la evidencia empírica sobre esta temática.

The aim of this paper is to present preliminary results of a study analyzing the effects of physical abuse on the quality of attachment representations in children. In order to assess the attachment representation the Attachment Story Completion Task was used with de A.S.C.T. Q-sort coding system. The physical abuse was coded using the Modified Maltreatment Classification System. The results show that physical abuse has a negative effect on the quality of attachment representation. The children who were victims of physical abuse have a higher preference for the use of hyperactivation and disorganization attachment strategies than non abused children. The results are discussed in relation to attachment theory and empirical evidence on this issue.