Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery].

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

Human rights and support groups to improve quality of life, self-care and disability in epilepsy: [Rights and support groups for epilepsy].

BACKGROUND: People with epilepsy have multiple barriers to recovering their quality of life. The objective of the present study was to determine the impact of a community group intervention focused on the components of mutual aid and human rights, to improve the quality of life in people with epilepsy. METHODS: Prospective quasi-experimental study, incorporating pre- and post-intervention evaluations. There were 102 people who underwent an intervention focused on the central components of mutual aid groups (Active agency, Coping strategies, Emotion recognition and management, Problem solving, Supportive interaction, Identity construction, Trust, and Social networks) and in the QualityRights strategy. As evaluation instruments, scales were used to determine quality of life (QOLIE-10), treatment adherence (Morisky Test), self-care behaviors, perception of disability and quality in the provision of health services. RESULTS: Correlations were shown between the variables proposed for quality of life. The intervention showed an improvement in all variables and a moderate to large effect in the self-care domain. There was a significant effect size in the self-care and quality of life variables with the intervention. Pharmacological adherence showed a moderate effect size in young people, adults and older adults. Regarding the perception of disability, the effect size was found only in adults. The pharmacological adherence variable also had a moderate effect size. This does specify the age groups, but not in the general sample. CONCLUSION: Seizure-free time constitutes a fundamental element in recovery. However, psychosocial conditions constitute key elements to achieve a better quality of life in people with epilepsy.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia.

Objectives: To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods: The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) - 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results: The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion: The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia / Validación de un instrumento para orientar la implementación de las estrategias de atención de salud mental en Colombia / Validação de um instrumento para orientar a implementação de estratégias de atenção à saúde mental na Colômbia

[ABSTRACT]. Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) – 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementa- tion, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Read- iness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

[RESUMEN]. Objetivos. Validar la escala de impulsores de implementación en profesionales de la salud mental del nivel de atención primaria en Colombia. La escala está diseñada como una herramienta para orientar la implementación de estrategias que permitan reducir de manera efectiva las desigualdades existentes en la atención de salud mental. Métodos. Se adoptó el marco de implementación activa, que es un modelo ampliamente utilizado para medir este tipo de implementaciones. Los participantes fueron 380 personas (55,56% hombres), de las cuales 349 eran profesionales de la salud capacitados mediante el Programa de acción mundial para superar las brechas en salud mental (mhGAP, por su sigla en inglés) y 31 formaban parte del personal territorial encargado de planificar estrategias de atención de salud mental a nivel territorial en Colombia. Para evaluar los dominios cruciales de la implementación del mhGAP, elaboramos una escala de 18 puntos basada en el marco de implementación activa. Para evaluar la escala se realizaron determinaciones de la validez de contenido y un análisis factorial exploratorio. Como patrón de referencia se utilizó la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Resultados. La escala de impulsores de la implementación determinó cuatro dominios: facilitadores del sistema para la implementación, accesibilidad de la estrategia, adaptabilidad y aceptabilidad, y capacitación en la estrategia y supervisión. Estos dominios presentaron valores de alfa de Cronbach de 0,914, 0,868, 0,927 y 0,725, respectivamente, lo que indica una coherencia interna elevada. Además, todos los dominios mostraron una correlación adecuada con la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Conclusión. La escala de impulsores de la implementación permite determinar de manera efectiva la adaptabilidad y la implementación de diversos componentes de los programas de salud mental, en particular de los que se centran en enfoques basados en la comunidad y en entornos de atención primaria. En este sentido, esta escala puede contribuir a una implementación más eficaz de las estrategias esbozadas en los marcos políticos locales y mundiales, con la consiguiente mejora de la atención de salud mental.

[RESUMO]. Objetivos. Validar a escala de determinantes da implementação entre profissionais do primeiro nível de atenção à saúde mental na Colômbia. A escala foi concebida como uma ferramenta para orientar a implementação de estratégias que reduzam efetivamente as lacunas na atenção à saúde mental. Métodos. Foi adotada a Estrutura de Implementação Ativa, um modelo amplamente utilizado para medir a implementação. O estudo incluiu 380 indivíduos (55,56% homens): 349 profissionais de saúde treinados no Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e 31 profissionais dos territórios encarregados de planejar estratégias de saúde mental em nível territorial na Colômbia. Para avaliar as dimensões essenciais da implementação do mhGAP, criou-se uma escala de 18 itens com base na Estrutura de Implementação Ativa. Foram realizadas avaliações da validade do conteúdo e uma análise fato- rial exploratória para avaliar a escala. A escala de prontidão organizacional para tradução de conhecimentos (OR4KT, na sigla em inglês) foi utilizada como padrão de comparação. Resultados. A escala de determinantes da implementação identificou quatro dimensões: facilitadores sistêmicos de implementação; acessibilidade da estratégia; adaptabilidade e aceitabilidade; e capacitação e monitoramento da estratégia. Essas dimensões tiveram valores de alfa de Cronbach de 0,914, 0,868, 0,927 e 0,725, respectivamente, indicando alta consistência interna. Além disso, todas as dimensões demonstraram correlações adequadas com a escala OR4KT. Conclusão. A escala de determinantes da implementação avalia efetivamente a adaptabilidade e a imple- mentação de vários componentes dos programas de saúde mental, especialmente componentes que se concentram em abordagens baseadas na comunidade e ambientes de atenção primária. Dessa forma, essa escala pode contribuir para uma implementação mais efetiva de estratégias delineadas por estruturas políticas mundiais e locais, melhorando assim a atenção à saúde mental.

Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care.

The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.

Design and validation of a scale of core components of community interventions in mental health.

AIMS: To develop and validate an instrument to identify the core components of community strategies for mental health, especially mutual aid groups: The Mutual Aid Scale . METHODS: 135 community strategies leaders participated in the study. The core components are active agency, coping strategies, recognition, and management of emotions, problem-solving strategies, supportive interaction, trust, self-identity construction, and strengthening of social networks. With these components a scale was designed. Content validity was carried out in addition to an exploratory factor analysis. RESULTS: Two dimensions resulted, strengthening of agency capacity and Coping strategies, and the internal consistency of both factors was acceptable, with a Cronbach's alpha of 0.722 and 0.727, respectively. The Kaiser-Meyer-Olkin (KMO) statistic was used with a score of 0.831 and the Barlett Sphericity Test, with a significant value of 265.175. CONCLUSION: This scale identifies the components of community interventions for mental health and can contribute to a better implementation of these strategies. It also articulates autonomous community processes with strategies developed in health services.

Validation of an instrument to guide the implementation of strategies for mental health care in Colombia / Validación de un instrumento para orientar la implementación de las estrategias de atención de salud mental en Colombia / Validação de um instrumento para orientar a implementação de estratégias de atenção à saúde mental na Colômbia

ABSTRACT Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) - 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

RESUMO Objetivos. Validar a escala de determinantes da implementação entre profissionais do primeiro nível de atenção à saúde mental na Colômbia. A escala foi concebida como uma ferramenta para orientar a implementação de estratégias que reduzam efetivamente as lacunas na atenção à saúde mental. Métodos. Foi adotada a Estrutura de Implementação Ativa, um modelo amplamente utilizado para medir a implementação. O estudo incluiu 380 indivíduos (55,56% homens): 349 profissionais de saúde treinados no Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e 31 profissionais dos territórios encarregados de planejar estratégias de saúde mental em nível territorial na Colômbia. Para avaliar as dimensões essenciais da implementação do mhGAP, criou-se uma escala de 18 itens com base na Estrutura de Implementação Ativa. Foram realizadas avaliações da validade do conteúdo e uma análise fatorial exploratória para avaliar a escala. A escala de prontidão organizacional para tradução de conhecimentos (OR4KT, na sigla em inglês) foi utilizada como padrão de comparação. Resultados. A escala de determinantes da implementação identificou quatro dimensões: facilitadores sistêmicos de implementação; acessibilidade da estratégia; adaptabilidade e aceitabilidade; e capacitação e monitoramento da estratégia. Essas dimensões tiveram valores de alfa de Cronbach de 0,914, 0,868, 0,927 e 0,725, respectivamente, indicando alta consistência interna. Além disso, todas as dimensões demonstraram correlações adequadas com a escala OR4KT. Conclusão. A escala de determinantes da implementação avalia efetivamente a adaptabilidade e a implementação de vários componentes dos programas de saúde mental, especialmente componentes que se concentram em abordagens baseadas na comunidade e ambientes de atenção primária. Dessa forma, essa escala pode contribuir para uma implementação mais efetiva de estratégias delineadas por estruturas políticas mundiais e locais, melhorando assim a atenção à saúde mental.

RESUMEN Objetivos. Validar la escala de impulsores de implementación en profesionales de la salud mental del nivel de atención primaria en Colombia. La escala está diseñada como una herramienta para orientar la implementación de estrategias que permitan reducir de manera efectiva las desigualdades existentes en la atención de salud mental. Métodos. Se adoptó el marco de implementación activa, que es un modelo ampliamente utilizado para medir este tipo de implementaciones. Los participantes fueron 380 personas (55,56% hombres), de las cuales 349 eran profesionales de la salud capacitados mediante el Programa de acción mundial para superar las brechas en salud mental (mhGAP, por su sigla en inglés) y 31 formaban parte del personal territorial encargado de planificar estrategias de atención de salud mental a nivel territorial en Colombia. Para evaluar los dominios cruciales de la implementación del mhGAP, elaboramos una escala de 18 puntos basada en el marco de implementación activa. Para evaluar la escala se realizaron determinaciones de la validez de contenido y un análisis factorial exploratorio. Como patrón de referencia se utilizó la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Resultados. La escala de impulsores de la implementación determinó cuatro dominios: facilitadores del sistema para la implementación, accesibilidad de la estrategia, adaptabilidad y aceptabilidad, y capacitación en la estrategia y supervisión. Estos dominios presentaron valores de alfa de Cronbach de 0,914, 0,868, 0,927 y 0,725, respectivamente, lo que indica una coherencia interna elevada. Además, todos los dominios mostraron una correlación adecuada con la escala Predisposición Organizacional a la Transferencia del Conocimiento para el Cambio de Práctica Clínica. Conclusión. La escala de impulsores de la implementación permite determinar de manera efectiva la adaptabilidad y la implementación de diversos componentes de los programas de salud mental, en particular de los que se centran en enfoques basados en la comunidad y en entornos de atención primaria. En este sentido, esta escala puede contribuir a una implementación más eficaz de las estrategias esbozadas en los marcos políticos locales y mundiales, con la consiguiente mejora de la atención de salud mental.

Poetry in youth mutual aid groups for recovery in rural and semi-urban environments.

BACKGROUND: For mental disorders Mutual Aid Groups (MAG) have been proposed, however, these have lack of methodologies that approach the needs of young people. The aim of the present study was to determine the impact of MAG in rural and semi-urban environments, developed through poetry, on the improvement of mental health. METHODS: A quasi-experimental study was carried out in Caldas, Colombia. 171 adolescents participated, divided into 10 MAG. Child Behavior Checklist 4-18 (CBCL/4-18) was used and the nuclear components of the MAG were applied, adding elements of introduction to poetry, creation and group rituals. RESULTS: Statistically significant associations (P < .001) were found between the number of sessions and the reduction of symptoms, as well as a decrease in Internalizing Problems and Social problems, after participating in the groups. CONCLUSION: Poetry applied to the core components of the MAG can improve psychiatric symptoms in adolescents.

[Gaps in primary mental health care in Chocó, Colombia: barriers and challengesLacunas na atenção primária à saúde mental em Chocó, Colômbia: barreiras e desafios]. / Brechas en la atención primaria en salud mental en Chocó, Colombia: barreras y desafíos.

Objective: Describe barriers and challenges in the implementation of the global Mental Health Gap Action Program (mhGAP), and determine the association between facilitators of implementation, accessibility, acceptability, and supervision, in Chocó, Colombia. Methods: Cross-sectional evaluation study, with mixed and sequential methods. Forty-one people participated: 30 health personnel and 11 administrative workers. Five focus groups were formed within the framework of the mhGAP training. The Likert scale of implementation drivers was used to determine factors affecting the strategy, such as system facilitators, accessibility of the strategy, adaptation and acceptability, and training and supervision. Semi-structured interviews were also conducted, with a subsequent thematic analysis. Results: A statistically significant correlation was found between the components of implementation. This was reaffirmed by the information from the interviews. Notable barriers include dispersion, armed conflict, difficulty in changing one's perspective on the area where they live, and administrative problems in accessing treatment. These factors are addressed in a proposed care pathway. Conclusions: With respect to mhGAP in the department of Chocó, despite adequate acceptability, access, and supervision, there are barriers and challenges at the social, geographical, political, cultural, and health administration levels, which could be overcome through implementation of locally-built intersectoral recovery routes.

Objetivo: Descrever barreiras e desafios na implementação do Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e determinar a associação entre facilitadores de implementação, acessibilidade, aceitabilidade e supervisão em Chocó, Colômbia. Métodos: Estudo avaliativo de corte transversal, com métodos mistos e sequenciais, que contou com 41 participantes (30 da equipe de saúde e 11 da equipe administrativa). Um total de cinco grupos focais foram formados como parte do treinamento do mhGAP. Utilizou-se a escala de motivadores de implementação, que determinou fatores como facilitadores do sistema para implementação, acessibilidade da estratégia, adaptação e aceitabilidade, treinamento e supervisão da estratégia. Também foram realizadas entrevistas semiestruturadas, com posterior análise temática. Resultados: Foi encontrada uma correlação estatisticamente significativa entre os componentes da implementação, o que foi reafirmado com as informações das entrevistas. Em termos das barreiras identificadas, destacam-se fatores como dispersão, conflito armado, a dificuldade de mudar a perspectiva da pessoa sobre a área em que vive e problemas administrativos no acesso ao tratamento. Esses fatores são abordados em uma proposta de via de atendimento. Conclusões: Apesar da aceitabilidade, do acesso e da supervisão adequados, há barreiras e desafios sociais, geográficos, políticos, culturais e de administração de saúde no mhGAP do departamento de Chocó que poderiam ser superados com a implementação de rotas de recuperação intersetoriais, construídas a partir do próprio território.

Brechas en la atención primaria en salud mental en Chocó, Colombia: barreras y desafíos / Gaps in primary mental health care in Chocó, Colombia: barriers and challenges / Lacunas na atenção primária à saúde mental em Chocó, Colômbia: barreiras e desafios

[RESUMEN]. Objetivo. Describir barreras y desafíos en la implementación del Programa de Acción Mundial para Reducir las Brechas de Atención en Salud Mental mhGAP, y determinar la asociación entre facilitadores de implementación, accesibilidad, aceptabilidad y supervisión, en Chocó, Colombia. Métodos. Estudio evaluativo de corte transversal, con métodos mixtos y secuenciales. Se contó con la participación de 41 personas (30 correspondientes a personal de salud y 11 personas del área administrativa). Se conformaron cinco grupos focales, en el marco de la formación en mhGAP. Se usó la escala de impulsores de implementación, que determinó factores como: facilitadores del sistema para la implementación, acce- sibilidad de la estrategia, adaptación y aceptabilidad, formación y supervisión en la estrategia. También se realizaron entrevistas semiestructuradas, con un posterior análisis temático. Resultados. Se encontró una correlación estadísticamente significativa entre los componentes de la imple- mentación, lo cual fue reafirmado con la información de las entrevistas. A nivel de las barreras señaladas, se destacan factores como dispersión, conflicto armado, la dificultad para cambiar la perspectiva de la zona en la que se vive y los problemas administrativos para acceder a los tratamientos. Estos factores se abordan en una propuesta de ruta de atención. Conclusiones. En mhGAP en el departamento del Chocó, pese a una adecuada aceptabilidad, acceso y supervisión, se evidencian barreras y desafíos de orden social, geográfico, político, cultural y a nivel de la administración en salud, que podrían ser superados con la implementación de rutas intersectoriales de recu- peración, construidas desde el mismo territorio.

[ABSTRACT]. Objective. Describe barriers and challenges in the implementation of the global Mental Health Gap Action Program (mhGAP), and determine the association between facilitators of implementation, accessibility, acceptability, and supervision, in Chocó, Colombia. Methods. Cross-sectional evaluation study, with mixed and sequential methods. Forty-one people participated: 30 health personnel and 11 administrative workers. Five focus groups were formed within the framework of the mhGAP training. The Likert scale of implementation drivers was used to determine factors affecting the strategy, such as system facilitators, accessibility of the strategy, adaptation and acceptability, and training and supervision. Semi-structured interviews were also conducted, with a subsequent thematic analysis. Results. A statistically significant correlation was found between the components of implementation. This was reaffirmed by the information from the interviews. Notable barriers include dispersion, armed conflict, difficulty in changing one's perspective on the area where they live, and administrative problems in accessing treat- ment. These factors are addressed in a proposed care pathway. Conclusions. With respect to mhGAP in the department of Chocó, despite adequate acceptability, access, and supervision, there are barriers and challenges at the social, geographical, political, cultural, and health administration levels, which could be overcome through implementation of locally-built intersectoral recovery routes.

[RESUMO]. Objetivo. Descrever barreiras e desafios na implementação do Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e determinar a associação entre facilitadores de implementação, acessibilidade, aceitabilidade e supervisão em Chocó, Colômbia. Métodos. Estudo avaliativo de corte transversal, com métodos mistos e sequenciais, que contou com 41 participantes (30 da equipe de saúde e 11 da equipe administrativa). Um total de cinco grupos focais foram formados como parte do treinamento do mhGAP. Utilizou-se a escala de motivadores de implementação, que determinou fatores como facilitadores do sistema para implementação, acessibilidade da estratégia, adaptação e aceitabilidade, treinamento e supervisão da estratégia. Também foram realizadas entrevistas semiestruturadas, com posterior análise temática. Resultados. Foi encontrada uma correlação estatisticamente significativa entre os componentes da implementação, o que foi reafirmado com as informações das entrevistas. Em termos das barreiras identificadas, destacam-se fatores como dispersão, conflito armado, a dificuldade de mudar a perspectiva da pessoa sobre a área em que vive e problemas administrativos no acesso ao tratamento. Esses fatores são abordados em uma proposta de via de atendimento Conclusões. Apesar da aceitabilidade, do acesso e da supervisão adequados, há barreiras e desafios sociais, geográficos, políticos, culturais e de administração de saúde no mhGAP do departamento de Chocó que poderiam ser superados com a implementação de rotas de recuperação intersetoriais, construídas a partir do próprio território.

PACES: a primary care tool to detect mental health disorders in Indigenous Colombians.

INTRODUCTION: The aim of this research was to present the process of intercultural creation and validation, in addition to the analysis of the psychometric properties of the Parenting, Behavior, Emotions and Suicide risk scale. METHODS: A cross-sectional study, cultural adaptation and validation with an ethnic approach were carried out by expert judges in mental health; subsequently, the instrument was applied, and a factorial analysis was carried out, and it was established that there was agreement between the instrument results and two expert perspectives regarding spiritual disharmony. The sample consisted of 168 families of children and young people (54.8% women, 45.2% men), with a mean age of 11.2 years, in Colombia. Regarding the geographical location, 44% were from Guajira, 44.6% were from Nariño and 11.3% were from Vaupés, from the Wayuu, Awá and Emberá communities, respectively. RESULTS: The scale showed high reliability (Chronbach's α=0.911), and in the factorial analysis the following parenting domains were formed from the parents: involvement, monitoring and bond, from boys, girls and young people; suicidal risk perceived by caregivers and perceived by children and young people; in addition to a total mental health risk. The questions that inquired about hallucinations and seizures did not show grouping in any factor, and two questions were eliminated. Similarly, a high inter-rater concordance was shown, with a higher Cohen's κ coefficient for all domains. CONCLUSION: There are few intercultural and early detection studies of parenting and mental health problems in children and youth that have an ethnic approach. It is observed that the instrument serves as a means of monitoring mental health issues in children and adolescents, as well as the parenting practices employed in their socialization, from both the perspective of caregivers and the young individuals themselve. This study indicates that the scale is an adequate tool, quick and easy to administer in first-level care settings.

Suicide in a Colombian indigenous community: Beyond mental illness.

BACKGROUND: Among the causes associated with suicide there are social factors such as forced displacement has been described and health factors in general that have an impact on pediatric mental health. AIMS: To describe clinical and psychosocial factors, and their relationship with suicidal behavior in a Colombian indigenous community. PARTICIPANTS AND SETTING: The mean age were 9.23 years old, 53.7% male and 46.3% female. METHOD: Mixed approach study. A thematic analysis was carried out with the youth of the community to investigate emotional aspects. A descriptive cross-sectional study was carried out and correlations between variables were made. RESULTS: Correlations were found between suicidal behavior and medical findings. When comparing the mental health disorders and nutritional problems, statistically significant differences were found in the Suicide Risk domain (<.001). This was reaffirmed in the thematic analysis, where factors such as migration and difficulty understanding the language are highlighted as related to suicidal behavior in the pediatric population. CONCLUSIONS: Suicidal behavior should not be approached solely from psychopathology. Hunger, the weakening of one's own culture, armed conflict, migration, and other clinical conditions are found to be associated with suicidal behavior.

Resilience, adverse childhood experiences, and mental health in Health Science students during the COVID-19 pandemic / Resiliencia, eventos adversos en la infancia y salud mental en estudiantes de Ciencias para la Salud en la pandemia por COVID-19

Abstract Introduction A steady rise in mental problems has been observed in the university population, particularly in the area of health, related to the COVID-19 pandemic. Protective factors such as resilience and risk factors such as adverse events in childhood have been associated with mental health outcomes. Objective Describe psychiatric symptoms and their association with adverse childhood experiences and resilience in first-semester students in the three undergraduate programs of the Faculty of Health Sciences of the University of Caldas, Colombia in 2020. Method Descriptive, cross-sectional, correlational study, using a virtual survey including the SRQ (Self Reporting Questionnaire), Wagnild and Young's Resilience Scale and questions on adverse childhood experiences. Results A total of 108 students with a mean age of 19.6 years participated in the study. Affective symptoms were found in 6.4% of subjects. The most frequent level of resilience was medium, while the most commonly reported adverse event was child abuse. An association was found between being exposed to adverse childhood experiences and the presence of symptoms that compromise mental health and alter one of the domains of resilience. A link was also found between the presence of these symptoms and the alteration of domains of resilience. Discussion and conclusion It was possible to identify a risk of mental health disorders in students, and to establish an association between adverse events in childhood and resilience.

Resumen Introducción Se ha descrito un aumento progresivo de problemas mentales en la población universitaria, especialmente en el área de la salud, relacionado con la pandemia por COVID-19. Factores protectores como la resiliencia y factores de riesgo como eventos adversos en la infancia, se han relacionado con desenlaces en la salud mental. Objetivo Describir síntomas psiquiátricos y su asociación con eventos adversos en la infancia y resiliencia, en estudiantes de primer semestre de los tres programas de pregrado de la Facultad de Ciencias para la Salud de la Universidad de Caldas, Colombia en 2020. Método Estudio descriptivo, transversal, correlacional, mediante una encuesta virtual incluyendo el SRQ (Self Reporting Questionnaire), escala de resiliencia de Wagnild y Young y preguntas relacionadas con eventos adversos en la infancia. Resultados Participaron 108 estudiantes con edad media de 19.6 años. Hubo presencia de síntomas afectivos en 6.4%. El nivel de resiliencia más frecuentemente encontrado fue "medio" y el evento adverso en la infancia más comúnmente reportado fue el maltrato. Se demostró asociación entre haber estado expuesto a eventos adversos en la infancia tanto con presencia de síntomas que comprometen la salud mental como con afectación de uno de los dominios de resiliencia. Asimismo, hubo asociación entre presencia de dichos síntomas con afectación de los dominios de la resiliencia. Discusión y conclusión Se pudo identificar riesgo de alteraciones de la salud mental en los estudiantes, resaltando la asociación con eventos adversos en la infancia y la resiliencia.

Mental Health Services in Colombia: A National Implementation Study.

Laws in Latin American countries are based on scientific evidence that calls for mental health services to move to the community. These care modalities have implementation problems. The objective of this article is to describe the implementation of the services proposed in Law 1616 of 2013 of Colombia (Mental Health Law): emergencies, hospitalization, community-based rehabilitation, pre-hospital care, day hospital for children and adults, Drug Addiction Care Center, groups support and mutual aid, telemedicine, and home and outpatient care. We used a mixed study, with a cross-sectional descriptive quantitative component, where an instrument was used to determine the level of implementation of these services, consisting of a scale that established the availability and use of these services, in addition to the climate of implementation of the services and community mental health strategies, in addition to a qualitative determination of barriers and facilitators of implementation. We found a low availability of all services in departments such as Amazonas, Vaupés, Putumayo, and Meta and an implementation of services in Bogotá and Caldas. The least implemented services are the community ones, and those with the greatest presence at the territorial level are emergencies and hospitalization. We conclude that low- and middle-income countries have few community models and invest a large part of their technical and economic effort in emergencies and hospitalization. There are difficulties in the implementation of most of the services proposed by Colombian legislation related to mental health.

Traducción y adaptación de la Escala de Continuidad de Servicios de Salud Mental de Alberta en un contexto latinoamericano

Introducción: La continuidad de atención es considerada como un proceso que involucra una atención ordenada, un movimiento ininterrumpido de personas entre los diversos elementos del sistema de prestación de servicios. No existe evidencia suficiente en cuanto a instrumentos de medición en Iberoamérica. Por lo anterior, el objetivo del presente estudio consiste en describir el proceso de traducción, adaptación cultural a un contexto latinoamericano, así como la consistencia interna y validez de constructo de la Escala de Continuidad de Servicios de Salud Mental de Alberta (ACSS-MH). Método: Este instrumento fue sometido a la evaluación de validez de contenido por expertos y este fue aplicado a una población rural en un contexto colombiano. Se realizaron pruebas de consistencia interna y validez de constructo para cada una de las partes de la escala. Resultados: Bajo el consenso del experto, se realizan cambios en algunos ítems, buscando una mejor adaptabilidad del instrumento a las características lingüísticas del español, sin perder de vista el objetivo de evaluación de cada uno de los ítems del cuestionario original. El resultado del análisis de la parte A convergió en 5 componentes que explican el 69,69% de la varianza con 24 ítems; de igual forma, el análisis de la parte B agrupó 13 ítems en cuatro componentes, los cuales explican el 72.02% de la varianza. Conclusiones: este instrumento podría ser implementado para mejorar la prestación de los servicios en salud mental en contextos latinoamericanos, donde la continuidad del cuidado ha presentado importantes dificultades.

Objective: Describe the process of translation, cultural adaptation to Colombia, as well as the internal consistency and construct validity of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH). Methods: This instrument was subdued to the evaluation of validity of the content by experts and this was applied to a rural population in a Colombian context. Were performed tests of internal consistency and construct validity for each of the parts of the scale. Results: Under the consensus of the expert, it is made changes on some items, looking for a better adaptability of the instrument to the linguistic characteristics of Spanish, without losing sight of the evaluation objective of each one of the items on the original questionnaire. The result of the analysis of part A converged in 5 components that explain the 69.69% of the variance with 24 Items; Similarly, the analysis of part B grouped 13 items into four components, which explain the 72.02% of the variance. Discussion: This scale could be implemented to improve the provision of mental health services in Latin American contexts, where continuity of care has presented significant difficulties.

Brechas en la atención primaria en salud mental en Chocó, Colombia: barreras y desafíos / Gaps in primary mental health care in Chocó, Colombia: barriers and challenges / Lacunas na atenção primária à saúde mental em Chocó, Colômbia: barreiras e desafios

RESUMEN Objetivo. Describir barreras y desafíos en la implementación del Programa de Acción Mundial para Reducir las Brechas de Atención en Salud Mental mhGAP, y determinar la asociación entre facilitadores de implementación, accesibilidad, aceptabilidad y supervisión, en Chocó, Colombia. Métodos. Estudio evaluativo de corte transversal, con métodos mixtos y secuenciales. Se contó con la participación de 41 personas (30 correspondientes a personal de salud y 11 personas del área administrativa). Se conformaron cinco grupos focales, en el marco de la formación en mhGAP. Se usó la escala de impulsores de implementación, que determinó factores como: facilitadores del sistema para la implementación, accesibilidad de la estrategia, adaptación y aceptabilidad, formación y supervisión en la estrategia. También se realizaron entrevistas semiestructuradas, con un posterior análisis temático. Resultados. Se encontró una correlación estadísticamente significativa entre los componentes de la implementación, lo cual fue reafirmado con la información de las entrevistas. A nivel de las barreras señaladas, se destacan factores como dispersión, conflicto armado, la dificultad para cambiar la perspectiva de la zona en la que se vive y los problemas administrativos para acceder a los tratamientos. Estos factores se abordan en una propuesta de ruta de atención. Conclusiones. En mhGAP en el departamento del Chocó, pese a una adecuada aceptabilidad, acceso y supervisión, se evidencian barreras y desafíos de orden social, geográfico, político, cultural y a nivel de la administración en salud, que podrían ser superados con la implementación de rutas intersectoriales de recuperación, construidas desde el mismo territorio.

ABSTRACT Objective. Describe barriers and challenges in the implementation of the global Mental Health Gap Action Program (mhGAP), and determine the association between facilitators of implementation, accessibility, acceptability, and supervision, in Chocó, Colombia. Methods. Cross-sectional evaluation study, with mixed and sequential methods. Forty-one people participated: 30 health personnel and 11 administrative workers. Five focus groups were formed within the framework of the mhGAP training. The Likert scale of implementation drivers was used to determine factors affecting the strategy, such as system facilitators, accessibility of the strategy, adaptation and acceptability, and training and supervision. Semi-structured interviews were also conducted, with a subsequent thematic analysis. Results. A statistically significant correlation was found between the components of implementation. This was reaffirmed by the information from the interviews. Notable barriers include dispersion, armed conflict, difficulty in changing one's perspective on the area where they live, and administrative problems in accessing treatment. These factors are addressed in a proposed care pathway. Conclusions. With respect to mhGAP in the department of Chocó, despite adequate acceptability, access, and supervision, there are barriers and challenges at the social, geographical, political, cultural, and health administration levels, which could be overcome through implementation of locally-built intersectoral recovery routes.

RESUMO Objetivo. Descrever barreiras e desafios na implementação do Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) e determinar a associação entre facilitadores de implementação, acessibilidade, aceitabilidade e supervisão em Chocó, Colômbia. Métodos. Estudo avaliativo de corte transversal, com métodos mistos e sequenciais, que contou com 41 participantes (30 da equipe de saúde e 11 da equipe administrativa). Um total de cinco grupos focais foram formados como parte do treinamento do mhGAP. Utilizou-se a escala de motivadores de implementação, que determinou fatores como facilitadores do sistema para implementação, acessibilidade da estratégia, adaptação e aceitabilidade, treinamento e supervisão da estratégia. Também foram realizadas entrevistas semiestruturadas, com posterior análise temática. Resultados. Foi encontrada uma correlação estatisticamente significativa entre os componentes da implementação, o que foi reafirmado com as informações das entrevistas. Em termos das barreiras identificadas, destacam-se fatores como dispersão, conflito armado, a dificuldade de mudar a perspectiva da pessoa sobre a área em que vive e problemas administrativos no acesso ao tratamento. Esses fatores são abordados em uma proposta de via de atendimento Conclusões. Apesar da aceitabilidade, do acesso e da supervisão adequados, há barreiras e desafios sociais, geográficos, políticos, culturais e de administração de saúde no mhGAP do departamento de Chocó que poderiam ser superados com a implementação de rotas de recuperação intersetoriais, construídas a partir do próprio território.

Implementation of a multi-family intervention for children with behavioural and emotional problems in a semi-rural population.

OBJECTIVE: To determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia. METHODS: Qualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families. RESULTS: The contents of the sessions and the topics and experiences that were most significant for the children and their families are described. CONCLUSIONS: The adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.

[Depressive symptoms in caregivers and association with affective and behavioral problems in children and adolescents]. / Síntomas depresivos en cuidadores y su relación con problemas afectivos y comportamentales en niños, niñas y adolescentes.

OBJECTIVE: To evaluate the association between depressive symptoms in the caregiver and the presen ce of affective and behavioral problems in children and adolescents. SUBJECTS AND METHOD: Descripti ve correlational cross-sectional research. SAMPLE: 1100 children and adolescents with their respective parents or caregivers from public schools in Caldas, Colombia. Instruments used: Child Behavior Checklist (CBCL) and Patient Health Questionnaire (PHQ-9). RESULTS: The mean age was 12.1 years. According to the CBCL, up to 20% of the children and adolescents showed alteration in one of the syndromes for affective or behavioral difficulties. 34% of mothers and 14% of fathers showed for at least two weeks sadness, discouragement, depression, and loss of interest. When applying the PHQ- 9, 32.4% of the parents/caregivers were classified with depression. Parents/caregivers with such di sorders tend to perceive greater difficulty in coping with their daily lives compared with parents/ caregivers of children and adolescents who are not at risk (p < 0.003). CONCLUSIONS: The presence of depressive symptoms in the parents/caregivers is related to an increase in internalizing and externali zing symptoms in children and adolescents.

Implementation of a Multi-Family Intervention for Children With Behavioural and Emotional Problems in a Semi-Rural Population. / Implementación de una intervención multifamiliar para niños con problemas conductuales y emocionales en una población semirrural.

OBJECTIVE: To determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia. METHODS: Qualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families. RESULTS: The contents of the sessions and the topics and experiences that were most significant for the children and their families are described. CONCLUSIONS: The adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.