Mental illness stigma. A comparative cross-sectional study of social stigma, internalized stigma and self-esteem / El estigma de la enfermedad mental. Estudio comparativo transversal del estigma social, el internalizado y la autoestima

The aim of this study was to explore the role of stigma in different diagnoses of mental illness. A cross-sectional study (N = 255) was developed in two groups: users of a rehabilitation network for people with severe mental illness (Group-I) and people with common diagnoses in an ambulatory psychiatric service (Group-II). Internalized stigma, social stigma, self-esteem, and sociodemographic variables were measured. Mean comparisons, ANOVAs, and independent linear regression models were carried out. Similar overall scores were obtained for the internalized stigma, but Group-I reported more discrimination and resistance to stigma and also had less social stigma. The regression model for Group-I revealed social stigma and self-esteem as predictors, while in Group-II only self-esteem was significant. The study reveals differences in internalized stigma according to the care resource and diagnoses, suggesting different intervention lines and underlining the importance of further research on this topic. (AU)

El objetivo de este estudio ha sido explorar el papel del estigma en los diferentes diagnósticos de la enfermedad mental. Se llevó a cabo un estudio transversal (N = 255) en dos grupos: usuarios de una red de rehabilitación para personas con enfermedad mental grave (grupo I) y personas con diagnósticos comunes en un servicio psiquiátrico ambulatorio (grupo II). Se midió el estigma internalizado, el social, la autoestima y las variables sociodemográficas. Se llevaron a cabo comparaciones medias, ANOVA y modelos de regresión lineal independientes. Se obtuvieron puntuaciones generales similares para el estigma internalizado, pero el grupo I manisfestó más discriminación y resistencia al estigma y también menor estigma social. El modelo de regresión para el grupo I mostró como predictores el estigma social y la autoestima, mientras que en el grupo II sólo la autoestima era significativa. El estudio muestra diferencias en el estigma internalizado según el recurso de atención y los diagnósticos, lo que sugiere diferentes líneas de intervención y subraya la importancia de seguir investigando en este tema. (AU)

Specific phobia disorder symptoms in people over 65 in Madrid: a network analysis / El trastorno de fobia específica en las personas mayores de 65 años en Madrid: análisis de redes de síntomas

A symptom network analysis of specific phobia disorder (SPD) was conducted according to gender and age in 555 people over 65 in the Region of Madrid (Spain). The network was estimated using the InsingFit package that implements a procedure called eLasso. These results reveal differences in the strength, closeness, and betweenness of the different networks according to gender but not for the 65-74 and 75-84 age groups. The gender variable presents a greater presence of symptoms in women than in men. For all types of specific phobia, the symptom of greater occurrence for both groups was fear. The main difference between men and women over 65 with SPD lies in the situational type, where centrality is more distributed and where the most central symptoms are distress for women and fear for men. These differences in the networks seem to support the conceptualization of SPD from a dimensional point of view. (AU)

Se realizó un análisis de redes de síntomas del trastorno de fobia específica (TFE) según el género y la edad en 555 personas mayores de 65 años de la Comunidad de Madrid (España). La red se estimó utilizando el paquete InsingFit que implementa un procedimiento llamado eLasso. Los resultados presentan diferencias en la fuerza, cercanía e intermediación de las distintas redes según el género, pero no para los grupos de edad de 65-74 y 75-84 años. El análisis de la variable género muestra una mayor presencia de síntomas en las mujeres que en los hombres. Para todos los tipos de fobia específica, el síntoma de mayor presencia para ambos grupos fue el miedo. La principal diferencia entre hombres y mujeres mayores de 65 años con TFE radica en el tipo situacional, donde la centralidad está más distribuida y donde los síntomas más centrales son la angustia para las mujeres y el miedo para los hombres. Estas diferencias en las redes parecen reforzar la conceptualización del TFE desde un punto de vista dimensional. (AU)

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study.

BACKGROUND: This study aims to longitudinally assess the psychological impact of the COVID-19 pandemic in the general Spanish population. It uses four assessment points: two weeks after the start of confinement, one month after, two months after, and one year after the first evaluation. METHODS: Evaluations were conducted through an online survey, with a sample of 3,480 people at the first data collection and 1,041, 569, and 550 people at successive evaluation points. Depressive symptoms (PHQ-2), anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS), loneliness (UCLA-3), and discrimination (InDI-d) were evaluated. RESULTS: Significant changes were found in the variables depression and anxiety with a greater presence of this kind of symptomatology after one year (p < .01). There were also significant changes in the variable social support, which showed a substantial reduction after one year (p < .001). Similarly, there were significant variations in the variable intersectional discrimination (p < .001), with greater levels of discrimination. The temporal models show no significant differences in terms of post-traumatic symptomatology (p = .12) or loneliness (p = .19). CONCLUSIONS: The pandemic had a negative impact on mental health and these effects were further exacerbated one year later.

Study of the relationship between implicit and explicit stigmas associated with mental illness.

The emergence of the Implicit Association Test (IAT) has encouraged the study of the implicit stigma associated with mental illness in recent years, although further research is still needed in this area. A sample (n = 102) composed of psychology students and people from the general population completed explicit stigma tests: Attribution Questionnaire-9 (AQ-9), Social Distance Scale (DS) and a Spanish version of the IAT. A statistical analysis of sociodemographic measures and variables, and the relationships between explicit and implicit evidence, was carried out. The presence of implicit and explicit stigma was observed throughout the sample. Significantly lower AQ-9 scores were found in the student group. A greater desire for social distance was related to older age, belonging to the general population group and not having a diagnosed relative. In contrast, greater implicit stigma was found in people who had a family member with a diagnosis. No relationship was observed between explicit tests and IAT. An analysis of the main components revealed one implicit component and other explicit. Our study supports the existence of a stigma model with two different dimensions. These findings highlight the need to consider explicit and also implicit stigma, in future theoretical models and applied studies.

Age-related self-stigma of people over 65 years old: adaptation of the Internalized Stigma of Mental Illness scale (ISMI) for use in age-related self-stigma (IS65+) in a Spanish sample.

OBJECTIVES: To adapt the Internalized Stigma of Mental Illness scale (ISMI) to examine self-stigma associated with aging and to study the psychometric properties of this adapted version (IS65+). Finally, self-stigma associated with age in older people is studied. METHOD: The IS65+ was administered to a random sample of 419 people over 65 years from Madrid (Spain) to study the psychometric properties of this adapted version. A regression model was estimated to identify the variables that best predict self-stigma associated with old age. RESULTS: The IS65+ showed good internal consistency (α = .89) and a factorial structure of five factors. The data showed lower levels of self-stigma related to age in the sample than the levels of mental illness self-stigma in people with mental illness. The variables associated with age-related self-stigma are: high levels of perceived loneliness, low levels of coping strategies, gender (female), mental disorder, major depressive disorder, low levels of optimism and quality of life, and high levels of functional impairment. CONCLUSION: A new version of ISMI (IS65+) with acceptable psychometric criteria has been developed for use in people over 65 years old.

Loneliness, Sociodemographic and Mental Health Variables in Spanish Adults over 65 Years Old.

Loneliness is a risk factor for morbidity as well as mortality. Older people are more vulnerable to feeling alone due to age-associated changes and losses they might experience. This study aimed to analyze sociodemographic, psychosocial, and mental health variables related to loneliness in the elderly. A random sample of 419 people over 65 years old from the Community of Madrid was used. The UCLA Loneliness Scale, the CIDI65+ Diagnostic Interview, and the WHOQOL-BREF Quality of Life Measure were administered. A regression p model was estimated to identify the variables that best predict loneliness associated with old age. Loneliness-associated variables included living alone t(161.41) = 2.07; p < .040, marital status F(5, 404) = 4.52; p < .001, frequency of economic problems F(1, 408 ) = 4.86; p < .028, quality of life F(4, 405) = 7.36; p < .001, satisfaction with life F(4, 405) = 3.80; p < .005, satisfaction with social relationships F(4, 405) = 19.50; p < .001, presence of a mental disorder (t(98.70) = 2.92; p < .004), and having an anxiety disorder (t(51.11) = 2.19; p < .033). The results presented in this paper highlight some predictors of loneliness in older people that could be useful in intervention, to minimize harmful conditions that can lead to loneliness in people over 65.

Test Barcelona para discapacidad intelectual: un nuevo instrumento para la valoración neuropsicológica clínica de adultos con discapacidad intelectual / Barcelona Test for Intellectual Disability: a new instrument for the neuropsychological assessment of adults with intellectual disability

Introducción. La evaluación neuropsicológica en las personas con discapacidad intelectual es importante para determinar los déficits cognitivos específicos que subyacen a la afectación cerebral, limitan el funcionamiento intelectual y afectan al comportamiento adaptativo. A pesar de ello, no existen baterías neuropsicológicas en castellano adaptadas y validadas para esta población. Objetivo. Adaptar el programa integrado de exploración neuropsicológica-test Barcelona y validar la nueva versión, el test Barcelona para discapacidad intelectual (TB-DI), estableciendo datos normativos para el empleo clínico. Sujetos y métodos. A partir de los datos obtenidos en una muestra piloto de 65 personas con discapacidad intelectual, se realizaron cambios en el test original. Para estudiar las propiedades psicométricas del TB-DI, se administró a una muestra de 170 personas con discapacidad intelectual y a un grupo de 60 personas sin ella. Mediante modelos de regresión, se determinó qué variables eran importantes para la estratificación de los datos normativos. Resultados. El TB-DI, compuesto de 67 subtests agrupados en ocho dominios cognitivos, muestra unas buenas propiedades psicométricas. Se crean datos normativos para cinco grupos en función del nivel de discapacidad intelectual, la edad y la competencia curricular. Estos datos se organizan en percentiles, lo que permite trazar perfiles cognitivos en el ámbito clínico y experimental. Conclusión. El TB-DI es un instrumento de alta aplicabilidad para la población con discapacidad intelectual, y muestra una validez y una fiabilidad adecuadas, y con buenas propiedades psicométricas. Los perfiles cognitivos determinados mediante el TB-DI proporcionarán información valiosa para el tratamiento integral de las personas adultas con discapacidad intelectual leve y moderada (AU)

Introduction: Neuropsychological assessment in individuals with intellectual disability is of utmost importance in order to determine the cognitive deficits underlying brain dysfunction and limiting intellectual functioning and adaptive behavior. However, no neuropsychological batteries in Spanish language have been created and validated for this population. Aim: To adapt the ‘programa integrado de exploración neuropsicológica-test Barcelona’ and to validate the new version, the Barcelona Test for Intellectual Disability (TB-DI). To create normative data for its clinical use. Subjects and Methods: The original test was modified based on data from a pilot sample of 65 individuals with intellectual disability. In order to study the psychometric properties of the TB-DI, it was administered to a sample of 170 individuals with intellectual disability and to a group of 60 individuals without it. The relevant variables for stratification of normative data were determined by means of regression models. Results: The TB-DI was finally composed by 67 subtests grouped in eight cognitive domains and it showed good psychometric properties. Normative data were created for five groups taking into account intellectual disability level, age and acquired curricular competence. These data were organized in percentiles in a way that allows the creation of cognitive profiles in the clinical and experimental fields. CONCLUSION. The TB-DI constitutes a tool of high applicability in the population with intellectual disability. It shows adequate validity and reliability, and it has good psychometric properties. The cognitive profiles obtained by the TB-DI will provide valuable information for the treatment of adult adults with mild and moderate intellectual disability (AU)

Prevalence of Mental Disorders in the Elderly in the Community of Madrid: Results of the Mentdis_ICF65+ Study.

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcohol-related disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substance-related disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorder's prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted.

Prevalence of mental disorders in the elderly in the community

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcoholrelated disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/ women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substancerelated disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorder’s prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted (AU)

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Loneliness, sociodemographic and mental health variables in Spanish adults over 65 years old

Loneliness is a risk factor for morbidity as well as mortality. Older people are more vulnerable to feeling alone due to age-associated changes and losses they might experience. This study aimed to analyze sociodemographic, psychosocial, and mental health variables related to loneliness in the elderly. A random sample of 419 people over 65 years old from the Community of Madrid was used. The UCLA Loneliness Scale, the CIDI65+ Diagnostic Interview, and the WHOQOL-BREF Quality of Life Measure were administered. A regression p model was estimated to identify the variables that best predict loneliness associated with old age. Loneliness-associated variables included living alone t(161.41) = 2.07; p < .040, marital status F(5, 404) = 4.52; p < .001, frequency of economic problems F(1, 408 ) = 4.86; p < .028, quality of life F(4, 405) = 7.36; p < .001, satisfaction with life F(4, 405) = 3.80; p < .005, satisfaction with social relationships F(4, 405) = 19.50; p < .001, presence of a mental disorder (t(98.70) = 2.92; p < .004), and having an anxiety disorder (t(51.11) = 2.19; p < .033). The results presented in this paper highlight some predictors of loneliness in older people that could be useful in intervention, to minimize harmful conditions that can lead to loneliness in people over 65 (AU)

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Post-conflict affiliation by chimpanzees with aggressors: other-oriented versus selfish political strategy.

Consolation, i.e., post-conflict affiliation directed from bystanders to recent victims of aggression, has recently acquired an important role in the debate about empathy in great apes. Although similar contacts have been also described for aggressors, i.e., appeasement, they have received far less attention and their function and underlying mechanisms remain largely unknown. An exceptionally large database of spontaneous conflict and post-conflict interactions in two outdoor-housed groups of chimpanzees lends support to the notion that affiliation toward aggressors reduces the latter's aggressive tendencies in that further aggression was less frequent after the occurrence of the affiliation. However, bystander affiliation toward aggressors occurred disproportionally between individuals that were socially close (i.e., affiliation partners) which suggest that it did not function to protect the actor itself against redirected aggression. Contrary to consolation behavior, it was provided most often by adult males and directed toward high ranking males, whereas females engaged less often in this behavior both as actors and recipients, suggesting that affiliation with aggressors is unlikely to be a reaction to the distress of others. We propose that bystander affiliation toward aggressors may function to strengthen bonds between valuable partners, probably as part of political strategies. Our findings also suggest that this post-conflict behavior may act as an alternative to reconciliation, i.e., post-conflict affiliation between opponents, in that it is more common when opponents fail to reconcile.

Consolation as possible expression of sympathetic concern among chimpanzees.

Chimpanzees are known to spontaneously provide contact comfort to recent victims of aggression, a behavior known as consolation. Similar behavior in human children is attributed to empathic or sympathetic concern. In line with this empathy hypothesis, chimpanzee consolation has been shown to reduce the recipient's state of arousal, hence to likely alleviate distress. Other predictions from the empathy hypothesis have rarely been tested, however, owing to small sample sizes in previous studies. An exceptionally large database of spontaneous consolation in two outdoor-housed groups of chimpanzees lends further support to the empathy hypothesis in that consolation occurred disproportionally between individuals that are socially close (i.e., kin and affiliation partners) and was more typical of females than males, which differences are also known of human empathy. These effects were demonstrated using generalized linear mixed models, which control multiple variables at once. An exception to the above pattern was formed by the highest-ranking males, which frequently offered consolation to victims of aggression, probably as part of their general policing function in chimpanzee society. Consolation occurred more frequently in the absence of reconciliation between former opponents, suggesting that actors are sensitive to the contact need of victims of aggression, which may be greater if the aggressor ignores them. That consolation is an integrated part of close mutual relationships is supported by the tendency for it being reciprocated.

Estenosis biliares benignas: experiencia 77 casos / Benign biliary strictures: experience 77 cases

Se presenta la experiencia de los autores con 77 casos de estenosis biliares benignas tratadas en Unidad de Cirugía Hepática, Biliar y trasplante de hígado del Hospital Universitario de Maracaibo. Desde agosto de 1989 hasta diciembre de 2009, fueron registrados 77 casos de estenosis biliares benignas. Se tipificaron según la clasificación de Bismuth. 83,12% (64) de los pacientes habían sido colecistectomizados (estenosis post-iatrogenia durante este procedimiento): 41 (53,25%) abiertas y 23 (29,87%) laparoscópicas. 89,61 (69) de los pacientes consultaron por ictericia, 62,34% fiebre y 58,44% dolor abdominal. 9% (7) presentó estenosis Bismuth I, 22% (17) tipo II, 44,16% (34) tipo III y 24,68% (19) tipo IV. A todos se les realizó exploración biliar quirúrgica y anastomosis mucosa-mucosa con Y-Roux, tipo Hepp-Couinaud en 70 (87,5%) de los pacientes. La mortalidad fue 2,6% (2) paciente en el transoperatorio. Se presentaron en el peri-operatorio 19 (24,39%) complicaciones en 17 (22%) pacientes: 12 (15,6%) mayores y 7 (8,79%) menores. En un seguimiento promedio de 49 meses, 7-79% (6) pacientes presentaron re-estenosis de la derivación bilioentérica. El mayor porcentaje de estenosis biliares benignas son posteriores a procedimientos quirúrgicos, principalmente colecistectomia. La anastomosis bilioentérica tipo Hepp-Couinaud se realizó en el mayor número de pacientes con excelentes resultados.

Present experience of the authors with 77 cases of bening biliary strictures. From August of 1989 to December of 2009, 77 patients were recorded. Classification of Bismuth was used to classificate the strictures 64 (83,12%) patients were cholecistectomizated (stricture by iatrogenia during this procedure): 41 (53,25%) open and 23 (29,87%) laparoscopic. 89,61% (69) consulted by jaundice, 62,34 by fever and 58,44% by abdominal pain. 9%(7) had stricture Bismuth 1,22% (17) type II, 44,16% (34) type III and 24,68% (19) type IV. All patients were summated to surgical biliary exploration and mucous-mucous biliary anastomosis with Y-Roux. Hepp-Couinaud type in 70 (87,7%) of the patients. Perioperative mortality was 2,6% (2). Perioperative complications were 19 (24,39%) in 17 (22%) patients: 12 (15,6%) mayor and 7(8,79%) minors. In medial following of 49 months, 7,79% (6) presented re-stricture of bilio-enteric anastonosis. The majority of the strictures were due to surgical procedures. Hepp-Couinaud anastomosis was performed in almost all the patients with excellent outcome.