Confidencialidad y conducta de búsqueda de ayuda para problemas de salud mental en adolescentes / Confidentiality and help-seeking behavior for adolescent mental health problems / Confidencialidade e conduta de busca de ajuda para problemas de saúde mental em adolescentes

Resumen: Prevenir y detectar tempranamente los problemas de salud mental en población adolescente es fundamental para disminuir la posibilidad de desarrollar trastornos más graves. Asimismo, buscar ayuda para estos problemas y acceder de manera oportuna a la atención en salud mental en este grupo es necesario. No obstante, se ha constatado que los adolescentes tienden a no buscar ayuda profesional cuando presentan sintomatología de trastornos emocionales y, cuando la buscan, más bien lo hacen en fuentes informales. Diversas barreras, a nivel individual, estructural, social, y de la relación profesional salud-paciente, pueden obstaculizar la conducta de búsqueda de ayuda en los adolescentes. Entre estas se encuentra la preocupación de los jóvenes por la confidencialidad. En el presente artículo se expone y analiza evidencia sobre el rol de la confidencialidad en la conducta de búsqueda de ayuda para problemas de salud mental en adolescentes, planteando en su análisis una mirada desde la bioética y señalando algunas de sus implicancias en el abordaje de las prestaciones de salud mental juvenil.

Abstract: Prevention and early detection of mental health problems in the adolescent population is essential to reduce the possibility of developing more serious disorders. Likewise, seeking help for these problems and timely access to mental health care in this group is necessary. However, it has been found that adolescents tend not to seek professional help when they present symptoms of emotional disorders and, when they do seek help, they do so from informal sources. Various barriers, at the individual, structural, social, and health professional-patient relationship levels, can hinder help-seeking behavior in adolescents. Among these is young people's concern about confidentiality. This article presents and analyzes evidence on the role of confidentiality in help-seeking behavior for mental health problems in adolescents, presenting an analysis from a bioethical perspective and pointing out some of its implications in the approach to youth mental health services.

Resumo: Prevenir e detectar precocemente os problemas de saúde mental em população adolescente é fundamental para diminuir a possibilidade de desenvolver transtornos mais graves. Assim mesmo, para esse grupo é necessário buscar ajuda para esses problemas e acessar oportunamente atenção em saúde mental. Não obstante, constatou-se que os adolescentes tendem a não buscar ajuda profissional quando apresentam sintomatologia de transtornos emocionais e, quando buscam, o fazem em fontes informais. Diversas barreiras, em nível individual, estrutural, social e da relação profissional da saúde-paciente, podem obstaculizar a conduta de busca de ajuda pelos adolescentes. Entre estas se encontra a preocupação dos jovens com a confidencialidade. No presente artigo se expõe e analisa-se evidencias sobre o papel da confidencialidade na conduta de busca de ajuda para problemas de saúde mental em adolescentes, propondo-se um olhar a partir da bioética e ressaltando algumas de suas implicações na abordagem da saúde mental juvenil.

Longitudinal trajectories of suicidal ideation and attempts in adolescents with psychiatric disorders in Chile: study protocol.

INTRODUCTION: Adolescent suicide is a worldwide public health problem, being the second and the third leading cause of death in the 15-29 and the 15-19 age groups, respectively. Among adolescents, it is estimated that for every suicide, there are 100-200 suicide attempts. Although 79% of suicides in the world occur in low/middle-income countries, most of scientific evidence comes from high-income and low-risk countries. In recent years, adolescent suicide rates have steadily increased in Chile. Deaths caused by self-harm increased by 220% in the population aged 10-19 years between 2000 and 2015. The Maule Region is one of the regions of Chile with the highest levels of suicide among those aged 15 and 19 years old. The objective of this study is to evaluate the trajectories of ideation and suicidal attempts in adolescents with psychiatric disorders treated within the public health system of the Maule Region, Chile, based on different clinical, psychological and neuropsychological factors. METHOD: A prospective naturalistic study of a clinical sample of adolescents under psychiatric treatment in the Maule Region, Chile. Adolescents will be evaluated using a thorough protocol that includes suicide-related clinical variables. The study seeks to establish patterns of change in the trajectories of ideation and suicide attempts among adolescents. ETHICS AND DISSEMINATION: Ethical approval was granted by the Scientific Ethics Committee of the Universidad Católica del Maule in Chile. This protocol was registered in ClinicalTrials.gov. The results of this study will be disseminated to health centres through executive reports and feedback sessions. In addition, the most relevant findings will be presented in scientific articles, conferences and seminars open to the community. TRIAL REGISTRATION NUMBER: NCT04635163.

Antibody Conjugates for Sarcoma Therapy: How Far along Are We?

Sarcomas are one of the most difficult type of cancer to manage and treat because of their extremely heterogeneous molecular and morphological features. Despite the progress made over the years in the establishment of standard protocols for high and low grading/staging sarcoma patients, mostly with chemotherapy and/or radiotherapy, 50% of treated patients experience relapse episodes. Because of this, in the last 20 years, new therapeutic approaches for sarcoma treatment have been evaluated in preclinical and clinical studies. Among them, antibody-based therapies have been the most studied. Immunoconjugates consist of a carrier portion, frequently represented by an antibody, linked to a toxic moiety, i.e., a drug, toxin, or radionuclide. While the efficacy of immunoconjugates is well demonstrated in the therapy of hematological tumors and more recently also of epithelial ones, their potential as therapeutic agents against sarcomas is still not completely explored. In this paper, we summarize the results obtained with immunoconjugates targeting sarcoma surface antigens, considering both preclinical and clinical studies. To date, the encouraging results obtained in preclinical studies allowed nine immunoconjugates to enter clinical trials, demonstrating the validity of immunotherapy as a promising pharmacological tool also for sarcoma therapy.

Preferred sources of help for mental health problems among Chilean adolescents: a descriptive study / Fuentes de ayuda preferidas para problemas de salud mental por adolescentes chilenos: estudio descriptivo

Abstract Background: A timely search for professional help regarding mental health issues in adolescents is critical in preventing severe disorders. However, adolescents generally tend not to seek help. This investigation aimed to study Chilean adolescents’ willingness to seek help in mental health issues by identifying their preferred help-seeking sources. Methods: We conducted a cross-sectional-correlational study with 493 high school students between 14 and 19 years of age (mean ± standard deviation = 16.28 ± 1.29). The instruments we used were the general help-seeking questionnaire (vignette version), adapted and validated in Chile, and a sociodemographic questionnaire. Results: Data showed that adolescents are more willing to seek help from informal rather than from formal sources. We identified no sex differences in terms of willingness to seek help from formal sources. However, males were more willing to seek help from informal sources. Conclusions: Similar to other cultures, Chilean adolescents are more willing to seek help from informal sources regarding mental health problems.

Resumen Introducción: La búsqueda de ayuda profesional oportuna para temas de salud mental en adolescentes es fundamental para evitar el desarrollo de trastornos más graves. No obstante, en general los adolescentes tienden a no solicitar ayuda. El objetivo de la presente investigación fue identificar las fuentes de ayuda para problemas de salud mental a las que los adolescentes chilenos están más dispuestos a dirigirse. Métodos: Estudio transversal-correlacional en el que participaron 493 estudiantes de secundaria de entre 14 y 19 años (media ± desviación estándar = 16.28 ± 1.29). Los instrumentos aplicados fueron el Cuestionario General de Búsqueda de Ayuda (versión viñeta), adaptado y validado en Chile, y un cuestionario de datos sociodemográficos. Resultados: Los resultados obtenidos muestran que los adolescentes prefieren buscar ayuda en fuentes informales. No se identificaron diferencias por sexo en la disposición a buscar ayuda en fuentes formales, pero sí en la disposición a buscar ayuda en fuentes informales, pues los varones mostraron mayor disposición a hacerlo. Conclusiones: En concordancia con la evidencia en otras culturas, los adolescentes chilenos presentan una mayor disposición a buscar ayuda para problemas de salud mental en fuentes informales.

Preferred sources of help for mental health problems among Chilean adolescents: a descriptive study.

BACKGROUND: A timely search for professional help regarding mental health issues in adolescents is critical in preventing severe disorders. However, adolescents generally tend not to seek help. This investigation aimed to study Chilean adolescents' willingness to seek help in mental health issues by identifying their preferred help-seeking sources. METHODS: We conducted a cross-sectional-correlational study with 493 high school students between 14 and 19 years of age (mean ± standard deviation = 16.28 ± 1.29). The instruments we used were the general help-seeking questionnaire (vignette version), adapted and validated in Chile, and a sociodemographic questionnaire. RESULTS: Data showed that adolescents are more willing to seek help from informal rather than from formal sources. We identified no sex differences in terms of willingness to seek help from formal sources. However, males were more willing to seek help from informal sources. CONCLUSIONS: Similar to other cultures, Chilean adolescents are more willing to seek help from informal sources regarding mental health problems.

Recognition of mental health disorders in adolescent students in Chile: a descriptive study. / Reconocimiento de trastornos de salud mental en adolescentes escolarizados: estudio descriptivo.

OBJECTIVE: To describe high school students’ ability to recognize six mental health disorders. METHOD: This is a descriptive, cross-sectional study. Participants were teenagers between 14-19 years of age, high-school students from the town of Talca, in the Maule Region (Chile). In order to examine the recognition of mental health issues, six vignettes were used, each describing a teenager showing symptoms of six different problems (stress, anxiety, depression, suicidal thoughts, alcohol abuse, and psychosis). The vignettes are part of the general help-seeking questionnaire for mental health problems in adolescents (vignette version). Participants were instructed to read the vignettes and then answer the question: what do you think is happening to them? The descriptive analysis mainly considered frequencies and percentages. RESULTS: The vignette questionnaire was administered to 400 adolescents of both genders between 14-19 years of age (Mean = 15.73 years). The topic most recognized by the participants was the abuse of alcohol, while anxiety was the least recognized. Women showed a greater tendency to recognize all mental health issues, being the topic of alcohol abuse the one showing the most differences in recognition, with 56.6% of female adolescents recognizing the problem and 41.4% of males identifying it. CONCLUSIONS: In general, results showed low levels of ability to recognize mental health disorders among participating adolescents. Female adolescents and participants of subsidized educational establishments tended to better acknowledge the different problems presented.

OBJETIVO: Describir el reconocimiento de seis trastornos de salud mental, en adolescentes escolarizados en enseñanza secundaria. MÉTODO: Estudio de tipo exploratorio, descriptivo y transversal. Los participantes fueron adolescentes entre 14 y 19 años, estudiantes de enseñanza secundaria de la localidad de Talca, en la Región del Maule (Chile). Para examinar el reconocimiento de problemas de salud mental se utilizaron seis viñetas, que forman parte del cuestionario general de búsqueda de ayuda (versión viñeta), donde en cada una se describía a un adolescente que presentaba síntomas de seis distintos problemas (estrés, ansiedad, depresión, ideación suicida, abuso de alcohol, psicosis). Los participantes fueron instruidos para leer estas viñetas y luego responder a la pregunta ¿Qué crees que le está sucediendo? El análisis descriptivo consideró principalmente frecuencias y porcentajes. RESULTADOS: Se administró el cuestionario con las viñetas a 400 adolescentes de ambos sexos entre 14 y 19 años (Media = 15,73 años). El tema más reconocido por los participantes fue el abuso de alcohol, mientras que la ansiedad fue la menos reconocida por los adolescentes. Las mujeres tendieron a reconocer más todos los problemas de salud mental, siendo el tema que más diferencias evidenció el abuso de alcohol, con un 56,6% de adolescentes mujeres que reconocieron el problema y un 41,4% de varones que lo identificaron. CONCLUSIONES: En general, los resultados mostraron bajos niveles de reconocimiento de trastornos de salud mental en los adolescentes participantes. Las adolescentes mujeres y los participantes de establecimientos educacionales subvencionados, tendieron a reconocer más correctamente los distintos problemas presentados.

Adaptación y validación del cuestionario de barreras para la búsqueda de ayuda para problemas de salud mental en adolescentes chilenos / Adaptation and Validation of Barriers to Adolescents Seeking Help Scale for Mental Health Problems in Chilean Teenagers

Resumen La presente investigación tuvo como objetivo, adaptar y validar en adolescentes chilenos, el cuestionario de barreras para la búsqueda de ayuda para problemas de salud mental, versión breve (BASH-B). Este cuestionario mide las barreras o razones percibidas por los adolescentes para no buscar ayuda profesional cuando presentan algún problema psicológico. Los participantes fueron 387 adolescentes de entre 14 y 19 años (M = 15.71 años), escolarizados en establecimientos de enseñanza media de la comuna de Talca (Chile). Se analizaron las propiedades psicométricas del instrumento. El análisis confirmatorio corroboró la estructura factorial unidimensional. Además, los índices de confiabilidad fueron adecuados. La escala presentó asociación significativa con las variables depresión y autoeficacia en las direcciones esperadas. En base a estos resultados, es posible decir que el BASH-B es un instrumento que posee propiedades psicométricas adecuadas para medir las barreras de la búsqueda de ayuda en el ámbito de la salud mental en adolescentes.

Abstract This research has a goal to adapt and validate for Chilean teenagers the Barriers to Adolescents Seeking Help Scale, brief version (BASH-B). This questionnaire measures the perceived barriers and reasons for teenagers not looking for professional help when they presents some psychological problem. There were 387 teenagers participants between 14 and 19 years olds (M = 15.71 years), attending high schools in Talca regional area. The psychometric properties of the instrument were analyzed. A confirmatory factor analysis corroborated the one-dimensional structure. The reliability indexes as appropriate. In addition, the scale presented significant association with the variables depression and self-efficacy in the hipothesized directions. Based on these results is possible to confirm that the BASH-B a appropriate psychometric properties to measure the barriers to help seeking for Mental health Problems in teenagers.

[Validation of the general help-seeking questionnaire for mental health problems in adolescents]. / Validación del cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes.

Help-seeking behavior is a protective factor in young people, essential for their mental health, well-being and development. However, some adolescents do not seek professional help when they need to. In this context, it is relevant to study the help-seeking behavior for mental health problems in adolescent population. OBJECTIVE: To adapt and validate the general help-seeking questionnaire for mental health problems in Chilean adolescents. SUBJECTS AND METHOD: Cross-sectional and correlational study of a non-random sample of 793 adolescent students, between 14 and 19 years old, from the city of Talca (Chile). The general help-seeking questionnaire, vignette version, (GHSQ-V) was administered after a transcultural adaptation and criterion validation. Descriptive statistics, exploratory factor analysis and non-parametric Mann-Whitney U test were used for analysis. RESULTS: An exploratory analysis identified two factors regarding available sources of help: 1) informal sources; 2) formal sources. Reliability was calculated separately for each of the health problems, resulting alpha values ranging from 0.87 to 0.75. In addition, the scale showed significant association with the variables self-efficacy and depression in the hypothesized directions. Finally, significant differences were identified in the willingness to seek help by adolescent’s level of mental health literacy, for all mental health issues presented, except suicide. CONCLUSION: The adaptation of the GHSQ-V for Chilean adolescent and youth population is a valid and reliable instrument to measure willingness to seek help for mental health problems in our socio-cultural environment.

Validación del cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes / Validation of the general help-seeking questionnaire for mental health problems in adolescents

La conducta de búsqueda de ayuda en los jóvenes es un factor protector, fundamental para su salud mental, bienestar y desarrollo. Sin embargo, un número de ellos no busca ayuda profesional, a pesar de necesitarla. En este contexto, es relevante estudiar la conducta de búsqueda de ayuda para problemas de salud mental en población adolescente. Objetivo: Adaptar y validar en adolescentes chilenos el cuestionario general de búsqueda de ayuda para temas de salud mental. Sujetos y Método: Estudio transversal y correlacional de una muestra no probabilística de 793 adolescentes estudiantes, entre 14 y 19 años, de la ciudad de Talca (Chile). En ellos se aplicó un Cuestionario General de Búsqueda de Ayuda versión viñeta (GHSQ-V) previa adaptación transcultural y validación de criterio. Para el análisis se utilizó estadística descriptiva, prueba no paramétrica de Mann-Whitney y análisis factorial exploratorio. Resultados: Un análisis exploratorio, identificó 2 factores respecto a las fuentes de ayuda disponibles: 1° fuentes informales, 2° fuentes formales. Se calculó la confiabilidad separadamente para cada uno de los problemas de salud, obteniéndose valores alfa que oscilaron entre 0,87 y 0,75. Además, la escala presentó asociación significativa con las variables auto eficacia y depresión en las direcciones hipotetizadas. Por último, se identificaron diferencias significativas en la disposición a buscar ayuda según el nivel de alfabetización en temas de salud mental de los adolescentes, para todos los temas de salud mental presentados, excepto el suicidio. Conclusión: El GHSQ-V adaptado en población adolescente y juvenil chilena es un instrumento que posee adecuadas propiedades psicométricas para medir la disposición a buscar ayuda para temas de salud mental en nuestro medio sociocultural.

Help-seeking behavior is a protective factor in young people, essential for their mental health, well-being and development. However, some adolescents do not seek professional help when they need to. In this context, it is relevant to study the help-seeking behavior for mental health problems in adolescent population. Objective: To adapt and validate the general help-seeking questionnaire for mental health problems in Chilean adolescents. Subjects and Method: Cross-sectional and correlational study of a non-random sample of 793 adolescent students, between 14 and 19 years old, from the city of Talca (Chile). The general help-seeking questionnaire, vignette version, (GHSQ-V) was administered after a transcultural adaptation and criterion validation. Descriptive statistics, exploratory factor analysis and non-parametric Mann-Whitney U test were used for analysis. Results: An exploratory analysis identified two factors regarding available sources of help: 1) informal sources; 2) formal sources. Reliability was calculated separately for each of the health problems, resulting alpha values ranging from 0.87 to 0.75. In addition, the scale showed significant association with the variables self-efficacy and depression in the hypothesized directions. Finally, significant differences were identified in the willingness to seek help by adolescent’s level of mental health literacy, for all mental health issues presented, except suicide. Conclusion: The adaptation of the GHSQ-V for Chilean adolescent and youth population is a valid and reliable instrument to measure willingness to seek help for mental health problems in our socio-cultural environment.

Is it Acceptable for a Psychologist to Break A Young Client's Confidentiality? Comparing Latin American (Chilean) and Western European (French) Viewpoints / ¿Es aceptable para un psicólogo romper la confidencialidad de un joven cliente? Una comparación entre las perspectivas latinoamericana (chilena) y europea occidental (francesa)

En el presente estudio, fueron examinadas y comparadas las perspectivas de adultos chilenos y franceses respecto a la ruptura de la confidencialidad, frente al tema del consumo de drogas ilícitas. A 12 psicólogos chilenos, 143 adultos chilenos, y 100 adultos franceses se les presentó una serie de 64 viñetas, en las cuales un psicólogo conversa con su joven cliente que presenta consumo de drogas. Estas viñetas fueron compuestas de acuerdo a un diseño factorial de 6 factores intra-sujeto: la edad del cliente, la peligrosidad de la droga, el tiempo que lleva consumiendo la droga, si el cliente está de acuerdo en recibir tratamiento para la adicción, la estabilidad de su familia y si el psicólogo consulta a un experto antes de informar a la familia. Los resultados evidenciaron cuatro tipo de posiciones diferentes: "Nunca aceptable" (20%), "Siempre aceptable" (27%), "Principalmente dependiendo de la edad del cliente" (20%), y "Principalmente dependiendo del tipo de problemas familiares" (33%). Un alto porcentaje de participantes chilenos expresaron la perspectiva llamada "nunca aceptable", en comparación a los participantes franceses, y un alto porcentaje de participantes franceses expresaron la perspectiva "dependiendo de la edad del cliente", comparado con los participantes chilenos. Los participantes chilenos expresaron posiciones que son generalmente compatibles con el código de ética chileno.

The views of Chilean and French adults concerning breaking confidentiality about illicit drug consumption were examined and compared. Twelve Chilean psychologists, 143 Chilean adults, and 100 French adults were presented with a series of 64 vignettes of a psychologist told by her young client that he is using illicit drugs. They were composed according to a six within-subject factor design: client's age, dangerousness of the drug, duration of drug consumption, whether he agreed to be treated for addiction, stability of his family, and whether the psychologist consulted an expert before informing the family. Four qualitatively different personal positions were found, called Never acceptable (20% of the participants), Always acceptable (27%), Mainly depends on client's age (20%), and Mainly depends on family problems (33%). A larger percentage of Chileans expressed the never acceptable view compared to French lay people, and a larger percentage of French expressed the mainly depends on client's age view, compared to Chilean lay people. Chilean psychologists infrequently endorsed positions that are not fully compatible with the Chilean code of ethics.