The effect of stressful life events on the risk for psychosis: differences between Mexican at clinical and familial high risk.

Background: Stressful life events (SLEs) in the development of early psychosis have been little studied in low-income countries. This study examines differences in the prevalence of SLEs in Mexican at clinical high risk (CHR) and those with familial high risk for psychosis who do not meet CHR criteria (non-CHR FHR). We also analyze the association between SLEs and CHR. Methods: Participants included 43 persons with CHR and 35 with non-CHR FHR. CHR criteria were assessed with the Comprehensive Assessment of At-Risk Mental State. SLEs were assessed using the Questionnaire of Stressful Life Events. Results: Participants with CHR reported more SLEs associated with negative academic experiences than those in the non-CHR FHR group. Bullying (OR = 7.77, 95% CI [1.81, 33.32]) and low educational level (OR = 21.25, 95% CI [5.19, 46.90]) were the strongest predictors of CHR, while starting to live with a partner (OR = 0.26, 95% CI [0.10, 0.84]) was associated with a lower risk of CHR. Conclusion: Negative school experiences increase the risk of psychosis, particularly bullying, suggesting that schools may be ideal settings for implementing individual preventive strategies to reduce risk factors and increase protective factors to improve the prognosis of those at risk of developing psychosis. In Latin America, there are multiple barriers to early intervention in psychosis. It is thus crucial to identify risk and protective factors at the onset and in the course of psychosis in order to design effective preventive interventions.

Quality of life, anxiety, depression, and distress in patients with advanced and metastatic lung cancer.

OBJECTIVE: Lung cancer (LC) patients have shown a predisposition for developing emotional and physical symptoms, with detrimental effects on the quality of life (QoL). This study evaluates the bidirectional relationship between main psychological disorders and clinical/sociodemographic factors with the QoL. METHODS: In this observational cross-sectional study, patients with a confirmed LC diagnosis from February 2015 to March 2018 were eligible for this study. Each participant completed screening instruments of anxiety, depression, distress, and QoL assessment. Other relevant clinical data were extracted from electronic health records. Then comparisons, correlations, and logistic regression analyses were performed. RESULTS: Two hundred and four cases were eligible; of them, the median age was 61 (24-84) years, most had clinical stage IV (95%), and most were under first-line therapy (53%). Concerning psychological status, 46% had symptoms of emotional distress, 35% anxiety, and 31% depression. Patients with psychological disorders experienced a worse global QoL than those without psychological impairment (p < 0.001). Increased financial issues and physical symptoms, combined with lower functioning, were also significantly associated with anxiety, depression, and distress. In the multivariate analysis, female sex and emotional distress were positively associated with an increased risk of depression; likewise, female sex, low social functioning, insomnia, and emotional distress were associated with anxiety. CONCLUSIONS: Emotional symptoms and QoL had a significant bidirectional effect on this study; this underscores the necessity to identify and treat anxiety, depression, and distress to improve psychological well-being and the QoL in LC patients.

Clinical and Functional Differences Between Mexican Youth at Clinical High Risk for Psychosis and With Familial High Risk.

Few studies have explored the differences in clinical psychopathology between youth at high risk for psychosis and those at familial high risk for psychosis. This study seeks to describe and compare the sociodemographic, clinical, and functional characteristics of At-Risk Mental State (ARMS) for psychosis youth and those with a first- or second-degree relative with psychosis (Familial High-Risk: FHR) in a Mexican sample. Twenty-one ARMS individuals and 21 with FHR were evaluated for sociodemographic characteristics, psychopathological symptoms, and functional impairment. ARMS individuals were significantly younger, had fewer years of schooling, and were more likely to be male than those in the FHR group. Groups did not differ as regards marital status or occupation. The ARMS group showed greater severity of prodromal symptoms, schizotypal personality traits, and general psychopathology than the FHR group. In addition, they reported more premorbid adjustment deficit from early adolescence than the FHR group. Current overall social and role functioning was significantly lower in the ARMS group. Findings are consistent with ARMS studies from other countries. First- or second-degree relatives of patients with psychosis should be considered a vulnerable group as they display several symptoms of general psychopathology and may experience social adjustment problems in their adult lives. The lack of early detection and intervention psychosis programs in Mexico underlines the need to prioritize the development of preventive strategies to help close the care gap.

Dignity therapy in Mexican lung cancer patients with emotional distress: Impact on psychological symptoms and quality of life.

Lung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness. OBJECTIVE: To analyze the effect of DT on anxiety, depression, hopelessness, emotional distress, dignity-related distress, and quality of life (QoL) in a group of Mexican patients with stage IV LC undergoing active medical treatment with baseline emotional distress. METHOD: In this preliminary pretest-posttest study, patients received three sessions of DT and were evaluated with the HADS, Distress Thermometer, Patient Dignity Inventory, single-item questions, and QLQ-30. RESULTS: In total, 24 out of 29 patients completed the intervention. Statistically significant improvements were found in anxiety, depression, emotional distress, hopelessness, and dignity-related distress with large effect sizes. Patients reported that DT helped them, increased their meaning and purpose in life, their sense of dignity, and their will to live, while it decreased their suffering. No changes were found in QoL. SIGNIFICANCE OF RESULTS: DT was well accepted and effective in improving the emotional symptoms of LC patients with distress that were undergoing medical treatment. Although more research is warranted to confirm these results, this suggests that DT can be used in the context of Latin-American patients.

Emotional responses and coping strategies in adult Mexican population during the first lockdown of the COVID-19 pandemic: An exploratory study by sex / Respuestas emocionales y estrategias de afrontamiento en población adulta mexicana durante el primer confinamiento por la pandemia de COVID-19: un estudio exploratorio por sexo

Abstract Introduction The COVID-19 outbreak has involved a permanent and significant increase of fear and worries related to the virus and the measures taken to avoid contagion, such as confinement. Objective To explore the relationship between emotional responses and coping strategies used to face the first confinement among the Mexican adult population and inquire about differences by sex. Method An exploratory study was conducted through a self-administered online survey. It included questions about sociodemographic characteristics, emotions about pandemic information, and coping strategies. An informed consent form was presented prior to data collection. Chi square and Kruskal-Wallis were performed for bivariate analyses. Results A total of 2,650 participants completed the survey (21.6% were men). Significantly more men than women reported feeling calm (p < .001), hopeful (p = .011), and indifferent (p = .002). In contrast, more women, compared to men significantly reported feeling worried (p < .001), fearful (p < 0.001), and sad (p < .001). More women reported being emotionally close to other people (p = .027), seeking help from friends and family to share emotions and concerns (p < .001), and they frequently prayed as a coping strategy regardless of their emotions (p = .005). Discussion and conclusion While women are the least affected by the contagion and their symptoms are milder than in men, they present the most negative emotions, particularly of worry, but they also used more caring and helpful behaviors in comparison with men. These results can serve as a basis for developing research with a gender perspective that delves into the differences by sex found in this study.

Resumen Introducción El brote de COVID-19 ha implicado un aumento significativo y permanente en el miedo y las preocupaciones relacionadas con el virus y las medidas de mitigación, como el confinamiento. Objetivo Explorar la relación entre emociones y estrategias de afrontamiento utilizadas durante el primer confinamiento en población adulta mexicana e indagar sus diferencias por sexo. Método Estudio exploratorio mediante una encuesta en línea autoadministrada. Se obtuvo el consentimiento informado antes de recopilar la información. Se utilizó estadística no paramétrica para los análisis bivariados. Las respuestas de estrategias de afrontamiento se analizaron como variables cuantitativas y se reportaron las medias. Resultados Un total de 2,650 participantes completaron la encuesta (21.6% fueron hombres). Significativamente, más hombres que mujeres informaron sentirse calmados (p < .001), esperanzados (p = .011) e indiferentes (p = .002). Más mujeres, en comparación con los hombres, informaron sentirse significativamente preocupadas (p < .001), temerosas (p < .001) y tristes (p < .001). Más mujeres informaron estar emocionalmente cercanas a otras personas (p = .027), buscar ayuda de amigos y familiares para compartir emociones y preocupaciones (p < .001) y utilizar frecuentemente la oración como una estrategia de afrontamiento (p = .005). Discusión y conclusión Aunque las mujeres son las menos afectadas por el contagio en comparación con los hombres, son las que presentan las emociones más negativas, particularmente de preocupación. Sin embargo, también han utilizado más comportamientos de cuidado y ayuda. Estos resultados pueden servir como base para desarrollar investigación con perspectiva de género que profundice en las diferencias por sexo encontradas en este estudio.

Effects of Family-to-Family Psychoeducation Among Relatives of Patients With Severe Mental Disorders in Mexico City.

OBJECTIVE: This study examined the effects of a three-month Family-to-Family (FTF) Education Program on expressed emotion and subjective knowledge about mental illness among relatives of Mexican patients with severe mental disorders. METHODS: A total of 230 relatives of patients with severe mental disorders completed self-reported questionnaires before (pretest) and after (posttest) the FTF program. RESULTS: FTF led to reductions in negative emotional attitudes and improved the understanding of the disorder, regardless of sex or age of the relative. CONCLUSIONS: This study supported the evidence-based practice of FTF in a Mexican population and confirmed the importance of providing routine family psychoeducation as an additional component of health care service provision for relatives of people with severe mental illness in the community.

Apoyo social y funcionalidad familiar en personas con trastorno mental / Social support and family functionality in people with mental disorder

Antecedentes Cuando algún miembro de la familia presenta un padecimiento mental como la esquizofrenia, y un familiar asume el rol de cuidador, el apoyo social es elemental para afrontar con éxito la funcionalidad familiar y los problemas que ocasionan. Objetivo Determinar los factores de apoyo social y estructural asociados con la percepción de funcionalidad familiar en las personas con trastorno mental y los familiares cuidadores. Material y método Estudio descriptivo, correlacional, transversal, no probabilístico, de participación secuencial, en dos grupos: 72 pacientes ambulatorios diagnosticados con un trastorno de salud mental y 66 familiares cuidadores. Se utilizaron tres instrumentos: el Cuestionario MOS, el Cuestionario APGAR-Familiar y el Cuestionario Duke-UNC-11. Resultados La Funcionalidad familiar (APGAR) es percibida por 58.3% de los pacientes; el 19.4%, disfuncionalidad severa y 22.2%, disfuncionalidad leve. En los familiares, 66.7% percibe funcionalidad familiar; 10.6%, disfuncionalidad severa y 22.7%, disfuncionalidad leve. En el reporte del apoyo estructural (MOS) se observó una diferencia estadísticamente significativa (t=-2.478, gl=136, p=0.014) en la percepción de apoyo instrumental entre los pacientes (̅x=11.68) y los familiares. Estos últimos percibieron menor apoyo instrumental (̅x=9.91). En cuanto al apoyo funcional social (Duke-UNC-11) no se indica diferencia (t=1.170, gl=136, p=.244) entre los familiares (̅x=40.36) y los pacientes (̅x=38.07). El modelo de regresión lineal mostró que los pacientes con mayor tiempo de evolución y con diagnóstico de esquizofrenia predicen disfuncionalidad; en cambio el apoyo social predice funcionalidad (p<.001). En los familiares, a mayor tiempo de evolución se pronostica disfuncionalidad en tanto que el apoyo social predijo funcionalidad (p<.001). Conclusión Es evidente que en la funcionalidad familiar el apoyo social juega un papel importante en pacientes que padecen problemas mentales y en los familiares cuidadores. En los pacientes se observó que a mayor AS perciben mayor funcionalidad familiar. En los familiares el apoyo estructural demostró una mejor percepción de funcionalidad familiar, lo que permite disminuir la probabilidad de recaídas y hospitalización.

Antecedents When a family member suffers from a mental disorder, such as schizophrenia, and a relative takes on the role of caregiver, social support is crucial to successfully addressing family functionality and the problems this may cause. Objective Determine the factors of social and structural support associated with the perception of family functionality in persons with a mental disorder and family caregivers. Material and method This is a descriptive, corelational, cross-sectional, non-probabilistic study, with sequential participation. Subjects were divided into two groups: 72 outpatients diagnosed with a mental health disorder, and 66 kinship caregivers. Three instruments were used: an MOS Questionnaire, an APGAR-Family Questionnaire and a Duke-UNC-11 Questionnaire. Results 58.2% of the patients perceived family functionality (APGAR); 19.4%, severe dysfunctionality, and 22.2%, slight dysfunctionality. Among relatives, 66.7% perceived family functionality; 10.6%, severe dys-functionality, and 22.7%, slight dysfunctionality. In the Structural Support Report (MOS), a statistically significant difference was observed (t=2.478, gl=136, p=0.014) in the perception of instrumental support among patients (̅x=11.68) and relatives; the latter perceiving the least instrumental support (̅x=9.91). In functional social support (Duke-UNC-11) no difference (t=1.170; gl= 136, p=.244) was indicated between relatives (̅x=40.36) and patients (̅x=38.07). The linear regression model showed that patients with the longest period of evolution and diagnosis of schizophrenia predict dysfunctionality, whereas social support predicts functionality (p<.001). Among relatives, longer periods of evolution indicated dysfunctionality, while social support predicted functionality (p<.001). Conclusion It is clear that social support plays an important role in family functionality in patients suffering from mental problems and kinship caregivers. In patients, it was observed that the greater the AS, the higher the degree of family functionality. Among relatives, structural support showed an increased perception of family functionality, which reduces the likelihood of relapses and hospitalization.

Coping and emotional discomfort in primary caregivers of cancer patients.

OBJECTIVES: To assess the psychometric properties of the Carer's Assessment of Managing Index. To compare coping styles in caregivers of patients with terminal cancer (CPTC) and caregivers of patients on oncologic treatment (CPOT). To revise the association between coping styles, socio-demographic variables, and emotional discomfort in caregivers. MATERIAL AND METHODS: A cross-sectional and correlational study was conducted, in which 133 caregivers, 59 CPOT and 74 CPTC, were interviewed. Emotional discomfort (depression, anxiety, caregiver's burden) and coping styles were measured. RESULTS: The instrument was defined by three factors (alternate perception of events, active coping, and emotional regulation), with an internal consistency of α = 0.78. The alternate perception of events was the only coping style with statistically significant difference between CPOT and CPTC, and CPOT score higher in this regard. Different coping styles allow for more accurate prediction of emotional discomfort in CPTC, which showed more symptoms of anxiety, depression, caregiver's burden and physical illness. The study found a high occurrence of behaviors such as crying, screaming, smoking, anxiety eating and alcohol consumption in both CPOT and CPTC, all of which related to intense emotional discomfort. Active coping scores were higher when the caregivers had social support and a higher level of education (bachelor's degree or postgraduate studies). Active coping scores went down when different aspects of the caregiver's life were affected, when physical or psychological symptoms were present, and when the caregivers had more time in their role.

[Mental health in a municipality of the State of Querétaro: a community-based psychiatric research model]. / La salud mental en el municipio de Querétaro: un modelo de investigación psiquiátrica en la comunidad.

The main object of this study was to determine, by means of a house-to-house survey, prevalence of mental disorders and type of alcohol consumption in an underprivileged population from a municipality in the State of Querétaro, Mexico. Results show that there was an 18.26% prevalence of psychiatric disorders with psychiatric comorbility of 56.8%. Anxiety disorders with 14.9% were the most frequent diagnosis and additional problems in descending order were affective disorders (10.2%), alcohol abuse and dependency (4.9%), schizophrenia (2%), and drug abuse (1.2%). Total prevalence was above that reported previously in Mexican population. There was a 48.8% association between unemployment and presence of one or more psychiatric disorders. Nearly 50% of male population had a problem with or excessive consumption of alcohol. These results lead us to consider that this is a high-risk population and that efforts must be made to continue these assessments to better determine prevalence of mental disorders and problems associated with them as well as the optimal mechanisms for attention to therm.

Factores psicosociales relacionados con la rehospitalización de pacientes con psicosis orgánica / Psychosocial factors associated with hospital readmissions of patients with organic psychoses

Objetivo. Conocer los factores psicosociales relacionados con la frecuente rehospitalización de pacientes con psicosis orgánica. Material y métodos. Estudio de tipo observacional descriptivo, de corte transversal. La muestra estuvo formada por 33 pacientes del Hospital Psiquiátrico Guillermo Dávila, con Unidad de Medicina Familiar Número 10 del Instituto Mexicano del Seguro Social de la Ciudad de Mé-xico, con psicosis orgánica y quienes durante los años de 1993-1994 presentaron más de dos rehospitalizaciones. Ins-trumentos: Entrevista grabada, o muestra de conversa-ción de cinco minutos, para la emoción expresada (EE), cuestionarios mixtos para la Concepción de Enfermedad y la Relación médico-paciente. La validez y confiabilidad de los datos se establecieron con las pruebas de Kappa y Alpha de Cronbach y se efectuó análisis estadístico descriptivo e inferencial. Resultados. El 60.9 por ciento de los familiares presentan alto nivel de EE, es decir, expresan crítica, hostilidad o sobreinvolucramiento emocional; el 64.3 por ciento de los sujetos de la muestra conviven más de 35 horas a la semana con familiares que presentan Alta EE. Conclusiones. Altos niveles de EE estuvieron asociados con los frecuentes reingresos a hospitalización. Existe mayor conocimiento de las características de la enfermedad por parte del familiar que del paciente. La re-lación médico-paciente es satisfactoria pero no forma conciencia de enfermedad ni propicia apego al tratamiento terapeútico. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html