Cyber sexual harassment against women and impact on health. A cross-sectional study in a representative population sample.

BACKGROUND: This study focuses on the frequency of cyber sexual harassment (CSH) and examines its link with five health impact indicators (self-perceived health, medication, suicidal ideation, suicide attempts and use of health services). METHODS: Analyzing the data provided by the 2019 Macro-survey on violence against women in Spain, two items of which refer to CSH. It was conducted in Spain on a representative sample of 9568 women aged over 16 years old. RESULTS: A total of 9.15% of the women surveyed had experienced CSH at some point in their lives. Being under 25 years old, having higher education, not being in a relationship, having no religious beliefs and having a certified disability are sociodemographic characteristics associated with a higher risk of CSH. Women who have experienced other forms of gender-based violence also show an increased risk. Female victims of CSH reported higher rates of suicidal ideation (20% versus 9.79% in non-victims of CSH) and suicidal attempts (7.20% versus 1.74% in non-victims of CSH). CONCLUSIONS: These findings have significant implications for the design of preventive health polices, which should incorporate strategies to address CSH as part of the continuum of multiple interrelated forms of gender violence that affect women and girls throughout their lives.

[Barriers and proposals for a health care approach to trafficking for sexual exploitation]. / Barreras y propuestas para el abordaje sanitario de la trata con fines de explotación sexual.

OBJECTIVE: To examine the perception of the trafficking in women for sexual exploitation, identify the difficulties and collect the proposals of professionals in direct contact with the victims of trafficking in women for sexual exploitation in Andalusia (Spain). METHOD: Qualitative study based on interviews with 10 key informants, selected from organizations providing support and care to victims of trafficking in women for sexual exploitation in 2021. Two researchers carried out a thematic categorical content analysis, integrative and relational analysis. Three themes with different sub-themes were analyzed. RESULTS: Difficulties have been identified in relation to women (delay in recognizing themselves as victims, cultural differences, distrust of the system), traffickers (modification of strategies), health professionals (lack of sensitivity and lack of homogeneity in actions) and the health system (lack of cultural intermediation, administrative complexity). The key informants propose more training for professionals, the use of effective action protocols and better coordination between institutions. CONCLUSIONS: The health sector faces a number of challenges in responding comprehensively and effectively to trafficking in women for sexual exploitation. Improvements are needed in raising awareness among health professionals, the development of standardized protocols, greater collaboration between sectors, the provision of specialized mental health services and effective cultural mediation.

Characteristics and effectiveness of interventions to reduce cyberbullying: a systematic review.

Background: This paper presents the results from a systematic review on the effectiveness of interventions to reduce Cyberbullying (CB) as a function of their outcomes and main characteristics; and an analysis of the level of completeness to which the characteristics of these interventions are described. Methods: Systematic searches were conducted in PubMed, Scopus, ERIC and Psycinfo databases on February 14, 2022. In addition, relevant publications were hand searched for relevant studies. We considered interventions that provided data on CB prevalence changes in populations between primary school and college age. Results: In total, 111 studies were retained for further screening from 3,477 results. Following rigorous screening, 43 reports including 46 studies and information from 36 different interventions were included in our systematic review. Results shows that most of the interventions measuring reductions in global CB, cyberperpetration/victimization, cybervictimization and cyberperpetration were effective or partially effective. While the interventions measuring reductions in cyber-bystanding were not effective. Multicomponent interventions showed higher effectiveness than single-component interventions. After completion of the TIDieR check-list, included interventions were considered to offer an insufficient level of detail for a number of the analyzed items in relation to "how well planned," "intervention modifications" and "tailoring." Conclusion: Given the aforementioned, it is critical to increase the number of studies and the quality of interventions targeting CB and the level of detail of its description in order to obtain more robust outcomes about how to reduce its prevalence and facilitate the replication of the effective interventions. Systematic review registration: https://archive.org/details/osf-registrations-wn5u4-v1, Identifer DOI: 10.17605/OSF.IO/WN5U4.

Cuidados paliativos y desigualdades sociales en cáncer. Una revisión narrativa de la literatura / Palliative care and social inequalities in cancer. A narrative literature review

Objetivos: a) Hacer una propuesta de agrupación y clasificación de los diversos abordajes que se recogen en la literatura para analizar el acceso y la utilización de los cuidados paliativos en pacientes con diagnóstico de cáncer avanzado, y b) revisar las desigualdades sociales que se han abordado en la literatura con relación a los cuidados paliativos en estos pacientes. Métodos: Revisión narrativa utilizando las bases de datos Embase, CINAHL y PubMed hasta noviembre de 2022. Resultados: Se realizó cribado por título y abstract de los 2666 estudios recuperados y lectura completa de los artículos incluidos para la extracción de datos. Se detectaron 5 temas principales de los diferentes abordajes en relación con el acceso y uso de los cuidados paliativos: a) control de síntomas, b) adecuación y calidad de los cuidados, c) atención paliativa oportuna, d) planificación de los cuidados y e) lugar de fallecimiento. Las personas mayores, hombres, pertenecientes a minorías étnicas, de bajo nivel socioeconómico y residentes en áreas rurales tienen menos posibilidades de acceder a los cuidados paliativos para aliviar el dolor y el sufrimiento producidos durante la enfermedad oncológica y al final de la vida. Conclusiones: Los cuidados paliativos se consideran un componente esencial para poder proporcionar una atención integral durante el continuo de la enfermedad oncológica. Sin embargo, a pesar de existir evidencia científica que recomienda la aplicación de los cuidados paliativos desde el diagnóstico de la enfermedad, edad, sexo, etnia/raza, nivel socioeconómico y residencia crean inequidad en el acceso y la utilización de los cuidados paliativos en pacientes con cáncer avanzado, produciendo grupos de mayor vulnerabilidad estructural. (AU)

Objectives: To conduct a broad literature review in order to: a) propose a grouping and a classification of the different approaches described in the literature to analyse the access and use of palliative care in advanced cancer patients, and b) review the social inequalities examined in the literature in relation to the access to and use of palliative care in advanced cancer patients. Methods: A narrative review using the Embase, CINAHL, and PubMed databases until November 2022. Results: A total of 2,666 articles were retrieved and screened by title and abstract, with included studies read in full for data extraction. Five main themes of the different approaches were identified in relation to access to and use of palliative care: a) symptom management, b) adequacy and quality of care, c) appropriate palliative care, d) advance care planning, and e) place of death. Older people, men, from a minority ethnic group, of low socioeconomic status, and residing in rural areas are less likely to have access to palliative care to relieve the pain and suffering produced by cancer disease and at the end of life. Conclusions: Palliative care is considered an essential component of comprehensive care all along the cancer disease continuum. However, despite the existence of scientific evidence to recommend the integration of palliative care from diagnosis, age, sex, ethnicity, socioeconomic level and residence create inequity in the access to and use of palliative care in patients with advanced cancer, producing groups of greater structural vulnerability. (AU)

Relationship between Sexual Violence and the Health of Spanish Women-A National Population-Based Study.

BACKGROUND: Health consequences are likely to be different when sexual violence is analysed independently from other types of violence. It is also likely that different health consequences will result in the cases of partner or ex-partner sexual violence, non-partner sexual violence and sexual harassment. METHODS: This study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality on a sample of 9568 women aged 16 years or older. Odds ratios were calculated, and multinomial logistic regression analyses were performed. RESULTS: The present study estimates that 4 out of 10 surveyed women had experienced some form of sexual violence in their lifetime. Sexual harassment is the most frequently reported form of this violence, while intimate partner sexual violence is the form with the most unfavourable sociodemographic characteristics and the worst health impact indicators, such as a greater likelihood of suicidal behaviour. CONCLUSIONS: Sexual violence is a widespread, under-studied problem with negative health impacts. Women exposed to intimate partner violence are the most vulnerable and at risk. It is advised that responses and comprehensive care plans be developed that place special emphasis on the protection of victims' mental health.

The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature.

PURPOSE: Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability. METHODS: We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability. RESULTS: We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability. CONCLUSIONS: Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.

Barreras y propuestas para el abordaje sanitario de la trata con fines de explotación sexual / Barriers and proposals for a health care approach to trafficking for sexual exploitation

Objetivo: Explorar la percepción de la trata de mujeres con fines de explotación sexual, identificar las dificultades y recoger las propuestas de profesionales en contacto directo con las víctimas en Andalucía. Método: Estudio cualitativo basado en entrevistas a 10 informantes clave seleccionados en entidades de apoyo y atención a víctimas de trata de mujeres con fines de explotación sexual en 2021. Dos investigadoras llevaron a cabo un análisis de contenido categórico temático. Se analizaron tres temas con diferentes subtemas. Resultados: Se han identificado dificultades relacionadas con las mujeres (tardan en reconocerse como víctimas, diferencias culturales, desconfianza en el sistema), con los traficantes (modificación de estrategias), con profesionales de la salud (falta de sensibilidad y poca homogeneidad en las actuaciones) y con el sistema sanitario (ausencia de intermediación cultural, complejidad administrativa). Las personas informantes clave proponen una mayor capacitación de profesionales, el empleo de protocolos de actuación efectivos y una mejor coordinación entre instituciones. Conclusiones: El sector sanitario enfrenta diversos desafíos para dar una respuesta integral y efectiva a la trata de mujeres con fines de explotación sexual. Se requieren mejoras en la sensibilización de profesionales de la salud, el desarrollo de protocolos estandarizados, una mayor colaboración entre sectores, la provisión de servicios especializados en salud mental y una mediación cultural eficaz.(AU)

Objective: To examine the perception of the trafficking in women for sexual exploitation, identify the difficulties and collect the proposals of professionals in direct contact with the victims of trafficking in women for sexual exploitation in Andalusia (Spain). Method: Qualitative study based on interviews with 10 key informants, selected from organizations providing support and care to victims of trafficking in women for sexual exploitation in 2021. Two researchers carried out a thematic categorical content analysis, integrative and relational analysis. Three themes with different sub-themes were analyzed. Results: Difficulties have been identified in relation to women (delay in recognizing themselves as victims, cultural differences, distrust of the system), traffickers (modification of strategies), health professionals (lack of sensitivity and lack of homogeneity in actions) and the health system (lack of cultural intermediation, administrative complexity). The key informants propose more training for professionals, the use of effective action protocols and better coordination between institutions. Conclusions: The health sector faces a number of challenges in responding comprehensively and effectively to trafficking in women for sexual exploitation. Improvements are needed in raising awareness among health professionals, the development of standardized protocols, greater collaboration between sectors, the provision of specialized mental health services and effective cultural mediation.(AU)

Characterization of Cyberbullying Victimization and Perpetration Before and During the COVID-19 Pandemic in Spain.

Cyberbullying is an extremely damaging form of interpersonal violence. Little is yet known about cyberbullying behaviors in the child and youth population during the COVID-19 pandemic and what effect this reduction in face-to-face social interactions has had on an increase in socialization via the Internet and cyberbullying. The present study is a cross-sectional descriptive study conducted in young people between the ages of 12 and 27 years attending two secondary schools in southern Spain (N = 733) to examine differences regarding sociodemographic characteristics, academic performance, and digital device use (independent variables) in the experiences of cybervictimization, cyberperpetration, and adverse psychological effects (dependent variables). Logistic regression models were constructed for each of the dependent variables including the independent variables mentioned above. More than 50 percent of the sample were victims of cyberbullying. Females and the LGBTIQ+ Community were at greater risk of being cybervictims and suffer adverse psychological effects. A total of 22.8 percent of the students reported having been victims and 26.5 percent perpetrators of cyberbullying for the first time during the COVID-19 pandemic, but no other major differences were observed. These findings point out that cyberbullying must be prioritized in public policy as part of an overall strategy for combating violence in childhood and adolescence, as well as gender-based and discriminatory violence.

Frequency, Types, and Manifestations of Partner Sexual Violence, Non-Partner Sexual Violence and Sexual Harassment: A Population Study in Spain.

BACKGROUND: This study analyzes the frequency and sociodemographic characteristics associated with sexual violence by a partner/ex-partner (PSV), someone other than a partner or ex-partner (NPSV), or sexual harassment (SH). METHODS: The study is based on the 2019 Macro-survey of Violence against Women conducted by the Spanish Ministry of Equality among a sample of 9568 women age 16 or more years. Odds Ratios were calculated and multinomial logistic regression analyses were performed. RESULTS: Forty-four women had suffered some kind of sexual violence over their lifetime, 9.2% had experienced PSV, 6.5% NPSV and 40.4% SH. More than 7% of women had been raped by a partner and 2.2% by another man. In the three groups, violence was associated with lower age and having a certified disability. NPSV and SH were significantly associated with a higher education and internet use. In NPSV, 9.2% of cases were reported to the police and 3.9% were reported to the courts. In SH, 91.7% of women told a family member or a close friend and 4.2% reported it to the police or the courts. CONCLUSIONS: A greater emphasis needs to be placed on reporting sexual violence in its various forms. Rape within intimate partnerships ought to be investigated and studied in greater depth.

Cyberbullying and Associated Factors in Member Countries of the European Union: A Systematic Review and Meta-Analysis of Studies with Representative Population Samples.

The aim of this study is to conduct a systematic review and meta-analysis to summarise the current state of empirical research and establish an up-to-date estimate of the prevalence of cyberbullying through the gathering of self-reported experiences from representative population samples from EU countries. Bibliographic searches were conducted on main electronic databases for studies until November 2021. We considered observational studies that provided data on cyberbullying prevalence and/or associated factors. Seven studies with data from 25 countries were included. Rates ranged between 2.8-31.5% for cybervictimization, between 3.0-30.6% for cyberperpetration, and between 13.0-53.1% for cyberbystanding. The rate of cybervictimization perpetration was 4%. Meta-analysis-pooled prevalence showed rates of 9.62% and 11.91% for cybervictimization and cyberperpetration, respectively. Given the large variation in the rates seen between the different examined studies, in addition to the increase over recent years in the prevalence rates of the different examined dimensions of cyberbullying, it would be useful to deepen research into the causes of these differences and the factors associated with each of the dimensions. This should be performed through populational surveys which enable the collection of a greater quantity of more consistent information with a view to designing prevention and intervention CB programs that are targeted and adapted towards the characteristics of the target population.

Impact of socioeconomic and health-related factors on consumption of homeopathic and natural remedies in Spain in 2006, 2011 and 2017.

OBJECTIVE: Complementary and alternative medicine use and type of use may be influenced by sociodemographic and economic determinants through which we could identify characteristics of patients with greater trend to use it. This paper aims to describe the changes in the consumption of homeopathic and natural remedies in Spain for three time points in order to discern changes in rate of consumption, associated factors and whether their use has been affected by a period of economic recession. METHODS: This study utilized 2006, 2011 and 2017 cross-sectional data from the Spanish National Health Survey, a nationally representative survey of the population aged more than 15 years old and resident in Spain. Independent bivariate and multivariate descriptive analyses for each of the 3 years studied were performed. RESULTS: The rate of consumption of both homeopathic and natural remedies has decreased over the periods studied. In spite of this decrease, the consumer profile appears to remain stable over the three periods. The sociodemographic factors associated with their consumption were being female, being 30-64 years old, being separated/divorced, having higher education qualifications, being employed and belonging to a higher social class. Psychiatric morbidity, chronic health problems such as pain, mental health problems or malignant tumors, and absence of major cardiovascular events were the clinical factors associated. CONCLUSION: It can be concluded that beyond the economic situation, the use of homeopathic and natural remedies obeys to the needs of the patients related to their state of health and the response they receive from the health system. It may be that women have different needs and expectations of the healthcare system and, given this breach of expectations, seek remedy to alleviate their needs outside the system and conventional medicine.

Gender-based differences in perceptions about sexual violence, equality and drug­facilitated sexual assaults in nightlife contexts. / Diferencias de género en percepciones sobre violencia sexual, igualdad y agresiones sexuales facilitadas por drogas en ocio nocturno.

Sexual violence, including drug-facilitated sexual assaults, is a serious issue that is becoming increasingly common in leisure nightlife contexts. This study provides information about the attitudes and perceptions of Spanish youths towards sexual violence within that setting. The participants were recruited by a snowball sampling scheme. A bivariate analysis was performed to identify possible sociodemographic and nightlife recreational habit factors related to gender. The statistical significance of the differences between the studied variables was assessed using the chi-squared and Fisher's exact tests. Women perceived a low level of personal security, as well as the existence of social perceptions penalizing female more than male drug use, and blaming women for the sexual violence they suffer. Women also recognised less explicit violent behaviours as violence significantly more than men did. Men were more willing to have sexual intercourse with someone unable to express consent because of drugs. In addition, they believed more strongly that sexual assaults take place because of the victim's use of alcohol or other drugs. In a leisure nightlife context, women are prone to perceive a lack of social support for themselves and the feeling of impunity for the perpetrators. Furthermore, numerous misconceptions surround drug-facilitated sexual assaults, with the majority of respondents believing that assaults happen after the surreptitious administration of substances to the victim by an unknown assailant. Moreover, the involvement of alcohol was underestimated. Our findings are useful for designing prevention efforts, demystifying the drug-facilitated sexual assaults and enhancing social support for victims.

La violencia sexual, incluyendo las agresiones sexuales facilitadas por drogas, es un serio problema cada vez más común en los contextos de ocio nocturno. Este trabajo estudia las actitudes y percepciones de la juventud española en torno a la violencia sexual en dicho ámbito. Los participantes se reclutaron mediante muestreo en bola de nieve. Se realizó un análisis bivariado para identificar posibles factores sociodemográficos y de ocio nocturno relacionados con género. La significación estadística de las diferencias entre estas variables se evaluó mediante las pruebas de chi-cuadrado y exacta de Fisher. Las mujeres percibieron un menor nivel de seguridad personal, así como la existencia de percepciones sociales que penalizan en mayor medida el consumo de drogas femenino que el masculino, y que culpabilizan a las mujeres por la violencia que sufren. Además, ellos mostraron mayor disposición a mantener relaciones sexuales con personas incapaces de otorgar su consentimiento debido a los efectos de las drogas. Los hombres creen en mayor medida que las agresiones sexuales ocurren debido al uso de alcohol u otras drogas por parte de las víctimas. En el contexto de ocio nocturno, las mujeres son propensas a percibir la existencia de una falta de apoyo social hacia ellas, así como un sentimiento de impunidad social hacia los agresores. Además, existen numerosas concepciones erróneas en torno a las agresiones sexuales facilitadas por drogas. La mayoría cree que las agresiones ocurren tras la administración encubierta de sustancias a la víctima por parte de un agresor desconocido. Además, se subestimó la participación del alcohol. Nuestros hallazgos son útiles para diseñar esfuerzos preventivos bien dirigidos, desmitificar el fenómeno de las agresiones sexuales facilitadas por drogas y mejorar el apoyo social a las víctimas.

Diferencias de género en percepciones sobre violencia sexual, igualdad y agresiones sexuales facilitadas por drogas en ocio nocturno / Gender-based differences in perceptions about sexual violence, equality and drug-facilitated sexual assaults in nightlife contexts

La violencia sexual, incluyendo las agresiones sexuales facilitadas pordrogas, es un serio problema cada vez más común en los contextos de ocionocturno. Este trabajo estudia las actitudes y percepciones de la juventudespañola en torno a la violencia sexual en dicho ámbito. Los participantesse reclutaron mediante muestreo en bola de nieve. Se realizó un análisisbivariado para identificar posibles factores sociodemográficos y de ocionocturno relacionados con género. La significación estadística de lasdiferencias entre estas variables se evaluó mediante las pruebas de chicuadrado y exacta de Fisher. Las mujeres percibieron un menor nivelde seguridad personal, así como la existencia de percepciones socialesque penalizan en mayor medida el consumo de drogas femenino que elmasculino, y que culpabilizan a las mujeres por la violencia que sufren.Además, ellos mostraron mayor disposición a mantener relaciones sexualescon personas incapaces de otorgar su consentimiento debido a los efectosde las drogas. Los hombres creen en mayor medida que las agresionessexuales ocurren debido al uso de alcohol u otras drogas por parte delas víctimas. En el contexto de ocio nocturno, las mujeres son propensasa percibir la existencia de una falta de apoyo social hacia ellas, así comoun sentimiento de impunidad social hacia los agresores. Además, existennumerosas concepciones erróneas en torno a las agresiones sexualesfacilitadas por drogas. La mayoría cree que las agresiones ocurren trasla administración encubierta de sustancias a la víctima por parte de unagresor desconocido. Además, se subestimó la participación del alcohol.Nuestros hallazgos son útiles para diseñar esfuerzos preventivos biendirigidos, desmitificar el fenómeno de las agresiones sexuales facilitadaspor drogas y mejorar el apoyo social a las víctimas. (AU)

Sexual violence, including drug-facilitated sexual assaults, is a seriousissue that is becoming increasingly common in leisure nightlife contexts.This study provides information about the attitudes and perceptionsof Spanish youths towards sexual violence within that setting. Theparticipants were recruited by a snowball sampling scheme. A bivariateanalysis was performed to identify possible sociodemographic andnightlife recreational habit factors related to gender. The statisticalsignificance of the differences between the studied variables was assessedusing the chi-squared and Fisher’s exact tests. Women perceived a lowlevel of personal security, as well as the existence of social perceptionspenalizing female more than male drug use, and blaming women for thesexual violence they suffer. Women also recognised less explicit violentbehaviours as violence significantly more than men did. Men were morewilling to have sexual intercourse with someone unable to expressconsent because of drugs. In addition, they believed more strongly thatsexual assaults take place because of the victim’s use of alcohol or otherdrugs. In a leisure nightlife context, women are prone to perceive alack of social support for themselves and the feeling of impunity for theperpetrators. Furthermore, numerous misconceptions surround drugfacilitated sexual assaults, with the majority of respondents believingthat assaults happen after the surreptitious administration of substancesto the victim by an unknown assailant. Moreover, the involvement ofalcohol was underestimated. Our findings are useful for designingprevention efforts, demystifying the drug-facilitated sexual assaults andenhancing social support for victims. (AU)

Medidas de contención de la violencia de género durante la pandemia de COVID-19 / Measures to contain gender-based violence during the COVID-19 pandemic

Las crisis, las emergencias y las épocas de disturbios se han relacionado con un aumento de la violencia interpersonal, incluida la violencia hacia las mujeres. A raíz de la declaración de estado de alarma y confinamiento se han puesto en marcha nuevas medidas encaminadas a paliar el posible impacto de la violencia de género (Plan de Contingencia contra la violencia de género ante la crisis del coronavirus o Real Decreto-Ley de medidas urgentes). Se revisan en este documento las medidas de contención adoptadas hasta el momento por el gobierno de España y las comunidades autónomas, y las iniciativas formuladas en diferentes países. Ante la ausencia de medidas económicas concretas planteadas hasta la fecha y el escenario de incertidumbre económica concluimos que no es posible prevenir la violencia de género de manera integral sin considerar el aumento del desempleo, la temporalidad y la inestabilidad laboral, la dependencia económica o la sobrecarga de tareas reproductivas, entre otros elementos que la facilitan. (AU)

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it. (AU)

Changes in Employment Situation and Macroeconomic Indicators Linked to Mental Health Following the Recession in Spain: A Multi-level Approach.

BACKGROUND: Periods of financial crisis are associated with higher psychological stress in the population and greater use of mental health services. This paper analyses the individual and contextual factors associated with mental health in the Spanish population in 2006, 2012 and 2017. METHOD: This was a cross-sectional, descriptive study at three timepoints: before (2006), during (2012) and after the recession (2017). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. Dependent variable: psychiatric morbidity (PM). INDEPENDENT VARIABLES: 1) Individual socio-economic variables: (socio-demographic and psycho-social variables) and 2) contextual socio-economic variables (financial, public welfare services and labour market indicators). Multilevel logistic regression models with mixed effects were constructed to determine changes in PM in relation to the variables studied. RESULTS: Among women, the risk of PM increased when per capita health spending decreased and the percentage of temporary workers increased. The risk for men and women was lower when the employment rate decreased and the unemployment rate increased. CONCLUSIONS: It is possible that not only unemployment but also insecure employment entails a risk to mental health and that much of the employment created no longer guarantees basic levels of security it had achieved in previous decades.

A Mobile Phone-Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial.

BACKGROUND: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. OBJECTIVE: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. METHODS: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. RESULTS: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference -0.04; 95% CI -0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (-0.29; 95% CI -0.48 to -0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (-0.25; 95% CI -0.49 to -0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. CONCLUSIONS: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. TRIAL REGISTRATION: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818.

Effect of a mobile-based intervention on mental health in frontline healthcare workers against COVID-19: Protocol for a randomized controlled trial.

AIM: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain. DESIGN: We will carry out a two-week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention. METHODS: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID-19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire-primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation. DISCUSSION: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context. IMPACT: Despite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits. CLINICAL TRIAL REGISTRATION: NCT04393818 (ClinicalTrials.gov identifier). APPROVED FUNDING: May 2020.

[Measures to contain gender-based violence during the COVID-19 pandemic]. / Medidas de contención de la violencia de género durante la pandemia de COVID-19.

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it.

Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis.

BACKGROUND: This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers' (HCWs) mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact. METHOD: Rapid systematic review. We searched MEDLINE, Embase, and PsycINFO (inception to August 2020). We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence. RESULTS: We included 117 studies. The pooled prevalence was higher for acute stress disorder (40% (95%CI 39 to 41%)), followed by anxiety (30%, (30 to 31%)), burnout (28% (26 to 31%)), depression (24% (24 to 25%)), and post-traumatic stress disorder (13% (13 to 14%)). We identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, stigmatization), and occupational (working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience) factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving (very low certainty), whereas one multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty). LIMITATIONS: We only searched three databases, and the initial screening was undertaken by a single reviewer. CONCLUSION: Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions.

Salud mental en España y diferencias por sexo y por comunidades autónomas / Mental health in Spain and differences by sex, and by autonomous communities

OBJETIVO: Describir la evolución de la morbilidad psíquica en la población adulta española en 2006, 2011 y 2017. Estudiar la salud mental en 2017, determinando la prevalencia de morbilidad psíquica, consumo de psicofármacos, diagnóstico y salud autopercibida. Todo ello tanto en el ámbito nacional como por comunidades autónomas, y diferenciando entre hombres y mujeres. MÉTODO: Estudio transversal. Fuente de información: Encuesta Nacional de Salud de los años 2006, 2011 y 2017. Variables: morbilidad psíquica (GHQ-12), salud autopercibida, diagnóstico de trastorno mental, prescripción de psicofármacos, sexo y comunidad autónoma. Se calcularon los porcentajes y los intervalos de confianza del 95%, y se consideró estadísticamente significativo un valor de p <0,05 en la prueba de ji al cuadrado. RESULTADOS: La morbilidad psíquica global en España fue del 22,2% en 2006, el 22,1% en 2011 y el 19,1% en 2017. Salvo en Cantabria en 2011, la frecuencia de morbilidad psíquica fue mayor en las mujeres que en los hombres. En 2017, la mayoría de las comunidades autónomas tuvieron una frecuencia de diagnóstico y mala salud autopercibida similar a la media española (15,4% y 33,6%, respectivamente). La media española de prescripción de tranquilizantes fue del 9,2%; destacan Galicia con la frecuencia más elevada y Cantabria (global y hombres), Ceuta y Melilla (mujeres) con las más bajas. La media de prescripción de antidepresivos en España fue del 3,6%. Las frecuencias más altas se observaron en Asturias (global y mujeres) y en Galicia (hombres), y las más bajas en Ceuta y Melilla. CONCLUSIONES: La morbilidad psíquica es un fenómeno prevalente, aunque las cifras en España han descendido ligeramente. Existe una importante variabilidad con respecto a la prescripción de psicofármacos entre comunidades autónomas. Las mujeres presentan peores resultados en todos los indicadores de salud mental estudiados

OBJECTIVE: To describe the evolution of psychological distress in the adult Spanish population in 2006, 2011 and 2017. To study the mental health status of the population in 2017 analyzing the prevalence of psychological distress, prescription of psychiatric drugs, diagnosis and self-perceived health, in Spain and in the autonomous regions, and differentiating between men and women. METHOD: Cross-sectional study, using data from the 2006, 2011 and 2017 National Health Surveys in Spain. Variables: psychological distress (GHQ-12), self-perceived health, mental disorder diagnosis, prescription of psychiatric drugs, sex and autonomous community. The frequencies, percentages and confidence intervals at 95% were calculated. The statistical significance level for the chi-square test was p <0.05. RESULTS: The prevalence of psychological distress in Spain was 22.2% in 2006, 22.1% in 2011 and 19.1% in 2017. With the exception of Cantabria in 2011, in all cases the prevalence of psychological distress was higher in women than men. In 2017, most of the autonomous communities showed prevalence of diagnosis and poor self-perceived health near the Spanish average (15.4% and 33.6%, respectively). The Spanish average of tranquilizer prescription was 9.2%. The highest prevalence was found in Galicia while the lowest was found in Cantabria (overall population and men) and Ceuta and Melilla (women). The Spanish average of antidepressant prescription was 3.6%. The highest prevalence was found in Asturias (overall population and women) and in Galicia (men), while the lowest was found in Ceuta and Melilla. CONCLUSIONS: Psychological distress is a prevalent phenomenon although its prevalence in Spain has decreased slightly. There are big differences in the prescription of psychiatric drugs between each autonomous community. Women showed poorer outcomes on each mental health indicator analyzed