Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic.

OBJECTIVE/BACKGROUND: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. AIM: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. METHOD: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. RESULTS: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. CONCLUSION: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

Sintomatología Depresiva y Bienestar en Personas Mayores de Concepción, Chile: Rol moderador del apoyo social

Antecedentes: La población sobre 60 años va en aumento y es relevante tener más conocimiento sobre los factores que inciden en su bienestar y salud mental. Objetivo: Este estudio busca comprender la relación entre bienestar, apoyo social y sintomatología depresiva en personas mayores de la provincia de Concepción. Método: 538 adultos mayores fueron seleccionados aleatoriamente de 15 Centros de Salud Primaria de la provincia de Concepción, Chile. Se midieron sus niveles de bienestar (con el Pemberton Happiness Index), de apoyo Social (con la Escala Multidimensional de Percepción de Apoyo Social de Zimet) y de sintomatología depresiva (mediante el Patient Health Questionnaire-9). Resultados: Los adultos mayores mostraron un puntaje elevado (M=8,54; DE = 1,34) en bienestar, sin diferencias por sexo (t(536) = −1,065, p = 0,288 > 0,05). En los análisis de regresión lineal, el apoyo social (β =0,463, p<0,001) y la sintomatología depresiva (β =-1,585, p<0,001) aparecen como influyentes en el bienestar de las personas mayores; y el apoyo social actúa como un factor moderador (β=0,049, p=0,007, IC =0,021; 0,077) en la relación entre sintomatología depresiva y bienestar. Conclusiones: Las personas mayores muestran elevado bienestar. Los resultados refuerzan la relevancia del apoyo social como un factor protector en las personas mayores. Ello corrobora la importancia del fomento de este aspecto en los programas promocionales y preventivos destinados al bienestar y salud mental de adultos mayores.

Background: The population over 60 years of age is increasing. Aim: This research aims to understand the relationship between well-being, social support, and depressive symptoms in older Chilean people. Method: 538 older adults were randomly selected from 15 Primary Health Centers in the province of Concepción, Chile, 341 women and 197 men. Well-being was measured with the Pemberton Happiness Index, Social Support with the Zimet Multidimensional Scale of Perceived Social Support, and Depressive Symptomatology using the Patient Health Questionnaire-9. Results: Older adults showed a high mean score (M=8.54; SD=1.34) in well-being, with no differences by sex (t(536) = −1.065, p = .288 > .05.) In linear regression analyses, social support (β =0,463, p<0,001) and depressive symptomatology (β =-1,585, p<0,001) influence the well-being of the elderly, and social support acts as a moderating factor (β=0.049, p=0.007, CI =0.021; 0.077) in the relationship between social support and well-being. Conclusions: Older people show high well-being. The results reinforce the relevance of social support as a protective factor for the positive mental health of older adults. This corroborates the importance of including this aspect in promotional and preventive mental health programs for older adults.

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile.

Background: This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups. Methods: We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups. Results: We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001). Conclusion: Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.

Interventions to reduce the stigma of mental health at work: a narrative review.

BACKGROUND: While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. OBJECTIVE: We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. METHOD: The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. RESULTS: These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. DISCUSSION AND CONCLUSION: Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Interventions to reduce the stigma of mental health at work: a narrative review

Abstract Background While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. Objective: We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. Method The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. Results: These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. Discussion and conclusion Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

Measurement invariance between online and paper-and-pencil formats of the Launay-Slade Hallucinations scale-extended (LSHS-E) in the Chilean population: Invariance between LSHS-E formats.

Research on the multidimensionality of hallucination-like experiences (HLEs) can contribute to the study of psychotic risk. The Launay-Slade Hallucinations Scale-Extended (LSHS-E) is one of the most widely used tools for research in HLEs, but the correspondence of its paper and online formats has not been established yet. Therefore, we studied the factorial structure and measurement invariance between online and paper-and-pencil versions of LSHS-E in a Chilean population. Two thousand eighty-six completed the online version, and 578 students completed the original paper-and-pencil version. After matching by sex, age, civil status, alcohol and cannabis consumption, and psychiatric treatment received, we selected 543 students from each group. We conducted a confirmatory factor analysis of a four-factor model and a hierarchical model that included a general predisposition to hallucination, explaining the strong relationship between the different types of hallucinations. Both models showed a good fit to the data and were invariant between paper-and-pencil and online versions. Also, the LSHS-E has good reliability in both online and paper-and-pencil formats. This study shows that the online LSHS-E possesses psychometric properties equivalent to the paper-and-pencil version. It should be considered a valuable tool for research of psychosis determinants in the COVID-19 era. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02497-7.

Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente.

This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.

A multicentric study on stigma towards people with mental illness in health sciences students.

BACKGROUND: There is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology. METHODS: A comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians' Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain. RESULTS: We found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour. CONCLUSIONS: Our study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

Evaluación de la discapacidad en población con trastornos mentales graves atendida en el Distrito Metropolitano de Quito (Ecuador) / Disability Assessment of Severe Mental Disorders in Metropolitan District of Quito-Ecuador Population / Avaliação da deficiência em população com transtornos mentais graves atendidas no distrito metropolitano de Quito-Equador

Resumen Introducción: en Ecuador existen parámetros de calificación de discapacidad basados en la Clasificación Internacional del Funcionamiento de la Discapacidad y la Salud; sin embargo, los avances en investigación en el ámbito de la psiquiatría y la salud mental aún son escasos. Se empleó la Escala de Evaluación de Discapacidad de la Organización Mundial de la Salud para determinar el grado de discapacidad en población consultante. Materiales y métodos : estudio observacional, de corte transversal y correlacional. Usando un muestreo por conveniencia, se recogió información sobre discapacidad en una muestra de 297 adultos con trastornos mentales graves en contacto con servicios ambulatorios de psiquiatría. Se estimó un modelo de regresión lineal que determinó el aporte de variables sociodemográficas, clínicas y sociales. Resultados: el 89.2 % de la muestra presentó algún grado de discapacidad. El modelo multivariado final para el total de la muestra incluyó las variables explicativas edad (p = -0.234), escolaridad (p = -0.552), ser pensionado (p = 39.44), presencia de episodio depresivo actual (p = 21.654) y tener cuidador (p = 9.574), que explican el 37.46 % de la discapacidad de las personas con trastornos mentales graves atendidas en servicios de psiquiatría y salud mental en Quito. Conclusión: la discapacidad en personas con trastornos mentales graves que están en contacto con servicios de salud de Quito (Ecuador) involucra cambios en el desempeño de actividades en escenarios familiares y comunitarios. Se identificó una proporción de discapacidad moderada y severa que demanda respuestas institucionales que incluyan el acompañamiento de cuidadores y aborden barreras actitudinales.

Abstract Introduction: In Ecuador, there are disability qualification parameters based on the International Classification of the Functioning of Disability and Health; however, advances in the research fields of psychiatry and mental health are still scarce. For this particular study, The World Health Organization Disability Assessment Scale was used to determine the degree of disability in the consulting population. Materials and methods: The study design was an observational, cross-sectional and correlational study. Using convenience sampling, disability information was collected from a study population of 297 adults with severe mental disorders who were in contact with outpatient psychiatric services. A linear regression model was used to determine the contribution of sociodemographic, clinical, and social variables. Results: It was observed that 89.2% of the sample presented some degree of disability. The final multivariate model for the total sample included the explanatory variables of age (p = -0.234), schooling (P = -0.552), being retired (p = 39.44), presence of current depressive episode (p = 21.654), and having a caregiver (p = 9.574), which explained 37.46% of disability in people with serious mental disorders who were treated in psychiatric and mental health services in Quito. Conclusion: Disabilities in people with severe mental disorders who are in contact with health services in Quito (Ecuador) may involve changes in the performance of activities among family and community settings. We identified a proportion of moderate and severe disabilities that demand institutional responses, which includes the accompaniment of caregivers and also addresses attitudinal barriers.

Resumo Introdução: no Equador, existem parâmetros de qualificação de deficiência com base na Classificação Internacional do Funcionamento da Deficiência e da Saúde; no entanto, avanços em pesquisas no âmbito da psiquiatria e saúde mental ainda são escassos. Empregou-se a Escala de Avaliação da Deficiência da Organização Mundial da Saúde, para se determinar o grau de deficiência na população avaliada. Materiais e métodos: estudo observacional, de corte transversal e correlacional. Usando uma amostragem por conveniência coletou-se informação sobre deficiência em uma amostra de 297 adultos com transtornos mentais graves em contato com serviços ambulatórios em psiquiatria. Estimou-se um modelo de regressão linear que determinou a contribuição de variáveis sociodemográficas, clínicas e sociais. Resultados: 89.2% da amostra apresentou algum grau de deficiência. O modelo multivariado final para o total da amostra incluiu as variáveis explicativas idade (p=-0,234), escolaridade (p=-0,552), ser aposentado (p=39,44), presença de episódio depressivo atual (p=21,654) e, ter cuidador (p=9,574), explicando 37,46% da deficiência em pessoas com transtornos mentais graves atendidas em serviços de psiquiatria e saúde mental em Quito. Conclusão: A deficiência em pessoas com transtornos mentais graves que estão em contato com serviços de saúde em Quito (Equador) envolve mudanças no desempenho de atividades em cenários familiares e comunitários. Identificou-se uma proporção de deficiência moderada e severa que demandam respostas institucionais que inclua o acompanhamento de cuidadores e abordem barreiras de atitude.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

Modelo explicativo de discapacidad en población con trastornos mentales graves: un estudio multicéntrico en tres países de Sudamérica / Explanatory Model of Disability in a Population with Severe Mental Disorders: A Multicenter Study in Three Countries of South America / Modelo explicativo da deficiência em uma população com transtornos mentais graves: um estudo multicêntrico em três países da América do Sul

Introducción: en el contexto latinoamericano se está generando evidencia sobre el empleo de instrumentos derivados de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud en psiquiatría y salud mental. Este estudio corresponde a la primera investigación de carácter explicativo en población con trastornos mentales graves en tres países de Sudamérica. El objetivo es determinar un modelo explicativo de discapacidad en una muestra de personas con trastornos mentales graves en contacto con servicios ambulatorios de psiquiatría en Chile, Colombia y Ecuador. Materiales y métodos: se llevó a cabo un estudio multicéntrico, observacional, correlacional, de corte transversal, a partir de un muestreo probabilístico en Colombia y un muestreo por conveniencia en Chile y Ecuador. En total, participaron 803 adultos con trastornos mentales graves, en contacto con servicios ambulatorios de psiquiatría en Concepción (Chile), Cali (Colombia) y Quito (Ecuador). Resultados: el 91.3 % de la muestra presentó algún grado de discapacidad. El modelo multivariado final incluyó las variables explicativas país (Colombia; ß = 6.724); edad (ß = −0.163); escolaridad (ß = −0.5029); síntomas actuales de depresión (ß = 23.26); episodio psicótico (ß = 4.795); episodio hipomaniaco/maniaco (ß = 7.498; t = 3.711); tener práctica religiosa (ß = −2.834), y tener cuidador (ß = 10.363). Obtuvo un coeficiente de determinación de 0.3275 (F [23, 760] = 16.09; p < 0.001, R²∆ = 30.71), que explica el 32.75 % de la discapacidad de las personas de la muestra de los tres países participantes. Conclusiones: en un modelo multivariado de discapacidad para trastornos mentales graves, los síntomas actuales y la presencia de cuidador son las principales variables explicativas de discapacidad

Introduction: Currently, evidence is being generated on the use of the International Classification of Functioning, Disability, and Health-derived tools in psychiatry and mental health. This study corresponds to the first investigation of explanatory character about a wide range of persons with severe mental disorders in three countries of South America. Aim: This study aims to determine an explanatory model of disability in a population with severe mental disorders in contact with outpatient psychiatry services in Chile, Colombia, and Ecuador. Materials and methods: A multicenter, observational, correlational, cross-sectional study was carried out based on a probabilistic sampling in Colombia and a convenience sampling in Chile and Ecuador. A total of 803 adults with severe mental disorders participated, who were in contact with outpatient psychiatry services in Concepción (Chile), Cali (Colombia), and Quito (Ecuador). Results: Some degree of disability was presented by 91.3% of participants. The final multivar-iate model included the explanatory variables country (Colombia; ß = 6.724); age (ß = −0.163); schooling (ß = −0.5029); current depression symptoms (ß = 23.26), psychotic episode (ß = 4.795); hypomanic/manic episode (ß = 7,498; t = 3,711); to have religious practice (ß = −2.834); and to have a caregiver (ß = 10.363); a coefficient of determination of 0.3275 (F [23, 760] = 16.09; p < 0.001M R2∆ = 30.71) was obtained, explain-ing a 32.75% disability in participants from the three participating countries. Conclusions: Current symp-toms and the presence of a caregiver are the main explanatory variables of the disability burden in a multivariate model of disability for severe mental disorders

Introdução: atualmente, no contexto latino-americano, estão sendo geradas evidências sobre o uso de instrumentos derivados da Classificação Internacional de Funcionalidade, da Deficiência e da Saúde em psiquiatria e saúde mental. Este estudo corresponde à primeira pesquisa explicativa em uma popula-ção com transtornos mentais graves em três países da América do Sul. Objetivo: determinar um modelo explicativo da deficiência em uma amostra de pessoas com transtornos mentais graves em contato com serviços psiquiátricos ambulatoriais no Chile, Colômbia e Equador. Materiais e métodos: foi realizado um estudo multicêntrico, observacional, correlacional, transversal, a partir de uma amostra probabilística na Colômbia e uma amostra de conveniência no Chile e Equador. No total participaram 803 adultos com transtornos mentais graves, em contato com serviços psiquiátricos ambulatoriais em Concepción (Chile), Cali (Colômbia) e Quito (Equador). Resultados: 91,3% da amostra apresentou algum grau de deficiência. O modelo multivariado final incluiu as variáveis explicativas país (Colômbia; ß = 6,724); idade (ß = −0,163); escolaridade (ß = −0,5029); sintomas atuais de depressão (ß = 23,26); episódio psicótico (ß = 4,795); episódio hipomaníaco/maníaco (ß = 7,498; t = 3,711); ter prática religiosa (ß = −2,834), e ter cuidador (ß= 10,363). Obteve coeficiente de determinação de 0,3275 (F[23, 760] = 16,09; p < 0,001; R2∆ = 30,71), explicando 32,75% da deficiência das pessoas da amostra dos três países participantes. Conclusões: em um modelo multiva-riado de deficiência para transtornos mentais graves, os sintomas atuais e a presença de um cuidador são as principais variáveis explicativas da deficiência

Psychometric Properties of the Patient Health Questionnaire-9 in Elderly Chilean Primary Care Users.

Background: This study aimed to assess the measurement properties (reliability, factor structure, and criterion validity) of the Patient Health Questionnaire (PHQ-9) as an instrument for screening major depressive disorder (MDD) in elderly primary care users in Chile. Method: About 582 participants aged between 65 and 80 years were enrolled from primary care centers. They completed the Composite International Diagnostic Interview (CIDI), a survey with sociodemographic characteristics and the PHQ-9. Results: The PHQ-9 revealed an acceptable internal consistency (ω = 0.79 [95% CI: 0.75-0.80] and α = 0.78 [95% CI: 0.75-0.81]); confirmatory factor analysis demonstrated a good fit for both 1- and 2-factor solutions. The chi-square difference test (χ2 = 0.61, gl = 1, p = 0.43) and correlation between the somatic and the cognitive-effective latent factors were very high (r = 0.97, p < 0.001), indicating that the 1 factor model was more parsimonious. Utilizing the CIDI as the gold standard, the area under the curve (AUC) was 0.88 (SE = 0.04, 95% CI: 0.84-0.90). The optimal cut-off score of ≥ 6 yielded good sensitivity and specificity for detecting MDD (0.95 and 0.76, respectively). However, considering the clinical utility index, the cut-off score of ≥9 proved to be a more effective marker for discarding cases of MDD. Conclusion: The PHQ-9 has adequate psychometric properties for elderly primary care users. In clinical settings, it showed its greatest utility in ruling out the presence of an MDD, however, its clinical value for identifying possible cases of MDD is limited. In cases above the cut-off point, it is recommended to perform a more thorough evaluation.

Etifoxine is non-inferior than clonazepam for reduction of anxiety symptoms in the treatment of anxiety disorders: a randomized, double blind, non-inferiority trial.

OBJECTIVE: To determine whether etifoxine, a non-benzodiazepine drug of the benzoxazine family, is non-inferior compared with clonazepam in the treatment of anxiety disorders. METHOD: A randomized controlled double blind trial with parallel groups was conducted. A total of 179 volunteer patients with a diagnosis of anxiety disorder (DSM-IV), between 18 and 64 years of age, participated in this study. The experimental group received 150 mg/day of etifoxine and the control 1 mg/day of clonazepam, both in three daily doses for 12 weeks. This treatment was completed by 87 participants, and 70 were available for follow-up at 24 weeks from start of treatment. The primary objective was a non-inferiority comparison between etifoxine and clonazepam in the decrease of anxiety symptoms (HAM-A) at 12 weeks of treatment. Secondary outcomes included the evaluation of medication side effects (UKU), anxiety symptoms at 24 weeks of treatment, and clinical improvement (CGI). Data analysis included multiple imputation of missing data. The effect of etifoxine on the HAM-A, UKU, and CGI was evaluated with the intention of treatment, and a sensitivity analysis of the results was conducted. Non-inferiority would be declared by a standardized mean difference (SMD) between clonazepam and etifoxine not superior to 0.31 in favour of clonazepam. RESULTS: Using imputed data, etifoxine shows non-inferiority to clonazepam on the reduction of anxiety symptoms at the 12-week (SMD = 0.407; 95% CI, 0.069, 0.746) and 24-week follow-ups (SMD = 0.484; 95% CI, 0.163, 0.806) and presented fewer side effects (SMD = 0.58; 95% CI, 0.287, 0.889). LOCF analysis shows that etifoxine is non-inferior to clonazepam on reduction of anxiety symptoms and adverse symptoms even when no change was assigned as result to participant whom withdrew. Non-inferiority could be declared for clinical improvement (SMD = 0.326; 95% CI, - 0.20, 0.858). CONCLUSION: Etifoxine was non-inferior to clonazepam on reduction of anxiety symptoms, adverse effects, and clinical improvement.

Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors.

BACKGROUND: According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience. AIMS: Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster. METHOD: Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003-2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD. RESULTS: Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08-1.37, and OR = 1.16, 95% CI 1.06-1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52-5.04), and a dose-response relationship between pre-disaster stressors and post-disaster MDD was found. CONCLUSIONS: In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.

Stigma towards people with a diagnosis of severe mental disorder in primary healthcare centers: perspectives of service users and health teams in Chile.

BACKGROUND: Stigma towards people diagnosed with a severe mental disorder (SMD) is one of the main obstacles for these service users to receive timely and relevant healthcare. This study was undertaken to understand how stigmatizing attitudes are demonstrated towards people with SMD in primary healthcare centers (PHC) from the perspective of those affected and primary healthcare professionals. METHODS: We used a qualitative exploratory research design to contrast the differences and similarities regarding stigmatizing attitudes towards people with SMD in primary healthcare centers (PHC) from the perspective of two groups: (i) people diagnosed with a severe mental disorder, and (ii) healthcare professionals. Data was collected through semi-structured interviews and discussion groups and subsequently analyzed using Atlas.ti software. RESULTS: Our results indicate that both service users and healthcare professionals manifest stereotypes, prejudices, and discriminatory behavior in health care. In addition, structural aspects of the health system and organizational culture appear to contribute to stigmatization. Both groups agreed that there is a need for healthcare professionals to have more education, specialization, and skill development related to mental health issues. CONCLUSIONS: Interventions to reduce the stigma towards people with SMD in PHC must consider delivery of information about mental disorders, development of skills in the healthcare professionals, and modifications in the culture of the health centers.

Randomized cluster trial of a parenting program in Chile: Key mediators in the decrease in behavior problems in preschool children.

BACKGROUND: Parenting training is a proven strategy for the promotion of positive parenting practices and for the prevention and treatment of behavior problems in children. The processes that explain this efficacy are less clear. The aim of this study was to assess the mediating role of parenting practice modification, encouraged through the implementation of a universal parenting training program, for the decrease of behavior problems in 3- to 6-year-old children. METHOD: A cluster randomized trial was carried out in 19 educational centers in low and middle socioeconomic areas. A total of 178 families received the program and 154 of them were the control group. The following parenting practices were assessed: positive reinforcement, involvement, inconsistency, unsuitable treatment behaviors and physical punishment, as well as hostility and humiliation behaviors. Parent-child interaction was also assessed using an observational instrument. A multiple mediation analysis was carried out, identifying the indirect effects. RESULTS: Reduction of harsh discipline and physical punishment, and parental inconsistency mediated the effects observed in the reduction of child behavior problems during the program. CONCLUSION: Within Chilean families, harsh discipline, physical punishment, and parental inconsistency are important aspects to be considered in the implementation of universal parenting training programs.

Modelo explicativo de discapacidad en población con trastornos mentales graves atendida en una institución especializada de la ciudad de Cali (Colombia) / Explanatory Model of Disability in a Population with Severe Mental Disorders Attended in a Specialized Institution in the City of Cali (Colombia) / Modelo explicativo de deficiência em população com transtornos mentais graves atendida em uma instituição especializada da cidade de Cali (Colômbia)

Resumen Introducción: En Colombia, según la Encuesta Nacional de Salud Mental realizada en 2015, la prevalência de vida de depresión mayor, trastorno afectivo bipolar y esquizofrenia es del 9,1 %, 1,3 % y 1 %, respectivamente. Estos trastornos mentales graves se caracterizan por ser asumidos desde una postura nosográfica que no incorpora la interacción entre el contexto y la persona. La discapacidad es una dimensión de los trastornos mentales graves, y requiere ser investigada desde herramientas como la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud. Conocer su frecuencia y los factores personales y ambientales que la explican puede facilitar la implementación de estrategias para mejorar la calidad de vida de esta población. Materiales y métodos: Se llevó a cabo un estudio exploratorio, observacional, de corte transversal, para determinar la prevalencia y describir el aporte de variables sociodemográficas, clínicas y psicosociales en un modelo explicativo de discapacidad en personas con trastornos mentales graves que asisten a servicios de salud mental y psiquiatría de una institución especializada de Cali (Colombia). Resultados: El 65,9 % de la muestra presenta algún grado de discapacidad; el 46,2 %, discapacidad moderada; el 19,4 %, discapacidad severa; y el 0,4 %, discapacidad extrema. El modelo explicativo incluye el aporte de variables sociodemográficas, clínicas y psicosociales. Conclusión: Este estudio demuestra que la frecuencia de discapacidad en la población con TMG es recurrente, y al parecer poco estudiada, vinculando el desempeño desde cada dominio que hace parte de la vida diaria. Los resultados de la investigación permiten identificar el aporte de factores personales y ambientales en la discapacidad experimentada por esta población en Cali.

Abstract Introduction: In Colombia, according to the National Mental Health Survey conducted in 2015, the lifetime prevalence of major depression, bipolar affective disorder, and schizophrenia is 9.1 %, 1.3 %, and 1 %, respectively. These severe mental disorders (SMD) are characterized by being assumed from a nosographic stance that does not incorporate the interaction between the context and the person. Disability is a dimension of severe mental disorders, and it needs to be investigated using tools such as the International Classification of the Functioning of Disability and Health. Knowing their frequency and personal and environmental factors that explain them can facilitate the implementation of strategies to improve the quality of life of this population. Materials and methods: An exploratory, observational, cross-sectional study was conducted to determine the prevalence and to describe the contribution of socio-demographic, clinical, and psychosocial variables in an explanatory model of disability in people with severe mental disorders, attended in the mental health and psychiatry services of a specialized institution in Cali, Colombia. Results: From the sample, 65.9 % showed some degree of disability; 46.2 %, moderate disability; 19.4 %, severe disability, and 0.4 %, extreme disability. The explanatory model includes the contribution of socio-demographic, clinical, and psychosocial variables. Conclusion: This study shows that the frequency of disability in the population with SMD is recurrent, and little studied linking performance from each domain that is part of daily life. The results of the investigation allow identifying the contribution of personal and environmental factors in the disability experienced by this population in Cali.

Resumo Introdução: Na Colômbia, segundo o Inquérito Nacional de Saúde Mental realizado em 2015, a prevalência de vida de depressão maior, transtorno afetivo bipolar e esquizofrenia são de 9,1 %, 1,3 %, e 1 %, respetivamente. Estes transtornos mentais graves se caracterizam por serem assumidos desde uma postura nosográfica que não incorpora a interação entre o contexto e a pessoa. A deficiência é uma dimensão dos transtornos mentais graves, e requere ser pesquisada desde ferramentas como a Classificação Internacional do Funcionamento da Deficiência e da Saúde. Conhecer sua frequência e os fatores pessoais e ambientais que a explicam, pode facilitar a implementação de estratégias para melhorar a qualidade de vida desta população. Materiais e métodos: Se realizou um estudo exploratório, observacional, de corte transversal, para determinar a prevalência e descrever o aporte de variáveis sociodemográficas, clínicas e psicossociais em um modelo explicativo de deficiência em pessoas com transtornos mentais graves que assistem a serviços de Saúde Mental e Psiquiatria de uma instituição especializada de Cali, Colômbia. Resultados: O 65,9 % da amostra apresenta algum grau de deficiência. O 46,2 % deficiência moderada, o 19,4 % deficiência severa, e o 0,4 % deficiência extrema. O modelo explicativo inclui o aporte de variáveis sociodemográficas, clínicas e psicossociais. Conclusão: Este estudo demostra que a frequência de deficiência na população com TMG é recorrente, e aparentemente pouco estudada, vinculando o desempenho desde cada domínio que faz parte da vida diária. Os resultados da pesquisa permitem identificar o aporte de fatores pessoais e ambientais na deficiência experimentada por esta população em Cali.

Effectiveness of a group-based psychosocial program to prevent depression and anxiety in older people attending primary health care centres: a randomised controlled trial.

BACKGROUND: Evidence about the effectiveness of psychosocial interventions to reduce the incidence of depression and anxiety and promote subjective well-being in older people is limited, particularly in Latin-American countries. This study thus aims to assess a program specifically designed to address this issue in persons aged 65 to 80 and attending primary health care centres. METHOD: Older people who use primary care centres are to be randomly assigned to the program or to a control group. Only independent users will be included; those having had a major depressive disorder or an anxiety disorder in the last 6 months will be excluded. The program is group based; it includes cognitive stimulation, expansion of social support networks and cognitive behaviour strategies. Depressive and anxiety symptoms and disorders, as well as psychological well-being, will be assessed using standardised instruments, once before implementing the program and later, after 18 and 36 weeks. DISCUSSION: Primary care is a setting where interventions to improve mental health can be beneficial. Providing evidence-based programs that work with older people is a priority for public mental health. TRIAL REGISTRATION: A protocol for this study has been registered prospectively at ISRCTN registry on 25 July 2018. Identifier: ISRCTN32235611 .