Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal.

Mental ill-health is increasingly recognized by policymakers for its significant human and economic toll. The main objective of this study is to capture patient-reported outcomes and experiences on mental health care in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 397 participants, 247 (62.2%) women, divided into four age groups: ages 16-24 years, ages 25-44 years, ages 45-65 years, and ages 66 years or older. The data collection procedure and analysis followed the OECD PaRIS Mental Health Working Group 2021 protocol allowing subsequent comparability with data from other OECD member countries. Findings on the WHO-5 Well-Being Index showed that women manifest a lower score in well-being following mental health care services use. This finding may be, at least in part, explained by the study population (mental health services users), including individuals with clinical depression which is more frequently observed in women. In terms of the level of satisfaction with treatment (provided by nurses, doctors, phycologists, etc.) the response "Yes, definitely" varied from 67% of answers regarding "time spent by care providers", 76.3% "involvement in decisions" to 79.7% regarding "clarity of explanations" and 84.4% regarding the item courtesy and respect. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in mental health services in Portugal. The study results generate useful clinical information to help meet the expectations and needs of patients, contributing to a continuous improvement of mental health community services.

Experiential avoidance and emotion regulation difficulties in hoarding disorder.

Experiential avoidance can be defined as the tendency to avoid contact with unwanted internal experiences. Current conceptualizations of pathological hoarding appear broadly consistent with an experiential avoidant model. Eighty participants in four groups, namely hoarding disorder (HD) without comorbid obsessive-compulsive disorder (OCD), HD with comorbid OCD, non-hoarding OCD, and healthy controls, were administered measures of experiential avoidance and emotion regulation difficulties. Hoarding individuals reported higher levels of experiential avoidance and difficulties in emotion regulation compared to healthy but not to OCD participants. Both experiential avoidance and emotion regulation difficulties were significantly more prominent when HD was comorbid with OCD than when HD occurred without comorbid OCD. Correlation analyses further showed that both experiential avoidance and emotion regulation were moderately but significantly associated with obsessive-compulsive but not hoarding symptoms. Thus, experiential avoidance and emotion regulation difficulties are not specifically relevant to HD but to a broad range of psychopathologies. However, despite the lack of specificity, the findings raise some potentially useful clinical implications for the treatment of HD.

Stressful life events and material deprivation in hoarding disorder.

Traumatic life events and early material deprivation have been identified as potential environmental risk factors for the development of pathological hoarding behavior, but the evidence so far is preliminary and confounded by the presence of comorbid obsessive-compulsive disorder (OCD). This study retrospectively examined the occurrence of traumatic/stressful life events and material deprivation in four well-characterized groups: hoarding disorder without comorbid OCD (HD; n=24), hoarding disorder with comorbid OCD (HD+OCD; n=20), OCD without hoarding symptoms (OCD; n=17), and non-clinical controls (Control; n=20). Participants completed clinician and self-administered measures of hoarding, OCD, depression, psychological adjustment, and traumatic experience. Semi-structured interviews were undertaken to assess the temporal relation between traumatic/stressful life events and the onset and worsening of hoarding symptoms, and to determine the level of material deprivation. Although rates of post-traumatic stress disorder were comparable across all three clinical groups, hoarders (regardless of the presence of comorbid OCD) reported greater exposure to a range of traumatic and stressful life events compared to the two non-hoarding groups. Results remained unchanged after controlling for age, gender, education level, depression, and obsessive-compulsive symptoms. The total number of traumatic life events correlated significantly with the severity of hoarding but not of obsessive-compulsive symptoms. About half (52%) of hoarding individuals linked the onset of hoarding difficulties to stressful life circumstances, although this was significantly less common among those reporting early childhood onset of hoarding behavior. There was no link between levels of material deprivation and hoarding. Results support a link between trauma, life stress and hoarding, which may help to inform the conceptualization and treatment of hoarding disorder, but await confirmation in a representative epidemiological sample and using a longitudinal design.