Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies.

BACKGROUND: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS: A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

[Validity and reliability of the Center for Epidemiologic Studies-Depression scale in Colombian adolescent students]. / Validez y confiabilidad de la escala del Center for Epidemiologic Studies-Depression en estudiantes adolescentes de Colombia.

INTRODUCTION: Major depressive disorder is the second major cause of adolescent psychological incapacitation in Latin-America. However, scales for detecting these disorders have not been validated for screening adolescents in Colombia. OBJECTIVE: The validity and reliability of a Spanish translation of the Center for Epidemiologic Studies (CES-D)-Depression scale was assessed in adolescent students. MATERIALS AND METHODS: A validation study for a diagnostic scale was performed with a sample of 390 adolescent students from Bucaramanga, Santander Province, in northwestern Colombia. The students were evaluated by two methods: (a) the CPS-depression scale and (b) a semi-structured clinical interview. Three to 28 days after the interview, the scale was re-applied. Criterion validity, internal consistency and test-retest reliability was analyzed. RESULTS: The mean age was 14.8 +/- 1.2 years old. The prevalence of major depressive disorder was 11.5%. Cronbach's alpha was 0.85. The area under the curve produced by the receiver operating characteristic curve was 0.82, and the cut point of > or =23 showed a sensitivity of 73.3%; specificity, 73.6%; positive predictive value, 26.6%, and negative predictive value, 95.5%. Lin's coefficient of concordance was 0.75. CONCLUSIONS: The validity and reliability of the Spanish translation of the CES-D scale were similar to those reported in the international literature although with a higher cut point. CONCLUSIONS: The validity and reliability of the Spanish translation of the CES-D scale were similar to those reported in the international literature although with a higher cut point.

[Prevalence of irritable bowel syndrome and associated factors according to the Rome III diagnostic criteria in a general population in Colombia]. / Factores sociosanitarios y prevalencia del síndrome del intestino irritable según los criterios diagnósticos de Roma III en una población general de Colombia.

INTRODUCTION: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with a clinical diagnosis. The prevalence of this disorder and associated factors are unknown among the Colombian population. Nowadays, diagnosis of IBS is made by applying the Rome III criteria, and other disorders should be excluded before establishing the diagnosis. OBJECTIVE: To assess the prevalence of IBS and associated factors in a population aged between 18 and 60 years old in Bucaramanga, Colombia. METHODS: A cross-sectional study was performed. We applied a questionnaire that included sociodemographic variables, types of food, identification of IBS by the Rome III criteria, the Zung self-rating depression scale, the State-Trait Anxiety Inventory (STAI) test and self-reported use of medical services among a random sample of an adult population in Bucaramanga. Univariate analysis and logistic regression was used to establish associations. RESULTS: Of the 615 individuals selected, 558 were included in the study. The mean age was 36.4 years and 62.4% was female. The prevalence of IBS was 19.9%. Logistic regression analysis showed an association with depressive symptoms and female sex independently of age and anxiety symptoms. CONCLUSIONS: The prevalence of IBS is high and is associated with depressive symptoms and female sex in an adult population in Colombia. This disorder generates substantial health system utilization and medical disability and restricts activities of daily life.

[Prevalence of Obsessive Compulsive Disorder and its comorbidity with Major Depressive Disorder in adolescent students]. / Prevalencia del Trastorno Obsesivo Compulsivo y su comorbilidad con el Trastorno Depresivo Mayor en adolescentes escolarizados.

INTRODUCTION: at least two-thirds of the adolescents with Obsessive Compulsive Disorder have another psychiatric disorder. The objective of this study was to estimate the prevalence of Obsessive Compulsive Disorder and Major Depressive Disorder in adolescent students and its comorbidity. METHODS: 390 adolescents were performed a structured clinical interview, clinical version: Obsessive Compulsive Disorder and Major Depressive Disorder modules. The inquired sociodemographic factors were analyzed with bivariate and multivariate statistical analysis and with non conditional logistic regression. RESULTS: Obsessive Compulsive Disorder was 7.63, its comorbility with major depressive disorder was 48.27 and there was an association between both disorders (OR 6.6 IC 3.45 - 12.61); Major Depressive Disorder prevalence was 11.7; when we controlled confusing variables in women we found that work (OR 3,14), age (OR 1,45) and major depressive disorder (OR 3,88), showed higher risk of having Obsessive Compulsive Disorder; in contrast with the men just Major Depressive Disorder showed higher risk of having obsessive compulsive disorder (OR 10,88). CONCLUSIONS: the Obsessive Compulsive Disorder and Major Depressive Disorder prevalence and its association in adolescent students are high; age and work could be a risk factor of having Obsessive Compulsive Disorder.

Validation of the Beck Hopelessness Scale in patients with suicide risk. / Validación de la Escala de Desesperanza de Beck en pacientes con riesgo suicida.

INTRODUCTION: Only a few scales have been validated in Spanish for the assessment of suicide risk, and none of them have achieved predictive validity. OBJECTIVE: To determine the validity and reliability of the Beck Hopelessness Scale in patients with suicide risk attending the specialist clinic. METHODS: The Beck Hopelessness Scale, reasons for living inventory, and the suicide behaviour questionnaire were applied in patients with suicide risk attending the psychiatric clinic and the emergency department. A new assessment was made 30 days later to determine the predictive validity of suicide or suicide attempt. RESULTS: The evaluation included a total of 244 patients, with a mean age of 30.7±13.2 years, and the majority were women. The internal consistency was .9 (Kuder-Richardson formula 20). Four dimensions were found which accounted for 50% of the variance. It was positively correlated with the suicidal behaviour questionnaire (Spearman .48, P<.001), number of suicide attempts (Spearman .25, P<.001), severity of suicide risk (Spearman .23, P<.001). The correlation with the reasons for living inventory was negative (Spearman -.52, P<.001). With a cut-off ≥12, the negative predictive value was 98.4% (95% CI: 94.2-99.8), and the positive predictive value was 14.8% (95% CI: 6.6-27.1). CONCLUSION: The Beck Hopelessness Scale in Colombian patients with suicidality shows results similar to the original version, with adequate reliability and moderate concurrent and predictive validity.

[Association between depressive symptoms and alcohol abuse among students from Bucaramanga, Colombia]. / Asociación entre síntomas depresivos y consumo abusivo de alcohol en estudiantes de Bucaramanga, Colombia.

Various studies have reported an important association between depressive symptoms and alcohol abuse. However, the topic had not been investigated in Colombian students. This study focused on the association between depressive symptoms and alcohol abuse among high school students in Bucaramanga, Colombia. A self-reported anonymous questionnaire was answered by 560 15-19-year-olds. The survey included the Zung Self-Reported Depression Scale, CAGE Questionnaire for Alcohol Use, and VESPA questionnaire (Epidemiological Surveillance of Psychoactive Drugs). Logistic regression was used to establish associations. Prevalence was 5.7% for alcohol dependence and 39.5% for depressive symptoms. Associations were found between alcohol abuse and depressive symptoms (PR = 3.33; 95%CI: 1.41-7.83), poor self-perceived academic achievement (PR = 2.59; 95%CI: 1.16-5.37), and smoking (PR = 2.47; 95%CI: 1.13-5.40). The authors conclude that there is a strong association between depressive symptoms and alcohol abuse in Colombian high school students. Preventive programs are needed to identify early depressive disorders and alcohol abuse.

[Validity and Reliability of Two Silhouette Scales to Asses the Body Image in Adolescent Students]. / Validez y confiabilidad de dos escalas de siluetas para valorar la imagen corporal en estudiantes adolescentes.

OBJECTIVE: To determine the validity and reliability of the 13-figure images scale (13-CS) and Standard Figural Stimuli (SFS) for the evaluation of body images in adolescent students from Bucaramanga. METHODS: A probabilistic sample with 189 students was evaluated with the two scales. Two weeks later, the valuation together with the size, weight, percentage of body fat, SCOFF questionnaire and Rosenberg self-esteem valuation was repeated. RESULTS: The average age was 14.1 years; 62.7% were women. The correlation of the 13-CS and SFS with body fat index, weight and body fat percentage was 0.61, 0.74, 0.40 and 0.72, 0.55, 0.45 respectively. The correlation of dissatisfaction with body image according to the SCOFF and the Rosenberg scales was 0.43 and 0.26 with the 13-CS; 0.50 and -0.23 with the SFS. The reproducibility shows that perceived and ideal figure was 0.93 and 0.90 with the 13-CS; and 0.85 and 0.78 with the SFS. CONCLUSION: the concurrent validity of both scales was good. The reproducibility of the 13-CS was excellent while the SFS was good.

[Alcohol Abuse and Associated Factors in Student Children and Adolescents]. / Abuso de alcohol en niños y adolescentes escolarizados y factores asociados.

INTRODUCTION: Previous studies have confirmed high prevalence of alcohol abuse in adolescent students from Bucaramanga, Colombia. However, few studies on the associated factors have been carried out. OBJECTIVE: Assessment of prevalence of alcohol abuse and associated factors in student children and adolescents from Bucaramanga. METHODOLOGY: A random sample of adolescent students completed an anonymous questionnaire about the consumption of alcohol, illegal and legal substances, together with the CAGE questionnaire and a series of scales and questionnaires assessing risk factors for alcohol abuse. To adjust for confusing variables, a multivariate analysis was performed using a logistic regression model. RESULTS: 2916 students were surveyed with an average age between 10 and 22, and a mean of 14.4 years (SD 1.65), 51.1% were female, 36% were in the last two years of high school (10(th) and 11(th) grades), and 17.66% were in private schools. The alcohol abuse pattern as measured by the CAGE scale was 14.6% (95% CI, 13.3 - 16.0%). The associated factors were: age (OR: 1.15, 95% CI 1.04 - 1.27), having a smoking or consuming alcohol sibling (OR: 1.48, 95% CI, 1.01 - 1.17) antisocial behavior (OR 3.03, 95% CI, 2.12 - 4.32) and best friend who uses illicit substances (OR 1.71, 95% CI, 1.06 - 2.76), best friend who smokes or drinks alcohol (OR 2.01, 95% CI, 1.40 - 2.88). CONCLUSIONS: One out of 7 students showed a pattern of alcohol abuse. The associated factors were the influence of friends, family, age and antisocial behavior.

[Validation of two short versions of the Centre for Epidemiological Studies Depression Scale in Colombian adolescents]. / Validación de dos versiones cortas de la escala para depresión del Centro de Estudios Epidemiológicos en adolescentes colombianos.

OBJECTIVE: To establish the validity and reliability of a Brief and Ultra-short Center for Epidemiological Studies Depression (CES-D) Scale in adolescents. DESIGN: Validation study. SETTING: Secondary schools in Bucaramanga, Colombia. PARTICIPANTS: A total of 474 students were selected through a three stage process; 68 did not agree to participate, 8 were excluded and 8 did not complete the process. MAIN MEASUREMENTS: Adolescent students were evaluated with CES-D and the clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The CES-D scale was re-applied 3 to 28 days after the first application. The ten items and the three items with the highest correlation with total score were selected to construct a Brief scale and Ultra-short scale, respectively. Construct validity, criterion validity, test-retest reliability and internal consistency were analyzed. RESULTS: For the Brief CES-D Scale the Cronbach's alpha was 0.86 and Lin's coefficient was 0.77. The area under ROC curve was 0.83, with a sensitivity of 77.8%; specificity 74.1%. Two main factors were identified to explain the 55.81% variance. For the Ultra-short Scale the Cronbach's alpha was 0.76 and Lin's coefficient was 0.74. The area under ROC curve was 0.80, with a sensitivity of 75.56%; specificity 70.67%. One main factor was identified to explain the 68.19% of variance. CONCLUSIONS: The Brief and Ultra-Short CES-D Scale are as useful as the original scale for the screening of MDD in adolescents; Ultra-short CES-D Scale does not preserve the original factorial structure.

Abuso de alcohol en niños y adolescentes escolarizados y factores asociados / Alcohol abuse and associated factors in student children and adolescents

Introducción: Estudios previos han confirmado altas prevalencias de abuso de alcohol en adolescentes escolarizados de Bucaramanga; sin embargo, son escasos los estudios sobre factores asociados. Objetivo: Evaluar la prevalencia del abuso de alcohol en niños y adolescentes escolarizados de Bucaramanga, Colombia, y sus factores asociados. Metodología: Una muestra aleatoria de estudiantes adolescentes completó un cuestionario anónimo acerca del consumo de alcohol, sustancias ilegales y legales, el cuestionario CAGE y una serie de escalas y cuestionarios que evaluaban factores de riesgo para abuso de alcohol. Para ajustar por variables de confusión, se realizó un análisis multivariado mediante un modelo de regresión logística. Resultados: Se encuestaron 2.916 estudiantes. La edad de la muestra estuvo entre 10 y 22 años, con una media de 14,4 años (DE = 1,65); 51,1% eran mujeres, 36% cursaban básica superior (10° y 11°), el 17,66 % en colegios privados. El patrón de consumo abusivo de alcohol medido por la escala del CAGE fue del 14,6% (IC95%; 13,3-16,0%). Los factores asociados fueron: edad (OR = 1,15, IC95% 1,04-1,27), tener un hermano consumidor de cigarrillo o alcohol (OR = 1,48, IC95% 1,01-1,17), comportamiento antisocial (OR = 3,03, IC95% 2,12-4,32), mejor amigo que consume sustancias ilícitas (OR =1,71, IC95% 1,06-2,76), mejor amigo que fuma o consume alcohol (OR = 2,01, IC95% 1,40-2,88). Conclusiones: Uno de cada siete estudiantes presentó un patrón de consumo abusivo de alcohol. La influencia de los amigos, la familia, la edad y el comportamiento antisocial fueron los factores asociados…

Introduction:Previous studies have confirmed high prevalence of alcohol abuse in adolescent students from Bucaramanga, Colombia. However, few studies on the associated factors have been carried out. Objective: Assessment of prevalence of alcohol abuse and associated factors in student children and adolescents from Bucaramanga. Methodology: A random sample of adolescent students completed an anonymous questionnaire about the consumption of alcohol, illegal and legal substances, together with the CAGE questionnaire and a series of scales and questionnaires assessing risk factors for alcohol abuse. To adjust for confusing variables, a multivariate analysis was performed using a logistic regression model. Results: 2916 students were surveyed with an average age between 10 and 22, and a mean of 14.4 years (SD 1.65), 51.1% were female, 36% were in the last two years of high school (10thand 11th grades), and 17.66% were in private schools. The alcohol abuse pattern as measured by the CAGE scale was 14.6% (95% CI, 13.3 - 16.0%). The associated factors were: age (OR: 1.15, 95% CI 1.04 - 1.27), having a smoking or consuming alcohol sibling (OR: 1.48, 95% CI, 1.01 - 1.17) antisocial behavior (OR 3.03, 95% CI, 2.12 - 4.32) and best friend who uses illicit substances (OR 1.71, 95% CI, 1.06 - 2.76), best friend who smokes or drinks alcohol (OR 2.01, 95% CI, 1.40 - 2.88). Conclusions: One out of 7 students showed a pattern of alcohol abuse. The associated factors were the influence of friends, family, age and antisocial behavior…

Validez y confiabilidad de dos escalas de siluetas para valorar la imagen corporal en estudiantes adolescentes / Validity and reliability of two silhouette scales to asses the body image in adolescent students

Objetivo: Determinar la validez y confiabilidad de la escala de los trece dibujos del contorno de la figura (13-CS) y del Standard Figural Stimuli (SFS) para la evaluación de la imagen corporal en estudiantes adolescentes de Bucaramanga. Métodos: Se evaluó una muestra probabilística de 189 estudiantes con las dos escalas. Dos semanas después se repitió la valoración junto con la talla, el peso, el porcentaje de grasa corporal, el cuestionario SCOFF y la escala de autoestima de Rosenberg. Resultados: La edad promedio fue 14,1 años; 67,2% fueron mujeres. La correlación de la 13-CS y SFS con el índice de masa corporal, peso y porcentaje de grasa corporal fue 0,61, 0,74, 0,40 y 0,72, 0,55, 0,46, respectivamente. La correlación de la insatisfacción de la imagen corporal con el SCOFF y la Rosemberg fue 0,43 y -0,26 con la 13-CS y 0,50 y -0,23 con la SFS. La reproducibilidad prueba-reprueba de la figura percibida e ideal fue de 0,93 y 0,90 con la 13-CS y de 0,85 y 0,78 con la SFS. Conclusión: La validez concurrente de ambas escalas fue buena. La reproducibilidad de la 13-CS fue excelente, y la de la SFS fue buena…

Objective: To determine the validity and reliability of the 13-figure images scale (13-CS) and Standard Figural Stimuli (SFS) for the evaluation of body images in adolescent students from Bucaramanga. Methods: A probabilistic sample with 189 students was evaluated with the two scales. Two weeks later, the valuation together with the size, weight, percentage of body fat, SCOFF questionnaire and Rosenberg self-esteem valuation was repeated. Results:The average age was 14.1 years; 62.7% were women. The correlation of the 13-CS and SFS with body fat index, weight and body fat percentage was 0.61, 0.74, 0.40 and 0.72, 0.55, 0.45 respectively. The correlation of dissatisfaction with body image according to the SCOFF and the Rosenberg scales was 0.43 and 0.26 with the 13-CS; 0.50 and -0.23 with the SFS. The reproducibility shows that perceived and ideal figure was 0.93 and 0.90 with the 13-CS; and 0.85 and 0.78 with the SFS. Conclusion: the concurrent validity of both scales was good. The reproducibility of the 13-CS was excellent while the SFS was good…

[Validation of the short version of the Leyton obsessional inventory for children and adolescents in Bucaramanga, Colombia]. / Validación del Inventario de Obsesiones de Leyton, versión corta, en niños y adolescentes de Bucaramanga (Colombia).

OBJECTIVE: To determine the internal consistency, factorial structure, reproducibility and validity of criterion of the Leyton Obsessional Inventory in children and adolescents. DESIGN: Study of validation with probabilistic sampling. SETTING: Secondary schools in Bucaramanga, Colombia. PARTICIPANTS: A total of 581 students selected at random, of whom 38 did not answer, 8 were excluded because they were over 17, and 33 did not attend the clinical interview. MAIN MEASUREMENTS: The Inventory and the Structured Clinical Interview for axis I of the DSM-IV (SCID-I), clinical version, were used. Cronbach's alpha, factorial analysis, sensibility, specificity, probability, and Lin' s coefficient were calculated. RESULTS: The prevalence of obsessive-compulsive disorder was 11.8% (95% CI, 8.9-14.6). Cronbach's alpha was 0.803 and just one factor with 3.60 eigenvalue explained 74.8% of variance. The area under the ROC curve was 0.799 (95% CI, 0.752-0.847) and the best cut-off point was 12, with sensitivity at 69.5% (95% CI, 56.0-80.5) and specificity at 77.7% (95% CI, 72.9-88.9). Its reproducibility was acceptable (Lin's coefficient at 0.752; 95% CI, 0.714-0.790). CONCLUSION: The Leyton Obsessional Inventory is a fair screening tool for detecting obsessive-compulsive disorder in Colombian children and adolescents.

Trastorno bipolar y suicidabilidad en pacientes colombianos / Bipolar Disorder and Suicidality in Colombian Patients.

Introducción: Tradicionalmente se ha considerado que el riesgo de muerte por suicidio de un paciente con trastorno depresivo mayor (TDM) es superior a un paciente con trastorno bipolar (TB); sin embargo, evidencia reciente muestra que el riesgo es similar o mayor para los pacientes con TB. Los objetivos son determinar las diferencias según el diagnóstico (TDM o TB) en una muestra de pacientes con suicidabilidad que acuden a consulta especializada en una clínica privada de Bucaramanga, Colombia, y determinar las características específicas de pacientes con TB. Métodos: Estudio de casos y controles anidados en una cohorte prospectiva. Se tomó una muestra consecutiva de los pacientes que consultan con suicidabilidad. Se realizó un análisis multivariado donde se compararon los pacientes con TB con aquellos en los cuales su diagnóstico fue TDM. Resultados: Se entrevistaron 612 pacientes, pero en el estudio se incluyeron 593, puesto que 19 presentaban datos incompletos; 125 pacientes presentaron TB; 335, TDM, y 133, otros diagnósticos. Edad: OR=0,98 (0,96-0,99); abuso de sustancias: OR=2,14 (1,3-3,5); impulsividad: OR=1,85 (1,2-2,9); apoyo familiar: OR=0,46 (0,3-0,7). Estos factores diferenciaron a los pacientes con TB de los pacientes con TDM. Conclusión: Los pacientes con TB que acudieron por suicidabilidad a una clínica privada de Bucaramanga, Colombia, presentaron mayor riesgo suicida que pacientes similares con TDM u otros diagnósticos. Los factores que diferencian los pacientes con TB de aquellos con TDM fueron una edad menor, el abuso de sustancias, la impulsividad y la falta de apoyo familiar.

Introduction: Traditionally suicidally in a patient with major depressive disorder (MDD) is considered to be s higher than in a patient with bipolar disorder (BD), however recent evidence shows that the risk is similar or greater for patients with BD. The aim of this study was to determine the differences according to diagnosis in a sample of patients with suicidality attending a specialized private clinic in Bucaramanga, Colombia, and to identify specific characteristics of patients with BD. Methods: Case-control study nested in a prospective cohort. A consecutive sample of patients with suicidality was collected. A multivariate analysis was performed in patients with BD to compare with those in whom the diagnosis was MDD. Results: 612 patients were interviewed but only 593 were included in the study because of incomplete data in the other 9. 125 patients had BD, 335 MDD and 133 other diagnoses. Age OR = 0.98 (0.96 to 0.99), substance abuse, OR = 2.14 (1.3 to 3.5), impulsivity OR = 1.85 (1.2-2.9), and family support OR = 0.46 (0.3 to 0.7) differentiated patients with BD from patients with MDD. Conclusion: Suicidal patients with BD who attended a private clinic in Bucaramanga had higher suicidal risk than patients with MDD or other diagnoses. The factors that differentiated patients with BD from patients with MDD were younger age, substance abuse, impulsivity, and lack of family support.

Desarrollo y validación de la versión II de la escala EMUN / Development and Validation of the EMUN-II Scale

Introducción: La escala EMUN se desarrolló para medir síntomas psiquiátricos en pacientes Con trastorno afectivo bipolar. Aunque ha mostrado adecuadas propiedades psicométricas, Varios estudios han reportado que la labilidad afectiva, la agresividad y la impulsividad (Síntomas no incluidos en la escala) son características importantes del trastorno. Objetivo:Determinar las propiedades psicométricas de la EMUN al adicionar tres ítems: labilidad afectiva, agresividad e impulsividad. Métodos: Los datos para el estudio fueron recolectados En 223 pacientes con diagnóstico de episodio maniaco, hipomaniaco o mixto, utilizando una Versión modificada de la escala EMUN (EMUN-II), que incluye tres ítems adicionales. Se usó El alfa de Cronbach para evaluar consistencia interna. El contenido se validó usando métodos Factoriales y modelamiento con ecuaciones estructurales. Resultados: Una solución de cuatro factores (activación general, agresividad, activación cognoscitiva y depresión) da cuenta Del 96% de la varianza total. Los coeficientes de correlación-concordancia de Lin revelaron Valores adecuados para la confiabilidad test-retest. La escala detectó una diferencia significativa entre las medias antes del tratamiento farmacológico y después de este. Conclusión:La inclusión de tres ítems adicionales mejoró la validez de contenido de la escala EMUN y Conservó un instrumento con adecuadas propiedades psicométricas...

Introduction: The EMUN scale has been developed as a psychiatric rating scale for measuring Manic symptoms in patients with bipolar disorder. Although the instrument has shown adequate psychometric properties, additional symptoms not included in the scale such as mood lability, aggressiveness, and impulsivity have been reported as important clinical characteristics in several studies. Objectives: To determine the psychometric properties of the EMUN scale when items measuring mood lability, aggressiveness, and impulsivity are included in the instrument. Method: Study data was collected from 223 patients with manic, hypomanic or mixed episodes using a modified version of the EMUN scale that includes three additional items (EMUN-II). The CARS-M scale was applied simultaneously to measure concurrent validity. Reliability and sensitivity to change were determined using a repeated measures design. Results: A four-factors solution (general activation, aggressiveness, cognitive activation, and depression) accounts for 96% of the total variance of the scale. Lin’s concordance correlation coefficient revealed adequate scores for test-retest reliability. The scale detected a significant difference between the means before and after pharmacological treatment. Conclusion: When three additional items are included content validity of the EMUN scale improves. All of the psychometric properties of the original instrument are preserved...

Factores asociados al uso de sustancias ilícitas en adolescentes escolarizados / Associated factors with Illicit drug use among adolescent students

Introducción: El abuso de sustancias ilícitas se establece durante la adolescencia temprana. Objetivo: Determinar la prevalencia y los factores asociados al consumo de sustancias ilícitas en adolescentes escolarizados de Bucaramanga. Método: Una muestra aleatoria de estudiantes adolescentes que completó un cuestionario anónimo acerca del consumo de sustancias ilegales y legales más escalas y cuestionarios de diferente tipo. Resultados: 2.916 estudiantes participaron en esta investigación. La prevalencia del uso de sustancias ilícitas durante el último año fue del 3,81%. El uso de sustancias ilícitas en hombres se asoció de manera independiente con la presencia de comportamientos antisociales, fumar todos los días durante el último mes, patrón de dependencia a alcohol y tener un amigo que usa sustancias ilícitas. En mujeres se asoció de manera independiente con la presencia de comportamientos antisociales, tener un amigo que usa sustancias ilícitas, fumar todos los días durante el último mes y la edad. Conclusión: Uno de cada 26 adolescentes escolarizados de Bucaramanga ha usado sustancias ilícitas durante el último año. Mujeres y hombres mostraron factores asociados similares, sin embargo, los hombres mostraron asociación con dependencia al alcohol y las mujeres mostraron asociación con la edad...

Introduction: The abuse of illicit drugs is established during early adolescence. Furthermore, a lot of variables in Colombian adolescents have not been studied yet. Objective: To establish the prevalence and associated factors of illicit drug use among adolescent students in Bucaramanga, Colombia. Methods: A random sample of adolescent students completed an anonymous questionnaire about illegal and legal substance use, and others questionnaires and scales.. Logistical regression was used to control confounding variables. Results: 2,916 students participated in this research. The prevalence of illicit drug use during the last year was 3.81%. Illicit drug use in men was independently associated with antisocial behavior, smoking everyday during the last month, alcohol dependence pattern and having a friend who uses illicit drugs. In women was independently associated with antisocial behavior, having a friend who uses illicit drugs, smoking everyday during the last month, and the age. Conclusions: One in 26 adolescent students from Bucaramanga has used illicit drugs during the last year. Women and men showed similar associated factors, although, men also showed an association with alcohol dependence and women showed an association with the age...

Common mental disorders in Colombian women trastornos mentales comunes en mujeres colombianas

Objective: To explore the prevalence of common mental disorders and their association with health-related behaviors in Colombian women. Method: A cross-sectional study was carried out with a multi-stage probability sample of women from the general population. Common mental disorders were explored with the General Health Questionnaire (GHQ-12) with a cut-off point of eleven or more. Non conditional logistic regression was computed to adjust associated variables. Results: A total of 1,740 women participated in this research. The mean age of participants was 38.3 years (SD=13.3), mean years of education were 8.8 years (SD=3.9), 59.5% were married, 37.0% were employed, 1.4% reported abusive alcohol consumption, 6.3% daily cigarette smoking, 44.5% daily coffee intake, 17.5% a medical condition, and 15.7% (95% CI 14.0-17.4) scored for a common mental disorder. Abusive alcohol consumption (OR=6.4, 95% CI 2.7-15.2), daily cigarette smoking (OR=3.3, 95% CI 2.1-5.0), medical condition (OR=2.0, 95% CI 1.4-2.8), and daily coffee intake (OR=1.3, 95% CI 1.0-1.8) were associated with common mental disorders, adjusted for age and education. Conclusions: Common mental disorders are frequent in Colombian women. Health risk behaviors and stressful events are strongly related to common mental disorders. It is necessary to identify and treat these mental disorders early on to reduce health risk behaviors in women...

Objetivo: Explorar la prevalencia y variables asociadas a trastornos mentales comunes en mujeres de Bucaramanga, Colombia. Método: Se realizó un estudio transversal. Además, se tomó de la población general una muestra probabilística multietápica de mujeres. Los trastornos mentales comunes se cuantificaron con el Cuestionario General de Salud (GHQ-12). Las variables asociadas se ajustaron mediante regresión logística. Resultados: Participaron 1.740 mujeres. La media para la edad fue 38,3 años (DE=13,3) y para la escolaridad, 8,8 años (DE=3,9). El 59,5% estaba casada, el 37% era empleada, el 1,4% informó consumo abusivo de alcohol, el 6,3% consume cigarrillos diariamente, el 44,5% toma café todos los días, el 17,5% posee una condición médica conocida y 15,7% (IC 95%: 14,0-17,4) puntuó para un trastorno mental común. El consumo abusivo de alcohol (OR=6,4; IC 95%: 2,7- 15,2), consumo diario de cigarrillo (OR=3,3; IC 95%: 2,1-5,0), presentación de una condición médica (OR=2,0; IC 95%: 1,4-2,8) y consumo diario de café (OR=1,3; IC95%: 1,0-1,8) se asociaron estadísticamente a trastornos mentales comunes, con ajuste por edad y educación. Conclusiones: Los trastornos mentales comunes son frecuentes en mujeres de Bucaramanga, Colombia. Comportamientos relacionados con la salud (consumo abusivo de alcohol, consumo diario de cigarrillo y consumo diario de café) y eventos estresores (condición médica) se relacionan significativamente con trastornos mentales comunes...

Prevalencia de trastorno obsesivo compulsivo en adolescentes colombianos y su asociación con la doble condición de trabajo y estudio / Prevalence of obsessive-compulsive disorder among Colombian adolescents and its association with working while going to school

Objetivos: Estimar la prevalencia del trastorno obsesivo compulsivo (TOC) en niños y adolescentes escolarizados y determinar los factores sociodemográficos asociados. Método: Se desarrolló un estudio transversal con una muestra de 501 niños y niñas de 10 a 17 años de colegios de Bucaramanga. Se tomaron los datos sociodemográficos y se les realizó la entrevista clínica estructurada para los trastornos del eje I del DSM-IV, versión clínica. Se examinaron los factores sociodemográficos con un análisis bivariado. Se realizó análisis estratificado y una regresión logística no condicional, tomando el trabajo por dinero como una variable explicatoria de riesgo para el desarrollo de TOC. Resultados: La prevalencia del TOC fue de 7,4% (IC 95%: 5,3-10,0). Los estudiantes con TOC presentan una prevalencia de trabajo por dinero mayor que en los que no tienen (OR: 2,23; IC 95%: 1,0-4,4). Al controlar variables confusoras, las niñas que trabajaban por dinero mostraron un mayor riesgo en la presencia de TOC (OR: 5,4; IC 95%: 1,7-17,4). Conclusión: El estudio sugiere que la prevalencia del TOC en niños escolarizados de Bucaramanga es alta. La doble condición de trabajar y estudiar en las niñas podría ser un factor de riesgo asociado con TOC...

Objectives: To estimate the prevalence of obsessive-compulsive disorder (OCD) in children and adolescents attending school in Bucaramanga, Colombia, and to determine its associated socio-demographic factors. Method: A cross-sectional design was used with a sample size of 501 individuals between the ages of 10 to 17 years enrolled in Bucaramanga’s schools. They were administered a structured clinical interview OCD module. Socio-demographic data was also collected. The inquired sociodemographic factors were analyzed with bivariate analysis. Work for money was taken as a risk explanatory variable for developing OCD; stratified analysis and unconditional logistic regression were carried out. Results: Prevalence of OCD was found to be 7.4% (95% CI: 5.3-10.0) in this population. Students with OCD had a prevalence of working for money higher than those who did not (OR: 2.2; 95% CI: 1.0-4.4). Girls who worked for money showed a higher risk of having OCD than those who did not (OR: 5.4; 95% CI: 1.7-7.4), in a logistic regression model. Conclusion: These results suggest that the prevalence of OCD among Colombian school children is higher than elsewhere. In addition, working while going to school might be a risk factor associated with OCD in girls...

Dependencia a la nicotina: desempeño psicométrico de dos escalas en adultos / Nicotine dependence: psychometric performance of two scales among adults

Objetivo: comparar el desempeño psicométrico de la Escala de Fagerstrõm para Dependencia a la Nicotina (FTND) y la Escala para Dependencia al Cigarrillo (CDS) en adultos de Bucaramanga, Colombia. Metodología: ciento veintiséis fumadores completaron la FTND y la CDS. La Entrevista Diagnóstica Internacional Compuesta para la dependencia de la nicotina se tomó como criterio de referencia.Resultados: la FTND mostró alfa de Cronbach de 0,72; sensibilidad, 0,69;especificidad, 0,71; valor predictivo positivo, 0,90; valor predictivo negativo, 0,40; razón de probabilidad positiva, 2,38; razón de probabilidad negativa, 0,43; kappa de Cohen, 0,32; y área bajo la curva, 0,74. La CDS presentó alfa de Cronbach de 0,90; sensibilidad, 0,77; especificidad, 0,71; valor predictivo positivo, 0,90; valor predictivo negativo, 0,47; razón de probabilidad positiva, 2,66; razón de probabilidad negativa, 0,33; kappa de Cohen, 0,40; y área bajo la curva, 0,80. Conclusiones: la CDS muestra mejor desempeño que la FTND en fumadores de Bucaramanga.

Introduction: to compare psychometric performance of the Fagerström TestNicotine Dependence (FTND) and Cigarette Dependence Scale (CDS) among adults from Bucaramanga, Colombia. Method: one-hundred twenty-six current smokers completed the FTND and CDS. Cronbach alpha, sensitivity, specificity, predictive values, likelihood values, Cohen kappa, and ROC area were computed for each scale. The Compose International Diagnostic Interview was taken as the gold-standard. Internal consistencies andROC curve were compared. Results: the FTND showed Cronbach alpha of 0.72; sensitivity, 0.69; specificity, 0.71; positive predictive value, 0.90; negative predictive value, 0.40; positive likelihood value, 2.38; negative likelihood value, 0.43; Cohen kappa, 0.32; and ROC area, 0.74. The CDS presented Cronbach alpha of 0.90; sensitivity, 0.77; specificity, 0.71; positive predictive value, 0.90; negative predictive value, 0.47; positive likelihood value, 2.66; negative likelihood value, 0.33; Cohen kappa, 0.40; and ROC area, 0.80. Conclusions: the CDS exhibits better performance than FTND in smokers from Bucaramanga (Colombia).

Suicidabilidad en adolescentes, una comparación con población adulta / Suicide potential in adolescents: a comparison with adult population

Introducción: El suicidio es la tercera causa de muerte violenta en los adolescentes colombianos. En las últimas cuatro décadas del siglo XX, en Colombia y en el mundo las tasas de suicidio aumentaron en adolescentes. Son escasos los trabajos que comparan las características de los pacientes adolescentes con potencial suicida en Latinoamérica. Objetivo: Determinar las diferencias entre adolescentes y adultos con ideas o actitudes suicidas que acuden a una clínica privada de Bucaramanga, Colombia. Método: Se tomó una muestra consecutiva a pacientes con potencial suicida que acudieron a atención psiquiátrica. Se les realizó una entrevista semiestructurada que interrogaba sobre los principales factores de riesgo y protectores para suicidio. Se realizó una regresión logística tomando como variable dependiente la adolescencia y se ajustó por las variables de confusión. Resultados: Se entrevistaron 448 adultos y 85 menores de 18 años de edad. Los adolescentes presentaron una edad promedio de 15,2±1,5, y los adultos, 35,9±13,6 años. Los adolescentes fueron con mayor frecuencia mujeres, presentaron más intentos suicidas (OR=3,64; IC95%: 2,13-6,20), pero menos trastornos mentales severos (OR=0,42; 0,25-0,71). Conclusiones: Los adolescentes bumangueses con riesgo suicida fueron con mayor frecuencia mujeres, tuvieron mayor porcentaje de intentos suicidas y problemas mentales de menor gravedad que los adultos...

Introduction: Suicide is the third leading cause of violent death in Colombian adolescents. In the last four decades of the twentieth century adolescent suicide rates increased in Colombia and in the world. There are few studies comparing the characteristics of suicidal adolescent patients in Latin America. Objective: To determine the differences between suicidal adolescents and adults seen at the mental health services of a private clinic in Bucaramanga, Colombia. Methods: The sample consisted of all consecutive suicidal patients attending a clinic for psychiatric care. They all underwent a semistructured interview asking about demographic characteristics and major risk and protective factors for suicide. A logistic regression analysis was performed with adolescence as the dependent variable adjusted for confounding variables. Results: We interviewed 448 adults and 85 patients under 18. Adolescents had a mean age of 15.2±1.5 and adults 35.9 ± 13.6 years. Adolescents were more often female, had more suicide attempts (OR=3.64; 95%CI: 2.13-6.20), but less severe mental disorders (OR=0.42; 0.25-0.71). Conclusions: Colombian suicidal adolescents were more often female, with the highest percentage of suicide attempts, and with less severe mental health problems than adults...

Factores de riesgo y protectores para intento suicida en adultos colombianos con suicidabilidad / Risk and protective factors in Colombian suicidal adults

Introducción: El suicidio es un problema de salud pública y es una de las tres primeras causas de muerte en jóvenes. El potencial suicida contribuye a la hospitalización y representa más de un tercio de las visitas anuales a los servicios de urgencias psiquiátricas. Los intentos repetidos se asocian con un riesgo elevado de obtener un desenlace fatal e incrementan los costos en salud. Su estudio es importante para la atención en suicidio. Objetivo: Determinar los factores de riesgo y protección para intento suicida en una población de pacientes con suicidabilidad que acude a consulta especializada en una clínica privada de Bucaramanga, Colombia. Método: Estudio de casos y controles. Los casos fueron los pacientes con suicidabilidad en quienes el motivo de consulta fue un intento suicida, y los controles, aquellos con suicidabilidad pero sin intento suicida. Se realizó un análisis de regresión logística para ajustar por las variables de confusión. Resultados: Se encontraron como factores de riesgo para intento suicida el consumo de alcohol durante el último año (OR=2,01; 1,30-3,11) y los problemas familiares o de pareja (OR=2,16; 1,31-3,55); como factores protectores, la edad (OR=0,39; 0,22-0,69) y el tener hijos (OR=0,46: 0,29-0,73). Conclusiones: Los factoresprotectores y de riesgo para intento suicida en pacientes con suicidabilidad de Bucaramanga fueron similares a los informados previamente en la literatura...

Introduction: Suicide is a public health problem and is considered one of the top three causes of death in young population. Suicidality contributes to hospitalization and represents more than one third of the annual visits to psychiatric emergencies. Repeated suicide attempts are common and are associated with an increased risk of obtaining a fatal outcome, and also increase health care costs. Research is important to determine the best care in cases of attempted suicide. Objective: To determine the risk and protective factors for suicide attempts in a population of suicidal patients seen at the mental health services of a private clinic in Bucaramanga, Colombia. Methods: This is a case-control study. The cases were suicidal patients that attempted suicide and the controls were also suicidal patients but without suicide attempt. We performed a logistic regression analysis adjusting for confounding variables. Results: Risk factors for attempted suicide were alcohol consumption during the last year (OR=2.01; 1.30-3.11) and family or marital problems (OR=2.16; 1.31-3.55). Protective factors were age (OR=0.39; 0.22-0.69) and having children (OR=0.46; 0.29-0.73). Conclusions: The risk and protective factors for suicide attempts in suicidal patients in Bucaramanga were similar to those reported in the literature...