Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions.

BACKGROUND: The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. METHODS: This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. RESULTS: 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28-0.67, stopping self: 0.54-0.72, stigma consciousness: -0.32-0.57], as was internal consistency reliability (α = 0.74-0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. CONCLUSIONS: The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis.

Patient therapeutic adherence lies at the core of mental health care. Health Care professionals and organizations play a major role in promoting adherence among people with mental disorders. However, defining therapeutic adherence remains complex. We used Rodgers' evolutionary concept analysis to explore the concept of therapeutic adherence in the context of mental health. We conducted a systematic literature search on Medline/PubMed and CINAHL for works published between January 2012 and December 2022. The concept analysis showed that major attributes of therapeutic adherence include patient, microsystem and meso/exosystem-level factors. Antecedents are those related to patients, such as their background, beliefs and attitudes, and acceptance of mental illness-and those related to patient-HCP therapeutic engagement. Lastly, three different consequences of the concept emerged: an improvement in clinical and social outcomes, commitment to treatment, and the quality of healthcare delivery. We discuss an operational definition that emerged from the concept analysis approach. However, considering the concept has undergone evolutionary changes, further research related to patient adherence experiences in an ecological stance is needed.

The relation between lifestyles and positive mental health in Portuguese higher education students.

Healthy lifestyles are commonly associated with improved physical and mental health. Sleep patterns, nutrition, physical exercise, consumption of psychoactive substances, among others, can strongly influence positive mental health. The aims are: characterize lifestyles based on positive mental health clusters, considering the cross-sectional cohort sample of higher education students, and analyse the lifestyles associated with positive mental health. A cross-sectional, descriptive, correlational and multicentric study of quantitative approach was conducted. The Positive Mental Health Questionnaire was applied. Through the k-means method, four clusters were obtained based on positive mental health levels. The sample of 3647 higher education students was mostly female (78.8%), single (89.5%), with an average age of 23 years (SD = 6.68). Differences were found between clusters based on the sociodemographic characteristics and lifestyles. Findings in Cluster 1 were highlighted because they included students with a higher level of positive mental health, which was associated with greater satisfaction in affective relationships, higher recreational and sports activities, better sleep quality, a healthy diet, and lower medication and illicit drugs consumption. These key findings emphasize the promotion of healthy lifestyles and highlight the importance of positive mental health in promoting the health of higher education students.

"Looking beyond Mental Health Stigma": An Online Focus Group Study among Senior Undergraduate Nursing Students.

Evidence highlights the need for professionals to be aware of their stigmatizing attitudes and discriminatory practices in order to minimize the negative impact on the people they take care of. However, nursing students' perceptions of these issues have been poorly studied. This study explores the perspective of senior undergraduate nursing students on mental health and the stigma around it, by considering a simulated case vignette of a person with a mental health problem. A descriptive qualitative approach was chosen and involved three online focus group discussions. The findings show various manifestations of stigma, both at an individual and collective level, which indicates that it is an obstacle to the wellbeing of people with mental illness. Individual manifestations of stigma concern its effect on the person with mental illness, while at the collective level they concern the family or society in general. Stigma is a multifactorial, multidimensional, and complex concept, in terms of identifying and fighting it. Thus, the strategies identified involve multiple approaches at the individual level, aimed at the patient and family, namely through education/training, communication, and relationship strategies. At the collective level, to intervene with the general population and specific groups, such as groups of young people, strategies suggested include education/training, use of the media, and contact with people with mental disorders as ways to fight stigma.

Positive Mental Health and Mental Health Literacy of Informal Caregivers: A Scoping Review.

Positive mental health and mental health literacy are two main concepts to ensure an individual and social state of mental health and well-being. A scoping review of the scientific literature published in the field of health sciences was conducted to identify the relationship between mental health literacy and the positive mental health of family caregivers. A research expression was used to search for articles in health databases, respecting the main topics of the Participants/Concept/Context (PCC) framework. A total of eight articles were included from the 2830 initially identified using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) process. It was noticeable that none of the studies related positive mental health and mental health literacy of caregivers. Nevertheless, it was possible to identify predictors of mental health and self-efficacy, such as burden and a lack of information about and support in the process of care. Caregivers' quality of life, self-esteem and confidence are also important positive mental health predictors that are closely related to health literacy. The knowledge of these factors can contribute to the reduction in negative determinants of mental health of caregivers and the resolution of strategies to meet caregivers' needs.

Positive Mental Health Literacy: A Concept Analysis.

Background: The positive component of Mental Health Literacy (PMeHL) refers to a person's awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners. Aim: To identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications. Methods: Literature search (using the Medline and CINAHL databases) and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach. Results: Positive component of Mental Health Literacy is considered one component of MHL, integrating positive mental health. The concept's attributes include: (a) competence in problem-solving and self-actualization; (b) personal satisfaction; (c) autonomy; (d) relatedness and interpersonal relationship skills; (e) self-control; and (f) prosocial attitude. Four case scenarios (model, borderline, related and contrary cases) were used to clarify the antecedents (individual factors and social/contextual factors) and consequences (individual sphere; relational/social sphere; contextual/organizational sphere) of PMeHL. Conclusion: Positive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families.

Violence in intimate relationships in adolescents: effectiveness of an intervention by peers through forum theater.

OBJECTIVE: The main goal was the peer evaluation of the effectiveness of a health education intervention, also seeking the characterization of violent behaviors experienced by teens in intimate relationships. METHOD: A pretest-posttest quasi-experimental study was performed with a non-probabilistic sample of 197 teens of both genders without control group. The intervention performed consisted of one peer-run forum theater session about intimate violence in dating relationships of teens. RESULTS: Boys reported being both victims and perpetrators of violent behaviors more frequently than girls. The sample reported more behaviors associated with victimization than perpetration. Girls showed a higher level of knowledge on the topic and this knowledge increased after the intervention. CONCLUSION: Psychological violence is highly prevalent in dating relationships, particularly in cases of victimization. It seems essential to understand and act upon adolescents' perceptions about what violent behavior is. This study confirmed the effectiveness of health education in acquiring knowledge on this topic.

Violence in intimate relationships in adolescents: effectiveness of an intervention by peers through forum theater / Violência nas relações íntimas entre adolescentes: eficácia de uma intervenção mediada por pares por meio do teatro-fórum / Violencia en las relaciones íntimas entre adolescentes: efectividad de una intervención mediada por pares mediante el teatro fórum

Abstract Objective: The main goal was the peer evaluation of the effectiveness of a health education intervention, also seeking the characterization of violent behaviors experienced by teens in intimate relationships. Method: A pretest-posttest quasi-experimental study was performed with a non-probabilistic sample of 197 teens of both genders without control group. The intervention performed consisted of one peer-run forum theater session about intimate violence in dating relationships of teens. Results: Boys reported being both victims and perpetrators of violent behaviors more frequently than girls. The sample reported more behaviors associated with victimization than perpetration. Girls showed a higher level of knowledge on the topic and this knowledge increased after the intervention. Conclusion: Psychological violence is highly prevalent in dating relationships, particularly in cases of victimization. It seems essential to understand and act upon adolescents' perceptions about what violent behavior is. This study confirmed the effectiveness of health education in acquiring knowledge on this topic.

Resumo Objetivo: O principal objetivo foi a avaliação por pares da eficácia de uma intervenção educacional em saúde, também buscando a caracterização de comportamentos violentos vivenciados por adolescentes nas relações íntimas. Método: Um estudo quase-experimental pré e pós teste foi realizado com uma mostra não probabilística de 197 adolescentes de ambos os gêneros sem grupo controle. A intervenção realizada consistiu de uma sessão de teatro-fórum entre pares sobre violência íntima nos relacionamentos amorosos entre adolescentes. Resultados: Os meninos relataram ser tanto vítimas quanto perpetradores dos comportamentos violentos mais frequentemente do que as meninas. A amostra relatou mais comportamentos associados à vitimização do que perpetração. As meninas mostraram um nível mais alto de conhecimento sobre o assunto e esse conhecimento aumentou após a intervenção. Conclusão: A violência psicológica é altamente prevalente nos relacionamentos amorosos, particularmente nos casos de vitimização. Parece essencial compreender as percepções dos adolescentes sobre o que é um comportamento violento e agir nesse sentido. Este estudo confirmou a eficácia da educação em saúde na aquisição de conhecimento sobre esse tópico.

Resumen El principal objetivo: fue la evaluación por pares de la efectividad de una intervención educativa en salud, también buscando la caracterización de comportamientos violentos vividos por adolescentes en las relaciones íntimas. Método: Un estudio cuasi-experimental pre y post prueba fue llevado a cabo con una muestra no probabilística de 197 adolescentes de ambos géneros sin grupo control. La intervención realizada se constituyó en una sesión de teatro fórum entre pares acerca de la violencia íntima en las relaciones amorosas entre adolescentes. Resultados: Los chicos relataron ser tanto víctimas como perpetradores de los comportamientos violentos con más frecuencia que las chicas. La muestra relató más comportamientos asociados con la victimización que la perpetración. Las chicas mostraron un nivel más alto de conocimiento acerca del tema y dicho conocimiento se incrementó después de la intervención. Conclusión: La violencia psicológica es altamente prevaleciente en las relaciones amorosas particularmente en los casos de victimización. Parece esencial comprender las percepciones de los adolescentes acerca de qué es un comportamiento violento y actuar en ese sentido. Este estudio confirmó la efectividad de la educación sanitaria en la adquisición de conocimiento sobre ese tópico.

Impacto de uma intervenção no estigma em saúde mental e ansiedade intergrupal / Impacto de una intervención sobre el estigma en salud mental y ansiedad intergrupal / Impact of an intervention on stigma in mental health and intergroup anxiety

Resumo Objetivo Avaliar a eficácia de uma intervenção na redução das atitudes estigmatizantes e ansiedade perante o doente mental em estudantes de enfermagem. Métodos Estudo quase experimental, realizado com uma amostra intencional de 99 estudantes de enfermagem de um instituto universitário da região centro de Portugal. No grupo de controlo, os estudantes desenvolveram o plano de ensino clínico em Enfermagem de saúde mental e psiquiátrica em serviços de psiquiatria, conforme o plano de estudos (n=50). No grupo de teste, além de cumprirem o plano de estudos, os estudantes participaram de um programa psicoeducativo dirigido ao estigma (n=49). Utilizaram-se as versões portuguesas da Mental Illness: Clinicians' Attitudes Scale (MICA-4) e AQ27 para avaliação do estigma e a Intergroup Anxiety Scale (EAI) para medir a ansiedade intergrupal. Resultados A amostra apresenta homogeneidade de variáveis no momento inicial (p>0,05), com melhorias estatisticamente significativas das atitudes estigmatizantes e redução da ansiedade perante o doente mental em ambos os grupos (p<0,005). O impacto da intervenção não foi significativo, tendo o grupo de teste melhorado as atitudes estigmatizantes de medo (p=0,03) e piorado relativamente à ajuda (p= 0,04). Conclusão Verificou-se um impacto positivo do ensino clínico na redução da ansiedade perante o doente mental, conduzindo a uma redução do estigma em saúde mental. A intervenção dirigida ao estigma não revelou efeitos significativos no estigma global nem na ansiedade intergrupal o que aponta para a necessidade futura da sua reformulação e comparação com amostras de estudantes de outras instituições de ensino de enfermagem.

Resumen Objetivo Evaluar la eficacia de una intervención en la reducción de actitudes estigmatizantes y ansiedad ante la persona con enfernedad mental en estudiantes de Enfermería. Métodos Se trata de un estudio cuasi experimental, realizado con un muestreo intencional de 99 estudiantes de Enfermería de un instituto universitario de la región centro de Portugal. En el grupo de control, los estudiantes realizaron el plan de enseñanza clínica en enfermería de salud mental y psiquiátrica en servicios de psiquiatría, de acuerdo con el plan de estudios (n=50). En el grupo experimental, además de cumplir con el plan de estudios, los estudiantes participaron en un programa psicoeducativo orientado al estigma (n=49). Se utilizaron las versiones portuguesas de la Mental Illness: Clinicians' Attitudes Scale (MICA-4) y AQ27 para evaluar el estigma y la Intergroup Anxiety Scale (EAI) para medir la ansiedad intergrupal. Resultados La muestra presentó homogeneidad de variables en el momento inicial (p>0,05), con mejoras estadísticamente significativas de las actitudes estigmatizantes y reducción de la ansiedad ante la persona con enfermedad mental en ambos grupos (p>0,005). El impacto de la intervención no fue significativo: el grupo experimental mejoró las actitudes estigmatizantes de miedo (p=0,03) y empeoró relativamente la ayuda (p=0,04). Conclusión Se verificó un impacto positivo de la enseñanza clínica en la reducción de la ansiedad ante la persona con enfermedad mental, lo que lleva a una reducción del estigma en salud mental. La intervención orientada al estigma no reveló efectos significativos en el estigma global ni en la ansiedad intergrupal, lo que advierte la necesidad futura de su reformulación y comparación con muestras de estudiantes de otras instituciones educativas de Enfermería.

Abstract Objective To assess the effectiveness of an intervention to reduce stigmatizing attitudes and anxiety towards people with mental illness among nursing students. Methods This was a quasi-experimental study including an intentional sample of 99 nursing students from university of Central Portugal. In the control group, students developed the clinical teaching plan in mental health and psychiatric nursing in psychiatric health services, according to the syllabus (n=50). In the experimental group, in addition to complying with the syllabus, the students participated in a psychoeducational program oriented towards stigma (n=49). To assess stigma, the Portuguese versions of Mental Illness: Clinicians' Attitudes Scale (MICA-4) and AQ27 were used; and to measure intergroup anxiety, the Intergroup Anxiety Scale (IAS). Results The sample presents homogeneous variables in the initial time (p>0.05), with statistically significant improvement of stigmatizing attitudes and reduction of anxiety towards people with mental illness in both studied groups (p<0.005). The impact of the intervention was not significant, the experimental group improved stigmatizing attitudes regarding fear (p=0.03) and the ones regarding help had worsened (p= 0.04). Conclusion We verified a positive impact of clinical teaching in the reduction of anxiety towards people with mental illness, which led to a reduction of stigma associated to mental health. The intervention oriented towards stigma did not reveal significant effects concerning global stigma, nor intergroup anxiety, which showed the future necessity of its reformulation and comparison with samples of students from other nursing universities.

Health-promoting behaviors: psychometric properties of an assessment tool / Comportamientos promotores de la salud: propiedades psicométricas de un instrumento de evaluación / Comportamentos promotores de saúde: propriedades psicométricas de um instrumento de avaliação

Aiming to evaluate the psychometric properties of an instrument to assess the levels of health promoting behaviors, as well as to encounter those same levels related to their age, sex and graduation in a sample of 1213 Portuguese adolescents, the study was conducted of a quantitative, descriptive, correlational, retrospective and cross-sectional. The instrument has good internal consistency (Cronbach's Alpha de 0,889) and reasonable correlations between items (entre -0,009 e 0,788), confirming the six factors defined by the authors of the scale. Levels of health-promoting behaviors in the sample are good (x=3,70), being higher in girls than boys, and youth to the detriment of younger older. Thus demonstrates the reliability of the instrument in the assessment of healthy behavior in portuguese adolescents, as well as the need for an health intervention in this population.

Con el objetivo de evaluar las propiedades psicométricas de un instrumento para evaluar los niveles de comportamientos promotores de la salud, así como para conocerlos en una muestra de 1213 adolescentes portugueses en relación a su edad, sexo y años de escolaridad, se realizó este estudio de tipo cuantitativo, descriptivo, correlacional, retrospetivo y transversal. El instrumento tiene buena consistencia interna (Cronbach's Alpha de 0,889) y correlación razonable entre los elementos (entre -0,009 e 0,788), confirmado por los seis factores definidos por los autores de la escala. Los niveles de comportamientos promotores de la salud en la muestra son buenos (x=3,70), siendo mayor en las niñas que en los niños, y la juventud en detrimento de los jóvenes mayores. Por lo tanto se demuestra la confiabilidad del instrumento en la evaluación de los comportamientos saludables en los adolescentes portugueses y la necesidad de una intervención de salud en esta población.

Com o objetivo de avaliar as propriedades psicométricas de um instrumento de avaliação dos níveis de comportamentos promotores de saúde, bem como de conhecer esses mesmos níveis numa amostra de 1213 adolescentes portugueses, em relação à sua idade, sexo e ano de escolaridade, foi realizado este estudo, de caráter quantitativo, descritivo-correlacional, retrospetivo e transversal. O instrumento apresenta bons valores de consistência interna (Cronbach's Alpha de 0,889) e razoáveis correlações entre itens (entre -0,009 e 0,788), confirmando-se os seis fatores definidos pelos autores da escala. Os níveis de comportamentos promotores de saúde na amostra são bons (x=3,70), sendo mais elevados nas raparigas do que nos rapazes, e nos jovens mais novos em detrimento dos mais velhos. Demonstra-se assim a fiabilidade do instrumento na avaliação dos comportamentos promotores de saúde nos adolescentes portugueses, e a necessidade de uma intervenção em saúde, nesta população.

Crianças em perigo: o papel das Comissões de Proteção de Menores em Portugal / Children at risk: the role of Commissions for the Protection of Minors in Portugal

Since children have been acknowledged as an autonomous social group, it has become necessary to create adequate laws to protect their fundamental rights, including the right to education, health, and affection. However, despite significant progress for childhood worldwide, children's fundamental rights are still not ensured. It is thus important to reflect on the way laws for the protection of children have developed, analyzing their original objectives and principles and the means used in their enforcement. This article discusses the role of the Commissions for the Protection of Minors at Social Risk in Portugal.