Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients

Prevalence and associated factors of passive suicidal ideation in a population treated by a community mental health unit

BACKGROUND

Suicide is a major public health problem affecting an increasing number of people. It is a complex and multicausal phenomenon whose first step is passive suicidal ideation (PSI). The identification of people with PSI could facilitate specific interventions with those who are at greater risk and/or suffering.

AIMS

To explore the frequency of passive suicidal ideation (PSI) and its association with sociodemographic, psychological, and psychopathological variables in a sample of persons seen in first consultation in a community mental health unit.

METHODS

Data from 2,354 persons seen in first consultation in a community mental health unit were analyzed. Descriptive statistics were used for quantitative variables, and frequency distribution was used for qualitative variables. Differences between groups were explored using the t-test for independent groups and Chi-square for qualitative variables.

RESULTS

The results showed a high frequency of these ideas in the analyzed sample, with a notable prevalence where more than half of the subjects (55.6%) reported experiencing these ideas in the last 2 weeks. There was a significant association of these ideas with sociodemographic variables such as age, type of cohabitation, and employment status. Likewise, significant positive associations were observed with symptom severity (depressive and anxious) and with the functional impact of these symptoms, with an increase in the PSI as symptom intensity and functional impact increase. Experiential avoidance and social support also showed a highly significant association with PSI. There was an increase in PSI as experiential avoidance increased and a decrease in PSI as social support increased.

CONCLUSIONS

The high prevalence of PSI within the clinical mental health sample highlights the critical need for targeted interventions. The significant associations with sociodemographic variables, symptom severity, functional impact, experiential avoidance, and social support emphasize the multifaceted nature of PSI and the importance of addressing these factors in clinical practice to effectively reduce PSI and improve overall mental health outcomes.

Psychopathological and interpersonal factors associated with suicide attempts in Mexican clinical patients with and without a history of child sexual abuse

Suicidal behavior in the Mexican population is understudied, and there is a paucity of research exploring the role of psychological factors and of the interpersonal theory of suicide in this population. The objectives of this work were: to explore the associations between interpersonal and psychopathological variables and suicide attempts. We also explored psychopathological differences in suicidal behavior between patients with a history of child sexual abuse and those without and examined the most accurate predictors of suicide attempts in the study sample. Finally, we tested the mediation between related variables. Results showed that the most accurate predictors of suicide attempts were perceived burdensomeness, suicidal ideation, and suicide plans. Patients with a history of child sexual abuse differed in levels of depressive symptoms, hopelessness, perceived burdensomeness, and NSSI frequency. Suicide plans mediated the associated between perceived burdensomeness and suicide attempts. Clinical and intervention implications are discussed.

Understanding the role of positive body image in chronic low back pain: A path-analytic model

Chronic low back pain (CLBP) is a prevalent and disabling condition that significantly affects individuals' quality of life. Recently, the cognitivebehavioral model of body image and chronic pain has emphasized the influence of body image on the course of this condition. Nevertheless, the role of positive body image constructs, such as body appreciation and appreciation of body functionality, in CLBP remains underexplored. This study examined associations between body appreciation and functionality appreciation with pain intensity and interference in individuals with CLBP, with pain catastrophizing and kinesiophobia as potential mediators. A sample of 99 Spanish adults suffering from CLBP completed self-report measures. The path-analytic model showed an acceptable fit. While body appreciation showed no significant associations, functionality appreciation was negatively associated with pain catastrophizing, which in turn was positively associated with both pain intensity and interference. Indirect associations revealed that pain catastrophizing mediated the relationships between functionality appreciation and both pain outcomes. These results suggest the potential role of functionality appreciation in relation to pain outcomes in CLBP, with pain catastrophizing mediating these associations, highlighting the need for research examining whether targeting positive body image constructs, especially functionality appreciation, in pain management interventions could influence CLBP outcomes.

Losses Related to Breast Cancer Diagnosis: The Impact on Grief and Depression Symptomatology Within the Context of Hispanic/Latina Patients with Breast Cancer

Objective: The present study explored the association between the losses incurred due to breast cancer diagnosis, symptoms of depression, PANIC/GRIEF, and contextual factors within the context of Hispanic/Latina (H/L) patients diagnosed with breast cancer (BC). Methods: This study was a cross-sectional study of adult H/L BC patients (n = 129). The participants were H/L women diagnosed with breast cancer (stages 0-4) in the past five years. Sociodemographic variables were assessed, as well as depression symptoms (Patient Health Questionnaire-9; Spanish version), grief (The Affective Neuroscience Personality Scales, Grief subscale; Spanish version), and general losses (Grief diagnostic instrument for general practice, loss categories section). Results: The mean age for the sample was 55.37 (SD = 11.57). The most frequent non-death-related losses were loss of liberty (f = 63, p = 48.8%), followed by fear of own death (f = 67, p = 51.9%) and loss of quality of life (f = 65, p = 50.4%). A higher mean rank was observed in depressive symptomatology scores for those who experienced loss of liberty (U = 73.91, p < 0.008), quality of life (U = 77.30, p < 0.001), and fear of their own death (U = 74.88, p < 0.002). The results indicate a significant positive relationship between the number of reported losses and depressive symptomatology (r = 0.340, p < 0.001). In terms of contextual factors, the participants who reported their income not being enough to cover their expenses reported a greater number of losses related to diagnosis (U = 74.67, p < 0.001) and more depressive symptomatology (U = 69.84, p = 0.041). Moreover, a relationship was observed between grief and academic levels (r = -0.234, p = 0.008). Likewise, a relationship was observed between age and the number of losses (r = -0.461, p < 0.001). Conclusions: Our results provide new evidence on how primary non-death-related losses due to a breast cancer diagnosis impact the mental health of H/L BC patients.

Evaluation of a meaning in life intervention applied to work: A randomized clinical trial

Meaning-based interventions have demonstrated promising outcomes in enhancing meaning in life. However, understanding their efficacy in diverse contexts requires further research. This study aims to investigate the effectiveness of a meaning-based intervention in a military sample and the impact of incorporating an additional emotion regulation module into the intervention. We conducted a randomized three-group parallel trial with active-duty military personnel: a waitlist control group (n = 21), a meaning-based intervention group (n = 42), and a meaning-based intervention with emotion regulation group (n = 43). Both intervention groups received six 2-hour sessions and a follow-up session 4 months later. Meaning in life and work-related variables, as well as well-being, depression, emotion regulation, and work-related factors, were assessed using a mixed-factorial analysis of variance (ANOVA). The results showed that only the meaning-based intervention with an emotion regulation component significantly increased the presence of meaning in life. We also observed a trend toward improved well-being scores over time that did not emerge for the other intervention. This study provides initial support for the efficacy of meaning-based interventions within the military context when supplemented with emotion regulation skills.

Structural brain changes in post-COVID condition and its relationship with cognitive impairment

It has been estimated that ∼4% of individuals infected with SARS-CoV-2 will be diagnosed with post-COVID condition. Previous studies have evidenced the presence of cognitive dysfunction and structural brain changes in infected individuals; however, the relationship between structural changes and cognitive alterations in post-COVID condition is still not clear. Consequently, the aim of this work is to study structural brain alterations in post-COVID condition patients after almost 2 years of infection and their likely relationship with patients' cognitive impairment. Additionally, the association with blood biomarkers and clinical variables was also explored. One hundred and twenty-eight individuals with post-COVID condition and 37 non-infected healthy controls from the Nautilus Project (ClinicalTrials.gov IDs: NCT05307549 and NCT05307575) underwent structural brain magnetic resonance imaging and a comprehensive neuropsychological assessment. A subsample of 66 post-COVID participants also underwent blood extraction to obtain levels of blood biomarkers. Cortical thickness and subcortical volumes were obtained and analysed using FreeSurfer (v7.1). FMRIB Software Library software (v6.0.4) was used to perform grey matter voxel-based analysis and to study microstructural white matter integrity. Patients with post-COVID performed significantly worse in working and verbal memory, processing speed, verbal fluency and executive functions, compared to healthy controls. Moreover, patients with post-COVID showed increased cortical thickness in the right superior frontal and the right rostral middle frontal gyri that negatively correlated with working memory performance. Diffusion tensor imaging data showed lower fractional anisotropy in patients in the right superior longitudinal fasciculus, the splenium and genu of the corpus callosum, the right uncinate fasciculus and the forceps major, that negatively correlated with subjective memory failures. No differences in blood biomarkers were found. Once patients were classified according to their cognitive status, post-COVID clinically cognitively altered presented increased cortical thickness compared to those classified as non-cognitively altered. In conclusion, our study showed that grey and white matter brain changes are relevant in this condition after almost 2 years of infection and partly explain long-term cognitive sequelae. These findings underscore the critical importance of monitoring this at-risk population over time.

Efficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial

BACKGROUND

Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems.

OBJECTIVE

This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings.

METHODS

A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to "intervention + iTAU" (combining a face-to-face intervention with a supporting web-based program) or "iTAU" alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future.

RESULTS

At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=-0.34, 95% CI -0.64 to -0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=-0.15, bootstrapped 95% CI -0.28 to -0.03; negative affect: indirect effect=-0.14, bootstrapped 95% CI -0.28 to -0.02).

CONCLUSIONS

This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/S12888-019-2037-3.

Associations between depression and nature-based recreation: A cross-sectional study of adults in the United States, Spain, and Brazil

Cumulating evidence suggests that nature-based interventions may alleviate depression, but the association between engagement in nature-based activities and specific depressive symptoms remains unknown. We conducted a cross-sectional study to investigate how Major Depressive Disorder (MDD) symptom criteria relate to engagement in nature-based recreation (any nature-based activities, forest-based activities, gardening, nature-based adventure activities) among American (n = 606), Spanish (n = 438), and Brazilian (n = 448) adults (≥ 18 years old). People who reported engaging in any nature-based activities at least once per month reported experiencing all nine symptom criteria for MDD (e.g., anhedonia, feeling depressed or hopeless, sleep problems, trouble concentrating, and suicidal ideation) at lower rates than those who did not participate in nature-based recreation as frequently. Results were relatively consistent across countries and types of nature-based activities, suggesting that many forms of nature-based recreation are negatively correlated with the nine symptom criteria for MDD. The associations tended to be weaker overall among Spanish respondents. Nature-based recreation appeared to have a stronger inverse relationship with suicidal ideation than with other depressive symptoms. The cross-sectional design of this study limits the causal interpretation of the observed associations. If future experimental studies confirm our findings, practitioners across different countries can consider recommending participation in nature-based recreation to alleviate their clients' MDD symptoms.

Self-Perceptions of Aging and Loneliness Interact when Predicting Cognition in Older Adults

There is growing interest in the link between self-perceptions of aging (SPA) and cognition in older adults. This study evaluates the relationship between SPA dimensions and objective cognition and its interaction with loneliness. A sample of 184 community-dwelling Spanish older adults aged 65 and above was recruited. The short form of the Aging Perceptions Questionnaire (APQ-S) was used along with a neuropsychological battery and sociodemographic and health measures. The findings reveal links between negative consequences and processing speed; chronic time and inhibition; cyclical time and selective and alternating attention; and emotional representations and inhibition, selective attention, and working memory. SPA dimensions were found to moderate the relationship of loneliness on processing speed and selective attention. This study offers evidence of the differential link between SPA dimensions and cognition as well as their interaction with loneliness, which is valuable for designing intervention programs that promote cognitive health and active aging.

Effectiveness of a Web-Based Self-Guided Intervention (MINDxYOU) for Reducing Stress and Promoting Mental Health Among Health Professionals: Results From a Stepped-Wedge Cluster Randomized Trial

BACKGROUND

The high levels of sustained stress that health professionals often experience are a significant risk factor for developing mental health problems, such as anxiety, depression, and somatic symptoms, that not only affect their well-being but also have major social and organizational consequences. Different interventions, including those based on third-wave psychotherapy principles (ie, mindfulness, compassion, and acceptance), have proven to be effective in reducing stress in this population. Among them, those delivered on the web constitute a promising alternative with notable advantages in accessibility and flexibility, but some adherence inconveniences may limit their efficacy.

OBJECTIVE

This study aimed to evaluate the effectiveness of the MINDxYOU program, a web-based self-guided intervention based on third-wave psychotherapy principles, to reduce perceived stress and promote mental health in a sample of health professionals.

METHODS

In a stepped-wedge cluster randomized design, 357 health professionals from health centers in Aragon and Málaga, Spain, were recruited. They were divided into 6 clusters-3 per region-and randomly assigned to 1 of the 3 sequences, each starting with a control phase and then transitioning to the intervention phase (the MINDxYOU program) after 8, 16, or 24 weeks. This self-guided, web-based program, designed to be completed over 8 weeks, included weekly contact (via WhatsApp, call, or email) from the research team to promote adherence. Participants were assessed on the web every 8 weeks for 5 assessments. Perceived stress was the study's primary outcome, with additional measures of clinical factors (anxiety, depression, and somatization) and process variables (resilience, mindfulness, compassion, and acceptance).

RESULTS

The program was initiated by 229 participants, 112 (48.9%) of whom were completers (ie, completed at least 3 of the 4 modules). Perceived stress demonstrated a significant reduction both when considering the entire sample (β=-1.08, SE 0.51; P=.03) and the sample of completers (β=-1.84, SE 0.62; P=.003). The proportion of participants reflecting "low stress" increased after the treatment (n=90, 46.6% vs n=100, 28.8% at baseline). Intracluster analysis revealed that pre- versus postintervention moderate effects were present in 2 clusters (Cohen d=0.46 and 0.62), and these were maintained in subsequent assessments. The linear mixed-effects models also showed that depression, anxiety, and somatization, as well as resilience, self-compassion, and some mindfulness facets, experienced significant improvements (P<.05) when comparing the intervention and control phases.

CONCLUSIONS

The MINDxYOU program was effective in reducing perceived stress and promoting mental health, as well as increasing resilience, mindfulness facets, and self-compassion. These effects suggest that participants experienced a tangible improvement that could potentially enhance their well-being. Adherence to the intervention was moderate, while program use was notable compared to similar interventions. Finding ways to promote adherence to the intervention would contribute to increasing the effectiveness of this program.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/study/NCT05436717.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12912-022-01089-5.

The unfolding of psychological distress following the October 7 attack on Israel: The impact of exposure, gender, and event centrality

BACKGROUND

Mass disasters, whether natural or human-made, pose significant public health challenges, with some individuals demonstrating resilience, whereas others experience persistent emotional distress that may meet diagnostic criteria for mental health disorders. We explored key risk factors for distress following the October 7, 2023, Hamas attacks on Israel, focusing on trauma exposure, gender, and event centrality.

METHOD

A longitudinal study design was used, assessing posttraumatic distress (PTSD), depression, generalized anxiety, event centrality, and functioning at approximately three (T1; n=858) and seven (T2, n=509) months post-attack.

RESULTS

Replicating findings from war trauma literature, we documented a high comorbidity among PTSD, depression, and anxiety; greater distress in women; and a dose-response relationship between exposure and distress. Event centrality was consistently linked to distress at both time points. Extending the literature, we found that gender, exposure, and event centrality contributed to distress at each time point. Moreover, important gender-specific patterns of risk and distress were revealed. In addition, distress at T1, event centrality at T1, gender, and continuous exposure contributed to distress at T2. Whereas distress and event centrality remained stable, functioning improved significantly from T1 to T2, highlighting the different trajectories of distress and recovery.

CONCLUSIONS

Personalized approaches and continuous monitoring of individuals exposed to cumulative trauma are highlighted. The importance of assessing multiple indices of trauma - distress, functioning, and meaning -to address mental health needs in the wake of mass disasters is emphasized.

Patient-reported outcome measures to assess mental and physical health status, functionality, and quality of life in patients with major depression or schizophrenia

BACKGROUND

Patient-reported outcomes measures (PROMs) are standardized self-administered tools that assess the patient's opinion on the level of health, quality of life, and disability among other aspects. The objective of this study was to gather information on physical and mental health in patients with major mental illness using PROMs.

METHODS

This was an observational, naturalistic, prospective study carried out in adult stabilized outpatients attended at nine Adult Mental Health Centers in Barcelona, Spain. All participants had a confirmed diagnosis of major depression disorder or schizophrenia (DSM-5) and were currently on drug treatment. Participants (n = 508) self-completed a baseline questionnaire for clinical data and PROMs scales (PHQ-19, SF-12, and WHODAS 2.0) at baseline and 9 months thereafter (n = 482).

RESULTS

Mean (SD) age was 50.9 (13.2) years, and 83% of patients lived with their families. Although 93.9% of patients recognized having a mental illness, 15.7% did not know their diagnosis. When asked if they considered that during the last year their treatment had offered some type of improvement, 83.9% answered affirmatively. Patients reported that their degree of adherence to treatment was high (77%) and most of them (80%) believed the medication had a beneficial effect. Depressed patients showed both at baseline and at follow up significantly more depressive symptoms than the group with schizophrenia. In the schizophrenia group, a statistically significant improvement in depressive symptoms was noted at 9 months follow-up. We did not find significant differences within or between groups in quality of life (SF-12 scores) obtained at baseline and after 9 months of follow-up Both at baseline and at follow-up, patients with depression reported a significantly higher degree of disability (WHODAS scores) than those with schizophrenia.

CONCLUSIONS

PROMs can be used in real-world conditions to assess severity of disease, quality of life, and disability in major depression and schizophrenia. The present results are relevant for both patients and clinicians.

Pain as a Symptom of Mental Health Conditions Among Undocumented Migrants in France: Results From a Cross-Sectional Study

Objectives

This study aimed to explore the associations between mental health status and experienced pain among undocumented migrants (UMs) in France.

Methods

We used data from the multicentric cross-sectional "Premier Pas" study conducted in the Parisian and Bordeaux regions from February to April 2019. Participants over 18 years of age were recruited from sixty-three sites. Pain was assessed through two variables: overall pain and musculoskeletal pain. Mental health conditions, including anxiety, sleep disorders, depression, and posttraumatic stress disorder (PTSD) were evaluated. Logistic regression models were used to explore associations, controlling for social determinants of health (SDHs).

Results

Our findings revealed significant associations between mental health status and pain among the 1,188 included participants. Sleep disorder was associated to higher odds of musculoskeletal pain (aOR = 2.53, 95% CI [1.20-5.33], p = 0.014). Stratified results indicated that among women, depression was associated to higher odds of pain (aOR = 4.85, 95% CI [1.53-13.36], p = 0.007).

Conclusion

This large study confirms the connection between mental health status and pain among UMs, providing valuable evidence for clinicians to address mental health issues in this population.

Trajectories of antidepressant use and 6-year change in body weight: a prospective population-based cohort study

Background

Antidepressant drug treatment may be associated with weight gain, but long-term studies are lacking.

Methods

We included 3,127 adults (1,701 women) from the REGICOR study, aged 55.6 (SD = 11.6) years on average in 2003-2006, living in the northeast of Spain. They had data at two time points (baseline and a median of 6.3 years later) on self-reported antidepressant use, body weight and height, and on baseline smoking, physical activity, diet quality, education, civil status, and depressive symptoms assessed with the Patient Health Questionnaire (PHQ-9) at follow-up. We defined four trajectories of antidepressant use as follows: never use, new use at follow-up, initial use discontinued, repeated use at both time points. We used multivariable linear models to estimate the association of these trajectories with the percentage of weight change. In people without obesity at baseline (n = 2,404), we also estimated the association with obesity incidence at follow-up.

Results

The average 6-year weight gain was 0.53 kg (1.01% body weight), and 24.5% of the participants gained >5% of body weight. The majority (83.6%) of participants did not report any use of antidepressants, 6.2% initiated during follow-up, 5.1% discontinued it, and 5.1% reported their use at both time points. In multivariable analyses, compared to never users, all trajectories were associated with greater weight gain: +1.78% (0.57, 2.98) for initial use discontinued, +2.08% (0.97, 3.19) for new use at follow-up, and +1.98% (95% CI: 0.75, 3.20) for repeated use. In non-obese participants at baseline (n = 2,404), the odds ratio for becoming obese was 2.06 (1.03, 3.96) for repeated use and non-statistically significant for the other trajectories.

Conclusions

In a population-based adult cohort, repeated use of antidepressants was strongly associated with weight gain. New and discontinued use was associated with weight gain, but non-significantly to obesity incidence. Given the global obesity epidemic and the widespread use of antidepressants, weight management and metabolic monitoring should be encouraged and integrated into depression follow-up guidelines alongside antidepressant prescriptions.

Do we interpret ambiguity and feel according to how we define ourselves? Relationships between self-perception, interpretation biases, and their role on emotional symptoms

Introduction

In today's fast-paced world, depression and anxiety are the most prevalent health problems, generating high economic and social burdens. Interpretation biases seem to play a pivotal role in this emotional problems, influencing how individuals interpret emotionally ambiguous information. These interpretation biases can emerge due to the activation of latent schemas related to how individuals perceive themselves. Therefore, integrating the study of cognitive and self-discrepancy models can offer a comprehensive approach to better understanding the onset or maintenance of emotional symptoms, through their relationship with interpretation biases. In this paper, we aimed to test whether differences in self-perception might act like a cognitive schema that activate cognitive bias, influencing information processing and predicting emotional symptoms.

Method

Seventy-three undergraduates completed two different experimental tasks, evaluating self-discrepancies and self-referential negative interpretation bias. Moreover, emotional symptoms were collected after completing the tasks and 1-2 months after, prior to coping with a natural stressor (exam period). The main analyses comprised mediational models, both cross-sectional and longitudinal, with the aim to test whether interpretation bias might act like a mediator in the relation between self-discrepancies and emotional symptoms.

Results

First, the results showed significant correlations between higher levels of self-discrepancies (actual-ideal and actual-ought) and higher levels of emotional symptoms (depression and anxiety), as well as with higher negative interpretation biases. Further, cross-sectional mediational models showed that negative interpretation biases partially mediated the relationship between self-discrepancies and emotional symptoms. As for the longitudinal mediation analysis, interpretation bias only mediated the specific relation between actual-ideal self-discrepancies and increases in anxiety symptoms, while the rest of the indirect effects were not significant.

Discussion

These results suggest that self-discrepancies could be understood as indices of the activation of latent cognitive schemas, which would influence subsequent stages of information processing, such as negative interpretations of ambiguous information, partly accounting for the emergence and/or maintenance of emotional symptoms.

Efficacy and safety of a non-immersive virtual reality-based neuropsychological intervention for cognitive stimulation and relaxation in patients with critical illness: study protocol of a randomized clinical trial (RGS-ICU)

BACKGROUND

Experiencing a critical illness may be a stressful life event that is also associated with cognitive dysfunction during and after the intensive care unit (ICU) stay. A deep-tech solution based on non-immersive virtual reality, gamification and motion capture called Rehabilitation Gaming System for Intensive Care Units (RGS-ICU) has been developed that includes both cognitive stimulation and relaxation protocols specifically designed for patients with critical illness. This study aims to evaluate whether the cognitive and relaxation protocols of the RGS-ICU platform are 1) effective in improving neuropsychological outcomes during and after ICU stay and 2) safe for patients with critical illness.

METHODS

This is a study protocol for a multicenter longitudinal randomized clinical trial. At least 80 patients with critical illness will be included: 40 experimental subjects and 40 control subjects. Patients in the experimental group will receive daily 20-min sessions of cognitive stimulation and relaxation with the RGS-ICU platform adjuvant to standard ICU care in their own rooms during the ICU stay and until discharge from the ICU or up to a maximum of 28 days after randomization, provided they are alert and calm. Patients in the experimental group will be constantly monitored as part of standard ICU care to ensure the safety of the intervention and that no avoidable adverse events occur. Patients in the control group will receive standard ICU care. The primary outcome is objective cognition 12 months after ICU discharge, assessed with a composite index including measures of attention, working memory, learning/memory, executive function and processing speed. The secondary outcome is the safety of the intervention, assessed by considering the number of sessions terminated early due to unsafe events in physiological parameters. Other outcomes are comfort experienced during the ICU stay, and subjective cognition, mental health (anxiety, depression and post-traumatic stress disorder), functionality and health-related quality of life 12 months after ICU discharge.

DISCUSSION

The expected results are 1) better neuropsychological outcomes during and after the ICU stay in patients in the experimental group compared to patients in the control group and 2) that the cognitive and relaxation protocols of the RGS-ICU platform are safe for patients with critical illness.

TRIAL REGISTRATION

Clinicaltrials.gov NCT06267911. Registered on February 20, 2024.

"Validation of three scales for enhanced suicide prevention in Spanish-speaking populations: Suicidal ideation, stigma, and literacy"

BACKGROUND

Escalating suicide rates in Spain and Latin America underscore the critical need for accurate assessment and prevention tools tailored to these populations. This study aimed to culturally adapt and validate three essential scales: the Suicidal Ideation Attributes Scale (SIDAS), the Suicide Stigma Scale - Short Form (SOSS-SF), and the Suicide Literacy Scale - Short Form (LOSS-SF).

METHOD

A total of 678 participants (including 150 with suicidal ideation) completed an online survey. The scales underwent rigorous back-translation and adaptation by native speakers from Spain and Latin America. SIDAS and SOSS-SF were validated using Confirmatory Factor Analysis (CFA), with criteria including fit indices (e.g., RMSEA, CFI). LOSS-SF underwent validation through Item Response Theory (IRT). Additionally, gender invariance was assessed across all scales.

RESULTS

CFA confirmed the original factor structures of SIDAS and SOSS-SF, demonstrating good fit indices and internal consistency. The analysis of LOSS-SF required excluding two items, resulting in a final Spanish version with 10 items and an unifactorial structure. Gender invariance was established across all scales.

CONCLUSIONS

The culturally adapted and validated scales in this study demonstrate robust reliability and validity for assessing suicidal ideation, suicide stigma, and suicide literacy among Spanish-speaking populations. These validated tools have the potential to enhance clinical assessment, inform personalized interventions, monitor public health initiatives, educate communities about suicide, and advance research in suicide prevention and treatment.

Association between different diet quality scores and depression risk: the REGICOR population-based cohort study

BACKGROUND

Our aim was to determine the association between diet quality and depression incidence in the population-based REGICOR cohort study, Catalonia, Spain.

METHODS

Prospective observational study using participants' baseline (2003-2006), follow-up (2007-2013) and clinical records data. Five diet quality scores were derived from a food frequency questionnaire (FFQ) at baseline: the relative Mediterranean Diet Score (rMED), the Modified Mediterranean Diet Score (ModMDS), a Dietary Approaches to Stop Hypertension (DASH) score, a Healthful Plant-based Diet Index (HPDI) and the World Health Organization Healthy Diet Indicator (WHO-HDI). Participants using pharmacological antidepressant treatment were excluded as a proxy for presence of depression at baseline. At follow-up, the Patient Health Questionnaire (PHQ-9) was applied to assess depressive symptoms (≥ 10 defining depressive disorder). A secondary outcome was depression diagnosis assessed through clinical records. Logistic regression and Cox proportional hazards models were used.

RESULTS

Main analysis included 3046 adults (50.3% women) with a mean age of 54.7 (SD = 11.6) years. After 6-years follow-up, 184 (6.04%) cases of depressive disorder were identified. There was 16% lower odds of depressive disorder per 1SD increase of rMED (OR = 0.84; 95%CI = 0.71-0.98). Secondary outcome analysis (n = 4789) identified 261 (5.45%) incident cases of clinical depression diagnosis over 12 years follow-up, and 19% lower risk of clinical depression was observed with the WHO-HDI (HR = 0.81; 95%CI = 0.70-0.93). Adjusting for BMI did not attenuate the findings.

CONCLUSIONS

A significant inverse association between diet quality and depression incidence was found in this population-based cohort study, independent of sociodemographic, health and lifestyle. Adherence to a healthy diet could be a complementary intervention for the prevention of depression.

Evaluation of the effectiveness of cognitive-behavioural therapy for insomnia delivered by nurses and physicians for patients in primary care (the NPD study): protocol for a cluster randomised controlled trial

INTRODUCTION

Insomnia is the most common sleep disorder, and it adversely impacts daily living and increases the risk of chronic and acute health problems. Of the few individuals who seek treatment for insomnia, most pursue help in primary care settings. The management of insomnia most commonly focuses on the prescription of hypnotics and sleep hygiene recommendations, although these are not the most effective treatments. Conversely, cognitive-behavioural therapy for insomnia (CBT-i), which is considered to be the first-line treatment for persistent insomnia, is seldom prescribed by primary care physicians (PCPs) or primary care nurses (PCNs). The hesitancy of these professionals to provide CBT-i is mainly attributed to their heavy workloads and the difficulties in acquiring the skills needed to administer this intervention.

METHODS AND ANALYSIS

A two-arm cluster-randomised study (in which patients are assigned to a PCP or PCN) will be conducted in primary health centres of Majorca Island (Spain). A total of 206 patients will be recruited. Healthcare professionals will be allocated to the intervention or control group in a 1:1 ratio. The intervention group will receive CBT-i and the control group will receive usual care. We will include patients with Insomnia Severity Index scores of 8 or more who also report that insomnia interferes with daily functioning or is noticeable to others. The CBT-i will consist of four individual structured sessions, three in person (20 min each) and one by telephone (10 min) that are administered at intervals of 2-3 weeks. An additional session will be provided for patients taking hypnotic medications. The primary outcome measure is the decrease in sleep latency, which will be measured with the Pittsburg Sleep Quality index at 6 months and 12 months.

ETHICS AND DISSEMINATION

This project was approved by the Ethical Committee of the Balearic Islands (IB 4604/21 PI) and the Primary Care Research Committee of the Department of Majorca Primary Care (PI19/24). All participants are required to provide written informed consent and no study-related procedures will be performed until consent is obtained. The trial results will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN10144646.

Psychological mediators between risk perception and psychological wellbeing in emergency healthcare workers

Healthcare workers are subjected to numerous work-related stress factors, which have negative consequences on their physical and mental health, making them a vulnerable group. The recent pandemic caused by the new coronavirus created a high demand for attention from healthcare workers, which put their mental health at risk. This study aimed to test a mediation model in which resilience and the satisfaction of psychological needs play a mediating role in risk perception, the attitude toward the management carried out by the administration, emotional intelligence on psychological wellbeing, and depressive symptoms of frontline professionals. The sample consisted of 405 healthcare professionals aged between 22 and 65 years, belonging to critical care units in southern Spain. Linear correlation and mediation analyses were performed. The results showed that psychological wellbeing had positive correlations with resilience and negative correlations with the discrepancy in the satisfaction of psychological needs. Depressive symptoms had negative correlations with resilience and positive correlations with the satisfaction of psychological needs. To explore these results further, a mediation analysis was conducted, and a large set of significant indirect effects was found.

Emotion Regulation Frequency and Self-Efficacy: Differential Associations with Affective Symptoms

Successful emotion regulation is a critical component of mental health, and difficulties with emotion regulation have been associated with a wide range of disorders, including anxiety and depressive disorders. However, although much is known about commonly used forms of emotion regulation such as cognitive reappraisal and expressive suppression, the relative contribution of two important facets of emotion regulation-frequency and self-efficacy-is not yet clearly established. To address this issue, we conducted two studies. Study 1 employed a community sample (cross-sectional N = 431; 4- to 5-month longitudinal N = 182). Study 2 employed a clinical sample (cross-sectional N = 132). Both assessed emotion regulation frequency and self-efficacy, as well as affective outcomes (anxiety and depressive symptoms). Findings indicated cognitive reappraisal self-efficacy appears to be a relevant variable understanding negative affect outcomes, cross-sectionally, longitudinally and in the clinical sample. Our findings support the process model of emotion regulation in affective symptomatology. Implications for theory and treatment are discussed.

Relationship between Problematic Internet Use and Depression in Young Latin American College Students

(1) Problematic Internet use (PIU) in young people is a topic of great interest both in the field of addictions and mental health, but scientific evidence is limited in Latin America. The aim was to analyze the relationship between PIU and depression in Latin American college students. (2) Methods: The sample consisted of 1828 college students (63.7% women), aged between 18-30 years (M = 21.64 years). (3) Results: PIU was detected in 40.2% of cases, and severe or moderately severe depression in 31.7%. Rates of severe depression in students with PIU were 3.02 times higher than in those without PIU (χ2(3) = 168.443; p < 0.000). The presence of PIU was also statistically significantly higher among youth with depressive symptoms. Linear and logistic regression models for predicting PIU, show how the depression level constitutes a risk factor for PIU: seven times higher for severe depression; more than five times higher for moderate depression; and more than two times for mild depression. (4) Conclusions: There is a clear association between depression and PIU, suggesting that a higher level of depression would act as a predictor of PIU. However, this finding is exploratory. Future studies should clarify the directionality of the relationship between both variables.

A multimodal group-based immersive virtual reality intervention for improving cognition and mental health in patients with post-covid-19 condition. A quasi-experimental design study

Introduction

Adults with Post-COVID-19 Condition (PCC) may show cognitive impairments in attention, processing speed, memory, and executive function. Multimodal programs that combine cognitive training, physical activity and emotional tasks, such as mindfulness-based interventions (MBIs), may offer a suitable alternative for improving PCC treatments. Immersive Virtual Reality (IVR) is a promising technology that can enhance traditional cognitive training, physical activity, and MBIs. The use of IVR technology may increase engagement with these interventions and potentially enhance the individual benefits of cognitive training, exercise and MBIs. The current study evaluated the impact of a multimodal IVR intervention, comparing this with a usual care intervention (control group), in order to assess changes in cognition and mental health in adults with PCC. We also aimed to assess user experience factors such as enjoyment, perceived improvement, and fatigue following each multimodal IVR session within the experimental group.

Method

Thirty-one participants with PCC symptoms were assigned to either the experimental group (IVR, n = 15) or the control group (usual care intervention, n = 16) in a quasi-experimental design study. The multimodal IVR intervention consisted of MBI, cognitive training and physical exercise and was delivered in a 60-min group session with 5 participants, twice a week, for 8 weeks (16 sessions in total). Measures of global cognition, attention, processing speed, verbal episodic memory and subjective memory complaints (primary measures), and depressive and anxiety symptoms and fatigue (secondary measures) were assessed at baseline and also after 8 weeks (post-intervention).

Results

Mixed between-group (group) and within-group (pre-post assessments) ANOVAs revealed significant group*time interactions in global cognition, simple attention, processing speed, memory and depressive symptoms, with large effect sizes (p < 0.05; partial η2 > 0.14). There was also a marginally significant group*time interaction for executive function (p = 0.05). Follow-up analyses comparing pre-and post-intervention outcomes for each group separately showed that the experimental group significantly improved in global cognition, processing speed, memory and depressive symptoms, while the control group showed no significant pre-post changes. Friedman tests showed a significant main effect of time (χ2(2) = 6.609, p = 0.04), with a gradual increase in enjoyment from the first, to the mid, and then to the final session. In addition, perceived improvement scores remained high throughout the intervention, and patient-reported fatigue levels did not fluctuate significantly throughout the intervention.

Conclusion

To our knowledge, no previous research has combined cognitive training, physical exercise and MBI using an IVR paradigm in adults with PCC. Despite their inherent limitations, our findings mark a pioneering step toward improving cognition and mental health outcomes in PCC through the innovative use of new technology and multimodal approaches. This first study should be accompanied by more extensive, randomized clinical trials aimed at further exploring and refining these interventions.

Validation of the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish Women during the Perinatal Period

Introduction

No specific instruments are available to detect the risk of suicide in women during the perinatal period. Suicide in perinatal women is little studied despite being one of the main causes of maternal mortality. Its prevalence has increased by 100% in the United States in a decade. Moreover, it has consequences for the mother and the newborn.

Objective

To validate the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish women during the perinatal period.

Materials and Methods

Cross-sectional study with Spanish women who were pregnant or who had given birth less than 18 months ago. Information was collected on sociodemographic variables, obstetric variables, and the newborn. A questionnaire that included both suicide scales and the Edinburgh Postnatal Depression Scale (EDPS) was used. An exploratory factor analysis (EFA), convergent and criterion validation, as well as internal consistency analysis, were performed.

Results

In total, 237 women participated. The EFA determined that in the Plutchik Suicide Risk Scale 4 components explained 54.8% of the variance, while in the Paykel Scale, a single component explained 53.0% of the variance. In the convergent validity, the risk of suicide or suicidal ideation was related to the Plutchik Suicide Risk Scale and the Paykel Suicide Scale, respectively, with the variables: perception of low social support, risk of intimate partner violence, level of anxiety, history of mental pathology, and having experienced a stressful event in the last year, among others (p  < 0.05). The area under the receiver operating characteristic curve for the Plutchik Suicide Risk Scale scores was 0.88 (95% CI: 0.82-0.93), and for the Paykel Scale, it was 0.90 (95% CI: 0.85-0.95). The value of Cronbach's alpha (α) was placed for the Plutchik Suicide Risk Scale at 0.806 and for the Paykel Suicide Scale at 0.766.

Conclusion

Both scales presented adequate psychometric characteristics to be used as a screening instrument for suicide risk in Spanish women in the perinatal period.

Validation of the Spanish Childhood Trauma Questionnaire-Short Form in adolescents with suicide attempts

Background

Child maltreatment is associated with a higher probability of mental disorders and suicidal behavior in adolescence. Therefore, accurate psychometric instruments are essential to assess this.

Objective

To validate the Spanish version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in adolescents with suicide attempts.

Methods

Multisite cohort study of 208 adolescents with suicide attempts using data from the following scales: Mini International Neuropsychiatric Interview (MINI), Columbia Suicide Severity Rating Scale (C-SSRS), Patient Health Questionnaire (PHQ-9), and CTQ-SF. Statistical analysis: CTQ-SF scores analyzed by descriptive statistics. Internal consistency: McDonald's omega and Cronbach's alpha. Concurrent validity with PHQ-9 and C-SSRS scores: Spearman correlation coefficient. Structural validity: Confirmatory factor analysis.

Results

Floor and ceiling effects: Physical abuse and neglect as well as sexual abuse demonstrated high floor effects (50.0, 35.1, and 61.1% of adolescents, respectively). No ceiling effects were found. The CTQ-SF had excellent internal consistency (McDonald's omega = 0.94), as did the majority of its subscales (Cronbach's alpha 0.925-0.831) except for physical neglect (0.624). Its concurrent validity was modest, and the emotional neglect subscale had the lowest Spearman correlation coefficients (0.067-0.244). Confirmatory factor analysis: Compared with alternative factor structures, the original CTQ-SF model (correlated 5-factor) exhibited a better fit [S-B χ 2 = 676.653, p < 0; RMSEA (90% CI = 0.076-0.097) = 0.087; SRMR = 0.078; CFI = 0.980; TLI = 0.978].

Conclusion

The Spanish CTQ-SF is a reliable, valid instrument for assessing traumatic experiences in adolescents at high risk of suicide. It appears appropriate for use in routine clinical practice to monitor maltreatment in this group.

Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems

There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.

Guided web app intervention for reducing symptoms of depression in postpartum women: Results of a feasibility randomized controlled trial

Background

Chile faces a significant postpartum depression prevalence and treatment gap, necessitating accessible interventions. While cognitive-behavioral internet-based interventions have proven effective in high-income countries, this field is underdeveloped in Chile. Based on the country's widespread use of digital technology, a guided 8-week cognitive-behavioral web app intervention named "Mamá, te entiendo" was developed.

Objective

This study aimed to assess the acceptability and feasibility of "Mamá, te entiendo", for reducing depressive symptomatology in postpartum women.

Methods

Sixty-five postpartum women with minor or major depression were randomly assigned to either intervention or waitlist. Primary outcomes centered on study feasibility, intervention feasibility, and acceptability. Semi-structured interviews with a sub-sample enriched the understanding of participants' experiences. Secondary outcomes included mental health variables assessed at baseline, post-intervention, and 1-month follow-up.

Results

Chilean women displayed great interest in the intervention. 44.8 % of participants completed the intervention. Participants reported high satisfaction and engagement levels, with interviewees highlighting the value of the intervention's content, exercises, and therapist's feedback. However, preliminary efficacy analysis didn't reveal a significant interaction between group and time for outcome measures.

Discussion

This research represents a pioneering effort in Chile to evaluate an internet-based intervention for postpartum depression symptoms. The demonstrated feasibility and acceptability highlight the potential of integrating technology-driven approaches into mental health interventions. However, the intervention did not demonstrate superiority, as both groups exhibited similar positive progress in several outcomes. Therefore, the following research phase should involve a larger and more diverse sample to assess the intervention's effectiveness, identify influencing factors, and determine the individuals who benefit the most.

Psychosocial factors associated with treatment preference in mental health

BACKGROUND

Studies examining the effects of incorporating patients' preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals' rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices.

AIM

This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences.

METHODS

A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied.

RESULTS

Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size.

CONCLUSIONS

There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.

Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial

INTRODUCTION

Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions.

METHODS AND ANALYSIS

People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community.

ETHICS AND DISSEMINATION

The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences.

TRIAL REGISTRATION NUMBER

NCT06046326.

Provision of Telepsychological Care Via Email during COVID-19 Confinement: An Exploratory Study

Within teletherapy, email interventions have been studied scarcely. For this reason, this exploratory study aims to characterize the assistance provided by email in a university telepsychology service and to compare the data with the assistance provided by telephone in the same service and period. For this purpose, the records of 81 users assisted via email during the COVID-19 pandemic lockdown in Spain were analyzed. The data were compared with those of the 338 users assisted by telephone in the same period. Despite its many limitations, results indicate high satisfaction with the email modality. Users express that they prefer a preference for using email when they do not feel safe in other ways. We found a lot of variation between the number of emails exchanged and the days that each case was active. Additionally, differences were found with telephone users in aspects such as age (email users being younger) and in a depression screening (email users scoring more positively). This study concludes on the high potential of this channel for the application of certain techniques (e.g., psychoeducation) or for people with certain characteristics.

Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial

BACKGROUND

Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC.

OBJECTIVE

This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting.

METHODS

A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years.

RESULTS

Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained.

CONCLUSIONS

The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/S12888-019-2037-3.

Perceived burdensomeness, thwarted belongingness, and hopelessness as predictors of future suicidal ideation in Spanish university students

The Interpersonal Theory of Suicide (IPTS) has received support for its role in understanding suicidal thoughts and behaviors. However, few longitudinal studies have focused on testing this theory in university students. The present study aimed to confirm the theoretical model of the IPTS in a sample of 225 Spanish university students, using path analysis in a longitudinal study. We assessed thwarted belongingness and perceived burdensomeness at T1 and hopelessness and suicidal ideation at T2, 12-14 weeks later. Moreover, we assessed suicidal ideation weekly for 14 weeks. Path analyses confirmed the Interpersonal Theory of Suicide model, with thwarted belongingness and perceived burdensomeness as direct and indirect predictors of suicidal ideation through hopelessness. Providers of guidance and clinical services in university settings should be trained to identify perceived burdensomeness, social belongingness, hopelessness, and suicidal ideation when screening for suicide prevention.

Relationship between Depressive Symptoms, Caregiver Strain, and Social Support with Dementia Grief in Family Caregivers

Background and Objectives: Dementia grief in family caregivers of people with dementia refers to grieving prior to the death of the care recipient. It is related to psychosocial risk factors that may have a negative impact on the health of these family caregivers. This study aimed to describe the relationship between depressive symptoms, caregiver strain, and social support with dementia grief in family caregivers of people with dementia. Materials and Methods: A descriptive correlational cross-sectional study was conducted. A total of 250 family caregivers of people with dementia participated. Dementia grief was the main variable, and depressive symptoms, caregiver strain, and social support were assessed. Additionally, socio-demographic data were collected. Descriptive statistics were calculated, and a bivariate correlation analysis and a multiple linear regression analysis were performed for dementia grief. Results: Higher scores for dementia grief were found in women, in family caregivers of patients at advanced stages of dementia, and in family caregivers with a low level of education. High levels of depressive symptoms and caregiver strain and low levels of social support indicated greater intensity of dementia grief. Depressive symptomatology was the variable with the greatest influence on dementia grief. Caregiver strain and social support also related to dementia grief, but to a lesser extent. Conclusions: In family caregivers, depressive symptoms, caregiver strain, and social support are related to the intensity of dementia grief, with a greater influence of depressive symptoms. Moreover, being female, having a low level of education, and caring for a care recipient at an advanced stage of dementia are factors associated with increased dementia grief. Concerning study limitations, the sample was restricted, belonging to a specific region of Spain and to a Provincial Federation of associations. It is necessary to exercise caution in generalizing results due to the sociodemographic and geographical characteristics of the sample.

Impact of COVID-19 first wave on the mental health of healthcare workers in a Front-Line Spanish Tertiary Hospital: lessons learned

Healthcare workers (HCWs) were at high risk of experiencing psychological distress during COVID-19 pandemic. The objective of this study was to evaluate the impact on HCWs' mental health in a Spanish hospital. Cross-sectional study of HCW, active between May and June 2020. A web-based survey assessed probable current mental disorders (major depressive disorder [PHQ-8 ≥ 10], generalized anxiety disorder [GAD-7 ≥ 10], panic attacks, post-traumatic stress disorder [PTSD; PLC-5 ≥ 7], or substance use disorder [CAGE-AID ≥ 2]). The Sheehan Disability Scale (SDS) was used to assess severe impairment and items taken from the modified self-report version of the Columbia Suicide Severity Rating Scale (C-SSRS) assessed suicidal thoughts and behaviors. A total of 870 HCWs completed the survey. Most frequent probable mental disorders were major depressive disorder (33.6%), generalized anxiety disorder (25.5%), panic attacks (26.9%), PTSD (27.2%), and substance use disorder (5.0%). Being female, having aged 18-29 years, being an auxiliary nurse, direct exposure to COVID-19-infected patients, and pre-pandemic lifetime mental disorders were positively associated with mental issues. Hospital HCWs presented a high prevalence of symptoms of mental disorders, especially depression, PTSD, panic attacks, and anxiety. Younger individuals and those with lifetime mental disorders have been more vulnerable to experiencing them.

Anxiety and suicidality in the college student population

Objective: This study examined symptoms of anxiety, depression and suicidality in a national sample of college students. Participants: Using national survey data from the Healthy Minds Study (HMS), a random sample from 184 U.S. campuses from fall 2016 to spring 2019 was analyzed (N = 119,875). Methods: Prevalence rates were examined with the Generalized Anxiety Disorder 7-Item scale, Patient Health Questionnaire-9 and suicidality questions. Relationships between anxiety, depression and suicidality were assessed through Spearman's correlations, the Kruskal-Wallis H test and logistic regressions. Results: Findings revealed that screening only for depression would pick up 23% of suicidal ideation, increasing to 35% when also screening for anxiety. Those with anxiety and no to minimal depression had the second highest likelihood of suicide attempt, following those with anxiety and depression. The symptom "feeling afraid something awful might happen" doubled the odds of suicidal ideation. Conclusions: College campuses may benefit from assessing particular anxiety symptoms in relation to suicide.

Psychological characteristics associated with chemsex among men who have sex with men: Internalized homophobia, conscientiousness and serostatus as predictive factors

Background

Although significant progress has been made in the rights of the LGBTQ+ community, even today this population still faces stigma and discrimination that impacts their mental health. In the case of men who have sex with men, it has been demonstrated that the use of drugs in a sexual context (chemsex) is one of the coping mechanisms and means of escape to deal with these situations.

Method

We assessed 284 native Spanish speakers' participants, 45,4 % were not engaged in sexualised drug use (n = 129) while 54,6 % were chemsex users (n = 155) using 18,7 % of them the injected via. The participants completed six questionnaires about life and sexual satisfaction, depression, anxiety, internalised homophobia and personality. Bivariate and multivariable logistic regression were performed to assess the associations between sexual behaviour-related and psychological variables. Kruskal-Wallis H test was used to analysed the impact on mental health of the administration via.

Results

Aged, unprotected sexual relationships, positive serostatus, homonegativity and conscientiousness predicted the chemsex engagement. Furthermore, we found differences regarding the administration via.

Conclusions

We conclude that mental health significantly correlates with the practice of chemsex, highlighting the importance of integrating mental health considerations into the prevention of risky sexual behaviors.

Caring for patients in the Covid era: Are the quality of life the same for doctors and nursing staff?

BACKGROUND

The Covid-19 pandemic has represented one of the most stressful events of recent times and has placed enormous psychological pressure on doctors and nurses.

AIMS

The objective of this work is to evaluate the psychological impact of the Covid-19 outbreak on Spanish nurses and doctors, and to identify factors related to their mental health.

METHODS

The study is a descriptive study and examined 812 doctors and 768 nurses. The dependent variables were health-related quality of life, anxiety, depression, perceived stress and insomnia. Participants completed the Health-related Quality of Life-Questionnaire, the Generalized Anxiety Disorder 7-item-Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, and the Insomnia Severity Index. Sociodemographic and Covid-related data were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were used.

RESULTS

A greater proportion of nurses than doctors suffered clinical anxiety, depression and insomnia (56.84 % vs 45.81 p-value<0.0001, 64.67 % vs 53.39 p-value<0.0001, and 23.04 % vs 18.02 p-value 0.01, respectively). Although in our study nurses were more likely to suffer clinical anxiety, stress and insomnia than doctors, our results nevertheless showed that there were no differences in terms of quality of life. Different factors related to mental health were identified for doctors and nurses. Nurses working in care homes or geriatric services (OR = 4.13, IC95% 1.71-9.99, p-value 0.002), and in services with greatest contact with Covid-19 patients (OR = 1.71,IC95% 1.10-2.68, p-value 0.02) were more likely to suffer depression.

CONCLUSIONS

Our study confirms that doctors and nurses are at high risk of clinical anxiety, depression, stress or insomnia during the Covid-19 pandemic.

Lower serum ferritin levels are associated with worse cognitive performance in aging

OBJECTIVES

Iron is important for neurogenesis, synaptic development, and neurotransmitter synthesis. Serum ferritin (SF) is a reliable marker for assessing iron stores. Therefore, we evaluated the cognitive function associated with SF levels. We also assessed brain iron content using R2* Magnetic Resonance Imaging (MRI) and its association with SF levels.

DESIGN

Data from three cross-sectional observational studies were used. Aging Imageomics (n = 1030) was conducted on aged subjects. Health Imageomics (n = 971) and IR0NMET (n = 175) were conducted in middle-aged subjects.

SETTING AND PARTICIPANTS

Participants were enrolled at Dr. Josep Trueta University Hospital facilities. The three cohorts included a total of 2176 subjects (mean age, 52 years; 48% men).

MEASUREMENTS

SF levels were measured by standard laboratory methods. Total Digits Span (TDS), and Phonemic Verbal Fluency (PVF) were used to assess executive function. Language function was assessed by semantic verbal fluency (SVF), attention by the Symbol Digit Modalities Test, and memory by the Memory Binding Tests - Total Free Recall and Total Delayed Free Recall. MRI was used to assess the iron content of the brain by R2*.

RESULTS

In subjects aged 65 years or older, SF levels were associated with increased TDS (β = 0.003, p = 0.02), PVF (β = 0.004, p = 0.01), and SVF (β = 0.004, p = 0.002) scores. After stratification by sex, these findings were significant only in men, where SF was associated with increased TDS (β = 0.003, p = 0.01), PVF (β = 0.004, p = 0.03), and SVF (β = 0.004, p = 0.009) scores. In middle-aged subjects, SF was also associated with increased SVF scores (β = 0.005, p = 0.011). Lastly, in men, SF levels were negatively associated with R2*, a surrogate marker of brain iron content, in both the left frontal inferior opercular area (r = -0.41, p = 0.005) and the right frontal inferior opercular area (r = -0.44, p = 0.002).

CONCLUSIONS

SF is significantly and positively associated with cognition. In older people with low SF levels, iron supplementation may be a promising therapy to improve cognition.

Design of a Remote Multiparametric Tool to Assess Mental Well-Being and Distress in Young People (mHealth Methods in Mental Health Research Project): Protocol for an Observational Study

BACKGROUND

Mental health conditions have become a substantial cause of disability worldwide, resulting in economic burden and strain on the public health system. Incorporating cognitive and physiological biomarkers using noninvasive sensors combined with self-reported questionnaires can provide a more accurate characterization of the individual's well-being. Biomarkers such as heart rate variability or those extracted from the electrodermal activity signal are commonly considered as indices of autonomic nervous system functioning, providing objective indicators of stress response. A model combining a set of these biomarkers can constitute a comprehensive tool to remotely assess mental well-being and distress.

OBJECTIVE

This study aims to design and validate a remote multiparametric tool, including physiological and cognitive variables, to objectively assess mental well-being and distress.

METHODS

This ongoing observational study pursues to enroll 60 young participants (aged 18-34 years) in 3 groups, including participants with high mental well-being, participants with mild to moderate psychological distress, and participants diagnosed with depression or anxiety disorder. The inclusion and exclusion criteria are being evaluated through a web-based questionnaire, and for those with a mental health condition, the criteria are identified by psychologists. The assessment consists of collecting mental health self-reported measures and physiological data during a baseline state, the Stroop Color and Word Test as a stress-inducing stage, and a final recovery period. Several variables related to heart rate variability, pulse arrival time, breathing, electrodermal activity, and peripheral temperature are collected using medical and wearable devices. A second assessment is carried out after 1 month. The assessment tool will be developed using self-reported questionnaires assessing well-being (short version of Warwick-Edinburgh Mental Well-being Scale), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) as the reference. We will perform correlation and principal component analysis to reduce the number of variables, followed by the calculation of multiple regression models. Test-retest reliability, known-group validity, and predictive validity will be assessed.

RESULTS

Participant recruitment is being carried out on a university campus and in mental health services. Recruitment commenced in October 2022 and is expected to be completed by June 2024. As of July 2023, we have recruited 41 participants. Most participants correspond to the group with mild to moderate psychological distress (n=20, 49%), followed by the high mental well-being group (n=13, 32%) and those diagnosed with a mental health condition (n=8, 20%). Data preprocessing is currently ongoing, and publication of the first results is expected by September 2024.

CONCLUSIONS

This study will establish an initial framework for a comprehensive mental health assessment tool, taking measurements from sophisticated devices, with the goal of progressing toward a remotely accessible and objectively measured approach that maintains an acceptable level of accuracy in clinical practice and epidemiological studies.

TRIAL REGISTRATION

OSF Registries N3GCH; https://doi.org/10.17605/OSF.IO/N3GCH.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51298.

Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial

BACKGROUND

There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them.

METHODS

A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories.

RESULTS

Four trajectories were identified that best explained the observed response patterns: "recovery" (64.18%), "late recovery" (10.15%), "relapse" (13.67%), and "chronicity" (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination.

CONCLUSIONS

There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.

Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus

OBJECTIVES

The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool.

METHODS

This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire.

RESULTS

MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean).

CONCLUSION

Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.

Cognitive and emotional predictors of quality of life and functioning after COVID-19

OBJECTIVE

A long-term decline in health-related quality of life (HRQoL) has been reported after coronavirus disease 2019 (COVID-19). Studies with people with persistent symptoms showed inconsistent outcomes. Cognition and emotion are important determinants in HRQoL, but few studies have examined their prognostic significance for HRQoL and functionality in post-COVID patients with persisting symptoms. We aimed to describe QoL, HRQoL, and functioning in individuals post-COVID with varying COVID-19 severities and to investigate the predictive value of cognitive and emotional variables for QoL, HRQoL, and functioning.

METHODS

In total, 492 participants (398 post-COVID and 124 healthy controls) underwent a neurobehavioral examination that included assessments of cognition, mood, QoL/HRQoL (WHOQOL-BREF, EQ-5D), and functioning (WHODAS-II). Analysis of covariance and linear regression models were used to study intergroup differences and the relationship between cognitive and emotional variables and QoL and functioning.

RESULTS

The Physical and Psychological dimensions of WHOQoL, EQ-5D, and WHODAS Cognition, Mobility, Life Activities, and Participation dimensions were significantly lower in post-COVID groups compared with a control group. Regression models explaining 23.9%-53.9% of variance were obtained for the WHOQoL-BREF dimensions and EQ-5D, with depressive symptoms, post-COVID symptoms, employment status, income, and mental speed processing as main predictors. For the WHODAS, models explaining 17%-60.2% of the variance were obtained. Fatigue, depressive symptoms, mental speed processing, and post-COVID symptoms were the main predictors.

INTERPRETATION

QoL/HRQoL and functioning after COVID-19 in individuals with persistent symptoms were lower than in non-affected persons. Depressive symptoms, fatigue, and slower mental processing speed were predictors of lower QoL/HRQoL and functioning.

Cognitive reserve, depressive symptoms, obesity, and change in employment status predict mental processing speed and executive function after COVID-19

The risk factors for post-COVID-19 cognitive impairment have been poorly described. This study aimed to identify the sociodemographic, clinical, and lifestyle characteristics that characterize a group of post-COVID-19 condition (PCC) participants with neuropsychological impairment. The study sample included 426 participants with PCC who underwent a neurobehavioral evaluation. We selected seven mental speed processing and executive function variables to obtain a data-driven partition. Clustering algorithms were applied, including K-means, bisecting K-means, and Gaussian mixture models. Different machine learning algorithms were then used to obtain a classifier able to separate the two clusters according to the demographic, clinical, emotional, and lifestyle variables, including logistic regression with least absolute shrinkage and selection operator (LASSO) (L1) and Ridge (L2) regularization, support vector machines (linear/quadratic/radial basis function kernels), and decision tree ensembles (random forest/gradient boosting trees). All clustering quality measures were in agreement in detecting only two clusters in the data based solely on cognitive performance. A model with four variables (cognitive reserve, depressive symptoms, obesity, and change in work situation) obtained with logistic regression with LASSO regularization was able to classify between good and poor cognitive performers with an accuracy and a weighted averaged precision of 72%, a recall of 73%, and an area under the curve of 0.72. PCC individuals with a lower cognitive reserve, more depressive symptoms, obesity, and a change in employment status were at greater risk for poor performance on tasks requiring mental processing speed and executive function. Study registration: www.ClinicalTrials.gov , identifier NCT05307575.

New psychometric evidence from the Revised Mental Health Inventory (R-MHI-5) in Peruvian adolescents from a network psychometrics approach

BACKGROUND

Mental health is an aspect that has been relegated in recent years, prioritizing physical health care. However, there are more and more mental problems and disorders worldwide. In this context, adolescents are considered at risk for developing psychological difficulties due to the important transition stage they are going through. Given this, an adequate measurement of mental health in the adolescent population is necessary. This research aims to evaluate the internal structure and estimate the reliability of the R-MHI-5.

METHOD

The sample covered 662 adolescents (55.2% men and 44.7% women) aged 12 to 17 years (M = 14.5; SD = 1.6).

RESULTS

Exploratory graph analysis revealed a two-dimensional structure encompassing well-being and psychological distress. Furthermore, confirmatory factor analysis results indicated that a model with two related factors demonstrated superior fit indices (CFI = 0.99; TLI = 0.99; SRMR = 0.04; RMSEA = 0.101) in comparison to a one-dimensional model (CFI = 0.85; TLI = 0.71; SRMR = 0.23; RMSEA = 0.451). Additionally, adequate values were found in the reliability of the dimensions.

CONCLUSION

It is concluded that the R-MHI-5 is an instrument with robust psychometric evidence from the perspective of the EGA and CFA, providing adequate evidence of reliability and validity so that it can be used effectively in future research and prevention and intervention processes. Furthermore, our study is the first to provide psychometric evidence of the scale from a media approach in Peruvian adolescents.

Risk and Preventive Factors for Depressive Symptoms Among Older Chilean Adults During the SARS-CoV-2 Outbreak: A Longitudinal Study

OBJECTIVE

To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile.

METHOD

A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation.

RESULTS

A total of 424 older adults were included. Female sex (β = 0.95, 95% CI: 0.22 to 1.68) and loneliness (β = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (β=-0.70, 95% CI: -1.39 to -0.02), living in company (β=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (β=-5.04, 95% CI:-6.33 to -3.75) and greater resilience (β=-0.30, 95% CI: -0.38 to -0.23) were preventive factors.

CONCLUSION

These results provide useful evidence to develop mental health prevention or control strategies for older adults.

CLINICAL IMPLICATIONS

The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life.

Post-COVID job Stressors and Their Predictive Role on Mental Health: A Cross-Sectional Analysis Between Physicians and Nurses

Introduction

Health care providers face heightened stress and increased rates of anxiety and depression post-COVID-19. The pandemic, officially declared over in May 2023, continues to impact their wellbeing significantly, with ongoing mental health monitoring and tailored interventions crucial for support.

Objectives

The aim of this study was to describe the frequency of job stressors in a sample of Spanish health care providers post-COVID and to explore potential differences between physicians and nurses, hypothesizing that while both professional categories could experience similar job stressors, some of them could have a differential impact on the mental health of each subgroup.

Methods

This cross-sectional substudy is part of the MINDxYOU project. The data were collected from 191 health care providers from two regions in Spain. Participants completed the UNIPSICO test battery, used to assess job stressors, and questionnaires to evaluate perceived stress, depressive symptomatology, anxiety, and resilience. Descriptive analyses, bivariate correlations, and linear regression models were performed to compare the two professions that were the most representative of our sample: physicians (n = 82) and nurses (n = 54).

Results

The most frequent job stressors were workload, lack of positive feedback, and inequity in social interactions. Physicians reported worse outcomes in terms of workload, autonomy, role conflicts, inequity in social interactions, and work-family balance compared to nurses. Mobbing, despite not being very frequent, significantly predicted different mental health outcomes for both physicians and nurses. Inequity in social interactions and job satisfaction were significant predictors of physicians' mental health, while role ambiguity, interpersonal conflicts, and career turnover intentions predicted nurses' mental health.

Conclusion

As hypothesized, our findings highlight that certain job stressors (i.e., inequity in social interactions, conflicts in the workplace) might be affecting physicians' and nurses' mental health differently. Therefore, effective strategies addressing each subgroup's specific stressors would be necessary to prevent the development of burnout syndrome and other serious mental health conditions associated with occupational stress. These strategies would imply organizational changes in most cases.

Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people

Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population.

Objective

To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it.

Methods

A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items.

Results

Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147).

Conclusion

This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.

Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic

BACKGROUND

There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic.

AIMS

This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers.

METHODS

A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors.

RESULTS

432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD.

CONCLUSIONS

Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.

Epigenetic, psychological, and EEG changes after a 1-week retreat based on mindfulness and compassion for stress reduction in healthy adults: Study protocol of a cross-over randomized controlled trial

INTRODUCTION

The main objective of the study will be to evaluate the effects of two widely used standardized mindfulness-based programs [Mindfulness-Based Stress Reduction (MBSR) and Compassion Cultivation Training (CCT)], on epigenetic, neurobiological, psychological, and physiological variables.

METHODS

The programs will be offered in an intensive retreat format in a general population sample of healthy volunteer adults. During a 7-day retreat, participants will receive MBSR and CCT in a crossover design where participants complete both programs in random order. After finishing their first 3-day training with one of the two programs, participants will be assigned to the second 3-day training with the second program. The effects of the MBSR and CCT programs, and their combination, will be measured by epigenetic changes (i.e., DNA methylation biomarkers), neurobiological and psychophysiological measures (i.e., EEG resting state, EKG, respiration patterns, and diurnal cortisol slopes), self-report questionnaires belonging to different psychological domains (i.e., mindfulness, compassion, well-being, distress, and general functioning), and stress tasks (i.e., an Arithmetic Stress Test and the retrieval of negative autobiographical memories). These measures will be collected from both groups on the mornings of day 1 (pre-program), day 4 (after finishing the first program and before beginning the second program), and day 7 (post-second program). We will conduct a 3-month and a 12-month follow-up using only the set of self-report measures.

DISCUSSION

This study aims to shed light on the neurobiological and psychological mechanisms linked to meditation and compassion in the general population. The protocol was registered at clinicaltrials.gov (Identifier: NCT05516355; August 23, 2022).

Effectiveness of an amygdala and insula retraining program combined with mindfulness training to improve the quality of life in patients with long COVID: a randomized controlled trial protocol

BACKGROUND

There has been growing clinical awareness in recent years of the long-term physical and psychological consequences of the SARS-CoV-2 virus, known as Long COVID. The prevalence of Long COVID is approximately 10% of those infected by the virus. Long COVID is associated with physical and neuropsychological symptoms, including those related to mental health, psychological wellbeing, and cognition. However, research on psychological interventions is still in its early stages, in which means that available results are still limited. The main objective of this study is to evaluate the effects of a program based on amygdala and insula retraining (AIR) combined with mindfulness training (AIR + Mindfulness) on the improvement of quality of life, psychological well-being, and cognition in patients with Long COVID.

METHODS

This study protocol presents a single-blind randomized controlled trial (RCT) that encompasses baseline, post-treatment, and six-month follow-up assessment time points. A total of 100 patients diagnosed with Long COVID by the Spanish National Health Service will be randomly assigned to either AIR + Mindfulness (n = 50) or relaxation intervention (n = 50), the latter as a control group. The primary outcome will be quality of life assessed using the Short Form-36 Health Survey (SF-36). Additional outcomes such as fatigue, pain, anxiety, memory, and sleep quality will also be evaluated. Mixed effects regression models will be used to estimate the effectiveness of the program, and effect size calculations will be made.

DISCUSSION

Long COVID syndrome is a clinical condition characterized by the persistence of symptoms for at least 12 weeks after the onset of COVID-19 that significantly affects people's quality of life. This will be the first RCT conducted in Spain to apply a psychotherapy program for the management of symptoms derived from Long COVID. Positive results from this RCT may have a significant impact on the clinical context by confirming the beneficial effect of the intervention program being evaluated on improving the symptoms of Long COVID syndrome and aiding the development of better action strategies for these patients.

TRIAL REGISTRATION

Clinical Trials.gov NCT05956405. Registered on July 20, 2023.