Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

Invited Commentary: Improving Instruments to Counter the Bias in Their Construction

In this issue of the Journal, Villalonga-Olives et al. (Am J Epidemiol. 2023;192(8):1264-1273) examined the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there was differential item functioning (DIF) in social capital by race, and also when stratified by educational attainment, as a measure of socioeconomic status. The authors tested whether there is DIF in social capital items between Black and White people and found that DIF across these items was significant although not large, but they were still indicative of measurement error, which they suspected was related to the way these items were developed-that is, based on cultural assumptions tested in mainstream White America. However, some gaps remain to be fleshed out.

The Effects of Social Determinants and Resilience on the Mental Health of Chilean Adolescents

The aim of this research was to evaluate the effects of social determinants (i.e., gender, educational vulnerability, and socioeconomic status) and resilience on the mental health of Chilean adolescents in pre-, during, and post-COVID-19 pandemic contexts. The study included a group of 684 students, ranging in age from 12 to 18 years, who were attending educational institutions in the city of Arica. The Child and Adolescent Assessment System (SENA) was used to measure mental health problems, the Brief Resilience Scale for Children and Youth (CYRM-12) was used to measure resilience, and the Vulnerability Index of Educational Institutions was used to measure educational vulnerability. The results suggest increases in depressive, anxious, and social anxiety symptomatologies over time (wave by year, 2018, 2020, and 2021). In addition, multiple linear regression models showed predictive effects of the COVID-19 pandemic, gender, vulnerability index, socioeconomic status, and resilient behaviors on mental health problems. The worsening of mental health indicators over time requires the greater coordination and integration of mental health experts in the most vulnerable educational centers.

Defining recovery in schizophrenia: A review of outcome studies

Schizophrenia is a chronic disorder with a heterogenous course and different ways in which recovery is measured or perceived. Recovery in schizophrenia is a complex process that it can be defined either from a clinical perspective focused on sustained symptom and functional remission, or from a patient-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Therefore, this meta-analysis aimed to examine the relationship of global measures of subjective recovery with each of the components of clinical recovery such as symptom severity and functioning, in patients with schizophrenia spectrum disorders. The results showed that the association between different indicators of personal recovery and remission are weak and inverse (^dIG⁺ = -0.18, z = -2.71, p < 0.01), however, this finding is not substantial according to the sensitivity indicators. With respect to functionality and personal recovery, there was a moderate relationship (^dIG⁺ = 0.26, z = 7.894, p < 0.01) with adequate sensitivity indices. In addition, a low consensus exists between subjective measures that are more related to the patient's perspective and clinical measures based on experts and clinician's viewpoint.

Pre and Post Pandemic Depressive and Anxious Symptoms in Children and Adolescents in Northern Chile

The psychological effects of the COVID-19 pandemic still represent a focus of concern, especially in children and adolescents who are a group particularly vulnerable to the psychological consequences of the COVID-19 pandemic, mainly due to the loss of socialization and leisure spaces. The aim of the study is to determine the variation in the levels of depressive and anxious symptomatology in children and adolescents in the North of Chile.

METHODS

A Repeated cross-sectional design (RCS) was used. The sample consisted of a total of 475 students aged 12 to 18 years (high school) from educational establishments in the city of Arica. To evaluate the changes in the mental health of students associated with the COVID-19 pandemic, the same mental health measures applied to students were compared in two waves (2018-2021).

RESULTS

An increase in the symptomatology levels of depression, anxiety, social anxiety, and problems with the family, while a decrease in problems with school and peers was observed.

CONCLUSIONS

The results show that there is an increase in mental health problems associated with the periods of time in which the COVID-19 pandemic transformed the social relation spaces and classrooms of secondary school students. The observed changes point to future challenges, which include that it may be important to improve the coordination and integration of mental health professionals in educational centers and schools.

Optimism and Intolerance to Uncertainty May Mediate the Negative Effect of Discrimination on Mental Health in Migrant Population

(1) Background: Migration causes effects on the people who migrate and on the societies that receive them, which can be positive or negative, depending on the characteristics of the interaction. One negative effect is the emergence of mental health disorders associated with the presence of discrimination, a relationship for which there is abundant evidence, although there is less research on factors that may alter this effect. (2) Objective: To evaluate the possible mediating role of optimism and intolerance to uncertainty in the relationship between discrimination and mental health. (3) Method: Nine hundred and nineteen adult Colombian migrants residing in Chile, 49.5% were men and 50.5% women, ages from 18 to 65 years, were evaluated. The Discrimination Experience Scale, BDI-IA Inventory, BAI, LOT-R and the Intolerance to Uncertainty Scale were applied. The effects were estimated using structural equation modeling. (4) Results: A mediating effect of both dispositional optimism and intolerance to uncertainty on the relationship between discrimination and mental symptomatology was observed. (5) Conclusions: The impact on individual suffering and the social cost of mental health problems require investigating variables on the relationship between discrimination and mental health, including mediators of this relationship, which turn out to be central elements in the development of future strategies for the reduction of anxiety and depression symptoms.

Mental Health in Indigenous Children and Adolescents: The Contribution of Cultural Backgroud

The purpose of this study is to describe and compare the prevalence of mental health problems in Aymara and non-Aymara children and adolescent. The study sample comprised 1839 students from 8 to 19 years, from educational institutions of Northern Chile. Forty-nine percent of students identified with the Aymara ethnic group. The Child and Adolescent Evaluation System was used to evaluate internal and external problems. In Elementary school, Aymara students showed significantly lower scores in externalized problems and in high school, there were significantly lower scores in interiorized, exteriorized and other problems than Non-Aymara students. It seems that the legacy of the Aymara culture has favored the development of protective factors in relation to the mental health of these students. In a context of growing recognition and appreciation of this culture, greater involvement with Aymara culture could promote better mental health of school children.

Well-Being and Mental Health in Teachers: The Life Impact of COVID-19

The impact of the pandemic on teachers' mental health has also been an important issue. The aim of the study was to analyze the vital impact of COVID-19, spirituality, and the use of social-emotional strategies on teacher well-being, mediated by mental health. The sample was non-random, inviting all teachers in a city North of Chile to participate in the study. The sample consisted of 624 teachers. A total of 74.4% were women and 25.6% were men. The mean age was 44.1 and the standard deviation was 11.9. A total of 56.4% belonged to public schools and 43.6% belonged to subsidized schools. Structural equations were used to analyze the data, finding a mental health mediating effect between the death of a close person, affected areas and family history with life satisfaction. Spirituality and the use of socio-emotional strategies self-applied by the teachers had no direct relationship with their mental health, so their mediating effect in relation to life satisfaction was discarded. Teachers who used social-emotional strategies, as well as those who reported higher levels of spirituality, obtained greater satisfaction with life, both general and specifically. Women had higher levels of depression, anxiety and stress symptomatology, but also higher levels of life satisfaction. The implications are discussed.

Children’s Mental Health: Discrepancy between Child Self-Reporting and Parental Reporting

(1) Background: Discrepancies between children’s self-reports and their parents’ reports on mental health indicators are associated with measurement errors or informant bias. However, they are a valuable tool in understanding the course of child psychopathology. This study aims to determine the level of discrepancies between parents’ perceptions and children’s self-reports in mental health indicators in Northern Chile. (2) Methods: A System of Evaluation of Children and Adolescents self-report (Sistema de Evaluación de Niños y Adolescentes, SENA) was responded to by 408 students between 8 and 13 years old and their parents. (3) Results: Children reported a significantly higher frequency of emotional problems, defiant behavior, and executive functions as compared to their parents’ responses. (4) Conclusions: There is a disjunction between the report of parents and children, which could originate in poor family communication.

Internalizing Problems and Resilience in Primary School Students in Low and High Socioeconomic Vulnerability Establishments in Chile

BACKGROUND

The processes involved in this study were 2-fold. First, we analyzed the levels of resilience and internalized problems (defined as group of emotional symptoms) in children aged 9 to 12 years. Second, we examined whether the relationship between them varies according to the low or high vulnerability of school communities.

METHODS

About 1460 students from schools in northern Chile participated. A total of 52.6% were girls, and 47.4% were boys. The scales of internalizing problems of the System of Evaluation of Children and Adolescents (SENA) and the short scale of resilience (CYRM-12) were applied. Correlations in each group and differences between groups were analyzed using a MANOVA. A 2-level path analysis was also performed.

RESULTS

Resilience was higher in the context of low vulnerability while depression, social anxiety, and posttraumatic stress symptomatology were greater in the context of high vulnerability. A 2-level path analysis showed that the slope of gender, anxiety, and depression symptomatology varies between schools and an interaction effect between vulnerability and anxiety symptomatology.

CONCLUSION

There are differences in the relationship between internalized problems and resilience according to whether the students belong to low or high vulnerability establishments. This study contributes to a better understanding of the relationship between internalizing problems and resilience.

Latent Profiles of Premorbid Adjustment in Schizophrenia and Their Correlation with Measures of Recovery

Premorbid adjustment (PA) has classically been defined as psychosocial functioning in the areas of education, occupation, social and interpersonal relationships prior to evidence of characteristic positive symptomatology. It is a concept which possesses ample evidence regarding its predictive nature for the course of Schizophrenia. The study aimed to analyze the latent profiles of premorbid adjustment and their relationship with symptomatology, functionality, subjective recovery, stigma resistance and years of untreated psychosis. Latent class analysis (LCA) was used to elaborate a solution of three premorbid adjustment profiles in a sample of 217 patients diagnosed with Schizophrenia from Public Mental Health Centers in the city of Arica, Chile. The results show that premorbid adjustment was significantly correlated with recovery indicators and that latent profiles of better premorbid adjustment predict better outcomes in subjective recovery and stigma resistance. The results show that premorbid adjustment not only has implications for the severity of the disorder, but that psychosocial functioning prior to psychosis affects the patient’s subjectivity, the representation of the disorder and the recovery process.

Symptomatology of attention deficit, hyperactivity and defiant behavior as predictors of academic achievement

BACKGROUND

It is essential to understand the factors that affect the academic achievement of schoolchildren, both in general and in terms of the major subsectors of each grade. Although symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Negative Defiant Disorder (NDD-which are commonly recognized as externalizing problems in childhood and adolescence-have been associated with lower academic achievement in the international literature, few studies have addressed this problem in Latin America. This study aimed to analyze the possible predictive relationship of attention problems, hyperactivity, and defiant behavior on academic achievement.

METHODS

We recruited a sample of 4580 schoolchildren (50.9% female, 1754 belonging to primary school, and 2826 to secondary school, ranging from 9 to 18 years old). This cross-sectional study used the scales pertaining to attention problems, hyperactivity, and challenging behavior from the Child and Adolescent Evaluation System.

RESULTS

The analysis showed that attention problems significantly affected all academic achievement areas, while hyperactivity and challenging behavior affected only some of them. The regression models explained 24% of the variability in overall academic achievement in primary school and 17% in secondary school. Other predictors included sex, age, socioeconomic level, and school attendance.

CONCLUSIONS

It is important to consider this symptomatology in the design of educational interventions.

Cigarette and alcohol consumption among Colombian migrants and Chileans living in Northern and Central Chile

INTRODUCTION

In Chile, the migrant population generally reports lower rates of cigarette and alcohol consumption. However, the migratory process and assimilation of behaviors after extended exposure to the host country could increase the consumption of these substances. The aim of this study was to compare cigarette and alcohol consumption among Colombian migrants and Chileans residing in Chile.

METHODS

In 2019, data were collected from 963 Colombian migrants and 909 Chileans in three cities in Chile. The chi-squared test was used to analyze significant differences in cigarette and alcohol consumption between the groups. Subsequently, the relative risk (RR) and corresponding p-values were obtained.

RESULTS

Colombian migrants had a significantly lower consumption of cigarettes than Chileans (16.6% and 25.1%, respectively). Regarding alcohol consumption, Colombian migrants reported lower consumption than Chileans (43.3% and 48.4 %, respectively ).

CONCLUSIONS

The lower consumption of cigarettes and alcohol by Colombian migrants compared to Chileans is positive for the health of migrants. However, it is advisable to promote health interventions to avoid an increase in the consumption of these substances, especially considering that migrants could assimilate the consumption habits of Chileans.

Ethnic Identity and Collective Self-Esteem Mediate the Effect of Anxiety and Depression on Quality of Life in a Migrant Population

Migration processes can often trigger negative interactions with the context, generating problems in both the physical and mental health of migrants, which have an impact on both their well-being and their quality of life. In this framework, the research aimed to assess the mediating effect of ethnic identity and collective self-esteem on the inverse relationship between mental health problems and quality of life. Data were collected from 908 first-generation Colombian migrants living in Chile, of whom 50.2% were women and with an average age of 35 years. They were assessed with The World Health Organization Quality of Life (WHOQoL)-Bref, Smith's ethnic identity questionnaire, Basabe's collective self-esteem, and Beck's Anxiety and Depression questionnaires. The results provide evidence that both collective self-esteem and ethnic identity exert a partial mediation effect on the relationship between anxiety and depression on quality of life. The study provides evidence of the protective role that the maintenance and reinforcement of ethnic identity and collective self-esteem can have, with a view to strengthening the planning of interventions both in the field of prevention of mental health problems and in the improvement of quality of life based on evidence.

Psychosocial Effects of the COVID-19 Pandemic on Patients With Schizophrenia and Their Caregivers

The aim of this study was to analyze the psychosocial effects of the COVID-19 pandemic on 120 patients with schizophrenia, and their caregivers (control group), in the city of Arica, northern Chile. The hypotheses of this study hold that (1) self-reports of the impact of the COVID-19 pandemic among patients and caregivers would be positively correlated, (2) caregivers would self-report a greater impact of the pandemic on their daily lives, and (3) patients infected with COVID-19 would experience lower levels of mental health improvement and higher levels of psychological distress. Hypotheses were tested using correlations, mean differences, and effect sizes (Cohen’s d). The results showed that patients with schizophrenia who had been in quarantine for almost a year showed similar levels of concern as their caregivers in the domains of health and social life. However, caregivers showed significant differences from patients in the areas of income, concern, and employment status. In addition, patients who were infected with COVID-19 showed lower levels of well-being and worse psychological recovery. The implications of the findings highlight the need to incorporate mental health interventions in the pandemic health context for caregivers of people with schizophrenia. Finally, the results suggest that Covid-19 infection has a significant effect on the recovery and psychological well-being of patients with schizophrenia.

Understanding the Relationship between Preschool Teachers' Well-Being, Interaction Quality and Students' Well-Being

A substantial body of research shows that teacher-student interactions have a significant impact on student outcomes. However, to our knowledge, less is known about the association between teachers' and students' well-being and the implications for teacher-child interactions, particularly in the preschool context. Research Findings. Using ordinary least squares regression, we investigated the association between affective balance and burnout among 28 preschool teachers and the emotional and behavioral problems of 593 students between three and four years old. We found that teacher affective balance-not teacher burnout-was associated with fewer emotional and behavioral problems in children. Furthermore, the different domains of interaction quality affected children's well-being in different ways. Practice or Policy. In initial teacher training and continuing professional development, teachers should be provided with support and strategies to help them manage their mental health and children well-being. Some interventions which have shown encouraging results are discussed.

Public Policy Responses to Address the Mental Health Consequences of the COVID-19 Pandemic: Evidence From Chile

Objectives: This paper reviews the mental health policies that have been implemented in Chile in response to the COVID-19 pandemic and the international context of countries' responses. Even before the start of the pandemic, there were significant barriers to access mental health services in Chile, coupled with a scenario of nationwide social unrest and protests that questioned the legitimacy of public institutions; now the rapidly worsening outbreaks of COVID-19 are exacerbating the pre-existing mental health crisis. Methods: We conducted a bibliometric and content analysis of the Chilean mental health public policies implemented during the COVID-19 pandemic and then compared these policies with international experiences and emerging scientific evidence on the mental health impact of pandemics. Results: Our analysis of the policies identifies five crucial points of action developed in Chile: (i) an established framework to address mental health in emergency and disaster situations; (ii) a timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in the public health agenda; (iv) development of a presidential strategy during the pandemic for comprehensive mental health and well-being; and (v) emerging research assessing the mental health implications of COVID-19. Conclusions: In Chile, the public policy responses to address the mental health consequences of the COVID-19 pandemic has been characterized by the coordinated implementation of mental health plans, ranging from a health sectoral initiative to inter-agency and intersectoral efforts. However, it is imperative that increased funding is allocated to mental health, and efforts should be made to promote the participation of people with lived experiences and communities in the design and implementation of the proposed actions. This aspect could be of key importance to social peace and community recovery after the pandemic.

Relationship between eating disorders and internalized problems in chilean adolescents

BACKGROUND

Eating disorders (ED) are associated with internalized problems (INTP), such as depression and anxiety. Evidence shows that ED and INTP are associated with comorbidities. The relationship between these variables has not been the focus of studies on young people from Northern Chile. Children and adolescents are considered as an at-risk group, since they have been found to experience greater vulnerability to psychological problems than other age groups within the population and given the scarcity of studies in Chile, it is necessary to study the relationship between these variables.

METHODS

This study analyzed the relationship between ED and INTP in Chilean high school students aged 12 to 18 years using Pearson's correlation. This is a non-experimental and transactional correlational study. We included 2277 students belonging to the public, government-subsidized, and private educational establishments in Northern Chile. The Child and Adolescent Evaluation System [Sistema de Evaluación de Niños y Adolescentes (SENA)] was used to detect a range of INTP, as well as ED. The Brief Self-Control Scale was used in this study.

RESULTS

A strong and direct correlation of the eating disorder variable with depression and anxiety was found. Additionally, significant differences were observed with sex, highlighting females with a higher presence of INTP and ED.

CONCLUSIONS

There is a need to establish strategies in the school setting for detecting frequent symptomatology in adolescents with INTP and ED to achieve a timely and accessible intervention. Since the symptomatology of ED is more prevalent in adolescents, this research evaluated relationships between ED and INTP in young people from Northern Chile. This research is relevant because the evidence on this topic in Chile is scarce and the relationships found could be the first research on the subject and serve to design an intervention plan at the school level in the medium and long terms. It is a non-experimental and transactional correlational study because all variables were measured at a single moment, and it sought to establish relationships between variables without assuming causality. The sample of secondary school students consisted of 2277 students, belonging to the public, subsidized, and private schools. Strong relationships were observed between INTP and ED, the strongest correlations being with the variables depression and anxiety. In addition, female participants presented greater problems in ED and INTP.

Relationship between Everyday Discrimination and Substance Use among Adolescents in Northern Chile

Substance use is a public health problem that affects the normal physical, neurological, and psychological development of adolescents. Apparently, discrimination is an important variable for explaining the initiation and continued use of alcohol and marijuana. Since most research focused on discrimination based on factors, such as race, ethnicity, sexual orientation, or gender faced by minority groups, studies on discrimination faced by the general population remain scarce. This cross-sectional study described the relationship between everyday discrimination and alcohol and marijuana use-related behaviors among Chilean adolescents. It included 2330 students between 12 and 20 years of age from educational establishments in the city of Arica. To evaluate substance use, specifically alcohol and marijuana, the Child and Adolescent Evaluation System (SENA) was used. The Everyday Discrimination scale was used to evaluate discrimination. Age and everyday discrimination can predict up to 11% of the variance in substance use. Reducing the incidence of everyday discrimination may help reduce heavy alcohol and marijuana consumption among adolescents.

Discrimination and Health: The Mediating Effect of Acculturative Stress

There is not much evidence on the effects of south–south migration and its consequences on physical and mental health. Our objective was to examine the mediating role of Acculturative Stress in the association between ethnic discrimination and racial discrimination with physical and mental health. This research is a non-experimental, analytical, cross-sectional study. A total of 976 adult Colombian migrants living in Chile were interviewed. We used the Everyday Discrimination Scale, the acculturative stress scale, and the Medical Outcomes Study Short Form (SF-12) for health status; we found that racial and ethnic discrimination had a negative effect on physical and mental health. In the simultaneous presence of both types of discrimination, racial discrimination was completely absorbed by ethnic discrimination, the latter becoming a total mediator of the effect of racial discrimination on mental and physical health. Our findings are consistent with the literature, which suggests that there are various types of discrimination which, individually or in their intersectionality, can have negative effects on health.

Effects of Resilience and Acculturation Stress on Integration and Social Competence of Migrant Children and Adolescents in Northern Chile

Migration in Chile has increased exponentially in recent years, with education being one of the main focuses of attention in this cultural transformation. Integration and social competence in the migrant population are determined by several factors. The aim of this study is to evaluate the potential effects of resilience and acculturation stress on the levels of integration and social competence in migrant students in Northern Chile. In total, 292 school children of both genders aged 8 to 18, from the fourth grade to senior year of high school, participated in the investigation. A subscale of the Child and Adolescent Assessment System (Sistema de evaluación de niños y adolescentes SENA) was used to assess integration and social competence. Additionally, the Child and Youth Resilience Measure (CYRM-12) and the Acculturation Stress Source Scale (FEAC) were used. The results show that integration and social competence have statistically significant and direct associations with resilience (p < 0.001) and indirect associations with acculturation stress (p = 0.009). Both constructs could be defined as protection and risk factors, respectively, and should be considered in educational contexts to favor adaptation in the integration of migrant children and adolescents.

Perceived discrimination and contextual problems among children and adolescents in northern Chile

Discriminatory behaviors among inter-ethnic relations in schools have long been noted and studied, but there are several correlations between discriminatory behaviors and other constructs that need further investigation. As an example, the relation between perceived discrimination and contextual problems-which include family, school and peer problems-among children and adolescents in Latin America has received little attention from previous studies. Further, the mediating role of ethnic identification and collective self-esteem in this relation also needs to be considered as they could be proven as protective factors for discriminatory behavior and its outcomes. Therefore, this study aimed to, first, establish the relationship between perceived discrimination and contextual problems in inter-ethnic students aged 8-19 years living in Arica, Chile; and second, to identify the role that ethnic identification and collective self-esteem play within this relation. In order to investigate this matter, a cross-sectional study was carried out with 3700 students in 29 schools between the fourth year of primary education and the last year of secondary education, aged between 9-18 years, with 48.4% men and 51.6% women. The sample was divided into primary and secondary school groups. The scales utilized were the Everyday Discrimination Scale, Multi-Group Ethnic Identity Measure-Revised Scale, Collective Self-Esteem Scale and the dimensions of contextual family, school and peer problems, as well as the general index of contextual problems of the Child and Adolescent Assessment System. For data analysis, we tested a path analytic model at both the within and between levels to account for the relations between variables. In each group the models obtained an optimal fit. We found that perceived discrimination and ethnic identification were directly related to contextual problems (.23-.39), and collective self-esteem had only a mediating role. This study showed that strategized interventions focusing on ethnic identification and perceived discrimination should be utilized by schools to create a better developing environment.

Cross-Cultural Adaptation and Validation of the Quality of Life Questionnaire for Caregivers of Patients with Schizophrenia (S-CGQoL) in Latin America

OBJECTIVES

The aim of this study was to adapt and validate the Schizophrenia Caregiver's Quality of Life Questionnaire (S-CGQoL) for use in the Hispanic-American population from the caregiver's perspective.

METHODS

A cross-sectional instrumental model was used, with a sample of 253 caregivers of patients suffering of Schizophrenia in Bolivia, Peru and Chile. The psychometric properties of the S-CGQoL were tested through construct validity, reliability and some aspects of external validity. In addition, in order to assess the nature of the different items across the three countries, a Differential Performance Analysis (DPA) was conducted.

RESULTS

A confirmatory factor analysis showed that the scale structure was well correlated to the initial structure of the QoL-MDS. The results confirmed the existence of adequate reliability indicators (α>.70 and ω>.80) and the absence of FIDs supporting the invariance of item calibrations among the three Latin American countries.

CONCLUSIONS

The adaptation and validation of the S-CGQoL questionnaire demonstrate adequate psychometric properties to assess the quality of life of caregivers in samples of middle-income countries in Latin America.

Validation of the brief scale for the evaluation of acculturation stress in migrant population (EBEA)

Background

Acculturation stress is associated with poorer physical and mental health and a lower level of psychological well-being. The causes of acculturation stress are diverse, but most are similar in the migrant population. Despite the importance of evaluating this variable, few studies have reported culturally adapted and validated instruments for specific populations. Based on this, the aim of this study was to evaluate the psychometric properties of a short scale for the evaluation of acculturation stress (EBEA).

Methods

Two studies were conducted, involving 1725 first-generation Colombian and Peruvian migrants living in Chile, between the ages of 18 and 60 years. In addition to the EBEA and as evidence of validity, the Beck Anxiety Scale and the WHOQOL-BREF psychological health domain were applied. A confirmatory factor analysis was carried out, and the reliability and nomological validity were evaluated.

Results

The results in both studies indicated that the scale presents a factorial structure of three dimensions: (a) the stress derived from the preparation and departure from the country of origin, (b) the stress produced by socioeconomic concerns in the host country, and (c) the tensions typical of adaptation to sociocultural changes or Chilean society. The reliability coefficients and the analysis of their nomological validity were very good.

Conclusions

The EBEA is a measure that offers quick, useful screening for researchers who need a short measure for research among migrants. This tool contributes to the work of education, prevention, and intervention in the field of general health and migrants’ mental health.

[Mental health problems among health care workers during the COVID-19 pandemic]

BACKGROUND

COVID-19 has effects on the mental health of health care workers.

AIM

To explore the presence of symptoms associated with mental health problems and associated risk factors in health workers.

MATERIAL AND METHODS

The questionnaires PHQ-9 for depression, GAD-7 for anxiety, ISI-7 for insomnia and IES-R-22 for psychological distress were applied to 125 health care workers aged 18 to 67 years (32 physicians, 22 nurses and 71 of other professions) laboring in hospitals and primary care facilities along Chile.

RESULTS

Sixty five percent reported depression symptoms, 74% anxiety, 65% insomnia and 57% distress. Physicians had lower median scores in all scales than nurses and other health professionals. Professionals attending patients with respiratory infections or with COVID-19 had higher median scores in the scales that their counterparts.

CONCLUSIONS

The frequency of mental health problems among these professionals is high and preventive measures should be taken.

Life satisfaction in childhood: Latin American immigrant children in Chile

The goal of the current study was to evaluate life satisfaction in a sample of 300 immigrant children aged between 8 and 13 years old. Satisfaction in different domains and overall life, was evaluated using the General Domain Satisfaction Index and the Overall Life Satisfaction index, respectively. These instruments were also applied to a sample of 300 non-immigrant children of similar age. Statistically significant differences were found only in the 12?13 years group, where the mean scores for immigrants were lower than those for natives, on the domains of family and home, material goods, interpersonal relationships, health, and use of time. Additionally, immigrants had higher mean scores on the domains of area of residence, school, and personal satisfaction. These results allow us to reflect on the influence of society in all domains throughout their lives. Thus, these findings contribute toward the creation of policies that integrate migrants.

Affects as Mediators of the Negative Effects of Discrimination on Psychological Well-Being in the Migrant Population

There is abundant empirical evidence on the negative effects of discrimination on psychological well-being. However, little research has focused on exploring the factors that can mitigate this effect. Within this framework, the present study examined the mediating role of positive and negative affects in the relationship between ethnic and racial discrimination and psychological well-being in the migrant population. About 919 Colombians, first-generation migrants, residing in Chile (Arica, Antofagasta, and Santiago) were evaluated, of which 50.5% were women, and the participants' average age was 35 years (range: 18-65 years). Krieger's discrimination questionnaires, Watson's Positive and Negative Affect Schedule (PANAS), and Ryff's Psychological Well-Being Scale were applied. The measurement models of each variable were estimated, and then the structural equation models were used. The results of the hypothesized multiple mediation model showed that the main mediator in the relationship between ethnic-racial discrimination and psychological well-being was positive affects over negative ones.

Mental Health in Immigrant Children and Adolescents in Northern Chile Mental Health in Immigrant Children and Adolescents

Approximately 1.251.225 foreign-born migrants reside in Chile, including 183.315 children. This study compares mental health indicators in immigrant and non-immigrant children to understand the mental health effects of migration. A cross-sectional study of 634 students from Chilean schools was conducted. Fifty percent of the students were immigrants. The System for the Evaluation of Children and Adolescents was used to evaluate mental health. No significant differences were observed in mental health indicators between immigrant and non-immigrant children. At both elementary and secondary levels, immigrant students had higher rates of contextual problems (family problems and problems with peers) and lower scores in integration and social consequence. Immigrant students in elementary schools scored lower in self-esteem. The higher rates of contextual problems in immigrant children should be addressed through structural changes in migration policies, such as providing support for employment of parents, welfare assistance, and access to health systems.

Locus of Control, Self-Control, and Gender as Predictors of Internalizing and Externalizing Problems in Children and Adolescents in Northern Chile

BACKGROUND

Both the control that people attribute to themselves over a situation (locus of control) and the control they attribute to themselves (self-control) have been proposed as aspects that can have an effect on internalizing problems in young people. There is little evidence of this relationship in the infantile-juvenile population in Latin America.

OBJECTIVE

To establish whether there is a significant predictive relationship of locus of control and self-control over internalizing and externalizing problems in the infantile-juvenile population, both at a general level and dimension-specific. These include depression, anxiety, social anxiety, somatic complaints, and post-traumatic stress.

METHODS

A cross-sectional-correlational study was carried out to establish if there was a possible predictive relationship in 3,664 schoolchildren of both primary (4th-6th grade) and secondary (7th-12th grade) in northern Chile, using the short version of the Nowicki-Strickland scale to measure locus of control, the Tangney scale to measure self-control, and the Child and Adolescent Evaluation System (SENA) to measure the dimensions of internalized problems.

HYPOTHESES

(1) Greater self-control is associated with lower levels of internalizing and externalizing problems. (2) Higher external locus of control is associated with higher levels of internalizing and externalizing problems. (3) Self-control, locus of control, and gender can together significantly predict each of the internalizing and externalizing problems.

RESULTS

Evidence is found to support the first two hypotheses fully and partially support the third, since gender did not function as a predictor in all models.

CONCLUSION

The results confirm previous international research in that both locus of control and self-control appear to have a significant influence on internalizing and externalizing problems. Implications for mental health promotion in this population are discussed.

Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries

The relationships between stigma and quality of life in schizophrenia (QoL) have been extensively explored but have mostly focused on self-stigma and self-esteem and have never been explored in Latin-America. The objective of this study was to determine which stigma dimensions were associated with QoL in a sample of community-dwelling SZ subjects of three Latin-American countries. Stabilized outpatients with SZ were recruited in three Mental Health Services in three Latin-American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Stigma and Qol-SZ were evaluated by self-administered questionnaires, the Internalized Stigma of Mental Illness scale (ISMI-12) and the SQoL-18. 253 participants were included. In multivariate analyses, QoL has been associated with each stigma dimension (social stigma, stigma experience and self-stigma), independently of age, gender, education level, ethnicity, age at illness onset, illness symptomatology and mental health treatment. More specifically, social stigma was significantly associated with impaired psychological and physical well-being, self-esteem and friendship. Self-stigma was significantly associated with impaired psychological well-being, self-esteem and autonomy. The present results confirm the importance of stigma in QoL of SZ subjects and identify new targets to develop stigma-orientated programs. Most of the previous programs have focused on self-stigma while social stigma has shown to be associated with a wide range of impaired QoL areas. Stigma and QoL may have a bidirectional relationship and targeting some specific QoL areas (like autonomy through self-empowerment approaches) may also improve the effectiveness of these programs to reduce stigma impact on the quality of life of subjects with schizophrenia. Future studies should also explore differences across countries as subjects from Bolivia were more frequently Aymara and reported higher stigma and lower QoL than SZ subjects from other countries.

Mental health and the COVID-19 pandemic in Chile

With one of the highest testing rates of COVID-19 in Latin America, Chile continues to record low mortality rates from the disease. Several measures such as curfews, cancellation of large gatherings, and closure of schools and businesses have been implemented. Against the backdrop of high levels of alcohol/substance abuse, mental health disorders, and inequalities across Chile, it is likely that levels of stress and anxiety will peak during the COVID-19 pandemic. As key public health responses such as testing, contact tracing, isolation and management of confirmed cases of COVID-19 are being ramped up, it is expedient to prioritize measures to safeguard the mental health of Chileans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychiatric disorders in children and adolescents in a middle-income Latin American country

BACKGROUND

Child and adolescent mental health has scarcely been studied in developing countries, though it is an important aspect of health. Mental health problems in youth often continue into adulthood if not diagnosed or treated in time.

METHODS

The Sistema de Evaluación de Niños y Adolescentes (SENA) [Child and Adolescent Evaluation System] was used to evaluate mental health indicators in a sample of students in Northern Chile. Two age-appropriate versions of the assessment were applied to a total sample of 5043 students, which included an elementary education sample of 1953 schoolchildren from fourth grade through sixth grade (ages 8 to 13 years), and a Secondary School sample of 3090 schoolchildren from seventh grade (the last year of elementary school) through the last year of Secondary school (senior high school) (ages 12 to 19 years). For each group, the version of the assessment used was determined by the students' grade level. Both samples included municipal, government-subsidized, and private schools.

RESULTS

In this student population, depression, anxiety, and behavioral disorders were the main mental health problems identified, and indicators revealed a progressive increase in cases over the years, coinciding with the global epidemiological scenario. Males showed a greater presence of externalizing behaviors related to mental health problems associated with aggression and defiant behavior. However, females showed the highest number of mental health issues overall, especially regarding problems related to internalization. There are significant differences between school types.

CONCLUSIONS

Our sample population analysis indicates that early intervention is necessary for the diagnosis and treatment of youth, with the goal of reducing the probability that psychiatric disorders will be prolonged, evolving, and worsening in adulthood.

Adherence to Antipsychotic Medication and Quality of Life in Latin-American Patients Diagnosed with Schizophrenia

PURPOSE

The purpose of this study was to describe the association between adherence to antipsychotic medication and quality of life (QoL) in a sample of individuals diagnosed with schizophrenia.

METHODS

Two hundred fifty-three patients were included from three public mental health services from Bolivia, Peru, and Chile. Data were collected using the Drug Attitude Inventory (DAI-10) and the Schizophrenia Quality of Life short-version questionnaire (SQoL-18), which considers 8 dimensions.

RESULTS

Significant associations were found between adherence to antipsychotic medication treatment and QoL (S-QoL-18 index: β = 0.26, p = 0.004; self-esteem: β = 0.37, p = 0.000; and sentimental life: β = 0.20, p = 0.033). Associations of clinical and socio-demographic variables with QoL were identified: severity of psychotic symptoms, awareness of the disease, gender, age, and ethnicity were found to be associated with a lower level of QoL (β from 0.14 -0.56).

CONCLUSION

This study provides evidence of the association between adherence to treatment and quality of life in patients diagnosed with schizophrenia. Therefore, as in developed countries, improving adherence to antipsychotic medication would appear to be an important issue to address to improve patients' QoL in Latin American countries.

Fuentes de estrés por aculturación en la infancia y adolescencia. Propuesta del instrumento de medición FEAC-IA

El estrés por aculturación ha sido asociado fuertemente al surgimiento de problemas en la salud de las personas, principalmente en la salud mental. Pese a su importancia como factor de riesgo, su estudio se ha realizado mayoritariamente en población adulta, siendo menor la investigación realizada al respecto en población infantil y adolescente. En esta investigación, se evalúan las propiedades psicométricas del FEAC-IA, cuestionario destinado a evaluar las fuentes de estrés por aculturación. Se recogieron datos de 401 escolares entre 8 a 18 años (M = 12.4; K = 2.5). Se realizaron análisis de confiabilidad y de los indicadores de bondad de ajuste para la evaluación de modelos de la estructura factorial, mediante análisis de ecuaciones estructurales exploratorias (MEEE) y análisis factorial confirmatorio (AFC). El cuestionario presenta buenos indicadores de bondad de ajuste para un modelo trifactorial: añoranza y diferencias con el país de origen, adaptación en la escuela, familia y relación con los pares y experiencias de discriminación (CFI = 0.98; TLI = 0.976; RMSEA = 0.052). La escala propuesta puede constituirse en un aporte importante para recoger insumos en población migrante infanto-juvenil sobre las fuentes de estrés, que permitan elaborar planes específicos de intervención.

The Latin American version of the internalized stigma of mental illness scale (LA-ISMI): a multicentric validation study from three Latin American countries

Background

To date, no data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries. The aim of this study was to validate a Latin American version of the ISMI in people with schizophrenia.

Methods

The study included 253 stabilized outpatients with schizophrenia from 3 Mental Health Services in three Latin American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). We analyzed the psychometric properties using item response and classical test theories. An item reduction was then performed to improve the psychometric properties of the ISMI-29. The final version of the ISMI was tested for construct validity, reliability, external validity and differential item functioning (DIF).

Results

The five-factor structure of the ISMI-29 was not confirmed using confirmatory factor analysis (RMSEA = 0.12, CFI = 0.77, and WRMR = 2.20). Seventeen items were discarded to obtain a satisfactory psychometric version. The ISMI-12 evaluates 3 dimensions: social stigma (4 items), stigma experience (4), and self-stigma (3). The factor structure accounted for 68% of the total variance. Internal consistency was satisfactory. The scalability was satisfactory, with INFIT statistics within an acceptable range. In addition, the results confirmed the absence of DIF and supported the invariance of the item calibrations between countries.

Conclusion

The ISMI-29 is not valid in our sample and should not be used in Latin American countries. The ISMI-12 is the first internalized stigma questionnaire with satisfactory psychometric properties available in Latin American countries. Its brevity could facilitate its dissemination and use in clinical settings.

Rooting mediates the effect of stress by acculturation on the psychological well-being of immigrants living in Chile

Migration is a social phenomenon that has an impact both on the lives of the people who migrate, and on the societies who receive them; with psychological well-being being one of the most affected variables. The objective of this research is to analyze the possible mediating role of rooting in the host location on the negative effect that acculturation stress has on the level of well-being. Data for this study were collected using 699 Colombian and Peruvian immigrants who have been permanently residing in Chile for more than six months. Participants were assessed by using Riff’s Psychological Well-being Scale, rooting of Torrente et al., and Ruiz et al. scales of stress. The results demonstrated the mediating role of settling down within the host country in relation to stress and psychological well-being, except for the sub-dimension of autonomy. It is concluded that the need for rooting in the host country is a protective factor against the negative effects of stress on perceived well-being.

Differences on Quality of Life of Patients with Schizophrenia: A Multicentric Study from Three Latin-America Countries

The aim of the study is to explore the variation on patient's Quality of Life (QoL) across three Latin-Americans countries. The study included 253 stabilized outpatients with schizophrenia from three Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Patients' were assessed using Schizophrenia Quality of Life Questionnaire (SQoL18). We collected socio-demographic information and clinical data, while recognizing the cultural complexity/dynamics of each country, and the influence of cultural contexts on how people experience the health systems. There are differences in QoL according to each country. Peru reports better levels of QoL at the Total Score Index and in most of the dimensions of the SQoL18. Bolivia shows the lowest indicators of QoL, except, interestingly, for the Resilience dimension where it reaches the highest scores. Even when the studied regions in the three Latin American countries share several cultural characteristics, there are also some important differences between them on patients' QoL. Possible disparities at investment in mental health by the Governments of each country are discussed while possible influences of (inter)cultural contexts are taken into account.

Predictors of unmet needs in Chilean older people with dementia: a cross-sectional study

BACKGROUND

The needs of people with dementia (PWD) have not been assessed in any Latin American country. Several European countries have already related unmet needs with quality of life, caregiver's age, burden, stress, anxiety and depression. The aim of this study was to identify met and unmet needs in Chilean older adults with dementia and to determine if those needs were associated with PWD's, their informal caregivers' and social factors.

METHOD

This was a cross-sectional study. One-hundred and sixty-six informal caregivers and their care recipients were interviewed. PWD was assessed about cognitive function and their caregivers answered instruments about PWD's needs, functional status and behavioral and psychological symptoms. Caregiver's burden, depression, anxiety and social support were also evaluated. A stepwise multiple linear regression analysis was performed to determine predictors of unmet needs in Chilean PWD.

RESULTS

The most frequent met needs were "Looking after home" (81.3%%), "Food" (78.9%) and "Selfcare" (75.3%). Most common unmet needs were "Daily living activities" (39.2%), "Company" (36.1%), and "Memory" (34.9%). Caregivers' lower age was correlated to a higher number of PWD's unmet needs (rs = -.216; p < 0.005). Higher PWD's dependence was associated with higher number of unmet needs (rs = .177; p < 0.05). The best predictors of unmet needs were caregivers' low level of social support, high burden, young age and high level of anxiety.

CONCLUSION

It is necessary to address psychological and social needs of PWD. The fact that PWD's unmet needs were associated mostly with caregivers' factors, highlights the importance of considering both, the PWD and their informal caregivers as targets of institutional support. It is expected that recently launched national public policies decrease PWD's unmet needs by the provision of new services for them and their informal caregivers.

The mediating role of self-esteem on the relationship between perceived discrimination and mental health in South American immigrants in Chile

Psychological aspects in South-South migration have been little studied. The following study aimed to describe the effect of individual self-esteem as a mediator in the relationship between perceived discrimination and mental health (understood as the presence of anxious and depressive symptomatology) in South American migrants in Chile. We surveyed 853 people, of Peruvian and Colombian nationality, residing in three cities (Arica, Antofagasta and Santiago). Three ad-hoc scales were applied to evaluate the study variables, analyzing the measurement models for each of them using the Confirmatory Factor Analysis method. Subsequently, the hypothesized mediation model is evaluated through Structural Equations (SEM). The results show that discrimination has a positive and direct relationship with both anxiety and depression, and that the effect of interaction between the variables of discrimination, self-esteem and symptoms associated with depression and anxiety, had a simple partial mediating effect. Discrimination would have a positive and minor effect on anxious and depressive symptoms, as it is mediated by self-esteem.

The mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in immigrants

The aim of the study is to analyze the mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in South American immigrants in Chile. An analytical, cross sectional, non-experimental design was used. We evaluated 853 Peruvians and Colombians living in the northern cities of Arica, Antofagasta, and Santiago de Chile, the capital located in the center of the country. The instruments used were the Ryff Psychological Well-being Scale, the Rosenberg Self-Esteem Scale and the Perceived Discrimination Scale by Basabe, Paez, Aierdi and Jiménez-Aristizabal. We used the estimation method (RWLS) and polychoric correlation matrices, to estimate the effect size and overall fit of the direct effect models of discrimination and self-esteem on psychological well-being, and indirect and total effects of discrimination mediated by self-esteem. While both populations reported similar levels of perceived discrimination, it was found that the means in psychological well-being and self-esteem of the Colombian population were significantly higher than that of the Peruvian population. Regarding self-esteem, the results provided evidence for the possible mediating effect on the relationship between perceived discrimination and psychological well-being. This research aims to contribute to the development of interventions seeking to strengthen self-esteem in order to circumvent possible negative consequences of perceived discrimination, as a consequent, improving immigrants´ personal resources to successfully cope with the diverse demands of their new context.

Needs of Patients with Schizophrenia Among an Ethnic Minority Group in Latin America

The aim of the study is to describe the need profile of outpatients with schizophrenia belonging to an Aymara ethnic group in Latin-America and to compare that profile to non-Aymara patients. A sample of 253 patients were evaluated with the Two-Way Communication Checklist (2-COM Checklist) measuring the needs and satisfaction of the patient; Positive and Negative Syndrome scale for Schizophrenia (PANSS) and Attitude to the Drugs (DAI-10). No significant differences were found between Aymara and non-Aymara, either in the total number of needs or in the subscales of satisfaction or in the types of needs. After adjustment for socio-demographic and clinical factors, patients with higher severity (PANSS) had higher number of needs and lower level of satisfaction. Higher score on DAI-10 is related to a higher total number of needs and better satisfaction with medication. Age, sex, ethnicity and employment were also associated with specific needs. The profile of the needs of schizophrenic Aymara patients does not differ from that of non-Aymara patients, and that in both groups it is necessary that the treatment primarily address symptom management and the subjective aspects of quality of life.

Calidad de vida en pacientes con esquizofrenia de origen Aymara en la zona Centro-Sur de los Andes

El objetivo de este estudio consistió en comparar la calidad de vida (CV) de pacientes con esquizofrenia pertenecientes al grupo étnico aymara de los Andes Centro-Sur, con pacientes no Aymara. En este estudio transversal participaron 253 pacientes de tres clínicas de salud mental en Chile, Perú y Bolivia. Se recogieron datos sociodemográficos y características clínicas. La calidad de vida se evaluó utilizando el Cuestionario S-QoL18. Los análisis comparativos exploraron las diferencias de QoL entre los pacientes Aymara y no Aymara. Los participantes de origen Aymara tuvieron puntuaciones de CV más bajos en comparación con los pacientes no Aymara para el Índice total, las relaciones familiares y la dimensión de vida sentimental. Los ingresos familiares mensuales y la duración del trastorno fueron significativamente más bajos en los pacientes Aymara. Nuestro estudio soporta la hipótesis de una peor CV en pacientes aymaras con esquizofrenia.

[Mental health and stress by acculturation in immigrants from South America in northern Chile]

BACKGROUND

Coping with changes brought about by immigration and social circumstances that often characterize this process may cause mental health problems.

AIM

To analyze the relationship between acculturation stress and mental health symptoms in South American immigrants residing in Antofagasta, Chile.

MATERIAL AND METHODS

The OQ questionnaire, which assesses mental health and the acculturation stress questionnaire from Ruiz, were answered by 431 immigrants (53.8% Colombian and 46.2% Peruvian) aged between 18 and 65 years old.

RESULTS

The major source of acculturation stress was distance from origin, followed by difficulties in social relationships and perceived discrimination and rejection. About 50% of respondents had elevated levels of discomfort in their life, with mental health problems derived from their adjustment to social roles and relationships. There was a high correlation between acculturation stress levels and severity of mental health symptoms.

CONCLUSIONS

Immigrants are exposed to high levels of stress resulting in a negative impact on their mental health.