Psychological Distress in the Galapagos Islands During the COVID-19 Pandemic

Objectives: to explore the emotional impact of the COVID-19 pandemic in the Galapagos Islands.

Methods: an online survey of 369 participants, conducted on October of 2020, was used to assess levels of depression, anxiety, and stress, as well as specific behavioral and emotional reactions to the pandemic.

Results: the prevalence of anxiety was 4% and depression 3.65%. Perceived stress level was higher, with 52% of the sample reporting moderate amounts. Women had higher levels of depression and perceived stress. Financial distress, interpersonal conflicts, feelings of isolation and fear of contagion of COVID-19 were all associated with higher levels of anxiety, depression, and stress.

Conclusion: prevalence of anxiety and depression is lower in the Galápagos Islands during the pandemic compared to other regions, while stress levels are more significant and may warrant intervention. Despite being low, anxiety and depression were associated with potentially problematic behaviors and emotional reactions.

Self-Esteem, Happiness, and Flourishing in Times of COVID-19: A Study During the Lockdown Period in Ecuador

Objective: Several studies have investigated the negative toll the pandemic has had on people’s mental health. However, there is limited research on the pandemic’s effect on positive mental health variables. This article reports on the levels of self-esteem and well-being (flourishing and happiness) in a sample of adults living in Ecuador and their relationships with the characteristics of their personal situation and the effects of the COVID-19 pandemic had on their personal lives.

Methods: A total of 766 adults completed an anonymous online survey between March and August 2020.

Results: Participants reported average scores in the flourishing scale, the majority considered themselves to be happy or very happy people, and more than half presented high levels of self-esteem. Age, education, socioeconomic status, time spent using mobile phones and on hobbies, among others, explained self-esteem, happiness, and flourishing.

Conclusion: The relationships between sociodemographic and situational variables of confinement during the pandemic are discussed, as well as the possible predictors of happiness, flourishing, and self-esteem.

Optimism and Health Self-Perception-Related Differences in Indigenous Kiwchas of Ecuador at Low and High Altitude: A Cross-Sectional Analysis

Ortiz-Prado, Esteban, Katherine Simbaña-Rivera, Diego Duta, Israel Ochoa, Juan S. Izquierdo-Condoy, Eduardo Vasconez, Kathia Carrasco, Manuel Calvopiña, Ginés Viscor, and Clara Paz. Optimism and health self-perception-related differences in indigenous Kiwchas of Ecuador at low and high altitude: a cross-sectional analysis. High Alt Med Biol 00:000-000, 2021. Background: Living at high altitude causes adaptive responses at every physiological and molecular level within the human body. Emotional and psychological short- or long-term consequences, including mood changes, higher mental overload, and depression prevalence, as well as increased risk to commit suicide have been reported among highlanders. The objective of this report is to explore the differences in self-reported dispositional optimism and health perception among sex-, age-, and genotype-controlled indigenous Kiwcha natives living at two different altitudes. Methods: A cross-sectional analysis of the comparison of means of subscales and summary scores of the 36-item short-form health survey (SF-36) self-reported questionnaire and the Life Orientation Test-Revised was conducted among 219 adults Kiwchas living at low (230 m) and high altitude (3,800 m) in Ecuador. Results: High-altitude dwellers presented lower scores in all the studied dimensions of SF-36 and the total score. Differences were found for the role limitation sphere due to vitality (p = 0.005), mental health (p = 0.002), and social functioning (p = 0.005). In all the cases, participants living at low altitudes scored higher than those living at high altitudes. Lowland women were more optimistic than their high-altitude counterparts. Conclusions: We observe that populations located at high altitudes have more unfavorable self-reported health states. Although our results depict the existence of significant differences in the health status of indigenous peoples living at different altitudes, further studies are needed to explain in depth the sociodemographic and/or environmental factors that might underlie these differences.

Trajectories of success and/or distress: protocol for an observational cohort study investigating changing psychological distress among emerging Ecuadorian adults over a year

INTRODUCTION

Emerging adulthood is a period of instability with changes in personal relationships and often a series of job changes before life trajectories clarify and more lasting decisions are possible. These changes often produce distress, and they might explain why most of the symptoms that impact the individual's mental health throughout their lives appear at this stage, although full-blown disorders are often only diagnosed subsequently. The objective of this study is to analyse the intraindividual changes in psychological distress and health-related quality of life in both student and non-student emerging adults over 1 year. Between-individual differences in variability will be analysed and life events will be recorded to identify possible associations.

METHODS AND ANALYSIS

Participants will be emerging adults (18-29 years of age) students and non-students. The primary outcome will be psychological distress measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure and the secondary outcome will be health-related quality of life measured by the EuroQol five-dimension-three-level. Sociodemographic and life events will be recorded. Information will be collected using an online survey.Analyses, described in a data analysis plan with the registration, will check the psychometric properties of the measures, describe the distribution of scores on the outcome measures, their relationship to group and other demographic variables and how they change over the seven assessment points across a year and explore any relationship between scores and life events.

ETHICS AND DISSEMINATION

This study received ethical approval by the Comité de Ética y Bioética (Ethics and Bioethics Committee) of the Universidad de Las Américas, Quito-Ecuador (2020-0807). Results will be published in peer-reviewed journals and presented at relevant meetings. Brief reports of these publications will be disseminated using social media to reach the community and private or public organisations interested in emerging adults.

TRIAL REGISTRATION NUMBER

NCT04596345.

Does virtual reality increase the efficacy of psychotherapy for young adults with mild-to-moderate depression? A study protocol for a multicenter randomized clinical trial

BACKGROUND

The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person's sense of identity and focuses on meaning-making processes.

METHODS

The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists' adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study.

DISCUSSION

We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04321525 . Registered on 18 February 2020.

Psychological Factors, Leisure Activities, and Satisfaction during the COVID-19 Pandemic: A Cross-Sectional Study in Eleven Spanish-Speaking Countries

The COVID-19 pandemic has affected the lives of millions of people worldwide. This study aimed to analyze the effects of several psychological factors (self-esteem, self-control, and emotional stability) over lifestyle-related variables (time spent on leisure activities) and the levels of satisfaction (family, friends, work, and leisure satisfaction) experienced during the COVID-19 outbreak. Data for this article were retrieved as part of a cross-sectional international study conducted in eleven Spanish-speaking countries between March and September 2020. The analyses were conducted using the responses of 9500 persons (65.95% women, 34.05% men). Structural equation modeling was used to test the direct and indirect effects of the psychological variables on satisfaction variables mediated by the time engaged in leisure activities. Our model indicated that psychological factors significantly predicted the amount of time spent in leisure activities and satisfaction. Overall, results indicate that self-esteem is a relevant psychological factor to consider in the development of psychological interventions directed at promoting healthy lifestyles. Nevertheless, further research is needed to validate the direction of the associations found in this study.

Geosocial Networking Apps Use Among Sexual Minority Men in Ecuador: An Exploratory Study

Geosocial networking applications (GSN apps) have become important socialization contexts for sexual minority men (SMM). Despite their popularity, there is limited research carried out in Latin American countries and no single previous study done in Ecuador. To fill this gap, this exploratory study described and analyzed the relationships between the sociodemographic characteristics of SMM using GSN apps, their sought and fulfilled expectations, profile shared and sought characteristics, and the evaluation of their experiences as users including their perceptions of support, and discrimination. We used an online recruited sample of 303 participants enrolled between November 2019 and January 2020. Most respondents used Grindr and reported spending up to 3 h per day using apps. Most common sought expectations were getting distracted, meeting new friends, and meeting people for sexual encounters. The least met expectation was meeting someone to build a romantic relationship with. When asked about their profiles, participants reported sharing mainly their age, photographs, and sexual role. Participants also prioritized these characteristics when looking at others' profiles. When asked about their experiences, most reported having been discriminated against, weight being the main reason for it. Some participants also indicated having received emotional support from other users. Correlation analyses indicated significant but weak relationships among the variables. Results indicated a positive correlation between time as an active GSN app user and higher experiences of discrimination. Likewise, higher number of used apps related positively with levels of received support. These results provide information that could inform future research in the country and the region regarding GSN apps use among SMM, socialization practices, and modern dating tools.

Sexual Behaviors and HIV/STI Prevention Strategies Among Sexual Minority Men in Ecuador Who Use Geosocial Networking Apps

Around the world, geosocial networking apps have become widely popular among sexual minority men (SMM). This research analyzed the sexual behaviors and HIV and STI prevention strategies (HIV/STI testing, HIV/STI inquiry, and HIV/STI disclosure) of an online-recruited sample of 284 SMM living in Ecuador. Sexting and oral sex were the most common sexual behaviors among SMM in the sample. Most participants had low perceptions of HIV and STI risk; 85% reported being tested for HIV and 70% for STIs. Being older predicted higher odds of being tested for either HIV or STIs at least once. Being single also predicted HIV testing. Future interventions in the country should explore apps' utility as intervention tools to spread information about sexual health and HIV prevention strategies, such as condom use and event-driven PrEP. Apps can also facilitate connections to sexual health services, including programs for PrEP initiation and linkage to HIV treatment. They should also focus on promoting sexual harm reduction conversations among potential app-met sexual partners.

"Infeliz" or "Triste": A Paradigm for Mixed Methods Exploration of Outcome Measures Adaptation Across Language Variants

The literature on measure translation tends to hold, overtly or covertly, a questionable assumption about the possibility of exact translation and almost completely ignores issues of within language variation. Equally, psychometric methods used to assess cross-cultural validity after translation focus on large sample tests of cross-sectional measurement invariance. Such invariance is often not found and is of dubious pertinence to change/outcome measures usually used in psychotherapy research. We present a sequential process of three substudies using quantitative and qualitative procedures to explore whether an outcome measure needs to be changed when used across language variation. Qualitative data confirmed that an item was not ideal in the new context. However, quantitative exploration showed that, although statistically significant and affected by gender and item order, the impact of changing the item in the overall score was small, allowing retention of the existing Spanish translation. We argue that the myth of perfect translation and over-reliance on large-sample psychometric testing pursuing measurement invariance limit exploration of language effects. We recommend that these be used in the companion of user-based, sequential, mixed-method exploration to support the development of a richer field of understanding of outcomes and change self-report measures across languages and cultures and both across and within languages.

Teachers' Mental Health and Self-Reported Coping Strategies During the COVID-19 Pandemic in Ecuador: A Mixed-Methods Study

PURPOSE

This study assessed the psychological distress, life satisfaction, and perceived stress of Ecuadorian teachers who adopted online learning in response to the COVID-19 pandemic. It also aimed to qualitatively report the coping strategies used to maintain their mental health and well-being.

METHODS

A web-based cross-sectional survey was conducted from June to mid-August 2020.

RESULTS

In total, 394 teachers completed the questionnaire, and from those, 320 also completed an optional open-ended question included in the survey. More than half of the participants reported taking care of children under 11 years and/or adults over 65 years. At the time of the study, most of the participants were teaching in higher education settings. Age was significantly correlated with all the psychological variables, females presented higher levels of perceived stress, and teachers with home care responsibilities presented higher psychological distress as well as perceived stress. Teachers who had previous training and experience with online teaching presented lower levels of distress, perceived stress as well as higher levels of life satisfaction. The most used coping strategies included seeking social support, exercising, and engaging in leisure activities.

CONCLUSION

The results provide useful information to help develop initiatives that promote teacher well-being. Future studies should consider using a more diverse sample and dedicate attention to work-family conflicts as well as social and structural inequalities that may have a toll on teachers' mental health and performance.

FSI modeling on the effect of artery-aneurysm thickness and coil embolization in patient cases

BACKGROUND AND OBJECTIVE

The attainment of a methodology to simulate the hemodynamic in patient-specific cerebral vessels with aneurysms is still a challenge. The novelty of this work is focused on the effect of coil embolization in a realistic cerebral aneurysm, according to the vessel wall thickness and aneurysm thickness, through transient FSI simulations.

METHODS

The quality of the mesh for simulations was checked with a specific mesh convergence study; and the numerical methodology was validated using numerical research data of the literature. The model was implemented in ANSYS® software. The total deformation and equivalent stress evolution in the studied cases, before and after coil embolization, were compared. More than 20 different models were employed due to different arterial wall thickness and aneurysm wall thickness combinations.

RESULTS

The obtained results have showed that deformation and stress values are highly influenced with the sac thickness. The thinner sac aneurysm thickness is, the greater deformation and stress are. The results after coil embolization process have highlighted that considering typical values of arterial wall thickness and aneurysm thickness 0.3 mm and 0.15 mm respectively, a deformation reduction around 50% and a stress reduction around 70% can be achieved.

CONCLUSIONS

The proposed methodology is a step forward in the personalized medicine, quantifying the aneurysm rupture risk reduction, and helping the medical team in the preoperative planning, or to deciding the optimal treatment.

What Happens When Individuals Answer Questionnaires in Two Different Languages

The aim of the present study was to compare scores from the English and the Spanish versions of two well-known measures of psychological distress using a within-subject approach. This method involved bilingual participants completing both measures in four conditions. For two groups of people, measures were offered in the same language both times and for the other two groups, each language version was offered, the order differing between the groups. The measures were the Clinical Outcomes in Routine Evaluation-Outcome Measure and the Schwartz Outcome Scale-10, both originally created in English and then translated to Spanish. In total, 109 bilingual participants (69.7% women) completed the measures in two occasions and were randomly allocated to the four conditions (English-English, English-Spanish, Spanish-English and Spanish-Spanish). Linear mixed effects models were performed to provide a formal null hypothesis test of the effect of language, order of completion and their interaction for each measure. The results indicate that for the total score of the Clinical Outcomes in Routine Evaluation-Outcome Measure just language had a significant effect, but no significant effects were found for completion order or the language by order interaction. For the Schwartz Outcome Scale-10 scores, none of these effects were statistically significant. This method offers some clear advantages over the more prevalent psychometric methods of testing score comparability across measure translations.

Effectiveness of integrated treatment for eating disorders in Spain: protocol for a multicentre, naturalistic, observational study

INTRODUCTION

Eating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves.

METHODS AND ANALYSIS

This protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models.

ETHICS AND DISSEMINATION

The study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED.

TRIAL REGISTRATION NUMBER

NCT04127214.

Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador

The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak.

Supervision Model of Mental Health Telecare Volunteers During the Covid-19 Pandemic

The COVID-19 outbreak is a pandemic that has strained significantly the capacity of many public and private health systems. To alleviate the burden, many students of health-related professions volunteered to offer their expertise to attend to the health needs of the public. This brief article aims to share a replicable supervision model that is currently in place to care for those volunteers in telecare mental health. The key aspects of this supervision model are the team composition, ongoing group supervision, formally structured supervision sessions, and the objective monitoring of members' well-being.

Acceptability and Psychometric Properties of the Spanish Translation of the Schwartz Outcome Scale-10 (SOS-10-E) Outside the United States: A Replication and Extension in a Latin American Context

The Schwartz Outcome Scale-10 is a 10-item measure that has proven utility for assessing well-being and mental health and measuring change over time. Although there is a Spanish translation of the measure created in the United States for the Latino population, its acceptability and psychometric properties have not been studied in unilingual Spanish speakers, nor outside the United States. The aim of the present study is to explore these properties in larger samples, clinical and non-clinical, from Latin America adding convergent validity checking and exploration of effects of gender and age on scores. A qualitative study was conducted with 11 participants to test for dialect/language issues, then a psychometric exploration of data from 886 participants in a non-clinical sample and 172 in a clinical sample. The results showed good psychometric characteristics and suggest that the SOS-10-E can be used in Latin America. A cutoff of 42.51 differentiates clinical scores from non-clinical. Future studies are needed to explore sensitivity to change and check replication in other Spanish speaking populations.

Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador

Ecuador has been one of the most affected countries by the Corona Virus Disease 19 (COVID-19) pandemic, by April 2020 this country presented the highest rates of mortality in Latin America. The purpose of the present study was to identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients who were part of the epidemiological surveillance program in Ecuador that included mandatory confinement and self-isolation. A cross-sectional study was performed from March 22th to April 18th, 2020 using an online survey. The survey collected socio-demographic information and severity of depressive symptoms using the Patient Health Questionnaire-9 and anxiety symptoms through the Generalized Anxiety Disorder-7. A total of 759 patients completed the questionnaire, 20.3% presented moderate to severe symptoms of depression and 22.5% moderate to severe symptoms of anxiety. Being a woman and from the Coastal region were risk factors. Exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to an hour was associated with better mental health. Regression analysis indicated that the mentioned behaviors explained approximately 17% of the variance for depression sum scores and 11.8% of the variance for anxiety sum scores while controlling for gender and region. Understanding the association between sociodemographic variables and psychological states in patients with COVID-19 is relevant to tackle future public mental health problems and to implement health policies that are intended to palliate further psychiatric complications. Promotion of modifiable behaviors such as exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to less than an hour is recommended.

Common and differential dimensions of personal identity between psychosis and depression: The relevance of gender and depressive mood

Disturbances in personal identity are recognized in psychosis and depression. However, it is unknown whether these disruptions share common processes across clinical groups, or whether there are unique alterations by group or between men and women within each clinical group. To advance on this question, we compared personal identity dimensions in psychosis and depression and investigated the effects of gender and depressive mood. This study assessed dimensions of personal identity using the repertory grid technique among 85 outpatients with psychosis, 85 outpatients with depressive disorders and 85 healthy controls who were matched by age. Data regarding depressive mood and general functioning was also collected. Results showed that self-discrepancies were higher in psychosis and depression than in controls, and were associated with depressive mood. Interpersonal dichotomous thinking was more prevalent in women in both clinical groups. Women with psychosis showed higher ideal-others discrepancy and had a more complex structure of personal identity than their male counterparts. To conclude, alterations in self-ideal and self-others discrepancies may be transdiagnostic dimensions related to depressive mood. Interpersonal dichotomous thinking may also be a common dimensional characteristic in psychosis and depression but more specific to women. Finally, critical views of others and a higher complexity of personal identity may be more specific to women than men with psychosis. Our results are consistent with other studies pointing to the need for person-focused treatments promoting the recovery of a full sense of personal identity, rather than just focusing on specific thoughts and feelings.

Psychological intervention change measurement in Latin America: Where from? Where to?

Objective: To conduct a scoping review of measure utilization in Latin America. We relate the findings to the needs of the region and give recommendations for measure usage in LA. Methods: Six electronic databases (PubMed, Web of Science, CINAHL, PsychInfo, SCOPUS, and SCIELO) were searched to identify peer-reviewed literature. In total, 207 studies using change and/or outcome measures were identified based on a priori inclusion criteria. Results: Production by country varied markedly; more than three quarters of the studies took place in just three of the 20 Latin American countries: Brazil, Chile, and Mexico. The most frequently used measures were the Outcome Questionnaire, Beck Depression Inventory-II, Hamilton Rating Scale, and Yale-Brown Obsessive-Compulsive Scale. The most common diagnosis was depression (n = 54). Conclusions: Outcome and change research in Latin America is growing rapidly but future efforts should focus more tightly on the needs of the region, as well as on forging collaborations with researchers from other regions. The use of change measures for serial assessment throughout interventions is recommended in view of its adaptability to highly diverse Latin American social realities. Dissemination of research findings and promotion of outcome and change measure use through implementation of public policy is recommended.

Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial

Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia.

METHODS AND ANALYSIS

This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02711020.

A Nationwide Study of Incidence and Mortality Due to Traumatic Brain Injury in Ecuador (2004-2016)

OBJECTIVE

Traumatic brain injury (TBI) is a public health problem worldwide. Information regarding TBI from low- and middle-income countries is scarce. The objectives of this study are to determine the incidence, mortality and geodemographic distribution of TBI in Ecuador.

METHODS

A population-based analytical study from 2004 to 2016 was conducted in Ecuador. Men and women with a diagnosis of TBI from all ages (0-110 years) were included. Data was obtained from official hospital-discharges records and retrieved from the National Institute of Statistics and Census (INEC) Database. We analyzed data by region, province and canton with a monthly resolution. The incidence, mortality, case fatality rates and the risk of developing TBI within the population were calculated based on the last 13 years of available data.

RESULTS

A total of 124,576 hospital admissions and 5,264 deaths due to TBI were registered in Ecuador from 2004 to 2016. The overall TBI-related hospital admission rate was 70.68 per 100,000. The sex- and age-specific rate was 90.1 per 100,000 for men and 64.1 per 100,000 for women. Mestizos' population has the highest adjusted incidence rate of 195.6 per 100,000, followed by the indigenous with 61.4 per 100,000 and Afro-Americans with 14.2 per 100,000. The overall annual mortality rate during the study ranged from 2.11 to 3.35 per 100,000. Case fatality rates were significantly higher in older populations, becoming fatal in up to 27% of men >90 years/old and in 15% of women older than 90 years/old.

CONCLUSION

This is the first recorded epidemiological study of the socio-demographic distribution of TBI in Ecuador to date. The study found that young men were almost 4 times more likely to be hospitalized due to TBI than women of this age. Fatalities due to TBI were less likely to occur among younger age groups, increasing significantly among the elderly population. The national incidence rate of TBI has been decreasing since 2011, which coincides with the introduction of stricter alcohol regulation, suggesting that this measure might have played a role in this reduction.

One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies

BACKGROUND

Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT.

METHOD

A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects.

FINDINGS

According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22).

INTERPRETATION

Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.

TRIAL REGISTRATION

ClinicalTrials.gov; ID: NCT01542957.