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Oelker A, Rumpf HJ, Brand M, Müller SM. Validation of the ACSID-11 for consistent screening of specific Internet-use disorders based on ICD-11 criteria for gaming disorder: A multitrait-multimethod approach. Compr Psychiatry 2024; 132:152470. [PMID: 38631271 DOI: 10.1016/j.comppsych.2024.152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. METHODS The ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior - Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. RESULTS The multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. CONCLUSION The current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.
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Affiliation(s)
- Andreas Oelker
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany.
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, Research Group S:TEP (Substance use and related disorders: Treatment, Epidemiology, and Prevention), University of Lübeck, Lübeck, Germany.
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany.
| | - Silke M Müller
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany.
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Žmavc M, Pontes HM, Griffiths MD, Selak Š. Psychometric properties of the Slovenian version of Internet Disorder Scale-IDS-15. PLoS One 2022; 17:e0276663. [PMID: 36269724 PMCID: PMC9586407 DOI: 10.1371/journal.pone.0276663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Conceptualising internet addiction and assessing its symptoms has presented a significant challenge for researchers over the past 25 years. Recently, the Internet Disorder Scale (IDS-15), which is based on the criteria for Internet Gaming Disorder (IGD) from DSM-5, has emerged as a promising instrument to assess internet addiction. The main objective of the present study was to evaluate the psychometric properties of the Slovenian IDS-15. METHODS The sample was recruited from the National Survey on the Use of Tobacco, Alcohol and Other Drugs that was conducted in 2018 on a nationally representative sample (N = 16,000; age range: 15-64 years; 62.4% response rate). The final sample comprised 9,161 participants, with 80.9% reporting having used the internet at least once a week (n = 7,413). A structured questionnaire was designed and internet addiction was assessed using the IDS-15. RESULTS Confirmatory Factor Analysis showed acceptable fit to the proposed four-factor structure of the IDS-15. The reliability, and criterion, convergent and discriminant validity were also found to be adequate with a notable exception of the first item of the scale, as shown by its lower factor loading and higher variability. Additionally, latent profile analysis was used to distinguish between internet users with low (n = 3,818; 51.5%), medium (n = 3,111; 42.0%) and high (n = 484; 6.4%) addiction risk. Furthermore, the high-risk class was associated with higher IDS-15 factor scores, higher frequency of internet use in leisure time, and lower age of first internet use. CONCLUSIONS The present study provides new insights about the strengths and shortcomings of the IDS-15. Moreover, the results provide an insight into the prevalence of internet addiction in Slovenia, as well as associations with other potential factors. The results serve as the basis for further analyses on internet addiction epidemiology, policymaking activities, and design for targeted public health interventions in Slovenia.
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Affiliation(s)
- Mark Žmavc
- National Institute of Public Health, Ljubljana, Slovenia
| | - Halley M. Pontes
- Department of Organizational Psychology, Birkbeck, University of London, London, United Kingdom
| | - Mark D. Griffiths
- International Gaming Research Unit Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Špela Selak
- National Institute of Public Health, Ljubljana, Slovenia
- * E-mail:
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Wölfling K, Dreier M, Beutel ME, Müller KW. Inanspruchnehmende einer Spielsuchtambulanz mit „Doppeldiagnosen“. SUCHT 2022. [DOI: 10.1024/0939-5911/a000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zusammenfassung: Zielsetzung: Internetnutzungsstörungen werden als wichtiges gesundheitsrelevantes Phänomen akzeptiert und sind bekanntermaßen mit hohen Raten an komorbiden psychischen Erkrankungen assoziiert. Jedoch ist das Wissen über das gleichzeitige Auftreten mit einer weiteren Verhaltenssucht begrenzt. Die vorliegende Arbeit bietet eine erste klinische Charakterisierung bei gleichzeitig auftretender Internetnutzungs- und Glücksspielstörung (Doppeldiagnose). Methodik: Die Analyse beruhte auf einer konsekutiven klinischen Stichprobe von Betroffenen ( N=1813), die sich wegen einer Verhaltenssucht ambulant vorstellten. Daten wurden aus der klinischen Exploration sowie psychometrischen Verfahren zur Erfassung von Depressivität, Stress, Angstsymptomen und Funktionsniveau erhoben und mit Betroffenen, die entweder eine Computerspiel- oder Glücksspielstörung aufwiesen, verglichen. Ergebnisse: Bei n=46 Betroffenen wurde eine Doppeldiagnose gestellt. Diese Gruppe wies zudem eine höhere Anzahl weiterer psychischer Störungen auf. Die Auswertung der klinischen Inventare wies auf eine insgesamt hohe Symptombelastung hin, ohne dass sich die Gruppen signifikant voneinander unterschieden. Schlussfolgerungen: Eine kleine Gruppe Inanspruchnehmender erfüllt die Kriterien einer Internetnutzungs- und einer Glücksspielstörung. Es ergeben sich keine auffälligen Unterschiede in der Symptombelastung zu Betroffenen mit singulärer Abhängigkeit, jedoch ist zu vermuten, dass Doppeldiagnosen eine differenzierte therapeutische Herangehensweise erfordern.
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Affiliation(s)
- Klaus Wölfling
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Michael Dreier
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Manfred E. Beutel
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Kai W. Müller
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
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Dudfield FWH, Malouff JM, Meynadier J. The Association between the Five-factor Model of Personality and Problem Gambling: a Meta-analysis. J Gambl Stud 2022; 39:669-687. [PMID: 35604521 PMCID: PMC10175427 DOI: 10.1007/s10899-022-10119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 01/08/2023]
Abstract
AbstractThis meta-analysis examined the associations between five-factor personality model traits and problem gambling. To be eligible for inclusion in the meta-analysis, studies had to provide effect size data that quantified the magnitude of the association between all five personality traits and problem gambling. Studies also had to use psychometrically sound measures. The meta-analysis included 20 separate samples from 19 studies and 32,222 total participants. The results showed that problem gambling was significantly correlated with the five-factor model of personality. The strongest personality correlate of problem gambling was neuroticism r = .31, p = < 0.001, 95% CI [0.17, 0.44], followed by conscientiousness r = − .28, p = < 0.001, 95% CI [-0.38,-0.17] ), agreeableness r = − .22, p = < 0.001, 95% CI [-0.34, − 0.10], openness r = − .17, p = < 0.001, 95% CI [-0.22,-0.12], and extraversion r = − .11, p = .024, 95% CI [-0.20,-0.01]. These results suggest problem gamblers tend to share a common personality profile – one that could provide clues as to the most effective ways to prevent and to treat problem gambling.
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Affiliation(s)
| | - John M Malouff
- University of New England Psychology, Armidale, NSW 2351, Australia.
| | - Jai Meynadier
- University of New England Psychology, Armidale, NSW 2351, Australia
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Wejbera M, Wölfling K, Dreier M, Michal M, Brähler E, Wiltink J, Schulz A, Wild PS, Münzel T, König J, Lackner K, Pfeiffer N, Beutel ME. Risk factors, physical and mental health burden of male and female pathological gamblers in the German general population aged 40-80. BMC Psychiatry 2021; 21:123. [PMID: 33663432 PMCID: PMC7931586 DOI: 10.1186/s12888-021-03110-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gambling Disorder (GD) has been associated with considerable mental and physical health risks in clinical samples. The paper determines risk factors, mental and physical health burden of probable GD for both men and women in the general population. METHODS In the Gutenberg Health Study, a population-based sample of N = 11,875 aged 40-80 years was analyzed regarding lifetime probable GD prevalence (measured with the Lie/ Bet Questionnaire) and a wide array of health variables including standardized measures of depression, anxiety, and somatic symptoms. RESULTS Probable GD lifetime prevalence was 2.1%, with higher rates among 1st generation migrants (5.5%; vs. non-migrants 1.6%), men (3.0%; vs. women 1.2%), and the sample's youngest age decade (40-49 y., 3.1%). Lifetime probable GD was associated with current work-related, family and financial stressors as well as unhealthy behavior (smoking, extended screen time), and lifetime legal offenses. In men, but not in women, increased rates of imprisonment, mental and somatic symptoms were found. CONCLUSIONS GD is a major public health problem with serious social, mental and physical health burden. Epidemiological findings underscore the preponderance of GD among 1st generation migrants and men. Findings are consistent with a vicious cycle of family, work related and financial stress factors, and mental and physical burden, particularly in men. Demographic risk factors may help to target specific prevention and treatment efforts.
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Affiliation(s)
- Martin Wejbera
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Klaus Wölfling
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Dreier
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Elmar Brähler
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörg Wiltink
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Schulz
- grid.410607.4Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- grid.452396.f0000 0004 5937 5237DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany ,grid.410607.4Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jochem König
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Karl Lackner
- grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Norbert Pfeiffer
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Wölfling K, Duven E, Wejbera M, Beutel ME, Müller KW. Discounting delayed monetary rewards and decision making in behavioral addictions - A comparison between patients with gambling disorder and internet gaming disorder. Addict Behav 2020; 108:106446. [PMID: 32408114 DOI: 10.1016/j.addbeh.2020.106446] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/16/2022]
Abstract
Behavior addictions, such as Gambling Disorder and Internet Gaming Disorder, have been demonstrated to have severe negative impact. Heightened impulsivity, deficits in decision making, and cognitive biases in the preference of immediate rewards have been shown to be crucial aspects in addictive disorders. While for Gambling Disorder (GD), dysfunctional decision making has been documented before, data for Internet Gaming Disorder (IGD) are still underrepresented. In order to allow for a direct comparison of both disorders, we assessed different measures of impulsivity (trait, impulsive choice, and decision making) in a clinical sample. N = 31 patients meeting criteria for GD and n = 30 patients with IGD were recruited from an outpatient clinic and compared regarding their performance in a Delay Discounting Task (DDT), the Iowa Gambling Task (IGT), and self-report data on impulsivity (Barratt Impulsiveness Scale). Healthy controls (n = 27) were included as a reference group. In the DDT, the area under the curve was associated with the severity of GD only. No correlations were found for the impulsivity subscales and the area under the curve which, however, was similar between the two patient groups in contrast to controls. The GD-group performed poorer then the other groups in the IGT while IGD-patients performed poorer only at the beginning of the experiment. Although only few significant differences occurred, similarities between GD and IGD regarding the DDT point towards a tendency on discounting rewards faster. Likewise, both patient groups were performing worse in the IGT than healthy controls which indicates deficiencies in decision making. Interestingly, the IGD-group was able to shift towards more advantageous decision making, which might have important implications for therapeutic interventions.
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Affiliation(s)
- K Wölfling
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - E Duven
- Praxengemeinschaft Gonsenheim, Kapellenstraße 7, 55124 Mainz, Germany
| | - M Wejbera
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - M E Beutel
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - K W Müller
- Outpatient Clinic for Behavioural Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
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Jiménez-Murcia S, Granero R, Fernández-Aranda F, Sauvaget A, Fransson A, Hakansson A, Mestre-Bach G, Steward T, Stinchfield R, Moragas L, Aymamí N, Gómez-Peña M, del Pino-Gutiérrez A, Agüera Z, Baño M, Talón-Navarro MT, Cuquerella À, Codina E, Menchón JM. A Comparison of DSM-IV-TR and DSM-5 Diagnostic Criteria for Gambling Disorder in a Large Clinical Sample. Front Psychol 2019; 10:931. [PMID: 31133919 PMCID: PMC6524728 DOI: 10.3389/fpsyg.2019.00931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background and Aims: Gambling-related crimes are known to be associated with gambling disorder (GD). Due to a lack of consensus in the scientific community regarding the relevance of this diagnostic criterion, it was removed from the DSM-5. The primary aim of this study was to investigate through structural equation modeling (SEM) whether higher GD severity in treatment-seeking GD patients with a criminal record is mediated through the illegal acts criterion itself, or whether it can be better explained by other related clinical factors. Methods: An initial sample of 2,081 patients seeking treatment for gambling problems was included in the sample. SEM was used to evaluate the mediational role of the illegal acts criterion between the sex, age and personality traits, gambling severity, and comorbid depression levels. Comparisons between patients with coinciding and divergent DSM criterion for GD diagnosis were carried out. Results: Illegal acts mediated the relationship between personality traits and GD severity: younger age, high levels of novelty seeking, and low levels of self-transcendence increased the risk of endorsing the illegal acts criterion. No differences between coincident-divergent groups in terms of DSM-IV and DSM-5 diagnosis were found with regards to sex (p = 0.878), education level (p = 0.387), or civil status (p = 0.792). Discussion and Conclusion: The results obtained in the present study offer new insights into the utility of using a history of illegal acts, their different personality characteristics, and psychopathology to categorize GD patients. Our findings suggest that patients who engage in criminal behavior may require a more comprehensive intervention.
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Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anne Sauvaget
- Addictology and Liaison Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Andreas Fransson
- Faculty of Medicine, Department of Clinical Sciences Psychiatry, Lund, Sweden
| | - Anders Hakansson
- Faculty of Medicine, Department of Clinical Sciences Psychiatry, Lund, Sweden
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Randy Stinchfield
- Department of Psychiatry, University of Minnesota Medical School, Saint Paul, MN, United States
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Amparo del Pino-Gutiérrez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Public Health, Mental Health and Mother-Infant Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Baño
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | | | - Àngel Cuquerella
- Institute of Legal Medicine and Forensic Sciences of Catalonia, Barcelona, Spain
| | - Ester Codina
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Public Health, Mental Health and Mother-Infant Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain
| | - José M. Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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