Real-World Evidence of Ribociclib Plus Aromatase Inhibitors as First-Line Treatment in Advanced Breast Cancer: The BrasiLEEira Study

PURPOSE

Cyclin inhibitors plus endocrine therapy represent the reference standard for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) locally advanced or metastatic breast cancer (ABC). Efficacy results on hard end points such as overall survival come from well-designed randomized clinical trials (RCTs). However, a limitation of RCTs is the low external results validity, and their extrapolation to a broader population may not be appropriate. Real-world studies can overcome these limitations, also increasing the reliability of RCTs.

MATERIALS AND METHODS

The BrasiLEEira was an observational, longitudinal, retrospective, multicenter study to evaluate the effectiveness and safety of ribociclib plus nonsteroidal aromatase inhibitors in Brazilian women age 18 years or older with HR+/HER2- ABC. The study was approved by the institutional review boards of all 11 hospitals. Data were collected anonymously from medical records using an electronic case report form designed by an independent academic research organization, which conducted the study considering all recommendations of international guidelines. The primary end point was 1-year progression-free survival (PFS) rate. Secondary end points included mortality, dose reduction, and safety.

RESULTS

The mean age of 76 patients was 57 years, and 28.9% were Black/Brown. The most prevalent comorbidity was arterial hypertension (34.7%). About 26.0% had endocrine-resistant disease, and 54.1% had more than three metastatic sites. The PFS rate was 77.6%. Three patients died (3.9%). Dose reductions occurred in 37.7% of patients. The most common adverse event was neutropenia (68.4%).

CONCLUSION

The high-quality evidence from the BrasiLEEira study corroborates the RCTs' findings, expanding its validity to a broader spectrum and underrepresented population who may benefit from ribociclib treatment.

Patient-Reported Distress and Acute Care Utilization for Cervical Cancer Patients Undergoing Concurrent Chemoradiation

PURPOSE/OBJECTIVE(S)

Although concurrent chemo-radiation (CRT) and brachytherapy (BT) is curative for locally advanced cervical cancer (LACC), it requires complex coordination of care and is associated with treatment-related toxicity. Our objective was to evaluate patient-reported symptoms and social distress in LACC patients undergoing concurrent CRT and BT to determine whether they are predictive of unplanned acute care utilization.

MATERIALS/METHODS

Patients with LACC treated with concurrent CRT and BT between 2013-2020 completed the Edmonton Symptom Assessment Scale-revised (ESAS-r; 9 cancer-related symptoms ranked 0-10) and the Social Difficulties Inventory-21 (SDI-21; 21 social issues ranked 0-3) at every visit as part of routine distress screening. Acute care utilization was defined as any unplanned visit to the radiation nursing clinic, urgent care clinic, emergency department or hospitalization within 1 year from starting treatment. A logistic regression model will be used to evaluate associations between ESAS-r and SDI-21 scores and acute care utilization.

RESULTS

Among 151 LACC patients, a total of 354 ESAS-r and SDI questionnaires were completed longitudinally. Mean age at diagnosis was 49.9 years (30-90), 44% were FIGO 2B and overall treatment time was 53.6 days (32-135). At baseline, the most prevalent moderate to severe symptoms (ESAS-r score ≥4) were well-being (50%), anxiety (44%), tiredness (43%) and pain (36%). Post-treatment, these persisted in 42%, 27%, 38%, and 26%, respectively. The most common social distress at baseline was financial (33%). Financial distress post-treatment was significantly predictive of worse well-being (OR = 5.80, p<0.06), anxiety (OR = 3.33, p<0.04) and depression (OR = 4.76, p<0.01). Use of acute care within 1 year after starting treatment occurred in 103 patients (68%) for a total of 617 visits: radiation nursing clinic 71.3%, urgent care clinic 4.4%, emergency department 8.3%, hospitalization 16%. On average there were 6.6 visits/patient (0-31), with the average number of days between treatment start and first acute care visit being 17.9 (0-74).

CONCLUSION

Cervical cancer patients undergoing concurrent CRT report prevalent financial distress and moderate to severe symptoms that persist post-treatment. Acute care utilization commonly occurred during treatment, highlighting a time when additional support is needed. Predictive modelling for distress factors resulting in acute care utilization is now underway.

NKG2A Expression among CD8 Cells Is Associated with COVID-19 Progression in Hypertensive Patients: Insights from the BRACE CORONA Randomized Trial

Cardiovascular comorbidities and immune-response dysregulation are associated with COVID-19 severity. We aimed to explore the key immune cell profile and understand its association with disease progression in 156 patients with hypertension that were hospitalized due to COVID-19. The primary outcome was progression to severe disease. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome. Obesity; diabetes; oxygen saturation; lung involvement on computed tomography (CT) examination; the C-reactive protein concentration; total lymphocyte count; proportions of CD4+ and CD8+ T cells; CD4/CD8 ratio; CD8+ HLA-DR MFI; and CD8+ NKG2A MFI on admission were all associated with progression to severe COVID-19. This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of the functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.

Portuguese validation of the Self-Generated Stress Scale

Introduction

Self-Generated Stress might be defined as stress that is created by oneself by engaging in behavior or making decisions that ultimately add strain to pre-existing personal stress. The Self-Generated Stress Scale (SGSS; Flett et al. 2020) is a seven-item self-report measure built to assess this tendency to make one’s own life more stressful.

Objectives

To analyze the psychometric properties of the Portuguese Version of the SGSS.

Methods

Participants (127 medicine and dentistry students; 78.0% female) answered an online survey including the preliminary Portuguese version of the SGSS and other validated questionnaires: Maslach Burnout Inventory – Students Survey, Depression Anxiety and Stress Scales, HEXACO-60 and Big Three Perfectionism Scale.

Results

Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.546; RMSEA=.0666, p<.001; CFI=.982 TLI=.972, GFI=.960). The Cronbach’s alfa was .868. Pearson correlations between SGSS and the other measures were significant (p<.01) and moderate/high: Burnout, .412; Stress/Anxiety/Depression, >.550; Perfectionism, .600; Emotionality, .315; Extroversion, -.411. After controlling for the effect of Emotionality and Extroversion, SGSS explained significant additional increments of 19.9% and 14.0% of the DASS and MBI variance; controlling for Perfectionism, the increments were respectively of 27.9% and 2.0%. SGSS mean score (22.96±5.90 was not significantly different by gender.

Conclusions

As observed with the original English-language scale, the Portuguese version of SGSS showed good validity (construct and convergent-divergent) and internal consistency. As such, the SGSS might be useful in further investigation, particularly to explore the different pathways between personality traits, emotional regulation processes and psychological distress.

Disclosure

No significant relationships.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction

The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.

Objectives

To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).

Results

Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ²/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ²/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.

Conclusions

This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

Disclosure

No significant relationships.

COVID-19 Pandemic: Another Source of Stress for Medical Students

Introduction

The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students’ wellbeing.

Objectives

To compare medicine/dentistry students’ depression/anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress.

Methods

Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1; n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2; n=650) the COVID-19 pandemic. Mean age (21.12±3.75), personality traits scores, and gender proportions (»75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues).

Results

SAMPLE2 presented significantly higher mean scores of depression (3.89±3.55vs.3.33±3.34), anxiety (3.27±4.08vs.2.86±3.29), stress (7.07±5.72vs.6.18±4.59) and total DASS (12.28±10.55vs.13.65±11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001).

Conclusions

This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students’ psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.

Disclosure

No significant relationships.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MH-COVID19) - Development and validation

Introduction

The COVID-19 crisis has generated an increasing stress throughout the population.

Objectives

To develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19).

Methods

The items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MH-COVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female; mean age=31.02±14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female; mean age=34.02±14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA; CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19; Pereira et al. 2020).

Results

CFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: χ²/df=2.747; RMSEA=.0980, p<.001; CFI=.973; TLI=.918, GFI=.972; Sample2: χ²/df=3.327; RMSEA=.0490, p<.001; CFI=.993; TLI=.983, GFI=.990). Cronbach’s alfas were α<.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p<.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739; House and personal hygiene, r=.584; Use of remote services and isolation r=.425).

Conclusions

The new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.

Disclosure

No significant relationships.

The Portuguese adapted version of the fear of covid-19 scale for the postpartum period

Introduction

The Portuguese version of the Fear of COVID-19 Scale (FCV-19S; Cabaços et al. 2021), composed of seven items, presented good validity and reliability to be used in general population. To be used within perinatal context, specifically in the postpartum period, we have added an item related to the baby (item 8 – “I’m afraid my baby will be infected with coronavirus-19”).

Objectives

To analyze the psychometric properties of Portuguese adapted version of the Fear of COVID-19 Scale for the postpartum period (FCV-19SP), namely construct validity, internal consistency, and convergent validity.

Methods

207 women (mean age= 33.51 ± 5.23 years) recruited in the postpartum period (9,06 ± 8,52 months after delivery) fill in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS) and Coronavirus-19 Fear Scale for the postpartum period (FCV-19SP).

Results

CFA revealed that the unifactorial model composed of eight items presented good fit indexes (X²/df=1.508; CFI=.991; GFI=.974; TLI=.983; p[RMSEA≤.01] = .049), better than those of the seven items version (X²/df=3.963; CFI=.957; GFI=.909; TLI=.905; p[RMSEA≤.01] =.219). Cronbach alpha for the FCV-19SPP was α=.880. The total score significantly (p<.01) and moderately correlated with PDSS (r=.262) and PASS (r=.371).

Conclusions

The FCV-19SP is a valid and reliable questionnaire to assess fear of COVID-19 in women in the postpartum period.

Disclosure

No significant relationships.

Eating problems in ADHD: self-regulatory or inattentive/impulsive

Introduction

ADHD is a risk factor for impulsive/compulsive eating problems (EP). In, bulimia nervosa and compulsive eating disorder, EP are frequently preceded by negative affect and experienced as loss of control. Clarifying the underlying causes (eg., ADHD symptoms and/or psychological distress) of EP in ADHD would allow the development of targeted interventions.

Objectives

To a) compare levels of EP between ADHD patients and a community sample, and b) test if ADHD symptoms and psychological distress predict EP, in ADHD patients.

Methods

Adults with ADHD (n=32; age=23.78+/-6.12; 69% males) from the Neurodevelopmental Outpatient Unit of Coimbra and healthy participants (n=30; age=36.90+/-13.23; 57% males) answered an online survey including the Portuguese versions of the Adult ADHD Self-Report Scale Symptom Checklist, the Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire-Current Short and the Depression, Anxiety and Stress Scale.

Results

The ADHD group reported experiencing more EP than healthy individuals (18/32 vs. 4/30; χ2=12.458, p<.001). ADHD patients with EP suffered from severer ADHD inattentive, hyperactive, and global symptoms and higher levels of psychological distress (p<.001 to p=.027). Logistic regression model testing if ADHD and psychological distress symptoms predicted EP, in ADHD, explained 38.8% of the variance and showed that the only significant predictor was ADHD symptoms (B=.121, SE=.051, p=.017).

Conclusions

Our results indicate that EP are associated with severer ADHD clinical pictures. EP arose secondarily to ADHD symptoms, instead of serving as means to alleviate psychological distress. Clinicians should be mindful that, in ADHD patients, EP follow specific motivations, i.e., impulsivity and inattention, and may respond to combined cognitive-behavioural/executive training strategy.

Disclosure

No significant relationships.

Screening Accuracy of the Portuguese version of the Postpartum Depression Screening Scale-7 according to DSM-5 criteria

Introduction

The Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.

Objectives

To determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.

Methods

he pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2^nd-6^thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.

Results

During pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p<.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p<.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).

Conclusions

The Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.

Disclosure

No significant relationships.

Worries during the COVID-19 pandemic – which were the most prevalent and disturbing?

Introduction

The COVID-19 pandemic has brought additional worries and challenges to people’s lives, with potential implications for psychological well-being.

Objectives

To understand which worries and life changes have affected most the Portuguese general population during the COVID-19 pandemic and to analyse which contents are associated with higher levels of repetitive negative thinking/RNT and psychological distress/PD.

Methods

In September-December 2020, 413 Portuguese adults (69.2% female; Mean age= 31.02±14.272) were asked one open questions, with reference to the COVID-19 pandemic period: “what was your biggest worry?”; the answers were independently categorized by two researchers. Participants also filled the validated Depression Anxiety and Stress Scale and the Perseverative Thinking Questionnaire.

Results

The most prevalent worries were about: 1) fear of contamination (oneself and others-48.7%; 2) physical and mental health and well-being (self and others)-27.2%; 3) studies and profession-13.3%; 4) uncertainty about the future-7.7%; 5) economic-financial issues-6.5%; 6) miscellaneous-3.3%; 7) no worries-0.7%. Participants who had worries of the theme 4 had the highest RNT and PD mean scores, followed by themes 3 and 5, and then themes 2 and 1. These thematic groups significantly (p<.01) differ between each other (except 3-5) and from the other groups. RNT was a significant predictor of PD (R²=37.0%, β=.609, p<.001).

Conclusions

People who worry about the future uncertainties, occupational activities and finances should be systematically assessed with regard to their levels of anxiety, depression and stress and they can learn to deal with the RNT as a way to reduce their psychological suffering in times of pandemic.

Disclosure

No significant relationships.

Further Validation of the Short Form of the Self-Compassion Scale in a sample of Portuguese Medicine Students

Introduction

The Short Form of the Self-Compassion Scale (SCS-SF; Raes et al. 2011) is composed of 12 items that evaluate the same six dimensions (Self-Kindness/SK, Self-Judgement/SJ, Common Humanity/CH, Isolation, Mindfulness/M, Over-Identification/OI) as the long scale (26 items). The Portuguese version of the SCS-SF (Castilho et al. 2015) was validated in a vast sample from clinical and general populations, the latter being composed of students, other than from medicine courses.

Objectives

To analyze the psychometric properties of the Portuguese version of the SCS-SF in a sample of Medicine/Dentistry students.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the SCS and other validated questionnaires from the OECD Study on Social and Emotional Skills/SSES: Stress resistance, Emotional control, Optimism and Persistence.

Results

Confirmatory Factor Analysis showed that the model composed of six factors, two second order factors (positive and negative) and one third order factor (total) presented good fit indexes (χ2/df=3.013; RMSEA=.0066, p<.001; CFI=.970; TLI=.948, GFI=.947). The Cronbach’s alfas were .892, .869 and .877 respectively for the total, self-compassion and self-criticism dimension. Pearson correlations of the SCS-SF total score, self-compassion and self-criticism dimensional scores were moderate to high with the SSES measures, from .272/-.236/.247 with Persistence to .709/-.634/.615 with Optimism.

Conclusions

Although reduced to less than half than the original SCS, the SCS–SF is a valid and useful alternative to measure general self-compassion and their positive and negative components in an ongoing longitudinal research with medicine/dentistry students.

Disclosure

No significant relationships.

Relationship between personality, adherence to (mental) health behaviours and psychological distress during the COVID-19 pandemic

Introduction

Public health authorities around the world have been disseminating messages to support mental health and psychosocial well-being during the COVID-19 pandemic. Based on the Portuguese guidelines, we have developed the Adherence Scale to the Recommendations for Mental Health during the COVID-19 Pandemic (ASR-MH-COVID19) to better understand this health behaviour.

Objectives

To analyse the relationship between sociodemographics, personality traits, Adherence (to the Recommendations for Mental Health during the COVID-19 Pandemic) and psychological distress.

Methods

413 individuals (69.2% female; mean age=31.02±14,272) completed an on-line survey, in September-December 2020, including sociodemographic questions, ASR-MH-COVID19, NEO-FFI-20 and Depression Anxiety Stress Scale (DASS-21) and Health Perception Scale.

Results

Adherence scores did not significantly differ by gender, age and years of education. Women presented higher DASS and Neuroticism scores (p<.01). Adherence were negatively correlated with Neuroticism (r=-.247) and with Depression/Anxiety/Stress (all r».-200), positively with Openness to Experience (r=.174), Conscientiousness (r=.194) and Perceived Health (Physical, r=.173 and Psychological, r=.215) (all p<.01). Mediation analysis (Hays’ Macro Process - Model 4) revealed that Adherence is a partial mediator between Openness and DASS and Conscientiousness and DASS; when considering Neuroticism, only the direct effect was significant. The effect of Perceived Health (both Physical and Psychological) on DASS was also mediated by Adherence.

Conclusions

The Health Behaviour Model proposes a pathway linking personality and health that applies to these results about adherence and psychological distress during the COVID-19 pandemic. Personality and perceived health (also a trait) influence both adherence to mental health behaviours and psychological distress. Understanding personality is vital for health care providers.

Disclosure

No significant relationships.

Grief during the COVID-19 pandemic: A cross-sectional online survey in university students

Introduction

Almost 5 million people worldwide have lost their lives due to SARS-CoV-2 (source: WHO coronavirus (COVID-19) dashboard, data of 1.10.2021; https://covid19.who.int/) and therefore, globally, there is an increase of people in grief due to the death of a significant other.

Objectives

To study psychological correlates of grief during the COVID-19 pandemic.

Methods

591 university students, with a mean age of 23.84±7.95 years (range 18-65 years; 76.8% women; 91.2% Portuguese) completed an online questionnaire during the second COVID-19 confinement (from 15.02 to 13.03.2021), with sociodemographic questions, the Pandemic Stress Index, the Mental Health Inventory, Insomnia Scale, questions on physical/ psychological health, and social isolation.

Results

Students bereaving the death of a significant other (n=93, 15.7%; n=25, 26.9% reported cause was SARS-CoV-2; time since death: < 3 months to 1-year), compared to those who did not (n= 498; 84.3%), described poorer psychological health, higher psychological distress (depression, anxiety, lack of control) and sleep difficulties, higher levels of stress (higher impact of COVID pandemic in daily life, and higher behavior changes in response to COVID-19) and more social isolation.

Conclusions

COVID-19 pandemic-related stress is a source of additional stress for bereaved students. Grief is also associated with social isolation, poor mental health (depression, anxiety, lack of control) and sleep difficulties. Screening efforts, guidance, and counseling from professionals of mental health care, primary health care, and universities health care services during and after the COVID-19 pandemic could be extremely beneficial for bereaved students, particularly for those at higher risk of developing prolonged grief disorder.

Disclosure

No significant relationships.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction

The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.

Objectives

To further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).

Results

Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.

Conclusions

This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

Disclosure

No significant relationships.

From Perceived Vulnerability to Disease to Psychological Distress in times of COVID19 pandemic

Introduction

Perceived vulnerability to disease/PVD may influence psychological reactions to COVID-19 pandemic.

Objectives

To analyse the role of PVD in psychological distress/PD during the COVID-19 pandemic, testing whether it is mediated by perceived risk of COVID-19, fear of COVID-19 and repetitive negative thinking/RNT.

Methods

Participants (N=413 adults; 69.2% women) were recruited from September until December 2020, via social networks. They completed the following self-report validated questionnaires: Perceived Vulnerability to Disease Questionnaire/PVDQ; Perceived Risk of COVID-19 Scale, Fear of COVID-19 Scale; Perseverative Thinking Questionnaire and Depression Anxiety and Stress Scale. As women had significantly higher levels of PVD, COVID-19 perceived risk and fear, RNT, and psychological distress/PD, gender was controlled in mediation analysis (using PROCESS macro for SPSS; Hayes 2018).

Results

All the variables significantly (p<.01), moderately (r>.20) and positively correlated. The serial mediation model 6 with the three sequential mediators resulted in significant total effect (c=.326, se=.0791, p<.001, CI:.1702-.4814), non-significant direct effect (c’=.111, se=.065, p=.087, CI:-.0162 to .2380), significant total indirect effect (.2149, se=.065, CI:.1079-.3278); most indirect effects were significant, including the indirect 7 (.0144, se=.0077, CI=.0017-.0320), that goes through all mediators (PVD->COVID19 perceived risk->COVID19 fear->RNT->PD), meaning full mediation.

Conclusions

The effect of PVD on psychological distress operates by increasing the perception of risk and the fear of COVID-19, which intensify related worries and ruminations in times of pandemic. People with high perceived threat, aversion and discomfort in situations associated with increased risk of infection should be helped to decrease dysfunctional cognitive contents and processes in times of pandemic.

Disclosure

No significant relationships.

Adherence to the Recommendations from the Portuguese General Directorate of Health (GDH) during the COVID-19 pandemic: fear or prosocial behaviour?

Introduction

During a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged.

Objectives

To analyse the differential role of individual and contextual variables in the adherence to public health recommendations.

Methods

1376 adults (70.5% female; mean age=35.55±14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19; evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ; assesses empathy and altruism).

Results

Adherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASR-COVID19 and all dimensions were positively correlated to ProBeQ’s altruism and empathy (from r=.32 to r=.54); FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26; all p<.01). Linear regressions revealed that altruism and empathy (first model), as well as fear of Covid-19 (second model), were significant predictors of adherence; however, while the first model explained ≅28% of its variance, the second (FCV19S as independent variable) only explained ≅3%. Regression models performed in a subsample of participants with personal or family history of COVID-19 revealed that only empathy, but not altruism, was a significant predictor of adherence; in this subsample, fear was no longer a significant predictor of adherence, except for lockdown and use of teleservices.

Conclusions

Based on our results, we suggest health care providers and public health campaigns should take into consideration social solidarity and altruism, as well as previous experiences, when appealing to public’s engagement in health behaviour.

Disclosure

No significant relationships.

Further validation of the European and Brazilian Portuguese short version of the Postpartum Depression Screening Scale-7

Introduction

We have recently validated the Portuguese shortest version of the Perinatal Depression Screening Scale-PDSS-7 (items selected from the PDSS-21; each one representing a dimension evaluated by the PDSS-35), for the assessment of depression severity in pregnancy, both in Portugal and Brazil.

Objectives

To analyze the validity and reliability of the PDSS-7 Portuguese version to evaluate postpartum women both from Portugal and Brazil.

Methods

The Portuguese sample was composed of 304 women between the 2nd-6th postpartum months (Mean=20.09±7.21 weeks postpartum). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 121 women (Mean=10.51±4.53 weeks postpartum). All the participants completed the European/Brazilian Portuguese versions of PDSS-21, which was composed of the same items and included the seven items of PDSS-7. Participants also filled in the validated versions of Perinatal Anxiety Screening Scale and Profile of Mood States.

Results

Confirmatory Factor Analysis revealed that the unidimensional model of PDSS-7 presented acceptable/good fit indexes in both samples (Portuguese/Brazilian: χ²/d.f.=2.6598/1.7897; RMSEA=.0740/.0807, CFI=.8289/.7934, TLI=.7901/.8434, GFI=.9298/.9496; p<.001). The PDSS-7 Cronbach’s alphas were of .841/.856 and all the items contributed to the internal consistency. Pearson correlations with postpartum anxiety (.646/.763) and negative affect (.666/.676) were significantly (p<.01) high. PDSS-7 mean scores were higher in the Brazilian sample (16.06±7.39 versus 11.37±4.37, p<.01).

Conclusions

PDSS-7 presented validity (construct and convergent), reliability and utility in clinical and research settings, including in transcultural studies, in Portugal and Brazil, namely in the postpartum.

Disclosure

No significant relationships.

Relationship between personality, adherence to (mental) health behaviours and psychological distress during the COVID-19 pandemic

Introduction

Public health authorities around the world have been disseminating messages to support mental health and psychosocial well-being during the COVID-19 pandemic. Based on the Portuguese guidelines, we have developed the Adherence Scale to the Recommendations for Mental Health during the COVID-19 Pandemic (ASR-MH-COVID19) to better understand this health behaviour.

Objectives

To analyse the relationship between sociodemographics, personality traits, Adherence (to the Recommendations for Mental Health during the COVID-19 Pandemic) and psychological distress.

Methods

413 individuals (69.2% female; mean age=31.02±14,272) completed an on-line survey, in September-December 2020, including sociodemographic questions, ASR-MH-COVID19, NEO-FFI-20 and Depression Anxiety Stress Scale (DASS-21) and Health Perception Scale.

Results

Adherence scores did not significantly differ by gender, age and years of education. Women presented higher DASS and Neuroticism scores (p<.01). Adherence were negatively correlated with Neuroticism (r=-.247) and with Depression/Anxiety/Stress (all r».-200), positively with Openness to Experience (r=.174), Conscientiousness (r=.194) and Perceived Health (Physical, r=.173 and Psychological, r=.215) (all p<.01). Mediation analysis (Hays’ Macro Process - Model 4) revealed that Adherence is a partial mediator between Openness and DASS and Conscientiousness and DASS; when considering Neuroticism, only the direct effect was significant. The effect of Perceived Health (both Physical and Psychological) on DASS was also mediated by Adherence.

Conclusions

The Health Behaviour Model proposes a pathway linking personality and health that applies to these results about adherence and psychological distress during the COVID-19 pandemic. Personality and perceived health (also a trait) influence both adherence to mental health behaviours and psychological distress. Understanding personality is vital for health care providers.

Disclosure

No significant relationships.

Stigma towards mental illness in med students: you label me, I label you?

Introduction

Evidence suggests that besides having stigmatizing misconceptions towards people with mental illness, medical students and doctors often resist seeking help for their own mental issues. This is a vulnerable group for stress and other mental health problems, due not only to professional burden but also high perfectionism and low self-compassion.

Objectives

To analyse the relationship between mental health stigma (MHS) and other variables related to personality and emotional states in a sample of medical students.

Methods

634 medicine and dentistry students (mean age = 21.6±6.9;81.4% female) answered to a survey including sociodemographic data, self-perception of psychological health/SPPH and the Portuguese validated versions of: Link’s Perceived Discrimination and Devaluation (PDD) scale to assess MHS and its two dimensions - social stigma/SocS and self-stigma/SelS; Depression Anxiety Stress Scale (DASS-21); Neff’s Self-Compassion Scale (SCS); and Big Three Perfectionism Scale (BTPS). Correlations, t-student tests and linear regressions were performed with SPSS 27.0.

Results

Stigma correlated negatively to SPPH and positively to DASS, the negative poles of SCS (self-judgement, isolation and over-identification) and BTPS second-order factors (all from p<.05 to p<.01). No gender differences in MHS were observed. Participants with higher mean levels of total and SelS had significantly higher scores in all DASS dimensions and lower SPPH; participants with higher SocS also scored higher in DASS, but didn’t reveal lower SPPH. Isolation was a significant predictor of SocS (R2=2.8%;p<.05); isolation and narcissistic perfectionism were significant predictors of SelS (R2=11%;p<.01).

Conclusions

Our results highlight the importance of including MHS as a main need in the curricula of future doctors.

Disclosure

No significant relationships.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MH-COVID19) - Development and validation

Introduction

The COVID-19 crisis has generated an increasing stress throughout the population.

Objectives

To develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19).

Methods

The items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MH-COVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female; mean age=31.02±14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female; mean age=34.02±14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA; CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19; Pereira et al. 2020).

Results

CFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: χ²/df=2.747; RMSEA=.0980, p<.001; CFI=.973; TLI=.918, GFI=.972; Sample2: χ²/df=3.327; RMSEA=.0490, p<.001; CFI=.993; TLI=.983, GFI=.990). Cronbach’s alfas were α<.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p<.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739; House and personal hygiene, r=.584; Use of remote services and isolation r=.425).

Conclusions

The new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.

Disclosure

No significant relationships.

The portuguese version of the big three perfectionism scale – further validation with adults from the general population

Introduction

Both original Big Three Perfectionism Scale (BTPS; Smith et al. 2016), and the Portuguese version validated with a sample of university students (Lino et al. 2018) evaluates three second-order factors (rigid, self-oriented and narcissistic perfectionism) and ten facets.

Objectives

To confirm the BTPS three-factors-ten-dimensions’ structure in a sample of Portuguese adults from the general population.

Methods

A sample of 467 adults (70.7% females; Mean age=38.44±12.27; range: 25-82) answered the BTPS Portuguese version and other validated perfectionism measures (Multidimensional Perfectionism Scales from Frost and Hewitt & Flett; Self-Presentation Perfectionism Scale). To study the temporal stability a sub-sample of 132 participants completed the BTPS again after approximately five weeks. SPSS and AMOS software was used.

Results

The second order model presented an acceptable fit (X²/df=3.115; TLI=.811; CFI=.825; RMSEA=.067). There was also evidence of a general factor comprising all the 45 items (X²/df=3.127; TLI=.809; CFI=.823; [JA1] RMSEA=.068). The Cronbach alphas of the three factors ranged from a=.88 to a=.92; and facets had a>.70 showing a total of a=.94. Total and dimensional scores showed significant positive and moderate to high correlations with the other perfectionism measures and their test-retest correlation coefficients were r=.85 (p<0.001).

Conclusions

This study confirms the validity and reliability of the Portuguese BTPS underlying three-factors structure. Additionally, we found, for the first time, that BTPS can also be validly and reliably used to measure a global perfectionism construct. It is our intention to develop a shorter version the Portuguese BTPS in the near future.

Generalized problematic internet use, use of social networks, and appearance schemas in late adolescence

Introduction

Research on the association between internet use and concerns about body image is still scarce.

Objectives

To explore the associations between generalized problematic internet use, number of social networks, and appearance schemas.

Methods

216 Portuguese late adolescents (89.3% females), with a mean age of 18.62 years old (SD = .488, range: 18-19) filled in an internet patterns of use questionnaire, the Generalized Problematic Interne Use Scale 2 (GPIUS2) and The Appearance Schemas Inventory-Revised (ASI-R).

Results

A total of 99.6% of the students use social networks. Subjects were divided into three groups (group1: 1-2 social networks; group 2: 3 social networks, and group 3: >3 social networks). There was a statistically difference in Motivational Salience scores (ASI-R) for the three groups [F (2, 503) = 6.0, p = .003]. Post-hoc comparisons indicated that the mean score for group 3 (M = 28.29, SD = 4.95) was significantly different from group 1 (M = 26.69, SD =4.55), and from group 2, (M = 26.87, SD =4.95). Generalized problematic internet subscales (Mood Regulation, Self-Deficient Regulation, and Negative Consequences) and total score were significantly correlated with both dimensions of ASI-R: Self-Evaluation Salience (coefficients varied from r = .31** to r = .47**) and Motivational Salience (from r = .14*, to r = .31**).

Conclusions

Generalized problematic internet use and the number of social networks are associated with adolescent’s cognitive-behavioural investment in one’s own appearance. Study carried out under the strategic project of the Centre for Philosophical and Humanistic Studies (CEFH) UID/FIL/00683/2019, funded by the FCT.

The role of shame in the relationship between bullying and self-harm in portuguese adolescents

Introduction

Bullying consists in acts of intentional and repeated physical or psychological violence, completed by an individual or a group of individuals, provoking pain, distress and shame. Currently, it is considered a serious problem with health implications in adolescents. Shame is a self-conscious, multifaceted and socially focused emotion that relates to a negative self-assessment.

Objectives

The study aim was to investigate the mediating role of Shame in the relationship between Bullying and Self-harm and Suicide Ideation in Portuguese adolescents.

Methods

346 adolescents (58.4% girls), aged 15.32±1.193 from public and private schools (9^th to 12^th grades) in Coimbra, answered the validated Portuguese versions of the Bullying Questionnaire, the Other as Shame Scale for Adolescents and the Self-Harm and Suicidal Ideation Questionnaire. For data analysis the SPSS 26 and Macro Process (Hayes 2020) was used.

Results

Bullying Victimization had a prevalence of 18.78%. Girls and boys significantly differ in Bullying Victimisation, Self-Harm, Suicidal Ideation and Shame mean scores (all p<.05). In girls, Bullying Victimisation was correlated with Shame and Suicidal Ideation. The mediation analysis showed that, in girls, Shame partially mediated the relationship between Bullying and Suicidal Ideation (p<.001). We didn’t find these results in boys.

Conclusions

Bullying is a global problem that needs to be addressed. Adolescents of today are the adults of tomorrow. In a physical growth and mental maturation phase, it is urgent to avoid disruptors which lead to psychopathology. Our results corroborate that Shame can be a harmful factor in Bullying with deleterious consequences in adolescents.

Relationship between fear of COVID-19 and individual factors – a preliminary study

Introduction

Fear associated to infectious diseases is directly related with their transmission rate, morbidity and mortality. High levels of fear associated with COVID-19 can affect people’s ability to act and think rationally. In a time of pandemics, it is essential to understand individual factors that might be associated to higher vulnerability to stress and fear.

Objectives

To analyse: a)correlations between Fear of Covid-19 and clinical and sociodemographic characteristics; b)the mediator role of repetitive negative thinking on the relationship between personality traits and Fear of Covid-19.

Methods

234 adults (75.6% women; mean age=29.53±12.51) completed an on-line survey with the Portuguese version of the Fear of Covid-19 Scale (FCV-19S) and other questionnaires to evaluate clinical and sociodemographic characteristics (years of education, perceived physical and mental health and infection by Covid-19), Personality (NEO-FFI-20) and Repetitive negative thinking (PTQ-15). SPSS and Process Macro (Hays, 2020) were used.

Results

FCV-19 mean scores were significantly higher in women and significantly correlated with years of education (r=-.14) (p<.05). History of previous/current Covid-19 infection did not significantly distinguish FCV-19 scores and they did not correlate with perceived health. FCV-19 correlated significantly with neuroticism and PTQ total and dimensional scores (r>.20, p<.01). Both Repetitive thinking and Cognitive interference were mediators of the relationship between neuroticism and fear of COVID, even after controlling for gender and education.

Conclusions

This study provides preliminary evidence on individual factors that might be associated to the emotional response to the Covid-19 pandemics, aiming to facilitate public health initiatives to ease people’s fears in a near future.

Generalized problematic internet use: An impulsive-compulsive spectrum disorder?

Introduction

Generalized problematic internet use/GPIU has recently been associated with the impulsive-compulsive spectrum/ICS, but its mapping onto these behaviour dimensions is relatively unexplored.

Objectives

To compare patterns of internet use and scores of BIG-5 personality traits, perfectionism and psychological distress between groups with low/high levels of GPIU.

Methods

475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese versions of: GPIU Scale, Multidimensional Perfectionism Scale-13, NEO-FFI-20, Depression, Anxiety and Stress Scales and other questions about internet use. Chi-square and Mann-Whitney tests were performed using SPSS.

Results

Individuals with high levels of GPIU (median+2SD; n=18; 3.8%) spent significantly more time/day in online activities, exceeding what they have planned; had no other hobbies and used social networks to meet friends; reported that GPIU interfered with affective/work relationships and academic performance (all p<.05). There were no significant differences in the purposes of the internet use (e-mail, social networks, shopping, videogames, multimedia, sexual, work…), unless for general information searching and betting games (both p<.05). High-PGIU group also presented significant higher levels of neuroticism, negative (but not positive) perfectionism, depression, anxiety, and stress (all p<.001).

Conclusions

Our results indicate that unlike the purposes of internet use, personality, perceived interference and the associated cognitive-emotional processes and symptoms (psychological distress) may help distinguishing between functional vs. dysfunctional internet use. Considering the preponderance of processes over contents and the presence of certain dimensions, such as perception of uncontrollability, interference and social isolation we add more evidence to consider PGIU as falling within the spectrum of impulsive-compulsive disorders.

Conflict of interest

No significant relationships.

Habits and quality of life in portuguese girl adolescents: Association with psychological disturbance distress

Introduction

Adolescence is a life period with considerable biological, psychological and social changes. Quality of life is a complex and multifactorial construct that necessarily encompasses the adolescent’s mental well-being. Some life habits like sleep, sport practice and screen time can be either risk factors or protective factors, influencing the quality of life and mental health.

Objectives

To investigate the role of sleep habits, sport practice and screen time in quality of life, and psychological distress in a Portuguese adolescent girl sample.

Methods

409 girls, mean aged 13.51±2.298, from public and private schools in Coimbra answered questions about sleep time, sport practice and screen time habits; the Portuguese versions of the Quality of Life Questionnaire (reduced version) and theAnxiety, Depression and Stress Scale. SPSS 26 was used.

Results

Girls mentioned to sleep 8,2 hours/night during the week and 9,4 hours/night at the weekend. They spend 1,5 hours/day during the week and 1,8 hours/day at the weekend with Screens. They spend 2,1 hours/ week in Sport Practice. Quality of Life was positive correlated with Sleep Time and negative correlated with Screen Time, Anxiety, Depression and Stress (all p<.05). Multiple regression analysis showed that Screen Time, Anxiety and Depression were all significant predictors of Quality of life in girls (p<0,05).

Conclusions

Our findings show that Screen Time is related with poor Quality of Life in girls. These results suggest the importance of addressing Screen Time and Psychological Distress in adolescent girls during adolescent health care consults.

Childbirth expectations questionnaire – a psychometric study with a sample from brazil

Introduction

The Childbirth Expectations Questionnaire (CEQ; Gupton, A., Beaton, J., Sloan, J. & Bramadat, I.; 1991) evaluates the women childbirth expectation’s with 34 items organized in four dimensions: Pain and coping; Significant others; Nursing support and Interventions.

Objectives

To analyze the psychometric properties (construct validity using Confirmatory Factor Analysis, discriminant validity and reliability) of the Brazilian preliminary version of CEQ.

Methods

350 women (Mean age: 30.01±5.452) in the second trimester of pregnancy (Mean weeks of gestation=25.17±6.55), with uncomplicated pregnancies, completed the CEQ. To analyze discriminant validity, thirty of these women participated in a workshop (12 hours, integrated in the GentleBirth, a specific perinatal education intervention program) and fill in the CEQ again after approximately 8 weeks.

Results

After deleting seven items (1-3-20-24-33-34-35) and some errors were correlated the four-dimensional second-order model of CEQ presented good fit (χ²=2.496; RMSEA=.071; CFI=.845, TLI=.828). The CEQ Cronbach’s alpha for the total was α=.90; all factors presented good reliability: Pain coping (α=.87); Significant others (α=.66), Nursing support (α=.84), and Interventions (α=.76). The CEQ mean scores (total, Pain coping and Nursing support) were significantly higher after the workshop, indicating more positive expectations for childbirth (p<.05).

Conclusions

This additional validation study emphasizes that CEQ is an adequate measure of expectations of labour. It will be very useful to understand the correlates of childbirth expectations and also to access the efficacy of childbirth preparation programs.

Not guilty by reason of insanity and dangerousness: A demographic, clinical and forensics description of the patients in the forensic inpatinent service of Coimbra

Introduction

Despite being essential for the service quality improvement, empirical research on the characteristics of people hospitalized in forensic psychiatry units and the psychopharmacological treatment instituted in this care context is scarce in Portugal.

Objectives

To describe the sociodemographic, clinical and criminological characteristics of the patients admitted to a forensic psychiatric unit in Portugal, as well as, the psychiatric drugs prescription pattern in this care context.

Methods

A retrospective observational study was carried out, through the data analysis of patients admitted to the Sobral Cid Forensic Psychiatry unit of the Coimbra Hospital and University over the past 12 years.

Results

The sample had 194 inpatients, 153(78.9%) male and 41(21.1%) females. The mean age was 43.3 years and 74.7% had no professional, school or occupational activity. The most frequent psychiatric diagnoses were psychotic disorders (56.7%) and neurodevelopmental disorders(33.5%). 24.2% had at least two psychiatric diagnoses and 38.7% had concomitant medical conditions. 77.8% had history of psychiatric hospitalizations and 21.6% had history of self-injurious behaviors. 37.1% of the sample had a criminal record. Crimes against people were the most frequent. The use of injectable antipsychotic formulations was frequent and 18.6% of the patients were medicated with Clozapine. The prescribed daily doses were above the defined daily dose. Psychotic disorders and addictive disorders were less frequent in women. Statistically significant differences were found in the frequency of homicide between females(41.5%) and males(22.2%).

Conclusions

Tailored solutions are crucial to accomplish the purpose of security measures, mostly by addressing the identified needs and rethinking the approach on this specific context.

Disclosure

No significant relationships.

Keyword

Forensic Psychiatry Units

Generalized problematic internet use and perfectionism in portuguese university students

Introduction

Although there are several empirical studies exploring the relationship between problematic Internet use and personality traits, few had considered perfectionism.

Objectives

To explore the association between generalized problematic Internet use and perfectionism.

Methods

A sample of 433 Portuguese university students (M_age = 20.15 years, SD = 1.77, range = 18-25 years) completed the Generalized Problematic Internet Use Scale 2/GPIU and the Multidimensional Perfectionism Composite Scale – short version.

Results

GPIU total score (rs=.16**), Mood Regulation (rs=.22**), and Deficient Self-Regulation (rs=.13**) were correlated with Positive Striving factor. GPIU total score (rs=.38**), Preference for Online Social Interaction (rs=.16**), Mood Regulation (rs=.28**), Deficient Self-Regulation (rs = .33**), and Negative Consequences (rs=.41**) were significantly correlated with Evaluative Concerns factor. A one-way between groups analysis of variance was conducted to explore the relation between GPIU and perfectionism. Subjects were divided into three groups according to their GPIU risk levels (Group1:low-risk; Group2:medium-risk; Group3:high-risk). There was a statistically difference at p >.05 level in Positive Striving scores for the three risk level groups: F (2,430)=4.39, p=.013, and in Evaluative Concerns scores, F (2,430)=28.83, p=<.001. Post-hoc comparisons using the Tukey USD test, for Positive Striving, indicated that the mean score for Group1 (M=39.21, SD=8.56) was significantly different from Group3 (M=43.69, SD=9.74). Considering Evaluative Concerns, the mean score for Group1 (M=39.86, SD=11.31) was significantly different from Group2 (M=46.91, SD=11.42) and from Group3 (M=51.75, SD=8.54).

Conclusions

GPIU is consistently related to maladaptive perfectionism. Future longitudinal studies are needed to clarify the bidirectional association between GPIU and perfectionism traits.

Profile of mood states-27: A valid and reliable measure of negative and positive affect for brazilian pregnant women

Introduction

The original Profile of Mood States (McNair et al. 1971) is composed of 65 items to measure six affect dimensions. There is a Portuguese shorter version (POMS-27) for the perinatal period (Bos et al. 2013), which reduced the number of items (adjectives) down to 27. Although briefer, it still covers relevant mood states with good psychometric properties, being considered a good alternative to use during this demanding and busy period.

Objectives

To test if PoMS-27, composed of four dimensions (Depression, Anxiety, Vigour, Fatigue) and one second-order factor (Negative Affect, composed by the former two) is valid and reliable to be used with pregnant women from Brazil.

Methods

After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PoMS-27 and the Brazilian recently validated versions of Perinatal Depression Screening Scale and Perinatal Anxiety Screening Scale (PDSS; PASS; Barros et al. 2021). SPSS and AMOS software were used.

Results

After deleting two items (20 and 22) and some errors were correlated, CFA indicated that the PoMS-25 four-dimensional model presented an acceptable fit (χ2=3.163; RMSEA=.079, CFI=.868, TLI=.849). The Cronbach alphas of the dimensions were: Depression (.82), Anxiety (.86), Negative Affect (.89), Fatigue (.80) and Vigor (.50).

Conclusions

Within this psychometric study we found useful, valid and reliable measure of negative and positive affect for Brazilian pregnant women. From now on we will denominate it Profile of Mood States-25Br

The relationship between perfectionism, generalized problematic internet use and bulimic behaviours

Introduction

Perfectionism is a consistent risk factor for various psychopathological conditions, including psychological distress and eating disorders. Recently, we have shown, for the first time, that there is a relationship between perfectionism and generalized problematic internet use/GPIU (Sobral et al. 2020). Specifically, we found that the role of perfectionism in psychological disorder is partially mediated by GPIU. On the other hand, it has been suggested that the widespread use of digital media can lead to negative body image perception and abnormal eating attitudes and behaviors.

Objectives

To explore, for the first time, the relationship between perfectionism, GPIU and disordered eating behavior.

Methods

475 university students (78.9% girls; mean age 20.22±1.695) answered the Portuguese validated versions of: Composite Multidimensional Perfectionism Scale, GPIU Scale and Eating Attitudes Test-25. SPSS and Hayes’ Process Macro (2020) were used.

Results

Bulimic Behaviours/BB significantly and moderately correlated with Perfectionist efforts (r=.263), Perfectionist concerns (r=.284) and GPIU (r=.25) (all p<.001). The mediation analyses revealed that GPIU is a partial mediator of the relationship between both perfectionism dimensions and BB.

Conclusions

The evidence that both negative and “positive” perfectionism dimensions are associated to eating pathology is in line with our previous research. The present study adds, for the first time, that one of the perfectionism pathways of influence on BB operates through UGPI. Assessment and intervention to diminish eating psychopathology should focus on perfectionism and compulsive traits which could be involved in both ED and GPIU and in their comorbidity.

Disclosure

No significant relationships.

Autistic traits predict obsessive-compulsive symptoms: Study in a clinical sample

Introduction

Co-occurrence of obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) features is well stablished. Diagnosis of OCD increases the risk of a later diagnosis of ASD, and vice versa. Moreover, a recent combined genome-wide association study identified a shared polygenic risk between the two disorders. Our preliminary results also indicate that OCD patients have higher levels of autistic traits than individuals from the community.

Objectives

To determine which autistic dimensions (social skill, communication, attention switching, attention to detail imagination) are predictors of OC symptoms.

Methods

39 OCD patients (52,5% female; 19 to 64 years old) answered the Portuguese versions of the Autism-Spectrum Quotient for Adults and Obsessive Compulsive Inventory – Revised (OCI-R). Spearman correlation and linear multiple regression tests were performed using SPSS.

Results

The OCI-R global score showed positive correlations with some AQ dimensions (attention switching, attention to detail and communication). The regression model showed that attention to detail (β = .43, p = .01) and attention switching (β = .33, p = .038) explained 36% of obsessive-compulsive symptoms variance.

Conclusions

Our results are in line with a dimensional perspective of psychopathological continua and indicate that the overlap between OCD and ASD occurs through shared neurocognitive processes. We suggest that, besides being a predisposing factor for social difficulties (e.g.: facial/emotion recognition) in ASD, attention to detail and deficits in attention switching may also lead to difficulties to dismiss repetitive thoughts or extinguish behaviours in OCD. Future studies should investigate the distinctive features and underlying processes between OCD/ASD.

Validity and reliability of the perinatal anxiety screening scale in a brazilian sample of pregnant women

Introduction

The Perinatal Anxiety Screening Scale was translated and validated for European Portuguese (PASS-29; Pereira et al. 2019), from the original PASS (composed of 31 items; Somerville et al. 2014) to allow epidemiological and correlational research and early detection, which is an health policy imperative. This need also applies to Brazil, where a specific instrument to measure perinatal anxiety is not available.

Objectives

To study the psychometric properties of the PASS Brazilian version factor structure using confirmatory factor analysis (CFA), internal consistency and pattern of correlations with mood states.

Methods

350 women (Mean age: 30.01±5.452) in the second trimester of pregnancy (Mean weeks =25.17±±6.55) completed the PASS and the Brazilian version of Profile of Mood States (POMS-25; Barros et al. 2021). SPSS and AMOS software were used.

Results

After deleting two items (1 and 2) and some errors correlated, CFA indicated a good fit for the second-order model (X2/df=2.987; CFI=.903; TLI=.889; GFI=.797, RMSEA=.075; p[rmsea≤0.01]<0.001). The Cronbach alpha was α=.937, and for the four dimensions (general anxiety and specific fear, perfectionism and control, social anxiety and adjustment disorder, acute anxiety and trauma.), were all α>.800. PASS total and dimensional scores significantly (p<.01) and moderately correlated with Profile of Mood States dimensions: negative affect (.471), Depression (.294), Anxiety (.548), Fatigue (.438) and Vigour (-.288).

Conclusions

Similarly, to what has been found for Portuguese version, the Brazilian PASS resulted in a 29-items-and-four-factors version, with good construct and convergent validity and reliability. In the near future we will determine the PASS cut-offs to screen for anxiety disorders in pregnancy and postpartum.

Brazilian version of the postpartum depression screening scale-24

Introduction

The PDSS-24 is a Portuguese short version of the Postpartum Depression Screening Scale (Beck and Gable, 2002). Items were selected on the basis of exploratory factor analysis (those with loadings >.60). The PDSS-24 proved to be superior to the 35-items PDSS in reliability, validity and screening ability (Pereira et al. 2013).

Objectives

To analyze the psychometric properties (construct validity using Confirmatory Factor Analysis, discriminant validity and reliability) of the Brazilian preliminary version of PDSS-24

Methods

After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PDSS-24 and the Brazilian recently validated versions of Profile of Mood States-25 (PoMS; Barros et al. 2021). SPSS and AMOS software were used.

Results

After some errors were correlated the multidimensional second-order model of PDSS-24 presented an aceptable fit (χ2=3.448; RMSEA=.099; CFI=.817, TLI=.886, GFI=.886). The PDSS Cronbach’s alpha for the total was α=.90. Cronbach alpha was .90 for the total and >.75 for the dimensions. Appling the Portuguese validated cut-off score for Major Depression/DSM-5 (>42) to this sample 224 (64.0%) participants presented clinical relevant depressive symptoms.

Conclusions

The Brazilian PDSS-24 has acceptable validity and reliability. The percentage of women with high depressive symptomatology is three times higher than the figures reported in Portuguese Studies. This can be partly explained by the fact that data collection was done during the COVID19 pandemic. It is important to determine the PDSS cut-offs to screen for perinatal depression in Brazil.

Further validation of the internet addiction test: Psychometric characteristics in a portuguese university sample

Introduction

The Internet Addiction Test (IAT) is a 20-item, self-reported questionnaire that measures the presence and severity of Internet addiction which is an increasing problem in adolescents. Although a Portuguese version IAT has been validated in adults, its psychometric properties have never been evaluated before, in adolescents.

Objectives

To analyse the reliability and construct and concurrent validity of the IAT in a Portuguese adolescent sample.

Methods

772 adolescents (53.5% girls), mean aged 13.21±2.246, answered the Portuguese versions of the IAT and the Portuguese versions of validated scales to evaluate: Cyberbullying, Game Addiction, Agressivity and Anxiety, Depression Scales. To study the temporal stability, 377 (60.5% girls) respondents answered the questionnaires again after approximately four-six weeks. The total sample was aleatory splitted to realize the exploratory and the confirmatory factor analyses.

Results

Exploratory and confirmatory factor analyses supported a second order two-factor structure - “Isolation and Social Commitment” and F2-“Negligence and Functional Commitment”. The χ2/df value was 2.260 and had a significant p value; it had the lowest RMSEA score = .074 (p< .001) and it had the highest TLI (.980) and CFI (.905). IAT mean scores were no different between genders [Girls=29.25±18.775 vs. Boys: 30.85±17.929, p=.405]. The Cronbach’s alphas were > .85. Pearson correlation between the test and the re-test was r=.660. The IAT, video game addiction (r=.434), Cyberbullying (r=.383), anxiety (r=.209) and depression (r=.263) were significantly correlated (p<.001).

Conclusions

The Portuguese IAT has good reliability and validity, showing to be an adequate instrument for measuring Internet Addiction symptoms in Portuguese Adolescents.

Antepartum depressive and anxious symptoms: Association with physiological parameters of the newborn

Introduction

The Perinatal period is a time of vulnerability for developing psychiatric disorders of higher prevalence in the female gender - depression and anxiety1. Numerous authors have proposed that maternal psychological factors could influence pregnancy course and the well-being of mother and newborn2.

Objectives

To explore the relationship between perinatal psychological disorder and physiological parameters evaluated at birth, such as the Apgar Index (AI; 1, 5 and 10 minutes), head circumference, weight, length and age.

Methods

533 women answered, in the second trimester of pregnancy (16.98±4.83 weeks of gestation), several questions about psychosocial variables, the Perinatal Depression Screening Scale3 and the Perinatal Anxiety Screening Scale4. Of these, 208 (39.0%) women were interviewed with the Diagnostic Interview for Psychological Distress5. Newborn physiological parameters were obtained from electronic health records.

Results

AI was significantly (p<.01) and moderately (r≈.25) correlated with maternal anxious symptomatology, and with the experience of a stressful event in the last year (only AI 1 minute). Newborns of women with clinically relevant anxious symptomatology (>cutoff point, 14.6%) had significantly lower AI (p<.05), which was also observed in newborns of women who considered having had a stressful event (only AI 1 minute). Women’s newborns with maternal anxiety disorders during pregnancy (5.3%), had significantly lower values in AI, head circumference, weight and age of birth. Regression analyses showed that anxiety in pregnancy (symptoms and/or diagnoses) is a predictor of newborn physiological parameters, explaining significant percentages(r≈22%; p<.05) of its variability.

Conclusions

Early detection of psychological disorders in pregnancy, namely anxiety, is determinant to prevent adverse neonatal outcomes.

Disclosure

No significant relationships.

Relationship between COVID-19 perceived risk and perfectionism – a preliminary study

Introduction

Research following the Covid-19 pandemics has shown that psychological reactions to the pandemic and its constraints can vary significantly depending on personality. One of the traits that has not been studied yet, but can play a harmful role in the COVID-19 psychological impact is perfectionism. This trait, characterized by setting excessively high standards of performance and striving for flawlessness, has increased in recent years and is considered a transdiagnostic process involved in several (mental) health problems (Curran & Hill 2019).

Objectives

To analyze the role of Perfectionism in the levels of fear of COVID19 and of perception of infection risk by COVID-19.

Methods

234 adults (75.6% women; mean age=29.53±12.51) completed an on-line survey with the Portuguese validated versions of Covid-19 Perceived Risk Scale (C19PRS; Pereira et al. 2020), Fear of COVID-19 Scale (FC19S; Cabaços et al. 2020) and Big Three Perfectionism Scale (BTPS; Garrido et al. 2020). SPSS was used to perform correlation and regression analysis.

Results

Perceived Risk and Fear of COVID-19 were significantly correlated with perfectionism (.243, .228, respectively) (both, p<.01). Perfectionism explains 5.5% (Adjusted R2) of the FC19S variance (Beta=.243, p<.001) and 4.8% of the C19PRS variance (Beta=.228, p=.01).

Conclusions

This study provides preliminary, but completely innovative evidence that perfectionism contribute to the psychological impact of Covid-19 pandemics. In the near future we will test the hypothesis that the nature of unpredictability and the limitations imposed by the global crisis may be exacerbating the already high levels of psychological distress that affect negative perfectionists.

Eating disorder examination-questionnaire – 7: Construct validity in a sample of portuguese overweight women

Introduction

Although the Eating Disorder Examination Questionnaire (EDEQ; Fairburn et al. 2008) is the most used instrument worldwide for the assessment of eating disorders symptoms, its factorial structure considerably varies, which limits its construct validity. Using exploratory factor analisys in data from a sample of overweight women, our group found a three-factors structure of the EDEQ Portuguese version (Peixoto et al. 2013), Although it was in accordance with other psychometric studies (eg. Peterson et al 2007), it was different from the original matrix. Further investigation regarding its factor structure has been conducted, with studies supporting a modified seven-item-three-factors structure (dietary restraint, shape/weight overvaluation, body dissatisfaction) with improved psychometric properties (Grilo et al. 2013, 2015), including with Portuguese samples (Machado et al. 2018; Santos et al. 2019).

Objectives

To analyze if the EDEQ version composed of seven items and three factors is replicated in a Portuguese sample of overweight women.

Methods

The EDEQ was administered to an outpatient sample of 276 women (Mean age= 43.85±11.89 years; Mean BMI=32.82±5.43 Kg/height²) attending a weight loss treatment consultation in a public hospital.

Results

Confirmatory factor analysis (CFA) revealed an adequate fit of the EDEQ-7 second order model with three dimensions (χ²/df=1.5497; RMSEA=.0452, CFI=.9955, TLI=.9914, GFI=.xxx; p<.001). The EDEQ7 Cronbach’s alphas for the total and its dimensions were α<.70.

Conclusions

Given its good psychometric properties, the overlap of the measurement model with those found with different samples and the reduced number of items, the EDEQ7 will be very useful both in research and clinical settings with/for overweight women.

Mindfulness and self-compassion based intervention program to prevent burnout in medical and dentistry students

Introduction

Burnout occurs in every stage of a medical graduation and career. In the first years of graduation, is affects 35-45% of medical and dentistry students. This has severe consequences, such as: higher levels of suicidal ideation, substance abuse, medical errors and medical neglect; lower levels of empathy and self-compassion - essential to the quality of healthcare. Students with certain personality traits (e.g., neuroticism and, particularly, perfectionism) are more vulnerable to emotional dysregulation when facing stressors of daily life. Our recent studies proved that mindfulness and self-compassion can attenuate the effect of perfectionism on psychological distress.

Objectives

To present the rational, materials, methodology and preliminary results of our project COMBURNOUT, aimed to develop, implement and assess the efficacy of a mindfulness and self-compassion-based intervention to prevent burnout in medical and dentistry students.

Methods

Students with high levels of burnout, psychological distress and perfectionism will be randomly assigned to intervention (8 weekly sessions) or control groups. The sessions will be composed by psychoeducation about burnout, mindfulness and self-compassion practices, within and between sessions. The follow up will include three assessment moments until a year after the intervention.

Results

We expect that the experimental group will present significantly lower levels of burnout, psychological distress and perfectionism, and higher levels of emotional regulation skills.

Conclusions

The facilitators training and the manualization are guaranties of standardization and sustainability. If the positive impact of COMBURNOUT is verified, we intend to provide the program to medical/dentistry students from all over the country.

Pertinence and development of cibd – clinical interview for bipolar disorder

Introduction

Bipolar disorder (BD) is frequently underdiagnosed and due to poor screening, the average time between onset of symptoms and diagnosis is more than 7-years (Mantere et al., 2004). Improper diagnosis has serious consequences in intervention (Ghaemi et al., 2001), and previous assessment instruments are now considered insufficient to detect intervention changes, and to provide a more functional and integrated view of BD.

Objectives

Our study aims to develop a new DSM-5 based Clinical Interview for Bipolar Disorder (CIBD), providing criteria to diagnose BD, but also the individual’s perceptions dealing with BD symptoms. This interview follows the same structure of CIPD (Martins et al., 2015), which has shown acceptability by the participants and experts.

Methods

CIBD was developed by a multidisciplinary team considering the DSM-5 criteria for Bipolar Disorders. There was a thorough research regarding assessment and evaluation of BD, and several suggestions from an international task force of specialist working with BD patients were considered, when writing the questions for the interview. A detailed description of CIBD development is presented. The authors of the interview have extended experience in the management and assessment of BD patients, and CIBD is now being assessed by a wider non-related panel, regarding pertinence and clarity.

Results

Preliminary assessment and qualitative feedback from participants that were interviewed is shown, with an overall positive feedback.

Conclusions

CIBD assesses both the diagnosis/presence of mood episodes (hypo/mania, and depressive) and symptoms’ psychosocial correlates. CIBD detects subtle changes caused by intervention adding a much needed recovery focused perspective.

Disclosure

No significant relationships.

Impulsivity and compulsivity aggregate in alcohol use disorder and explain comorbidity with impulse-control and related disorders

Introduction

The conceptualization of impulsivity and compulsiveness has fluctuated between two different perspectives: they are (1) distinct and orthogonal dimensions, (2) extreme poles of the same dimension/ spectrum. We favor this latter, accepting that these dimensions contribute to the etiopathogenesis of impulsive-compulsive disorders, namely alcohol use disorder/AUD.

Objectives

To analyze: Differences of impulsivity and compulsivity levels between AUD patients vs. participants from the community; prevalence of impulsive-compulsive disorders/ICD in AUD; if impulsivity/compulsivity predict the severity of alcohol use and ICD in AUD.

Methods

32 AUD patients (21% women, mean age 46±10) answered the Portuguese versions of: Alcohol-Use-Disorders-Identification-Test, Questionnaire-for-Impulsive-Compulsive-Disorders-in-Parkinson’s-Disease, Barrat-Impulsiveness-Scale, Obsessive-Compulsive-Inventory and Depression-Anxiety-Stress-Scales; 50 adults from the community (68% women, mean age 29±14) answered the former three. Mann-Whitney-U, Spearman and regression tests were performed using SPSS.

Results

AUD individuals vs. subjects from the community presented higher levels of impulsivity and compulsivity (p<.001). AUD-group: AUDIT median score was 25 (>8 harmful use); 81% reported ICD-symptoms; impulsivity and compulsivity highly correlated (r=.639; p<.001); impulsivity levels explained the presence of certain ICD (gambling, compulsive buying, eating disorders) and depression/anxiety/stress (OR=.152; p<.05); compulsivity levels also explained the occurrence of specific ICD (compulsive buying and other repetitive automatic behaviours) and depression/anxiety/stress (OR=.131 p<.05).

Conclusions

Our results indicate that impulsivity and compulsivity co-occur and contribute to the explanation of AUD, and related comorbidity and psychological distress. This highlights the utility of considering impulsivity and compulsivity when subtyping, stratifying, and treating AUD patients. Finally, we assert that disorders of impulsivity and compulsivity (eg.: AUD and ICD) co-occur.

Conflict of interest

No significant relationships.

Postpartum depression screening scale-7: A valid and reliable short version both for portugal and brasil

Introduction

Screening programs for perinatal depression are systematicly implemented in developed countries. To circumvent the most commonly pointed limitation by the primary healthcare professionals (the questionnaires length), we have developed shorter forms of the Beck and Gable Postpartum Depression Screening Scale-35. The shortest version consists of seven items, each one representing a dimension evaluated by the PDSS. This PDSS-7 demonstrated equal levels of reliability and validity as the 35-item PDSS with the advantage of being completed in as little as 1-2 minutes(Pereira et al. 2013).

Objectives

To analyze the construct validity of the PDSS-7 using Confirmatory Factor Analysis, to use both in Portugal and in Brazil.

Methods

The Portuguese sample was composed of 616 women (Mean age: 32.29±4.466; Mean gestation weeks=17.13±4.929). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 350 women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55). They all had uncomplicated pregnancies and completed the European/Brazilian Portuguese versions of PDSS-24 (Pereira et al. 2013/ Barros et al. 2021), which was composed of the same items and included the seven items that compose the PDSS-7.

Results

The unidimensional model of PDSS-7 presented a good fit in both samples (Portuguese/Brazilian: χ²/d.f.=3.439/2.653; RMSEA=.066/.069, CFI=.974/.981, TLI=.947/.957, GFI=.939/.957; p<.001). The PDSS-7 Cronbach’s alphas were .82/.83 and all the items contribute to the internal consistency.

Conclusions

The PDSS-7 is a valid and precise, economic, fast and easy screening instrument for perinatal depression, a major public health problem, both in Portugal and in Brazil.

The role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder

Introduction

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%¹. PPD is associated with a range of adverse outcomes for both the mother and infant². Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue³.

Objectives

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

Methods

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale⁴, the Postpartum Depression Screening Scale⁵ and the Diagnostic Interview for Psychological Distress-Postpartum⁶. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Results

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Conclusions

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

Disclosure

No significant relationships.

Portuguese version of the fear of COVID-19 scale – psychometric study

Introduction

More than in other conditions, fear is associated with infectious diseases, and is directly associated with its transmission rate, morbidity and mortality. High levels of fear can affect the individual’s ability to think clearly, react proportionately and make rational decisions in the context of COVID-19. Recently, Mertens et al. (2020) developed the Fear of Covid-19 Scale (FCV-19S) to measure this construct.

Objectives

To analyse the psychometric properties of the FCV-19S Portuguese version, namely construct validity, internal consistency and convergent validity.

Methods

A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the FCV-19S, the Covid-19 Perceived Risk Scale (CPRS) and the Depression Anxiety Stress Scale (DASS-21).The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA.

Results

EFA resulted in one component. CFA revealed that the unifactorial model presented acceptable fit indexes (X2/df=3.291; CFI=.977; GFI=.932; TLI=.919; p[RMSEA≤.01]=.091). Cronbach alpha was α=.855. The total score significantly correlated with Covid-19 Perceived Risk (r=.529, p<.01) and with anxiety from DASS-21 (r=.132, p<.05).

Conclusions

This study provides preliminary evidence for the validity and reliability of the Portuguese version of FCV-19S, which will be used in an ongoing research project on the relationship between fear of Covid-19, personality, cognitive processes and adherence to public health measures to contain the pandemic.

From trauma to pain - a pathway to dental anxiety

Introduction

The main risk factor for dental anxiety is previous traumatic experiences of pain in the dental office. Other consistent etiologic factors are trait-anxiety and preparedness (genetic predisposition to increased sensitivity to pain and aversive stimuli). However, there is a wide inter-individual diversity in the anxiety experience – not all individuals with traumatic experiences at the dentist will develop dental anxiety anxiety

Objectives

To explore potential paths by which a traumatic experience at the dentist (TRAUMA) can lead to dental anxiety.

Methods

A community sample of 552 adults (68.2% women; mean age= 35.15±15.790) completed the Portuguese validated versions of: Dental Fear Survey/DFS, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire and Perseverative Thinking Questionnaire–15.

Results

140 participants (25.2%) had TRAUMA; it was significantly (p<.01) correlated with trait-anxiety (Spearman r=.190), SPT (r=.192), FDP (r=.333), RNT (r=.274) and dental anxiety (DFA total score; r=.418). In the mediation analysis (PROCESS macro 3.5 for SPSS; Model 81; Hays, 2020), trait-anxiety and gender were controlled (as RNT, SPT, FDP mean scores were higher in women, p>.01). Our model was significant (R²=17.15%; p<.001) and showed that TRAUMA predicted dental anxiety directely [direct effect: 10.25 (95% CI - 7.10-13.40)] and also through SPT, FDP and RNT (5 significant indirect effects).

Conclusions

This study underlines the importance of avoiding traumatic experiences in the dental office and of good clinical communication in pain management. If trauma still occurs, dentist should learn how to reduce its impact on the sensitivity and fear of pain and on the RNT.

Levels of depressive and anxious symptoms of pregnant women before vs. during the COVID-19 pandemic

Introduction

The effects on the population’s mental health due to the rapid global spread of COVID-19 are even greater for specific groups such as pregnant women.

Objectives

To compare levels of depressive and anxiety symptoms of pregnant women before vs. during the COVID-19 pandemic and to analyze the role of COVID-19 fear in perinatal psychological disorder.

Methods

200 Brazilian women evaluated during the pandemic in May-June 2020 (Sample-1) with the Brazilian Covid-19 Fear Scale for the Perinatal Period (Barros et al. 2020) and Screening for Perinatal Depression and the Perinatal Anxiety Crawl Scale, both with α> .90. Sample-1 was compared with a sample of 300 Portuguese women; these responded to the same questionnaires, before the pandemic, in 2017 and 2018 (Sample-2).

Results

Sample-1 had significantly higher mean scores of depression (52.73 ± 20.26 vs. 35.87 ± 16.98, t = 10.77, p <.001) and anxiety (36.58 ± 18.23 vs. 18.50 ± 13.71, t = 11.94, p <.001) and correlated significantly (p <.05) and moderate (r.30) with the fear of COVID-19. Hierarchical regression analyzes showed that, even after controlling for the effect of risk factors for PPP (Pereira et al. 2020), fear of COVID-19 is a significant predictor of depressive symptomatology levels (increments of 2-5%) and anxious (10-15%) during the pandemic.

Conclusions

The Sample-1 being from a different country may be a confusing factor, however, the magnitude of differences in PPP levels and the relevant role of fear in COVID-19, alert us to be aware of perinatal mental health.

Psychosocial risk factors for dysfunctional beliefs towards motherhood

Introduction

Motherhood-related beliefs are characterized by themes of failure and maternal role idealization. Recent studies found that postpartum depression/PPD is both predicted and a predictor by/for dysfunctional beliefs/DB. Additionally, it is possible that when contextual factors (eg. lack of social support) are present, women may anticipate the parenting experience as being of isolation, which in turn can lead to more dysfunctional attitudes.

Objectives

To explore psychosocial risk factors for motherhood-DB.

Methods

233 women were evaluated in the second trimester (17.05±4.82 weeks) of pregnancy and in the third month (12.08±4.25 weeks) postpartum sociodemographically and psychosocially (years of education, previous children and social support) and the Portuguese validated self-report questionnaires to assess: perinatal depression; perinatal anxiety; perfectionism; negative affect; self-compassion; and repetitive negative thinking (all in T0). The Attitudes Towards Motherhood Scale was administered in the postpartum. When Pearson/Spearmen correlation coefficients proved significant (p<.05), linear/logistic (hierarchic) regression analysis were performed.

Results

Motherhood-DB correlated significantly with all the variables, except for years of education, Other-oriented-Perfectionism and Common-Humanity. Motherhood-DB were significantly higher in women without previous children (p<.05). The final regression model was statistically significant (p<.001) explaining 15% of the Motherhood-DB variance, with Socially-Prescribed-Perfectionism and social support being the only statistically significant predictors. Hierarchic regression showed that even after controlling for social support, SSP significantly incremented the variance in 9%.

Conclusions

Our results highlight the need for preventive approaches to help women understand the origins of their dysfunctional beliefs (perfectionism, the myths of perfect motherhood) and for the promotion of positive cognitions.

Disclosure

No significant relationships.

Portuguese version of the COVID-19 perceived risk scale – psychometric study

Introduction

Risk perception of COVID-19 is potentially a significant determinant of the pandemic evolution and the public’s response to it. Acceptable levels of risk perception can be considered good for people to effectively fight the pandemic and adopt preventive health behaviors while high levels of risk perception may be damaging. Recently, Yıldırım&Güler (2020) developed the Covid-19 Perceived Risk Scale (C19PRS) to measure this construct.

Objectives

To analyze the psychometric properties of the C19PRS Portuguese version, namely construct validity, internal consistency and convergent validity.

Methods

A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the CPRS and the Fear of Covid-19 Scale (FCV-19S; Cabaços et al. 2020). The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA.

Results

EFA resulted in three components. CFA revealed that the second-order model with three factors presented good fit indexes (X2/df=1.471; CFI=.959; GFI=.948; TLI=.932; p[RMSEA≤.01]=.065). CPRS Cronbach alphas was α=.687; for F1 Worry, F2 Susceptibility to Covid-19 and F3 Susceptibility to Overall Morbimortality were α=.747, α=.813 and α=.543, respectively. The total and dimensional scores significantly correlated with FCV-19S (r>.30, p<.01).

Conclusions

This study provides evidence for the validity and reliability of the Portuguese version of CPRS, which will be used in an ongoing research project on the relationship between Covid-19 perceived risk, perfectionism, cognitive processes and adherence to public health measures to contain the pandemic.