Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders

BACKGROUND

Childhood/adolescence adversities and mental disorders are higher among LGB youths.

AIMS

To evaluate the role of childhood maltreatment, bullying, and mental disorders on the association between sexual orientation and suicidal ideation (SI); and the role of mental disorders on the association between sexual orientation discrimination and SI.

METHODS

Baseline and 12-month follow-up online surveys of Spanish first-year university students (18-24-year-olds). Multivariable logistic regression models assessed the effects of childhood/adolescence adversities and mental disorders in the relationship between sexual orientation, discrimination and SI.

RESULTS

A total of 1224 students were included (16.4 % LGBs). Risk factors of lifetime SI were sexual orientation (OR 2.4), any bullying (OR 2.4), any childhood maltreatment (OR 4.0), and any mental disorders (OR 3.8). Final model Area Under the Curve (AUC) 0.78. Among homosexual and bisexual students, discrimination showed increased risk of 12-month SI (OR 2.2), but this effect was no longer statistically significant when any 12-month mental disorder was added (OR 7.8). Final model AUC 0.72.

LIMITATIONS

Sample of interest was relatively small. But it was similar to comparable studies and statistical adjustments have been performed. Assessment of mental disorders and SI was not based on clinical assessment. However, validated scales showing good diagnostic agreement with clinical judgement were used.

CONCLUSIONS

Childhood/adolescence adversities and mental disorders interact in the association between sexual orientation and SI. Mental disorders may mediate the association between sexual orientation discrimination and SI. Further research using larger samples and causal modelling approach assessing the mediators of SI risk among LGBs is needed.

Psychometric properties of the Spanish Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R)

Based on the original 22-item single-factor questionnaire, the 10-item second-order Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) was developed for measuring weight-related experiential avoidance. This instrument showed good psychometric properties, and it has been validated to different contexts. However, no Spanish validation has been conducted, to date. Therefore, the aim of this study was to analyze the psychometric properties of the Spanish version of the instrument in a sample of adults from the Spanish context across the whole body mass index spectrum (N = 393). Confirmatory factor analysis was performed to examine the fit of the first- and second-order AAQW-R structures. Internal reliability, construct validity, external reliability, and sensitivity to change were also analyzed. The Spanish AAQW-R presented a good fit to the data, the overall scale and subscale scores showed acceptable-to-good internal consistencies, and adequate construct validity. Likewise, test-retest reliability parameters were high, and the instrument showed sensitivity to change. The findings demonstrate that the Spanish AAQW-R is an instrument with good psychometric properties, supporting its use for measuring adults' weight-related experiential avoidance in both research and clinical settings within the Spanish context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adolescents Adjudicated for Sexual Offending: Differences Between Sexual Reoffenders and Sexual Non-Reoffenders

Although a very small group of adolescents adjudicated for sexual offending (ASO) will persist into adulthood, the use of official records of sexual recidivism after long-term follow-up periods underrates the repetition of sexually coercive behaviors during adolescence. Additionally, limited research has considered sexual reoffending as a criterion to classify this heterogeneous population. The aims of this study were to determine the prevalence of ASO who engaged in repetitive sexual offending before their adjudication, and to use it as a classification criterion to examine the differential characteristics associated with each group. A sample of 73 adjudicated ASO in Spain was examined. They were divided into sexual reoffenders (SR) (n = 34) and sexual nonreoffenders (SNR) (n = 39). An ex post facto research design was carried out. Assessments included reviews of official files, interviews with professionals in charge, and interviews with the ASO in which the Interpersonal Reactivity Index (IRI) was administered. Descriptive analyses were conducted for all variables and Odds Ratio (OR) was used to compare intergroup differences. Results showed that SR had 12.95 times the odds of sexual victimization, 6.91 times the odds of having lived in a sexualized family environment, and 3 times the odds of bullying victimization. Deviant sexual fantasies were exclusively present among SR (44%). Significant differences between groups were also found in some sexual crime variables but not on the empathy scale. These results have implications for the distinction between ASO who have repeatedly engaged in sexually coercive behavior and those who engaged in a single event of sexual offending. The identification of specific risk factors and criminogenic needs for each group would benefit court decisions and more tailored interventions.

Predictive models for first-onset and persistence of depression and anxiety among university students

BACKGROUND

Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions.

METHODS

Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up.

RESULTS

A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline.

LIMITATIONS

Self-report data were used; external validation of the multivariable prediction models is needed.

CONCLUSION

MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

Cognitive Behavioral Therapy Program for Cannabis Use Cessation in First-Episode Psychosis Patients: A 1-Year Randomized Controlled Trial

Despite the negative influence of cannabis use on the development and prognosis of first-episode psychosis (FEP), there is little evidence on effective specific interventions for cannabis use cessation in FEP. The aim of this study was to compare the efficacy of a specific cognitive behavioral therapy (CBT) for cannabis cessation (CBT-CC) with treatment as usual (TAU) in FEP cannabis users. In this single-blind, 1-year randomized controlled trial, 65 participants were randomly assigned to CBT-CC or TAU. The primary outcome was the reduction in cannabis use severity. The CBT-CC group had a greater decrease in cannabis use severity and positive psychotic symptoms over time, and a greater improvement in functioning at post-treatment than TAU. The treatment response was also faster in the CBT-CC group, reducing cannabis use, anxiety, positive and general psychotic symptoms, and improving functioning earlier than TAU in the follow-up. Moreover, patients who stopped and/or reduced cannabis use during the follow-up, decreased psychotic symptoms and increased awareness of disease compared to those who continued using cannabis. Early intervention based on a specific CBT for cannabis cessation, may be effective in reducing cannabis use severity, in addition to improving clinical and functional outcomes of FEP cannabis users.

The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review

Several studies have examined acceptance and commitment therapy's (ACT) effectiveness for addressing physical and psychological distress people with obesity can face. Nevertheless, no review focusing specifically on ACT analysing randomized controlled trials (RCT) has been done up to date in this field. The present systematic review was developed following the PRISMA statement and aimed to examine ACT's effects on weight management and psychological well-being of adults with overweight or obesity. A conjunction of keywords related to ACT and excess weight was searched in four databases (Medline, PubMed, Psycinfo and Scopus) for articles meeting inclusion criteria. The literature search yielded 2,074 papers, and 16 were included in the review, finally. In 71.43% of the studies, ACT was effective to enhance psychological well-being; in 50% effectively targeted process variables and health behaviours related to weight management; in 31.82% of studies, physical variables were improved; and 21.38% of studies showed evidence in favour of ACT for eating behaviour modification. The present review supports ACT for promoting emotional aspects of individuals immersed in such weight-related battles and highlights the benefits of psychological well-being-oriented ACT in the context of obesity treatment. More studies targeting psychological well-being primarily and with longer follow-ups are required.

Characteristics and risk factors in juvenile sexual offenders

BACKGROUND

It is estimated that juvenile sexual offences constitute about 7% of the total annual rate of sexual offences in Spain. Nevertheless, research on Spanish juvenile sex offenders (JSO) is virtually non-existent. This paper analyzes the risk factors related to sexual violence committed by adolescents.

METHOD

The participants were 73 adolescents (M = 15.68 years, SD = 1.12) aged between 14 and 18, who were serving a sentence for committing a sexual offence in various Spanish Autonomous Regions. In this descriptive study multiple methods were used to collect the data: court records, self-reports, along with an interview with the JSO and with the professionals involved.

RESULTS

Risk factors related to family history, certain personality characteristics, and the development of "inadequate sexualisation" (96% of cases) were analyzed. This latter variable was mainly related to an early onset of pornography consumption (70%), to a sexualized family environment (26%), and to sexual victimization during childhood (22%).

CONCLUSION

These results are consistent with international research on juvenile sex offending, so we can conclude that the process of development of sexualization from infancy onwards should be deeply examined with regard to sexual violence.

Validation of an Online Version of the Alcohol Use Disorders Identification Test (AUDIT) for Alcohol Screening in Spanish University Students

Online alcohol screening may be helpful in preventing alcohol use disorders. We assessed psychometric properties of an online version of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish university students. We used a longitudinal online survey (the UNIVERSAL project) of first-year students (18-24 years old) in five universities, including the AUDIT, as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. A reappraisal interview was carried out with the Timeline Followback (TLFB) for alcohol consumption categories and the Mini International Neuropsychiatric Interview (MINI) for alcohol use disorder. Reliability, construct validity and diagnostic accuracy were assessed. Results: 287 students (75% women) completed the MINI, of whom 242 also completed the TLFB. AUDIT's Cronbach's alpha was 0.82. The confirmatory factor analysis for the one-factor solution of the AUDIT showed a good fit to the data. Significant AUDIT score differences were observed by TLFB categories and by MINI disorders. Areas under the curve (AUC) were very large for dependence (AUC = 0.96) and adequate for consumption categories (AUC > 0.7). AUDIT cut-off points of 6/8 (women/men) for moderate-risk drinking and 13 for alcohol dependence showed sensitivity/specificity of 76.2%/78.9% and 56%/97.5%, respectively. The online version of the AUDIT is useful for detecting alcohol consumption categories and alcohol dependence in Spanish university students.

The Effectiveness of an Acceptance and Commitment Therapy and Mindfulness Group Intervention for Enhancing the Psychological and Physical Well-Being of Adults with Overweight or Obesity Seeking Treatment: The Mind&Life Randomized Control Trial Study Protocol

Although several interventions that target obesity have been examined, the success of these interventions in generating and maintaining positive results has yet to be confirmed. This study protocol therefore presents a trial aimed at analyzing the effectiveness of a well-being-centered acceptance and commitment therapy (ACT)- and mindfulness-based group intervention following the valued-based healthy living (VHL) approach (Mind&Life intervention) for individuals experiencing overweight-related distress. A randomized controlled trial with two parallel groups will be conducted in 110 adults attending primary care units with overweight or obesity. Participants will be randomly allocated to one of the two study conditions. Interventions will either be the treatment as usual (TAU) or the Mind&Life intervention—an ACT- and mindfulness-based intervention—plus the TAU intervention. Quality of life, weight self-stigma, general health status, eating habits, physical activity, eating behavior, anthropometric, body composition, cardiovascular, and physiological variables, as well as process variables, will be examined at baseline, posttreatment, 6-month follow-up, and 1-year follow-up. This trial aims to offer a novel psychological approach for addressing the psychological and physical impairments suffered by people with overweight or obesity in the current environment. ClinicalTrials.gov identifier: NCT03718728.

Social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

Introduction

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear.

Objectives

The aim of the study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

Methods

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

Results

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).

Conclusions

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Disclosure

This work was supported by the Carlos III Institute of Health and European Fund for Regional Development (PI08/1213, PI11/ 01977, PI14/01900, PI08/01026, PI11/02831, PI14/01621, PI08/1161, PI16/ 00359, PI16/01164, PI18/00805), the Basque Foundation for He

Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

BACKGROUND

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

METHODS

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

RESULTS

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively).

CONCLUSIONS

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

Cognitive Distortions in Gamblers and Non-gamblers of a Representative Spanish Sample

Cognitive biases or distortions related to gambling, present in all people, are considered a relevant factor in the development of gambling-related problems.

OBJECTIVE

to establish whether the presence of these biases or cognitive distortions, in gamblers and non-gamblers, is related to the presence of gambling problems.

METHOD

3000 people aged 18-81 years, representative of the Spanish adult population, underwent a structured survey.

RESULTS

the presence of distortions was relevant to distinguish gamblers according to their level of gambling engagement and problems. There is a constant and significant tendency to have more cognitive distortions as gambling problems increase. But not all distortions have the same ability to distinguish between the different groups of gamblers. The results seem to group gamblers into three groups according to the presence of cognitive distortions, from less to more: (1) non-gamblers, (2) low-risk and at-risk gamblers, and (3) problem and pathological gamblers. The relevance of this research and its practical implications for both treatment and prevention work is discussed.

Mental disorders in Spanish university students: Prevalence, age-of-onset, severe role impairment and mental health treatment

BACKGROUND

The university period carries risk for onset of common mental disorders. Epidemiological knowledge on mental disorders among Spanish university students is limited.

AIMS

To estimate lifetime and 12-month prevalence, persistence and age-of-onset of mental disorders among Spanish first-year university students, as well as associated role impairment and mental health treatment use.

METHODS

First-year university students (N=2,118; 55.4% female; mean age=18.8 years) from five Spanish universities completed a web-based survey, screening possible DSM-IV mental disorders (major depressive episode(MDE), mania/hypomania, generalized anxiety disorder(GAD), panic disorder(PD), alcohol abuse/dependence(AUD), drug abuse/dependence(DUD), and adult attention-deficit/hyperactivity disorder(ADHD)). Role impairment and treatment associated with mental disorders were assessed.

RESULTS

Lifetime and 12-month prevalence of any possible mental disorder was 41.3%(SE=1.08) and 35.7%(SE=1.05), respectively. Persistence (i.e., ratio of 12-month to lifetime prevalence) was 86.4%(SE=1.58). Median age-of-onset was 14 for adult ADHD, 15 for mood disorders and AUD, and 16 for anxiety disorders and DUD. One third (29.2%) of 12-month disorders were associated with role impairment. Twelve-month PD (OR=4.0;95%CI=1.9-8.5) had the highest odds for role impairment. Only 12.6% of students with 12-month disorder received any mental health treatment. Twelve-month treatment was the highest among those students with 12-month GAD (OR=7.4;95%CI=3.7-14.8).

LIMITATIONS

The assessment of mental disorders was based on self-reports. Cross-sectional nature of the data prevents causal associations.

CONCLUSION

One third of Spanish university students report a common mental disorder in the past year, and one third of those report severe role impairment. Only one out of eight students with 12-month mental disorders receives mental health treatment.

Partner’s Emotional Dependency Scale: Psychometrics

INTRODUCTION

Emotional dependency in a partner implies an excessive permanent affectional bonding to the other individual that is dysfunctional, associated with low self-esteem and conceals a lack of affection. Emotional dependency generates a series of negative emotional consequences: symptoms of anxiety and depression, obsessive thoughts, sleep disorders and abandonment of social relations and leisure. In recent decades several tools have been developed to measure emotional dependency, but they are more focused on measuring dependent personality disorder, centered on an exclusively young population or are not validated in the Spanish population. The aim of this research is to design and validate a new scale to overcome these limitations.

METHOD

The sample population included 166 adults (53 men and 113 women) from the general population, to whom a new scale was applied (partner’s emotional dependency scale, SED), as well as the CDE (Emotional Dependency Questionnaire).

RESULTS

The scale has a unidimensional structure, showing good internal consistency (Cronbach’s alpha = .90) and a high convergent validity with the CDE (r = .86). There is no difference between men and women with regarding emotional dependency. Some cut-off points have been established based on the degree of emotional dependency (low, moderate, high and extreme).

CONCLUSIONS

The SED is a brief assessment tool, simple to conduct and allows the degree of emotional dependency to be assessed unidimensionally with regard to a stable intimate relationship (current or past) in a normative population.

Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students

AIM

To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students.

METHODS

Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed.

RESULTS

We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females.

CONCLUSIONS

Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

Improving clinical symptoms, functioning, and quality of life in chronic schizophrenia with an integrated psychological therapy (IPT) plus emotional management training (EMT): A controlled clinical trial

Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.

Accuracy of online survey assessment of mental disorders and suicidal thoughts and behaviors in Spanish university students. Results of the WHO World Mental Health- International College Student initiative

Objective

To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive Episode[MDE], Mania/Hypomania[M/H], Panic Disorder[PD], Generalized Anxiety Disorder[GAD]) and suicidal thoughts and behaviors[STB] used in the UNIVERSAL project.

Methods

Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18–24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales [CIDI-SC], the Self-Injurious Thoughts and Behaviors Interview [SITBI] and the Columbia-Suicide Severity Rating Scale [C-SSRS]. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview [MINI]. Measures of diagnostic accuracy and McNemar χ² test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity.

Results

A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1–55.1% and negative predictive values 90.2–99.0%; likelihood ratios positive were in the range of 2.1–14.6 and likelihood ratios negative 0.1–0.6. All outcomes showed adequate areas under the curve [AUCs] (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8).

Conclusion

The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.

Juego patológico en población reclusa colombiana: resultados preliminares en prevalencia y comorbilidad

El objetivo de este trabajo fue conocer la prevalencia de probable ludopatía en una muestra no aleatoria de reclusos hombres y mujeres (N = 334), localizados en cinco centros penitenciarios. Se empleó un cuestionario en dos versiones. La parte común a ambas formas incluyó el Cuestionario Breve de Juego Patológico ([CBJP]; Fernández-Montalvo, Báez, & Echeburúa-Odriozola, 1995), una Lista de Chequeo de Consumo de Sustancias Psicoactivas (Ruiz-Pérez, 2015) e información sociodemográfica. La forma A del cuestionario incorporó la Escala de Impulsividad de Plutchik (Ruiz-Pérez, 2015); la forma B, el cuestionario de evaluación de síntomas de psicopatología SA-45 (Sandín, Valiente, Chorot, Santed, & Lostao, 2008). Los resultados mostraron que la proporción de probables jugadores patológicos fue del 32.3 % para hombres y del 18.8 % para mujeres. El puntaje en el SA-45 y el consumo de alcohol se asociaron directamente con los síntomas de juego patológico. En cuanto al análisis de regresión, en las mujeres, las variables predictoras de la ludopatía fueron la participación en juegos de azar y el consumo de alcohol; en los hombres, fue el grado de psicopatología, sobre todo la hostilidad.

Suicidal Thoughts and Behaviors: Prevalence and Association with Distal and Proximal Factors in Spanish University Students

OBJECTIVE

We report on the prevalence of suicidal thoughts and behaviors in Spanish university students and their risk and protective factors (distal/proximal; individual/environmental).

METHODS

First-year university students completed an online survey including Self-Injurious Thoughts and Behaviors Interview (SITBI) items, the screening version of the Columbia-Suicide Severity Rating Scale (C-SSRS) along with adversities and positive relationships during childhood/adolescence, recent stressful experiences, and lifetime mental disorders. Nested logistic regression models were estimated and areas under the curve (AUC) compared.

RESULTS

A total of 2,118 students completed the survey (mean age = 18.8 [SD = 1.4] years; 55.4% female). Twelve-month prevalence of suicide ideation (SI) was 9.9%, plans, 5.6%, and attempts, 0.6%. Risk factors of 12-month SI were as follows: parental psychopathology (OR = 1.7, 95% CI 1.2-2.5); sexual assault (OR = 5.6, 95% CI 1.4-22.1); lifetime mood disorder (OR = 5.2, 95% CI 3.5-7.7); and lifetime anxiety disorder (OR = 1.7, 95% CI: 1.1-2.5). Childhood positive relationships protected from SI were as follows: peers/others (OR = 0.6, 95% CI 0.4-0.9 for the second highest tertile) and family (OR = 0.4, 95% CI 0.3-0.7 for the highest tertile). AUC of the final model was 0.82 (SE = 0.015).

CONCLUSION

Our results indicate a high prevalence of SI among Spanish university students and identify protective and risk factors from a comprehensive conceptual model.

Preventing cognitive decline in chronic schizophrenia: Long-term effectiveness of integrated psychological therapy and emotional management training

BACKGROUND

Effective group psychological therapies in the chronic phases of schizophrenia are rare. This paper describes the results of testing a group therapy that includes integrated psychological therapy (IPT) together with an adaptation of emotional management therapy (EMT), delivered in a sample of outpatients with chronic schizophrenia.

METHOD

42 patients received the psychological intervention during eight months and they were assessed at baseline, posttreatment and 1, 3, 6 and 12 months follow-up.

RESULTS

The program was well accepted, and there was only one dropped out during the therapy and 2 hospital admissions during the 20 months of contact with patients along the study. Improvements were observed in cognition, social functioning, and quality of life after the treatment, and these results were maintained to the long-term follow-up. To summarize, patients were better 12 months after the treatment than in baseline.

CONCLUSION

the integrative psychological program applied was effective and it was well accepted and could be used in public mental health services as a protective factor, reducing hospitalizations, preventing cognitive decline, helping patients to manage their daily worries and making them feel more supported.

The effect of body dissatisfaction on disordered eating: The mediating role of self-esteem and negative affect in male and female adolescents

This study aimed to determine whether self-esteem and negative affect sequentially mediate the relationship between body dissatisfaction and disordered eating. A total of 806 adolescents (61.8% females) completed the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory-2, the Anxiety and Depression subscales of the General Health Questionnaire-28, and the Negative Self-beliefs subscale of the Eating Disorder Belief Questionnaire. Mediational analyses showed that body dissatisfaction had both direct and indirect effects through self-esteem and negative affect on disordered eating. It was also observed that negative self-esteem mediated-completely in boys and partially in girls-the relationship between body dissatisfaction and negative affect.

The effect of body dissatisfaction on disordered eating: The mediating role of self-esteem and negative affect in male and female adolescents

This study aimed to determine whether self-esteem and negative affect sequentially mediate the relationship between body dissatisfaction and disordered eating. A total of 806 adolescents (61.8% females) completed the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory-2, the Anxiety and Depression subscales of the General Health Questionnaire-28, and the Negative Self-beliefs subscale of the Eating Disorder Belief Questionnaire. Mediational analyses showed that body dissatisfaction had both direct and indirect effects through self-esteem and negative affect on disordered eating. It was also observed that negative self-esteem mediated-completely in boys and partially in girls-the relationship between body dissatisfaction and negative affect.

Current psychological therapeutic approaches for gambling disorder with psychiatric comorbidities: A narrative review

Background. Although the presence of a gambling disorder (GD) together with another mental disorder poses special treatment challenges, such as relapses, severe outcomes for patients and families, and increased number of hospitalizations, there are only a few critical reviews in the literature. Objective. To review empirical evidence of psychological approaches to cope specifically with these dual disorders. Method. A narrative review of the relevant bibliography on this topic was carried out. A systematic search of original articles (2010-October 2017) was conducted in MEDLINE and PsycInfo. Key terms were: 1. gambling/gamblers, 2. treatment/intervention/therapy/therapeutics, and 3. dual diagnosis/comorbidity. Results. Current treatment for GD involves a number of different options, including inpatient treatments, intensive outpatient therapy, individual and group cognitive-behavioral options (CBT), self-help groups, and pharmacotherapy. Inpatient care is generally limited to patients with severe acute crises, treatment failures, and severe comorbid disorders, particularly depression and attempted suicide. Treatment for GD with other mental disorder needs more research. CBT, motivational enhancement therapy and self-help groups have some empirical support when GD is comorbid with other addiction, mood disorder, or schizophrenia. Programs that combine pharmacotherapy and psychosocial treatments for GD into a single comprehensive package are most likely to have good treatment outcomes, at least with regard to treatment retention. Discussion and conclusion. Interventions should be tailored to the needs of the patients. Future research should be concerned about the statistical power of the studies, implement motivational strategies for patients with poor medication adherence, and design measures to study treatment fidelity in the CBT groups.

Comparison of methods for dealing with missing values in the EPV-R

BACKGROUND

The development of an effective instrument to assess the risk of partner violence is a topic of great social relevance. This study evaluates the scale of “Predicción del Riesgo de Violencia Grave Contra la Pareja” –Revisada– (EPV-R - Severe Intimate Partner Violence Risk Prediction Scale-Revised), a tool developed in Spain, which is facing the problem of how to treat the high rate of missing values, as is usual in this type of scale.

METHOD

First, responses to the EPV-R in a sample of 1215 male abusers who were reported to the police were used to analyze the patterns of occurrence of missing values, as well as the factor structure. Second, we analyzed the performance of various imputation methods using simulated data that emulates the missing data mechanism found in the empirical database.

RESULTS

The imputation procedure originally proposed by the authors of the scale provides acceptable results, although the application of a method based on the Item Response Theory could provide greater accuracy and offers some additional advantages.

CONCLUSIONS

Item Response Theory appears to be a useful tool for imputing missing data in this type of questionnaire.

Prediction of Relapse After Cognitive-Behavioral Treatment of Gambling Disorder in Individuals With Chronic Schizophrenia: A Survival Analysis

Gambling disorder (GD) in individuals with chronic schizophrenia is relevant because there are higher rates of GD in schizophrenic populations (10%) than in the nonschizophrenic population (1%-5%). In addition, these patients have more severe alcohol use disorder (i.e., meeting at least 6 of the DSM-5 11 criteria for diagnosis of this disorder), higher depression scores, a poor adherence to treatment, and more frequent use of outpatient mental health care. One of the main problems in GD is therapeutic failure (defined as three or more lapse episodes during treatment) or relapse (three or more lapse episodes in the follow-up period). Predicting a relapse of GD in individuals with chronic schizophrenia can be useful in targeting the patients for aftercare services. The main aim of this study was to estimate the time to a GD relapse (survival rate) and to evaluate some of the qualitative and quantitative variables related to a GD relapse by a survival analysis. The sample consisted of 35 patients with chronic schizophrenia and GD who were treated with pharmacological and cognitive-behavioral therapy. The therapeutic failure rate in the treatment period was 43%, and it was associated with the number of episodes of schizophrenia, the age of gambling onset, and the age of the patients. The relapse rate in the follow-up period was 32%, and it was associated with the patients' age, educational level, and weekly allowance. The implications of this study for future research are discussed.

Cognitive behavioral therapy program for cannabis use cessation in first-episode psychosis patients: study protocol for a randomized controlled trial

BACKGROUND

The high rate of cannabis use among patients with first-episode psychosis (FEP), as well as the associated negative impact on illness course and treatment outcomes, underlines the need for effective interventions in these populations. However, to date, there have been few clinical treatment trials (of pharmacological or psychological interventions) that have specifically focused on addressing comorbid cannabis use among these patients. The aim of this paper is to describe the design of a study protocol for a randomized controlled trial in which the objective is to assess the efficacy of a specific cognitive behavioral therapy program for cannabis cessation in patients with FEP compared to standard treatment (psychoeducation).

METHODS/DESIGN

This is a single-blind randomized study with 1 year of follow-up. Patients are to be randomly assigned to one of two treatments: (1) specific cognitive behavioral therapy for cannabis cessation composed of 1-hour sessions once a week for 16 weeks, in addition to pharmacological treatment scheduled by the psychiatrist, or (2) a control group (psychoeducation + pharmacological treatment) following the same format as the experimental group. Participants in both groups will be evaluated at baseline (pre-treatment), at 16 weeks (post-treatment), and at 3 and 6 months and 1 year of follow-up. The primary outcome will be that patients in the experimental group will have greater cannabis cessation than patients in the control group at post-treatment. The secondary outcome will be that the experimental group will have better clinical and functional outcomes than the control group.

DISCUSSION

This study provides the description of a clinical trial design based on specific cognitive behavioral therapy for cannabis cessation in FEP patients, aiming to improve clinical and functional outcome, as well as tackling the addictive disorder.

TRIAL REGISTRATION

NCT02319746 ClinicalTrials.gov Identifier. ClinicalTrials.gov Protocol and Results Registration System (PRS) Receipt Release Date: 15 December 2014.

Psychological Treatment of Slot Machine Pathological Gambling

In this article, treatment with stimulus control, exposure, and relapse prevention of a patient affected by pathological gambling is described. The patient, a 47-year-old woman, was suffering from this disorder for 5 years. Treatment consisted of nine individual sessions (five sessions of stimulus control and exposure and four sessions of relapse prevention) in a period of 10 weeks. At the end of 1-year follow-up, the patient was much improved, without gambling behavior or associated symptoms, as well as with a greater overall adaptation. Implications of this case for clinical research and practice are discussed.

Normal-weight and overweight female adolescents with and without extreme weight-control behaviours: Emotional distress and body image concerns

The objective of this study was to analyse emotional distress and concerns related to body image in 712 normal-weight and overweight adolescent girls. A total of 12.3 per cent of the normal-weight girls and 25 per cent of the overweight girls showed extreme weight-control behaviours. In normal-weight adolescents, their engagement in extreme weight-control behaviours was associated with high levels of somatic symptoms, a drive for thinness and control over eating. In overweight girls, high levels of drive for thinness and anxiety were associated with extreme weight-control behaviours. Finally, the implications for preventive and therapeutic programmes are discussed.

Substance abuse and crime: considerations for a comprehensive forensic assessment

There is a strong link between drug use and crime, but this relationship is complex. Drug use does not necessarily lead to an increase in crimes, such as theft, rape or assault, even among regular users or addicts. However, in cases of individuals who consume drugs excessively and commit crimes, both factors are linked. Poverty, personality disorders, social and cultural variables, relationships with other users and previous incarceration or drug use are all factors. These issues play an important role in understanding the risk of crime and drug use. Most addicts should be held liable for most criminal behaviour motivated by addiction, but that addiction can, in some cases, affect one's capacity for self-control over one's actions. This paper examines the current response of the Spanish Criminal Justice System to various aspects of drug abuse, focusing on court decisions related with the nature and enforcement of drug laws. It also addresses aspects of criminal responsibility for drug abuse and drug-related crimes and suggests legislation on drugs, sentencing alternatives for drug offenses, and drug treatment options. Expert evidence plays a crucial role in this area in the court.

The hybrid model for the classification of personality disorders in DSM-5: a critical analysis

A personality disorder can be considered to be a generalized pattern of behaviors, cognitions, and emotions that is enduring, begins in adolescence or early adulthood, remains stable over time, and generates stress or psychological damage. The current focus on personality disorders (PDs) is found in Section II of DSM-5 and is unchanged compared to DSMIV, except that the PDs were removed from the former Axis II of the DSM-IV and included in the central classification of disorders. However, an alternative model for further study is presented in Section III that aims to address the deficiencies in the current categorical model of PDs. The underlying idea is that PDs are an extreme version of the personality traits that everyone has. According to this approach, PDs are characterized by impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) and pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism). The diagnostic categories derived from this model include only antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal PDs. This hybrid approach to the diagnosis of PDs is complex and requires more empirical evidence before it can be incorporated into clinical practice. The proposals of the draft ICD-11 for PDs, which are based primarily on severity and dominant personality traits, are also included.

Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis

Background

Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use.

Methods

64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome.

Results

Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001) and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009).

Conclusions

Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

Effectiveness of a psychological support program for relatives of people with mental disorders compared to a control group: a prandomized controlled trial

Families of people affected by mental illness may suffer an adverse effect on well-being. In this study, the effectiveness of a cognitive-behavioral treatment designed for relatives of people with mental health problems was evaluated. The sample comprised 50 individuals: 30 in the experimental group, who completed assessment measures in pre-posttreatment and 6 months later, and 20 participants in the control group, who were assessed at baseline and 6 months later. In the experimental group, significant improvements in well-being were observed following the treatment and 6 months later, when compared to the control group, which did not demonstrate any significant changes in outcomes between the baseline and the second assessment 6 months later. This program has proven to be effective as a treatment for the relatives of people with mental disorders. Finally, several topics that may contribute to future research are discussed.

Individual Versus Individual and Group Therapy Regarding a Cognitive-Behavioral Treatment for Battered Women in a Community Setting

The current study aimed to test the clinical effectiveness of a cognitive-behavioral therapy (CBT) program for battered women in a community setting and to find out whether effectiveness of individual therapy can be improved in conjunction with group therapy. One hundred sixteen treatment-seeking battered women were assigned either to CBT on an individual basis or an individual and group basis. Psychological treatment, focused on post-traumatic stress disorder (PTSD), emotional discomfort, and impaired functioning, comprised a 17-session program, including emotional expression, psychoeducation, trauma re-exposure, coping skills, and problem-solving training. Although most treated patients in both groups improved in all variables (PTSD, emotional discomfort, and impaired functioning) at all assessments, the combined individual and group therapy did better than the individual therapy regarding PTSD symptoms and impaired functioning at follow-up assessments. These findings partially support the beneficial effects of group CBT as adjunctive therapy to individual CBT. Implications of this study for clinical practice and future research in this field are commented on.

Piloting a cognitive-behavioral intervention for family members living with individuals with severe mental disorders

Living with a person who experiences mental health problems can have an adverse effect on well-being. The aim of this study is to evaluate the effectiveness of a psychological treatment for relatives of people with mental health problems, byusing an interrupted time-series design. The sample comprised 20 individuals, who completed assessment measures at baseline and 6 months later. Sixteen of these participants then received the treatment and were assessed again at the end of the program. There were no significant changes in outcomes between the baseline and the second assessments done 6 months later and there were significant improvements in well-being following treatment The program shows promise as a treatment for relatives of people with mental health problems and therefore warrants further evaluation in more controlled studies.

Risky eating behaviors and beliefs among adolescent girls

This study investigated the prevalence of weight control and binge eating behaviors in a sample of 767 adolescent girls aged 16–20 years, and the differences between adolescents with and without altered eating behaviors regarding anthropometric and body image variables and beliefs associated with eating disorders. Adolescents who engaged in unhealthy strategies were found to be at a higher risk of eating disorders, since these behaviors were accompanied by higher levels of drive for thinness and body dissatisfaction, as well as by beliefs associated with the importance of weight and body shape as a means of personal and social acceptance.