RESUMEN
BACKGROUND: Multiple psychological consequences of the COVID-19 outbreak and quarantine have been described. However, there is a lack of global conceptualization. We argue that the stressful aspects of the situation, the multiple environmental consequences of the outbreak, and the diversity of symptoms observed in such a situation, suggest that Adjustment disorder (AD) is a promising way to conceptualize the psychological consequences of the outbreak and quarantine. The first aim of the study was to validate the French version of the ADNM. The second aim was to set out adjustment difficulties resulting from COVID-19 outbreak and quarantine. METHOD: We recruited 1010 (840 women, 170 men) who consented online to participate. They filled out the French ADNM, visual analogic scales, HADS, IES, and the COPE, to evaluate coping strategies. RESULTS: We confirmed the factor structure of the ADNM and we found good psychometric properties. We found that 61.3% of participants presented an adjustment disorder related to COVID-19 outbreak. We found multiple risk factors and protective factors to AD due to quarantine and outbreak. We also identified the coping strategies negatively and positively associated with AD. CONCLUSION: Adjustment disorder is a relevant concept to understand psychological manifestations caused by quarantine and outbreak. The French ANDM has good psychometric properties to evaluate such manifestations. The association between coping strategies and AD symptoms suggest that CBT may be the best intervention to help people suffering from AD.
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COVID-19 , Cuarentena , Brotes de Enfermedades , Femenino , Humanos , Masculino , Psicometría , SARS-CoV-2RESUMEN
BACKGROUND: Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. METHODS: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. RESULTS: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. DISCUSSION: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.
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Trastornos de Adaptación/diagnóstico , Clasificación Internacional de Enfermedades , Encuestas y Cuestionarios , Trastornos de Adaptación/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis Factorial , Femenino , Humanos , Irlanda/epidemiología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to finalize the development of the International Trauma Questionnaire (ITQ), a self-report diagnostic measure of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), as defined in the 11th version of the International Classification of Diseases (ICD-11). METHOD: The optimal symptom indicators of PTSD and CPTSD were identified by applying item response theory (IRT) analysis to data from a trauma-exposed community sample (n = 1051) and a trauma-exposed clinical sample (n = 247) from the United Kingdom. The validity of the optimized 12-item ITQ was assessed with confirmatory factor analyses. Diagnostic rates were estimated and compared to previous validation studies. RESULTS: The latent structure of the 12-item, optimized ITQ was consistent with prior findings, and diagnostic rates of PTSD and CPTSD were in line with previous estimates. CONCLUSION: The ITQ is a brief, simply worded measure of the core features of PTSD and CPTSD. It is consistent with the organizing principles of the ICD-11 to maximize clinical utility and international applicability through a focus on a limited but central set of symptoms. The measure is freely available and can be found in the body of this paper.
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Clasificación Internacional de Enfermedades , Escalas de Valoración Psiquiátrica/normas , Trauma Psicológico/diagnóstico , Autoinforme/normas , Trastornos por Estrés Postraumático/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Reino Unido , Adulto JovenRESUMEN
The first description of posttraumatic stress disorder (PTSD) in the 1980s marked the origin of psychotraumatology. Based on the variety of developments in the meantime and being relevant for basic research and clinical application, a differentiation of diagnoses according to the new International Classification of Diseases (ICD-11) are presented including PTSD, complex PTSD, prolonged grief disorder and adjustment disorder. In addition, extension towards traumatic and adverse childhood experiences and their significance for lifetime mental and somatic morbidity are described. Concerning these childhood traumata and adversities, distinct biological and epigenetic factors have been extensively investigated. Also, research groups have postulated that important psychological disorders should be differentiated according to those with and those without reference to pathogenetic trauma. Lastly, regarding relevant public discourses, societal dimensions of victimhood and compensation are discussed as well as a global perspective with respect to continuous and historical traumatization.
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Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Trastornos de Adaptación/diagnóstico , Trastornos de Adaptación/fisiopatología , Trastornos de Adaptación/psicología , Trastornos de Adaptación/terapia , Adulto , Experiencias Adversas de la Infancia , Niño , Diagnóstico Diferencial , Humanos , Clasificación Internacional de Enfermedades , Trastornos Psicofisiológicos/clasificación , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/psicología , Trastornos Psicofisiológicos/terapia , Factores de Riesgo , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/terapiaRESUMEN
The aim of this EPA guidance was to develop recommendations on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). A systematic literature search was performed and 40 articles were retrieved and assessed with regard to study characteristics, applied technologies, therapeutic approaches, diagnostic ascertainment, efficacy, sustainability of clinical effects, practicability and acceptance, attrition rates, safety, clinician-supported vs. non-supported interventions and active vs. waiting-list controls. The reviewed studies showed a great heterogeneity concerning study type, study samples, interventions and outcome measures. Based on these findings, five graded recommendations dealing with symptom reduction, acceptability, type of administration, clinician support, self-efficacy and coping were developed.
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Guías de Práctica Clínica como Asunto , Trastornos por Estrés Postraumático/terapia , Telemedicina/normas , Adaptación Psicológica , Adulto , Femenino , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Psicoterapia , Trastornos por Estrés Postraumático/psicologíaRESUMEN
BACKGROUND: The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves. METHOD: Young survivors of the 2011 Norway attacks (n = 325) and their parents (n = 451) were interviewed at 4-6 months (wave 1) and 15-18 months (wave 2) after the shooting. PTSD was assessed with the UCLA PTSD Reaction Index for DSM-IV adapted for DSM-5, and a subset was used as diagnostic criteria for ICD-11. RESULTS: In survivors, PTSD prevalence did not differ significantly at any time point, but in parents, the DSM-5 algorithm produced significantly higher prevalence rates than the ICD-11 criteria. The overlap was fair for survivors, but amongst parents a large proportion of individuals met the criteria for only one of the diagnostic systems. No systematic differences were found between ICD-11 and DSM-5 in predictive validity. CONCLUSIONS: The proposed ICD-11 criteria and the DSM-5 criteria performed equally well when identifying individuals in distress. Nevertheless, the overlap between those meeting the PTSD diagnosis for both ICD-11 and DSM-5 was disturbingly low, with the ICD-11 criteria identifying fewer people than the DSM-5. This represents a major challenge in identifying individuals suffering from PTSD worldwide, possibly resulting in overtreatment or unmet needs for trauma-specific treatment, depending on the area of the world in which patients are being diagnosed.
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Manual Diagnóstico y Estadístico de los Trastornos Mentales , Clasificación Internacional de Enfermedades , Padres/psicología , Trastornos por Estrés Postraumático/diagnóstico , Sobrevivientes/psicología , Terrorismo/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Prevalencia , Trastornos por Estrés Postraumático/epidemiologíaRESUMEN
OBJECTIVE: Adjustment disorder (AD) is one of the most debated diagnoses in psychiatry since it has been recognised as vaguely defined and causing a lot of difficulties in clinical practice. We aimed to analyse the structure of adjustment disorder based on International Classification of Diseases (ICD)-11 proposals by the WHO ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress in the general population in Lithuania. Three structural models of adjustment disorder were tested using Confirmatory Factor Analysis (CFA). METHOD: Data from the sample of 649 participants who experienced at least one significant stressor during the last two years was included in CFA analysis. Stressor exposure and AD symptoms were measured with the Lithuanian version of the Adjustment Disorder New Module (ADNM-20). RESULTS: The CFA analysis revealed that the two core factor model of the AD with two core symptoms: preoccupation and failure to adapt fitted data the best in contrast to other two models. CONCLUSION: The study supports the ICD-11 proposal for the structure of adjustment disorder with two core symptoms: preoccupation and failure to adapt. Further studies are needed to analyse the structure of AD in other populations.
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Trastornos de Adaptación/clasificación , Trastornos de Adaptación/diagnóstico , Evaluación de Síntomas/clasificación , Adulto , Diagnóstico Diferencial , Análisis Factorial , Femenino , Humanos , Clasificación Internacional de Enfermedades , Lituania , Masculino , PsiquiatríaRESUMEN
The classical concept of social support has recently become of relevance again, particularly in the context of traumatized patient groups, which include refugees and migrants. This article summarizes the evidence from social support research, e. g. different types of positive effects as well as context, gender and cultural aspects. These aspects are highlighted by means of studies stemming from applied healthcare research and thus describe a wide range of health effects, e.g. increased well-being and reduced depressive symptoms, improved functional abilities, better immune status and longevity. Two new trauma-specific differentiations of the social support concept are introduced: societal acknowledgement as a trauma survivor and disclosure of traumatic experiences. Against this background several implications for working with refugees arise: promotion of self-efficacy and posttraumatic maturation as well as the treatment of mental disorders show considerable benefits from focusing on social support. Finally, possibilities emerging from digital communication media are discussed, which are particularly relevant in this context.
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Modelos Organizacionales , Refugiados/psicología , Medicina Social/organización & administración , Apoyo Social , Trastornos de Estrés Traumático/psicología , Trastornos de Estrés Traumático/terapia , Atención a la Salud , Alemania , Humanos , Medio Social , Trastornos de Estrés Traumático/diagnósticoRESUMEN
BACKGROUND: Adjustment disorder (AjD) is a transient mental health condition emerging after stressful life events. Its diagnostic criteria have recently been under revision which led to the development of the Adjustment Disorder--New Module 20 (ADNM-20) as a self-report assessment. OBJECTIVE: To identify a threshold value for people at high risk for AjD. METHODS: As part of a randomized controlled trial evaluating a self-help manual for burglary victims, the baseline data of all participants (n=80) were analyzed. Besides the ADNM-20, participants answered self-report questionnaires regarding the external variables post-traumatic stress disorder symptomatology, depression, anxiety, and stress levels. We used cluster analysis and ROC analysis to identify the most appropriate cut-off value. RESULTS: The cluster analysis identified three different subgroups. They differed in their level of AjD symptomatology from low to high symptom severity. The same pattern of impairment was found for the external variables. The ROC analysis testing the ADNM-20 sum scoreagainst the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. CONCLUSION: The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.
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Trastornos de Adaptación/diagnóstico , Estrés Psicológico/psicología , Encuestas y Cuestionarios , Trastornos de Adaptación/etiología , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Ansiedad/psicología , Análisis por Conglomerados , Depresión/psicología , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Curva ROC , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/psicología , Adulto JovenRESUMEN
Among the most important innovations within the psychotherapeutic care system are the new opportunities in the field of e-mental health. During the past decade, Internet-based and other e-mental health approaches for the treatment of post-traumatic stress disorder and related stress-associated symptoms have been developed in great variety. Solely Internet-based self-help programs are the lowest-threshold approaches in a stepped-care system. By contrast, individualized online psychotherapy and virtual reality programs are at the opposite pole of the spectrum. Approaches in the field of m(obile)-mental health complement these new developments in psychotherapy. The existing evidence supports the clinical efficacy of all the described approaches, although not all have been tested rigorously analog to phase III studies in psychopharmacology. Nonetheless, e-mental health approaches will shape our field more and more in the future.
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Atención Dirigida al Paciente/organización & administración , Psicoterapia/métodos , Autocuidado/métodos , Trastornos por Estrés Postraumático/terapia , Telemedicina/organización & administración , Terapia Asistida por Computador/organización & administración , Atención a la Salud/métodos , Atención a la Salud/organización & administración , Medicina Basada en la Evidencia , Alemania , Humanos , Internet/organización & administración , Servicios de Salud Mental/organización & administración , Atención Dirigida al Paciente/métodos , Autocuidado/psicología , Trastornos por Estrés Postraumático/psicología , Telemedicina/métodos , Terapia Asistida por Computador/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: In a sample of ex-political prisoners in the GDR examined in the middle of the 1990s, a follow-up examination carried out 15 years later investigated alterations in the diagnosis and symptom prevalence of post-traumatic stress syndrome PTSS) as well as other psychiatric disorders. The diagnosis course given by the clinicians was compared with the retrospective subjective estimations by participants. METHODS: A total of 93 ex-political prisoners participated in the follow-up study (85 %) with an average age of 64 years. Diagnoses and symptoms were collated using structured clinical interviews and questionnaires. The retrospective subjective estimation of progression of the participants was calculated using a PTSS symptom index based on four symptom groups (intrusions, avoidance, numbing and hyperarousal). RESULTS: At the time of follow-up PTSS was present in 33 % of participants (in 1997 it was 29 %). In 1994 this was present in only approximately 50 % of cases and in the other 50 % it concerned newly incident or remission cases. The next most common diagnoses were major depression episodes (26 %), panic (with or without agoraphobia 24 %) and somatoform disorders (19 %). In the PTSS symptom profile intrusions, flashbacks and alienation feelings decreased with time but in contrast irritability and shock reactions increased. The subjective self-estimation of the course of PTSS symptoms by the participants often gave a resilient (never PTSS) or delayed and rarely a remission course pattern in comparison to the diagnosing clinicians. CONCLUSIONS: The results indicate a trauma-related long-term morbidity which is, however less stable than previously assumed.
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Comunismo , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Prisioneros/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Segunda Guerra Mundial , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Escolaridad , Femenino , Estudios de Seguimiento , Alemania Oriental , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Psicoterapia , Resiliencia Psicológica , Factores Socioeconómicos , Trastornos por Estrés Postraumático/epidemiologíaRESUMEN
BACKGROUND: Despite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends. METHODS: A cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale-Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss. RESULTS: Of the 85 participants, 13% met the criteria for full PTSD (cut-off≥35), 6.5% met the criteria for subthreshold PTSD (cut-off≥25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%. CONCLUSION: A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.
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Familia/psicología , Pesar , Trastornos por Estrés Postraumático/psicología , Suicidio Asistido/psicología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/psicología , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Depresión/psicología , Femenino , Amigos/psicología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , SuizaRESUMEN
AIMS: To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. METHOD: Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). RESULTS: Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. CONCLUSION: In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.
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Unión Europea/estadística & datos numéricos , Trastornos Mentales/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Adulto , Costo de Enfermedad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/economía , Trastornos Mentales/terapia , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/economía , Enfermedades del Sistema Nervioso/terapia , Prevalencia , Adulto JovenRESUMEN
INTRODUCTION: Prospective studies on victims of sexual abuse and retrospective studies on offender populations have indicated a connection between experiences of childhood sexual abuse (CSA) and delinquency in adulthood. METHOD: Using a representative sample of violent and sex offenders from the Canton of Zurich (Switzerland; N=354), the aim of this study was to identify the characteristics of offenders who have experienced CSA. Two multivariable models for CSA were generated. RESULTS: CSA was documented for 13% of the sex offenders and 5.8% of the violent offenders. Child molesters displayed the highest prevalence rate with 18.9%. Multivariable analyses identified Swiss nationality, having stayed in a foster home and violence in the nuclear family as the strongest risk factors for CSA. In a second model, only offender characteristics from adulthood were taken into account as predictors: child molesters, offenders who prostituted themselves and repeat violent and sex offenders had a significantly higher risk of belonging to the group of offenders who had experienced CSA. DISCUSSION: The results suggest that the experience of CSA leads to an elevated and chronic risk for committing child abuse.
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Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Abuso Sexual Infantil/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Anciano , Causalidad , Comorbilidad , Crimen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Suiza/epidemiología , Adulto JovenRESUMEN
In a representative epidemiological study (n=2426) with a broad age range of respondents (14-93 years), prevalence rates of traumatic life events, post-traumatic stress disorder (PTSD), and partial PTSD were estimated. A standardized interview using the trauma checklist of the Composite International Diagnostic Interview and a DSM-IV PTSD symptom checklist (Modified PTSD Symptom Scale) were applied. One-month prevalence rates were 2.3% for DSM-IV PTSD and 2.7% for partial PTSD. There were no gender differences but age-group differences did appear: among persons older than 60, the prevalence of PTSD was 3.4%, whereas the prevalence was estimated at 1.3% among persons aged 14-29 years and 1.9% among those aged 30-59 years. Partial PTSD exhibited the same age distribution, with 3.8% in the elderly, 2.4% in the middle-aged, and 1.3% in young adults. The results correspond with those of other international studies taking war-related consequences for older age groups into account. Our representative study provides the first evidence of higher PTSD prevalence rates among older age groups in the German population, which is assumed to be related to consequences of World War II.
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Medición de Riesgo/métodos , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por SexoRESUMEN
Bereaved parents and individuals bereaved by the sudden, unexpected, or violent death of a loved one are at high risk for developing complicated grief. However, preventive interventions for this at-risk population remain scarce. In the present pilot study, an Internet-based intervention for individuals bereaved in the previous 14 months was tested using a pretest/posttest design. A total of 35 bereaved individuals participated in a 3-week manualized prevention program. Counselor and participants communicated exclusively via email. The intervention consisted of the following modules: (1) describing the circumstances of the death, (2) using the life-imprint method to explore the biography and life imprint of the deceased, (3) keeping a daily diary of social activities and sleep hygiene, (4) cognitive restructuring of dysfunctional thoughts, such as responsibility for the death and feelings of guilt, (5) communication within the family, (6) gender-specific coping with bereavement, and (7) bond with the deceased. Completer and intent-to-treat analyses suggest that the intervention led to a significant reduction in symptoms of complicated grief and depression at posttreatment.
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Terapia Conductista , Aflicción , Terapia Cognitivo-Conductual , Depresión/etiología , Depresión/terapia , Pesar , Internet , Adaptación Psicológica , Adulto , Depresión/prevención & control , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
INTRODUCTION: Although everyone working in routine mental health services recognizes the scientific and ethical importance to ensure that treatments being provided are of highest quality, there is a clear lack of consensus regarding what outcome domains to include, what measure of assessment to use and, moreover, who to question when assessing. LITERATURE FINDINGS: Since the fifties, social functioning is considered as an important dimension to take into account for treatment planning and outcome measuring. But for many years, symptoms scales have been considered as sufficient outcome measures and social functioning improvement expected on the basis of symptoms alleviation. As symptoms and social adjustment sometimes appear relatively independent, no accurate conclusion concerning the patient's social functioning can so be driven on the basis of his clinical symptoms. More attention has then been directed toward the development of instruments specifically intended to measure the extent and nature of social functioning impairments observed in most psychiatric syndromes. Many of these instruments are designed to be completed by caregivers or remain time consuming and difficult to use routinely. Presently, in clinical practice, there is a need to rely on simple and brief instruments considering patients'perspective about their social adjustment as a function of time. AIM OF THE STUDY: The aim of this study is to present a new instrument, the QFS, initially developed in order to assess social functioning in patients involved in group psychotherapy programs conducted in a specialist mental health setting, as well as its psychometric characteristics. METHODOLOGY: It was designed to be completed in less than 10 minutes and the questions are phrased in a simple and redundant way, in order to limit problems inherent to illiteracy or language comprehension. The QFS is a 16 items self-report instrument that assesses both the frequency of (8 items) and the satisfaction with (8 items) various social behaviours adopted during the 2 weeks period preceding the assessment. It yields three separate indexes of social functioning, defined a priori and labelled "frequency", "satisfaction" and "global". The higher the scores, the better the social functioning. The QFS was administered to 457 subjects, aged between 18 and 65, including 176 outpatients (99 with anxious or depressive disorders, 25 with personality disorders and 52 with psychotic disorders) and 281 healthy control subjects. RESULTS: No significant difference was found between patients and controls according to age or gender distribution. Acceptance rate was high (>95%). Moreover, the QFS was generally acceptable to the clinicians who used it. Internal consistency calculated for each index ranged from 0.65 to 0.83 (Cronbach alpha). Test-retest reliability, calculated within a 15 days time interval on a sample of 49 healthy controls, ranged from 0.69 to 0.71 (intraclass correlation coefficient). Discriminant validity was calculated on healthy controls and patients divided into sub-groups according to their diagnosis. It showed to be excellent, with significantly higher scores in control subjects than in psychiatric patients and significant differences across diagnostic categories (Kruskal-Wallis ANOVA with post-hoc tests, all p<0.05). The convergent validity of the QFS with other measures of social functioning was calculated, using the Social Adaptation Self-Evaluation Scale (SASS) and the Social Adjustment Scale Self-Report (SAS-SR). With the SASS, the convergent validity was higher among patients (Spearman rS 0.71 to 0.92, p<0.01) than controls (rS from 0.49 to 0.66, p<0.001). In healthy controls, correlation with the SAS-SR was moderate but statistically significant (rS from - 0.21 to - 0.44, p<0.05). When comparing QFS scores with self-rated symptoms severity, lower levels of social functioning were significantly associated with more severe symptoms according to the Brief Symptom Inventory (BSI: rS from - 0.38 to - 0.65, p<0.001). The QFS indexes demonstrated sensitivity to change (Wilcoxon: all p<0.05) on a sample of 27 out-patients suffering from anxious-depressive disorders questioned before and after 4 months of cognitive behavioural group therapy running on a weekly basis during 16 sessions of 2 hours each.The factorial validity of the QFS was measured through 3 separate factor analysis conducted using the data of 457 subjects. The first analysis considered only Frequency items; 7 out of 8 items had loadings above 0.5 on Factor 1 accounting for 30.7% (unrotaded) of the variance. The second analysis considered only Satisfaction items; all items had loadings above 0.6 on Factor 1 explaining 43.4% (unrotaded) of the variance. And finally, in the third factor analysis, all QFS items were included; 15 out of 16 items had loadings above 0.4 on Factor 1 accounting for 30% (unrotated) of the variance. Concerning the factorial validity of the instrument, these results suggest that all QFS items belong to the same underlying dimension. DISCUSSION: Finally, provisional norms for the QFS are provided for healthy controls, in order to characterise individual patients or patient subgroups. In conclusion, the need for assessment in clinical routine, in order to estimate different aspects of patients conditions as well as the quality of the treatment provided, has contributed to the development of a large variety of instruments measuring several domains. Concerning the level of social functioning, many instruments fail to meet chief criterion of feasibility, remaining often too complex or time onsuming. Moreover, only few of them are available in French. CONCLUSION: The QFS presented here is a brief, simple and easy to administer self-rating scale that displays satisfactory psychometric properties. It seems to be a valuable instrument for the monitoring of social functioning in psychiatric patients which, from a therapeutic point of view, may have a clear impact as it sets up expectation of change and allows both to reality test patients and therapists beliefs about the presence of progress or not and to identify if therapy is working on this specific outcome domain. Though, to date, the administration of the QFS to other populations and treatment modalities requires further investigation.
Asunto(s)
Trastornos Mentales/psicología , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Satisfacción Personal , Inventario de Personalidad/estadística & datos numéricos , Autoevaluación (Psicología) , Ajuste Social , Conducta Social , Adolescente , Adulto , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/terapia , Servicio de Psiquiatría en Hospital , Psicometría/estadística & datos numéricos , Psicotrópicos/uso terapéutico , Valores de ReferenciaAsunto(s)
Trasplante de Corazón/psicología , Trasplante de Pulmón/psicología , Calidad de Vida , Trastornos por Estrés Postraumático/etiología , Estrés Psicológico , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
En el presente trabajo se revisa, en primer lugar, la literatura sobre la eficacia global de las psicoterapias de grupo en relación con las individuales y luego se comparan los resultados de las terapias grupales duraderas con las breves y de las de diferentes orientaciones teóricas (dinámica, cognitivo-comportamental y psícoeducativa) entre sí y en pacientes con distintos diagnósticos. Algunos estudios meta-analíticos muestran un "efecto talla" ("effect size") similar al que se puede obtener en los estudios de eficacia de los psicofármacos. Hay algunos trabajos de revisión que afirman que no existen claras ventajas de unas variedades respecto de otras pero otros estudios, en cambio, privilegian ya sea las unas o las otras. Después discutimos el grado de objetividad de las investigaciones en el campo y de los instrumentos que se han utilizado con más frecuencia. Finalizamos describiendo la Batería "Bel-Air" de evaluación que utilizamos en el Departamento de Psiquiatría de la Facultad de Medicina de la Universidad de Ginebra. Consta de tres instrumentos adaptados de otros conocidos en la literatura: Una lista corta de síntomas (The Brief Symptoms Inventory, BSI), La Escala de Funcionamiento Global (GBS), El Cuestionario de Estrategias de Enfrentamiento de ("Coping index" de K. Sherrer y U. Scherrer) y El Cuestionario de Clima Grupal (adaptado de McKezie, 1990). Hemos añadido también dos instrumentos de creación propia. El cuestionario de evaluación de las relaciones con los demás (ERA, Fredenrich & Zinetti, 2000, en prensa) y el Cuestionario de Funciones sociales (QFS). Todos estos instrumentos permiten medir características comunes a grupos de muy diverso tipo en un tiempo corto. En cada grupo específico, se pueden naturalmente añadir otros instrumentos específicos para distintas patologías para otras variables. (AU)