RESUMO
Resumen Los instrumentos para explorar los trastornos alimentarios han sido desarrollados y evaluados principalmente para la población Caucásica. Esta realidad ha limitado la disponibilidad de instrumentos validados y adaptados para la población latina/hispana. Debido al reto que representa para los investigadores en los Estados Unidos que estudian TA en latinos/hispanos, este artículo tiene como propósito revisar los instrumentos en español que hayan sido validados y adaptados para la población latina/hispana que vive en los Estados Unidos. También, se discutirán consideraciones psicométricas y culturales que tienen que incorporarse al utilizar un instrumento que haya sido construido y evaluado para una población o sub población en específico. Cuatro instrumentos, dos para establecer diagnósticos de TA (S-EDE y EDE-Q) y dos para explorar síntomas asociados a la insatisfacción corporal (BSQ y BICI) fueron identificados. La disponibilidad de instrumentos en español para el uso con latinos en los Estados Unidos es muy limitada y no han sido evaluados en todos los sub-grupos de latinos/hispanos que comprenden la población en los Estados Unidos. Esto constituye un reto para los clínicos e investigadores que trabajan con la comunidad latinos/hispanos con TA en los Estados Unidos. (palabras: 188).
Abstract The instruments to explore eating disorders (ED) have been developed and evaluated mainly for the Caucasian population. This situation has limited the availability of instruments validated and adapted for the Latino/Hispanic population. Due to the challenge it represents for researchers in the United States who study ED in Latinos/Hispanics, this article aims to review the instruments in Spanish that have been validated and adapted for the Latino/Hispanic population living in the United States. In addition, psychometric and cultural considerations that should be incorporated when using an instrument that has been constructed and evaluated for a specific population or sub-population will be discussed. Four instruments, two to establish diagnoses of ED (S-EDE and EDE-Q) and two to explore symptoms associated with body dissatisfaction (BSQ and BICI) were identified. The availability of instruments in Spanish for use with Latinos in the United States is very limited and has not been evaluated in all the subgroups of Latinos / Hispanics that comprise the population in the United States. This is a challenge for clinicians and researchers working with the Latino / Hispanic community with ED in the United States. (Words count: 186).
RESUMO
The instruments to explore eating disorders (ED) have been developed and evaluated mainly for the Caucasian population. This situation has limited the availability of instruments validated and adapted for the Latino/Hispanic population. Due to the challenge it represents for researchers in the United States who study ED in Latinos/Hispanics, this article aims to review the instruments in Spanish that have been validated and adapted for the Latino/Hispanic population living in the United States. In addition, psychometric and cultural considerations that should be incorporated when using an instrument that has been constructed and evaluated for a specific population or sub-population will be discussed. Four instruments, two to establish diagnoses of ED (S-EDE and EDE-Q) and two to explore symptoms associated with body dissatisfaction (BSQ and BICI) were identified. The availability of instruments in Spanish for use with Latinos in the United States is very limited and has not been evaluated in all the subgroups of Latinos / Hispanics that comprise the population in the United States. This is a challenge for clinicians and researchers working with the Latino / Hispanic community with ED in the United States. (Words count: 186).
Los instrumentos para explorar los trastornos alimentarios han sido desarrollados y evaluados principalmente para la población Caucásica. Esta realidad ha limitado la disponibilidad de instrumentos validados y adaptados para la población latina/hispana. Debido al reto que representa para los investigadores en los Estados Unidos que estudian TA en latinos/hispanos, este artículo tiene como propósito revisar los instrumentos en español que hayan sido validados y adaptados para la población latina/hispana que vive en los Estados Unidos. También, se discutirán consideraciones psicométricas y culturales que tienen que incorporarse al utilizar un instrumento que haya sido construido y evaluado para una población o sub población en específico. Cuatro instrumentos, dos para establecer diagnósticos de TA (S-EDE y EDE-Q) y dos para explorar síntomas asociados a la insatisfacción corporal (BSQ y BICI) fueron identificados. La disponibilidad de instrumentos en español para el uso con latinos en los Estados Unidos es muy limitada y no han sido evaluados en todos los sub-grupos de latinos/hispanos que comprenden la población en los Estados Unidos. Esto constituye un reto para los clínicos e investigadores que trabajan con la comunidad latinos/hispanos con TA en los Estados Unidos. (palabras: 188).
RESUMO
This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.
Este es un ensayo clínico longitudinal aleatorizado y controlado sobre el efecto de agregar una intervención psicoeducativa para los padres (TEPSI, en inglés) como parte de la terapia cognitivo-conductual (TCC) para adolescentes con trastorno depresivo mayor (TDM) en una muestra puertorriqueña. Evaluamos la eficacia de agregar 8 sesiones grupales de TEPSI a 12 sesiones de TCC individual en la reducción de síntomas depresivos, en el diagnóstico de TDM y en la mejora del funcionamiento familiar. Los participantes (n = 121) fueron distribuidos al azar a la TCC individual con o sin TEPSI. No se encontraron efectos grupales principales en la mayoría de las áreas de los pacientes, como en los síntomas de depresión ni en la presencia de un diagnóstico de TDM en los adolescentes después del tratamiento. Los resultados sí demostraron un efecto principal de la TCC con el tiempo para los síntomas de depresión, las ideas suicidas, la crítica familiar y la presencia de un diagnóstico de TDM que disminuye desde antes hasta después de la intervención. Un año después del final del tratamiento, casi el 70 % de los adolescentes en ambas condiciones (TCC y TCC + TEPSI) se mantuvo en remisión. Se obtuvo un efecto principal del tratamiento en la percepción de los adolescentes del familismo y la implicación emocional familiar. No se respaldó la hipótesis principal de que la psicoeducación familiar optimizaría la TCC para la depresión en los adolescentes. Ambas condiciones dieron variables clínicas similares. Se descubrió que la TCC culturalmente adaptada fue eficaz con los adolescentes latinos, ya que demostró mejoras clínicas considerables desde antes del tratamiento hasta después del tratamiento y permaneció estable un año después al momento del seguimiento. Con respecto a los resultados familiares, los adolescentes de la TCC + TEPSI se mantuvieron estables desde antes del tratamiento hasta después del tratamiento en la implicación emocional familiar, mientras que los adolescentes de la TCC sola demostraron un aumento. Se debaten las implicancias de estos resultados.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Terapia Familiar/métodos , Pais/educação , Educação de Pacientes como Assunto/métodos , Adolescente , Adulto , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Porto Rico , Resultado do TratamentoRESUMO
The aim of this study was to develop fotonovelas, a popular type of graphic novel in the Latino population, to raise awareness and educate about eating disorders (EDs). Four illustrated cartoons and scripts tailored for adults and adolescents of both sexes were presented in focus groups and an in-depth interview. Seventeen Latino adults (14 females; 3 males) and 10 adolescents (9 females; 1 male) participated in the study. Participants found the fotonovelas interesting, and eye-catching than traditional brochures. The use of Spanglish and clarification of differences across EDs were suggested by adolescent females. Male adults suggested changing the title to focus on the health consequences of EDs in order to catch the male attention in reading the story. Based on the receptivity we found in this study, fotonovela could be a promising avenue to raise awareness and to educate the Latino community in the United States about EDs.
RESUMO
Abstract: The aim of this study was to develop fotonovelas , a popular type of graphic novel in the Latino population, to raise awareness and educate about eating disorders (EDs). Four illustrated cartoons and scripts tailored for adults and adolescents of both sexes were presented in focus groups and an in-depth interview. Seventeen Latino adults (14 females; 3 males) and 10 adolescents (9 females; 1 male) participated in the study. Participants found the fotonovelas interesting, and eye-catching than traditional brochures. The use of Spanglish and clarification of differences across EDs were suggested by adolescent females. Male adults suggested changing the title to focus on the health consequences of EDs in order to catch the male attention in reading the story. Based on the receptivity we found in this study, fotonovela could be a promising avenue to raise awareness and to educate the Latino community in the United States about EDs.
Resumen: El objetivo de este estudio fue desarrollar fotonovelas, un tipo de novela gráfica popular en la población latina, para crear conciencia y educar sobre los trastornos de la conducta alimentaria (TCA). Cuatro caricaturas ilustradas y guiones adaptados para adultos y adolescentes de ambos sexos fueron presentados en discusiones focales y en una entrevista de profundidad. Diecisiete latinos adultos (14 mujeres; 3 hombres) y 10 adolescentes (9 féminas; 1 varón) participaron en el estudio. Los participantes encontraron las fotonovelas interesantes y que captaban más la atención que los folletos tradicionales. El uso del espanglish y la clarificación de las diferencias entre los TCA fueron sugeridos por las adolescentes femeninas. Los adultos varones sugirieron cambiar el título, que se enfocara en las consecuencias en la salud de los TCA para que llame la atención en los hombres a leer la historia. Basado en la aceptación encontrada en este estudio, la fotonovela pudiera ser una avenida prometedora para crear conciencia y educar a la comunidad latina sobre los TCA en los Estados Unidos.
RESUMO
Objective: We describe cognitive-behavioral therapy for bulimia nervosa (CBT-BN) with a Latina woman that incorporates culturally relevant topics. Method: A single case report of a 31-year-old monolingual Latina woman with BN describes the application of a couple-based intervention adjunctive to CBT-BN. Results: The patient reported no binge and purge episodes by session 20 and remained symptom free until the end of treatment (session 26). Improvement was observed in the Eating Disorders Examination (EDE) comparing baseline (EDE=5.74) with post treatment (EDE=1.25). Conclusions: The case illustrates how cultural adaptations such as including a family member, being flexible on topics and scheduling, and providing culturally relevant interventions can lead to successful completion of a course of therapy and facilitate ongoing interventions to ensure continued recovery.
Objetivo: Describimos la terapia cognitiva conductual para la bulimia nerviosa (TCC-BN) con una mujer latina incorporando tópicos que son culturalmente relevantes. Método: Un estudio de caso de una mujer latina monolingüe de 31 años con BN en el que se describe la incorporación de una intervención de pareja adjunta al TCC-BN. Resultados: Para la sesión 20, la paciente no reportó atracones ni conductas purgativas y continuó libre de síntomas hasta el final del tratamiento (sesión 26). La mejoría se observó en el Eating Disorders Examination (EDE) al comparar la evaluación de base (EDE=5.74) con la evaluación post tratamiento (EDE=1.25). Conclusión: El caso ilustra como adaptaciones culturales como incluir a un miembro familiar, ser flexible en los tópicos y en la agenda de trabajo, y proveer intervenciones culturalmente relevantes pueden llevar a una exitosa culminación de un proceso terapéutico y facilita las intervenciones que se llevan a cabo para asegurar un continuo proceso de recuperación.
RESUMO
OBJECTIVE: We describe cognitive-behavioral therapy for bulimia nervosa (CBT-BN) with a Latina woman that incorporates culturally relevant topics. METHOD: A single case report of a 31-year-old monolingual Latina woman with BN describes the application of a couple-based intervention adjunctive to CBT-BN. RESULTS: The patient reported no binge and purge episodes by session 20 and remained symptom free until the end of treatment (session 26). Improvement was observed in the Eating Disorders Examination (EDE) comparing baseline (EDE=5.74) with post treatment (EDE=1.25). CONCLUSIONS: The case illustrates how cultural adaptations such as including a family member, being flexible on topics and scheduling, and providing culturally relevant interventions can lead to successful completion of a course of therapy and facilitate ongoing interventions to ensure continued recovery.
RESUMO
BACKGROUND: The transition from adolescence to adulthood is associated with stressful adaptation experiences that may increase symptoms of depression. We explored the prevalence and sex differences of depressive symptoms and suicidal ideation in freshmen Latino college students in Puerto Rico, and identified stressful life events that could contribute to symptoms of depression. METHODS: Two thousand one hundred sixty-three freshmen college students from the University of Puerto Rico (UPR) public education system were assessed for depression symptoms using the Beck Depression Inventory (BDI) and stressful life events using open questions. RESULTS: Nine percent of the sample reported depression symptoms at a moderate or severe level (BDI>20). Chi square analyses revealed a significantly higher prevalence for three of the stressful life events in females than males: relocation (10.2% females vs. 7.3% males; X(2) (1)=4.13, p=.042), break-up of a significant relationship (25.3% females vs. 17.8% males; X(2) (1)=13.76, p<.001), and illness (11.2% females vs. 7.3% males; X(2) (1)=7.23, p=.007). The model that best explained the variance of BDI scores among females was the presence of suicide risk, relationship break-up, illness, and relocation for college, whereas for males a similar model without the relationship break-up variable resulted in a better fit. CONCLUSIONS: Freshmen college students present a broad range of depression symptoms and certain stressful life events are associated with an increased prevalence of depression symptoms. Early detection of depression and tailored prevention programs should be developed to improve both mental health and academic performance among the college population.
Assuntos
Depressão/epidemiologia , Acontecimentos que Mudam a Vida , Estresse Psicológico/psicologia , Estudantes/psicologia , Ideação Suicida , Adolescente , Feminino , Humanos , Masculino , Inventário de Personalidade , Prevalência , Escalas de Graduação Psiquiátrica , Porto Rico/epidemiologia , Distribuição por Sexo , Estudantes/estatística & dados numéricos , Universidades , Adulto JovemRESUMO
OBJECTIVE: To explore disordered eating and eating disorders (EDs) in Latino males. PARTICIPANTS: Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. METHODS: Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test-Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). RESULTS: Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. CONCLUSION: College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Saúde do Homem , Adaptação Psicológica , Adolescente , Distribuição de Qui-Quadrado , Depressão/epidemiologia , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Hispânico ou Latino/psicologia , Humanos , Masculino , Estado Nutricional , Prevalência , Psicometria , Porto Rico/epidemiologia , Fatores de Risco , Autorrelato , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
In Latino culture, the family is a major source of social support. We explored the needs and the role of the Puerto Rican eating disorders patient's family in the treatment process by conducting a focus group with five close relatives of youth with eating disorders. Qualitative analyses indicated the need to integrate the family into treatment and to provide management guidelines to assist with the resolution of situations that emerge frequently during recovery. These results underscored the importance of developing and incorporating psychosocial interventions that include family support and guidance for relatives of Puerto Rican youth patients with eating disorders.
RESUMO
Los trastornos de la conducta alimentaria (TCA) ocurren en todos los grupos étnicos y niveles socioeconómicos. Sin embargo, los tratamientos basados en la evidencia para los TCA han sido desarrollados mayormente para la población caucásica. Con el propósito de desarrollar un modelo de intervención culturalmente sensible, los objetivos de este trabajo fueron: 1) identificar y describir algunos de los elementos culturales pertinentes al tratamiento de los TCA en la población latina y, 2) esbozar un modelo de intervención para los TCA que sea culturalmente sensible a la población latina de los Estados Unidos. El desarrollo de intervenciones culturalmente sensibles es un componente importante para reducir la disparidad en los servicios de salud brindados a la población latina residente en los Estados Unidos.
Eating disorders affect all ethnic and socioeconomic groups. However, currently available assessment instruments, which were developed and validated for exclusively Caucasian populations. With the purpose to develop a culturally sensitive framework for the eating disorders treatment in Latinos/as, the objectives of this work were: 1) identify and describe some of the relevant cultural elements for eating disorders in the Latino population and, 2) to draft a culturally sensitive intervention model for eating disorders in Latino population in the United States. Providing culturally sensitive treatments for Latinos with psychiatric disorders is essential to reverse public health disparities.
RESUMO
This study investigated the prevalence of eating disorder symptoms in first-year students at the University of Puerto Rico. Responses to the Bulimia Test Revised (BULIT-R), the Eating Attitudes Test (EAT-26), and the Beck Depression Inventory (BDI) were analyzed in a sample of 2,163 freshman students. The percentage of students at or above the clinical cut-off points was 3.24% for the BULIT-R and 9.59% for the EAT-26, and 1.88% met the cut-off point for both instruments. The 36.44% of the students who screen positive on eating disorders measures scored 18 or more on the BDI and 5.93% on this group presented high suicidal risk based on their responses to BDI items assessing suicidal thoughts. Eating disorder symptoms occur frequently in Puerto Rican college students, and prevention, detection, and treatment efforts are needed.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Hispânico ou Latino , Adolescente , Índice de Massa Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , Estudantes/psicologia , Inquéritos e Questionários , Universidades , Adulto JovemRESUMO
OBJECTIVE: This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico. METHODS: A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to receive collaborative care or usual care. The collaborative care intervention involved enhanced collaboration among physicians, mental health specialists, and care managers paired with depression-specific treatment guidelines, patient education, and follow-up. In usual care, study personnel informed the patient and provider of the diagnosis and encouraged patients to discuss treatment options with their provider. Depression severity was assessed with the Hopkins Symptom Checklist; social functioning was assessed with the 36-item Short Form. RESULTS: Compared with usual care, collaborative care significantly reduced depressive symptoms and improved social functioning in the six months after randomization. Integration of collaborative care in primary care practices considerably increased depressed patients' use of mental health services. CONCLUSIONS: Collaborative care significantly improved clinical symptoms and functional status of depressed patients with coexisting chronic general medical conditions receiving treatment for depression in primary care practices in Puerto Rico. These findings highlight the promise of the collaborative care model for strengthening the relationship between mental health and primary care services in Puerto Rico.
Assuntos
Doença Crônica/psicologia , Doença Crônica/reabilitação , Comportamento Cooperativo , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/reabilitação , Equipe de Assistência ao Paciente , Adulto , Idoso , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapia Combinada , Comorbidade , Feminino , Humanos , Relações Interprofissionais , Masculino , Programas de Assistência Gerenciada , Pessoa de Meia-Idade , Porto Rico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Ajustamento Social , Resultado do TratamentoRESUMO
Eating disorders affect all ethnic and socioeconomic groups. However, evidence based treatments for eating disorders have been developed and tested exclusively on Caucasian populations. With the purpose to develop a culturally sensitive framework for the eating disorders treatment in Latinos/as, the objectives of this work were: 1) identify and describe some of the relevant cultural elements for eating disorders in the Latino population and, 2) to draft a culturally sensitive intervention model for eating disorders in Latino population in the United States. Providing culturally sensitive treatments for Latinos with psychiatric disorders is essential to reverse public health disparities.