Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19.

Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical practice are still scarce, particularly in low- and middle-income countries. Objective: To describe and evaluate the implementation process and clinical impact of a brief, remote, manualized CBT-based intervention for moderate anxiety, depressive, and somatic symptoms among Mexican HCW-COVID-19 ≥18 years old. Methods: The implementation process comprises community engagement, intervention systematization and education, leadership engagement, and team-based coaching as main strategies. A total of 26 participants completed self-report measures of symptoms before and after treatment, and a subsample of 21 answered a final questionnaire on the acceptability of the intervention. Therapists registered the techniques used in each case, regardless of whether they were part of the intervention manual. Results: The number of sessions was 4.6 (2.43). The most frequently employed techniques were those included in the intervention manual, especially identifying and modifying maladaptive thoughts, used to treat 70% of HCW-COVID-19. Supplementary techniques were implemented to enhance treatment or meet HCW-COVID-19s special needs (such as workplace issues, insomnia, COVID-19 status, and bereavement). The intervention had a significant effect (delta Cohen's coefficients ≥1), and the majority of HCW-COVID-19 were "totally satisfied" with its contents and considered it "not complex" (95.2% and 76.1%, respectively). Conclusions: Telepsychotherapy for anxiety, depression, and somatization in HCW coping with health emergencies in middle-income countries is a feasible, clinically valuable, and acceptable form of treatment.

Psychosocial factors associated with the risk of developing psychosis in a Mexican general population sample.

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and without a positive screen for Clinical High-Risk for psychosis (CHR), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population who completed an online survey. Of the participants, 17.3% (n = 142) met the CHR screening criteria. Comparisons between those who screened positive (CHR-positive group) and those who did not (Non-CHR group) showed that participants in the CHR-positive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. Furthermore, relative to the Non-CHR group, the CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences (bullying, intimate partner violence, and experiencing a violent or unexpected death of a relative or friend), as well as higher levels of childhood maltreatment, poorer family functioning, and more distress associated with the COVID-19 pandemic. Groups did not differ in sex, marital/relationship status, occupation, and socio-economic status. Finally, when examined in multivariate analyses, the variables associated with screening positive for CHR were: having an unhealthy family functioning (OR = 2.75, 95%CI 1.69-4.46), a higher risk associated with cannabis use (OR = 2.75, 95%CI 1.63-4.64), a lower level of education (OR = 1.55, 95%CI 1.003-2.54), having experienced a major natural disaster (OR = 1.94, 95%CI 1.18-3.16), having experienced a violent or unexpected death of a relative or friend (OR = 1.85, 95%CI 1.22-2.81), higher levels of childhood emotional abuse (OR = 1.88, 95%CI 1.09-3.25), physical neglect (OR = 1.68, 95%CI 1.08-2.61), and physical abuse (OR = 1.66, 95%CI 1.05-2.61), and higher COVID-related distress (OR = 1.10, 95%CI 1.01-1.20). An older age was a protective factor for screening positive for CHR (OR = 0.96, 95%CI 0.92-0.99). Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.

Measurement invariance of the GAD-5 Generalized Anxiety Disorder Scale in a Mexican general population sample.

The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionnaire during the COVID-19 pandemic in Mexico. The sex variable was classified as male or female; age was categorized as minors, youth, young adults, adults, and older adults; and educational level was divided into basic, upper secondary, higher, and graduate education. To test for configural invariance, confirmatory factor models were constructed. For metric invariance, equality restrictions were established for the factor loadings between the construct and its items; for scalar invariance, equality restrictions were established between the intercepts; strict variance implied the additional restriction of the residuals. Statistical analysis was performed in R software with the lavaan package. The results show that with respect to sex, age, and educational level, configural and metric measurement invariance was confirmed (ΔCFI < 0.002; ΔRMSEA < 0.015). However, with respect to scalar and strict invariance, the results showed significant differences regarding the fit model (ΔCFI > 0.002; ΔRMSEA > 0.015). We conclude that the GAD-5 presents configural and metric invariance for sex, age, and educational level, and scalar invariance for sex and age groups. However, the scale does not demonstrate strict invariance. We discuss the implications and suggest that this result could be related to the evaluation of sociodemographic variables.

Measurement invariance of the GAD-5 Generalized Anxiety Disorder Scale in a Mexican general population sample

The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionnaire during the COVID-19 pandemic in Mexico. The sex variable was classified as male or female;age was categorized as minors, youth, young adults, adults, and older adults;and educational level was divided into basic, upper secondary, higher, and graduate education. To test for configural invariance, confirmatory factor models were constructed. For metric invariance, equality restrictions were established for the factor loadings between the construct and its items;for scalar invariance, equality restrictions were established between the intercepts;strict variance implied the additional restriction of the residuals. Statistical analysis was performed in R software with the lavaan package. The results show that with respect to sex, age, and educational level, configural and metric measurement invariance was confirmed (ΔCFI < 0.002;ΔRMSEA < 0.015). However, with respect to scalar and strict invariance, the results showed significant differences regarding the fit model (ΔCFI > 0.002;ΔRMSEA > 0.015). We conclude that the GAD-5 presents configural and metric invariance for sex, age, and educational level, and scalar invariance for sex and age groups. However, the scale does not demonstrate strict invariance. We discuss the implications and suggest that this result could be related to the evaluation of sociodemographic variables.

Brief Screening for Distress among Healthcare Professionals: Psychometric Properties of the Physician Well-Being Index-Spanish Version.

BACKGROUND: The Physician Well-Being Index (PWBI) is a brief, valid, reliable self-assessment instrument to identify health professionals' distress and those in need of an intervention. OBJECTIVE: to evaluate the construct, predictive validity (of depression, suicidal ideation, insomnia, and generalized anxiety), and internal consistency of the 7-item Spanish version of the PWBI (PWBI-S). METHODS: out of a national population of approximately 1 million Mexican healthcare professionals, a sample of 3506 subjects (42.0% physicians, 28.7% nurses and 29.3% psychologists) completed an online survey between 17 April and 7 May 2020, at the time of the COVID-19 case cluster transmission scenario in Mexico. RESULTS: In the three sub-samples, PWBI-S's Confirmatory factor analyses (adding residual covariances) exhibited adequate goodness of fit indices for the PWBS original unidimensional model. Overall Cronbach's alphas were 0.89 for physicians, 0.90 for nurses, and 0.86 for psychologists. Univariate logistic regression models showed that a cutoff point of 3 on the total score of the PWBI-S was generally related to the presence of depression, suicidal ideation, and insomnia, but not with generalized anxiety among nurses and psychologists. When trying with a cutoff point of 3, a relationship with GA was shown in psychologists, but not in nurses. CONCLUSIONS: our findings suggest that PWBI-S is a valid, reliable measure for clinical and research purposes in the field.

An international survey examining the impact of the COVID-19 pandemic on telehealth use among mental health professionals.

BACKGROUND: COVID-19 has profoundly affected the work of mental health professionals with many transitioning to telehealth to comply with public health measures. This large international study examined the impact of the pandemic on mental health clinicians' telehealth use. METHODS: This survey study was conducted with mental health professionals, primarily psychiatrists and psychologists, registered with WHO's Global Clinical Practice Network (GCPN). 1206 clinicians from 100 countries completed the telehealth section of the online survey in one of six languages between June 4 and July 7, 2020. Participants were asked about their use, training (i.e., aspects of telehealth addressed), perceptions, and concerns. OUTCOMES: Since the pandemic onset, 1092 (90.5%) clinicians reported to have started or increased their telehealth services. Telephone and videoconferencing were the most common modalities. 592 (49.1%) participants indicated that they had not received any training. Clinicians with no training or training that only addressed a single aspect of telehealth practice were more likely to perceive their services as somewhat ineffective than those with training that addressed two or more aspects. Most clinicians indicated positive perceptions of effectiveness and patient satisfaction. Quality of care compared to in-person services and technical issues were the most common concerns. Findings varied by WHO region, country income level, and profession. INTERPRETATION: Findings suggest a global practice change with providers perceiving telehealth as a viable option for mental health care. Increasing local training opportunities and efforts to address clinical and technological concerns is important for meeting ongoing demands.

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW's MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

A qualitative assessment of psycho-educational videos for frontline COVID-19 healthcare workers in Mexico / Evaluación cualitativa de videos psicoeducativos para personal de salud de primera línea ante el COVID-19 en México

Abstract Introduction Frontline COVID-19 healthcare workers (FLHCWs) are at a high-risk of suffering occupational stress- and trauma-related mental health problems, including burnout and compassion fatigue (B&CF). Given the time limitations (due to their heavy workloads) and need to minimize face-to-face interventions (in order to avoid contagions), psychological interventions for FHCWs should be as brief and remote as possible. Objective To evaluate the usability and clarity of evidence-based psycho-educational videos to prevent B&CF, to deal with uncooperative, hostile, and anxious patients and relatives, and to use personal protective equipment (PPE), from the perspective of Mexican FLHCWs. Method Based on a convenience sampling by intensity approach, videos were distributed requesting feedback based on specific questions through WhatsApp to FLHCWs. Field notes were used to triangulate the information. Results Content analysis of feedback from a final sample of 24 participants ‒75% women, 42 ± 8.4 years old‒ yielded three general thematic categories and seven subthemes: 1. content evaluation, which included three subthemes: utility, pertinence, and practicality; 2. dissemination and other needs, with two subcategories: willingness to share and receive more videos (other needs); and 3. format aspects, also comprising two subthemes: attractiveness and duration. All participants found the videos content very beneficial, relevant, and applicable to the workplace and even in their everyday personal and family life, and were willing to share them and to receive more videos on other issues, including strategies to manage problems related to isolation. Discussion and conclusion Escalation of this remote preventive intervention to other COVID-19 centers and future similar epidemics is recommended.

Resumen Introducción Los trabajadores de la salud de primera línea (TSPL) ante el COVID-19 presentan alto riesgo de desgaste profesional y fatiga por compasión (DP&FC). Tomando en cuenta sus limitaciones de tiempo y la necesidad de minimizar las intervenciones cara a cara, las intervenciones psicológicas para los TSPL deben ser tan breves y remotas como sea posible. Objetivo Evaluar la utilidad y claridad de videos psicoeducativos basados en evidencia para prevenir DP&FC, el manejo de pacientes y familiares no cooperativos, hostiles o ansiosos, y el uso de equipo de protección personal desde la perspectiva de los TSPL mexicanos. Método Los videos se distribuyeron a los TSPL por medio de WhatsApp, solicitándoles su opinión con base en preguntas específicas. Se utilizaron notas de campo para triangular esta información. Resultados El análisis de contenido de las retroalimentaciones recibidas por una muestra final de 24 participantes ‒75% mujeres, 42 ± 8.4 años‒ arrojó tres categorías temáticas y nueve subtemas: 1. evaluación de contenido, con tres subtemas: utilidad, pertinencia y practicidad, 2. difusión y otras necesidades, con dos subcategorías: disponibilidad tanto a compartir como a recibir más videos (otras necesidades), y 3. aspectos de forma, también con dos subtemas: atractivo y duración. La totalidad consideró los videos muy benéficos, relevantes y aplicables en el trabajo y su vida diaria personal y familiar; y reportó disposición a compartirlos y a recibir más material de este tipo. Discusión y conclusión Se recomienda el escalamiento de esta medida preventiva y remota a otros centros COVID-19 y en futuras epidemias similares.

Mental health problems among healthcare workers involved with the COVID-19 outbreak.

OBJECTIVE: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. METHODS: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. RESULTS: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). CONCLUSION: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.