Mental health professionals' attitudes towards mental illness: professional and cultural factors in the INTER NOS study.

BACKGROUND: Research shows that personnel working in mental health facilities may share some of the societal prejudices towards mental illness. This might result in stigmatizing behaviours towards people suffering from mental disorders, undermining the quality of their care. AIMS: To describe and compare attitudes towards mental illness across a sample of professionals working in a wide range of mental health facilities in Spain, Portugal and Italy. METHOD: We administered a survey to personnel including two questionnaires related to stigmatizing attitudes: The Community Attitudes toward the Mentally Ill (CAMI) and the Attribution Questionnaire (AQ-27). Data were compared according to professional category, work setting and country. RESULTS: 34.06% (1525) professionals of the surveyed population responded adequately. Psychologists and social therapists had the most positive attitudes, and nursing assistants the most negative, on most factors of CAMI and AQ-27. Community staff had more positive attitudes than hospital-based professionals in most factors on CAMI and in discriminatory responses on AQ-27. CONCLUSIONS: Globally, mental health professionals showed a positive attitude towards mental illness, but also a relative support to coercive treatments. There are differences in attitudes modulated by professional category and setting. Results can guide preventive strategies, particularly for the hospital-based and nursing staff.

Intervenciones en el cuidador del enfermo con demencia / Interventions for caregivers of patients with dementia

Introducción. El envejecimiento de la población trae aparejado un aumento del número de personas afectadas de demencia. La mayoría de estas personas son atendidas en el domicilio. Sus cuidadores se ven expuestos a toda una serie de factores estresantes, de los que se deriva la aparición de sobrecarga, depresión y ansiedad. Se han desarrollado diversos programas o intervenciones estructuradas destinadas a prevenir o reducir estas consecuencias negativas. La eficacia de estas intervenciones es objeto de discusión, debido principalmente a las diferencias metodológicas entre estudios. Los trabajos de revisión realizados hasta ahora también presentan importantes diferencias entre sí, lo que contribuye a perpetuar la falta de claridad en este importante problema asistencial geriátrico. Se revisan de manera precisa y rigurosa la eficacia de las intervenciones destinadas a prevenir o reducir la sobrecarga del cuidador, y/o la sintomatología ansiosa y depresiva del cuidador informal. Metodología. Revisión sistemática de estudios controlados y aleatorizados que valoran la eficacia de las intervenciones en cuidadores informales de pacientes con demencia en las variables de sobrecarga, depresión y ansiedad. Resultados. La búsqueda bibliográfica obtuvo 997 trabajos, de los que 35 cumplían con los criterios de selección. El 51,4% de los trabajos presentaron resultados estadísticamente favorables a la intervención. Existe una gran variabilidad en la metodología empleada. Conclusiones. En conjunto, la evidencia disponible favorece la aplicación de programas estructurados de intervención,si bien existe una amplia heterogeneidad de resultados. Las intervenciones psicoeducativas ofrecen mejores resultados, y se adaptan mejor a las necesidades de los cuidadores

Introduction. With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/ or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously.Methods. A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. Results. The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. Conclusions. Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers

Interventions for caregivers of patients with dementia.

INTRODUCTION: With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously. METHODS: A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. RESULTS: The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. CONCLUSIONS: Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers.

Instrumentos para medir la sobrecarga en el cuidador informal del paciente con demencia / Assessment tools to measure burden in the informal caregiver of patients with dementia

La complejidad del concepto de sobrecarga del cuidador del paciente con demencia ha dado lugar a gran número de pruebas de evaluación, empleando diferentes enfoques. Por ello, puede resultar de utilidad para el clínico o el investigador disponer de una revisión de las mismas. Objetivo. Efectuar una revisión actualizada de los instrumentos disponibles, clasificándolos según el criterio de sobrecarga, estudiando sus características y propiedades psicométricas y presentando con más detalle aquellos más relevantes para su aplicación. Método. La metodología aplicada ha sido la búsqueda en bases de datos −Pubmed, PsycINFO, Embase y Psicodoc (1980-2012). Resultados. Se han seleccionado 31 instrumentos de evaluación, que han sido agrupados en función de 3 enfoques: sobrecarga objetiva/subjetiva, sobrecarga desde un enfoque multidimensional y sobrecarga como estrés asociado al deterioro del paciente. Conclusiones. Este trabajo proporciona una recopilación de instrumentos, clasificados de forma que facilite la selección y uso de los mismos. Se constata la necesidad de establecer consensos sobre el concepto de sobrecarga y los métodos de evaluación utilizados para desarrollar un marco de conocimiento uniforme y de aplicación a la práctica asistencial (AU)

The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes.ObjectiveThe objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application.MethodThe method applied consisted of a database search −Pubmed, PsycINFO, Embase and Psicodoc (1980-2012).ResultsA total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment.ConclusionsThis study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice (AU)

[Assessment tools to measure burden in the informal caregiver of patients with dementia]. / Instrumentos para medir la sobrecarga en el cuidador informal del paciente con demencia.

UNLABELLED: The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes. OBJECTIVE: The objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application. METHOD: The method applied consisted of a database search -Pubmed, PsycINFO, Embase and Psicodoc (1980-2012). RESULTS: A total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment. CONCLUSIONS: This study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice.

¿Es mejorable la versión castellana del General Health Questionnaire en escalas (GHQ-28)? / Is there room for improvement in the Spanish version of the scaled General Health Questionnaire (GHQ-28)?

Objetivo: Desarrollar una versión en escalas del GHQ (GHQ-28) para una población de atención primaria de nuestro medio. Diseño:Análisis de componentes principales del GHQ-60 con selección posterior de los 7 ítems con mejores coeficientes en sus 4 primeros componentes. Emplazamiento: 3 centros de atención primaria en el área metropolitana de Bilbao. Participantes: 202 pacientes procedentes de un estudio previo sobre frecuentación asistencial en atención primaria. Mediciones principales: Comparación de la versión del GHQ-28 obtenida y de la canónica respecto a la discriminación entre casos psiquiátricos y no casos, diagnosticados de manera independiente mediante entrevista estructurada. Resultados: La estructura de 2 de las escalas fue similar a la conocida. Las otras 2 presentaron mayor variabilidad, con inclusión de nuevos ítems, y combinaciones de otros previamente asociados a diferentes escalas. No hubo diferencia significativa en la discriminación de casos entre la nueva versión y la previamente validada en nuestro medio (p=0,63). Conclusiones: Las escalas del GHQ-28 más estables son la de disfunción social y depresión. La variabilidad obtenida en las otras 2 escalas pudiera reflejar mejor que la versión previamente validada la sintomatología psiquiátrica inespecífica presente en atención primaria(AU)

Objective: To develop a new scaled GHQ version (GHQ-28) for use in Primary Care in Spain. Design: Principal components analysis of the parental version (GHQ-60) with subsequent selection of 7 items with higher loadings for the first 4 components. Site: Three Primary Care Centres in the metropolitan area of Bilbao. Participants: A total of 202 patients coming from a prior study on frequent visits to Primary Care clinics. Main measurements: Comparison between the new and the authorised version of GHQ-28 in discriminating between psychiatric and non-psychiatric cases, diagnosed independently by psychiatric interview. Results: Whereas the structure of two scales was similar to that described previously, the other two scales showed higher variability with the inclusion of new items and a combination of others previously ascribed to different measurement constructs. No significant difference (P=.63) was observed between both versions regarding their discriminant validity. Conclusions: The most stable GHQ-28 scales were social dysfunction and depression. The variability found among the other scales could be explained by the non-specificity of psychiatric symptoms presented in Primary Care(AU)

GHQ-60: revisión de su estructura factorial en pacientes de atención primaria / GHQ-60: review of its factorial structure in primary care patients

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