The Effectiveness of Day Hospitals in the Personal Recovery of Mental Disorder Patients during the COVID-19 Pandemic.

BACKGROUND: In recent years, a new recovery model has gained ground in which recovery is understood as a process of change where individuals are able to improve their health and wellbeing, lead self-sufficient lives and strive to achieve their maximum potential (personal recovery). Despite the existence of data regarding the effectiveness of mental health day hospitals (MHDHs) in reducing relapses in terms of hospital admissions and emergencies, no studies have to date assessed how this change affected the new personal recovery model. OBJECTIVES: To verify the effectiveness of MHDHs in improving personal recovery processes among people with mental disorders (MDs). METHODS: A prospective cohort study. A group of patients receiving follow-up at MHDHs was compared with another group of patients receiving follow-up in other therapeutic units over a period of three months. RESULTS: Patient recovery at the MHDHs, assessed using the Individual Recovery Outcomes Counter (I.ROC), was found to be significantly better than that of patients attended in other units. CONCLUSIONS: MHDHs can contribute to the recovery of people with MDs. This is particularly important at a time when some patients may have experienced impediments to their recovery processes due to the pandemic.

Problematic Internet Use and Psychological Problems among University Students with Disabilities. / Uso problemático de Internet y problemas psicológicos entre estudiantes universitarios con discapacidad.

Problematic internet use (PIU) among people with disabilities has received very little attention in scientific literature. The objective of this work is to study PIU among Spanish university students with disabilities, and determine whether it is related to the presence of psychological problems and discomfort. A total of 432 Spanish university students with disabilities from six universities participated in the study (35% motor disability, 22.7% sensory disability and 42.1% other disabilities, excluding psychical or intellectual disability). PIU in the sample was assessed using the Internet Addiction Test (IAT), while psychological problems were assessed using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). PIU prevalence was 6.3%, and significant differences were found by age (< 22 had a PIU prevalence five times higher), onset of disability (prevalence was 3.7 times higher in those with congenital disability) and main type of internet use (recreational). There were no differences by sex, level of education or type of disability. In all the dimensions measured by CORE-OM (psychological problems, subjective well-being, life functioning and risk of self-harm and harm to others), the prevalence of psychological problems was significantly higher among problematic internet users. In conclusion, university students who are disabled from birth (regardless of their type of disability and sex), under the age of 22, and use the internet mainly for social networking and recreational purposes are at greater risk of psychological distress and are more vulnerable to problems like anxiety and difficulties with social relationships.

El uso problemático de internet (UPI) entre las personas con discapacidad ha recibido muy poca atención en la literatura científica. El objetivo de este trabajo es estudiar el UPI entre los estudiantes universitarios españoles con discapacidad, y si se relaciona con malestar y problemas psicológicos. En el estudio participaron 432 universitarios españoles con discapacidad de seis universidades (35 %: discapacidad motora, 22,7 %: discapacidad sensorial y 42,1 %: otras discapacidades, excluyendo la discapacidad psíquica o intelectual). El UPI se evaluó mediante el Test de Adicción a Internet (IAT), mientras que los problemas psicológicos se evaluaron mediante el cuestionario Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). La prevalencia del UPI fue del 6,3 %, y no hubo diferencias estadísticamente significativas por sexo, tipo de discapacidad o estudios. Sí hubo diferencias en función de la edad (< 22 mostraron una prevalencia 5 veces mayor), origen de la discapacidad (discapacidad congénita mostraron una prevalencia 3,7 veces mayor) y tipo principal de uso (recreativo). La prevalencia de problemas psicológicos es significativamente mayor entre los usuarios problemáticos de Internet, en todas las dimensiones medidas por el CORE-OM (problemas psicológicos, bienestar subjetivo, funcionamiento general y riesgo de autolesión y de daño a otros). En conclusión, los estudiantes universitarios con discapacidad desde el nacimiento (independientemente del tipo de discapacidad y del sexo), menores de 22 años y que utilizan Internet principalmente con fines recreativos y las redes sociales tienen mayor riesgo de sufrir trastornos psicológicos y mayor vulnerabilidad a problemas como ansiedad y dificultades en las relaciones sociales.

Uso problemático de Internet y problemas psicológicos entre estudiantes universitarios con discapacidad / Problematic Internet Use and Psychological Problems among University Students with Disabilities

El uso problemático de internet (UPI) entre las personas con discapacidadha recibido muy poca atención en la literatura científica. El objetivo de estetrabajo es estudiar el UPI entre los estudiantes universitarios españoles condiscapacidad, y si se relaciona con malestar y problemas psicológicos. En elestudio participaron 432 universitarios españoles con discapacidad de seisuniversidades (35 %: discapacidad motora, 22,7 %: discapacidad sensorialy 42,1 %: otras discapacidades, excluyendo la discapacidad psíquicao intelectual). El UPI se evaluó mediante el Test de Adicción a Internet(IAT), mientras que los problemas psicológicos se evaluaron mediante elcuestionario Clinical Outcomes in Routine Evaluation-Outcome Measure(CORE-OM). La prevalencia del UPI fue del 6,3 %, y no hubo diferenciasestadísticamente significativas por sexo, tipo de discapacidad o estudios. Síhubo diferencias en función de la edad (< 22 mostraron una prevalencia 5veces mayor), origen de la discapacidad (discapacidad congénita mostraronuna prevalencia 3,7 veces mayor) y tipo principal de uso (recreativo). Laprevalencia de problemas psicológicos es significativamente mayor entre losusuarios problemáticos de Internet, en todas las dimensiones medidas porel CORE-OM (problemas psicológicos, bienestar subjetivo, funcionamientogeneral y riesgo de autolesión y de daño a otros). En conclusión, los estudiantesuniversitarios con discapacidad desde el nacimiento (independientementedel tipo de discapacidad y del sexo), menores de 22 años y que utilizanInternet principalmente con fines recreativos y las redes sociales tienenmayor riesgo de sufrir trastornos psicológicos y mayor vulnerabilidad aproblemas como ansiedad y dificultades en las relaciones sociales. (AU)

Problematic internet use (PIU) among people with disabilities has receivedvery little attention in scientific literature. The objective of this work isto study PIU among Spanish university students with disabilities, anddetermine whether it is related to the presence of psychological problemsand discomfort. A total of 432 Spanish university students with disabilitiesfrom six universities participated in the study (35% motor disability, 22.7%sensory disability and 42.1% other disabilities, excluding psychical orintellectual disability). PIU in the sample was assessed using the InternetAddiction Test (IAT), while psychological problems were assessed usingthe Clinical Outcomes in Routine Evaluation-Outcome Measure (COREOM). PIU prevalence was 6.3%, and significant differences were foundby age (< 22 had a PIU prevalence five times higher), onset of disability(prevalence was 3.7 times higher in those with congenital disability) andmain type of internet use (recreational). There were no differences by sex,level of education or type of disability. In all the dimensions measured byCORE-OM (psychological problems, subjective well-being, life functioningand risk of self-harm and harm to others), the prevalence of psychologicalproblems was significantly higher among problematic internet users. Inconclusion, university students who are disabled from birth (regardless oftheir type of disability and sex), under the age of 22, and use the internetmainly for social networking and recreational purposes are at greater risk ofpsychological distress and are more vulnerable to problems like anxiety anddifficulties with social relationships. (AU)

Estilos de cuidados y la implicación como protector psicológico del cuidador de personas con Parkinson en España / Care styles and involvement as a psychological protective of the caregiver of people with Parkinson's disease in Spain

Resumen Los familiares de personas con enfermedad de Parkinson (EP) se enfrentan a una variedad de situaciones estresantes como consecuencia del desempeño de su rol de cuidadores. Esto puede tener un impacto negativo en su calidad de vida. Un mayor conocimiento de la relación entre las variables evaluadas en los cuidadores puede ser importante de cara a implementar programas de intervención eficaces. El objetivo fue explorar la personalidad y las estrategias de afrontamiento en familiares cuidadores de personas con EP, estudiando su relación con el malestar psicológico y el grado de implicación en los cuidados. Se trabajó con una muestra de 106 cuidadores que completaron los cuestionarios de personalidad NEO-FFI, estrategias de afrontamiento COPE-28, malestar psicológico CORE-OM y un instrumento para evaluar la implicación del cuidador realizado a partir del índice Katz. El análisis de regresión logística mostró que las personas con puntuaciones por encima de la media en neuroticismo y por debajo en el resto de factores de personalidad y estrategias de afrontamiento tenían más riesgo de padecer malestar psicológico (OR = 9.250; p < .001) y una menor implicación en los cuidados (OR = 4.125; p < .001). Estos resultados sugieren que la personalidad y las estrategias de afrontamiento pueden contribuir a identificar estilos para los cuidados más eficientes, que impliquen una mayor participación en los cuidados con un menor impacto negativo.

Abstract Carers of people with Parkinson's disease (PD) experience stressful situations as a result of performing their role as caregivers. This can have a negative outcome on their quality of life. A greater understanding of the relationship between the variables assessed in caregivers can be important in implementing effective intervention programs. The aim of this study was to explore the personality and coping strategies used by family caregivers of people with PD, analyzing their relationship with psychological distress and the carer involvement. A cross-sectional study based on a sample of 106 caregivers of people with Parkinson's disease tested the hypothesis that personality and coping strategies can contribute to identifying differences in carer involvement and psychological distress. Caregiver psychological distress was assessed using the CORE-OM questionnaire. The CORE-OM is able to distinguish the population within the clinical and non-clinical range. NEO Five-Factor Inventory (NEO-FFI) was used to assess personality. Coping strategies were evaluated with the COPE-28 inventory. An operational measure of the carer involvement was also used. For this purpose, an adaptation of the Katz index assessing basic functional capacity was made. Results: First, all cases were clustered according to personality variables and coping strategies. A K-means cluster analysis was performed and two groups were requested. After this, binary logistic regression analysis was used to test the research hypothesis. The resulting clusters in the above analysis were selected as predictors. Two analyses were performed. In the first, the dependent variable in logistic regression analysis was the psychological distress of the caregivers (dichotomized variable: clinical and non-clinical). Results showed that people clustered within cluster 1 had a 9.250 times higher risk of psychological distress than those included in cluster 2 (OR = 9.250; p < .001). In a second logistic regression analysis, the dependent variable was participation in care (dichotomized variable: low - high carer involvement). The group of people belonging to cluster 1 showed a carer involvement 4.125 times lower than the people grouped in cluster 2 (OR = 4.125; p < .001). The results of this research suggest the existence of a relationship between psychological variables and carer involvement, showing two different styles of care, which are described based on the personality and coping strategies of the family caregivers. In addition, we found that these styles of care show clear differences in efficiency, reflected in greater carer involvement and a lower psychological distress. The results reported that the cluster of people with below-average scores on neuroticism and above-average scores on the other personality factors (extraversion, openness to experience, agreeableness, and conscientiousness) and coping strategies (planning; active coping; emotional support; social support; positive re-evaluation and acceptance) were associated with increased carer involvement and reduced risk of psychological distress. It has already been suggested that high scores in neuroticism may affect the need to take on a large number of care-related tasks or manage stressful situations in people with PD (Tew et al., 2013). However, our results indicate that the definition of different types of caregivers, where other care-related variables are also included, can help define more efficient styles of care. This is associated with increased carer involvement and minor psychological distress. We propose that in the future these variables be investigated in order to know the outcome of carer involvement and psychological distress, contributing to the description of more efficient care styles in family caregivers.

Subjective well-being and vulnerability related to problematic Internet use among university students with and without disabilities: A comparative study.

This study aims to observe whether people with disabilities experience problematic Internet use (PIU) like that of young people without disabilities; to relate PIU to psychological distress in young disabled people and to determine whether these problems are similar to or different from those experienced by young people without disabilities. The sample comprised 408 university students with disabilities and 1386 university students without disabilities from several Spanish universities. PIU was evaluated using the Internet Addiction Test (IAT) and psychological distress was evaluated using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). The group of university students with disabilities showed less PIU than the nondisabled students, but the worst scores in variables referencing psychological discomfort were found among those students with disabilities who also had PIU. Although the results are not completely generalizable, PIU is related to bigger problems in disabled people for whom it represents a higher risk than for people without disabilities.

Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study.

BACKGROUND: Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients' illnesses. OBJECTIVE: To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. METHOD: A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. RESULTS: The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). CONCLUSIONS: COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.

Retorno Social de la Inversión (SROI) en Tratamientos Psicológicos Basados en la Evidencia / Social return of investment (SROI) in evidence-based treatments

La innovación en los servicios sanitarios afronta retos en cuanto a la generación de alternativas eficaces para las crecientes necesidades de la población, así como el desarrollo de metodologías para su evaluación. El propósito de éste estudio fue determinar el retorno social de la inversión (SROI) de un tratamiento psicológico basado en la evidencia. Se llevó a cabo el análisis de un programa de intervención psicológica con un diseño que incluía medidas pre/postratamiento y un grupo control. Como resultado se obtuvo un impacto social positivo: cada euro invertido ofreció un retorno social neto de 2.98€. En conclusión, puede decirse que el SROI puede ofrecer información sobre el impacto social provocado por las intervenciones clínicas, determinando los rendimientos tangibles obtenidos con la inversión

Innovation in health care services generates the development of new initiatives. Research should focus on the development of methodologies that allow the evaluation of interventions and determine the true impact they have. The purpose of this study was to determine the social return of investment (SROI) of a health treatment. An analysis of a psychological intervention program was carried out with a design that included pre/post-treatment measures and control group. As results, a positive social impact was obtained. Each monetary unit spent offered a net social return of 2.98. In conclusion, SROI can offer information about the social impact caused by health care interventions, determining the tangible return obtained with the investment

Paternal and Maternal Variables Related to Depression in Childhood.

Several studies have highlighted the relationship between parenting styles and depression in children. The aim of this study is to ascertain whether there are differences in the parenting practices received by two groups of children who obtain low-risk and high-risk scores respectively in relation to depression and determine which parenting variables are linked with the presence or absence of this kind of internalizing problem. From a sample of 550 subjects, obtained by probabilistic cluster sampling, we selected 140 children between 3 and 12 years of age who met a set of specific criteria as having high risk scores (70 children) for depression according to the Behavior Assessment System for Children (BASC) or having low scores in this variable (70 children). Then, the Parent-Child Relationship Inventory (PCRI) was applied to both parents. We carried out a binomial logistic regression analysis which resulted in a prediction model for 89.3% of the sample, based on the following parenting variables: limit setting and involvement from the mothers, and parental support, autonomy, satisfaction with parenting, and communication from the fathers. Finally, the usefulness of our results to plan intervention strategies within families of children with depression is discussed.

Tratamiento combinado de la esquizofrenia aplicado en el ámbito domiciliario / Combined treatment of the schizophrenia applied in the home setting

En el presente estudio se describen ocho casos de esquizofrenia paranoide a los que se aplica un tratamiento combinado (farmacológico-psicológico) en su ámbito domiciliario. Dentro de la intervención se lleva a cabo un entrenamiento en habilidades de la vida diaria tanto básicas como instrumentales y un módulo de formación para la adhesión al tratamiento farmacológico. El diseño utilizado es de caso único con 8 réplicas (N= 8) y diseño ABAB. Finalizados los períodos de intervención en sus domicilios, los resultados indican que el entrenamiento aumenta el número de habilidades y la adherencia al tratamiento farmacológico y que se produce una mejora en la sintomatología general de los pacientes (AU)

In the present study eight cases of paranoid schizophrenia are described in which a combined treatment is applied (pharmacological-psychological) in the home setting. During the intervention, it is also carried out a training in skills of the daily life as basic as instrumental and a formation module for the adhesion to the pharmacological treatment. The used design is the only example with eight replies (N= 8) and a ABAB design. After the periods of intervention in their homes, the results show that the training increases the number of skills and the adherence to the pharmacological treatment and that they produce an improvement in the general symptomatology of the patients (AU)