Exploring the impact of social protest on mental health: A study of the 2019 "Social Uprising" in Chile.

Socio-political conflicts, especially if accompanied by violent events, can affect the mental health of the population. This study aimed to estimate the causal effect of social protest-related violence on depressive symptoms during the 2019 social uprising in Chile. We collected population-representative data from a nationwide longitudinal survey (n = 2918), the fourth wave of which took place during the months of the social uprising in Chile (November 2019 and March 2020). Depressive symptoms were measured using the Patient Health Questionnaire-9, while violence related to social protest was measured as the perception of destruction at the neighbourhood level. To assess the casual relationship between destruction perception and depressive symptoms, we utilized an instrumental variable regression model. Our analysis controlled for relevant sociodemographic factors, participation in social protest, and history of mental health treatment. Results showed that perceived neighbourhood destruction during the 2019 social uprising significantly increased PHQ-9 score by 3.702 points, prevalence of moderate to severe depressive symptoms by 18.7%, and likelihood of having a Subthreshold or Major Depressive Episode by 15.2% (p < 0.01). The impact of perceived destruction on depressive symptoms varies by gender, with a significant effect found in men (an increase in depression indicators of 5.769 points, 26.8% and 23.0%, respectively, p < 0.05) but not in women. Stratified regression models by age demonstrate a positive association between the perception of neighbourhood destruction and depressive symptoms across all age groups, with a stronger effect observed among young adults. We found a casual effect of violence related to social protest on depressive symptoms. These findings have implications for the planning of social policies aimed at protecting the mental well-being of the population in times of increasing socio-political turmoil.

Social contagion, violence, and suicide among adolescents.

PURPOSE OF REVIEW: Social Contagion is defined as the spread of behaviors, attitudes, and affect through crowds and other types of social aggregates from one member to another. Adolescents are prone to social contagion because they may be especially susceptible to peer influence and social media.In this article, we provide a brief review of the most recent findings on social contagion, violence, and suicide among adolescents. RECENT FINDINGS: Recent evidence support social contagion in gun violence, bullying, cyberbullying, violent offending, and suicide, but is inconclusive on the role of violent video game exposure on aggressive behavior. SUMMARY: The mechanisms underlying the contagion effect of violence and suicide are currently unclear. It has been argued that social learning, identification with significant others, and the normalization of specific norms play a role. All these mechanisms require understanding social contagion as a complex interaction between individual, relational and social factors. This is key if the social contagion perspective is to be used not only to investigate negative outcomes, but also as a framework for promoting prosocial attitudes and behaviors. Additionally, more research is needed on psychosocial interventions and public policies to minimize the potential spillover effect of violence and suicide.

Suicide and quarantine during the COVID-19 pandemic: Do we know everything?

BACKGROUND: There is widespread concern over the impact of COVID-19 and lockdown measures on suicidal behaviour. We assessed their effects on suicide and hospitalization for attempted suicide during the initial phase of the pandemic in Chile. METHODS: We used panel data at the county and month level from January 1, 2016 to December 31, 2020 on suicides and related hospitalizations and a pandemic quarantine dataset. Poisson regression models and a difference-in-difference (DiD) methodology was used to estimate the impact of quarantine on both measures. FINDINGS: Suicide and hospitalizations for attempted suicide decreased (18% and 5.8%, respectively) during the COVID-19 outbreak in Chile (March-December 2020) compared to the same period in 2016-2019. The DiD analysis showed that there was at least a 13.2% reduction in suicides in quarantined counties relative to counties without such restrictions. This reduction was in male suicides and unaffected by age. There was no significant difference between quarantined and non-quarantined counties in terms of hospitalization for suicide attempts. CONCLUSIONS: This study shows a significant quarantine effect on reducing suicide during the initial phase of the COVID-19 pandemic in Chile. Changes in the number of hospitalizations for suicide attempts do not explain the differences between quarantined and non-quarantined counties.

A Longitudinal Nationwide Study of Psychological Distress During the COVID-19 Pandemic in Chile.

Background: Despite numerous efforts to assess the impact of the COVID-19 pandemic on mental health, there are few longitudinal studies that examine the change in the burden of psychological distress over time and its associated factors, especially in developing countries. Objective: The primary aim of this study was to assess the levels of psychological distress at two time points during the COVID-19 outbreak based on a representative community sample in Chile. The secondary aim was to identify groups that are more vulnerable to psychological distress during the pandemic. Methods: A nationally representative, longitudinal telephone survey of Chilean adults was conducted. This study analyses panel data from two waves in 2020: May 30 to June 10 and September 15 to October 9. A total of 823 people participated in both surveys. Changes in mental health outcomes (anxiety and depressive symptoms) were assessed, estimating the effect of demographic characteristics, psychosocial and economic factors, household conditions, and health status. Results: There was a significant increase in psychological distress (PHQ-4 ≥ 6) between Waves 1 (22.6%) and 2 (27.0%), especially among younger participants. Overall, the results of this study show that being female, living in or near the capital, living in overcrowded households and having a perceived lack of space in the home, loneliness or perceived social isolation, and having received mental health treatment within the last year are significantly associated with psychological distress over time (p < 0.05). Conclusion: This study highlights the need to implement psychosocial programs to protect people's psychological well-being, as well as social policies to improve household living conditions and levels of social connectedness during the COVID-19 outbreak.

Salud mental en estudiantes de educación superior en Chile: una revisión de alcance con meta-análisis / Mental Health of Higher Education Students in Chile: Scoping Review and Meta-Analysis

Resumen Realizamos una revisión de alcance sobre la prevalencia de síntomas psicológicos, factores asociados a la salud mental, barreras y facilitadores para la búsqueda de ayuda, y la efectividad de intervenciones de salud mental en estudiantes de educación superior en Chile. Buscamos reportes indexados hasta el 15 de octubre de 2019 en las bases de datos CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME y Web of Science. Evaluamos la calidad de los estudios de prevalencia y exploramos la prevalencia combinada de síntomas psicológicos mediante meta-análisis. Incluimos 32 estudios publicados, 20 sobre prevalencia de síntomas - 10 con la calidad suficiente para ser incluidos en el meta-análisis. Observamos una heterogeneidad sustantiva en la exploración de prevalencia combinada de síntomas, con rangos entre 22,9% a 40,7% para malestar psicológico, 16,5% a 38,8% para síntomas depresivos, 16,5% a 23,7% para síntomas ansiosos, 19,7% a 29,7% para consumo de cannabis en los últimos 12 meses, y 84,0% a 92,6% para consumo de alcohol en los últimos 12 meses. El sexo femenino se asoció consistentemente con problemas de salud mental. Es necesario realizar más estudios que evalúen el acceso a tratamiento, facilitadores y barreras para la búsqueda de ayuda, e intervenciones para mejorar la salud mental de la población objetivo.

Abstract We conducted a scoping review on the prevalence of psychological symptoms, factors associated with mental health, barriers and facilitators to help-seeking, and effectiveness of mental health interventions in higher education students in Chile. We searched for indexed reports up to October 15, 2019, in CINAHL, Google Scholar, PubMed, Virtual Health Library/BIREME, and Web of Science databases. We assessed the quality of prevalence studies and explored the pooled prevalence of psychological symptoms using meta-analyses. We included 32 published studies, 20 on the prevalence of psychological symptoms - 10 of sufficient quality to be included in meta-analyses. We observed substantial heterogeneity in the exploration of combined prevalence of psychological symptoms, with ranges from 22.9% to 40.7% for psychological distress, 16.5% to 38.8% for depressive symptoms, 16.5% to 23.7% for anxious symptoms, 19.7% to 29.7% for cannabis use in the past 12 months, and 84.0% to 92.6% for alcohol use in the past 12 months. Female sex was consistently associated with mental health problems. More studies evaluating access to treatment, help-seeking barriers and facilitators, and interventions to improve the mental health of the target population are needed.

Psychological distress during the COVID-19 epidemic in Chile: The role of economic uncertainty.

Previous research has shown that the COVID-19 outbreak, social distancing, and lockdown can affect people's psychological well-being. The aims of this study were (1) to estimate the extent to which perceptions and expectations regarding the social, economic, and domestic effects of the COVID-19 outbreak are associated with psychological distress and (2) to identify some demographic, psychosocial, and economic factors associated with increased vulnerability to psychological distress during the COVID-19 outbreak in Chile. 1078 people participated in a telephone survey between May 30 and June 10, 2020. The sample is representative of the Chilean adult population. Psychological distress was assessed through a questionnaire of anxious and depressive symptoms (Patient Health Questionnaire-4). We analyzed the data set using ordinary least-squares regression models, first estimating models for the entire sample, and then stratifying the sample into different groups to explore differences by gender and age. 19.2% of participants displayed significant psychological distress (PHQ-4 ≥ 6), with moderate to severe anxiety-depression symptoms being more prevalent in women than in men (23.9% vs 14.1%, χ2 16.78, p<0.001). The results of this study suggest that being a woman, feeling lonely and isolated, living in the areas hit hardest by the pandemic and lockdown, expecting a lack of income due to having to stop working as a consequence of the pandemic, and having a history of diagnosed mental disorders are significantly associated with psychological distress (p<0.05). The results of this study highlight the need to implement psychosocial programs to guard people's psychological well-being and social policies to address economic uncertainty during the current COVID-19 outbreak in Chile.

Feasibility and Acceptability of "Cuida tu Ánimo" (Take Care of Your Mood): An Internet-Based Program for Prevention and Early Intervention of Adolescent Depression in Chile and Colombia.

The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. "Cuida tu Ánimo" (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention.

[Socioeconomic determinants and gender gaps in depressive symptoms in Chile]. / Determinantes socioeconómicos y brechas de género de la sintomatología depresiva en Chile.

BACKGROUND: There are marked differences associated with socio-economic factors in the prevalence of depressive symptoms (DS) in men and women. AIM: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. MATERIAL AND METHODS: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. RESULTS: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. CONCLUSIONS: There is a combined effect between socio-economic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women.

Determinantes socioeconómicos y brechas de género de la sintomatología depresiva en Chile / Socioeconomic determinants and gender gaps in depressive symptoms in Chile

Background: There are marked differences associated with socio-economic factors in the prevalence of depressive symptoms (DS) in men and women. Aim: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. Material and Methods: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. Results: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. Conclusions: There is a combined effect between socio-economic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women.

Impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios en Chile / Impact of the COVID-19 pandemic on the mental health of university students in Chile

La pandemia por COVID-19 ha tenido un impacto negativo en el bienestar psicológico de la población. El objetivo de este estudio fue evaluar el impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios(as) en Chile, explorando el rol de los acontecimientos adversos en el núcleo familiar y las experiencias negativas relacionadas. Contestaron una encuesta en línea 2.411 estudiantes de primer año de una universidad en Chile. Tres de cada cuatro estudiantes reportaron que su estado de ánimo era peor o mucho peor en comparación con el contexto pre-pandémico. Las estudiantes mujeres presentaron significativamente mayores niveles de sintomatología depresiva y ansiosa y reportaron de forma significativa una mayor percepción de empeoramiento del estado de ánimo. Los hallazgos de este estudio refuerzan la necesidad de implementar intervenciones y estrategias orientadas a favorecer una mejor salud mental de los(as) estudiantes universitarios(as) en Chile.

Abstract. The COVID-19 pandemic has had a negative impact on the psychological well-being of the population. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the mental health of university students in Chile, exploring the role of adverse events in the family and related negative experiences. An online survey was answered by 2,411 first-year students from a university in Chile. Three out of four students reported that their mood was worse or much worse compared to the pre-pandemic context. Female students presented significantly higher levels of depressive and anxious symptoms and reported significantly greater perception of worsening mood. The findings of this study reinforce the need to implement interventions and strategies aimed at promoting better mental health for university students in Chile.

Stigmatizing Beliefs and Attitudes to Depression in Adolescent School Students in Chile and Colombia.

Major depressive disorder (MDD) affects between 4 and 5% of adolescents. However, there is still a huge gap between adolescents who meet criteria for MDD and those who receive mental health care. Stigmatizing attitudes toward depression are among the main barriers to seeking professional help. The aim of this article is to examine the individual characteristics associated with stigmatizing attitudes toward depression in a sample of adolescent school students from Chile and Colombia, and present the adaptation and psychometric properties of the Personal Depression Stigma Scale (DSS-Personal) for both countries. A total of 2971 adolescents, aged 10-19 (M = 14.6, SD = 1.5), who were recruited from eight schools in Santiago, Chile (n = 2022), and eight schools in Medellín, Colombia (n = 949), completed the DSS-Personal, the Patient Health Questionnaire (PHQ-9), and a questionnaire of individual sociodemographic characteristics. Factor structure, internal consistency, and validity of the DSS-Personal were assessed. Multiple linear regression models were used to evaluate the association between DSS-Personal scores and sociodemographic information, depression scores, and the use of health services by country. Confirmatory factor analysis supported the unidimensional structure of the DSS-Personal, while the estimated reliability of its scores was acceptable. Results show that DSS-Personal scores were higher in adolescents in Colombia than in Chile (U = 9.36, p < 0.001). Immigrant status was the only variable significantly related to personal depression stigma in both samples. Being female was associated with lower levels of stigma in adolescents in Chile, while depressive symptoms were associated with lower levels of stigma in adolescents in Colombia. Age, having been diagnosed with depression, and being in pharmacological or psychological treatment were not related to levels of personal depression stigma in either sample. The identified associated factors of personal depression stigma should be considered in the development of anti-stigma campaigns; also, gender differences require special attention. The results of this study suggest that it is important to offer school-based programs to reduce personal stigma, and that specific anti-stigma campaigns should address personal stigma in men and immigrants.

Subthreshold depression in adolescence: Gender differences in prevalence, clinical features, and associated factors.

BACKGROUND: Subthreshold depression (SD) is an important mental health problem in adolescence given its high prevalence, comorbidity, and functional impairment. However, currently little is known about gender differences of SD in adolescence. The aim of this study was to examine gender differences in prevalence, clinical features, and associated factors in adolescents with subthreshold depressive episode (SDE). METHODS: The participants were 2,022 adolescents between 9th and 11th grades (49.5% girls, 15.2 years average age) recruited from eight state-subsidized schools located in the northern part of Santiago, Chile. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Descriptive statistics, bivariate and multinomial logistic regression analyses were used. RESULTS: The prevalence of SDE and major depressive episode were 16.5% (95% CI: 14.9-18.2) and 17.7% (95% CI: 16.1-19.4), respectively. Both mental health problems were more prevalent in females (p < 0.001). With regard to SDE, girls displayed a higher rate of depressive mood and sleep problems, while boys had greater anhedonia, problems related with concentration, and psychomotor retardation/agitation. High levels of dysfunctional thoughts and perceived social support were associated with SDE in females and males. Social problem solving and emotion regulation had a differentiated impact on SDE depending on gender. CONCLUSION: Depressive symptoms and SDE were found to be common health problems among adolescents in Chile. SDE had major gender differences in terms of prevalence, clinical features, and associated factors. These differences should be considered in the development of preventive and early interventions.

Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review.

Background: There is a huge gap in the treatment of mental disorders in Latin America, especially among socioeconomically disadvantaged groups. Given the sharp increase in Internet access and the rapid penetration of smartphones in the region, the use of Internet-based technologies might potentially contribute to overcoming this gap and to provide more widely distributed and low-cost mental health care in a variety of contexts. Methods: We conducted a scoping review of the literature in order to systematically map the existing evidence on use of Internet-based interventions for prevention, treatment, and management of mental disorders across Latin American countries, as well as to identify existing gaps in knowledge. Six electronic databases were searched for published papers (PubMed, Embase, CINAHL, Web of Science, SciELO, and CENTRAL). Results: After the eligibility assessment, we identified 22 Internet-based studies carried out in Latin America for prevention, treatment, education, or facilitating self-management of mental disorders. Included studies mainly targeted depression (n = 11), substance misuse (n = 6), anxiety (n = 3), and mental health literacy for education and health professionals (n = 2). Most studies were undertaken in Brazil (n = 6), Mexico (n = 5), and Chile (n = 4). Only 3 studies were randomized controlled trials (RCTs), 4 were pilot RCTs, and 15 were naturalistic, acceptability, or feasibility studies. The three RCTs identified showed disparate results, but overall, there are challenges to face. Better results are seen in the short-term (postintervention or after 3 months), but most studies do not explore outcomes for long enough (follow-up after 6 or 12 months). Most of the feasibility and pilot studies showed reasonably good acceptability for a wide range of strategies but difficulties to engage and retain participants for long enough or adhering to established protocols. Conclusion: This study shows that Internet-based interventions for the prevention and treatment of mental disorders are growing rapidly in Latin America, but there are few studies on effectiveness and cost effectiveness, making it difficult to provide the evidence needed to justify scaling up these interventions.

The multiple meanings of ADHD: between deficit, disruption and hidden potential / Os diversos significados de TDAH: entre déficit, distúrbio e potencial oculto

Abstract The purpose of this article is to describe the subjective experience of the diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) and the cultural meanings that shape this experience. Based on interviews and discussion groups with diagnosed people and their families in Chile and France, this article show that ADHD can acquire multiple meanings. From a thematic analysis, we identified three registers or ways of living and thinking about ADHD. In the deficit register, the disorder is experienced primarily as a failure of certain abilities. In the disruption register, the disorder is experienced as disrupting the person's life, personality and interactions, which must then be normalized. In the register of hidden potential, on which this article focuses, ADHD is simultaneously thought of as a difficult and valuable condition, a source of exceptional capacities that are often hidden in the ordinary functioning of social life. We therefore invite reflection that identifies the factors of mobilization or non-mobilization of the hidden potential register, with particular emphasis not only on relational configurations, socio-economic variables, and the gender variable, but also on the institutional and political context of each country.

Resumo O objetivo deste artigo é descrever a experiência subjetiva do diagnóstico de Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e os significados culturais que moldam essa experiência. Com base em entrevistas e grupos de discussão com pessoas diagnosticadas e suas famílias no Chile e na França, este artigo demonstra que diversos significados podem ser atribuídos ao TDAH. A partir de análise temática, foram identificados três registros ou modos de viver e pensar TDAH. No registro déficit, o transtorno é vivenciado primariamente como falha de certas habilidades. No registro distúrbio, o transtorno é vivenciado como uma perturbação da vida pessoal, personalidade e interações que necessita ser normalizada. No registro de potencial oculto, foco deste artigo, TDAH é considerado simultaneamente condição difícil e valiosa, fonte de capacidades excepcionais que estão habitualmente ocultas no andamento comum da vida social. Portanto, propõe-se refletir e identificar os fatores de mobilização e não mobilização do registro de potencial oculto, com particular ênfase não só nas configurações relacionais, variáveis socioeconômicas e de gênero, mas também no contexto institucional e político de cada país.

Improving Mental Health Care in Developing Countries Through Digital Technologies: A Mini Narrative Review of the Chilean Case.

The uneven distribution of mental health resources contributes to the burden of mental disorders in vulnerable groups, especially in developing countries. Internet-based interventions and digital technologies can contribute to reducing the gap between high prevalence of mental disorders, demand for treatment, and access to mental health care, thereby reducing inequities in mental health. This mini review summarizes the current state of the field of e-mental health research in Chile, showing its progress, limitations, and challenges. Internet-based interventions are at an early stage of development in Chile. The interventions included are heterogeneous in terms of participants (e.g., secondary students, patients, healthcare professionals) and contexts (e.g., rural, urban, schools, primary health care), aims, and modalities (e.g., website, online games). While these studies confirmed the feasibility of Internet-based interventions, the shortage of studies on effectiveness and cost-effectiveness makes it difficult to disseminate and scale up these Internet-based programs. However, the growing amount of knowledge accumulated in the Chilean context could guide practices in other developing countries for supporting the mental health of underserved populations.

"No hay salud mental sin justicia social": desigualdades, determinantes sociales y salud mental en Chile / "No mental health without social justice": inequalities, social determinants and mental health in Chile

Las desigualdades en las condiciones de vida impactan negativamente sobre la salud mental de las personas y comunidades. Este artículo tiene por objetivo describir algunas de las principales líneas de investigación y reflexión en torno a la relación entre desigualdad y salud mental. Más que una revisión sistemática, se trata de una discusión orientada a contribuir al debate público en torno a las dimensiones materiales, simbólicas y subjetivas de la desigualdad, mencionando algunos mecanismos que permiten comprender su relación con la salud mental. Entre estas dimensiones abordamos las desigualdades de ingreso y de género, además de otras que han recibido menor atención en los estudios nacionales e internacionales: las desigualdades en la participación, en la interacción cotidiana, y las desigualdades socio-territoriales y en el uso del tiempo. Finalmente, mencionamos algunas limitaciones teóricas de la investigación tradicional sobre desigualdad en salud y sugerimos potenciales líneas de investigación que pueden orientar los estudios en torno a desigualdades y salud mental