Proposal for an implicit stigma measure in mental illness: A multigroup study.

An Implicit Association Test was developed to assess the mental illness stigma in people from the general population, mental health professionals, people with a diagnosis, and family members. No differences were found between groups. Implicit stigma was found throughout the sample, with lower scores in the younger age group.

Study of the relationship between implicit and explicit stigmas associated with mental illness.

The emergence of the Implicit Association Test (IAT) has encouraged the study of the implicit stigma associated with mental illness in recent years, although further research is still needed in this area. A sample (n = 102) composed of psychology students and people from the general population completed explicit stigma tests: Attribution Questionnaire-9 (AQ-9), Social Distance Scale (DS) and a Spanish version of the IAT. A statistical analysis of sociodemographic measures and variables, and the relationships between explicit and implicit evidence, was carried out. The presence of implicit and explicit stigma was observed throughout the sample. Significantly lower AQ-9 scores were found in the student group. A greater desire for social distance was related to older age, belonging to the general population group and not having a diagnosed relative. In contrast, greater implicit stigma was found in people who had a family member with a diagnosis. No relationship was observed between explicit tests and IAT. An analysis of the main components revealed one implicit component and other explicit. Our study supports the existence of a stigma model with two different dimensions. These findings highlight the need to consider explicit and also implicit stigma, in future theoretical models and applied studies.

Confirmatory factor analysis of the Revised UCLA Loneliness Scale (UCLA LS-R) in individuals over 65.

GOALS: The UCLA LS-R is the most extensively used scale to assess loneliness. However, few studies examine the scale's use on older individuals. The goal of the study is to analyse the suitability of the scale´s structure for assessing older individuals. METHOD: The UCLA LS-R scale was administered to a random sample of 409 community-dwelling residents of Madrid (53% women) aged 65-84 years (obtained from the MentDis_ICF65+ study). Confirmatory factor analysis was used to assess the factor structure of the UCLA LS-R. RESULTS: The internal consistency of the scale obtained a Cronbach's alpha of .85. All the analysed models of factor structure of the UCLA LS-R achieved a fairly good fit and RMSEA values over .80. The models that best fit the empirical data are those of Hojat (1982) and Borges et al. (2008). CONCLUSION: The data suggest an equivalent effectiveness of UCLA LS-R in adults under 65 and over 65, which may indicate a similar structure of the loneliness construct in both populations. This outcome is consistent with the idea that loneliness has two dimensions: emotional loneliness and social loneliness. The use of short measures that are easy to apply and interpret should help primary care professionals identify loneliness problems in older individuals sooner and more accurately.

Age-related self-stigma of people over 65 years old: adaptation of the Internalized Stigma of Mental Illness scale (ISMI) for use in age-related self-stigma (IS65+) in a Spanish sample.

OBJECTIVES: To adapt the Internalized Stigma of Mental Illness scale (ISMI) to examine self-stigma associated with aging and to study the psychometric properties of this adapted version (IS65+). Finally, self-stigma associated with age in older people is studied. METHOD: The IS65+ was administered to a random sample of 419 people over 65 years from Madrid (Spain) to study the psychometric properties of this adapted version. A regression model was estimated to identify the variables that best predict self-stigma associated with old age. RESULTS: The IS65+ showed good internal consistency (α = .89) and a factorial structure of five factors. The data showed lower levels of self-stigma related to age in the sample than the levels of mental illness self-stigma in people with mental illness. The variables associated with age-related self-stigma are: high levels of perceived loneliness, low levels of coping strategies, gender (female), mental disorder, major depressive disorder, low levels of optimism and quality of life, and high levels of functional impairment. CONCLUSION: A new version of ISMI (IS65+) with acceptable psychometric criteria has been developed for use in people over 65 years old.

Prevalence of Mental Disorders in the Elderly in the Community of Madrid: Results of the Mentdis_ICF65+ Study.

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcohol-related disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substance-related disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorder's prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted.

Prevalence of mental disorders in the elderly in the community

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcoholrelated disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/ women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substancerelated disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorder’s prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted (AU)

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A structural equation modeling study of the Spanish Mental Illness Stigma Attribution Questionnaire (AQ-27-E).

The main purpose of this study was the translation and analysis of psychometric properties of the Attribution Questionnaire for use in Spanish-speaking populations (AQ-27-E) and to test the dangerousness and responsibility models of mental illness stigma in a Spanish sample. The sample consisted of 439 adults from the general population of the community of Madrid (Spain). The questionnaire was translated using the translation/back-translation method. Cronbach's alpha was used to carry out the reliability analysis, and structural equations were used to test the dangerousness and the responsibility models of stigma. Internal reliability of AQ-27-E was .855, which can be interpreted as good. However, some factors (Pity, Responsibility, and Coercion) showed limited internal consistency. Results suggest that the AQ-27-E is a standardized instrument with acceptable psychometric properties comparable to previous versions, which can be used to assess stigma in Spanish-speaking populations.

La Enfermedad Mental en los Medios de Comunicación: Un Estudio Empírico en Prensa Escrita, Radio y Televisión / Mental Illness in the Media: An Empirical Study in Press, Radio and Television

La percepción social de la enfermedad mental está teñida de una serie de estereotipos negativos y prejuicios que conducen a la discriminación y aumentan el sufrimiento de las personas que padecen un trastorno mental. En repetidas ocasiones se ha señalado el papel de los medios de comunicación como agentes estigmatizadores de gran repercusión y difusión social. El presente estudio pretende cubrir la escasez de trabajos que analizan las posibles tendencias estigmatizantes en los principales medios de comunicación españoles. Los resultados muestran una utilización abusiva e incorrecta de terminología relacionada con los trastornos mentales en los contenidos informativos de prensa, radio y televisión, mientras que el seguimiento real del tema es escaso y se aleja de un tratamiento informativo óptimo. De hecho, una cuarta parte de las noticias analizadas incluían contenidos estigmatizadores, siendo los estereotipos con mayor frecuencia de aparición el de peligrosidad e impredecibilidad. Todo ello hace necesaria la puesta en marcha de iniciativas de sensibilización social y erradicación del estigma, con el fin de favorecer la integración y el bienestar de las personas que sufren algún trastorno mental (AU)

The social perception of mental illness is characterised by a wide range of negative stereotypes and prejudices which lead to discrimination and increase the suffering of people with a mental disorder. The media have been repeatedly described as important stigmatizing agents with enormous social influence and repercussion. This study intends to compensate for the lack of investigations about possible stigmatizing trends in the main Spanish media. The results have shown an abusive and improper use of terminology related to mental disorders in the radio, television and press news reports, which contrasts with a lack of news stories which really dealt with the subject and offered high quality information. In fact, a quarter of the analyzed news stories included stigmatizing contents, and a significant presence of stereotypes concerning danger and unpredictability. This reality requires the setting up of social sensitization and stigma eradication campaigns, aimed at promoting the integration and well-being of those people suffering from a mental disorder (AU)

Proposal of a socio-cognitive-behavioral structural equation model of internalized stigma in people with severe and persistent mental illness.

The social stigma of mental illness has received much attention in recent years and its effects on diverse variables such as psychiatric symptoms, social functioning, self-esteem, self-efficacy, quality of life, and social integration are well established. However, internalized stigma in people with severe and persistent mental illness has not received the same attention. The aim of the present work was to study the relationships between the principal variables involved in the functioning of internalized stigma (sociodemographic and clinical variables, social stigma, psychosocial functioning, recovery expectations, empowerment, and discrimination experiences) in a sample of people with severe and persistent mental illness (N=108). The main characteristics of the sample and the differences between groups with high and low internalized stigma were analyzed, a correlation analysis of the variables was performed, and a structural equation model, integrating variables of social, cognitive, and behavioral content, was proposed and tested. The results indicate the relationships among social stigma, discrimination experiences, recovery expectation, and internalized stigma and their role in the psychosocial and behavioral outcomes in schizophrenia spectrum disorders.

Evaluación de la Atención a las Personas con Enfermedad Mental Grave y Persistente: la Experiencia de Madrid / Evaluation of the Care Program for People with Chronic and Severe Mental Illiness: the Madrid Experience

En este artículo se presenta una experiencia de evaluación de programas de atención a las personas con enfermedad mental grave y persistente llevada a cabo en la Comunidad de Madrid: la evaluación del Plan de atención social para personas con enfermedad mental grave y crónica 2003-2007, de la Consejería de Familia y Asuntos Sociales. En este caso se aborda la evaluación de una forma global, abarcando los distintos aspectos del Plan, aunque prestando una atención especial a la red de recursos que se incluyen en el mismo. Se describe el proceso de evaluación global explicando los objetivos, metodología y procedimientos seguidos, así como las fases del proceso, las tareas y actividades desarrolladas, los instrumentos aplicados y los procedimientos de evaluación establecidos. Se presentan también algunos de los resultados obtenidos mediante dicha evaluación durante el año 2006 (AU)

This paper presents the experience of a program evaluation in Madrid –the evaluation of a social care program for people with chronic and severe mental illness. It is a global evaluation, including different aspects of the program –although a special attention is paid to the resources network. The evaluation process is described, including goals, methodology, phases, activities, instruments and procedures. Finally, some results are shown concerning evaluation in 2006 (AU)

Descriptive study of stigma associated with severe and persistent mental illness among the general population of Madrid (Spain).

The aim is to analyze the stigma associated with severe and persistent mental illness in the general population of the community of Madrid, Spain, as a first step to promote strategies to fight against it. Participants (n = 439) showed adequate general knowledge about mental illness, but a high degree of confusion with mental retardation. Stigmatizing attitudes focusing mainly on the disposition to help and on pity. Moreover, there were some perception of contamination and pity toward other family members. Psychosis seems to shows more stigma attitudes than cancer and depression, but less than cocaine addiction and AIDS.

Primeros auxilios psicológicos: protocolo ACERCARSE / Psychological first aid: ACERCARSE protocol

En los últimos años se ha producido un aumento en el interés por la intervenciones psicológicas posteriores a un suceso traumático, tanto tras incidentes masivos como los ataques del 11 de Septiembre de 2001 en Nueva York o el 11 de Marzo de 2004 en Madrid, o tras catástrofes naturales como el tsunami del 26 de Diciembre de 2004 en el sureste asiático, como por la necesidad de intervenir en víctimas recientes de sucesos traumáticos (violaciones, malos tratos, accidentes, etc). El presente artículo muestra una revisión de los principales acercamientos e intervenciones psicológicas tempranas. Los Primeros Auxilios Psicológicos (PAP) se define como un grupo de intervenciones psicológicas tempranas, breves y prácticas orientadas a paliar y prevenir los efectos psicológicos de los sucesos traumáticos a corto, medio y largo plazo. Los primeros auxilios psicológicos pueden emplearse tanto para facilitar apoyo psicológico en experiencia moderadamente estresantes de la vida cotidiana, como en sucesos traumáticos de gran intensidad, Los principales objetivos de los primeros auxilios psicológicos son la estabilización emocional de la persona, su conexión con las redes de apoyo social y la decisión de derivación a un servicio de salud mental. Se revisan los principio básicos y los principales protocolos de PAP propuestos hasta el momento y se resumen sus características comunes. Por último, se ofrece al lector una guía de primeros auxilio psicológicos desarrollada y utilizada por los autores en múltiples escenarios de desastres natural, guerra o terrorismo (Protocolo ACERCARSE)

Nowadays, interest in the emerging field of disaster psychology has increased significantly after events such as September 1, 2001 in New York, March 11, 2004 in Madrid, or December 26, 2004 tsunami in Asia. Also this interest has been centred in the need to treat rape, assault or other crime or accident victims. The present article shows a revision of the main early psychological approaches and interventions in the immediate response to disaster. Psychological First Aid (PFA) is defined as a group of short, practical and early psychological interventions oriented to relieve and prevent the psychological effects of traumatic events in the short, middle or long term. PFA is useful to offer psychological support in the medium or moderate stressful life events as well as in great intensity ones. The main objectives of PFA are the person emotional stabilization, their connection with the natural social support networks and the decision of the derivation to mental health services. The basic principles and the protocols of PFA are revised and their common characteristics are summarized. Finally a PFA are revised guide developed and applied in different disasters, war and terrorism settings by the authors is presented (ACERCARSE protocol)

Dimensiones comunitarias. Vivir con autonomía personal: prevención e intervención en situaciones de exclusión / Communitary dimensions. To live with personal autonomy: prevention and intervention in social exclusion

Parece evidente la necesidad de contar con herramientas de clasificación y valoraciónprecisas, que ayuden a abordar la situación de dependencia. Esta comunicación abordaprincipalmente el tema de la evaluación en dependencia destacando los problemas y losavances realizados en los últimos años en este sentido, teniendo en cuenta fundamentalmentela situación española. Además de abordar la importancia de la evaluación a la horade determinar la existencia y el nivel de dependencia, se expone la evaluación de la intervencióncon un colectivo en riesgo real de llegar a situaciones de dependencia: las personassin hogar con enfermedad mental grave y crónica

Instruments to classify and assess are necessary to understand the dependence situation.This communication deals with assessment in dependence, overall the problems andadvances in the last years in Spain. Also an evaluation of an intervention for a group inrisk of dependence (people with severe and chronic mental illness) is discussed

Utilidad de un programa de entrenamiento en detección de trastornos psicológicos en centros de atención a víctimas de exclusión social / Utility of a program of training in detection of psychological disorders in social exclusion centers

Introducción: En el presente trabajo se revisan los principales barreras que afectan a las personas que sufren procesos de exclusión social en su acceso a los servicios de salud mental y se analizan las principales alternativas de intervención. Se resalta la búsqueda activa (outreach) como principal estrategia de superación de dichas barreras y, en especial, el papel de los programas de entrenamiento de los profesionales y voluntarios de atención directa en la detección de trastornos psicológicos que permitan iniciar de forma más rápida el proceso de atención. Métodos: Se diseño y se sometió a prueba un programa de Educación y entrenamiento para la detección de trastornos mentales graves en personas Sin Hogar (12 horas: 6 módulos de entrenamiento en detección y manejo de trastornos de Ansiedad, Estado de Animo, Esquizofrenia, Trastornos Cognitivos y Abuso de Alcohol y otros drogas).Se entrenó a los profesionales del centro y se contrastó la concordancia de sus diagnósticos con los realizados mediante instrumentos estandarizados: Entrevista de detección(Vázquez y Muñoz, 2002; Mini-mental (Foldstein et al, 1975) y SCID-I (First et al, 1999)). Resultados: Se observó una mejoría muy importante en todos los índices de concordancia entre el personal del centro y los instrumentos estandarizados. Mejoraron igualmente los índices de sensibilidad y especificidad y el poder predictivo de los diagnósticos realizados por los profesionales. Conclusiones: Se revisan los principales resultados desde el punto de vista de su utilidad inmediata en su aplicación en centros de atención a personas con problemas de exclusión social en los que le personal de atención directa a los usuarios no tenga una formación en diagnóstico y en Salud Mental

Introduction: In the present article the main barriers affecting excluded people access to health services are analyzed. The main intervention alternatives are revised. Outreach orientation in the intervention process is presented like the more useful strategy to break these barriers. The role of psychological disorders screening training programs is delimited. Methods: An education and training program in mental health screening in homeless persons was designed (12 hours: 6 training modules in detection and management of Anxiety, Mood disorders, Schizophrenia, Cognitive disorders and Alcohol and other drugs abuse). The professionals were trained and their diagnostics compared with the obtained with some well-standardized screening and diagnostic instruments: Screening interview (Vázquez & Muñoz, 2002; Mini-mental (Foldstein et al., 1975; SCID-I (First, et al. 1999). Results: An improvement in the agreement indexes among professionals and standardized instruments is observed. In the same way, specificity, sensibility and predictive power of staff diagnostics hare increased after the training program. Conclusions: The results are analyzed from their usefulness and rapid application by workers without specific mental health training of excluded people centers

Early psychological consequences of the March 11, 2004, terrorist attacks in Madrid, Spain.

On March 11, 2004, Al-Qaeda set off 10 bombs on several train routes in Madrid. 192 people were killed and 2,000 wounded. In this study, 1,179 questionnaires were administered Week 2 after the attacks to residents 18 years and over from the affected geographical areas. The questionnaire included items about sociodemographic variables and exposure to the attacks. Psychological effects were assessed as presence of acute stress and depressive symptomatology and functional impairment. 46.7% of the sample presented symptomatology of acute stress and 49.6% depressive symptoms. Among the symptoms of acute stress, the most frequent were re-experiencing (72.5%) and dissociative symptoms (71.8%). The chief predicting variables in symptomatology were being female, over 65 yr. old, and a habitual train user. The large number of affected people was refined with an item analysis and the consideration of severity of interference in psychosocial functioning.

Emotional disclosure in homeless people: a pilot study.

Symptoms of stress are prevalent among the homeless. Growing evidence suggests that disclosure of traumatic experiences is beneficial to health. This pilot study examined the effects of an emotional disclosure protocol on a group of 8 homeless people, using a single-group design. Clinical effectiveness was evaluated using the Impact of Event Scale, the Beck Depression Inventory, the Beck Anxiety Inventory, the Perceived Stress Scale, the Reading Span Task, and the Digit Span Test. Participant satisfaction was also measured. Results showed significant improvements in functioning at 1- and 6-week follow-up, and good satisfaction levels. The discussion remarks on the limitations (lack of a control group, small sample size, and other biases) and the need for more research in this topic.