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BACKGROUND: Emotional and stress-related disorders show high incidence, prevalence, morbidity, and comorbidity rates in Mexico. In recent decades, research findings indicate that cognitive behavioral interventions, from a disorder-specific perspective, are the effective front-line treatment for anxiety and depression care. However, these treatments are not often used. Reasons include limited access and low availability to effective interventions and comorbidity between mental disorders. Emotional deregulation of negative affectivity has been found to be a mediating factor in addressing emotional disorders from a transdiagnostic perspective, aimed at two or more specific disorders. In addition, technological advancement has created alternatives for psychological assistance, highlighting the possibilities offered by technologies since Internet-supported intervention programs have been empirically tested for effectiveness, efficiency and efficacy and can be key to ensuring access to those who are inaccessible. The aim of the study is to evaluate the efficacy, moderators of clinical change and acceptability of a transdiagnostic guided Internet-delivered intervention versus a transdiagnostic self-guided Internet-delivered intervention for emotional, trauma and stress-related disorders, and waiting list in community sample. METHODS: A three-armed, parallel group, superiority randomized controlled clinical trial with repeated measurements at four times: pretest, posttest, follow-up at 3, 6 and 12 months. Outcomes assessor, participant, care provider and investigator will be blinded. Participants aged 18 to 70 years will be randomly allocated 1:1:1 to one of three study arms: a) Transdiagnostic guided internet-delivered intervention with synchronous assistance, b) Transdiagnostic self-guided internet-delivered intervention, c) Waiting list group. Based on sample size estimation, a minimum of 207 participants (69 in each intervention group) will be included. DISCUSSION: The study could contribute to improving the efficacy of transdiagnostic internet-delivered interventions to promote the dissemination of evidence-based treatments and eventually, to decrease the high prevalence of emotional and trauma-related disorders in the Mexican population. TRIAL REGISTRATION: ClinicalTrial.gov: NCT05225701 . Registered February 4, 2022.
Subject(s)
Cognitive Behavioral Therapy , Therapy, Computer-Assisted , Anxiety Disorders/diagnosis , Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Humans , Internet , Mexico , Randomized Controlled Trials as Topic , Therapy, Computer-Assisted/methods , Treatment OutcomeABSTRACT
Abstract Introduction Suffering from psychosocial vulnerability, particularly during adolescence, increases the likelihood of experiencing adverse life circumstances, psychiatric conditions, and non-suicidal self-injury (NSSI). Objective We studied: 1. record-based demographic and clinical characteristics, as well as the frequency of NSSI in adolescents, beneficiaries of services for vulnerable population of one of six Non-Governmental Organizations (NGO's), we compared by beneficiary type: internal (IB) versus external (EB); 2. predictive relationship of NSSI with depression, difficulties in emotion regulation (DER) and suicidal ideation (administered measures); 3. Comparison of average scores on measures by: quality of attachment (QOA) and presence/absence of NSSI. Method A convenience sample of 255 adolescents (45.5% women, ages 11-15) answered instruments in institutional facilities (Mexico City and Puebla), where 181 (71%) resided as IB and 74 (29%) resided in family home (EB). The mental health staff of each NGO specified according to the record: demographics, psychiatric diagnoses, history of trauma, and QOA between the minor and his attachment figure. Results 42% denied NSSI episodes, 16.9% indicated a non-significant pattern, and 35.6% reported a significant and recent pattern. IB presented higher scores in all measurements, higher report of interpersonal trauma, depressive, anxiety, and behavior disorders. Minors with positive QOA obtained significantly lower scores. Discussion and conclusion Compared to EB's, adolescents residing in NGOs have a higher risk profile, particularly those without a positive QOA, a fact that is associated with a greater presence of psychopathology and significant and recent NSSI.
Resumen Introducción Padecer vulnerabilidad psicosocial, particularmente durante la adolescencia, incrementa la probabilidad de experimentar circunstancias vitales adversas, afecciones psiquiátricas y autolesiones no suicidas (ALNS). Objetivo Se estudiaron: 1. características demográficas y clínicas con base en expediente, así como la frecuencia de ALNS en adolescentes, usuarios de servicios para población vulnerable de una de seis Organizaciones No Gubernamentales (ONG's), se comparó por tipo de beneficiario: interno (BI) versus externo (BE); 2. relación predictiva de ALNS con depresión, dificultades en la regulación emocional (DRE) e ideación suicida (medidas administradas); 3. comparación de puntajes promedio de las mediciones por: calidad del vínculo (CV) y presencia/ausencia de ALNS. Método Una muestra de conveniencia de 255 adolescentes (45.5% mujeres, edades 11-15), contestaron instrumentos en instalaciones institucionales (Ciudad de México y Puebla), donde 181 (71%) residían como BI y 74 (29%) residían en casa de familiar (BE). El personal de salud mental de cada ONG especificó conforme a expediente: demografía, diagnósticos psiquiátricos, historial de trauma y CV entre el menor y su figura de apego. Resultados 42% negó episodios de ALNS, 16.9% indicó una pauta no significativa y 35.6% reportó un pauta significativa y reciente. Los BI presentaron puntuaciones superiores en todas las mediciones, mayor reporte de trauma interpersonal, trastornos depresivos, de ansiedad y conducta. Los menores con CV positiva obtuvieron puntuaciones significativamente menores. Discusión y conclusión En comparación con los BE, los adolescentes que residen en las ONG's presentan un perfil de mayor riesgo, particularmente, aquellos sin una CV positiva, hecho que se asocia con mayor presencia de psicopatología y ALNS reciente y significativa.
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Objetivo: Evaluar la relación entre estrategias de afrontamiento y calidad de vida relacionada con la salud en pacientes incidentes en diálisis peritoneal. Material y Método: Estudio transversal en 106 pacientes incidentes en diálisis peritoneal, en cuatro centros de Ciudad de México. Se usaron los instrumentos Kidney Disease Quality of Life Short Form (KDQOL-SF36) y Coping Strategies Inventory para evaluar la calidad de vida relacionada con la salud y las estrategias de afrontamiento, respectivamente. Se evaluó la correlación de puntuaciones de estrategias de afrontamiento y calidad de vida. Se comparó la calidad de vida relacionada con la salud entre los pacientes con estrategia de afrontamiento activa y pasiva. Resultados: La estrategia de afrontamiento activa mostró correlación positiva con componentes físico y mental, efectos de la enfermedad renal y carga de la enfermedad renal del KDQOL-SF36, en tanto que el puntaje de estrategia pasiva correlacionó negativamente con componente mental y carga de la enfermedad renal en el KDQOL-SF36. Los puntajes de componentes físico y mental, efectos de enfermedad renal, carga de enfermedad renal y problemas por síntomas del KDQOL-SF36 fueron significativamente más altos en pacientes con estrategia de afrontamiento activa que en los que presentaron estrategia pasiva. Conclusiones: A partir de los resultados encontrados podemos concluir que los pacientes con estrategia de afrontamiento activa presentan mejor calidad de vida relacionada con la salud, tanto en las dimensiones del cuestionario específico de las alteraciones renales como en el genérico de calidad de vida, en comparación con los pacientes con estrategia de afrontamiento pasiva
Background: An important feature of chronic diseases, is it permanent character with a significant impact on long-term treatments, as it is the case of patients on peritoneal dialysis, that transcendently modifying their personal, family and social dynamic. Objective: To evaluate the relationship of coping strategies and health-related quality of life in incident patients on peritoneal dialysis. Material and Method: One hundred and six incident patients (within 0 to 3 months from the beginning of PD treatment) from 4 PD centers in Mexico City were included in a cross-sectional study. Kidney Disease Quality of Life Short Form (KDQOL-SF36) and Coping Strategies Inventory (CSI) were used to evaluate health-related quality of life and coping strategies respectively. Correlation of the coping strategies and the health-related quality of life scores were assessed. Distributions of health-related quality of life scores between engagement and disengagement coping strategies were compared. Results: Engagement coping strategy score showed significant positive correlation with the KDQOL SF-36 physical and mental composite, effects of kidney disease and burden of kidney disease, while disengagement coping strategy score negatively correlated with the KDQOL SF-36 mental component, and burden of kidney disease. KDQOL SF-36 physical and mental components, effects of kidney disease, burden of kidney disease, and symptom problem scores were significantly higher in patients with engagement coping strategy than in patients with disengagement coping strategy. Conclusions: The results support the hypothesis of a relationship between coping strategies and health-related quality of life
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Renal Insufficiency, Chronic/psychology , Renal Insufficiency, Chronic/therapy , Quality of Life , Adaptation, Psychological , Renal Dialysis/psychology , Cross-Sectional Studies , Socioeconomic FactorsABSTRACT
INTRODUCTION: Middle-income countries are in need of research that uses theoretical-based models to assess factors that predict adherence to antiretroviral therapy (ART) and help in the design, implementation, and evaluation of interventions for nonadherent populations. In Mexico, the Information and Motivation and Behavioral Skills (IMB) Model of ART Adherence constructs is useful in describing and predicting adherence behaviors in various samples but has not been articulated to people living with HIV (PLWH) on ART. The aim of this was to characterize the IMB core constructs and identify correlates of ART adherence in an HIV-positive clinic sample in Mexico. METHODS: A convenience sample of 109 HIV-positive patients attending their monthly visits at a local public hospital were interviewed with the Spanish version of the LifeWindows IMB ART Adherence Questionnaire (LW-IMB-AAQ) as well as a sociodemographic questionnaire. All participants were recruited from a hospital-based outpatient clinical care site. RESULTS: Partial confirmation of the relationships proposed by the IMB Model of ART Adherence was found. As predicted by the model, only behavioral skills had direct association with all measures of self-reported adherence, and motivation was associated with behavioral skills. Information did not demonstrate significant relations to either motivation or behavioral skills, nor did it directly associate with adherence. Self-reported adherence did not associate with CD4 counts, nor did any of the IMB model core constructs. CONCLUSION: Applicability of the IMB Model of ART Adherence in this setting is discussed. The IMB Model of ART Adherence offered promise in this population and could help tailor population-specific interventions to promote high rates of ART adherence.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/psychology , Health Behavior , Medication Adherence/psychology , Models, Psychological , Motivation , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Mexico , Middle Aged , Statistics, Nonparametric , Young AdultABSTRACT
Many variables related to risk of HIV infection, progression of the disease and adherence to antiretroviral drug therapy have been studied from different approaches. This review incorporates a group of studies including optimism as a variable related to Positive Psychology and HIV/AIDS, to explain how it interacts with: sexual risk behaviors, disease progression and adherence to antiretroviral (ARV) therapy. Refereed academic journals published from 1994 to 2009, were accessed from the EBSCO database. Subject Terms were related both to HIV and optimism. Articles were arranged into three classifications: infection, disease progression and ARV therapy adherence. The review included 32 articles carried out mainly in the USA. Most articles showed significant relationships between optimism and risk behaviors, disease progression and ARV adherence. This study concluded that more research in evaluation of optimism, and optimism related interventions should be made to disentangle the complex relationship it has with sex risk behaviors, disease progression and adherence to ARV Therapy. Moderate optimism appears to be a predictor to health related sexual behaviors.
Muchas variables relacionadas a los riesgos de infección por el VIH, la progresión de la enfermedad y la adherencia a la terapia antirretroviral se han estudiado desde diferentes puntos de vista. Esta revisión presenta un grupo de estudios que incluyen a la variable optimismo, relacionada a la Psicología Positiva y el VIH/SIDA, para explicar la manera en que interactúa con los comportamientos sexuales de riesgo, la progresión de la enfermedad y la adherencia a la terapia antirretroviral (ARV). Se consultaron revistas académicas arbitradas publicadas en el período 1994-2009, en la base de datos EBSCO. Los términos seleccionados fueron VIH y optimismo. Se organizaron los artículos en tres categorías: infección, progresión de la enfermedad, y adherencia terapéutica a los ARV. La revisión incluyó 32 artículos de investigación conducida principalmente en E.U. La mayoría de los artículos mostraron relaciones significativas entre la variable optimismo y las conductas de riesgo, la progresión de la enfermedad y la adherencia ARV. El estudio concluye que se requiere más investigación en evaluación de las tendencias optimistas, e intervenciones relacionadas con optimismo para esclarecer la relación compleja que guarda con las conductas sexuales de riesgo, la prognosis y la adherencia a la terapia ARV. El optimismo moderado parece predecir comportamientos sexuales saludables.
