Implementation of the individual placement and support pilot program in Spain.

OBJECTIVE: This article describes the adoption of Individual Placement and Support (IPS) supported employment between 2013 and 2017 in Catalonia (Spain) in the context of high unemployment and a predominance of traditional preemployment training approaches. It reports the experience of implementing IPS to promote competitive job placement of people with mental disorders. METHOD: The Avedis Donabedian Research Institute (FAD) designed, trained, implemented, and evaluated the project. We used a longitudinal, mixed-methods approach. RESULTS: The demonstration project comprised 7 employment services and 12 ambulatory mental health centers. It followed up programs and participants from October 2013 to December 2017. The project added 1,188 new competitive jobs, increased the rate of competitive employment from 16% to 43%, and improved the fidelity of IPS by 44% on the organizational dimension and by 34% on services dimension. The quality of employment was similar to the overall employment market, with 94% of temporary jobs. The qualitative analysis confirmed several areas of improvement, including the vision of recovery, collaborations between vocational and mental health services, work patterns of practitioners, and views of work as an important treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A strong leadership team, consistent training, and commitment to model fidelity have established IPS in the pilot region as an important intervention to obtain and maintain competitive employment and recovery for people with a mental health condition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española / Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)

Objetivo: Adaptar y validar el Experience of Caregiving Inventory (ECI) en población española, aportando evidencia empírica de su consistencia interna, estructura interna y validez. Método: Validación psicométrica de la versión adaptada del ECI. Participaron 172 personas cuidadoras (69,2% mujeres) con una edad media de 57,51 años (rango: 21-89). Se usaron datos sociodemográficos y clínicos, e instrumentos estandarizados (ECI, escala de sufrimiento SCL-90-R y escala de sobrecarga Zarit). Se analizaron las dos escalas de apreciación negativa del ECI más relacionadas con trastornos mentales graves (conductas disruptivas [CD] y síntomas negativos [SN]) y las dos escalas de apreciación positiva (experiencias personales positivas [EPP] y aspectos buenos de la relación [ABR]). Se utilizó unExploratory Structural Equation Modelingpara analizar la estructura interna. También se estudió la relación entre las escalas del ECI y las puntuaciones de SCL-90-R y Zarit. Resultados: El modelo de cuatro factores presentó buen ajuste. El alfa de Cronbach (CD: 0,873; SN: 0,825; EPP: 0,720; ABR: 0,578) mostró una mayor homogeneidad en las escalas negativas. Las puntuaciones del SCL-90-R se correlacionaron con las escalas negativas del ECI, y ninguna de las escalas del ECI se correlacionó con la escala Zarit. Conclusiones: La versión ECI en español puede considerarse un instrumento válido, fiable y factible para su administración en los contextos sanitario y comunitario

Objective: To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. Method: Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. Results: The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. Conclusions: The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context

[Caregiver's health: adaption and validation in a Spanish population of the Experience of Caregiving Inventory (ECI)]. / Salud del cuidador: adaptación y validación del cuestionario Experience of Caregiving Inventory (ECI) en población española.

OBJECTIVE: To adapt and to validate the Experience of Caregiving Inventory (ECI) in a Spanish population, providing empirical evidence of its internal consistency, internal structure and validity. METHOD: Psychometric validation of the adapted version of the ECI. One hundred and seventy-two caregivers (69.2% women), mean age 57.51 years (range: 21-89) participated. Demographic and clinical data, standardized measures (ECI, suffering scale of SCL-90-R, Zarit burden scale) were used. The two scales of negative evaluation of the ECI most related to serious mental disorders (disruptive behaviours [DB] and negative symptoms [NS]) and the two scales of positive appreciation (positive personal experiences [PPE], and good aspects of the relationship [GAR]) were analyzed. Exploratory structural equation modelling was used to analyze the internal structure. The relationship between the ECI scales and the SCL-90-R and Zarit scores was also studied. RESULTS: The four-factor model presented a good fit. Cronbach's alpha (DB: 0.873; NS: 0.825; PPE: 0.720; GAR: 0.578) showed a higher homogeneity in the negative scales. The SCL-90-R scores correlated with the negative ECI scales, and none of the ECI scales correlated with the Zarit scale. CONCLUSIONS: The Spanish version of the ECI can be considered a valid, reliable, understandable and feasible self-report measure for its administration in the health and community context.

Women with compulsive buying or gambling disorder: Similar profiles for different behavioural addictions.

The aim of the present study was to examine the differences in sociodemographic and clinical characteristics of 104 women diagnosed with compulsive buying behaviour (CBB = 55) or gambling disorder (GD = 49) treated at three public hospitals unit specialized in behavioural addictions from January 2004 to December 2015. Significant between-group differences in sociodemographic variables were observed for cohabitation status (living with a partner or not) and educational level, with a higher percentage of women in the GD group cohabiting (х2 (1), p = .029). By contrast, the CBB group had a significantly higher educational level (х2 (1) = 7.4, p = .007). There were no significant differences between the groups in age of onset, age at treatment initiation, age at the onset of behavioural problems, or in the years elapsed until presenting addiction problems. However, there were significant between-group differences in the amount of money spent weekly (F (1.100) = 4.9, p = .028), with women in the CBB group spending on average €289.4/week (SD, 412.4) versus €151/week (SD, 141.23) in the GD group. The CBB group had significantly more depressive disorders compared to the GD group (х2(1) = 5.4, p = .020). In contrast, the GD group presented significantly more tobacco use than the CBB group (х2(1) = 1.19, p = .000). This study suggests that women with CBB or GD share more characteristics than differences and the treatment approaches must take into account gender related factors.

Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España / When the healthcare does not follow the evidence: the case of the lack of early intervention programs for psychosis in Spain

Actualmente existe evidencia suficiente que avala la importancia de las intervenciones en fases tempranas de la psicosis. El retraso en la detección y el tratamiento del primer episodio psicótico se asocia con una recuperación menor y más lenta, así como con un riesgo mayor de recaídas. A pesar de ello, todavía no se han implementado de forma regular programas de intervención temprana en los servicios de salud mental en España. En este artículo de opinión se revisarán los principales argumentos que nos permitan defender la necesidad de la implementación de estos programas y las estrategias a seguir para cumplir con este objetivo. Existen actualmente programas de intervención temprana para la psicosis bien establecidos en otros países que incluyen intervenciones farmacológicas y psicosociales, junto con actividades de sensibilización al público, de colaboración entre familias y profesionales y de difusión de información. Los datos publicados acerca de la experiencia de estos programas ya instaurados indican que esta atención es eficiente no solo en términos de salud, sino también desde el punto de vista económico. Se resumen en este artículo las principales acciones y estrategias para la implementación de servicios de atención temprana en nuestro país (AU)

There is now sufficient evidence to support the importance of interventions in the early stages of psychosis. The delay in the detection and treatment of the first-episode psychosis is related to a lower and slower recovery, as well as a higher risk of relapse. Despite this fact, early intervention units or teams are still not regularly implemented in mental health service settings in Spain. In this opinion article, a review is presented of the main arguments for defending the need to implement these programs and strategies in order to achieve this aim. There are a number of programs for early intervention for psychosis currently working in other countries, with a therapeutic program that includes pharmacological and psychosocial interventions, together with public awareness, information dissemination, and family-professional collaboration activities. Published literature on the experience of these programs indicates that early intervention is not only effective in terms of the improvement of health status, but is also economically efficient. The main steps and recommendations needed to implement such early intervention programs in our country are described (AU)

When the healthcare does not follow the evidence: The case of the lack of early intervention programs for psychosis in Spain. / Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España.

There is now sufficient evidence to support the importance of interventions in the early stages of psychosis. The delay in the detection and treatment of the first-episode psychosis is related to a lower and slower recovery, as well as a higher risk of relapse. Despite this fact, early intervention units or teams are still not regularly implemented in mental health service settings in Spain. In this opinion article, a review is presented of the main arguments for defending the need to implement these programs and strategies in order to achieve this aim. There are a number of programs for early intervention for psychosis currently working in other countries, with a therapeutic program that includes pharmacological and psychosocial interventions, together with public awareness, information dissemination, and family-professional collaboration activities. Published literature on the experience of these programs indicates that early intervention is not only effective in terms of the improvement of health status, but is also economically efficient. The main steps and recommendations needed to implement such early intervention programs in our country are described.

An integrative cross-design synthesis approach to estimate the cost of illness: an applied case to the cost of depression in Catalonia.

BACKGROUND: Cost of illness (COI) studies are carried out under conditions of uncertainty and with incomplete information. There are concerns regarding their generalisability, accuracy and usability in evidence-informed care. AIMS: A hybrid methodology is used to estimate the regional costs of depression in Catalonia (Spain) following an integrative approach. METHODS: The cross-design synthesis included nominal groups and quantitative analysis of both top-down and bottom-up studies, and incorporated primary and secondary data from different sources of information in Catalonia. Sensitivity analysis used probabilistic Monte Carlo simulation modelling. A dissemination strategy was planned, including a standard form adapted from cost-effectiveness studies to summarise methods and results. RESULTS: The method used allows for a comprehensive estimate of the cost of depression in Catalonia. Health officers and decision-makers concluded that this methodology provided useful information and knowledge for evidence-informed planning in mental health. CONCLUSIONS: The mix of methods, combined with a simulation model, contributed to a reduction in data gaps and, in conditions of uncertainty, supplied more complete information on the costs of depression in Catalonia. This approach to COI should be differentiated from other COI designs to allow like-with-like comparisons. A consensus on COI typology, procedures and dissemination is needed.

A long-term prospective study on the outcome of bipolar patients treated with long-acting injectable risperidone.

BACKGROUND: Risperidone is the first atypical antipsychotic to become available in a long-acting, injectable formulation. This is the first prospective study to assess the effectiveness of long-acting risperidone in a cohort of bipolar patients. METHODS: Twenty-nine DSM-IV acutely manic bipolar inpatients with a history of poor or partial adherence to medication entered the mirror-design observational study. They received naturalistic treatment for a manic episode plus long-acting, injectable risperidone for a mean period of 2 years. The following measures were used to assess the effectiveness of risperidone: the number of hospitalizations, the number of manic, mixed, and depressive episodes leading to hospitalization, the mean duration of hospitalizations, time to relapse, treatment adherence, aggression and suicide attempts. The Clinical Global Impressions (CGI) was used for clinical relevance as well. RESULTS: During the follow-up, there was a significant decrease in the number of hospitalizations per patient (Z-2.72 P < 0.006), in the number of manic or mixed episodes leading to hospitalization (Z-2.68 P < 0.007) but not in the hospitalizations due to depressive episodes, a decrease in the average length of hospitalization per patient (Z-3.27 P < 0.001), a significant increase in the time to any new episode (first relapse) (Z-3.28, P < 0.001), and significant improvements in treatment adherence (P < 0.0001) and hetero-aggressive episodes (P < 0.0001), but not suicide attempts (P = NS). At study endpoint 14 patients (48%) were very much improved according to the CGI. DISCUSSION: This observational long-term study provides support to long-acting injectable risperidone being effective for the maintenance treatment of mania and improving treatment adherence, reducing relapses and re-hospitalization rates.