Effectiveness of a universal personalized intervention for the prevention of anxiety disorders: Protocol of a randomized controlled trial (the prevANS project).

Background: To date, all preventive anxiety disorders interventions are one-fit-all and none of them are based on individual level and risk profile. The aim of this project is to design, develop and evaluate an online personalized intervention based on a risk algorithm for the universal prevention of anxiety disorders in the general population. Methods: A randomized controlled trial (RCT) with two parallel arms (prevANS vs usual care) and 1-year follow-up including 2000 participants without anxiety disorders from Spain and Portugal will be conducted.The prevANS intervention will be self-guided and can be implemented from the prevANS web or from the participants' Smartphone (through an App). The prevANS intervention will have different intensities depending on the risk level of the population, evaluated from the risk algorithm for anxiety: predictA. Both low and moderate-high risk participants will receive information on their level and profile (risk factors) of anxiety disorders, will have access to stress management tools and psychoeducational information periodically. In addition, participants with a moderate-high risk of anxiety disorders will also have access to cognitive-behavioral training (problem-solving, decision-making, communication skills, and working with thoughts). The control group will not receive any intervention, but they will fill out the same questionnaires as the intervention group.Assessments will be completed at baseline, 6 and 12-month follow-up. The primary outcome is the cumulative incidence of anxiety disorders. Secondary outcomes include depressive and anxiety symptoms, risk probability of anxiety disorders (predictA algorithm) and depression (predictD algorithm), improvement in physical and mental quality of life, and acceptability and satisfaction with the intervention. In addition, cost-effectiveness and cost-utility analyses will also be carried out from two perspectives, societal and health system, and analyses of mediators and moderators will also be performed. Discussion: To the best of our knowledge, prevANS study will be the first to evaluate the effectiveness and cost-effectiveness of a personalized online intervention based on a risk predictive algorithm for the universal prevention of anxiety disorders. Trial registration: ClinicalTrials.gov: NCT05682365.

[Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study]. / Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo.

BACKGROUND: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. METHODOLOGY: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. RESULTS: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals' discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. CONCLUSIONS: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate.

Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo / Opinions of healthcare professionals on the definition of severe mental illness. A qualitative study

Fundamento: Aunque a lo largo de los años se han propuesto diferentes definiciones de trastorno mental grave (TMG), aún existe una gran controversia a la hora de obtener una definición consensuada. El objetivo de este trabajo fue analizar la opinión de un grupo de profesionales de la red pública de servicios sanitarios sobre cuáles son los criterios que se deben tener en cuenta en la definición de TMG. Método: Estudio cualitativo en el cual se llevaron a cabo 5 grupos focales con profesionales (psiquiatras, psicólogos, enfermeras, médicos de familia, monitores y trabajadores sociales) relacionados con la atención a la salud mental del área de la Unidad de Gestión Clínica Salud Mental del Hospital Regional Universitario Carlos Haya de Málaga (España). Se codificaron las transcripciones mediante un análisis de contenido llevado a cabo por tres investigadoras de forma independiente. Resultados: Los profesionales entrevistados estuvieron de acuerdo en que debe tenerse en cuenta un cierto grado de disfuncionalidad para la definición de un TMG. Sin embargo, existía cierta discrepancia en función de la profesión en la inclusión de dimensiones como el diagnóstico, el soporte familiar y social, el uso de recursos sanitarios y la duración de la enfermedad como criterios necesarios y suficientes para la definición de TMG. En el discurso de los profesionales emergieron variables personales de los pacientes como la edad de comienzo de la enfermedad, la falta de insight y el nivel de formación, como relevantes para la definición del TMG. Conclusión: Además de las dimensiones propuestas por la literatura, los profesionales de salud mental entrevistados consideran otros criterios a tener en cuenta en la definición del TMG. Los discursos difieren en función de la profesión y ámbito laboral al que pertenecen (AU)

Background: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. Methodology: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. Results: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals’ discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. Conclusions: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate (AU)