Can an app increase health literacy and reduce the stigma associated with obsessive-compulsive disorder? A crossover randomized controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling condition with a high delay in seeking treatment. esTOCma is an app developed to increase mental health literacy (MHL) about OCD, reduce stigma, and increase the intention to seek professional treatment. It is a serious game and participants are asked to fight against the "OCD stigma monster" by accomplishing 10 missions. The aim of this study is to evaluate the effectiveness of this app in a community sample. METHODS: A randomized controlled trial with a crossover design was carried out. Participants were randomized to two groups: immediate use (iApp, n = 102) and delayed use (dApp, n = 106) of esTOCma. The iApp group started using the app at baseline until the game was over. The dApp group initiated at 10-days until the game finished. Participants were requested to complete a set of questionnaires at baseline and 10-day, 20-day and 3-month follow-ups. RESULTS: The Time×Group interaction effect was significant for the primary outcome measures: there was an increase in MHL and intention to seek help, and a decrease in stigma and OC symptoms, with large effect sizes, only after using the app. Changes were maintained (or increased) at follow-up. LIMITATIONS: The study did not include an active control group and some of the scales showed low internal consistency or a ceiling effect. CONCLUSIONS: This study provides first evidence for the effectiveness of esTOCma as a promising intervention to fight stigma and reduce the treatment gap in OCD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04777292. Registered February 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04777292.

Fases temporales y variables motivacionales: dos perspectivas complementarias en el proceso de búsqueda de ayuda por enfermedad mental / Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders

Introducción: La búsqueda de ayuda profesional por enfermedad mental es un proceso complejo, con etapas y momentos temporales diferentes, en el que desempeñan un papel especialmente relevante los aspectos motivacionales. Sin embargo, no hay instrumentos de evaluación que permitan valorar tanto las variables temporales como las motivacionales. El objetivo de este estudio es ofrecer información detallada sobre ambos conjuntos de variables, mediante un instrumento específicamente diseñado para ello, de tal manera que se pueda comprender mejor el proceso de búsqueda de tratamiento. Material y métodos: Participaron 152 pacientes ambulatorios que habían solicitado ayuda profesional en una unidad de salud mental del SNS. Los diagnósticos principales fueron: trastorno obsesivo-compulsivo (n=71), agorafobia (n=21), trastorno depresivo mayor (n=18), anorexia nerviosa (n=20) y dependencia a cocaína (n=22). Los pacientes fueron evaluados mediante una entrevista estructurada, específicamente diseñada para el estudio. Asimismo, se obtuvieron datos sobre gravedad y calidad de vida. Resultados: Los pacientes con agorafobia y depresión mayor tardaron menos en reconocer los síntomas que los pacientes de los otros grupos. Asimismo, los pacientes con depresión mayor demoraron menos en solicitar ayuda profesional. Las variables motivacionales se agruparon en 3 conjuntos: motivos de consulta, relacionados con el malestar y la falta de control; motivos de demora de la consulta, relacionados con la minimización del problema; y motivos asociados al estigma. Conclusiones: Los resultados indican la necesidad de valorar las distintas variables motivacionales implicadas en las diferentes etapas del proceso de búsqueda de ayuda profesional. La entrevista que presentamos ha mostrado ser útil para ello

Introduction: Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. Material and methods: A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. Results: The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. Conclusions: The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour

Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders. / Fases temporales y variables motivacionales: dos perspectivas complementarias en el proceso de búsqueda de ayuda por enfermedad mental.

INTRODUCTION: Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. MATERIAL AND METHODS: A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. RESULTS: The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. CONCLUSIONS: The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour.

The long and complex road in the search for treatment for mental disorders: An analysis of the process in five groups of patients.

Seeking treatment for mental-health problems is a complex process, with different underlying motives in each stage. However, the entire process and these motives have hardly been investigated. This study aims to analyze the different stages of the help-seeking process and their underlying motives in five groups of patients with different mental disorders. In all, 156 patients seeking treatment in outpatient mental health clinics were individually interviewed: 71 had Obsessive-Compulsive Disorder (OCD), 21 had Agoraphobia (AGO), 18 had Major Depressive Disorder (MDD), 20 had Anorexia Nervosa (AN), and 22 had Cocaine Dependence (COC). The AGO and MDD patients delayed significantly less time in recognizing their mental health symptoms. Moreover, MDD patients disclosed their symptoms and searched for professional help faster than the other groups. The most relevant variables in the recognition of disorders were the loss of control over the symptoms, the interference produced by these symptoms, and their negative impact on the person's emotional state. The most frequent barriers to seeking treatment were related to minimizing the symptoms and fear of stigma. Finally, the most important motivator for seeking treatment was the awareness that minimizing the symptoms did not help to reduce them, lessen their interference, or make them disappear.

To seek advice or not to seek advice about the problem: the help-seeking dilemma for obsessive-compulsive disorder.

BACKGROUND: Although obsessive-compulsive disorder (OCD) is associated with considerable distress, it has been reported that OCD patients delay considerably in seeking treatment for their problem. The present study aimed to explore some variables hypothetically involved in the help-seeking process among OCD patients. METHODS: Twenty-six OCD patients without comorbid conditions completed the Interview of Help-Seeking, specifically designed for this study, which assesses to what extent patients delay seeking treatment for their problem, and three group of variables: factors influencing the recognition of the problem, reasons for delaying the treatment-seeking, and reasons for finally seeking treatment. Participants also completed OCD measures, as well as a questionnaire on thought control strategies. RESULTS: The mean length of delay in seeking treatment was 39.38 (SD = 50.95) months, and a great variety of reasons for delaying were observed. The OCD patients who delayed consultation longer, in comparison with patients who delayed less time, used fewer social control strategies, and they were less aware of the interference and behavioral changes associated with the problem. CONCLUSIONS: To gain more insight about the problem and to experience greater interference from the symptoms were determinants in the active search for help. Conversely, the main barriers to the help-seeking were the fears of stigma and the meaning of the thought contents. Additionally, the fact that patients are willing to disclose their obsessions to other people may favor an adequate representation of the problem and the need to seek mental health treatment.

Protocolo de tratamiento psicológico grupal para abordar sintomatología depresiva / Psychological group therapy to manage depression symptomatology

Este artículo propone un protocolo de terapia grupal para el tratamiento de los síntomas depresivos, cada vez más frecuentes en los trastornos mentales y en las enfermedades orgánicas. Con esta iniciativa pretendemos disminuir la presión asistencial existente en las Unidades de Salud Mental y optimizar los escasos recursos humanos y materiales existentes en el sistema sanitario público. El trabajo incluye la descripción del contenido de cada sesión y un modelo explicativo integrador de la etiología, psicopatología y tratamiento de la sintomatología depresiva

This paper proposes a psychological group therapy protocol to treat depressive symptoms in mental and organic diseases. We aim to reduce assistance demand in Mental Health Units and optimize the few human and material resources of the public sanitary services. This work includes a detailed description of the content of each session, as well as an explanatory model of depression about the etiology, psychopatology and treatment of depressive symptoms