Development of a Multiplatform Tool for the Prevention of Prevalent Mental Health Pathologies in Adults: Protocol for a Randomized Control Trial.

BACKGROUND: The prevalence of depression and anxiety has increased in recent years, with many individuals having trouble accessing mental health support. Smartphones have become an integral part of modern life, with apps offering new ways to deliver evidence-based self-help strategies to cope with common mental health symptoms. However, most of them do not have empirical evidence of their overall effectiveness or the effectiveness of their components, which could pose a risk for users. OBJECTIVE: The aim of this study is to evaluate the effectiveness of the modules of evaluation, psychoeducation, and emotional regulation strategies in a multiplatform self-help mental health mobile app in the Maule region of Chile. METHODS: A sample of 196 adults will be selected, who will be randomly assigned to different components of the app for a fixed period to assess its ability to reduce symptomatology. RESULTS: The trial is not yet recruiting and is expected to end in October 2024. The first results are expected in April 2024. CONCLUSIONS: This is the first study in Chile to develop and test the effectiveness of a mobile app to manage anxiety and depression symptoms in adults. The intervention proposed is based on evidence suggesting that the internet or remote intervention tools and self-management of prevalent symptomatology could be the future of mental health care systems in the digital era. If the effects of the intervention are positive, wide implementation in Chile and other Spanish-speaking countries could be possible in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52324.

Initial validation of the International Trauma Questionnaire (ITQ) in a sample of Chilean adults.

BACKGROUND: ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) are stress-related disorders. The International Trauma Questionnaire (ITQ) is a widely used instrument to assess PTSD and CPTSD. To date, there is no evidence of the psychometric characteristics of the ITQ in Latin American countries. OBJECTIVE: The aim of this study was to assess the construct and concurrent validity of the Latin American Spanish adaptation of the ITQ in a sample of Chilean adults. METHODS: A sample of 275 Chilean young adults completed the ITQ, a traumatic life events checklist, the Adverse Childhood Experiences Questionnaire, the Depression Anxiety Stress Scales-21, and the Columbia-Suicide Severity Rating Scale short version. Four alternative confirmatory factor analysis models were tested. Correlation analyses were performed to determine concurrent validity with associated measures (number of reported traumatic events, number of adverse childhood experiences, anxiety, depression, and suicidal risk). RESULTS: The second-order two-factor (PTSD and DSO) and the correlated first-order six-factor model provided acceptable fit; however, the first model showed a better fit based on the BIC difference. The PTSD and DSO dimensions, as well as the six ITQ clusters showed positive correlations with reported number of traumatic life-events, reported number of adverse childhood experiences, levels of anxiety, depression, and suicidal risk. CONCLUSIONS: The ITQ Latin American Spanish adaptation provides acceptable psychometric evidence to assess PTSD and CPTSD in accordance with the ICD-11.

This study is an initial validation of the Latin American Spanish adaptation of the ITQ with a Chilean young adults sample.The latent structure of the Latin American Spanish ITQ was better supported by a two-factor second-order model (PTSD/DSO); a six-factor correlated model was also acceptable.The six ITQ symptom clusters, as well as the PTSD/CPTSD dimensions were significantly positively correlated with three criterion variables: anxiety, depression, and suicidal risk.The number of potentially traumatic experiences, as well as number of exposure to adverse childhood experiences, was significantly associated with PTSD/CPTSD symptoms.

Propiedades Psicométricas de la Escala de Evaluación Socioemocional Breve de Infantes y Niños (BITSEA) en una muestra de niños y niñas chilenos / Psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in a sample of Chilean children

Introducción: La infancia temprana es una etapa crítica para la salud mental, por lo que es fundamental contar con herramientas eficaces para detectar tempranamente conductas infantiles relacionadas con psicopatología. Objetivo: Investigar las propiedades psicométricas de la Escala de Evaluación Socioemocional Breve de Infantes y Niños (BITSEA) en una muestra de infantes chilenos. Método: 289 padres de niños y niñas de entre 12 y 36 meses de edad completaron la BITSEA y el CBCL 1½-5. Resultados: Se encontró una confiabilidad aceptable para las puntuaciones de la subescala "problema socioemocional" (ω=0.84), y una confiabilidad baja para las puntuaciones de la subescala "competencia socioemocional" (ω=0.59). La estructura factorial fue adecuada y se observó una alta validez concurrente con otras escalas. El modelo confirmatorio mostró índices aceptables (CFI= 0.94; TLI= 0.94; SRMR= 0.07; RMSEA= 0.027). Conclusión: La BITSEA en esta muestra arrojó resultados similares a otros estudios, su aplicabilidad es prometedora para la detección temprana de problema socioemocional en la infancia temprana. Se sugiere continuar su estudio en muestra nacional representativa.

Introduction: Early childhood is a critical stage for mental health, and it is necessary to have effective tools for early detection of child behaviours related to psychopathology. Objective: to assess the psychometric properties of the Brief Infant and Toddler Social-Emotional Evaluation Scale (BITSEA) in a sample of Chilean children. Methods: 289 parents of infants and toddlers aged 12-36 months completed the BITSEA and the CBCL 1½-5. Results: Acceptable reliability was found for the "socioemotional problems" dimension (ω=0.84), and low reliability for the "socioemotional competence" subscale scores (ω=0.59). The factor structure was adequate and high concurrent validity with other scales was observed. The confirmatory model showed acceptable fit indices (CFI= 0.94; TLI= 0.94; SRMR= 0.07; RMSEA= 0.027). Conclusion: The BITSEA in this sample showed similar results to other studies, its applicability is promising for the early detection of socioemotional problems in early childhood. It is suggested to continue its study in a nationally representative sample.

Using Exploratory Structural Equation Modeling (ESEM) to Examine the Internal Structure of Posttraumatic Stress Disorder Symptoms.

Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC-5) and PTSD Checklist for DSM-5 (PCL-5). All six tested CFA models showed good fit indexes (RMSEA = .051-.056, CFI = .969-.977, TLI = .965-.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027-.036, CFI = .991-.996, TLI = .985-.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD.

Using Exploratory Structural Equation Modeling (ESEM) to examine the internal structure of posttraumatic stress disorder symptoms

Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC-5) and PTSD Checklist for DSM-5 (PCL-5). All six tested CFA models showed good fit indexes (RMSEA = .051-.056, CFI = .969-.977, TLI = .965-.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027-.036, CFI = .991-.996, TLI = .985-.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD

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Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami / Eficacia de la terapia cognitivo-conductual para el estrés posdesastre en síntomas de estrés postraumático tras un terremoto y tsunami en Chile

Objective: This is the first time that the effectiveness of cognitive-behavioural therapy for post-disaster stress (CBT-PD) in symptoms of posttraumatic stress disorder (PTSD) has been tested outside the United States of America. Design: Quasi-experiment with three groups. In the quasi-control group, complete CBT-PD was applied even though its members did not have PTSD; in quasi-experimental conditions, participants received complete treatment because they had this diagnosis; and in the third group, participants with PTSD received an abbreviated treatment (double sessions) due to organisational requirements. Location: Primary health care workers in Constitución (Chile), city exposed to earthquake and tsunami; public department workers in Talca (city exposed only to earthquake) and teachers from a school (Constitución). Participants: A total of 13 of the 91 people diagnosed with PTSD participated. In addition, 16 people without diagnosis voluntarily participated. The treatment was completed by 29 participants. There were no dropouts. Only 1 of the 9 participants in the quasi-experimental group did not respond to treatment. Interventions: CBT-PD is a group therapy (10-12 sessions) that includes psychoeducation, breathing retraining, behavioural activation and cognitive restructuring. CBT-PD (complete and abbreviated) was applied between September and December 2010. Measurements: Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E) was used to measure PTSD symptoms before and after treatment. Results: The group that received the complete treatment and was diagnosed with PTSD showed a significant decrease in the total symptoms to below dangerous levels (IGAAB: 31.556; p<0.01; 95%CI: 0.21-2.01]; η2=0.709). Discussion: The effectiveness and benefits of incorporating CBT-PD in the health network after events like disasters were discussed

Objetivo: Evaluar la eficacia de la terapia cognitivo-conductual para el estrés posdesastre (TCC-PD) en síntomas de estrés postraumático (TEPT) por primera vez fuera de los Estados Unidos. Diseño: Cuasiexperimental con tres grupos. Al grupo de cuasicontrol se le aplicó la TCC-PD completa pese a que sus miembros no tenían diagnóstico de TEPT; el grupo cuasiexperimental recibió el tratamiento completo porque sus miembros tenían ese diagnóstico. En el tercer grupo, las personas con TEPT recibieron un tratamiento abreviado (sesiones dobles) por exigencias organizativas. Emplazamiento: Trabajadores de atención primaria de salud de Constitución (Chile), ciudad expuesta al terremoto y tsunami; trabajadores de un servicio público de Talca (ciudad expuesta solo al terremoto) y profesores de escuela (Constitución). Participantes: Participaron 13 de las 91 personas diagnosticadas de TEPT; además, 16 personas sin diagnóstico participaron voluntariamente. Finalizaron el tratamiento 29 personas. No se produjeron abandonos. Solo uno de los nueve participantes del grupo cuasiexperimental no respondió al tratamiento. Intervenciones: La TCC-PD es una terapia grupal (10-12 sesiones) que incluye psicoeducación, reentrenamiento respiratorio, activación conductual y reestructuración cognitiva. Se aplicó TCC-PD (completa y abreviada) entre septiembre y diciembre de 2010. Mediciones principales: Para medir síntomas de TEPT se utilizó la Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E), antes y después del tratamiento. Resultados: Solo el grupo que recibió el tratamiento completo y fue diagnosticado de TEPT disminuyó significativamente sus síntomas por debajo de los niveles peligrosos (IGAAB: 31,556; p<0,01; IC95%: 0,21-2,01]; η2=0,709). Conclusiones: Se comprueban la efectividad y los beneficios de incorporar la TCC-PD en la red de salud después de desastres

Does the Type of Abuse Matter? Study on the Quality of Child Attachment Narratives in a Sample of Abused Children.

Child abuse has been associated with the development of insecure-disorganized patterns of attachment. However, the way in which different types of abuse relate to variations in attachment representations is not entirely clear. Thus, the objective of this study was to determine the relationship between three types of abuse (sexual abuse, physical abuse, and neglect) and the quality of child attachment representation, as assessed through attachment narratives. The results indicate that abuse in general, as well as each of its typologies in particular, is associated with insecure-disorganized attachment narratives. No differences were observed in the association between each individual type of abuse and the quality of attachment narratives, as well as between the number of abuse experiences and the quality of attachment. The findings are discussed from attachment theory and the literature on child development and maltreatment.

Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami.

OBJECTIVE: This is the first time that the effectiveness of cognitive-behavioural therapy for post-disaster stress (CBT-PD) in symptoms of posttraumatic stress disorder (PTSD) has been tested outside the United States of America. DESIGN: Quasi-experiment with three groups. In the quasi-control group, complete CBT-PD was applied even though its members did not have PTSD; in quasi-experimental conditions, participants received complete treatment because they had this diagnosis; and in the third group, participants with PTSD received an abbreviated treatment (double sessions) due to organisational requirements. LOCATION: Primary health care workers in Constitución (Chile), city exposed to earthquake and tsunami; public department workers in Talca (city exposed only to earthquake) and teachers from a school (Constitución). PARTICIPANTS: A total of 13 of the 91 people diagnosed with PTSD participated. In addition, 16 people without diagnosis voluntarily participated. The treatment was completed by 29 participants. There were no dropouts. Only 1 of the 9 participants in the quasi-experimental group did not respond to treatment. INTERVENTIONS: CBT-PD is a group therapy (10-12 sessions) that includes psychoeducation, breathing retraining, behavioural activation and cognitive restructuring. CBT-PD (complete and abbreviated) was applied between September and December 2010. MEASUREMENTS: Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E) was used to measure PTSD symptoms before and after treatment. RESULTS: The group that received the complete treatment and was diagnosed with PTSD showed a significant decrease in the total symptoms to below dangerous levels (IGAAB: 31.556; p<0.01; 95%CI: 0.21-2.01]; η2=0.709). DISCUSSION: The effectiveness and benefits of incorporating CBT-PD in the health network after events like disasters were discussed.

The effect of sexual abuse on children's attachment representations in Chile.

Child sexual abuse is associated with problems in children's emotional development, particularly increased insecurity of attachment. However, few studies have examined its effect on the organization of attachment representations in preschoolers, and the findings of those that have been conducted have not been entirely consistent. Therefore, this study aims to analyze the effect of child sexual abuse on attachment representation quality in a sample of children 3 to 7 years old in Chile. The results indicate child sexual abuse does affect children's attachment representation quality. The attachment narratives of child sexual abuse victims scored significantly higher than nonvictims on the hyperactivity and disorganization dimensions of attachment. These results are discussed in terms of attachment theory, clinical findings on child sexual abuse, and clinical implications.

Romantic attachment in Chilean adults: development of a short-form version of the experiences in close relationships.

Though the study of romantic attachment has expanded into all areas of psychology, it remains the case that there is no valid, reliable test available to measure it in Latin America. The present research objective was to adapt a Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark, & Shaver 1998) questionnaire, developing a short-form version, and to determine its factor structure in two samples of Chilean adults of different ages. A pool of 25 items was chosen to capture the two dimensions (Anxiety and Avoidance), which were obtained through principal components analysis in a sample of 477 adults. Subsequently, the short-form ECR's two-dimensional structure was confirmed using confirmatory factor analysis in a new sample (N = 296). All sub-dimensions' internal consistencies were found to be satisfactory. Evidence for the test's concurrent validity with the variables age, gender, and socioeconomic status was also obtained. The dimensions of romantic attachment showed no differences according to age or gender. However, participants of high socioeconomic status exhibited lower levels of anxious attachment than those with low socioeconomic status. It was concluded that the Chilean short-form version of the ECR has good psychometric properties and is a suitable assessment of adult attachment.

Validación chilena del cuestionario de evaluación del apego romántico experiences in close relationships (ECR): análisis de la validez de criterio / A Chilean validation of the romantic attachment questionnaire experiences in close relationships (ECR): analysis of criterion validity

El objetivo de esta investigación fue analizar la validez de criterio del cuestionario de apego romántico Experiences in Close Relationships (ECR, Brennan, Clark y Shaver, 1998) para la población chilena de adultos. Este cuestionario evalúa las dos dimensiones del apego romántico adulto: la evitación (de la intimidad) y la ansiedad (acerca de las relaciones). Los participantes fueron 549 adultos, quienes completaron el cuestionario ECR y el cuestionario de apego adulto CaMir. Se evaluó las propiedades psicométricas del cuestionario, mostrando que es un instrumento con una adecuada validez de criterio y con una estructura factorial que representa las dos dimensiones teóricas propuestas por los autores originales. Se concluye que la versión chilena del ECR es válida para examinar el apego romántico en la adultez.

The aim of this study was to analyze the criterion validity of the Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark y Shaver 1998) questionnaire in a sample of Chilean adults. This self-report questionnaire assesses two dimensions of romantic attachment: avoidance (of intimacy) and anxiety (about relationships). 549 Chilean adults completed the ECR and the Chilean version of the adult attachment questionnaire CaMir. Data analyses evaluated psychometric properties of the Chilean ECR, and showed adequate evidence of reliability, criterion validity, and a bifactorial structure similar to the original instrument. We can conclude that the Chilean version of the ECR is a reliable and valid measure to assess the romantic attachment in this population.

Romantic attachment in Chilean adults: development of a short-form version of the experiences in close relationships

Though the study of romantic attachment has expanded into all areas of psychology, it remains the case that there is no valid, reliable test available to measure it in Latin America. The present research objective was to adapt a Chilean version of the Experiences in Close Relationships (ECR; Brennan, Clark, & Shaver 1998) questionnaire, developing a short-form version, and to determine its factor structure in two samples of Chilean adults of different ages. A pool of 25 items was chosen to capture the two dimensions (Anxiety and Avoidance), which were obtained through principal components analysis in a sample of 477 adults. Subsequently, the short-form ECR’s two-dimensional structure was confirmed using confirmatory factor analysis in a new sample (N = 296). All sub-dimensions’ internal consistencies were found to be satisfactory. Evidence for the test’s concurrent validity with the variables age, gender, and socioeconomic status was also obtained. The dimensions of romantic attachment showed no differences according to age or gender. However, participants of high socioeconomic status exhibited lower levels of anxious attachment than those with low socioeconomic status. It was concluded that the Chilean short-form version of the ECR has good psychometric properties and is a suitable assessment of adult attachment (AU)

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Efecto del maltrato físico en la calidad de las representaciones de apego infantil en Chile: resultados preliminares / The effect of physical abuse on the quality of infant attachment representations in Chile: preliminary results

El objetivo de este artículo es presentar los resultados preliminares de un estudio que analiza el efecto del maltrato físico sobre la calidad de las representaciones de apego infantil. Para evaluar las representaciones del apego se utilizó la tarea de completación de historias de apego con el sistema de codificación A.S.C.T. Q-sort. El maltrato físico fue categorizado con el Sistema de Codificación de Maltrato Modificado. Los resultados indican que el maltrato físico tiene un efecto negativo en la calidad de las representaciones del apego. Los niños víctimas de maltrato físico presentan una mayor preferencia por la utilización de estrategias de hiperactivación y desorganización del apego que los niños no maltratados. Los resultados son discutidos en relación a la teoría del apego y a la evidencia empírica sobre esta temática.

The aim of this paper is to present preliminary results of a study analyzing the effects of physical abuse on the quality of attachment representations in children. In order to assess the attachment representation the Attachment Story Completion Task was used with de A.S.C.T. Q-sort coding system. The physical abuse was coded using the Modified Maltreatment Classification System. The results show that physical abuse has a negative effect on the quality of attachment representation. The children who were victims of physical abuse have a higher preference for the use of hyperactivation and disorganization attachment strategies than non abused children. The results are discussed in relation to attachment theory and empirical evidence on this issue.