Mental Health Information Reporting Assistant (MHIRA)-an open-source software facilitating evidence-based assessment for clinical services.

Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.

The Effect of Child Trauma on the Relation between Psychological Well-Being and Depressive Symptoms in Chilean University Students.

(1) Background: There is consistent evidence of the impact of early adverse experiences on mental health in adulthood, especially as a risk factor for depression. However, their influence on positive aspects of mental health such as well-being has been less extensively studied. Therefore, this study aims to investigate the effect of traumatic childhood experiences on the relationship between depression and psychological well-being in a sample of university students. (2) Methods: The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Depression Inventory (BDI-IA), and Ryff's psychological well-being scale were administered to 700 Chilean university students. Several regression models were used to analyze the interaction between variables, with multivariate SEM being applied to hierarchize the relationships found. (3) Results: Emotional Neglect and Abuse stand out as the types of maltreatment with the greatest impact on mental health, associated first with a decrease in the self-acceptance dimension of psychological well-being and then with depressive symptomatology in adulthood. (4) Conclusions: Results provide evidence that early trauma has an important impact on mental health, increasing the risk of depression, however, its impact is greater on positive aspects of health, such as self-acceptance, a fundamental element in the construction of psychological well-being.

Potential epigenetic mechanisms in psychotherapy: a pilot study on DNA methylation and mentalization change in borderline personality disorder.

Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables.

Digital use of standardised assessment tools for children and adolescents: can available paper-based questionnaires be used free of charge in electronic format?

QUESTION: Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. METHODS: For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. RESULTS: In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. CONCLUSIONS: Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument's authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.

"What If We Get Sick?": Spanish Adaptation and Validation of the Fear of Illness and Virus Evaluation Scale in a Non-clinical Sample Exposed to the COVID-19 Pandemic.

Distinct sources of stress have emerged during the COVID-19 pandemic. Particularly, fear is expected to generate significant psychological burden on individuals and influence on either unsafe behavior that may hinder recovery efforts or virus-mitigating behaviors. However, little is known about the properties of measures to capture them in research and clinical settings. To resolve this gap, we evaluated the psychometric properties of a novel measure of fear of illness and viruses and tested its predictive value for future development of distress. We extracted a random sample of 450 Chilean adult participants from a large cross-sectional survey panel and invited to participate in this intensive longitudinal study for 35 days. Of these, 163 ended up enrolling in the study after the demanding nature of the measurement schedule was clearly explained to them. For this final sample, we calculated different Confirmatory Factor Analyses (CFA) to evaluate the preliminary proposed structure for the instrument. Complementarily, we conducted a content analysis of the items to qualitatively extract its latent structure, which was also subject to empirical test via CFA. Results indicated that the original structure did not fit the data well; however, the new proposed structure based on the content analysis did. Overall, the modified instrument showed good reliability through all subscales both by its internal consistency with Cronbach's alphas ranging from 0.814 to 0.913, and with test-retest correlations ranging from 0.715 to 0.804. Regarding its convergent validity, individuals who scored higher in fears tended to also score higher in depressive and posttraumatic stress symptoms at baseline. Furthermore, higher fears at baseline predicted a higher score in posttraumatic stress symptomatology 7 days later. These results provide evidence for the validity, reliability, and predictive performance of the scale. As the scale is free and multidimensional potentially not circumscribed to COVID-19, it might work as a step toward understanding the psychological impact of current and future pandemics, or further life-threatening health situations of similar characteristics. Limitations, practical implications, and future directions for research are discussed.

[Depressive symptomatology and psychological well-being among Chilean university students]. / Sintomatologia depresiva y bienestar psicológico en estudiantes universitarios chilenos.

BACKGROUND: Quality of life and psychological well-being are readily hampered by depression. The changes that students face during college life impact their psychological health and well-being, including the emergence of mental health problems like depression Aim: To determine the relationship between depressive symptoms, sociodemographic parameters and psychological well-being in undergraduate university students. MATERIAL AND METHODS: Five hundred eighty university students of both sexes, from the Metropolitan and IX Regions of Chile answered the Beck Depression Inventory (BDI-IA) and the Ryff's psychological well-being scale. RESULTS: Twenty eight percent of respondents had clinically significant depressive symptoms, and these were more frequent in women. There was an inverse and statistically significant relationship between psychological well-being and depressive symptoms. This fact was especially marked in dimensions of autonomy, positive relationships with others and purpose in life. CONCLUSIONS: There is a high frequency of depressive symptoms among these students. We discuss whether psychological well-being and depressive symptomatology represent two extremes within a continuum or they are two independent dimensions that can account for differential causal mechanisms linked to mental health and illness.

Sintomatologia depresiva y bienestar psicológico en estudiantes universitarios chilenos / Depressive symptomatology and psychological well-being among Chilean university students

Background: Quality of life and psychological well-being are readily hampered by depression. The changes that students face during college life impact their psychological health and well-being, including the emergence of mental health problems like depression Aim: To determine the relationship between depressive symptoms, sociodemographic parameters and psychological well-being in undergraduate university students. Material and Methods: Five hundred eighty university students of both sexes, from the Metropolitan and IX Regions of Chile answered the Beck Depression Inventory (BDI-IA) and the Ryff's psychological well-being scale. Results: Twenty eight percent of respondents had clinically significant depressive symptoms, and these were more frequent in women. There was an inverse and statistically significant relationship between psychological well-being and depressive symptoms. This fact was especially marked in dimensions of autonomy, positive relationships with others and purpose in life. Conclusions: There is a high frequency of depressive symptoms among these students. We discuss whether psychological well-being and depressive symptomatology represent two extremes within a continuum or they are two independent dimensions that can account for differential causal mechanisms linked to mental health and illness.

Psychotherapy and Genetic Neuroscience: An Emerging Dialog.

Recent research in psychiatric genetics has led to a move away from simple diathesis-stress models to more complex models of psychopathology incorporating a focus on gene-environment interactions and epigenetics. Our increased understanding of the way biology encodes the impact of life events on organisms has also generated more sophisticated theoretical models concerning the molecular processes at the interface between "nature" and "nurture." There is also increasing consensus that psychotherapy entails a specific type of learning in the context of an emotional relationship (i.e., the therapeutic relationship) that may also lead to epigenetic modifications across different therapeutic treatment modalities. This paper provides a systematic review of this emerging body of research. It is concluded that, although the evidence is still limited at this stage, extant research does indeed suggest that psychotherapy may be associated with epigenetic changes. Furthermore, it is argued that epigenetic studies may play a key role in the identification of biomarkers implicated in vulnerability for psychopathology, and thus may improve diagnosis and open up future research opportunities regarding the mechanism of action of psychotropic drugs as well as psychotherapy. We review evidence suggesting there may be important individual differences in susceptibility to environmental input, including psychotherapy. In addition, given that there is increasing evidence for the transgenerational transmission of epigenetic modifications in animals and humans exposed to trauma and adversity, epigenetic changes produced by psychotherapy may also potentially be passed on to the next generation, which opens up new perspective for prevention science. We conclude this paper stressing the limitations of current research and by proposing a set of recommendations for future research in this area.

[Changes in the pattern of substance use after bariatric surgery: report of one case]. / Cambio en el patrón de consumo de sustancias posterior a cirugía bariátrica: presentación de un caso clínico.

Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances.

Cambio en el patrón de consumo de sustancias posterior a cirugía bariátrica: presentación de un caso clínico / Changes in the pattern of substance use after bariatric surgery: report of one case

Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances.