Association between time of residence and self-perception of distress, interpersonal relationships, and social role in Venezuelan immigrants in Lima, Peru 2018-19: mixed-methods study.

BACKGROUND: Immigrants arriving in a new country face changes that affect their social, employment, and migratory status. We carried out a mixed-methods study in the rapidly growing Venezuelan immigrant population in Lima, Peru. The objective was to determine whether there was an association between time in Peru and self-perception of symptom distress (SD), interpersonal relationships (IR), and social role (SR). METHODS: The quantitative central component consisted of a cross-sectional study, surveying 152 participants using the Outcome Questionnaire 45.2 (OQ-45.2). The qualitative component, based on phenomenology, explored experiences and challenges during the migration process. Semi-structured in-depth interviews were conducted in 16 informants. RESULTS: An association that was observed was the increase in the risk of clinically significant SR score with additional years of age. All informants mentioned having witnessed or experienced xenophobia in Peru. Every informant stated that significant labor differences existed between the countries. The most reported somatic symptoms were symptoms of anxiety and alterations of sleep. Additionally, no informant expressed a desire to remain in Peru long term. CONCLUSIONS: A minority of participants registered a clinically significant total score and in each of the three domains of SD, IR, and SR. No association between months in Lima and the self-perception of distress was found. However, this could be due to the short amount of time spent in Peru and any change in self-perception might only be perceived after years or decades spent in Peru. This study is one of the first to use mixed-methods to explore the mental health of the immigrant Venezuelan population.

Cuestionario de efectividad de la psicoterapia outcome questionnaire. validación en muestra clínica colombiana / Questions effectiveness of psychotherapy outcome questionnaire. validation in colombian clinical sample

Resumen Establecer las propiedades estructurales y psicométricas del OQ-45.2 e identificar la sensibilidad al cambio y diferencias según género. Método: se realizó en población clínica, participaron 214 consultantes (111 hombres y 103 mujeres), Instrumento: Outcome Questionnaire (OQ-45.2). Resultados: El AFC mostró índices de bondad de ajuste bajos y valor de RMSEA de 0.071. Se recomendó realizar el AFE, y esta estructura incluyó 20 ítems y explicó el 58,8% de la varianza total: preocupación, problemas del desempeño del rol social, insatisfacción global, alcohol/drogas, dificultades en las relaciones e insatisfacción en las relaciones afectivas. Para la escala original, los coeficientes se encontraron entre 0.52 y 0.92; no se presentaron diferencias según género en ninguno de los factores pero sí sensibilidad al cambio en la terapia en todas las dimensiones. Para la estructura encontrada a través del AFE con 20 ítems, los coeficientes se encontraron entre 0.47 y 0.75. Los índices de ajustes para esta nueva estructura fueron muy favorables (CFI = 0,920, TLI = 0,902 y NFI = 0,790) y valor de RMSEA de 0.046. Se reportaron diferencias con relación al género en las dimensiones Insatisfacción global (más elevadas en mujeres) y Alcohol/droga (puntuaciones más elevadas en hombre). La prueba reportó sensibilidad al cambio en la escala original en Estrés, Desempeño y Relaciones interpersonales negativas, y en la escala abreviada en Preocupación, Problemas del rol social e Insatisfacción en las relaciones afectivas. Conclusiones: el OQ 45.2 no presentó una estructura adecuada a través del AFC. El AFE reportó 6 factores y 20 ítems, adecuados índices de ajustes, pero no todos los factores con buen nivel de confiabilidad.

Abstract To establish the structural and psychometric properties of the OQ-45.2 and identify sensitivity to change and differences by gender. Method: It was done in clinical population included 214 consultants (111 men and 103 women) Instrument: Outcome Questionnaire (OQ-45.2). Results: The AFC showed low rates of kindness adjustment and RMSEA value of 0.071. It was recommended that the AFE, and this structure included 20 items, explaining 58.8% of the total variance: worry, problems performing the social role, overall dissatisfaction, alcohol / drugs, relationship difficulties and dissatisfaction with relationships. For the original scale, the coefficients were found between 0.52 and 0.92; no gender difference appeared in any of the factors but sensitivity to change in therapy in all dimensions. For the structure found throughout the AFE with 20 items, the coefficients were between 0.47 and 0.75. The rates for this new structure adjustments were very suitable (CFI = 0.920, TLI = 0.902 and NFI = 0.790) and RMSEA value of 0.046. Gender-related differences in size (higher in women) overall dissatisfaction and Alcohol / drug (higher scores in man) were reported. The test reported sensitivity to change in the original scale Stress, Performance and negative interpersonal relations, and the abbreviated scale Worry, Problems of the social role and Dissatisfaction in relationships. Conclusions: 45.2 OQ did not provide a suitable structure through the AFC. The AFE reported six factors and 20 items, appropriate indexes setup, but not all factors with a high level of reliability.

Therapeutic conversations: Therapists' use of observational language contributes to optimal therapeutic outcomes.

OBJECTIVE: Reflexivity is the process of critically examining one's own experience. Emerging literature suggests that reflexivity is a positive predictor of outcomes in psychotherapy. However, limited research has been conducted regarding therapists' use of reflexivity as a therapeutic technique. In particular, we have a limited understanding of how therapists use language to initiate reflexive conversations. This study investigates the characteristics of therapist language that elicit reflexivity focused on internal and external processes. DESIGN AND METHODS: Therapeutic outcomes of 42 trainee-therapists who provided psychotherapy to 173 clients were tracked with the OQ-45.2 with the view of identifying client-trainee-therapist dyads (CTTDs) with the best and poorest outcomes. Six best outcome and six poorest outcome CTTDs were identified. Thirty-six therapy transcripts were initially coded with the Narrative Process Coding System to identify each Narrative Process Mode (NPM). Sixty external, internal, and reflexive NPMs (N = 180 NPMs) were randomly selected across all therapy transcripts for the best outcome group and the same number for the poorest outcome group. The Narrative Initiating Language Element Coding Manual, developed for this study, was used to code therapists' use of language to initiate each NPM. RESULTS: Therapists belonging to the best outcome group utilized more observational language to initiate internal and reflexive NPMs. Therapists belonging to the poorest outcome group evidenced high proportions of questioning language to elicit each NPM. CONCLUSIONS: Examining how therapists use language to elicit NPMs provides further insight as to how therapeutic language may contribute to successful therapeutic outcomes. PRACTITIONER POINTS: Reflexive therapeutic conversations characterized by a greater use of observational language were associated with positive therapeutic outcomes. Therapeutic conversations characterized by a high proportion of questioning language were associated with poorer therapeutic outcomes. Supervisors of trainee-therapists have a key role in coaching supervisees to use language that contributes to client treatment outcomes.

Trainee-therapists are not all equal: Examination of therapeutic efficiency, effectiveness and early client dropout after 12 months of clinical training.

OBJECTIVE: Contemporary research demonstrates the feasibility of assessing therapeutic performance of trainee-therapists through the use of objective measures of client treatment outcome. Further, significant variation between individual therapists based on their client treatment outcomes has been demonstrated. This study sets out to determine whether a reliable composite measure of therapeutic efficiency, effectiveness and early dropout can be developed and used to objectively compare trainee-therapists against each other. DESIGN AND METHODS: Treatment outcomes of 611 clients receiving treatment from 58 trainee-therapists enrolled in a professional training programme were tracked with the OQ-45.2 over a 6-year period to assess therapeutic efficiency, therapeutic effectiveness and early client dropout. RESULTS: Significant variation between trainee-therapists was observed for each index. Findings of a moderately strong correlation between therapeutic efficiency and effectiveness enabled the ranking of trainee-therapists based upon a composite measure of these indexes. A non-significant correlation was found between early client dropout and measures of therapeutic effectiveness and efficiency. CONCLUSIONS: The findings stress the importance of utilizing objective measures to track the treatment outcomes. Despite all trainee-therapists being enrolled in the same training programme, significant variation between trainee-therapists' therapeutic efficiency and effectiveness was found to exist. PRACTITIONER POINTS: Developing of potential benchmarking tools that enable trainee-therapists, supervisors and educational institutions to quickly assess therapeutic performance can become part of a holistic assessment of a trainee-therapist's clinical development. Despite an inherent optimistic belief that therapists do not cause harm, there appears to be a small and significant proportion of trainee-therapists who consistently evidence little therapeutic change. Considerable variability in trainee-therapists' therapeutic efficiency and effectiveness can exist in the one training programme. Early client dropout may not be associated with therapists' therapeutic effectiveness and efficiency.

Cambio terapéutico con psicofármacos solos versus adición de psicoterapia en pacientes depresivos hospitalizados / Change Therapy with Psychotropic Drugs Alone Versus the Addition of Psychotherapy in Depressed Inpatients

Objetivo: Describir y comparar el grado de Cambio Terapéutico en 2 grupos de pacientes, con depresión de moderada a severa, con intento y/o ideación suicida, bajo internación psiquiátrica; según el tipo de intervención que reciben. Metodología: Se seleccionaron 43 pacientes, donde un grupo de 21 sujetos recibió atención psiquiátrica y psicológica durante la internación y posteriormente tuvieron 8 sesiones de psicoterapia. El segundo grupo se compuso de 22 pacientes, quienes sólo recibieron atención psiquiátrica durante la hospitalización. Ambos grupos fueron evaluados con el instrumento Outcome Questionnaire (OQ-45.2) al momento del alta y en una segunda aplicación posterior a 8 semanas del alta. Resultados: El grupo con psicoterapia tuvo 1 sujeto sin cambio confiable y 20 pacientes con cambio confiable, representando el 4,8 por ciento y 95,2 por ciento respectivamente. Por otra parte, el grupo sin psicoterapia presenta 21 pacientes sin cambio confiable (95,5 por ciento) y 1 sujeto con éste, que sólo representa un 4,5 por ciento. Conclusión: El nivel de cambio terapéutico alcanzado por el grupo 1(con psicoterapia) respecto del grupo 2 (sin psicoterapia), es estadísticamente significativo (p<0,05), tanto en los resultados totales, como para cada una de las áreas. Es relevante señalar que el grupo con psicoterapia no solamente mejora, sino que el grupo sin psicoterapia empeora una vez dada el alta de internación. Por lo que se concluye que la complementariedad entre psicoterapia y psicofármacos es el tratamiento más efectivo.

Objectives: To describe and compare the degree of therapeutic change in 2 groups of patients with moderate to severe depression, with intent and / or suicidal ideation, under psychiatric care, depending on the type of assistance they receive. Methodology:43 patients, where a first group of 21 subjects received psychiatric and psychological care during hospitalization and subsequently had 8 sessions of psychotherapy. The second group consisted of 22 patients who only received psychiatric care during hospitalization. Both groups were evaluated with the instrument Outcome Questionnaire (OQ-45.2) at discharge and a second application after 8 weeks later. Results: The psychotherapy group had 1 subject no reliable change and 20 patients with reliable change, accounting for 4.8 percent and 95.2 percent respectively. The second group has 21 patients without reliable change (95.5 percent) and 1 subject with it, which constitutes only 4.5 percent. Conclusion: The level of therapeutic change achieved by the group 1compared to group 2, is statistically significant (p <0.05), both in the overall results and for each of the areas. It is important to note that the psychotherapy group not only improves, but the group without psychotherapy worse after being discharged from hospital. It is concluded that the complementarity between psychotherapy and psychotropic drugs is the most effective treatment.

El uso del cuestionario OQ-45. 2 como indicador de psicopatología y de mejoría en pacientes psiquiátricos hospitalizados / OQ-45. 2 questionnaire as an indicator of psychopathology and improvement in psychiatric inpatients

Objective: To test the OQ-45.2 questionnaire as an indicator of psychopathology and improvement in hospitalized patients, at the psychiatric unit of Hospital del Salvador, Santiago de Chile. Methods: A sample of 116 hospitalized patients was collected between August 2003 and September 2004. All of them had three OQ-45.2 questionnaire measurements: at admission, at discharge, and during follow-up. The scores obtained were compared with progression of the psychiatric condition and co-morbidity. Results: All patients, except those diagnosed as suffering psycho-organic syndromes, had a statistically significant reduction in OQ-45-2 scores, when the results at admission and follow-up were compared. Even though this instrument has not been validated in psychotic patients, they showed improvement and their scores were below the average for this sample. Patients suffering psychiatric co-morbidity had higher scores, when compared with those with no co-morbidity and similar improvement. Conclusions: The OQ-45.2 questionnaire is a valid and sensitive instrument for assessing improvement in psychiatric inpatients.

Objetivos: Probar el cuestionario OQ-45.2 como un indicador de psicopatología y de cambio en pacientes hospitalizados en un servicio de psiquiatría y estudiar la relación existente entre mejoría según OQ y tanto diagnóstico como comorbilidad psiquiátrica. Metodología: Se seleccionaron 116 pacientes hospitalizados en el servicio entre Agosto de 2003 y Septiembre de 2004 con tres mediciones del cuestionario OQ-45.2; al ingreso, alta y control post-alta. Se estudió la progresión de las mediciones y se compararon según diagnóstico y comorbilidad. Resultados: Solamente los pacientes con diagnóstico de trastornos orgánicos no presentaron una reducción del puntaje OQ-45.2 estadísticamente significativa entre el ingreso y el control post-alta. Los pacientes psicóticos, en quienes no se ha validado este instrumento, mostraron mejoría y puntajes menores a la media de la muestra. Los pacientes con comorbilidad psiquiátrica presentaron puntajes superiores a los que presentaban un sólo diagnóstico, pero con igual nivel de mejoría. Conclusión: El cuestionario OQ-45.2 resultó ser un instrumento sensible y válido que ilustra la mejoría significativa experimentada por los pacientes hospitalizados.