Depression screening and treatment among uninsured populations in Primary Care

Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients (N = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, n = 7,935) and 24% (n = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan (n = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.     

Active school travel is associated with fewer suicide attempts among adolescents from low-and middle-income countries

Background/Objective: This study explored the association between active school travel (AST) and suicide attempts among adolescents in low- and middle-income countries (LMICs). Method: We used the data from the Global School-based Health Survey, including 127,097 adolescents aged 13-17 years from 34 LMICs. A self-reported survey was used to collect data on AST and suicide attempts as well as some variables. Multivariable logistic regression was performed to assess the association between AST and suicide attempts. A meta-analysis with random effects was undertaken to identify the difference in the association between AST and suicide attempts. Results: Across all the adolescents, the prevalence of AST was 37% and the prevalence of suicide attempts was 11.60%. Adolescents who engaged in AST were less likely to have suicide attempts irrespective of gender. The country-wise analysis indicated a large inconsistency in the association between AST and suicide attempt across the countries. Conclusions: AST would appear to be a protective factor for reducing suicide attempts among adolescents. However, the association between AST and suicide attempts varied greatly across the countries. Future studies should confirm the association between AST and suicide attempts.     

Social status and friendship in peer victimization trajectories

Background/Objective: Most studies have evaluated victimization at a single time point, making it difficult to determine the impact of the time during which an individual is victimized. This longitudinal study aims to examine the differences in the levels of social status (social preference and perceived popularity) and friendship in peer victimization trajectories, and to analyse if there were changes over time in the levels of social status and friendship in each trajectory. Method: The final sample was composed of 1,239 students (49% girls) with ages between 9 and 18 (M = 12.23, SD = 1.73), from 22 schools in southern Spain. Peer nominations were collected. Results: The General Linear Model results associated the highest levels of social preference, perceived popularity and friendship with the sporadic victimization profile and the lowest levels of these dimensions with the stable profile. Conclusions:The results are discussed based on important personal aspects of stable victimization that confirms social rejection, unpopularity, and the low social support that victimization causes. This contribution is discussed in terms of health and social welfare in adolescence.     

Relative effects of breastfeeding intention and practice on maternal responsiveness

Our objective was to examine the differential effects of antenatal breastfeeding intention (BI) and breastfeeding practice (BP) on maternal postnatal responsiveness. We conducted a secondary analysis of longitudinal data from a subsample of 962 mother–infant dyads from a U.K.-based birth cohort study the Avon Longitudinal Study of Parents and Children. Exposures were BI and BPs measured at 32 weeks of gestation and 18 months’ postpartum. The outcome was maternal responsiveness assessed at 12 months’ postpartum. We used logistic regression analyses unadjusted and adjusted for confounders. Intention to breastfeed was associated with increased odds of postnatal maternal responsiveness independent of BP, adjusted odds ratio (OR) = 2.34, 95% CI [1.42, 3.86]. There was no evidence that BP was an independent predictor of maternal responsiveness, OR = 0.93, 95% CI [0.55, 1.57]. Life-course epidemiology analyses demonstrated that maternal responsiveness is most positive when both BI and BP are present. This is the first population-based study to provide evidence that BI during pregnancy is more strongly associated with maternal postnatal responsiveness than is BP. Further research is needed to understand the determinants of BI in pregnancy and its relationships with maternal responsiveness.     

Problematic,absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists’ and psychiatrists’ opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed.     

Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.     

The “impact factor style of thinking”: A new theoretical framework

Over the last few years, university policy in developed countries has placed too much emphasis on assessing publications on the basis of the impact factor. Any scientific material that has not been published in a journal indexed in the Journal Citation Reports is academically irrelevant. Hence, researchers strive hard to publish in such journals. Failure to achieve this means not having a successful career or receiving any academic recognition. A thorough analysis of the effects of this phenomenon on the researcher community leads to the conclusion that the overestimation of the impact factor is likely to cause disappointment among many researchers. Researchers only have two options: adopting a politically correct behavior, that is, following the “impact factor style of thinking”, or accepting the futility of their research regardless of its relevance. This is an example of the involvement of university policy habitus obsessed impact index. O policy impact index is accepted, or is doomed to academic ostracism, and exclusion from participation in all university policy.     

An abridged Spanish version of Sexual Double Standard Scale: Factorial structure,reliability and validity evidence

Background/Objective

Sexual double standard (SDS) has long been associated to several dimensions of sexual health. Therefore the assessment of SDS is relevant and requires self-reported measures with adequate psychometric properties. This study aims to adapt the Sexual Double Standard Scale (SDSS) into heterosexual Spanish population and examine its psychometric properties. Method: Using quota incidental sampling, we recruited a sample of 1,206 individuals (50% women), distributed across three groups based on their age (18-34, 35-49 and 50 years old and older). Results: We performed both, Exploratory Factor Analysis and Confirmatory Factor Analysis. An abridged version was yielded, consisting of 16 items distributed into two factors (Acceptance for sexual freedom and Acceptance for sexual shyness). A second-order factor structure was also adequate, which facilitates the use of a global index for SDS. Reliability, based on internal consistency and temporal stability was good for the factors. Evidence of validity is also shown and reported. Conclusions: This adapted version of the SDSS is reliable and valid. The importance for its use to estimate the prevalence of both traditional and modern forms of this phenomenon is discussed.