Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that ...vignettes do not accurately reflect “real world” phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a “hybrid” of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to “real life” behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians’ diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations
Las metodologías basadas en viñetas se utilizan frecuentemente para examinar los procesos de toma de decisiones, incluyendo los de profesionales sanitarios. No obstante, existen dudas sobre si las viñetas reflejan adecuadamente los fenómenos del “mundo real” permitiendo resultados y conclusiones válidas. Ofrecemos una visión de las características, variaciones de diseño, fortalezas y debilidades de estos estudios para examinar cómo los profesionales forman juicios clínicos (como el diagnóstico y tratamiento). Siendo “híbridos” de las encuestas tradicionales y los métodos experimentales, estos estudios pueden ofrecer la alta validez interna de los experimentos y la alta validez externa de las encuestas, para aislar múltiples factores predictivos del comportamiento de los clínicos. Un diseño adecuado para poner a prueba preguntas específicas acerca de los juicios y la toma de decisiones permite resultados altamente generalizables a la “vida real”, sin las limitaciones éticas, prácticas y científicas de los métodos alternativos (observación, auto-informe, pacientes estandarizados, análisis de archivos clínicos). Concluimos con recomendaciones metodológicas que se ilustran tras una descripción del uso de las metodologías de viñetas para investigar las decisiones diagnósticas de los clínicos en los estudios de campo de casos y controles para la clasificación de los trastornos mentales y del comportamiento en la CIE-11
Background: Transgender people are often victims of multiple types of violence across several areas of life due to society's marked intolerance of gender nonconformity. Objective: This study seeks to ...describe experiences of violence in transgender individuals and explore the relationship between different types of violence and specific, high-risk gender incongruence and social rejection factors during adolescence. Method: The sample consisted of 245 transgender adults receiving transgender-related health services at a public specialised clinic in Mexico City. Results: Findings are in line with the evidence in the literature and confirm that transgender people are at a high risk of different types of violence, with psychological violence being the most common, followed by physical and sexual violence. This occurs at an early age and in different contexts, mainly through social experiences with family members and school peers. Experiences of rejection, seeking to be treated as the gender identity and asking to be called by the name selected for gender identity were the most important predictors for all types of violence. Conclusion: This study highlights the need for interventions to prevent violence against transgender youth from an early age to provide safe family and school environments for their healthy development.
Worldwide, three out of four of the general population have reported experiencing violence. Governments should address solutions to violence and its effects on mental health. The study aimed to ...determine depressive, anxious, and posttraumatic stress symptoms related to the violence experienced during the COVID-19 pandemic in the general population. The study was conducted with 18,449 Mexicans of 33 years (SD = 11.00, range = 18-59), with 12,188 (66.10%) being women, 3559 (19.29%) having COVID-19, 2706 (14.67%) seeking psychological care, and 5712 (30.96%) experiencing violence. Subjects completed the Major Depressive Episode (MDE) Checklist, Generalized Anxiety (GA) Scale, and the Posttraumatic Stress (PTS) Checklists (PCL-5) programmed in a WebApp application. We assessed the dimensionality of the scales through the Confirmatory Factor Analysis (CFA), the measurement invariance, and a structural equation model (SEM). In the total sample, 28.10% fulfilled the MDE criteria, and 42.30% had high levels of GA. In the sample of those experiencing violence, 48.40% met the MDE criteria, 61.70% had high GA symptoms, and 50% met the criteria for a PTS disorder. Experiencing violence was associated with GA and severe PTS symptoms when the discomfort had bothered them for over a month since the onset of these symptoms. Subjects who had experienced violence and had mental health symptoms seemed ready for treatment. Further studies will evaluate the effect of remote psychological care to help reduce the treatment gap.
Objectives
Psychological treatment of depression in end‐stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural ...intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD.
Design
For the purpose of this study, a single‐blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI.
Methods
Depression and anxiety symptoms were screened in 152 subjects (18–60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self‐reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4‐week follow‐up. All scores were compared by ANOVA for repeated measures with post‐hoc tests adjusted by Bonferroni's method (p < .05 was considered significant).
Results
At follow‐up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety.
Conclusions
A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients.
Practitioner points
A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end‐stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically.
This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self‐labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD.
The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non‐specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
Introduction Pediatricians in training are a population at risk for anxiety and depression: they face long working hours, they are confronted with the suffering and death of a vulnerable population ...and may have personal characteristics that put them in danger. Nonetheless, few studies have looked at their prevalence and associated factors. We aimed to compare demographic, professional activities, adversities and perfectionism personality features between a group of pediatricians in training with depression and/or anxiety and a group of pediatricians in training without depression nor anxiety and, to identify the variables that increase the probabilities of depression and/or anxiety in pediatricians in training. Methods Pediatric residents who voluntarily answered an online survey distributed via personal and institutional social media channels from October 2019 to April 2021, as part of a cross-sectional study with medical specialists and residents from Mexico were included. Demographic information, professional activities and adversities, perfectionism personality features (Multidimensional Perfectionism Scale), depression and anxiety (ICD-11 PHC) were evaluated. For comparison purposes Chi-square tests (χ 2 ) and independent sample t -tests were used. A logistic regression analysis was used to identify those variables that increase the probabilities of depression and/or anxiety. Results 934 pediatric residents answered the survey. 11.6% reported having depression and 20% anxiety. Being single, a history of anxious or depressive episodes, being the resident in charge of a patient who died, aggressions from colleagues and a high concern for errors were associated with current depression and/or anxiety. Discussion Screening for depressive and anxious symptoms should be routinely performed from entry to the residency to favor early intervention. A shift from promoting perfectionism to a more compassionate training could serve a population facing so many adversities.
During the health emergency caused by the COVID-19 pandemic, one of the most affected sectors was the healthcare workers (HCWs), since it is a population group with a high risk of developing ...post-traumatic stress disorder (PTSD), anxiety, or depression. Resilience is one of the abilities that can favor a greater adaptation to adverse circumstances. Therefore, the aim of the present research was to know the association between resilience and PTSD in HCWs during the COVID-19 outbreak, which contributes to the development of preventive strategies and therapeutic interventions for this debilitating mental disorder. The study was prospective ex post facto, cross-sectional; it had a non-probabilistic sample of 613 Mexican HCWs. Data was collected through the platform www.personalcovid.com. The results obtained showed that resilience is negatively related to PTSD, with nurses being the most at-risk group among HCWs.
The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this ...study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems.
A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19.
The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001).
The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.
The COVID-19 pandemic may have increased interpersonal and intimate violence, harmful use of alcohol and other drugs (AODs), and mental health problems. This study uses a valid path model to describe ...relationships between these conditions of young Mexicans during the second year of the pandemic. A sample of 7420 Mexicans ages 18 to 24-two-thirds of whom are women-completed the Life Events Checklist, the Alcohol, Smoking, and Substance Involvement Screening Test, the Major Depressive Episode Checklist, the Generalized Anxiety Scale, and the Post-traumatic Stress Disorder (PTSD) Checklist. Young Mexicans reported higher rates of victimization and perpetration of interpersonal and intimate violence and mental health symptomatology than those noted pre- and in the first year of the pandemic. The harmful use of AOD rates were similar to those reported by adolescents before. The findings suggest asymmetric victimization and perpetration of intimate violence by gender (with women at a higher risk). More men than women have engaged in the harmful use of AODs (except for sedatives, which more women abuse). More women than men were at risk of all mental health conditions. The path model indicates that being a victim of intimate violence predicts the harmful use of tobacco, alcohol, cocaine, and sedatives, depression, anxiety, and specific PTSD symptoms (such as re-experimentation and avoidance symptoms). Being a victim of interpersonal violence resulted in severe PTSD symptoms (including avoidance, negative alterations in cognition-mood, and hyperarousal signs). The harmful use of sedatives predicted depressive symptoms. Men's victimizing intimate violence model contrasted with that of women, which included being the victim of interpersonal violence and severe PTSD symptoms. The high school youth model had three paths: victimizing intimate violence, victimizing interpersonal abuse, and sedative use, which predicted depression. Our findings could serve as the basis for future studies exploring the mechanisms that predict violence to develop cost-effective preventive programs and public policies and to address mental health conditions during community emergencies.
The conceptualisation of transgender identity as a mental disorder has contributed to precarious legal status, human rights violations, and barriers to appropriate health care among transgender ...people. The proposed reconceptualisation of categories related to transgender identity in WHO's forthcoming International Classification of Diseases (ICD)-11 removes categories related to transgender identity from the classification of mental disorders, in part based on the idea that these conditions do not satisfy the definitional requirements of mental disorders. We aimed to determine whether distress and impairment, considered essential characteristics of mental disorders, could be explained by experiences of social rejection and violence rather than being inherent features of transgender identity, and to examine the applicability of other elements of the proposed ICD-11 diagnostic guidelines.
This field study used a retrospective interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services at the Condesa Specialised Clinic in Mexico City, Mexico. Participants completed a detailed structured interview focusing on sociodemographic characteristics, medical history related to gender identity, and, during a specific period of adolescence, key concepts related to gender identity diagnoses as proposed for ICD-11 and from DSM-5 and ICD-10, psychological distress, functional impairment, social rejection, and violence. Data were analysed with descriptive statistics and univariate comparisons and multivariate logistic regression models predicting distress and dysfunction.
Between April 1, 2014, and Aug 17, 2014, 260 transgender adults were approached and 250 were enrolled in the study and completed the interview. Most (n=202 81%) had been assigned a male sex at birth. Participants reported first awareness of transgender identity at a mean age of 5·6 years (SD 2·5, range 2-17), and 184 (74%) had used health interventions for body transformation, most commonly hormones (182 73%), with the first such intervention at a mean age of 25·0 years (SD 9·1, range 10-54). 84 (46%) of those who had used hormones did so initially without medical supervision. During adolescence, distress related to gender identity was very common, but not universal (n=208 83%), and average level of distress was quite high among those who reported it (79·9 on a scale of 0 none at all to 100 extreme, SD 20·7, range 20-100). Most participants (n=226 90% reported experiencing family, social, or work or scholastic dysfunction related to their gender identity, but this was typically moderate (on a scale of 0 not at all disrupted to 10 extremely disrupted, family dysfunction mean 5·3 SD 3·9, range 0-10; social dysfunction mean 5·0 SD 3·8, range 0-10; work or scholastic dysfunction mean 4·8 SD 3·6, range 0-10). Multivariate logistic regression models indicated that distress and all types of dysfunction were strongly predicted by experiences of social rejection (odds ratios ORs 2·29-8·15) and violence (1·99-3·99). A current male gender identity also predicted distress (OR 3·90). Of the indicators of gender incongruence, only asking to be treated as a different gender was a significant predictor, and only of work or scholastic dysfunction (OR 1·82).
This study provides additional support for classifying health-related categories related to transgender identity outside the classification of mental disorders in the ICD-11. The reconceptualisation and related reclassification of transgender-related health conditions in the ICD-11 could serve as a useful instrument in the discussion of public health policies aimed at increasing access to appropriate services and reducing the victimisation of transgender people.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico.
Mexico is the third Latin American country with the most children and adolescents living with human immunodeficiency virus (ALHIV). There is a lack of information on the characteristics of this ...population. We aimed to describe the social and mental health characteristics of Mexican ALHIV. A census was conducted of all adolescent patients with HIV at a pediatric hospital (n = 47; mean age 14.39, S.D. = 3.65) and their caregivers. We collected data on socio-demographic characteristics, family, intelligence, mental health, adverse life events, substance use, treatment, knowledge of Antiretroviral Treatment (ART) and HIV, and biomarkers. Most cases were transmitted vertically and self-reported ART adherence was above 90%. Some obstacles to adherence were medicine discomfort, believing that they did not need it, and forgetfulness. The vulnerabilities were intellectual disability, adverse life events, possible mental health problems, and little knowledge of their illness and treatment. These findings suggest the importance of interventions to improve the perception and knowledge of HIV and ART to increase ART adherence.
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