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.
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.
Introduction. Cognitive assessment is the process whereby individuals assess the effect an adverse circumstance has on their well-being (primary assessment) and their ability to cope with it ...(secondary assessment), which is closely related to the emotional and behavioral response they show as a result. Objective. To determine the validity and internal consistency of the Spanish version of the Cognitive Assessment Inventory (CAI) for patients with chronic pain for Mexican population. Method. A total of 191 adults with chronic pain completed the Spanish version of the CAI, as well as self-report measures of disability, daily activities, anxiety and depression. Results. The confirmatory factor analysis for each type of primary cognitive assessment included in the CAI yielded models with satisfactory goodness of fit and Cronbach's a indices (loss/damage: CMIN/DF = 1.132, NFI = .935, CFI = .992,AGFI = .939, SRMR = .046, RMSEA= .026, a= .73; threat: CM IN/ DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA= .026, alpha= .81; and challenge: CMIN/ DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, alpha = .86). Cognitive assessments of loss/harm and threat were positively associated with the degree of disability, depression, and anxiety and negatively associated with the performance of daily activities. The opposite occurred with the cognitive assessment of challenge. Discussion and conclusion. The Spanish version of the CAI is a valid, quick, easy, and reliable tool for evaluating the primary cognitive assessment of pain, a construct closely related to physical disability and emotional suffering in response to this experience, which may be modified through brief cognitive interventions. Keywords: Cognitive evaluation, chronic pain, psychometric properties, Mexico. Introduccion. La evaluacion cognoscitiva es el proceso mediante el cual un individuo valora el efecto que ejerce una circunstancia adversa en su bienestar (evaluacion primaria) junto con las capacidades con que cuenta para afrontarla (evaluacion secundaria), con ello guarda una estrecha relacion con la respuesta emocional y conductual que despliega en consecuencia. Objetivo. Determinar la validez y consistencia interna de la version en espafiol del Inventario de Evaluacion Cognoscitiva (IEC) para pacientes con dolor cronico en poblacion mexicana. Metodo. Un total de 191 adultos con dolor cronico completaron la version en espafiol del IEC, asi como medidas de autorreporte de discapacidad, actividades cotidianas, ansiedad y depresion. Resultados. El analisis factorial confirmatorio para cada tipo de evaluacion cognoscitiva primaria incluida en el IEC arrojo modelos con indices de bondad de ajuste y a de Cronbach satisfactorios (perdida/dano: CMIN/ DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, alpha = .73; amenaza: CMIN/ DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, alpha = .81; y desafio: CMIN/ DF= 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, alpha = .86). Las evaluaciones cognoscitivas de perdida/dano y de amenaza se asociaron positivamente con el grado de discapacidad, depresion y ansiedad, y de forma negativa con la ejecucion de actividades cotidianas. Lo contrario ocurrio con la evaluacion cognoscitiva de desafio. Discusion y conclusion. La version en espafiol de la IEC es una herramienta facil, rapida, valida y confiable para evaluar la evaluacion cognoscitiva primaria del dolor, constructs intimamente relacionado con la discapacidad fisica y el sufrimiento emocional ante esta experiencia susceptible de modificacion mediante intervenciones cognoscitivas breves. Palabras clave: Evaluacion cognoscitiva, dolor cronico, propiedades psicometricas, Mexico.
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