Rebeca Robles García

• PhD on Clinical and Health Psychology
• Researcher at National Institute of Psychiatry Ramón de la Fuente Muñiz

The aim of this study was to identify psychological and physical correlates of Quality of Life (QOL) in patients undergoing hematopoietic stem cell transplantation (HSCT). A total of 146 adult patients participated, of which 67.12% receiving an autologous HSCT and 32.87% an allogeneic HSCT. The sample included 63.01% male patients with a mean age o...

Perceived risk for HIV acquisition among gay, bisexual, and other men who have sex with men (GBMSM) may not align with their actual sexual HIV exposure. Factors associated with low/moderate perceived risk among GBMSM eligible for pre-exposure prophylaxis (PrEP) (based on their high estimated HIV exposure) have been poorly described in Latin America...

Introduction According to pre-COVID-19 pandemic studies, occupational violence (OV) toward mental healthcare professionals (MHCPs) is a common phenomenon with important consequences for their own mental health. This study sought to assess the prevalence of different types and sources of OV toward MHCPs during the COVID-19 pandemic, analyze the risk...

Aim Cognitive disturbances typically precede the onset of overt psychotic symptoms and represent a neurobiological marker for psychosis risk that is also associated with poor functional outcomes. The Measure of Insight into Cognition‐Self Report (MIC‐SR) is a widely used 12‐item questionnaire that assesses the perceived frequency of cognitive impai...

Background: Schizophrenia, one of the most disabling disorders worldwide, is characterized by impaired empathy, which appears to be more common in women. Methods: This study aimed to compare empathy levels between control subjects and patients with schizophrenia by sex. We compared sixty-two patients with schizophrenia and 166 control subjects. All...

Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental...

The prevalence of mental health problems constitutes an open challenge for modern societies, particularly for low and middle-income countries with wide gaps in mental health support. With this in mind, five datasets were analyzed to track mental health trends in Mexico City during the pandemic's first year. This included 33,234 responses to an onli...

Background The COVID-19 epidemic had a deleterious impact on mental health and substance abuse as well as an increase in several forms of violence including self-harm, and interpersonal violence, among youth from low- and middle-income countries. However, the relationship among these variables and its directionality have not been established. The s...

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...

Introduction: Although the COVID-19 pandemic triggered an increase in intimate violence, drug use, and mental health problems in low- and middle-income countries, these fluctuations and the relationship directionality between these behaviors and symptoms, when comparing group-of-age risks and developmental trends during the pandemic in Mexico, are...

Objective: Interpersonal partner violence (IPV) is a pervasive social and public health problem worldwide. In the context of the response by the World Health Organization to this issue, proposals were developed to improve the usefulness of International Classification of Diseases (ICD-11) descriptions for helping clinicians to reliably identify rel...

Background and aims: The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals...

Aunque existe evidencia de la efectividad de las intervenciones psicológicas remotas o a distancia, es necesario evaluar la adherencia que las personas tienen a procedimientos de autocuidado, así como el grado de implementación de los mismos por parte de los profesionales de la salud.

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 ge...

Introduction Despite the propagation of virtual mental health services for vulnerable groups during COVID-19 pandemic, the implementation and evaluation of remote evidence-based practices (EBP) to manage them in low- and middle-income countries remains scarce. In the current study, we describe and evaluate the implementation process and clinical im...

Asumir y efectuar los cuidados de los pacientes con padecimientos crónicos que ya no pueden responder a intervenciones curativas −es decir, en cuidados paliativos−, representa una carga emocional y conductual excesiva para quienes otorgan esos cuidados, lo que tiene diversas implicaciones cognitivas y efectos muy dañinos en su salud. En los países...

Objective: The present study examined among orthopedic residents the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died. Method: A cross-sectional online survey based on self-reported measures was used to collect...

Objective: Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD). Method: Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert jud...

Background: Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. Method: A multilingual, longitudinal, global survey was conducted at three time points...

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...

The COVID-19 pandemic may have increased interpersonal and intimate violence, harmful use of alcohol and other drugs (AOD), and mental health problems. The present 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 7,420 young Mexicans ages 18 to 24—...

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....

Concerns about cancer recurrence in Mexican women breast cancer survivors. Psychometric properties of the CARS scale Preocupaciones acerca de la recurrencia del cáncer en mujeres supervivientes de cáncer de mama mexicanas. Propiedades psicométricas de la escala CARS Preocupações sobre a recorrência do câncer em mulheres mexicanas sobreviventes do c...

Introduction: the COVID-19 pandemic is associated with mental health symptoms. Objective: to screen mental health symptoms by validating the factor structure of the screening test related to sociodemographic variables during the COVID-19 pandemic. Method: we worked with 36,811 Mexican (M = 34 years; SD = 11.68), 61.8% (22,743) women, 15.3% (5,643)...

Objetivo: El cáncer de mama (CAM) es un problema de salud pública mundial. La ansiedad y depresión son las principales comorbilidades que aquejan a este sector, el programa psicoeducativo de navegación (PPN) se presenta como una estrategia psicosocial eficaz en hospitales públicos de México. Método: Se realizó la adaptación del PPN y la evaluación...

Aims: Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study com...

Background: Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems. Objective: The aim of the present study was to compare demographic features, professional activities and adversities, dep...

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and witho...

"Este volumen ofrece estudios alrededor de las emociones, sentimientos y afectaciones psicológicas a consecuencia de la contingencia sanitaria. Reúne aportaciones de la psicología y la filosofía, cuyo común denominador es la comprensión del fenómeno y la btención de lecciones útiles para el futuro. En principio, presenta los retos enfrentados en re...

Este volumen ofrece estudios alrededor de las emociones, sentimientos y afectaciones psicológicas a consecuencia de la contingencia sanitaria. Reúne aportaciones de la psicología y la filosofía, cuyo común denominador es la comprensión del fenómeno y la btención de lecciones útiles para el futuro. En principio, presenta los retos enfrentados en rel...

Este volumen ofrece estudios alrededor de las emociones, sentimientos y afectaciones psicológicas a consecuencia de la contingencia sanitaria. Reúne aportaciones de la psicología y la filosofía, cuyo común denominador es la comprensión del fenómeno y la btención de lecciones útiles para el futuro. En principio, presenta los retos enfrentados en rel...

Background Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru. Methods Implementation PrEP (ImPrEP) was a...

Diversos estudios han reportado que el cuidado informal de adultos mayores, personas con alguna enfermedad o discapacidad, e incluso el cuidado de menores de edad, tiene un impacto en la salud física y mental de las personas cuidadoras (PC). El objetivo del presente estudio fue identificar los riesgos a la salud mental de las PC, teniendo como refe...

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 intern...

Background Pre-exposure prophylaxis (PrEP) has recently been introduced in Mexico. Still, there are no data exploring the frequency and related factors of willingness to recommend it among non-physician health providers (Non-PHP). Objective Compare awareness, knowledge, attitudes, and willingness to recommend PrEP and combined HIV prevention among...

Introduction: The present study aims to examine sex differences in demographic variables, professional activities and adversities, self-reported mental health problems, and perceived discrimination in a sample of family doctors and family medicine residents in Mexico. METHODS: From a larger sample of medical specialists, an analytic, cross-section...

The primary objective of this study was to evaluate the measurement of invariance by sex, age, and educational level of an online version of the Generalized Anxiety Disorder Scale in a five-item version (GAD-5). Configural, metric, scalar, and strict invariance were evaluated using data from 79,473 respondents who answered a mental health questionn...

Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical prac...

This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk p...

Background: The Physician Well-Being Index (PWBI) is a brief, valid, reliable self-assessment instrument to identify health professionals' distress and those in need of an intervention. Objective: to evaluate the construct, predictive validity (of depression, suicidal ideation, insomnia, and generalized anxiety), and internal consistency of the...

HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised...

Aim: This study aimed to identify whether clinicians’ gender, clinical experience, and personal attitudes influenced their perception of criminality of specific sexual behaviours, their judgments about criminal liability if mentally disordered, and the need for treatment as part of criminal settings for those having ICD-11 paraphilic disorders. Met...

Background The COVID-19 pandemic has created a public mental health crisis. Brief, valid electronic tools are required to evaluate mental health status, identify specific risk factors, and offer treatment when needed. Objective To determine the construct validity, reliability, and measurement invariance of a brief screening tool for mental health...

Antecedentes. La insuficiencia cardiaca (IC) es una enfermedad crónica cuyos síntomas y evolución ocasionan limitaciones físicas y deterioro psicológico importantes. Las personas que padecen IC con depresión y ansiedad perciben su calidad de vida especialmente deteriorada. Objetivo. El presente estudio examinó la eficacia de una intervención cognit...

Abstract Background In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no c...

Background COVID-19 has profoundly affected the work of mental health professionals with many transitioning to telehealth to comply with public health measures. This large international study examined the impact of the pandemic on mental health clinicians’ telehealth use. Methods This survey study was conducted with mental health professionals, pr...

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW’s COVID-19 mortality. A cross-se...

Background/Objective: The most recent versions of the two main mental disorders classifications—the World Health Organization's ICD-11 and the American Psychiatric Association's DSM–5—differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is...

Es considerado actualmente que uno de los objetivos más importantes de la diálisis es mantener al enfermo sin sobrecarga de volumen. La presión arterial (PA) antes de la diálisis es el indicador clínico más utilizado para inferirlo. Se ha demostrado en diversos estudios que la depresión favorece la sobrecarga de volumen. La TCCB en grupo ha demostr...

En este texto, los profesionales de la salud encontrarán una guía y materiales didácticos para la aplicación de una intervención para apoyar a sus pacientes con enfermedad renal crónica (ERC) a lograr el cumplimiento de su estricto régimen de tratamiento médico, y entonces la mejor calidad de vida posible - objetivo último de la actuación del equip...

AIM: This article describes the general characteristics of community-based mental healthcare in Mexico. METHODS: Data from national surveys, special studies and statistics from the national information system during the period 20012017 are used. Available information on health systems, new regulations and the innovations implemented are reviewed,...

In Mexico, over 10 million persons are currently smokers. The motivation to quit smoking can be associated with individual and mental health factors. The aim of this study was to determine which variables related to smoking behavior, demographics, and current psychological symptoms distinguish highly motivated smokers (action stage) from less motiv...

Objective: ICD-11 clinical guidelines for mental and behavioral disorders must be tested in clinical settings to guarantee their usefulness worldwide. The purpose of this study was to evaluate interrater reliability and clinical utility of the ICD-11 guidelines for children and adolescents in assessing and diagnosing mood, anxiety, and fear-related...

Background: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. Methods: 1357 clinician members o...

Objective: ICD-11 clinical guidelines for mental and behavioral disorders must be tested in clinical settings to guarantee their usefulness worldwide. The purpose of this study was to evaluate interrater reliability and clinical utility of the ICD-11 guidelines for children and adolescents in assessing and diagnosing mood, anxiety, and fear-relate...

Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these co...

Background The diagnosis of paraphilic disorder is a complicated clinical judgment based on the integration of information from multiple dimensions to arrive at a categorical (present/absent) conclusion. The recent update of the guidelines for paraphilic disorders in ICD-11 presents an opportunity to investigate how mental health professionals use...

Background: The health crisis associated with the COVID-19 pandemic is causally linked to negative mental health symptoms in the same way as other diseases such as Ebola. Objective: The purpose of this paper is to describe the relationship between mental health symptoms, binge drinking, and the experience of abuse during the COVID-19 lockdown. Meth...

Objective The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees.MethodsA cross-sectional, retrospective, comparative study was conduct...

El objetivo del trabajo fue describir el nivel de riesgo a la salud mental en función de las condiciones socioeconómicas y las relacionadas con la pandemia por COVID19. Se trabajó con 15,335 personas mexicanas, (M= 26 años, DE=11.95), 52% solteras (8,001), 60% mujeres (9,175), 44% en cuarentena (6,769). Se utilizó un estudio correlacional causal ex...

Introduction. This article presents the history and rationales of conceptualization and classification of homosexuality and transgender identity in both ICD and DSM. We review the efforts that have been made (and those that remain pending) to improve psychiatric classifications with new scientific knowledge, changing social attitudes and human righ...

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 w...

Major depressive disorder may remain underdiagnosed as it can be hidden behind somatic complaints or behavioral problems such as impulsivity, making other symptoms difficult to be recognized. The aim of the study was to determine the presence of depression in a sample of patients first-time diagnosed with generalized anxiety disorder that do not re...

Introduction. A mental health survey was done in the context of the COVID-19 pandemic among Latin American dermatologists through CILAD (Colegio Ibero-Latinoamericano de Dermatología) with the participation of both specialists and residents from twenty countries. Objective. To evaluate mental health problems among Latin American dermatologists duri...

Introduction. In Mexico, a National Mental Health Strategy was implemented to identify and attend the mental health repercussions of the COVID-19 pandemic. It included the creation of five virtual clinics for health workers, being the Burnout, Post-traumatic Stress, and Compassion Fatigue clinic one of them. Objective. To describe the basal sociode...

Introduction Frontline COVID-19 healthcare workers (FLHCWs) are at a high-risk of suffering occupational stress- and trauma-related mental health problems, including burnout and compassion fatigue (B&CF). Given the time limitations (due to their heavy workloads) and need to minimize face-to-face interventions (in order to avoid contagions), psychol...

Introduction: the conditions of the COVID-19 pandemic promote mental health risks. Objective: the goal of the study was to assess the risk of developing mental health conditions as a result of COVID-19 situations: containment, symptoms or COVID-19 suspected, death of near people, use of alcohol, and violence. Method: it participated 8,348 Mexican,...

This chapter is divided into seven sections, beginning with a general overview of this group of substances, their definitions, and the current classification of the disorders associated with their use. This is followed by a description of prevalence, the groups of the population affected, and the patterns of use in different regions of the world. P...

Introduction Self-perceived health (SPH) is related to disease and well-being. Psychiatrists report burnout and mental disorders more frequently than other physicians, while personality traits related to perfectionism may influence the perception of well-being and health in these professionals. Objective To compare and determine the association be...

Objective Early-psychosis researchers have documented that duration of untreated psychosis (DUP) is an important predictor of outcomes in first-episode psychosis. Very few cross-national studies have been conducted, and none have been carried out involving patients from both Mexico and the U.S. We collaborated to answer three questions: (1)Are DUP...

Background: Schizophrenia diagnosis is associated with special communication difficulties between clinicians, service users and caregivers, which may hinder the therapeutic alliance, treatment compliance, and rehabilitation. A clinically useful psychiatric nosology should improve communication between all final users. Aim: To evaluate the accessibi...

Este artículo describe la creación e implementación de un Programa de Atención Psicológica (PAP) que trata pacientes que asisten al servicio de asesoramiento genético. Fue creado debido a una serie de colaboraciones entre la Universidad de Guadalajara y varios institutos de salud nacionales e internacionales. El objetivo del programa incluye evalua...

Cancer survivorship is a period of psychosocial adjustment that comprises challenges from and long-term side effects of the disease and treatments. Objective: To carry out a systematic literature search to explore the principal psychological affectations reported by breast cancer survivors Method: A literature review was made of the last 6 years (2...

La apreciación cognitiva es el proceso por el que un individuo evalúa o juzga un evento potencialmente estresante de acuerdo con la amenaza que éste le pueda representar a su bienestar. Los objetivos de este estudio fueron traducir al español y evaluar las propiedades psicométricas de la Escala de Apreciación Cognitiva del VIH/SIDA (EAC-VIH) en pob...

Background Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’s (i.e. the new childhood mood diagnosis, disrupti...

Introduction Empathy is defined as the ability or process to identify and understand other person’s situation, feelings, and motives. These responses are essential for relationships and social behavior. Baron-Cohen et al. created the Empathy Quotient (EQ), a scale explicitly designed to have a clinical application. The instrument evaluates three co...

Objective The functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) is a widely used instrument to assess quality of life (QOL) in hematopoietic stem cell transplant (HSCT) patients, but there is little evidence of its validity in Latin American populations. This study evaluated the psychometric properties of the Spanish languag...

Objective Describe and analyze the mental health service and medical needs of a group of transgender men from the point when they changed their gender identity to male. Material and method Transgender men volunteers who attended a specialized care center in Mexico City answered a qualitative semi-structured interview to explore their needs as well...

Purpose of review: To provide an update of recent or relevant studies on posttraumatic stress disorder (PTSD) in urban women, with a special focus on biopsychosocial risk factors. Recent findings: Urbanization itself can increase the risk for PTSD due to the concentration of poverty, substance use and crime. Women are usually at a greater social...

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with diffe...

Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical re...

Introduction. Benzodiazepines (BZDs) are some of the most frequently prescribed psychotropic medications in the world. Under proper prescription, BZDs have sedative and antianxiety properties useful for specific purposes in the treatment of several mental conditions, such as anxiety disorders and depression. For depression, BZDs are not routinely i...

Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting low awareness. We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among men who have sex with men (MSM) from these countries. Methods MSM were recruited t...

Abstract: The concept of psychopathy has shifted from people who commit crimes to those with a particular personality and deviant behaviors. Although antisocial personality disorder is associated with psychopathy, it also seems common in individuals with narcissistic personality traits. Psychopathy may be the expression of earlier, persistent patte...

Background: Psychiatrists may be at an increased risk of suicide, since they encounter stressful factors in their everyday activities in addition to the sociodemographic factors for suicidal ideation reported for Mexican population. Aim of the study: To determine whether experiences inherent to the profession were related to the self-report of s...

Background. Transgender individuals are often targets of abuse, bullying, harassment, discrimination and violence at school, which causes significant personal suffering and serious consequences for their education process. Research suggests that structural interventions and changes are needed to reduce these phenomena and ensure that schools functi...

Backgound: In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally. Aim of the study: To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depress...

Introduction: The World Health Organization (WHO) has made substantial changes to the classification of paraphilic disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), recently approved by the World Health Assembly. The most important is to limit paraphilic disorders primarily to...

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with diffe...