Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.
Abstract: Language is being systematized as an area of clinical research because it contains features that function as a biomarker for the prediction of psychosis. The aim of the study was to contrast two types of continuity features such as connection, iteration, and referential distance, and, on the other hand, those of verbal fluency, understood as the presence of aberrant pauses. Clinical interviews of 10 patients diagnosed with schizophrenia, 10 CHR and 10 healthy controls were analyzed. For the analysis of referentiality, sentence windows were selected and for verbal fluency, 15 minutes of speech were considered. The results suggest the presence of abnormalities in referentiality and verbal fluency among the CHR population. These similarities are found in terms of occurrence and similarity to those of the schizophrenia group, which supports our hypothesis that they are predictive biomarkers. Keywords: Biomarker. Referentiality. Verbal Fluency. Mental States of High-Risk Psychosis.
Background: The Generalized Anxiety Disorder 7-item (GAD-7) scale is widely used for the assessment of generalized anxiety disorder. Aim: To adapt the GAD-7 to the Chilean adolescent population and to evaluate its psychometric properties. Material and Methods: The GAD-7 was adapted and administered to 2,022 adolescents between 13 and 19 years of age, recruited from eight schools in the northern area of Santiago, Chile. Other self-report instruments were used to assess depressive symptoms and health-related quality of life. The one factor structure and invariance by sex were examined using Confirmatory Factor Analysis. Its reliability and validity based on its relationship with other variables were assessed. Results: The one-factor structure and invariance by sex were confirmed. The results showed an adequate internal reliability (Cronbach’s alpha = 0.86, Spearman-Brown coefficient = 0.82). As expected, significant correlations were observed with measures of depressive symptoms and health-related quality of life. Higher scores were observed in women than in men. Conclusions: The Chilean version adapted for adolescents of the GAD-7 has good psychometric properties. Thus, it may be a useful and valid instrument for the assessment of generalized anxiety disorder in adolescents in Chile.
Knowing the state of mental health research in adolescents and youth can be an important tool for decision-making, especially in contexts of limited resources. The aim of this study is to map the scientific research on adolescent and youth mental health in Chile using an ontological framework. We have mapped the population of research articles on mental health of adolescents and youth in Chile in Scopus, Web of Science, and SciELO databases onto the ontology. The PRISMA reporting guidelines were used to screen the 1688 items based on relevance, duplication, and version. The corpus of 346 articles was coded into the ontology through an iterative process among the seven authors. This ontological mapping shows isolated research efforts that have been carried out in Chile to explain the whole state of mental health in adolescents and youth. There is a lack of coordination between the priorities established by the decision-makers and the researchers. Our results coincide with the need to strengthen mental health research in the country, and to prioritizing those topics that contribute to decision-making based on the needs of the population.
En todo el mundo se han descrito efectos negativos de la pandemia de COVID-19 en la salud mental, especialmente en la población infanto-juvenil. Sin embargo, en Chile, la investigación disponible aún no se ha sistematizado. El objetivo de este estudio fue revisar sistemáticamente las publicaciones científicas sobre salud mental infanto-juvenil en Chile durante la pandemia de COVID-19. Se buscaron reportes de investigación en las bases de datos WoS, Scopus, SciELO y LILACS. Se incluyeron 13 estudios que cumplieron los criterios de inclusión. Los estudios son heterogéneos en cuanto a sus objetivos e instrumentos utilizados. Varios estudios coinciden en que hay un aumento de los síntomas internalizantes, externalizantes y somáticos en la población infanto-juvenil desde la pandemia. Es necesario promover investigaciones colaborativas y longitudinales e investigaciones que evalúen la eficacia de intervenciones preventivas y terapéuticas. Estos resultados pueden ser útiles para clínicos, académicos y tomadores de decisión en políticas públicas para que puedan adoptar medidas para mejorar la salud mental de esta población.
The COVID-19 pandemic has harmed the mental health of young people. This study aimed to assess the influence of the COVID-19 pandemic on the mental wellbeing of Chilean university students, focusing on the role of adverse family events and stressful experiences related to COVID-19. An online survey was conducted in 2021 with first-year students from five universities, including questions on sociodemographic characteristics and COVID-19-related events and experiences. Mental well-being was measured with the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Multivariate ordinal logistic regression models were used to assess the association between different factors and mental wellbeing and perceived worsening mood. A total of 4,795 university students participated in the current study (mean age = 19.26 ± 2.43; 66% females). Of the students, 64.9% reported that their mood was worse or much worse compared with the prepandemic context, and 69.9% had at least one adverse event due to COVID, where the most frequent was a decreased household income (44.9%). Multivariate linear and ordinal logistic regression analysis revealed that the risk factors for mental wellbeing and perceived worsening mood after controlling for sex and age were a higher number of family adverse events due to COVID-19, economic difficulties, problems in the relationship with family and friends, difficulties studying at a distance, and not having adequate study space. The finding of this research highlights the importance of implementing strategies and interventions to promote better mental health among Chilean university students. Keywords: university students, wellbeing, COVID-19, stressful experiences
Background: Despite numerous efforts to assess the impact of the COVID-19 pandemic on mental health, there are few longitudinal studies that examine the change in the burden of psychological distress over time and its associated factors, especially in developing countries. Objective: The primary aim of this study was to assess the levels of psychological distress at two time points during the COVID-19 outbreak based on a representative community sample in Chile. The secondary aim was to identify groups that are more vulnerable to psychological distress during the pandemic. Methods: A nationally representative, longitudinal telephone survey of Chilean adults was conducted. This study analyses panel data from two waves in 2020: May 30 to June 10 and September 15 to October 9. A total of 823 people participated in both surveys. Changes in mental health outcomes (anxiety and depressive symptoms) were assessed, estimating the effect of demographic characteristics, psychosocial and economic factors, household conditions, and health status. Results: There was a significant increase in psychological distress (PHQ-4 ≥ 6) between Waves 1 (22.6%) and 2 (27.0%), especially among younger participants. Overall, the results of this study show that being female, living in or near the capital, living in overcrowded households and having a perceived lack of space in the home, loneliness or perceived social isolation, and having received mental health treatment within the last year are significantly associated with psychological distress over time (p < 0.05). Conclusion: This study highlights the need to implement psychosocial programs to protect people's psychological well-being, as well as social policies to improve household living conditions and levels of social connectedness during the COVID-19 outbreak. Keywords: COVID-19, lockdown, social determinants of mental health, psychological distress, anxiety symptom, depressive symptom, longitudinal survey, Chile
Resumen: Las desigualdades en las condiciones de vida impactan negativamente sobre la salud mental de las personas y comunidades. Este artículo tiene por objetivo describir algunas de las principales líneas de investigación y reflexión en torno a la relación entre desigualdad y salud mental. Más que una revisión sistemática, se trata de una discusión orientada a contribuir al debate público en torno a las dimensiones materiales, simbólicas y subjetivas de la desigualdad, mencionando algunos mecanismos que permiten comprender su relación con la salud mental. Entre estas dimensiones abordamos las desigualdades de ingreso y de género, además de otras que han recibido menor atención en los estudios nacionales e internacionales: las desigualdades en la participación, en la interacción cotidiana, y las desigualdades socio-territoriales y en el uso del tiempo. Finalmente, mencionamos algunas limitaciones teóricas de la investigación tradicional sobre desigualdad en salud y sugerimos potenciales líneas de investigación que pueden orientar los estudios en torno a desigualdades y salud mental. Palabras clave: Salud mental, Desigualdad, Determinantes Sociales, Chile Abstract: Inequalities in living conditions negatively impact the mental health of individuals and communities. This article aims to describe some of the main lines of research and reflection on the relationship between inequality and mental health. More than a systematic review, it contributes to the public debate about the material, symbolic and subjective dimensions of inequality, emphasising some mechanisms that allow for understanding its relationship with mental health. Among these dimensions we address income and gender inequalities in addition to others that have received less attention in national and international studies: inequalities in participation, in daily interaction, and socio-territorial and time-use inequalities. Finally, we mention some theoretical limitations of traditional research on health inequality and suggest potential lines of research that can guide studies on inequalities and mental health. Keywords: Mental health, Inequality, Social Determinants, Chile
The rapid internet penetration in Latin American countries has made it possible to implement digital mental health interventions. “Cuida tu Ánimo” (Take Care of Your Mood) is an internet-based program for the prevention and early intervention of depression in adolescents. A pilot study was conducted in Chile and Colombia to study the feasibility and acceptability of the program and estimate its effects. There were 199 participants (53.3% women; mean age = 14.8 years, SD = 1.0) recruited from two schools in Chile and two schools in Colombia. Qualitative and quantitative methods were applied for data collection and analyses. Although the levels of acceptance were moderate to high across all variables, adherence was lower than expected. The participants deemed important for an intervention of this type offered a higher level of interaction with team members through internet-based and face-to-face activities. Post-intervention outcomes show a reduction in depressive and anxious symptoms in adolescents in Chile, while there were no significant changes in the level of symptomatology in adolescents in Colombia. The women used the program more than the men. Results show the need to improve the intervention by increasing its levels of customization and developing strategies to achieve better adherence. The contradictory results of the program in Chile and Colombia suggest the importance of other variables beyond the content of the intervention, such as the setting or context of the intervention. Keywords: adolescent; depression; prevention; internet-based interventions; e-mental health
Background: There are marked differences associated with socioeconomic factors in the prevalence of depressive symptoms (DS) in men and women. Aim: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. Material and Methods: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. Results: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. Conclusions: There is a combined effect between socioeconomic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women. Keywords: Chile, Depression, Gender, Mental Health, Poverty (Rev Med Chile 2021; 149: 533-542)
La pandemia por COVID-19 ha tenido un impacto negativo en el bienestar psicológico de la población. El objetivo de este estudio fue evaluar el impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios(as) en Chile, explorando el rol de los acontecimientos adversos en el núcleo familiar y las experiencias negativas relacionadas. Contestaron una encuesta en línea 2.411 estudiantes de primer año de una universidad en Chile. Tres de cada cuatro estudiantes reportaron que su estado de ánimo era peor o mucho peor en comparación con el contexto pre-pandémico. Las estudiantes mujeres presentaron significativamente mayores niveles de sintomatología depresiva y ansiosa y reportaron de forma significativa una mayor percepción de empeoramiento del estado de ánimo. Los hallazgos de este estudio refuerzan la necesidad de implementar intervenciones y estrategias orientadas a favorecer una mejor salud mental de los(as) estudiantes universitarios(as) en Chile. Palabras Claves: COVID-19, salud mental, estudiantes universitarios, sintomatología depresiva, sintomatología ansiosa. The COVID-19 pandemic has had a negative impact on the psychological well-being of the population. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the mental health of university students in Chile, exploring the role of adverse events in the family and related negative experiences. An online survey was answered by 2,411 first-year students from a university in Chile. Three out of four students reported that their mood was worse or much worse compared to the pre-pandemic context. Female students presented significantly higher levels of depressive and anxious symptoms and reported significantly greater perception of worsening mood. The findings of this study reinforce the need to implement interventions and strategies aimed at promoting better mental health for university students in Chile. Keywords: COVID-19, mental health, university students, depressive symptoms, anxious symptoms.
Jóvenes lesbianas, gays, bisexuales y trans (LGBT+) manifiestan más problemas de salud mental y consumo de sustancias que sus pares heterosexuales y cisgénero (HC), sin embargo, no hay suficiente evidencia de estas diferencias en Chile. El objetivo fue comparar la prevalencia de sintomatología depresiva, ideación suicida, consumo de sustancias y tratamiento de salud mental de jóvenes LGBT+ y HC. Se realizó un análisis secundario de la 9na Encuesta Nacional de Juventud 2018 (n = 9.700; 15-29 años) que incluyó auto-reporte de síntomas depresivos, ideación suicida, consumo de sustancias (alcohol, tabaco, marihuana, cocaína y pasta base), tratamiento de salud mental actual y percepción de barrera económica de acceso a tratamiento. Mediante modelos de regresión logística múltiple se estimaron razones de prevalencia ajustadas. Jóvenes LGBT+ tuvieron más sintomatología depresiva alta, ideación suicida, consumo de tabaco, marihuana, cocaína y/o pasta base y usan más servicios de salud mental que los/as jóvenes HC. No hubo diferencias en el consumo de alcohol y en la percepción de barrera económica de acceso a tratamiento. Los resultados muestran que jóvenes LGBT+ en Chile poseen peores resultados en salud mental y consumo de sustancias que jóvenes HC, por lo que las políticas públicas orientadas a disminuir los problemas de salud mental debieran considerar estas diferencias.
Major depressive disorder (MDD) affects between 4 and 5% of adolescents. However, there is still a huge gap between adolescents who meet criteria for MDD and those who receive mental health care. Stigmatizing attitudes toward depression are among the main barriers to seeking professional help. The aim of this article is to examine the individual characteristics associated with stigmatizing attitudes toward depression in a sample of adolescent school students from Chile and Colombia, and present the adaptation and psychometric properties of the Personal Depression Stigma Scale (DSS-Personal) for both countries. A total of 2971 adolescents, aged 10–19 (M = 14.6, SD = 1.5), who were recruited from eight schools in Santiago, Chile (n = 2022), and eight schools in Medellín, Colombia (n = 949), completed the DSS-Personal, the Patient Health Questionnaire (PHQ-9), and a questionnaire of individual sociodemographic characteristics. Factor structure, internal consistency, and validity of the DSS-Personal were assessed. Multiple linear regression models were used to evaluate the association between DSS-Personal scores and sociodemographic information, depression scores, and the use of health services by country. Confirmatory factor analysis supported the unidimensional structure of the DSS-Personal, while the estimated reliability of its scores was acceptable. Results show that DSS-Personal scores were higher in adolescents in Colombia than in Chile (U = 9.36, p < 0.001). Immigrant status was the only variable significantly related to personal depression stigma in both samples. Being female was associated with lower levels of stigma in adolescents in Chile, while depressive symptoms were associated with lower levels of stigma in adolescents in Colombia. Age, having been diagnosed with depression, and being in pharmacological or psychological treatment were not related to levels of personal depression stigma in either sample. The identified associated factors of personal depression stigma should be considered in the development of anti-stigma campaigns; also, gender differences require special attention. The results of this study suggest that it is important to offer school-based programs to reduce personal stigma, and that specific anti-stigma campaigns should address personal stigma in men and immigrants.
Los seres humanos podemos llegar a ser muy crueles con nosotros mismos. Y a través de la violencia autoimpuesta, podemos también llegar a ser muy crueles con el otro. Los adolescentes describen a menudo las autolesiones como un modo de regular las emociones y lidiar con el malestar. Sin embargo, en algunos casos las autolesiones pueden cumplir la función de agredir al Otro. Este ensayo aborda algunas relaciones entre las autolesiones en la adolescencia y expresiones sociales y estéticas de la crueldad en la cultura popular contemporánea (literatura, artes plásticas, internet).
En esta guía puedes encontrar Información fiable sobre las alteraciones del pensamiento, los sentidos y/o las emociones. Algunas palabras y secciones dirigidas a tus seres queridos (padres, hermanos, entre otros). Información sobre recursos a los que puedes acudir en caso de necesitarlo. Ilustraciones que acompañan al texto y tratan de hacerlo más comprensible y divertido.
Non-suicidal self-injury (scratching, cutting and burning on body tissue) has become a major problem among adolescents. Psychiatric and social science research has rarely examined non-suicidal self-injury beyond the clinical setting. More specifically, little attention has been paid to the lives of homeless youth, a group particularly at high risk of self-harm. This article aims to describe the meaning of self-injury in everyday life on the street, and its uses in the context of a life exposed to violence. Using the case study of Violeta, a 17-year-old girl who lives between the street and youth shelters in Santiago, Chile, this article shows how cutting emerges as a paradoxical practice of (self)care that is part of the subjective work of reconstructing a broken life. This paper develops a sociological reflection on self-injury demonstrating how individuals sometimes mobilize so-called “pathological” strategies to cope with the structural fragility of the (psychological and social) experience on the street and to maintain the stability of ordinary life.
Lo que hoy entendemos por inteligencia artificial está asociado a la planificación, la comprensión del lenguaje, el reconocimiento de objetos y sonidos, la resolución de problemas. Se trata de nuevos algoritmos que conducirían al aprendizaje acumulativo, emulando de esta manera el aprendizaje a través de la experiencia. En la última década hemos sido testigos del rápido progreso de la inteligencia artificial en diversos campos determinantes del quehacer humano. Tal como ocurre con cualquier tecnología, la IA viene acompañada de enormes desafíos y potenciales riesgos para la sociedad, por lo que es imperioso contar con conocimiento relevante que promueva el accionar para reducir o evitar los posibles efectos negativos. Numerosas iniciativas a nivel global dan cuenta de los esfuerzos por establecer formas de gobernanza de la IA para reducir sus potenciales impactos negativos y fortalecer los beneficios que puede brindar a la sociedad en campos como el futuro del trabajo, los sistemas de transporte autónomos, la salud, la educación, las finanzas, el comercio, entre otros. Sin duda son muchas las oportunidades que estas tecnologías pueden ofrecer, pero sabemos que existe un riesgo real de que, sin una intervención cuidadosa, la IA pueda exacerbar los desequilibrios estructurales, económicos, sociales y políticos, y reforzar aún más las desigualdades basadas en diferentes variables demográficas (incluyendo etnicidad, raza, género, identidad sexual y de género, religión, nacionalidad, edad y nivel educativo o socioeconómico) y así impactar negativamente las vidas de muchos jóvenes en el mundo, y en el caso particular que nos ocupa, de la juventud latinoamericana. Es por esto también que los estudios en la región adquieren suma relevancia, ya que estas tecnologías son creadas principalmente en países como Estados Unidos y China, lo que extiende las brechas no sólo en lo referente al acceso, sino en cómo estos sistemas están siendo diseñados, pensados y su consecuente impacto.
Background: There is a huge gap in the treatment of mental disorders in Latin America, especially among socioeconomically disadvantaged groups. Given the sharp increase in Internet access and the rapid penetration of smartphones in the region, the use of Internet-based technologies might potentially contribute to overcoming this gap and to provide more widely distributed and low-cost mental health care in a variety of contexts. Methods: We conducted a scoping review of the literature in order to systematically map the existing evidence on use of Internet-based interventions for prevention, treatment, and management of mental disorders across Latin American countries, as well as to identify existing gaps in knowledge. Six electronic databases were searched for published papers (PubMed, Embase, CINAHL, Web of Science, SciELO, and CENTRAL). Results: After the eligibility assessment, we identified 22 Internet-based studies carried out in Latin America for prevention, treatment, education, or facilitating self-management of mental disorders. Included studies mainly targeted depression (n = 11), substance misuse (n = 6), anxiety (n = 3), and mental health literacy for education and health professionals (n = 2). Most studies were undertaken in Brazil (n = 6), Mexico (n = 5), and Chile (n = 4). Only 3 studies were randomized controlled trials (RCTs), 4 were pilot RCTs, and 15 were naturalistic, acceptability, or feasibility studies. The three RCTs identified showed disparate results, but overall, there are challenges to face. Better results are seen in the short-term (postintervention or after 3 months), but most studies do not explore outcomes for long enough (follow-up after 6 or 12 months). Most of the feasibility and pilot studies showed reasonably good acceptability for a wide range of strategies but difficulties to engage and retain participants for long enough or adhering to established protocols. Conclusion: This study shows that Internet-based interventions for the prevention and treatment of mental disorders are growing rapidly in Latin America, but there are few studies on effectiveness and cost effectiveness, making it difficult to provide the evidence needed to justify scaling up these interventions. Keywords: Internet, technology, telepsychiatry, mental disorders, prevention, treatment, Latin America
The uneven distribution of mental health resources contributes to the burden of mental disorders in vulnerable groups, especially in developing countries. Internet-based interventions and digital technologies can contribute to reducing the gap between high prevalence of mental disorders, demand for treatment, and access to mental health care, thereby reducing inequities in mental health. This mini review summarizes the current state of the field of e-mental health research in Chile, showing its progress, limitations, and challenges. Internet-based interventions are at an early stage of development in Chile. The interventions included are heterogeneous in terms of participants (e.g., secondary students, patients, healthcare professionals) and contexts (e.g., rural, urban, schools, primary health care), aims, and modalities (e.g., website, online games). While these studies confirmed the feasibility of Internet-based interventions, the shortage of studies on effectiveness and cost-effectiveness makes it difficult to disseminate and scale up these Internet-based programs. However, the growing amount of knowledge accumulated in the Chilean context could guide practices in other developing countries for supporting the mental health of underserved populations.
Background: Subthreshold depression (SD) is an important mental health problem in adolescence given its high prevalence, comorbidity, and functional impairment. However, currently little is known about gender differences of SD in adolescence. The aim of this study was to examine gender differences in prevalence, clinical features, and associated factors in adolescents with subthreshold depressive episode (SDE). Methods: The participants were 2,022 adolescents between 9th and 11th grades (49.5% girls, 15.2 years average age) recruited from eight state-subsidized schools located in the northern part of Santiago, Chile. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Descriptive statistics, bivariate and multinomial logistic regression analyses were used. Results: The prevalence of SDE and major depressive episode were 16.5% (95% CI: 14.9-18.2) and 17.7% (95% CI: 16.1-19.4), respectively. Both mental health problems were more prevalent in females (p < 0.001). With regard to SDE, girls displayed a higher rate of depressive mood and sleep problems, while boys had greater anhedonia, problems related with concentration, and psychomotor retardation/agitation. High levels of dysfunctional thoughts and perceived social support were associated with SDE in females and males. Social problem solving and emotion regulation had a differentiated impact on SDE depending on gender. Conclusion: Depressive symptoms and SDE were found to be common health problems among adolescents in Chile. SDE had major gender differences in terms of prevalence, clinical features, and associated factors. These differences should be considered in the development of preventive and early interventions.