The association between different domains of quality of life and symptoms in primary care patients with emotional disorders
AbstractDespite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionn…
Tratamiento psicológico de los trastornos emocionales en Atención Primaria: el manual de tratamiento transdiagnóstico del estudio PsicAP
Resumen Una parte sustancial de las consultas de Atencion Primaria (AP) tiene como motivo principal algun tipo de trastorno emocional, especialmente los relacionados con la depresion, la ansiedad y las somatizaciones. Estos trastornos mentales mas comunes tienen altos costes para los afectados y para la sociedad en general. Pese a la existencia de terapias psicologicas que han demostrado ser eficaces para esos trastornos, rara vez se utilizan en el primer nivel asistencial. El objetivo del proyecto de Psicologia en Atencion Primaria (PsicAP) es demostrar la eficacia de una terapia de cognitivo-conductual grupal transdiagnostica para tratar los trastornos emocionales mas frecuentes en AP. Es…
The relevance of cognitive, clinical and premorbid variables in predicting functional outcome for individuals with first-episode psychosis: A 3 year longitudinal study
Real-world functional deficits are common and persistent in individuals with psychosis. Cognitive deficits have been shown to compromise functioning. We aimed to study the predictive values of premorbid, sociodemographic, and baseline clinical and neurocognitive factors on long-term functional outcome for individuals with first episode non-affective psychosis. We failed to demonstrate a significant relationship between cognitive deficits at baseline and functional disability at 3 year follow-up. Diagnosis of schizophrenia (OR=2.457, p=0.011), shorter education (OR=1.177, p=0.005) and poor premorbid social adjustment (OR=1.628, p=0.013) emerged as the strongest predictors for the 114 subject…
Factorial invariance of a computerized version of the GAD-7 across various demographic groups and over time in primary care patients.
Abstract Background The Generalized Anxiety Disorder 7-item scale (GAD-7) is commonly used by clinicians and researchers to screen for anxiety disorders and to monitor anxiety symptoms in primary care. However, findings regarding its factor structure are mixed, with most studies reporting a best-fitting for a one-factor structure, whereas others indicate a two-factor model. To be valid for comparisons, the GAD-7 should measure the same latent construct with the same structure across groups and over time. We aimed to examine the best-fit factor structure model of the GAD-7 among primary care patients and to evaluate its measurement invariance. Methods A total of 1255 patients completed the c…
Modelo jerárquico de diagnóstico y derivación de los trastornos mentales comunes en centros de atención primaria. Una propuesta a partir del ensayo clínico PsicAP
Resumen Los trastornos mentales comunes son los mas prevalentes en atencion primaria (AP) en Espana. Desgraciadamente existe un porcentaje elevado de casos que no son detectados correctamente, tanto por infradiagnostico como por sobrediagnostico. Una incorrecta deteccion de estos trastornos conlleva que los pacientes no sean derivados correctamente, asi como que un 39% no reciba ningun tratamiento y solo uno de cada 3 pacientes tratados siga un tratamiento minimamente basado en la evidencia. En el ensayo clinico PsicAP se han estudiado las propiedades psicometricas del Patient Health Questionnaire (PHQ) y sus diferentes modulos, de ansiedad (GAD-7), depresion (PHQ-9) y panico (PHQ-PD), asi …
A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care
Abstract Background The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting. Method A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ. In addition, 178 of these patients also underwent in clinical interviews as a gold standard. Result…
The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial
Background: Emotional disorders are highly prevalent in primary care. Transdiagnostic cognitive behavior therapy (TD-CBT) is a promising treatment of emotional disorders. In this study, we evaluated several emotion regulation strategies as potential mediators of treatment outcomes in a clinical sample of primary care. Methods: A total of 1061 primary care patients were included in a randomized clinical trial comparing treatment- as-usual (TAU) to TD-CBT+TAU. Of these, 631 (TAU=316; TD-CBT+TAU=315) completed the full treatment and all pre- and post-treatment scales to assess symptoms (anxiety, depression, somatization), emotion regulation strategies (worry, rumination, negative metacognition…
Factor structure and measurement invariance across various demographic groups and over time for the phq-9 in primary care patients in spain
The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance w…
Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP
Resumen El proyecto Psicologia en Atencion Primaria (PsicAP) pretende promover el tratamiento psicologico basado en la evidencia para los trastornos emocionales en atencion primaria. Este trabajo presenta los fundamentos teoricos y empiricos del programa de tratamiento de PsicAP, destacando 4 aspectos clave: la evidencia sobre la eficacia del tratamiento cognitivo-conductual, el modelo de tratamiento escalonado, el enfoque transdiagnostico y el formato de tratamiento grupal. Por ultimo, se destacan las implicaciones practicas de esta iniciativa que puede ayudar a reducir la distancia entre la investigacion sobre la eficacia de los tratamientos psicologicos y la practica clinica, asi como la…
Latent structure and factor invariance of somatic symptoms in the patient health questionnaire (PHQ-15).
Abstract Background Somatic symptoms are highly prevalent in primary care although insufficiently understood. The Patient Health Questionnaire (PHQ-15) is a valuable screening test but it has not yet been possible to unequivocally demonstrate its latent structure and measurement invariance. Methods A total of 1,255 patients from 28 primary care centres suffering symptoms of anxiety, depression or somatisation participated in a clinical trial. They completed the PHQ-15 at baseline and 374 retook it at three months. Exploratory structural equation modelling (ESEM) was used to compare three models: 1) a single global factor for somatisation, 2) four specific correlated factors, and 3) a bifact…
Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol
Abstract Background Emotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of t…
Validity of Brief Scales for Assessing Transdiagnostic Cognitive Emotion Regulation Strategies in Primary Care Patients With Emotional Disorders
Abstract. Cognitive emotion regulation strategies have been proposed as an explanation for transdiagnostic vulnerability to emotional disorders, which are highly prevalent in the primary care setting. The use of brief psychological instruments to detect cognitive-emotional factors – such as worry, rumination, interpretative and attentional distortions, and metacognitions – could provide valuable clinical data to better guide treatment in primary care. The aim of the present study was to evaluate the psychometric properties of four brief scales derived from the full versions of four assessment instruments (PSWQ, RRS, IACTA, and MCQ-30). The brief scales were completed by 1,250 primary care …
Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients
Abstract This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was assoc…
The factor structure of the Medical Outcomes Study-Social Support Survey: A comparison of different models in a sample of recently diagnosed cancer patients
[EN] Objective: To analyse the factor structure and psychometric properties of the original and abbreviated versions of the Medical Outcomes Study-Social Support Survey (MOS-SSS) in recently-diagnosed cancer patients. Method: A sample of 128 newly-diagnosed cancer patients were assessed with the Spanish versions of the MOS-SSS and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses were conducted to analyse six different factor structures. Internal consistency and convergent validity indexes were calculated. The models tested included all of the following: 1) the original five-factor model (comprised of the following dimensions: emotional, informational, and tangi…
Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica
Resumen Trastornos mentales comunes hace referencia a los mas prevalentes, en especial trastornos de ansiedad, trastornos del animo y, a veces, somatizaciones. Se trata de desordenes emocionales muy presentes en Atencion Primaria, con un 49.2% de probables casos, presentando una frecuente asociacion con varias enfermedades cronicas. Por su alta prevalencia, asi como por el alto porcentaje de casos no tratados y el bajo porcentaje que siguen un tratamiento minimamente basado en la evidencia, generan los mayores costes y carga entre los trastornos mentales. Sin embargo, existen diferentes enfoques y metodologias a la hora de cuantificar su impacto. El objetivo de este estudio es llevar a cabo…
Differential associations of cognitive insight components with pretreatment characteristics in first-episode psychosis
An increasing number of studies have focused on cognitive insight (i.e. awareness of one's own thinking) in psychotic disorders. However, little is known about the premorbid and pretreatment correlates of cognitive insight in the early course of psychosis. One hundred and three patients experiencing first-episode psychosis (FEP) were assessed shortly after treatment initiation for cognitive insight. Pretreatment and baseline clinical, functional and neurocognitive characteristics were examined. The self-reflectiveness dimension of cognitive insight was independently associated with clinical insight and executive functioning, whereas self-certainty was associated with premorbid IQ, premorbid…