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…
Worry about COVID-19 contagion and general anxiety: Moderation and mediation effects of cognitive emotion regulation
The global pandemic caused by coronavirus disease 2019 (COVID-19) occasioned that most of the population in Spain was confined to home to reduce the risk of contagion. This affected mental health, increasing anxiety and worry about COVID-19 contagion. The aim of this study was assessing the moderation and mediation effect of cognitive emotion regulation strategies (CERS) on general anxiety and whether the mediation effect was moderated by gender and/or age. A total of 1753 Spanish adults (78,6% female; M = 40.4 years, SD = 12.9) participated in an online survey that was available from March 26 to April 25 (2020) during the time period in which the population in Spain was confined. Participa…
Transdiagnostic cognitive behavioral therapy versus treatment asusual in adult patients with emotional disorders in the primarycaresetting (PsicAP Study): protocol for a Randomized Controlled Trial
BACKGROUND Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)-anxiety, depression, and somatic symptom disorders-and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. OBJECTIVE We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability…
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…
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…
APROXIMACIÓN CONCEPTUAL Y PRÁCTICA A LOS MODELOS DE ECUACIONES ESTRUCTURALES
En el presente trabajo se expone una aproximación conceptual y práctica a los Modelos de Ecuaciones Estructurales o Structural Equation Modeling (SEM). Los SEM están considerados entre las herramientas más potentes para el estudio de relaciones causales en datos no experimentales. Son una combinación del análisis factorial y la regresión múltiple y están compuestos por dos componentes: el modelo de medida y el modelo estructural. El modelo de medida describe la relación existente entre una serie de variables observables; mientras que en el modelo estructural se especifican las relaciones hipotetizadas entre las variables, es decir, se describen las relaciones entre las variables latentes me…
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…
Screening for generalized anxiety disorder in Spanish primary care centers with the GAD-7.
The aim of the study was to determine the criterion validity of a computerized version of the General Anxiety Disorder-7 (GAD-7) questionnaire to detect general anxiety disorder in Spanish primary care centers. A total of 178 patients completed the GAD-7 and were administered the Composite International Diagnostic Interview (CIDI) for DSM-IV Axis I Disorders, which was used as a reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. A cut-off of 10 yielded a sensitivity of .87, a specificity of .78, a positive predictive value of .93, a negative predictive value of .64, a positive likelihood ratio o…
Conceptions of happiness and its relationship with subjective well-being: A study through Natural Semantic Networks
La búsqueda de la felicidad es uno de los fines más ansiados por los seres humanos. Así mismo, cada vez son más los estudios dentro de la psicología que buscan hallar cuáles son los factores involucrados en la felicidad. Existen dos grandes enfoques para su estudio, el paradigma hedonista y el paradigma eudaimónico. El paradigma hedónico propone que el bienestar depende principalmente de vivir una vida con experiencias placenteras; mientras que el paradigma eudaimónico refiere que el bienestar no solo se logra mediante el placer, sino principalmente a través de la actualización del potencial humano. En el presente estudio se trabajó con una muestra compuesta por 340 ciudadanos de Córdoba (A…
Cost-effectiveness and cost-utility analysis of the treatment of emotional disorders in primary care: psicap clinical trial. description of the sub-study design
Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, moo…
Terapia cognitivo-conductual transdiagnóstica en atención primaria: un contexto ideal.

 
 
 La eficacia, efectividad y eficiencia de la Terapia Cognitivo-Conductual (TCC) para una amplia variedad de problemas psicológicos, particularmente para los trastornos de ansiedad y la depresión, cuenta con mayor apoyo empírico que ninguna otra forma de intervención psicológica. Sin embargo, sólo una pequeña parte de las personas con trastornos mentales comunes recibe un tratamiento adecuado. La expansión del enfoque transdiagnóstico en los trastornos mentales, especialmente en el contexto de Atención Primaria (AP), donde son tratados la mayor parte de las personas con trastornos mentales comunes, puede servir para facilitar el acceso a los tratamientos psicológicos efic…
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…
El psicólogo interno residente (PIR) en atención primaria: experiencia en el Complejo Hospitalario Universitario de Albacete
En los últimos tiempos se ha detectado un interés creciente en la inclusión de psicólogos clínicos (PC) en el ámbito de la atención primaria (AP), puesto que una parte significativa de las consultas de este nivel están relacionadas con problemas de salud mental, aumentando la presión asistencial de los médicos y ocasionando un elevado coste económico. La presencia del PC en AP mejoraría la accesibilidad de este servicio, revirtiendo en una mejor calidad asistencial. En varios países se han implementado programas en esta línea, existiendo algunos intentos pioneros en España. Uno de los cambios significativos en este sentido ha sido la inclusión desde el año 2009 de la rotación por AP como ob…
Victimization and Peer and Parents Attachment: The Mediating Effect of Regulatory Emotional Self-Efficacy
Studies of the Spanish adolescent population has concluded that victimization is related to lack of emotional regulation and impulse control. Therefore, if a victim is unable to recognize, understand and regulate their emotions, this can result in rejection by their peers. A cross-sectional study was conducted to examine regulatory emotional self-efficacy as a possible mediator in the association between peer and parents attachment and victimization. Adolescents (n = 563) completed Regulatory Emotional Self-Efficacy, Inventory of Parents and Peer Attachment and Kid at School questionnaires. Structural equation models (SEMs) were used to predict a latent variable of victimization with parent…
The PHQ-PD as a screening tool for panic disorder in the primary care setting in Spain
INTRODUCTION Panic disorder is a common anxiety disorder and is highly prevalent in Spanish primary care centres. The use of validated tools can improve the detection of panic disorder in primary care populations, thus enabling referral for specialized treatment. The aim of this study is to determine the accuracy of the Patient Health Questionnaire-Panic Disorder (PHQ-PD) as a screening and diagnostic tool for panic disorder in Spanish primary care centres. METHOD We compared the psychometric properties of the PHQ-PD to the reference standard, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. General practitioners referred 178 patients who completed the entir…
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…
Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres.
Abstract Background The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. Methods A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluat…
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 …
An appraisal of the fit of a cognitive behavioural model of headache in University students
The aim of this study was to evaluate the fit of a cognitive behavioural model of headache in the population of University students, from Córdoba,Argentina. The direct and indirect contributions to pain intensity of control beliefs, beliefs and thoughts about pain and coping strategies weredetermined, as were the direct contributions of pain behaviours and disability. The sample was comprised of 382 students of both genders fromseveral Universities. Multiple instruments were administered to measure the variables proposed in the cognitive behavioural model of headachefollowed by a descriptive and exploratory analysis of the data. Structural equation modelling was used and revealed an accepta…
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…
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…
Procesos cognitivos y regulación emocional: aportes desde una aproximación psicoevolucionista
Resumen Antecedentes La psicologia evolucionista plantea que existirian procesos cognitivos arcaicos que favorecieron la supervivencia de nuestros antepasados. Al ser evolutivamente antiguos se asentarian sobre estructuras subcorticales, lo cual genera que sean automaticos y dificulten la regulacion emocional. Objetivo En este trabajo se analizo el papel de procesos cognitivos automaticos y elaborativos sobre las respuestas de ansiedad. Metodo Se utilizaron analisis con ecuaciones estructurales (N = 386). Resultados Se verifico la plausibilidad de dos modelos de procesamiento (automatico vs. elaborativo), con una contribucion directa e intensa de los procesos automaticos sobre la ansiedad (…
Traditional Masculinity and Aggression in Adolescence: Its Relationship with Emotional Processes
Traditional masculinity includes norms that encourage many of the aggressive behaviors whereas traditional femininity emphasizes aggression very little. In addition, the lack of emotional regulation as well as a poor impulse control have been related to aggression and, in particular, with reactive and proactive aggression. The objective of this study is to examine the role of gender stereotypes (masculinity/femininity) in reactive and proactive aggression, through regulatory emotional self-efficacy and emotion regulation. A total of 390 adolescents participated in a longitudinal study in Valencia, Spain. Structural equations modeling (SEM) was employed to explore a two-wave longitudinal mod…