Blanca Reneses

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey

BACKGROUND Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. METHODS In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. FINDINGS 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. INTERPRETATION Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. FUNDING European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Stigma and discrimination against people with schizophrenia related to medical services.

Objective: To investigate whether people with schizophrenia experience discrimination when using health care services. Methods: A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Results: More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries. Conclusions: Mental health service providers have a key role in decreasing stigma in their provision of health care, and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will require a change of attitudes and practices among mental and physical health care staff.

Factors predicting drop-out in community mental health centres

This study aimed to identify treatment, therapist and patient factors associated with dropping out of treatment in four outpatient mental health services. The experimental group comprised all 789 individuals who attended for the first time the mental health services during one year and dropped out of treatment in the same year or during the two following ones. The control group consisted of the same number of individuals, chosen at random from patients who, in the same year, attended for the first time the services and did not subsequently drop out of treatment. The overall drop-out rate was 33.2%. According to logistic regression analysis, the predictive factors of dropping out were: being treated in a particular centre, the involvement of more than one therapist in treatment, having no previous history of psychiatric disorders, being young and being male.

The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt.

BACKGROUND Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. AIMS To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. METHODS Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). RESULTS 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. CONCLUSIONS Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

Dynamic risk control by human nucleus accumbens

The nucleus accumbens is a key node in the network linking reward to action. Studying a rare series of patients with bilaterally implanted electrodes in the nucleus accumbens, Nachev et al. show that external electrical stimulation of the accumbens dynamically shifts behaviour towards more risky decision making.

Capacidad de detección de patología psiquiátrica por el médico de familia

Resumen Objetivo Conocer la capacidad de detección de patología psiquiátrica por el médico de familia, comparando la presencia de patología psiquiátrica detectada mediante test validados y la referida por su médico de familia. Diseño Estudio transversal de doble fase. Emplazamiento Centros de Salud de un área urbana de Madrid. Participantes Pacientes entre 18 y 65 años que acuden a consulta por motivos no administrativos. Mediciones principales Para la detección de posible patología psiquiátrica, en la sala de espera se utilizaron instrumentos de cribado, el GHQ-28 (punto de corte 6 o superior) y el MULTICAGE CAD-4 (punto de corte 2 o superior). Como instrumento de identificación de «caso» en la segunda fase se utilizó la entrevista MINI en los pacientes con puntuación positiva en uno de los instrumentos de cribado y un 20% de los negativos. Por otro lado, cuando los pacientes entraban en la consulta entregaban a su médico una tarjeta con un número de identificación para que, de manera ciega, registrase: presencia de patología psiquiátrica actual según su criterio y existencia, o no, de tratamiento actual con psicofármacos. Resultados Participaron 628 sujetos. La prevalencia de patología psiquiátrica corregida por metodología de doble fase fue del 31,7% (IC 95%: 27,9-35,5). De 185 pacientes con patología psiquiátrica detectada, el 44,2% (IC 95%: 36,7-51,7) fueron identificados como pacientes con patología psiquiátrica por su médico de familia. Las patologías mejor identificadas fueron: hipomanía, trastorno distímico, episodio depresivo con síntomas melancólicos y trastorno por angustia. Conclusiones Un porcentaje importante de pacientes con patología psiquiátrica detectada con test validados no han sido identificados por su médico de familia.

Quality of the written information about suicide attempters.

INTRODUCTION: The aim of the study was to assess the quality of the clinical records of the patients who are seen in public hospitals in Madrid after a suicide attempt in a blind observation. METHODS: Observational, descriptive cross-sectional study conducted at four general public hospitals in Madrid (Spain). Analyses of the presence of seven indicators of information quality (previous psychiatric treatment, recent suicidal ideation, recent suicide planning behaviour, medical lethality of suicide attempt, previous suicide attempts, attitude towards the attempt, and social or family support) in 993 clinical records of 907 patients (64.5% women), ages ranging from 6 to 92 years (mean 37.1±15), admitted to hospital after a suicide attempt or who committed an attempt whilst in hospital. RESULTS: Of patients who attempted suicide, 94.9% received a psychosocial assessment. All seven indicators were documented in 22.5% of the records, whilst 23.6% recorded four or less than four indicators. Previous suicide attempts and medical lethality of current attempt were the indicators most often missed in the records. The study found no difference between the records of men and women (z=0.296; p=0.767, two tailed Mann-Whitney U test), although clinical records of patients discharged after an emergency unit intervention were more incomplete than the ones from hospitalised patients (z=2.731; p=0.006), and clinical records of repeaters were also more incomplete than the ones from non-repeaters (z=3.511; p<0.001). CONCLUSIONS: Clinical records of patients who have attempted suicide are not complete. The use of semi-structured screening instruments may improve the evaluation of patients who have self- harmed.

EPA-1323 - Stigma and discrimination associated with major depression in a spanish simple. a cross sectional study

Introduction The study of associated stigma to mental illness has been usually oriented to psychotic disorders. Recently the ASPEN Project has had the objective to study the stigma associated to depressive disorders worldwide. As a part of this study, we present the results of a Spanish sample. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder. Additionally we investigated whether experienced discrimination is related to severity of depression and level of self-esteem. Methods In a cross-sectional survey, 100 adult outpatients with a diagnosis of major depressive disorder were interviewed with the discrimination and stigma scale (version 12; DISC-12). Severity of depression and self-esteem were measured by the Hamilton-17 questionnaire and the Rosemberg scale respectively. Socio-demographic variables were included. Results the life domains where the major proportion of individuals experienced discrimination were: treatment by their family (46%), in marriage or divorce (30%) and been avoided or shunned by people who know their mental health problem (34%). 60% of patients anticipated discrimination avoiding intimate relationships and 67% of them concealed or hid his/her mental health problem from others. Experienced discrimination had a significant association with the severity of depression and with a low level of self-esteem. Conclusions Discrimination related to depression acts as a barrier in some fields of social life. Non-disclosure of depression could be a barrier to seeking help. It is important to consider effective actions to prevent stigma and discrimination in the field of depressive disorders. INDIGO-ASPEN Group

EPA-1135 – Psychotherapy focused on psychic representation (PFPR)for borderline personality disorders. rct results.

Introduction Psychotherapy Focused on Psychic Representation (PFPR) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a manualized psychodynamic technique based on brief psychoanalytic psychotherapies principles and designed to be applied in the framework of public care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PFPRs efficacy. We are reporting the final results at the end of treatment and at the 6 and 12 months of follow up. Methods Both groups, the experimental (n=25) and control group (n=28) received treatment as usual. The experimental group received 20 additional PFPR sessions performed by four therapists with homogenous characteristics, specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and conditions at the end of treatment and at the 6 and 12 months of follow up period were compared. Results and Conclusions Results showed significantly better outcomes for the experimental group in all main variables and in most of the secondary ones at the end of treatment. At 6 months follow up, the significant differences remain in level of impulsivity and some other secondary variables. At 12 months follow up the experimental group shows better results in all variables but only depressive symptoms measurement remains significant.