Jesús Montero-Marín

Perceived injustice in fibromyalgia: Psychometric characteristics of the Injustice Experience Questionnaire and relationship with pain catastrophising and pain acceptance

OBJECTIVE To validate a Spanish version of the Injustice Experience Questionnaire (IEQ), a measure of perceived injustice, in a fibromyalgia sample and to examine its relationship with pain catastrophising and pain acceptance. METHODS The IEQ was administered along with the Pain Visual Analogue Scale, the Fibromyalgia Impact Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale (PCS) and the Chronic Pain Acceptance Questionnaire (CPAQ) to 250 primary care patients with fibromyalgia. RESULTS The IEQ had good test-retest reliability (intraclass correlation coefficient=0.98) and internal consistency (Cronbachs α=0.92). The factor structure obtained was similar to the original validation study. The multiple regression analyses showed that perceived injustice (PI) accounted for significant pain-related outcomes after controlling pain intensity, PCS and CPAQ. Principal component analysis of both the IEQ and the CPAQ taken together showed that the two constructs do not represent opposite extremes of the same dimension. CONCLUSION The IEQ is a reliable assessment tool for measuring PI among patients with fibromyalgia. PI seems to be distinct from catastrophising, although the two constructs are very similar. The factor analysis showed that PI and acceptance represent related constructs, and this entails relevant implications for therapy, as acceptance-based interventions would be appropriate.

The efficacy of mindfulness-based interventions in primary care: a meta-analytic review

PURPOSE Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. METHODS We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. RESULTS The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I2 = 59; P <.05). We found no indication of publication bias in the overall estimates. MBIs were efficacious for improving mental health (g = 0.56; P = .007), with a high heterogeneity (I2 = 78; P <.01), and for improving quality of life (g = 0.29; P = .002), with a low heterogeneity (I2 = 0; P >.05). CONCLUSIONS Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care.

Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS)

BackgroundSelf-compassion is a key psychological construct for assessing clinical outcomes in mindfulness-based interventions. The aim of this study was to validate the Spanish versions of the long (26 item) and short (12 item) forms of the Self-Compassion Scale (SCS).MethodsThe translated Spanish versions of both subscales were administered to two independent samples: Sample 1 was comprised of university students (n = 268) who were recruited to validate the long form, and Sample 2 was comprised of Aragon Health Service workers (n = 271) who were recruited to validate the short form. In addition to SCS, the Mindful Attention Awareness Scale (MAAS), the State-Trait Anxiety Inventory–Trait (STAI-T), the Beck Depression Inventory (BDI) and the Perceived Stress Questionnaire (PSQ) were administered. Construct validity, internal consistency, test-retest reliability and convergent validity were tested.ResultsThe Confirmatory Factor Analysis (CFA) of the long and short forms of the SCS confirmed the original six-factor model in both scales, showing goodness of fit. Cronbach’s α for the 26 item SCS was 0.87 (95% CI = 0.85-0.90) and ranged between 0.72 and 0.79 for the 6 subscales. Cronbach’s α for the 12-item SCS was 0.85 (95% CI = 0.81-0.88) and ranged between 0.71 and 0.77 for the 6 subscales. The long (26-item) form of the SCS showed a test-retest coefficient of 0.92 (95% CI = 0.89–0.94). The Intraclass Correlation (ICC) for the 6 subscales ranged from 0.84 to 0.93. The short (12-item) form of the SCS showed a test-retest coefficient of 0.89 (95% CI: 0.87-0.93). The ICC for the 6 subscales ranged from 0.79 to 0.91. The long and short forms of the SCS exhibited a significant negative correlation with the BDI, the STAI and the PSQ, and a significant positive correlation with the MAAS. The correlation between the total score of the long and short SCS form was r = 0.92.ConclusionThe Spanish versions of the long (26-item) and short (12-item) forms of the SCS are valid and reliable instruments for the evaluation of self-compassion among the general population. These results substantiate the use of this scale in research and clinical practice.

A newer and broader definition of burnout: Validation of the "Burnout Clinical Subtype Questionnaire (BCSQ-36)"

BackgroundBurnout syndrome has been clinically characterised by a series of three subtypes: frenetic, underchallenged and worn-out, with reference to coping strategies for stress and frustration at work with different degrees of dedication. The aims of the study are to present an operating definition of these subtypes in order to assess their reliability and convergent validity with respect to a standard burnout criterion and to examine differences with regard to sex and the temporary nature of work contracts.MethodAn exploratory factor analysis was performed by the main component method on a range of items devised by experts. The sample was composed of 409 employees of the University of Zaragoza, Spain. The reliability of the scales was assessed with Cronbachs α, convergent validity in relation to the Maslach Burnout Inventory with Pearsons r, and differences with Students t-test and the Mann-Whitney U test.ResultsThe factorial validity and reliability of the scales were good. The subtypes presented relations of differing degrees with the criterion dimensions, which were greater when dedication to work was lower. The frenetic profile presented fewer relations with the criterion dimensions while the worn-out profile presented relations of the greatest magnitude. Sex was not influential in establishing differences. However, the temporary nature of work contracts was found to have an effect: temporary employees exhibited higher scores in the frenetic profile (p < 0.001), while permanent employees did so in the underchallenged (p = 0.018) and worn-out (p < 0.001) profiles.ConclusionsThe classical Maslach description of burnout does not include the frenetic profile; therefore, these patients are not recognised. The developed questionnaire may be a useful tool for the design and appraisal of specific preventive and treatment approaches based on the type of burnout experienced.

Coping with stress and types of burnout: explanatory power of different coping strategies.

Background Burnout occurs when professionals use ineffective coping strategies to try to protect themselves from work-related stress. The dimensions of ‘overload’, ‘lack of development’ and ‘neglect’, belonging to the ‘frenetic’, ‘under-challenged’ and ‘worn-out’ subtypes, respectively, comprise a brief typological definition of burnout. The aim of the present study was to estimate the explanatory power of the different coping strategies on the development of burnout subtypes. Methods This was a cross-sectional survey with a random sample of university employees, stratified by occupation (n = 429). Multivariate linear regression models were constructed between the ‘Burnout Clinical Subtypes Questionnaire’, with its three dimensions –overload, lack of development and neglect– as dependent variables, and the ‘Coping Orientation for Problem Experiences’, with its fifteen dimensions, as independent variables. Adjusted multiple determination coefficients and beta coefficients were calculated to evaluate and compare the explanatory capacity of the different coping strategies. Results The ‘Coping Orientation for Problem Experiences’ subscales together explained 15% of the ‘overload’ (p<0.001), 9% of the ‘lack of development’ (p<0.001), and 21% of the ‘neglect’ (p<0.001). ‘Overload’ was mainly explained by ‘venting of emotions’ (Beta = 0.34; p<0.001); ‘lack of development’ by ‘cognitive avoidance’ (Beta = 0.21; p<0.001); and ‘neglect’ by ‘behavioural disengagement’ (Beta = 0.40; p<0.001). Other interesting associations were observed. Conclusions These findings further our understanding of the way in which the effectiveness of interventions for burnout may be improved, by influencing new treatments and preventive programmes using features of the strategies for handling stress in the workplace.

Understanding burnout according to individual differences: ongoing explanatory power evaluation of two models for measuring burnout types

BackgroundThe classic determination of burnout is by means of the dimensions exhaustion, cynicism and inefficacy. A new definition of the syndrome is based on clinical subtypes, consisting of “frenetic” (involved, ambitious, overloaded), “underchallenged” (indifferent, bored, with lack of personal development) and “worn-out” (neglectful, unacknowledged, with little control). The dimensions of overload, lack of development and neglect form a shortened version of this perspective. The aims of this study were to estimate and to compare the explanatory power of both typological models, short and long, with the standard measurement.MethodsThis was a cross-sectional survey with a randomly sample of university employees (n=409). Multivariate linear regression models were constructed between the “Maslach Burnout Inventory General Survey” (MBI-GS) dimensions, as dependent variables, and the “Burnout Clinical Subtype Questionnaire” (BCSQ-36 and BCSQ-12) dimensions, as independent variables.ResultsThe BCSQ-36 subscales together explained 53% of ‘exhaustion’ (p<0.001), 59% of ‘cynicism’ (p<0.001) and 37% of ‘efficacy’ (p<0.001), while BCSQ-12 subscales explained 44% of ‘exhaustion’ (p<0.001), 44% of ‘cynicism’ (p<0.001), and 30% of ‘efficacy’ (p<0.001). The difference in the explanatory power of both models was significant for ‘exhaustion’ (p<0.001), and for ‘cynicism’ (p<0.001) and ‘efficacy (p<0.001).ConclusionsBoth BCSQ-36 and BCSQ-12 demonstrate great explanatory power over the standard MBI-GS, while offering a useful characterization of the syndrome for the evaluation and design of interventions tailored to the characteristics of each individual. The BCSQ-36 may be very useful in mental health services, given that it provides a good deal of information, while the BCSQ-12 could be used as a screening measure in primary care consultations owing to its simplicity and functional nature.

Reassessment of the Psychometric Characteristics and Factor Structure of the ‘Perceived Stress Questionnaire’ (PSQ): Analysis in a Sample of Dental Students

Background The training to become a dentist can create psychological distress. The present study evaluates the structure of the ‘Perceived Stress Questionnaire’ (PSQ), its internal consistency model and interrelatedness with burnout, anxiety, depression and resilience among dental students. Methods The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the PSQ, the ‘Goldberg Anxiety and Depression Scale’ (GADS), ‘Connor-Davidson Resilience Scale’ (10-item CD-RISC) and ‘Maslach Burnout Inventory-Student Survey’ (MBI-SS). The structure was estimated using Parallel Analysis from polychoric correlations. Unweighted Least Squares was the method for factor extraction, using the Item Response Theory to evaluate the discriminative power of items. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variable. The relationships between the PSQ and the other constructs were analysed using Spearman’s coefficient. Results The results showed a PSQ structure through two sub-factors (‘frustration’ and ‘tenseness’) with regard to one general factor (‘perceived stress’). Items that did not satisfy discriminative capacity were rejected. The model fit were acceptable (GFI = 0.98; RSMR = 0.06; AGFI = 0.98; NFI = 0.98; RFI = 0.98). All the factors showed adequate internal consistency as measured by the congeneric model (≥0.91). High and significant associations were observed between perceived stress and burnout, anxiety, depression and resilience. Conclusions The PSQ showed a hierarchical bi-factor structure among Spanish dental students. Using the questionnaire as a uni-dimensional scale may be useful in perceived stress level discrimination, while the sub-factors could help us to refine perceived stress analysis and improve therapeutic processes.

Detecting depression among adolescents in Santiago, Chile: sex differences

BackgroundDepression among adolescents is common but most cases go undetected. Brief questionnaires offer an opportunity to identify probable cases but properly validated cut-off points are often unavailable, especially in non-western countries. Sex differences in the prevalence of depression become marked in adolescence and this needs to be accounted when establishing cut-off points.MethodThis study involved adolescents attending secondary state schools in Santiago, Chile. We compared the self-reported Beck Depression Inventory-II with a psychiatric interview to ascertain diagnosis. General psychometric features were estimated before establishing the criterion validity of the BDI-II.ResultsThe BDI-II showed good psychometric properties with good internal consistency, a clear unidimensional factorial structure, and good capacity to discriminate between cases and non-cases of depression. Optimal cut-off points to establish caseness for depression were much higher for girls than boys. Sex discrepancies were primarily explained by differences in scores among those with depression rather than among those without depression.ConclusionsIt is essential to validate scales with the populations intended to be used with. Sex differences are often ignored when applying cut-off points, leading to substantial misclassification. Early detection of depression is essential if we think that early intervention is a clinically important goal.

Mindfulness, Resilience, and Burnout Subtypes in Primary Care Physicians: The Possible Mediating Role of Positive and Negative Affect

Purpose: Primary care health professionals suffer from high levels of burnout. The aim of the present study was to evaluate the associations of mindfulness and resilience with the features of the burnout types (overload, lack of development, neglect) in primary care physicians, taking into account the potential mediating role of negative and positive affect. Methods: A cross-sectional design was used. Six hundred and twenty-two Spanish primary care physicians were recruited from an online survey. The Mindful Attention Awareness Scale (MAAS), Connor-Davidson Resilience Scale (CD-RISC), Positive and Negative Affect Schedule (PANAS), and Burnout Clinical Subtype Questionnaire (BCSQ-12) questionnaires were administered. Polychoric correlation matrices were calculated. The unweighted least squares (ULS) method was used for developing structural equation modeling. Results: Mindfulness and resilience presented moderately high associations (φ = 0.46). Links were found between mindfulness and overload (γ = −0.25); resilience and neglect (γ = −0.44); mindfulness and resilience, and negative affect (γ = −0.30 and γ = −0.35, respectively); resilience and positive affect (γ = 0.70); negative affect and overload (β = 0.36); positive affect and lack of development (β = −0.16). The links between the burnout types reached high and positive values between overload and lack of development (β = 0.64), and lack of development and neglect (β = 0.52). The model was a very good fit to the data (GFI = 0.96; AGFI = 0.96; RMSR = 0.06; NFI = 0.95; RFI = 0.95; PRATIO = 0.96). Conclusions: Interventions addressing both mindfulness and resilience can influence burnout subtypes, but their impact may occur in different ways, potentially mediated by positive and negative affect. Both sorts of trainings could constitute possible tools against burnout; however, while mindfulness seems a suitable intervention for preventing its initial stages, resilience may be more effective for treating its advanced stages.

Mindfulness may both moderate and mediate the effect of physical fitness on cardiovascular responses to stress: a speculative hypothesis

The psychological construct of mindfulness refers to an awareness that emerges by intentionally paying attention to the present experience in a non-judgmental or evaluative way. This particular quality of awareness has been associated to several indicators of physical and psychological health, and can be developed using mindfulness-based interventions (MBIs), and therefore MBIs have been successfully applied as preventive and complementary interventions and therapies in medicine and psychology. Together with quiet sitting and lying meditation practices, mindful physical exercises such as “mindful walking” and “mindful movement” are key elements in MBIs and couple muscular activity with an internally directed focus, improving interoceptive attention to bodily sensations. In addition, MBIs seem to share similar mechanisms with physical fitness (PF) by which they may influence cardiovascular responses to stress. Based on these facts, it is feasible to raise the question of whether physical training itself may induce the development of that particular quality of awareness associated with mindfulness, or if ones dispositional mindfulness (DM) (the tendency to be more mindful in daily life) could moderate the effects of exercise on cardiovascular response to stress. The role of mindfulness as a mediator or moderator of the effect of exercise training on cardiovascular responses to stress has barely been studied. In this study, we have hypothesized pathways (moderation and mediation) by which mindfulness could significantly influence the effects of PF on cardiovascular responses to stress and discussed potential practical ways to test these hypotheses.