Jorge Gaete

School Intervention to Improve Mental Health of Students in Santiago, Chile A Randomized Clinical Trial

IMPORTANCE Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries. OBJECTIVE To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families. DESIGN, SETTING, AND PARTICIPANTS A 2-arm, parallel, cluster, randomized clinical trial was conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated. INTERVENTIONS Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum. MAIN OUTCOMES AND MEASURES Scores on the self-administered Beck Depression Inventory-II at 3 months (primary) and 12 months (secondary) after completing the intervention. RESULTS There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1% of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, -0.19; 95% CI, -1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months. CONCLUSIONS AND RELEVANCE A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN19466209.

School-based intervention to improve the mental health of low-income, secondary school students in Santiago, Chile (YPSA): study protocol for a randomized controlled trial.

BackgroundDepression is common and can have devastating effects on the life of adolescents. Psychological interventions are the first-line for treating or preventing depression among adolescents. This proposal aims to evaluate a school-based, universal psychological intervention to reduce depressive symptoms among students aged 13-14 attending municipal state secondary schools in Santiago, Chile.Study designThis is a cluster randomised controlled trial with schools as the main clusters. We compared this intervention with a control group in a study involving 22 schools, 66 classes and approximately 2,600 students. Students in the active schools attended 11 weekly and 3 booster sessions of an intervention based on cognitive-behavioural models. The control schools received their usual but enhanced counselling sessions currently included in their curriculum. Mean depression scores and indicators of levels of functioning were assessed at 3 and 12 months after the completion of the intervention in order to assess the effectiveness of the intervention. Direct and indirect costs were measured in both groups to assess the cost-effectiveness of this intervention.DiscussionAs far as we are aware this is the first cluster randomised controlled trial of a school intervention for depression among adolescents outside the Western world.Trial RegistrationISRCTN19466209

Smoking and common mental disorders : a population-based survey in Santiago, Chile

BackgroundSmoking and common mental disorders (CMD), anxiety and depression, tend to co-exist and are important public health challenges for countries at all levels of development. We aimed to study the association between smoking and common mental disorders after adjusting for alcohol, illicit drug use and other confounders.MethodsCross-sectional household survey. CMD were assessed with a detailed psychiatric interview and smoking, alcohol, and illicit drug use with self-reported questionnaires.ResultsAbout 3,870 randomly selected adults were interviewed of whom 12.9% (95% CI 12–15) met criteria for ICD-10 CMD diagnoses. 38% (36–40) of the respondents were current smokers and 11% (10–13) ex-smokers. There was a robust association between heavier smoking and the presence and severity of CMD. However there were no major differences between non-smokers, ex-smokers and light smokers. In the fully adjusted models those individuals with ICD-10 CMD were significantly more likely to be current smokers [OR 1.6 (1.1–2.2)]. Smoking was also strongly associated with drinking heavily [OR 5.4 (4.0–7.3)] and illicit drug use [(OR 2.1 (1.1–4.1)] but there were no significant interactions.ConclusionsSmoking is highly prevalent and associated with CMD and other addictive behaviours in Chile. These are major public health problems in need of urgent action.

Self-Criticism: A Measure of Uncompassionate Behaviors Toward the Self, Based on the Negative Components of the Self-Compassion Scale.

Background: The use of the Self-Compassion Scale (SCS) as a single measure has been pointed out as problematic by many authors and its originally proposed structure has repeatedly been called into question. The negative facets of this construct are more strongly related to psychopathology than the positive indicators. The aim of this study was to evaluate and compare the different structures proposed for the SCS, including a new measure based only on the negative factors, and to assess the psychometric features of the more plausible solution. Method: The study employed a cross-sectional and cross-cultural design. A sample of Brazilian (n = 406) and Spanish (n = 416) primary care professionals completed the SCS, and other questionnaires to measure psychological health-related variables. The SCS factor structure was estimated using confirmatory factor analysis by the maximum likelihood method. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the SCS and other constructs were analyzed using Spearmans rs. Results: The structure with the best fit was comprised of the three negative first-order factors of “self-judgment”, “isolation” and “over-identification”, and one negative second-order factor, which has been named “self-criticism” [CFI = 0.92; RMSEA = 0.06 (90% CI = 0.05–0.07); SRMR = 0.05]. This solution was supported by both samples, presented partial metric invariance [CFI = 0.91; RMSEA = 0.06 (90% CI = 0.05–0.06); SRMR = 0.06], and showed significant correlations with other health-related psychological constructs. Reliability was adequate for all the dimensions (R ≥ 0.70). Conclusions: The original structure proposed for the SCS was not supported by the data. Self-criticism, comprising only the negative SCS factors, might be a measure of uncompassionate behaviors toward the self, with good psychometric properties and practical implications from a clinical point of view, reaching a stable structure and overcoming possible methodological artifacts.

Association between drug consumption and depression among high school students

BACKGROUND The presence of emotional problems may trigger drug abuse. AIM To determine the association between illicit drug use and severity of depression symptoms among students of public secondary schools in Santiago, Chile. MATERIAL AND METHODS A probabilistic sample of 2,597 adolescents aged between 12 and 18 years (45% women), attending first year in public high-schools in Santiago, answered self-report questionnaires about consumption, during the last 30 days ,of alcohol, tobacco and marihuana, and the Beck Depression Inventory - II. Logistic regression models were used to study the association between drug use and severity of depression symptoms, adjusting by sex. RESULTS Tobacco and marihuana use was reported by 38 and 13% of students, respectively. Frequency of consumption was significantly higher among women. Mild, moderate or severe depressive symptoms were found among 16%, 14% and 9% of students, respectively. Depressive symptoms were more common among women. There was a significant association between drug use and severity of depression among participants of both genders. CONCLUSIONS The association between depressive symptoms and drug use should be considered on the design of treatment guidelines for these health problems in Chile.

Use of psychotropic medication in Santiago, Chile

Background: During the last few decades, the use of psychotropic medication by the general population has been a topic of scientific and public interest. However there have been few studies in Latin America to assess this situation. Aims: To study the prevalence in use of psychotropic medication in the city of Santiago and the associations with sociodemographic and physical and mental health factors. Methods: Cross-sectional survey of private households randomly chosen with a probabilistic sampling design. Results: Three-thousand-eight-hundred-and-seventy subjects were interviewed. The overall prevalence of the use of psychotropic medication in Greater Santiago was 6.4% (95% CI). Sex, age, mental and physical health problems were all significantly associated with a higher prevalence of psychotropic medication use. Conclusions: The prevalence of psychotropic use in the Greater Santiago area seems lower than in other cities. However similar socio-demographic and health factors were associated with the use of psychotropic medication as in other countries. There is a need to unify methodologies to be able to compare results internationally.

The Association Between School Bonding and Smoking Amongst Chilean Adolescents

BACKGROUND The objective of the research was to study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) data set. METHODS The CHSS-2003 is a stratified cross-sectional survey that gathers information about personal, familial, peer, and school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An exploratory factor analysis (EFA) was performed in order to explore the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking. RESULTS The construct validity of the school attachment and school commitment scales was mainly supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (students good grades and school attendance) appears to have a clear inverse association with current smoking (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16, 95% CI: 0.88-1.53). CONCLUSIONS School commitment was strongly associated with current smoking. It is important to further study this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.

Development and validation of the short-form adolescent health promotion scale

BackgroundHealth-promoting lifestyle choices of adolescents are closely related to current and subsequent health status. However, parsimonious yet reliable and valid screening tools are scarce. The original 40-item adolescent health promotion (AHP) scale was developed by our research team and has been applied to measure adolescent health-promoting behaviors worldwide. The aim of our study was to examine the psychometric properties of a newly developed short-form version of the AHP (AHP-SF) including tests of its reliability and validity.MethodsThe study was conducted in nine middle and high schools in southern Taiwan. Participants were 814 adolescents randomly divided into two subgroups with equal size and homogeneity of baseline characteristics. The first subsample (calibration sample) was used to modify and shorten the factorial model while the second subsample (validation sample) was utilized to validate the result obtained from the first one. The psychometric testing of the AHP-SF included internal reliability of McDonald’s omega and Cronbachs alpha, convergent validity, discriminant validity, and construct validity with confirmatory factor analysis (CFA).ResultsThe results of the CFA supported a six-factor model and 21 items were retained in the AHP-SF with acceptable model fit. For the discriminant validity test, results indicated that adolescents with lower AHP-SF scores were more likely to be overweight or obese, skip breakfast, and spend more time watching TV and playing computer games. The AHP-SF also showed excellent internal consistency with a McDonald’s omega of 0.904 (Cronbach’s alpha 0.905) in the calibration group.ConclusionThe current findings suggest that the AHP-SF is a valid and reliable instrument for the evaluation of adolescent health-promoting behaviors. Primary health care providers and clinicians can use the AHP-SF to assess these behaviors and evaluate the outcome of health promotion programs in the adolescent population.

Validation of the Spanish Version of the Psychological Sense of School Membership (PSSM) Scale in Chilean Adolescents and Its Association with School-Related Outcomes and Substance Use.

School membership appears to be an important factor in explaining the relationship between students and schools, including school staff. School membership is associated with several school-related outcomes, such as academic performance and expectations. Most studies on school membership have been conducted in developed countries. The Psychological Sense of School Membership (PSSM) scale (18 items: 13 positively worded items, 5 negatively worded items) has been widely used to measure this construct, but no studies regarding its validity and reliability have been conducted in Spanish-speaking Latin American countries. This study investigates the psychometric properties, factor structure and reliability of this scale in a sample of 1250 early adolescents in Chile. Both exploratory and confirmatory factor analyses provide evidence of an excellent fit for a one-factor solution after removing the negatively worded items. The internal consistency of this new abbreviated version was 0.92. The association analyses demonstrated that high school membership was associated with better academic performance, stronger school bonding, a reduced likelihood of school misbehavior, and reduced likelihood of substance use. Analyses showed support for the reliability and validity of the PSSM among Chilean adolescents.

Factores asociados a conductas promotoras de salud en adolescentes chilenos

BACKGROUND Health-promoting behaviors are important to prevent diseases and prolong life in the population. People develop these behaviors throughout life. However, better benefits for health are obtained with an early development. AIM To determine the prevalence of health-promoting behaviors among early adolescents and its associated factors. MATERIAL AND METHODS Cross-sectional survey performed in 1,465 students of high, medium and low socio-economic status, attending fifth to eighth grades of schools located in a small Chilean city. Participants answered a questionnaire that gathered information about frequency of health-promoting behaviors such as health responsibility and nutrition, physical exercise and stress management, life appreciation, social support and different personal, school and familial factors. RESULTS A higher frequency of health-promoting behaviors was associated with better academic achievement, better school commitment, and higher perception of school membership. It also was associated with a better perception of health status and a higher conformity with physical appearance. CONCLUSIONS Health promoting behaviors in these children are related to a better academic achievement and a higher integration with school environment.