Marcelo Leiva-Bianchi

Validation of the Davidson Trauma Scale in its original and a new shorter version in people exposed to the F-27 earthquake in Chile

Background On February 27, 2010 (F-27), an earthquake and tsunami occurred having a significant impact on the mental health of the Chilean population, leading to an increase in cases of post-traumatic stress disorder (PTSD). Objectives Within this context, validated for the first time in Chile was the Davidson Trauma Scale (DTS) using three samples (each one consisting of 200 participants), two of them random from the Chilean population. Results Reliability analyses (i.e., α=0.933), concurrent validity (63% of the items are significantly correlated with the criteria variable “degree of damage to home”) and construct validity (i.e., CMIN = 3.754, RMSEA = 0.118, NFI = 0.808, CFI = 0.850 and PNFI = 0.689) indicate validity between regular and good for DTS. However, a new short version of the scale (DTS-SF) created using the items with heavier factor weights, presented better fits (CMIN = 2.170, RMSEA = 0.077, NFI = 0.935, CFI = 0.963, PNFI = 0.697). Discussion Finally, the usefulness of DTS and DTS-SF is discussed, the latter being briefer, valid and having better psychometric characteristics.

Relevancia y prevalencia del estrés post-traumático post-terremoto como problema de salud pública en Constitución, Chile

Objectives An increase in the prevalence of post-traumatic stress disorder (PTSD) is expected following the February 27th 2010 (F-27) earthquake and tsunami, according to previous research; the current research was aimed at showing the importance of this problem by identifying PTSD prevalence in Constitucion, one of the Chilean cities most affected by F-27. Methods The number of severe PTSD symptoms was measured in two samples taken from staff from a local school and a primary care network, using the short post-traumatic stress disorder rating interview (SPRINT-E) scale. Results PTSD prevalence was higher than expected in both groups: 36 % in the local school staff (where 23 % was expected) and 20 % for primary care network staff (15 % was expected). Conclusions The article deals with PTSD prevalence, reflecting on the serious public mental health problem affecting this city in particular and all affected areas in general. It also discusses the feasibility of solving this public health problem by using available health network resources. While its resolution is complex, initiatives in applied research can always be supported, such as those currently being conducted by the University of Talcas psychology faculty.Objetivos Segun investigaciones previas, despues del terremoto y tsunami del 27 de febrero de 2010 (27-F), se espera un aumento de la prevalencia del estres post-traumatico (TEPT). Esta investigacion pretende mostrar la importancia de este problema, identificando la prevalencia del TEPT en la ciudad de Constitucion, una de las mas afectadas por el 27-F. Metodo Mediante la escala Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E), se midio la cantidad de sintomas intensos de TEPT en dos muestras: apoderados de un colegio municipal y personal de la red de atencion primaria. Resultados La prevalencia del TEPT en ambos grupos es mayor a lo esperado: 36 % en el grupo de apoderados (en el cual se esperaba un 23 %) y 20 % en el de funcionarios (en el cual se esperaba un 15 %). Conclusiones Se reflexiona respecto del grave problema de salud mental publica presente en esta ciudad en particular y en todas las zonas afectadas en general. Tambien se discute respecto de la factibilidad de resolver este problema de salud publica, mediante los recursos disponibles en la red de salud. Si bien su resolucion es compleja, es posible apoyar iniciativas cientificas de investigacion aplicada, como la que actualmente esta llevando a cabo la Facultad de Psicologia de la Universidad de Talca.Objectives An increase in the prevalence of post-traumatic stress disorder (PTSD) is expected following the February 27 th 2010 (F-27) earthquake and tsunami, according to previous research; the current research was aimed at showing the

Confirmatory Factor Analysis of the Post-Traumatic Growth Inventory After the Chilean Earthquake

The Post-Traumatic Growth Inventory (PTGI) was validated for the first time in South America using a sample of 270 people exposed to the February 27, 2010, Chilean earthquake. Analyses indicated validity ranging between regular and good for the PTGIs five original dimensions. However, an alternative three-factor version (PTGI-2) proposed here also had good adjustment indicators (CMIN/df = 3.133, RMSEA = .089, NFI = .843, CFI = .887, PNFI = .747). The new proposed structure is discussed in order to contribute to the debate on the constructs that compose it. We recommend use of the PTGI-2 because it has higher theoretical consistency and is more parsimonious.

The relevance and prevalence of post-traumatic stress after an earthquake: public health problem in Constitucion, Chile

Objectives An increase in the prevalence of post-traumatic stress disorder (PTSD) is expected following the February 27th 2010 (F-27) earthquake and tsunami, according to previous research; the current research was aimed at showing the importance of this problem by identifying PTSD prevalence in Constitucion, one of the Chilean cities most affected by F-27. Methods The number of severe PTSD symptoms was measured in two samples taken from staff from a local school and a primary care network, using the short post-traumatic stress disorder rating interview (SPRINT-E) scale. Results PTSD prevalence was higher than expected in both groups: 36 % in the local school staff (where 23 % was expected) and 20 % for primary care network staff (15 % was expected). Conclusions The article deals with PTSD prevalence, reflecting on the serious public mental health problem affecting this city in particular and all affected areas in general. It also discusses the feasibility of solving this public health problem by using available health network resources. While its resolution is complex, initiatives in applied research can always be supported, such as those currently being conducted by the University of Talcas psychology faculty.Objetivos Segun investigaciones previas, despues del terremoto y tsunami del 27 de febrero de 2010 (27-F), se espera un aumento de la prevalencia del estres post-traumatico (TEPT). Esta investigacion pretende mostrar la importancia de este problema, identificando la prevalencia del TEPT en la ciudad de Constitucion, una de las mas afectadas por el 27-F. Metodo Mediante la escala Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E), se midio la cantidad de sintomas intensos de TEPT en dos muestras: apoderados de un colegio municipal y personal de la red de atencion primaria. Resultados La prevalencia del TEPT en ambos grupos es mayor a lo esperado: 36 % en el grupo de apoderados (en el cual se esperaba un 23 %) y 20 % en el de funcionarios (en el cual se esperaba un 15 %). Conclusiones Se reflexiona respecto del grave problema de salud mental publica presente en esta ciudad en particular y en todas las zonas afectadas en general. Tambien se discute respecto de la factibilidad de resolver este problema de salud publica, mediante los recursos disponibles en la red de salud. Si bien su resolucion es compleja, es posible apoyar iniciativas cientificas de investigacion aplicada, como la que actualmente esta llevando a cabo la Facultad de Psicologia de la Universidad de Talca.Objectives An increase in the prevalence of post-traumatic stress disorder (PTSD) is expected following the February 27 th 2010 (F-27) earthquake and tsunami, according to previous research; the current research was aimed at showing the

Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la Atención Primaria en Chile

BACKGROUND Traumatic experiences during childhood may influence the development of mental disorders during adulthood. AIM To determine clinical and psychosocial variables that are associated with a higher frequency of adverse childhood experiences (ACE) in patients who consult for depression in Primary Health Care clinics in Chile. MATERIAL AND METHODS A socio-demographic interview, the mini international neuropsychiatric interview (MINI), a screening for ACE, a questionnaire for partner violence (PV), the Life Experiences Survey (LES) and the Hamilton Rating Scale for Depression (HRDS) were applied to 394 patients with major depression (87% women). RESULTS Eighty two percent of patients had experienced at least one ACE and 43% of them reported three or more. Positive correlations were observed between the number of ACE and severity of depressive symptoms (r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). CONCLUSIONS These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood.

Childhood trauma and psychiatric comorbidities in patients with depressive disorder in primary care in Chile.

ABSTRACT Childhood trauma is associated with different psychiatric disorders during adulthood. These disorders are often presented in comorbidity with depression. Objective: To establish the relationship between psychiatric comorbidities and childhood traumatic events in patients with depression in Chile. Methods: Three hundred and ninety-four patients with major depression were assessed using the MINI International Neuropsychiatric Interview and a screening for childhood trauma. Results: Social anxiety disorder was associated with having witnessed domestic violence during childhood (OR = 2.2, CI 1.2 - 3.8), childhood physical abuse (OR = 2.7, CI 1.6 - 4.4), physical injury associated with physical abuse (OR = 2.3, CI 1.3 - 4.7) and sexual abuse by a non-relative (OR = 2.7, CI 1.3 - 4.2). Posttraumatic stress disorder was associated with physical injury associated with physical abuse (OR = 1.9, CI 1.1 - 3.6), sexual abuse by a relative (OR = 3.2, IC 1.8 - 5.9) and sexual abuse by a non-relative (OR = 2.2, CI 1.2 - 4.1). Antisocial personality disorder was associated with traumatic separation from a caregiver (OR = 3.2, CI 1.2 - 8.5), alcohol abuse by a family member (OR = 3.1, CI 1.1 - 8.1), physical abuse (OR = 2.8, CI 1.1 - 6.9) and sexual abuse by a non-relative (OR = 4.8, CI 1.2 – 11.5). Panic disorder was associated with sexual abuse by a relative (OR = 1.9, CI 1.1 - 3.1). Generalized anxiety disorder was associated with sexual abuse by a non-relative (OR = 1.9, CI 1.1- 3.3). Conclusions: Further clinical recognition is required in patients seeking help for depression in primary care. This recognition must take into account the patient’s current psychiatric comorbidities and adverse childhood experiences.

What is the Psychosocial Impact of Disasters? A Meta-Analysis

ABSTRACT The psychosocial impact concept improves the understanding of the effects of disasters on people and communities. However, its definition is not clear. This work explores consistencies between studies (k = 21) that refer to the psychosocial impact of disasters by way of a meta-analytic synthesis. This synthesis indicates that people are more prone to illness when they are exposed to a disaster, and less when they are protected (OR = 2.737). Please check the change conveys the intended meaning or amend Nevertheless, there are no differences in healthy responses, regardless of how protected or exposed they are (OR = 1.053). Finally, a model is proposed to explain four types of psychosocial impact: resilient, traumatic, sensitive, witness.

Factors Associated with Psychiatric Comorbidity in Depression Patients in Primary Health Care in Chile

Objective To identify the clinical and psychosocial factors associated with psychiatric comorbidity in patients consulting for depression in Primary Health Care (PHC) in Chile. Methods 394 patients with a diagnosis of major depression being treated in a Chilean PHC were evaluated using a sociodemographic and clinical interview, the mini-international neuropsychiatric interview (MINI), a childhood trauma events (CTEs) screening, the intimate partner violence (IPV) scale, the Life Experiences Survey (LES), and the Hamilton Depression Rating Scale (HDRS). Results Positive correlations were established between higher number of psychiatric comorbidities and severity of depressive symptoms (r = 0.358), frequency of CTEs (r = 0.228), frequency of IPV events (r = 0.218), frequency of recent stressful life events (r = 0.188), number of previous depressive episodes (r = 0.340), and duration of these (r = 0.120). Inverse correlations were determined with age at the time of the first consultation (r = -0.168), age of onset of depression (r = -0.320), and number of medical comorbidities (r = -0.140). Of all associated factors, early age of the first depressive episode, CTEs antecedents, and recent stressful life events explain 13.6% of total variability in psychiatric comorbidities. Conclusions A higher prevalence of psychiatric comorbidity among subjects seeking help for depression in Chilean PHCs is associated with early onset of depression, clinical severity, chronicity, and interpersonal adversity experienced since childhood.

Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami

OBJECTIVE This is the first time that the effectiveness of cognitive-behavioural therapy for post-disaster stress (CBT-PD) in symptoms of posttraumatic stress disorder (PTSD) has been tested outside the United States of America. DESIGN Quasi-experiment with three groups. In the quasi-control group, complete CBT-PD was applied even though its members did not have PTSD; in quasi-experimental conditions, participants received complete treatment because they had this diagnosis; and in the third group, participants with PTSD received an abbreviated treatment (double sessions) due to organisational requirements. LOCATION Primary health care workers in Constitución (Chile), city exposed to earthquake and tsunami; public department workers in Talca (city exposed only to earthquake) and teachers from a school (Constitución). PARTICIPANTS A total of 13 of the 91 people diagnosed with PTSD participated. In addition, 16 people without diagnosis voluntarily participated. The treatment was completed by 29 participants. There were no dropouts. Only 1 of the 9 participants in the quasi-experimental group did not respond to treatment. INTERVENTIONS CBT-PD is a group therapy (10-12 sessions) that includes psychoeducation, breathing retraining, behavioural activation and cognitive restructuring. CBT-PD (complete and abbreviated) was applied between September and December 2010. MEASUREMENTS Short Posttraumatic Stress Disorder Rating Interview (SPRINT-E) was used to measure PTSD symptoms before and after treatment. RESULTS The group that received the complete treatment and was diagnosed with PTSD showed a significant decrease in the total symptoms to below dangerous levels (IGAAB: 31.556; p<0.01; 95%CI: 0.21-2.01]; η2=0.709). DISCUSSION The effectiveness and benefits of incorporating CBT-PD in the health network after events like disasters were discussed.