Vania Martínez

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

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.

Intervenciones psicológicas perinatales en depresión materna y vínculo madre-bebé: una revisión sistemática

Perinatal depression constitutes a high prevalence disorder, with negative repercussions in the mother and the baby. From these precedents, this article reviews different psychological interventions developed to re- duce depression and/or to promote a mother-infant bond-quality, from pregnancy to childrens second year of life. There are considered 27 studies published between 1996 and 2012, with inclusion of experimental and control groups. Results show that most of the interventions are focused in perinatal depression as a vari- able, differentiating between interventions during pregnancy and at postpartum. A minor number of studies focused on the mother-baby bond quality and to modify both variables in a simultaneous way. Interventions that were reported to be successful considered group and individual interventions focused on promoting maternal sensitivity and corporal techniques.

Factores asociados a la continuidad del uso anticonceptivo en adolescentes solteras nulíparas

BACKGROUND Factors such as personal issues, family, sexuality and sexual partner characteristics are strongly associated with contraceptive continuation among single, nulliparous female adolescents. AIM To determine factors associated to contraceptive maintenance among female nulliparous adolescents. MATERIAL AND METHODS A cohort of 2,811 adolescents, who confidentially requested contraception in a sexual and reproductive health university center from 1990 to 2006 was analyzed. Two years after the request, their clinical records were reviewed to determine the time and length of contraception. Using life table analysis, the variables related to continuation or discontinuation of contraception were identified. RESULTS Factors associated with a longer contraceptive use were a lower age at the moment of initiating the method, a better academic achievement and aspirations, higher schooling of the partner, higher age of the mother, having an adolescent mother, supervision of permissions by people different than parents and not attending to religious services. Variables associated with a higher risk for abandonment were a higher age of the adolescent, greater number of sexual partners, lack of communication with parents, non-catholic religious affiliation, use of oral hormonal contraceptive, greater number of siblings, commenting sexual issues with relatives or friends, having a partner without academic activity or working and to live without parents. CONCLUSIONS Several personal, familial and environmental factors influence contraceptive use continuity among adolescents.

Bullying y calidad de vida relacionada con la salud en adolescentes escolares chilenos

BACKGROUND Bullying has a negative impact on the perception of adolescents of their quality of life. AIM To analyze the association between being bullied and health related quality of life in Chilean adolescents. MATERIAL AND METHODS The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. RESULTS Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. CONCLUSIONS Bullying is associated with a lower quality of life perception among Chilean students.BACKGROUND: Bullying has a negative impact on the perception of adolescents of their quality of life. AIM: To analyze the association between being bullied and health related quality of life in Chilean adolescents. MATERIAL AND METHODS: The bullying module of the KIDSCREEN 52 survey and the KIDSCREEN 10 survey to assess health related quality of life were applied to 7737 students aged 10 to 18 years. Social and demographic data, information about disability and type of school were also gathered. RESULTS: Fifteen percent of surveyed students were bullied. A lower quality of life perception increased by a factor of 2.6 among bullied students. It also increased by a factor of 4.4 among students with a low self-esteem, by a factor of 3.1 among those who perceived their health status as regular or bad and by a factor of 1.4 among women. CONCLUSIONS: Bullying is associated with a lower quality of life perception among Chilean students. Language: es

Ideas autolíticas, violencia autoinfligida, y síntomas depresivos en escolares chilenos

BACKGROUND Suicidal behaviors and depression are prevalent phenomena among adolescents, and are considered a public health problem. AIM To determine the prevalence of depressive symptoms and suicidal behaviors and the relationship between both phenomena, in a representative sample of students from ninth grade in Santiago, Chile. MATERIAL AND METHODS We recruited a probability sample of 2,597 adolescents who answered a questionnaire with questions about suicidal behavior and the Beck Depression Inventory (BDI-II). RESULTS The lifetime prevalence of suicidal ideation and planning was 21 and 14%, respectively. The prevalence for the past two weeks was 6.7 and 4.4% for suicidal ideation and planning, respectively. Autolytic behaviors, once in lifetime and in the past week were referred by 26 and 4% of respondents, respectively. In one third of these, self-harm coincided with recent suicide ideation or planning. All levels of suicidal behavior were more frequently reported by women. Clinically significant depressive symptoms were present in 23.5% of adolescents. Females doubled male rates. Severe depressive symptoms were present in 9.4% of the sample. A higher level of suicidal behavior correlated with more severe forms of depression. Sixty percent of adolescents who reported recent self-harm, had clinically relevant depressive symptoms. Two thirds of them had severe symptoms. CONCLUSIONS Suicidal behavior in Chilean adolescents is prevalent, and there is an association between this behavior and the level of depression. The school is a good place to identify and develop preventive measures for teenagers.

Factores asociados al inicio sexual en adolescentes de ambos sexos de nivel socioeconómico medio-bajo de la Región Metropolitana

Antecedentes: Escasa evidencia esta disponible en Chile acerca del inicio de la actividad sexual adolescente. Objetivo: Examinar cuales variables identificadas previamente estan asociadas al inicio de la actividad sexual en una poblacion adolescente de nivel socioeconomico medio-bajo de la Region Metropolitana. Metodo: Los datos corresponden a adolescentes consultantes en CEMERA. Se compararon con adolescentes que habian iniciado actividad sexual y aquellos que no. La informacion fue recolectada en la primera consulta a 5.854 adolescentes de ambos sexos entre 12 y 19 anos. Se uso regresion logistica para identificar los factores asociados al inicio sexual. Resultados: 92,6% mujeres y 7,4% hombres. El 84,2% habia iniciado actividad sexual y no el 15,8%. Las variables asociadas al inicio sexual fueron: ser hombre; mayor edad; mayor escolaridad; aspiraciones academicas basicas; desempeno escolar bajo; repitencia escolar; no afiliacion religiosa; no asistencia a servicios religiosos; tener un trabajo; tener pareja mayor; tener una pareja que trabaje; conversar temas de sexualidad solo con la pareja; mas parejas romanticas; no participacion social; historia de abuso sexual; mayor numero de hijos; mala relacion padre-hijo; mala comunicacion familiar; supervision parental limitada; historia de paternidad y/o maternidad adolescente en los padres; padres con baja educacion; menor supervision parental. Conclusion: Se necesitan programas que motiven a retardar el inicio sexual. Los programas de educacion sexual deberian animar a la conversacion de los temas de sexualidad con los padres y capacitar a los educandos a demorar el inicio sexual y/o obtener anticonceptivos, en forma expedita, amigable y confidencial.

Association between drug consumption and depression among high school students, vol 141, pg 411, 2013

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.

Prevención, detección, tratamiento o seguimiento en salud mental de adolescentes a través del uso de Internet: una revisión sistemática cualitativa

BACKGROUND The widespread use of INTERNET by adolescents, renders it a simple and accessible means for health care campaigns Aim: To perform a systematic review of ISI publications about INTERNET use for adolescent mental health prevention, detection, treatment or follow up. MATERIAL AND METHODS Systematic reviews, meta analyses and controlled clinical trials in all languages were searched. Manuscripts without an abstract or only publishing the study design were excluded. All selected articles were critically read. RESULTS One hundred and five papers were found and 61 were excluded because they did not address the research question. Of the resting 44, only six complied with the search criteria among then, 3 articles correspond to systematic reviews addressing early intervention programs and mental hearth treatment based on Internet; the other 3 articles correspond to controlled clinical trials addressing treatment interventions of anxiety and depression and 1 address on depression prevention program. CONCLUSIONS INTERNET facilitates the application of mental health promotion, prevention and intervention among adolescents. However the resource is still underused.