Daniel Núñez

Millennium Institute for Research in Depression and Personality

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Jorge Gaete

Universidad de Los Andes, Chile

Susana Campos

Millennium Institute for Research in Depression and Personality

Andrés Fresno

Universidad Carlos III de Madrid

Víctor B. Arias

Universidad de Salamanca

Javiera Andaur

University of Talca

ÁI

Álvaro I. Langer

Millennium Institute for Research in Depression and Personality

Daniela Meza

University of Talca

Johanna T. W. Wigman

University of Groningen

Jo Robinson

University of Melbourne

Vania Martínez

Millennium Institute for Research in Depression and Personality

Cooperative Institutions

University of Talca

University of Chile

Millennium Institute for Research in Depression and Personality

Centro de Investigación Biomédica en Red

Millennium Science Initiative

Heidelberg University

University of Amsterdam

University Medical Center Groningen

Universidad de Los Andes, Chile

Universidad de Los Andes

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Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic

Social Psychiatry and Psychiatric Epidemiology (2024)

Marcelo A. Crockett Vania Martínez Scarlett Mac‐Ginty Daniel Núñez Álvaro I. Langer

Abstract Purpose To examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic. Methods: 7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models. Results: Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems. Conclusion: The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

Sexual identity

10.1007/s00127-024-02683-5

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Taxonomía de Pacientes con Diabetes Tipo 2 Basada en sus Representaciones de Enfermedad

Psykhe (Santiago) (2011)

Constanza J. Letelier Daniel Núñez Ricardo Rey

Se estableció una taxonomía de personas con diabetes tipo 2 basada en sus representaciones de enfermedad.Para ello se realizó un análisis de conglomerados con las respuestas de una muestra de conveniencia de 103 adultos de atención primaria de salud de la zona central de Chile, los que completaron la escala IPQ-R.Este análisis arrojó 3 grupos de pacientes, denominados Preocupado, Desesperanzado y Negador.El primero confía en los procedimientos para atenuar los efectos de la enfermedad.El segundo manifiesta una baja creencia acerca de la posibilidad de controlarla.El tercero no la considera como una enfermedad crónica.Los grupos fueron comparados en respuesta emocional, intención de adherir, percepción de necesidad y preocupación por el tratamiento, para complementar el procedimiento de análisis de conglomerado, utilizando ANOVA o Chi cuadrado.Consistente con sus perfiles, presentan diferencias significativas en sus respuestas emocionales, creencias acerca de los medicamentos, intención de adherir, tiempo de tratamiento, edad y educación.Se discute la utilidad de estas taxonomías para el tratamiento diferencial de los pacientes. Palabras clave: representación de enfermedad, adherencia, análisis de conglomerados, diabetesA taxonomy of patients with type 2 diabetes based on their illness representations was developed.To do this a cluster analysis was conducted, using the responses of a convenience sample of 103 adults from primary health care in central Chile, who completed the IPQ-R scale.This analysis lead to 3 groups of patients labeled Preoccupied, Hopeless, and Deniers.The first relies on procedures to mitigate the effects of the disease.The second shows a low belief about the possibility to control the disease.The third does not consider diabetes as a chronic disease.The groups were compared on emotional response, intention to adhere, perception of need and concern about the treatment, to complement the cluster analysis procedure, using ANOVA or chi-square.Consistent with their profiles, the groups present significant differences in their emotional response, beliefs about medications, intention to adhere, treatment time, age, and education.The utility of these taxonomies for differential treatment of patients is discussed.

10.4067/s0718-22282011000200010

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Psychometric evidence of the Acceptance and Action Questionnaire-II (AAQ-II): an item response theory analysis in university students from Chile

BMC Psychology (2024)

Álvaro I. Langer Fernando P. Ponce Jorge L. Ordóñez-Carrasco Reiner Fuentes-Ferrada Scarlett Mac‐Ginty

Abstract Background Experiential avoidance (EA) is a psychological mechanism associated with several mental health disorders and is regarded as a relevant target by third-generation cognitive behavioral therapies. It has been mainly assessed through self-report questionnaires, and the AAQ-II is the most used tool. Its psychometric evidence has been mostly tested through the classical test theory (CTT) and very scarcely assessed through Item Response Theory (IRT). Methods We used the Graded Response Model to examine its psychometric properties in Spanish-speaking university students ( n = 1503; women = 995 (66.2%), mean age = 19.29, SD = 2.45). We tested whether the empirical data fit the model’s predictions and estimated the dispersion of persons and items along the experiential avoidance continuum. Moreover, we examined category probability curves to identify the response probability of each answer. Likewise, an item-person map was made where the measurement of persons and items, both on the same scale and along the experiential avoidance continuum, could be observed jointly. Finally, we tested the gender invariance of the scale. Results We found that the values of the individuals and the items were in the established range to be considered an adequate measure of EA. Additionally, we observed high discrimination indices for all items. The current version with seven answer options could not be optimal and should be tested in future studies. Finally, we found evidence of differential functioning by gender in one of the seven items of the instrument. Conclusions Our results indicate that the AAQ-II is a suitable tool for measuring EA and accurately classifying and differentiating EA levels in university students.

Experiential avoidance

Differential item functioning

Classical test theory

Measurement Invariance

Empirical Research

10.1186/s40359-024-01608-w

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Testing the Effectiveness of a Blended Intervention to Reduce Suicidal Ideation among School Adolescents in Chile: A Protocol for a Cluster Randomized Controlled Trial

International Journal of Environmental Research and Public Health (2022)

Daniel Núñez Jorge Gaete Daniela Meza Javiera Andaur Jo Robinson

Suicidal ideation is prevalent in adolescents and is a marker for subsequent psychiatric vulnerability and symptom severity. Literature shows that blended care (integrating online and offline components in a treatment process) could improve the effectiveness and adherence of interventions targeting suicidal ideation in adolescents, but the evidence is inconclusive. Thus, we will test the effectiveness of a blended intervention to reduce suicidal ideation (primary outcome) in school settings using a single-blind two-armed cluster randomized controlled trial (cRCT). The internet-based component corresponds to the Reframe-IT, a program encompassing eight online sessions based on cognitive-behavioral therapy (CBT) principles. The face-to-face intervention will be delivered through four CBT sessions. Additionally, we will assess the effect of the intervention on the following secondary outcomes: suicidal attempts, depressive symptoms, hopelessness, emotional regulation, and problem-solving skills. Primary and secondary outcomes will be assessed at post-intervention, 3-month, 6-month, and 12-month follow-up. Finally, we will explore the mediation role of cognitive, emotional, and behavioral correlates of suicide on the effect of the intervention. Results will inform whether the intervention can reduce suicide among school adolescents and be implemented on a large scale in Chile.

10.3390/ijerph19073947

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Evidence for validity, reliability and measurement invariance of the emotion regulation questionnaire for children and adolescents (ERQ-CA) in secondary students from Chile

Current Psychology (2022)

César Villacura-Herrera Jorge Gaete Javiera Andaur Daniela Meza Jo Robinson

Measurement Invariance

Discriminant validity

Convergent validity

10.1007/s12144-022-03833-1

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Evidence for Specific Associations Between Depressive Symptoms, Psychotic Experiences, and Suicidal Ideation in Chilean Adolescents From the General Population

Frontiers in Psychiatry (2021)

Daniel Núñez Pía Monjes Susana Campos Johanna T. W. Wigman

Associations between psychotic experiences and suicidal ideation are not yet fully understood, and the potential role of depressive symptoms in this relationship remains unclear. The current study examined relationships between depressive symptoms (DS), psychotic experiences (PE) and suicidal ideation (SI) using two complementary approaches on cross-sectional data from a community sample of adolescents aged 13–19 years ( N = 1,591). First, we investigated the association between the three domains using mediation analysis, showing that depressive symptoms partly mediate the relationship between psychotic experiences and suicidal ideation. Second, we looked at associations between the three domains at item level using network analysis. Specific associations between symptoms of the three domains were found, indicating depressive symptoms of sadness, avolition, pessimism, and self-criticalness/worthlessness as the most central symptoms in the network. Suicidal ideation was associated with the depressive symptoms pessimism and worthlessness, to social anxiety, and to perceptual anomalies. Our results show that the mediating effect of depressive symptoms between psychotic experiences and suicidal ideation may be due to associations between specific aspects of SI, depressive symptoms and psychotic experiences. These findings can contribute to the planning of health services and programs aimed at the timely detection of psychopathology and suicidal risk in young people.

Sadness

10.3389/fpsyt.2020.552343

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The Reliability and Validity of Liu´s Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS) in Adolescents

PLoS ONE (2016)

Daniel Núñez Víctor B. Arias Susana Campos

The usage of rigorous analyses based on contemporary methods to enhance psychometric properties of screening questionnaires aimed to address psychotic-like experiences (PLE) is currently being encouraged. The Brief Self-Report Questionnaire for Screening Putative Pre-psychotic States (BQSPS) is a recently created tool addressing PLE beyond attenuated positive symptoms (APS). Its psychometric properties as a screening tool for first step assessment seems to be adequate, but further research is needed to evaluate certain validity aspects, particularly its dimensionality, internal structure, and psychometric properties in different populations. We assessed the reliability, construct validity, and criterion validity of BQSPS in two samples: 727 adolescents aged 13–18 years, and 245 young adults aged 18–33 years. We used exploratory structural equation modeling (ESEM), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM). The original four-factor structure was not replicated. The best fit in adolescents was obtained by a structure of three-correlated factors: social anxiety (SA), negative symptoms (NS), and positive symptoms (PS). This structure was confirmed in young adult subjects. The three-factor model reached a predictive capability with suicidality as external criterion. PLE are represented by a three-factor structure, which is highly stable between adolescent and young-adult samples. Although the BQSPS seems to be a valid tool for screening PLE, its psychometric properties should be improved to obtain a more accurate measurement.

Exploratory factor analysis

Criterion validity

10.1371/journal.pone.0167982

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M28. BIDIRECTIONAL INFLUENCES BETWEEN PSYCHOTIC EXPERIENCES AND SUICIDAL IDEATION IN CHILEAN ADOLESCENTS: THE ROLE OF DEPRESSIVE SYMPTOMS AS MEDIATORS

Schizophrenia Bulletin (2020)

Daniel Núñez Susana Campos Rosario Spencer María José Faúndez Andrés Fresno

Abstract Background Along with other domains of psychopathology, adolescents are at increased risk for psychotic experiences (PE) as well as for suicidal ideation (SI) and suicidal attempts. Literature has found robust associations between PE and SI, with suicidal risk appearing higher in subjects with persistent PE, in general and clinical samples. However, the associations between psychotic experiences and suicidal ideation are not clearly understood, and the role of common risk factors in this link, such as depression (DS), is controversial. Moreover, causality has yet to be properly stablished between PE and SI. A study recently found psychosis may be consequential to suicidal behavior. Under the novel “suicidal drive hypothesis for psychosis” framework, we examined whether depressive symptoms mediate the association between psychotic experiences and suicidal ideation on cross-sectional data from a community sample of adolescents. Additionally, we tested this mediating role when both PE and SI were the outcome variables. Methods 1708 Chilean school adolescents aged 13–19 years (M=15.68 + 1, 67, women= 39%) answered an online mental health screening between May and October 2019. The screening encompassed several questionnaires adapted for Chilean subjects, including the Columbia-suicide Severity Rating scale, the Community assessment for Psychic experiences (CAPE-P15) and the Patient Health Questionnaire (PHQ-9). Informed consent was granted by the parents and caregivers of adolescents. Mediation analyses were executed with the PROCESS statistical package. PROCESS runs regression-based mediations based on the Baron & Kenny procedure. A 5000 bootstrap resampling was used to estimate 95% confidence intervals; these are used to identify an indirect effect that suggests mediation. Results Pearson’s correlations showed significant associations between all the variables in (SI-DS: r= .624, p<.001; PE-SI: r= .539, p<.001; PE-DS: r= .708, p<.001). No demographic variables (i.e age, gender, education) were correlated significantly to the dependent variable (DV), therefore no covariates were controlled for in the mediation analyses. In the mediation analyses, model 1 showed SI as the DV. The link between psychotic experiences and suicide was mediated by depression (b= .3433, 95% BCa CI [.2981, .3885]). When the mediators were not included in the model, PE significantly predicted SI (b = .113, t = 26.45, p < 0.001). Additionally, in model 2, where PE was the DV, the link between suicidal ideation and psychotic experiences was mediated by depression as well (b= .3794, 95% BCa CI [.3431, .4150]). When the mediators were not included in the model, SI significantly predicted PE (b = 2.57, t = 26.45, p < 0.001). Both models exhibit robust and significant partial mediations. Discussion Our results indicate that depressive symptoms partially mediate the association between SI and PE. Moreover, either PE or SI could be outcome variables when depressive symptoms are mediators. This adds new evidence supporting that PE could consequential to SI as stated by the “suicidal drive hypothesis for psychosis”. Our exploratory findings must be carefully interpreted, mainly because of our cross-sectional design, and the fact that there could be unmeasured or non-controlled psychopathological confounder variables in our models.

Depression

10.1093/schbul/sbaa030.340

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A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

Frontiers in Psychiatry (2022)

Álvaro I. Langer Klaas J. Wardenaar Johanna T. W. Wigman José Luis Ulloa Daniel Núñez

Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.

Depression

10.3389/fpsyt.2022.926556

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Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study

JMIR Formative Research (2024)

Susana Campos Daniel Núñez J. Carola Pérez Jo Robinson

Background Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health–related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. Objective The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. Methods A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. Results Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles—one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. Conclusions WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions.

McNemar's test

10.2196/57038

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