COVID-19 and Mental health in School-Aged Children and Young People: Thinking ahead while preparing the return to school and to life “as usual”

From December 2019 onwards, the COVID-19 pandemic brought with it several health, social and economic issues, particularly associated with home confinement measures, lockdown, and fear of being infected or otherwise affected by the virus, or even die. As with everybody else, children and young people are experiencing a new reality. The question is how well, and how long will it take for recovery. Furthermore, what is the likely affective, social, academic and economic cost for this recovery. There are at least four psychosocial scenarios that must be separately analysed: children and young people with previous mental ill health that may be left unattended by health services; those who may have a first episode of mental ill health during home confinement and had no health care; those with psychosocial vulnerabilities that may be left under-monitored and exposed to undermining circumstances, and finally those that have faced a huge change in their routines and may have formed a relatively stable pessimistic outlook that affects their wellbeing. Social isolation and quarantine have precipitated a decrease in wellbeing and an increase in mental health problems and psychosocial vulnerabilities, plus a lowering of general capacity for health, education and social security care. Confined children and young people are separated from their usual social support, deprived of the personal freedom that they are used to, and see a comprehensive change in the usual life routine and lifestyle with an enormous change in physical, social, affective and even digital environments. All children and young people are in need of a monitoring system and of arrangements to promote social participation and engagement, that runs at the same time as their return to school. Mitigating negative mental health effects requires a concerted effort from the general population, policy makers, education and healthcare professionals. Moreover, international health and educational organisations have advised governments that this action would benefit by being proactive: meaning there is an urgent need to get ready immediately – being ready for the “day after”, thinking ahead and being able to put together in the field and on time, an adequate nation-wide, participatory, multidisciplinary, mental health related set of interventions.

Are Agatha, Dashiell, and Arthur alive? Assessing the link between hand movements and false intentions

Background: With the ever-increasing political, ideological and social tension which followed 9/11, crime prevention stands as an issue of major relevance. The development of the ability to accurately detect statements of false intent is of great societal and legal value. It could aid intelligence services in preventing crimes (e.g., terrorist threats) and security services in reinforcing their protocols (e.g., airport security checks, parole hearings, and border control).Goals: To examine the associations between hand movements and false intentions in adults.Methods: Using a laboratory-based variation of the ‘Portsmouth design’, 23 students completed a questionnaire about their intentions to travel in the near future. Participants with a planned trip were placed in the truth tellers’ condition (n = 12). Those who did not have a planned trip were placed in the liars’ condition (n = 11). Based on the main theoretical approaches, three hypotheses were proposed. Hypothesis 1 advocated a decrease in the three categories of illustrators (movements interconnected to speech that serve to illustrate what is being verbally said) in liars, as compared to the truth tellers. Hypothesis 2 also suggested a decrease in the category of subtle hand and finger movements in the lying condition, comparatively with the truth condition. Finally, hypothesis 3 proposed a lack of significant differences between liars and truth-tellers in the five categories of self-adaptors (movements in which one part of the body does something to another body part, such as scratching the ear or squeezing the hands).Results: Hypothesis 1 was partially supported. The general and the unilateral categories of illustrators decreased in the case of the liars, as compared to the truth tellers; however, the bilateral category of illustrators slightly increased in the lying condition, in comparison with truth telling. Hypotheses 2 and 3 were fully supported. Discussion: Apart from the slight increase of bilateral illustrators in the case of the liars, all the results are in accordance with the empirical findings on deception research about past events. This similarity is noteworthy, considering the cognitive differences between lies about past events and lies about future events.

A Structural Model of Relationships between Stressful Life Events and Older Adults’ Loneliness: Religious Orientation as Mediator

Background: Loneliness is an issue, among many, faced by older adults through stressful life events, which may lead them to unbalanced life.Goals: This study aimed to construct a structural model of associations between stressful life events and older adults’ loneliness, with religious orientation functioning as a mediator.Methods: This correlational-descriptive survey involved participants over 60 nursing homes in Hamedan, who were selected by convenience sampling. The tools utilized in this study were the Paykel Life Events Questionnaire, the Allport-Ross Religious Orientation Scale, and the Short Version of the Social and Emotional Loneliness Scale for Adults (SELSA-S). Data analysis was performed through statistical tests of path analysis and Pearson correlation coefficient.Results: The sample is composed of 92 participants (40 females). Results showed that stressful life events and loneliness have significantly positive and negative relationships, respectively, to religious orientation. Moreover, religious orientation played a mediating role in the association pattern between stressful life events and loneliness. Discussion: These results suggest that although stressful events perform an important role in older adults’ loneliness, religious orientation as a mediating variable have a crucial place in reducing the loneliness in the old age.

The Subjective Experience of Pregnancy and the Ex-pectations of Childbirth on a Medicalized World: a Qualitative Study

Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment. Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth.Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes.Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their homes. Data resulting from these interviews, focusing on the relationship with the health team, the partner and the unborn baby, and on the moment of childbirth, were analysed using ALCESTE software. Two senior researchers, psychologists, conducted the content analysis. Investigator triangulation was achieved through independent content analysis by each researcher and subsequent discussion and consensual interpretation.Results: Thirty-seven pregnant women were interviewed. Four classes emerged from the analysis: "Expectations about childbirth and baby health", “Significant relational experiences of the past”, "Mother-baby relationship process" and “Health care in pregnancy". Results emphasize the desire of future mothers to have a quick childbirth, without stress and with minimal suffering and anxiety. Despite these worries, women described a positive subjective experience of pregnancy and a feeling of security related to the knowledge they attribute to health professionals. Discussion: “Medicalization” seems to be perceived as positive and securing, with no mention to a sense of disempowerment or loss of control. Therefore, the existence of spaces for sharing disturbing experiences and expectations of childbirth is prophylactic,contributing to the creation of conditions that foster positive expectations and mitigate fears related to childbirth.

Mental health in primary health care: professionals’ perceptions and patients’ levels of depression, anxiety and stress

Background: The integration of mental health in primary health care, throughout its various functional units and with effective articulation between primary health care and mental health services, has been considered an essential objective of the legislative documents produced in the last three decades in Portugal, among them the National Health Plan 2011-2016.Goals: This study aimed to inquire health professionals’ perceptions about mental health care provided by public primary health care units, namely their perceptions about the mental health of their patients. It also intended to explore the difficulties perceived by the health professionals in their daily activity about the mental health problems of their patients and about the need of clinical psychologists’ activity in the public primary health care.Methods: This is an observational cross-sectional study with two non-probabilistic samples: health professionals (doctors, nurses and psychologists) and patients from two public health care units. Health professionals were interviewed (individual structured face-to-face interviews) about their perceptions of needs for improving their capacity to provide mental healthcare and about patients’ mental health conditions. Patients responded (by self-administration) to the Depression, Anxiety and Stress Scale (DASS-21), providing a characterization of patients’ stress, anxiety and symptoms of depression.Results: Health professionals in their daily practice often identify in their patients symptoms of stress, anxiety and depression (most particularly in adults),. Several issues were identified as problematic, such as: poor access of the referral system for psychiatric and clinical psychological specialized care, insufficient number of health professionals, particularly of psychologists, and lack of appropriate mental health care specialization. The results also revealed relevant levels of stress, anxiety and depression in primary health care patients (both genders), which seem to increase with age. Discussion: Difficulties identified by health professionals may relate to the centralisation of resources, resistance to change from human resources management, lack of consensus among the various decision groups linked to mental health and, at institutional level, insufficient and inadequate funding. These factors may contribute to a failure in early diagnosis of symptoms of depression, anxiety and stress. It is expected that articulation between primary health services and differentiated health services will improve, with improvement in teamwork among professionals and increase of the quality of life of users, satisfaction with work, from health professionals, and reduction of health costs.

Pediatric Psychology in Emergency Services: a Clinical Practice to Follow in Hospital Context

SiSince the beginning of 2016, the team of the Emergency Service (SU) of the Pediatric Department of the Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (HSM-CHULN), counts with another valence in its intervention plan. Traditionally specialized in an approach of organic pathology, the service is now composed of a specialized intervention of Pediatric Psychology. This paper has the purpose of review, deepen and disclose (i) the psychological intervention model that is used in the SU, focused on babies, children and adolescents, as well as on direct/indirect support to families, at a Physical and Mental Health levels, (ii) the developed work in stress management of the emergency team and (iii) the performance of psychologists in the emergency context, as a way to update the intervention protocols within this practice according to international guidelines. The intervention carried in this SU, in situations of emergency, urgency or crisis, resort from strategies that mitigate and treat the intense cognitive, behavioral and emotional malaise of the pediatric patient and families/caregivers, in a interprofessional perspective and always as a first line resource. Given the increase and clinical relevance of the psychological variables, the inclusion of this specialized area presents itself as a sustainable and important intervention for a practice that we wish to be implemented transversally, contributing to the reduction of outpatient visits, therapeutic prescriptions, number of consultations and frequency of hospitalizations. A pre- and postgraduate training that privilege this type of knowledge and enables the implementation of these intervention models in a larger number of institutions presents itself as a sustained practice of health services.

Mothers’ eating style’s influence on their feeding practices and on their children’s appetite traits

Background: Overweight and obesity in children and adolescents has become an important public health concern in the last decades. To study the way mothers and children’s behavioral factors interact with each other, influencing eating and body weight, may provide information to be used in preventive and treatment strategies.Goals: To study the association of mothers’ eating style on their feeding behavior and on their children’s eating behavior.Methods: Cross-sectional observational study with a non-probabilistic sample of mother and child dyads (from three schools). Mothers’ eating behavior (assessed with Dutch Eating Behavior Questionnaire scale; DEBQ) was classified and they were grouped into three eating styles: restrictive, emotional-external or neutral styles. Mothers’ feeding restriction, pressure to eat and concern about child’s weight were assessed (through the Child Feeding Questionnaire; CFQ). Finally, mothers classified their child’s appetite behaviors (with the Children’s Eating Behaviour Questionnaire; CEBQ).Results: Overall, participated 279 mothers, aged between 23 and 59 years (Mean= 38.03 years, SD=5.09) and respective children (n=279), aged between 6 and 13 years (Mean= 9.43 years, SD= 1.35), 140 of those were females (50.2 %). Associations between mothers’ eating style, their feeding behaviors and children’s appetite traits showed that restrictive and emotional-external eating mothers had higher scores of CFQ and CEBQ items related with obesity, when compared to neutral eating style mothers. Mothers’ feeding restriction and children’s weight concern associated positively with children’s food approach behaviors (enjoyment of food, food responsiveness, emotional over-eating), and negatively with food avoidance behaviors (satiety responsiveness and slowness in eating). On the contrary, pressure to eat associated positively with food avoidance behaviors and negatively with food approach behaviors. Mother´s concern about child weight and feeding restriction were positively associated with CEBQ subscales that reflect food approach and negatively associated with subscales that reflect food avoidance. Pressure to eat had the symmetric associations. Discussion: Results support the hypothesis of the transmission of eating behaviors that promote obesity from mothers to children, and have implications both for prevention and children and adolescents’ obesity treatment. Therefore, mothers should be a part of the intervention when treating their children obesity

Long-term efficacy of psychotherapy in major depression: protocol of a network meta-analysis

Background: Depression is currently considered the epidemic of the century. In recent decades, research has established that psychotherapy is globally effective for the treatment of depression; however, it remains open which psychotherapeutic treatment is most effective and, particularly, if its efficacy is maintained over the long term. Given the difficulty in performing randomized and controlled clinical trials (RCTs) that simultaneously compare several psychotherapeutic models, meta-analyses aim to provide answers by synthesizing the evidence generated through direct comparisons of treatments.Goals: This protocol describes the meta-analysis study we will perform in order to assess the efficacy and acceptability of long-term results of psychotherapy (i.e., 18-month follow-up or higher) in the treatment of major depression in adults.Methods: Through the use of a recent methodological approach - the network meta-analysis - we will integrate the direct and indirect analysis of evidence from randomized and controlled clinical trials in this domain. We will systematically search seven databases for RCTs of psychotherapy, published since 1994, with evaluation of the efficacy in terms of long-term results for the treatment of depression. All studies with adult participants (18 to 65 years of age) diagnosed with major depression (according to DSM-IV, IV-TR, V or ICD-9, 10) will be eligible and all studies that compare psychotherapy (individual and face-to-face treatment) with a control condition (waiting-list, placebo) will be considered. Data extraction, quality assessment and risk of bias will be carried out independently by three researchers. The primary outcome measure will be the long-term efficacy of treatments (follow-ups of 18 months or above) measured by changes in the overall clinical response and symptoms of depression since post-treatment and follow-ups. The secondary measure will be the acceptability of treatment as measured by the proportion of participants who drop out of follow-up or start another treatment (not psychotherapy). A direct comparison (pairwise meta-analysis) of all studies comparing different psychotherapies will be performed. We will compare relative efficacy and acceptability by indirect comparison, through a bayesian network meta-analysis of random effects to compare different psychological interventions. Further analyses will be conducted if inconsistency and heterogeneity values are found. Discussion: The purpose of this review is to systematize and integrate evidence of long-term maintenance of the results of different psychotherapeutic treatments for major depression, administered individually and face-to-face in RCTs. For this reason, multiple direct and indirect comparisons of treatments (bayesian network) will be made, and the interrelationships between treatments will be estimated in terms of long-term efficacy and acceptability. Even though our scope will be focused on RCTs, we hope that the results obtained can contribute to summarize the present evidence available in terms of long-term results of psychotherapy (i.e., its effectiveness), optimizing the planning of future studies, providing public health guidelines and more informed clinical decisions on the treatment of depression.

IV OPP Congress | Book of Proceedings | Braga, 2018

This proceedings book integrates the collection of short papers that have been submitted and accepted by the Scientific Commitee of the 4th Congress of OPP, venued in Braga, between the 12th and 15th September 2018, under the scope of: Psicologia na Prevenção e Promoção do Desenvolvimento das Pessoas, Coesão Social e Crescimento Económico.

Brief assessment of depression: Psychometric properties of the Portuguese version of the Patient Health Questionnaire (PHQ-9)

Background: The lack of knowledge regarding psychometric characteristics of brief scales for assessing the severity of symptoms of depression for the Portuguese population limits the ability of health professionals to signal clinically relevant situations, as well as the implementation of alternative forms of mental health care. The Patient Health Questionnaire (PHQ-9) is a scale whose usefulness in various professional contexts has been amply demonstrated by research. However, some of its psychometric qualities remain unknown for the Portuguese version.Goals: The main objective of this study was to analyse the validity of the factorial structure and the psychometric characteristics of the PHQ-9 in two different clinical Portuguese contexts, namely in primary health care units and in a university clinic, also reflecting the similarities and differences found regarding the factorial structures.Methods: The first study was carried out with 153 patients (83.66% females), with a mean age of 46.10 years (SD = 16.79), from eight health units of primary health care (non-probabilistic sampling). All participants underwent an initial screening for the detection of symptoms of depression and suicidal ideation, within the context of a regular family medicine appointment or nursing visit. Participants who scored positively for one of these symptoms were invited to participate in the study. The PHQ-9 and the Work and Social Adjustment Scale (WSAS) were used and exploratory and semi-confirmatory factor analyses of the PHQ-9 were performed. In the second study, 106 adults (70.78% females) participated in a psychological counselling session at a university clinic, with a mean age of 32.47 years (SD = 11.01), also constituting a non-probabilistic sample. As instruments, the PHQ-9, the Beck-II Depression Inventory and the State-Trait Anxiety Inventory were used, which participants completed before the beginning of the psychological treatment. As in the first study, exploratory and semi-confirmatory factor analyses of the PHQ-9 were conducted. Results: The results of the two studies revealed a factorial structure consisting of three factors. In the first study, the three factors were: (1) depressed mood and anhedonia; (2) self-devaluation and suicidal ideation; and (3) fatigue, psychomotor agitation/retardation, and changes in appetite, sleep problems or difficulty in concentration. In the second study, the three factors that were found were: (1) sleep problems and fatigue; (2) changes in appetite and difficulty in concentration, psychomotor agitation/retardation, and suicidal ideation; and (3) depressed mood, anhedonia, and self-devaluation. The factorial structure found in both studies revealed a good fit. The PHQ-9 also presented good internal consistency, convergent validity and criterion validity in both studies. The cut-off point of 9 emerged as an indicator of major depression.Discussion: The results of this study enhance the use of this scale in different contexts of health care provision in Portugal, since it was possible to determine the cut-off point for the detection of cases with major depression, as well as the criteria for delimiting severity degrees of depression-related symptomatology.Keywords: PHQ-9, Depression, Psychometric qualities, Primary health care, University clinic