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Para prevenir el avance de la COVID-19, países como Ecuador adoptaron medidas de confinamiento obligatorio, el teletrabajo y la educación remota. Durante estos periodos, las personas recurrieron al uso de sus teléfonos móviles, al igual que a otros dispositivos, con el fin de informarse, socializar y trabajar. Este estudio buscó identificar los efectos del uso de estos dispositivos sobre los niveles de malestar psicológico. Se reclutó una muestra de 766 personas quienes respondieron una encuesta en línea durante la primera fase de confinamiento por COVID-19 en Ecuador. Los resultados sugieren que las personas estuvieron aproximadamente 9.75 horas al día conectadas a sus dispositivos tecnológicos, incluido el teléfono móvil. Igualmente, se encontró que el nivel de malestar de las personas aumenta conforme incrementa el uso problemático del teléfono móvil, el número total de minutos empleados por día conectados a dispositivos tecnológicos y el número de minutos empleados en redes sociales. Asimismo, el uso problemático del teléfono móvil, usarlo para distraerse de algo incómodo y para expresar o buscar afecto se asociaron con mayores niveles en cuanto al grado de malestar de los participantes. Por el contrario, el uso del teléfono móvil para hacer compras en línea y percibir mayores niveles de control del uso se asoció con una disminución del malestar. Se discuten las implicaciones de estos hallazgos a la luz de las condiciones actuales de la pandemia, las nuevas variantes del coronavirus y las cuarentenas obligatorias para aquellas personas diagnosticadas con el virus.

Despite the burden associated to depression, current standards of care are still limited in scope and effectiveness. In addition, therapy outcomes have frequently focused solely on symptoms, leaving patients' wellbeing relatively unaddressed.The objective of this study was to test whether two cognitive therapies increased subjective wellbeing in a sample of adults diagnosed with a depressive disorder, additionally assessing the relationship between this growth and decreases in both depression severity and psychological distress.Data from 116 participants from a randomised controlled trial comparing the efficacy of cognitive behavioural therapy and dilemma-focused therapy were analysed. Multilevel linear models were employed, together with correlational analyses.Results showed that both interventions significantly improved wellbeing with moderate to large effect sizes, while no significant differences were found between treatments. In turn, the increase in wellbeing was significantly associated to improvements in depression severity and psychological distress.This study sheds light on the complex relationship between happiness and depression, supporting their conceptualisation as related yet independent human experiences, and strengthening subjective wellbeing as a useful outcome for psychological research. Psychotherapy is presented as an effective intervention to enhance wellbeing, even among individuals with severe depressive symptoms.

El desarrollo de la psicología en Guatemala durante las últimas décadas se ha visto fortalecido por varios hitos en su historia como han sido los congresos, encuentros académicos y profesionales, colaboraciones internacionales y conferencias para nombrar algunos. Este número especial de nuestra revista da testimonio de uno de ellos. Gracias a la confianza, apoyo y mentoría de los grandes exponentes de las psicoterapias integrativas de América Latina y de la valiosa y comprometida colaboración de un comité organizador, pudo realizarse en Guatemala, de manera virtual con sólido apoyo tecnológico, el VIII Encuentro Latinoamericano de Psicoterapias Integrativas (ELAPSI). Si bien, el producto final fue de una excelente calidad académica, científica, profesional y sociocultural, también fue de inmenso valor el llegar a concretarlo. Desde el momento en que nos fue confiada la realización del mismo en el marco del VII Encuentro Latinoamericano que se llevó a cabo en Uruguay en 2018, sabíamos que estábamos abriendo brecha. Por primera vez, un ELAPSI sería realizado fuera de América del Sur, en donde históricamente se había congregado la comunidad académica y profesional de las psicoterapias integrativas. Por lo tanto, iniciar el proceso de organización implicaba no solo colocar a Guatemala en el mapa latinoamericano de la integración psicoterapéutica sino también consolidar un equipo organizador que representara las voces integrativas de las Américas particularmente de aquellos países donde hasta el momento estaban casi silenciadas. Los valores de solidaridad, apoyo, entusiasmo y compromiso se hicieron presentes para emprender una tarea que, aunque ambiciosa desde sus albores, fue apasionante.

Ortiz-Prado, Esteban, Katherine Simbaña-Rivera, Diego Duta, Israel Ochoa, Juan S. Izquierdo-Condoy, Eduardo Vasconez, Kathia Carrasco, Manuel Calvopiña, Ginés Viscor, and Clara Paz. Optimism and health self-perception-related differences in indigenous Kiwchas of Ecuador at low and high altitude: a cross-sectional analysis.

Most of the studies about mental health and quality of life of emerging adults have been conducted in developed countries and non-students’ population has been neglected, limiting the generalisation of the results to other socioeconomic realities. This paper reports the results of an observational study on differences between the two cohorts (students vs non-students) both on mental health and quality of life measures but also on demographic, lifestyle and mental health variables in emerging adults living in a middle-income country. Associations between variables and interactions in the prediction of both outcomes scores were explored to understand how much other variables may contribute to differences between the two groups. We found poorer mental health and worse health-related quality of life in the students than the non-students, although effect sizes were small. Differences between the groups on some sociodemographic predictor variables were statistically significant, showing fairly strong effects, for social status, sleeping hours and parenting, however, none of the predictor variables showed confounding with group effects on both outcomes. Developing countries are growing and work forces are changing, creating a huge global need to understand these changes and the effects on the mental health and quality of life of this evolving population.Registration: ClinicalTrials.gov (NCT04596345).

Psychological research often seeks general rules applying across individuals, an aim that is in tension with examining that which is unique to any individual. There are general statistical regularities across individuals’ subjective self-report which enable much psychology and psychotherapy research to combine data from self-report questionnaire responses with statistical and psychometric methods to create a fundamental part of Cronbach and Meehl’s foundational nomological networks of validity. However, these methods only apply when most participants answer the same questions on measures creating nomothetic data and this has led to a neglect of idiographic data. This paper reviews a method of analysis of idiographic data, of “rigorous idiography”: the method of derangements. This is a remarkably simple statistical test of whether purely idiographic data convey reliable information. We show how the method appeared to become stuck in a bibliometric backwater but we expand on its potential for research and practise and hope it will be taken up and used correctly and more widely.

Background The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person’s sense of identity and focuses on meaning-making processes. Methods The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists’ adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study. Discussion We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder. Trial registration ClinicalTrials.gov NCT04321525. Registered on 18 February 2020

Objetivo: Describir el estado de la salud mental de los adultos ecuatorianos durante la pandemia por COVID-19 de marzo a agosto de 2020. Para este fin, se analizaron los datos de un estudio más amplio que involucró varios países hispanohablantes. La investigación tuvo un diseño no experimental, cuantitativo, transversal de tipo descriptivo donde se aplicó una encuesta anónima en línea. Resultados: En total participaron 766 personas, 64.23% fueron mujeres y la edad media fue de 32.35 (DT = 12.54). Alrededor del 8% de los participantes declararon haber tenido diagnóstico de COVID-19 y un 12.9% haber experimentado síntomas relacionados. La mayor parte de los participantes (77.4%) indicaron no haber tenido problemas de salud mental en el pasado y el 87.6% no tener estos problemas durante la pandemia. Sin embargo, el 41% reconoció tener mayor malestar psicológico. Los participantes presentaron niveles bajos de síntomas (depresión, ansiedad y estrés). Las mujeres y los adultos jóvenes fueron los grupos más afectados por los síntomas evaluados. Conclusiones: En situaciones de confinamiento y pandemia es necesaria la atención de la salud mental de la población general y, en especial, la de las mujeres y los adultos jóvenes.

This is an observational exploratory study assessing self-concept and its association with depression, anxiety, satisfaction with life, and quality of life 6 months after experiencing a traumatic brain injury. Participants were 33 patients who suffered a traumatic brain injury 6 months before the assessment. The measures used in this study were the Repertory Grid Technique, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Satisfaction With Life Scale, and the Quality of Life after Brain Injury. We calculated Euclidean distances to assess differences in pre-and post-injury self-perception, as well as the proportion of opposed pole construct rating and polarization to understand how they are associated with the scores of the other offered measures. We found that the distance between the present and ideal self, as well as the distance between the present self and the self before the lesion showed moderate positive correlations with depression, and negative correlations with satisfaction with life and quality of life. Also, for the present and self before the lesion, the proportion of opposed pole ratings was correlated with depression symptoms, quality, and satisfaction with life, while for the present self and the ideal self this proportion was correlated with all the measures. The proportion of polarization of the present self and the total polarization was negatively correlated with symptom measures. The repertory grid might facilitate a greater understanding of self-concept after traumatic brain injury. This information could be used to guide treatments that address the emotions related to distances observed in the perception of the self.

The COVID-19 pandemic has forced many companies to adopt different work modalities to ensure their operation during this period. In this study, we described and compared working conditions and perceptions among face-to-face workers, teleworkers, and hybrid workers in Ecuador. A cross-sectional study was conducted with a sample of 542 participants, using a self-report survey to assess sociodemographic data, working conditions, and workers’ perceptions. Variables were described and then compared by the Chi-square test, ANOVA, and the Kruskal–Wallis test. The results indicated a higher proportion of on-site workers without higher education and in the public sector compared to the other modalities. At the same time, there was evidence of increased perceived productivity. People in the hybrid modality tended to have more than one job, earning a higher monthly salary, perceiving a decrease in productivity, an increase in daily working hours, and a lower capacity for time management. In addition, most teleworkers reported fair working conditions, a dedicated workspace, and easy adaptation to this work mode. This study builds a more in-depth understanding of how workers perceived their working conditions among work modalities for organizational decision-making because the evolution of the COVID-19 pandemic is modifying the ways of working permanently.

Background: Some patients who have recovered from COVID-19 have experienced a range of persistent symptoms or the appearance of new ones after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to a significant number of patients. Methods: A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 2103 surveys were included in this study. We compared socio-demographic variables and long-term persisting symptoms at low (< 2,500 m) and high altitude (>2,500 m).Results: Overall, 1100 (52.3%) responders claimed to have long-term symptoms after SARS-CoV-2 infection. Most of these symptoms were reported by women (64.0%), the most affected group was young adults (68.5%), and the majority of long-haulers were mestizos (91.6%). We found that high altitude residents were more likely to report persisting symptoms (71.7%) versus those living at lower altitudes (29.3%). The most common symptoms were fatigue or tiredness (8.4%), hair loss (5.1%) and difficulty concentrating (5.0%). The highest proportion of persisting symptoms was observed among those who received an incomplete vaccine scheme.Conclusions: This is the first study describing post-COVID symptoms' persistence in low and high-altitude residents. Our findings demonstrate that women, especially those aging between 20-40, are more likely to describe sequalae associated with post-COVID. We also found that living at a high altitude was associated with earlier onset and longer symptom duration. Finally, we found a greater risk to report long lasting symptoms among women, those with previous comorbidities and those who had a severer acute SARS-CoV-2 infection.

IntroductionData-informed psychotherapy and routine outcome monitoring are growing as referents in psychotherapy research and practice. In Ecuador, standardised web-based routine outcome monitoring systems have not been used yet, precluding data-driven clinical decisions and service management. Hence, this project aims at fostering and disseminating practice-based evidence in psychotherapy in Ecuador by implementing a web-based routine outcome monitoring system in a university psychotherapy service.Methods and analysesThis is a protocol for an observational naturalistic longitudinal study. Progress and outcomes of treatment in the Centro de Psicología Aplicada of the Universidad de Las Américas in Quito, Ecuador will be examined. Participants will be adolescents and adults (≥11 years) seeking treatment, as well as therapists and trainees working at the centre between October 2022 and September 2025. Clients’ progress will be monitored by a range of key variables: psychological distress, ambivalence to change, family functioning, therapeutic alliance and life satisfaction. Sociodemographic information and satisfaction with treatment data will be collected before and at the end of treatment, respectively. Also, semi-structured interviews to explore therapists’ and trainees’ perceptions, expectations and experiences will be conducted. We will analyse first contact data, psychometrics of the measures, reliable and clinically significant change, outcome predictors as well as trajectories of changes. Moreover, we will conduct a framework analysis for the interviews.Ethics and disseminationThe protocol for this study was approved by the Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador (#PV-10–2022). The results will be disseminated in peer-reviewed scientific articles, at conferences and in workshops.Trial registration numberNCT05343741.

The Schwartz Outcome Scale-10 is a 10-item measure that has proven utility for assessing well-being and mental health and measuring change over time. Although there is a Spanish translation of the measure created in the United States for the Latino population, its acceptability and psychometric properties have not been studied in unilingual Spanish speakers, nor outside the United States. The aim of the present study is to explore these properties in larger samples, clinical and non-clinical, from Latin America adding convergent validity checking and exploration of effects of gender and age on scores. A qualitative study was conducted with 11 participants to test for dialect/language issues, then a psychometric exploration of data from 886 participants in a non-clinical sample and 172 in a clinical sample. The results showed good psychometric characteristics and suggest that the SOS-10-E can be used in Latin America. A cutoff of 42.51 differentiates clinical scores from non-clinical. Future studies are needed to explore sensitivity to change and check replication in other Spanish speaking populations.

Objective: To conduct a scoping review of measure utilization in Latin America. We relate the findings to the needs of the region and give recommendations for measure usage in LA.\ud \ud \ud \ud Methods: Six electronic databases (PubMed, Web of Science, CINAHL, PsychInfo, SCOPUS, and SCIELO) were searched to identify peer-reviewed literature. In total, 207 studies using change and/or outcome measures were identified based on a priori inclusion criteria.\ud \ud \ud \ud Results: Production by country varied markedly; more than three quarters of the studies took place in just three of the 20 Latin American countries: Brazil, Chile, and Mexico. The most frequently used measures were the Outcome Questionnaire, Beck Depression Inventory-II, Hamilton Rating Scale, and Yale-Brown Obsessive-Compulsive Scale. The most common diagnosis was depression (n = 54).\ud \ud \ud \ud Conclusions: Outcome and change research in Latin America is growing rapidly but future efforts should focus more tightly on the needs of the region, as well as on forging collaborations with researchers from other regions. The use of change measures for serial assessment throughout interventions is recommended in view of its adaptability to highly diverse Latin American social realities. Dissemination of research findings and promotion of outcome and change measure use through implementation of public policy is recommended.

Tras el diagnóstico de la primera persona infectada con el coronavirus SARS-CoV-2 este ha llegado a expandirse por todo el mundo, ocasionando una pandemia y poniendo en alerta a los sistemas de salud. Actualmente, la evidencia indica que los efectos de este coronavirus en humanos no siempre se limitan al tracto respiratorio, pueden invadir el sistema nervioso central ocasionado dolor de cabeza, convulsiones y alteraciones de conciencia. Por esta razón, se recomienda pensar en una infección con SARS-CoV-2 como un diagnóstico diferencial en pacientes que presentan manifestaciones neurológicas.

Objective: Several studies have investigated the negative toll the pandemic has had on people’s mental health. However, there is limited research on the pandemic’s effect on positive mental health variables. This article reports on the levels of self-esteem and well-being (flourishing and happiness) in a sample of adults living in Ecuador and their relationships with the characteristics of their personal situation and the effects of the COVID-19 pandemic had on their personal lives.Methods: A total of 766 adults completed an anonymous online survey between March and August 2020.Results: Participants reported average scores in the flourishing scale, the majority considered themselves to be happy or very happy people, and more than half presented high levels of self-esteem. Age, education, socioeconomic status, time spent using mobile phones and on hobbies, among others, explained self-esteem, happiness, and flourishing.Conclusion: The relationships between sociodemographic and situational variables of confinement during the pandemic are discussed, as well as the possible predictors of happiness, flourishing, and self-esteem.

Procrastination involves voluntarily or habitually delaying unpleasant tasks for later. It is characterized by short-term benefits and long-term costs. The COVID-19 pandemic set specific circumstances that may have influenced procrastination behavior. This scoping review identified the existing peer-reviewed literature in English or Spanish about procrastination during the COVID-19 pandemic (January 2020 to April 2021) in six electronic databases. To conduct the review, a five-step methodological framework, as well as established PRISMA guidelines, was followed. A total of 101 articles were found. After removing duplicates and reviewing the articles, only 13 were included in the review. Findings indicate that procrastination was studied mostly in academic contexts in various parts of the globe. Procrastination behavior was related to anxiety, distress, time management, self-control, and other variables. There is limited information about interventions to prevent or decrease procrastinating behaviors in the context of confinement or in the living conditions generated by the pandemic. Future research should consider how procrastination evolved during the pandemic using longitudinal methodologies. Individual differences related to procrastination also should be identified, and the evaluation of the efficacy of existing interventions is still needed. This information might help in the creation of appropriate interventions that target detrimental procrastination behaviors.

Latin American mental health services are moving from the psychiatric hospital model to a community-based model. The effectiveness of these new services needs to be evaluated and that can be done through routine outcome monitoring. The present communication introduces the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), a free instrument, supported with rigorous psychometric exploration, and which has been translated to Spanish and Brazilian Portuguese that can be used for monitoring purposes across the region.

The COVID-19 pandemic has affected the lives of millions of people worldwide. This study aimed to analyze the effects of several psychological factors (self-esteem, self-control, and emotional stability) over lifestyle-related variables (time spent on leisure activities) and the levels of satisfaction (family, friends, work, and leisure satisfaction) experienced during the COVID-19 outbreak. Data for this article were retrieved as part of a cross-sectional international study conducted in eleven Spanish-speaking countries between March and September 2020. The analyses were conducted using the responses of 9500 persons (65.95% women, 34.05% men). Structural equation modeling was used to test the direct and indirect effects of the psychological variables on satisfaction variables mediated by the time engaged in leisure activities. Our model indicated that psychological factors significantly predicted the amount of time spent in leisure activities and satisfaction. Overall, results indicate that self-esteem is a relevant psychological factor to consider in the development of psychological interventions directed at promoting healthy lifestyles. Nevertheless, further research is needed to validate the direction of the associations found in this study.

The literature on measure translation tends to hold, overtly or covertly, a questionable assumption about the possibility of exact translation and almost completely ignores issues of within language variation. Equally, psychometric methods used to assess cross-cultural validity after translation focus on large sample tests of cross-sectional measurement invariance. Such invariance is often not found and is of dubious pertinence to change/outcome measures usually used in psychotherapy research. We present a sequential process of three substudies using quantitative and qualitative procedures to explore whether an outcome measure needs to be changed when used across language variation. Qualitative data confirmed that an item was not ideal in the new context. However, quantitative exploration showed that, although statistically significant and affected by gender and item order, the impact of changing the item in the overall score was small, allowing retention of the existing Spanish translation. We argue that the myth of perfect translation and over-reliance on large-sample psychometric testing pursuing measurement invariance limit exploration of language effects. We recommend that these be used in the companion of user-based, sequential, mixed-method exploration to support the development of a richer field of understanding of outcomes and change self-report measures across languages and cultures and both across and within languages.

Objectives: to explore the emotional impact of the COVID-19 pandemic in the Galapagos Islands.Methods: an online survey of 369 participants, conducted on October of 2020, was used to assess levels of depression, anxiety, and stress, as well as specific behavioral and emotional reactions to the pandemic.Results: the prevalence of anxiety was 4% and depression 3.65%. Perceived stress level was higher, with 52% of the sample reporting moderate amounts. Women had higher levels of depression and perceived stress. Financial distress, interpersonal conflicts, feelings of isolation and fear of contagion of COVID-19 were all associated with higher levels of anxiety, depression, and stress.Conclusion: prevalence of anxiety and depression is lower in the Galápagos Islands during the pandemic compared to other regions, while stress levels are more significant and may warrant intervention. Despite being low, anxiety and depression were associated with potentially problematic behaviors and emotional reactions.

The aim of the present study was to compare scores from the English and the Spanish versions of two well-known measures of psychological distress using a within-subject approach. This method involved bilingual participants completing both measures in four conditions. For two groups of people, measures were offered in the same language both times and for the other two groups, each language version was offered, the order differing between the groups. The measures were the Clinical Outcomes in Routine Evaluation-Outcome Measure and the Schwartz Outcome Scale-10, both originally created in English and then translated to Spanish. In total, 109 bilingual participants (69.7% women) completed the measures in two occasions and were randomly allocated to the four conditions (English-English, English-Spanish, Spanish-English and Spanish-Spanish). Linear mixed effects models were performed to provide a formal null hypothesis test of the effect of language, order of completion and their interaction for each measure. The results indicate that for the total score of the Clinical Outcomes in Routine Evaluation-Outcome Measure just language had a significant effect, but no significant effects were found for completion order or the language by order interaction. For the Schwartz Outcome Scale-10 scores, none of these effects were statistically significant. This method offers some clear advantages over the more prevalent psychometric methods of testing score comparability across measure translations.

IntroductionEating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves.Methods and analysisThis protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models.Ethics and disseminationThe study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED.Trial registration numberNCT04127214.

The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak., Departamento de Física

Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia.We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47,PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo del estudio es probar la eficacia de la Terapia de Constructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas depresivos en mujeres con fibromialgia.Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromialgia y síntomas depresivos (Ambas condiciones redujeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (La TCP y la TCC parecerían ser igualmente efectivas para el tratamiento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

Disturbances in personal identity are recognized in psychosis and depression. However, it is unknown whether these disruptions share common processes across clinical groups, or whether there are unique alterations by group or between men and women within each clinical group. To advance on this question, we compared personal identity dimensions in psychosis and depression and investigated the effects of gender and depressive mood. This study assessed dimensions of personal identity using the repertory grid technique among 85 outpatients with psychosis, 85 outpatients with depressive disorders and 85 healthy controls who were matched by age. Data regarding depressive mood and general functioning was also collected. Results showed that self-discrepancies were higher in psychosis and depression than in controls, and were associated with depressive mood. Interpersonal dichotomous thinking was more prevalent in women in both clinical groups. Women with psychosis showed higher ideal-others discrepancy and had a more complex structure of personal identity than their male counterparts. To conclude, alterations in self-ideal and self-others discrepancies may be transdiagnostic dimensions related to depressive mood. Interpersonal dichotomous thinking may also be a common dimensional characteristic in psychosis and depression but more specific to women. Finally, critical views of others and a higher complexity of personal identity may be more specific to women than men with psychosis. Our results are consistent with other studies pointing to the need for person-focused treatments promoting the recovery of a full sense of personal identity, rather than just focusing on specific thoughts and feelings.

Resumen El artículo presenta una revisión teórica sobre el paradigma de la Práctica Basada en la Evidencia y sobre el de la Evidencia Basada en la Práctica en el ámbito de la psicoterapia; se profundiza especialmente en este último paradigma y su asociación con la investigación de la efectividad en psicoterapia. Posteriormente, se contextualiza el funcionamiento de este último paradigma en los sistemas de salud y en particular en la atención en salud mental, haciendo hincapié en su aplicabilidad en la evaluación rutinaria y su potencial para contribuir al campo de la investigación en psicoterapia. Finalmente, se presentan algunas conclusiones sobre cómo promover la investigación orientada a la Evidencia Basada en la Práctica en contextos psicoterapéuticos, a partir de Redes de Investigación en la Práctica en los países latinoamericanos. Abstract This article presents a theoretical review of the Evidence-Based Practice and the Practice-Based Evidence in psychotherapy, the latter is explained in depth considering its association with the research of the effectiveness in psychotherapy. Subsequently, the functioning of this last paradigm in health systems, particularly in mental health care is contextualized, emphasizing its applicability in routine evaluation and its potential to contribute to the field of research in psychotherapy. Finally, some conclusions are presented on how to promote research based on the paradigm of Practice-Based Evidence in psychotherapeutic contexts, based on Practice Research Networks in Latin American countries.

Around the world, geosocial networking apps have become widely popular among sexual minority men (SMM). This research analyzed the sexual behaviors and HIV and STI prevention strategies (HIV/STI testing, HIV/STI inquiry, and HIV/STI disclosure) of an online-recruited sample of 284 SMM living in Ecuador. Sexting and oral sex were the most common sexual behaviors among SMM in the sample. Most participants had low perceptions of HIV and STI risk; 85% reported being tested for HIV and 70% for STIs. Being older predicted higher odds of being tested for either HIV or STIs at least once. Being single also predicted HIV testing. Future interventions in the country should explore apps’ utility as intervention tools to spread information about sexual health and HIV prevention strategies, such as condom use and event-driven PrEP. Apps can also facilitate connections to sexual health services, including programs for PrEP initiation and linkage to HIV treatment. They should also focus on promoting sexual harm reduction conversations among potential app-met sexual partners.

Background The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pan-theoretical and pan-diagnostic measure of mental health designed to cover issues that people wish to change in psychotherapy. The objective of this study was to explore the psychometric properties of the Spanish translation of the CORE-OM, in a country, Ecuador for which there is not a single measure suitable for this purpose with empirically demonstrated local acceptability and psychometric properties. Methods In total, 886 adults not currently receiving psychotherapy treatment or taking psychotropic medication were included in the analysis. The analyses broadly followed and compared with results from previous studies. These analyses consisted of assessment of acceptability, internal consistency, test-retest reliability, influences of demographic variables, correlations between domain scores, and convergent validity with Spanish versions of the Outcome Questionnaire 45.2 and Schwartz Outcome Scale-10. Results The questionnaire showed good acceptability (overall omission rate of 0.56%), good reliability (α = .93 [.92, .94], test-retest correlations ranged from .59 to .85), and good convergent validity with the Outcome Questionnaire 45.2 (r = .84) and the Schwartz Outcome Scale-10 (r = −.73). Statistically significant gender differences were found in two domains: females scored higher on Well-being (M = 1.23) than males (M = 1.01), though effect size was small (g = 0.31); and males (M = 0.31) scored higher than females on Risk (M = 0.25), with even smaller effect size (g = 0.06). Age was negatively correlated with psychological distress in all domains and coefficients ranged from −.14 for Risk to −.29 for Functioning. Conclusions The results support the use of the CORE-OM as a valid and reliable instrument in a non-clinical Ecuadorean population. Exploration of the psychometric properties in a clinical population is recommended to assure its use in clinical settings.

Geosocial networking applications (GSN apps) have become important socialization contexts for sexual minority men (SMM). Despite their popularity, there is limited research carried out in Latin American countries and no single previous study done in Ecuador. To fill this gap, this exploratory study described and analyzed the relationships between the sociodemographic characteristics of SMM using GSN apps, their sought and fulfilled expectations, profile shared and sought characteristics, and the evaluation of their experiences as users including their perceptions of support, and discrimination. We used an online recruited sample of 303 participants enrolled between November 2019 and January 2020. Most respondents used Grindr and reported spending up to 3 h per day using apps. Most common sought expectations were getting distracted, meeting new friends, and meeting people for sexual encounters. The least met expectation was meeting someone to build a romantic relationship with. When asked about their profiles, participants reported sharing mainly their age, photographs, and sexual role. Participants also prioritized these characteristics when looking at others’ profiles. When asked about their experiences, most reported having been discriminated against, weight being the main reason for it. Some participants also indicated having received emotional support from other users. Correlation analyses indicated significant but weak relationships among the variables. Results indicated a positive correlation between time as an active GSN app user and higher experiences of discrimination. Likewise, higher number of used apps related positively with levels of received support. These results provide information that could inform future research in the country and the region regarding GSN apps use among SMM, socialization practices, and modern dating tools.

This paper describes three linked reactions to the COVID-19 pandemic, a mix of pragmatic change and reflection that can be seen as action research. Our case studies, stories, come from the UK, Spai...

Clara Paz,1 Mari Aguilera,2 Marta Salla,3 Victoria Compañ,3 Joan C Medina,3,4 Arturo Bados,3 Eugeni García-Grau,3 Antoni Castel,5 José Cañete Crespillo,6 Adrián Montesano,7 Leticia Medeiros-Ferreira,8 Guillem Feixas3,4 1School of Psychology, Universidad de Las Américas, Quito, Ecuador; 2Department of Cognition, Development and Educational Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 3Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 4The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; 5Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; 6Department of Psychiatry, Hospital de Mataró, Mataró, Spain; 7Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; 8Nou Barris Nord Adult Mental Health Centre, Barcelona, SpainCorrespondence: Clara Paz Jose Queri y Av, De Los Granados, Quito EC170125, EcuadorTel +593 2 3981000 ext. 2518Email clara.paz@udla.edu.ecBackground: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia.Methods and Analysis: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3– 5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions.Trial Registration: ClinicalTrials.gov: NCT02711020.Keywords: psychotherapy, pain, repertory grid technique, study protocol, CBT, personal construct therapy

Ecuador has been one of the most affected countries by the Corona Virus Disease 19 (COVID-19) pandemic, by April 2020 this country presented the highest rates of mortality in Latin America. The purpose of the present study was to identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients who were part of the epidemiological surveillance program in Ecuador that included mandatory confinement and self-isolation. A cross-sectional study was performed from March 22th to April 18th, 2020 using an online survey. The survey collected socio-demographic information and severity of depressive symptoms using the Patient Health Questionnaire-9 and anxiety symptoms through the Generalized Anxiety Disorder-7. A total of 759 patients completed the questionnaire, 20.3% presented moderate to severe symptoms of depression and 22.5% moderate to severe symptoms of anxiety. Being a woman and from the Coastal region were risk factors. Exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to an hour was associated with better mental health. Regression analysis indicated that the mentioned behaviors explained approximately 17% of the variance for depression sum scores and 11.8% of the variance for anxiety sum scores while controlling for gender and region. Understanding the association between sociodemographic variables and psychological states in patients with COVID-19 is relevant to tackle future public mental health problems and to implement health policies that are intended to palliate further psychiatric complications. Promotion of modifiable behaviors such as exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to less than an hour is recommended.

The implicative dilemma (ID) is gradually receiving attention of clinical psychologists and researchers. Although research on its clinical relevance is promising, there are still some issues regard...

Latin American mental health services are moving from the psychiatric hospital model to a community-based model. The effectiveness of these new services needs to be evaluated and that can be done through routine outcome monitoring. The present communication introduces the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), a free instrument, supported with rigorous psychometric exploration, and which has been translated to Spanish and Brazilian Portuguese that can be used for monitoring purposes across the region.

Five populations of the invasive species Limnoperna fortunei were studied using polymorphic molecular (nine allozyme loci) and morphological (11 traits) markers in order to understand the patterns of genetic and morphological variability, structure and dispersion dynamics of this species in South America. High levels of genetic variability were found in South American invasive populations, and significant deviations from the Hardy-Weinberg proportions clearly indicated that the invasion process is still under way, probably by means other than natural migration.

IntroductionEmerging adulthood is a period of instability with changes in personal relationships and often a series of job changes before life trajectories clarify and more lasting decisions are possible. These changes often produce distress, and they might explain why most of the symptoms that impact the individual’s mental health throughout their lives appear at this stage, although full-blown disorders are often only diagnosed subsequently. The objective of this study is to analyse the intraindividual changes in psychological distress and health-related quality of life in both student and non-student emerging adults over 1 year. Between-individual differences in variability will be analysed and life events will be recorded to identify possible associations.Methods and analysisParticipants will be emerging adults (18–29 years of age) students and non-students. The primary outcome will be psychological distress measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure and the secondary outcome will be health-related quality of life measured by the EuroQol five-dimension-three-level. Sociodemographic and life events will be recorded. Information will be collected using an online survey.Analyses, described in a data analysis plan with the registration, will check the psychometric properties of the measures, describe the distribution of scores on the outcome measures, their relationship to group and other demographic variables and how they change over the seven assessment points across a year and explore any relationship between scores and life events.Ethics and disseminationThis study received ethical approval by the Comité de Ética y Bioética (Ethics and Bioethics Committee) of the Universidad de Las Américas, Quito-Ecuador (2020-0807). Results will be published in peer-reviewed journals and presented at relevant meetings. Brief reports of these publications will be disseminated using social media to reach the community and private or public organisations interested in emerging adults.Trial registration numberNCT04596345

The comorbidity of depression and fibromyalgia chronic syndrome has been well documented in the literature; however, the cognitive structure of these patients has not been assessed. Previous results reported variability in cognitive rigidity in depressive patients, the key for this might be the presence of chronic physical pain such as fibromyalgia. The present study explores and compares the cognitive rigidity and differentiation, between patients with depression with and without fibromyalgia syndrome.Thirty one patients with depression and fibromyalgia were matched, considering age, sex and number of depressive episodes, with 31 patients with depression but without fibromyalgia diagnosis. Cognitive rigidity and differentiation were measured with the repertory grid technique.The results indicated that depressed patients with fibromyalgia presented higher levels of depressive symptoms, greater cognitive rigidity and lower cognitive differentiation than those without fibromyalgia.The results might inform future treatments to address the cognitive structure of these patients.La comorbilidad de la depresión y la fibromialgia ha sido bien documentada en la literatura. Sin embargo, la estructura cognitiva de estos pacientes no ha sido evaluada. Estudios previos muestran variabilidad en medidas de rigidez cognitiva en pacientes con depresión. Los síndromes físicos crónicos podrían ser una variable clave para explicar esta variabilidad presente en estudios previos. El presente estudio explora y compara la rigidez y la diferenciación cognitiva entre paciente con depresión que tienen y aquellos que no tienen fibromialgia.Treinta y un pacientes con depresión y fibromialgia fueron emparejados, considerando edad, sexo y números de episodios depresivos con 31 pacientes con depresión, pero sin diagnóstico de fibromialgia.Los resultados indican que los pacientes que presentan depresión y fibromialgia evidencian niveles más altos de síntomas depresivos, mayor rigidez cognitiva y menor diferenciación cognitiva que los pacientes sin fibromialgia.Estos resultados podrían ser considerados al momento de crear tratamientos ajustados a la estructura cognitiva de estos pacientes.

BACKGROUND: Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted. METHODS: One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up. RESULTS: Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms. CONCLUSIONS: Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required.© 2016 The Authors. Depression and Anxiety published by Wiley Periodicals, Inc. Language: en

Objective: This study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons in perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. Method: Ninety-five mothers of one-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. Results: Results indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. Conclusions: The results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjusting to parenthood., Objetivo: Este estudo visou examinar as diferenc¸as entre mães de múltiplos prematuros e mães de filhos únicos prematuros a respeito de estresse percebido e sintomas psicológicos maternos e explorar o efeito adverso amplificado putativo da desvantagem socioeconômica. Método: 95 mães de crianc¸as com idade de um ano nascidas prematuras participaram deste estudo transversal. A coleta de dados foi feita em dois hospitais públicos do norte de Portugal. Para avaliar o estresse diário percebido e os sintomas psicológicos maternos, as mães responderam dois questionários. As mães relataram fatores socioeconômicos, incluindo pobreza familiar, desemprego dos pais e baixo nível de escolaridade, e foram criados dois grupos de desvantagem socioeconômica familiar. Foi calculado um índice de risco médico infantil. Resultados: Os resultados indicaram que as mães de múltiplos prematuros relataram maiores níveis de estresse que as mães de filhos únicos prematuros. Além disso e especificamente com relac¸ão ao funcionamento psicológico, as mães de múltiplos prematuros relataram mais sintomas que as mães de filhos únicos prematuros, porém apenas quando morando em um contexto de adversidade socioeconômica. Conclusões: Os resultados deste estudo possuem importantes implicac¸ões para a prática. As mães de múltiplos prematuros apresentam maior risco de dificuldades de saúde mental, em comparac¸ão a mães de filhos únicos, principalmente quando expostas a adversidades socioeconômicas. O desenvolvimento de programas de intervenc¸ão psicossocial e políticas públicas é de importância decisiva ao ajudar as mães de filhos múltiplos a se ajustarem à maternidade., The authors are very grateful to the children and parents who participated in the study. This study was conducted within the Psychology Research Center, University of Minho, and partially supported by the Portuguese Foundation for Science and Technology (SFRH/BPD/100994/2014 assigned to the first author; also grant SFRH/BD/86075/2012) and by the Portuguese Ministry of Education and Science through national funds and when applicable co-financed by European Regional Development Fund (ERDF) under the PT2020 Partnership Agreement (UID/PSI/01662/2013)., info:eu-repo/semantics/publishedVersion

In recent years, constructivist psychotherapy has evolved as a plausible treatment for different disorders. The present study aimed to explore the effectiveness of this therapy in terms of symptom improvement and changes in the personal construct system. Forty-seven anxiety clients received brief integrative constructivist therapy. Scores on symptom and personal construct measures decreased after the treatment, but not all of them showed a statistically significant change. The percentage of clients with implicative dilemmas decreased after psychotherapy. The results provide preliminary support for the effectiveness of brief constructivist psychotherapy as a treatment for anxiety disorders in primary care services. Several limitations are acknowledged. Further controlled research is needed.