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BackgroundAlthough the Hospital Anxiety and Depression Scale (HADS) has been widely studied across various populations, there is still no consensus on its factor structure. This study aims to evaluate the psychometric properties of the HADS in cancer patients.MethodsOur study was cross-sectional and non-probabilistic. It involved 467 cancer patients aged 18 years and over, who were treated at a public institution specialized in oncology. The Hospital Anxiety and Depression Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory were used. We evaluated their internal structure, measurement invariance, relationship with other variables, and reliability.ResultsIt was found that the HADS is best suited to a bifactorial structure where there is one general factor (emotional distress) and two specific factors (anxiety and depression). The HADS demonstrates invariance with respect to sex and years of education. It shows a moderate correlation with the Beck Anxiety Inventory and the Beck Depression Inventory. In addition, it presents acceptable levels of reliability and relationship with instruments used in the diagnosis of anxiety and depression.ConclusionThe HADS is best suited to a bifactorial structure in cancer populations, with comparisons across both sexes and varying levels of education. Its brevity, versatility, hospital-focused design, and extensive validation make the HADS a very important instrument in the detection of anxiety and depression in cancer patients.

Abstract Background Anxiety disorders are among the main mental health problems worldwide and are considered one of the most disabling conditions. Therefore, it is essential to have measurement tools that can be used to screen for anxiety symptoms in the general population and thus identify potential cases of people with anxiety symptoms and provide them with timely care. Our aim was to evaluate the psychometric properties of the General Anxiety Disorder-7 scale (GAD-7) in the Peruvian population. Method Our study was a cross-sectional study. The sample included people aged 12 to 65 years in Peru. Confirmatory factor analysis, analysis of measurement invariance, convergent validity with the Patient Health Questionnaire-9 (PHQ-9) and internal consistency analysis were performed. Results In total, 4431 participants were included. The one-factor model showed the best fit (CFI = 0.994; TLI = 0.991; RMSEA = 0.068; WRMR = 1.567). The GAD-7 score showed measurement invariance between men and women and between age groups (adults vs. adolescents) (ΔCFI

BackgroundOnline psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants.MethodsA multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis.DiscussionThis protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.

Abstract Background The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms. Method We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms. Results The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms. Conclusions Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Background: The COVID-19 pandemic significantly impacted the mental and emotional health of the elderly, especially those from low to middle-income countries. However, COVID-19 vaccination may reduce this influence. Therefore, we aimed to estimate the effect of vaccination against COVID-19 on the emotional health of older adults. Methods: We selected a national, random, and stratified sample of non-hospitalized adults aged 60 to 79 years from Peru who intended to receive or had already received the COVID-19 vaccine during recruitment. During June and July 2021, the assessed outcomes were fear, anxiety, and worry about COVID-19, general anxiety, and depression at baseline and after a month. We estimated the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for each altered emotional health outcome in those who had one and two doses, compared with those who were not vaccinated using multilevel logistic regression with mixed effects. Results: We recruited 861 older adults with 20.8% of loss to follow-up. At baseline, 43.9% had received only one dose of the vaccine, and 49.1% had two doses. In the analysis during follow-up, those who had two doses had less fear (aOR: 0.19; CI 95%: 0.07 to 0.51) and anxiety to COVID-19 (aOR: 0.45; CI 95%: 0.22 to 0.89), compared to unvaccinated. Also, those with two doses were significantly less likely to have fear of COVID-19 (aOR: 0.35; CI 95%: 0.21 to 0.59), anxiety about COVID-19 (aOR: 0.48; CI 95%: 0.34 to 0.68), and worry about COVID-19 (aOR: 0.58; CI 95%: 0.37 to 0.94), compared to those who had only one dose. We observed no effects in those with only one dose compared to unvaccinated. Conclusions: Two doses of COVID-19 vaccination in older adults improves their perception of COVID-19 infection consequences. This information could be integrated into the vaccination campaign as an additional beneficial effect.

BackgroundThe long-lasting impact of the COVID-19 pandemic cannot be overstated. To combat its dire consequences, some screening measures have been hastily developed and require robust verification to explore their adequacy across different groups. The present research study aimed to analyze measurement invariance by sociodemographic characteristics of the Coronavirus Reassurance Seeking Behavior Scale (CRSB) in Peruvian adults.MethodsA total of 661 participants completed The Coronavirus Reassurance Seeking Behavior Scale (CRSB), the Coronavirus Anxiety Scale (CAS), and sociodemographic information a subgroup filled in the Patient Health Questionnaire (PHQ-9). Reliability and measurement invariance across sociodemographic characteristics were analyzed. Likewise, associations with depression and dysfunctional coronavirus anxiety were examined.ResultsResults showed that the single factor structure of the CRSB with correlated errors fitted the data adequately and the instrument was invariant across gender, age, and loss of a significant relative to COVID-19. In addition, significant associations with depressive symptoms and dysfunctional anxiety were found.ConclusionThe findings of the present study suggest that the Coronavirus Reassurance Seeking Behaviors Scale is invariant across different sociodemographic characteristics.

Background: One of the mental health problems with the greatest impact on people's lives is suicidal behavior, a largely preventable public health problem that accounts for almost half of all violent deaths. The aim of the study is to propose a model that can explain and predict suicidal ideation based on mental health problems (stress-anxiety-depression) and family functionality (cohesion, flexibility, and cohesion). Methods: Our study is cross-sectional. The population consisted of medical interns from all over Peru. Non-probability sampling was used. We used Family Cohesion and Adaptability Evaluation Scale (FACES-III), Family Communication Scale, Family Satisfaction Scale, Depression Anxiety and Stress Scales (DASS-21), and the Scale for Suicide Ideation – Worst (SSI-W). Results: A total of 480 participants were included. The prevalence of suicidal ideation was 39Poisson regression analysis adjusted identified that people with anxiety symptoms were more than four times more likely to have suicidal ideation (PR=4.89; 95% CI:1.90-12.64). Also, people with moderate to high levels of family communication were much less likely to have suicidal ideation (PR= 0.07; 95% CI: 0.01-0.41), making it a protective factor. The proposed model presented optimal goodness-of-fit indices (CFI=0.974; TLI=0.974; SRMR=0.055; RMSEA=0.062). In addition, the proposed model can explain the presence of suicidal ideation in 88.3% (R2=0.883). Conclusions: Our model can explain 88.3% of suicidal behavior based on family relationships and mental health problems in medical interns. In addition, the variables that alone were most associated with suicidal behavior were anxious symptoms and family communication as risk factors and protective factors, respectively.

Abstract Background This study has two aims. First, determine the fit of the fear model to COVID-19, anxiety, and post-traumatic stress in the general population and health-care workers. Second, determine which model best explains the relationship between depression and the triad of fear, anxiety, and post-traumatic stress in both groups. Method A cross-sectional study was conducted using self-reported questionnaires for anxiety, fear of COVID-19, depression, and post-traumatic stress. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural equation model. Results A total of 830 participants were included, including general population (n = 640) and health-care workers (n = 190). A high overall prevalence of depressive symptoms (16%), anxiety (11.7%), and post-traumatic stress (14.9%) were identified. A higher prevalence of depressive, anxious, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19, anxiety, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; SRMR = 0.06). In the general population post-traumatic stress mediated the relationship between anxiety and depression (β = 0.12; 95%CI = 0.06 to 0.18) which was significant, but the indirect effect of post-traumatic stress was not significant in health care workers (β = 0.03; 95%CI = − 0.11 to 0.19). Limitations The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. Conclusions Our study proposes and tests one model that explains more than 70% of depressive symptoms. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms.

Background: The COVID-19 pandemic significantly impacted the mental and emotional health of the elderly, especially those from low to middle-income countries. However, COVID-19 vaccination may reduce this influence. Therefore, we aimed to estimate the effect of vaccination against COVID-19 on the emotional health of older adults. Methods: We selected a national, random, and stratified sample of non-hospitalized adults aged 60 to 79 years from Peru who intended to receive or had already received the COVID-19 vaccine during recruitment. During June and July 2021, the assessed outcomes were the fear, anxiety, and worry about COVID-19, general anxiety, and depression at baseline and after a month. We estimated the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for each altered emotional health outcomes in those who had one and two doses, compared with those who were not vaccinated using multilevel logistic regression with mixed effects. Results: We recruited 861 older adults with 20.8% of loss to follow-up. At baseline, 43.9% had received only one dose of the vaccine, and 49.1% had two doses. In the analysis during follow-up, those who had two doses had less fear (aOR: 0.19; CI 95%: 0.07 to 0.51) and anxiety to COVID-19 (aOR: 0.45; CI 95%: 0.22 to 0.89), compared to unvaccinated. We observed no effects in those with only one dose. Conclusions: Two doses of COVID-19 vaccination in older adults improves their perception of COVID-19 infection consequences. This information could be integrated into the vaccination campaign as an additional beneficial effect.