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Introduction Mental health-related stigma occurs not only within the public community but is also an issue among healthcare professionals. The relationship between national culture and provider stigma remains yet to be empirically attested. Objectives We performed a cross-sectional multicentre study across 32 European countries to investigate the attitudes of psychiatrists towards patients with mental health problems. We aimed to examine the relationship of attitude with country-specific indicators. Methods We measured stigmatizing attitudes using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) within an online survey among specialists and trainees in general adult, child and adolescent psychiatry. Its total score was correlated with the Human Development Index (HDI), the Democracy Index (DI), the Social Progress Index (SPI), the number of psychiatrists per 100,000 people, and the Hofstede dimensions. Latent class analysis was done to find subgroups of countries according to the stigmatizing attitudes of psychiatrists and the six Hofstede dimensions. Results Altogether, n=4245 participants completed the survey. The total score of the OMS-HC significantly correlated with the long-term orientation (r=0.453, p=0.015) and indulgence dimensions (r=-0.629, p

Introduction The Profile of Mood States is one of the most widely used instruments to assess mood states. It is a rapid and economic method of assessing transient affective states (McNair et al. 2003) and it has been translated and validated to several languages including Portuguese. In our country we have several versions, with different factorial structures and number of items. The scale presents a list of feelings and emotions (adjectives) that people commonly experience. With university students, we have used a version composed of 36 items that evaluates three factors, with good validity and reliability: Depression, Anxiety/Hostility and Positive Affect (Amaral et al. 2013). However, to be included in digital apps that in addition to ecological momentary assessment parameters require a weekly or even daily assessment of mood states, this version has little usability. Objectives To develop a shorter version of the POMS-36 based on Exploratory Factor Analysis and to analyse its construct validity using Confirmatory Factor Analysis in a sample of Portuguese college students. Methods 765 students (69.2% females; mean age=22.09±2.433; range: 17-26) fill in the POMS-36 and the Perceived Stress Scale (Amaral et al. 2014). The total sample was randomly divided in two sub-samples. Sample A (N=380) was used to EFA and sample B (N=385) was used to CFA. Results Through EFA (with varimax rotation and extracting three factors), the four items with the highest loadings in their respective factor were selected. Then, the CFA, carried out with the AMOS, revealed that this three-factor model, with two pairs of correlated errors, indicated a good fit (X2/df= 4.6010; CFI =.9561; GFI =.9406; TLI=.9559; RMSEA=.0687, p[rmsea=0.04]. The internal consistency analysis resulted in α (Cronbach alphas)

Introduction Postpartum depression, refers to depressive symptoms within a 12-month period after the birth of an infant in a new father or mother. It’s have been a growing mental health concern, as it is one of the leading causes of poor familial and infant health outcomes. Despite the growing attention being given to fathers’ depression, including in Portugal, prevalence data and its possible correlates are still scarce compared to depression in mothers, especially during the COVID-19 pandemic. Objectives To explore and compare levels of depressive symptomatology and to analyze potential correlates for postpartum depression in Portuguese new mothers and fathers during the COVID-19 pandemic. Methods 153 men and 187 women (mean age: 36.61± 4.99 vs. 32.98 ±5.00 years, respectively) were recruited in the perinatal period (7.29±3.22 vs 8.58± 0.97 months post-partum) and answered to an online survey that included questions related to sociodemographic and psychosocial variables and validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perseverative Thinking Questionnaire (for Repetitive Negative Thinking/RNT) and Dysfunctional Beliefs Towards Motherhood/Fatherhood Scale (DBTM/F). Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS Version 26 for Mac). Results New-mothers had significantly higher levels of depressive symptoms than new-fathers (41.89±16.94 VS. 33.95±14.99, p.55) significantly and positively correlated with PDSS scores. In both genders, DBT-M/F and RNT significantly (p

Introduction For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this. Objectives Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process. Methods Clinical case report and review of the literature on the subject. Results We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery. Conclusions This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma. Disclosure of Interest None Declared

Introduction Besides the traditionally studied group of young females, disordered eating occurs in all age groups (Eedena, Hoekena, and Hoek 2021). In recent years, there has been an increase in the prevalence of eating disorders and symptoms in middle-aged and older women (40 years old and over) (Mangweth-Matzek and Hoek 2017). Experts in eating psychopathology in special groups such as Samuels, Maine and Taltillo (2019) suggest the use of the Screen for Disordered Eating (SDE; Magen et al. 2018) in the psychometric assessment of women in middle age and older. The SDE was developed to allow the Eating Disorders (ED) screening in Primary Health Care in people of all ages and without excluding Binge Eating Disorder (BED). The SDE is composed of five items (yes or no answers), extracted from other validated self-reported questionnaires for the assessment of eating psychopathology. Objectives To analyze the psychometric properties of the Portuguese Version of the Screen for Disordered Eating in a sample of women from the general population aged 40 and over. Methods Participants were 516 women with a mean age of 50.28 of years old (± 8.063; range: 40-80). They answered an online survey including the preliminary Portuguese version of the SDE and the Portuguese version of the Eating Disorder Examination – Questionnaire (EDE-Q-7; Pereira et al. 2021). Results Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.502; RMSEA=.0311, p

Introduction The Portuguese version of the Big Three Perfectionism Scale (BTPS), a 45-item self-report measure of rigid, self-critical, and narcissistic perfectionism, presented good reliability, construct and concurrent validity both in a sample of university students (Lino, Pereira et al. 2018) and of adults from the general population (Oliveira, Pereira et al. 2021). Objectives To develop and validate a Portuguese brief version of the BTPS, the Big Three Perfectionism Scale–Short Form (BTPS-SF) in a sample of university students. Methods The procedure followed to select items for the short version was based on the 45-items BTPS confirmatory factorial analysis (Lino, Pereira et al. 2018). Following Feher et al. (2020) strategy, with Canadian university students, we retained between one and two from each of the 10 perfectionism facets in the BTPS, 16 items in total. The 16 items selected had loadings ranging from .63 to .88 (Lino, Pereira et al. 2018), thus meeting the suggested requirement of high loadings being above .60 in magnitude (Afifi et al. 2011). Participants were 633 Portuguese students (medicine, dentistry and health technologies; 82.1% girls; mean age=21.25±3.115); they answered an online survey including the BTPS and the Depression Anxiety and Stress Scale (DASS; Xavier et al. 2017). Results Confirmatory Factor Analysis showed that both the first (χ2/df=3.074; RMSEA=.0573, p

Introduction More than in other conditions, fear is associated with infectious diseases, and is directly associated with its transmission rate, morbidity and mortality. High levels of fear can affect the individual’s ability to think clearly, react proportionately and make rational decisions in the context of COVID-19. Recently, Mertens et al. (2020) developed the Fear of Covid-19 Scale (FCV-19S) to measure this construct. Objectives To analyse the psychometric properties of the FCV-19S Portuguese version, namely construct validity, internal consistency and convergent validity. Methods A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the FCV-19S, the Covid-19 Perceived Risk Scale (CPRS) and the Depression Anxiety Stress Scale (DASS-21).The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA. Results EFA resulted in one component. CFA revealed that the unifactorial model presented acceptable fit indexes (X2/df=3.291; CFI=.977; GFI=.932; TLI=.919; p[RMSEA≤.01]=.091). Cronbach alpha was α=.855. The total score significantly correlated with Covid-19 Perceived Risk (r=.529, p

Introduction Fear associated to infectious diseases is directly related with their transmission rate, morbidity and mortality. High levels of fear associated with COVID-19 can affect people’s ability to act and think rationally. In a time of pandemics, it is essential to understand individual factors that might be associated to higher vulnerability to stress and fear. Objectives To analyse: a)correlations between Fear of Covid-19 and clinical and sociodemographic characteristics; b)the mediator role of repetitive negative thinking on the relationship between personality traits and Fear of Covid-19. Methods 234 adults (75.6% women; mean age=29.53±12.51) completed an on-line survey with the Portuguese version of the Fear of Covid-19 Scale (FCV-19S) and other questionnaires to evaluate clinical and sociodemographic characteristics (years of education, perceived physical and mental health and infection by Covid-19), Personality (NEO-FFI-20) and Repetitive negative thinking (PTQ-15). SPSS and Process Macro (Hays, 2020) were used. Results FCV-19 mean scores were significantly higher in women and significantly correlated with years of education (r=-.14) (p.20, p

Introduction Personality traits like neuroticism and trait-anxiety, as well as the predisposition to a greater sensitivity to pain, are risk factors for dental anxiety. Although perfectionism has been associated with both anxiety and pain, particularly when mediated by repetitive negative thinking/RNT (Macedo et al. 2015; Albuquerque et al. 2013), its role in dental anxiety has not yet been studied. Objectives To analyze the role of perfectionism and RNT in dental anxiety. Methods A community sample of 552 adults (68.2% women; mean age=35.15±15.79 years) completed the Portuguese versions of:Hewit and Flett Multidimensional Perfectionism Scale–13, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire, Perseverative Thinking Questionnaire and Dental Fear Survey/DFS. Results Trait-anxiety (r=.225), socially prescribed perfectionism/SPP (r=.177), SPT (r=.286), FDP (r=.509) and RNT (r=.274) were significantly (p

Introduction The main risk factor for dental anxiety is previous traumatic experiences of pain in the dental office. Other consistent etiologic factors are trait-anxiety and preparedness (genetic predisposition to increased sensitivity to pain and aversive stimuli). However, there is a wide inter-individual diversity in the anxiety experience – not all individuals with traumatic experiences at the dentist will develop dental anxiety anxiety Objectives To explore potential paths by which a traumatic experience at the dentist (TRAUMA) can lead to dental anxiety. Methods A community sample of 552 adults (68.2% women; mean age= 35.15±15.790) completed the Portuguese validated versions of: Dental Fear Survey/DFS, State-Trait Anxiety Inventory, Sensitivity to Pain Traumatization/SPT Scale, Fear of Dental Pain/FDP Questionnaire and Perseverative Thinking Questionnaire–15. Results 140 participants (25.2%) had TRAUMA; it was significantly (p.01). Our model was significant (R2=17.15%; p

Introduction Co-occurrence of obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) features is well stablished. Diagnosis of OCD increases the risk of a later diagnosis of ASD, and vice versa. Moreover, a recent combined genome-wide association study identified a shared polygenic risk between the two disorders. Our preliminary results also indicate that OCD patients have higher levels of autistic traits than individuals from the community. Objectives To determine which autistic dimensions (social skill, communication, attention switching, attention to detail imagination) are predictors of OC symptoms. Methods 39 OCD patients (52,5% female; 19 to 64 years old) answered the Portuguese versions of the Autism-Spectrum Quotient for Adults and Obsessive Compulsive Inventory – Revised (OCI-R). Spearman correlation and linear multiple regression tests were performed using SPSS. Results The OCI-R global score showed positive correlations with some AQ dimensions (attention switching, attention to detail and communication). The regression model showed that attention to detail (β = .43, p = .01) and attention switching (β = .33, p = .038) explained 36% of obsessive-compulsive symptoms variance. Conclusions Our results are in line with a dimensional perspective of psychopathological continua and indicate that the overlap between OCD and ASD occurs through shared neurocognitive processes. We suggest that, besides being a predisposing factor for social difficulties (e.g.: facial/emotion recognition) in ASD, attention to detail and deficits in attention switching may also lead to difficulties to dismiss repetitive thoughts or extinguish behaviours in OCD. Future studies should investigate the distinctive features and underlying processes between OCD/ASD.

Introduction Risk perception of COVID-19 is potentially a significant determinant of the pandemic evolution and the public’s response to it. Acceptable levels of risk perception can be considered good for people to effectively fight the pandemic and adopt preventive health behaviors while high levels of risk perception may be damaging. Recently, Yıldırım&Güler (2020) developed the Covid-19 Perceived Risk Scale (C19PRS) to measure this construct. Objectives To analyze the psychometric properties of the C19PRS Portuguese version, namely construct validity, internal consistency and convergent validity. Methods A community sample of 234 adults (75.6% women; mean age= 29.53±12.51; range:16-71) completed an on-line survey with the Portuguese versions of the CPRS and the Fear of Covid-19 Scale (FCV-19S; Cabaços et al. 2020). The total sample was randomly divided in two sub-samples: sample A (n=117) was used to perform an exploratory factor analysis/EFA; sample B (n=117) to make a confirmatory factor analysis/CFA. Results EFA resulted in three components. CFA revealed that the second-order model with three factors presented good fit indexes (X2/df=1.471; CFI=.959; GFI=.948; TLI=.932; p[RMSEA≤.01]=.065). CPRS Cronbach alphas was α=.687; for F1 Worry, F2 Susceptibility to Covid-19 and F3 Susceptibility to Overall Morbimortality were α=.747, α=.813 and α=.543, respectively. The total and dimensional scores significantly correlated with FCV-19S (r>.30, p

Introduction Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%1. PPD is associated with a range of adverse outcomes for both the mother and infant2. Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue3. Objectives To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder. Methods 247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale4, the Postpartum Depression Screening Scale5 and the Diagnostic Interview for Psychological Distress-Postpartum6. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p

Introduction Many people think that people with mental disorders might be dangerous or unpredictable. These patients face various sources of disadvantages and experience discrimination in job interviews, in education, and housing. Mental health-related stigma occurs not only within the public community, it is a growing issue among professionals as well. Our study is the first that investigates the stigmatising attitude of psychiatrists across Europe. Objectives We designed a cross-sectional, observational, multi-centre, international study of 33 European countries to investigate the attitude towards patients among medical specialists and trainees in the field of general adult and child and adolescent psychiatry. Methods An internet-based, anonymous survey will measure the stigmatising attitude by using the local version of the Opening Minds Stigma Scale for Health Care Providers. Data gathering started in July this year and will continue until December 2020. Results This study will be the first to describe the stigmatising attitude of psychiatric practitioners across Europe from their perspectives. Conclusions The study will contribute to knowledge of gaps in stigmatising attitude towards people with mental health problems and will provide with new directions in anti-stigma interventions. Disclosure No significant relationships.

Introduction Research following the Covid-19 pandemics has shown that psychological reactions to the pandemic and its constraints can vary significantly depending on personality. One of the traits that has not been studied yet, but can play a harmful role in the COVID-19 psychological impact is perfectionism. This trait, characterized by setting excessively high standards of performance and striving for flawlessness, has increased in recent years and is considered a transdiagnostic process involved in several (mental) health problems (Curran & Hill 2019). Objectives To analyze the role of Perfectionism in the levels of fear of COVID19 and of perception of infection risk by COVID-19. Methods 234 adults (75.6% women; mean age=29.53±12.51) completed an on-line survey with the Portuguese validated versions of Covid-19 Perceived Risk Scale (C19PRS; Pereira et al. 2020), Fear of COVID-19 Scale (FC19S; Cabaços et al. 2020) and Big Three Perfectionism Scale (BTPS; Garrido et al. 2020). SPSS was used to perform correlation and regression analysis. Results Perceived Risk and Fear of COVID-19 were significantly correlated with perfectionism (.243, .228, respectively) (both, p

Introduction Mentalization (MZ) is the capacity by which people make sense of their own’s and others’ mental states; when compromised, it is associated with several mental disorders (Bateman & Fonagy, 2010). A valid instrument to assess MZ is missing and required for the Portuguese population. Objectives To develop and validate a Portuguese version (Questionário de Mentalização – QMZ) of the Mentalization Questionnaire (MZQ) (Hausberg et al., 2012). Methods A sample of 184 Portuguese medical students (mean age = 21.6 ± 2.47 years, 59.8% female) was used to explore the psychometric properties of the scale, using reliability and factor analysis (varimax rotation method). Results The QMZ exhibited a Cronbach’s alpha score of .80. All items contributed to its reliability. Based on the scree plot of Cattell and interpretability of items, a 2-factor and a 5-factor structures were further explored. The former explained 38.8% of the total variance (VE) and included a regulation of affect (VE= 27.3%, α=.79) and a self-reflection and emotional awareness (VE= 11.5%, α=.62) factors. The latter explained 60.6% of the total variance and incorporated the following dimensions: self-control (VE= 27.3%, α=.74), daily relationships (VE= 11.5%, α=.67), self-comprehension (VE= 8.1%, α=.54), close relationships (VE= 7.0%, α=.41) and self-monitoring (VE= 6.7%, α=.52). The 5-factor structure was closer to the dimensional concept of mentalization. Conclusions The QMZ has proved to be a promising instrument, with adequate psychometric properties, confirmed by its acceptable construct, criterion and factorial validity and reliability to assess mentalization in Portuguese language.

Introduction Burnout occurs in every stage of a medical graduation and career. In the first years of graduation, is affects 35-45% of medical and dentistry students. This has severe consequences, such as: higher levels of suicidal ideation, substance abuse, medical errors and medical neglect; lower levels of empathy and self-compassion - essential to the quality of healthcare. Students with certain personality traits (e.g., neuroticism and, particularly, perfectionism) are more vulnerable to emotional dysregulation when facing stressors of daily life. Our recent studies proved that mindfulness and self-compassion can attenuate the effect of perfectionism on psychological distress. Objectives To present the rational, materials, methodology and preliminary results of our project COMBURNOUT, aimed to develop, implement and assess the efficacy of a mindfulness and self-compassion-based intervention to prevent burnout in medical and dentistry students. Methods Students with high levels of burnout, psychological distress and perfectionism will be randomly assigned to intervention (8 weekly sessions) or control groups. The sessions will be composed by psychoeducation about burnout, mindfulness and self-compassion practices, within and between sessions. The follow up will include three assessment moments until a year after the intervention. Results We expect that the experimental group will present significantly lower levels of burnout, psychological distress and perfectionism, and higher levels of emotional regulation skills. Conclusions The facilitators training and the manualization are guaranties of standardization and sustainability. If the positive impact of COMBURNOUT is verified, we intend to provide the program to medical/dentistry students from all over the country.

Introduction Both original Big Three Perfectionism Scale (BTPS; Smith et al. 2016), and the Portuguese version validated with a sample of university students (Lino et al. 2018) evaluates three second-order factors (rigid, self-oriented and narcissistic perfectionism) and ten facets. Objectives To confirm the BTPS three-factors-ten-dimensions’ structure in a sample of Portuguese adults from the general population. Methods A sample of 467 adults (70.7% females; Mean age=38.44±12.27; range: 25-82) answered the BTPS Portuguese version and other validated perfectionism measures (Multidimensional Perfectionism Scales from Frost and Hewitt & Flett; Self-Presentation Perfectionism Scale). To study the temporal stability a sub-sample of 132 participants completed the BTPS again after approximately five weeks. SPSS and AMOS software was used. Results The second order model presented an acceptable fit (X²/df=3.115; TLI=.811; CFI=.825; RMSEA=.067). There was also evidence of a general factor comprising all the 45 items (X²/df=3.127; TLI=.809; CFI=.823; [JA1] RMSEA=.068). The Cronbach alphas of the three factors ranged from a=.88 to a=.92; and facets had a>.70 showing a total of a=.94. Total and dimensional scores showed significant positive and moderate to high correlations with the other perfectionism measures and their test-retest correlation coefficients were r=.85 (p

Introduction Motherhood-related beliefs are characterized by themes of failure and maternal role idealization. Recent studies found that postpartum depression/PPD is both predicted and a predictor by/for dysfunctional beliefs/DB. Additionally, it is possible that when contextual factors (eg. lack of social support) are present, women may anticipate the parenting experience as being of isolation, which in turn can lead to more dysfunctional attitudes. Objectives To explore psychosocial risk factors for motherhood-DB. Methods 233 women were evaluated in the second trimester (17.05±4.82 weeks) of pregnancy and in the third month (12.08±4.25 weeks) postpartum sociodemographically and psychosocially (years of education, previous children and social support) and the Portuguese validated self-report questionnaires to assess: perinatal depression; perinatal anxiety; perfectionism; negative affect; self-compassion; and repetitive negative thinking (all in T0). The Attitudes Towards Motherhood Scale was administered in the postpartum. When Pearson/Spearmen correlation coefficients proved significant (p

Introduction The COVID-19 pandemic has brought additional worries and challenges to people’s lives, with potential implications for psychological well-being. Objectives To understand which worries and life changes have affected most the Portuguese general population during the COVID-19 pandemic and to analyse which contents are associated with higher levels of repetitive negative thinking/RNT and psychological distress/PD. Methods In September-December 2020, 413 Portuguese adults (69.2% female; Mean age= 31.02±14.272) were asked one open questions, with reference to the COVID-19 pandemic period: “what was your biggest worry?”; the answers were independently categorized by two researchers. Participants also filled the validated Depression Anxiety and Stress Scale and the Perseverative Thinking Questionnaire. Results The most prevalent worries were about: 1) fear of contamination (oneself and others-48.7%; 2) physical and mental health and well-being (self and others)-27.2%; 3) studies and profession-13.3%; 4) uncertainty about the future-7.7%; 5) economic-financial issues-6.5%; 6) miscellaneous-3.3%; 7) no worries-0.7%. Participants who had worries of the theme 4 had the highest RNT and PD mean scores, followed by themes 3 and 5, and then themes 2 and 1. These thematic groups significantly (p

Introduction During a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged. Objectives To analyse the differential role of individual and contextual variables in the adherence to public health recommendations. Methods 1376 adults (70.5% female; mean age=35.55±14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19; evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ; assesses empathy and altruism). Results Adherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASR-COVID19 and all dimensions were positively correlated to ProBeQ’s altruism and empathy (from r=.32 to r=.54); FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26; all p

Introduction Public health authorities around the world have been disseminating messages to support mental health and psychosocial well-being during the COVID-19 pandemic. Based on the Portuguese guidelines, we have developed the Adherence Scale to the Recommendations for Mental Health during the COVID-19 Pandemic (ASR-MH-COVID19) to better understand this health behaviour. Objectives To analyse the relationship between sociodemographics, personality traits, Adherence (to the Recommendations for Mental Health during the COVID-19 Pandemic) and psychological distress. Methods 413 individuals (69.2% female; mean age=31.02±14,272) completed an on-line survey, in September-December 2020, including sociodemographic questions, ASR-MH-COVID19, NEO-FFI-20 and Depression Anxiety Stress Scale (DASS-21) and Health Perception Scale. Results Adherence scores did not significantly differ by gender, age and years of education. Women presented higher DASS and Neuroticism scores (p

Introduction Since the literature investigating the stigmatising attitudes of psychiatrists is scarce, this is the first study which examines the phenomena across Europe. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure stigma in healthcare providers towards people with mental illness, although it has not been validated in many European countries. Objectives A cross-sectional, observational, multi-centre study was conducted in 32 European countries to investigate the attitudes towards patients among specialists and trainees in general adult and child psychiatry. In order to be able to compare stigma scores across cultures, we aimed to calculate measurement invariance. Methods An internet-based, anonymous survey was distributed in the participating countries, which was completed by n=4245 psychiatrists. The factor structure of the scale was investigated by using separate confirmatory factor analyses for each country. The cross-cultural validation was based on multigroup confirmatory factor analyses. Results When country data were analysed separately, the three dimensions of the OMS-HC were confirmed, and the bifactor model showed the best model fit. However, in some countries, a few items were found to be weak. The attitudes towards patients seemed favourable since stigma scores were less than half of the reachable maximum. Results allowed comparison to be made between stigma scores in different countries and subgroups. Conclusions This international cooperation has led to the cross-cultural validation of the OMS-HC on a large sample of practicing psychiatrists. The results will be useful in the evaluation of future anti-stigma interventions and will contribute to the knowledge of stigma. Disclosure No significant relationships.

Introduction The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA. Objectives To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress. Methods Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS). Results Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students. Conclusions This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability. Disclosure No significant relationships.

Introduction The Short Form of the Self-Compassion Scale (SCS-SF; Raes et al. 2011) is composed of 12 items that evaluate the same six dimensions (Self-Kindness/SK, Self-Judgement/SJ, Common Humanity/CH, Isolation, Mindfulness/M, Over-Identification/OI) as the long scale (26 items). The Portuguese version of the SCS-SF (Castilho et al. 2015) was validated in a vast sample from clinical and general populations, the latter being composed of students, other than from medicine courses. Objectives To analyze the psychometric properties of the Portuguese version of the SCS-SF in a sample of Medicine/Dentistry students. Methods Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the SCS and other validated questionnaires from the OECD Study on Social and Emotional Skills/SSES: Stress resistance, Emotional control, Optimism and Persistence. Results Confirmatory Factor Analysis showed that the model composed of six factors, two second order factors (positive and negative) and one third order factor (total) presented good fit indexes (χ2/df=3.013; RMSEA=.0066, p

Introduction The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students’ wellbeing. Objectives To compare medicine/dentistry students’ depression/anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress. Methods Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1; n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2; n=650) the COVID-19 pandemic. Mean age (21.12±3.75), personality traits scores, and gender proportions (»75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues). Results SAMPLE2 presented significantly higher mean scores of depression (3.89±3.55vs.3.33±3.34), anxiety (3.27±4.08vs.2.86±3.29), stress (7.07±5.72vs.6.18±4.59) and total DASS (12.28±10.55vs.13.65±11.13) than SAMPLE1 (all p

Introduction The COVID-19 crisis has generated an increasing stress throughout the population. Objectives To develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19). Methods The items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MH-COVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female; mean age=31.02±14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female; mean age=34.02±14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA; CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19; Pereira et al. 2020). Results CFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: χ2/df=2.747; RMSEA=.0980, p

Introduction Self-Generated Stress might be defined as stress that is created by oneself by engaging in behavior or making decisions that ultimately add strain to pre-existing personal stress. The Self-Generated Stress Scale (SGSS; Flett et al. 2020) is a seven-item self-report measure built to assess this tendency to make one’s own life more stressful. Objectives To analyze the psychometric properties of the Portuguese Version of the SGSS. Methods Participants (127 medicine and dentistry students; 78.0% female) answered an online survey including the preliminary Portuguese version of the SGSS and other validated questionnaires: Maslach Burnout Inventory – Students Survey, Depression Anxiety and Stress Scales, HEXACO-60 and Big Three Perfectionism Scale. Results Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.546; RMSEA=.0666, p.550; Perfectionism, .600; Emotionality, .315; Extroversion, -.411. After controlling for the effect of Emotionality and Extroversion, SGSS explained significant additional increments of 19.9% and 14.0% of the DASS and MBI variance; controlling for Perfectionism, the increments were respectively of 27.9% and 2.0%. SGSS mean score (22.96±5.90 was not significantly different by gender. Conclusions As observed with the original English-language scale, the Portuguese version of SGSS showed good validity (construct and convergent-divergent) and internal consistency. As such, the SGSS might be useful in further investigation, particularly to explore the different pathways between personality traits, emotional regulation processes and psychological distress. Disclosure No significant relationships.

Introduction The Portuguese version of the Fear of COVID-19 Scale (FCV-19S; Cabaços et al. 2021), composed of seven items, presented good validity and reliability to be used in general population. To be used within perinatal context, specifically in the postpartum period, we have added an item related to the baby (item 8 – “I’m afraid my baby will be infected with coronavirus-19”). Objectives To analyze the psychometric properties of Portuguese adapted version of the Fear of COVID-19 Scale for the postpartum period (FCV-19SP), namely construct validity, internal consistency, and convergent validity. Methods 207 women (mean age= 33.51 ± 5.23 years) recruited in the postpartum period (9,06 ± 8,52 months after delivery) fill in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS) and Coronavirus-19 Fear Scale for the postpartum period (FCV-19SP). Results CFA revealed that the unifactorial model composed of eight items presented good fit indexes (X2/df=1.508; CFI=.991; GFI=.974; TLI=.983; p[RMSEA≤.01] = .049), better than those of the seven items version (X2/df=3.963; CFI=.957; GFI=.909; TLI=.905; p[RMSEA≤.01] =.219). Cronbach alpha for the FCV-19SPP was α=.880. The total score significantly (p

Introduction Evidence suggests that besides having stigmatizing misconceptions towards people with mental illness, medical students and doctors often resist seeking help for their own mental issues. This is a vulnerable group for stress and other mental health problems, due not only to professional burden but also high perfectionism and low self-compassion. Objectives To analyse the relationship between mental health stigma (MHS) and other variables related to personality and emotional states in a sample of medical students. Methods 634 medicine and dentistry students (mean age = 21.6±6.9;81.4% female) answered to a survey including sociodemographic data, self-perception of psychological health/SPPH and the Portuguese validated versions of: Link’s Perceived Discrimination and Devaluation (PDD) scale to assess MHS and its two dimensions - social stigma/SocS and self-stigma/SelS; Depression Anxiety Stress Scale (DASS-21); Neff’s Self-Compassion Scale (SCS); and Big Three Perfectionism Scale (BTPS). Correlations, t-student tests and linear regressions were performed with SPSS 27.0. Results Stigma correlated negatively to SPPH and positively to DASS, the negative poles of SCS (self-judgement, isolation and over-identification) and BTPS second-order factors (all from p

Introduction Perceived vulnerability to disease/PVD may influence psychological reactions to COVID-19 pandemic. Objectives To analyse the role of PVD in psychological distress/PD during the COVID-19 pandemic, testing whether it is mediated by perceived risk of COVID-19, fear of COVID-19 and repetitive negative thinking/RNT. Methods Participants (N=413 adults; 69.2% women) were recruited from September until December 2020, via social networks. They completed the following self-report validated questionnaires: Perceived Vulnerability to Disease Questionnaire/PVDQ; Perceived Risk of COVID-19 Scale, Fear of COVID-19 Scale; Perseverative Thinking Questionnaire and Depression Anxiety and Stress Scale. As women had significantly higher levels of PVD, COVID-19 perceived risk and fear, RNT, and psychological distress/PD, gender was controlled in mediation analysis (using PROCESS macro for SPSS; Hayes 2018). Results All the variables significantly (p.20) and positively correlated. The serial mediation model 6 with the three sequential mediators resulted in significant total effect (c=.326, se=.0791, pCOVID19 perceived risk->COVID19 fear->RNT->PD), meaning full mediation. Conclusions The effect of PVD on psychological distress operates by increasing the perception of risk and the fear of COVID-19, which intensify related worries and ruminations in times of pandemic. People with high perceived threat, aversion and discomfort in situations associated with increased risk of infection should be helped to decrease dysfunctional cognitive contents and processes in times of pandemic. Disclosure No significant relationships.

Background: Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce., Methods: A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978)., Findings: A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups., Interpretation: Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration., Funding: National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution., Competing Interests: DŐ received the National Youth Talent Award in 2020 and 2021 (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134 and NTP-NFTÖ-21-B-0280) that covered the membership fee for one year of the online survey platform, and the expenses of the dissemination of the results at international congresses. She received grants from the Fulbright Program in 2022, the Semmelweis 250+ Excellence PhD Scholarship in 2023 and the New National Excellence Program in 2023 (ÚNKP-23-III-2). She received support for travel from Kerpel-Fronius Talent Support Program of Semmelweis University in 2022 and 2023 (EFOP-3.6.3-VEKOP-16-2017-00009). She is a medical Secretariat at the Hungarian Psychiatric Association. The article processing charge is covered by the Semmelweis University. SMa received a grant to attend the World Congress of Psychiatry (WPA) in 2022 and 2023 from the World Psychiatric Association. She is the Vice-chair of Psychiatric trainees committee (2020–2021) of the Royal College of Psychiatrists (UK). MW is the past president of the European Federation of Psychaitric Trainees. He is a Co-president of the Verband der Schweizerischen Assistenz—und Oberarzte (Association of Swiss Assistant and Senior Physicians) Section Thuragu. SRó received support from The Károli Gáspár University of the Reformed Church for the statistical analyses carried out (Grant No. 20754B800). Other authors declare no competing financial interests., (© 2023 The Author(s).)

Introduction: Stigma is associated with poor prognosis of illness and reduced help-seeking behavior, self-esteem and treatment compliance. The aims of this study were to study the reliability and construct validity of the King's et al Stigma Scale, and its association with Illness and Help-Seeking Behaviors scale (IHSBS) scores., Material and Methods: One hundred and forty mental health patients filled out the Stigma scale and the Illness and Help-Seeking Behaviors scale. The exploratory factor analysis of the stigma scale was performed, and its reliability studied. The correlation analysis was used and mean differences in Stigma Scale scores among IHSBS groups were explored., Results: The exploratory factor analysis indicated four factors (F): F1-Disclosure, F2-Discrimination, F3-Acceptance and F4-Personal Growth, which showed acceptable/good internal consistency (α from 0.70 to 0.91). Help-seeking behaviors were not associated with stigma. The levels of Discrimination were high in the group with global high-IHSB and in patients with medium/high illness behavior (IB) and health-related worries (HW). Additionally, Disclosure and overall stigma levels were higher in groups with high-HW and with medium-IB scores (when compared with the group with low-IB). The group with low-IB also had lower levels of Acceptance and Personal Growth when compared with the groups with medium-IB and high-IB, respectively., Conclusion: The Stigma Scale (27 items) is a valid, reliable instrument and useful tool to assess stigma in mental health patients.

Background: Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive-Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale., Objectives: (1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive-Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum., Methods: 212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress-Postpartum., Results: Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ 2 /df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach's alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94-0.99]) was 20, corresponding to an Area Under the Curve of 0.970 ( p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum., Conclusions: The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.

Recent studies have documented the high prevalence of burnout among medicine and dentistry students, with potentially catastrophic consequences for both students and patients. Both environmental and personality factors play a part in burnout; perfectionism, a common trait in medicine students' personalities, has been linked to psychological distress and increasing students' vulnerability to burnout. Self-compassion, i.e., treating oneself kindly through hardship, has recently emerged as a buffer between perfectionism and psychological distress. While using a novel three-factor conceptualization of perfectionism (BIG3), this study aims to analyze if self-compassion has a protective role in the relationship between perfectionism and burnout, in a sample of medicine and dentistry students, through mediation analysis. We found that self-compassion significantly mediated the relationship between all three forms of perfectionism and burnout: as a partial mediator in self-critical and rigid perfectionism, as well as a full mediator in narcissistic perfectionism. Our findings underline self-compassion's relevance in burnout prevention and management, supporting its use as an intervention target in burnout reduction programs and strategies.

Psychological reactions to pandemics and their constraints depend heavily on personality. Although perfectionism is consistently associated to depression, anxiety and stress, its role in the pandemics' psychological impact has not been yet empirically studied. Our aim was to analyze the role of perfectionism in psychological distress during the pandemic of COVID-19, testing whether it is mediated by fear of COVID-19 and repetitive negative thinking/RNT. Participants (N = 413 adults; 269.2% women) were recruited from September until December 2020, via social networks. They completed self-report validated questionnaires to evaluate perfectionism dimensions (self-critical, rigid and narcissistic perfectionism), fear of COVID-19, RNT and psychological distress (sum of anxiety, depression and stress symptoms). As women had significantly higher levels of self-critical perfectionism, RNT, fear of COVID-19 and psychological distress, gender was controlled in mediation analysis. The three perfectionism dimensions correlated with RNT, fear of COVID-19 and psychological distress. The effect of self-critical perfectionism on psychological distress was partially mediated by fear of COVID-19 and RNT whereas the effect of rigid and narcissistic perfectionism was fully mediated. Perfectionism influences emotional and cognitive responses to the COVID-19 and therefore should be considered both in the prevention and psychological consequences of the pandemic., (© 2021 Elsevier Ltd. All rights reserved.)