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Objective: Machine learning has a great potential for prospectively forecasting individual patient response to mental health care (MHC), thereby enabling treatment personalization. However, previous efforts have been limited to populations living in predominantly higher income, developed countries. This study aimed to extend the reach of precision MHC systems by developing and testing a feasible and readily implementable algorithm for identifying patients at risk of nonresponse to routinely delivered psychotherapy in Chile, a developing country in Latin America. Method: Data were derived from a community-based, randomized trial that tested the effects of progress feedback on naturalistically delivered psychotherapy outcome. Patients were 547 adults who were consecutively admitted to an outpatient clinic in Santiago, Chile. Treatment response was defined using norms for reliable improvement on the Outcome Questionnaire–30. Based on 10 sociodemographic and seven clinical predictors, we trained elastic net and random forest algorithms on a randomly selected training set (70%; n = 384). The best performing algorithm was tested on a hold-out sample (30%; n = 163). Results: Reliable improvement was achieved in 42% of the cases. A random forest algorithm demonstrated moderate performance in the hold-out sample (area under the curve =.74, Brier score =.21), correctly identifying 73% of the patients who did not respond. Conclusion: This study developed a predictive algorithm that demonstrated moderate accuracy in identifying patients at risk of nonresponse to naturalistic psychotherapy in Chile, using routinely assessed and easy-to-collect sociodemographic and clinical information. Using such tools may represent one step toward reducing the multilayered outcome disparities faced by individuals receiving MHC in socioeconomically disadvantaged contexts. What is the public health significance of this article?: This study provides a freely available algorithm that uses routinely assessed and easy-to-collect sociodemographic and clinical information and demonstrates moderate accuracy in predicting psychotherapy outcome in the context of a developing country in Latin America. This tool represents one step toward reducing the multilayered outcome disparities that are often faced by individuals receiving mental health care in economically disadvantaged contexts. [ABSTRACT FROM AUTHOR]

Higher lifetime trauma exposure and increased peritraumatic dissociation (PD) are well-known predictors of Post-Traumatic Stress Disorder (PTSD) symptoms following new trauma (prospective PTSD symptoms). The interplay between those factors, however, is not well established. In this study, we aimed to assess whether PD mediates the influence of lifetime trauma exposure on prospective PTSD symptoms. A total of 387 adults visiting five emergency departments who had experienced a traumatic event within 72 hours completed baseline assessments on lifetime trauma exposure count and PD. PTSD symptoms were assessed 1 month later. Structural equation modeling was used to examine the mediation effect of PD in the relationship between lifetime trauma exposure count and 1-month PTSD symptoms. We found that PD mediated the association between lifetime trauma exposure count and 1-month PTSD symptoms, even after accounting for some confounders. However, the mediation was partial, accounting for 17.9% of the lifetime trauma exposure count's total effect. While this finding is significant, it also suggests that additional mechanisms beyond PD play a role in explaining the influence of higher lifetime trauma exposure on prospective PTSD symptoms. These findings provide valuable insights into the complex dynamics of PTSD development and call for further research to explore complementary factors and preventive strategies. [ABSTRACT FROM AUTHOR]

This paper presents a Spanish-language adaptation of the Self-Concealment Scale (SCS) by Larson and Chastain (1990) and its validation in a Chilean convenience sample. The participants were 193 adults (100 men and 93 women) with a mean age of 28.39 years (SD = 8.75), grouped in 3 subsamples from the Metropolitan Region: 53 college students, 64 students from a technical institute, and 76 professionals and community leaders of a non-profit organization. In order to examine the validity of the Spanish-language version of the SCS, a confirmatory factor analysis was conducted. Results suggest that the Spanish-language version of the SCS has satisfactory psychometric properties, showing high internal consistency (a = 0.85) and acceptable stability over time (r = 0.74). Like the original scale, the validated Spanish-language version proved to be unidimensional and its scores correlated directly with anxious and depressive symptomatology as measured with the Outcome Questionnaire 30.2 (OQ 30.2). These findings support the use of this version of the SCS with Spanish-speaking population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The article examines the role of family income on the relationship between change in symptomatic burden and change in life satisfaction during six sessions of naturalistically delivered individual psychotherapy. Method: Five hundred and thirty‐two clients receiving psychotherapy were assessed at baseline and on a session‐to‐session basis with the OQ‐30.2 and with a life satisfaction questionnaire. Data were analysed using a bivariate latent class model with structured residuals that included cross‐lagged and autoregressive components between residual scores at each time point. Adjusted family income and a binary low versus high‐income group variable were added as exogenous baseline covariates at different stages of the analyses. Results: Regardless of income level, clients show improvement in psychological distress and life satisfaction as a function of time during treatment. Initial levels and improvement in life satisfaction are related to initial levels and improvement in psychological distress, and lower family income is related to slower decreases in psychological distress. When the whole sample is analysed, psychological distress and life satisfaction show reciprocal prospective relationships at the within‐person level. When models are estimated by income group, casual relationships at the within‐person level vary as a function of income. Conclusion: Family income level appears to play a significant role in the relationship between symptom improvement and life satisfaction during psychotherapy. [ABSTRACT FROM AUTHOR]

Background: Complementing the development of evidence-based psychological therapies, practice-based evidence has developed from patient samples collected in routine care, addressing questions relevant to patients and practitioners, and thereby expanding our knowledge of psychological therapies and their impact. Implementation of assessments in routine care allows for timely clinical decision support and the collection of multiple practice-based data sets by addressing the needs of patients and clinicians (e.g., routine outcome monitoring) and the needs of researchers (e.g., identifying the impact of therapist variables on outcomes)., Method: In this article we describe an initiative developed in Europe, through the European Chapter of the Society for Psychotherapy Research, aimed at creating a consortium that has the potential for collecting data on tens of thousands of patients per year., Results: A survey identified one of the main problems in the development of a common data set to be the heterogeneity of measures used by members (e.g., 87 different pre-post outcomes). We report on the results of the survey and the initial stage of identifying a single-item - the Emotional and Psychological Outcome (EPO-1) - measure and the process of its translation into multiple European languages., Conclusions: We conclude this first stage of the overall project by discussing the future potential of the Consortium in relation to the development of procedures that allow crosswalks of outcome measures and the creation of a task force that may be consulted when new data sets are collected, aiming for new common measures to be implemented and shared., Competing Interests: Michael Barkham declares that he is a co-developer of the CORE-OM and CORE-10.

In spite of the high prevalence of mental health disorders in Chile, there is a significant financing deficit in this area when compared to the world's average. The financing for mental health has not increased in accordance with the objectives proposed in the 2000 Chilean National Mental Health and Psychiatry Plan, and only three of the six mental health priorities proposed by this plan have secure financial coverage. The National Health Strategy for the Fulfilment of Health Objectives for the decade 2011-2020 acknowledges that mental disorders worsen the quality of life, increase the risk of physical illness, and have a substantial economic cost for the country. Thus, this article focuses on the importance of investing in mental health, the cost of not doing so, and the need for local mental health research. The article discusses how the United States is trying to eliminate the financial discrimination suffered by patients with mental health disorders, and concludes with public policy recommendations for Chile.

This longitudinal study examined whether mothers' depressive symptomatology predicted parenting practices in a sample of 199 mothers of 3-year-old children with behavior problems who were assessed yearly until age 6. Higher maternal depressive symptoms were associated with higher overreactivity and laxness and lower warmth when children were 6 years old. Higher maternal depressive symptoms were also related to increases in overreactivity across the preschool years. Moreover, depression and parenting practices (overreactivity and laxness) covaried over time within mothers. These results provide evidence of a strong link between maternal depression and parenting during the preschool years.