Propiedades psicométricas del Inventario de Situaciones y Respuestas de Ansiedad Breve (ISRA-B)

Introducción y objetivos La ansiedad es la reacción emocional más estudiada, que nos pone en alerta ante la posibilidad de obtener un resultado negativo, por lo que resulta adaptativa en la gran mayoría de las ocasiones, aunque también está en la base de los trastornos emocionales más prevalentes. Por ello, su evaluación ha generado mucha investigación y transferencia. El Inventario de Situaciones y Respuestas de Ansiedad (ISRA) fue desarrollado en España, incluye 22 situaciones (S) y 24 respuestas (R) de ansiedad, que al cruzarlas se forman 224 reactivos (del tipo «en tal S, experimento esta R»). Desde hace más de tres décadas ha sido ampliamente utilizado en la investigación, así como en la práctica, y se han publicado estudios sobre sus propiedades psicométricas en diferentes países. Una versión más breve (ISRA-B) de 46 ítems, sin contenidos cruzados S × R, sino una escala de 22 S y otra de 24 R, con las que evalúan las mismas ocho facetas de la ansiedad, ha mostrado buenas propiedades psicométricas también; sin embargo, existen menos publicaciones psicométricas en población española. El objetivo de este estudio fue analizar las propiedades psicométricas del ISRA-B en España. Método Para ello se contó con 3, 346 voluntarios (36.4% hombres), con edades de 15 a 94 años (media: 30.3; DE: 14.6). Resultados Los resultados confirmaron excelente consistencia interna para Total (.94) y subescala R (.91), buena para S (.89) y sistemas de respuesta Fisiológico (.86) y Cognitivo (.84), y aceptable para Motor (.70). También se encontró buena estabilidad test-retest al cabo de un mes (.78) y buena validez externa al correlacionar .87 con el ISRA original. La estructura factorial del ISRA-B obtenida se adecuó al modelo de Lang de tres sistemas de R y al modelo de Endler de interacción S × R, en los que se basa. Asimismo, se presentan los datos normativos, por sexo y grupo. Conclusión Se concluye que el ISRA-B es válido y confiable, mejora su aplicabilidad respecto al ISRA original, conservando sus propiedades psicométricas. Introduction and objectives: Anxiety is the most studied emotional reaction, which alerts us of the possibility of obtaining a negative result, making it adaptive in the vast majority of cases, although it is also one of the underlying factors of the most prevalent emotional disorders. Therefore, its assessment has generated a lot of research and transfer. The Inventory of Situations and Responses of Anxiety (ISRA) was developed in Spain and it includes 22 situations (S) and 24 responses (R) of anxiety, by which 224 items are formed by crossing them (i.e., «in such Situation, I experience this Reaction»). For more than three decades, it has been widely used in research and practice, and its psychometric properties have been published in different countries. A shorter, 46-item version (ISRA-B), with a 22 S scale plus another of 24 R was developed. The same eight facets of anxiety were assessed, showing good psychometric properties as well. However, there are few publications on the psychometric data using Spanish population. The objective of this study was to analyze the psychometric properties of ISRA-B in Spain. Methods: Three thousand three hundred and forty six volunteers (36.4% men), aged 15 to 94 years (mean: 30.3; SD: 14.6) were included. Results: The results confirmed excellent internal consistency for the Total (.94) and the Responses subscale (0.91), good for the Situations (0.89), as well as the Physiological (, 86) and Cognitive (0.84) response systems, and acceptable for the Motor (0.70). Good test-retest stability was also found after two months (0.78) and good external validity when correlated with the original ISRA (0.87). The results confirm the factor structure of the ISRA-B, adjusted to Lang''s triple response system model and to Endler''s S × R interaction model, on which it is based. Likewise, the normative data are presented, differentiated by sex and group. Conclusions: It is concluded that the ISRA-B is a valid and reliable instrument, which improves its applicability compared to the original ISRA by simplifying its format and number of items, while preserving its psychometric properties

The association between different domains of quality of life and symptoms in primary care patients with emotional disorders

Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL- Bref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care

Cost-effectiveness and cost-utility analysis of the treatment of emotional disorders in primary care: psicap clinical trial. description of the sub-study design

In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment. Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC

Disability and perceived stress in primary care patients with major depression

Background: Major depressive disorder (MDD) is highly prevalent in the Spanish primary care (PC) setting and the leading cause of disability in Spain. The aim of this study was to evaluate several key psychometric properties of the Sheehan Disability Scale (SDS) in patients with or without MDD and varying degrees of symptom severity using the Patient Health Questionnaire-9 (PHQ-9). Method: A total of 1, 704 PC patients participating in the PsicAP clinical trial completed the SDS and PHQ-9. We evaluated the factor structure, measurement invariance across gender, internal consistency, and the discriminative and predictive validity. Results: Confirmatory factor analyses revealed a unifactorial model of the SDS containing 4 items (SDS-4) with the best model fit (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). This model contained the three life domain items (work, family, and social life) plus perceived stress (PS) with significant loadings. The internal consistency of the SDS-4 was acceptable in patients with or without MDD, regardless of symptom severity. The SDS-4 also showed good discriminative capacity and acceptable predictive validity in all subsamples. Conclusions: These findings support the use of the SDS-4 to assess depression-related disability in patients at Spanish primary care centres

Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients: a network perspective

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients (N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy, fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity

Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders

The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills¿cognitive reappraisal and expressive suppression¿on the relation- ship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = 0.530, p = .026), depression (b = 0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expres- sive suppression benefited more from the addition of trans- diagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms

Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial

Background. Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. Methods. A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8–10 patients) delivered over a 12–14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. Results. Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. Conclusions. Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. Trial Registration, isrctn.org identifier: ISRCTN5843708

Factor structure and measurement invariance across various demographic groups and over time for the phq-9 in primary care patients in spain

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demo- graphic groups (i.e., gender, age, marital status, level of education, and employment situa- tion) and over time. Both one-factor and two-factor re-specified models met all the pre- established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting

Protocolo transdiagnóstico PsicAP de entrenamiento cognitivo-conductual en grupo para trastornos emocionales

Anxiety disorders and depression are highly prevalent today. The PsicAP clinical trial showed that adding 7 sessions of group cognitive-behavioural training with a transdiagnostic approach to the usual treatment of emotional disorders in adult primary care patients increased efficacy and cost-effectiveness in reducing symptom levels, reduced disability and improved quality of life. In this work, these 7 sessions of the PsicAP protocol of transdiagnostic treatment are described, aimed at intervening on the factors common to the different disorders: cognitive distortions and emotional regulation strategies. It is an intervention based on learning through psychoeducation, cognitive restructuring, relaxation, behavioural techniques and relapse prevention. It concludes by arguing about the usefulness of this protocol to reduce the gap between research and clinical practice, something necessary in today's societyLos trastornos de ansiedad y la depresión son altamente prevalentes en la sociedad actual. El ensayo clínico PsicAP demostró que añadir 7 sesiones de entrenamiento cognitivo-conductual en grupo con enfoque transdiagnóstico al tratamiento habitual de trastornos emocionales en pacientes adultos de atención primaria aumentó la eficacia y coste-efectividad para reducir los niveles de síntomas, redujo la discapacidad y mejoró la calidad de vida. En este trabajo se describen esas 7 sesiones del protocolo PsicAP de tratamiento transdiagnóstico, dirigido a la intervención sobre los factores comunes a los distintos trastornos: las distorsiones cognitivas y las estrategias de regulación emocional. Se trata de una intervención basada en el aprendizaje mediante psicoeducación, reestructuración cognitiva, relajación, técnicas conductuales y prevención de recaídas. Se concluye argumentando sobre la utilidad de este protocolo para reducir la brecha entre investigación y práctica clínica, algo necesario en la sociedad actua