Estabilidad diagnóstica y persistencia de los trastornos de ansiedad de inicio en la infancia y la adolescencia

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Psiquiatría. Fecha de lectura: 22 de Febrero de 200

Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain

Aims The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk. Methods We recruited 147 adolescents aged 11–17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI). Results TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly. Conclusions ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.2022-2

Suicidal Behaviour and Stressful Life Events: The Mediating Role of the Impulsivity-Aggression-Hostility Triad Through Psychological Autopsy

Stressful life events (SLEs), impulsivity, aggression, and hostility are known risk factors for suicide. The existence of an “I-A-H Triad” (composed of impulsiveness, aggressiveness and hostility) is proposed as a mediating factor between SLEs and suicide2024-2

El papel mediador de la disregulación emocional en la adherencia al tratamiento en adolescentes con diabetes mellitus tipo 1.

ntroducción: La Diabetes Mellitus tipo 1 (DM1) es una enfermedad crónica que requiere de un estrecho seguimiento y control terapéutico para la prevención de complicaciones. Un peor funcionamiento ejecutivo contribuye a un peor cumplimiento terapéutico y a un peor manejo de la diabetes. El fenotipo de disregulación emocional se ha señalado como un indicador de autorregulación deficiente, psicopatología general, gravedad de los síntomas, exposición a la adversidad psicosocial y deterioro funcional. Se desconoce el papel de la disregulación emocional en la adherencia al tratamiento de la DM1. Hipótesis y objetivos: El objetivo del presente estudio es determinar el papel de l fenotipo de disregulación emocional en la adherencia al tratamiento de la DM1. Se hipotetiza que el fenotipo de disregulación emocional mediará la relación entre las funciones ejecutivas y la adherencia al tratamiento de la DM1. Población y método: Se reclutaron 55 pacientes entre 10 y 18 años con un diagnóstico de DM1 de al menos 3 años de evolución atendidos en el Servicio de endocrinología infantil de los Hospitales Universitarios Gregorio Marañón y Fundación Jiménez Díaz. Se evaluó la adherencia al tratamiento a la DM1 con la escala de vida relacionada con la DM1 (PedsQL- heteroinformada), las funciones ejecutivas con un cuestionario heteroaplicado (BRIEF-2) y la disregulación emocional con la subescala del Cuestionario de Capacidades y Dificultades (SDQ-Dysregulation Profile). Se desarrollaron modelos de mediación para evaluar el papel de la disregulación emocional como variable de mediación en la relación entre las funciones ejecutivas y la adherencia al tratamiento de la DM1. Los modelos de mediación se analizaron mediante métodos de muestreo Bootstrap. Resultados: Se halló una correlación estadísticamente significativa entre la variable Independiente (BRIEF-2) y el mediador propuesto (SDQ-DP). Los resultados apoyan el modelo de mediación total de la disregulación emocional en la relación entre las funciones ejecutivas y la adherencia al tratamiento de la DM1. El efecto indirecto mediante bootstrapping apoya el modelo de mediación ya que el efecto indirecto es significativamente diferente de cero en p<.05 (0.098). Discusión: Este estudio es pionero en presentar la disregulación emocional como un potencial factor de riesgo en la adherencia al tratamiento de la DM1. El fenotipo de disregulación emocional medido por el SDQ-DP parece mediar de forma completa la asociación establecida entre alteraciones en la función ejecutiva y la adherencia al tratamiento en la DM1 Conclusiones: El objetivo principal del tratamiento en la DM1 es proporcionar al paciente las herramientas necesarias para lograr el mejor control de su enfermedad a fin de evitar, retardar o detener las complicaciones agudas y a largo plazo. El perfil de disregulación emocional podría ser un factor de riesgo en la adherencia al tratamiento de la DM1. Se requieren más estudios y diseños prospectivos para confirmar el papel mediador de la disregulación emocional de las funciones ejecutivas y la adherencia al tratamiento en la DM1. Bibliografía: Hilliard ME, Harris MA, Weissberg-Benchell J. Diabetes resilience: a model of risk and protection in type 1 diabetes. Curr Diab Rep. 2012 Dec;12(6):739-48. Sildorf SM, Breinegaard N, Lindkvist EB, Tolstrup JS, Boisen KA, Teilmann GK, Skovgaard AM, Svensson J. Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity. Diabetes Care. 2018 Nov;41(11):2289-2296 Carballo JJ, Serrano-Drozdowskyj E, García Nieto R, Díaz de Neira-Hernando M, Pérez-Fominaya M, Molina-Pizarro CA, De León-Martínez V, Baca-García E. Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting. Psychopathology. 2014;47(5):303-11.2022-2

Perceived Stressful Life Events and Suicide Risk in Adolescence: The Mediating Role of Perceived Family Functioning

Aim: Suicidal behavior is a serious public health problem and a major cause of death among adolescents. Three categories of major risk factors have been identified: psychological factors, stressful life events, and personality traits. Severe and objective stressful life events (SLEs), such as childhood mistreatment or abuse, have been clearly associated with higher rates of suicide risk. However, the relationship between suicide risk and adolescents’ perceptions of the SLE impact is not as clear. This paper studies the relationship between SLE impact perception and suicide risk and the possible mediating role of perceived family functioning in this relationship. The need for longer-term or more intense psychological or psychiatric treatment in relation to SLE impact perception is also addressed. Method: One hundred forty-seven adolescents aged 11–17 were consecutively recruited from the Child and Adolescent Mental Health Outpatient Services Department of a general hospital in Madrid, Spain. Self-informed questionnaires were used to assess suicide risk, SLEs, and family functioning. In addition, the clinical records of the participants were consulted to collect information about their treatment histories, including the number of appointments and the duration of follow-up. Results: SLE impact perception correlates significantly with suicide risk, the number of clinical appointments, the duration of treatment, and the perceived level of family functioning. The mediation model of the family functioning perception variable in the relationship between SLE impact perception and suicide risk is significant. The linear regression model of SLE impact perception and family functioning perception on suicide risk is also significant, accounting for 25.7% of the variance. Conclusions: Beyond the clear and proven effect of serious and objective SLEs, the perceived impact of SLEs reported by adolescents is related to an increased risk of suicide and more intense psychological and/or psychiatric follow-up. This relationship is mediated by the perceived level of family functioning. Adolescents’ perceptions of their life experiences and perceived family support may be key determinants of suicide risk prevention.2023-2

El impacto subjetivo de los acontecimientos vitales estresantes como factor de riesgo suicida en población clínica adolescente

Objetivo: El suicidio es un problema grave de salud pública y una de las principales causas de muerte entre adolescentes. La exposición a acontecimientos vitales estresantes (AVE) se ha asociado con mayor riesgo suicida. Sin embargo, las percepciones subjetivas del impacto experimentado por dichos AVE no se han estudiado en relación con el riesgo suicida. Este trabajo estudia la relación entre la percepción subjetiva del impacto de los AVE y el riesgo suicida en población adolescente. Método: Se reclutaron 147 adolescentes de entre 11 y 17 años (M = 15,34; Dt = 1,316) del servicio de consultas ambulatorias de Salud Mental Infantojuvenil de un hospital general de Madrid. Se aplicaron cuestionarios autoinformados para evaluar el riesgo, la ideación y los intentos de suicidio (SITBI, García-Nieto et al., 2013), exposición e impacto subjetivo a AVE (Oliva et al., 2008) y una entrevista clínica para recoger datos sociodemográficos. Se calcularon correlaciones bivariadas y dos modelos de regresión sobre el riesgo suicida: uno con la exposición a AVE como variable predictora y otro con la percepción subjetiva del impacto de dichos AVE como variable predictora. Se incluyó el sexo como covariable en ambos. Resultados: El impacto subjetivo de los AVE correlacionó significativamente con la ideación, los intentos y el riesgo suicida (Tabla 1). Haber estado expuesto a AVE explicó el 17,5% de la varianza del riesgo suicida (F = 15,071; Gl=2; p < 0,001), mientras que la percepción subjetiva del impacto de esos AVE explicó el 18,9% (F = 16,571; Gl=2; p < 0,001). Conclusiones: El impacto percibido de los AVE se relaciona con mayor riesgo suicida en adolescentes. Las percepciones subjetivas sobre las experiencias vividas pueden ser determinantes clave en la prevención del suicidio.2023-2

The impulsivity-aggressiveness-hostility triad mediates the relationship between stressful life events and completed suicide

Background and Objectives: The Interpersonal Theory of Suicide outlines a range of dynamic factors that heighten an individual's susceptibility to displaying suicidal tendencies. Among these factors lies the acquired capacity for suicidal behaviours, which denotes a person's desensitization to pain (both physical and psychological), and fearless to death, cultivated through exposure to adverse life circumstances. Stressful life events (SLE), in conjunction with certain personal traits, notably contribute to this capacity for suicidal behaviour. Traits such as impulsivity, aggression, and hostility are linked to a heightened likelihood of engaging in risky behaviours over one's lifetime, thereby fostering an increased propensity for suicidal acts. The objective of this study, is to introduce the concept of an "I-A-H triad” (“Activating triad”) comprising impulsiveness, aggressiveness, and hostility, as a pivotal intermediary between SLE and suicidal tendencies. Method: Data were gathered from 399 deceased individuals (274 suicides, 125 non-suicides) through psychological autopsy methods. Adapted versions of the Paul Ramsey Life Experience Scale, Barrat Impulsivity Scale (BIS-11), and Buss-Durkee Hostility Inventory (BDHI) were employed to collect information. Findings: Results from comparative analyses between the two groups revealed significant distinctions in key variables of interest (SLE: t = 7.280; BDHI: t = 4.201; BIS-11: t = 3.812; I-A-H Triad: t = 4.84). Mediation analysis affirmed the mediating function of the "I-A-H Triad" in connecting SLE with suicide. Discussion: In conclusion, elevated levels of impulsivity, aggression, and hostility amplify the risk of suicide, particularly in the presence of stressful life events.University of Glasgow2023-2

Smartphone-based Ecological Momentary Intervention for secondary prevention of suicidal thoughts and behaviour: protocol for the SmartCrisis V.2.0 randomised clinical trial

Auteurs : MEmind Study GroupInternational audienceSuicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to evaluate the effectiveness of a smartphone-based Ecological Momentary Intervention to prevent suicidal thoughts and behaviour. Methods and analysis: the SmartCrisis V.2.0 study is a randomised clinical trial with two parallel groups, conducted among patients with a history of suicidal behaviour treated at five sites in France and Spain. The intervention group will be monitored using Ecological Momentary Assessment (EMA) and will receive an Ecological Momentary Intervention called ‘SmartSafe’ in addition to their treatment as usual (TAU). TAU will consist of mental health follow-up of the patient (scheduled appointments with a psychiatrist) in an outpatient Suicide Prevention programme, with predetermined clinical appointments according to the Brief Intervention Contact recommendations (1, 2, 4, 7 and 11 weeks and 4, 6, 9 and 12 months). The control group would receive TAU and be monitored using EMA. Ethics and dissemination: this study has been approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz. It is expected that, in the near future, our mobile health intervention and monitoring system can be implemented in routine clinical practice. Results will be disseminated through peer-reviewed journals and psychiatric congresses. Reference number EC005-21_FJD. Participants gave informed consent to participate in the study before taking part. Trial registration number NCT04775160

Es mi hijo mal estudiante? : causas médicas del fracaso escolar y tratamientos para superarlo

Resumen basado en el de la publicaciónSe parte de la premisa de que, a principios del siglo XXI, el fracaso escolar afecta a un número elevado de niños en España, quienes no cumplen los objetivos pedagógicos de Primaria y Secundaria. Se reflexiona sobre las causas de este fenómeno, los factores que contribuyen a su aparición y persistencia, el papel que corresponde a cada uno de los agentes implicados y las medidas que deberían tomarse desde distintos ámbitos para evitarlo y remediarlo. Se trata sobre las causas médicas del fracaso escolar, haciendo también referencia a aspectos educativos, familiares y sociales que tienen un destacado papel en el aprendizaje y rendimiento académico de los niños. Asimismo, se da respuesta a los padres a sus preguntas sobre el mal rendimiento académico de sus hijos.Castilla y LeónBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]