Browsing by Author "Alvarado, Ruben"

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    Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries
    (2020) Mascayano, Franco; Toso-Salman, Josefina; Ho, Yu Chak Sunny; Dev, Saloni; Tapia, Thamara; Thornicroft, Graham; Cabassa, Leopoldo J.; Khenti, Akwatu; Sapag, Jaime; Bobbili, Sireesha J.; Alvarado, Ruben; Yang, Lawrence Hsin; Susser, Ezra
    Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.
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    Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic
    (2024) Czepiel, Diana; Mccormack, Clare; da Silva, Andrea T. C.; Seblova, Dominika; Moro, Maria F.; Restrepo-Henao, Alexandra; Martinez, Adriana M.; Afolabi, Oyeyemi; Alnasser, Lubna; Alvarado, Ruben; Asaoka, Hiroki; Ayinde, Olatunde; Balalian, Arin; Ballester, Dinarte; Barathie, Josleen A. l.; Basagoitia, Armando; Basic, Djordje; Burrone, Maria S.; Carta, Mauro G.; Durand-Arias, Sol; Eskin, Mehmet; Fernandez-Jimenez, Eduardo; Frey, Marcela I. F.; Gureje, Oye; Isahakyan, Anna; Jaldo, Rodrigo; Karam, Elie G.; Khattech, Dorra; Lindert, Jutta; Martinez-Ales, Gonzalo; Mascayano, Franco; Mediavilla, Roberto; Gonzalez, Javier A. Narvaez; Nasser-Karam, Aimee; Nishi, Daisuke; Olaopa, Olusegun; Ouali, Uta; Puac-Polanco, Victor; Ramirez, Dorian E.; Ramirez, Jorge; Rivera-Segarra, Eliut; Rutten, Bart P. F.; Santaella-Tenorio, Julian; Sapag, Jaime C.; Seblova, Jana; Soto, Maria T. S.; Tavares-Cavalcanti, Maria; Valeri, Linda; Sijbrandij, Marit; Susser, Ezra S.; Hoek, Hans W.; van der Ven, Els
    Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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    Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study
    (2022) Sapag, Jaime C.; Traub, Carolina; Velasco, Paola R.; Arratia, Tamara; Alvarado, Ruben; Aracena, Marcela; Poblete, Fernando C.; Villarroel, Luis; Bravo, Paulina; Alvarez-Huenchulaf, Cinthia; Jofre Escalona, Ana; Vargas-Malebran, Nelson; Bobbili, Sireesha; Bustamante, Ines; Khenti, Akwatu; Corrigan, Patrick W.
    Background: Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. Methods: The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster "). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects.
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    Stigma Toward Psychosis in Urban Chile: Engaging "What Matters Most" to Resist Stigma Through Recovery-Oriented Services
    (2023) Becker, Timothy D.; Blasco, Drew; Burrone, Maria Soledad; Dishy, Gabriella; Velasco, Paola; Reginatto, Gabriel; Mascayano, Franco; Wu, Maximillian S.; Hu, Cindy; Bharadwaj, Simran; Khattar, Shivangi; Calderon, Liz; Filgueira, Cynthia; Alvarado, Ruben; Susser, Ezra S.; Yang, Lawrence H.
    Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood " in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most " (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. Methods: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. Conclusions and Implications for Practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM.
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    Stigma towards people with mental disorders: perceptions of devaluation and discrimination in a sample of Chilean workers
    (2019) Teresa Solis-Soto, Maria; Soledad Burrone, Maria; Reginatto, Gabriel; Sapag, Jaime C.; Alvarado, Ruben
    Introduction. Mental disorders represent one of the main causes of disease burden in the adult population. Negative public attitudes and behaviors toward people with mental disorders negatively affect the treatment, recovery, and social inclusion of those affected. Chile laks surveys on workers that address this issue. Objective. To describe the perceptions of devaluation and discrimination towards people with mental disorders in a sample of Chilean workers. Method. A cross-sectional study was carried out with 1516 workers in the formal sector of four regions of Chile (Metropolitan Region [RM], Bio Bio [VIII], Valparaiso [V] and Coquimbo [IV]). The perception of discrimination and devaluation was explored through a modified version of the The perceived Devaluation-Discrimination Scale (PDD) comprising 15 questions. The relationship of each question with sociodemographic variables (age, sex, years of study, and region) and type of economic activity was assessed. Results. The study found a high percentage of perceptions of devaluation and discrimination in most aspects considered, particularly those related to hiring a person who has been hospitalized due to a mental illness (85%), feeling sorry for people with severe mental illnesses (80%), and the unwillingness to marry a person with a mental illness (78%). Significant differences were observed in the opinions by sociodemographic variables and region of residence. Discussion and conclusion. The perception of Chilean workers has high levels of stigma towards people living with mental disorders. It is necessary and urgent to develop effective anti-stigma public policies to promote a more inclusive, tolerant society.
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    Validation of the Opening Minds Scale and patterns of stigma in Chilean primary health care
    (2019) Sapag, Jaime C.; Klabunde, Rachel; Villarroel, Luis; Velasco, Paola R.; Alvarez, Cinthia; Parra, Claudia; Bobbili, Sireesha J.; Mascayano, Franco; Bustamante, Ines; Alvarado, Ruben; Corrigan, Patrick
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    Validation of the Spanish version of the Eating Disorders Diagnostic Scale
    (SOC MEDICA SANTIAGO, 2012) Silva, Jaime R.; Behar, Rosa; Cordella, Patricia; Ortiz, Manuel; Jaramillo, Karina; Alvarado, Ruben; Jose Jorquera, Maria
    Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: The factorial structure, internal consistency and test-retest reliability of the Spanish-language version of the EDDS was analyzed in a sample of 1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion. (Rev Med Chile 2012; 140: 1562-1570).