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Text messaging is the primary form of technology-mediated interpersonal contact and the most carried out activity on cell phones. Despite its advantages, text messaging is not exempt from risks. The present paper aimed to validate and expand the psychometric properties of the Self-perception of Text-message Dependency Scale (STDS) in a Brazilian sample of adult internet users. In this cross-sectional study, we recruited a convenience sample of Brazilian internet users aged 18 and over. A total of 1,642 (M.sub.age = 38.6, SD = 13.5; 73% female) participants completed the STDS, the Mobile Phone Problem Usage Scale-27 (MPPUS), and the Problematic Internet Use Questionnaire - Short form - 9 questionnaires (PIUQ-SF-9). Multigroup confirmatory factor analysis showed measurement invariance for gender and age. Internal consistency was high when accessed by both McDonalds' Omega and Cronbach's alpha. Network Analysis provided insights into the core symptoms of problematic text messaging. Convergent validity of the STDS was demonstrated by the subscale's correlation with MPPUS and PIUQ-SF-9. Due to its expanded psychometric properties and brevity, the STDS can be used in more comprehensive investigations about other excessive technology-related behaviors, such as problematic smartphone and internet use, allowing a better understanding of the mechanisms involved in problematic technology use., Author(s): Daniel Tornaim Spritzer [sup.1] , André Luiz Monezi Andrade [sup.2] , Aurora Zamora Xavier [sup.1] , Gabriel Teixeira da Silva [sup.2] , Hyoun S. Kim [sup.3] , Katarzyna Kaliszewska-Czeremska [...]

Objectives: There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods: The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/ discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results: EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusion: The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil. [ABSTRACT FROM AUTHOR]

Introduction: Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. Methods: The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. Results: All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. Conclusion: Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP. [ABSTRACT FROM AUTHOR]

Introduction: Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions. Aims: To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment. Results: Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]). Discussion: Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between reflective function and global functionality in borderline personality disorder (BPD) patients, controlling for symptomatology and defensive style. Method: Thirty-nine female inpatients were evaluated employing a sociodemographic questionnaire, the Structured Clinical Interview for Personality Disorders-II (SCID-II), the Self-Reporting Questionnaire (SRQ-20), the Reflective Functioning Questionnaire (RFQ), the Defence Style Questionnaire-40 (DSQ-40) and the Global Assessment of Functioning (GAF). Results: Functionality was inversely associated with the reflective function uncertainty score (–.458; p <.01) and neurotic defences (–.335; p <.05). Symptom severity (SRQ-20) was associated with the use of immature defences (–.445; p <.01). The association between functionality and the reflective function uncertainty score remained significant, even when controlled for symptoms and defensive style (p =.002). Conclusion: The ability to mentalise seems to play a central and somehow independent role in BPD psychopathology. [ABSTRACT FROM AUTHOR]

Introduction: Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents. Method: This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables. Result: Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family. Conclusion: Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods. [ABSTRACT FROM AUTHOR]

Objective: The goal of the study is to adapt and examine the psychometric properties of the Brazilian version of the nine-item Problematic Internet Use Questionnaire (PIUQ-SF-9). Methods: A convenience sample of Brazilian internet users aged between 18 and 89 years (72.7% female, mean age 38.7 years ± 13.5) was recruited online from September 2018 to July 2019 (test sample = 1,525; retest sample = 237). Participants responded to the adapted version of the PIUQ-SF-9, as well as the Center for Epidemiologic Studies-Depression Scale (CES-D-10) and sociodemographic questions. Results: A bifactor model with one general factor and three specific dimensions (obsession, neglect and control disorder) yielded the best fit indices [χ2 = 67.66, df = 15, CFI = 0.99, TLI = 0.99, RMSEA = 0.048 (0.037–0.060), RMSEA p close = 0.587 and SRMR = 0.01]. McDonald's hierarchical omega coefficient was 0.76 for the general factor and varied between 0.16 and 0.33 for the specific dimensions. The intraclass correlation coefficient was 0.73 for the general factor and varied between 0.64 and 0.72 for the specific dimensions. The MIMIC model supported the scale's construct validity as the relationship of the predictors (age, time spent online, self-perception of problematic internet use, and depression symptoms) with the PIUQ-SF-9 factors was in line with the assumptions based on the literature. Conclusion: PIUQ-SF-9 seems to be a brief and culturally validated instrument with sound psychometric properties to be used in future studies on problematic internet use in the Brazilian population. [ABSTRACT FROM AUTHOR]

Introduction: The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective: The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method: This study is a narrative review of the literature on social isolation in the context of the COVID- 19 pandemic. Results: 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions: It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families. [ABSTRACT FROM AUTHOR]

Introduction: Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA. Method: The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales' items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors. Results: The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use. Conclusion: This study provides important tools for the ED research field in Brazil. [ABSTRACT FROM AUTHOR]

Introduction: Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method: After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results: The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion: Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts. [ABSTRACT FROM AUTHOR]

This paper presents and discusses the outcomes of the psychodynamic psychotherapy of a patient with somatic symptom disorder and chronic diseases in a naturalistic setting. The entire treatment included 120 weekly sessions and lasted 30 months. It was interrupted by the patient. The treatment was considered successful in terms of its results. Regarding symptomatic evaluation (assessed by Outcome Questionnaire, OQ‐45), the patient showed an improvement, especially during the three‐month follow‐up assessment period, showing a change from dysfunction to functionality. In relation to personality evaluation (assessed by the Shedler‐Westen Assessment Procedure, SWAP‐200), although structural changes were not completed, the patient achieved a high level of overall functioning (i.e. strengthening of the ego). The clinical evaluation and the measures provided by the instruments were in agreement. This study showed that psychodynamic psychotherapy can help patients who show characteristics such as chronic diseases and operative functioning. Moreover, the pluralistic perspective used for evaluating treatment outcome proved to be very hopeful for improving our understanding of the patient's idiosyncrasies. [ABSTRACT FROM AUTHOR]

Background: Medical students are a population at higher risk for psychological distress and mental health disorders when compared to the general population. Evidence-based interventions to promote well-being are available, but the rates of anxiety, burnout, depression, and suicide are not decreasing as expected. This scenario can lead to poor academic outcomes and lower assistance capability. Students are frequently targeted in interventions, but the academic environment itself is seldomly a target. Qualitative research is an insightful approach in deriving a deeper understanding of phenomena that are suitable to culture-sensitive interventions. Objective:To explore student’s perception of medical school and their understanding of which factors underly the path from well-being to impaired mental health. Methods: A qualitative exploratory study was performed. Focus groups and in-depth interviews were conducted, comprising students from all medical school years. Grounded theory was used to analyze data, and Consolidated Criteria for Reporting Qualitative Research were followed. Feedback from participants and through external supervision were conducted in ensuring saturation, reliability, and coherence. Results: Five main categories were identified: socioeconomic aspects, university environment (including culture, institutional functioning, and relationships), training issues, career demands, and mental health. Both personal and environmental factors were highlighted as contributors and stressors. Conclusion: A medical career appears to be related to a culture of omnipotence where excellence is frequently misconstrued as perfection. The complex relations between personal and environmental factors demand comprehensive strategies. Institutional rules could be adapted to avoid enhancing excessive competition. In some cases, individual assistance is needed. Inclusion of the academic community’s perspective and targeting the negative aspects of the medical culture seem essential to move forward in the field of mental health and person-centered learning. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors potentially associated with burnout in Brazilian physicians and medical students. Methods: In this cross-sectional online survey, participants were evaluated in October 2019 regarding sociodemographic, personal, work-related, and mental health factors. Different phases of medical careers and work settings were represented. Burnout symptoms were assessed by means of the Maslach Burnout Inventory. The most common cut-off points were used for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The total scores of these dimensions were used as dependent variables in order to assess the risk factors for each burnout dimension. Results: 2,486 participants were included in the study. The mean age was 38.92 years (SD = 12.64), 62.8% were female, and 39.9% declared themselves as burned out. EE was present in 59.3%, DP in 45.5%, and low PA in 33.1% of the sample. Workload, age, sex, work environment, psychiatric history, quality of the relationships with family and friends, leisure and physical activity were all associated with burnout. Those participants who reported that they were not undergoing any type of psychological treatment, but nevertheless felt like they should be in treatment, actually had more symptoms. Burnout was also related to having suicidal ideation in the last month and to alcohol abuse. Conclusion: In addition to individual risk factors, this study shows the importance of characteristics of the work environment such as fostering cooperation, empathy and shared values between superiors, institutions, and physicians. Also, stigma and the barriers to seeking care appear as an important issue, as well as the association between burnout, alcohol abuse, and suicidal ideation. [ABSTRACT FROM AUTHOR]

Copyright of Trends in Psychiatry & Psychotherapy is the property of Associacao de Psiquiatria do Rio Grande do Sul and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Trends in Psychiatry & Psychotherapy is the property of Associacao de Psiquiatria do Rio Grande do Sul and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information on the Pega Leve (PL) gatekeeper training program to address the mental health of college students at the Federal University of Rio Grande do Sul in Brazil amidst the COVID-19 pandemic.

Objective: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure. Method: Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit. Results: The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model. Conclusion: Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. Method: Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning and Clinical Global Impression were assessed before and after 6 weeks of treatment. Results: Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. Conclusions: These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the impact of parental bonding as a resilience or a risk factor for psychopathology after rape. Women rape victims were assessed regarding the perception of parental bonding in childhood, acute posttraumatic stress disorder symptoms, acute stress disorder (ASD), and clinical severity. The perception of having less affective parents was correlated with severity, and ASD was more frequent in participants with less affectionate and more controlling fathers. Perceived support was associated with clinical impairment. These findings could help in identifying those who need early interventions and highlight the importance of social and emotional support in facing traumatic situations, reinforcing aspects of the parent–child relationship that generate adults more apt to face adverse situations. [ABSTRACT FROM AUTHOR]

The article discusses the institutional factors in the medical burnout epidemic. It states that burnout in physicians has increased due to increasing expectations regarding the electronic medical record. It also mentions that physicians often carry some of the typical obsessive-compulsive personality traits of those who choose the medical profession, such as perfectionism and excessive devotion to work.

A letter to the editor is presented in response to the article "Factor Structure of the Rutter Teacher Questionnaire in Portuguese Children," by Ana Telma Pereira and colleagues, published in a 2008 issue.

Objectives: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome. Method: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83% were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. Results: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4%. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61% less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95% 0.16-0.95). There was no association between initial CT and treatment outcome. Conclusions: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome. [ABSTRACT FROM AUTHOR]

Background: Although social distancing is necessary to decrease COVID-19 dissemination, it might also be associated with suicidal ideation. Therefore, we analyzed the impact of social distancing and loneliness in suicidal ideation.Methods: We performed two waves of a snowball sample, web-based survey in Brazil (W1: from May 6th to June 6th, 2020; W2: from June 6th to July 6th, 2020). We assessed whether risk factors related to social relationships (loneliness, living alone, not leaving home, and the number of days practicing social distancing) at W1 were associated with suicidal ideation at W1 and W2 using multiple regression models. Analyses were adjusted for sociodemographic, mental health, and lifestyle variables.Results: A total of 1,674 (18-75 years old; 86.5% females) were included in our longitudinal sample. Living alone (OR: 1.16; 95%CI = 1.03 - 1.30; p=0.015), number of days practicing social distancing (OR: 1.002; 95%CI = 1.000 - 1.004; p=0.027), and loneliness (OR: 1.49; 95%CI = 1.32 - 1.68; p<0.001) were associated with suicidal ideation in the cross-sectional analysis of W1. Only loneliness (OR= 2.12; 95%CI = 1.06 - 4.24; p = 0.033) remained significant as a risk factor to suicidal ideation in the longitudinal analysis between both waves.Limitation: Snowball, convenience sample design limits outcome estimates. Assessments were not objectively performed.Conclusion: Loneliness was consistently associated with the incidence of suicidal ideation, while other variables, such as living alone, not leaving home, and the number of days practicing social distancing, were not. Measures to overcome loneliness are therefore necessary to reduce suicidal ideation during pandemics. [ABSTRACT FROM AUTHOR]

Background & objectives: Evidence has suggested that parenting styles have peculiar characteristics in families with drug-related issues. This study was undertaken to investigate the perception of crack (smoke cocaine) users and non-users about parental bonding quality regarding care and control in Brazil. Methods: A total of 198 hospitalized crack users and 104 users of any non-illicit drug were assessed using the Parental Bonding Instrument (PBI), the sixth version of the Addiction Severity Index (ASI) and Mini International Neuropsychiatric Interview (MINI). Results: Adjusted logistic regression analysis showed that crack users were more likely (ORadj = 9.68; 95% CI: 2.82, 33.20) to perceive neglectful mothers, as well as more likely (ORadj = 4.71, 95% CI: 2.17, 10.22) to perceive controlling and affectionless fathers in comparison with non-illicit drug users who were more likely to perceive optimal parenting. Interpretation & conclusions: Our findings indicate that the perception of neglectful mothers and affectionless controlling fathers may be associated with the tendency of the children to be less resilient when facing stressful events, leading them to a greater risk to use crack. [ABSTRACT FROM AUTHOR]

Objectives: To assess occupational burnout (OB) changes among Brazilian healthcare workers (HCWs) from COVID-19 onset to six months later (T1) and identify risk and protective factors., Methods: Using the Copenhagen Burnout Inventory and hierarchical multivariate linear regression in a two-stage online survey (initial n = 1,054; T1 n = 316), this study examined the impact of various factors on OB., Results: Significant increases in personal and work-related OB were observed by T1. Psychiatric diagnosis and workload emerged as risk factors (p < 0.01), while having a partner, good family relations, workplace well-being, and adequate sleep were protective (p < 0.001)., Conclusions: OB levels among Brazilian HCWs increased during the COVID-19 pandemic. Interventions should target personal and organizational wellness to alleviate burnout, emphasizing the importance of strong relationships, workplace health, and good sleep practices., Competing Interests: Conflict of interest for all authors: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Introduction: Despite the growing recognition of gaming disorder as a mental disorder, there is still debate about how it should be best screened for. This is especially relevant in countries where prevalence studies that could support evidence-based policymaking are still to be conducted. This study aims to evaluate the psychometric properties of the Brazilian Portuguese version of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and to explore its association with functional impairment., Methods: An online convenience sample of 805 Brazilian adults who reported playing games completed the adapted version of IGDT-10 and World Health Organization Disability Assessment Schedule 2.0, as well as the Problematic Internet Use Questionnaire, the Center for Epidemiologic Studies-Depression Scale, the Rosenberg Self Esteem Scale and socio-demographic questions., Results: The Brazilian Portuguese version of IGDT-10 demonstrated a unidimensional structure in both confirmatory and exploratory factor analysis, with satisfactory internal consistency and adequate temporal stability. Participants who scored five or more on IGDT-10 presented higher levels of functional impairment compared to those who scored positive for four symptoms or less. The difference between the two groups was statistically significant and showed a moderate effect size. Network analysis showed a direct connection between IGDT-10 and functional impairment, and identified "negative consequences" as the most relevant item connecting these variables., Conclusion: The IGDT-10 is a brief, easy-to-understand, valid, and reliable instrument, proving to be a suitable candidate for screening gaming disorder in future epidemiological studies., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Objectives: There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI)., Methods: The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence., Results: EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups., Conclusion: The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil., Competing Interests: No conflicts of interest declared concerning the publication of this article.

Introduction: Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions., Aims: To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment., Results: Among the 382 students who completed the survey (87.6% completion rate), 38.5% ( n  = 147) were in treatment, and 33% ( n  = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% ( n  = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81])., Discussion: Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Introduction: Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents., Method: This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables., Result: Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family., Conclusion: Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods., Competing Interests: No conflicts of interest declared concerning the publication of this article.

This study aimed to examine the associations between countertransference induced by sex offenders, defense mechanisms, and manifestations of vicarious trauma in forensic psychiatrists and psychologists. A cross-sectional study using a mixed-methods design was performed with 56 Brazilian forensic psychiatrists and psychologists from October 2016 to May 2017. Countertransference, defense mechanisms, and vicarious trauma were assessed with the Assessment of Countertransference Scale, the Defense Style Questionnaire-40, and the Trauma and Attachment Belief Scale (TABS), respectively. Qualitative data analysis based on grounded theory was also performed to explore the influence of sex-offender assessments on the experts' personal and professional lives. Positive and moderate correlations were found between feelings of indifference and the Other-Safety TABS subscale (rho .43, P < .01) and between immature defense mechanisms and TABS total score (rho .45, P < .01). Qualitative data revealed changes in the professionals' identity, worldview, and beliefs related to safety and trust. Specific maladaptive coping strategies, such as feelings of indifference and immature defenses, during the assessment of sex offenders were associated with manifestations of vicarious trauma in forensic psychiatrists and psychologists. These findings indicate the need for awareness and care about the forensic expert's mental health., (© 2020 American Academy of Psychiatry and the Law.)

Introduction: Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA., Method: The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales' items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors., Results: The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use., Conclusion: This study provides important tools for the ED research field in Brazil.

Objective: This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms., Methods: The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified., Result: The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time., Conclusion: Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.