Adaptación y Validación de un Instrumento de Medición del Estigma hacia los Problemas de Salud Mental en Menores entre Profesionales de la Salud
##plugins.themes.bootstrap3.article.main##
Resumen
ntroducción. Una de las principales barreras que enfrentan los niños y adolescentes para recibir atención es el estigma.
Objetivo. Evaluar la confiabilidad y validez de constructo del Cuestionario para Personal de Salud, así como determinar los indicadores de eficiencia de las viñetas clínicas que lo componen. Método. El Cuestionario para Personal de Salud (CPS), es un instrumento auto-administrado con 20 viñetas clínicas y 37 ítems, se aplicó a 2,477 profesionales de la salud, evaluando conocimiento, prejuicio e intenciones de discriminación como componentes del estigma. Se calcularon los valores de eficiencia para las viñetas clínicas presentadas, utilizando las evaluaciones de psiquiatras infantiles como estándar de oro. Se realizó un análisis de consistencia interna para determinar la validez de constructo. La muestra se dividió aleatoriamente en dos grupos. Se realizó un Análisis Factorial Exploratorio (AFE) con el primer grupo (n=1250) y un Análisis Factorial Confirmatorio (AFC) con el segundo (n=1227).
Resultados. La eficiencia de las viñetas clínicas obtuvo una tasa de acuerdo global entre los psiquiatras infantiles del 97%. El análisis factorial exploratorio identificó seis dimensiones para prejuicio y una para intenciones de discriminación. En el AFC, los factores se comportaron de la misma manera, con cargas factoriales para los ítems y alfas similares.
Discusión y conclusión. La investigación sobre el estigma hacia la salud mental infantil en personal sanitario es escasa, en parte por falta de instrumentos válidos y confiables. El CPS exploró eficazmente problemas de actitud (prejuicio) e intenciones de discriminación como aspectos del estigma hacia las enfermedades mentales en niños y adolescentes. El análisis de estos componentes en profesionales de la salud tiene implicaciones significativas en la atención de salud mental de los niños y adolescentes.
Referencias
Caraveo, J. (2016). Vigilando la salud mental infantil en atención primaria. Norderstedt, Germany: Editorial Académica Española.
Caraveo, J., López, J.L., Soriano, A., López, J.C., Contreras, A., & Reyes, A. (2011). Eficiencia y validez concurrente del CBTD para la vigilancia de la salud mental de niños y adolescentes en un centro de atención primaria de México. Revista de Investigación Clínica, 63(6), 590-600.
Cardoso, N. O., Sanvicente-Vieira, B., De Ferracini, I. M. V., & de L. Argimon, I. I. (2020). Instruments for measuring perceived and experienced Mental Illness Stigma: A systematic review. Psicologia: Teoria e Prática, 22(1), 64-88. https://doi.org/10.5935/1980-6906/psicologia.v22n1p64-88
Corrigan, P. W., & Wassel, A. (2008). Understanding and influencing the stigma of mental illness. Journal of Psychosocial Nursing and Mental Health Services, 46(1), 42-48. https://doi.org/10.3928/02793695-20080101-04
Davis, J. A., Smith, T. W., & Marsden, P. V. (2007). General Social Surveys, 1972-2006: cumulative codebook (pp. 805–825; 1178–1204; 1399–1402; 1451–1485). Chicago: NORC.
Freţian, A. M., Graf, P., Kirchhoff, S., Glinphratum, G., Bollweg, T. M., Sauzet, O., & Bauer, U. (2021). The Long-Term Effectiveness of Interventions Addressing Mental Health Literacy and Stigma of Mental Illness in Children and Adolescents: Systematic Review and Meta-Analysis. International journal of public health, 66, 1604072. https://doi.org/10.3389/ijph.2021.1604072
Graham, N., Lindesay, J., Katona, C., Bertolote, J. M., Camus, V., Copeland, J. R., de Mendonça Lima, C. A., Gaillard, M., Gély Nargeot, M. C., Gray, J., Jacobsson, L., Kingma, M., Kühne, N., O’Loughlin, A., Rutz, W., Saraceno, B., Taintor, Z., Wancata, J., Old Age Psychiatry section, World Psychiatric Association, & World Health Organization (2003). Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement. International Journal of Geriatric Psychiatry, 18(8), 670–678. https://doi.org/10.1002/gps.876
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10, 113. https://doi.org/10.1186/1471-244X-10-113
Hair, J. F., Jr., Sarstedt, M., Hopkins, L., & Kuppelwieser, V. G. (2014). Partial least squares structural equation modeling (PLS-SEM): An emerging tool in business research. European Business Review, 26(2), 106-121. https://doi.org/10.1108/ebr-10-2013-0128
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/ajph.2012.301069
Henderson, C., Noblett, J., Parke, H., Clement, S., Caffrey, A., Gale-Grant, O., Schulze, B., Druss, B., & Thornicroft, G. (2014). Mental health-related stigma in health care and mental health-care settings. The Lancet. Psychiatry, 1(6), 467-482. https://doi.org/10.1016/S2215-0366(14)00023-6
Hu, L.-t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Kaushik, A., Papachristou, E., Dima, D., Fewings, S., Kostaki, E., Ploubidis, G. B., & Kyriakopoulos, M. (2017). Measuring stigma in children receiving mental health treatment: Validation of the Paediatric Self-Stigmatization Scale (PaedS). European Psychiatry, 43, 1-8. https://doi.org/10.1016/j.eurpsy.2017.01.004
Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. The American Journal of Psychiatry, 152(7), 1026-1032. https://doi.org/10.1176/ajp.152.7.1026
Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-Soto, V., Morgan, K., Saldivia, S., & Vicente, B. (2018). Mental health in the Americas: an overview of the treatment gap. Revista Panamericana de Salud Pública, 42, e165. https://doi.org/10.26633/rpsp.2018.165
McLeod, J. D., Fettes, D. L., Jensen, P. S., Pescosolido, B. A., & Martin, J. K. (2007). Public knowledge, beliefs, and treatment preferences concerning attention-deficit hyperactivity disorder. Psychiatric Services (Washington, D.C.), 58(5), 626–631. https://doi.org/10.1176/ps.2007.58.5.626
Medina-Mora, M. E., Borges, G., Lara, C., Benjet, C., Blanco, J., Fleiz, C., Villatoro, J., Rojas, E., Zambrano, J., Casanova, L., & Aguilar, S. (2003). Prevalencia de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental, 26(4), 1-16.
Mkubwa, B., Angwenyi, V., Nzioka, B., Newton, C. R., Sijbrandij, M., & Abubakar, A. (2024). Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review. International Journal of Mental Health Systems, 18(1). https://doi.org/10.1186/s13033-024-00644-8
Mora-Ríos, J., Bautista-Aguilar, N., Natera, G., & Pedersen, D. (2013). Adaptación cultural de instrumentos de medida sobre estigma y enfermedad mental en la Ciudad de México. Salud Mental, 36(1), 9-18.
Nearchou, F., O’Driscoll, C., McKeague, L., Heary, C., & Hennessy, E. (2021). Psychometric properties of the Peer Mental Health Stigmatization Scale-Revised in adolescents and young adults. Early Intervention in Psychiatry, 15(1), 201–205. https://doi.org/10.1111/eip.12933
Őri, D., Szocsics, P., Molnár, T., Bankovska Motlova, L., Kazakova, O., Mörkl, S., Wallies, M., Abdulhakim, M., Boivin, S., Bruna, K., Cabacos, C., Carbone, E. A., Dashi, E., Grech, G., Greguras, S., Ivanovic, I., Guevara, K., Kakar, S., Kotsis, K., Klinkby, I. M. I., Maslak, J., Matheiken, S., Mirkovic, A., Nechepurenko, N., Panayi, A., Pereira, A. T., Pomarol-Clotet, E., Raaj, S., Rus Prelog, P., Soler-Vidal, J., Strumila, R., Schuster, F., Kisand, H., Hargi, A., Ahmadova, G., Vircik, M., Yilmaz Kafali, H., Grinko, N., Győrffy, Z., & Rózsa, S. (2023). Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries – A bifactor ESEM representation. Frontiers in Public Health, 11, 1168929. https://doi.org/10.3389/fpubh.2023.1168929
Perry, B. L., Pescosolido, B. A., Martin, J. K., McLeod, J. D., & Jensen, P. S. (2007). Comparison of public attributions, attitudes, and stigma in regard to depression among children and adults. Psychiatric Services (Washington, D.C.), 58(5), 632–635. https://doi.org/10.1176/ps.2007.58.5.632
Pescosolido, B. A. (2007). Culture, children, and mental health treatment: special section on the national stigma study-children. Psychiatric Services (Washington, D.C.), 58(5), 611–612. https://doi.org/10.1176/ps.2007.58.5.611
Pescosolido, B. A., Fettes, D. L., Martin, J. K., Monahan, J., & McLeod, J. D. (2007). Perceived dangerousness of children with mental health problems and support for coerced treatment. Psychiatric Services (Washington, D.C.), 58(5), 619–625. https://doi.org/10.1176/ps.2007.58.5.619
Pescosolido, B. A., Jensen, P. S., Martin, J. K., Perry, B. L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and assessment of child mental health problems: findings from the National Stigma Study-Children. Journal of the American Academy of Child and Adolescent Psychiatry, 47(3), 339–349. https://doi.org/10.1097/CHI.0b013e318160e3a0
Pescosolido, B. A., Perry, B. L., Martin, J. K., McLeod, J. D., & Jensen, P. S. (2007). Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services (Washington, D.C.), 58(5), 613–618. https://doi.org/10.1176/ps.2007.58.5.613
Porfyri, G. N., Athanasiadou, M., Siokas, V., Giannoglou, S., Skarpari, S., Kikis, M., Myroforidou, A., Anoixa, M., Zerakis, N., Bonti, E., Konsta, A., Diakogiannis, I., Rudolf, J., & Deretzi, G. (2022). Mental health-related stigma discrimination and prejudices among Greek healthcare professionals. Frontiers in Psychiatry, 13, 1027304. https://doi.org/10.3389/fpsyt.2022.1027304
Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30, 183-211. https://doi.org/10.1007/s00787-019-01469-4
Sastre-Rus, M., García-Lorenzo, A., Lluch-Canut, M. T., Tomás-Sábado, J., & Zabaleta-Del-Olmo, E. (2019). Instruments to assess mental health-related stigma among health professionals and students in health sciences: A systematic psychometric review. Journal of Advanced Nursing, 75(9), 1838–1853. https://doi.org/10.1111/jan.13960
Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures. Methods of Psychological Research, 8(2), 23-74.
Shreffler, J., & Huecker, M. R. (2023). Diagnostic Testing Accuracy: Sensitivity, Specificity, Predictive Values and Likelihood Ratios. In: StatPearls. StatPearls Publishing.
Singh, S. P., & Winsper, C. (2017). Adolescent mental health: the public health response. In Cherry, A., Baltag, V., Dillon, M. (eds). International Handbook on Adolescent Health and Development (pp. 93–114). Springer. https://doi.org/10.1007/978-3-319-40743-2_6
Thornicroft, G. (2007). Most people with mental illness are not treated. The Lancet, 370(9590), 807–808. https://doi.org/10.1016/s0140-6736(07)61392-0
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123–1132. https://doi.org/10.1016/s0140-6736(15)00298-6
Thornicroft, G., Sunkel, C., Alikhon Aliev, A. A., Baker, S., Brohan, E., El Chammay, R., Davies, K., Demissie, M., Duncan, J., Fekadu, W., Gronholm, P. C., Guerrero, Z., Gurung, D., Habtamu, K., Hanlon, Ch., Heim, E., Henderson, C., Hijazi, Z., Hoffman, C., Hosny, N., Huang, F., Kline, S., Kohrt, B. A., Lempp, H., Li, J., London, E., Ma, N., Mak, W. W. S., Makhmud, A., Maulik, P. K., Milenova, M., Morales Cano, G., Ouali, U., Parry, S., Rangaswamy, T., Rüsch, N., Sabri, T., Sartorius, N., Schulze, M., Stuart, H., Taylor Salisbury, T., Vera San Juan, N., Votruba, N., & Winkler, P. (2022). The Lancet Commission on ending stigma and discrimination in mental health. The Lancet, 400(10361), 1438–1480. https://doi.org/10.1016/S0140-6736(22)01470-2
Vila-Badia, R., Martínez-Zambrano, F., Arenas, O., Casas-Anguera, E., García-Morales, E., Villellas, R., Martín, J. R., Pérez-Franco, M.B., Valduciel, T., Casellas, D., García-Franco, M., Miguel, J., Balsera, J., Pascual, G., Julia, E., & Ochoa, S. (2016). Effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. World Journal of Psychiatry, 6(2), 239-247. https://doi.org/10.5498/wjp.v6.i2.239
Villamil-Salcedo, V., Vargas-Terrez, B. E., & Díaz-Anzaldúa, A. (2017). Collaborative Care model in mental health. Scope and experiences after three years of activity in Mexico City. Primary Health Care Research & Development, 18(3), 227–234. https://doi.org/10.1017/S1463423617000032
Whitney, D. G., & Peterson, M. D. (2019). US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatrics, 173(4), 389–391. https://doi.org/10.1001/jamapediatrics.2018.5399
Williams, S. L., & Polaha, J. (2014). Rural parents’ perceived stigma of seeking mental health services for their children: Development and evaluation of a new instrument. Psychological Assessment, 26(3), 763-773. https://doi.org/10.1037/a0036571
World Health Organization [WHO]. (2002). Mental health global action programme (mhGAP): close the gap, dare to care.
World Health Organization [WHO]. (2006). WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development.
Zwaanswijk, M., Verhaak, P. F. M., van der Ende, J., Bensing, J. M., & Verhulstet, F. C. (2005). Consultation for and identification of child and adolescent psychological problems in Dutch general practice.Family Practice, 22(5), 498–506. https://doi.org/10.1093/fampra/cmi045
