Validación de la Escala Razones Para Vivir en Consultantes a Salud Mental de la Región Metropolitana de Chile

Abstract

El estudio tuvo como objetivo la validación para Chile de la escala Razones para Vivir (RFL) en una muestra intencionada y consecutiva de 705 consultantes a salud mental en la Región Metropolitana. La RFL evalúa la importancia atribuida a las razones para vivir cuando se piensa en el suicidio. Se analizó la estructura factorial a través de análisis exploratorio y confirmatorio del instrumento original. Se estudió la consistencia interna, la validez de constructo y la validez concurrente y se definieron los parámetros de puntajes. El punto de corte sugerido para Chile es 4,1, lo que significa que bajo este puntaje hay una mayor probabilidad de riesgo suicida. La sensibilidad es del 62,1% y la especificidad, 66%, considerado aceptable, dada la alta incidencia de falsos negativos y positivos. El resultado de la evaluación advierte a los tratantes para indagar clínicamente el riesgo suicida detectado en el momento de aplicar el instrumento. Además, para el tratamiento de pacientes con depresión y riesgo suicida, destaca el potencial adaptativo y terapéutico de las razones para mantenerse con vida cuando se está contemplando el suicidio. Palabras clave: suicidio, validación, riesgo, factores de protecciónThe aim of the study was to validate the Reasons for Living (RFL) Inventory in Chile, using a purposive and consecutive sample of 705 mental health patients in the Metropolitan Region. The RFL scale assesses the importance ascribed to reasons for living when contemplating suicide. The factorial structure of the scale was analyzed through exploratory and confirmatory analysis of the original instrument. Internal consistency, construct validity, and concurrent validity were studied and score parameters were defined. The suggested cut-off point for Chile is 4.1, which means that lower scores indicate a higher probability of suicide risk. Sensitivity was estimated at 62.1% and specificity at 66%, which is considered to be acceptable, given the high incidence of false negatives and positives. The

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

“…Secondly, with respect to past mental health interventions the participants experienced, they shared that the few programs they had been offered tended to be vertical and adult-centric, thereby confirming the findings of the reviewed literature, which discussed the dominant prevalence of the adult- and risk-centered paradigms of adolescence ( 17 – 19 , 47 ). The participants stated that the interventions they had previously seen did not comply with the criteria they considered essential for the acceptability and relevance of an intervention model ( 48 , 49 ), and they also viewed traditional mental health services as distant, stigmatizing, and ineffective, reflective of the documented treatment gap between adolescents and clinical services ( 7 , 14 ). Our results show that the adolescents wanted to ensure the creation of an intervention which respected and understood their point of view, which could be seamlessly inserted into their daily lives and which nurtured the establishment of horizontal, rather than vertical, caring relationships, with peers and professionals, thus reducing access barriers.…”

“…These strategies are in line with the literature that demonstrates the importance of peer groups and social support for adolescent well-being, which is a protective factor for mental health problems and to prevent bullying, for instance ( 40 , 58 , 59 ). Lastly, they viewed the psychologists—the so called “Clan Councilmembers”-–who would be available to give users individual and group orientation and support through the platform, as a positive contribution, which would serve to reduce treatment access barriers in Chile ( 7 , 14 ).…”

“…Unfortunately, the real impact of these well-intentioned initiatives has been modest, and suicide rates have stabilized in recent years ( 9 ). In part, this stagnation could be due to the fact that few interventions have been implemented and evaluated in educational establishments, the frontline settings where suicide prevention programs are most needed, given the aforementioned treatment gap associated with adolescents' access to formal health services ( 7 , 14 ), as well as their lack of satisfaction with the quality of these services ( 15 ). School-based interventions, meanwhile, have been shown to be appealing to students, teachers, and parents, and they significantly impact academic and psychosocial outcomes long term ( 16 ).…”

Desarrollo y evidencia de validez de una escala multidimensional de riesgo de suicidio y factores protectores en un contexto chileno

“…Escala de suicidalidad de Okasha(Okasha et al, 1981); y Escala sad persons(Patterson et al, 1983), todos ellos se encuentran desactualizados y se limitan a identificar factores de riesgo, restando otras perspectivas relevante en la comprensión del fenómeno. En este escenario, parece relevante ampliar a una valoración multifactorial del fenómeno, lo que implica disponer de instrumentos multidimensionales, de alcance masivo, accesibles, de bajo costo y que cumplan los requisitos éticos mínimos para sustentar sus conclusiones y decisiones, derivados del proceso de medición (AERA, APA y NCME, 1999, 2014), de modo de reforzar el desarrollo de evaluaciones o diagnósticos.Si bien, existen múltiples instrumentos de medida que evalúan la ideación suicida (e.gAlarcón-Vasquez et al, 2019;Beck et al, 1988; Fonseca-Pedrero y Albeniz, 2020;Okasha et al, 1981;Paykel et al, 1974), incluyendo algunas propuestas que incorporan factores protectores(Echávarri et al, 2018; Linehan et al., 1983; Ponce-Garcia et al, 2015;Stanley et al, 2017), los instrumentos localizados, que incluyen factores protectores, presentan algunas limitaciones para el contexto nacional: (1) la mayoría de los cuestionarios han sido desarrollados en idiomas extranjeros, lo cual puede presentar sesgos culturales que no son subsanables desde los procesos de traducción(Krach et al, 2016); y (2) ninguno de ellos cuenta con evidencias de validez para su uso en población chilena. Por tanto, el presente estudio G. Sepúlveda-Páez, J. Escudero-Pastén, J. F. Santibáñez-Palma y R. Ferrer-Urbina Terapia Psicológica, vol.…”