Institutionalized elderly presents a higher risk of falling than those who are not. The issue of falls among elderly people should be considered as a serious public health problem because of its consequences and permanent costs. Objective: This study will intend to assess the risks and the determinative factors of falls among institutionalized elderly. Methods: A non-experimental, cross-sectional, descriptive- correlational and quantitative study. We used a non-probability convenience sampling composed of 136 elderly people who were institutionalized at the time. They were between 65 and 99 years old, with an 85,98 years old average age. To collect the data, we used a protocol formed by questions about these people’s socio-demographic, contextual and clinical characterization. We also used the Family Functionality Scale, the Self-care Dependency Evaluation Scale and the Tinetti Scale (POMA I). Results: Most of the people from our sample show a high risk of suffering from falls: we have concluded that about 45.6% of elderly people present a high risk of falling, 16.5 % a medium risk and 38.2% a low risk of suffering from this kind of accident. We also observed that the risk of falling was higher among elderly who showed the following characteristics: in females (p=0,014), in those who show a poor literacy (p=0,000), in those who exhibit any kind of cognitive impairment (p=0,014), in people who suffer from neurological and osteoarticular diseases (p=0,000) and in elderly who suffer from loss of visual and hearing acuity (p=0,010). By contrast, the elderly who experience a better autonomy as far as their walking capacity, personal hygiene and medication are concerned are those who show a lower risk of fall accidents. Conclusions: Falls in institutionalized elderly are becoming a serious problem in the elderly, requiring health professionals to effectively intervene in their prevention.

O Investimento na vida pessoal (IVP), remete-nos para a valorização e atribuição de objetivos de vida ao ser humano, em todos os seus atributos e fases de vida contribuindo positivamente para o envelhecimento ativo. Assim, o objetivo do estudo visa avaliar níveis e determinantes do Investimento na vida pessoal percecionado por um grupo de idosos institucionalizados. Trata-se de um estudo não experimental, transversal, descritivo-correlacional de caráter quantitativo, que foi realizado numa amostra de 270 pessoas idosas a residir em Instituições, na zona Centro e Norte de Portugal. Foi utilizada uma bateria de escalas que composta por: um protocolo de caraterização sócio demográfica, o índice de Barthel, a Escala de Apgar Familiar, e uma Escala de Avaliação de Investimento na Vida Pessoal (EAIVP). Os resultados mostraram que a perceção dos idosos sobre o investimento na sua vida pessoal se distribui de uma forma relativamente equitativa por três níveis. Assim 36,3% perceciona o seu investimento como elevado, 30,7% entende-o como moderado e 33,0% baixo. Os homens tendem a avaliar o IVP de uma forma mais positiva que as mulheres. A análise dos fatores determinantes revela que os idosos que sentem ter investido mais na vida pessoal são os que possuem maior escolaridade (p=0,047), que apresentam maior independência na realização das AVD (p=0,035) e que percecionam maior funcionalidade familiar (p=0,022). As evidências encontradas no estudo revelam que os níveis de investimento na vida pessoal percecionado pelos idosos são divergentes, oscilando maioritariamente entre o moderado e elevado. Níveis superiores de escolaridade, de capacidade funcional e funcionalidade familiar parecem estar associados ao IVP, variáveis estas que depois de devidamente identificadas devem ser trabalhadas no sentido de assegurar aos idosos um envelhecimento ativo e com qualidade.

Cognitive fusion refers to the dominance of verbal processes over behavior regulation, in detriment of being sensitive to contextual contingencies and pursuing valued life goals. It is a core process within Acceptance and Commitment Therapy and seems to have a crucial role in the development and maintenance of psychopathology. The first goal of this investigation was to explore the factor structure, factorial invariance and psychometrics of the Portuguese version of the Cognitive Fusion Questionnaire (CFQ). A multigroup confirmatory factor analysis attested the invariant one-dimensional factor structure of the CFQ across three samples from the general population (n = 408; n = 291; n = 101) with different demographic characteristics. Additionally, the CFQ showed to be a psychometrically robust and reliable measure. A second major goal was to investigate the convergent and incremental validity of this version of CFQ (n = 408). Convergent validity was explored and attested with several psychological indicators. Regarding incremental validity, the predictive power of depressive symptoms of cognitive fusion and three related processes, with origin in different conceptual frameworks, was tested. Results showed that even when the effects of decentering, mindfulness and metacognitions were controlled for, cognitive fusion consistently maintained a significant and unique predictive power over depressive symptoms. These findings suggest that these processes relate differentially and independently with depressive symptoms and, moreover, that cognitive fusion has a superior contribution to its explanation. Given the evidence that cognitive fusion plays an important role in the comprehension of depressive symptoms, conceptual and clinical implications were discussed.

Introduction: Palliative Care is demanding and humanized care that aims to maximize the quality of life and dignity of the Person. For the same purpose, rehabilitation nurses intervene in specialized care. Objective: Thus, it was intended to know the nurses' perception about the interventions of specialized nurses in rehabilitation nursing in Palliative Patients. Methods: Qualitative study, using content analysis. The sample consisted of 13 nurses, (12 female and 1 male). They were all licensed in nursing and exercised their professional activity in Palliative Care Units. For data collection, a semi-structured interview was used. Results: The participants present very positive perceptions about the specialized care of the rehabilitation nurses, considering them as facilitating agents in meeting the patient's needs. The most prominent interventions in the pursuit of the patient's well-being were mobilization, respiratory kinesitherapy, deglutition / dysphagia training, massage and preservation of autonomy and independence. Conclusion: Nurses 'perception of the intervention of the Rehabilitation Specialist Nurse in people hospitalized in PC units is positive, emphasizing the maintenance of the patients' functional capacities, prevention of complications and reduction of disabilities, however the visibility by peers is still insipid.

Background Epidemiologic evidence highlights the harmful consequences of unemployment on health and well-being. This emphasizes the need to design low-cost interventions to prevent the adverse mental health effects of unemployment. The main aim of this study was to create expert-consensus regarding development and implementation of a brief, sustainable, and effective intervention program for promoting mental health among unemployed. Methods The Delphi technique entailed a selected panel of 75 experts from various relevant professional backgrounds. Panel members were asked to state their level of agreement (5-point Likert scale) regarding (a) required characteristics for an effective mental health intervention for unemployed people and (b) key variables for assessing the effectiveness of that intervention. Consensus was obtained throughout two rounds of data collection through e-mail contact, with structured questionnaires. Items of the questionnaire were based on literature reviews about community-based interventions for unemployed individuals. Results Overall, 46 experts collaborated with the Delphi process (final participation rate: 61.3%). Based on a review of the literature, 185 items were identified and grouped into two broad categories (set of characteristics of the intervention and set of variables for effectiveness assessment), aggregating a total of 11 dimensions. The two Delphi rounds resulted in the selection of 35 characteristic items for the intervention program and 54 variables for its effectiveness assessment. Brief group interventions were considered to be effective and sustainable for mental health promotion in unemployment conditions if targeting mental health literacy, training interpersonal skills, and job-search skills. Conclusion As agreed by the panel of experts, a brief, sustainable and effective intervention can be developed and implemented by accounting for unemployed capacity-building for mental health self-care and adequate job-searching attitudes and skills. These results should be further implemented in community and multisector-based standardized interventions, targeting mental health among unemployed people, ensuring adequate conditions for its effectiveness assessment.

Non-suicidal self-injury (NSSI) is a serious and alarming phenomenon during adolescence. There is a need for understanding the intrapersonal variables that might contribute to the maintenance of these self-injurious behaviors.

Na literatura esta bem documentado o papel das experiencias adversas precoces na psicopatologia. Apesar de ser conhecido o papel mediador do auto-criticismo associado a psicopatologia na adultez, pouco ainda se sabe acerca do seu efeito na adolescencia. Alem disso, parece que desde a adolescencia o sexo feminino e mais vulneravel ao desenvolvimento da psicopatologia. O objetivo deste estudo foi testar se o impacto das experiencias negativas com os pais na sintomatologia depressiva e mediado atraves do auto-criticismo em sujeitos do sexo feminino durante a adolescencia e idade adulta. Este estudo inclui duas amostras: 50 raparigas adolescentes (12-17 anos de idade; M = 14.90, DP = 1.49) e 44 mulheres adultas da populacao geral (18-56 anos de idade; M = 30.95, DP = 10.01). Ambas as amostras preencheram questionarios de autorresposta que avaliavam a recordacao de experiencias de ameaca e subordinacao na infância, as formas do auto-criticismo e a sintomatologia depressiva. Os resultados do teste t-Student mostraram que as raparigas adolescentes apresentam pontuacoes mais elevadas nas formas eu inadequado e eu detestado do autocriticismo e nos sintomas de depressao do que as mulheres adultas. O modelo de mediacao atraves de Path Analysis indica que o modelo total explica 64% e 31% da sintomatologia depressiva para as raparigas adolescentes e para as mulheres adultas, respetivamente. A analise multigrupos evidencia que o modelo e equivalente para ambos os grupos. Verifica-se um efeito indireto das experiencias de submissao para a depressao atraves do eu-inadequado. Apesar de o modelo estrutural ser identico para ambas as amostras, verifica-se que a forca das associacoes e mais robusta na adolescencia. The role of early adverse experiences in psychopathology is well documented in literature. Previous research suggests a mediator role of selfcriticism and its link to psychopathology in adulthood. However, its effect in adolescence is unclear. Moreover, for girls, the transition into adolescence is a vulnerable period for the development of psychopathology. This study aims to test whether the impact of early negative experiences with parents in depressive symptoms occurs through self-criticism in female adolescents and adults. The current study includes two samples: 50 female adolescents and 44 women from general population. Female adolescents are aged between 12 and 17 years old (M = 14.90, SD = 1.49); and women are aged between 18 and 56 years old (M = 30.95, SD = 1.10). Both samples filled out self-report questionnaires that assess the recall of threat and submissiveness experiences in childhood, forms of self-criticism and depressive symptoms. Results from Student’s t-test showed that female adolescents have more levels of inadequate self, hated self, and depressive symptoms than female adults. The mediation model through Path Analysis showed that the full model accounted for 64% and 31% of depressive symptoms for female adolescents and adults, respectively. Multi-group analysis indicated the invariance of the structural model for both groups. There was an indirect effect of submissiveness experiences in depression through inadequate self. Although the structural model is equivalent for both samples, the strength of associations is more robust in adolescence. Palavras-chave / Keywords Adolescencia, Adultez, Auto-criticismo, Depressao, Experiencias precoces negativas. Adolescence, Adulthood, Depression, Early negative experiences, Self-criticism.

Introduction: Huntington’s disease (HD) is an inherited neurodegenerative disease which affects the movement and leads to the progressive cognitive deficits and behavioral capacities. Care for a Huntington patient is a complex process with a major impact on health, well-being and quality of life of Informal Caregivers (IC). Objective: To evaluate the impact of HD in the Quality of Life (QoL) Informal Caregiver, and to verify if the socio-demographic, contextual and clinical variables relate to that QoL. Methods: This is a quantitative study, descriptive and correlational with 50 IC members of the “Asociacion de Corea de Huntington Espanola”. We used the Spanish version of the questionnaire: Huntington’s Disease Quality of Life Battery for Carers (HDQoL-C) as the data collection instrument. Results: The participants are mostly female, averaging 50.04 years of age, married with a high level of literacy and active. The IC have a moderate QoL in which the caregiver role has great impact. However “the life satisfaction” and “feelings about life with HD” which appear to alleviate this burden. Data showed that the educational level and the number of hours of daily care influenced the QoL. Conclusions: The results reinforce the multidimensionality and variability of QoL of the Huntington’s patients IC and highlight the need for health professionals to take a chance on intervention programs in the community, in order to capacitate the IC to provide care and promote their QoL.

Previous studies have suggested that shame memories can have a pervasive impact on depression symptoms, and avoidant-focused processes may play a mediating role. In addition, it is stated in Acceptance and Commitment Therapy (ACT) literature that experiential avoidance is a consequence of cognitive fusion. This study aims to explore the role of cognitive fusion and experiential avoidance in the relationship between shame memories (with caregivers and traumatic shame memories with others) and depression symptoms. In order to do that, we used Structural Equation Modeling to conduct a path analysis in a sample of 181 subjects of the general population. Our results add new information on the processes through which shame memories impacts on both experiential avoidance and depression symptoms. It is suggested that shame memories are not itself pervasive, but the entanglement with painful internal experiences (cognitive fusion) and/or the attempts to control them (experiential avoidance). This suggests the importance of planning an intervention that targets these processes when dealing with shame memories, particularly in patients with depression symptoms.

Introducao: A Doenca de Huntington (DH) e uma patologia neuro degenerativa hereditaria que afeta o movimento e conduz a um defice progressivo das capacidades cognitivas e comportamentais. Cuidar um doente de Huntington e um processo complexo com impacto na saude, bem-estar e qualidade de vida do Cuidador Informal (CI). Objetivo: Avaliar o impacto da DH na Qualidade de Vida (QDV) do CI e verificar se as variaveis sociodemograficas, contextuais e clinicas se relacionam com essa QDV. Metodos: Trata-se de um estudo quantitativo, descritivo-correlacional com 50 CI, membros da “Asociacion de Corea de Huntington Espanola”. Utilizamos a versao espanhola do questionario: Huntington’s Disease Quality of Life Battery for Carers (HDQoL-C) como instrumento de colheita de dados. Resultados: Os participantes sao na sua maioria do sexo feminino, com uma media de idades de 50,04 anos, casados, com elevado grau de literacia e profissionalmente ativos. Os CI possuem uma QDV moderada na qual o papel de cuidador tem grande impacto. Contudo a “satisfacao com a vida” e os “sentimentos sobre a vida com DH” parecem atenuar esta sobrecarga. Os dados revelam que as habilitacoes literarias e o numero de horas de cuidados diarios influenciam a QDV. Conclusoes: Os resultados reforcam a multidimensionalidade e variabilidade da QDV e evidenciam a necessidade dos profissionais de saude apostarem em programas de intervencao na comunidade, de forma a capacitar os CI para a prestacao de cuidados e assim promover a sua QDV

BACKGROUND Shame experiences have been suggested to be related with psychopathological symptoms and with self-relevant beliefs. Recent studies also suggest that avoidant-focused strategies (e.g., rumination, thought suppression and dissociation) mediate the impact of shame memories and depression symptoms. However, experiential avoidance has been found to mediate the relation between early experience of abuse and psychopathological symptoms. Our goal was to test the mediating effect of experiential avoidance in the relation between both the nature of shame experiences at the hands of caregivers and the centrality of shame memories with others, and depression symptoms. METHOD Using structural equation modelling, we assessed the frequency and nature of recalled shame experiences at the hands of caregivers, the centrality of shame experiences with others throughout childhood and adolescence, experiential avoidance and depression symptomatology in 161 participants from general population. RESULTS Experiential avoidance mediates the impact of shame experiences with caregivers and depression symptoms. Experiential avoidance also mediated the association between the centrality of shame experiences with others and depression symptoms. CONCLUSION Our results suggest that shame memories with others do not per se impact on depression symptoms, but rather the unwillingness to experience them and the attempts to control them. Hence, our results emphasize the importance of addressing affect regulation processes such as avoidance when dealing with shame memories, particularly with patients who experience depression symptoms. KEY PRACTITIONER MESSAGE The recall of shame experiences with caregivers is associated with the experience of depression symptoms, even when these experiences are not perceived as central points to one's life identity and story. This seems to suggest a necessity to explore these experiences in a therapeutic setting. Our findings suggest that experiential avoidance is a key process through which these memories of shame experiences impact on depression symptomatology. Hence, it seems to be of great importance to reduce experiential avoidance and help people change the way they relate with these memories.

The aim of the following paper was to adapt and validate the Portuguese version of the Acceptance and Action Questionnaire- II (AAQ-II), which measures Psychological Flexibility/Inflexibility, central components in Acceptance and Commitment Therapy. We assessed the psychometric properties of this scale in both general population and clinical samples. Exploratory Factor Analysis supported a single-factor structure with seven items and results from a Confirmatory Factor Analysis showed the goodness of fit of the model. This version also demonstrated a good level of internal consistency and good convergent and discriminant validity. Overall, the results stressed out that this Portuguese version of AAQ-II is a consistent and valid scale.

O Questionário de Expressividade Familiar (Family Expressiveness Questionnaire – FEQ; Halberstadt, 1986) destina-se a avaliar o ambiente expressivo geral da família e inclui itens que estão relacionados com a expressividade não-verbal e o conteúdo da expressão emocional. O presente estudo examina as propriedades psicométricas da versão portuguesa numa ampla amostra da população geral. A validade de constructo foi examinada com recurso a procedimentos da Análise em Componentes Principais, cujos resultados suportaram uma estrutura de dois factores. Os resultados mostram que a escala possui uma boa consistência interna e estabilidade temporal. A validade de constructo foi estudada através da análise das correlações com medidas de psicopatologia (particularmente ansiedade, depressão e stress, e o afecto negativo e o afecto positivo), bem como medidas de contexto familiar (especificamente, ligação parental e experiências de cuidado e negligência parental). O QEF é um instrumento fiável e válido para medir a expressividade familiar na população portuguesa.