PÉREZ EWERT, JANET CAROLA
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PÉREZ EWERT, JANET CAROLA
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janetperez@udd.cl
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57211037751

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“How it is said”: Analyses of WhatsApp communications in a postpartum depression preventive intervention

2024 , Olga Fernández , PÉREZ EWERT, JANET CAROLA , Nicolle Alamo , Sofia Fernandez , Pamela Franco , COO CALCAGNI, SOLEDAD , M Ignacia García , Marcela Aravena

Introduction: “m-What Were We Thinking” (m-WWWT) is an m-health, intervention oriented to prevent symptoms of postpartum depression and anxiety in first-time mothers. Mothers receive psychoeducation and socioemotional support through written communication via text-messaging (i.e., WhatsApp) with the program counsellor. Although the use of m-health interventions targeting mental health has increased, the form/style of communication through text messages between participants and program counsellors has been understudied. Objective: The aim was to describe the formal structure of the communication (Basic Forms) and the communicational intentions (Communicative Intentions) used in the messages sent by the counsellor and to determine if these are related to the post-intervention outcomes. Methods: 438 text messages sent by the counsellor to 53 first-time mothers (M = 25.32 years, SD = 4.23) who participated in the m-WWWT intervention were analyzed. The Therapeutic Activity Coding System was used to capture the communication as a “Communicative Action”. Results: The study highlighted the counsellor's frequent use of the “assertion” communicative form (82%) and attuned communicative intentions (52%) and explored (39%) in her messages. The attractors of communication were “assert to attune” and “assert to explore”, indicating an empathetic and informative communication style. With respect to their relationship with the intervention outcome, only “assert to explore” messages were positively related to maternal self-efficacy increases. The number of messages was not associated with participants’ characteristics at baseline, except for educational level. Discussion: Our results show the relevance of combining the delivery of information with a communication style that allows the counsellor to connect with the specific needs and emotional tone of the participants.

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Online Intervention Targeting Postnatal Depression and Anxiety in Chilean First-Time Mothers: Feasibility Trial

2023 , COO CALCAGNI, SOLEDAD , María Ignacia García , PÉREZ EWERT, JANET CAROLA , Marcia Olhaberry , ALDONEY RAMIREZ, DANIELA , Olga Fernández , Nicolle Alamo , Pamela Franco , Sofía Fernández , Francisca Pérez , Jane Fisher , Heather Rowe

Abstract Objective Internet-based interventions may positively impact maternal symptoms of postnatal depression and anxiety. This study assessed the feasibility, acceptability, perceived usefulness, and preliminary effectiveness of an m-Health version of “What Were We Thinking?” (m-WWWT). Methods A mixed-methods with a 2-arm randomized parallel design was used. From a total of 477 women, 157 met the inclusion criteria. 128 first-time mothers of full-term infants, aged 4–10 weeks, who received health care at primary public health centers in Chile, were randomly assigned to the experimental (EG, n = 65) or control (CG, n = 63) groups; data of 104 of them (53 and 51, respectively) was analyzed. We used percentages and rates to measure feasibility outcomes and mixed analysis of variance (ANOVA) and latent class analyses (LCA) to assess preliminary effectiveness. Participants completed questionnaires on mental health, social support, and maternal self-efficacy upon recruitment and 3 months after completing the intervention. For the qualitative component, 12 women from the EG were interviewed. Results Quantitative results show good feasibility outcomes, such as high recruitment (82%), low attrition (EG = 12% and CG = 17%), and high follow-up (EG = 97% and CG = 91%) rates. Qualitative results indicate high acceptability and perceived usefulness of m-WWWT. Mixed ANOVA did not show significant differences between the groups (all p >.05). However, multinomial regression analysis in LCA showed that women with low baseline symptoms of depression and anxiety benefit from the intervention (B = 0.43, 95% confidence interval 1.09–2.16). Conclusion m-WWWT is feasible to be implemented in Chile; future studies are needed to assess the intervention’s effectiveness.

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Understanding the use/non-use of an internet-based intervention complementing standard depression treatment: A qualitative study of user's experiences

2023 , Olga Fernández , PÉREZ EWERT, JANET CAROLA , Sofía Fernández , Mariane Krause , Cristián Cáceres , Daniel Espinosa-Duque

Introduction There is sufficient evidence about the effectiveness of internet-based interventions; however, the users’ level of adoption and utilization remains low, with this phenomenon requiring adequate explanation. Objective The aim of this qualitative study was to explore the users’ perceptions and experience of a web-based program (ASCENSO), designed to complement (usual) in-person depression treatment. Method Twelve participants of the ASCENSO program, comprised of adult individuals ( M = 44.3, SD = 13.4) of both genders (67% women) undergoing treatment for depression, were interviewed through semi-structured interviews. The data obtained from these interviews were analyzed utilizing a constructivist grounded theory approach. The interviews were transcribed and analyzed by trained coders. A constant comparative analysis of emergent themes was conducted. Results These show that users employ and appreciate the program when their interaction with it emulates a “humanized relationship,” that is, when the program is proactive in assisting users with their requests and when it responds in a pertinent and individualized manner to their emotional states and needs. Conclusions Our findings highlight the challenges associated with the development of algorithms capable of attracting different potential users. These should be designed to generate a virtual relationship that emulates human interaction and targets the characteristics of each user, for example, considering the specific phenomenology of their health condition, their present emotional states, and perceived needs. Elements that will vary as mental symptomatology evolve.

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Corrigendum: Parental psychological control: Maternal, adolescent, and contextual predictors

2022 , PÉREZ EWERT, JANET CAROLA , Paula Huerta , Bernardita Rubio , Olga Fernández

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Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial

2022 , PÉREZ EWERT, JANET CAROLA , ALDONEY RAMIREZ, DANIELA , Marcia Olhaberry , Olga Fernández , María I García , Nicolle Alamo , Pamela Franco , Francisca Perez , Jane Fisher , Heather Rowe , COO CALCAGNI, SOLEDAD

Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

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Episodios de Cambio y Estancamiento en Psicoterapia: Características de la comunicación verbal entre pacientes y terapeutas

2012 , Olga Fernández , Pablo Herrera , Mariane Krause , PÉREZ EWERT, JANET CAROLA , Nelson Valdés , Oriana Vilches , Alemka Tomicic

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An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial

2021 , PÉREZ EWERT, JANET CAROLA , Olga Fernández , Cristián Cáceres , Álvaro E Carrasco , Markus Moessner , Stephanie Bauer , Daniel Espinosa-Duque , Sergio Gloger , Mariane Krause

Background Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider–assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center’s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). Conclusions The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients’ limited use of the online platform. Trial Registration ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467

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Importancia de los Cambios Iniciales en la Psicoterapia con Adolescentes

2015 , Olga Fernández , PÉREZ EWERT, JANET CAROLA , Sergio Gloger , Mariane Krause

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Parental Psychological Control: Maternal, Adolescent, and Contextual Predictors

2021 , PÉREZ EWERT, JANET CAROLA , Paula Huerta , Bernardita Rubio , Olga Fernández

Parental psychological control (PC) hinders the development of autonomy, identity formation, and the attainment of self-determination and individuation of adolescents. The aim of this study was to deepen the understanding of which conditions increase the risk of the use of maternal PC by simultaneously considering the contribution of adolescent temperament, maternal separation anxiety, and adolescents’ perception of interparental conflict. A correlational study involving a sample of 106 Chilean adolescent-mother dyads was done. Adolescents were, on average, 15.42 years old (SD = 1.09) and 77% male. Mothers were, on average, 45.46 years old (SD = 6.39). We administered self-report questionnaires to the adolescent measuring effortful control and frustration as temperamental dimensions, along with the perception of interparental conflict. Mothers reported on their separation anxiety. Both the adolescents and their mothers reported on the use of maternal PC. Adolescents reported higher levels of maternal PC than their mothers did. All predictors were associated with PC reports. Higher levels of maternal anxiety about adolescent distancing, inter-parental conflict, and adolescent frustration were associated with higher reported levels of PC. In contrast, higher levels of adolescent effortful control were associated with lower levels of maternal PC. Finally, when maternal separation anxiety and inter-parental conflict were high there was a higher use of maternal PC. The present findings inform on how adolescent’s self-regulatory skills could reduce the risk of being exposed to maternal PC. And highlight the importance of using a systemic and interactional conceptualization when trying to understand their use.

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