Browsing by Author "Errázuriz Concha, Antonia"

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    Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times-Children and Adolescents (COH-FIT-C&A)
    (2022) Solmi, Marco; Estrade, Andres; Thompson, Trevor; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schloegelhofer, Monika; Akimova, Elena; Schneeberger, Andres; Huber, Christian G.; Hasler, Gregor; Conus, Philippe; Do Cuenod, Kim Q.; von Kanel, Roland; Arrondo, Gonzalo; Fusar Poli, Paolo; Gorwood, Philip; Llorca, Pierre Michel; Krebs, Marie Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna Zydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kaminski, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Mankova, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer Lindenberg, Andreas; Kahl, Kai G.; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pal; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P.; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R.; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana, V; Valvassori, Samira S.; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu Bernabeu, Alvaro; Caceres, Antonia San Jose; Arango, Celso; Diaz Caneja, Covadonga M.; Hidalgo Mazzei, Diego; Vieta, Eduard; Gonzalez Penas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A.; Verdolini, Norma; Farkova, Eva; Janku, Karolina; Millan, Mark; Honciuc, Mihaela; Moniuszko Malinowska, Anna; Loniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Lukasz; Marlicz, Maria; Sowa, Pawel; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Machado, Ana Ines; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H.; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching Fang; Guu, Ta Wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winke, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi Bahmani, Dena; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errázuriz Concha, Antonia; Crossley Karmelic, Nicolás Andrés; Ristic, Dragana Ignjatovic; Lopez Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F.; Daskalakis, Jeff; Yatham, Lakshmi N.; Yang, Lin; Okasha, Tarek; Dahdouh, Aicha; Gerdle, Bjorn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Abu Jamei, Yasser; Weiser, Mark; Correll, Christoph U.
    Background: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www. coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via nonprobability/snowball and representative sampling and assessed via self-rating and parental rating. Nonmodifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. Results: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COHFIT project, with representative samples from eleven countries. Limitations: Cross-sectional and anonymous design. Conclusions: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.
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    Prevalence of anxiety disorders in Latin America: a systematic review and meta-analysis
    (Elsevier Ltd., 2025) Errázuriz Concha, Antonia; Avello Vega, Dalia de los Ángeles; Passi, Álvaro; Torres Barrenechea, Rafael; Bacigalupo Izquierdo, Félix; Crossley, Nicolás; Undurraga Fourcade, Eduardo Andrés; Jones, Peter B.
    Background The prevalence of anxiety disorders among the adult population in Latin America (LATAM) and its association with development indicators is insufficiently characterised. We estimated pooled regional, country, and sex-specific prevalence rates of anxiety disorders in LATAM based on International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Additionally, we examined the association between its prevalence and four country-level development indicators: Human Development Index (HDI), income inequality (Gini coefficient), Gender Inequality Index (GII), and Intentional Homicide Rate (IHR). Methods We conducted a systematic review and meta-analysis of population-based studies on the prevalence of ICD/ DSM anxiety disorders in LATAM from 1990 to 2024, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO, LILACS, and grey literature. Study quality was assessed using JBI's critical appraisal tools. Pooled estimates were generated using random-effects meta-analysis, and heterogeneity was evaluated using the I-squared (I2) statistic. Meta-regression analyses were performed to examine the ecological association between anxiety disorders prevalence and four development indicators. The study was registered with PROSPERO (CRD42020190238). Findings Using data from 36 studies in LATAM, we calculated the lifetime, 12-month, and current prevalence of ICD/ DSM anxiety disorders at 14.55% (95% Confidence Interval 12.32%-17.11%; I2 = 97.9%); 6.61% (5.20-8.37; I2 = 98.1%), and 3.27% (2.34-4.56; I2 = 97.5%), respectively. Heterogeneity was high across prevalence periods, sexes, and countries (all I2 >= 91.4%), warranting caution in interpreting pooled estimates. Elevated 12-month and current prevalence rates of anxiety disorders were associated with higher Gini coefficients (p <= 0.0013). Additionally, higher current prevalence was associated with lower HDI (p = 0.0103) and higher GII (p = 0.0023), while elevated 12-month prevalence was associated with higher IHR (p = 0.011). Interpretation This study shows that approximately one in seven people in LATAM experience anxiety disorders at some point in their lives. These findings highlight the need to strengthen mental health systems in the region, and evidence the association between prevalence of anxiety disorders and development indicators. Our results can serve as a baseline for tracking anxiety disorders and for informed decision-making at the national and regional levels. The substantial heterogeneity between studies and the underrepresentation of some countries underscore the imperative for enhancing regional mental health capacities.
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    Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis
    (Elsevier Ltd, 2023) Errázuriz Concha, Antonia; Avello-Vega, Dalia; Ramírez Mahaluf, Juan P.; Torres Barrenechea, Rafael; Crossley Karmelic, Nicolas Andrés; Undurraga Fourcade, Eduardo Andrés; Jones, Peter B.; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile
    © 2023 The Author(s)Background: Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR). Methods: We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054). Findings: Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%–14.16%); 5.30% (4.55–6.06%), and 3.12% (2.22–4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR. Interpretation: We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region. Funding: Pfizer Independent Medical Education Grant.
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    The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic
    (2022) Solmi, Marco; Estrade, Andrés; Thompson, Trevor; Agorastos, Agorastos; Radua, Joaquim; Cortese, Samuele; Dragioti, Elena; Leisch, Friedrich; Vancampfort, Davy; Thygesen, Lau Caspar; Aschauer, Harald; Schloegelhofer, Monika; Akimova, Elena; Schneeberger, Andres; Huber, Christian G.; Hasler, Gregor; Conus, Philippe; Do Cuenod, Kim Q.; von Kanel, Roland; Arrondo, Gonzalo; Fusar Poli, Paolo; Gorwood, Philip; Llorca, Pierre Michel; Krebs, Marie Odile; Scanferla, Elisabetta; Kishimoto, Taishiro; Rabbani, Golam; Skonieczna Zydecka, Karolina; Brambilla, Paolo; Favaro, Angela; Takamiya, Akihiro; Zoccante, Leonardo; Colizzi, Marco; Bourgin, Julie; Kaminski, Karol; Moghadasin, Maryam; Seedat, Soraya; Matthews, Evan; Wells, John; Vassilopoulou, Emilia; Gadelha, Ary; Su, Kuan Pin; Kwon, Jun Soo; Kim, Minah; Lee, Tae Young; Papsuev, Oleg; Mankova, Denisa; Boscutti, Andrea; Gerunda, Cristiano; Saccon, Diego; Righi, Elena; Monaco, Francesco; Croatto, Giovanni; Cereda, Guido; Demurtas, Jacopo; Brondino, Natascia; Veronese, Nicola; Enrico, Paolo; Politi, Pierluigi; Ciappolino, Valentina; Pfennig, Andrea; Bechdolf, Andreas; Meyer Lindenberg, Andreas; Kahl, Kai G.; Domschke, Katharina; Bauer, Michael; Koutsouleris, Nikolaos; Winter, Sibylle; Borgwardt, Stefan; Bitter, Istvan; Balazs, Judit; Czobor, Pal; Unoka, Zsolt; Mavridis, Dimitris; Tsamakis, Konstantinos; Bozikas, Vasilios P.; Tunvirachaisakul, Chavit; Maes, Michael; Rungnirundorn, Teerayuth; Supasitthumrong, Thitiporn; Haque, Ariful; Brunoni, Andre R.; Costardi, Carlos Gustavo; Schuch, Felipe Barreto; Polanczyk, Guilherme; Luiz, Jhoanne Merlyn; Fonseca, Lais; Aparicio, Luana, V; Valvassori, Samira S.; Nordentoft, Merete; Vendsborg, Per; Hoffmann, Sofie Have; Sehli, Jihed; Sartorius, Norman; Heuss, Sabina; Guinart, Daniel; Hamilton, Jane; Kane, John; Rubio, Jose; Sand, Michael; Koyanagi, Ai; Solanes, Aleix; Andreu Bernabeu, Alvaro; San Jose Caceres, Antonia; Arango, Celso; Diaz Caneja, Covadonga M.; Hidalgo Mazzei, Diego; Vieta, Eduard; Gonzalez Penas, Javier; Fortea, Lydia; Parellada, Mara; Fullana, Miquel A.; Verdolini, Norma; Farkova, Eva; Janku, Karolina; Millan, Mark; Honciuc, Mihaela; Moniuszko Malinowska, Anna; Loniewski, Igor; Samochowiec, Jerzy; Kiszkiel, Lukasz; Marlicz, Maria; Sowa, Pawel; Marlicz, Wojciech; Spies, Georgina; Stubbs, Brendon; Firth, Joseph; Sullivan, Sarah; Darcin, Asli Enez; Aksu, Hatice; Dilbaz, Nesrin; Noyan, Onur; Kitazawa, Momoko; Kurokawa, Shunya; Tazawa, Yuki; Anselmi, Alejandro; Cracco, Cecilia; Ines Machado, Ana; Estrade, Natalia; De Leo, Diego; Curtis, Jackie; Berk, Michael; Ward, Philip; Teasdale, Scott; Rosenbaum, Simon; Marx, Wolfgang; Horodnic, Adrian Vasile; Oprea, Liviu; Alexinschi, Ovidiu; Ifteni, Petru; Turliuc, Serban; Ciuhodaru, Tudor; Bolos, Alexandra; Matei, Valentin; Nieman, Dorien H.; Sommer, Iris; van Os, Jim; van Amelsvoort, Therese; Sun, Ching Fang; Guu, Ta wei; Jiao, Can; Zhang, Jieting; Fan, Jialin; Zou, Liye; Yu, Xin; Chi, Xinli; de Timary, Philippe; van Winke, Ruud; Ng, Bernardo; Pena, Edilberto; Arellano, Ramon; Roman, Raquel; Sanchez, Thelma; Movina, Larisa; Morgado, Pedro; Brissos, Sofia; Aizberg, Oleg; Mosina, Anna; Krinitski, Damir; Mugisha, James; Sadeghi Bahmani, Dena; Sadeghi, Masoud; Hadi, Samira; Brand, Serge; Errázuriz Concha, Antonia; Crossley Karmelic, Nicolás Andrés; Ristic, Dragana Ignjatovic; Lopez Jaramillo, Carlos; Efthymiou, Dimitris; Kuttichira, Praveenlal; Kallivayalil, Roy Abraham; Javed, Afzal; Afridi, Muhammad Iqbal; James, Bawo; Seb Akahomen, Omonefe Joy; Fiedorowicz, Jess; Carvalho, Andre F.; Daskalakis, Jeff; Yatham, Lakshmi N.; Yang, Lin; Okasha, Tarek; Dahdouh, Aicha; Gerdle, Bjorn; Tiihonen, Jari; Shin, Jae Il; Lee, Jinhee; Mhalla, Ahmed; Gaha, Lotfi; Brahim, Takoua; Altynbekov, Kuanysh; Negay, Nikolay; Nurmagambetova, Saltanat; Abu Jamei, Yasser; Weiser, Mark; Correll, Christoph U.
    Background: . High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed.
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    Validation of the Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) questionnaire for adults
    (2023) Solmi M.; Fiedorowicz J.; Dragioti E.; Estrade A.; Radua J.; Fusar-Poli P.; Winter S.; Correll C.U.; Thompson T.; Anselmi A.; Cracco C.; Machado A.I.; Estrade N.; Agorastos A.; Bozikas V.P.; Solanes A.; Fortea L.; Fullana M.A.; Tiihonen J.; Cortese S.; Arrondo G.; Gerdle B.; Leisch F.; Vancampfort D.; Thygesen L.C.; Hoffmann S.H.; Aschauer H.; Schlogelhofer M.; Aschauer E.; Schneeberger A.; Huber C.G.; Hasler G.; Sehli J.; Conus P.; Do Cuenod K.Q.; von Kanel R.; Brondino N.; Politi P.; Gorwood P.; Scanferla E.; Krebs M.-O.; Llorca P.-M.; Honciuc M.; Kishimoto T.; Takamiya A.; Kitazawa M.; Kurokawa S.; Tazawa Y.; Rabbani G.; Haque A.; Skonieczna-Zydecka K.; Loniewski I.; Marlicz M.; Brambilla P.; Boscutti A.; Cereda G.; Enrico P.; Ciappolino V.; Favaro A.; Gerunda C.; Zoccante L.; Colizzi M.; Bourgin J.; Kaminski K.; Sowa P.; Moghadasin M.; Seedat S.; Spies G.; Matthews E.; Wells J.; Vassilopoulou E.; Efthymiou D.; Gadelha A.; Costardi C.G.; Fonseca L.; Su K.-P.; Kwon J.S.; Kim M.; Lee T.Y.; Papsuev O.; Movina L.; Mankova D.; Andrlikova E.; Janku K.; Saccon D.; Righi E.; Monaco F.; Croatto G.; Demurtas J.; Veronese N.; Pfennig A.; Bauer M.; Bechdolf A.; Meyer-Lindenberg A.; Kahl K.G.; Domschke K.; Koutsouleris N.; Borgwardt S.; Bitter I.; Czobor P.; Unoka Z.; Balazs J.; Mavridis D.; Tsamakis K.; Tunvirachaisakul C.; Maes M.; Rungnirundorn T.; Supasitthumrong T.; Brunoni A.R.; Polanczyk G.; Aparicio L.V.; Schuch F.B.; Luiz J.M.; Valvassori S.S.; Nordentoft M.; Vendsborg P.; Sartorius N.; Heuss S.; Guinart D.; Kane J.; Rubio J.; Hamilton J.; Sand M.; Koyanagi A.; Andreu-Bernabeu A.; Caceres A.S.J.; Arango C.; Diaz-Caneja C.M.; Gonzalez-Penas J.; Parellada M.; Hidalgo-Mazzei D.; Vieta E.; Verdolini N.; Millan M.J.; Moniuszko-Malinowska A.; Samochowiec J.; Kiszkiel L.; Marlicz W.; Stubbs B.; Firth J.; Sullivan S.; Darcin A.E.; Aksu H.; Dilbaz N.; Noyan O.; De Leo D.; Curtis J.; Berk M.; Teasdale S.; Marx W.; Carvalho A.F.; Ward P.; Rosenbaum S.; Horodnic A.V.; Oprea L.; Turliuc S.; Bolos A.; Alexinschi O.; Ifteni P.; Ciuhodaru T.; Matei V.; Nieman D.H.; Sommer I.; van Os J.; van Amelsvoort T.; Sun C.-F.; Guu T.-W.; Jiao C.; Zhang J.; Fan J.; Zou L.; Chi X.; Yu X.; de Timary P.; van Winkel R.; Ng B.; Pena E.; Arellano R.; Roman R.; Sanchez T.; Morgado P.; Brissos S.; Aizberg O.; Mosina A.; Krinitski D.; Mugisha J.; Sadeghi-Bahmani D.; Brand S.; Sheybani F.; Sadeghi M.; Hadi S.; Errázuriz Concha, Antonia; Crossley Karmelic, Nicolás Andrés; Ristic D.I.; Lopez-Jaramillo C.; Kuttichira P.; Kallivayalil R.A.; Javed A.; Afridi M.I.; James B.; Seb-Akahomen O.J.; Daskalakis J.; Yatham L.N.; Yang L.; Okasha T.; Dahdouh A.; Shin J.I.; Lee J.; Mhalla A.; Gaha L.; Brahim T.; Altynbekov K.; Negay N.; Nurmagambetova S.; Jamei Y.A.; Weiser M.
    The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology “P-score”. Methods: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1–4 items (“COH-FIT items”) were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ? 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed. Results: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (? = 0.95). Factor structure was consistent across age and sex. Conclusions: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health.