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Medical students encounter specific stressors that can lead to higher levels of psychological distress compared to their similar aged counterparts who study other subjects. The Medical Student Stressor Questionnaire (MSSQ) was developed to specifically identify stressors among medical students as well as measure the intensity of stress caused by the stressors. However, no Italian version has been validated to date. The aim of this study was to develop an Italian version of the MSSQ (MSSQ-I) and to assess its psychometric properties. The MSSQ has been translated and culturally validated into Italian. All medical students from the University of Brescia were asked to participate in a web-survey in which they were asked to complete the MSSQ-I. For the analysis of the stability over time, participating students were asked to complete again the MSSQ-I after about one month. Among 1754 medical students, 964 completed the MSSQ-I for the validation analyses. A first Confirmatory Factor Analysis and a subsequent Explanatory Factor Analysis outlined a slightly modified factor structure of the scale with five factors instead of six as in the original scale. The internal consistency on the overall scale was high (α = 0.94), as well as the internal consistency of each of the new factors: (α > 0.83 for the first four factors and α = 0.67 for the fifth). External validity analysis confirmed moderate/high concurrent validity. These results suggest that the MSSQ-I can be used as a tool to identify stressors among Italian medical students, although further research is needed to confirm its individual test-retest reliability.

This study assessed the effect of a question prompt sheet (QPS) on the oncologist-patient relationship as compared with a question listing (QL). In particular, the differences in difficulties perceived by the oncologist during the consultation and in the patient’s experience of the therapeutic aspects of the relationship were assessed. A total of 324 patients with a recent diagnosis of early stage breast cancer were involved in the study. The results showed that 15.7% of patients were perceived as ‘difficult’ by the oncologists. The proportion of ‘difficult’ patients varied in the two groups: 20.6% in the QPS group versus 11.8% in the QL group. The results also showed that the higher the difficulty perceived by oncologists, the lower the satisfaction of patients for their relationship with the oncologists during the consultation (r = − .135, p = .033). It is likely that the higher level of difficulty perceived by the oncologist in the QPS group may be connected with the pre-prepared list of evidence-based questions. Further research is needed to understand which components of the interventions, relating to the patient, the oncologist or their interaction, really promote patient participation in cancer setting. Trial registration: ClinicalTrials.gov NCT01510964. https://clinicaltrials.gov/ct2/show/NCT01510964 .

The objectives of this study are to identify all studies for stress-management carried out in medical students, in order to analyze their impact on psychological distress and on academic performance, and to assess how these interventions are incorporated into the medical education curriculum. For this purpose, a systematic narrative review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search was performed in PubMed, Embase, and PsycInfo, using the following keywords: “stress” AND (“intervention” OR “treatment”) AND (“college” OR “university”) AND “medical” AND “student.” The quality of study was assessed using the Cochrane quality assessment tool and the Methodological Index for Nonrandomized Studies. Seventeen studies were included in the review: 3 randomized controlled trials and 14 non-randomized. The results have identified different stress-management interventions, mainly focused on mindfulness programs. Most studies were also carried out on the pre-clinical students in the first 2 years. Results showed that students who attended stress-management interventions had a decrease in their stress level; conversely, the data concerning the decrease in depression scores were contrasting. Findings suggest that stress-management programs may be helpful for medical students, but further studies are needed to assess a broader range of outcomes, including the correlation of stress-reduction with academic and health conditions. Prospective Registering of Systematic Reviews (PROSPERO). Identifier: CRD42019130789.

Aims: The aims of the present study were to assess: the effectiveness of psychoeducation in mental health service (MHSs) in terms of time to first hospitalization during 4-year follow-up; the number and the days of hospitalizations, and the number of people hospitalized at 4-year follow-up; and variables associated with better outcome in BD patients. Methods: This is a controlled study involving an experimental group (N = 57) and a control group (N = 52). The treatment phase consists of 21 weeks, in which all participants received TAU, while the experimental group received additional psychoeducation. Results: The survival analysis showed significant differences in terms of time to first hospitalization of up to 4-year follow-up: the patients in the psychoeducation group showed a longer time free from hospitalizations than the control group. Concerning the predictors of time to first hospitalization, the only factor that showed a trend to statistical significance was psychoeducation. Conclusions: This is one of few studies assessing the long-term effectiveness of psychoeducation in a naturalistic setting. The data confirm that psychoeducation can impact illness course, in terms of longer time free from hospitalizations. Trial registration: ISRCTN17827459.

Objective (1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression. Methods 308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists’ interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists’ evaluations of the patient were collected after. Results Breast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist’s attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist’s ability to pick up on patient’s worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions. Conclusion Both contextual and interactional aspects have an impact on patient emotional expressions. Practice implications Oncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account.

ObjectivesTo investigate, prior to an oncology consultation, the use of a pre-prepared list of evidence based questions, Question Prompt Sheet (QPS), compared with a Question List (QL), a patient self-generated list of questions.DesignMulti-centred, randomised controlled trial.SettingSecondary-care patients attending three outpatient oncology clinics in Northern Italy.Participants308 women completed the study. Inclusion criteria were an age between 18 and 75 years, a recent diagnosis of early stage, non-metastatic breast cancer, adequate Italian language skills, no previous oncology visits and no evidence of cognitive impairment.InterventionPatients received the QPS or the QL prior to the consultation, completed it without suggestion or coaching session and delivered back before the visit.The consultations were audio-recorded and analysed for the number and content of questions. Multilevel linear models were used to compare the two groups.Outcome measuresThe primary outcome was the comparison of questions asked between QPS and QL group. Secondary outcomes included satisfaction about questions asked, satisfaction with decision, and level of anxiety.ResultsPatients in the QPS and QL group asked 13 and 16 questions respectively. The difference was not significant (b=1.7, CI –0.3 to 3.6, p=0.10). A mean of 22 questions was selected in the QPS, while a mean of 2 questions was written in the QL. Patients in the QPS group were significantly less satisfied (t=3.60, pConclusionsBoth interventions have similar impact on patients’ participation in terms of question asking during the consultation. Future research is needed in order to explore which components of the interventions are really useful and efficacious.Trial registrationClinicalTrials.govNCT01510964

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.

A growing number of severely ill patients require long-term care in non-hospital residential facilities (RFs). Despite the magnitude of this development, longitudinal studies surveying fairly large resident samples and yielding important information on this population have been very few. The aims of the study were (1) to describe the socio-demographic, clinical, and treatment-related characteristics of RF patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at the 1-year follow-up; (3) to evaluate clinicians’ predictions about each patient’s likelihood of home discharge (HD). A prospective observational cohort study was conducted involving all patients staying in 23 medium-long-term RFs of the St John of God Order with a primary psychiatric diagnosis. A comprehensive set of socio-demographic, clinical, and treatment-related information was gathered and standardized assessments (BPRS, HONOS, PSP, PHI, SLOF, RBANS) were administered to each participant. Logistic regression analyses were run to identify independent discharge predictors. The study involved 403 patients (66.7 % male), with a mean age of 49 years (SD = 10). The participants’ average illness duration was 23 years; median value for length of stay in the RF was 2.2 years. The most frequent diagnosis was schizophrenia (67.5 %). 104 (25.8 %) were discharged: 13.6 % to home, 8.2 % to other RFs, 2.2 % to supported housing, and 1.5 % to prison. Clinicians’ predictions about HD were generally erroneous. Very few patients were discharged to independent accommodations after 1 year. The main variables associated with a higher HD likelihood were: illness duration of

Introduction Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, the patients who participate in the decision-making process show greater treatment adherence and have better health outcomes. Different methods to encourage the active participation during oncological consultation have been described; however, similar studies in Italy are lacking. The aims of the present study are to (1) assess the effects of a preconsultation intervention to increase the involvement of breast cancer patients during the consultation, and (2) explore the role of the attending companions in the information exchange during consultation. Methods and analysis All female patients with breast cancer who attend the Oncology Out-patient Services for the first time will provide an informed consent to participate in the study. They are randomly assigned to the intervention or to the control group. The intervention consists of the presentation of a list of relevant illness-related questions, called a question prompt sheet. The primary outcome measure of the efficacy of the intervention is the number of questions asked by patients during the consultation. Secondary outcomes are the involvement of the patient by the oncologist; the patient9s perceived achievement of her information needs; the patient9s satisfaction and ability to cope; the quality of the doctor–patient relationship in terms of patient-centeredness; and the number of questions asked by the patient9s companions and their involvement during the consultation. All outcome measures are supposed to significantly increase in the intervention group. Ethics and dissemination The study was approved by the local Ethics Committee of the Hospital Trust of Verona. Study findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration ClinicalTrials.gov identifier: NCT01510964

The negative attitudes surrounding mental disorders and their treatment are a major obstacle to the correct identification and treatment of emerging psychopathologies. The purpose of this study was to investigate mental health literacy in a large and representative sample of high school students in Italy, via a booklet containing several questionnaires delivered to 1032 teenagers. The items in the questionnaires probed knowledge about mental health and illness, stigmatization, stereotypes, behaviors, opinions, and attitudes. In general, the students had a reasonable knowledge of mental disorders and were able to distinguish these from somatic disorders. However, a large portion of the students nourished some misconceptions about mental disorders and was also rather skeptical about the effectiveness of treatment or the chance of recovery for people with severe mental disorders. Nevertheless, roughly half of the students reported being willing to provide help to someone with a mental disorder when in need. Poor mental health literacy is a major barrier to seeking help and receiving effective treatment. Young people are the ideal target of raising awareness and antistigma campaigns because they are at a higher risk for developing a psychopathology.

The Sexual Attraction Questionnaire (SAQ) was designed to measure sexual attraction (Fernández, Quiroga, & Rodríguez, 2006), because the current questionnaires were considered inadequate. The purpose of this research was to test whether the SAQ factors remain meaningful after several years (stability) and whether the Italian version is equivalent to the Spanish one (consistency). Three groups of university students participated: two from Spain (n = 182 and 255, respectively) and one from Italy (n = 293). The Spanish groups were tested with a 7-year interval (2001-2008). The Italian group was tested in 2008. The main hypotheses were to test, across time interval and countries: (a) factor congruence, (b) predictive power of factors (proportion of variance accounted for), and (c) scale reliability. Sexual attraction typology also was analyzed, within and between countries, to test the validity of the underlying theoretical model. The results obtained show that the SAQ factor structure remains the same, the resulting factors have high predictive power, and the SAQ scales are highly reliable. Sexual dimorphism and sexual attraction typology are highly associated, thus validating the underlying theoretical model.

Background Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices. The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi – in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia. Method Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores. Results 31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning. Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study). Conclusion The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated.

Objective: To identify the constituent elements of the stigma from the perspective of those having first-hand experiences of it. Methods: Subjective experiences of stigma were explored in six focus groups: three with people suffering from schizophrenia and three with patients' relatives. Focus group sessions were taperecorded, transcribed and analyzed by means of an inductive method, forming categories from the texts, as a basis for coding. Analysis aimed at establishing a typology of stigmatization experiences from the spoken words of the focus group participants. Results: Four dimensions of stigma were identified: access to social roles; internalization of stigma; quality of mental health services, public image of mental illness. Conclusion: The most frequently found topics concerned experiences of marginalization and discrimination that people with schizophrenia experience in their daily life. These results mirror the findings of similar studies obtained in other cultural contexts.