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The paper evaluates a digitally-supported pedagogical tool for promoting well-being from the perspective of students (N=428) and teachers (N=43) from nine secondary schools in five European countries (Poland, Italy, Great Britain, Lithuania, Bulgaria). Each of the eight thematic modules (decision making, coping with anger and aggressiveness, conflict resolution, stress management, self-esteem and self-awareness, collaboration and teamwork skills, empathy, communication skills) included in the online educational training was evaluated. Students demonstrated high satisfaction with the tool; however, there were differences between modules (Self-esteem and Stress management were the most appreciated, Communication the least). The students assessment was influenced by age, gender and national differences, while the teachers evaluation of usefulness and sustainability was influenced by nationality. Digitally-supported school-based programs can promote well-being among adolescents; however, the interventions need to address differences between boys, girls and nationalities in order to be effective. Teachers, as an immanent part of school life, should be engaged in promoting health programs.

Background: Perinatal depression is a widespread and burdensome mental disorder. The objectives of this study were to assess the prevalence of both antenatal and postnatal depression in a large sample of women in Italy and to analyse their association with sociodemographic and socioeconomic factors. Methods: Cross-sectional data from eleven healthcare centres located throughout Italy (2017–2018) were analysed (n = 1471). Depressive disorder was assessed with the Edinburgh Postnatal Depression Scale (EPDS), and sociodemographic and socioeconomic factors were also measured. Prevalences by perinatal period and by sociodemographic and socioeconomic factors were estimated, and their associations were evaluated using logistic regression models. All analyses were stratified by perinatal period: antenatal (i.e., from conception to delivery) vs. postnatal (i.e., the nine months after delivery). Results: With a cut-off score set at 12 points, the prevalence of perinatal depression was 6.4% during pregnancy and 19.9% in the postnatal period, and the odds ratio for postpartum vs. antepartum depression was 3.65 (2.56–5.39). High economic status was associated with an approximate fivefold reduction in odds of depression in the antenatal period (ORa: 0.23, 95%CI: 0.10-0.54) and about a sixfold reduction in the postnatal period (ORa: 0.15, 95%CI: 0.05-0.45). Limitations: The data were cross-sectional. The EPDS has a sensitivity of 55.6%. Conclusion: The prevalence of perinatal depression in Italy is strongly associated with socioeconomic disadvantages. Early procedures to evaluate socioeconomic status and the provision of economical support for mothers might reduce the prevalence of perinatal depression and its direct and indirect costs.

There is ongoing interest in using brief screening instruments to identify perinatal depression in clinical practice. One ultra-brief screening instrument for depression is the Patient Health Questionnaire-2 (PHQ-2), but thus far its accuracy in perinatal clinical practice has been barely researched. In the present study, we aimed to assess the screening accuracy of the PHQ-2 against the Patient Health Questionnaire-9 (PHQ-9) in a large sample of perinatal women.A total of 1155 consecutive women attending 11 health care centers throughout Italy completed the PHQ-9 (which includes the PHQ-2) during pregnancy (27-40 weeks) or postpartum (1-13 weeks). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, and overall accuracy were calculated using cut points 3 or greater and 2 or greater.During pregnancy, PHQ-2 greater than or equal to 3 revealed low sensitivity (38.4%-44.7%) but high specificity (97.8%-99.3%). In postpartum, it revealed moderate sensitivity (56.9%-70.6%), high specificity (95.8%-99.8%), and fair overall accuracy in pregnancy (70%). The alternative threshold greater than or equal to 2 revealed very high sensitivity (pregnancy: 92.1%-95.2%; postpartum: 87.1%-95.2%), moderate specificity (pregnancy: 78.1%-83.2%; postpartum: 68.8%-81.1%) and good overall accuracy, both during pregnancy (87%) and postpartum (84%).The PHQ-2 provided acceptable accuracy for screening for depression compared with the PHQ-9. In perinatal screening practice, a threshold of 2 or greater should be preferred as this ensures high sensitivity, missing only approximately 6% to 8% of cases, and a false-positive rate (percentage of women classified as affected with depressive symptoms when they are not) of 19% to 25%.

Anxiety is a common perinatal disorder that can cause severe adverse consequences. This study (a) assesses the prevalence of maternal postnatal anxious symptomatology, and (b) analyses its association with demographic and socioeconomic variables as well as obstetric and other psychosocial variables. The assessment included 307 mothers aged ≥18 years with a biological baby aged ≤ 52 weeks and from seven Italian healthcare centres, evaluated using a Psychosocial and Clinical Assessment Form (also covering demographic and socioeconomic factors), and the state scale of the State-Trait Anxiety Inventory. We found an overall prevalence of self-reported postnatal anxious symptoms of 34.2%. More specifically, the prevalence was 34.5% at 1–24 weeks postpartum, and 30.8% at >24 weeks postpartum. No associations between postnatal anxious symptoms and demographic or socioeconomic variables were observed. As regards the other variables, the findings indicated antenatal depression or anxiety, parity, and current psychological support from the partner as having the strongest relationships.

The perinatal depression is one of the leading pathologies in the world causing disabilities and represents an important public health problem. Since 2003, the Center for Behavioral Sciences and Mental Health (Istituto Superiore di Sanità - ISS) has promoted studies and research on the mental health of women, children, partners and family in the perinatal period, leading to the realization of a structured program adopted in many Italian services. In this article, we describe the feasibility and effectiveness of the perinatal mental health approach in Italian health services and discuss the progress and new challenges.

Quarantine, loss of routine and social support can negatively impact mothers who have just given birth and their babies, generating concerns and reactions of intense fear. Following the COVID-19 emergency, we described a structured program for screening and treatment of perinatal depression and anxiety as a medium for constant monitoring of perinatal risk factors and early screening, which can also be implemented in emergencies with remote intervention methods, to offer women an appropriate, timely and effective treatment. In this scenario, it is desirable that the monitoring of the psychological well-being of women in postpartum is maintained over time, with the participation of all the professional figures with whom the woman comes into contact, to intercept any forms of psychological distress related to the epidemic and that could occur even after some time.

Background Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. Methods In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. Results The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22–7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83–16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31–5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07–0.65; OR=0.26, 95% CI: 0.09–0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13–0.80; OR=0.22, 95% CI: 0.09–0.53) were associated with lower odds of developing CAD. Limitations The cross-sectional design; the use of self-report questionnaires. Conclusion CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.

Background: The most common mental disorders in women during the perinatal (antenatal and postnatal) period are depressive syndromes and anxiety syndromes. The global prevalence of maternal perinatal depression ranges from 10% to 20%, while the prevalence of perinatal anxiety ranges from 10% to 24%. The comorbidity of mood and anxiety disorders in perinatal women is common, reaching 40%. In Italy, a few studies have been undertaken to evaluate the prevalence of perinatal depression and anxiety, and there is still a scarcity of research and intervention programmes regarding primary prevention. Three of the main aims of this study are (1) to evaluate the prevalence of maternal perinatal depression and anxiety in a large sample of women attending healthcare centres in Italy; (2) to investigate the psychosocial risks and protective factors associated with maternal perinatal depression and anxiety; (3) to evaluate the effectiveness of a manualized psychological intervention (Milgrom, Martin and Negri, 1999) to treat perinatal depression; (4) to evaluate the psychometric properties of both the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire–9 in detecting perinatal depression; (5) to evaluate the influence of maternal depression and anxiety on the development of infant temperament. Methods: This is a prospective cohort study, which merges an observational design and a pre-post intervention design. The study includes a one-year recruitment period and a one-year follow-up period. The methodological strategy includes (1) self-report questionnaires on maternal depression, anxiety, health status, quality of life and psychosocial risks; (2) a self-report questionnaire to measure the infant’s temperament; (3) a clinical interview; (4) a structured diagnostic interview; (5) a psychological intervention. Discussion: The results of this study may contribute to our knowledge about prevalence of antenatal and postnatal depression and anxiety (during both the trimesters of pregnancy and the first six trimesters after birth) and about the effectiveness of early psychological intervention in the perinatal health services. Trial Registration: ISRCTN12733828 - Registered 20 may 2019 Keywords: Perinatal, Antenatal, Postnatal, Anxiety, Depression, Screening, Assessment, Psychological Treatment.

Introduction Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).

The present study investigated students' preferences about technology tools and digital education activities to be used in classroom to facilitate the implementation of a mental health promotion program.Students' preferences have been elicited during one session focus group lasting 60 minutes. Overall, 26 focus groups, facilitated by 33 teachers, were organized in 9 schools of five European countries. Overall, 283 students who attended the first, second and third year of middle school (aged 10-15 years) volunteered to participate in the focus groups.The majority of preferences indicated smartphone to communicate or to get information and tablet for a better use in classroom. Collaborative games have been considered as more useful and beneficial compared to the other digital educational activities proposed.Teachers require further insight into the pedagogical role of ICT and training. There is a need to encourage them to provide opportunities to allow students to use technology to solve problems or develop abilities for a better socio-emotional functioning and, ultimately, mental health.

This study evaluates the effectiveness of a psychological intervention based on a brief cognitive behavioural and psycho-educational treatment for women suffering from post partum depression.The sample was recruited within a programme of screening and early intervention for post partum depression risk. 1558 women were screened between the 6th and 12th week after birth. 110 (7.1%) of them resulted positive to the Edinburgh Postnatal Depression Scale (score ≥12) and 81 accepted a thorough clinical diagnostic examination through the administration of the Mini International Neuropsychiatric Interview and the self-assessment instruments Beck Depression Inventory, State-Trait Anxiety Inventory, Psychological Well-being Scales, Short-Form Health Survey and Positivity Scale. Women who had been confirmed with the diagnosis of major depression episode (N=65; 80.2%) were offered to follow the treatment (10 weekly sessions) and to fill in again the instruments at the end of the treatment and after six months. Out of the 81, 63 women accepted and begun the treatment.56 (88.9%) women completed treatment and filled in the instruments. Most of them (N=43) completed the instruments even after 6 months. At the end of treatment and after 6 months significant improvements were found in all scores of the instruments used. Furthermore, up to 70% of women who had been treated showed a clinically significant improvement in one or more evaluated outcomes. Such improvements were persistent in women evaluated 6 months after the treatment.The results of the study are consistent with studies that in other Countries evaluated, even experimentally, the same intervention or similar interventions with postnatal women and based on cognitive behavioural techniques. Such brief and structured interventions are most likely effective and easily accepted by women who suffer from post partum depression even in the routine practice of Italian health care services.

Background: The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs. Objectives: To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians. Methods: Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4.999 people were drawn in 7 centres of 6 Italian regions. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors. Results: 3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs. Conclusions: Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.

This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women.The sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated.Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them.The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.

In Italy, the Mental Health Unit of the National Institute of Public Health has developed a school-based mental health programme based on a structured handbook. The aim of this programme is to promote self-efficacy, psychological well-being, and life satisfaction. In this study, we evaluated the effectiveness of this programme. We used data from 308 students who participated in a study in 9 Italian high schools during the 2011-2012 school year. In order to analyse the school intervention programme, we set up a pre-post test design study involving 18 classrooms (8 of which acting as a control). The schools were selected via a snowball technique, and then the classrooms that agreed to participate were randomly assigned to intervention and control groups. The programme was performed during regular school hours in one-hour a week sessions for a total of 20 hours of classroom time. Assessments before and 2 months after the programme were performed using Regulatory Emotional Self-Efficacy, Satisfaction With Life, and Ryff’s Psychological Well-Being Scales. The results showed an improvement in self-efficacy in regulating negative affect, overall psychological well-being, and satisfaction with life. These results demonstrate that the programme produced significant positive effects on the mental health status of participating students.

The prevalence of eating disorders (ED) in the community is still under debate, as well as the measure of their impact on the well-being of individuals. It was decided to evaluate the prevalence of eating disorders in an Italian community sample as well as to measure the burden of the quality of life of people and to compare it to those attributable to other chronic illnesses. A community survey of 4,999 people using a questionnaire on health services utilization, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), a semi-structured clinical interview derived from the non-patient version of the DSM-IV (SCID/NP) and Short Form Health Survey (SF-12) was conducted. A total of 3,398 individuals were interviewed (68% of those recruited). Lifetime prevalence for overall ED was 1.7%; for anorexia 0.7%; for bulimia 0.6% and for binge eating disorder 0.5%. ED was more frequent in women than in men. No cases of anorexia in men were identified. ED showed an attributable burden in impairing quality of life with no statistically significant differences with those due to major depressive disorder, bipolar spectrum disorders and Wilson's disease. Of the pathological conditions considered, only multiple sclerosis showed a worsening attributable burden. ED thus has a non-negligible frequency in Italy, with severe impact on quality of life comparable to that produced by severe chronic psychiatric and general medical conditions. These elements emphasize that ED is a serious public health issue.

Background The prevalence of bipolar spectrum disorders in the community is under debate and the prescription of antidepressant drugs (ADs) in bipolar depression appears to be an underestimated problem. Objectives To evaluate the prevalence of bipolar disorders by means of a screening instrument in seven communities within six regions of Italy and evaluate the appropriateness and number of prescriptions for ADs in bipolar depression. Methods Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4999 people from seven communities within six regions of Italy. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Mood Disorder Questionnaire (MDQ). Training: interviewers were trained psychologists or medical doctors. Study limitations: the population studied did not represent a nationally representative multistage clustered area probability sample of households. Results 3398 subjects were interviewed (68% of recruited sample). Positivity at MDQ (MDQ+) was higher in males (3.4% vs. 2.8%) but the difference was not significant (OR = 1.2, P = 0.37). The association between MDQ+ and Major Depressive Disorder (MDD) was statistically significant for both males (OR = 14.9, P Conclusions These overall rates of being MDQ+ are similar to community surveys conducted within USA and the use of ADs in people with MDQ+ and MDD diagnoses are.

A programme of personal relationships improvement is under way in the town of Trento in Northern Italy. It was decided to carry out a survey to describe the frequency and quality of interpersonal links as a baseline. A questionnaire to assess frequency and quality of interpersonal relationships has been validated (QRI) and a first description of its distribution in a representative sample of Trento population has been achieved. The questionnaire has some interesting original features, in particular it investigates the relationships with relatives in the same ways as with others, gives special attention to neighbours and asks separate judgements about the quality of relationships with different kind of people. The questionnaire gives important information which are not easy to find. In Trento interpersonal relationships seem good, especially for the possibility to receive practical help. Neighbourhood networks can certainly be improved. Only comparisons with other settings and in time can allow more solid conclusions. The English version of the questionnaire is available through the first author.

Background: In Italy, few studies on the prevalence of psychiatric disorders have considered all of the most common disorders and very few have adopted the most common tools, that is, the Composite International Diagnostic Interview (CIDI) and the Present State Examination (PSE). The objective of the present study was to estimate the prevalence of psychiatric disorders and its correlates in the town of Jesi, Italy, using the PSE and CIDI, administered 7 years apart. Methods: The two surveys were conducted among adults in Jesi (central Italy), using the PSE in 1993 and the CIDI in 2000. Participants were randomly chosen from the patient lists of general practitioners. Results: The one-month prevalence of persons with a psychiatric disorder was 7.3% (95% CI: 4.4–11.6) in 1993 and 6.0% (95% CI: 3.5–9.5) in 2000. The lifetime and 1-year prevalence rates were 21.0 and 8.2%, respectively. The most common disorders were depressive and anxiety disorders. Mood and anxiety disorders were more common among women and unmarried persons. Conclusions: The prevalence is lower than that in most other areas of the world yet consistent with estimates for Italian populations reported by studies using the same (or similar) tools.