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A change in implicit behavioural tendencies toward foods may contribute to the maintenance of calorie restriction in Anorexia Nervosa (AN). To test this hypothesis, we assessed approach-avoidance tendencies toward different categories of stimuli using a novel mobile version of the approach-avoidance task (AAT). The sample included 66 patients with restrictive AN and 84 healthy controls, all females. All participants performed the AAT in which they were required to approach or avoid stimuli (high-calorie foods, low-calorie foods, and neutral objects) by respectively pulling their phone towards themselves of pushing it away. Both the response time and the force of each movement were collected by means of the smartphone's accelerometer. The results revealed that patients with AN had a reduced tendency to approach food stimuli compared to healthy controls, who instead presented faster and stronger movements in approaching rather than avoiding foods as compared to neutral objects. This finding was particularly pronounced in patients with greater levels of malnutrition. No differences were instead observed comparing high-calorie and low-calorie foods. The observed reduction in the natural tendency to approach food stimuli is consistent with patients' eating behaviour and may contribute to the maintenance of calorie restriction, thus representing a possible target for novel therapeutic approaches., Competing Interests: Declaration of competing interest The authors have no competing financial interests to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Bulimic episodes experienced by patients with Binge Eating Disorder (BED) might be sustained by an enhanced behavioral propensity to approach food stimuli., Methods: To test this hypothesis, automatic approach avoidance tendencies toward high-calorie foods (HCF), low-calorie foods (LCF), and neutral objects were assessed in a group of 23 patients with BED, and their performance was compared to the one of 17 patients with obesity without BED and a group of 32 normal weight participants. All participants performed a mobile approach-avoidance task in which they were required to approach and avoid different stimuli by respectively pulling their phone toward themselves or pushing it away. Reaction times were analyzed., Results: Results showed a significant three-way interaction between group, type of movement and stimulus. Post-hoc analyses revealed that all the groups displayed an approach bias toward HCF. Patients with BED and healthy controls also displayed an approach bias toward LCF, a bias that was absent in obese individuals without BED. Moreover, patients with BED were faster in approaching food stimuli, both HCF and LCF, compared to healthy controls., Discussion: These behavioral tendencies are quite consistent with the real-life attitudes of both BED patients and patients with obesity and might contribute to the maintenance of unhealthy eating habits such as binging in patients with BED and high-calorie diets in patients with obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Collantoni, Meregalli, Granziol, Di Vincenzo, Rossato, Giovannini, Capobianco, Zech, Vettor and Favaro.)

Indexes for estimating the overall reliability of a test in the framework of knowledge space theory (KST) are proposed and analyzed. First, the possibility of applying in KST the existing classical test theory (CTT) methods, based on the ratio between the true score variance and the total variance of the measure, has been explored. However, these methods are not suitable because in KST error and true score are not independent. Therefore, two new indexes based on the concepts of entropy and conditional entropy are developed. One index is used to estimate the reliability of the response pattern given the knowledge state, while the second one refers to the reliability of the estimated knowledge state of a person. Some theoretical considerations as well as simulations and an empirical example on real data are provided within a study of the behavior of these indexes under a certain number of different conditions., (© 2024. The Author(s).)

Commonly identified patterns of psychological distress in response to adverse events are characterized by resilience (i.e., little to no distress), delayed (i.e., distress that increases over time), recovery (i.e., distress followed by a gradual decrease over time), and sustained (i.e., distress remaining stable over time). This study aimed to examine these response patterns during the COVID-19 pandemic. Anxiety and depressive symptom data collected across four European countries over the first year of the pandemic were analyzed (N = 3,594). Participants were first categorized into groups based on the four described patterns. Network connectivity and symptom clustering were then estimated for each group and compared. Two thirds (63.6%) of the sample displayed a resilience pattern. The sustained distress network (16.3%) showed higher connectivity than the recovery network (10.0%) group, p = .031; however, the resilient network showed higher connectivity than the delayed network (10.1%) group, p = .016. Regarding symptom clustering, more clusters emerged in the recovery network (i.e., three) than the sustained network (i.e., two). These results replicate findings that resilience was the most common mental health pattern over the first pandemic year. Moreover, they suggest that high network connectivity may be indicative of a stable mental health response over time, whereas fewer clusters may be indicative of a sustained distress pattern. Although exploratory, the network perspective provides a useful tool for examining the complexity of psychological responses to adverse events and, if replicated, could be useful in identifying indicators of protection against or vulnerability to future psychological distress., (© 2023 The Authors. Journal of Traumatic Stress published by Wiley Periodicals LLC on behalf of International Society for Traumatic Stress Studies.)

Every day, we make thousands of finger movements on the touchscreen of our smartphones. The same movements might be directed at various distal goals. We can type "What is the weather in Rome?" in Google to acquire information from a weather site, or we may type it on WhatsApp to decide whether to visit Rome with a friend. In this study, we show that by watching an agent's typing hands, an observer can infer whether the agent is typing on the smartphone to obtain information or to share it with others. The probability of answering correctly varies with age and typing style. According to embodied cognition, we propose that the recognition process relies on detecting subtle differences in the agent's movement, a skill that grows with sensorimotor competence. We expect that this preliminary work will serve as a starting point for further research on sensorimotor representations of digital actions.

In recent years, different studies highlighted the importance of assessing behavioral tendencies toward different food stimuli in healthy and pathological samples. However, heterogeneities in experimental approaches and small sample sizes make this literature rather inconsistent. In this study, we used a mobile approach-avoidance task to investigate the behavioral tendencies toward healthy and unhealthy foods compared to neutral objects in a large community sample. The role of some contextual and stable subjective variables was also explored. The sample included 204 participants. The stimuli comprised 15 pictures of unhealthy foods, 15 pictures of healthy foods, and 15 pictures of neutral objects. Participants were required to approach or avoid stimuli by respectively pull or push the smartphone toward or away from themselves. Accuracy and reaction time of each movement were calculated. The analyses were conducted using a generalized linear mixed-effect model (GLMMs), testing the two-way interaction between the type of movement and the stimulus category and the three-way interactions between type of movement, stimulus, and specific variables (BMI, time passed since the last meal, level of perceived hunger). Our results evidenced faster approaching movement toward food stimuli but not toward neutrals. An effect of BMI was also documented: as the BMI increased, participants became slower in avoiding unhealthy compared to healthy foods, and in approaching healthy compared to unhealthy stimuli. Moreover, as hunger increased, participants became faster in approaching and slower in avoiding healthy compared to unhealthy stimuli. In conclusion, our results show an approach tendency toward food stimuli, independent from caloric content, in the general population. Furthermore, approach tendencies to healthy foods decreased with increasing BMI and increased with perceived hunger, indicating the possible influence of different mechanisms on eating-related behavioral tendencies., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Discriminating between different quantities is an essential ability in daily life that has been demonstrated in a variety of non-human vertebrates. Nonetheless, what drives the estimation of numerosity is not fully understood, as numerosity intrinsically covaries with several other physical characteristics. There is wide debate as to whether the numerical and spatial abilities of vertebrates are processed by a single magnitude system or two different cognitive systems. Adopting a novel approach, we aimed to investigate this issue by assessing the interaction between area size and numerosity, which has never been conceptualized with consideration for subjective experience in non-human animals. We examined whether the same perceptual biases underlying one of the best-known size illusions, the Delboeuf illusion, can be also identified in numerical estimation tasks. We instructed or trained human participants and guppies, small teleost fish, to select a target numerosity (larger or smaller) of squares between two sets that actually differed in their numerosity. Subjects were also presented with illusory trials in which the same numerosity was presented in two different contexts, against a large and a small background, resembling the Delboeuf illusion. In these trials, both humans and fish demonstrated numerical biases in agreement with the perception of the classical version of the Delboeuf illusion, with the array perceived as larger appearing more numerous. Thus, our results support the hypothesis of a single magnitude system, as perceptual biases that influence spatial decisions seem to affect numerosity judgements in the same way., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Exercise addiction (EA) refers to excessive exercise, lack of control, and health risks. The Exercise Addiction Inventory (EAI) is one of the most widely used tools in its assessment. However, the cross-cultural psychometric properties of the EAI could be improved because it misses three pathological patterns, including guilt, exercise despite injury, and experienced harm. Therefore, the present study tested the psychometric properties of the expanded EAI (EAI-3) in a large international sample. The EAI-3 was administered to 1931 physically active adult exercisers speaking five languages (Chinese, German, Italian, Japanese, and Turkish) and other measures for obsessive-compulsive behavior, eating disorders, and personality traits. The assessment structure and reliability of the EAI-3 were tested with factorial analyses and through measurement invariance across languages and sex. Finally, a cutoff point for dysfunction-proneness was calculated. The EAI-3 comprised two factors, reflecting the positive and pathological sides of exercise. The structure had excellent reliability and goodness-of-fit indices and configural and metric invariances of the scale were supported. However, three items caused violations in scalar invariance. The results of partial measurement invariance testing suggested an adequate fit for the data. Following sensitivity and specificity analysis, the EAI-3's cutoff score was 34 out of a maximum score of 48. This preliminary study suggests that the EAI-3 is a promising tool for screening EA in an international sample, with a robust and reliable structure comparable across languages and sex. In addition, the proposed cutoff could pave the way toward a consensus on a threshold to screen for EA., Competing Interests: Conflict of InterestMS has received honoraria/has been a consultant for Angelini, Lundbeck, Otsuka. All the other authors declare no conflict of interest., (© The Author(s) 2023.)

Vaccine confidence has emerged as one of the most relevant psychological factors implied in the worldwide affecting the fight against COVID-19-as well as public trust in doctors, medicine, and science. Indeed, the vaccine confidence is crucial to maximize the trust in vaccines and their use for prevention, with several implications for public health. This study aimed to analyse the relationships among between vaccine confidence, conspiracy beliefs about COVID-19, and satisfaction with science and medicine in handling the COVID-19 pandemic. A longitudinal observational survey was administered to a convenience sample (n = 544; mean age 52.76 y.o., SD = 15.11; females 46.69%) from the Italian general population. A two-waves mediation model-a structural equation model technique-was used. The survey was part of a larger international project ( https://osf.io/qy65b/ ). The model highlighted that the conspiracy beliefs about COVID-19 had a negative effect on the satisfaction with medicine and science (β = - 0.13, se = 0.03, p < .001). The latter, in turn, had a positive effect on vaccine confidence (β = 0.10, se = .05, p < .001). Interestingly, the effect of conspiracy beliefs on vaccine confidence was completely mediated by the scientifical-medical satisfaction (β = - 0.02, se = 0.01, p < .05). These results highlight how the scientifical-medical satisfaction can fully mediate the relationship between conspiracy beliefs about COVID-19 and vaccine confidence. These findings about vaccine hesitancy and confidence and disclose have implications for psychological and social interventions that could promote vaccine confidence by targeting the satisfaction with science and medicine., (© 2022. The Author(s).)

Many daily activities involve responding to the actions of other people. However, the functional relationship between the motor preparation and execution phases still needs to be clarified. With the combination of different and complementary experimental techniques (i.e., motor excitability measures, reaction times, electromyography, and dyadic 3-D kinematics), we investigated the behavioral and neurophysiological signatures characterizing different stages of a motor response in contexts calling for an interactive action. Participants were requested to perform an action (i.e., stirring coffee or lifting a coffee cup) following a co-experimenter's request gesture. Another condition, in which a non-interactive gesture was used, was also included. Greater corticospinal inhibition was found when participants prepared their motor response after observing an interactive request, compared to a non-interactive gesture. This, in turn, was associated with faster and more efficient action execution in kinematic terms (i.e., a social motor priming effect). Our results provide new insights on the inhibitory and facilitatory drives guiding social motor response generation. Altogether, the integration of behavioral and neurophysiological indexes allowed us to demonstrate that a more efficient action execution followed a greater corticospinal inhibition. These indexes provide a full picture of motor activity at both planning and execution stages.

Literature showed that the link between right-wing attitudes and ethnocentric attitudes gets stronger under existential threats, but the role exerted by an impersonal threat - as COVID-19 - on right-wing attitudes is still unclear. This study aimed to highlight the role of anxiety exerted by the impersonal COVID-19 threat on the relationship between right-wing attitudes and ethnocentric attitudes, as nationalism and anti-immigrants' sentiments. As part of an international project to evaluate the impact of COVID-19, this study administered an online survey to a representative sample (n 1038). The anxiety generated by an impersonal threat as COVID-19 - thus not exerted by any outgroup - can moderate the relationship among personal Right-Wing Authoritarianism, social dominance orientation, and ethnocentric attitudes. This is the first study demonstrating that existential threat is effective also when exerted by an impersonal agent (as COVID-19) rather than by an outgroup. Second, these findings disclose useful implications for preventive psychological interventions and for social policy makers., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04305-w., Competing Interests: Conflict of interestThe Authors have no conflict of interest to declare., (© The Author(s) 2023.)

Background: Although numerous studies have examined associations between personality traits and eating disorders in females, few studies have been conducted on female exercisers. Given the high risk of disordered eating in female exercisers, this study investigated the associations between the Big Five personality traits and disordered eating in female exercisers, and further explored the potential mediators, namely exercise dependence symptoms, and obsessive-compulsive symptoms underlying this association., Methods: A total of 295 female exercisers aged between 18 to 67 years (M =  22.11, SD =  6.65) participated in this study., Results: Negative and statistically significant correlations between conscientiousness (r = - 0.17, p < 0.01), emotional stability (r = - 0.27, p < 0.001) and agreeableness (r = - 0.18, p < 0.01) and disordered eating were observed in our sample of female exercisers. The multiple mediation analyses revealed that exercise dependence symptoms and obsessive-compulsive symptoms mediate the relationship between conscientiousness (β = 0.016, CI = [0.003, 0.031]), emotional stability (β = -0.012, CI = [- 0.028, - 0.002]), and disordered eating in female exercisers, whereas obsessive-compulsive symptoms (β = - 0.041, CI = [- 0.088, - 0.001]) but not exercise dependence symptoms are a mediator of the relationship between agreeableness and disordered eating., Conclusions: Our findings can be used to improve the screening procedures for eating disorders in female exercisers as they contribute to a better understanding of the psychological mechanisms that underlie the associations between the Big Five personality traits and disordered eating., (© 2022. The Author(s).)

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a "victim", supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Due to pandemic-imposed restrictions on lab-based research, we have recently witnessed a flourishing of online studies in experimental psychology, based on the collection of fine behavioral measures such as reaction times (RTs) and accuracy. However, it remains unclear whether participants' alerting levels may have a different impact on behavioral performance in the online vs. lab setting. In this work we administered online and in-lab the dynamic temporal prediction (DTP) task, which requires an implicit modulation of participants' alerting by alternating experimental conditions implying either slower or faster response rates. We then compared data distribution, RTs, accuracy, and time-on-task effects across the adult lifespan between the settings. We replicated online and across the whole age range considered (19-69 y) all the task-specific effects already found in-lab (both in terms of RTs and accuracy) beyond the overall RTs delay typical of the online setting. Moreover, we found an interaction between the setting and task-specific features so that participants showed slower RTs only in experimental conditions implying a less urgent response rate, while no RTs delay and a slight accuracy increase emerged in faster conditions. Thus, the online setting has been shown to be methodologically sound in eliciting comparable effects to those found in-lab. Moreover, behavioral performance seems to be more sensitive to task-induced alerting shifts in the online as compared to the lab setting, leading to either a heightened or reduced efficiency depending on a faster or slower response rate of experimental conditions, respectively., Competing Interests: The authors declare no conflict of interest.

Background: The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country., Method: Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models., Results: Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning., Conclusions: The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain., (© 2022. The Author(s).)

The use of observational tools in psychological assessment has decreased in recent years, mainly due to its personnel and time costs, and researchers have not explored methodological innovations like adaptive algorithms in observational assessment. In the present study, we introduce the behavior-driven observation procedure to develop, test, and implement observational adaptive instruments. In Study 1, we use a preexisting observational checklist to evaluate nonverbal behaviors related to psychotic symptoms and to specify the adaptive algorithm's model. We fit the model to observational data collected from 114 participants. The results support the model's goodness of fit. In Study 2, we use the estimated model parameters to calibrate the adaptive procedure and test the algorithm for accuracy and efficiency in adaptively reconstructing 58 nonadaptively collected response patterns. The results show the algorithm's good accuracy and efficiency, with a 40% average reduction in the number of administered items. In Study 3, we used real raters to test the adaptive checklist built with behavior-driven observation. The results indicate adequate intrarater agreement and good consistency of the observed response patterns. In conclusion, the results support the possibility of using behavior-driven observation to create accurate and affordable (in terms of resources) observational assessment tools.

Background : People suffering from mental disorders are affected by public stigma in many areas of daily life, including mental health services. Stigma among mental health professionals needs to be addressed. Aims : This study explores the path leading to attitudes toward seclusion and restraint practices among future mental health professionals, considering the complex interplay among demographic variables, personality, stigma, and experience in psychiatric services. Method: Network analysis and Structural Equation Modeling were used to explore 1512 Psychology students. The survey instrument included a form for demographic and academic variables, the Attribution Questionnaire-9, the Ten Items Personality Inventory, and few questions exploring attitudes toward open-door and restraint-free policies in Psychiatry. Results: The personality trait of Openness and previous experience with psychiatric patients resulted to play a positive effect on stigma. Openness was also associated with a better disposition towards restraint-free policies. Conversely, higher levels of stigma predicted a negative attitude toward no restraint, decreasing the positive effect of Openness. Conclusions: In conclusion, some personality traits may be associated with lower levels of stigma and a more open view about treatment policies in Psychiatry. Direct educational or professional experience with patients suffering from mental disorders may be a crucial factor in reducing the risk of stigmatizing attitudes in future professionals.

Objectives: To identify predictors and time trends over 10 years of psychiatric consultation or treatment in adolescents and young adults referring to Emergency Department (ED)., Methods: Real-world cohort data from 50,056 adolescents and young adults referring 105,596 times to ED between 2007 and 2016. We tested whether gender, age, triage code (red, yellow, green, white with decreasing severity), and referral modality predicted primary (psychiatric consultation) or secondary outcomes (anxiolytic treatment, sedative treatment, psychiatric admission), and whether these outcomes increased over the last 10 years., Results: Mean age was 19.57(SD = 2.52), female percentage was 48.77%. Overall, 6.93% underwent psychiatric consultation, treatment, or admission. Among 2,547 adolescents and young adults undergoing a psychiatric consultation, 58.07% had either yellow or red triage code, and 47.2% were brought by ambulance. Female gender predicted psychiatric consultation and anxiolytic treatment, male gender predicted sedative treatment, suggesting gender differences in help-seeking behaviors. Older age predicted all outcomes. Severe triage presentation and being brought by ambulance increased the risk of primary and secondary outcomes. Psychiatric consultation (1.77% to 3.64%), anxiolytic (3.04% to 6.15%), or admission (0.40% to 0.98%) roughly doubled, and sedative (0.27% to 1.23%) treatment had a four-fold increase from 2007 to 2016., Conclusions: Among adolescents and young adults aged 15 to 24 years old ED appears to be necessary for young help-seeking subjects given the severe presentations and the increasing number of adolescents referring to ED. More studies should assess whether ED might be helpful in detecting subjects with sub-threshold or early psychiatric symptoms, or at risk for severe mental illness., Competing Interests: Dr. Solmi received honoraria from Lundbeck and has been a consultant for Angelini on the advisory board. He is also a Joint Editor for JCPP Advances. Other authors have no conflict of interest to declare. [Corrections made on 22 June 2022, after first online publication: This Conflict of Interest statement has been updated in this version.]The present study adhered to Helsinki Declaration. Subjects consented to use data in aggregated anonymous form., (© 2021 The Authors. JCPP Advances published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Exercise is overwhelmingly beneficial for physical and mental health, but for some people exercise addiction (EA) can develop and negatively impact an individual. This study sought to (a) compare the latent structure of two instruments assessing EA and (b) examine differences in attitudes toward stopping exercise, if required to on medical grounds, among exercise-addicted and non-addicted athletes. In a cross-sectional study, 1,011 athletes competing at different levels completed an anonymous on-line survey. The survey contained Exercise Dependence Scale-Revised (EDS-R), Exercise Addiction Inventory (EAI), and questions on adherence to medical prescriptions to stop exercise. We tested the latent structure of EDS-R and EAI with multigroup confirmatory factor analyses (CFA), across gender and competition level. Finally, we measured the difference of athletes' attitudes toward stopping exercise, if prescribed by a physician. Both instruments showed good fit indexes, even across gender. CFAs on EAI scores showed some violations of measurement invariance across competition level (ΔCFI = .03; ΔRMSEA = .02). On the contrary, CFAs on EDS-R scores did not show invariance violations across competition level (ΔCFI = <.01; ΔRMSEA = <.01). Finally, athletes who reached thresholds for exercise addiction, by means of EDS-R, were more prone to not follow medical prescriptions to cease exercise, independently of the competition level. These results suggest that athletes' answers on the EDS-R seem to be less affected by competition level, compared to EAI. Moreover, EDS-R outcomes could be used to identify individuals who may be unlikely to cease exercise for medical reasons, independently of their competition level. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Systematic reviews and meta-analyses pool data from individual studies to generate a higher level of evidence to be evaluated by guidelines. These reviews ultimately guide clinicians and stakeholders in health-related decisions. However, the informativeness and quality of evidence synthesis inherently depend on the quality of what has been pooled into meta-research projects. Moreover, beyond the quality of included individual studies, only a methodologically correct process, in relation to systematic reviews and meta-analyses themselves, can produce a reliable and valid evidence synthesis. Hence, quality of meta-research projects also affects evidence synthesis reliability. In this overview, the authors provide a synthesis of advantages and disadvantages and main characteristics of some of the most frequently used tools to assess quality of individual studies, systematic reviews, and meta-analyses. Specifically, the tools considered in this work are the Newcastle-Ottawa scale (NOS) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies, the Consolidated Standards of Reporting Trials (CONSORT), the Jadad scale, the Cochrane risk of bias tool 2 (RoB2) for randomized controlled trials, the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and the Assessment of Multiple Systematic Reviews 2 (AMSTAR2), and AMSTAR-PLUS for meta-analyses. WHAT IS ALREADY KNOWN?: The informativeness and quality of evidence synthesis inherently depend on the quality of what has been pooled into meta-research projects. Beyond the quality of included individual studies, only a methodologically correct process, in relation to systematic reviews and meta-analyses themselves, can produce a reliable and valid evidence synthesis. WHAT IS NEW?: In this overview, the authors provide a synthesis of advantages and disadvantages and main characteristics of some of the most frequently used tools to assess quality of individual studies, systematic reviews, and meta-analyses. POTENTIAL IMPACT: This overview serves as a starting point and a brief guide to identify and understand the main and most frequently used tools for assessing the quality of studies included in meta-research. The authors here share their experience in publishing several meta-research-related articles covering different areas of medical sciences., (© 2020 John Wiley & Sons Ltd.)

Objective: This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS)., Methods: We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken., Results: We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant., Conclusions: Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely., (Copyright © 2020 by the American Psychosomatic Society.)

The COVID-19 pandemic represents a major stressor for the psychological health of people worldwide. In the UK, the COVID19-Psychological Research Consortium Study (C19PRC) launched to evaluate the psychological impact of COVID-19 in the general population and its implications. The project was then extended to Italy and several other countries. This article provides an overview of the Italian C19PRC study and its replication of two specific findings from the UK C19PRC. In the first part, the relationship between anxiety and somatic symptomatology is examined. In the second part, we analyze the association between several factors and psychological health outcomes: depression/anxiety, traumatic stress, COVID-19 anxiety. In line with the study conducted in the UK, an online survey was administered to the adult Italian general population. The sample included 1038 respondents (age, mean = 49.94, SD = 16.14, 51.15% females) taken from four regions: Lombardia, Veneto, Lazio, and Campania. The relationship between predictors and outcomes was evaluated by means of logistic regression models. Somatic indices showed a positive association with anxiety, worse somatic symptoms were associated with mourning a loss of a beloved one due to COVID-19 and with precarious health conditions. Females showed a higher incidence of psychological issues. No differences in anxiety, depression, and traumatic stress were found across regions but the Campania region showed the most severe somatic symptomatology. In the second analysis, the factors associated with more severe psychological outcomes (i.e., anxiety and/or depression, traumatic stress, and COVID-19 related anxiety) were younger age, the presence of minors in the household, traumatic stressors, and precarious health conditions. No differences across regions emerged. The Italian results correspond to the UK findings for anxiety, depression, and traumatic stress. Both in the UK and Italy, the factors associated with worse psychological health were gender (female), younger age, having children, pre-existing health issues (both for oneself or someone close), and the moderate/high perceived risk of contracting COVID-19 within one month. In Italy, unlike the UK, lower household income and having (had) COVID-19 were not associated with poorer mental health. The psychological impact of COVID-19 can last for months; future research should explore all aspects of the psychological burden of COVID-19 in order to implement psychological interventions and promote psychological health.

Human behavior is continuously shaped not just as a function of explicitly responding to external world events but also by internal biases implicitly driven by the capacity to extract statistics from complex sensory patterns. Two possible sources of predictability engaged to generate and update temporal expectancy are the implicit extraction of either local or global statistical contingencies in the events' temporal structure. In the context of action preparation the local prediction has been reported to be stable from the age of 6. However, there is no evidence about how the ability to extract and use global statistical patterns to establish temporal expectancy changes across development. Here we used a new, child-friendly reaction time task purposely designed to investigate how local (within-trial expectancy bias) and global (between-block expectancy bias) prediction interplay to generate temporal expectancy and consequently shape action preparation in young (5- to 6-year-old), middle-aged (7- to 8-year-old) and old (9- to 10-year-old) typically developing children. We found that while local temporal prediction showed stable developmental trajectories, the ability to use a global rule to action preparation in terms of both accuracy and speed becomes stable after the age of seven. These findings are discussed by adopting a neuroconstructivist-inspired theoretical account, according to which the developmental constraints on learning from hierarchically nested levels of sensory complexity may constitute a necessary prerequisite for mastering complex domains., (© 2020 John Wiley & Sons Ltd.)

The objective of this study is to assess the potential role of Emergency Department (ED) for early detection of mental disorders. Two cohorts (6,759 subjects aged 14 to 24 accessing ED, 165 subjects with mental disorders) were matched by ID and merged. Primary outcome was the proportion of individuals accessing ED before receiving a diagnosis of mental disorder in Mental Health Service (MHS). Secondary outcomes were age of first access to ED in subjects later accessing to MHS, and time from first ED access to receiving a diagnosis of mental disorder at MHS. We assessed whether gender, severity of ED presentation, and number of ED accesses predicted primary outcome. Almost half of individuals who later developed mental disorders (49.7%) accessed ED before access to MHS. Mean age of first ED contact among those later accessing to MHS was 17.34 (2.1), and ED access preceded access to MHS by 3.68 (2.11) years. Gender and severity of ED presentation were not associated with the access to MHS, while higher number of ED accesses was associated with later access to MHS (OR range: 1.17-1.36, p<0.05). Despite its limitations, the present study suggests ED might represent a contact point for individuals who later access to MHS. Future early detection programs should involve ED in their outreach and screening approaches. Additional studies are needed to assess if subjects earlier accessing to ED are at risk-of-developing or already suffer from a mental disorder, and to validate screening instruments specifically designed for ED., Competing Interests: Conflict of interest: The Authors declare no potential conflict of interests., (©Copyright: the Author(s).)

Despite rapidly increasing knowledge about Trichotillomania (TTM), no gold-standard evidence-based psychological intervention has been identified. In the current study, we evaluated the potential efficacy of an eight-session psychological intervention for TTM, namely the Comprehensive Behavioral Model (ComB) treatment, using a multiple-baseline single-case experimental design with three Italian women with TTM. The study included three phases: baseline, intervention, and 3-month follow-up. We assessed the intervention using daily self-monitoring of number of hair-pulling episodes, number of pulled hairs per episode, degree of resistance to pulling urges, and degree of associated distress. We also assessed for reliable improvement in general distress from baseline to post-intervention. All participants completed treatment and showed improvements on those symptom measures that were most relevant to their individualized case conceptualization. However, no participants recovered completely or demonstrated reliable improvement in general distress. Our results provide initial evidence for the utility of the ComB treatment for TTM in an Italian clinical setting. Furthermore, they support the delivery of individualized and flexible psychological treatments when treating TTM., (Copyright © 2020 Bottesi, Ouimet, Cerea, Granziol, Carraro, Sica and Ghisi.)

One of the most important sources of predictability that human beings can exploit to create an internal representation of the external environment is the ability to implicitly build up subjective statistics of events' temporal structure and, consequently, use this knowledge to prepare for future actions. Stimulus expectancy can be subjectively shaped by hierarchically nested sources of prediction, capitalizing on either local or global probabilistic rules. In order to better understand the nature of local-global proactive motor control in Down Syndrome, in the present study a group of participants with Down Syndrome (DS group; n = 28; mean age 29.5 ± 13 years; range 10-54) and a group of typically developing participants matched by either gender or mental age (TD-MA group; n = 28; 5.6 ± 1 years; range 4-8) were administered a novel motor preparation task, defined as the Dynamic Temporal Prediction (DTP) task. In the DTP, the temporal preparation to imperative stimuli is implicitly shaped by the local increase of expectancy. This is manipulated trial-by-trial as a function of the preparatory foreperiod interval (Stimulus-Onset Asynchrony or SOA). In addition, temporal preparation can be also implicitly adjusted as a function of global predictive context, so that a block-wise SOA-distribution bias toward a given preparatory interval might determine a high-order source of expectancy, with functional consequences on proactive motor control adjustment. Results showed that in both groups motor preparation was biased by temporal expectancy when this was locally manipulated within-trials. By contrast, only the TD-MA group was sensitive to global rule changes: only in this cohort was behavioral performance overall impacted by the SOA probabilistic distribution manipulated between-blocks. The evidence of a local-global dissociation in DS suggests that the use of flexible cognitive mechanisms to implicitly extract high-order probabilistic rules in order to build-up an internal model of the temporal properties of events is disrupted in this developmental disorder. Moreover, since the content of the information to be processed in the DTP task was neither verbal nor spatial, we suggest that atypical global processing in Down Syndrome is a domain-general rather than specific aspect characterizing the cognitive profile of this population., (Copyright © 2020 Mento, Scerif, Granziol, Franzoi and Lanfranchi.)

Background: The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to accurately assess the main pretransplant psychosocial risk factors that may impact transplant outcomes., Objective: As neither established assessment procedures nor standardized tools designed to perform pretransplant psychosocial evaluation are currently available in Italy, the present study was designed to develop and preliminarily validate the Italian version of the SIPAT., Methods: First, our team developed the Italian version of the SIPAT, following standard forward-back translation procedures. Then, the Italian version of the SIPAT was retrospectively and blindly applied to 118 randomly selected transplant cases (40 heart, 40 lung, and 38 liver) by 2 independent examiners. Information about the patients' final transplant listing recommendation (i.e., listing vs. deferral) was independently collected from the respective transplant teams., Results: The inter-rater reliability of the Italian version of the SIPAT scores was substantial (Cohen's kappa = 0.77; P < 0.001). Moreover, the predictive value of the SIPAT ratings on the final transplant listing recommendation (i.e., listing vs. deferral) for each examiner was significant (both P < 0.05)., Conclusion: Current findings suggest that SIPAT is a promising and reliable instrument in its Italian version. Given these excellent psychometric characteristics, the use of the SIPAT as part of the pretransplant psychosocial evaluation in Italian medical settings is highly encouraged., (Copyright © 2019 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Stigma is one of the most important barriers to help-seeking and to personal recovery for people suffering from mental disorders. Stigmatizing attitudes are present among mental health professionals with negative effects on the quality of health care., Methods: Network and moderator analysis were used to identify what path determines stigma, considering demographic and professional variables, personality traits, and burnout dimensions in a sample of mental health professionals (n = 318) from six Community Mental Health Services. The survey included the Attribution Questionnaire-9, the Maslach Burnout Inventory, and the Ten-Item Personality Inventory., Results: The personality trait of openness to new experiences resulted to determine lower levels of stigma. Burnout (personal accomplishment) interacted with emotional stability in predicting stigma, and specifically, for subjects with lower emotional stability lower levels of personal accomplishment were associated with higher levels of stigma., Conclusions: Some personality traits may be accompanied by better empathic and communication skills, and may have a protective role against stigma. Moreover, burnout can increase stigma, in particular in subjects with specific personality traits. Assessing personality and burnout levels could help in identifying mental health professionals at higher risk of developing stigma. Future studies should determine whether targeted interventions in mental health professionals at risk of developing stigma may be effective in stigma prevention.

Although observing other's gaze and body movements provides a crucial source of information to successfully interact with other people, it remains unclear whether observers weigh differently these cues and whether the convergence of gaze and body's directions determines facilitation effects. Here we aim to shed more light on this issue by testing the reliance upon these cues from both a behavioral and a neurophysiological perspective in a social interactive context. In Experiment 1, we manipulated the convergence between the direction of an actor's upper limb movement and gaze direction while he attempts to socially interact with the participants observing the scene. We determined the direction of gaze as well as the duration of participants' ocular fixations during the observation of the scene. In Experiment 2, we measured and correlated the effect of the body/gaze manipulation on corticospinal excitability and on the readiness to interact-a disposition to engage in social situations. Eye-tracking data revealed that participants fixated chiefly the actor's head when his hand and gaze directions were divergent. Possibly a strategy to disambiguate the scene. Whereas participants mainly fixated the actor's hand when he performed an interactive request toward the participants. From a neurophysiological point of view, the more participants felt involved in the interaction, the lower was motor preparation in the muscle potentially needed to fulfill the actor's request. We contend that social contexts are more likely to elicit motor preparation compared to non-social ones, and that muscular inhibition is a necessary mechanism in order to prevent unwanted overt reactions during action observation tasks., Competing Interests: The authors have declared that no competing interests exist.

Direct gaze is a powerful social cue able to capture the onlooker's attention. Beside gaze, head and limb movements as well can provide relevant sources of information for social interaction. This study investigated the joint role of direct gaze and hand gestures on onlookers corticospinal excitability (CE). In two experiments we manipulated the temporal and spatial aspects of observed gaze and hand behavior to assess their role in affecting motor preparation. To do this, transcranial magnetic stimulation (TMS) on the primary motor cortex (M1) coupled with electromyography (EMG) recording was used in two experiments. In the crucial manipulation, we showed to participants four video clips of an actor who initially displayed eye contact while starting a social request gesture, and then completed the action while directing his gaze toward a salient object for the interaction. This way, the observed gaze potentially expressed the intention to interact. Eye tracking data confirmed that gaze manipulation was effective in drawing observers' attention to the actor's hand gesture. In the attempt to reveal possible time-locked modulations, we tracked CE at the onset and offset of the request gesture. Neurophysiological results showed an early CE modulation when the actor was about to start the request gesture looking straight to the participants, compared to when his gaze was averted from the gesture. This effect was time-locked to the kinematics of the actor's arm movement. Overall, data from the two experiments seem to indicate that the joint contribution of direct gaze and precocious kinematic information, gained while a request gesture is on the verge of beginning, increases the subjective experience of involvement and allows observers to prepare for an appropriate social interaction. On the contrary, the separation of gaze cues and body kinematics can have adverse effects on social motor preparation. CE is highly susceptible to biological cues, such as averted gaze, which is able to automatically capture and divert observer's attention. This point to the existence of heuristics based on early action and gaze cues that would allow observers to interact appropriately.

Measurement is a crucial issue in psychological assessment. In this paper a contribution to this task is provided by means of the implementation of an adaptive algorithm for the assessment of depression. More specifically, the Adaptive Testing System for Psychological Disorders (ATS-PD) version of the Qualitative-Quantitative Evaluation of Depressive Symptomatology questionnaire (QuEDS) is introduced. Such implementation refers to the theoretical background of Formal Psychological Assessment (FPA) with respect to both its deterministic and probabilistic issues. Three models (one for each sub-scale of the QuEDS) are fitted on a sample of 383 individuals. The obtained estimates are then used to calibrate the adaptive procedure whose performance is tested in terms of both efficiency and accuracy by means of a simulation study. Results indicate that the ATS-PD version of the QuEDS allows for both obtaining an accurate description of the patient in terms of symptomatology, and reducing the number of items asked by 40%. Further developments of the adaptive procedure are then discussed.

The nonverbal behavior (NVB) of people diagnosed with schizophrenia consistently interacts with their symptoms during the assessment. Previous studies frequently observed such an interaction when a prevalence of negative symptoms occurred. Nonetheless, a list of NVBs linked to negative symptoms needs to be defined. Furthermore, a list of items that can exhaustively assess such NVBs is still needed. The present study aims to introduce both lists by using the Formal Psychological Assessment. A deep analysis was performed on both the scientific literature and the DSM-5 for constructing the set of nonverbal behaviors; similarly, an initial list of 138 items investigating the behaviors was obtained from instruments used to assess schizophrenia. The Formal Psychological Assessment was then applied to reduce the preliminary list. A final list of 23 items necessary and sufficient to investigate the NVBs emerged. The list also allowed us to analyze specific relations among items. The present study shows how it is possible to deepen a patient's negative symptomatology, starting with the relations between items and the NVBs they investigate. Finally, this study examines the advantages and clinical implications of defining an assessment tool based on the found list of items., (Copyright © 2017 John Wiley & Sons, Ltd.)

The clinical assessment of mental disorders can be a time-consuming and error-prone procedure, consisting of a sequence of diagnostic hypothesis formulation and testing aimed at restricting the set of plausible diagnoses for the patient. In this article, we propose a novel computerized system for the adaptive testing of psychological disorders. The proposed system combines a mathematical representation of psychological disorders, known as the "formal psychological assessment," with an algorithm designed for the adaptive assessment of an individual's knowledge. The assessment algorithm is extended and adapted to the new application domain. Testing the system on a real sample of 4,324 healthy individuals, screened for obsessive-compulsive disorder, we demonstrate the system's ability to support clinical testing, both by identifying the correct critical areas for each individual and by reducing the number of posed questions with respect to a standard written questionnaire., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.