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Background Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The “gold standard” treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to assess the clinical and neurobiological changes following Metacognitive Interpersonal Therapy (MIT) compared with Structured Clinical Management (SCM) derived from specific recommendations in APA (American Psychiatric Association) guidelines for BPD. Methods The study design is a randomized parallel controlled clinical trial and will include 80 BPD outpatients, aged 18–45 enrolled at 2 recruitment centers. Primary outcome will be the clinical change in emotion regulation capacities assessed with the Difficulties in Emotion Regulation Scale (DERS). We will also investigated the effect of psychotherapy on metacognitive abilities and several clinical features such as BPD symptomatology, general psychopathology, depression, personal functioning, and trait dimensions (anger, impulsivity, alexithymia). We will evaluate changes in brain connectivity patterns and during the view of emotional pictures. A multidimensional assessment will be performed at the baseline, at 6, 12, 18 months. We will obtain structural and functional Magnetic Resonance Images (MRIs) in MIT-Treated BPD (N = 30) and SCM-treated BPD (N = 30) at baseline and after treatment, as well as in a group of 30 healthy and unrelated volunteers that will be scanned once for comparison. Discussion The present study could contribute to elucidate the neurobiological mechanisms underlying psychotherapy efficacy. The inclusion of a multidisciplinary study protocol will allow to study BPD considering different features that can affect the treatment response and their reciprocal relationships. Trial registration NCT02370316. Registered 02/24/2015. Electronic supplementary material The online version of this article (10.1186/s12888-019-2127-2) contains supplementary material, which is available to authorized users.

Quality of life (QOL) has been considered an important outcome measure in psychiatric research and determinants of QOL have been widely investigated. We aimed at detecting predictors of QOL at baseline and at testing the longitudinal interrelations of the baseline predictors with QOL scores at a 1-year follow-up in a sample of patients living in Residential Facilities (RFs). Logistic regression models were adopted to evaluate the association between WHOQoL-Bref scores and potential determinants of QOL. In addition, all variables significantly associated with QOL domains in the final logistic regression model were included by using the Structural Equation Modeling (SEM). We included 139 patients with a diagnosis of schizophrenia spectrum. In the final logistic regression model level of activity, social support, age, service satisfaction, spiritual well-being and symptoms' severity were identified as predictors of QOL scores at baseline. Longitudinal analyses carried out by SEM showed that 40% of QOL follow-up variability was explained by QOL at baseline, and significant indirect effects toward QOL at follow-up were found for satisfaction with services and for social support. Rehabilitation plans for people with schizophrenia living in RFs should also consider mediators of change in subjective QOL such as satisfaction with mental health services.

Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12 ; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001) ; at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001) ; poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032 ; unpaid employed 0·34 [0·09-0·60], p=0·007 ; looking for a job 0·26 [0·09-0·43], p=0·002 ; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression ; p

BackgroundNo study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures.AimsTo (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD.MethodCross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used.ResultsPeople living in ‘very high HDI’ countries reported higher discrimination than those in ‘medium/low HDI’ countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only.ConclusionsContextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.

Background Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. Methods In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. Findings 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coeffi cient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p lt 0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in fi nding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. Interpretation Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving eff ective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the eff ects of stigma when it is already established. Funding European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Soil degradation phenomena are induced by both natural (soil characteristics, climate conditions) and anthropogenic (overgrazing, deforestation, improper agricultural practices) factors. Among the man-induced factors, the intensive agriculture is one of the widest diffused causes of soil deterioration. Particularly, persistent passes of operative machineries produce a dangerous alteration of soil chemical-physical properties. In the framework of Interreg IIIB MILDMAP-MEDIA project, we developed a new index based on the integration of land cover classifications and slope for assessing the level of mechanization that combined with information on soil types allows for estimating the soil vulnerability to compaction. Two Landsat-TM images were classified with a hybrid unsupervised/supervised approach to obtain land cover maps. On the basis of cultivation type and slope values, derived from a DEM, we associated the required number of machinery passes and evaluated the different use between tyred and tracked vehicles. Results obtained form the comparison of the implemented index with other commonly used indices enhanced its capability to provide a more detailed classification of vulnerability to soil compaction representing precious information for land degradation assessment.

This paper deals with the characterization of erosive processes in a degraded area of Southern Italy, by means of the integrated measurements of different chemical and physical soil parameters. In particular, we measured soil magnetic susceptibility. electrical conductivity, and pH. In the Mediterranean areas, climatic, geopolitical and anthropogenic factors are likely driving land degradation processes enhancing desertification risk. Particularly, we focused on a form of accelerated erosion producing landforms characterized by steep, scarp slopes with knife-edge ridges, known as calanchi. In this framework, our goal was to evaluate the ability of some physical parameters to discriminate areas with different degree of erosion. We selected a pair of eroded-vegetated contiguous sides for each one of the two calanchi. and we collected 50 samples of soil. According to our preliminary results, electrical conductivity seems to be able to discriminate calanchi characterized by different erosion degrees, whereas magnetic susceptibility values seem to discriminate soils with different geological characteristics. In addition. in situ measurements of superficial soil magnetic susceptibility shows a spatial distribution with a clear directionality that is probably ascribable to the water motion in the subsurface of the calanchi form.