Search

Introduction: The link between poverty and mental illness has sparked discussions about the role of poverty as a risk factor for mental health. If poverty is indeed confirmed as a causal factor for mental illness, it would have profound implications for our comprehension of mental well-being and guide efforts to address the growing occurrence of mental health disorders. Methods: Building on the recent breakthrough discovery of heritability of poverty traits and utilizing large-scale genome-wide association studies of mental illness, we used Mendelian randomization (MR) and Genomic structural equation modeling to investigate evidence of causality of the relationship between poverty and mental illness. We examined nine distinct mental disorders, namely attention deficit and hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorders (ANX), autism spectrum disorders (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and schizophrenia (SZ). Joint measures of poverty derived from household income (HI), occupational income (OI), and social deprivation (SD) were examined while accounting for the influence of cognitive ability (CA). Results: Our analysis highlights HI as the most pertinent poverty measure when compared to OI and SD. Bidirectional MR investigations of the poverty common factor was consistent with the existing paradigm that mental illness leads to poverty. New was evidence that poverty increases the likelihood of developing ADHD (Inverse Variance Weighted Odds Ratio [IVW OR]=4.26[95%CI:3.42-5.29]), MDD (IVW OR=1.49[95%CI:1.29-1.72]), and SZ (IVW OR=1.53[95%CI:1.35-1.73]), while decreasing the risk of AN (IVW OR=0.50[95%CI:0.40-0.62]). This support for a causal relation held strong after adjusting for CA, albeit with reduced effect sizes. Conclusion: Our research indicates that poverty plays a causal role in the development of SZ, MDD, and ADHD, while resulted inversely associated to risk of AN. Notably, CA explains a significant portion of the impact of poverty, echoing prior reports highlighting the contribution of impaired cognitive function to severe mental illnesses. Given that income and education are malleable factors in the population, our study provides compelling evidence to examine income-based policies as a means of promoting better mental health outcomes in the population. This underscores the importance of developing targeted interventions that address the root causes of mental illness and advance health equity.

The aim of this study is to validate the Italian version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS): a self-report measure of religious beliefs that may contribute to stigma regarding mental disorders. Scale validation included: linguistic validation; pilot test for understandability; face validity; factor analysis as test of dimensionality; Kaiser–Meyer–Olkin test to evaluate sample sampling adequacy; internal consistency was assessed using Cronbach’s alpha; scale validity was assessed through concurrent criterion validity using as gold standard the Italian version of Attribution Questionnaire 27 and mental health knowledge schedule; A total of 311 people agreed to participate in the study. Face validity showed that 13 items out of 16 were completely understandable while only three items (4, 9 and 13) highlighted small lexical concerns. The average compilation time was under 4 min. Bartlett’s test for sphericity was statistically significant (Χ2 = 1497.54; df = 120; p

Le tecnologie digitali a servizio della salute hanno raggiunto notevoli livelli di interesse e di possibilita d’intervento che hanno portato ad una e-mental health (salute mentale digitale) autogestita, su larga scala ed operativa. In questo articolo-discussione, ci si propone di evidenziare alcuni problemi attuali derivanti dall’invasione della tecnologia digitale nel contesto della psichiatria considerando, in particolare, che la domanda globale di miglioramento della salute mentale e in continuo aumento. Gli autori portano le loro riflessioni personali nei rispettivi settori di competenza in merito al tema della salute mentale digitale, prendendone in considerazione sia le potenziali insidie sia le opportunita terapeutiche. Nell’introduzione viene definito il concetto di salute mentale digitale e vengono descritti i suoi principali utilizzi in contesti come la depressione e la gestione dell'ansia. Sono inoltre presentati i dati recenti riguardanti, ad esempio, i tassi dei ricoveri ospedalieri che vengono utilizzati come misura iniziale di successo della salute mentale digitale. Attraverso una revisione non sistematica delle evidenze pubblicate negli ultimi cinque anni si evince come il tema della salute mentale digitale stia raccogliendo molta attenzione: i risultati sono pero ancora limitati a contesti numericamente ridotti e quindi c'e un fondamento di evidenze limitato. Vengono inoltre prese in considerazione le implicazioni riguardanti il coinvolgimento, attraverso le tecnologie della salute mentale digitale, di persone che presentano anche comorbilita neurologiche: ad esempio le persone con disabilita intellettiva che a tutt’oggi non possono ancora beneficiare di una significativa inclusione sociale e dell’accesso ad attivita digitali. La conclusione dell’articolo pone al lettore una domanda circa due ambiti ritenuti critici: come monitorare, valutare e regolamentare le attivita legate alla salute mentale digitale e le implicazioni etiche ad essa connesse?

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder. We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores. We conducted a case–control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge − assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test. The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered. We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image. Level II: controlled trial without randomization.

Stigmatizing attitudes have been found among psychology students in many studies, and they are becoming more common with time.This study examines whether participation in clinical psychology lessons reduces levels of stigmatization in a population of psychology students and whether it leads to any change in stigmatization.The study is a pre/post evaluation of the effectiveness of clinical psychology lessons (63 hours of lectures) as a tool to fight stigma. The presence of stigmatizing attitudes was detected using the Italian version of the Attribution Questionnaire-27 (AQ-27-I). Stigmatization was described before and after the lessons with structured equation modeling (SEM).Of a total of 387 students contacted, 302 (78.04%) agreed to be involved in the study, but only 266 (68.73%) completed the questionnaires at both t0 and t1. A statistically significant reduction was seen in all six scales and the total score on the AQ-27-I. The models defined by the SEM (pre- and post-intervention) showed excellent model fit indices and described different dynamics of the phenomenon of stigma.A cycle of clinical psychology lessons can be a useful tool for reducing stigmatizing attitudes in a population of students seeking a psychology degree.

To explore gender differences in patients suffering from anxious-depressive symptoms, Metabolic Syndrome (MetS) and Colorectal Adenomas (CRAs) in a sample of outpatients undergoing colonoscopy for screening purposes.Cross-sectional study. 126 consecutive outpatients of both sexes undergoing colonoscopy for non-specific abdominal symptoms between January 2015 and June 2021 at the Modena Policlinico General Hospital (Modena, Northern Italy) were enrolled. MetS was diagnosed according to ATPIII and IDF criteria. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), while the Temperament and Character Inventory (TCI) was used to study personality. The SF-36 was also included as a measure of quality of life perception.Among 126 outpatients (51.60% male) undergoing colonoscopy, 51 (44%) had CRAs, 54 (47%) MetS, 41 (41.40%) anxiety symptoms, 22 (22.20%) depressive symptoms and 13 (13.10%) combined anxious-depressive symptoms. HADS-Anxiety (t=2.68, p=0.01) and TCI Reward Dependence (TCI-RD) (t=3.01, p=0.00) mean scores were significantly higher in women; conversely, SF-36 Mental Component Summary scores were higher in men. CRAs were significantly prevalent in men (χ2=9.32, p=0.00) and were statistically significantly associated with male sex at the univariate logistic regression analysis (OR=3.27; p0.01). At the multivariate logistic regression, diastolic hypertension (p0.01) was positively associated with male sex, while TCI-RD (p=0.04) and HDL hypocholesterolemia (p=0.02) were inversely associated with male sex.Several significant gender differences in anxious-depressive symptoms, MetS and CRAs were found. These preliminary data suggest the need to consider gender specificities while implementing therapeutic, diagnostic, and preventive strategies.

STUDY OBJECTIVES: The media are the primary sources of information about health for the public. The media portrayal of narcolepsy might contribute to the stigmatization of people affected by this condition. This study aimed to describe how narcolepsy is portrayed in newspapers. METHODS: We collected 257 newspaper articles from the digital archive of La Stampa published between 1980 and 2020 that mentioned key search terms. The content was assessed using an ad hoc coding schema developed to evaluate the presence of sensationalistic title, negative language, stigmatizing content, stereotypical description, disclosure of a person diagnosed with narcolepsy, person with narcolepsy described as dangerous, presence of an accurate diagnosis, identifiable symptoms, indications about diagnostic and treatment services. Chi-square analysis was performed to identify changes over time in the type of content. RESULTS: In 10.9% of the articles, there was a sensationalistic title; inappropriate, negative, and outdated language appeared in 10.5% of the articles. Stigmatizing and stereotypical content was reported in 19.5% and 14.8% of the articles, respectively. In 62.3% of the articles, it was disclosed that a person had narcolepsy, and in 5.1% of the articles patients with narcolepsy were described as dangerous. The presence of an accurate diagnosis was referred to in 30.4% of the articles, while 16.7% described identifiable symptoms. Services for diagnosis and treatment were mentioned in 24.1% of the articles. Changes over time in the content of articles are discussed. CONCLUSIONS: Our findings highlight areas for improvement in the media portrayal of narcolepsy and could help guide the development of new targeted anti-stigma campaigns. CITATION: Varallo G, Pingani L, Musetti A, et al. Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles. J Clin Sleep Med. 2022;18(7):1769–1778.

The Italian version of the South Oaks Gambling Screen questionnaire (SOGS) and a socio-demographic questionnaire were administered to a sample of 275 healthcare professions students aged 19 to 58 years (mean age = 22.17; females = 81.1%) to address the research objectives: to examine the prevalence and correlates of problem gambling in a population of university healthcare professions students in Italy. Among the sample, 8.7% (n = 24) of participants showed problem gambling and 1.5% (n = 4) pathologic gambling. Lottery and scratch cards were the most frequent type of gambling in the sample, followed by cards and bingo. Compared to females, males tend to be more involved in problem gambling and pathological gambling. Males tend to be more involved than females in different types of gambling (such as cards, sports bets, gambling at the casino). Pathological gambling is positively associated with gender, being students lagging behind the regular schedule of exams and parents’ level of education. These findings have important implications in terms of prevention and intervention on gambling and pathological gambling. Universities should make available educational programs and counselling services to address this issue.

The primary aim is to describe the changes in the knowledge of mental health conditions, the attitudes toward the mentally ill, and the intended behaviour towards people with mental illness among the entire student population of the third year of a degree course in Psychology. A total of 570 students attended a seminar on stigma towards mental illness and were invited to complete an online survey which collected data on sociodemographic characteristics and three validated questionnaires evaluating different aspects of stigma at three different time points (pre-intervention, post-intervention, and at one year follow up). A total of 253 students (44.39%) completed the questionnaires at t0, t1, and t2. The mean age of the sample was 23.7 (SD = ±5.89), and 86.96% (n = 220) were females. Between t0 and t1, a statistically significant improvement was observed for all three outcomes, while the intended behaviour outcome was no longer significant between t1 and t2 (Z = −0.70, p = 0.48). Females and who participated live at the seminar maintained a significant knowledge of mental illness and a better attitude toward community mental health care. The effects of the seminar focused on reducing stigma tended to diminish over time at one year follow-up, particular in relation to intended behaviour.

to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015.ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions.the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis.number of people who smoke per 100 people with the same features.among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men.men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.

Il presente articolo si propone di approfondire il fenomeno dello stigma nel contesto della salute mentale. In particolare, dopo una introduzione dedicata alle radici storiche del termine "stigma", vengono analizzate le sue diverse tipologie alla luce della più recente letteratura: public stigma, structural stigma, selfstigma, felt or perceived stigma, experienced stigma, label avoidance, courtesy stigma e spiritual stigma. Fra le diverse declinazioni che il fenomeno discriminante può assumere, viene fornita una ampia descrizione di quella iatrogena: la discriminazione perpetrata dai professionisti sanitari nei confronti delle persone con disagio psichico. Proprio su questa tipologia di stigma viene proposta una revisione narrativa e non sistematica della letteratura al fine di permettere al lettore di avere una panoramica esaustiva per l'inquadramento di questa particolare forma di stigma. L'ultima parte dell'articolo è dedicata alle principali strategie, sostenute da evidenze scientifiche, utilizzate per la lotta allo stigma. Oltre alle ormai consolidate metodiche come la formazione, la protesta e il contatto, viene anche presentata la traduzione italiana del manuale "Coming Out Proud" del prof. Corrigan (Illinois Institute of Technology) che si propone come utile strumento per la lotta al selfstigma. Esso è pensato per utenti e promotori della salute pubblica per affrontare il processo di coming out e il tema dell'identità. È articolato in tre parti che affrontano le questioni chiave della rivelazione: soppesare costi e benefici del coming out; considerare i diversi approcci strategici (gradi) per la rivelazione; apprendere un metodo efficace per formulare le storie personali relative all'esperienza di malattia mentale.

Consultation&ndash, liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000&ndash, 2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen&rsquo, s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937, 32.3%), followed by agitation (n = 1534, 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs, in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

BackgroundEvidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour.Methods and findingsThis is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up.ConclusionsTeaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments.Study registrationThe protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262.Update of the overviewYoung T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi:10.1371/journal.pone.0086706.

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000&ndash, 2019 (N = 19,278) were included, two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.

The purpose of this study was to describe the psychometric characteristics of the AQ-27-I in a high school student population. Students aged between 17 and 20 years and attending the fourth and fifth year of a scientific high school in Milan were approached at the school and were asked to fill in an anonymous socio-demographic form and the AQ-27-I. Cronbach&rsquo, s alpha was used to estimate the instrument reliability and confirmatory factor analysis (CFA) was conducted and compared to the original English version factor structure. The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach&rsquo, s alpha of 0.87 and only one subscale (Personal responsibility) with an alpha lower than 0.60. Fit indices were very positive for the Dangerousness Model supporting the factor structure and paths of the original version. The Personal Responsibility Model, on the other hand, showed some weakness, concerning the process dynamics of the model. The results obtained are similar with those from other studies carried out in Italy and other countries. The questionnaire can be used for the quantitative description of stereotypes, emotions and behaviors associated with stigma in mental health in high school student populations.

Anxiety and depressive symptoms are common worldwide and, according to the World Health Organization, their prevalence has increased in the last decades. Further, dysfunctional personality traits are frequently coupled with anxiety and depressive symptoms. The prevalence of these symptoms is particularly relevant in medical students.This study assessed the prevalence of anxiety and depressive symptoms in Italian medical students from the University of Modena and Reggio Emilia, by using the Hospital Anxiety and Depression Scale (HADS). Personality traits were assessed as well by employing the Personality Inventory for DSM-5, Brief Form (PID-5-BF), to explore their association with anxiety and depressive symptoms. A self-administered questionnaire was sent by e-mail to all the 944 students and 459 (48.6%) were enrolled. Besides the HADS and the PID-5-BF, the questionnaire included items concerning everyday life activities such as sports and academic features such as the years of attendance and average marks.A high prevalence of anxiety (n=92; 20%), depression (n=32; 7%), and comorbid anxiety-depressive symptoms (n=218; 47%) was reported. Multiple binary logistic analysis showed increased levels of anxiety and depression to be associated with personality traits, namely detachment and negative affect, and use of cognitive enhancers. On the other hand, sports activities, social activities and distraction were related to lower levels of symptoms.Symptoms of depression and anxiety are common among Italian medical students and specific interventions should be implemented to target them.

Background: Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population. Aim: To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy. Methods: Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000–2015). Statistics performed by means of linear regression models. Results: Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11–20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p Conclusion: The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

The aim of this study is to validate the Italian version of the Mental Health Knowledge Schedule (MAKS-I). The validation process included: linguistic validation; analysis of the feasibility; face validity; internal consistency; floor and the ceiling effects; divergent validity. Multiple linear regression was performed to examine the relationship between mental health knowledge and independent variables. MAKS-I was administered to 453 people. The linguistic validation was successful and face validity of the questionnaire showed no critical issues. The estimated composite reliability was 0.638. Divergent validity was supported by lack of statistical significant correlation between MAKS-I and RIBS-I with a positive correlation index. Participation in seminars or conferences related to the issue of mental health stigma, gender, qualification and having a first or second-degree relatives with a psychiatric disorder can be considered possible predictors of the MAKS-I score. MAKS-I is a reliable questionnaire to assess mental health knowledge and familiarity with psychiatric clinical conditions in Italian language.

Background: The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. Methods: Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). Results: Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17), (b) affective needs (N = 11), (c) personal experiences (N = 61), (d) regulation of sexual relations (N = 18), (e) Mental Health Professionals&rsquo, (MHPs) openness towards the topic (N = 17), (f) MHPs&rsquo, responses to RPFUs&rsquo, sexual behaviors (N = 33), and (g) RPFUs&rsquo, proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs&rsquo, affective and sexual needs as well as to provide effective solutions to manage them. Conclusions: RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.

International media has paid attention to the use of substances by healthy subjects to enhance cognitive performance. Medical students are liable to use cognitive enhancers (CE) with the aim of improving academic performance. The study explored use and attitudes toward the use of CE in Italian medical students. The authors anonymously surveyed 433 medical students of the University of Modena and Reggio Emilia with an ad hoc 36-items questionnaire. CE were broadly defined as any substance taken with the purpose of improving cognitive functions, from readily available beverages and substances, such as coffee, tea, energy drinks, and supplements to prescription only medication, such as psychostimulants and modafinil. Response rate was 83.8% (n = 363). While the majority of the students (74.7%, n = 271) said that they had used substances to improve cognitive functions, only 2 students (0.6%) reported the use of prescription-only medications in the last 30 days. Main reasons for not taking prescription-only drugs were concerns about safety and side effects, reported by 83.3% of students (n = 295). A positive attitude toward use was held by 60.3% (n = 219) subjects. The surveyed Italian medical students used many substances as CE, but this did not seem to apply significantly to psychostimulants. A multivariable analysis showed that the following variables were related to the propensity to use substances as CE: male gender, self-reported memory impairment, concerns about worsening of cognitive performance, lifetime use of at least one illegal substance, use of any substance (both legal or illegal) in the last 30 days.

The study aims to report the number of newspaper articles including the word "schizo" in the period 2001 - 2015 and to identify possible predictors reinforcing negative stereotypes about people with schizophrenia. The electronic archives of the Italian newspaper "La Stampa" have been searched for the term "schizo". Selected articles were grouped in articles related to mental health (rMH) or article not related to mental health (nrMH). 946 articles were identified. Schizophrenia-related terms were used in 356 (36.03%) article rMH, which mainly reinforce negative stereotypes regarding mental illness both in rMH and nrMH groups. Over time, only in the rMH group a significant reduction of articles reinforcing negative stereotypes was found. Several factors have been identified as predictors of article reinforcing negative stereotypes: unnecessarily dramatic or sensational headline or content; inaccurate or not in the correct context use of medical terminology; emphasis to the illness rather than to the person; mental disorders are the same; disclosure of particular individual has a mental illness. Although there has been a significant reduction in stigmatizing articles, in the rMH group one article out of three reinforces negative stereotypes.

Objective The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation. Methods This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as “undergoing two or more psychiatric consultations”. Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions. Results In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43–4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09–3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14–4.07), and female gender (OR = 1.77; 95% CI, 1.01–3.11) were significantly associated with an increased probability of being cases. Conclusions Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation.

Background Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity). Methods We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377. Findings Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen's d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01–0·11) for any mental disorder, and 0·12 (0·05–0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I2 89·3%; p

Background Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). Objective The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. Methods Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. Results BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. Conclusions Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.

To report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities. This is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions. After the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (−5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide. The data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions.

Objectives: Several modalities currently exist to rate the degree of facial function clinically but even though it has significant limitations, the most widely used scale is the House-Brackmann grading system (HBGS). A simplified scale is introduced here, the 'Rough' Grading System (RGS - Grade I: normal movement; Grade II: slight paralysis; Grade III: frank paralysis with eye closure; Grade IV: frank paralysis without eye closure; Grade V: almost complete paralysis with only slight movements; Grade VI: total paralysis). The aim of the present study was to verify the interrater reliability and the interscale validity of this simplified grading system. Study design: Scale validation study based on a prospective cohort. Methods: Fifty patients with facial palsy, consecutively referred to our department were filmed while performing some codified facial movements. Then two independent groups (one rating using the HBGS, the other rating using the RGS) assigned a grade after reviewing the videos. The time required for the rating was also noted. Results: The HBGS showed a mean value of interrater agreement of 0.46 while the RGS showed a mean value of 0.59. The concurrent validity between HBGS and RGS ranged from 0.86 to 0.90 (p < 0.001 for every comparison). There was no statistically significant difference between HBGS and RGS in the mean time taken for rating (p = 0.15). Conclusions: The RGS reached an adequate level of interrater reliability, higher than the HBGS. The correlation between the two scales is high and the times required for rating are similar. The present results may justify the use of the RGS in routine clinical practice. Level of evidence: N/A. © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights.

Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian final year medical students from the University of Modena and Reggio Emilia were asked to fill in an on-line questionnaire during the first semester of two consecutive academic years (2009-2010, 2010-2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate = 46.7%). Women constituted 66%, and mean age was 25.14 (SD = 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n = 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p = 0.01), believing that 'the problems presented by psychiatric patients are often particularly interesting and challenging' (p0.01), and by accounts of personal/family experience with physical illness (p0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specificities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry.

INTRODUCTION: The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). MATERIALS AND METHODS: The present study consisted of a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in a three-year period (01/01/2006–31/12/2009). Sociodemographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQ), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. RESULTS: Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents’ divorcing, parents’ history of substance abuse and difficulties in interpersonal relationships. DISCUSSION: Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.

Aims: This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in ‘big cities’ can influence the levels of patients’ perceived insecurity and social contacts compared to living in a non-urbanized context. Methods: A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools. Results: The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found. Conclusion: Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients’ psychological and physical well-being, contributing to high levels of distress.