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Silvia Rossi Ferrario,1 Anna Panzeri,1,2 Pasquale Anselmi,3 Giulio Vidotto21Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy; 2Department of General Psychology, University of Padova, Padova, Italy; 3Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, ItalyCorrespondence: Silvia Rossi FerrarioPsychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Via per Revislate 13, Veruno 28010, ItalyTel +39 032 288 4781Email silvia.ferrario@icsmaugeri.itOn behalf of the Italian Psychologist Study Group for SID (Sickness Illness and Disease)Background: Coping with chronic illness can be overwhelming for patients and caregivers, and may be inhibited by the denial mechanism, and therefore, denial represents a critical issue for health professionals. Assessing illness denial is far from easy, and brief tools suitable for medical settings are lacking. In this paper, the development of a short form of the Illness Denial Questionnaire (IDQ) for patients and caregivers is presented.Methods: In study 1, the IDQ was administered to 118 patients and 83 caregivers to examine the internal structure of denial; then the properties of the items (DIF, fit, and difficulty) were evaluated according to the Rasch model in order to select the best items for the Illness Denial Questionnaire-Short Form (IDQ-SF). Study 2 included 202 participants (113 patients and 89 caregivers). The internal structure of the IDQ-SF was tested via confirmatory factor analysis (CFA). Reliability and concurrent validity were also studied using the Anxiety and Depression Questionnaire-Reduced Form (AD-R).Results: The CFA showed a two-factor structure encompassing “Denial of negative emotions” and “Resistance to change”. Results of the Rasch analyses led to the selection of 4 items for each dimension. The resulting IDQ-SF (8 items) showed a two-factor structure as well as good reliability and concurrent validity with AD-R.Conclusion: The IDQ-SF represents a valid tool for quickly evaluating the core of illness denial in patients and caregivers. This brief and easily administrable questionnaire allows health professionals to outline the presence and severity of illness denial in order to set individually tailored interventions.Keywords: denial, illness, Illness Denial Questionnaire, patients, caregivers, assessment

Silvia Rossi Ferrario,1 Ines Giorgi,2 Paola Baiardi,3 Laura Giuntoli,4 Gianluigi Balestroni,1 Paola Cerutti,1 Marina Manera,2 Paola Gabanelli,2 Valentina Solara,5 Roberta Fornara,6 Michela Luisetti,1 Pierangela Omarini,1 Giovanna Omarini,1 Giulio Vidotto4 1Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy; 2Psychology Unit, 3Scientific Direction, Istituti Clinici Scientifici Maugeri SpA SB, Pavia, Italy; 4Department of General Psychology, University of Padova, Padova, Italy; 5Department of Neurology, ALS Centre, “Maggiore della Carita`” University Hospital, Novara, Italy; 6Psychology Unit, SS Trinità Hospital, Borgomanero, NO, Italy Purpose: Interest in assessing denial is still present, despite the criticisms concerning its definition and measurement. We tried to develop a questionnaire (Illness Denial Questionnaire, IDQ) assessing patients’ and caregivers’ denial in relation to their illness/disturbance. Patients and methods: After a preliminary study, a final version of 24 dichotomous items (true/false) was selected. We hypothesized a theoretical model with three dimensions: denial of negative emotions, resistance to change, and conscious avoidance, the first two composing the actual Denial and the last representing an independent component of the illness denial behavior. The IDQ was administered to 400 subjects (219 patients and 181 caregivers) together with the Anxiety–Depression Questionnaire – Reduced form (AD-R), in order to assess concurrent validity. Confirmatory factor analysis (CFA), internal consistency indices (Cronbach’s α and McDonald’s ω), and test–retest analysis were performed. Results: CFA and internal consistency indices (Cronbach’s α: 0.87–0.96) indicated a clear and meaningful three-factor structure of IDQ, for both patients and caregivers. Further analyses showed good concurrent validity, with Denial and its subscale negatively associated with anxiety and depression and avoidance positively associated with anxiety and depression. The IDQ also showed a good stability (r from 0.71 to 0.87). Conclusion: The IDQ demonstrated good psychometric properties. Denial of negative emotions and resistance to change seem to contribute to a real expression of denial, and conscious avoidance seems to constitute a further step in the process of cognitive–affective elaboration of the illness. Keywords: assessment, denial, avoidance, chronic diseases

Davide Massidda,1 Ines Giorgi,2 Giulio Vidotto,3 Salvatore Tringali,4 Marcello Imbriani,4,5 Paola Baiardi,6 Giorgio Bertolotti7 1Giunti O.S. Organizzazioni Speciali, Firenze, Italy; 2Psychology Unit, ICS Maugeri, IRCCS, Pavia, Italy; 3Department of General Psychology, University of Padova, Padova, Italy; 4ICS Maugeri, IRCCS, UOOML, Pavia, Italy; 5Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; 6Scientific Direction, ICS Maugeri, IRCCS, Pavia, Italy; 7Psychology Unit, ICS Maugeri, IRCCS, Tradate, Italy Introduction and objectives: A multidimensional self-report questionnaire to evaluate job-related stress factors is presented. The questionnaire, called Maugeri Stress Index – reduced form (MASI-R), aims to assess the impact of job strain on a team or on a single worker by considering four domains: wellness, resilience, perception of social support, and reactions to stressful situations. Material and methods: The reliability of a first longer version (47 items) of the questionnaire was evaluated by an internal consistency analysis and a confirmatory factor analysis. An item reduction procedure was implemented to obtain a short form of the instrument, and the psychometric properties of the resulting instrument were evaluated using the Rasch measurement model. Results: A total of 14 items from the initial pool were deleted because they were not productive for measurement. The analysis of internal consistency led to the exclusion of eight items, while the analysis performed using structural equation models led to the exclusion of another six items. According to the Rasch model, item properties and the reliability of the instruments appear good, especially for the scales for wellness and resilience. In contrast, the scales for perception of social support and negative coping styles show a lower internal consistency. Conclusions: The Maugeri Stress Index – reduced form provides a reliable and valid measure, useful for early identification of stress levels in workers or in a team along the eustress–vadistress continuum. Keywords: occupational stress, stress, psychometrics, questionnaire, validation

Giorgio Bertolotti,1 Paolo Michielin,2 Giulio Vidotto,2 Ezio Sanavio,2 Gioia Bottesi,2 Ornella Bettinardi,3 Anna Maria Zotti4 1Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Tradate, VA, 2Department of General Psychology, Padua University, Padova, 3Department of Mental Health and Addictive Behavior, AUSL Piacenza, Piacenza, 4Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Veruno, NO, Italy Background: Cognitive behavioral assessment for outcome evaluation was developed to evaluate psychological treatment interventions, especially for counseling and psychotherapy. It is made up of 80 items and five scales: anxiety, well-being, perception of positive change, depression, and psychological distress. The aim of the study was to present the metric qualities and to show validity and reliability of the five constructs of the questionnaire both in nonclinical and clinical subjects. Methods: Four steps were completed to assess reliability and factor structure: criterion-related and concurrent validity, responsiveness, and convergent–divergent validity. A nonclinical group of 269 subjects was enrolled, as was a clinical group comprising 168 adults undergoing psychotherapy and psychological counseling provided by the Italian public health service. Results: Cronbach’s alphas were between 0.80 and 0.91 for the clinical sample and between 0.74 and 0.91 in the nonclinical one. We observed an excellent structural validity for the five interrelated dimensions. The clinical group showed higher scores in the anxiety, depression, and psychological distress scales, as well as lower scores in well-being and perception of positive change scales than those observed in the nonclinical group. Responsiveness was large for the anxiety, well-being, and depression scales; the psychological distress and perception of positive change scales showed a moderate effect. Conclusion: The questionnaire showed excellent psychometric properties, thus demonstrating that the questionnaire is a good evaluative instrument, with which to assess pre- and post-treatment outcomes. Keywords: outcome evaluation, well-being, treatment effects, patient perception, anxiety, depression, questionnaire

The initial state parameters s[subscript 0] and w[subscript 0] are intricate issues of the averaging cognitive models in Information Integration Theory. Usually they are defined as a measure of prior information (Anderson, 1981; 1982) but there are no general rules to deal with them. In fact, there is no agreement as to their treatment except in specific situations such as linear models where they can be merged with the arbitrary zero inter-response scale C[subscript 0]. We present some considerations on their meaning and usefulness in the Functional Measurement approach, starting from different points of view. Furthermore, we suggest a method to deal with their complexity both within each single trial of a factorial design, and between the overall trials of an experiment. (Contains 2 tables and 1 footnote.)

The Functional Measurement approach, proposed within the theoretical framework of Information Integration Theory (Anderson, 1981, 1982), can be a useful multi-attribute analysis tool. Compared to the majority of statistical models, the averaging model can account for interaction effects without adding complexity. The R-Average method (Vidotto & Vicentini, 2007) can be used to estimate the parameters of these models. By the use of multiple information criteria in the model selection procedure, R-Average allows for the identification of the best subset of parameters that account for the data. After a review of the general method, we present an implementation of the procedure in the framework of R-project, followed by some experiments using a Monte Carlo method. (Contains 1 figure and 6 tables.)

Summary: Background: Low skin‐related quality of life (QoL) is usually associated with low levels of self‐confidence and self‐esteem and with high levels of anxiety and depression symptoms. The way patients cope with a physical disease impacts significantly on their psychosocial adjustment to the disorder and on their emotional functioning. Objectives: To explore how coping strategies, skin‐related QoL, psychological distress and self‐esteem interact in a sample of individuals with neurofibromatosis type 1 (NF1). Methods: Seventy‐two adult patients with NF1 completed the following questionnaires: Coping Orientation to Problem Experiences (COPE), Skindex‐29, Padua Skin‐Related QoL questionnaire (PSRQ), State–Trait Anxiety Inventory‐X2 form (STAI‐X2), Depression Questionnaire (DQ) and Rosenberg Self‐Esteem Scale (RSES). The k‐modes algorithm was used to identify clusters of patients based on four variables: sex, NF1 severity, number and distribution of cutaneous neurofibromas. Individuals in different clusters were compared with regard to their scores; correlations between scores were analysed within each cluster. Results: Two main clusters were identified: individuals in Cluster 1 had a larger number and more widespread distribution of neurofibromas compared with Cluster 2. Patients in Cluster 1 scored higher only on several PSRQ and Skindex‐29 scales. Among patients in Cluster 1, the COPE 'avoidance strategies' scale was significantly correlated with the PSRQ 'physical distress and impairments' scale, the Skindex‐29 'physical symptoms' and 'functioning' scales, the STAI‐X2, the DQ and the RSES. Conclusions: Patients with major skin involvement have reduced skin‐related QoL. Among them, current findings tentatively suggest that the higher the use of dysfunctional coping, the more impaired are QoL, psychological distress and self‐esteem. What's already known about this topic? Neurofibromatosis type 1 (NF1) can affect the quality of life (QoL) in adolescent and adult patients.Low skin‐related QoL is usually associated with low levels of self‐confidence and self‐esteem and with high levels of anxiety and depression symptoms.Questionnaires evaluating skin‐related QoL, anxiety, depression, self‐esteem and coping are available. What does this study add? Patients with a large number and a widespread distribution of cutaneous neurofibromas have reduced skin‐related QoL compared with patients with minor skin involvement.The newly developed Padua Skin‐Related QoL questionnaire allows the simultaneous evaluation of discomfort and comfort skin‐related QoL dimensions in patients with NF1.Among patients with major skin involvement, the higher the use of dysfunctional coping, the more impaired are skin‐related QoL, psychological distress and self‐esteem.Our data suggest that patients with NF1 with major skin involvement who endorse dysfunctional beliefs about their own coping abilities might benefit from psychological counselling and coping skills treatments aiming to both improve perceived self‐efficacy and learn more adaptive coping strategies. [ABSTRACT FROM AUTHOR]

Understanding which product attributes influence the most consumer evaluation is central in marketing research. In particular, comprehension of niche market has become of fundamental importance to survive in modern open markets. Functional measurement techniques have been shown to be useful in identifying the cognitive rules underlying the integration of different product attributes. Based on this rationale, an analysis on footwear and shoe market was carried out. Potential buyers of a target product were presented with different profiles created by manipulating design, brand and price, and their preferences were recorded. Functional measurement and cluster analysis techniques were employed to identify patterns in cognitive behavior. [ABSTRACT FROM AUTHOR]

The research is to assess how far a Honda Riding Trainer (HRT) simulator could improve hazard perception skills and awareness in teenagers. Previous studies have verified that participants performing a complete riding training show a clearly visible learning process and improvement in their performance in avoiding accidents significantly more than participants of the control group [12]. The aim of this research is to test whether different kinds of training yield the same improvement in avoiding accidents. Four hundred and thirteen participants were involved in the research. Participants were randomly assigned in either Experimental Group (EG, 207) or Control Group (CG. 203). The CG was composed the four CGs (CG1: 47 subjects; CG2: 50 subjects; CG3: 57 subjects; CG4: 49 subjects). A quasi-Solomon experimental design was implemented: participants of the EG performed a complete training composed by two tracks for the pre-test, eight tracks of training and two tracks for the post test. Different kinds of training were submitted to the four CGs. Results at post-test show a significantly lower performance in avoiding hazards of all the CGs compared to the EG. [ABSTRACT FROM AUTHOR]

Aim. Our paper presents an instrument for recognising the psychological problems of caregivers: the short form of a previously validated questionnaire, the Family Strain Questionnaire. Background. Individuals caring for chronic patients frequently suffer from psychological problems, which are underestimated by medical professionals and, consequently, are not adequately treated. Therefore, clinical nurses, general practitioners and the members of home care teams have to recognise the psychological problems of caregivers. To do so, they need to quickly measure the problem's severity quickly and track it over time, without a specific training in psychological diagnosis. Design. Survey. Method. Principal caregivers ( n = 811) completed the Family Strain Questionnaire in its original form (semi-structured interview plus 44 dichotomous items, administrable in about 20 minutes), aimed at investigating the subjective perception of emotional burden, problems in social involvement, the need for more information about the disease, satisfaction with family relationships and thoughts about death. Data were analysed using the Rasch model for the reduction of items. Thirty items were selected and reanalysed in a new sample of 40 caregivers. Results. The thirty items selected showed very good fit statistics and maintained the diagnostic qualities of the original form. They thus compose the Family Strain Questionnaire - Short Form that caregivers can complete in about five minutes. This brief measure can indicate the severity of stress and allows categorisation of caregivers by psychological risk, which is also represented by a graphic tool. Conclusion. This study confirms that the Family Strain Questionnaire - Short Form offers an initial measure of caregivers' psychological status, regardless of the patient's disease and allows professionals to monitor it over time with a rapid and effective instrument. Relevance to clinical practice. Clinical nurses, general practitioners and homecare teams should find the Family Strain Questionnaire - Short Form useful for assessing caregiving strain. The instrument is quick and easy to use and does not require any sophisticated psychological training. [ABSTRACT FROM AUTHOR]