Psychometric evaluation of three versions of the Italian Perceived Stress Scale

Online Short-Term Mindfulness-Based Intervention During COVID-19 Quarantine in Italy: Effects on Wellbeing, Stress, and Anxiety

To limit the first spread of COVID-19 in March 2020, the Italian government imposed strict lockdown measures to the population. Despite necessary to reduce the virus transmission and the burden to the hospitals, social isolation has caused detrimental effects on psychological wellbeing and mental health. Moreover, during this period, it was also difficult to deliver psychological treatments and psychiatric assistance. A short (a weekly session for 9 weeks) mindfulness-based meditation program, named Integral Meditation (IM), was administered entirely online to healthy adults from Italy. This is a two-groups pre–post-quasi-experimental study in which the two groups, treated and control, were not randomized. Through matching procedures aimed at overcoming the absence of randomization, we analyzed a sample of 84 subjects (42 for each group). By applying linear mixed effect models, we tested the hypothesis of a beneficial effect of IM on wellbeing, perceived stress, and state anxiety, as measured by three self-reported questionnaires (WEMWBS, PSS, and STAI-X1, respectively), assuming that this effect could be different according to the level of baseline trait anxiety, as measured by STAI-X2. The results showed a statistically significant effect of STAI-X1 (β = −8.24 [95%CI −15.39; −1.09], p = 0.02) and WEMWBS (β = 4.61 [95%CI 0.94; 8.29], p = 0.01) in the higher trait anxiety subgroup only. No statistically significant effect of IM was observed for PSS. These results suggest that our IM, delivered online, may increase mental wellbeing and decrease anxiety specifically in subjects with higher trait anxiety.

The behavioral immune system in action: Psychological correlates of pathogen disgust sensitivity in healthcare professionals working in a COVID-19 hospital

The behavioral immune system includes a set of proactive mechanisms that inhibit contact with pathogens in the first place. These mechanisms offer a sort of psychological and behavioral prophylaxis against infection. The aim of this study was to assess the functionality of the behavioral immune system under conditions of strong ecological validity. Our hypothesis was that the emotional and more primitive component of the behavioral immune system (i.e. pathogen disgust sensitivity) acts as a powerful predictor of fear of infection. The sample was made up of 101 healthcare professionals working in a COVID-19 hospital when vaccination was not yet available. We conducted a hierarchical regression analysis to assess the role of germ-related disgust in modulating levels of fear. After controlling for the significant effects of depressive symptoms and exposure to people with a confirmed diagnosis of COVID-19, we found that fear of infection was more intense in those healthcare workers who reported higher levels of germ-related disgust. Fear of infection was not related to perceived infectability, an individual variable informed by more rational cognitive appraisals. These findings show that, even in healthcare workers who can take advantage of their professional knowledge and acquired skills for rational appraisals, the most primitive component of the behavioral immune system still plays a major role in eliciting fear of COVID-19. It is likely that the psychological reactions elicited by the behavioral immune system promote preventive health behaviors in modern environments as well.

The Effects of Mindfulness-Based Strategies on Perceived Stress and Psychobiosocial States in Athletes and Recreationally Active People

The mindfulness-based stress reduction (MBSR) programme is gaining increasing attention in sport and physical activity domains. This programme comprises three meditation practices: mindful yoga, body scan, and sitting meditation. In this study, we aimed to examine the effects of a dynamic (mindful yoga) strategy and a static (a combination of body scan/sitting meditation) strategy on participants’ psychobiosocial states (PBS), perceived stress (PS) and mindfulness levels in athletes and recreationally active (RA) people. Thirty-four participants (athletes = 18; RA participants = 16) were assigned to a dynamic intervention strategy, and another 34 (athletes = 19; RA participants = 15) were assigned to the static intervention strategy. Before the intervention, after the intervention and three weeks later, the Italian versions of the PBS scale, the PS scale and the Mindful Attention Awareness scale were administered. RM-(M)ANOVAs revealed that intervention strategies improved functional PBS, reduced PS and enhanced mindfulness levels in both athletes and RA participants after the intervention (p < 0.001, ηp2 = 0.605). However, improved functional PBS after the intervention (p < 0.001; d = 0.62) and stable PS levels at follow-up (p = 1) were observed mainly in athletes. The findings reinforce the view of the importance of the body as a means to improve emotional and health processes, and support the use of mindfulness strategies in sport to enhance individuals’ well-being.

Heart Rate Fractality Disruption as a Footprint of Subthreshold Depressive Symptoms in a Healthy Population

OBJECTIVE

Psychopathology (and depression in particular) is a cardiovascular risk factor independent from any co-occurring pathology. This link is traced back to the mind-heart-body connection, whose underlying mechanisms are still not completely known. To study psychopathology in relation to the heart, it is necessary to observe the autonomic nervous system, which mediates among the parts of that connection. Its gold standard of evaluation is the study of heart rate variability (HRV). To investigate whether any association exists between the HRV parameters and sub-threshold depressive symptoms in a sample of healthy subjects.

METHOD

In this cross-sectional study, two short-term HRV recordings (5 min - supine and sitting) have been analyzed in 77 healthy subjects. Here we adopted a three-fold approach to evaluate HRV: a set of scores belonging to the time domain; to the frequency domain (high, low, and very low frequencies) and a set of 'nonlinear' parameters. The PHQ-9 (Patient Health Questionnaire-9) scale was used to detect depressive symptoms.

RESULTS

Depressive symptoms were associated only with a parameter from the non-linear approach and specifically the long-term fluctuations of fractal dimensions (DFA-α2). This association remained significant even after controlling for age, gender, BMI (Body-Mass-Index), arterial hypertension, anti-hypertensive drugs, dyslipidemia, and smoking habits. Moreover, the DFA-α2 was not affected by the baroreflex (postural change), unlike other autonomic markers.

CONCLUSIONS

Fractal analysis of HRV (DFA-α2) allows then to predict depressive symptoms below the diagnostic threshold in healthy subjects regardless of their health status. DFA-α2 may be considered as an imprint of subclinical depression on the heart rhythm.

Semantic Self-Images and Well-Being in Young and Older Adults: Does the Accessibility Matter?

In the present study we investigated whether and how age group, dimensions of well-being and their interactions predicted the phenomenological properties of semantic self-images, taking also into account the different levels of accessibility of self-images (i.e., order of generation). Results on the first self-image revealed that, independently of age, higher levels of life satisfaction predicted higher likelihood of positive than negative statement and higher levels of negative affect and life satisfaction predicted higher levels of personal relevance of the self-image. When all self-images were considered, for higher levels of life satisfaction neutral and positive self-images were more likely than negative ones, and for lower levels of positive affect, neutral images were more likely than negative ones. Moreover, young adults were more likely than older adults to report neutral rather than negative self-images and, for higher levels of positive affect, they were more likely to report neutral and positive images instead of negative ones. These results suggest that the accessibility of semantic self-images should be taken into account in the investigation of the complex association between well-being and semantic self-images. Theoretical and practical implications of these results are discussed.

Diurnal dynamics of stress and mood during COVID-19 lockdown: a large multinational ecological momentary assessment study

The COVID-19 pandemic resulted in severe disruption to people's lives as governments imposed national 'lockdowns'. Several large surveys have underlined the detrimental short- and long-term mental health consequences resulting from this disruption, but survey findings are only informative of individuals' retrospectively reported psychological states. Furthermore, knowledge on psychobiological responses to lockdown restrictions is scarce. We used smartphone-based real-time assessments in 731 participants for 7 days and investigated how individuals' self-reported stress and mood fluctuated diurnally during lockdown in spring 2020. We found that age, gender, financial security, depressive symptoms and trait loneliness modulated the diurnal dynamics of participants' momentary stress and mood. For example, younger and less financially secure individuals showed an attenuated decline in stress as the day progressed, and similarly, more lonely individuals showed a diminished increase in calmness throughout the day. Hair collected from a subsample (n = 140) indicated a decrease in cortisol concentrations following lockdown, but these changes were not related to any of the assessed person-related characteristics. Our findings provide novel insights into the psychobiological impact of lockdown and have implications for how, when and which individuals might benefit most from interventions during psychologically demanding periods.

Measuring Italian Resilience

Abstract. The Essential Resilience Scale (ERS) measures global trait resilience and three factors of physical, emotional, and social resilience. This study developed an Italian adaptation of the ERS and recruited participants from Italy ( N = 500) to complete the measure along with criterion validity measures of broad personality traits and related psychological concepts. Confirmatory factor analysis (CFA) demonstrated robust evidence for a well-fitting three-factor model of the ERS, with items strongly loading onto their respective latent factors. Utilizing Samejima’s graded response model, most item discrimination values were moderate-to-high, and category threshold parameters were well-distributed throughout the latent continuum. The ERS showed correlations in the expected directions with extraversion, emotionality, optimism, mastery, resilience, behavioral activation, behavioral inhibition, stress, and well-being. Cultural invariance was supported (at the scale- and item-level) with multigroup CFA and differential item functioning (DIF) with a sample of Canadian English speakers ( N = 874). Findings evinced the internal consistency (i.e., total MacDonald’s ω), factorial validity (i.e., three-factor CFA), criterion validity (i.e., personality, temperament), and convergent validity (i.e., trait resilience and well-being) of the Italian ERS. Results suggest the Italian ERS can be applied for measuring resilience for future research studies in Italian-speaking populations.

Positive personal resources and psychological distress during the COVID-19 pandemic: resilience, optimism, hope, courage, trait mindfulness, and self-efficacy in breast cancer patients and survivors

Purpose

This study aims to understand the association between positive personal resources (i.e., optimism, hope, courage, trait mindfulness, and self-efficacy), resilience, and psychological distress (i.e., anxiety, depression, stress) in women with breast cancer and breast cancer survivors during the COVID-19 pandemic. We hypothesized that personal positive resources can directly influence resilience, which in turn prevented psychological distress.

Methods

The research sample consisted of 409 Italian women (49% patients, 51% survivors) who were administered a questionnaire to assess positive resources, resiliency, and distress. structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model.

Results

Personal positive resources had a direct positive effect on resilience, which prevented from distress. These results were observed across cancer patients and survivors, and regardless the level of direct exposure to COVID-19.

Conclusions

In both patients and survivors, the relationships between positive personal resources, resilience, and psychological distress is strong enough to be not influenced by the level of exposure to COVID-19 and despite COVID-19 pandemic caused the disruption of active treatment plans and delays in routine check-ups.

Implications for cancer survivors

Implications of this study suggest the urgency to screen positive resources and to identify women with lower resilience and a potentially higher susceptibility to develop psychological distress. For these women, our findings suggest the implementation of psychological interventions that build resilience.

The Role of Stress and Cognitive Absorption in Predicting Social Network Addiction

Nowadays, the use of social networks (SNs) is pervasive and ubiquitous. Among other things, SNs have become a key resource for establishing and maintaining personal relationships, as further demonstrated by the emergence of the pandemic. However, easy access to SNs may be a source of addictive behaviour, especially among the younger population. The literature highlights various psychological and physiological factors as possible predictors of vulnerability to SN addiction. This paper explores the joint effects of stress level and cognitive absorption, in the form of temporal dissociation while on SNs, on the addiction of university students to SNs. Here, 312 participants were involved in an online survey. About 14% of the sample presented a risk for SN addiction. Moreover, it was found that stress level predicted SN addiction both directly and indirectly through the effect of individual temporal dissociation, as experienced during SN usage. These results suggest a significant role of perceived stress level on addiction risk, while also pointing out additional vulnerability to SN addiction for cognitive profiles that are relatively more prone to temporal dissociation while online.

Assessment of Subjective Well-Being in a Cohort of University Students and Staff Members: Association with Physical Activity and Outdoor Leisure Time during the COVID-19 Pandemic

Time spent outdoors and physical activity (PA) promote mental health. To confirm this relationship in the aftermath of COVID-19 lockdowns, we explored individual levels of anxiety, depression, stress and subjective well-being (SWB) in a cohort of academic students and staff members and tested their association with sport practice, PA at leisure time and time spent outdoors. Our cross-sectional study collected data during the COVID-19 outbreak (April−May 2021) on 939 students and on 238 employees, who completed an online survey on sociodemographic and lifestyle features, depression, anxiety, stress, and SWB. Results showed that the students exhibited higher levels of anxiety, depression, and stress, and lower levels of SWB (p < 0.001 for all domains) compared to the staff members. Correlation analysis confirmed that PA and time spent in nature were associated to high mental health scores among staff and, more consistently, among students. Finally, mediation analyses indicated that the time spent in nature, social relationships, and levels of energy play a mediator role in the relationship between sport practice and SWB. Our evidence reinforces the protective role of time spent in nature in improving mental health, and provides support for policymakers to make appropriate choices for a better management of COVID-19 pandemic consequences.

Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study

Background

One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students’ mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students.

Objective

The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study–related factors affecting or acting as a covariate during the COVID-19 lockdown.

Methods

Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study.

Results

The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F₂=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students’ negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings.

Conclusions

The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE.

Early Detection of Cardiovascular Risk Factors and Definition of Psychosocial Profile in Women Through a Systematic Approach: The Monzino Women Heart Center's Experience

Introduction

Cardiovascular (CV) disease is the leading mortality cause among women, yet an alarming misrepresentation of women in CV studies and a low awareness of the impact of CV among women still persist to date. The Monzino Women Heart Center has been established as a clinical and research program dedicated to primary prevention of CV disease in women.

Methods

Patients aged between 35 and 60 years and with no history of CV disease underwent a comprehensive evaluation including a cardiologic outpatient visit with electrocardiogram, individual CV risk calculation, first-level cardiovascular examinations and a psychological assessment.

Results

A total of 635 women, with a mean age of 52.2 ± 6.4 participated to the project on a voluntary basis during the period January 2017–August 2021. Included patients had a high level of education (40.4% with a graduate or postgraduate university degree), the majority of them, in a stable couple and with children, were actively working. More than half of the patients performed physical activity on a regular basis. Prevalence of traditional CV risk factors were family history (70.2%), hypertension (46%), hypercholesterolemia (22%) and diabetes (14%). Early or premature menopause was reported by 17.7% of the patients, gestational hypertension and diabetes by 4.96 and 1.7%, respectively. Symptoms of depression were reported by 27%; nearly 36% of the participants rated high score of state anxiety and 41% of trait anxiety. Nearly 69% of the participants showed moderate-to-high perceived stress. The mean value of perceived general self-efficacy was moderate (mean = 28.78, SD = 4.69).

Conclusion

A CV prevention program dedicated to women can help identifying a considerable number of patients with risk factors for whom early interventions can help reducing the risk of developing CV disease. Psychological assessment might unmask depression or anxiety disorders, which might have a potential long-terme detrimental effect on CV health.

Sleep Quality and Its Associations with Physical and Mental Health-Related Quality of Life among University Students: A Cross-Sectional Study

The association between sleep problems and quality of life has been well documented and the COVID-19 pandemic seemingly had an impact on both sleep quality and health-related quality of life (HRQoL). However, recent evidence about this relationship among university students is limited. The aims of this study are to investigate the prevalence of poor sleep quality and insomnia and to explore the associations between these outcomes, perceived stress, and HRQoL among Italian university students. An anonymous questionnaire comprising the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Short Form-12 health survey, and the Perceived Stress Scale was administered to a convenience sample of 1279 students (1119 females and 160 males, mean age: 23.4 ± 2.5 years) attending one of the largest Italian universities. A total of 65% of the participants showed poor sleep quality, whereas 55% reported insomnia symptoms. Students reporting poor sleep quality and insomnia obtained higher perceived stress scores and lower physical and mental HRQoL scores. Controlling for health-related variables and perceived stress, hierarchical regression analyses showed that sleep quality components added a significant contribution to the prediction of both physical (ΔR² = 0.1) and mental (ΔR² = 0.02) HRQoL. As a whole, these findings confirm the relevance of sleep for university students’ well-being and might inform the development of health promotion interventions for this population.

Impact of physical activity on response to stress in people aged 65 and over during COVID-19 pandemic lockdown

BACKGROUND

The outbreak of the COVID-19 pandemic has negatively affected the lives of many people. In particular, restrictions of physical activity (PA) due to pandemic-related lockdown have impacted their psychological status. The aim of this work was to investigate the relationship between PA habits, before the pandemic and during the lockdown, and responses to stress due to home isolation during the lockdown, in older people.

METHODS

To this aim, an online survey addressed to people aged 65 years and over was conducted during the first pandemic wave in Italy (Study 1). To explore the effect of PA restrictions on responses to stress over time, the survey was replicated during the second wave (Study 2). A group of 72 and 43 participants, from 65 to 88 years, completed the two studies, respectively. The survey required the completion of the International Physical Activity Questionnaire, and of two questionnaires on stress response, namely, the Impact of Event Scale-Revised and the Perceived Stress Scale. The correlation between the questionnaires' scores was examined.

RESULTS

Study 1 demonstrated that higher levels of PA during the lockdown, related to working and walking activities, were associated with fewer stress-related symptoms and lower stress perception. In parallel, greater reduction of PA, during lockdown compared to the pre-pandemic period, was associated with more stress-related symptoms. People who spent more time at rest (sitting) before and during the pandemic lockdown were those who showed higher psychological impact. Study 2 confirmed the benefits of maintaining working activities during lockdown, but also showed that during the second pandemic wave people were more resilient to PA restrictions and home isolation, even if conducting a sedentary lifestyle.

CONCLUSIONS

Maintaining good levels of PA during lockdown was a protective factor against developing stress-related symptoms in older people. On the other hand, more resilient response to stress emerged in this population during the second wave.

University Teachers During the First Lockdown Due to SARS-CoV-2 in Italy: Stress, Issues and Perceptions of Misconduct

With the spread of the pandemic and the introduction of measures aimed at its containment, it is necessary to understand in specific national contexts how home quarantine has affected the psychophysical well-being of academics, and their ability to maintain integrity. To this end we constructed an online questionnaire to investigate the levels of stress, well-being, and work-life balance in relationship with living and working conditions. Moreover, the questionnaire was designed to obtain information about the perceived occurrence, increase or decrease of misconduct in research (e.g., research misconduct by colleagues) and professional relationships (e.g., misbehaviors between colleagues, from students and toward students). The questionnaire was administered online by contacting faculty at three universities in Tuscany, Italy, asking them to relate their experience during the first lockdown (March-May 2020). Faculty members were invited to complete the questionnaire by their institutional e-mail account. The final sample consisted of 581 respondents. The results showed that inadequacies of the equipment, and particularly poor internet connection, were significantly correlated with main issues reported, such as relationships with students and research activities. Female teachers primarily suffered from stressful conditions, lacked well-being, and experienced work-life imbalance. Stress levels were related to perceptions of the frequency of misconduct and of an increase in their frequency during the period of home quarantine. Female professors, when compared to their male counterparts, perceived misconduct from students as increased and more frequent in the period of quarantine. Results point to a gender issue that is likely to arise from conditions of domestic activities imbalance and that increases stress and misconduct perception.

Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was to investigate if post-recovery TTS and ACS patients present different psychological profiles. We also investigated whether the occurrence of acute psychological stressful episodes that had occurred prior to the cardiac event could be found in either syndrome. Twenty TTS and twenty ACS female patients were recruited. All patients completed self-report questionnaires about anxiety and depressive symptoms, perceived stress, type-D personality and post-traumatic symptoms. Results showed that only three subscales of health anxiety (i.e., Fear of Death/Diseases, Interference and Reassurance) significantly differed between the two groups, while no differences were found in the other psychological measurements. Moreover, personality traits seem to not be associated with the impact of the cardiac traumatic event. Finally, only TTS patients reported the presence of a significant emotional trigger preceding the acute cardiac event. In conclusion, post-recovery TTS patients differ from ACS patients in their level of concern about their health and in their need of reassurance and information only, probably as a result of the different clinical characteristics of the two illnesses.

Well-being, Perceived Stress and Their Relations with Health-Relevant Behaviours Among Italian Medical Students: a Cross-Sectional Study at Sapienza University of Rome

Medical education is widely known to be demanding and stressful, with elevated levels of anxiety and depression among medical students. This study aims at examining well-being, perceived stress and quality of life in a sample of Italian first-year medical students in order to investigate the relations between these variables and individual characteristics and behaviours. An anonymous cross-sectional questionnaire was administered to a sample of 407 Italian first-year medical students. Psychological well-being, perceived stress and quality of life were assessed using standardised questionnaires PGWBI, PSS, SF-12. Data were analysed with multivariate statistical methods. Significant differences in PGWBI, PSS and SF-12 scores were found between males and females (with poorer scores for females), between smokers and non-smokers (with poorer scores for smokers) and between students who reported cannabis use in their lifetime and students who did not (with poorer scores for those who smoked cannabis). Logistic regression showed that gender (OR 0.38, 95% CI 0.24–0.61), reported cannabis use (OR 1.82, 95% CI 1.07–3.09) and regular physical exercise (OR 0.54, 95% CI 0.34–0.86) were significant predictors of distress. In summary, this study shows that female medical students and students who reported negative health behaviours and sporadic drug use reported lower psychological well-being and quality of life and higher stress, while positive health behaviours might prevent distress.

Psychological Support for Family Caregivers of Patients With Amyotrophic Lateral Sclerosis at the Time of the Coronavirus Disease 2019 Pandemic: A Pilot Study Using a Telemedicine Approach

The coronavirus disease 2019 (COVID-19) pandemic confined most of the population to homes worldwide, and then, a lot of amyotrophic lateral sclerosis (ALS) centers moved to telemedicine services to continue to assist both patients with ALS and their caregivers. This pilot, randomized, controlled study aimed to explore the potential role of psychological support interventions for family caregivers of patients with ALS through resilience-oriented sessions of group therapy during the COVID-19 pandemic. In total, 12 caregivers agreed to be remotely monitored by our center since March 2020 and underwent scales for global burden (i.e., Caregiver Burden Inventory, CBI), resilience (i.e., Connor Davidson Resilience Scale, CD-RISC), and perceived stress (i.e., Perceived Stress Scale, PSS) at two-time points (i.e., at pre-treatment assessment and after 9 months or at post-treatment assessment). They were randomized into two groups: the former group underwent resilience-oriented sessions of group therapy two times a month for 3 months, while the latter one was only remotely monitored. No significant differences were found in CBI, CD-RISC, and PSS during the 9-month observation period in the treated group compared with the control group, suggesting a trend toward stability of caregiver burden together with resilience and perceived stress scores in all the subjects monitored. The lack of differences in caregivers' burden, resilience, and perceived stress scores by comparing the two groups monitored during 9 months could be due to the co-occurrence of the COVID-19 pandemic with the stressful events related to caring for patients with ALS that might have hindered the detection of significant benefits from short-lasting psychological support.

Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association

OBJECTIVE

The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS).

METHODS

Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS).

RESULTS

Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms.

CONCLUSION

The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.

How COVID-19 Has Affected Caregivers' Burden of Patients with Dementia: An Exploratory Study Focusing on Coping Strategies and Quality of Life during the Lockdown

COVID-19 has caused a public and international health emergency, leading to isolation and social distancing. These restrictions have had a significant impact on the caregivers of people with dementia, increasing the burden of patient management. The purpose of this study was to investigate the stress perceived by caregivers of patients with Alzheimer’s disease (AD) during the pandemic. We used a cross-sectional survey design to evaluate the caregivers’ psychological responses and coping strategies. Eighty-four caregivers of patients with a diagnosis of AD were involved in this study by completing an online questionnaire. They presented a high perception of stress (the Perceived Stress Scale mean ± DS: 33.5 ± 4.5), and their high burden in caring was mainly related to physical difficulties (Caregiver Burden Inventory–Physical Burden mean ± DS: 15.0 ± 2.1) and perception of loss of time (Caregiver Burden Inventory–Time-dependence Burden mean ± DS: 16.5 ± 1.4). Moreover, caregivers perceived their quality of life as very low (Short Form-12 Health Survey Physical mean ± DS: 13.5 ± 2.7; Short Form-12 Health Survey Mental Health mean ± DS: 16.4 ± 4.2). Finally, we found that participants mostly used dysfunctional coping strategies, such as avoidance strategies (Coping Orientation to Problem Experiences–Avoidance Strategies mean ± DS: 39.5 ± 7.1), but these strategies did not affect the stress level of caregivers. Given that caregivers present a high burden and stress, innovative tools could be a valuable solution to investigate and support their emotional and behavioral status during difficult periods, such as the COVID-19 pandemic.

Impact of Perceived Stress and Immune Status on Decision-Making Abilities during COVID-19 Pandemic Lockdown

The ability to make risky decisions in stressful contexts has been largely investigated in experimental settings. We examined this ability during the first months of COVID-19 pandemic, when in Italy people were exposed to a prolonged stress condition, mainly caused by a rigid lockdown. Participants among the general population completed two cognitive tasks, an Iowa Gambling Task (IGT), which measures individual risk/reward decision-making tendencies, and a Go/No-Go task (GNG), to test impulsivity, together with two questionnaires, the Perceived Stress Scale and the Depression, Anxiety and Stress Scales. The Immune Status Questionnaire was additionally administered to explore the impact of the individual health status on decision making. The effect of the questionnaires scores on task performance was examined. The results showed that higher levels of perceived stress and a more self-reported vulnerable immune status were associated, separately, with less risky/more advantageous choices in the IGT in young male participants but with more risky/less advantageous choices in older male participants. These effects were not found in female participants. Impulsivity errors in the GNG were associated with more anxiety symptoms. These findings bring attention to the necessity of taking into account decision-making processes during stressful conditions, especially in the older and more physically vulnerable male population.

Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis

Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate psychological stress, anxiety, depression and salivary cortisol in psoriatic patients. A cross sectional study involving 126 adult patients with plaque psoriasis and 116 adult healthy controls was conducted. Demographic, clinical data, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were collected. Cases and controls were asked whether they felt stressed in the last month, whilst psoriatic patients were also interrogated whether they found that psoriasis could have been worsened by stress. Moreover, 54 randomly selected subjects (27 psoriasis patients and 27 controls) underwent salivary cortisol testing at 8 am. PSS, HADS depression and anxiety subscales were significantly higher in psoriatic patients than in controls (17.2 ± 0.6 vs. 15.1 ± 0.8 p = 0.0289), (9.5 ± 0.3 vs. 6.2 ± 0.3 p < 0.001) and (8.2 ± 0.4 vs. 4.2 ± 0.3 p < 0.001), respectively. A higher rate of psoriatic patients reported feeling stress over the last month (45% vs. 19%, p < 0.001), and stress was considered a potential trigger for psoriasis flare-ups in 69% of cases. Psoriasis was strongly associated with higher PSS and HADS scores independently of sex, body mass index, diabetes, hypertension, dyslipidemia, and occupational status. Salivary cortisol was significantly lower in psoriatic patients compared to controls (9.6 ± 0.5 vs. 14.0 ± 1.1 nmol/L, p < 0.001). In conclusion, psoriasis was associated with higher psychological stress, anxiety and depressive symptoms, and with impaired cortisol response to stress.

Don't Call It Smart: Working From Home During the Pandemic Crisis

The recent COVID-19 pandemic and related social distancing measures have significantly changed worldwide employment conditions. In developed economies, institutions and organizations, both public and private, are called upon to reflect on new organizational models of work and human resource management, which - in fact - should offer workers sufficient flexibility in adapting their work schedules remotely to their personal (and family) needs. This study aims to explore, within a Job Demands-Resources framework, whether and to what extent job demands (workload and social isolation), organizational job resources (perceived organizational support), and personal resources (self-efficacy, vision about the future and commitment to organizational change) have affected workers’ quality of life during the pandemic, taking into account the potential mediating role of job satisfaction and perceived stress. Using data from a sample of 293 workers, we estimate measurement and structural models, according to the Item Response Theory and the Path analysis frameworks, which allow us to operationalize the latent traits and study the complex structure of relationships between the latent dimensions. We inserted in the model as control variables, the socio-economic and demographic characteristics of the respondents, with particular emphasis on gender differences and the presence and age of children. The study offers insights into the relationship between remote work and quality of life, and the need to rethink human resource management policies considering the opportunities and critical issues highlighted by working full-time remotely.

The Differential Impact of COVID-19 Lockdown on Sleep Quality, Insomnia, Depression, Stress, and Anxiety among Late Adolescents and Elderly in Italy

The restraining measures due to the COVID-19 outbreak deeply affected the general population's sleep health and psychological status. The current literature proposes young and older people as two particularly at-risk groups. However, the differential impact of the lockdown period in these specific age categories needs to be disentangled. Through a web-based survey adopting validated questionnaires, we evaluated and compared sleep quality/habits, insomnia, perceived stress, depression, and anxiety symptoms of Italian late adolescents (n = 670; mean age ± SD, 19.38 ± 0.74, 18-20 years) and elderly (n = 253; 68.18 ± 2.79, 65-75 years). Young respondents reported more severe insomnia symptoms, worse subjective sleep quality, longer sleep latency, higher daytime dysfunction, and a more prevalent disruption of sleep habits (bedtime, get-up time, nap) than the elderly. On the other hand, older participants showed shorter sleep duration, lower habitual sleep efficiency, and greater use of sleep medications. Finally, the younger population displayed higher levels of depression and perceived stress. Our findings indicate that the lockdown period had more pervasive repercussions on sleep and the mental health of late adolescents. The implementation of supportive strategies is encouraged for this vulnerable population group.

Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up

INTRODUCTION

The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival.

AIM

The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation.

METHODS

A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field).

RESULTS

The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status.

CONCLUSIONS

The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.

"Thinking About Thinking" in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition

Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.

Psychological Impact of COVID-19 on Parents of Pediatric Cancer Patients

The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study were to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and the level of stress, anxiety, and the child's quality of life perceived by the parents during the COVID-19 epidemic. The parents of 45 consecutive children with solid and hematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. A 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation found a significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlation between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.

Influence of COVID-19 pandemic on stress levels of urologic patients

Introduction

Several studies have shown the consequences of COVID-19 pandemic on perceived stress of different populations, but none of them analyzed urological patients who underwent elective surgery.

Methods

We enrolled prospectively patients who underwent elective surgery between March and October 2020. A survey on COVID-19 and the 4-item Perceived Stress Scale (PPS-4) questionnaire were administered at hospital admission. Demographic and medical history data were also collected. Uni- and multivariate analyses were performed to identify independent predictors of higher PSS-4 values (≥7).

Results

A total of 200 patients were enrolled. Mean PSS-4 value resulted 6.04. Patients with PSS-4 value ≥7 resulted 43.5% (87/200). In multivariate analysis, PSS-4 value ≥7 was independently associated (p < 0.05) with female gender (OR 6.42), oncological disease (OR 2.87), high (>5 in a range between 0 and 10) fear of intrahospital transmission of SARS-CoV-2 infection (OR 4.75), history of bladder instillation (OR 0.26), and current smokers (OR 0.27)

Conclusion

High PSS-4 values at hospital admission in urologic surgical patients are positively correlated with female gender, fear of intrahospital transmission of SARS-CoV-2 infection, and oncological disease. PSS-4 questionnaire could be useful to select patients for whom a preadmission counselling is necessary to improve the management of their high stress level.

Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic-A Multi-Group Path-Analysis

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs' interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks.

Three Versions of the Perceived Stress Scale: Psychometric Evaluation in a Nationally Representative Sample of Chinese Adults during the COVID-19 Pandemic

(1) Background: The COVID-19 outbreak has created pressure in people’s daily lives, further threatening public health. Thus, it is important to assess people’s perception of stress during COVID-19 for both research and practical purposes. The Perceived Stress Scale (PSS) is one of the most widely used instruments to measure perceived stress; however, previous validation studies focused on specific populations, possibly limiting the generalization of results. (2) Methods: This study tested the psychometric properties of three versions of the Chinese Perceived Stress Scale (CPSS-14, CPSS-10, and CPSS-4) in the Chinese general population during the COVID-19 pandemic. A commercial online survey was employed to construct a nationally representative sample of 1133 adults in Mainland China (548 males and 585 females) during a one-week period. (3) Results: The two-factor (positivity and negativity) solution for the three versions of the CPSS showed a good fit with the data. The CPSS-14 and CPSS-10 had very good reliability and the CPSS-4 showed acceptable reliability, supporting the concurrent validity of the CPSS. (4) Conclusions: All three versions of the CPSS appear to be appropriate for use in research with samples of adults in the Chinese general population under the COVID-19 crisis. The CPSS-10 and CPSS-14 both have strong psychometric properties, but the CPSS-10 would have more utility because it is shorter than the CPSS-14. However, the CPSS-4 is an acceptable alternative when administration time is limited.

A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.

The Impact of Parental Stress on Italian Adolescents' Internalizing Symptoms during the COVID-19 Pandemic: A Longitudinal Study

The challenges and consequences of COVID-19 imposed massive changes in adolescents' daily routines (e.g., school closures, home confinement, and social distancing rules), which impacted their mental health. This longitudinal study aimed to better understand the changes in adolescents' internalizing symptoms and the underlying mechanisms of parental stress due to COVID-19. We asked 1053 parents of adolescents to complete an online survey during the second and fifth weeks and at the end of home confinement (i.e., four weeks later). Results showed that parents reported their adolescents' anxiety and depression symptoms were more severe at Time 2 than at the first administration. Anxiety symptoms slightly decreased at Time 3, while there was no significant change in depression symptoms. Moreover, parents' expressive suppression mediated the association between parental stress and adolescents' anxiety and depression symptoms, respectively. The findings suggest that as restriction increased, adolescents' anxiety and depression became more severe. Moreover, due to the link between parental stress and adolescents' internalizing disorders helping families to cope with the distress due to the pandemic may have a positive impact on parents, the child, and the family as a whole (i.e., the family climate).

"Stay at Home" in Italy during the COVID-19 Outbreak: A Longitudinal Study on Individual Well-Being among Different Age Groups

The restrictions imposed by the Italian government because of the coronavirus outbreak have been shown to be demanding on the Italian population. Data were collected at four different time points from 29 March 2020 to 3 May 2020 and during the final follow-up survey on 12 October 2020. In the present study, we provided longitudinal evidence on the relationship between the lockdown and mental health dimensions, such as emotional state, perceived stress, and time perspective, for three age groups. The results allowed us to observe their psychological status from different perspectives at five different time points. Notably, a negative effect of the lockdown individual well-beings emerged as a trend, and differences in individual adaptation strategies to a prolonged stressful situation were observed at the follow-up. Indeed, pairwise comparisons between age groups showed that the young adult group (18-23 years old) seemed to be the most psychologically affected by the lockdown. The findings are discussed according to the most recent literature on the topic. To the best of our knowledge, this is one of the first longitudinal studies carried out in Italy concerning the general psychological effects of the coronavirus lockdown.

Demographic, psychological, chronobiological, and work-related predictors of sleep disturbances during the COVID-19 lockdown in Italy

The first COVID-19 contagion wave caused unprecedented restraining measures worldwide. In Italy, a period of generalized lockdown involving home confinement of the entire population was imposed for almost two months (9 March-3 May 2020). The present is the most extensive investigation aimed to unravel the demographic, psychological, chronobiological, and work-related predictors of sleep disturbances throughout the pandemic emergency. A total of 13,989 Italians completed a web-based survey during the confinement period (25 March-3 May). We collected demographic and lockdown-related work changes information, and we evaluated sleep quality, insomnia and depression symptoms, chronotype, perceived stress, and anxiety using validated questionnaires. The majority of the respondents reported a negative impact of confinement on their sleep and a delayed sleep phase. We highlighted an alarming prevalence of sleep disturbances during the lockdown. Main predictors of sleep disturbances identified by regression models were: female gender, advanced age, being a healthcare worker, living in southern Italy, confinement duration, and a higher level of depression, stress, and anxiety. The evening chronotype emerged as a vulnerability factor, while morning-type individuals showed a lower predisposition to sleep and psychological problems. Finally, working from home was associated with less severe sleep disturbances. Besides confirming the role of specific demographic and psychological factors in developing sleep disorders during the COVID-19 pandemic, we propose that circadian typologies could react differently to a particular period of reduced social jetlag. Moreover, our results suggest that working from home could play a protective role against the development of sleep disturbances during the current pandemic emergency.

Personality and Lockdown: A Study on Italian Undergraduates During the COVID-19 Pandemic

The current study aimed at increasing our understanding of the psychological impact of the COVID-19 lockdown on undergraduate students, particularly with respect to the association between personality traits; defense mechanisms (DMs); depression, anxiety, and stress symptoms (DASSs); and compliance with the government recommended health measures. A sample of 1,427 Italian undergraduate students were administered the Personality Inventory for the DSM-5-Brief Form; the Defense Style Questionnaire-40; and the Depression, Anxiety and Stress Scale-21. Compliance with the COVID-19 behavioral recommendations was measured through a 10-item survey measure. Results showed that immature DMs and internalizing personality traits (i.e., detachment, negative affect, psychoticism) were risk factors of DASSs. Furthermore, subjects with higher levels of DASSs appeared less compliant with the health measures recommended by the Italian government. Experts may use these results to identify and subsequently support (via the Internet) young subjects at greater risk of mental health problems as a result of the COVID-19 pandemic.

Changes of evening exposure to electronic devices during the COVID-19 lockdown affect the time course of sleep disturbances

STUDY OBJECTIVES

During the coronavirus disease 2019 (COVID-19) lockdown, there was a worldwide increase in electronic devices' daily usage. Prolonged exposure to backlit screens before sleep influences the circadian system leading to negative consequences on sleep health. We investigated the relationship between changes in evening screen exposure and the time course of sleep disturbances during the home confinement period due to COVID-19.

METHODS

2,123 Italians (mean age ± standard deviation, 33.1 ± 11.6) were tested longitudinally during the third and the seventh week of lockdown. The web-based survey evaluated sleep quality and insomnia symptoms through the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. The second assessment survey inquired about intervening changes in backlit screen exposure in the two hours before falling asleep.

RESULTS

Participants who increased electronic device usage showed decreased sleep quality, exacerbated insomnia symptoms, reduced sleep duration, prolonged sleep onset latency, and delayed bedtime and rising time. In this subgroup, the prevalence of poor sleepers and individuals reporting moderate/severe insomnia symptoms increased. Conversely, respondents reporting decreased screen exposure exhibited improved sleep quality and insomnia symptoms. In this subgroup, the prevalence of poor sleepers and moderate/severe insomniacs decreased. Respondents preserving screen time habits did not show variations of the sleep parameters.

CONCLUSIONS

Our investigation demonstrated a strong relationship between modifications of evening electronic device usage and time course of sleep disturbances during the lockdown period. Monitoring the potential impact of excessive evening exposure to backlit screens on sleep health is recommendable during the current period of restraining measures due to COVID-19.

Effects of the Brain Wave Modulation Technique Administered Online on Stress, Anxiety, Global Distress, and Affect During the First Wave of the COVID-19 Pandemic: A Randomized Clinical Trial

This study aims to evaluate the effects of an innovative mind-body practice named the brain wave modulation technique (BWM-T) on stress, anxiety, global distress, and affect. The technique was administered online through a web-based video conferencing platform. The intervention started on week four of the first quarantine in Italy (week commencing 30th March 2020), for a duration of 4 weeks and ended before lockdown measures were loosened. 310 people participated in the study, mean age 28.73 years old (SD = 9.16), 77.8% women. Of these, about half were randomly assigned to the experimental group and the other half served as controls. Participants completed online psychological tests before and after the intervention. 266 people (144 experimental, 122 controls) completed the post-intervention tests. Consistent with our hypothesis, the study's findings indicate a reduction in the levels of stress, anxiety, global distress, and negative affect in the experimental group, compared to the control group. Moreover, the experimental group also showed higher levels of positive affect, compared to controls after the intervention. The present findings add to the current literature in suggesting that the BWM-T reduced stress not only when administered face-to face but also when administered online during the COVID-19 pandemic. Moreover, we also noted that the BWM-T has an effect on anxiety, global distress, and affect, which we had not investigated in previous studies.

Perceived Stress and Perceived Lack of Control of Spanish Education-Degree University Students: Differences Dependent on Degree Year, Basis for Admission and Gender

Stress in higher education students is an issue of growing concern, as stress impacts quality of life and has been linked to drop-out from higher education. The aim was to investigate how stress was related to how far along students were in their degree program, using the Spanish Perceived Stress Scale (PSS10). We expected 1) first-year education students to experience more perceived lack of control than second-year students, 2) second-year students to experience more perceived stress than first-year students. Participants were students in three university education-degree programs (N = 399). The psychometric properties of the Perceived Stress (PS) and Perceived Lack of Control (PLC) subscales were investigated using Rasch models. One item was eliminated from each subscale. The estimated interval-level Rasch scores were utilized for testing hypotheses with general linear models. Results showed a somewhat more complex pattern than predicted as interaction effects between degree year and gender and between degree year and basis for admission were found.

Sleeping under the waves: A longitudinal study across the contagion peaks of the COVID-19 pandemic in Italy

After the March–April 2020 coronavirus disease 2019 (COVID‐19) outbreak, a second contagion wave afflicted Europe in the autumn. The present study aimed to evaluate sleep health/patterns of Italians during this further challenging situation. A total of 2,013 Italians longitudinally participated in a web‐based survey during the two contagion peaks of the COVID‐19 outbreak. We investigated the risk factors for sleep disturbances during the second wave, and we compared sleep quality and psychological well‐being between the two assessments (March–April and November–December 2020). Female gender, low education, evening chronotype, being a high‐risk person for COVID‐19 infection, reporting negative social or economic impact, and evening smartphone overuse predicted a higher risk of poor sleep and insomnia symptoms during the second wave. Advanced age, living with a high‐risk person for COVID‐19 infection, and having a relative/friend infected with COVID‐19 before the prior 2 weeks were risk categories for poor sleep quality. Living with children, having contracted COVID‐19 before the prior 2 weeks, being pessimistic about the vaccine and working in healthcare, were risk factors for insomnia symptoms. The follow‐up assessment highlighted reduced insomnia symptoms and anxiety. Nevertheless, we found reduced sleep duration, higher daytime dysfunction, advanced bedtime and wake‐up time, and a shift to morningness, confirming the alarming prevalence of poor sleepers (~60%) and severe depression (~20%) in a context of increased perceived stress. The present study showed a persistent impact of the COVID‐19 pandemic on sleep and mental health. Large‐scale interventions to counteract the chronicity and exacerbation of sleep and psychological disturbances are necessary, especially for the at‐risk categories.

The Art of Happiness: An Explorative Study of a Contemplative Program for Subjective Well-Being

In recent decades, psychological research on the effects of mindfulness-based interventions has greatly developed and demonstrated a range of beneficial outcomes in a variety of populations and contexts. Yet, the question of how to foster subjective well-being and happiness remains open. Here, we assessed the effectiveness of an integrated mental training program The Art of Happiness on psychological well-being in a general population. The mental training program was designed to help practitioners develop new ways to nurture their own happiness. This was achieved by seven modules aimed at cultivating positive cognition strategies and behaviors using both formal (i.e., lectures, meditations) and informal practices (i.e., open discussions). The program was conducted over a period of 9 months, also comprising two retreats, one in the middle and one at the end of the course. By using a set of established psychometric tools, we assessed the effects of such a mental training program on several psychological well-being dimensions, taking into account both the longitudinal effects of the course and the short-term effects arising from the intensive retreat experiences. The results showed that several psychological well-being measures gradually increased within participants from the beginning to the end of the course. This was especially true for life satisfaction, self-awareness, and emotional regulation, highlighting both short-term and longitudinal effects of the program. In conclusion, these findings suggest the potential of the mental training program, such as The Art of Happiness, for psychological well-being.

Nature's Role in Supporting Health during the COVID-19 Pandemic: A Geospatial and Socioecological Study

The COVID-19 pandemic has brought about unprecedented changes to human lifestyles across the world. The virus and associated social restriction measures have been linked to an increase in mental health conditions. A considerable body of evidence shows that spending time in and engaging with nature can improve human health and wellbeing. Our study explores nature's role in supporting health during the COVID-19 pandemic. We created web-based questionnaires with validated health instruments and conducted spatial analyses in a geographic information system (GIS). We collected data (n = 1184) on people's patterns of nature exposure, associated health and wellbeing responses, and potential socioecological drivers such as relative deprivation, access to greenspaces, and land-cover greenness. The majority of responses came from England, UK (n = 993). We applied a range of statistical analyses including bootstrap-resampled correlations and binomial regression models, adjusting for several potential confounding factors. We found that respondents significantly changed their patterns of visiting nature as a result of the COVID-19 pandemic. People spent more time in nature and visited nature more often during the pandemic. People generally visited nature for a health and wellbeing benefit and felt that nature helped them cope during the pandemic. Greater land-cover greenness within a 250 m radius around a respondent's postcode was important in predicting higher levels of mental wellbeing. There were significantly more food-growing allotments within 100 and 250 m around respondents with high mental wellbeing scores. The need for a mutually-advantageous relationship between humans and the wider biotic community has never been more important. We must conserve, restore and design nature-centric environments to maintain resilient societies and promote planetary health.

The Influence of Personality, Resilience, and Alexithymia on Mental Health During COVID-19 Pandemic

Following the COVID-19 pandemic, many countries worldwide have put lockdowns in place to prevent the virus from spreading. Evidence shows that lockdown measures can affect mental health; it is, therefore, important to identify the psychological characteristics making individuals more vulnerable. The present study aimed, first, to identify, through a cluster analysis, the psychological attributes that characterize individuals with similar psychological responses to the COVID-19 home confinement; second, to investigate whether different psychological characteristics, such as personality traits, alexithymia, and resilience, specifically influence anxiety, stress, and depression, depending on the scope of the confinement. We analyzed data from 393 participants who completed an online survey on their experiences during two different phases of the Italian lockdown, characterized by more or less strict measures of confinement. Two clusters were identified which included participants reporting a better (+ER) and worse (−ER) emotional response to the lockdown, respectively. Individuals in the −ER group showed lower emotional stability, resilience, and higher alexithymia. Moreover, even if lifting part of the restrictions decreased psychological distress among all participants, a reduction in perceived stress was observed only among individuals with high resilience. Finally, personality traits, alexithymia, and resilience differently affected depression, anxiety, and stress. Our results suggest that different psychological interventions should be planned depending on the context: mental health professionals should focus on enhancing the individuals’ coping strategies to alleviate stress in emergencies, while long-term intervention aiming at alleviating anxiety and depressive symptoms should focus on alexithymic tendencies and personality constructs.

In the Eye of the Covid-19 Storm: A Web-Based Survey of Psychological Distress Among People Living in Lombardy

In March 2020, the World Health Organization announced the Covid-19 outbreak a pandemic and restrictive measures were enacted by the Governments to fight the spread of the virus. In Italy, these measures included a nationwide lockdown, with limited exceptions including grocery shopping, certain work activities, and healthcare. Consistently with findings from previous studies investigating the psychological impact of similar pandemics [e.g., Severe Acute Respiratory Syndrome (SARS)], there is evidence that Covid-19 is associated with negative mental health outcomes. Given this background, we conducted a cross-sectional study aimed at investigating the impact of the Covid-19 pandemic and the subsequent restrictive measures imposed by the Government on the psychological health of Italian men and women aged = 18 years and living in Lombardy, one of the worst-hit regions. The study also aimed at identifying what factors are associated with specific psychological outcomes. Thus, we developed an online survey that included a researcher-made questionnaire to collect sociodemographic, household, general health, and pandemic-related information. The Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and the Perceived Stress Scale were used to assess anxiety, depression, and perceived stress, respectively. We found that younger age, greater concerns about the pandemic, female gender, being unmarried, not having children, and being a student were associated with worse psychological health. These findings may provide further insight into the risk factors associated with negative psychological outcomes during the current pandemic, with identification of vulnerable groups. This body of evidence may help professionals implement targeted psychosocial treatment and prevention programs.

Parental stress during COVID-19: A brief report on the role of distance education and family resources in an Italian sample

Since the COVID-19 outbreak, school closures have affected over 1.5 billion children worldwide. Many countries implemented a rapid transition to distance education (DE), but the effects of such transition on family life remain largely underexplored. The current study used a cross-sectional, correlational survey design to explore the role of DE and family resources (parenting self-efficacy and family functioning) in perceived stress among Italian parents of first-grade children (N = 89). Results of hierarchical multiple regression indicated that, after controlling for stressful events experienced during school closure, parents’ difficulty to manage children’s DE was positively linked to levels of stress. However, this association became nonsignificant after adding family resources to the model, with more parental self-efficacy and good family functioning predicting less perceived stress. The findings underscore the importance of supporting positive resources within the family environment to reduce DE-related parental stress in the context of the ongoing COVID-19 pandemic.

Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease (COVID-19) outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers' exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers' stress levels, and the Brief COPE Scale and Coping Humor Scale were used to assess participants' avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that (1) levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 (i.e., who came into contact with COVID-19 patients or worked in wards dedicated to COVID-19) in comparison to less-exposed workers; (2) participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and (3) healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study.

The Impact of the COVID-19 Lockdown on Coaches' Perception of Stress and Emotion Regulation Strategies

The recent global outspread of the COVID-19 pandemic has influenced the lives of people across multiple countries including athletes, coaches, and supporting staff. Along with everybody else, coaches found themselves constrained to an at-home self-isolation, which limited their ability to normally engage with their profession and to interact with their athletes. This situation may also have impacted their own psychological well-being. With this study, we explored coaches’ perceptions of stress in relation to their emotion regulation strategies depending upon their gender and competitive level (elite vs. non-elite). A sample of 2272 Italian coaches were surveyed during the period of lockdown. Mean values for perceived stress and emotion regulation strategies were compared to normative data of the two instruments as reported in the original studies. Furthermore, two Multivariate analyses of variance (MANOVAs) were completed to observe the potential differences in the coaches’ emotion regulation strategies and perception of stress. Finally, a blockwise regression analysis was run to assess how coaches’ emotion regulation strategies impacted upon their perception of stress. Both women and men reported higher levels of perceived stress than those reported in the normative data. Similarly, average scores for emotion regulation strategies were significantly different from those reported for normative data, in particular, coaches reported slightly higher use of emotion regulation strategies than participants in the original study. Significant gender-based differences emerged in terms of emotional regulations, with men adopting more suppression than women. No differences by competitive level were found. In terms of perceived stress, male coaches and elite coaches showed to be more in control of the situation (positive stress) than female coaches and non-elite coaches, respectively, while women experienced more negative stress than men. The blockwise regression evidenced how reappraisal resulted to be predictive in helping coaches to reduce their perception of stress, while suppression predicted higher stress perceptions.

Screening for Early Signs of Paternal Perinatal Affective Disorder in Expectant Fathers: A Cluster Analysis Approach

Previous studies documented gender-related differences in the expression of Perinatal Affective Disorders. However, little attention has been paid to screening the male population during the perinatal period. This study was based on three aims: (1) to investigate the mental health of expectant fathers based on their levels of depression, anxiety, addiction, anger attacks/hostility, and somatization, identifying psychological profiles; (2) to analyze the association between these profiles and the individual variable of perceived stress; (3) and to examine the association between these profiles and the couple’s variable of marital adjustment. A total of 350 Italian expectant fathers in the last trimester of pregnancy were asked to fill in questionnaires concerning perceived stress, dyadic adjustment, psychiatric symptomatology, and depression. Three different clusters were found: “psychologically healthy men” (68%) with low levels of symptoms on all the scales; “men at risk of externalized behavioral problems” (17.1%), characterized by one or more addictive or risky behaviors and moderate levels of scales scores; and “men experiencing psychological distress” (14.9%), with the highest scores on all the scales. A significant association emerged among the perceived stress, marital adjustment, and cluster membership. These results highlight the importance of screening fathers in perinatal health services, which are still predominantly mother-centered, and underscore the necessity to create tailored and personalized interventions.

Boosting Psychological Well-Being through a Social Mindfulness-Based Intervention in the General Population

The benefits of mindfulness meditation among clinical and non-clinical populations have been largely reported in literature. Existing mindfulness-based programs are particularly useful in targeting specific populations while researchers have pointed out the possibility of developing programs adapted to the audience and the context. In this two-groups pre-post experimental design we developed a mindfulness-based social intervention program to target individuals from the general population. Here we present a two-groups pre-post experimental design to investigate its effectiveness on participants’ psychological functioning assessed by eight self-reported questionnaires (CORE-OM, FFMQ, SWLS, PANAS, PSS, SCS, WEMWBS, SHS) which encompass different domains of well-being, mindfulness and emotional functioning. Participants, recruited on voluntary basis, were randomly allocated to treated or passive control groups and were aware of group allocation. The intervention comprises a 12-week meditation training in a big group that represents the social aspect of meditation. Data were analysed via a linear mixed effect model and intention to treat. Statistically significant results were obtained for global score of CORE-OM (β = −0.20 [−0.30; −0.10], p = 0.0002), FFMQ (β = 0.20 [0.12; −0.28], p < 0.0001), SWLS (β = 1.43 [0.42; 2.45], p = 0.006), positive PANAS (β = 1.99 [0.95; 3.04], p = 0.0002), negative PANAS (β = −1.67 [−2.92; −0.43], p = 0.009), PSS (β = −2.98 [−4.25; −1.71], p < 0.0001), WEMWBS (β = 4.38 [2.93; 5.83], p < 0.0001) and SHS (β = 1.43 [0.42; 2.45], p = 0.006). Our intervention is causally associated with an improvement of the psychological functioning and hence can be considered as a preventive measure that may potentially reduce the risk of developing psychological problems and improve the subject’s general well-being. Given the voluntary recruitment, our inference only applies to those individuals who have decided to experience meditation as a way to well-being and not to a random person from the general population.

Psychological Health Issues Subsequent to SARS-Cov 2 Restrictive Measures: The Role of Parental Bonding and Attachment Style

Background: The novel coronavirus 2019 (COVID-19) has caused severe panic among people worldwide. In Italy, a nationwide state of alert was declared on January 31st, leading to the confinement of the entire population from March 11 to May 18, 2020. Isolation and quarantine measures cause psychological problems, especially for individuals who are recognized as being vulnerable. Parental bonding and attachment styles play a role in the programming of the stress response system. Here, we hypothesize that the response to restricted social contact and mobility due to the pandemic has detrimental effects on mental-psychological health and that this relationship is, at least in part, modulated by parental bonding and attachment relationships that are experienced at an early age. Methods: A sample of 68 volunteer University students was screened for psychopathological symptoms (SCL-90-R and STAI-Y), stress perception (PSS), attachment style (RQ), and parental care and overcontrol (PBI) 6 months before the confinement. In the same subjects, psychopathological symptoms and stress perception were measured again during confinement. Results: Overall, psychological health and stress management deteriorated across the entire sample during confinement. Specifically, a significant increase in phobic anxiety, depression, psychological distress, and perceived stress was observed. Notably, parental bonding and attachment styles modulated the psychological status during the lockdown. Individuals with secure attachment and high levels of parental care (high care) showed increased levels of state anxiety and perceived stress in phase 2, compared with phase 1. In contrast, individuals with insecure attachment and low levels of parental care (low care) already showed a high rate of state anxiety and perceived stress in phase 1 that did not increase further during phase 2. Conclusion: The general deterioration of psychological health in the entire sample demonstrates the pervasiveness of this stressor, a decline that is partially modulated by attachment style and parental bonding. These results implicated disparate sensitivities to environmental changes in the high- and low care groups during the lockdown, the former of which shows the greatest flexibility in the response to environment, suggesting adequate and functional response to stress in high care individuals, which is not observable in the low care group.