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Pagani LS, Harandian K, Necsa B, Harbec MJ. Prospective Associations between Maternal Depressive Symptoms during Early Infancy and Growth Deficiency from Childhood to Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7117. [PMID: 38063547 PMCID: PMC10706675 DOI: 10.3390/ijerph20237117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
Maternal health represents an important predictor of child development; yet it often goes unnoticed during pediatric visits. Previous work suggests that mental state affects parenting. The relationship between infant exposure to maternal depressive symptoms suggests conflicting findings on physical growth. Body mass index (BMI) has not been rigorously examined across development. Using a prospective-longitudinal birth cohort of 2120 infants (50.7% boys), we estimated the prospective relationship between symptoms of maternal depressive symptoms at 5 months postpartum and later BMI in typically developing children. We hypothesized that maternal depressive symptom severity would predict later BMI through to adolescence. Mothers self-reported depressive symptoms at 5 months. Child BMI was measured by a trained research assistant at ages 6, 8, 10, 13, and 15 years. We estimated a series of sex-stratified regressions in which BMI was linearly regressed on maternal symptoms, while controlling for potential pre-existing/concurrent individual and family confounding factors. Boys born to mothers with more severe depressive symptoms at age 5 months had a significantly lower BMI than other boys at subsequent ages. There were no such associations observed for girls. Maternal depressive symptoms were prospectively associated with later BMI for sons and not daughters, predicting risk of faltering in growth through to adolescence. Health practitioners should routinely assess maternal psychological functioning during pediatric visits to optimize parent and child flourishment.
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Affiliation(s)
- Linda S Pagani
- School of Psycho-Education, University of Montreal, Montreal, QC H3C 3J7, Canada
- School Environment Research Group, University of Montreal, Montreal, QC H3C 3J7, Canada
- Sainte-Justine's Pediatric Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Kianoush Harandian
- School of Psycho-Education, University of Montreal, Montreal, QC H3C 3J7, Canada
- School Environment Research Group, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Beatrice Necsa
- School of Psycho-Education, University of Montreal, Montreal, QC H3C 3J7, Canada
- School Environment Research Group, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Marie-Josée Harbec
- Institut National de Santé Publique du Québec, Montreal, QC H2P 1E2, Canada
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2
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Fellmeth G, Kanwar P, Sharma D, Chawla K, DasGupta N, Chhajed S, Chandrakant, Jose EC, Thakur A, Gupta V, Bharti OK, Singh S, Desai G, Thippeswamy H, Kurinczuk JJ, Chandra P, Nair M, Verma A, Kishore MT, Alderdice F. Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study. BMC Psychiatry 2023; 23:829. [PMID: 37957589 PMCID: PMC10644637 DOI: 10.1186/s12888-023-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.
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Affiliation(s)
- Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pankaj Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Diksha Sharma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | | | - Neha DasGupta
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shreyash Chhajed
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Chandrakant
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Emily C Jose
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Anita Thakur
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Vikesh Gupta
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, Shimla, India
| | - Sukhjit Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - M Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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3
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The Mother-Baby Bond: Role of Past and Current Relationships. CHILDREN 2023; 10:children10030421. [PMID: 36979979 PMCID: PMC10046950 DOI: 10.3390/children10030421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
During the perinatal period, up to 25% of women experience difficulties in relating to their child. The mother-child bond promotes the transition to motherhood, protects the woman from depression, and protects the child from the intergenerational transmission of the disease. This study prospectively investigated if the relationship with the co-parent, the attachment style, and the bond that women had with their parents influenced the mother-fetus and then mother-child bond. We also explored the role of depression and anxiety. One hundred nineteen pregnant women were enrolled. We administered clinical interviews and psychometric tools. A telephone interview was conducted at 1, 3, and 6 months of follow-up. Maternal insecure attachment style (r = −0.253, p = 0.006) and women’s dyadic adjustment in the couple’s relationships (r = 0.182, p = 0.049) were correlated with lower maternal–fetal attachment. Insecure attachment styles and depression correlate with bottle-feeding rather than breastfeeding. The bond women had with their mothers, not their fathers, was associated with breastfeeding. Depression (OR = 0.243, p = 0.008) and anxiety (OR = 0.185, p = 0.004; OR = 0.304, p < 0.0001) were related to mother-infant bonding. Close relationships, past and present, affect the bond with the fetus and the child differently. Psychotherapy can provide reassuring and restorative intersubjective experiences.
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Sampogna G, Di Vincenzo M, Giallonardo V, Perris F, Volpicelli A, Del Vecchio V, Luciano M, Fiorillo A. The Psychiatric Consequences of Long-COVID: A Scoping Review. J Pers Med 2022; 12:jpm12111767. [PMID: 36579511 PMCID: PMC9697474 DOI: 10.3390/jpm12111767] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic has represented a new form of traumatic event, affecting the general population worldwide and causing severe disruption of daily routine. A new urgent concern is related to the burden associated with COVID-19 symptoms that persist beyond the onset of infection, the so-called long-COVID syndrome. The present paper aims to: (1) describe the most frequent psychiatric symptoms reported by patients affected by long-COVID syndrome; (2) evaluate methodological discrepancies among the available studies; (3) inform clinicians and policy-makers on the possible strategies to be promoted in order to manage the psychiatric consequences of long-COVID syndrome. Twenty-one papers have been included in the present review, mostly with a cross-sectional or cohort design. Significant heterogeneity of long-COVID syndrome definitions was found. The presence of psychiatric symptoms was evaluated with very different assessment tools. The most common psychiatric symptoms of the long-COVID syndrome included fatigue, cognitive disturbances/impairment, depression, and anxiety symptoms. The rate of fatigue varied from 93.2-82.3% to 11.5%, cognitive impairment/cognitive dysfunction from 61.4% to 23.5% and depressive-anxiety symptoms from 23.5%to 9.5%.
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Menculini G, Albert U, Bianchini V, Carmassi C, Carrà G, Cirulli F, Dell'osso B, Fabrazzo M, Perris F, Sampogna G, Nanni MG, Pompili M, Sani G, Volpe U, Tortorella A. Did we learn something positive out of the COVID-19 pandemic? Post-traumatic growth and mental health in the general population. Eur Psychiatry 2022; 64:e79. [PMID: 35000665 PMCID: PMC8888429 DOI: 10.1192/j.eurpsy.2021.2263] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG). Methods Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth. Results The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of “relating to others” (B = −.107, 95% CI = −.181 to −.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG. Conclusions The assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, Piazza Lucio Severi 1, 06132Perugia, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128Trieste, Italy.,Department of Mental Health, Psychiatric Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina-ASUGI, 34128Trieste, Italy
| | - Valeria Bianchini
- Department of Life, Health and Environmental Sciences, Psychiatric Unit: Trattamenti Riabilitativi Psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, Early Interventions University Unit, University of L'Aquila, 67100L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126Pisa, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milan Bicocca, 20126Milano, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, National Institute of Health, 00161Rome, Italy
| | - Bernardo Dell'osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, 20157Milan, Italy.,Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, 20142Milan, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Maria Giulia Nanni
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44121Ferrara, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, University Cattolica del Sacro Cuore, 00168Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Agostino Gemelli IRCCS, 00168Rome, Italy
| | - Umberto Volpe
- Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università Politecnica delle Marche, 60121Ancona, Italy
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, Piazza Lucio Severi 1, 06132Perugia, Italy
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Luciano M, Di Vincenzo M, Brandi C, Tretola L, Toricco R, Perris F, Volpicelli A, Torella M, La Verde M, Fiorillo A, Sampogna G. Does antenatal depression predict post-partum depression and obstetric complications? Results from a longitudinal, long-term, real-world study. Front Psychiatry 2022; 13:1082762. [PMID: 36590632 PMCID: PMC9795022 DOI: 10.3389/fpsyt.2022.1082762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Main aims of the present paper are to: (1) assess the prevalence of antenatal depression (AD) and identify its predictors; (2) analyse the impact of AD on obstetric outcomes and on the incidence of post-partum depression. METHODS All pregnant women referring to the Gynecology and Obstetrics inpatients unit of the University of Campania "Luigi Vanvitelli" were invited to participate. Upon acceptance, women completed the Italian version of the Edinburgh Postnatal Depression Scale and an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women were assessed at each trimester of pregnancy, immediately after the childbirth and after one, three, 6 and 11 months. RESULTS 268 pregnant women were recruited, with a mean of 32.2 (±5.81) years. Ninety-seven women (36.2%) reported the presence of depressive symptoms during pregnancy. Predictors of AD were personal history of depression, a family history for depressive disorders and problematic relationships with the partner. The presence of AD was associated to a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, labor induction and admission of the new-born into neonatal intensive care unit. Mothers with antenatal depression are less likely to natural breastfeed. Lastly, antenatal depression was a risk factor for higher EPDS scores at follow-ups. CONCLUSIONS Our results support the idea that women should be screened during pregnancy and post-partum for the presence of depressive and anxiety symptoms. Health professionals should be adequately trained to detect psychiatric symptoms during pregnancy.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Lucia Tretola
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Rita Toricco
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Volpicelli
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Torella
- Obstetrics and Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Obstetrics and Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Sampogna G, Pompili M, Fiorillo A. Mental Health in the Time of COVID-19 Pandemic: A Worldwide Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010161. [PMID: 35010419 PMCID: PMC8750501 DOI: 10.3390/ijerph19010161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Maurizio Pompili
- Suicide Prevention Centre, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy;
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
- Correspondence:
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Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Perris F, Carfagno M, Raia ML, Di Vincenzo M, La Verde M, Torella M, Fiorillo A. The Transition From Maternity Blues to Full-Blown Perinatal Depression: Results From a Longitudinal Study. Front Psychiatry 2021; 12:703180. [PMID: 34803751 PMCID: PMC8595294 DOI: 10.3389/fpsyt.2021.703180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aims of the present study are to: (1) assess the frequency of maternity blues (MB); (2) identify the clinical and social characteristics more frequently associated with the onset of depressive symptoms after delivery; and (3) verify the hypothesis that the presence of maternity blues is a risk factor for the onset of a full-blown depressive episode in the 12 months after delivery. Methods: This is a longitudinal observational study. All pregnant women who gave birth at the inpatient unit of Gynecology and Obstetrics of the University of Campania "Luigi Vanvitelli" from December 2019 to February 2021 have been invited to participate in the study. Upon acceptance, women were asked to complete the Italian version of the Edinburgh Postnatal Depression Scale along with an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women have been reassessed after one, 3, 6 and 12 months. Results: A total of 359 women were recruited within 3 days from delivery, with a mean EPDS total score of 5.51 (±4.20). Eighty-three women (23.1%) reported the presence of maternity blues. Mean EPDS total scores were 12.8 (±0.2) in the MB group vs. 4.26 (±0.2) in the group without MB (p <0.0001). MB predictors were the presence of an anxiety disorder with an onset 6 months prior to pregnancy, of preeclampsia, of increased fetal health rate, of conflicts with relatives other than partner and having a partner with an anxiety disorder. At multivariate analyses the presence of MB increased 7-time the risk to have a higher EPDS score at follow-up assessments (OR: 7.79; CI: 6.88-8.70, p <0.000). This risk is almost four times higher 1 months after the delivery (OR: 4.66; CI: 2.54-6.75, p < 0.000), almost three times higher after 3 months (OR: 2.98; CI: 0.50-5.46, p < 0.01) and almost six times higher after 12 months (OR: 5.88; CI: 3.20-8.54, p < 0.000). Conclusions: Although MB was a self-limiting condition in the majority of cases, depressive symptoms arose quite often immediately after the childbirth. Professionals should be trained to monitor symptoms of MB and its transition toward a depressive episode.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Maria Luce Raia
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynaecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynaecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynaecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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