The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples

Self-care in patients affected by inflammatory bowel disease and caregiver contribution to self-care (IBD-SELF): a protocol for a longitudinal observational study

INTRODUCTION

Supporting patient self-care and the contribution of their caregivers is crucial in chronic illness care. Inflammatory bowel disease (IBD) is a chronic condition whose prevalence is expected to double, especially in Western countries. IBD symptoms can negatively impact patients' well-being, causing high anxiety, depression, stress and reduced quality of life. These symptoms also affect the health of family members and friends, who often take on caregiving roles during exacerbations. Knowledge about self-care in IBD (IBD-SELF) is limited, and few studies have explored this context. This paper outlines a research protocol for a multicentre longitudinal study to investigate patient self-care and caregiver contributions to IBD-SELF.

METHODS AND ANALYSIS

A sample of 250 consecutive patients diagnosed with IBD and their caregivers will be recruited from 9 dedicated IBD units in northern, central and southern Italy during outpatient visits. Data collection will occur at baseline, 6 and 12 months after enrolment. Multivariable regressions, path analyses and structural equation models will identify predictors (eg, health literacy, caregiver burden and depression) and outcomes (use of healthcare services, disease severity and quality of life) of self-care and caregiver contributions. Dyadic analyses will control for the interdependence of dyad members.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Territorial Ethics Committee (Lazio 3) N. 0023486/23 and registered on ClinicalTrials.gov (Identifier number: NCT06015789). This study will enhance our understanding of the self-care process in the patient-caregiver dyad in IBD, aiding the design of future educational interventions and promoting greater patient and caregiver involvement in the care pathway.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT06015789.

Altered mechanisms of adaptation in social anxiety: differences in adapting to positive versus negative emotional faces

Social anxiety is characterised by fear of negative evaluation and negative perceptual biases; however, the cognitive mechanisms underlying these negative biases are not well understood. We investigated a possible mechanism which could maintain negative biases: altered adaptation to emotional faces. Heightened sensitivity to negative emotions could result from weakened adaptation to negative emotions, strengthened adaptation to positive emotions, or both mechanisms. We measured adaptation from repeated exposure to either positive or negative emotional faces, in individuals high versus low in social anxiety. We quantified adaptation strength by calculating the point of subjective equality (PSE) before and after adaptation for each participant. We hypothesised: (1) weaker adaptation to angry vs happy faces in individuals high in social anxiety, (2) no difference in adaptation to angry vs happy faces in individuals low in social anxiety, and (3) no difference in adaptation to sad vs happy faces in individuals high in social anxiety. Our results revealed a weaker adaptation to angry compared to happy faces in individuals high in social anxiety (Experiment 1), with no such difference in individuals low in social anxiety (Experiment 1), and no difference in adaptation strength to sad vs happy faces in individuals high in social anxiety (Experiment 2).

Testing the role of extended thinking in predicting craving and problematic social network sites use

Background and aims Problematic Social Network Sites Use (PSNSU) mirrors substance use disorders with regard to symptoms (e.g., diminished control). Recent theoretical advances in the addiction research field recognize a central role of affective and cognitive processes in the development of addictive behaviors. For example, the metacognitive model of addictive behaviors sustains that cognitive processes like extended thinking, disruption in metacognitive monitoring, and thought suppression are associated with addictive behaviors leading to increased craving. The current study aims to test the mediating role of extended thinking (i.e., worry, rumination, and desire thinking) in the relationship between psychological distress and PSNSU. Methods A community sample of 548 individuals (F = 68.5%, Mage= 29.29 ± 12.04 years) completed an online survey. Structural Equation Modeling (SEM) was utilized to analyze the relationships among the variables under study. Results The assessed structural model adequately fits the data, accounting for 89% of PSNSU variance. Psychological distress predicted PSNSU through the mediation of desire thinking and rumination and the serial mediation of (i) worry and craving (ii) desire thinking and craving The model is gender invariant. Conclusions The current findings provide preliminary evidence for the role of extended thinking in PSNSU. Worry, rumination and desire thinking may be central cognitive processes in eliciting craving and PSNSU for individuals who experience psychological distress.

Comparing the DSM-5 Dimensional Trait and Triarchic Model Conceptions of Psychopathy: An External Validity Analysis

In the DSM-5 Alternative Model of Personality Disorders (AMPD), psychopathy is marked by the presence of attention seeking, low anxiousness, and lack of social withdrawal, along with traits from the domains of Antagonism and Disinhibition. The triarchic model of psychopathy (TriPM) posits three biobehaviorally based traits underlying it: disinhibition, meanness, and boldness. The current study directly compared relations for measures of the two models with the broad dimensions of externalizing, internalizing, and positive adjustment. Participants (1,678 adults) were surveyed regarding maladaptive personality traits, clinical symptoms, and positive adjustment features. The TriPM model explained more variance than the AMPD in substance use, positive adjustment, and empathy, whereas the AMPD model explained more variance in internalizing symptoms. In addition, AMPD Antagonism and the Psychopathy Specifier diverged from TriPM Meanness and Boldness in their associations with some specific outcomes. Overall, our study provides evidence for complementarity of the two models in characterizing the multifaceted nature of psychopathy.

Intolerance of uncertainty as a predictor of anxiety severity and trajectory during the COVID-19 pandemic

BACKGROUND

Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor.

METHOD

N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021.

RESULTS

In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as pre-pandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory.

CONCLUSIONS

IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.

Workplace ethical climate and its relationship with depression, anxiety and stress

BACKGROUND

Ethical climate in the workplace has been highlighted to have an important impact on workers' mental health; the evaluation of workplace ethics and its impact on workers' health should be considered an occupational health issue.

AIMS

The present study aims to investigate ethical climate as perceived by workers, and its correlation with mental health outcomes, in particular, symptoms of depression, anxiety and stress.

METHODS

A cross-sectional study was performed by administering an online survey, investigating socio-demographic variables, workplace ethics (through the Italian short version of the Corporate Ethical Virtues questionnaire) and mental health outcomes (using the short version of the Depression, Anxiety and Stress Scale). Descriptive analyses, analyses of variance and regression models were performed; P-values were considered significant for values ≤0.05.

RESULTS

The sample included 176 workers; the mean age of participants was 46.22 years and 44% were males. The most represented job sector was health care (37%), and 42% of participants had college-level education. Ethical climate was significantly correlated with all mental health outcomes investigated in the study: anxiety (P ≤ 0.001), depression (P ≤ 0.05) and stress (P ≤ 0.05).

CONCLUSIONS

Results from this study highlighted a significant correlation between workplace ethical climate and depression, anxiety and stress. This study underlines the importance of evaluating and improving ethical climate to prevent the onset of psychological distress in workers. Furthermore, results from this study should be a starting point for future research investigating the role of ethics and mental health in employees' turnover intention and job satisfaction.

The relation between body dysmorphic disorder symptoms and photo-based behaviors: is body appreciation a protective factor?

Body image and social media use seem to be significantly associated. In particular, photo-based behaviors (i.e., photo investment and manipulation) seemed to have a positive relation with negative body image dimensions. On the other hand, positive body image dimensions could demonstrate the role of moderators. However, current available studies did not support these findings consistently. Moreover, available studies did not assess Body Dysmorphic Disorder (BDD) and Muscle Dysmorphia (MD) symptoms. To address these issues, the associations between BDD/MD symptoms and photo-based behaviors and the possible moderation of body appreciation were examined in a sample of 485 social media users (71.1 % women). Findings from hierarchical multiple regressions highlighted that BDD symptoms were significantly associated with photo investment and manipulation, and MD symptoms were significantly associated with photo investment only. Body appreciation demonstrated a moderating role in the relation involving photo investment and BDD symptoms. Current findings supported that photo-based behaviors are significantly associated with negative body image dimensions, while positive body image demonstrated only a marginal protective role.

Italian university students' future time perspective and well-being during the COVID-19 pandemic

Introduction

During the COVID-19 pandemic, young adults worldwide showed signs of distress as they were affected in their specific developmental tasks, including the construction of personal and professional futures.

Methods

The present study aimed to assess the situational future time perspective of Italian university students during the second pandemic wave, as measured by an ad hoc constructed instrument, to explore its interaction with some dispositional traits relevant in future construction, such as optimism, sense of life, aggression, and dispositional future time perspective, and to test their effect on psychological well-being. The total sample consisted of 389 subjects (18-35 years, M = 23.5, SD = 4.4).

Results and discussion

The results indicated that the pandemic experience, assessed by surveying specific indicators, negatively affected the future time perspective of students, particularly those dispositionally optimistic and convinced that life has meaning. However, awareness of the negative impact that the pandemic brought to the vision of the future seems to have dampened the levels of depression and stress, while anxiety was found to be related only to dispositional traits. The results also suggested the need for educational and economic policies that help young adults develop confidence in the future and in their ability to build it.

Direct Losses and Media Exposure to Death: The Long-Term Effect of Mourning during the COVID-19 Pandemic

Background: The social distancing policies adopted during the COVID-19 pandemic forced many individuals to confront their mortality and worry about losing loved ones, making it impossible to say goodbye to them properly. Those not directly experiencing loss were inundated with information about COVID-19-related deaths throughout social media, leading to vicarious grief. This study delved into the long-term effects of direct and vicarious mourning on people's mental health during the COVID-19 pandemic. Method: A sample of 171 adults (65% female) aged 19-66 years (Mage = 25.8, SD = 8.57) voluntarily participated in an online survey assessing self-reported psychological measures of complicated grief, stress, depression, dispositional neuroticism, trait anxiety, and situational anxiety. Results: MANOVAs revealed that direct mourning experiences had an extremely severe impact on anxiety, stress, and fear of COVID-19, and a moderate effect on those without personal losses. Indeed, participants reporting high media exposure showed higher scores of depression and stress. Conclusions: Findings from the current study displayed that during the COVID-19 pandemic, people engaged more in proximal defenses than distal ones, taking health-protective measures, experiencing increased anxiety levels toward virus infection, and feeling distressed. Additionally, vicarious mourning was more strongly associated with depression due to emotional empathy with others.

Network analysis of negative emotions in patients with episodic migraine: need for a multidisciplinary perspective

Background

Episodic migraine (EM) is the second most prevalent neurological disorder worldwide and is responsible for more disability than all other neurological disorders combined. Triggers for the development of migraine include, stress, emotional burden, low blood sugar levels, tobacco, skipped meals, anxious and depressive feelings. Migraine affects both children and adults, occurring three times more frequently in women than in men.

Objective

The aim of this study was to evaluate the psychological profile of EM patients and the relationship among negative emotions in EM patients, analyzing self-efficacy measures in pain management.

Design

We performed an observational study in 60 outpatients aged 18-55 years (mean age 33.8; SD ±10.4) with EM.

Methods

All patients have been enrolled at the Headache Center of the San Salvatore Hospital of L'Aquila. The assessment comprised five standardized psychological self-assessments investigating relevant emotional dimensions and pain self-efficacy, along with two questionnaires assessing migraine-related disability. A network analysis of negative emotions was performed to evaluate which emotional traits and relationships play a crucial role in pain coping and management.

Results

Our findings indicate that migraine significantly impairs the quality of life of patients in their daily lives. Over half of the patients reported experiencing severe disability, with negative emotions significantly influencing their ability to cope with pain and maintain productivity during migraine attacks. Dysphoric variables (irritability, interpersonal resentment, and surrender) were correlated with difficulties in emotion regulation ability and with the capacity of engaging in goal-directed behaviors despite experiencing pain. The ability to regulate one's emotions and manage dysphoria were positively correlated with pain self-efficacy, whereas positive mental health was associated with individuals' confidence in performing activities despite experiencing pain.

Conclusion

Negative emotions had a negative correlation with positive mental health and were linked to a lower capacity to carry out daily activities despite experiencing migraine pain. This suggests that psychological interventions could improve mental health and potentially surpassing the effects of pharmacological interventions alone in migraine management. An integrated, patient-centered approach may represent an effective paradigm to address and reduce the burden of migraine, leading to a reduction in healthcare costs.

The neural substrates of social cognition deficits in newly diagnosed multiple sclerosis patients

OBJECTIVE

Cognitive and affective symptoms in multiple sclerosis (MS) can be independently impaired and have different pathways of progression. Cognitive alterations have been described since the earliest MS stages; by contrast, the social cognition (SC) domain has never been investigated in the first year from MS diagnosis. We aimed to evaluate SC and unravel its neural bases in newly diagnosed MS patients.

METHODS

Seventy MS patients underwent at diagnosis a 3 T-MRI and a neuropsychological/SC assessment (median time between diagnosis and MRI/cognitive evaluation = 0 months). We tested two matched reference samples: 31 relapsing-remitting MS patients with longer course (mean ± SD disease duration = 7.0 ± 4.5 years) and 38 healthy controls (HCs). Cortical thicknesses (CTh) and volumes of brain regions were calculated.

RESULTS

Newly diagnosed MS patients performed significantly lower than HCs in facial emotion recognition (global: p < 0.001; happiness: p = 0.041, anger: p = 0.007; fear: p < 0.001; disgust: p = 0.004) and theory of mind (p = 0.005), while no difference was found between newly diagnosed and longer MS patients. Compared to lower performers, higher performers in facial emotion recognition showed greater volume of amygdala (p = 0.032) and caudate (p = 0.036); higher performers in theory of mind showed greater CTh in lingual gyrus (p = 0.006), cuneus (p = 0.024), isthmus cingulate (p = 0.038), greater volumes of putamen (p = 0.016), pallidum (p = 0.029), and amygdala (p = 0.032); patients with higher empathy showed lower cuneus CTh (p = 0.042) and putamen volume (p = 0.007).

INTERPRETATIONS

SC deficits are present in MS patients since the time of diagnosis and remain persistent along the disease course. Specific basal, limbic, and occipital areas play a significant role in the pathogenesis of these alterations.

Randomized trial on the effects of an EMDR intervention on traumatic and obsessive symptoms during the COVID-19 quarantine: a psychometric study

Introduction

It has been suggested that the COVID-19 pandemic was a potentially traumatic occurrence that may have induced generalized anxiety and discomfort, particularly in susceptible populations like individuals with mental illnesses. The therapeutic approach known as eye movement desensitization and reprocessing (EMDR) has been shown to be successful in helping patients process traumatic events and restore wellbeing. Nevertheless, little is known about the precise processes through which EMDR fosters symptom recovery.

Methods

In order to disentangle these issues, we conducted a randomized controlled trial (ClinicalTrials.gov Identifier NCT06110702) with 107 participants who were selected from university hospitals as a sample of investigation. Random assignments were applied to the participants in order to assign them to the experimental and control groups. The experimental group, but not the control group, underwent an 8-week EMDR intervention. Body perception, disgust, and emotions of guilt and shame, as well as mental contamination and posttraumatic and obsessive-compulsive symptoms, were investigated before and after the EMDR intervention.

Results

The EMDR intervention was able to improve all of the variables investigated. Path analysis showed that body perception was able to predict both disgust and emotions of guilt and shame. Disgust was able to predict both mental contamination and obsessive-compulsive symptoms, while guilt and shame were able to predict post-traumatic symptoms.

Conclusions

EMDR is an effective therapy for the treatment of post-traumatic and obsessive symptoms that acts through the promotion of improvement of the emotions of guilt/shame and disgust, respectively. Implications for clinical practice are examined.

Clinical trial registration

https://www.clinicaltrials.gov, identifier NCT06110702.

Adaptive and maladaptive pathways of COVID-19 worry on well-being: A cross-national study

OBJECTIVE

In a preregistered study, we examined whether worries about COVID-19 are simultaneously linked with enhanced well-being through social interaction and with reduced well-being through depression symptoms.

METHOD

In August 2020, census-matched participants from high- and low-prevalence regions in the United States and Italy (N = 857) completed assessments of COVID-19 worry, social interaction, depression symptoms, and well-being.

RESULTS

Worries about COVID-19 predicted both more social interaction and more depression (ps < 0.001). In multiple mediational analyses, an adaptive pathway of COVID-19 worry through social interaction was associated with higher well-being, whereas a maladaptive pathway through depression symptoms was associated with lower well-being. Further, a comparison of high and low COVID-19 prevalence regions replicated the mediational findings for social interaction, providing evidence against reverse causation and common method variance.

CONCLUSION

Findings suggest that normative worries about acute stressors may both benefit and undermine well-being, depending on their impact on social behavior or depression symptoms.

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Factor structure and psychometric properties of the Jordanian version of the depression anxiety stress scale (DASS-21)

AIM

Early diagnosis of health conditions such as depression, anxiety, and stress, which have been recognized as global health issues, is essential for providing psychological support to people who experience negative emotions. Therefore, it is important to identify a reliable method for diagnosing depression, anxiety, and stress. To this end, this study investigated the factor structure and evaluated the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) in Jordan.

METHODS

A university sample of 336 Jordanians completed the Arabic version of the DASS-21 and several psychopathology measures. Cross-sectional study and confirmatory factor analysis (CFA) were applied to achieve the study's aims.

RESULTS

CFA favored the bifactor model compared to the other four models. In contrast, the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) strongly correlated with the DASS-21, indicating that the DASS-21 has adequate convergent and divergent validity. Subsequently, the scale's discriminant validity was tested using the heterotrait-monotrait (HTMT) correlation ratio, which was found to be relatively insufficient. While DASS-21 showed strong reliability, Cronbach's α and McDonald's omega values ranged between 0.83 and 0.93.

CONCLUSION

The bifactor model best fits the Jordanian sample data. The DASS-21 has optimum psychometric properties; therefore, it can be used to assess the general distress experienced by the Jordanian community during research investigations and in non-clinical settings.

The effect of the sense of Community on Depression, Anxiety, and Stress: the mediation role of a balanced time perspective

PURPOSE

Social context and time are two dimensions within which our entire existence is embedded. Therefore, prompting a positive set of attitudes and beliefs towards these elements is fundamental for individuals' psychological well-being. Currently, there is limited understanding regarding the interplay between the sense of community and time perspective in relation to psychological distress. The present study aims, at investigating the effects that the sense of community and time perspective have on the levels of anxiety, depression, and stress. Particular attention has been dedicated to testing whether the effect of sense of community on anxiety, depression, and stress is mediated by the deviation from a balanced time perspective.

METHODS

To accomplish our purposes, we asked 352 participants to complete an online survey and respond to the Depression, Anxiety, Stress Scale (DASS-21), the Zimbardo Time Perspective Inventory (ZTPI), and the Multi-Dimensional Sense of Community Scale (MTSOCS). From these scales, we obtained the scores for anxiety, depression, and stress as well as a general score for the sense of community and the deviation from a balanced time perspective. We computed three General Linear Mediation Models, one for each scale of the DASS-21.

RESULTS

The results showed that the relationship between sense of community and psychological distress was mediated by the deviation from a balanced time perspective extending previous findings and enriching the existing literature on time perspective.

CONCLUSION

The results described so far could be applied to build a series of interventions aimed at promoting psychological well-being in the general population. Considering our findings, we suggest that individuals' health could be promoted by both improving their sense of community, which in turn would decrease their levels of stress, and by restructuring their time perspective when it became dysfunctional and unbalanced.

Measuring Unipolar Traits With Continuous Response Items: Some Methodological and Substantive Developments

In recent years, some models for binary and graded format responses have been proposed to assess unipolar variables or "quasi-traits." These studies have mainly focused on clinical variables that have traditionally been treated as bipolar traits. In the present study, we have made a proposal for unipolar traits measured with continuous response items. The proposed log-logistic continuous unipolar model (LL-C) is remarkably simple and is more similar to the original binary formulation than the graded extensions, which is an advantage. Furthermore, considering that irrational, extreme, or polarizing beliefs could be another domain of unipolar variables, we have applied this proposal to an empirical example of superstitious beliefs. The results suggest that, in certain cases, the standard linear model can be a good approximation to the LL-C model in terms of parameter estimation and goodness of fit, but not trait estimates and their accuracy. The results also show the importance of considering the unipolar nature of this kind of trait when predicting criterion variables, since the validity results were clearly different.

Structural links from trait emotional intelligence to life satisfaction and depressive symptoms in women with breast cancer: post-traumatic responses as mediators

PURPOSE

The diagnosis of a disease such as breast cancer (BC) can be experienced as a sudden, unexpected, and life-threatening event accompanied by considerable uncertainty. This experience can precipitate the development of post-traumatic symptoms and depression. Conversely, certain individuals exhibit the capacity to reframe this traumatic event and transform it into an opportunity for personal growth. Existing research shows that individuals with high trait emotional intelligence (trait EI) tend to experience fewer post-traumatic stress symptoms (PTS), and greater post-traumatic growth (PTG). The aim of this study was to investigate the interrelationship among these variables and specifically examine whether PTS and PTG play a mediating role between trait EI, depression, and life satisfaction.

METHODS

Questionnaires were administered to 338 women with BC to assess trait EI, PTS, PTG, depression, and life satisfaction.

RESULTS

Results highlighted that trait EI was negatively related to PTS and depression and positively related to PTG and life satisfaction. In addition, both PTS and PTG showed a mediating role in the relationship between trait EI, depression, and life satisfaction. This study highlights the close link between depressive symptoms and post-traumatic cognitions in women with BC.

CONCLUSION

Current findings highlight links between trait EI, PTS, PTG, depressive symptoms, and life satisfaction. Clinicians could use these findings when developing interventions aimed at alleviating PTS, such as low mood and worry, and facilitating PTG. This study demonstrated that trait EI can reduce PTS and increase PTG, therefore it is important to include programs aimed at fostering trait EI.

A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study

BACKGROUND

Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women's psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders.

OBJECTIVE

This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women's psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective.

METHODS

This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs.

RESULTS

The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women's interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives.

CONCLUSIONS

Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/53890.

Urban safety and psychological distress during the pandemic: the results of a longitudinal study

Introduction

In the last decades, a large body of literature has explored the topic of perceived safety and fear of crime in urban environments. The effects of psychological factors on such feelings have been studied, but rarely using prospective studies, and never when these factors intercept a worldwide dramatic event like the pandemic. This research aimed to analyze the variations of the feelings of urban safety during the pandemic, the role of resiliency and the effect of psychological stressors such as anxiety, stress, and depression.

Methods

During 2019 and 2022, before and after the pandemic, a face-to-face interview was administered to the same group of 195 participants. The PUSAS scale was used to measure unsafety, the ER89-R to assess for resiliency, the DASS-21 to collect data about the general distress (anxiety, stress and depression), and the CAS scale was used to evaluate the specific coronavirus anxiety. Structural equation models were applied to test a theoretical framework grounded on the relationships between these measures.

Results

The research findings showed decreased feelings of unsafety across the pandemic, consistent with the literature. The positive effect of ego-resiliency was significant but only for its interaction with data collected before the pandemic, whilst stress and anxiety impacted unsafety in 2022 through different pathways. None of the symptoms of general distress influenced the concern about crime and sense of vulnerability, as the feelings of unsafety were found independent from the variations of the specific coronavirus anxiety.

Discussion

Although the research findings did not confirm the impact of coronavirus, they presented some facets that disconfirm what the literature reported about the relationships between psychological distress and fear of crime. Implications about measurement issues are discussed.

Media exposure related to COVID-19 is associated with worse mental health consequences in the United States compared to Italy

BACKGROUND

Prolonged media exposure after collective crises is widely shown to have adverse effects on people's mental health. Do these effects show variation across different countries? In the present study, we compared the link between media exposure related to COVID-19 and mental health-related outcomes in the United States and Italy, two countries with high levels of early COVID-19 prevalence.

METHOD

Participants matched on age and gender in the United States (n = 415) and Italy (n = 442) completed assessments of media exposure, stress, anxiety, COVID-19 worry, and other variables shortly after the first wave of infections in 2020.

RESULTS

COVID-19 related media exposure predicted higher levels of stress, anxiety, and COVID-19 worry, net of the effects of neuroticism, political identification, and demographics. Moreover, COVID-19 related media exposure interacted with country to predict more stress and COVID-19 worry in the United States than in Italy.

CONCLUSIONS

Findings are among the first to document cross-national differences in the association of media exposure with mental health outcomes.

Poor sleep hygiene practices are associated with a higher increase in sleep problems during the COVID-19 pandemic: A latent change score model

The Coronavirus 2019 (COVID-19) pandemic significantly influenced physical and mental health worldwide. The present study aimed to investigate changes in sleep problems across three waves of the COVID-19 pandemic, and to identify potential predictors of the inter-individual variability around these changes, with a particular focus on the role of detrimental sleep hygiene practices. A total of 352 participants completed an online survey of self-report questionnaires at three different waves of the COVID-19 pandemic: T1 (Spring 2020); T2 (Autumn-Winter 2020); and T3 (Spring 2021). The questionnaires collected information on socio-demographic and COVID-19-related variables, psychological distress (i.e. the Depression Anxiety Stress Scale-21), sleep hygiene (i.e. the Sleep Hygiene Index) and sleep problems (i.e. the Medical Outcomes Study-Sleep Scale). Latent change score modelling revealed an average increase in sleep problems between T1 and T2 with significant inter-individual variability. No substantial changes were observed on average between T2 and T3. Notably, poorer sleep hygiene practices were associated with a more pronounced increase in sleep problems between T1 and T2 (β = 0.191, p = 0.013), even after controlling for relevant confounders such as demographic factors, COVID-19-related information and psychological distress. These findings expand on previous research regarding the detrimental effects of the pandemic on mental health, suggesting that interventions targeting sleep hygiene practices may be beneficial for mitigating its negative impact on sleep disruptions.

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017-2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam.

The assessment of emotion reactivity: The Italian validation of the Perth Emotional Reactivity Scale-Short Form (PERS-S)

Emotion reactivity refers to the activation, intensity and duration of emotional responses to internal or external stimuli. It can be differentiated from emotion regulation since the former is the very first response to an emotional trigger, and the latter can be defined as a tool for maintaining one's arousal in a window of tolerance. Since, to date, there are no Italian self-report measures able to evaluate individuals' emotional reactivity, this study aimed to contribute to the Italian validation of the Perth Emotional Reactivity Scale-Short Form (PERS-S). The PERS-S is an 18-item self-report measure answered on a 5-point Likert scale that generates six subscale scores and two composite scores, with higher scores indicating higher levels of reactivity. Data from 768 individuals showed that the PERS-S had good to excellent goodness of fit. The internal consistency was high, with an overall reliability coefficient (Cronbach's α) of .87 and .86 for the negative and positive general scales, respectively. The PERS-S also demonstrated appropriate convergent validity, showing significant correlations with conceptually related measures, and acceptable divergent validity, showing minimal correlations with unrelated constructs. Finally, we evaluated the Test-Retest Reliability by administering the PERS-S to the same sample twice, with a 2-week interval. The significant correlations between the two PERS-S administrations suggest temporal stability. The Italian version of the PERS-S will enrich the repertoire of self-report measures for investigating the development and risk factors of mental health disorders and may have practical applications in clinical settings.

Nurses quality of life, sleep disturbance, and intention to leave critical care units: A cross-sectional moderated mediation analysis

OBJECTIVES

This study aims to explore the complex relationships between personal and demographic factors, intermediary factors such as quality of life (depression, anxiety, stress, burnout), and the mediating impact of sleep disturbance on nurses' intention to leave critical care units.

DESIGN

Cross-sectional quantitative survey.

SETTING

Data were collected from registered nurses at a major university hospital in southern Italy. Seven inpatient critical care units were sampled.

MAIN OUTCOME MEASURES

Intention to leave critical care units.

RESULTS

We included 160 participants recruited over five weeks in May and June 2023. The data showed that most were female, married, and possessed a bachelor's degree in nursing. The mean quality of life score was moderate, while stress, anxiety, and burnout were mild. A significant percentage of nurses reported poor sleep quality. Logistic regression indicates that service length did not significantly impact the intention to leave. The structural equation model showed that stress positively correlated with emotional exhaustion, whereas job quality was negatively associated with emotional exhaustion and the intention to leave. Sleep disturbance did not explain the relationship between stress and emotional fatigue; however, the results revealed that male gender moderated sleep mediation.

CONCLUSIONS

This study investigated factors influencing intention to leave among critical care unit nurses. The results suggest that the role of sleep disturbance should always be considered when assessing the issue. In this chain of causes, sleep disturbance explains the relationship between stress and emotional exhaustion. Furthermore, the strength of this mediation was influenced by gender, particularly by the male gender.

IMPLICATIONS FOR CLINICAL PRACTICE

Stress and emotional exhaustion significantly impact nurses' working quality of life, particularly when sleep quality is taken into account. This leads to a higher intention to leave critical care units. To reduce this tendency, healthcare managers could implement specific evidence-based interventions to promote a good climate of work, which would positively affect stress, emotional exhaustion and sleep disturbance. The likelihood of intention to leave decreased with achieving personal self-fulfilment among nurses.

How Is the Fear of War Impacting Italian Young Adults' Mental Health? The Mediating Role of Future Anxiety and Intolerance of Uncertainty

The Russian-Ukrainian conflict is affecting mental health even in communities that are not directly involved in the war; added to this is the escalating conflict in the Middle East and its dangerous spread, which brings the war back to the center of the contemporary social and economic horizon. The present study aims to explore the psychological impact of war in a sample of 310 Italian young adults (18-30 years; M = 22.0; SD = 2.6) while exploring the relationship between Fear of War and psychological distress and evaluating the mediating effects of Future Anxiety and Intolerance of Uncertainty in this relation. Findings highlighted how Fear of War positively and significantly affects Stress, Anxiety, and Depression, and, at the same time, how it fuels both Future Anxiety and Intolerance of Uncertainty. These constructs, in addition to positively affecting the mental health outcomes considered, mediate the relationship between Fear of War and youth psychological distress with a significant indirect effect observed in all three mediation models performed. Finally, significantly higher levels of psychological distress, Fear of War, and Future Anxiety are reported in women than in men. The findings are discussed with reference to the recent literature on the psychological impact of war and on contemporary youth psychological distress, indicating the importance of educational policies and targeted interventions aimed at supporting this target in coping with multiple contemporary collective stressors.

Trajectories of relationship and sexual satisfaction over 2 years in the Covid-19 pandemic: A latent class analysis

OBJECTIVE

Previous research on the impact of the Covid-19 pandemic on romantic relationships has mainly concentrated on short-term effects and average trends of change. This study aimed to explore different trajectories of relationship and sexual satisfaction from April 2020 to March 2022.

METHOD

Including a cross-national sample of 2859 individuals, a latent class approach was applied to identify subgroups of sexual and relationship satisfaction trajectories. Participants' satisfaction levels, attachment style, psychological symptoms, life satisfaction, and living arrangements were taken into account.

RESULTS

Three latent classes were identified for both relationship and sexual satisfaction: (1) a group with high satisfaction levels but a slightly declining trajectory, (2) a group with low satisfaction levels but an ascending trajectory, and (3) a fluctuating group. Living apart, having children, psychological symptoms, low life satisfaction, and avoidant attachment characterized the two groups with low or fluctuating trajectories.

CONCLUSIONS

The findings suggest that there were different trajectories of relationship and sexual satisfaction during the pandemic, which can be predicted by individual dispositions. Even 2 years after the pandemic, its effects had not disappeared.

Stroking in early mother-infant exchanges: The role of maternal tactile biography and interoceptive sensibility

Caress-like is a crucial component of caregiving and a key factor in mother-infant interactions. Mother's experience of touch during her own childhood (i.e., tactile biography) has been found to be related to maternal actual use of caress-like touch (i.e., stroking) during mother-infant exchanges. Evidence also suggests that maternal interoceptive sensibility (i.e., self-perceived sensitivity to inner-body sensations) might be related to sensitive caregiving abilities. However, further empirical investigation is needed to understand to what extent tactile biography and interoceptive sensibility have an impact on mothers' stroking when interacting with their infants. Using an online survey, this cross-sectional study explored the potential association between maternal tactile biography, interoceptive sensibility and use of touch for interaction with their own infants in a group of 377 Italian mothers (mean age = 33.29; SD = 4.79). We tested and compared a series of multivariate linear mediation models using maternal tactile biography as predictor, maternal use of affective touch as outcome variable and Multidimensional Assessment of Interoceptive Awareness (MAIA) subscale scores as mediators. We found that, if a mother had positive touch experiences in her own childhood, she may be more likely to use touch in a positive and nurturing way with her own infant (i.e., stroking). Furthermore, mothers' interoceptive sensibility in the form of attention regulation, self-regulation and body listening mediates the association between their past experiences of positive touch and their use of caress-like touch in mother-infant exchanges. This study highlights that maternal tactile biography is directly associated with mothers' use of caress-like touch and indirectly linked to it through the mediating role of interoceptive sensibility.

Assessing the Two Sources of Construct-Relevant Psychometric Multidimensionality of the Nomophobia Questionnaire: The Integrated Framework of Bifactor Exploratory Structural Equation Modeling

The current study aimed at investigating the two sources of construct-relevant psychometric multidimensionality of the Nomophobia Questionnaire (NMP-Q), applying the newly developed bifactor exploratory structural equation modeling (B-ESEM) approach. We first contrasted several CFA and ESEM models to test the psychometric multidimensionality due to the fallibility of indicators. Then, we compared the first-order structures with those specifying both global and specific factors to test the coexistence of hierarchically ordered factors. Results from 469 participants to the 20-item questionnaire showed the superiority of a B-ESEM representation with a well-defined G-factor and four weaker S-factors. On a methodological level, our findings provide additional support for the utility of using B-ESEM's integrative perspective to better capture the complexity of multidimensional constructs.

Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors

OBJECTIVE

Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation.

METHODS

In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected.

RESULTS

3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation.

DISCUSSION

The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.

Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: A feasibility study

OBJECTIVE

Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food-related anxiety in anorexia nervosa.

METHOD

One hundred and forty-five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self-report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure.

RESULTS

Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F(2,141)  = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found.

DISCUSSION

Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa.

PUBLIC SIGNIFICANCE

This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.

The association between stigma and wellbeing in an Italian cohort of PLWH: The role of social support and personal factors

Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (p = .009, p = .020) "disclosure concerns" (p = .012, p = .039), "concerns about public attitudes" (p =.007, p = .005) and "negative self-image" scores; (p < .001, p = .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (p = .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and p < .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.

Physical activity habits prevent psychological distress in female academic students: The multiple mediating role of physical and psychosocial parameters

Background

Psychological distress is recognised as the most common mental health difficulty in emerging adult (18-to-24-year-old) female academic students. This study aimed to test a novel model positing physical activity habits as a protective factor for psychological distress through the mediating role of physical and psychological parameters. Adherence to the Mediterranean diet and self-reported physical health status were included as physical parameters. Self-reported psychological health status and time spent on leisure activities were the psychological parameters considered.

Method

Data were collected between April and May 2021. Correlation analyses and a multiple mediation model were computed on 411 online questionnaires filled out by 18-to-24-year-old female students from the University of blind (Italy).

Results

The multiple indirect effects were significant (β = -0.088; p < 0.001). This means that physical activity habits reduce psychological distress through high adherence to the Mediterranean diet, a good self-assessment of one's physical and psychological health status, and more time spent on leisure activities outdoors, with friends, and with family members.

Conclusions

Results show that academic policies should be adopted so as to design physical activity programmes that may improve the students' healthy behaviours and social interactions, which, in turn, mitigate the detrimental effects of psychological distress.

Are anxiety, depression, and stress distinguishable in Italian adolescents? an examination through the Depression Anxiety Stress Scales-21

The adolescents' ability to discriminate between different negative emotional states is still under debate. The Depression Anxiety Stress Scales-21 (DASS-21) serves as a useful tool to unravel this issue, yet the literature on its structural validity in young people is ambiguous. Therefore, this study aimed to expand knowledge on the emotional experience of youth by investigating the factor structure and psychometric properties of the DASS-21 in Italian adolescents. Six hundred fifty-five students (60.6% girls) aged 14-18 (M = 16.3 ± 1.29) completed an online survey containing the DASS-21 and Positive and Negative Affect Schedule (PANAS). To evaluate the factor structure of the DASS-21, several alternative models were tested, also adopting an Exploratory Structural Equation Modeling (ESEM) procedure. Measurement invariance, reliability, validity, and latent means differences were addressed. The ESEM model with three correlated factors of Depression, Anxiety, and Stress yielded the best fit to the data, supporting a hierarchical structure of the DASS-21. In addition, this model was invariant across sex and age groups. The Anxiety scale predicted both positive and negative affect, while Depression predicted positive affect only. Finally, girls scored higher than boys on Anxiety and Depression, but no age differences emerged. Overall, our results indicate that anxiety, depression, and stress are distinguishable in Italian adolescents but, simultaneously, share an underlying condition of general distress, which may explain the comorbidity between internalizing problems. Such findings are discussed in terms of clinical and preventive implications for the adolescent population.

The Role of Psychological Parental Control and Internalizing Problems in the Etiology of Vigorexia and Orthorexia in Adolescence

The present study aims to explore the forms of psychological parental control that are interconnected with dysfunctional emotional states (i.e., anxiety and depression), and how these internalizing problems may manifest as distorted behaviors (i.e., vigorexic and orthorexic behaviors) during adolescence. Participants included 403 Italian adolescent athletes (231 boys and 172 girls) aged 14 to 18 years. The participants completed self-report questionnaires designed to assess psychological parental control oriented towards dependence and achievement, anxiety and depression, and vigorexia and orthorexia. The results highlight how both forms of psychological parental control predict anxiety and depression. Furthermore, anxiety was found to be linked to both vigorexic and orthorexic behaviors, while depression is connected only to vigorexia. This study delves into the intricacies of parental influence on adolescents, revealing that both dependency-oriented and success-oriented psychological parental control have notable implications for the mental well-being of adolescents. The findings underscore the interconnectedness of these factors, demonstrating that anxiety can set off a chain reaction, leading to engagement in vigorexic and orthorexic behaviors. On the other hand, depression appears to be uniquely associated with vigorexia. These insights contribute to our understanding of the complex dynamics between parental control and adolescent mental health. The implications of this research extend to both theoretical frameworks and practical interventions, emphasizing the need for a nuanced approach to supporting adolescents in navigating these challenges.

Accelerated long-term forgetting: from subjective memory decline to a defined clinical entity

Subjective memory decline (SMD) might represent the preclinical phase of Alzheimer's disease (AD), and has been reported in epileptic amnesia associated with accelerated long-term forgetting (ALF). We investigated ALF in SMD subjects by means of RAVLT recall and recognition and ROCF recall after 1-week retention and compared with a control group. Two-way ANOVAs for RAVLT and ROCF were conducted, and stepwise regression analysis was administered considering EMQ and DASS-21 as factors. SMD subjects performed significantly worse than controls at 1-week delay on RAVLT recall and recognition, but not on ROCF, and not associated with depression or memory complaints. SMD patients showed ALF, which is usually associated with temporomesial dysfunctions, representing a cognitive marker to assess objectively memory problems in SMD, and to undisclose initial neurodegenerative disease involving temporal structures usually compromised in AD. Therefore, SMD might no longer be "subjective," but rather a specific and defined clinical entity.

Effects of cancer severity on the relationship between emotional intelligence, perceived social support, and psychological distress in Italian women

PURPOSE

This study aims to understand the association between emotional intelligence, perceived social support, and psychological distress (i.e., anxiety, depression, stress) in women with cancer at different stages. Specifically, the aims of this study were to investigate: i) the links between emotional intelligence and psychological distress (i.e., symptoms of anxiety, stress and depression); ii) the mediating role of perceived social support provided by family members, friends, and significant others in the relationship between emotional intelligence and psychological distress; iii) the impact of cancer type and cancer stage (I-II vs III-IV) in moderating these relationships, among Italian women.

METHODS

The research sample consisted of 206 Italian women (mean age = 49.30 ± 10.98 years; 55% breast cancer patients) who were administered a questionnaire to assess emotional intelligence, perceived social support, and psychological distress. Structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model.

RESULTS

Emotional intelligence had a positive association with perceived social support, which in turn prevented psychological distress only in women with early-stages cancers. The type of cancer has no effect on these relationships.

CONCLUSIONS

The findings of this study indicate a pressing need to screen and recognize women with lower emotional intelligence and perceived social support, as they may be more prone to experiencing psychological distress. For such individuals, our results recommend the implementation of psychological interventions aimed at enhancing emotional intelligence and fortifying their social support networks, with consideration for the stage of cancer they are facing.

Gambling and virtual reality: unraveling the illusion of near-misses effect

Introduction

Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context.

Methods

This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform.

Results

The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses.

Discussion

Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.

The association between social isolation, loneliness and psychological problems in young adults: A study during the acute phase of COVID-19 in Italy

During the COVID-19 pandemic, governments had to impose social isolation measures to safeguard the citizens' health. However, this could have affected psychological problems. The aim of the present study was to investigate the psychological effects associated with social and emotional isolation during the acute phase of the COVID-19 in Italy. To this purpose, the degree of social isolation and loneliness and the presence of psychological problems (externalising and internalising) were investigated online in a sample of 395 young adults (18-30 years; 57% women). Results confirmed the relevant association between social isolation, loneliness and psychological problems, in both internalising and externalising dimensions. Particularly, loneliness showed the strongest association. Moreover, consistently with surveys conducted during the COVID-19-era, data highlighted that men were more vulnerable to social isolation and loneliness than women. These results underline the need for adequate interpersonal support during moments of isolation to prevent negative effects on psychological problems.

Internet Addiction and Psychological Distress: Can Social Networking Site Addiction Affect Body Uneasiness Across Gender? A Mediation Model

Introduction

The Internet, with its unlimited information, revolutionary communication capabilities, and innovative potential to expand knowledge, is ubiquitous throughout the world, but it also has significant implications for users' mental health. Given the not yet clearly defined and distinguishable nosographic categories of online addiction and the resulting difficulties in describing the impact on users' mental health, the present cross-sectional study aimed to gain new insights into the relationship between Internet addiction (especially social networking site [SNS] addiction), psychological distress, and physical discomfort, as well as gender differences in impact among users.

Method

A sample of 583 Italian speakers (50.8% males; 48.7% females) with a mean age of 30.96 (SD = 12.12) completed an online survey in July 2021. A set of psychometric self-report instruments was administered to assess the study variables. Mediation analyses were performed for both the whole sample and across genders.

Results

The study found that men exhibited higher levels of Internet addiction and craving than women, but no differences were found for SNS addiction. Furthermore, indicators of psychological distress (i.e., anxiety, depression, stress, loneliness, insomnia, and self-esteem) mediated the association between SNS addiction and body uneasiness, with slight differences across genders.

Conclusion

This paper contributes to the existing literature on online addictive behaviors by also highlighting gender differences. The findings underscore the need for educational experiences that can prevent problematic use of the Internet and SNSs.

Sexual functioning in patients with psoriasis: the role of body dissatisfaction and cognitive biases toward sexuality

Psoriasis is a chronic disease, involving skin and joints, characterized by inflamed lesions. Psoriasis negatively impacts the patients' quality of life due to the physical, emotional, and social burden that accompanies this condition. Also, psoriasis is associated with a number of psychiatric comorbidities, including sexual dysfunctions. The present study investigates the variables associated with sexual functioning in psoriasis patients. One-hundred-three psoriasis patients and 101 matched control subjects took part in the present study. Each participant completed five self-report measures investigating the presence of depression, anxiety and stress symptoms, body image, quality of life, and sexual experience. Our results show that differences in sexual activity, but not in sexual functioning, emerged between groups. In men with psoriasis, more sexual difficulties were associated with more negative automatic thoughts about sexuality. In women, more sexual difficulties were associated with more negative automatic thoughts; anxiety, depression, and stress; severity of symptoms; comorbid disease; age; quality of life. Our findings expand the current knowledge about sexual functioning in psoriasis and shed light on specific cognitive, psychological, and demographic variables associated with sexual impairment in men and women with psoriasis.

Personalized Virtual Reality Compared With Guided Imagery for Enhancing the Impact of Progressive Muscle Relaxation Training: Pilot Randomized Controlled Trial

BACKGROUND

Empirical evidence has shown that virtual reality (VR) scenarios can increase the effects of relaxation techniques, reducing anxiety by enabling people to experience emotional conditions in more vivid settings.

OBJECTIVE

This pilot randomized controlled study aims to investigate whether the progressive muscle relaxation technique (PMRT) associated with a personalized scenario in VR promotes psychological well-being and facilitates the recall of relaxing images more than the standard complementary intervention that involves the integration of PMRT and guided imagery (GI).

METHODS

On the basis of a longitudinal, between-subject design, 72 university students were randomly exposed to one of two experimental conditions: (1) standard complementary procedure (PMRT and GI exposure) and (2) experimental procedure (PMRT and personalized VR exposure). Individuals were assessed by a therapist before and after 7 training sessions based on measures investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data were also collected.

RESULTS

Differences in changes between the 2 groups after the in vivo PMRT session conducted by the psychotherapist (T1) were statistically significant for state anxiety (F1,67=30.56; P<.001) and heart rate (F1,67=4.87; P=.01). Individuals in the VR group obtained lower scores both before (t67=-2.63; P=.01; Cohen d=0.91) and after (t67=-7.23; P<.001; Cohen d=2.45) the relaxation session when it was self-administered by participants (T2). A significant reduction in perceived state anxiety at T1 and T2 was observed for both groups (P<.001). After the VR experience, individuals reported feeling higher engagement in the experience than what was mentioned by participants in the GI group (F1,67=2.85; P=.03; ηp2=0.15), and they experienced the environment as more realistic (F1,67=4.38; P=.003; ηp2=0.21). No differences between groups regarding sense of presence were found (F1,67=1.99; P=.11; ηp2=0.11). Individuals exposed before to the VR scenario (T1) referred to perceiving the scenario recalled in-imagination at T2 as more realistic than what those in the GI group experienced (F1,67=3.21; P=.02; ηp2=0.12). The VR group had lower trait anxiety levels than the GI group after the relaxation session during session 7 (T2; t67=-2.43; P=.02).

CONCLUSIONS

Personalized relaxing VR scenarios can contribute to improving relaxation and decreasing anxiety when integrated with PMRT as a complementary relaxation method.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05478941; https://classic.clinicaltrials.gov/ct2/show/NCT05478941.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/44183.

The quality of sleep: evaluation among university students

Introduction

This study explored the quality of sleep among university students in the South of Italy during the Covid-19 pandemic.

Methods

A cross-sectional study was conducted between March 2022 and January 2023 and involved students over the age of 18, who were invited to complete a self-administered questionnaire using an online application.

Results

Overall, 88% of men and 94.5% of women had Pittsburgh Sleep Quality Index (PSQI) scores of ≥5 and a mean PSQI score of 9.2 ± 3. Students with severe or extremely depression score, with sever or extremely stress score, male and who did not had Covid-19 infection were more likely to have a PSQI global score. Moreover, 62.6% of the students declared a reduction in social relations and 72.3% an increase in the use of social media during the pandemic period. The majority of respondents reported an extremely severe level of depression (68.1%), anxiety (84.4%) and stress (71.9%).

Conclusion

This finding indicate that a relevant percentage of students are poor sleepers with a higher overall PSQI score with depression and stress and underline the role the implementation of public health interventions to promote healthy life styles and in particular focus on the duration of long night sleep.

Exploring the relationship between perceived loneliness and subjective cognitive decline in older individuals

OBJECTIVE

Loneliness has been associated to a greater risk of cognitive decline and dementia in older individuals. However, evidence on whether this association also exists for older individuals who complain of cognitive problems is limited. We conducted a survey to examine the association between subjective cognitive decline in the working memory domain, perceived loneliness, depression, anxiety, and stress in older individuals with different profiles.

METHODS

A total of 302 healthy, old individuals completed 3 questionnaires to assess subjective cognitive problems in attention, executive functions, storage, depression, anxiety, stress, and perceived loneliness.

RESULTS

We conducted a cluster analysis and 3 clusters of individuals with different profiles emerged. Individuals with greater subjective cognitive problems (cluster 1) in the attention and storage domains, reported higher perceived loneliness and stress but not depression. In contrast, individuals with the least subjective cognitive problems (cluster 3) in the storage domain, reported lower perceived loneliness.

CONCLUSIONS

Individuals with higher subjective cognitive decline also report higher levels of perceived loneliness but not more depression than their peers. However, this correlation is present only for individuals with mild subjective cognitive decline (cluster 2). The implications for future research and interventions are discussed.

The Acceptability of a Psychoeducation and Skill-Based Training for Carers and Teachers to Cope with Risky Behaviours in Adolescence

Childhood and adolescence psychopathology is associated with an increased risk of psychological difficulties in adulthood. Early interventions for youth should provide carers and teachers with knowledge and skills to respond to adolescents' risky behaviours. This study evaluated the acceptability and effectiveness of a single 3-h workshop, combining psychoeducation and skills training to promote knowledge about, and confidence to address, adolescents' risky behaviours in carers and teachers of adolescents aged 10-14. Demographics and perceived self-efficacy in the parental or teaching role were collected at baseline using self-report questionnaires. Motivation and confidence to respond to adolescents' risky behaviours were measured before and after the workshop using motivational rulers. Participants provided written feedback about their experience about the workshop. Twenty-seven carers and 27 teachers attended the workshops. Teachers reported a significant increase in both importance (p = 0.021) and confidence (p < 0.001) to respond to risky behaviours following the workshop. This change was associated with baseline self-efficacy levels (importance: p = 0.011; confidence: p = 0.002). Carers also reported greater confidence to address risky behaviours following the workshop (p = 0.002). Participants found the contents and methods of the workshop highly acceptable. Online and multiple-session workshops might increase reach and effectiveness.

Whole-Body Cryostimulation in Functional Neurological Disorders: A Case Report

Functional neurological disorders (FNDs) are complex disabling conditions requiring a multiple rehabilitation intervention. Here, we propose a new use of whole-body cryostimulation (WBC) that was implemented in a multidisciplinary rehabilitation programme in a wheelchair-ridden woman diagnosed with FND and other comorbidities. WBC is a promising adjuvant treatment in various conditions of rehabilitation interest, mainly because of its wide range of rapid effects, from anti-inflammatory to pain and autonomic modulating effects. The 4-week program included physiotherapy, nutritional intervention, psychological support, and WBC (-110 °C for 2 min). Questionnaires to assess disease impact, pain level, fatigue and sleep quality were administered. At discharge, improvements in body composition, haematological biomarkers, physical performance, and questionnaire scores were observed. The patient was able to walk independently with a walker for medium distances and reported unprecedented improvements, particularly in functional parameters and questionnaire scores. Although the extent to which WBC per se contributed to the measured improvements cannot be ascertained, subjective reports and our clinical observations indicate that WBC, the only intervention not previously experienced by the patient, acted as a booster for the rehabilitation interventions. Further research will be necessary to rule out any possible placebo effect and to confirm the effects of WBC on FND.

Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin

Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.

The impact of COVID-19 pandemic in patients with a diagnosis of Oral Lichen Planus: Pain perception and psychological profile analysis

OBJECTIVES

To assess the impact of COVID-19 in patients affected by OLP, in terms of level of pain, stress, depression and anxiety and their impact on the clinical manifestation of the disease.

MATERIAL AND METHODS

A longitudinal design was employed. Psychometric evaluations of anxiety, stress, and depression were conducted using the DASS21 scale, while pain levels were measured using the VAS scale. Clinical diagnosis and phenotype evaluation were performed.

RESULTS

The study included 24 patients with an average age of 62.9 years, with 70.8% presenting erosive OLP. Results revealed a significant worsening of anxiety, stress, and depression scores during the pandemic. Pain level (1.5 ± 1.2 pre-pandemic VS 3.8 ± 1.1 during the pandemic, p < 0.0001) was also negatively affected.

CONCLUSIONS

These findings highlight the potential interplay between psychological stress and oral health conditions, emphasizing the need for a comprehensive understanding of OLP's complex etiology and its response to external stressors.

CLINICAL RELEVANCE

Multidisciplinary care strategies to address both physical and psychological aspects of OLP patients is recommended following the present findings. Further research is warranted to confirm these observations in larger multicenter studies and to guide tailored guidance approaches for OLP patients during challenging times.

Bullying Victimization and Adolescent Depression, Anxiety and Stress: The Mediation of Cognitive Emotion Regulation

BACKGROUND

Existing research has revealed a robust association between bullying victimization and psychological distress, but less is known about the underlying mechanism of this link. cognitive emotion regulation (CER) strategies could be a potential mediator. The current study examined the role of functional and dysfunctional CER strategies as potential mediators of the association between bullying victimization and depression, anxiety, and stress symptoms among 638 high school students (53.9% boys; Mean age = 15.65, SD = 1.32).

METHOD

Participants completed a series of questionnaires assessing bullying victimization (Olweus Bully/Victim Questionnaire), CER strategies (CERQ-18), and symptoms of depression, anxiety, and stress (DASS-21). The indirect relationships between bullying victimization and psychopathological symptoms via functional and dysfunctional CER strategies were tested through structural equation modeling.

RESULTS

Dysfunctional CER strategies mediated the impact of bullying victimization on depression, anxiety, and stress. In contrast, bullying victimization did not significantly influence functional CER strategies.

CONCLUSIONS

The findings provide additional support for the detrimental role of bullying victimization on mental distress, also suggesting that this effect is not only direct, but indirect is well. These results are particularly relevant in light of the absence of mediation by protective factors such as the use of positive emotion regulation strategies.

The HEXACO Adjective Scales and Its Psychometric Properties

The HEXACO model divides the space of personality into six main dimensions: Honesty-Humility, Emotionality, eXtraversion, Agreeableness (vs. anger), Conscientiousness, and Openness to Experience. Despite the lexical foundation, no validated adjective-based instruments are available yet. This contribution describes the newly developed HEXACO Adjective Scales (HAS), a 60 adjectives instrument to measure the six main personality dimensions. Study 1 (N=368) proceeds to the first pruning of a large set of adjectives to identify potential markers. Study 2 (N=811) delineates the final list of 60 adjectives and provides benchmarks for the new scales' internal consistency, convergent/discriminant, and criterion validity. Study 3 (N=411) confirms the HAS factorial structure, internal consistency, and criterion validity. The study also provides evidence of temporal stability (test-retest reliability) and convergence between raters (peer/self-evaluation). The HAS shows excellent psychometric properties and constitutes a valuable tool for assessing the HEXACO personality dimensions using adjectives.