COVID-19 post-traumatic stress disorder: the role of ACEs, alexithymia, and attachment in the Italian population

OBJECTIVE

The COVID-19 pandemic is considered a collective traumatic event. Several studies have highlighted high levels of post-traumatic stress disorder (PTSD) symptoms among the general population during the pandemic. The general aim of this research is to explore the role of adverse childhood experiences (ACEs), alexithymia, and anxiety and avoidance attachment dimensions as risk factors that are making individuals more vulnerable to PTSD-COVID-related symptoms.

SUBJECTS AND METHODS

The COVID-19-PTSD Questionnaire, 20-Item Toronto Alexithymia Scale (TAS-20), Adverse Childhood Experiences Questionnaire, and the Experiences in Close Relationships-Revised Form (ECR-R) were administered to 224 participants who were between 18 and 65 years of age, and residents of Italy. Socio-demographic variables were also collected. The data was collected between October 2021 and March 2022.

RESULTS

The findings of the Spearman correlation analysis showed several significant associations between alexithymia, attachment dimensions, and PTSD symptoms related to COVID-19 diagnosis and age. A multivariable logistic regression model was performed using the COVID-19-PTSD total scores over/under the clinical cut-off as dependent variables and age, gender, anxiety and avoidance attachment scores, ACEs, and total alexithymia as independent variables, with alexithymia total score (B = .071; p = .001), ECR-R Anxiety (B = .034; p = .001) and ECR-R Avoidance (B = -.033; p = .024) showing to respectively increase and reduce the possibility of reporting clinical symptomatology.

CONCLUSIONS

Emotional regulation and attachment have been shown to be risk factors for COVID-19 PTSD symptomatology. Focused intervention programs and emotional education can be useful tools for developing protective factors in the general population.

Sexological and traumatic aspects in reproductive difficulties: a psychometric study on couples seeking help for infertility

PURPOSE

To investigate the impact of infertility in gender differences on psycho-traumatological, sexological, relational and emotional aspects and gender differences in couples requiring assisted reproductive treatment.

METHODS

151 couples were recruited with a mean age of 36.7 ± 4.8 years for women and 39.8 ± 6.6f or men. 43% of women and 34% of men had already received the diagnosis of infertility. To recruited subjects was administered the following psychometric tests: Sexological and Emotional in Infertility questionnaire (SEIq), Arizona Sexual Experience Scale (ASEX), the Orgasmomether and the International Trauma Questionnaire (ITQ).

RESULTS

There was a significant difference in traumatic symptoms between men and women (t = 5,859, p < 0.05). Gender differences were found in the sexological dimension of the SEIq (t = 7,858, p < .001) and in the total ASEX score (t = 3,979, p < .001). Specifically, significant correlations emerged between the ASEX domains and the emotional and sexological aspects related to infertility only in women. The reaction to the diagnosis was negatively correlated with the emotional area of ​​the couple (r = -0.683, p < .001) and positively with the couple relationship (r = 0.815, p < .001). Multiple regression revealed that the overall functioning of the couple, rather than the single scales, is the main predictor of sexuality (R2 = 0.77).

CONCLUSION

A clear impact of infertility on the couple's psycho-traumatological, psycho-sexological and relational aspects emerged. It could be useful to promote targeted support interventions on the most compromised areas of couple functioning in assisted reproductive centers.

Psychopathological symptoms and their association with the quality of life and the sexual functioning in women affected by systemic scleroderma: a preliminary investigation

OBJECTIVE

This study aimed to investigate the presence of psychopathological symptoms and the relations of these dimensions with the quality of life and sexual function in a group of women affected by systemic scleroderma.

SUBJECTS AND METHODS

Seventy-one women with systemic scleroderma were invited to participate in the study; 65 agreed to participate, while 6 declined. Four questionnaires were administered to the patients: a specific socio-demographic questionnaire, the Symptom Checklist-90-Revised (SCL-90-R), the Female Sexual Function Index (FSFI), and the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41).

RESULTS

Of all the participants in this study, 48% of patients showed a clinical score on SCL-90-R Somatization, 45% on depression, and 37% on obsessive-compulsive. As hypothesized, psychopathological symptoms were related to lower quality of life since somatization and depression predicted the total score of health-related quality of life and lower sexual functions, showing a specific effect of depression on sexuality.

CONCLUSIONS

Our findings highlighted the presence of an association between psychopathological symptoms and reduced sexual functioning and the associations between somatization and the health-related quality of life dimensions in scleroderma patients. Furthermore, our results sustain the importance of also considering the mental health of patients with systemic sclerosis, within an integrated biopsychosocial care model.

P-498 Psychological care during ART treatments In Italy: the patients’ point of view

Study question

What are the characteristics of the psychological care and the emotional needs of couples undergoing ART treatment in Italy?

Summary answer

The presence of psychological support services in ART centers is poorly communicated to patients, with less than half being advised to take a pathway.

What is known already

Couples who decide to undergo ART treatment show significantly higher depression and shame scores, lower acceptance and self-compassion scores, greater reliance and avoidant coping strategies. Couples experience the procedure as source of stress, anxiety and pain, fluctuating between hope and despair, and all of this seem to negatively impact on treatment continuation and outcomes. A review of 25 studies using different psychological interventions (counseling, focused educational interventions and integrated educational programs) found positive effects on anxiety (61.5%), depression (38.4%) and infertility-related stress (100%) reduction. Several studies showed the effectiveness of psychological intervention in promoting pregnancy rates.

Study design, size, duration

The ART Italian National Register (National Health Institute) with the Department of Dynamic and Clinical Psychology and Health Studies (Sapienza University) proposed a national survey to 195 Italian ART centres and patient associations. Patient associations and the Medical Director of each centre were invited by e-mail to participate and to encourage all patients to fill a questionnaire made available on an on-line platform. Data collection was between March to October 2021.

Participants/materials, setting, methods

324 ART patients completed an online questionnaire consisting of 19 closed-ended and 8 open-ended questions. In this abstract we focus on the closed-ended questions. The questionnaire was created ad hoc for the survey starting from a previous study on the characteristics of the services offered in Italian ART centres.

Main results and the role of chance

In 90% of cases women responded to the questionnaire, only 10% of responses were from men. On average, participants are 38 years old, married (60%), and have a bachelor's degree or post-graduate degree (59%). In half of the cases respondents are employed. In 68% of cases, participants performed ART treatment in centers with public service.

Most of the respondents are facing their first or second ART cycle. They share their infertility condition with family and friends, and in 60% of cases they have been informed of the presence of the psychological service, mainly from gynecologists and through informed consent. Only in 31% of cases patients were invited to undertake psychological counseling, strongly recommended to only 8% of them. In fact, 65% of respondents never had a meeting with the psychologist during ART treatment. Those who resorted to counseling had mainly couple (45%) and individual (31.3%) meetings. Participants did not know the cost of counseling, would prefer it to be included in the cost of ART treatment, and would like it to be available throughout treatment The main emotions felt during ART treatment are sadness, fear and anger, those attributed to the partner are the same but joy also appears.

Limitations, reasons for caution

Firstly the limited sample size, mainly related to the ability of ART center staff to spread the initiative among patients.

The low response from male partners, that could be related to their rare presence in ART centers, as the medical treatment is mainly targeted to women.

Wider implications of the findings

In conclusion, the results show that psychological services in Italian ART centers are not yet fully operational and integrated in the ART procedure. All this highlights the importance of further investigations with the aim of sharing information to establish common protocols for psychological interventions in ART centres.

Trial registration number

Not applicable

P-492 Characteristics of the psychological care service in Italian ART centres: the point of view of physicians, psychologists and couples

Study question

What is the point of view of physicians, psychologists and patients on the characteristics of the psychological assistance offered by Italian ART centres?

Summary answer

Physicians, psychologists and patients alike affirm the importance of specialised psychological support during ART treatment

What is known already

The European Society of Human Reproduction and Embryology (ESHRE) has produced specific recommendations, establishing that all staff members should share the responsibility related to patients’ psychological wellbeing through their treatments. Moreover, when patients show increased risk of negative consequences some specialized services, as psychological counseling or psychotherapy, should be provided. In Italy, the Law 40/2004 regulates ART treatment and also provides the “Guidelines for the application of Assisted Reproductive Technology” (2008, 2015). According to this law, psychological support for women and couples undergoing ART procedures at any step of medical treatment (before, during, after the treatment) should be routinely included.

Study design, size, duration

To explore opinions on the characteristics of the psychological support service in ART centres: An online questionnaire was sent to the physicians in charge of 341 ART centres. 5 focus groups with psychologists working in ART centres were carried out. An online questionnaire for patients was sent to 195 centres and 8 patient associations. The surveys were conducted over a period from January 2020 to October 2021.

Participants/materials, setting, methods

Physicians from 113 centres (37%) responded to questionnaires composed of 20 closed-ended and 6 open-ended questions; 28 psychologists working in ART centres in 3 italian regions participated in focus groups with 3 open-ended questions; and 324 patients responded to questionnaires composed of 19 closed-ended and 8 open-ended questions. The questionnaires were created ad hoc for the surveys starting from the characteristics of the services offered in Italian ART centers.

Main results and the role of chance

Physicians affirm the importance of the psychologist in the ART centre to support their work: managing couples’ emotional difficulties; improving couples’ mood; and reducing couples’ stress (9% of answers). They also ask for an effective psychological intervention protocol to adopt. Concerning the characteristics of psychological services, physicians do not identify priority areas of intervention, but they admit the usefulness of psychological intervention throughout the treatment. Most physicians admit the utility of psychological counseling as defined by the 2015 Guidelines. Psychologists would like more recognition of their function and they affirm the positive contribution of networking among ART psychologists, believing that specific training is needed to work in the field. The psychologists find that multidisciplinary work in the team is functional and improves the quality of service offered in this field. Patients say that ongoing psychological support throughout the treatment could be helpful for them. They believe that psychologists should have specific training in ART and they would like the cost of psychological support to be included in ART treatment. They argue that psychological support should help their relationship with physicians. Despite this, the psychologist is a stable professional figure in only half of the responding ART Centres (47%).

Limitations, reasons for caution

Physicians’ opinions are based on a 37% response rate  from ART centres and cannot be considered conclusive. The 5 focus groups were conducted with psychologists working in ART centres located in only three Italian regions. There were few responses from male patients.

Wider implications of the findings

In conclusion, despite the scarce presence of psychological support in ART centres, physicians, psychologists and patients believe that it would be mportant throughout ART treatment. This highlights the importance of further investigation with the aim of sharing information to establish common protocols for psychological interventions in italian ART centres.

Trial registration number

not applicable

P–511 Characteristics of psychological services for couples undergoing ART treatment in Italy

Study question

What are the characteristics of the psychological services for couples undergoing ART treatment in Italy?

Summary answer

In the 47% of ART clinics the psychologist is a stable member of the team whereas psychological services are used by 10–20% of couples. What is known already: ART treatments are complex and emotionally demanding for both men and women. During the procedure the couples often experience stress and several negative emotions. In Italy the Law 40/2004 establishes the guidelines for ART application. This law sustains the importance of offering psychological support to the people who undergo ART treatments at any stage of the medical procedure. However, in Italy there are no specific recommendations or protocols for psychological interventions in ART centres. Furthermore, there is little or no studies regarding the characteristics of the psychological services offered to those undergoing ART treatments.

Study design, size, duration

This observational study aims to explore the characteristics of psychological services in ART clinics. Therefore, the ART Italian National Register (National Health Institute) with the Department of Dynamic and Clinical Psychology and Health study (Sapienza University) proposed a national survay to the 306 Italian ART centres. The Medical Director of each centre was invited to participate by e-mail and to fill a questionnaire on an on-line platform. Data collection was between Jenuary to February 2020.

Participants/materials, setting, methods

The participation has been proposed to all the Italian ART centres (n = 306). 35 centres have been previously excluded because participating in the first phase of the study regarding the questionnaire construction. Around the 40% of the centres participated in the study (n = 113). The questionnaire contains 26 items with multiple response answers. It mainly explored: the presence of the psychologist in the ART centres, charachteristics of the intervention offered, percentage of couples using the psychological service.

Main results and the role of chance

In the 47% of ART centres the psychologist is a stable member of the team. The 38% of respondents reported that the psychologist works on call in the centre, the 18% reported that the psychologist is present in the centre 1–2 times a week whereas the 32% reported that the psychologist works in a private practice outside the centre. The reported percentages of couples using the psychological service are: 10–20% (69%), 20–30% (13%), 30–50% (5%), more than 50% (5%) and around the 100% (8%). The number of psychological sessions usually offered are: up to five (9%), four (13%), three (29%), two (27%), one (10%). Couples interventions represent the 73%, single patient intervention the 14%, whereas the 13% are group interventions. The 60% of respondent reported the absence of a protocol for psychological intervention in the ART centre whereas the 40% reported the presence of a protocol. In around the 50% of cases the psychological service represents an extra cost for the couple/individual. In the 60% of cases the psychologist is not involved in the team meeting, however the 87% of respondents reported that confronting with the psychologist on patients is percived as useful.

Limitations, reasons for caution

These results should be considered with cautions due to the rate of participation (around 40%). Furthermore, this is a national study and the charachteristics of psychological services offered in ART centres of different countries should be investigated.

Wider implications of the findings: In conclusion, the results show that psychological services in Italian ART centers are not yet fully operational and integrated in the ART procedure. All of this highlights the importance of further investigations with the aim to shared information to use to establish common protocols for psychological interventions in ART centres.

Trial registration number

Not applicable

Alexithymia and obesity: controversial findings from a multimethod assessment

OBJECTIVE

The aim of the study is to assess alexithymia levels in obese patients using a multimethod measurement (TAS-20 and TSIA) to evaluate both possible differences between the two instruments and their relationship with body weight.

PATIENTS AND METHODS

54 obese patients, seeking surgical treatment, were enrolled. They completed a socio-demographic questionnaire, 20-items Toronto Alexithymia Scale and the Toronto Structured Interview for Alexithymia.

RESULTS

Data analysis showed a significant positive association between TAS-20 and TSIA total scores (r=.28, p<.05), but only the TSIA score was positively related to body weight (r=.39; p<.001). Multivariable linear regression models showed the predictive effects of TSIA total score (beta=.41; p<.001) and difficulty in identifying feelings (DIF) (beta=.56; p<.001) respectively on weight.

CONCLUSIONS

The findings showed a different association between body weight and alexithymia according to the instrument employed to evaluate alexithymia, supporting the importance of a multimethod assessment in some clinical conditions.

Linguistic analysis of autobiographical narratives in unipolar and bipolar mood disorders in light of multiple code theory

BACKGROUND

Discriminating bipolar disorder (BD) from unipolar disorder (UD) is crucial in diagnosing mood disorders. Neurophysiological studies have identified different correlates of emotional regulation in BD and UD. According to the Multiple Code Theory, bodily modifications relate to linguistic styles, as highlighted by studies on the language of depression. Our purpose is to verify the existence in the Italian language of linguistic features of depression differentiating BD from UD to provide tools for clinicians to use beyond self-report measures.

METHODS

The sample included 20 BD, 20 UD (all diagnosed using DSM-5), and 20 Control Group (CG) participants. Participants completed the Profile of Mood States (POMS) and an audio-recorded Relationship Anecdotes Paradigm Interview, transcribed and analyzed by the Discourse Attributes Analysis Program for Referential Process Linguistic Measures.

RESULTS

One-way ANOVAs confirmed that specific linguistic features characterized BD, UD and CG. The use of Sensory-Somatic words was significantly different in the groups: higher in BD, intermediate in UD, and lower in CG. Individuals with BD produced higher scores on the Referential Activity Intensity Index and the use of singular pronoun "I". Negative Affect, as well as several POMS subscales, distinguished UD and BD from CG.

LIMITATIONS

Narrow sample size, use of a single self-report instrument and treatment effects on measures in the clinical groups are limitations of the study.

CONCLUSION

Individuals with UD and BD appear to use sensory-somatic language in predictably different patterns from each other and from the non-clinical population. Observation and assessment of linguistic features could improve diagnostic accuracy.

Prevalence of severe ADHD: an epidemiological study in the Italian regions of Tuscany and Latium

BACKGROUND

The rate with which attention deficit/hyperactivity disorder (ADHD) is diagnosed varies widely across countries, suggesting that cultural factors influence the clinical interpretation of child behaviour. This study estimated the point prevalence of severe ADHD among elementary and middle-school Italian children.

METHOD

An epidemiological sample of 2016 children attending 2nd-8th grade in the Italian regions of Tuscany and Latium was selected based on census distribution of the school-age population. Teachers completed the Italian version of the ADHD Rating Scale for Teachers (SDAI). For children with at least six inattention symptoms and/or at least six hyperactivity/impulsivity symptoms rated 'very often' by the teachers, the parents completed the Italian ADHD Rating Scale for Parents (SDAG). Children with documented ADHD symptoms at both school and home received a complete psychiatric interview with the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version (K-SADS-PL).

RESULTS

Of the 1887 assessed children, 4.45% (95% CI 3.58-5.51) met the ADHD cut-off on teacher ratings, 1.43% (0.96-2.12) had ADHD symptoms endorsed by both teacher and parent, and 1.32% (0.87-1.97) were further confirmed by the psychiatric evaluation. The male:female ratio was 7:1. The inattentive type accounted for about half of the ADHD cases.

CONCLUSIONS

When applying stringent criteria for both severity and pervasiveness of symptoms, it is estimated that about 1.3% of the Italian elementary and middle-school children suffer from severe ADHD.

The dentist's role in recognizing childhood abuses: study on the dental health of children victims of abuse and witnesses to violence

Up to today, little attention and training has been paid, in the Italian dental field, to a dramatically widespread problem, childhood abuse and neglect (CAN). Our research fits into a current of thought on alerting physicians, not only paediatricians, to the problem of abused children. Violence is often part of neglect and carelessness toward children, and it often also concerns their personal hygiene and health care. Aim of our study was to verify the hypothesis that dental neglect, intended as a specific form of neglect, is often associated to other types of neglect, and therefore it could represent an important sign in identifying childhood abuse and neglect situations. These were investigated through the comparison between a group of children with psychological disorder and a control group, as far as their dental health is concerned. Our results indicate that the abused children show: a significantly higher dental plaque index (p=.02); a higher gingival inflammation (p =.2); a higher number of untreated decays (p=.004); more evidences of neglect (p = .0002). Additionally, the abused subjects were less cooperative during dental visits (p=.0005). Our data support the hypothesis that the abused children in our group are, both under the hygiene point of view and access to treatment, more neglected by their caregivers.

Inadvertent catheterization of the internal thoracic vein mimicking pulmonary embolism: a case report

Although aberrant locations are typical complications of central venous catheterization, the right internal thoracic vein (mammary vein) is an exceptional one. A case of this unusual aberrant location occurring after right internal jugular venous cannulation for total parenteral nutrition, is described. This aberrant position caused signs and symptoms resembling pulmonary embolism. This is the first known description of the symptoms induced by the infusion of parenteral solution into the right internal thoracic vein.