The Meaning of Living in the Time of COVID-19. A Large Sample Narrative Inquiry

The spread of the COVID-19 pandemic has been a sudden, disruptive event that has strained international and local response capacity and distressed local populations. Different studies have focused on potential psychological distress resulting from the rupture of consolidated habits and routines related to the lockdown measures. Nevertheless, the subjective experience of individuals and the variations in the way of interpreting the lockdown measures remain substantially unexplored. Within the frame of Semiotic Cultural Psychosocial Theory, the study pursued two main goals: first, to explore the symbolic universes (SUs) through which Italian people represented the pandemic crisis and its meaning in their life; and second, to examine how the interpretation of the crisis varies over societal segments with different sociodemographic characteristics and specific life challenges. An online survey was available during the Italian lockdown. Respondents were asked to write a passage about the meaning of living in the time of COVID-19. A total of 1,393 questionnaires (mean = 35.47; standard deviation = 14.92; women: 64.8%; North Italy: 33%; Center Italy: 27%; South Italy: 40%) were collected. The Automated Method for Content Analysis procedure was applied to the collected texts to detect the factorial dimensions underpinning (dis)similarities in the respondents' discourses. Such factors were interpreted as the markers of latent dimensions of meanings defining the SUs active in the sample. A set of χ2 analysis allowed exploring the association between SUs and respondents' characteristics. Four SUs were identified, labeled "Reconsider social priorities," "Reconsider personal priorities," "Live with emergency," and "Surviving a war," characterized by the pertinentization of two extremely basic issues: what the pandemic consists of (health emergency versus turning point) and its extent and impact (daily life vs. world scenario). Significant associations were found between SUs and all the respondents' characteristics considered (sex, age, job status, job situation during lockdown, and place of living). The findings will be discussed in light of the role of the media and institutional scenario and psychosocial conditions in mediating the representation of the pandemic and in favoring or constraining the availability of symbolic resources underpinning people's capability to address the crisis.

Emotional distress, psychosomatic symptoms and their relationship with institutional responses: A survey of Italian frontline medical staff during the Covid-19 pandemic

With the advent of Covid-19, health workers have been under constant physical and psychological pressure. Italy was among the first countries to face the health emergency in a period of great uncertainty about the virus and the ways to treat patients. The present study aims to analyse the levels of emotional distress (ED) and psychosomatic symptoms (PS) of Italian frontline health workers during the Covid-19 emergency, and their relationship with the evaluation of the institutional responses received. A survey was available online during the peak of health system overload. Health workers' ED, PS and perceived overall wellbeing were assessed, along with the perceived adequacy of the emotional support, hygiene and safety measures, and protection received from the national government, regional administration and local hospital. A total of 103 questionnaires were collected [Women: 51.5%; mean age, 41.8 years; SD: ±10,7; high-risk zone: 41.7%]. Correlation analyses were applied to investigate the relationship between the measures of emotional distress and psychosomatic symptoms; ANOVA was applied to compare these measures among groups from different risk zones and with different perceived emotional and safety protection. About half of the health workers showed medium or high scores on emotional exhaustion, exceeded the cut-off for medium, high or very high psychosomatic symptom burdens, felt they have never or rarely been protected by the institutional responses and judged the emotional support received as inadequate; 32% judged the safety and hygiene measures as insufficient. Significant associations were found between measures of ED, PS and perceived change in personal wellbeing. Differences in perceived institutional support and adequacy of hygiene and safety measures related to significant differences in PS and perceived change in personal wellbeing. ED and PS were widely experienced by frontline health workers. Physical and psychological symptoms were amplified by the perceived lack of institutional support. Ensuring PS and hygiene and safety measures is essential to prevent worsening of health and psychosomatic symptoms in frontline health workers.

Burnout and Psychological Vulnerability in First Responders: Monitoring Depersonalization and Phobic Anxiety during the COVID-19 Pandemic

Background: It is common knowledge that first responders are among the helping professionals most at risk of burnout and psychological vulnerability. During the COVID-19 pandemic, their mental health has been subjected to various risk factors. Methods: Data on socio-demographic characteristics, the Maslach Burnout Inventory (MBI) and psychological vulnerability (SCL-90-R) were obtained from 228 subjects (55.3% female; M age = 45.23, SD = 13.14) grouped on the basis of their actual involvement during the emergency phases (82% First Responders and 18% Second Responders). Results: First responders exceeded the MBI clinical cut-off, while SRs did not (χ² ≥ 0.5); specifically, EE = 89.8%, DP = 85.8%, and PA = 82.1%. The FR group showed a higher mean in the global severity index (GSI = 49.37) than did the SRs (=43.95), and the FR group exceeded the clinical cut-off in the SCL-90-R scales of SOM (51.06), ANX (52.40), and PHOB (53.60), while the SF group did so only for the PHOB scale (50.41). The MBI dimensions correlated significantly (p = 0.05) with all investigated clinical scales of the SCL-90-R. Conclusions: Emergency situations expose first responders to specific risk factors related to work performance and relational aspects, which contribute to increased psychological vulnerability and burnout.

Social Environment and Attitudes toward COVID-19 Anti-Contagious Measures: An Explorative Study from Italy

Social and cultural aspects (i.e., political decision making, discourses in the public sphere, and people's mindsets) played a crucial role in the ways people responded to the COVID-19 pandemic. Framed with the Semiotic-Cultural Psychological Theory (SCPT), the present work aims to explore how individual ways of making sense of their social environment affected individuals' perception of government measures aimed at managing the pandemic and the adherence to such measures. An online survey was administered from January to April 2021 to the Italian population. Retrieved questionnaires (N = 378) were analyzed through a Multiple Correspondence Analysis (MCA) to detect the factorial dimensions underpinning (dis)similarities in the respondents' ways of interpreting their social environment. Extracted factors were interpreted as markers of Latent Dimensions of Sense (LDSs) organizing respondents' worldviews. Finally, three regression models tested the role of LDSs in supporting the individual satisfaction with the measures adopted to contain the social contagion defined at national level, individual adherence to the containment measures and the perception of the population's adherence to them. Results highlight that all the three measures are associated with a negative view of the social environment characterized by a lack of confidence in public institutions (health system, government), public roles and other people. Findings are discussed on the one hand to shed light on the role of deep-rooted cultural views in defining personal evaluations of government measures and adherence capacity. On the other hand, we suggest that taking into account people's meaning-making can guide public health officials and policy makers to comprehend what favors or hinders adaptive responses to emergencies or social crises.

The Social Construction of the Pathological Gambler's Identity and Its Relationship With Social Adaptation: Narratives From Members of Italian Gambling Anonymous and Gam-Anon Family Groups

According to a socio-constructionist perspective, pathological gamblers’ “subjectivities” emerge out of social networks and networks of meaning-making in which scientists, politicians, health services, and common people take an active part. We are interested in showing how a legitimated view (socio-cultural model) of problem gambling as a disease affects the way in which the members of Gamblers Anonymous (GA) self-groups understand and present their identity and talk about their problem and the help they have received. The work is based on a qualitative analysis of 35 in-depth, semi-structured, open-ended interviews, 25 with gamblers who attend Italian GA self-help groups and 10 with gamblers’ relatives who attend Gam-Anon family groups. The main themes arising from the interviews show how a dominant view of problem gambling as a lifelong chronic illness opens the door to reconciliation with oneself and one’s relatives. This work provides insights into the close relationship between acculturation to a pathological identity, moral reconciliation, and “social belonging” that occurs through conforming to the GA group. Selon un point de vue socio-constructiviste, les «subjectivités» des joueurs pathologiques émergent des réseaux sociaux et des réseaux de création de sens dans lesquels les scientifiques, les politiciens, les services de santé et les personnes ordinaires participent activement. Nous sommes intéressés à montrer comment une vision légitimée (modèle socio-culturel) du jeu problématique en tant que maladie affecte la façon dont les membres des groupes autonomes de Gamblers Anonymes (GA) comprennent et présentent leur identité et parlent de leur problème et de l'aide qu’ils ont reçu. Le travail est basé sur une analyse qualitative de 35 entrevues approfondies, semi-structurées et ouvertes, 25 avec des joueurs qui fréquentent des groupes d'entraide italiens de GA et 10 avec des parents de joueurs qui fréquentent des groupes familiaux Gam-Anon. Les principaux thèmes découlant des entrevues montrent comment une vision dominante du jeu problématique en tant que maladie chronique tout au long de la vie ouvre la voie à la réconciliation avec soi-même et avec ses proches. Ce travail donne un aperçu de la relation étroite entre l'acculturation à une identité pathologique, une réconciliation morale et une «appartenance sociale» qui se produit en se conformant au groupe GA. 

The COVID-19 Pandemic from the Health Workers’ Perspective: Between Health Emergency and Personal Crisis

Different scholars have emphasised the psychological distress experienced by health workers during the COVID-19 pandemic; however, there are almost no qualitative studies and we know very little about the everyday experience of this group. The present study’s goal was to explore how health workers interpreted the meaning of the pandemic crisis in their life. An online survey was available during the Italian lockdown. Respondents were asked to write a passage about the meaning of living in the time of COVID-19. A total number of 130 questionnaires (M = 42.35; DS = 10.52; women: 56.2%) were collected. The Automated Method for Content Analysis (ACASM) procedure was applied to the collected texts to detect the factorial dimensions underpinning (dis)similarities in the respondents’ narratives. Such factors were interpreted as the markers of latent dimensions of meanings (DS). The two main DS that emerged were characterised by the pertinentisation of two extremely basic issues: what the pandemic represents (health emergency versus personal crisis) and its impact (powerlessness versus discovery of new meanings). On the whole, health workers’ narratives help to highlight the risk of normalising the feelings of fear and impotence experienced when facing the health emergency and the need to recognise that such feelings are strictly intertwined with the limited resources received to “face the battle”; the need to recognize the human vulnerability of the women and men “inside the lab coat” and the human effort to maintain or reconstruct a sense of self and purpose in the face of troubled circumstances.

Making sense of the COVID-19 pandemic: A qualitative longitudinal study investigating the first and second wave in Italy

The COVID-19 pandemic further highlighted the crucial role of people's compliance for the success of measures designed to protect public health. Within the frame of Semiotic Cultural Psycho-social Theory, we discuss how the analysis of people's ways of making sense of the crisis scenario can help to identify the resources or constraints underlying the ways the citizens evaluate and comply with the anti-covid measures. This study aimed to examine how Italian adults interpreted what was happening in the first wave of the pandemic and how the interpretation varied in the period up to the beginning of the second wave. Diaries were collected for six months, from 11 April to 3 November 2020. Participants were periodically asked to talk about their life 'in the last few weeks'. A total number of 606 diaries were collected. The Automated Method for Content Analysis (ACASM) procedure was applied to the texts to detect the factorial dimensions - interpreted as the markers of latent dimensions of meanings- underpinning (dis)similarities in the respondents' discourses. ANOVA were applied to examine the dissimilarities in the association between factorial dimensions and production time. Findings show that significant transitions occurred over time in the main dimensions of meaning identified. Whereas the first phase was characterized by a focus on one's own daily life and the attempt to make sense of the changes occurring in the personal sphere, in the following phases the socio-economic impact of the crisis was brought to the fore, along with the hope to returning to the "normality" of the pre-rupture scenario. We argued that, despite the differences, a low sense of the interweaving between the personal and public sphere emerged in the accounts of the pandemic crisis throughout the sixth months considered; a split that, we speculate, can explain the "free for all" movement that occurred at the end of the first wave and the beginning of the second wave.

What does anorexia nervosa mean? Qualitative study of the representation of the eating disorder, the role of the family and treatment by maternal caregivers

BACKGROUND

Anorexia nervosa is a serious health problem worldwide. The literature widely recognises the roles of the family and caregivers in modulating the onset, development, maintenance and treatment of this disorder. However, few studies have addressed the problem from the perspective of maternal caregivers.

AIMS

This study aims to fill this gap by exploring how the meaning given to the term 'eating disorder' influences how mothers communicate with each other about a family member's health problems, how they present symptoms and how this problem is managed.

METHOD

A narrative research project was conducted to capture the mothers' experiences of living with a daughter diagnosed with anorexia nervosa. In particular, four semi-structured interviews were conducted to explore the ways in which they made sense of the disorder, their roles in treatment and their daughters' treatment experiences.

RESULTS

The results show that the ways in which mothers characterise the disease guide their method of tackling it and the relationship they have with their daughter, as well as how they see their role in the care and treatment process.

CONCLUSIONS

Anorexia is experienced as something that is uncontainable, and a dimension of its accommodation characterises the relationship between mothers and daughters receiving treatment for the disorder. Treatment is accompanied by a delegating dimension, and the clinical implications are discussed in this study.

What game we are playing: the psychosocial context of problem gambling, problem gaming and poor well-being among Italian high school students

Gambling and gaming are not infrequent among adolescents and preventing low-risk youth from becoming at-risk appears to be a priority of public health strategies. Greater scrutiny of the risk and protective factors in the relationships and community of young people appears crucial in steering prevention initiatives adequately. This study aimed to explore the role of the qualities of relational networks (i.e. family functioning, perceived social and class support), family and peer approval and view of the social environment in predicting problem gambling, problem gaming and overall well-being among adolescents. High-school students aged 14-18 years (N: 595; female: 68,7%) completed a survey including the target variables. A multivariate multiple regression analysis was performed to examine the role of socio-demographic characteristics and psychosocial predictors on gaming, gambling, and well-being. Multivariate multiple regressions identify a common core underpinning problem gambling, gaming and poor well-being but also the distinct roles of psychosocial variables: being male, with low parental monitoring, and an anomic view of the social environment all predict problem gambling and gaming, which were also found to be associated. Low social support predicts problem gambling but not problem gaming; poor family functioning predicts problem gaming but not problem gambling. All the target psychosocial variables, except approval of gambling, predict poor well-being. On the whole the findings suggest the need to look more closely at the way adolescents, their system of activity and their culture participate in constructing the meaning of gambling and gaming activities and their impact on adolescents' well-being, so that future studies and strategies can more effectively examine the relational dynamics in which problem gambling and gaming develop.

Steps Towards a Unified Theory of Psychopathology: The Phase Space of Meaning Model

The hypothesis of a general psychopathology factor (p factor) has been advanced in recent years. It is an innovation with breakthrough potential, in the perspective of a unified view of psychopathology; however, what remains a controversial topic is how its nature might be conceptualized. The current paper outlines a semiotic, embodied and psychoanalytic conceptualization of psychopathology - the Phase Space of Meaning (PSM) model - aimed at providing ontological grounds to the p factor hypothesis. Framed within a more general model of how the mind works, the PSM model maintains that the p factor can be conceived as the empirical marker of the degree of rigidity of the meaning-maker's way of interpreting experience, namely of the dimensions of meanings used to map the environment's variability. As to the clinical implications, two main aspects are outlined. First, according PSM model, psychopathology is not an invariant condition, and does not have a set dimensionality, but is able to vary it locally, in order to address the requirement of situated action. Second, psychopathology is conceived as one of the mind's modes of working, rather than the manifestation of its disruption. Finally, the puzzling issue of the interplay between stability and variability in the evolutionary trajectories of patients along with their life events is addressed and discussed.

It Is Time to Take Complaints Seriously? An Exploratory Analysis of Communications Sent by Users to a Public Healthcare Agency before, during and after the COVID-19 Pandemic

Taking due account of users' perspectives is crucial for improving the quality of healthcare services. This study aimed to analyse the representations and evaluation criteria that users of a public health agency express towards care and treatment services and to explore whether and how the content and meaning of their communications varied according to pre-pandemic, pandemic or post-pandemic periods. A total of 501 communications sent to the public relations office of an Italian health agency were collected. An automatic content analysis procedure was applied to the textual corpus. Four main thematic cores were identified concerning the request for care and respect, the value of the doctor-patient relationship and the difficulties in contacting services and accessing care. Two main latent dimensions of meaning were identified, which capture the dialectic between the demand for relationships and the demand for access to care, and between attention to the relational competence of health workers and attention to the needs and rights of users. Communications collected during the pre-pandemic and post-pandemic periods mainly concern the difficulty of access to care; those collected during the pandemic period mainly concern the doctor-patient relationship. Interpersonal aspects and timely access to care appear to be crucial in users' assessment of the quality of care.

Supporting bereaved people: a qualitative study on the experience of informal support providers, before and during the pandemic scenario

The COVID-19 outbreak has further highlighted the need to strengthen support networks to sustain grieving people. However, we know very little about the experience of those who, because of their emotional connection with the bereaved person or of their social function, find themselves supporting people in grief. The current study aimed to analyze the experience of grievers' informal support providers (relatives and friends, teachers, religious leaders, funeral providers, pharmacists, volunteers, and social service workers). 162 in-depth interviews were collected (meanage = 42.3, SD = 14.9; women = 63.6%). Findings highlight two different ways of talking about one's experience and two different ways of offering support. Such dissimilarities do not relate to the period in which support was offered (before or during the pandemic). The results will be discussed in order to highlight emerging training needs to support bereaved people in their difficult transition.

Problem gambling among older people. An Italian study on habits, representations, levels of engagement and psychosocial determinants

Gambling participation among older people has grown over the years. Elders constitute a large and fast-growing population in Italy, but little empirical evidence describes gambling patterns among older Italian adults and the problem gambling (PG)’s psychosocial determinants, so a range of questions which are crucial to orient prevention strategies remain unanswered. The present study aims to investigate habits, representations, levels of engagement in gambling among Italian elders and the role of loneliness, social support and well-being in explaining their problem with gambling. A convenience sample of 165 participants (mean age: 66.93; SD = 5.73; women: 43.1%) was involved. Gambling activities, habits, representations and PG rates were examined. A group “at moderate risk/problem gambling” (scoring >7 on PGSI, n = 40) and a control group (scoring 0 on PGSI, n = 40) were selected from the whole sample, balanced on socio-demographic characteristics; a one-way analysis of variance (ANOVA) was used to compare the two groups on the target psychosocial variables. 11.5% of the sample was found to meet the PGSI criteria for PG; 26.7% for moderate risk; 11.5% for problem gambling; 50.3% were classified as no-problem gamblers. Scratch cards were the main form of gambling among all groups; the chance to make more money and to distract oneself from other problems were the main reasons to gamble. Finally, the group “at moderate risk/problem gambling,” compared to the control group, expressed higher loneliness, as well as lower perceived social support and well-being.RésuméLa pratique des jeux de hasard chez les personnes plus âgées augmente au fil des années. Les aînés représentent un segment important et à croissance rapide de la population en Italie, mais peu de données empiriques décrivent les habitudes de pratique de jeux de hasard des adultes italiens plus âgés et les déterminants psychosociaux du jeu compulsif. Tout un éventail de questions essentielles à l’orientation des stratégies de prévention reste sans réponse. La présente étude se penche sur les habitudes, les représentations et les niveaux de pratique de jeux de hasard chez les aînés italiens, ainsi que le rôle de la solitude, du soutien social et du bien-être pour expliquer leurs problèmes liés au jeu, à l’aide d’un échantillon de commodité de 165 participants (moyenne d’âge : 66,93; écart-type de la population = 5.73; femmes : 43,1 %). La pratique des jeux de hasard, les habitudes, les représentations et le jeu compulsif ont été examinés. Un groupe « à risque moyen/jeu compulsif » (pointage >7 sur l’indice de gravité de jeu compulsif (IGJC), n = 40) et un groupe témoin (pointage de 0 sur l’IGJC, n = 40) ont été choisis parmi l’ensemble de l’échantillon, équilibrés du point de vue des caractéristiques sociodémographiques; une analyse de variance à un critère de classification (ANOVA) a été utilisée pour comparer les deux groupes par rapport aux variables psychosociales cibles. On a constaté que 11,5 % de l’échantillon répondaient aux critères de jeu compulsif de l’IGJC; 26,7 % répondaient aux critères de risque modéré; 11,5 %, aux critères de jeu compulsif; et 50,3 % étaient classés comme des joueurs ne présentant pas de problème. Les cartes à gratter constituaient la forme principale de jeu de hasard dans tous les groupes; les principales raisons de jouer étaient la possibilité de faire plus d’argent et d’oublier d’autres problèmes. Enfin, par rapport au groupe témoin, le groupe « à risque moyen/jeu compulsif » a exprimé un plus grand sentiment de solitude et percevait un moins grand soutien social et un moins grand bien-être.

Caring for Daughters with Anorexia Nervosa: A Qualitative Study on Parents’ Representation of the Problem and Management of the Disorder

Background: This study explores the implicit theories by which primary caregivers (PC) of patients diagnosed with anorexia nervosa (AN) understand the eating disorder and interpret their role in treating and managing the problem. Methodology: In-depth, semi-structured, and open interview questions were used to achieve the study’s goals. In total, 19 caregivers, 16 mothers, and three fathers (mean age: 50.74; SD: 5.248) from a public service for the treatment of behavioral disorders in southern Italy were interviewed. A lexical correspondence analysis (LCA) was applied to the verbatim transcripts to identify the main factorial dimensions, which organize similarity and dissimilarity in the collected discourses. Results: The first dimension represents the dialectic between two different models of explanation of the problem, and the second dimension represents the dialectic between two different perspectives on the attribution of responsibility. Overall, the analyses show the difficulties of PC in exploring the emotional dynamics of the problem and the tendency to take out of the family context every possible representation of the role that it can play in the maintenance and evolution of the disorder. Conclusions: The strategies to prevent and treat AN may benefit from knowledge of the meaning’s lenses adopted by the primary caregivers to explain and cope with their daughters’ illness.