Depressive symptoms and suicidal ideation among medical students: a cross-sectional survey in Turin

Background

A high prevalence of mental illnesseshave been detected in medical students (MS) during college. The aim of this study was to evaluate depressive symptoms (DS) and suicidal ideation (SI) in MS and estimate factors that can influence these conditions.

Methods

In November 2018 a cross-sectional survey was conducted at the School of Medicine of Turin, Italy. The questionnaire consisted of a 30-item sociodemographic part and 3 psychometric tests, including the Beck Depression Inventory II (BDI-II). Overall, 506 surveys were collected. Multivariable logistic regressions were performed mainly. The significance level was p ≤ 0.05.

Results

Females were 65% and median age was 22 (IQR 19-24). Median BDI-II score was 9 (IQR 4-15). Presence of DS (BDI-II score>13) and of SI was found in 29% and 15% of the sample, respectively. Preliminary results showed that females (OR 2.03, CI: 1.16-3.56), non-heterosexuals (OR 2.69, CI: 1.49-4-84), participants negative about their college choice (OR 4.79, CI: 2.78-8.26) had a higher risk to report DS. MS who consider unsatisfying their friendships with classmates had a higher likelihood of reporting DS and SI (OR 3.10, CI: 1.16-8.30; OR 2.91, CI: 1.10-7.68, respectively). While the opposite was for those with good economic condition (OR 0.39, CI: 0.16-0.91; OR 0.21, CI: 0.09-0.52, respectively) and those practicing sports more than 90 min/week (OR 0.60, CI: 0.37-0.99; OR 0.47, CI: 0.25-0.89, respectively). Choosing Medicine for profit was related to a higher risk of reporting SI (OR 3.36, CI: 1.43-7.92), having a good family bond to a lower risk instead (OR 0.42, CI: 0.20-0.84).

Conclusions

Since depression is the leading cause of disability worldwide, it has to be a public health priority in Europe. It is essential to consider MS as at risk and set up interventions to improve factors surrounding them and help them to face difficulties in personal and academic life, without forgetting that they will be the future health professionals.

Key messages

Females, non-heterosexuals, students negative about Medical School choice and students unsatisfied with their friendships with classmates had a higher risk of reporting depressive symptoms. Students unsatisfied with their friendships with classmates and students who chose Medical School for profit had a higher risk of reporting suicidal ideation.

Supportive care needs, quality of life and psychological morbidity of advanced colorectal cancer patients

PURPOSE

This study describes the supportive care needs in a consecutive sample of Italian colorectal cancer (CRC) patients, evaluating their quality of life and psychological morbidity.

METHODS

This study used a cross-sectional design and self-assessment procedures and was conducted in an ambulatory setting. Demographics, basic clinical features, supportive care needs, quality of life and psychological morbidity of 203 CRC patients were gathered.

RESULTS

Approximately the 80% of the patients experienced one or more moderate- or high-level unmet need, notably regarding psychological concerns (approximately the 20% presented also signs of anxiety and depression). Functional roles and cognitive functioning were low. Symptoms of fatigue, nausea and vomiting and financial issues were frequent. The severity of anxiety, depression and quality of life impairment was significantly different across different levels of needs according to a unique linear relation. Patients with moderate or high needs had more severe anxiety and depression and a lower quality of life (i.e., lower level of functioning and more severe symptoms) than those with no needs or low needs.

CONCLUSIONS

The findings of this study suggest that meeting supportive care needs seems to improve psychological morbidity, functions and symptoms of CRC patients.

Psychometric assessment of the Italian version of the melanoma module (SCNS-M12-Ita) of the Supportive Care Needs Survey (SCNS-SF34)

INTRODUCTION

This study examines the validity and the reliability of the translated-into-Italian version of the SCNS-SF34 melanoma module (SCNS-M12-Ita) for a sample of patients with melanoma (n = 268).

METHODS

Content validity was analyzed by examining the redundancy of items. Floor/ceiling effects were investigated via frequency tables. Factor structure was studied through principal component analysis. Internal consistency was evaluated with Cronbach α. Test-retest reliability was analyzed using intraclass correlation coefficients (ICCs). Convergent-discriminant validity was studied by calculating Pearson correlations. Construct validity was investigated by comparing subgroups of patients through multivariate analysis of variance.

RESULTS

Content validity of the SCNS-M12-Ita was satisfactory. The floor effect ranged from 24.3% to 82.5%. The 2-factor solution explained 61.4% of the total variance. Internal consistency was excellent for component 1 (α = 0.92) and questionable (α = 0.58) for component 2. Test-retest reliability was excellent for component 1 (ICC = 0.92) and poor for component 2 (ICC = 0.58). Except for component 2, item-total correlations were greater than 0.60. Construct validity was confirmed, as the expected correlations (r < 0.40) were observed and 60% of the postulated hypotheses about between-group differences were confirmed.

CONCLUSIONS

The study demonstrated that the SCNS-M12-Ita is a valid and reliable instrument for assessing the supportive care needs of patients with melanoma.

Medical Students Reflections Toward End-of-Life: a Hospice Experience

In this study, we want to investigate the personal reflections toward care of the dying cancer patients among second year medical students. Two hundred fifty second year medical students attended an elective short course on end-of-life care and a brief training at the hospice Valletta, in Turin. After group discussion, the students explained their reflections about their experience. Two different supervisors of the study analyzed themes of the students and subdivided them in categories according to the frequency. The most recurrent themes were symptoms, coping skills, distress, hospice, and insight. Each theme is subdivided in categories. In 95 of 250 transcriptions, students talked about symptom (38%), 60 transcriptions (24%) were focused on coping skills. In 45 transcriptions (18%) students described emotional distress, and in the other 30 (12%) transcriptions, they pinpointed hospice philosophy. Finally, 20 recorded data (8%) were characterized by insight theme. These results have emphasized the need to integrate the clinical training with an experiential training that prepares future doctors for dealing with suffering and death. The qualitative analysis of the reflections showed that the students gained a deep appreciation of the human identity of hospice patients and the relevance of a humanistic approach to care as future physicians.

Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity

OBJECTIVE

Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics.

DESIGN

The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact.

MAIN OUTCOME MEASURES

Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey.

RESULTS

FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster2 (n = 46).

CONCLUSION

This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.

Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice

The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale - General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and 'Instrumental Support' coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end-of-life care.

A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data

OBJECTIVES

Fibromyalgia syndrome (FMS) is a chronic disorder characterised by widespread musculoskeletal pain, troubled sleep, disturbed mood, and fatigue. Recently published reviews have demonstrated that it is influenced by various psychological aspects, and antidepressants are now considered the treatment of choice for most patients. The aim of this randomised controlled trial was to compare the effects of duloxetine and acetyl L-carnitine on pain, depression, anxiety and well-being in FMS patients.

METHODS

Sixty-five female outpatients with FMS diagnosed by a rheumatologist were recruited between January 2011 and May 2012, and randomised to receive duloxetine 60 mg/day or acetyl L-carnitine 1500 mg/day (500 mg t.i.d.). Drug efficacy and side effects were assessed by the same psychiatrist at baseline, and four and 12 weeks later.

RESULTS

Both drugs led to a general clinical improvement, with positive effects on pain and depressive symptoms; but neither induced a significant improvement in anxiety. Both drugs had a positive effect on the physical component of the quality of life, but only duloxetine improved the psychological component.

CONCLUSIONS

Although they need to be confirmed by further studies, these preliminary findings confirm the efficacy of duloxetine, and suggest that acetyl L-carnitine is also efficacious in improving depressive symptoms, pain, and the quality of life of FMS patients.

An exploratory study to subtype obese binge eaters by personality traits

BACKGROUND

Obesity and binge eating disorder (BED) are prevalent conditions that severely affect the quality of life of many people in developed countries, but an effective treatment remains elusive. Personality traits have been studied extensively in this population, leading to different, and at times conflicting, results. Subtyping BED people along these features could add to our knowledge of the disorder.

METHODS

We applied a two-step cluster analysis, followed by bootstrapping validation, to the Temperament and Character Inventory scores of 462 subjects affected by obesity and BED or subthreshold BED.

RESULTS

We found two clusters of subjects; however, the categorization in clusters 1 and 2 did not appear to strictly overlap with the distinction between BED and subthreshold BED. The first cluster showed higher harm avoidance and a lower self-directedness. Cluster 1 patients had higher depression, higher eating impulsivity, greater problems with their body image and poorer quality of life than cluster 2 patients.

CONCLUSIONS

Our results seem to confirm the heterogeneity of the binge eater population and suggest the importance of harm avoidance and self-directedness to subtype these subjects. These results could generate exploratory works regarding personality in obese people with BED to discover more targeted treatments.

Measurement properties and confirmatory factor analysis of the Jefferson Scale of Empathy in Italian medical students

Medical educators agree that empathy is essential for physicians' professionalism and most studies on the patient-physician relationship demonstrate that this attitude has a key role in improving clinical outcomes. Literature findings show conflicting views in defining and measuring empathy. Nevertheless, the Jefferson Scale of Empathy (JSE) is a psychometric tool now widely used. Therefore, the aim of this study was to examine psychometrics and confirm factor structure of the Italian version of the JSE in Italian medical students (JSE S-Version). During 2012, 257 second-year Italian medical students completed the JSE S-Version. Internal consistency and test-retest reliability were assessed. A confirmatory factor analysis was performed to test the factor structure. The Italian JSE S-Version showed an acceptable internal consistency (r = 0.76) and test-retest reliability (r = 0.72). Confirmatory factor analysis found that the factor structure proposed by the developers of the tool provides an acceptable data fit. In this sample, female medical students showed a higher mean empathy score than did males. The present study provides evidence confirming the structural validity and reliability for the Italian JSE S-Version. Further studies are needed to confirm these findings and to explore cross-cultural differences and their implications.

Alexithymia, anger and psychological distress in patients with myofascial pain: a case-control study

Aims: The aim of this study was to investigate psychological distress, anger and alexithymia in a group of patients affected by myofascial pain (MP) in the facial region.

Methods: 45 MP patients [mean (SD) age: 38.9 (11.6)] and 45 female healthy controls [mean (SD) age: 37.8 (13.7)] were assessed medically and psychologically. The medically evaluation consisted of muscle palpation of the pericranial and cervical muscles. The psychological evaluation included the assessment of depression (Beck Depression Inventory—short form), anxiety [State-Trait Anxiety Inventory Form Y (STAI-Y)], emotional distress [Distress Thermometer (DT)], anger [State-Trait Anger Expression Inventory—2 (STAXI-2)], and alexithymia [Toronto Alexithymia Scale (TAS)].

Results: the MP patients showed significantly higher scores in the depression, anxiety and emotional distress inventories. With regard to anger, only the Anger Expression-In scale showed a significant difference between the groups, with higher scores for the MP patients. In addition, the MP patients showed significantly higher alexithymic scores, in particular in the Difficulty in identifying feelings (F1) subscale of the TAS-20. Alexithymia was positively correlated with the Anger Expression-In scale. Both anger and alexithymia showed significant positive correlations with anxiety scores, but only anger was positively correlated with depression.

Conclusion: A higher prevalence of depressive and anxiety symptoms associated with a higher prevalence of alexithymia and expression-in modality to cope with anger was found in the MP patients. Because the presence of such psychological aspects could contribute to generate or exacerbate the suffering of these patients, our results highlight the need to include accurate investigation of psychological aspects in MP patients in normal clinical practice in order to allow clinicians to carry out more efficacious management and treatment strategies.

Second-year Italian medical students' attitudes toward care of the dying patient: an exploratory study

To our knowledge, no other study has investigated Italian medical students' attitudes toward care of the dying patient. The purpose of this study is to investigate those attitudes among second-year Italian medical students. Two-hundred students completed the Italian version of the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD Form B). Students obtained a mean total score on FATCOD Form B of 112.8 (the possible total score ranges from 30 to 150). On some items, statistically significant differences (p < 0.05) emerged for gender and personal previous experiences with terminally ill people. This study shows poor attitudes toward care of the dying patient among second-year Italian medical students, as measured by FATCOD Form B. The need to establish tailored methods in End-of-Life Care education to make students aware of their relationship patterns and to improve students' attitudes toward dying patients is discussed.

Alexithymia and psychological distress in fibromyalgia: prevalence and relation with quality of life

OBJECTIVES

Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with other symptoms like fatigue, stiffness, non-restorative sleep and psychological distress that strongly affects the quality of life in FM patients. While the psychological distress has been widely explored in FM, only a few studies investigated alexithymia, an emotional dysregulation trait.

AIMS

Evaluate the prevalence of alexithymia and psychological distress and their impact on patients quality of life.

METHODS

A battery of tests assessing alexithymia, depression, anxiety, emotional distress symptoms and the health related quality of life (HRQoL) was filled out by 55 female FM patients. After having analysed their prevalence, two regression analyses were performed in order to evaluate the role that alexithymia, depression, anxiety, emotional distress and pain characteristics have on quality of life of FM patients.

RESULTS

Results showed that a clinically relevant level of psychological distress was present in more than half of our sample, whereas alexithymic traits were present in 20% of the patients. Regression analyses showed that pain intensity, depression and current pain were the variables that best contribute to explain the physical component of the HRQoL while anxiety, depression and pain intensity were the variables that mainly contributed to explain the mental component of quality of life.

CONCLUSIONS

These results underline the high prevalence of alexithymia in FM patients and the great impact of psychological symptoms on FM patients HRQoL. Wholistic care of FM patients which addresses both physical and psychological symptoms is needed.

Duloxetine for the treatment of mood disorder in cancer patients: a 12-week case-control clinical trial

OBJECTIVE

The aim of this study was to investigate the efficacy and tolerability of duloxetine in cancer patients with mood disorder (MD) by means of a comparison with a matched control group of patients with MD without medical illness.

METHODS

Fifty-nine consecutive patients with MD were enrolled in this prospective case-control study and received duloxetine 60/120 mg per day for 12 weeks. Twenty-seven patients were affected by cancer, whereas 32 had an MD without cancer. All the patients were assessed by means of efficacy and effectiveness tolerability scales for depression (Montgomery-Asberg Depression Rating Scale and Hospital Anxiety and Depression Scale), anxiety (State-Trait Anxiety Inventory-Y1/Y2) and severity of symptoms (Clinical Global Impression (CGI)-Severity) at baseline (T0), after 4 weeks (T1) and 12 weeks (T2). The CGI-Improvement, CGI-Effectiveness Index and Dosage Record Treatment Emergent Symptom Scale were administered at T1 and T2.

RESULTS

A significant global improvement in all the efficacy measures was found. The results showed no significant interaction 'Time X Group', suggesting a similar improvement in efficacy scores for cancer-depressed patients and depressed patients without cancer. No difference was found between the two groups with regard to drop-out percentage, effectiveness and tolerability.

CONCLUSION

Although the results of this case-control study are preliminary, they suggest that duloxetine can be considered a good option for the treatment of MD in cancer patients.