Post-traumatic stress disorder in Italy: a comprehensive evaluation of all the ICD comorbidities and gender-related differences

Coping strategies at the frontline of care: Comparisons between Covid-19 and non-Covid-19 units' nurses and the role of moderator variables

INTRODUCTION

Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies.

METHODS

A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models.

RESULTS

253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units.

DISCUSSION

Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found.

CONCLUSION

Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.

Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender

PURPOSE

Posttraumatic stress disorder (PTSD) includes different symptoms: re-experiencing, avoidance of reminders and numbing, and hyperarousal. Although questionnaires are widely used, clinician-administered interviews provide a more comprehensive exploration of symptoms. Few studies examined the convergence between clinician-rated and patient-reported general severity and symptoms, with mixed findings. We explored the association between clinician-rated and patient-reported general severity and symptoms and the moderator role of gender in PTSD patients referred to a specialized outpatient service.

DESIGN AND METHODS

The Clinician-Administered PTSD Scale and Davidson Trauma Scale were administered to 56 patients.

FINDINGS

Patients classified by clinicians as with higher avoidance/numbing symptoms and women classified with higher hyperarousal symptoms reported higher general severity.

PRACTICE IMPLICATIONS

The assessment of the patients reporting high severity should focus on hyperarousal, particularly for women.

Is Mindfulness-Based Stress Reduction Effective for People with Hypertension? A Systematic Review and Meta-Analysis of 30 Years of Evidence

Background: Hypertension is among the most important risk factors for cardiovascular diseases, which are considered high mortality risk medical conditions. To date, several studies have reported positive effects of mindfulness-based stress reduction (MBSR) interventions on physical and psychological well-being in other medical conditions, but no meta-analysis on MBSR programs for hypertension has been conducted. Objectives: The objective of this study was to determine the effectiveness of MBSR programs for hypertension. Methods: A systematic review and meta-analysis of randomized controlled trials examining the effects of MBSR on systolic and diastolic blood pressure (BP), anxiety, depression, and perceived stress in people with hypertension or pre-hypertension was conducted. The PubMed/MEDLINE and PsycINFO databases were searched in November 2020 to identify relevant studies. Results: Six studies were included. The comparison of MBSR versus control conditions on diastolic BP was associated with a statistically significant mean effect size favoring MBSR over control conditions (MD = -2.029; 95% confidence interval (CI): -3.676 to -0.383, p = 0.016, k = 6; 22 effect sizes overall), without evidence of heterogeneity (I2 = 0.000%). The comparison of MBSR versus control conditions on systolic BP was associated with a mean effect size which was statistically significant only at a marginal level (MD = -3.894; 95% CI: -7.736-0.053, p = 0.047, k = 6; 22 effect sizes overall), without evidence of high heterogeneity (I2 = 20.772%). The higher the proportion of participants on antihypertensive medications was, the larger the effects of MBSR were on systolic BP (B = -0.750, z = -2.73, p = 0.003). Conclusions: MBSR seems to be a promising intervention, particularly effective on the reduction of diastolic BP. More well-conducted trials are required.

Post-Traumatic Stress Disorder Secondary to Manic Episodes with Hypersexuality in Bipolar Disorder: A Case Study of Forensic Psychotherapy

Post-traumatic stress disorder (PTSD) can arise as a secondary condition to a primary bipolar disorder, an aspect which may be overlooked by clinicians and thus may contribute to the exacerbation of the bipolar disorder itself. The occurrence of manic symptoms can have a traumatic impact on a patient unaware of her/his diagnosis, especially during symptom remission. The present work describes a clinical case of a woman with type-1 bipolar disorder and PTSD secondary to previous manic episodes characterized by hypersexuality. This clinical case is characterized by the fact that the patient had not received an adequate psycho-educational intervention making her aware of bipolar symptoms and helping her to elaborate the trauma of hypersexuality experienced after remission. The psychodiagnostic and psychotherapeutic assessment procedures are described and the forensic psychiatric implications related to the importance of timely and evidence-based intervention on this comorbidity are discussed. Identification of the primary pathology may be complicated by behaviours provoked by the psychiatric symptoms which put these patients at risk of becoming victims of abuse. Therefore, it is necessary to correctly understand these dynamics in order to promptly provide the patient with the correct therapeutic pathways.

Post-traumatic Stress Disorder in Prisoners' Offspring: A Systematic Review and Meta-analysis

BACKGROUND

Parental incarceration can produce serious effects on the offspring's mental health. The presence of Post-Traumatic Stress Disorder (PTSD) in prisoners' offspring is understudied and the few literature data showed heterogeneous evidence, with some studies suggesting that about 25% of prisoners' offspring have PTSD and other reporting much lower prevalence rates around 2-3%. There is no systematic review and meta-analysis about PTSD in prisoners' offspring.

OBJECTIVES

The present systematic review and meta-analysis aimed to provide a first quantitative synthesis of the prevalence of the PTSD diagnosis in prisoners' offspring. Moderator variables of the effect sizes were assessed, including offspring's and parents' gender, offspring's generational cohort (children/adolescents versus adults), reasons for parental incarceration (political/war versus crime), and country type (Western versus Non-Western countries).

METHODS

A systematic review and a meta-analysis were conducted according to the PRISMA guidelines. Studies were included if they assessed the presence of a PTSD diagnosis in child, adolescent or adult offspring of prisoners through a diagnostic classification system, a clinician-administered interview or a self-report questionnaire, if they reported data necessary to calculate the effect sizes or the authors were available to provide them. Studies might have been based upon any design except review, single-case, case series, and case reports. Outcomes might have been measured at any time after parental incarceration. Parental imprisonment was defined as any kind of custodial confinement of a parent by the criminal justice system, including being held as a prisoner of war or for political reasons.Independent reviewers searched published/unpublished studies through electronic databases and additional sources and extracted the data. A random-effect meta-analysis was carried out by calculating the effect sizes as event rates. Heterogeneity was examined by the I² and the Q statistics. Moderators were assessed through meta-regressions.

RESULTS

Six studies (2512 participants) were included. Fifteen percent of prisoners' offspring had PTSD, as shown by a significant mean effect size of 0.14 without evidence of publication bias (95% CI: 0.081 - 0.249, p< 0.001). There were no significant differences on the mean effect sizes between the studies on adults and those on children/adolescents [Q₍₁₎ = 0.00, p = .999], between the studies on parents incarcerated for political/war reasons and those for crime [Q₍₁₎ = 0.00, p = .979], and between the studies conducted in Western and non-Western countries [Q₍₁₎ = 0.854, p = .355]. While offspring's gender was not related to the effect sizes [β = -0.01, 95% CI: -0.02 - 0.02, p = .452], parents' gender was significantly and positively associated with the effect sizes suggesting that in studies with higher percentages of incarcerated mothers, the prevalence of offspring's PTSD was higher [β = 0.01, 95% CI: 0.0 - 0.01, p = .019].

CONCLUSION

PTSD is a serious mental health condition among prisoners' offspring, particularly when mothers are incarcerated. The present findings point out the importance of thorough assessment and timely intervention/prevention strategies implemented by professionals of mental health settings and detention systems. The cross-sectional design of the studies does not allow causal conclusions to be drawn about the effect of parental incarceration as a risk factor for PTSD. Other variables related to parental incarceration may explain these findings. This limitation points out the importance of further longitudinal research.

Online Romance Scams: Relational Dynamics and Psychological Characteristics of the Victims and Scammers. A Scoping Review

Background:

Digital communication technologies can overcome physical, social and psychological barriers in building romantic relationships. Online romance scams are a modern form of fraud that has spread in Western societies along with the development of social media and dating apps. Through a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic. There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases.

Objectives:

This paper presents a scoping review of the quantitative and qualitative evidence on this issue, focusing on epidemiological aspects, relational dynamics, and the psychological characteristics of victims and scammers.

Methods:

A literature scoping review was conducted using electronic databases and descriptors. Studies were included if they had analyzed the phenomenon in any population or the relationship dynamics characterizing it through whatsoever typology of design. Scoping reviews are a form of knowledge synthesis, which incorporates a range of study designs and wide eligibility criteria to comprehensively summarize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities.

Results:

Twelve studies were included. Sixty-three percent of social media users and 3% of the general population report having been a victim at least once. Some psychological variables appear to be associated with the risk of being scammed, such as female gender, middle-age, higher levels of neuroticism, tendencies to the romantic idealization of affective relations, sensation seeking, impulsiveness and susceptibility to addiction. We analyse literature limitations and future directions.

Conclusion:

Since this emerging phenomenon is still largely unrecognized, understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention/intervention strategies to be developed.