The Media and their Informative Role in the Face of the Coronavirus Disease 2019 (COVID-19): Validation of Fear Perception and Magnitude of the Issue (MED-COVID-19)

A Worldwide Bibliometric Analysis of Published Literature Assessing Fear of COVID-19

Many people experience intense fear of COVID-19. The purpose of this study was to provide a comprehensive visual overview of the published literature from 2020 to 2022 assessing fear of COVID-19. From 2020 to 2022, we employed the Scopus database to conduct a bibliometric analysis. We used the VOSviewer program to perform the author co-citation analysis, Mapchart to produce a worldwide map, and Wordart to make a word cloud image. From the 1769 records examined, 1654 (93.50%) were articles, with English being the most common language (96.31%). From 2020 to 2022, annual citations experienced significant growth (R2 = 99.91%; p = 0.0195). The Institut National de la Santé et de la Recherche Médicale (INSERM, France) and China led in terms of publication output (n = 36; n = 255). M. D. Griffiths authored the highest number of articles (n = 21). The most active journal was the International Journal of Environmental Research and Public Health (n = 146), and the most prevalent keyword was "human/s" (11.51%). This bibliometric analysis evaluates the quality of the research on fear of the pandemic and the crisis management of COVID-19, which can provide managers and researchers with crucial insights for future decision making.

Factors associated with the use of medicines and self-medication during the COVID-19 pandemic in 12 Latin American countries

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has triggered a rise in the global phenomenon of self-medication. The use of medicines with unsubstantiated claims of benefit for the prevention and/or treatment of infected people has been widely adopted.

Objective

To determine the factors associated with the use of medicines and self-medication by Latin American populations during the COVID-19 pandemic.

Methods

This analytical cross-sectional study was conducted via an analysis of secondary data collected from 8777 responses from 12 Latin American countries obtained from a survey on the use of medicines and self-medication during the pandemic.

Results

Respondents who reported using Paracetamol, Ibuprofen, or antibiotics (ABx) disclosed this as self-medication in 26.9%, 16.6%, and 9.7% of cases respectively. In our multivariate analysis, significant associations were found between: self-medication by individual choice and the use of Hydroxychloroquine, ABx, or non-steroidal anti-inflammatory drugs (NSAIDs) (p = 0.026, = 0.003, and <0.001 respectively); self-medication on the recommendation of a family member, with ABx, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, and <0.001 respectively); and self-medication on the recommendation of another person, with Chloroquine, Hydroxychloroquine, Azithromycin, Penicillin, other ABx, Warfarin, Ivermectin, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, = 0.001, <0.001, <0.001, = 0.004, <0.001, <0.001, and <0.001 respectively).

Conclusion

There was a significantly high prevalence of self-medication in our Latin American study population, including the use of medicines not recommended for COVID-19 treatment and/or prevention. The implementation of public health measures aimed at combating the worrying COVID-19 infodemic is essential to prevent this ongoing issue and its associated negative impacts on both current public health and future medication efficacy. This is especially important in the case of ABx due to the threat of a future antimicrobial resistance pandemic.

Association between concern about COVID-19, social support and knowledge about tuberculosis with adherence to antituberculosis treatment in Lima, Perú

INTRODUCTION

In the context of the COVID-19 pandemic, information on factors associated with adherence to antituberculosis treatment in areas with high prevalence of tuberculosis is scarce.

OBJETIVE

To evaluate whether there is an association between social support, concern about COVID-19 infection and knowledge about tuberculosis, and non-adherence to antituberculosis treatment.

MATERIALS AND METHODOS

A cross-sectional study was carried out on patients under antituberculosis treatment, from January to March, 2022, in centers located in areas with a high prevalence of tuberculosis in Lima. We used the Morisky Green-Levine questionnaire to assess adherence to treatment as the dependent variable; the independent variables were evaluated using the Medical Outcomes Study Social Support Survey for perceived social support and concern about COVID-19 infection, and the Battle Test to assess patients’ knowledge about their disease. We used Poisson regression with robust variance to evaluate the association between the independent variables and the dependent one.

RESULTS

Out of 101 participants (73.3% male with an average age of 35.1 ± 16 years), 51.5% were non-adherent to antituberculosis treatment. Medium or high level of concern about getting COVID-19 was associated with a higher prevalence of non-adherence to treatment (odds ratio: 1.68; 95 % confidence interval: 1.09-2.57) (adjusted for considered confounding variables).

CONCLUSIONS

Non-adherence is a frequent condition among patients living in an area with a high prevalence of tuberculosis in Lima, especially among those with a higher concern for COVID-19 infection.

Latin American perceptions of fear and exaggeration transmitted by the media with regard to COVID-19: frequency and association with severe mental pathologies

Introduction

The COVID-19 pandemic contributed to the spread of abundant misinformation by the media, which caused fear and concern.

Objective

To determine the association between the pathologies of the mental sphere and the perceptions of fear and exaggeration transmitted by the media with respect to COVID-19 in Latin America.

Methodology

The present study has an analytical cross-sectional design that is based on a validated survey to measure fear and exaggeration transmitted by the media and other sources (Cronbach's α: 0.90). We surveyed more than 6,000 people, originally from 12 Latin American countries, who associated this perceived exaggeration with stress, depression, and anxiety (measured through DASS-21, Cronbach's α: 0.96).

Results

Social networks (40%) or television (34%) were perceived as the sources that exaggerate the magnitude of the events. In addition, television (35%) and social networks (28%) were perceived as the sources that generate much fear. On the contrary, physicians and health personnel are the sources that exaggerated less (10%) or provoked less fear (14%). Through a multivariate model, we found a higher level of global perception that was associated with whether the participant was older (p = 0.002), had severe or more serious anxiety (p = 0.033), or had stress (p = 0,037). However, in comparison with Peru (the most affected country), there was a lower level of perception in Chile (p < 0.001), Paraguay (p = 0.001), Mexico (p < 0.001), Ecuador (p = 0.001), and Costa Rica (p = 0.042). All of them were adjusted for gender and for those having severe or major depression.

Conclusion

There exists an association between some mental pathologies and the perception that the media does not provide moderate information.

Scale of concern about COVID-19 infection in Peruvian Health Care Workers

Introduction

The global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line.

Objective

To design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers.

Material and methods

Quantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12 ± 9.61).

Results

Aiken’s V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA = 0.079; P = .05; TLI = 0.967; IFC = 0.980; GFI = 0.971, and AGFI = 0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α = 0.865; CI 95%, 0.83−0.89).

Conclusions

The scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

Effect of religious fatalism and concern about new variants on the acceptance of COVID-19 vaccines

Introduction

To protect public health, it is important that the population be vaccinated against COVID-19; however, certain factors can affect vaccine acceptance.

Objective

The objective of this study was to determine whether religious fatalism and concern about new variants have a significant effect on the acceptance of COVID-19 vaccines.

Methodology

An explanatory study was conducted with 403 adults of legal age captured through non-probabilistic convenience sampling in vaccination centers in the 13 health networks of the Regional Health Directorate of Puno, Peru. Data were collected through a brief scale of religious fatalism, a scale of acceptance of vaccines against COVID-19 and a scale of concern about a new variant of COVID-19.

Results

The proposed model obtained an adequate fit. There was a negative effect of religious fatalism on vaccine acceptance, a positive effect of fatalism on vaccine rejection, a positive effect of concern about new variants on the acceptance of vaccines, and a positive effect of concern about new variants on vaccine rejection.

Conclusion

These findings provide evidence for the usefulness of considering both religious fatalism and concern about new variants affect the intention to receive the COVID-19 vaccine in adults in southern Peru.

Factors associated with COVID-19 fear among healthcare professionals in Bangladesh

To determine the factors associated with the COVID-19 fear, we conducted an online survey among healthcare professionals in Bangladesh. The "fear of COVID-19 scale" was used to measure the fear. The predicting factors were identified by deploying a multiple linear regression model. Structural equation modelling was used to explore the relationship between mental health symptoms and COVID-19 fear. The overall fear score was 19.39 ± 5.26 (M ± SD) out of 28. Multiple linear regression identified financial constraints, self-employment, and general duties as the independent predictors of COVID-19 fear. However, structural equation modelling found a strong positive relationship between anxiety, insomnia, and fear. Results might be helpful for the policymakers and mental healthcare professionals to identify and manage maladaptive levels of fear and worry because of the coronavirus outbreak.

Validity of a scale of Latin American perception of fear and concern transmitted by the media during the pandemic (MED-LAT-COVID-19)

Introduction

The pandemic has caused fear, especially due to the daily disseminated news; however, there is not an instrument to measure this fear in multiple realities.

Objective

To validate a scale for Latin American perception of fear and concern transmitted by the media during the pandemic.

Methodology

This is an instrumental study. The survey was based on an instrument which was pre-validated in Peru and submitted to 15 experts in almost 10 countries. Subsequently, thousands of people were surveyed in 13 Latin American countries, whose answers were used for descriptive statistics for validation.

Results

Confirmatory Factor Analysis (CFA) generated two re-specifications, where four items were eliminated from the original scale. With these changes, the global goodness of fit (absolute and incremental) were satisfactory (CFI = 0.978; TLI = 0.964; GFI = 0.976; AGFI = 0.949; RMSEA = 0.075 and RMR = 0.029). The first factor measures the media exaggeration (three questions); the second, the fear transmitted by the media (three questions); and the third, the fear transmitted by others different from the media (two questions). The Cronbach’s alpha coefficient was higher than 0.70 for the scale and its factors.

Conclusion

The MED-LAT-COVID-19 scale reported a good adjustment. It has eight items in three factors, which could be measured in an isolated way, or along with other tests that assess mental health in the current pandemic context.

A Study on the Correlation Between Media Usage Frequency and Audiences' Risk Perception, Emotion and Behavior

Whether risk events can be effectively controlled and mitigated is largely influenced by people's perceptions of risk events and their behavioral cooperation. Therefore, this study used a web-based questionnaire (N = 306) to investigate the specific factors influencing people's risk perceptions and behaviors, and included a test for the difference in the effect of positive and negative emotions of the audiences. The results show that the overall model has good explanatory power (R 2 = 61%) for the behavioral variables, and (1) how people's use of different media (especially TV and online media) significantly influenced their positive and negative emotions; (2) how people's frequency of TV use significantly influenced their risk susceptibility and how online media use significantly influenced their risk severity (with some differences in people's perceptions of efficacy between different media); (3) how people's sense of efficacy for risky events is the strongest predictor of their risk control behavior; and (4) that there are different mediating effects of different emotions and risk severity and sense of efficacy between the frequency of media use and risk control behavior.

Socioeconomic Impacts of the COVID-19 Lockdown on the Mental Health and Life Satisfaction of the Japanese Population

COVID-19 has been a global challenge ever since its emergence, with reports suggesting negative effects on the mental health and well-being of people. We investigated the associations of the socioeconomic changes driven by the pandemic, illness, well-being, and fear of COVID-19 in Japan. Totally, 565 Japanese individuals completed an online survey, including questions on their self-restraint and changing incomes, and the Fear of COVID-19 Scale; Depression, Anxiety, Stress Scale; and present, past, and future life satisfaction scale. Analysis using structural equation models revealed that refraining from going out was a predictor of illness due to the fear of COVID-19. Decreased income predicted increased illness, but was not due to fear of COVID-19. These results suggested that the interaction between decreased time outside and increased fear of COVID-19 could affect illness. Our study suggests the role of fear of COVID-19 during pandemic and the socioeconomic impacts on mental health.

Trust in Science, Perceived Media Exaggeration About COVID-19, and Social Distancing Behavior

For many individuals, the media function as a primary source of information about preventative measures to combat COVID-19. However, a considerable number of citizens believe that the media coverage about pandemics is exaggerated. Although the perception of media exaggeration may be highly consequential for individual health behaviors, we lack research on the drivers and consequences of this perception. In a two-wave panel study, we examined associations between trust in science, perceptions of media exaggeration about COVID-19, and social distancing behavior during the lockdown in Austria (NT2 = 416). Results showed that trust in science at T1 led to less perceptions of media exaggeration about COVID-19 at T2. Furthermore, consistent with the theory of psychological reactance, perceptions of media exaggeration about COVID-19 at T1 caused less social distancing behavior at T2. Thus, findings suggest that trust in science may positively affect individuals' social distancing behavior by decreasing perceived media exaggeration about COVID-19 over time. Implications for research on media effects in times of COVID-19 and conclusions for journalists are discussed.

A systematic review of questionnaires assessing the psychological impact of COVID-19

The COVID-19 pandemic has led to a number of complications in everyday life, greatly affecting public health. Estimating its impact on mental health constitutes a priority issue. The current study aims to summarize the scales that have been specifically developed for this reason and are not adaptations of already existing scales. A comprehensive search was conducted by two reviewers during the period 28/09/2020-30/09-2020 in the following databases: PubMed, ScienceDirect, ScieLo, Mendeley, Google Scholar. A quality appraisal of the identified scales was made by three reviewers using the COSMIN checklist for methodological issues and the Terwee criteria for measurement properties. Our search strategy yielded a total of 855 results. Of these, 832 articles were excluded according to exclusion criteria, 23 were assessed for eligibility and 10 were finally included. These are presented in the text with additional useful information found separately. The identified scales tended to be quite short and examine stress, anxiety or fear. All studies were cross-sectional and the majority was conducted online. Most of them had a good Cronbach value (> 0.80) and adequate fit indices. It is however noted that the evaluation of their quality may be untimely due to relevant lack of data.

Roles of social media and counselling support in reducing anxiety among Malaysian during Covid-19 pandemic

Covid-19 pandemic has created crises among some Malaysians. The crises have both opportunity and threat impacts. Without proper intervention, some people will develop stress, anxiety, and depression. This study aims to explore the emotional anxiety that exists in the society due to Covid-19 pandemic and the roles of social media and counselling support in reducing anxiety among Malaysians. This quantitative research involved online survey throughout the country. The online survey is administered during the First Phase and the Second Phase of Movement Control Order (MCO). The survey contains 13 items which cover three domain: i) anxiety, ii) roles of social media, and iii) roles of counselling support in reducing anxiety among members of the society. There were 8375 respondents from various age groups, locations, as well as economic and educational statuses involved in the study. Data were analysed using descriptive and inferential analysis. Majority of 7233 (86.6%) respondents felt anxious due to Covid-19 pandemic. A total of 7871 respondents (94%) followed the latest updates on Covid-19 to reduce their anxiety. They used social media such as Facebook, Instagram and Twitter to gather information and follow the updates through television and press conference. A total of 5251 respondents (62.7%) were aware of the counselling support provided during the MCO, and 4603 respondents (55%) felt comfortable to have counselling support by phone. The findings will contribute to knowledge on the society's emotional anxiety in facing Covid-19. It reflects the actual situation happened in Malaysia during Covid-19 and MCO.

Gender Differences in Fear and Risk Perception During the COVID-19 Pandemic

The COVID-19 pandemic has led many people to suffer from emotional distress. Previous studies suggest that women process and express affective experiences, such as fear, with a greater intensity compared to men. We administered an online survey to a sample of participants in the United States that measures fear of COVID-19, perceptions about health and financial risks, and preventative measures taken. Despite the empirical fact that men are more likely to experience adverse health consequences from COVID-19, women report greater fear and more negative expectations about health-related consequences of COVID-19 than men. However, women are more optimistic than men regarding the financial consequences of the pandemic. Women also report more negative emotional experiences generally during the pandemic, particularly in situations where other people or the government take actions that make matters worse. Though women report taking more preventative measures than men in response to the pandemic, gender differences in behavior are reduced after controlling for fear. These results shed light on how differences in emotional experiences of the pandemic may inform policy interventions.

Role of mass media and it’s impact on general public during coronavirus disease 2019 pandemic in North India: An online assessment

Objectives:

Based on the global experience, India has the possibility to be highly affected by coronavirus disease 2019 (COVID-19) pandemic. To contain the spread of the infection, a complete lockdown was enforced from March 25 to May 31, 2020 in India. During the unlock phase from June 1, 2020, only limited mobility was allowed. At present, in the pandemic, mass media is playing a very important role in sharing information and connecting people. The objective of this study is to understand the role and impact of mass media in the general public during COVID-19 pandemic.

Material and Methods:

This study has been conducted on the above 10-year aged population by the online survey through Google spreadsheets. The semi-structured questionnaire was circulated to the known contacts in north Indian states for responses. The data collection started on June 23 and was closed on July 3, 2020.

Results:

This study shows that the use of internet/social media was the highest, followed by TV news before and during lockdown. The use of the internet and TV news increased during the lockdown and the use of newspapers, radio, and magazine declined significantly. The anxiety due to COVID-related news through mass media was reported highest (27.3 %) in the 40–49 years age group and lowest (14.49%) in the 20–29 age group. About 43.18% of people of 30–39 years of age group developed fear, and 28% of 50–59 age groups felt panic due to COVID-related news in media. It has been found that the use of social media is highest in the 20–29 age group followed by 10–19 years age group

Conclusion:

Mass media is playing a very important role in the dissemination of the COVID-related information to the general public in north India. However, the misleading or wrong information shall be checked in the large public interest.

Scale of Concern about COVID-19 Infection in Peruvian Health Care Workers

INTRODUCTION

The global SARS-CoV-2 pandemic has generated concern about contagion, especially among healthcare workers who are on the front line.

OBJECTIVE

To design and analyse the evidence of content validity, internal structure and reliability of a measure of concern about the spread of COVID-19 among Peruvian healthcare workers.

MATERIAL AND METHODS

Quantitative study and instrumental design. The scale was administered to 321 health science professionals (78 males and 243 females), whose ages ranged from 22 to 64 years (38.12±9.61).

RESULTS

Aiken's V-coefficient values were statistically significant. An exploratory factor analysis was performed which indicated the existence of a single factor, and confirmatory factor analysis (CFA) confirmed a satisfactory six-factor model. The CFA solution obtained adequate fit indices (RMSEA=0.079; p=0.05; TLI=0.967; IFC=0.980; GFI=0.971, and AGFI=0.931), and showed good internal consistency based on Cronbach's alpha coefficient (α=0.865; CI 95%, 0.83-0.89).

CONCLUSIONS

The scale of concern for COVID-19 infection is a valid and reliable brief measure that can be used for research and professional purposes.

Instruments to measure fear of COVID-19: a diagnostic systematic review

BACKGROUND

The COVID-19 pandemic has become a source of fear across the world. Measuring the level or significance of fear in different populations may help identify populations and areas in need of public health and education campaigns. We were interested in diagnostic tests developed to assess or diagnose COVID-19-related fear or phobia.

METHODS

We performed a systematic review of studies that examined instruments diagnosing or assessing fear or phobia of COVID-19 (PROSPERO registration: CRD42020197100). We utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence, a database of pre-screened and pre-categorized studies. The Live map of covid-19 evidence identified references published since 1 December 2019 in MEDLINE, Embase, and the Centers for Disease Control and Prevention. Following biweekly searches, two researchers independently categorized all studies according to topic (seven main topics, 52 subordinate topics), population (41 available groups), study design, and publication type. For this review, we assessed for eligibility all studies that had been categorized to the topic "Experiences and perceptions, consequences; social, political, economic aspects" as of 25 September 2020, in addition to hand-searching included studies' reference lists. We meta-analyzed correlation coefficients of fear scores to the most common reference tests (self-reports of anxiety, depression, and stress), and reported additional concurrent validity to other reference tests such as specific phobias. We assessed study quality using the QUADAS-2 for the minority of studies that presented diagnostic accuracy statistics.

RESULTS

We found 18 studies that validated fear instruments. Fifteen validated the Fear of COVID-19 scale (FCV-19S). We found no studies that proposed a diagnosis of fear of COVID-19 or a threshold of significant/clinical versus non-significant/subclinical fear. Study quality was low, with the most common potential biases related to sampling strategy and un-blinded data analysis. The FSV-19S total score correlated strongly with severe phobia (r = 0.703, 95%CI 0.634-0.761) in one study, and moderately with anxiety in a meta-analysis.

CONCLUSIONS

The accuracy of the FSV-19S needs to be measured further using fear-related reference instruments, and future studies need to provide cut-off scores and normative values. Further evaluation of the remaining three instruments is required.

Intensive care nurses' experiences during the COVID-19 pandemic: A qualitative study

BACKGROUND

Because of the COVID-19 pandemic, health care systems worldwide are working under challenging conditions. Patients, who are seriously ill, require intensive care admission. In fighting COVID-19, nurses are frontline health care workers and, as such, have a great responsibility providing needed specialized patient care in intensive care units (ICU). However, working conditions and emotional factors have an impact on the quality of the care provided.

AIM

The purpose of the present study was to explore and describe the experiences and perceptions of nurses working in an ICU during the COVID-19 global pandemic.

STUDY DESIGN

Qualitative research was undertaken, using an empirical approach and inductive content analysis techniques.

METHODS

The selected population consisted of ICU nurses from a tertiary teaching hospital in Spain. Data were obtained via semi-structured videocall interviews from Apr 12th to Apr 30th, 2020. Subsequently, transcribed verbatims were analysed using the template analysis model of Brooks.

FINDINGS

A total of 17 nurses comprised the final sample after data saturation. Four main themes emerged from the analysis and 13 subthemes: "providing nursing care," "psychosocial aspects and emotional lability," "resources management and safety" and "professional relationships and fellowship."

CONCLUSION

Providing health care by intensive care nursing professionals, during the COVID-19 pandemic, has shown both strong and weak points in the health care system. Nursing care has been influenced by fear and isolation, making it hard to maintain the humanization of the health care.

RELEVANCE TO CLINICAL PRACTICE

Implications for practice include optimizing resource management (human and material), providing psychological support, and adequate training for ICU nurses, as well as high-quality protocols for future emergency situations.

Self-medication practices during the COVID-19 pandemic among the adult population in Peru: A cross-sectional survey

Self-medication impacts both negatively and positively the health of people, which has become evident during the COVID-19 pandemic. The study aimed to assess the prevalence of self-medicated drugs used for respiratory symptoms, as COVID-19 preventive, for its symptoms or once tested positive. To determine the perception of symptom relief and demographic variables that promote self-medication in Peru. We performed a cross-sectional, analytical, multicenter study in 3792 study respondents on the use, the reason for use, and perception of relief after the use of six drugs during the quarantine period. An online questionnaire was developed, pretested and submitted to the general public. Multivariable logistic regression was used to ascertain factors that influence an individual's desire to self-medicate, associations were considered significant at p < 0.05 and using region (coast, mountain and jungle) as cluster group. The majority of respondents self-medicated with acetaminophen for respiratory symptoms and mainly because they had a cold or flu. It was observed that all the surveyed drugs (acetaminophen, ibuprofen, azithromycin, penicillin, antiretrovirals and hydroxychloroquine) were consumed for various symptoms including: fever, fatigue, cough, sneezing, muscle pain, nasal congestion, sore throat, headache and breathing difficulty. Over 90% of respondents perceived relief of at least one symptom. Multivariable logistic regression showed that older people have a higher frequency of antiretroviral self-medication, respondents who currently have a job had a higher frequency of penicillin self-medication, and that respondents from the Andes consumed less acetaminophen, while the ones from the rainforest consumed it more. There were significant percentages of self-medication, including drugs without sufficient scientific evidence. Age, region where one lived and job status were variables associated with self-medication frequency. Continuous awareness and sensitization about the risks of self-medication are warranted.

Psychological support and psychotherapy via digital devices in Covid-19 emergency time: Some critical issues

The Covid-19 pandemic and the resulting fear, quarantine and lockdown measures implemented in Italy and other countries to contain the risk of contagion have seriously impacted the mental health of a large number of people. The need to offer psychological and psychotherapeutic support to these people, while respecting the government's pressing calls to "stay home", have led many psychologists and psychotherapists, both in the public and private sectors, to provide their professional services via teleconference, telephone, smartphone, etc. The aim of this work is to highlight some critical issues related to the sudden switch from the traditional method of providing psychological services to the digital one in Italy.