From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19

Breaking (Fake) News: No Personal Relevance Effect on Misinformation Vulnerability

The massive spread of fake news (FN) requires a better understanding of both risks and protective psychological factors underlying vulnerability to misinformation. Prior studies have mostly dealt with news that do not bear any direct personal relevance to participants. Here, we ask whether high-stakes news topics may decrease vulnerability to FN. Data were collected during the national lockdown in Italy (COVID-19 news) and one year later (political news). We compared truth discrimination and overall belief for true news (TN) and FN concerning COVID-19 and political topics. Our findings indicate that psychological risk and protective factors have similar effects on truth discrimination, regardless of whether the news topic is highly or minimally personally relevant. However, we found different effects of psychological factors on overall belief, for high and low personal relevance. These results suggest that, given a high level of cognitive dissonance, individuals tend to rely on proximal or emotional sources of information. In summary, our study underscores the importance of understanding the psychological factors that contribute to vulnerability to misinformation, particularly in high-stakes news contexts.

Emotional responses to COVID-19 stressors increase information avoidance about an important unrelated health threat

The COVID-19 pandemic, like other crises, has had direct and indirect impacts on individuals, many of which have been negative. While a large body of research has examined the impacts of COVID-19 on people's lives, there is little evidence about how COVID-19 affects decision-making broadly. Emotional responses to COVID-19-related stressors, such as illness and income loss, provide a pathway for these stressors to affect decision-making. In this study, we examine linkages between exposure to COVID-19-related stressors-focusing on temporally specific local case counts and loss of income due to the pandemic-and decisions to access information about antimicrobial resistance (AMR), another critically important health issue. COVID-19 constitutes a natural experiment in that people's exposure to stressors does not result from those individuals' current decisions. Using a nationally representative survey with 1223 respondents in December 2020, we linked the temporally specific COVID-19 cases and income loss experienced by participants to an increased likelihood of feeling hopeless. Higher feelings of hopelessness led to a higher probability of avoiding information about AMR. A mediation analysis confirms that emotional responses to COVID-19 stressors significantly increase information avoidance about an unrelated, but important health issue. Our results suggest that large-scale crises, like COVID-19 and climate change, may diminish action on other important health issues facing humanity.

The role of the COVID-19 impersonal threat strengthening the associations of right-wing attitudes, nationalism and anti-immigrant sentiments

Literature showed that the link between right-wing attitudes and ethnocentric attitudes gets stronger under existential threats, but the role exerted by an impersonal threat - as COVID-19 - on right-wing attitudes is still unclear. This study aimed to highlight the role of anxiety exerted by the impersonal COVID-19 threat on the relationship between right-wing attitudes and ethnocentric attitudes, as nationalism and anti-immigrants' sentiments. As part of an international project to evaluate the impact of COVID-19, this study administered an online survey to a representative sample (n 1038). The anxiety generated by an impersonal threat as COVID-19 - thus not exerted by any outgroup - can moderate the relationship among personal Right-Wing Authoritarianism, social dominance orientation, and ethnocentric attitudes. This is the first study demonstrating that existential threat is effective also when exerted by an impersonal agent (as COVID-19) rather than by an outgroup. Second, these findings disclose useful implications for preventive psychological interventions and for social policy makers.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04305-w.

The Rising of the Shield hero. Development of the Post-Traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of self-esteem from trauma-related Anxiety and Depression

Background

Adverse life events such as life-threatening accidents, domestic and/or sexual violence, organic diseases (i.e., cancer), or COVID-19 can have a strong traumatic impact - generating reactions as intrusive thoughts, hyperarousal, and avoidance. Indeed, the traumatic impact of COVID-19 seems to lead individuals to experience anxiety and depression. However, the Anxiety-Buffer Hypothesis suggests that self-esteem could be considered a shield (buffer) against traumatic experiences and their outcomes (i.e., anxiety and depression). The present study has two objectives. First, to develop a measure of the impact of the traumatic event considering the aforementioned reactions. Second, to test the process - triggered by COVID19-related traumatic experience - in which self-esteem buffers the path that leads to anxiety and depression.

Method

In Study 1 (N = 353), the Post-Traumatic Symptom Questionnaire (PTSQ) was developed and a deep investigation of its psychometric properties was conducted. In Study 2 (N = 445), a structural equation model with latent variables was performed to assess the buffering effect of self-esteem.

Results

The PTSQ has excellent fit indices and psychometric properties. According to the ABH, results confirm the buffering effect of self-esteem in the relationships between traumatic symptoms and both anxiety and depression.

Conclusion

On the one hand, the PTSQ is a solid and reliable instrument. On the other hand, that self-esteem is a protective factor against anxiety and depression related to a traumatic experience - such as COVID-19. Targeted psychological interventions should be implemented to minimize the psychological burden of the illness while promoting adaptation and positive aspects of oneself.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00503-z.

Understanding stigma toward schizophrenia

Schizophrenia is arguably one of the most stigmatized psychiatric disorders, with patients frequently seeing the burden of stigmatization as a "second illness." Thus, the purpose of this study was to investigate the relationships among the main aspects of the stigma toward schizophrenia. This study used a vignette methodology with 2053 individuals from the general population in Italy. The main aspects of stigma - causal beliefs, recommended treatments, social distance, perception of dangerousness, and avoidance - were investigated through participants' responses, and a latent variable structural equation model (SEM) approach was used to test the relationships among them. Perceived dangerousness predicts the desire for social distancing from an individual with schizophrenia, which predicts the desire for avoidance. In addition, biogenetic causal beliefs of schizophrenia and position on the appropriate medical treatment predict the perception of dangerousness and thus a greater desire for social distance. This study contributes to the literature on the stigmatization of mental health by improving our understanding of the phenomenon. Highlighting the relationships between aspects of stigma allows for a discussion of the implications for anti-stigma interventions.

Identifying the Predictors of Patient-Centered Communication by Machine Learning Methods

Patient-centered communication (PCC) quality is critical to increasing the quality of patient-centered care. Based on the nationally representative data of the Health Information National Trends Survey (HINTS) 2019–2020 (N = 4593), this study combined four machine learning methods, namely, Generalized Linear Models (GLM), Random Forests (Random Forests), Deep Neural Networks (Deep Learning), and Gradient Boosting Machines (GBM), to identify important PCC predictors through variable importance metrics. Fifteen variables were identified as important predictors, involving multiple dimensions, such as individual sociodemographic characteristics, health-related factors, and individual living habits. Among them, four novel potential associated variables are included, an individual’s level of verbal expression, exercise habits, etc., which significantly impacted respondents’ perceived PCC quality. This study revealed the value of combining feature selection with machine learning approaches to identify broad variables that could enhance PCC prediction and clinical decision-making, influence future PCC prediction research, and improve patient-centered care. In the future, other easy-to-interpret models can be combined to conduct further research on the impact direction and mechanism of important predictors on PCC.

New Psychological Perspectives on Death and Dying-Between Normality and the COVID-19 Emergency

In recent decades, there has been a constantly increasing preoccupation with physical perfection and the scientific urge to improve life expectancy [...].

Study protocol for a randomized controlled trial evaluating the effectiveness of an internet-based self-help intervention to cope with psychological distress due to COVID-19 in the Italian general population: the RinasciMENTE project

BACKGROUND

This study aims to evaluate the feasibility and effectiveness of the RinasciMENTE program, an Internet-based self-help intervention based on cognitive behavioral therapy (CBT) principles and techniques in supporting individuals experiencing psychological impairments during the COVID-19 pandemic. A randomized controlled trial (RCT) design with random allocation at the level of individual will be conducted to compare the impact of the RinasciMENTE program with a waiting list control in improving the psychological functioning of the general population during the COVID-19 pandemic.

METHODS

A minimum sample of 128 participants experiencing mild/subthreshold levels of psychological symptoms during the COVID-19 pandemic will be recruited. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 2 months, during which participants will receive 8 weekly CBT treatment modules. The impact of the RinasciMENTE program on selected primary and secondary psychological outcomes will be tested at the end of the intervention (2 months) and 6- and 12-month follow-ups.

DISCUSSION

We expect people to show an increased level of psychological functioning and to acquire the skills and self-confidence necessary to deal with the psychological consequences of the COVID-19 outbreak and its related social isolation during and following the pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT0497903 Registered on 28 May 2021.

The effects of a non-adaptive school-to-work transition on transition to adulthood, time perspective and internalizing and externalizing problems

The 21st-century world of work complexity is considered a health risk factor for young people. Due to the economic crisis, globalization, and challenges of post-industrial society, 28.8% of Italian young people experience the NEET condition. The study aims to understand the psychological factors associated with the NEET status, specifically the self-perception of transition to adulthood, the future time perspective, and the effects on health in terms of internalizing and externalizing problems. To this end, 450 young people (150 students, 150 employees, 150 NEET) were involved. Moreover, the study has also highlighted that socio-demographic characteristics can play a role in the relationship between the NEET status and these outcomes. The results show that the NEET condition is associated with a negative vision about the future, a low self-perception of transition to adulthood, and internalizing and externalizing health problems. Starting from findings, implications regarding intervention models and future research directions are discussed.

Women's EmotionS, Trauma and EmpowErMent (W-ES.T.EEM) study protocol: a psychoeducational support intervention for victims of domestic violence - a randomised controlled trial

INTRODUCTION

Intimate partner violence (IPV) is a widespread phenomenon that affects the physical and mental well-being of victims. Several barriers prevented sufferers from receiving face-to-face interventions. These obstacles increased with the advent of the COVID-19 pandemic, and online psychological intervention can represent a valid solution to increase the well-being of IPV victims. This manuscript describes the study protocol for a single blind randomised controlled trial that examines the efficacy of a web-based psychoeducational intervention for IPV victims that integrates dialectical behavioural therapy and the empowerment approach.

METHODS AND ANALYSIS

Eighty-six women who were victims of IPV during the COVID-19 outbreak will be recruited by the Interdepartmental Center for Family Research (CIRF) staff from the several antiviolence centres located in Italy. Participants will be randomly allocated to the Women's EmotionS, Trauma and EmpowErMent experimental group or the treatment as usual control condition. Both interventions will be administered individually to each woman.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of the University of Padua (protocol no 4300). Written informed consent will be obtained from all research participants before study entry. Study results will be published as peer-reviewed articles. Any relevant protocol changes will be reported in the published articles. The results will be reported anonymously.

TRIAL REGISTRATION NUMBER

ISRCTN12880309.

Managing uncertainty and responding to difficult emotions: Cancer patients' perspectives on clinician response during the COVID-19 pandemic

OBJECTIVE

Patients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians' responsiveness to patients' uncertainty and difficult emotions were associated with better health and well-being.

METHODS

Patients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress.

RESULTS

317 respondents participated in the study. Patients' perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health.

CONCLUSION

Even when controlling for patients' personal and health-related characteristics, clinicians' communication addressing patients' uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status.

PRACTICE IMPLICATIONS

Clinicians' communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

The mediating role of scientifical-medical satisfaction between COVID-19 conspiracy beliefs and vaccine confidence: a two-waves structural equation model

Vaccine confidence has emerged as one of the most relevant psychological factors implied in the worldwide affecting the fight against COVID-19-as well as public trust in doctors, medicine, and science. Indeed, the vaccine confidence is crucial to maximize the trust in vaccines and their use for prevention, with several implications for public health. This study aimed to analyse the relationships among between vaccine confidence, conspiracy beliefs about COVID-19, and satisfaction with science and medicine in handling the COVID-19 pandemic. A longitudinal observational survey was administered to a convenience sample (n = 544; mean age 52.76 y.o., SD = 15.11; females 46.69%) from the Italian general population. A two-waves mediation model-a structural equation model technique-was used. The survey was part of a larger international project ( https://osf.io/qy65b/ ). The model highlighted that the conspiracy beliefs about COVID-19 had a negative effect on the satisfaction with medicine and science (β = - 0.13, se = 0.03, p < .001). The latter, in turn, had a positive effect on vaccine confidence (β = 0.10, se = .05, p < .001). Interestingly, the effect of conspiracy beliefs on vaccine confidence was completely mediated by the scientifical-medical satisfaction (β = - 0.02, se = 0.01, p < .05). These results highlight how the scientifical-medical satisfaction can fully mediate the relationship between conspiracy beliefs about COVID-19 and vaccine confidence. These findings about vaccine hesitancy and confidence and disclose have implications for psychological and social interventions that could promote vaccine confidence by targeting the satisfaction with science and medicine.

Screening for Distress in Oncological Patients: The Revised Version of the Psychological Distress Inventory (PDI-R)

Background

Psychological research in oncological settings is steadily increasing and the construct of psychological distress has rapidly gained popularity-leading to the development of questionnaires aimed at its measurement. The Psychological Distress Inventory (PDI) is one of the most used instruments, but its psychometric properties were not yet deeply evaluated. The present studies aimed at investigating the psychometric properties of the PDI (Study 1) and providing a revised version of the tool (Study 2).

Methods

Oncological outpatients were enrolled at the Department of Medical Oncology of the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. For the first study (N = 251), an Exploratory Graph Analysis was used to explore the item structure of the PDI. In the second study (N = 902), the psychometric properties of the revised PDI (PDI-R) were deeply assessed.

Results

Study 1 showed that the PDI has a not clear structure and it should be reconsidered. On the opposite, Study 2 showed that the revised version (PDI-R) has a solid factorial structure, it is invariant across gender and age, and it has good psychometric properties.

Conclusion

Results suggest that the PDI-R is a reliable measure of psychological distress in different samples of oncological patients, with stronger psychometric properties than the original version. Its use in the clinical and research field is therefore recommended to improve the quality of both assessment and treatment of psychological distress in patients with oncological problems.

Patients’ Experiences with Cancer Care: Impact of the COVID-19 Pandemic

The COVID-19 pandemic heightened the psychosocial impact of a cancer diagnosis as patients face concerns about the risk of infection and serious disease and uncertainties about the impact on their treatment. We conducted an online survey (n = 317) and focus groups (n = 19) with patients to examine their experiences with cancer care during the pandemic. Most survey respondents (68%) reported one or more disruptions or delays in care, including appointments switched to telehealth (49%). Patients perceived both benefits (e.g., convenience) and drawbacks (e.g., more impersonal) to telehealth. For many patients, COVID-19-related restrictions on bringing family members to support them during appointments was a major concern and left them feeling alone and vulnerable during treatment. Patients’ self-reported coping during the pandemic was positively associated with age, education, and income (P < .05 for each) and better communication with their doctors during telehealth sessions (P < .001). Study findings highlight the importance of patient-centered care and communication to help patients cope with the challenges of the pandemic. Further research is needed to develop guidelines for use of telehealth as part of patient-centered cancer care.

Art therapists’ fear of COVID-19, subjective well-being, and mindfulness

The COVID-19 pandemic has hit face-to-face service fields, including art therapy. The present study examined changes in Korean art therapists’ subjective well-being between the pre- and during pandemic periods. We also investigated whether the fear of COVID-19 affected art therapists’ subjective well-being and verified the mediating effect of mindfulness on the relationship between COVID-19 fear and subjective well-being. We used the existing data of 203 Korean art therapists’ subjective well-being, and recruited 132 new participants. The participants were Korean art therapists and art therapy students who completed a subjective well-being questionnaire, a Fear of COVID-19 scale, and a mindfulness questionnaire. The results indicated lower levels of subjective well-being during the COVID-19 period than pre-pandemic. Furthermore, we confirmed that the fear of COVID-19 lowered subjective well-being, with mindfulness mediating the relationship. This study discusses core components of mindfulness, decentering, and embodiment as attributes shared with art therapy. Our results highlight the importance of dispositional mindfulness to foster subjective well-being during the pandemic.

ANXIETY DURING THE COVID-19 PANDEMIC: A WEB-BASED SURVEY OF THYROID CANCER SURVIVORS

Objective

Cancer patients and survivors may be disproportionately affected by COVID-19. We sought to determine the effects of the pandemic on thyroid cancer survivors’ health care interactions and quality of life.

Methods

An anonymous survey including questions about COVID-19 and the Patient-Reported Outcomes Measurement Information System profile (PROMIS-29, version 2.0) was hosted on the Thyroid Cancer Survivors’ Association, Inc website. PROMIS scores were compared to previously published data. Factors associated with greater anxiety were evaluated with univariable and multivariable logistic regression.

Results

From May 6, 2020, to October 8, 2020, 413 participants consented to take the survey; 378 (92%) met the inclusion criteria: diagnosed with thyroid cancer or noninvasive follicular neoplasm with papillary-like nuclear features, located within the United States, and completed all sections of the survey. The mean age was 53 years, 89% were women, and 74% had papillary thyroid cancer. Most respondents agreed/strongly agreed (83%) that their lives were very different during the COVID-19 pandemic, as were their interactions with doctors (79%). A minority (43%) were satisfied with the information from their doctor regarding COVID-19 changes. Compared to pre-COVID-19, PROMIS scores were higher for anxiety (57.8 vs 56.5; P < .05) and lower for the ability to participate in social activities (46.2 vs 48.1; P < .01), fatigue (55.8 vs 57.9; P < .01), and sleep disturbance (54.7 vs 56.1; P < .01). After adjusting for confounders, higher anxiety was associated with younger age (P < .01) and change in treatment plan (P = .04).

Conclusion

During the COVID-19 pandemic, thyroid cancer survivors reported increased anxiety compared to a pre-COVID cohort. To deliver comprehensive care, providers must better understand patient concerns and improve communication about potential changes to treatment plans.

Oncology patients' communication experiences during COVID-19: comparing telehealth consultations to in-person visits

PURPOSE

The COVID-19 pandemic created significant disruptions in cancer care, much of which was transitioned to telehealth. Because telehealth alters the way clinicians and patients interact with one another, this investigation examined patients' perceptions of their communication with clinicians during the pandemic.

METHOD

Patients were recruited from the Cancer Support Community, Fight Colorectal Cancer, and a market research firm to participate in an online survey. In addition to demographic and health-related information, respondents completed measures of patient-centered communication and evaluated how their communication in telehealth sessions compared with in-person visits.

RESULTS

From October to December 2020, 227 respondents (65.6% female, 64.6% Non-Hispanic White, 33.5% had 6 or more telehealth sessions, 55% were 50 or older) reported having some of their cancer care provided via telehealth. Respondents who were of racial/ethnic minorities, male, had more telehealth sessions, or had poorer mental health reported less patient-centered communication with clinicians. Most patients thought communication in telehealth sessions was "about the same" as in-person visits with respect to good communication (59%). However, patients thinking communication in telehealth sessions was "better" than in-person visits were more likely to be Hispanic (49%), Non-Hispanic Black (41%), under 50 years of age (32%), male (40%), and had more telehealth sessions (34%).

CONCLUSION

Respondents reporting less patient-centered communication during the pandemic-e.g., persons of racial/ethnic minorities and males-were also more likely to evaluate communication in telehealth sessions as better than in-person visits. Further research is needed to understand reasons underlying this finding. Cancer care clinicians should take into account patient preferences regarding telehealth care, which may be particularly important for racial and ethnic minority patients.

Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains

OBJECTIVE

To assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient's perspective.

METHODS

An online survey was carried out nationwide from March 12, 2020 to March 30, 2020 in China via a convenience sampling strategy. Patients who met the inclusion criteria were invited to complete a questionnaire regarding the quality of DPR, including sociodemographic information, the Patient-Doctor Relationship Questionnaire (PDRQ-9), and influencing factors for DPR during the pandemic.

RESULTS

A total of 1903 patients were included. Our result showed that participants had a higher PDRQ-9 score during the COVID-19 pandemic (4.18 ± 0.51) than that before the COVID-19 pandemic (3.86 ± 0.67). Importance-performance analysis (IPA) revealed that doctor-patient communication, patient satisfaction, consultation time, doctor's attitude, and medical knowledge were specific aspects that needed to be prioritized to improve the DPR. Multiple linear regression analysis suggested that positive media reports, telemedicine, and national policies had a significantly positive effect on the DPR during the pandemic (P < 0.05).

CONCLUSION

In general, the DPR had been improved during the COVID-19 pandemic. Our research found the key points that needed to be prioritized to improve the DPR during the pandemic, which may provide effective suggestions for building a harmonious DPR in the future.

Women and Violence: Alexithymia, Relational Competence and Styles, and Satisfaction with Life: A Comparative Profile Analysis

Background: This research investigates the two sides of violence by profiling female interpersonal violence offenders (IVO) and female interpersonal violence victims (IVV). These groups of women have been compared on three key variables within the context of violence: satisfaction with life (SWL), alexithymia, and relational styles-defined according to the Relational Competence Theory (RCT). Regarding the latter, the experience of functional or dysfunctional relational styles in childhood and adult relationships has been evaluated and compared with both groups of women. Methods: This study involved 131 women: IVO (n = 41; enrolled in a penitentiary), IVV (n = 41; enrolled in an anti-violence center), and a control group (CG; n = 49; enrolled from the general population). Profile analysis was performed. Results: Female IVO showed low SWL, high levels of alexithymia, and a pattern of mixed relational styles with both parents and the current partner. Female IVV revealed low SWL, low levels of alexithymia and dysfunctional relational styles with both parents and current partner. Women from the CG showed high SWL, absence of alexithymia and functional relational styles with both parents and current partner. Conclusions: The profiles outlined in this study are extremely informative regarding alexithymia, relational styles, and SWL in both female IVV and IVO. Clinical interventions for both groups of women should be developed relying on these results.

Changes in the Comprehensiveness of Rural Medical Care for Older Japanese Patients during the COVID-19 Pandemic

Help-seeking behaviors (HSBs) refer to how people use lay and medical care to address their symptoms and diseases. The COVID-19 pandemic may have changed older, rural patients’ preferences and experiences regarding HSBs, thereby, affecting the comprehensiveness of medical support for communities. This study identified changes in the comprehensiveness of medical care for older, rural patients, who are often dependent on others for accessing medical services. This observational study was performed with patients who lived in Unnan City. Patients’ dependency and changes in comprehensiveness of medical services were assessed and calculated. The total usage of medical care decreased from 2018 to 2020 at all medical care levels. The proportion of patients who received comprehensive care was higher in 2020 than in 2018, at all care levels. At care dependent levels 3 to 5, the differences in the proportions were statistically significant. This study illustrates an association between the COVID-19 pandemic and the proportion of comprehensiveness of medical care among older rural patients with a decrease in medical care usage. Moreover, an improved proportion of comprehensiveness of medical care leads to appropriate HSBs. Going forward, HSBs and patient-centered care should be promoted by policy makers.

Psychological difficulties of LVAD patients and caregivers: A follow up over 1 year from discharge

Background

After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home.

Objective

This study aimed at evaluating the post‐discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health.

Methods

In this observational follow‐up study, LVAD dyads discharged home from 1 year to 6 years were re‐contacted by phone and received by mail an envelope with self‐report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed.

Results

Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective–sexual relationship. Caregivers often reported impairment in social life and self‐care.

Discussions

Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.

Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model

Despite the severe psychological impact of the COVID-19 pandemic, some individuals do not develop high levels of psychological distress and can be termed resilient. Using the ecological resilience model, we examined factors promoting or hindering resilience in the COVID-19 pandemic. Of the 1034 participants (49.9±16.2 years; females 51.2%) from Italian general population, 70% displayed resilient outcomes and 30% reported moderate-severe anxiety and/or depression. A binary regression model revealed that factors promoting resilience were mostly psychological (e.g., trait resilience, conscientiousness) together with social distancing. Conversely, factors hindering resilience included COVID-19-anxiety, COVID-19-related PTSD symptoms, intolerance of uncertainty, loneliness, living with children, higher education, and living in regions where the virus was starting to spread. In conclusion, the ecological resilience model in the COVID-19 pandemic explained 64% of the variance and identified factors promoting or hindering resilient outcomes. Critically, these findings can inform psychological interventions supporting individuals by strengthening factors associated with resilience.