A patient with Fibromyalgia and Chronic Recurrent Multifocal Osteomyelitis: the importance of psychosomatic assessment

Background

Many patients affected by FM present different comorbidities, but to date no case of FM in patients with CRMO has been reported in literature. Several studies show the importance of psychosomatic assessment in FM, but only one reported the presence of allostatic overload.

Case presentation

In April 2022, a 21-year-old female patient, a third-year medical student, came to our clinic to be assessed and treated for FM. She presents with a diagnosis of CRMO made in 2014 and a diagnosis of FM made in 2019.

Results

At the psychiatric evaluation she presented symptoms of anxiety, depression, insomnia and reported widespread pain with the presence of almost daily headaches. From the psychosomatic point of view using DCPR-revised she presented diagnostic criteria for allostatic overload, related to study and periodic flare-ups of painful symptoms due to CRMO, persistent somatization, with musculoskeletal and gastroenterological symptoms, demoralization and type A behaviour.

Conclusion

This case shows how useful a psychosomatic assessment of the patient can be for offering insights into what stressors at the origin of allostatic overload may be present in different FM patients.

A Critical Overview of the Construct of Supportive Care Need in the Cancer Literature: Definitions, Measures, Interventions and Future Directions for Research

The growing amount of evidence about the role of supportive care in enhancing cancer patients' outcomes has made healthcare providers more sensitive to the need for support that they experience during cancer's trajectory. However, the lack of a consensus in the definition of supportive care and lack of uniformity in the theoretical paradigm and measurement tools for unmet needs does not allow for defined guidelines for evidence-based best practices that are universally accepted. Contemporary cancer literature confirms that patients continue to report high levels of unmet supportive care needs and documents the low effectiveness of most of the interventions proposed to date. The aim of this critical review is to consolidate the conceptual understanding of the need for supportive care, providing definitions, areas of expertise and a careful overview of the measurement tools and intervention proposals developed to date. The possible reasons why the currently developed interventions do not seem to be able to meet the needs, and the issues for future research were discussed.

Psychometric Properties of the Italian Version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34-It): A Multicenter Validation Study

This study aimed to evaluate psychometric properties of the Italian version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34) in a cancer population. A multicenter prospective observational study was carried out in outpatient and inpatient settings. The evaluated psychometric properties were as follows: the five-domain structure, the internal consistency, the convergent validity with the Edmond Symptom Assessment System (ESAS) questionnaire, the discriminant validity and test-retest reliability. A total of 714 patients with different types, stages and treatment settings of cancer were recruited. A total of 56% of participants were women, the median age 59 years (range 18-88). The prevalence of patients reporting at least one unmet need was 78.7%. The factor analysis explained 71.3% of the total variance, confirming the five-domain structure of the original model. Internal consistency was good, with Cronbach's alpha values ranging from 0.87 ("psychosocial need", "patient support and health system", "information") to 0.90 ("sexuality"). The convergent validity of the SCNS-SF34-It with the ESAS scale was low, suggesting that these questionnaires cover different concepts. The SCNS-SF34-It was able to discriminate differences between groups, and the test-retest reliability was good (ICC 0.72-0.84). The SCNS-SF34-It proved to be a reliable instrument for use in clinical practice for evaluating unmet needs in the Italian population of cancer patients. This study was not registered.

Preclinical and Clinical Medical Student Attitudes Toward the Care of the Dying: Testing the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale

The demand for palliative care is increasing worldwide. Beyond the acquisition of technical knowledge, the development of adequate personal disposition toward the relationship with the dying is a key aspect of the future training of doctors. This study evaluates the psychometric properties of the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD-9IT) the authors recently developed and its capability to distinguish medical students with different attitudes toward the care of the dying and at different stages of medical training. The study included 595 medical students, 400 at the first and 195 at the fifth year. The Rasch rating scale model was specified to assess scale dimensionality, functioning and measurement invariance. Internal consistency, test-retest reliability and between-group difference sensitivity (first-vs fifth-year students) were evaluated using Cronbach's alpha, Intraclass correlation coefficients, Paired sample t-test and Mann-Whitney U. Scale unidimensionality, rating scale functioning and measurement invariance were established. The scale demonstrated good internal consistency and test-retest reliability, and adequately discriminated between first- and fifth-year students. The study supports the validity and reliability of the FATCOD-9IT. Its effectiveness, simplicity of compilation and score calculation, and gratuitousness encourage its widespread use as fast assessment of the medical student attitudes toward the care of the dying.

Long-term psychological outcome of patients with moderate-to-severe atopic dermatitis continuously treated with Dupilumab: Data up to 3 years

Dupilumab effectiveness and safety in treating moderate-to-severe atopic dermatitis (AD) have been demonstrated in open-label studies up to 4 years. Evidence about long-term psychological outcome is lacking. This study evaluates the long-term psychological outcome of moderate-to-severe AD patients continuously treated with Dupilumab up to 3 years. A prospective observational real-life study was conducted at an Italian tertiary centre from January 2019 to September 2022. Measures of disease severity and psychological outcomes were assessed at baseline, after 4, 8, 12, 24 and 36 months. A total of 382 moderate-to-severe AD patients were included. After 36 months, EASI-75 and EASI-90 were achieved by 91.8% and 77.2% of participants. Significant improvement (p < 0.001; ω²  = 0.18-0.84) in objective and patient-reported measures of disease severity and in the psychological condition were observed after 4 months of treatment and maintained up to 36 months. Longitudinal analysis of interactions of demographic and clinical features found subgroups of patients who did not reported psychological improvement over the study period notwithstanding the positive clinical response. Long-term improvement in the psychological outcome of moderate-to-severe AD patients continuously treated with Dupilumab is confirmed up to 3 years, supporting its wide use in this population. Between-subject differences in the psychological outcome irrespective of clinical response observed in this study foster the biopsychosocial approach in the clinical management of these patients.

Demoralization during the Italian quarantine due to 2019 coronavirus disease pandemic: prevalence and association with psychological well-being and coping strategies

The aims of the study were to investigate demoralization in a sample of Italian citizens during the Italian quarantine due to COVID-19 pandemic and to explore its associations with psychological well-being, coping strategies, participants' socio-demographic characteristics and COVID-19-related factors. Italian citizens aged over 18 and quarantined in Italy were recruited. A cross-sectional online survey was launched through a snow-ball sampling and 1123 surveys were collected. Participants answered ad hoc questions and completed the Psychological General Well-Being Index, the Demoralization Scale, and the Coping Orientation to Problems Experienced-New Italian Version. Disheartenment, dysphoria, and sense of failure were the subdimensions of demoralization with higher scores. Demoralization was associated with depressed mood, positive well-being, self-control, general health, vitality, problem-solving, and avoidance and religious coping strategies. Individuals who were female, older, without children and not working during quarantine had higher demoralization. Quarantine-related changes can elicit demoralization that is associated to lower psychological well-being. Problem-solving and religious coping can protect against demoralization, while avoidant coping strategies can exacerbate it. Assessing and treating demoralization, especially in the categories of citizens most at risk of developing it, could be useful to provide adequate care against COVID-19-related distress.

The Italian validation of the Death and Dying Distress Scale

OBJECTIVES

Death anxiety (DA), a condition characterized by fear, angst, or panic related to the awareness of one's own death, is commonly observed in advanced cancer patients. The aim of this study was to examine the psychometric properties of the Italian version of the Death and Dying Distress Scale (DADDS-IT) in a sample of patients with advanced cancer.

METHODS

The sample included 200 Italian advanced cancer patients meeting eligibility criteria to access palliative care. Patients' levels of DA were assessed by using the DADDS-IT, while the levels of depression, anxiety, demoralization, spiritual well-being, and symptom burden were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, and the Edmonton Symptom Assessment System, respectively; Karnofsky Performance Status was used to measure functional impairment. Confirmatory factor analyses (CFA) of previous structures and exploratory factor analyses (EFA) were conducted.

RESULTS

CFA revealed that none of the previous structures adequately fitted data from our sample. EFA revealed a 4-factor model comprising Finitude (α = 0.91), Regret (α = 0.86), Dying (α = 0.88), and Relational Burden (α = 0.73), accounting for the 77.1% of the variance. Dying subscore was higher in hospice patients than in those recruited in medical wards.

SIGNIFICANCE OF RESULTS

The present study provides further evidence that DA is a condition that deserves attention and that DADDS-IT shows good psychometric properties to support its use in research and clinical settings.

Shortening the Frommelt Attitude Toward the Care Of the Dying Scale (FATCOD-B): a Brief 9-Item Version for Medical Education and Practice

End-of-life care training has gaps in helping students to develop attitudes toward caring for the dying. Valid and reliable assessment tools are essential in building effective educational programmes. The Frommelt Attitude Toward the Care Of the Dying scale (FATCOD-B) is widely used to measure the level of comfort/discomfort in caring for the dying and to test the effectiveness of end-of-life care training. However, its psychometric properties have been questioned and different proposals for refinement and shortening have been put forward. The aim of this study is to get to a definitive reduction of the FATCOD-B through a valid and parsimonious synthesis of the previous attempts at scale revision. Data were gathered from a sample of 220 medical students. The item response theory approach was used in this study. Of the 14 items selected from two previous proposals for scale revision, 3 had a weak correlation with the whole scale and were deleted. The resulting 11-item version had good fit indices and withstood a more general and parsimonious specification (rating scale model). This solution was further shortened to 9 items by deleting 2 of 3 items at the same level of difficulty. The final 9-item version was invariant for gender, level of religiosity and amount of experience with dying persons, free from redundant items and able to scale and discriminate the respondents.

End-of-life cancer patients' total pain: the necessity to supplement pharmacology with psycho-socio-spiritual treatments

Aim: To analyze pain considering its different bio-psycho-social-spiritual manifestations and to assess the effectiveness of the analgesic treatments in end-of-life cancer patients. Materials & methods: The study was cross-sectional. A total of 376 end-of-life cancer inpatients participated in the research. Their socio-demographic and clinical data were collected and, during the first psychological consultancy, they filled in a set of validated rating scales assessing pain, anxiety, depression and quality of life. Results: The results show that physical pain was well managed for almost all patients. Nevertheless, the majority showed clinically significant levels of psychological distress. Conclusion: Treating pain means caring for all its possible manifestations including psychological symptoms and reduced wellbeing. Thus, integrating pharmacological treatment with psycho-socio-spiritual interventions, in other words, psychological, social and spiritual support, could be effective and desirable.

Impact on health-related quality of life and symptoms of anxiety and depression after 32 weeks of Dupilumab treatment for moderate-to-severe atopic dermatitis

Dupilumab is the first biological agent approved for treatment of moderate‐to‐severe atopic dermatitis (AD). Evidence of Dupilumab effectiveness on psychological outcomes beyond 16 weeks of treatment from real‐life settings is lacking. To evaluate the effectiveness of Dupilumab treatment up to 32 weeks, focusing health‐related quality of life and psychological outcome of patients with moderate‐to‐severe AD. An observational prospective cohort study was conducted in a real‐life setting at an Italian tertiary centre. Assessment of outcome measures was carried out at baseline, after 16 and 32 weeks of treatment. A total of 171 patients were included. EASI‐75 and EASI‐90 were achieved in 85% and 60% of the participants, respectively, after 16 weeks, and in 89.6% and 69.8% after 32 weeks of treatment. Significant improvements (p < 0.001; r = 0.57–0.95) were found after 16 weeks for each outcome considered, including clinician and patient‐reported measures of AD severity and scales of health‐related quality of life and psychological morbidity, and maintained up to 32 weeks. Further analysis revealed that patients' quality of life was more associated with the subjective perception of disease severity rather than objective measures and suggested a possible different response to treatment based on the age of AD onset. Dupilumab was confirmed to be rapid, effective and safe in patients with moderate‐to‐severe AD. Its positive impact on psychological outcomes up to 32 weeks was ascertained here, adding new evidence on the need to consider subjective factors affecting patients' perception of disease severity in evaluating the response to treatment.

A Qualitative Study Regarding COVID-19 Inpatient Family Caregivers' Need for Supportive Care

Background:

Family caregivers of COVID-19 inpatients are exposed to multiple sources of distress. These include not only losing friends, colleagues and members of the family, but also the fear of possible losses in sociality, finances and, impoverished communication with sick family members and health care providers.

Objective:

This study describes the psychological experience of COVID-19 inpatient family caregivers to highlight the main sources of distress, issues, concerns and unmet needs.

Methods:

Two focus groups were independently organized with COVID-19 inpatient family caregivers and health care personnel of COVID-19 wards in order to highlight family caregivers’ practical and psychological burden and related needs. A thematic analysis was conducted to analyze the data.

Results:

Family caregivers mentioned they needed more information about the patient’s condition with more attention being paid to their own emotional state. Feelings of impotence, concerns about how to deal with patient’s discharge, significant psychological distress, and anxiety were frequently reported by study participants.

Conclusion:

Study findings suggest the need to strengthen the assistance of COVID-19 patient family caregivers. In the pandemic scenario, family caregivers might represent a crucial resource, which can guarantee rapid discharges, support home health care and thus relieve pressure on hospital systems.

Supportive Care Needs and the Impact of Loss of Functioning and Symptom Burden on the Quality of Life in Patients with Advanced Colorectal Cancer

Background/Aims Relationships between loss of functioning, symptom burden, supportive care needs, and quality of life (QoL) have been suggested in cancer populations. This cross-sectional study further investigates these relationships through mediation analyses. Methods 276 advanced colorectal cancer (CRC) patients completed validated instruments to assess cancer-related functioning, symptoms, supportive care needs and QoL. Pearson's correlations and multiple mediation models with bootstrapping method were performed. Results QoL had negative correlations with supportive care needs, positive correlations with functioning measures and negative correlations with symptom scales. Supportive care needs had negative correlations with functioning measures and positive correlations with symptom scales. Mediation analyses showed significant indirect effects of CRC-related functioning and symptoms on QoL through supportive care needs. Conclusions Significant links between CRC-related loss of functioning, symptom burden, QoL and supportive care needs have been established. Longitudinal studies are planned to clarify cause-and-effects relationships and establish sequences of events.

Emotional distress and psychiatric drug use among students in an Italian medical school: Assessing the role of gender and year of study

BACKGROUND

Previous studies have reported that medical students show high rates of depression, anxiety, and stress levels, but mixed findings were found regarding possible differences between gender and different years of medical training. This study evaluated depression, anxiety, and stress levels and psychiatric drug use in students in an Italian medical school and investigated the differences between gender and year of study.

MATERIALS AND METHODS

This cross-sectional study included 694 medical students in their 1^st (n = 286), 4^th (n = 209), and 6^th (n = 199) year of study. The questionnaire included demographic information, self-report questionnaires regarding depression, anxiety, and stress, and questions about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and analytic statistics, including Mann-Whitney U-test, Fisher's exact test, and GLM two-way ANOVA.

RESULTS

Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%), and 545 (78.5%) medical students, respectively. Female students in their 4^th year of study reported higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were higher in 6^th-year female students compared with those in their 1^st and 4^th years (P = 0.001; P = 0.025). Stress levels were consistently higher in females than in males for all 3 years (1^st year: P = 0.041; 4^th year: P < 0.001; 6^th year: P = 0.004). No gender differences were found in the use of psychiatric and stimulant drugs.

CONCLUSION

This study provides preliminary evidence suggesting the importance of planning interventions aimed at reducing emotional distress among medical students that should be targeted on gender and year of the study.

Distress, anxiety, depression and unmet needs in thyroid cancer survivors: a longitudinal study

PURPOSE

Despite a good prognosis, thyroid cancer (TC) survivors often report psychological distress and decreased quality of life. This longitudinal study aims to evaluate TC survivors' levels of distress, anxiety, depression and unmet needs, checking potential life events.

METHODS

Distress Thermometer, Hospital Anxiety Depression Scale, Supportive Care Need Survey (short form) and Interview for Recent Life Events were administered to 73 TC survivors (T0) and 44 of them were re-tested one year later (T1). Participants were at 0-5, 5-10 or >10 years from the end of their cancer-related treatments.

RESULTS

At T0, distress, anxiety and depression mean scores were 6.4, 6.8 and 5.3, while at T1 they were 5.5, 4.8 and 5.1. Only anxiety scores decreased significantly between T0 and T1. 50.7% of patients had unmet psychological needs at T0 and 50.0% at T1. Most participants were satisfied in the communicative/ informative (T0:79.5%; T1: 77.3%) and social/health care areas (T0:74.0%; T1:75.0%). The most experienced stressful events detected concerned their working areas.

CONCLUSIONS

Results confirmed that patients reported distress, anxiety and depression concerns even many years after the end of treatments. Both medical and psychological surveillance are relevant to improving TC survivors' wellbeing.

Suicidal ideation among Italian medical students: prevalence and associated factors from a multicenter study

OBJECTIVES

To estimate Suicidal Ideation (SI) prevalence among Italian medical students and explore associated factors.

METHODS

Multicentre cross-sectional study (2018). Students were enrolled through convenience sampling (sample size=2513). Questionnaires included socio-demographic items and Beck Depression Inventory-II, which has an item on SI. A multivariable regression was performed (p-value<0.05 significant).

RESULTS

SI prevalence was 13.7%. Among students with and without depression SI prevalence was 36.0% and 4.3%. Being female, being in a relationship, good/excellent family cohesion, perceived good economic status were significantly associated with lower SI. Increasing age, bisexual/asexual orientation, psychiatric family history, negative judgment on medical school choice, competitive/hostile climate and unsatisfying friendships among classmates, being worried about not measuring up to the profession significantly increased SI.

CONCLUSION

There was a high SI prevalence among Italian medical students, consistently with worldwide data. Demographic, relational, and motivational factors seem to influence SI. Determinants should be further investigated to plan university-level interventions.

COVID-19 pandemic-related anxiety, distress and burnout: prevalence and associated factors in healthcare workers of North-West Italy

BACKGROUND

The COVID-19 pandemic caused drastic changes in healthcare and severe social restrictions. Healthcare workers (HCWs) are on the front line against the virus and have been highly exposed to pandemic-related stressors, but there are limited data on their psychological involvement for a large sample in Italy.

AIMS

To investigate the prevalence of anxiety, distress and burnout in HCWs of North-West Italy during the COVID-19 pandemic, and to detect potential psychosocial factors associated with their emotional response.

METHOD

This cross-sectional, survey-based study enrolled 797 HCWs. Participants completed the Impact of Event Scale - Revised, the State-Trait Anxiety Inventory - Form Y and the Maslach Burnout Inventory; demographic, family and work characteristics were also collected. Global psychological outcome, differences among professions and independent factors associated with worst psychological outcome were assessed.

RESULTS

Almost a third of the sample had severe state anxiety and distress, high emotional exhaustion and depersonalisation, and low personal accomplishment. Distress was higher in women and nurses, whereas depersonalisation was higher in men. Family division, increased workload, job changes and frequent contact with COVID-19 were associated with worst psychological outcome. Trait anxiety was associated with significantly higher risk for developing state anxiety, distress and burnout.

CONCLUSIONS

An elevated psychological burden related to the COVID-19 pandemic was observed in HCWs of North-West Italy. The identification of family and work characteristics and a psychological pre-existing condition as factors associated with worst psychological outcome may help provide a tailored, preventive, organisational and psychological approach in counteracting the psychological effects of future pandemics.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial

Patients with advanced cancer suffer from psychosocial distress that may impair quality of life and that may be ameliorated by psychotherapeutic treatment. We describe here the methodology of a randomized controlled trial (RCT) to assess the effectiveness of a novel, brief, semi-structured psychotherapeutic intervention to reduce distress and increase well-being in patients with advanced or metastatic cancer. The intervention, called Managing Cancer and Living Meaningfully (CALM), was originally developed in Canada and we are now testing its Italian adaptation (CALM-IT).

The study is a single-blinded phase III RCT with assessment at baseline, 3 and 6 months with two conditions: CALM-IT versus a nonspecific supportive intervention (SPI). Eligibility criteria include: ≥ 18 years of age; fluency in the Italian language; no cognitive deficit, and diagnosis of advanced or metastatic cancer with an expected survival of 12–18 months. CALM-IT includes up to 12 sessions, delivered over 6 months and covers 4 domains: i) Symptom Management and Communication with Health Care Providers; ii) Changes in Self and Relations with Close Others; iii) Sense of Meaning and Purpose; and iv) the Future and Mortality. The primary outcome is difference in severity of depressive symptoms between treatment arm and the primary endpoint is 6 months. The secondary endpoint is 3 months and secondary outcomes are: generalized anxiety, distress about dying and death, demoralization, spiritual well-being, attachment security, posttraumatic growth, communication with partners, quality of life, and satisfaction with clinical care.

If shown to be effective, CALM-IT can be implemented nationally to relieve distress and to promote psychological well-being in patients with advanced cancer.

Exploring depressive symptoms among LGBT+ medical students: an Italian multicentre survey

Background

Sexual minorities are high-risk populations for mental issues. Recently, attention on medical students (MS) is growing as they might be at higher risk of depression, but few studies focused on mental health of LGBT+ minorities among MS. Our main aims were to investigate depressive symptoms (DS) among LGBT+ MS, compared with non-LGBT+ MS and explore DS predictors.

Methods

A multicentre cross-sectional survey was performed in 12 Medical Schools (Italy, 2018). The questionnaire included sociodemographic items and psychometric tests. The Beck Depression Inventory II was completed by 325 LGBT+ MS and by 2048 non-LGBT+. Chi-squared tests and multivariable logistic regressions were run (significance level: p &lt; 0.05).

Results

Females consisted of 61.5% of the sample, with no differences between the two groups (p = 0.075). DS were reported by 42.5% of LGBT+ MS and 27.4% of non-LGBT+ MS (p &lt; 0.001). Overall, LGBT+ MS took more stimulants (p = 0.001), psychiatric drugs (p &lt; 0.001) and were more frequently seen by psychologists/psychiatrists (p &lt; 0.001). Also, they reported worse family cohesion (p &lt; 0.001) and relationships with classmates (p = 0.018). Considering only non-depressed MS, it was confirmed that LGBT+ MS had higher frequencies of psychiatric drugs consumption (p = 0.036), psychologists/psychiatrists follow up (p = 0.003), poor family cohesion (p = 0.003), poor classmate relationships (p = 0.003). DS predictors were comparable between the two groups, except for age and female gender that were risk factors only in non-LGBT+ MS.

Conclusions

Depression is a great public health issue; it is essential to dedicate efforts targeted to youths at high concern. LGBT+ people confirmed to have an increased DS risk compared to their peers also in a high-risk population like the MS one. Results of non-depressed LGBT+ MS showed a higher necessity of care and a bad living environment, highlighting the need of specific preventive and supportive interventions to bolster sexual minorities.

Depression, suicidal ideation and stress among Italian medical students: PRIMES multicentre study

Background

Depression represents a public health priority and a major contributor to suicide worldwide. Medical students (MS) have been reported as a high-risk group and data are required to implement action plans. This study aimed to investigate depressive symptoms (DS), suicidal ideation (SI) and perceived stress (PS), and analyse factors that may impact on such conditions.

Methods

In 2018, a multicentre cross-sectional study (PRIMES) was carried out in 12 Medical Schools, reaching 2513 MS throughout Italy. Socio-demographic data and psychometric tests were collected. Main outcomes were measured by Beck Depression Inventory-II (DS and SI) and Perceived Stress Scale (PS). Mostly, multivariable logistic and linear regressions were run (p &lt; 0.05 as significant).

Results

The prevalence of DS and SI was 29.5% and 14%. The mean PS score was 18.6 (SD = 7.8), within a range to 0 from 40. Preliminary results showed that the variables associated with a higher risk of reporting all outcomes (DS, SI, PS, respectively) were: increasing age (p = 0.004, p = 0.016, p = 0.003), bisexuality (p = 0.002, p &lt; 0.001, p &lt; 0.001), poor economic status (p = 0.010, p = 0.014, p &lt; 0.001), psychiatric family history (p = 0.007, p = 0.003, p = 0.029), negative judgment about medical school choice (all p &lt; 0.001), unsatisfying classmates' friendships (p = 0.027, p &lt; 0.001, p &lt; 0.001) and classmates' climate competitive and hostile (all p &lt; 0.001). An excellent family bond reduced the odds instead (all p &lt; 0.001). Other socio-demographic and university-related items resulted associated to the outcomes in different ways.

Conclusions

PRIMES showed a high prevalence of DS and SI among MS, with alarming PS levels. Since this issue seems common worldwide, further analyses to understand the determinants are needed and a population-based approach pertaining to public health must be addressed, e.g. to increase resilience. Universities must realize interventions, offer counselling and improve modifiable factors, such as learning climate.

Key messages

Italian medical students reported a prevalence of depressive symptoms and suicidal ideation of 29.5% and 14% respectively, both higher than the prevalence among same-aged general population. Depression, suicidal ideation and stress were mainly influenced by age, sexuality, finances, psychiatric family history, judgment on medical school, family bond, classmates’ friendships and climate.

Prevalence of depressive symptoms among Italian medical students: The multicentre cross-sectional "PRIMES" study

Background

Four percent of the world’s population suffers from depression, which is a major public health issue. Medical students are at risk, as their depressive symptoms (DS) prevalence is reported to be approximately 27% worldwide. Since few data on Italian medical students exist, this study aimed to estimate their DS prevalence and assess risk and protective factors.

Methods

The PRIMES was a multicentre cross-sectional study performed in 12 Italian medical schools. Questionnaires were self-reported and included 30 sociodemographic items and the Beck Depression Inventory-II (BDI-II). The primary outcome was the presence of DS (BDI-II score≥14). The main analyses were chi-squared tests and multivariable logistic regressions with a p-value<0.05 considered significant.

Results

The number of collected questionnaires was 2,513 (117 BDI-II incomplete). Females accounted for 61.3% of the respondents, and the median age was 22 years (IQR = 4). The prevalence of DS was 29.5%. Specifically, 14.0% had mild depression, 11.1% had moderate depression, and 4.5% had severe depression. The main risk factors for DS were age, being female, bisexual/asexual orientation, living with partner/housemates, poor economic status (worsened by living far from home), less than 90 min of weekly exercise, relatives with psychiatric disorders, personal chronic disease, judging medical school choice negatively, unsatisfying friendships with classmates, competitive and hostile climate among classmates, thinking that medical school hinders specific activities and being worried about not measuring up to the profession. Protective factors included family cohesion, hobbies, intellectual curiosity as a career motivation and no worries about the future.

Conclusion

Italian medical students are at high risk of reporting DS, similar to the global population of medical students’. Medical schools must make efforts to implement preventive and treatment interventions by offering counselling and working on modifiable factors, such as lifestyle and learning climate.

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&gt;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.

Depression and the existential domain in the assessment of quality of life in HIV outpatients with the McGill questionnaire

AIM

The aim of the present study was to further test criterion validity and factorial validity of the McGIll Quality Of Life (MQOL) questionnaire, and to assess its reliability and sensitivity to clinical change in outpatients with HIV infection.

METHODS

The authors present a longitudinal study on a consecutive sample of 216 adults treated with HAART at the outpatient facility of an hospital-based tertiary care center in Italy. Patients completed the MQOL and the Beck Depression Inventory (BDI) both at baseline and follow-up assessments. Patients were classified into subgroups (improved, unchanged, worsened) based on change in BDI scores or CD4 count over time.

RESULTS

The pattern of correlation between MQOL subscales and the BDI was as hypothesised. A fairly simple factor structure emerged, with a striking resemblance between the factors and the MQOL subscales. The internal consistency of the MQOL and its subscales was high. The test-retest reliability in clinically unchanged patients was satisfactory. Sensitivity to change, as measured by Guyatt responsiveness statistic, was also satisfactory.

CONCLUSIONS

This study contributed to building evidence of reliability and validity for the MQOL questionnaire, which may be particularly useful to assess the so-called "existential" aspects of QOL that are particularly relevant for patients infected with HIV.