Italian Validation of the Short Version of the Failure to Mentalize Trauma Questionnaire in Adults at Risk Due to Childhood Trauma.

The impact of recurrent traumatic experiences during childhood may impede the integration of mentalization abilities and lead to psychopathology. Recently, the Failure to Mentalize Trauma Questionnaire (FMTQ), a comprehensive 29-item self-report scale aimed at identifying deficits in mentalization arising from childhood trauma, was developed. However, the length of the FMTQ may render it impractical for epidemiological studies involving multiple variables and measures. Furthermore, the initial testing revealed inadequate factor reliabilities for the two first-order factors. Therefore, this study aimed to shorten and create a unidimensional version (FMTQ-s) and investigate its psychometric properties, including internal consistency and convergent and concurrent validity, in a non-clinical Italian adult sample. The factor analysis supported a 13-item unidimensional version of the FMTQ with acceptable internal consistency (ordinal alpha = 0.88) and satisfactory convergent and concurrent validity. The FMTQ-s obtained scalar invariance between individuals with and without self-reported childhood traumas. Overall, the FMTQ-s appears to be a feasible and reliable tool for assessing deficits in mentalization resulting from childhood trauma.

Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care-related fears influence cancer worry and risk perception?

BACKGROUND: The impact of family and personal cancer history and emotional factors, such as depression and anxiety, on disease representation has received limited attention in studies investigating the development of cancer-related worry and risk perception within the context of genetic counseling. The current study endeavors to fill this gap by exploring the extent to which depression and anxiety influence cancer worry and risk perception, and the role of health care-related fear as potential mediator in this relationship. METHODS: A sample of 178 women who underwent their first genetic counseling for breast/ovarian cancer, 52% of whom had previous cancer diagnoses, completed questionnaires assessing sociodemographic and clinical information, emotional distress in terms of anxiety and depression, cancer-related worry, risk perception, and health care-related fears. RESULTS: Results of mediation analyses showed that cancer-related worry and risk perception increased with rising levels of depression and anxiety, with health care-related fears acting as a mediator in the relationship of depression and anxiety with cancer worry and risk perception. Covariate analysis revealed that previous cancer diagnosis increases cancer-related worry but not risk perception, while the number of family members affected by cancer increases both outcomes. CONCLUSION: These findings emphasize the need for a holistic approach in genetic counseling and have implications for the clinical practice.

A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles.

Shame is an intense, difficult to regulate, self-conscious emotion that predicts aspects of poor psychological functioning and is also strongly related to early relationships. Attachment insecurities, which constitute non-specific risk factors for psychological maladjustment, have been associated with an individual's tendency to experience shame. In this study, we sought to examine the serial mediating roles of dispositional shame and shame-coping styles (i.e., attack other, attack self, withdrawal and avoidance) in the association between anxious and avoidant attachment, and psychological distress. Using a cross-sectional design, self-reported data were collected. The study sample included 978 respondents (57% female) with a mean age of 32.17 ± 13.48 years. The results of the path analysis indicated that both attachment dimensions were sequentially associated with dispositional shame and then with the attack self shame-coping style, which was, in turn, positively related to psychological distress. Further, attachment insecurities were sequentially associated with dispositional shame and then with the avoidance shame-coping style, which was, in turn, negatively related to psychological distress. The model was gender invariant, suggesting that the serial mediation worked in a similar way for men and women. The practical implications of these findings are discussed.

Green Trust as a Mediator in the Relationship between Green Advertising Skepticism, Environmental Knowledge, and Intention to Buy Green Food.

Changing individual habits towards greener choices is an essential ingredient in tackling the environmental crisis. Engaging in green behavior may improve psychological wellbeing. Although the intention to buy green products is widespread, the eco-friendly market is struggling to leave the ground. Greenwashing can increase skepticism towards green advertising, which in turn can hinder the intention to buy green products. Conversely, a better knowledge of environmental issues can promote a positive attitude towards environment and thus the intention to purchase green products. This study aimed to investigate if trust in green claims can mediate the relationships of green advertising skepticism and environmental knowledge with the intention to buy green food. An online survey was administered to 410 Italian consumers (63% female; 18-78 years). Our mediation model explained 23% of the variability in intention. Trust fully mediated the relationship between green advertising skepticism and intention to buy green food, while it partially mediated the relationship between perceived environmental knowledge and intention. Specifically, GAS was associated with lower INT through lower TR, whereas PEK was linked to higher INT though higher TR. The findings of this study can provide green market operators and policy makers with valuable information to encourage green food purchases.

Common-sense model of self-regulation to cluster fibromyalgia patients: results from a cross-sectional study in Italy.

OBJECTIVES: Fibromyalgia is a severe and disabling chronic pain syndrome affecting millions of people worldwide. Various patients' subgroups were identified using different atheoretical measures, hardly effective to tailor treatments. Previous literature findings showed the relevance of fibromyalgia patients' illness perceptions in adjusting to the disease. The present study aims to identify clusters of fibromyalgia patients based on their illness perceptions and investigate whether they can differ across pain, mood, physical functioning, catastrophising, and pain acceptance measures. METHODS: Fifty-three newly referred fibromyalgia patients completed clinical and psychological questionnaires. Patients' subgroups were created by applying hierarchical cluster analysis to their answers to Illness Perception Questionnaire-Revised subscales. Potential differences across subgroups in outcome variables were tested. RESULTS: Cluster analysis identified two patient groups. Group A (32 patients) had a higher representation of fibromyalgia as a chronic disease with severe consequences, lower beliefs in personal and treatment control, and a higher fibromyalgia-related emotional distress than group B (21 patients). Clusters did not differ on pain intensity and duration. Group A, compared to group B, showed worse physical functioning and overall impairment due to fibromyalgia, a poorer psychological condition, a higher tendency to catastrophise, and less pain acceptance. CONCLUSIONS: Study findings reveal two fibromyalgia subgroups differing in emotional suffering and impairment despite similar pain intensity and duration. Patients' illness perceptions and attitudes towards pain, like catastrophising and acceptance, might be critical in adjusting to the disease. A detailed assessment of such risk and protective factors is critical to differentiate patients' subgroups with different needs and thus offering tailored treatments.

A Narrative Review of the Assessment of Depression in Chronic Pain.

OBJECTIVES: This narrative review sought to explore the main critical issues in the assessment of depression in chronic pain and to identify self-report tools that can be reliably used for measuring it. DESIGN: Narrative review of the literature. METHODS: Articles were obtained through a search of three databases and a hand search of the references of full-text papers. Key results within the retrieved articles were summarized and integrated to address the review objectives. RESULTS: Criterion contamination, different ways to define and evaluate pain and depression across studies, variability in chronic pain samples and settings, pitfalls of diagnostic systems and self-reports, and reluctance to address (or difficulty of recognizing) depression in patients and healthcare providers emerged as main critical issues. The Beck Depression Inventory seems to be the more accurate tool to evaluate depression in chronic pain patients, while other instruments such as the Patient Health Questionnaire could be recommended for a rapid screening. CONCLUSIONS: Assessment of depression comorbidity in chronic pain represents a challenge in both research and clinical practice; the choice and use of tests, as well as the score interpretation, require clinical reasoning. NURSING PRACTICE IMPLICATIONS: Nurses play an important role in screening for depression. Cognitive contents of depression should be carefully evaluated since somatic symptoms may be confusing in the chronic pain context. Some self-reports may be useful for rapid screening. It is also advisable to consider other relevant patient information in evaluating depression.

The Role of Organizational Citizenship Behavior and Gender between Job Satisfaction and Task Performance.

Job satisfaction (JS) is an indicator of individual psychosocial health. Consistent evidence showed that voluntary extra-role behavior in organizations, namely organizational citizenship behavior (OCB), can also contribute to individual psychological health. JS has been found to positively influence employees' OCB, and both JS and OCB have been found to predict employees' task performance (TP). The purpose of this study was to investigate whether employees' OCB mediates the relationship of JS with TP, taking into consideration gender as a potential moderator, and other sociodemographic and work-related characteristics as confounding variables. A total of 518 employees, 54.6% women, aged 19-66 years with a mean age of about 36 years, completed measures of JS, OCB, and TP. Results showed a partial mediation of OCB in the JS-TP relationship, which was invariant across gender. A potential practical implication of findings is that human resource managers and practitioners might ultimately benefit male and female employees' well-being as well as the organizations' productivity by developing targeted individual- and group-level trainings and interventions to enhance JS and OCB.

Development and validation of The Breaking Bad News Attitudes Scale.

BACKGROUND: Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS: The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS: The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION: The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

The Infertility-Related Stress Scale: Validation of a Brazilian-Portuguese Version and Measurement Invariance Across Brazil and Italy.

Infertility constitutes an essential source of stress in the individual and couple's life. The Infertility-Related Stress Scale (IRSS) is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals' lives. In the present study, the IRSS was translated into Brazilian-Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals (54.2% female, mean aged 36 ± 6 years) completed the Brazilian-Portuguese IRSS (IRSS-BP), and a subsample of 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals (54.2% female, mean aged 38 ± 6 years) was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling (ESEM) indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings.

Future Time Perspective and Perceived Social Support: The Mediating Role of Gratitude.

Future time perspective, perceived social support, and dispositional gratitude are topics of interest that positively influence people's psychological health. Although gratitude has been positively associated with future time perspective and social support, this is the first study to investigate its mediating role in the relationships of future time perspective with perceived social support. A convenience sample of 1256 adults (55.1% women), mean age 34.55 years (SD = 13.92), completed self-reported measures of future time perspective (conceptualized as remaining time and opportunities), dispositional gratitude, and received and given social support. Results indicated that higher dispositional gratitude mediated the relationship between the perception of more remaining time and opportunities and greater perception of received and given social support. These findings highlight the importance of considering dispositional characteristics to better understand the impact of perceived future on the individuals' subjective experience of social exchanges. Interventions addressing future time perspective and dispositional gratitude might have beneficial effects on individuals' social well-being.

Associations of Self-Efficacy, Optimism, and Empathy with Psychological Health in Healthcare Volunteers.

Optimism and self-efficacy have been associated with psychological health. Empathy has also been found to have a unique role in community health volunteering and promote positive functioning. This study investigated whether self-efficacy and optimism were associated with psychological health in terms of psychological and subjective well-being in healthcare volunteers. It also investigated whether empathy added to the explanation of psychological health, over and above that accounted for by self-efficacy and optimism. A convenience sample of 160 Italian clown doctors volunteering in various hospitals completed self-report measures of self-efficacy, optimism, empathy, psychological well-being, and subjective well-being. Results of hierarchical multiple regression analysis indicated that self-efficacy and optimism were associated with both outcomes and that aspects of empathy, such as others' perspective taking and personal distress for others' difficulties, added to the explanation of psychological health with opposite effects. The present study adds to previous research on the role of self-efficacy, optimism, and empathy for community health volunteers' psychological health. It also offers suggestions regarding the training for this type of volunteer.

Identification of MOR-Positive B Cell as Possible Innovative Biomarker (Mu Lympho-Marker) for Chronic Pain Diagnosis in Patients with Fibromyalgia and Osteoarthritis Diseases.

Fibromyalgia (FM) diagnosis follows the American College of Rheumatology (ACR) criteria, based on clinical evaluation and written questionnaires without any objective diagnostic tool. The lack of specific biomarkers is a tragic aspect for FM and chronic pain diseases in general. Interestingly, the endogenous opioid system is close to the immune one because of the expression of opioid receptors on lymphocytes membrane. Here we analyzed the role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM and osteoarthritis (OA) patients. We enrolled three groups of females: FM patients, OA patients (chronic pain control group) and healthy subjects (pain-free negative control group). We collected blood samples to apply immunophenotyping analysis. Written tests were administrated for psychological analysis. Data were statistically analyzed. Final results showed that the percentage of Mu-positive B cells were statistically lower in FM and OA patients than in pain-free subjects. A low expression of Mu-positive B cell was not associated with the psychological characteristics investigated. In conclusion, here we propose the percentage of Mu-positive B cells as a biological marker for an objective diagnosis of chronic pain suffering patients, also contributing to the legitimacy of FM as a truly painful disease.

Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight.

PURPOSE: This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. MATERIALS AND METHODS: Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (Kw) for test-retest reliability. RESULTS: Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. CONCLUSIONS: EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment.

This study adopted a dyadic approach to explore the associations between social support and stress as mediated by coping among infertile couples. All these variables were infertility-specific. A total of 201 couples starting their first assisted reproductive technology (ART) treatment completed self-reports of infertility-specific support from spouse and from social network, infertility-related coping with four strategies (active-avoidance, active-confronting, passive-avoidance, and meaning-based), and infertility stress. The actor-partner interdependence model was applied. Results indicated that dyadic associations between support and stress were either direct or mediated by individual or partner coping, with differences based on gender, source of support, and coping strategy. For both genders, greater support from spouse was associated with lower individual and partner stress directly and indirectly, through lower partner's use of active-avoidance coping. In men, the relationship between support from spouse and stress was also mediated by individual/partner avoidance coping strategies. As for support from social network, greater levels were directly associated with a lower partner stress in women and with higher individual stress in men. For both genders, the relationship between support from social network and stress was also mediated by active-confronting coping, which was associated with higher individual and partner stress. The findings suggest a potential protective role of support from spouse and an adverse effect of that from people outside the dyad. Interventions for couples starting ART treatment should focus on promoting infertility-related communication and support within the couple, which might help to reduce the use of infertility-specific maladaptive coping strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective.

OBJECTIVE: To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals' provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ). METHODS: A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested. RESULTS: The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient's agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients' social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients' educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient. CONCLUSION: The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals. PRACTICE IMPLICATIONS: The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients' reported experience is an important dimension of the clinician's performance.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

The Cancer Worry Scale Revised for Breast Cancer Genetic Counseling.

BACKGROUND: The Cancer Worry Scale was revised to be used in breast cancer genetic counseling (CWS-GC). This scale is used to identify dimensions that are relevant in the genetic counseling context, such as worry about developing breast cancer, impact of worries on daily life, and risk perception in women attending a counseling session for BRCA1/2 mutations. OBJECTIVE: The aim of this study was to estimate the psychometric properties of the CWS-GC in a sample of Italian women. METHODS: A total of 304 women aged 19 to 90 years, 58% with history and 42% with no history of breast or ovarian cancer, participated in the study. Validity, reliability, and sensitivity to change of the CWS-GC were assessed. RESULTS: Confirmatory factor analysis suggested a 2-factor structure of the CWS-GC measuring cancer worry and risk perception and with Cronbach's α coefficients of .90 and .70, respectively. Criterion validity was attested by substantial yet not overlapping correlations with anxiety and fear of medical procedures. In a subsample of 50 women, test-retest reliability at a 4-week interval ranged from 0.70 to 0.87, and the CWS-GC was able to detect small to medium changes 1 month after genetic counseling. CONCLUSIONS: Overall, the CWS-GC showed good psychometric characteristics in this population. IMPLICATIONS FOR PRACTICE: The CWS-GC would be appropriate for use by healthcare professionals to better understand how women react and adapt to information on genetic cancer risk to provide them with emotional support and encourage surveillance behaviors.

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil.

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.