Communicating the diagnosis of a hematological neoplastic disease to patients' minor children: a multicenter prospective study.

BACKGROUND: When a hematological malignancy is diagnosed, the whole family carries the burden of the disease; parents often try to protect minor children from suffering by avoiding communication about their disease. Since 2009, patients with minors at the Adult Hematology Division at San Gerardo Hospital (Monza) can take part in the "Emanuela Project": children can visit parents and talk with psychologists and hematologists, who explain the disease through simple metaphors. MATERIALS AND METHODS: The EMY STUDY aimed to evaluate the impact of illness-related communication on children's behavior, comparing Monza's experience with other Hematology Units, where the communication is delegated to parents or psychological support. Questionnaires exploring the children's main behaviors (school performance, appetite, sleeping patterns, attachment to family figures, and family dialogue) were administered to both sick (SP) and healthy (HP) parents. From 2017 to 2021, 32 patients were enrolled, 20 from Monza and 12 from other hospitals; 84 questionnaires were globally collected. RESULTS: In Monza's group, no major changes in children's behavior were observed and an open dialogue about the disease was often possible. Disease communication is considered crucial and perceived as a responsibility of parents together with a professional figure, mainly the hematologist. Patients were satisfied with "Emanuela Project," reporting positive effects on doctor-patient relationship. Difficulties in separation were significantly higher at other hospitals (P = .019) than in Monza. While at other centers communication is considered parents' responsibility, Monza's patients emphasize the role of professional figures (P = .007). Differently from other hospitals, the role of the hematologist is crucial to Monza's patients (P = .001). CONCLUSION: Disease communication to patients' offspring is a crucial moment in the process of care, and the hematologist can play a major role in this difficult task, with potential positive effects both on children's well-being and on doctor-patient relationship.

The impact of multi-organ procurement surgery in the nursing team: An Italian qualitative study.

The removal of organs and tissues is characterized by a high level of stress and can be very traumatic for the nursing team. This study was informed by a grounded theory approach and was based on data drawn from two focus groups with 15 nurses. Main themes centered on factors that modulate the level of stress (first experiences, children donors, doubts about death, organizational factors), and coping strategies (including nurses' attitudes toward organ donation and training needs). There is a need to implement training for the stress management of the operating nurses and to provide supportive interventions.

Psychological outcomes of left ventricular assist device long-term treatment: A 2-year follow-up study.

Left ventricular assist device (LVAD) is an effective therapy for patients with advanced or refractory heart failure. It may represent a temporary treatment in heart transplant (HTX) candidates (Bridge-To-Transplant-BTT), or a permanent therapy for patients unsuitable for HTX (Destination Therapy-DT). Living with the device may be stressful for both the patients and their caregivers. Currently, evidence on the psychological assessment of LVAD recipients, and factors influencing the patients' psychological adaptation to the device in the long-term period is limited. Here, we explored the quality of life in 20 patients who were treated with LVAD with BTT (n = 13) or DT indication (n = 7) before (T0), 1 year (T1) and 2 years (T2) after implantation, using the EuroQoL-5D-5L test. We also analyzed the influence of sociodemographic (eg, age, gender) and clinical variables (eg, the INTERMACS level and number of hospital admissions) on the quality of life at T2. We found a significant improvement in the self-perceived quality of life 2 years after LVAD implantation. Patients significantly improved in the domains of physical activity and anxiety and depression symptoms. Interestingly, we also demonstrated that the treatment indication was related to changes in self-assessed quality of life, which improved over time in patients implanted with DT indication, whereas it decreased from T1 to T2 in patients with BTT indication. Taken together, these findings suggest that LVAD-related emotional distress and coping strategies need to be carefully evaluated before and in the long-term after LVAD implantation.

Does the severity of psychopathology of Italian students receiving counselling services increase over time? A 5-year analysis and a comparison with a clinical and non-clinical sample.

Psychological problems-from the most minor such as exams anxiety to the more severe such as personality disorders-are not rare in young adults. University Counselling Services often present the only opportunity for undergraduates to meet health professionals and to be confronted with their difficulties in a non-clinical setting or-in cases of more severe psychopathology-to be referred to mental health services. Recent research attests to the increasing severity of psychological problems among undergraduate and graduate university students. The question necessarily arises as to whether this trend is replicated in the general population being referred to mental health services and, if such is the case, whether there are differences between the two populations. This paper analyses the change in the severity of self-reported symptoms in a sample of 194 students attending a University Counselling Service over a course of 5 years (2010-2014). Clinical severity was assessed in both groups by Symptoms Check List 90-Revised, Clinical Outcome in Routine Evaluation-Outcome Measure, and Emotion Regulation Questionnaire scores. Results show a substantial stability in severity level across time, and a comparison with an age-matched sample of patients referred to a public hospital clinical psychology service shows overlapping data with respect to disease severity level. As the mental health of university students is an important public health issue, the implications for the organization and structure of university counselling services and the connection with public mental health hospital centres are discussed.

Mental Health Issues as a Consequence of the Pandemic: Group Psycho-Educational Intervention to Support Patients Recovered from COVID-19 Infection.

Common psycho-physical symptoms have emerged in patients who were previously recovered for COVID-19 infection, including traumatic experience and enduring emotional disturbances. A group psycho-educational intervention of seven weekly sessions and a follow-up after three months was proposed to all Italian-speaking patients formally discharged from a public hospital in northern Italy and physically recovered from infection. Eighteen patients were recruited and divided into four age-homogenous groups, each led by two facilitators (psychologists and psychotherapists). The group sessions followed a structured format with thematic modules, including main topics, tasks, and homework assignments. Data were collected through recordings and verbatim transcripts. The objectives of the study were twofold: (1) to analyze the emerging themes and gain insight into the significant aspects of the participants' lived experience of COVID-19, and (2) to examine changes in how participants approached these themes throughout the intervention process. Semantic-pragmatic text analyses, specifically thematic analysis of elementary context and correspondence analysis, were conducted using T-LAB software. Linguistic analysis revealed a congruence between the intervention's objectives and the participants' experiences. The study highlighted an evolution in the narratives, as participants transitioned from a passive and concrete perspective on the disease to a more comprehensive cognitive and emotional elaboration of their personal illness stories. These findings hold potential relevance for healthcare services and professionals working in this field.

The impact of the second COVID-19 lockdown on anxiety and depressive symptoms in pregnant women: A case study of pregnant women in northern Italy.

Background: the different lockdown phases due to COVID-19 may have negatively impacted pregnant women's mental health. Concerning antenatal stress, most studies focused more on the effect of pandemic onset than on the impact of the following phases and restrictions. Aim: the present study aimed to assess levels of anxiety and depression in a group of Italian pregnant women during the second COVID-19 phase and possible risk factors. Method: We recruited 156 pregnant women through our Perinatal Psychology Outpatient Clinic. We divided the sample into women recruited before the pandemic (N = 88) through a face-to-face antenatal class and pregnant women recruited during the second lockdown (Covid-19 study group) (November 2020-April 2021) through the same antenatal class via Skype (N = 68). To investigate depressive and anxiety symptoms, we administered the Edinburgh Postnatal Depression Scale (EPDS) and the State and Trait Anxiety Inventory (STAI-Y) scales; women's medical history and obstetric data were collected. Findings: women belonging to the Covid-19 study group reported higher depressive and anxious levels than the pre-pandemic group. Moreover, during the second lockdown previous psychopathology and being close to childbirth were related to increased depression; a history of abortion was related to higher levels of trait anxiety instead. Conclusion: recurrent restrictive measures due to COVID-19 negatively affected the antenatal mental well-being of pregnant women, particularly worsening depressive and anxious feelings. Pregnant women during the pandemic represented a vulnerable population to be monitored more closely and timely to prevent psychological problems in the postpartum period and their consequences on the child. Keywords: anxiety, depression, pregnancy, COVID-19, mental health, lockdown.

[Psychological interventions in hospital during the first-wave of CoViD-19: an overview of the experiences of the Units of Clinical Psychology in Lombardy, Italy.] / Interventi psicologici in ospedale ai tempi della CoViD-19: una panoramica delle realtà proposte dalle Unità Operative di Psicologia (UOPSI) della Lombardia.

The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency: psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.

Pattern of self-injurious behavior and suicide attempts in Italian custodial inmates: A cluster analysis approach.

Self-injurious behaviors and suicide attempts are more frequent in prison settings than in the general population and represent a crucial problem. The aims of this work are to assess the prevalence of self-injurious behaviors and suicide attempts in an Italian prison setting, to determine whether inmates could be differentiated based on profiles of psychological distress and impulsiveness, and to assess the predictive power of the proposed profiles. A sample of 1422 male inmates of a north Italian penitentiary was assessed upon admission with a clinical interview and completed a set of self-report questionnaires to assess psychological distress and impulsiveness; the number of self-injurious behaviors and suicide attempts occurring in the first year of detention was recorded. A cluster analysis approach was used. Prevalence of self-Injurious behaviors and suicide attempts is similar to what has been observed in previous work. Cluster analysis revealed four clusters: dysregulated (high impulsivity and distress), impulsive (high impulsivity and mean distress), mildly distressed (mean impulsivity and moderate distress) and well-balanced (low impulsivity and distress). The four clusters help to discriminate subjects more at risk of self-injurious behaviors and suicide attempts and are confirmed by the inclusion of risk factors such as marital status and relatives'/social support. Clinical implications are discussed.