Reliability and Factor Structure of the Well-Being and Respect for Human Rights Questionnaire in Measuring Caregivers' Perception.

Background: This study has investigated perceptions of respect for users' rights among informal caregivers in mental healthcare settings, aligning with the guidelines outlined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the World Health Organization QualityRights initiative. The study has employed the questionnaire on Well-being at Work and Respect for Human Rights (WWRR) among informal caregivers and tested whether the questionnaire's factor structure among informal caregivers aligns with that of users and health workers. We have hypothesized that informal caregivers prioritize users' needs and rights over the care context's climate. Methods: This was a cross-sectional study. The "Well-being at Work and Respect for Human Rights" questionnaire was distributed to 100 caregivers in 4 territorial mental health facilities in Sardinia, Italy. Confirmatory Factor Analysis (CFA) was utilized to assess the participants' responses. Results: Participants reported high satisfaction with their relatives' treatment, perceiving a high level of respect for human rights among users and healthcare professionals. However, they highlighted insufficient resources for services, particularly the need for additional staff. CFA revealed that a scale with the first five items demonstrated good reliability, convergent validity, and discrimination. Mean scores indicated high satisfaction and perception of respect for human rights across the sample, with no significant differences by age or gender. Conclusion: Satisfaction with users' rights is closely correlated with other factors comprising the notion of organizational well-being within a healthcare service.

Organizational Wellbeing among Workers in Mental Health Services: A Pilot Study.

INTRODUCTION: Organizational wellbeing in mental health services influences the outcomes of users and their families. Workers should be motivated, have a positive morale and be able to recognize values and the deep meaning of their work. This survey aims to examine the organizational wellbeing of the services provided by the Department of Mental Health (DSM) in Lanusei (Italy) and the correlations between job satisfaction and the psychosomatic health of its workers. MATERIALS AND METHODOLOGY: Descriptive-correlational study on a population of 43 mental health workers. Organizational wellbeing, as well as workers' job satisfaction and psychosomatic health, were measured using the "Multidimensional Organizational Health Questionnaire" (MOHQ). It is a self-report questionnaire able to examine 14 dimensions of organizational wellbeing, 14 indicators about individual discomfort, 12 indicators about individual wellbeing, 8 psychosomatic symptoms related to job distress. RESULTS: 31 workers (72%) participated in the survey. Regarding the organizational wellbeing of DSM, the general profile mean±sd was 2.66±0.28 (values from 1 to 4: 1=never, 4=often). Job satisfaction was negatively correlated with headaches and concentration difficulties (R=-.584, p=0.001), nervousness, restlessness, anxiety (R=-.571, p=0.001), sense of excessive fatigue (R=-.634, p=0.000) and sense of depression (R=-.558, p=0.001) reported by workers. CONCLUSIONS: Data denoted an overall healthy state of the DSM. There were significant correlations between workers' job satisfaction and their psychosomatic health. The recognition and restitution about the weakness and strengths of the services could be useful to point out some organizational development perspectives.

Interventions on bullying and cyberbullying in schools: a systematic review.

Background : bullying (and cyberbullying) is a widespread phenomenon among young people and it is used to describe interpersonal relationships characterized by an imbalance of power. In this relationships often show aggressive behavior and intentional "harm doing" repeated over time. The prevalence of bullying among youth has been reported to vary widely among countries (5.1%-41.4%) and this behavior seems generally higher among student boys than girls. Several school interventions have been developed to reduce bullying, but reported inconsistent results possibly related to limitations in the study design or to other methodological shortcomings. Aims : evaluating randomized-controlled trials (RTCs) conducted between 2000 and 2013 to assess the effectiveness of school interventions on bullying and cyberbullying. Methods : a systematic search of the scientific literature was conducted on Pubmed/Medline and Ebsco online databases. We also contacted experts in the field of preventive bullying research. Results : 17 studies met the inclusion criteria. The majority of studies did not show positive effects in the long term; the interventions focused on the whole school were more effective in reducing bullying than interventions delivered through classroom curricula or social skills training alone. Conclusion : while there is evidence that programs aimed at reducing bullying can be effective in the short term, their long-term effectiveness has not been established, and there are important differences in the results based on gender, age and socio-economic status of participants. Internal inconsistency in the findings of some studies, together with the wide variability of experimental designs and lack of common standardized measures in outcome evaluation, are important limitations in this field of research.

Integrating children with psychiatric disorders in the classroom: a systematic review.

BACKGROUND: The school setting may be the optimal context for early screening of and intervention on child mental health problems, because of its large reach and intertwinement with various participants (child, teacher, parent, other community services). But this setting also exposes children to the risk of stigma, peer rejection and social exclusion. This systematic literature review investigates the efficacy of mental health interventions addressed to children and adolescents in school settings, and it evaluates which programs explicitly take into account social inclusion indicators. METHOD: Only randomized controlled trials conducted on clinical populations of students and carried out in school settings were selected: 27 studies overall. Most studies applied group Cognitive Behavioural Therapy or Interpersonal Psychotherapy. RESULTS: Findings were suggestive of the effectiveness of school-based intervention programs in reducing symptoms of most mental disorders. Some evidence was found about the idea that effective studies on clinical populations may promote the social inclusion of children with an ongoing mental disorder and avoid the risk of being highly stigmatized. CONCLUSION: School programs are still needed that implement standardized models with verifiable and evidence-based practices involving the whole school community.

Are Depressive Symptoms in Obstructive Sleep Apnea Attributable to a Syndrome of Dysregulation of Rhythms and Hyperactivity (DYMERS)?

Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea-hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari's sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS).

The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial.

Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder.

Prevalence and Risk by Age and Sex of Sleep Dysregulation and Depressive Episodes in Bipolar and Depressive Disorders in a Community Survey in Sardinia, Italy.

Background/Objectives: Sleep disturbances often accompany mood disorders and persistent insomnia after mood symptoms have resolved may be a marker of poor outcome. The association between sleep symptoms and mood disorders seems to change with age and sex. This study aims to assess the frequency of depressive episodes and sleep disorders in the general population through an agile screening questionnaire and to evaluate the association of depressive episodes and sleep symptoms by sex and age categories. Methods: 774 women and 728 men from Sardinia aged > 16 years old were enrolled. The Patient Health Questionnaire (PHQ-9) was administered through a computer-assisted telephonic interview. Results: The frequency of depressive episodes was double in women (10.6% vs. 4.4%; p < 0.0001), with the highest values in women > 75 yo (17.4%). The frequency of sleep dysregulation was double in women (18.7% vs. 9.6%; p < 0.0001), with the highest values in women > 75 yo (35.9%) and the lowest in the group of men > 75 yo. The group of young males showed the lowest frequency of depressive episodes (1.4%) and a frequency of sleep dysregulation (9.1%) similar to that of the other groups of age and sex. Sleep dysregulation without depressive episodes presented a higher distribution in the elderly, both in males (20.7%) and in females (18.5%). No significative differences were found across sex and age groups in the distribution of depressive episodes without sleep dysregulation. Conclusions: The use of an agile screener such as PHQ9 in the general population and/or in populations at risk can be a valuable tool in finding those individuals in whom sleep dysregulation may represent an early warning signal, one that may be thoroughly evaluated to identify and treat possible sleep disorders early.

Virtual Reality Cognitive Remediation in Older Adults with Bipolar Disorder: The Effects on Cognitive Performance and Depression in a Feasibility Randomized Controlled Trial.

INTRODUCTION: Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders. METHODS: This secondary analysis of a randomized controlled trial involves adults aged 58-75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment. RESULTS: No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test (p = 0.897) or in depressive symptoms (p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20). CONCLUSIONS: VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals.

An e-Health Psychoeducation Program for Managing the Mental Health of People with Bipolar Disorder during the COVID-19 Pandemic: A Randomized Controlled Study.

Background: Social rhythm dysregulation has been identified as a determining factor in bipolar disorder (BD) relapses. It directly impacts individuals' quality of life (QoL). This study aims to present preliminary data on the efficacy of an e-health psychoeducational intervention for BD for improving clinical outcomes. Methods: This study used an open-label, crossover, randomized controlled trial design. The inclusion criteria consisted of a BD diagnosis, affiliation with the Consultation Psychiatry and Psychosomatic Center at the University Hospital in Cagliari, Italy, age over 18, and the obtaining of informed consent. Anxiety and depressive symptoms, QoL, and social and biological rhythms were measured using standardized instruments validated in Italian. Results: A total of 36 individuals were included in the experimental group (EG) and 18 in the control group (CG). The final sample consisted of 25 in the EG and 14 in the CG. A statistically significant improvement in QoL was found in the EG post-treatment (p = 0.011). Significant correlations were found between QoL and the dysregulation of biorhythms in the EG at T0 (p = 0.0048) and T1 (p = 0.0014). Conclusions: This study shows that, during extreme distress, an e-health group psychoeducation intervention for people with BD could significantly improve the perception of QoL. The results must be confirmed by studies conducted with larger-sized samples.

Informal caregivers compared with users and health workers on well-being and respect for human rights in mental health care services.

Background: This study aimed to measure differences among informal caregivers, users, and mental healthcare workers (MHW) regarding job/organizational satisfaction and perceptions of respect for rights in the mental health services of one region of Italy. Methods: A sample of 100 caregivers, 240 MHW, and 200 users completed the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR) in community mental health centers in Sardinia. Results: Caregivers reported higher satisfaction toward MHW on perceiving respect for human rights among users (5.2 ± 1.0 vs 5.1 ± 1.1, p < 0.0001) and health professionals (5.3 ± 0.8 vs 4.5 ± 1.3, p < 0.0001) and organization well-being (5.1 ± 1.2 vs 3.9 ± 1.3, p < 0.0001); toward users about respect of rights of MHW (5.3 ± 0.8 vs 4.9 ± 1.2, p < 0.0001) and both toward users and MHW on dissatisfaction on resources (p < 0.0001). Caregivers strongly highlighted insufficient resources for services. Conclusion: Despite caregiver satisfaction, resource deficiencies signal a critical juncture in Italian mental health care. Continued cuts in healthcare spending, especially in mental health, raise concerns for future outcomes.