The association between traumatic experiences and substance and behavioral addictions in late adolescence: A role for PTSD and cPTSD as potential mediators.

BACKGROUND & AIM: Traumatic experiences (TEs) are a risk factor for behavioral and substance addictions (SBAs). However, the role of post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) deserves further elucidation. The present study assesses the association between different types of TEs on cannabis, alcohol, gambling, and problematic internet use in late adolescents. Furthermore, this study aims at evaluating the role of PTSD and cPTSD as potential mediators. METHODS: An observational cross-sectional study was conducted on one thousand ten late adolescents (510 males, 498 females; age: mean = 18.7, SD = 0.65). Data regarding intentional (iTEs) and unintentional TEs (uTEs), cannabis, alcohol, gambling and problematic use of the internet (PIU), PTSD, and cPTSD were collected. Association between TEs, SBAs, and PTSD/cPTSD symptoms were explored by means of logistic regressions. Mediation was assessed using a path analysis. RESULTS: uTEs were associated with cannabis use (OR = 1.34 [1.13,1.59]) and alcohol use (OR = 1.21 [1.10,1.35]), iTEs were associated with cannabis use (OR = 1.15 [1.06,1.25]), alcohol use (OR = 1.08 [1.02,1.13]), and PIU (OR = 1.17 [1.10,1.24]). PTSD was associated with alcohol use (OR = 1.59 [1.03,2.46]) and PIU (OR = 1.92 [1.18,3.13]). cPTSD was associated with cannabis use (OR = 3.54 [1.56,8.04]) and PIU (OR = 5.13 [2.71,9.70]). cPTSD mediated 58.75% of the total effect of iTEs on cannabis. Regarding PIU, PTSD mediated 68.18% of the effect of uTEs; the effect of iTEs on PIU was mediated by 65.5% via cPTSD and 34.45% via PTSD. CONCLUSION: cPTSD and SBAs show a complex pattern of association. A thorough assessment of stress-related conditions, including cPTSD, is of pivotal importance in treating SBAs.

Psychopathological mediators between insecure attachment and psychotic features in a non-clinical sample: the role of depression and interpersonal sensitivity.

INTRODUCTION: Attachment styles represent a personality pattern critical to psychological health, with insecure attachment being a central factor in developing psychopathological characteristics of psychosis. However, its downstream psychopathological pathways remain unclear. This study aimed to investigate the putative psychopathological mediators in the relationship between insecure attachment and psychotic features in a non-clinical sample of university students. METHODS: We recruited two non-clinical samples for a total of 978 subjects, 324 males and 654 females, and administered the Relationship Questionnaire (RQ) to assess attachment styles and the Symptom Check-List 90 (SCL-90) to assess psychopathological symptoms. Moreover, the Paranoia and Psychoticism subscales of SCL-90 were combined and used as a measure of Psychosis (PSY). A mediation analysis model was carried out to establish the relationship among variables. RESULTS: Mediation analysis showed a total effect from RQ-Preoccupied and RQ-Fearful to PSY, respectively, 0.31 and 0.28. Direct effects from the SCL-90-R factor candidate mediator to PSY ranged from 0.51 for somatization to 0.72 for depression and 0.72 for interpersonal sensitivity. Indirect effects ranged from 0.08 for RQ-Preoccupied via hostility to 0.21 for RQ-Preoccupied via depression. DISCUSSION: Our results show that the effect of insecure attachment on psychosis features is differentially mediated by some psychopathological dimensions, being depression and interpersonal sensitivity the most relevant ones. PSY feature, therefore, is predicted by other specific symptoms in the psychological context of insecure primary relationships. CONCLUSIONS: From a preventive and clinical point of view, our results could be relevant in informing the early-stage psychological treatment of pre-psychotic states and, in general, people experiencing sub-threshold psychotic symptoms.

Attachment and resilience as mediators or moderators in the relationship between trauma and psychotic-like experiences.

BACKGROUND: A large body of evidence has established a tight relation between traumatic experiences (TEs) and psychotic-like experiences (PLEs). Nevertheless, more comprehensive models involving multiple interactions of serial or parallel mediations and moderations still need to be elucidated. Among the many potential mediators or moderators, insecure attachment and resilience play a key role in the association of stress with PLEs. Hence, we aim to explore the complex pathways that lead from different types of TEs to PLEs, involving attachment and resilience modeled as mediators or moderators. METHODS: One thousand ten high school students completed the International Trauma Exposure Measure (ITEM), the 11-item Resilience Scale for Adults (RSA-11), the 16-item Prodromal Questionnaire (iPQ-16), and the Relationship Questionnaire (RQ). A path analysis was conducted to assess mediation and moderation. RESULTS: The final model showed that the impact of childhood TEs on PLEs was mediated by a pathway through anxious-insecure attachment styles (i.e., fearful and preoccupied, respectively, 8.75 % and 8.53 % of the total effect) and personal resilience resources. Conversely, the avoidant-insecure attachment was associated with lower interpersonal resilience (b = 0.14 [0.08, 0.20]), which in turn moderated the impact of recent TEs on PLEs (interaction term b = 0.34 [0.21, 0.47]). CONCLUSIONS: Our model examines a complex model that includes factors buffering the effect of traumatic experiences on PLEs. Our results highlight the importance of insecure-anxious attachment to personal resilience resources and of insecure-avoidant attachment to interpersonal resilience as potential targets for clinical practice.

Psychotic-like experiences associated with ICD-11 PTSD and cPTSD in a cohort of Italian late adolescents.

INTRODUCTION: Post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) are two sibling stress-related disorders. Evidence suggests a worse clinical picture associated with cPTSD in terms of comorbidities and outcomes. However, little is known about the association between cPTSD and psychotic-like experiences (PLEs). In this study, we aim to explore differences in PLEs in a sample of 1010 late adolescents with PTSD and cPTSD symptoms. METHODS: A sample of 1010 late-adolescents and young adults attending the last year of high school was selected. PLEs were assessed using the 16-items Prodromal Questionnaire (PQ-16), PTSD and cPTSD were assessed using the International Trauma Questionnaire (ITQ). RESULTS: 999 (501 males, 50.15% and 498 females, 49.85%) subjects had complete data on the selected variables. Of these, 91 (9.11%) and 40 (4.00%) screened positive for PTSD and cPTSD, respectively. Mean number of PLEs endorsed in subjects with PTSD, cPTSD and control groups were 7.02 (sd=2.99), 8.17 (sd=3.70) and 4.49 (sd=2.93), respectively. Mean PQ-16 distress score was 5.08 (sd=4.6) in subjects not endorsing PTSD/cPTSD, 10.11 (sd=6.17) in PTSD and 14.51 (sd=9.1) in cPTSD subjects. A linear regression analysis revealed a significant association between PTSD/cPTSD and PLEs scores (respectively, b=4.91 [3.73, 6.10] and b=10.05 [8.40, 11.70]). Such associations were reduced after adjustment for depression, anxiety and dissociation. DISCUSSION AND CONCLUSIONS: Our results find higher rates of PLEs in late adolescents screening positive for cPTSD and PTSD compared to negative subjects. Furthermore, cPTSD could be more specifically associated with distressing PLEs. These findings add to the vast literature of a worse psychopathological picture associated with cPTSD compared to PTSD, emphasizing the need for a separation between PTSD and cPTSD in terms of diagnosis and possibly treatment.

The relationships among metacognitive functions, sleep-related thought-control strategies and sleep quality: A mediation analysis.

In the context of sleep disturbances, increasing evidence suggests a critical role of sleep-related dysfunctional metacognitive activity, including metacognitive control of intrusive thoughts in the pre-sleep period. Although the relationship between sleep-related thought-control strategies and poor sleep quality is well recognized, the possible contribution of general metacognitive functioning within this relation is still unclear. In this study, we performed a mediation analysis to examine the role of thought-control strategies on the relationship between metacognitive abilities and sleep quality in individuals with different self-reported sleep characteristics. Two-hundred and forty-five individuals participated in the study. Participants completed the Pittsburgh Sleep Quality Index, the Thought Control Questionnaire Insomnia-Revised, and the Metacognition Self-Assessment Scale to evaluate sleep quality, thought-control strategies and metacognitive functions, respectively. The results showed that worry strategy in the pre-sleep period mediates the relationship between metacognitive functions and sleep quality. Particularly, the ability to understand one's mental states and mastery functions could be the two metacognitive domains primarily involved in the dysfunctional metacognitive thought-control activity responsible for reduced sleep quality. The observed effect suggests that inadequate metacognitive functioning is associated with poor sleep quality in healthy subjects via the mediation of dysfunctional worry strategy. These findings suggest the potential relevance of clinical interventions to enhance specific metacognitive abilities, with the aim to promote more functional strategies for managing cognitive and emotional processes during the pre-sleep period.

The role of emotional instability in borderline personality disorder: a systematic review.

BACKGROUND: The emotional regulation process plays a pivotal role in daily-life functioning, modulating goal-directed and adaptive behavior. Conversely, altering this cognitive function can disrupt self-regulation and bring emotional dysregulation. Emotional instability could represent a core characteristic of BPD, also modulating the BPD symptom's onset. This systematic review aims to summarize the existing literature reporting the role of emotional instability in BPD to better define the role of the impairment of the emotional processes in the onset of the cognitive and behavioral symptoms of this complex mental disorder. METHODS: MEDLINE, Scopus and Web of Science were independently searched for relevant studies. Eligible studies had to be identifiable through database searching, published and accessible. This systematic review was conducted according to PRISMA guidelines. The search period was from 2012 to 14 September 2022. RESULTS: A pool of 120 studies was identified, out of which 11 met the selection criteria and were included. Overall, the studies confirm a relationship between emotional instability and borderline personality disorder. CONCLUSIONS: The evidences retrieved seem to point out the role of the emotional impairment not only in worsening of the disorder, but could also be one of the risk factors for its onset.

Suicide and COVID-19: a rapid scoping review.

There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies' methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.

Violence in severe mental disorders: the association with age at onset and gender.

AIM: The aim of this study is to investigate the relation between perpetration and victimization of violence with gender and age at onset of mental disorders in patients with severe mental disorders. METHODS: 216 patients were recruited and evaluated with the Italian version of the Karolinska Interpersonal Violence Scale. RESULTS: We found higher levels of victimization of violence in women than men and more violence in patients with lower age at onset. DISCUSSION: Gender and age at onset impact on violence in the adult life in a sample of patients with severe mental disorders. CONCLUSIONS: Our findings confirmed the need of an early diagnosis and gender-tailored management of interpersonal violence.

Psychometric and factorial validity of the International Adjustment Disorder Questionnaire (IADQ) in an Italian sample: A validation and prevalence estimate study.

INTRODUCTION: Adjustment disorder (AjD) is a is a maladaptive emotional or behavioural reaction to a stressful event or change in a person's life. Compared to other previously validated tools, the International Adjustment Disorder Questionnaire (IADQ) stands out as one of the most reliable and handy one for AjD. Since no homologous instrument exists now, in this study, we aimed to validate an Italian version of the IADQ. METHODS: Twenty-one thousand two hundred and six subjects (80.4% females) during the initial stages of the SARS-CoV-2 pandemic were recruited. We conducted a confirmatory factor analysis (CFA), testing two latent models, a monofactorial and a bifactorial one. Concurrent validity by correlating the total and the two factors' scores with measures of depression, anxiety and post-traumatic stress was then estimated. We finally estimated the rates of AjD among the population, and a binary logistic regression was conducted to analyse the predictors of such disorder. RESULTS: CFA showed a bifactorial validity, with both excellent incremental and comparative fit indices. The IADQ scores correlated strongly with symptoms of depression, anxiety and stress. In the Italian sample, the prevalence of probable AjD was 8.23%. Female gender, being engaged, widowed and having COVID-19-related stressors resulted as significant independent risk factors for AjD. CONCLUSIONS: IADQ is an easy-to-use, brief and psychometrically sound self-report measure for AjD. Thus, it may be considered a reliable tool for both research and clinical settings. To the best of our knowledge, our study reported for the first time the prevalence of AjD during COVID-19 pandemic.

The therapeutic alliance in cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis.

Background: The therapeutic alliance has been recognized as one of the most researched key elements of treatment across different therapeutic approaches and diagnostic domains. Despite its importance, our current understanding of its clinical relevance in patients with obsessive-compulsive disorder (OCD) is still debated. This study aimed to examine empirical evidence on the effect of alliance on treatment outcomes in Cognitive Behavioral Therapy (CBT) in patients with OCD in a systematic review and meta-analysis. Methods: Original peer-reviewed articles until March 2022 were included if they were (1) written in English; (2) included a clinical group with a current primary OCD diagnosis; (3) involved individual CBT; (4) used a validated therapeutic alliance scale that was related to the outcome measurement; (5) reported an effect size. Results: Thirteen studies were included, six of which contained sufficient statistical information to be included in the meta-analysis. A total of 897 patients took part in all reviewed studies. We found a modest effect of alliance on post-treatment outcome [Tau 2 = -0.1562 (C.I. 95%: -0.2542 to -0.0582)]. Discussion: The results show the existence of considerable variability and methodological inconsistencies across studies. We discuss the role of methodological factors that could account for this divergence, the research limitations, and the implications for current research. Systematic review registration: [https://osf.io/dxez5/?view_only=bc2deaa7f0794c8dbef440255b2d4b3b].

Obsessive-compulsive symptoms among the general population during the first COVID-19 epidemic wave in Italy.

This study investigated obsessive-compulsive symptoms (OCS) in the Italian general population during the initial stage of the pandemic and the impact of COVID-19 related potential risk factors. A web-based survey was spread throughout the internet between March 27th and April 9th, 2020. Twenty thousand two hundred forty-one individuals completed the questionnaire, 80.6% women. The Dimensional Obsessive-Compulsive Scale (DOCS) was included to assess the severity of the obsessive-compulsive symptom domains. Further, selected outcomes were depression, anxiety, insomnia, perceived stress, and COVID-19 related stressful life events. A panel of logistic or linear regression analyses was conducted to explore the impact of COVID-19 related risk factors, socio-demographic variables, and mental health outcomes on OCS. A total of 7879 subjects (38,9%) reported clinically relevant OCS. Specifically, more than half of the sample (52%) reported clinically relevant symptoms in the Contamination domain, 32.5% in the Responsibility domain, 29.9% in the Unacceptable thoughts domain, and 28.6 in the Symmetry/Ordering domain. Being a woman was associated with OCS, except for Symmetry/Ordering symptoms. A lower education level and younger age were associated with OCS. Moreover, depression, anxiety, perceived stress symptoms, insomnia, and different COVID-19 related stressful events were associated with OCS. We found high rates of OCS, particularly in the contamination domain, in the Italian general population exposed to the first COVID-19 epidemic wave and COVID-19 related risk factors. These findings suggest the need to investigate further the trajectories of OCS in the general population along with the long-term socio-economic impact of the pandemic.

The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster.

The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.

Can Stimulus Valence Modulate Task-Switching Ability? A Pilot Study on Primary School Children.

Executive functions and emotional processes follow a time-dependent development that reflects the brain's anatomo-functional maturation. Though the assessment of these cognitive functions is largely examined, in children the role of emotions in the mental set-shifting is still rarely investigated. The aim of this study was to assess how attention shifting can be modulated by the valence of emotional stimuli. To this end, sixty-two primary school children were tested with a new emotional task-switching paradigm obtained by manipulating the emotional valence and physical features of the stimulus pool. Thus, two tasks were alternatively presented: the Valence task and the Color task. Based on executive performance results, we found a lengthening of response times and a lower accuracy in the emotionally connoted task (Valence task), compared to the neutral task (Color task). The data demonstrate that the processing of emotional stimuli modulates the task-switching performance during development. These findings could help in the implementation of teaching strategies that can promote the development of executive functions and, therefore, functionally improve the overall academic performance of children. Finally, a better understanding of the developmental trajectories of executive functions can help neuropsychologists both in the early diagnosis and treatment of potential executive alterations.

Personality disorders (PD) and interpersonal violence (IV) during COVID-19 pandemic: a systematic review.

Not only did the ongoing CoronaVIrus Disease-19 (COVID-19) pandemic cause a massive number of casualties, but also there is growing concern that the burden of its psychological aftermaths will only show up years down the road. This systematic review summarises the existing literature reporting the impact of COVID-19 on personality disorders (PDs)-related violence. MEDLINE and APA PsycINFO were independently searched for relevant studies by two authors. Eligible studies had to be identifiable through database searching, published and fully accessible. This systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. An initial pool of 241 studies were found, out of which 69 met the selection criteria and were, therefore, included. The majority reported a worse Mental Health Outcome (MHO) during the pandemic as related to dysfunctional personality and positive personality traits predicting a better outcome. Furthermore, increased levels of interpersonal violence (IV) and self-directed violence were reported. Further research should be conducted on the reciprocal interaction of PDs and IV during the time of pandemic. Nevertheless, the dramatic impact of restrictive measures on PDs has still to be appropriately addressed.

Validation of a brief version of the Resilience Scale for Adults on an Italian non-clinical sample.

AIM: The Resilience Scale for Adults (RSA) is a self-administered 7-point Likert scale of 33 items, structured in 6 factors measuring personal and interpersonal resources. We aimed to develop and validate a brief form of the RSA, in order to produce a short, fast and handy tool for assessing resilience. MATERIALS AND METHODS: A non-clinical sample of 500 university students was recruited using a research website. Reduction of the RSA-33 was performed using an item response theory (IRT) analysis by means of a Graded Response Model (GRM) protocol on the 6 RSA factors separately. After the IRT reduction process, a Pearson's correlation matrix of the original RSA-33 and the reduced version was estimated. Finally, a CFA was estimated to assess factorial validity. The estimation of item discrimination from the GRM ranged from 0.69 and 5.94 and allowed to retain 11 items. RESULTS: For both the original RSA-33 and the brief RSA-11, the strongest correlations were between Family Cohesion and Social Resources factors. CFA was estimated to assess factorial validity in a simplified model with two latent first-order factors, i.e., Personal and Contextual resources. CONCLUSIONS: The availability of short and psychometrically robust measures is needed to improve evaluation and monitoring in mental health programs. For this reason, we provided a brief and effective tool to assess resilience resources in both research and clinical settings.

Mental Health Outcomes Among Italian Health Care Workers During the COVID-19 Pandemic.

Importance: Health care workers (HCWs) exposed to COVID-19 have high rates of mental health issues. However, longitudinal data on the evolution of mental health outcomes in HCWs are lacking. Objective: To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic. Design, Setting, and Participants: This longitudinal cohort study collected data from March 1 to April 30, 2020 (T1) and from April 1 to May 31, 2021 (T2), from 2856 Italian HCWs aged 18 years or older who responded to an online questionnaire. Participants were also recruited via snowballing, a technique in which someone who receives the invitation to participate forwards it to his or her contacts. Exposures: Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19. Main Outcomes and Measures: Outcomes are depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms (PTSSs). Four different trajectories are described for each condition: resilient, remittent, incident, and persistent. Results: Of the 2856 HCWs, 997 (34.9%) responded to the follow-up assessment (mean [SD] age, 42.92 [10.66] years; 816 [82.0%] female). Depression symptoms (b = -2.88; 95% CI, -4.05 to -1.71), anxiety symptoms (b = -2.01; 95% CI, -3.13 to -0.88), and PTSSs (b = -0.77; 95% CI, -1.13 to -0.42) decreased over time; insomnia symptoms increased (b = 3.05; 95% CI, 1.63-4.47). Serving as a frontline HCW at T1 was associated with decreased symptoms of depression (b = -1.04; 95% CI, -2.01 to -0.07), and hospitalization for COVID-19 was associated with increased depression symptoms (b = 5.96; 95% CI, 2.01-9.91); younger age (b = -0.36; 95% CI, -0.70 to -0.03) and serving as a frontline HCW at T1 (b = -1.04; 95% CI, -1.98 to -0.11) were associated with decreased anxiety symptoms. Male sex was associated with increase in insomnia symptoms (b = 1.46; 95% CI, 0.39-2.53). Serving as a frontline HCW at T1 (b = -0.42; 95% CI, -0.71 to -0.13) and being a physician (b = -0.52; 95% CI, -0.81 to -0.24) were associated with a decrease in PTSSs, whereas younger age (b = 0.35; 95% CI, 0.09-0.61) and male sex (b = 0.12; 95% CI, 0.01-0.22) were associated with an increase in PTSSs. Depression trajectories were 629 resilient (65.5%), 181 remittent (18.8%), 58 incident (6.0%), and 92 persistent (9.6%). Anxiety trajectories were 701 resilient (73.3%), 149 remittent (15.6%), 45 incident (4.7%), and 61 persistent (6.4%). Insomnia trajectories were 858 resilient (88.9%), 77 remittent (8.0%), 20 incident (2.1%), and 10 persistent (1.0%). The PTSS trajectories were 363 resilient (38.5%), 267 remittent (28.3%), 86 incident (9.1%), and 226 persistent (24.0%). Conclusions and Relevance: In this cohort study, relative to the beginning of the COVID-19 pandemic, mental health among HCWs has improved. Factors associated with change in mental health outcomes could help in the design of prevention strategies for HCWs.

Stressful Life Events and Resilience During the COVID-19 Lockdown Measures in Italy: Association With Mental Health Outcomes and Age.

Background: The COVID-19 pandemic, due to its disproportionated higher morbidity and mortality rates in the older age, has been considered to be a "geropandemic." Several studies, however, have found that older age is associated with lower psychological distress in relation to the COVID-19 outbreak and related lockdown measures. Aim: To explore the role of Resilience as a mediator between stressful COVID-19 related life events and depressive and, anxiety symptoms and perceived stress, and to ascertain the role of age as a moderator of the mediator's effect. Methods: An on-line survey was spread through social networks during the first lockdown in Italy. Depressive and anxiety symptoms and perceived stress were measured using the Italian version of the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) and the Perceived Stress Scale (PSS). Resilience was measured using the Italian version of the Resilience Scale for Adults (RSA). Stressful COVID-19 related life events were explored using a checklist of events derived from the International Adjustment Disorder Questionnaire (IADQ). After a preliminary panel of linear regressions, mediation was tested using Structural Equation Modeling and inspecting the bootstrapped indirect effects. Afterwards, age was introduced as a mediator of the indirect effect in a moderated mediation analysis. Results: Twenty one thousand three hundred and thirty four subjects completed the questionnaire, 17,178 (80.52%) were female, 748 (3.5%) were >60 years old. In the whole sample, the presence of any stressful event was associated with depressive and anxiety symptoms and perceived stress. Resilience mediated the effects of stressful COVID-19-related events on depressive and anxiety symptoms and perceived stress. The moderated mediation analysis revealed that age moderated the mediation effect of Resilience between the presence of a stressful event and the selected outcomes. Conclusion: Taken together, our results show that age moderates the mediating effect of Resilience in the relationship between COVID-19-related stressful events and depressive and anxiety symptoms and perceived stress. Older adults' Resilience was less influenced by stressful events, and this could be one of the reasons accounting for the better mental health outcomes observed in the older age.

Childhood family stress and adult resilience in a sample of depressed patients.

BACKGROUND: The aim of this study is to explore the effect of childhood family stress on depression, personal, and social resilience in depressed patients. METHODS: We assessed childhood family stress (RFQ), depression (BSI, depression subscale), and resilience (RSA) in 152 depressed patients, 70 males, and 82 females. We calculated the 33rd and 66th percentiles of RFQ scores to divide the sample among Low, Medium, and High RFQ subgroups. A one-way ANOVA has been carried out to explore the differences between the variables in the subgroups. Finally, two regression analyses with depression, as the dependent variable, and resilience, divided for stress-sensitive and no stress-sensitive factors as independent variables, have been implemented. RESULTS: The one-way ANOVA showed that the Low subgroup had a positive profile, the Medium had an intermediate profile, while the High had a negative one for depression, personal (structured style and social competence), and interpersonal (social resources) resilience. The other factors (perception of self, planned future, and family cohesion) did not show differences in the subgroups, suggesting they are no stress sensitive. Regression analysis showed that no stress-sensitive factors have a constant and significant predictive value for depression in all subgroups; while, stress-sensitive ones showed a growing predictive value for depression from Low to Medium, but not in High, suggesting a ceiling effect. LIMITATIONS: The use of self-report measures, the cross-sectional nature of the study, and the lack of a non-clinical and/or outpatient samples. CONCLUSIONS: This study provides a contribution to the understanding of the effect of childhood family stress on adult resilience and depression.

Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak.

Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrument designed to assess a broad range of trauma-related symptoms with no available validation in the Italian population. Aims: This study aimed to examine the factor structure of the Italian version of the GPS in a general population sample exposed to the COVID-19 pandemic and to evaluate trauma-related symptoms in the context of COVID-19 related risk factors associated with lockdown measures. Methods: We conducted a cross-sectional web-based observational study as part of a long-term monitoring programme of mental health outcomes in the general population. Eighteen thousand one hundred forty-seven participants completed a self-report online questionnaire to collect key demographic data and evaluate trauma-related symptoms using the GPS, PHQ-9, GAD-7, ISI, and PSS. Validation analyses included both exploratory and confirmatory factor analysis and correlation analyses. The relation with putative COVID-19 related risk factors was explored by multivariate regression analysis. Results: Exploratory factor analyses supported a two-factor model. Confirmatory factor analysis showed that the best fitting model was a three-factor solution, with core Post-traumatic Stress Symptoms (PTSS) (re-experiencing, avoidance, hyperarousal), Negative Affect (symptoms of depressed mood, anxiety, irritability), and Dissociative symptoms. GPS Risk factors and specific COVID-19 related stressful events were associated with GPS total and the three factor scores. Conclusions: Our data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic. The GPS symptoms clustered best in three factors: Negative Affect symptoms, Core PTSS, and Dissociative symptoms. In particular, high rates of core PTSS and negative affect symptoms were associated with the COVID-19 pandemic in Italy and should be routinely assessed in clinical practice.

Antecedentes: Evidencias recientes revelaron resultados adversos para la salud mental asociados con la pandemia de COVID-19, incluyendo síntomas relacionados con el trauma. El Mapeo Global de Psicotrauma (GPS, en sus siglas en inglés) es un breve instrumento diseñado para evaluar una amplia gama de síntomas relacionados con el trauma, sin validación disponible en la población italiana.Objetivos: El objetivo de este estudio fue examinar la estructura de factores de la versión italiana del GPS en una muestra de la población general expuesta a la pandemia de COVID-19 y evaluar los síntomas relacionados con el trauma en el contexto de los factores de riesgo relacionados con COVID-19 asociados con las medidas de confinamiento.Métodos: Realizamos un estudio observacional transversal basado en la web como parte de un programa de vigilancia a largo plazo de los resultados de salud mental en la población general. Dieciocho mil ciento cuarenta y siete participantes completaron un cuestionario en línea de autorreporte para recopilar datos demográficos claves y evaluar los síntomas relacionados con el trauma utilizando el GPS, PHQ-9, GAD-7, ISI y PSS. Los análisis de validación incluyeron análisis factoriales y de correlación tanto exploratorios como confirmatorios. La relación con los posibles factores de riesgo relacionados con COVID-19 se exploró mediante un análisis de regresión multivariante.Resultados: Los análisis factoriales exploratorios apoyaron un modelo de dos factores. El análisis factorial confirmatorio mostró que el modelo que mejor se ajustaba era una solución de tres factores, con los principales síntomas de estrés postraumático (PTSS, en sus siglas en inglés) (reexperimentación, evitación, hiperactivación), el efecto negativo (síntomas de depresión, ansiedad, irritabilidad) y los síntomas disociativos. Los factores de riesgo del GPS y los eventos estresantes específicos relacionados con COVID-19 se asociaron con el total del GPS y las tres puntuaciones de los factores.Conclusiones: Nuestros datos sugieren que una amplia gama de síntomas de espectro traumático fueron reportados por una gran muestra italiana durante la pandemia de COVID-19. Los síntomas del GPS se agruparon mejor en tres factores: Síntomas de Afecto Negativo, PTSS Central y Síntomas Disociativos. En particular, las altas tasas de PTSS central y los síntomas de afecto negativo se asociaron con la pandemia de COVID-19 en Italia y deben ser evaluados rutinariamente en la práctica clínica.