A Systematic Review on Metabolomics Analysis in Hearing Impairment: Is It a Possible Tool in Understanding Auditory Pathologies?

With more than 466 million people affected, hearing loss represents the most common sensory pathology worldwide. Despite its widespread occurrence, much remains to be explored, particularly concerning the intricate pathogenic mechanisms underlying its diverse phenotypes. In this context, metabolomics emerges as a promising approach. Indeed, lying downstream from molecular biology's central dogma, the metabolome reflects both genetic traits and environmental influences. Furthermore, its dynamic nature facilitates well-defined changes during disease states, making metabolomic analysis a unique lens into the mechanisms underpinning various hearing impairment forms. Hence, these investigations may pave the way for improved diagnostic strategies, personalized interventions and targeted treatments, ultimately enhancing the clinical management of affected individuals. In this comprehensive review, we discuss findings from 20 original articles, including human and animal studies. Existing literature highlights specific metabolic changes associated with hearing loss and ototoxicity of certain compounds. Nevertheless, numerous critical issues have emerged from the study of the current state of the art, with the lack of standardization of methods, significant heterogeneity in the studies and often small sample sizes being the main limiting factors for the reliability of these findings. Therefore, these results should serve as a stepping stone for future research aimed at addressing the aforementioned challenges.

Duration of Untreated Illness in Patients with Obsessive-Compulsive Disorder and Its Impact on Long-Term Outcome: A Systematic Review.

Background: Duration of untreated illness (DUI)-defined as the time period between the onset of a mental disorder and its first adequate treatment-should influence patients' long-term prognosis and outcome. In patients with obsessive-compulsive disorder (OCD), DUI lasts on average from 87.5 up to 94.5 months, being significantly longer compared with data available from patients affected by other severe mental disorders, such as schizophrenia and bipolar disorder. We carried out a systematic review in order to assess the impact of DUI on long-term outcomes in OCD patients. Methods: A systemic review has been implemented, searching from inception to April 2023; only papers written in English were included. Results: Seventy-one articles were initially identified; only eight papers were included in the review. The DUI ranged from 7.0 ± 8.5 to 20.9 ± 11.2 years. Patients reporting a longer DUI have a poor long-term outcome in terms of lower level of treatment response and greater symptom severity. Conclusions: The present review confirms that longer DUI has a negative impact on the long-term outcome of patients with OCD. It should be useful to promote the dissemination of early interventions with a specific focus on OCD symptoms.

The Role of BDNF as a Biomarker in Cognitive and Sensory Neurodegeneration.

Brain-derived neurotrophic factor (BDNF) has a crucial function in the central nervous system and in sensory structures including olfactory and auditory systems. Many studies have highlighted the protective effects of BDNF in the brain, showing how it can promote neuronal growth and survival and modulate synaptic plasticity. On the other hand, conflicting data about BDNF expression and functions in the cochlear and in olfactory structures have been reported. Several clinical and experimental research studies showed alterations in BDNF levels in neurodegenerative diseases affecting the central and peripheral nervous system, suggesting that BDNF can be a promising biomarker in most neurodegenerative conditions, including Alzheimer's disease, shearing loss, or olfactory impairment. Here, we summarize current research concerning BDNF functions in brain and in sensory domains (olfaction and hearing), focusing on the effects of the BDNF/TrkB signalling pathway activation in both physiological and pathological conditions. Finally, we review significant studies highlighting the possibility to target BDNF as a biomarker in early diagnosis of sensory and cognitive neurodegeneration, opening new opportunities to develop effective therapeutic strategies aimed to counteract neurodegeneration.

Vascular Factors in Patients with Midlife Sensorineural Hearing Loss and the Progression to Mild Cognitive Impairment.

Background and Objectives: Midlife hearing loss (HL) has been considered as a major modifiable risk factor for a later-life progression to dementia. Our aim was to detect a link between precocious sensorineural hearing loss (SNHL) and mild cognitive impairment (MCI) and their association to putative risk factors for a common pathology. Materials and methods: In this study, a retrospective case-control study was carried out. A total of 112 patients were enrolled as following: 81 patients with bilateral SNHL and 31 subjects with normal hearing, whose ages ranged from 50 to 65 years. Both groups performed pure tone audiometry, a tinnitus handicap inventory (THI), Mini-Mental State examination (MMSE), and the Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Results: The mean age was 58 ± 5.2 in SNHL patients and 53.2 ± 4.8 in the control group. The mean pure tone average in the SNHL group was 40.2 ± 18.7 dB HL on the right side and 41.2 ± 17.2 dB HL on the left side, while in the control group it was 12.5 ± 2.8 dB HL on right side and 12.4 ± 3.1 dB HL on left side. About 64% of patients with SNHL exhibited comorbidities, and the most common condition was hypertension. Altered MoCA test scores were significantly related to the pure tone averages in patients with SNHL compared to the control group (p = 0.0004), while the differences in the HADS-A and HADS-D were not significant. Furthermore, a significant correlation was observed in SNHL patients between an altered MoCA test and hypercholesterolemia (p = 0.043). Conclusions: Hearing impairment and screening tests to detect MCI should be considered in the midlife in order to carry out strategies to prevent the progression to dementia. Hypertension and hypercholesterolemia are two risk factors in the development of endothelial dysfunction, oxidative stress, and vascular inflammation, and may represent the common pathology linking the inner ear and brain damage.

Parenting Stress in Mothers of Children with Permanent Hearing Impairment.

Permanent childhood hearing impairment (PCHI) represents the most frequent sensory pathology at birth. PCHI has a relevant psychological impact on the life of both the affected children and their families. Thus, the aim of this work is to explore the degree of parental distress felt by mothers of a deaf or hard-of-hearing child, to determine if this stress is associated with variables related to the children's health (e.g., the severity of hearing loss, presence of other conditions, difficulty with treatment options, difficulty with rehabilitation) or family characteristics such as socio-economic and educational status. The study used the Parenting Stress Index-Short Form (PSI-SF) questionnaire administered to mothers. The results were analyzed in relation to variables such as parents' education level, number of children, severity of hearing loss, presence of other chronic conditions, presence of cognitive delay, familiarity with hearing loss, time of diagnosis, use of prosthetics, and start in a rehabilitation program. The data indicate a correlation between maternal stress levels and low-educational levels, as well as the presence of congenital infections and cognitive delay. These results highlight the need for a comprehensive physical and psychological approach for hearing-impaired children, as stress factors can affect the adherence to effective rehabilitation.

Physical comorbidities in patients with severe mental disorders: a brief narrative review on current challenges and practical implications for professionals.

A paradox of the modern world is represented by the increasing rate of comorbidities, although the life expectancy is increasing worldwide, the number of disease-free years is not improving consequently. Physical comorbidities are often overlooked in people with severe mental disorders, although this problem needs to be adequately managed since it is associated with a worse quality of life and a poorer personal and social functioning. In this paper, we aim to: 1) carry out a narrative review of the recent literature in order to provide an update on the prevalence and incidence of the most frequent comorbid physical disorders in people with severe mental disorders; 2) highlight the most important difficulties in managing comorbidities in people with severe mental disorders in ordinary clinical care; 3) discuss possible solutions to overcome those difficulties, particularly through the role of education and scientific associations.

The Psychiatric Consequences of Long-COVID: A Scoping Review.

The COVID-19 pandemic has represented a new form of traumatic event, affecting the general population worldwide and causing severe disruption of daily routine. A new urgent concern is related to the burden associated with COVID-19 symptoms that persist beyond the onset of infection, the so-called long-COVID syndrome. The present paper aims to: (1) describe the most frequent psychiatric symptoms reported by patients affected by long-COVID syndrome; (2) evaluate methodological discrepancies among the available studies; (3) inform clinicians and policy-makers on the possible strategies to be promoted in order to manage the psychiatric consequences of long-COVID syndrome. Twenty-one papers have been included in the present review, mostly with a cross-sectional or cohort design. Significant heterogeneity of long-COVID syndrome definitions was found. The presence of psychiatric symptoms was evaluated with very different assessment tools. The most common psychiatric symptoms of the long-COVID syndrome included fatigue, cognitive disturbances/impairment, depression, and anxiety symptoms. The rate of fatigue varied from 93.2-82.3% to 11.5%, cognitive impairment/cognitive dysfunction from 61.4% to 23.5% and depressive-anxiety symptoms from 23.5%to 9.5%.

Use of social network as a coping strategy for depression among young people during the COVID-19 lockdown: findings from the COMET collaborative study.

BACKGROUND: Use of social media (SM) has exponentially grown particularly among youths in the past two years, due to COVID-19-related changing lifestyles. Based on the Italian COvid Mental hEalth Trial (COMET), we investigated the association between SM use and depressive symptoms among Italian young adults (aged 18-24). METHODS: The COMET is a nationwide multi-center cross-sectional study that investigated socio-demographic data, social networking addiction (BSNAS), depression, anxiety, and stress (DASS-21), as well as impulsiveness (BIS-15) and aggressiveness (AQ) in a large sample of youngsters, in order to assess the association between BSNAS and DASS-21 indices. Mediation analyses were performed to evaluate the role of impulsiveness and aggressive personality traits in the association between SM use (SMU) and depression. RESULTS: 75.8% of the sample (n = 491) had a problematic SMU. SMU was reduced by high AQ and high DASS-21 scores (F = 42.338, p < 0.001, R2 = 0.207). Mediation analyses showed that SMU negatively predicted depressive symptomatology with the interaction mediated by AQ total (ß = - 0.1075), physical (ß = - 0.207) and anger (ß = - 0.0582), BIS-15 total (ß = - 0.0272) and attentional (ß = - 0.0302). High depressive levels were predicted by high AQ scores, low SMU levels, low verbal and physical AQ, and low attentional BIS-15 (F = 30.322, p < 0.001, R2 = 0.273). Depressive symptomatology negatively predicted SMU with their interaction mediated by AQ total (ß = - 0.1640), verbal (ß = 0.0436) and anger (ß = - 0.0807), BIS-15 total (ß = - 0.0448) and attentional (ß = - 0.0409). CONCLUSIONS: SMU during the early phases of the COVID-19 pandemic could have a beneficial role in buffering negative consequences linked to social isolation due to quarantine measures, despite this association being mediated by specific personality traits.

The Absence of Permanent Sensorineural Hearing Loss in a Cohort of Children with SARS-CoV-2 Infection and the Importance of Performing the Audiological "Work-Up".

BACKGROUND: Currently, the novel coronavirus (SARS-CoV-2) causes an acute respiratory illness named COVID-19 and is a controversial risk factor for hearing loss (HL). Herein, we aim to describe the associated symptoms and to evaluate hearing function in the COVID-19 pediatric population. METHODS: A retrospective cross-sectional observational study was carried out on 37 children who contracted COVID-19 infection with no previous audio-vestibular disorders. Clinical data on the infections were collected, and an audiological assessment of all affected children was performed by using different diagnostic protocols according to their age. RESULTS: Fever, upper respiratory and gastrointestinal manifestations were common presentations of infection. Audiological function was normal in 30 (81.08%) children, while 7 children showed an increased hearing threshold: 6 (16.21%) had transient conductive hearing loss (CHL) due to middle ear effusion and normalized at the follow-up and 1 had sensorineural hearing loss (SNHL). A single child was affected by bilateral SNHL (2.7%); however, he underwent a complete audiological work-up leading to a diagnosis of genetic HL due to a MYO6 gene mutation which is causative of progressive or late onset SNHL. CONCLUSIONS: HL needs to be considered among the manifestations of COVID-19 in children, nevertheless, we found cases of transient CHL. The onset of HL during or following COVID-19 infection does not eliminate the indication for maintaining audiological surveillance and audiological work-ups, including genetic diagnosis, to avoid the risk of mistaking other causes of HL.

Mental health and well-being of LGBTQ+ people during the COVID-19 pandemic.

The COVID-19 pandemic has had a profound negative impact on the mental health of the general population. The COVID-19 pandemic and its related containment measures have increased structural disadvantages faced by marginalized communities, such as LGBTQ+ people. LGBTQ+ is an acronym used to identify lesbian, gay, bisexual, transgender and queer people plus all community members using different terms to describe their sexual orientation or gender identity. It is likely that the COVID-19 pandemic has exposed them to increased minority stress, which can also affect their physical health. Since the beginning of the pandemic, the few available studies on the mental health of LGBTQ+ have reported frequent worries about the future, negative emotions, and feelings of uncertainty. Moreover, they have faced further difficulties such as undertaking hormone therapy, accessing to health facilities or living with family members not accepting their condition. The COVID-19 pandemic has added a significant burden to the well-being of LGBTQ+ people, and therefore there is the need to provide them with dedicated supportive interventions in order to promote the early detection of mental health problems or of full-blown mental disorders.

Protocol and programme factors associated with referral and loss to follow-up from newborn hearing screening: a systematic review.

BACKGROUND: An effective newborn hearing screening programme has low referral rate and low loss to follow-up (LTFU) rate after referral from initial screening. This systematic review identified studies evaluating the effect of protocol and programme factors on these two outcomes, including the screening method used and the infant group. METHODS: Five databases were searched (latest: April 2021). Included studies reported original data from newborn hearing screening and described the target outcomes against a protocol or programme level factor. Studies were excluded if results were only available for one risk condition, for each ear, or for < 100 infants, or if methodological bias was observed. Included studies were evaluated for quality across three domains: sample, screening and outcome, using modified criteria from the Ottawa-Newcastle and QUADAS-2 scales. Findings from the included studies were synthesised in tables, figures and text. RESULTS: Fifty-eight studies reported on referral rate, 8 on LTFU rate, and 35 on both. Only 15 studies defined LTFU. Substantial diversity in referral and LTFU rate was observed across studies. Twelve of fourteen studies that evaluated screening method showed lower referral rates with aABR compared to TEOAE for well babies (WB). Rescreening before hospital discharge and screening after 3 days of age reduced referral rates. Studies investigating LTFU reported lower rates for programmes that had audiologist involvement, did not require fees for step 2, were embedded in a larger regional or national programme, and scheduled follow-up in a location accessible to the families. In programmes with low overall LTFU, higher LTFU was observed for infants from the NICU compared to WB. CONCLUSION: Although poor reporting and exclusion of non-English articles may limit the generalisability from this review, key influential factors for referral and LTFU rates were identified. Including aABR in WB screening can effectively reduce referral rates, but it is not the only solution. The reported referral and LTFU rates vary largely across studies, implying the contribution of several parameters identified in this review and the context in which the programme is performed. Extra attention should be paid to infants with higher risk for hearing impairment to ensure their return to follow-up.

NeonaTal Assisted TelerehAbilitation (T.A.T.A. Web App) for Hearing-Impaired Children: A Family-Centered Care Model for Early Intervention in Congenital Hearing Loss.

BACKGROUND: An early hearing detection and intervention program (EHDI) is the first step for the habilitation of children with permanent hearing impairment (PHI). Actually, early intervention programs have increasingly shifted toward family involvement, emphasizing that the child's family should take an active role in the habilitation process. Therefore, familiar empowerment is the best way to improve a child's emerging abilities. The aim of this study was to investigate parental self-efficacy beliefs and involvement as well as the language skills of deaf or hard of hearing DHH children who were habilitated with hearing aids and followed using the T.A.T.A web app (NeonaTal Assisted TelerehAbilitation), an example of asynchronous telepractice. METHODS: The study describes the early stages of the habilitation program of 15 PHI children followed through the T.A.T.A. web app, which empowers families through a weekly questionnaire submitted during the first 270 to 360 days of their child's life, for 14 weeks. The family involvement rate scale (FIRS) was used to evaluate parental compliance, and all children received in-person visits at the beginning and at the end of the training period. RESULTS: The children showed greater auditory perceptual skills at the end of the training period on the basis of both the Infant Listening Progress Profile (ILiP) score and the Categories of Auditory Performance (CAP) and FIRS scales. In other words, the auditory skills improved with age as well as with parental participation. CONCLUSIONS: The T.A.T.A. web app promotes a proactive management and a tailored habilitation through an active familiar involvement, easily achieved in clinical routine and in emergency settings without additional costs.

Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study.

OBJECTIVES: This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: (1) patients' symptoms and global functioning and (2) relatives' objective and subjective burden and coping strategies. METHODS: This is a multicentre, real-world, controlled, outpatient trial. Recruited patients and key-relatives were consecutively allocated to the experimental intervention or treatment as usual. Patients were assessed at baseline, and after one and five years. RESULTS: One hundred and thirty-seventh number families have been recruited; 70 have been allocated to the experimental intervention, and 67 have been allocated to the control group. We observed an increasing positive effect of the PFI on patients' clinical status, global functioning and objective and subjective burden after one year. We also found a reduction in the levels of relatives' objective and subjective burden and a significant improvement in the levels of perceived professional support and of coping strategies. The efficacy of PFI on patients' clinical status was maintained at five years from the end of the intervention, in terms of relapses, hospitalizations and suicide attempts. CONCLUSIONS: The study showed that the provision of PFI in real-world settings is associated with a significant improvement of patients' and relatives' mental health and psychosocial functioning in the long term. We found that the clinical efficacy of the intervention, in terms of reduction of patients' relapses, hospitalization and suicide attempts, persists after 5 years. It is advisable that PFI is provided to patients with BD I in routine practice.

Performance and characteristics of the Newborn Hearing Screening Program in Campania region (Italy) between 2013 and 2019.

PURPOSE: Universal newborn hearing screening (UNHS) in the first month of life is crucial for facilitating both early hearing detection and intervention (EHDI) of significant permanent hearing impairment (PHI). In Campania region, UNHS has been introduced in 2003 by the Regional Council Resolution and started on January 2007. The aim of this paper is to update a previous article describing the performance of the program since its implementation in the period between 2013 and 2019. METHODS: A longitudinal retrospective study was carried at the Regional Reference Center III on 350,178 babies born in the analysis period. The paper reports the main results of overall coverage, referral rate, lost-to-follow-up rate,yield for PHI and shall determine various risk factor associations with hearing impairment RESULTS: In Campania region, 318,878 newborns were enrolled at I level, with a coverage rate of 91.06%, 301,818 (86.18%) Well Infant Nurseries (WIN) and 17,060 (5.35%) Neonatal Intensive Care Unit (NICU) babies. PHI was identified in 413 children, 288 (69.73%) bilaterally and 125 (30.26%) unilaterally. The overall cumulative incidence rate of PHI was 1.29 per 1000 live-born infants (95% CI 1.17-1.42) with a quite steady tendency during the whole study period. CONCLUSIONS: This study confirms the feasibility and effectiveness of UNHS in Campania region also in a setting with major socioeconomic and health organization restrictions.The program meets quality benchmarks to evaluate the progress of UNHS. Nowadays, it is possible to achieve an early diagnosis of all types of HL avoiding the consequences of hearing deprivation.

Loneliness in Young Adults During the First Wave of COVID-19 Lockdown: Results From the Multicentric COMET Study.

The COVID-19 pandemic has affected the mental and physical health of the general population at any age, but it is expected to have a protracted and severe consequences for younger populations. The pandemic has had several consequences on mental health including anger and irritability, depressive symptoms and somatic complaints, insomnia, lack of motivation, and loneliness. In particular, loneliness and its related negative feelings are thought to be particularly pronounced during young adulthood because of the many social changes that young people deal with during this period of life. Therefore, it is essential to evaluate the type of impact of the pandemic on the mental health of young people and their levels of loneliness experienced during the first phase of the lockdown. Based on the largest Italian study on the effects of the COVID-19 pandemic on the mental health of general population, in this paper we aim to: (1) describe the levels of loneliness in a national sample of Italian young adults aged 18-34 years, during the first wave of lockdown in 2020; (2) evaluate the clinical and socio-demographic differences in young adults reporting low vs. high levels of loneliness; (3) assess the role of clinical symptomatology, coping strategies, levels of resilience, and duration of lockdown as possible predictors of loneliness. The final sample consists of 8,584 people, mainly female (72.6%), single, with a mean age of 26.4 (±4.4) years. The mean score at the UCLA was 47.5 (±13.6), with 27% (N = 2,311) of respondents exceeding the cut-off for high levels of loneliness. High levels of loneliness were predicted by the presence of avoidant coping strategies, such as self-distraction (Beta coefficient, B = 0.369, 95% Confidence Interval, CI = 0.328-0.411), venting (B = 0.245, 95% CI = 0.197-0.293), denial (B = 0.110, 95% CI = 0.061-0.159), and emotional disengagement (B = 0.133, 95% CI = 0.080-0.185). Weeks of exposure to the pandemic were significantly associated with worsening of loneliness (p < 0.000). There is currently considerable interest in trying to reduce loneliness, both within the context of COVID-19 and more generally. Our results highlight that young people are at a higher risk of developing loneliness and suggest that more interventions and practical guidelines are needed.

The Transition From Maternity Blues to Full-Blown Perinatal Depression: Results From a Longitudinal Study.

Background: The aims of the present study are to: (1) assess the frequency of maternity blues (MB); (2) identify the clinical and social characteristics more frequently associated with the onset of depressive symptoms after delivery; and (3) verify the hypothesis that the presence of maternity blues is a risk factor for the onset of a full-blown depressive episode in the 12 months after delivery. Methods: This is a longitudinal observational study. All pregnant women who gave birth at the inpatient unit of Gynecology and Obstetrics of the University of Campania "Luigi Vanvitelli" from December 2019 to February 2021 have been invited to participate in the study. Upon acceptance, women were asked to complete the Italian version of the Edinburgh Postnatal Depression Scale along with an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women have been reassessed after one, 3, 6 and 12 months. Results: A total of 359 women were recruited within 3 days from delivery, with a mean EPDS total score of 5.51 (±4.20). Eighty-three women (23.1%) reported the presence of maternity blues. Mean EPDS total scores were 12.8 (±0.2) in the MB group vs. 4.26 (±0.2) in the group without MB (p <0.0001). MB predictors were the presence of an anxiety disorder with an onset 6 months prior to pregnancy, of preeclampsia, of increased fetal health rate, of conflicts with relatives other than partner and having a partner with an anxiety disorder. At multivariate analyses the presence of MB increased 7-time the risk to have a higher EPDS score at follow-up assessments (OR: 7.79; CI: 6.88-8.70, p <0.000). This risk is almost four times higher 1 months after the delivery (OR: 4.66; CI: 2.54-6.75, p < 0.000), almost three times higher after 3 months (OR: 2.98; CI: 0.50-5.46, p < 0.01) and almost six times higher after 12 months (OR: 5.88; CI: 3.20-8.54, p < 0.000). Conclusions: Although MB was a self-limiting condition in the majority of cases, depressive symptoms arose quite often immediately after the childbirth. Professionals should be trained to monitor symptoms of MB and its transition toward a depressive episode.

How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention.

BACKGROUND: People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients' body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes. METHODS: This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients' physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected. RESULTS: Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31-2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80-28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45-20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention. CONCLUSIONS: The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.

[Lifestyle in patients with severe mental disorders: a new target for psychosocial interventions?] / Stili di vita nei pazienti con disturbi mentali gravi: quali opportunità per il trattamento?

INTRODUCTION: Patients with severe mental disorders (namely schizophrenia, major depression and bipolar disorder) have a reduced life expectancy of at least 10 to 25 years compared with the general population. This mortality gap is due to the higher prevalence of comorbid physical disorders (such as diabetes, hypertension and cardiovascular diseases) in these patients compared to the general population. Factors contributing to the mortality gap include lack of access to primary care services, severity of clinical symptoms, internalized stigma and discrimination by healthcare professionals, pharmacological treatments and unhealthy lifestyle behaviours. Several international studies have highlighted the high prevalence of unhealthy lifestyle behaviours in patients with severe mental disorders, but a few data are available from Italian real-world settings. AIM: The present study aims to: 1) describe the lifestyle behaviours adopted by a sample of real-world patients affected by severe mental disorders; 2) identify differences in lifestyle behaviours according to diagnostic category. MATERIALS: The final sample consisted of 402 patients, mainly female (57%), with a mean age of 45.8±11.8 years. 35% of them suffers from moderate obesity and 40% of them is affected by hyperinsulinemia, hypercolestereloemia and hypertrygliceridemia. 70% of patients has sedentary behaviours. Moderate to severe nicotine dependence is reported by 42% of patients. Patients with bipolar disorders are more frequently smokers compared to other patients. No significant differences in lifestyle behaviours have been found among the three diagnostic groups. RESULTS AND CONCLUSIONS: Our data confirm that patients with severe mental disorders adopt unhealthy lifestyle behaviours, regardless their diagnosis. New psychosocial interventions, including motivational and psychoeducational components and targeting lifestyle behaviours, should be developed and disseminated in order to reduce the mortality gap.

What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study.

The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% (n = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4-2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.

The impact of clinical and social factors on the physical health of people with severe mental illness: Results from an Italian multicentre study.

Our manuscript aims to: 1) assess physical health in a sample of patients with severe mental disorders; and 2) identify the psychopathological and psychosocial characteristics associated with an increased likelihood of having a poor physical health. The study, funded by the Italian Ministry of Education, has been carried out in psychiatric outpatient units of six Italian University sites. All recruited patients have been assessed through standardized assessment instruments. Moreover, anthropometric parameters have been obtained at recruitment and a blood samples have been collected to assess cardiometabolic parameters. Four-hundred and two patients with a primary diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were recruited. Internalized stigma, psychosocial functioning, quality of life, psychiatric hospitalizations, depressive/anxiety and manic symptoms and cognition were those domains more strongly associated with poor metabolic parameters, including high body mass index, HOMA and Framingham indexes and waist circumference. There were no statistically significant differences among the three diagnostic groups. Our findings highlight the importance of perceived stigma and quality of life on patients' physical health. This should be taken into account when developing plans for reducing the mortality rate in patients with severe mental disorders.