Failure to reduce benzodiazepine prescriptions through the implementation of a psychological intervention for insomnia in an Italian mental health service.

PURPOSE: Despite the evidence of higher effectiveness of psychological interventions for insomnia compared to pharmacological ones, drug prescriptions for insomnia remain frequent. This study has assessed patterns of prescriptions of BZDs for insomnia before and after the delivery of a training in psychological interventions to professionals working in the services of a Department of Mental Health in northern Italy. METHODS: The intervention consisted in two training sessions about psychological interventions for insomnia delivered to professionals of the participating services. The prevalence of users with a prescription of BZDs for insomnia in an index period after the delivery of the training was compared to the prevalence in an index period before the training. RESULTS: Among 727 people assessed for BZDs prescription at pre-intervention, 306 (42.1%, 95% CI 0.39-0.46) had a prescription, and 344 (49.2%, 95% CI 0.45-0.53) had a prescription among 699 people assessed at post-intervention, corresponding to a significant odds ratio of 1.33 to be prescribed with BZDs in the second index period compared to the first one. Psychological interventions were offered to a small group of patients. CONCLUSION: Prescribing attitudes of BZDs for insomnia were not modified after the training and delivery of a psychological intervention in a mental healthcare outpatient setting. Prescribing habits should be addressed more directly in training, and professionals should be more aware of risks of BZDs assumption. The failure in changing drug prescriptions in this study should prompt more real-world studies of the application of evidence-based strategies, particularly in outpatient mental health settings.

The Strategical Role of General Practitioner in the Prevention of Suicide: Preliminary Data From a Descriptive Study in the Province of Trento.

Suicide is a serious public health problem, as confirmed by the World Health Organization (WHO). It turns out to be, at least in part, preventable, but it is a complex problem, requiring complex solutions. Studies show us that about 44.5 percent of suicidal individuals would have expressed to someone, prior to the act, their intention to take their own life. Data in scientific literature specifically estimate that 44% of those who died by suicide had seen their general practitioner in the 30 days prior to the act. From this perspective, the general practitioner plays a potentially strategic role, as he or she can act as a "sentinel" in the early recognition of individuals in suicidal crisis and intervene directly, including by referring them to dedicated services. He can also disseminate correct information to the population and promote a culture of sensitivity and acceptance of vulnerabilities, facilitating the expression of possible distress and the potential request for help. In a community suicide prevention strategy, such as that of the Invitation to Life project, it was considered appropriate to investigate the knowledge and training needs of general practitioners in the Province of Trento in the present day, in order to specifically reorient training interventions to be developed in the future.

Depression, Self-Harm, Suicide. A Longitudinal Descriptive Study after the COVID 19 Pandemic in the Province of Trento.

The sudden and unexpected spread of the COVID 19 pandemic forced the political and health institutions of many countries to adopt drastic measures to contain the contagion, forcing millions of people into isolation and loneliness since 2020. For this reason, health organizations were committed from the beginning to develop all strategies available to support the mental health of the community and to reduce the risks of a rising suicide rate. Although an apparent "protective" role of emergency interventions on suicidal behavior was confirmed during the first months of forced isolation of the population, in the following months a close correlation was highlighted between pandemic period, rising of psychological and psychiatric disorders, and suicidal ideation. The increased suicide rate in Trentino in the first half of 2022 was not unexpected.Beyond the possible increase in suicide rates, a sustained and chronic increase in suicidal risk, suicidal ideation and in self harm could be confirmed in the future. The implementation of successful strategies for reducing suicidal deaths is a public health issue and will lay on the availability of local prevention projects, on their effort to better understand suicide and suicidal behaviors during outbreak, in order to develop the general capacity to early identify risk situation, and to enhance the effectiveness of prevention plans.

Suicidal Phenomenon in Pandemic Times. The Trentino's Reality.

Suicide is a major public health problem; according to the latest WHO data, it is among the top twenty causes of death in the world. After the sudden and unexpected spreading of a global pandemic in 2020, many mental health researchers have launched alarms about a possible suicide rates' rise, due to the inevitable consequences of the ongoing social and health emergency. However, recent articles in scientific literature have disconfirmed this thesis. Trentino also seems not to deviate from this dynamic: preliminary data, collected in an unconventional, and not yet official way, have been able to show that in 2020 the suicide rate remained stable. The finding that excludes up to date such a rise in rates does not unfortunately provide any guarantee that the situation will remain constant over time, and that there cannot be significant differences regarding gender, ethnicity, religious faith, sexual orientation or social class in determining a different impact of the current crisis on the suicidal phenomenon. Further studies and insights into the processing of the data in our possession are needed. Difficulties and uncertainties connected to the covid-19, with which it is now clear that the community will have to "learn to live together", could also in the medium and long term constitute a prolonged stress-generating element with a greater negative impact on the mental health of the population. It is essential, in light of the particular social and health situation we are experiencing, to carry out with even greater effectiveness, precision and continuity actions such as those promoted within the Invito alla Vita Project for the prevention of suicide, in order to guarantee the most effective prevention of this serious phenomenon. The psychological and social implications of the covid-19 pandemic will only be fully assessable in a few years, when the crisis will be effectively over. Only then we will be able to understand if the efforts put in place at a global level, and in particular in the province of Trento, have been effective in the managing of the suicidal phenomenon.

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.

Mental Illness and Prejudices in Psychiatric Professionals. Data from the Social Stigma Questionnaire for Psychiatric Professionals: A Multicentre Study.

The prejudices about mental illness and the related social stigma are still present in the population. People suffer from both the disease and the marginalization behaviors implemented by the "so-called healthy" towards them and their relatives. Even psychiatric professionals can get sick and suffer for the same reason. The authors of this multicentric study have focused their attention on the presence or absence of groups of psychiatric pathologies among the "insiders". The most frequent pathologies encountered were the mood and anxiety disorders, in a percentage similar to that of the general population. To continue the research on the stigma begun in a previous study, the authors asked themselves if there could be prejudices and/or stigma among psychiatric professionals towards sick colleagues, how they relate in the workplace and how they react to the behavior of colleagues. The stigma questionnaire has been used on psychiatric professionals, and 130 Italian colleagues were tested in the provinces of Avellino, Brindisi and Trento. The data were compared with those of the research on the stigma "Thinking of Psychiatric Disorders as" Normal "Illness" (Tavormina et al. 2016) and it emerged that among the attending professionals there are no statistically significant behaviors of marginalization, exclusion or stigma against sick colleagues, even if there is a certain discomfort in working together. Above all, it emerged that 80% of the interviewees, who have had work experience with sick colleagues, have replied that the latter can treat those who are also sick of their own disease, thus showing esteem and confidence in their work, in analogy with the Jungian thesis of the "wounded Healer" in the myth of the centaur Chiron.

Can clinical use of Social Media improve quality of care in mental Health? A Health Technology Assessment approach in an Italian mental health service.

Clinical use of modern Information and Communication Technologies such as Social Media (SM) can easily reach and empower groups of population at risk or affected by chronic diseases, and promote improvement of quality of care. In the paper we present an assessment of SM (i.e. e-mails, websites, on line social networks, apps) in the management of mental disorders, carried out in the Mental Health Service of Trento (Italy) according to Health Technology Assessment criteria. A systematic review of literature was performed to evaluate technical features, safety and effectiveness of SM. To understand usage rate and attitude towards new social technologies of patients and professionals, we performed a context analysis by a survey conducted over a group of 88 psychiatric patients and a group of 35 professionals. At last, we made recommendations for decision makers in order to promote SM for the management of mental disorders in a context of prioritization of investments in health care.

Suicide and attempted suicide: epidemiological surveillance as a crucial means of a local suicide prevention project in Trento's Province.

The World Health Organization identifies suicide among the top 10 causes of death in many countries with an overall mortality rate of 16 per 100,000 inhabitants. Furthermore suicide attempts present a frequency 4-10 times greater than the suicidal events, representing also one of the main risk factors to lead to recurrent attempts of suicide. In 2008 the Autonomous Province of Trento launched a suicide prevention pogram called "Invitation to Life" which includes various interventions intended to counter the phenomenon of suicide in the region. Actually the epidemiological research upon the phenomenon of suicide in Trentino region is one of the main pillars of the project: it represents a fundamental requirement to identify risk and protective factors in the population in order to adopt more specific and effective preventive strategies. This article aims to present methods and instruments for epidemiological monitoring of suicide and attempted suicide which are applied in Trentino and to describe results after seven years from the beginning of the local prevention program "Invitation to life".

Health Technology Assessment and Social Network in Mental Health: a pilot study to evaluate use of new technology communication in prevention, monitoring and treatment of mental disorders in Trentino region.

The clinical use of Information Communication Technology tools can facilitate the support of population groups at risk and / or with chronic conditions. Social networks and other forms of communication represent an opportunity to improve the quality of care and patient empowerment. The study intends to evaluate, in accordance with the dictates of the HTA, the possibilities related to the use of social networking technologies in the prevention and taking care of mental illness. On the basis of these results and in agreement with the context of the Trentino health system, several application proposals will be developed for the treatment of patients with bipolar disorder. The conclusion of the evaluation, and the related clinical and organizational data to support the implementation process in the Trentino health system is expected in the month of October 2014.

A "no-restraint" psychiatric department: operative protocols and outcome data from the "Opened-doors experience" in Trento.

The "Open Doors" and no restraint project in the psychiatric department of Trento originated from de-institutionalization and empowerment practices, amply extended in the Mental Health Service of Trento over the past years. This paper aims to present the authorized operative protocols of no restraint methods and data from the first four years experience of no restraint management in the psychiatric Department of Trento. Avoiding physical restraint and confinement force every member of the ward staff to look for innovative solutions and means a deeper and strenuous engagement of the staff in the therapeutic relationship. We are aware that this is basically a small thing, and that certainly it will create many contradictions. We chose to stay on the other hand in these contradictions, and to witness that it is possible, and indeed useful. The great lesson we learnt over past years in Community Psychiatry was that only the hard experience of these contradictions can allow people to regain health, not just as assimilation to stereotyped models, but as adhibition of resources and self-determination, normally stolen by psychiatric illness.

The Help-line "Invito alla Vita": a new project for suicide prevention in Trentino region.

"Invito alla Vita" is a community-based suicide prevention project that officially started in Trentino in late 2008. The project was promoted by the local Health Services, trying from the beginning to involve other community subjects, and has been working over five years and a half in different directions, particularly promoting a phone help-line. The aims of the Invito alla Vita (IaV) Help Line have been clear from the beginning: decrease the sense of loneliness, offer encouragement and support, promote engagement with health services, reduce stigma and prejudice. Contrary to popular misconceptions, talking with people about suicide will not increase suicide risk, neither will it induce patients to commit suicide.The volunteers involved in the IaV help-line offer people empathic listening without judgment and easy tips, to reduce loneliness, sadness and supply reassurance that other people care. In this study we tried to deepen our knowledges about the volunteers' motivations and necessities to use them for creating a better system of support: we realized indeed that continuous training and supervision, along with official awards given by community institutions, are basic factors to sustain the volunteers' motives to cooperate with the help line.