"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic.

BACKGROUND: Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not. METHODS: An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R). RESULTS: 1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning. CONCLUSIONS: Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study.

BACKGROUND: According to the WHO, detainees attempt suicide ten times more than the general population. AIMS: To investigate the impact of migration trauma on Suicidal and Self-Harm Behaviours (SSHB) of migrants in jail and to explore how substance use and other psychiatric features affect this relationship. METHODS: Prospective cohort study, conducted at the 'Sant'Anna' jail in Modena (Italy) between February 2017 and September 2019. Socio-demographic, psychiatric features and records of previous SSHB were collected. Experience of migration-related trauma was assessed with the LiMEs (List of Migration Experiences) checklist. Participants were followed-up for the occurrence of further SSHB. Survival analysis was performed and Cox's Hazard Ratios (HR) were used as a measure of association of comparisons. RESULTS: Amongst the 112 subjects (96% male, median age 33), the prevalence of any mental disorder was 26% and of substance abuse 59%. History of SSHB was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (of which three were suicide attempts). Cumulative survival probability was 85%. Having experienced trauma related to war and violence was significantly associated with SSHB, HR: 7.05. No SSHB were recorded amongst subjects without substance abuse. CONCLUSIONS: Migrants in custody who experienced trauma in the post-migration period, attempt SSHB seven times more frequently than those without traumas at any time. War trauma and post-migration trauma due to exposure to violence seem to be more strongly associated with SSHB, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties.

Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services.

Transition of young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a complex process. Transition rates are heterogeneously reported, with wide definitions and ranges. Few data are available regarding predictive factors of a successful transition. We explored factors associated with transition in a cohort of former inpatients of a Children and Adolescents Intensive Treatment Ward (CAITW). Socio-demographic and clinical features of patients previously admitted to CAITW were matched to AMHS data for those patients having reached age requirements. We built multiple logistic regression models to identify factors associated with transfer to AMHS (either inpatient or outpatient) and with successful retention in treatment (RIT) at six (short RIT), 12 (intermediate RIT) and 24 months after transfer (long RIT). From a cohort of 322 inpatients, 126 reached the age threshold for transfer to AMHS in the study period. The transfer rate was 50%. Two years after transition-age boundary, CAMHS-AMHS continuity of care was found in 40% and disengagement in 6% of cases. Longer and multiple hospitalizations, atypical antipsychotics prescription and a diagnosis of psychotic disorders were factors associated with short and intermediate RIT. A positive psychiatric family history was negatively associated with successful short and intermediate RIT. Diagnosis of psychosis and learning-supported school attendance were associated with long RIT. Young adults with a history of psychiatric inpatient admission as children or adolescents have a relatively high rate of transition to AMHS. A diagnosis of psychosis seems to be the strongest predictor for transition in these patients. Further research should focus on patients' schooling needs and on children of parents with mental health problems to enhance family and educational system engagement.