The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis.

COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.

Psychometric properties of a new instrument for the measurement of the perceived quality of distance learning during the coronavirus disease 2019 (COVID-19) pandemic.

Introduction: The lockdown restrictions due to the COVID-19 pandemic forced many students to use distance learning. Few studies have examined the psychological effects of distance learning during the pandemic on university or on non-university students using a specific psychometric tool. The principal aim of this study was the construction and validation of a new psychometric tool, the Perceived Quality of Distance Learning (PQDL), to measure students' appreciation and reaction to distance learning. The connection between anxiety, depression, perceived self-efficacy, and students' perception of distance learning was analyzed to assess the nomological validity of the new scale. Method: The sample consists of 429 students who attended university or training courses. The factor structure of the new instrument was analyzed through Exploratory and Confirmatory Factor Analyses and its nomological validity was analyzed through regression analysis. Conclusion: The results showed that PQDL consists of two subscales: Distance Learning Organization and Cognitive-Emotive Reaction to Distance Learning. Higher student's ability to organize and plan distance learning and higher student's positive cognitive-emotive reaction to distance learning, higher student's perceived quality of distance learning. Anxiety and depression scores were negatively correlated with students' perceived quality of distance learning. Furthermore, students' perceived emotional self-efficacy of negative emotions and perceived scholastic self-efficacy were positively correlated with students' perceived quality of distance learning. These data indicate that PQDL is a reliable questionnaire to assess student's perceived quality of distance learning.

Scholastic psychological well-being and irrational thoughts in students of primary and secondary school: An Italian study.

The period of pre-adolescence is a period of age transition during which undesirable feelings such as anxiety, shyness, guilt, depression and anger are experienced accompanied by physical and hormonal changes experienced during puberty. Therefore, during early adolescence the psychological well-being is a critical issue. This period of transition coincides to the passage from the primary to the secondary school in Italy. This transition could have some effects on the psychological well-being on children, in particular on their scholastic well-being. In addition, during early adolescence children develop irrational thoughts. We tested, therefore, the variation of scholastic well-being and irrational thoughts in children of the primary (n = 50; mean age 10.5; 56 % females) and secondary school (n = 61; mean age 11.5; 49 % females). Results showed that children of the secondary school have lower scholastic well-being and higher level of irrational thoughts than children of primary school. In particular, during the transition from the primary to the secondary school, children showed a lower level of satisfaction with academic results and the perception of a low support from their teachers. In addition, there was also a stronger reduction of self-esteem and an increment of distrust in achieving scholastic success. A scholastic psychological support, with particular attention to the emotional development of early-adolescents, is suggested.

Telerehabilitation proposal of mind-body technique for physical and psychological outcomes in patients with fibromyalgia.

Fibromyalgia (FM) syndrome is characterized by the close correlation of chronic widespread pain and other non-pain related symptoms. Aim of this study was to investigate whether telerehabilitation that provides physical and psychological support services of the mind-body techniques can affect the clinical profile and pain relief of FM patients. The study included twenty-eight female FM patients, mean aged 56.61 ± 8.56 years. All patients underwent a rehabilitation treatment (8 sessions, 1/week, 1 h/each) through Zoom platform, with the following principles of rehabilitation treatment: Anchoring to a positive emotion; listen and perceive your "own" body; conscious breathing; improve interoceptive awareness; relax. All patients then underwent clinical assessment of the physical distress and fear of movement for the Numeric Rating Scale (NRS); the Fatigue Assessment Scale (FAS); the Fear Avoidance Belief Questionnaire (FABQ); with measures of physical and mental disability for the Fibromyalgia Impact Questionnaire (FIQ); the 12-Items Short Form Survey; the Resilience Scale for Adults and the Coping Strategies Questionnaire-Revised. The evaluations were performed at T0 (baseline), T1 (after 8 weeks of treatment), and T2 (after 1 month of follow-up). The main finding was that telerehabilitation reduced physical and mental distress, fear, and disability (p < 0.001). Resilience and coping ability were less affected by the rehabilitative treatment. Our attempt of mind-body technique telerehabilitation has shown good results in the improvement of painful symptoms and quality of life for the FM patients but showed fewer positive impacts for the resilience and coping abilities aspects.

Connections between Children's Eating Habits, Mental Health, and Parental Stress.

Background: Obesity and eating disorders are increasing in occidental countries and can undermine physical and psychological health. Therefore, preventing the insurgency of unhealthy eating habits in childhood is fundamental. Parents can play an important role in assisting pediatricians, psychiatrists, and clinical psychologists in the diagnosis of eating disorders because they have an active role in observing and assessing the quality of their children's eating habits. Methods: In our study, we collected data from a sample of children (n = 125) and their parents (n = 161) without symptoms related to eating disorders. Parents assessed the eating habits, behavior problems, and mental health of their children and parental stress. In addition, we measured body mass index, anxiety, and lifestyle in children. Data were analyzed with bivariate correlation and MIMIC models. Results: Both mothers' and fathers' assessments of children's eating habits are reliable. Unhealthy eating habits are connected with children's behavioral problems and parental stress. We did not find significant differences in feeding styles and ways of assessing the quality of eating habits between mothers and fathers. Our study showed greater sensitivity of mothers toward the physical fitness of their children rather than fathers. Conclusions: Mothers and fathers both proved to be good observers of their children's eating behavior, and they could cooperate with medical and psychological operators in preventing the risk of obesity.

Fear of hypoglycemia in children with type 1 diabetes and their parents: Validation of the Italian version of the Hypoglycemia Fear Survey for Children and for Parents.

BACKGROUND: Currently, Italian versions of the Hypoglycemia Fear Survey for Children (CHFS) and for Parents (PHFS) quantifying Fear of Hypoglycemia (FoH) in pediatric diabetes are not available. OBJECTIVE: To validate the Italian version of the CHFS and PHFS. SUBJECTS AND METHODS: One hundred and seventy-four children with type 1 diabetes aged 6-18 and 178 parents completed the CHFS and PHFS, the PedsQL 3.0 Diabetes module and the KIDSCREEN-10. Internal consistency was good (α = 0.85 for CHFS, α = 0.88 for PHFS); validity was supported by correlations of CHFS total score (CHFS-T r = -0.50; p < 0.001, CI = -0.62 to -0.35) and Worry subscale (CHFS-W r = -0.49; p < 0.001, CI = -0.62 to -0.32) with measures of health-related quality of life (QoL), which were not related to PHFS scores. Factor analyses justified the structure and the separate scoring of Behavior and Worry subscales. Children's age was negatively correlated with CHFS-T (r = -0.16; p = 0.03, CI = -0.36 to 0.00), CHFS-W (r = -0.29; p = 0.02, CI = -0.39 to -0.07), PHFS-T (r = -0.20; p = 0.006, CI = -0.35 to -0.04), PHFS-B (r = -0.30; p = 0.001, CI = -0.43 to -0.17). Mean (SD) item scores of CHFS-T (1.47 ± 0.56 vs. 1.27 ± 0.57; p < 0.05) and CHFS-W (1.20 ± 0.73 vs. 0.96 ± 0.68; p < 0.05) were higher in children with HbA1c ≥7.5%. Higher levels of distress for upsetting hypoglycemia were associated with lower child's QoL scores as perceived by children (Peds-QL: 72.6 ± 12.8 vs. 80.4 ± 11.9; p < 0.001) and parents (Peds-QL: 70.6 ± 13.8 vs. 75.8 ± 12.9; p < 0.05). CONCLUSION: The Italian version of CHFS and PHFS appears to be a valid measure to assess FoH in clinical practice and factor analysis supports separate scoring for the Worry and Behavior subscales.

The location of emotional intelligence measured by EQ-i in the personality and cognitive space: Are there gender differences?

Introduction: Emotional Intelligence (EI) is first described by Salovey and Mayer as the ability to perceive and understand emotions and the ability to use them as supports for thoughts. Despite the great notoriety of EI, its definition remains not completely clear. An operative definition of EI can be achieved by studying its connection with other individual characteristics such as gender, personality traits, and fluid intelligence. Methods: The sample was composed of 1,063 Italian subjects. A total of 330 participants were employed (31.0%; 57.9% men) and 702 were university students (66.0%; 38.7% men). The Emotional Quotient Inventory (EQ-i), one of the most used questionnaires in literature, was used to measure EI. The exploratory structural equation modeling (ESEM) was used to assess the role of personality traits (five-factor model of personality) and fluid intelligence in EI. Statistical analyses on differences between men and women means of total and subscale EQ-i scores were estimated to evaluate whether EI, measured by EQ-i, is influenced by gender. Furthermore, a Multigroup Confirmatory Factor Analysis was conducted to assess measurement invariance in relation to gender groups. Results: Emotional Intelligence, measured by EQ-i, is prevalently connected with personality traits rather than fluid intelligence. Furthermore, men outperformed women in the Intrapersonal and Stress Management EI factors, and women outperformed men in the Interpersonal EI factor. No difference in the means of the EI total score and EI latent general factor did not differ between gender groups. Conclusion: Emotional Intelligence, measured by EQ-i, can be conceptually considered as a Trait EI. Furthermore, men are more capable to cope with negative events and to control impulses, while women are more able to distinguish, recognize, and comprehend others' emotions.

Association of COMT, BDNF and 5-HTT functional polymorphisms with personality characteristics.

Background: The real impact of genetic factors on personality is still unknown, even if in literature about 50% of variance in personality traits are considered genetically determined. The determination of the genetic variance in personality traits could promote psychological well-being and the prevention of psychopathologies, because there are many experimental evidences showing that mental illness is associated to personality. Numerous studies have showed that Catechol-O-methyltransferase (COMT), brain derived neurotrophic factor (BDNF) and serotonin transporter (5-HTT) are genes whose variants are associated with personality traits. This aim of this study is the investigation of the association between personality traits and 5-HTTLPR/rs255315-HTT promoter variant, COMT Val158Met and BDNF Val66Met gene polymorphisms. Methods: The sample was composed by 132 healthy female students. Genomic DNA was extracted from buccal swab, while personality was assessed with Cloninger's Temperament and Character Inventory-Revised (TCI-R). Linear discriminant analysis was used to analyze how personality characteristics can differentiate individuals in relation to their genetic polymorphisms. Results: Data showed that the temperament trait Reward Dependence discriminated individuals with different BDNF variants; Novelty Seeking and Harm Avoidance discriminated individuals with different 5HTTLPR variants; Persistence discriminated individuals with different COMT variants. Conclusions: Since these traits are connected to psychological diseases as depression, social anxiety, anorexia and obsessive-compulsive disorders of personality, the study of their genetic component can be used as intermediary issue to better define the connection between genes and predisposition toward maladaptive behavior and mental illness.

The Role of Gender in the Association Among the Emotional Intelligence, Anxiety and Depression.

Recent epidemiological data show an increase of depression and anxiety that cause a loss of about 3-4% of the gross domestic product in Europe, as a consequence of a reduced productivity and a premature death of people. Gender differences in both psychopathologies were found from mid-to-late adolescence until 55 years, and data indicate an increase of depression in women. Considering these data, new interventions focused on promoting psychological well-being were designed. A predictive factor of psychological disorders is Emotional Intelligence (EI), the ability to understand and regulate our own emotions, as well as those of others. EI is associated with psychological well-being, as well as with the treatment of mental illness, but gender differences in the association among EI, anxiety and depression remains unclear. The present study aims at analyzing the nomological associations among EI, anxiety and depression. Furthermore, the possible moderating role of gender in the relation between EI, depression and anxiety is investigated in a sample of 1725 healthy participants. Our results show that the ability to recognize and to control emotions in the social context helps us to reduce the risk to be affected by depression and anxiety. Moreover, our study shows that the association of EI with anxiety and depression wasn't gender moderated. In conclusion, the findings highlight that EI can help people to manage emotions linked to negative events and to successfully understand emotions in others. In addition, we found no moderation role of gender in the association between EI, anxiety and depression.

The Influence of Rehabilitation on Quality of Life in Breast Cancer Survivors: A Clinical Study.

BACKGROUND: Breast cancer survivors report negative impacts of cancer, augmented by specific vulnerabilities to body changes, negative self-assessment, and quality-of-life concerns. The main objective of our work was to test the effect of a rehabilitation program on breast cancer patients by evaluating the change in their physical well-being during an outpatient rehabilitation setting and, subsequently, in a home rehabilitation setting, considering the individual personality profile. METHODS: Patients who underwent total mastectomy with breast prostheses or tissue expanders were enrolled. Outcome assessments (Pain, Quality of Life, Personality traits for the Minnesota Multiphasic Personality Inventory-2) before treatment (T0), at the end of the rehabilitative treatment (T1 = 10 sessions 2/week, one hour/each), and after two months of follow-up (T2) were performed. RESULTS: The data of 38 included patients were analyzed. The quadratic trend of the Visual Analogue Scale can be explained by the fact that patients have a strong reduction in the perceived pain immediately after rehabilitation in the clinic. This reduction remains constant for the home period of the rehabilitation. The personality profiles of all the participants were substantially valid. Only three patients obtained scores higher than 65 points. CONCLUSIONS: The study evidenced that in the initial phase of the rehabilitation, psychological traits such as anxiety, depression, and preoccupation could have a strong association especially with the autonomous functions and the perceived physical symptoms. However, during the therapeutic process, this association decreased and these decrements were higher when patients performed their rehabilitation at home, in a more familiar and comfortable setting.

Improving the psychometric properties of the dissociative experiences scale (DES-II): a Rasch validation study.

BACKGROUND: The Dissociative Experiences Scale-II (DES-II) is a self-report questionnaire that measures dissociative experiences such as derealization, depersonalization, absorption and amnesia. The DES-II has been prevalently used as a screening tool in patients suffering from psychotic disorders or schizophrenia. However, dissociative experiences can also be part of normal psychological life. Despite its popularity, the most problematic aspect of the DES-II is the inconsistency in its factor structure, which is probably due to the tendency to treat ordinal responses as responses on an interval scale, as it is assumed in the Classical Test Theory approach. In order to address issues related to the inconsistency of previous results, the aim of the present study was to collect new psychometric evidence to improve the properties of the DES-II using Rasch analysis, i.e. analyzing the functioning of the response scale. METHODS: Data were obtained on a sample composed by 320 Italian participants (122 inmates and 198 community-dwelling individuals) and were analyzed with the Rasch model. This model allows the estimation of participants' level of dissociation, the degree of misfit of each item, the reliability of each item, and their measurement invariance. Moreover, Rasch estimation allows to determine the best response scale, in terms of response modalities number and their discriminant power. RESULTS: Three items of the scale had strong misfit. After their deletion, the resulting scale was composed by 25 items, which had low levels of misfit and high reliability, and showed measurement invariance. Participants tended to select more often lower categories of the response scale. CONCLUSIONS: Results provided new knowledge on the DES-II structure and its psychometric properties, contributing to the understanding and measurement of the dissociation construct.

Physical and Psychological Impact of the Phase One Lockdown for COVID-19 on Italians.

The exceptional pandemic due to the 2019 coronavirus disease (COVID-19) has obliged all Italians to stay at home. In the literature, there are evidences that traumatic global events, such as natural catastrophes and pandemic, have negative effects on the physical and psychological health of the population. We carried out a survey to analyze the physical and psychological conditions of Italians during the pandemic. Due to the severe limitations in moving during the phase one lockdown, the survey was administered by internet. Results show that Italians followed the provisions established by the Italian government to avoid contamination, but 43% of them declared to have suffered from physical symptoms, in particular migraine, sleep disorders, persistent exhaustion, and difficulty of concentration. They have great fear to be contaminated or that relatives or friends can be contaminated, and they actively take actions to avoid contamination. Participants declared that they had suffered a lot of inconveniences due to restrictions in their movements, and that their life habits were strongly changed. They spent their time at home in different activities, but their psychological well-being was strongly impaired by the lockdown. The level of anxiety tripled, in relation to the prepandemic period, and 30% of males and 41% of females declared to have severe levels of depression. Participants with high levels of optimism and hopefulness show a stronger resilience against anxiety and depression. In addition, there is a negative correlation between anxiety and depression and the five factors of personality. These results show that psychological diseases must not be neglected, and that people in lockdown do need support for their psychological health, also with the help of internet and communication technologies.

The WeReha Project for an Innovative Home-Based Exercise Training in Chronic Stroke Patients: A Clinical Study.

BACKGROUND: Telerehabilitation (TR) in chronic stroke patients has emerged as a promising modality to deliver rehabilitative treatment-at-home. The primary objective of our methodical clinical study was to determine the efficacy of a novel rehabilitative device in terms of recovery of function in daily activities and patient satisfaction and acceptance of the medical device provided. METHODS: A 12-week physiotherapy program (balance exercises, upper and lower limb exercises with specific motor tasks using a biofeedback system and exergaming) was administered using the WeReha device. Twenty-five (N = 25) chronic stroke outpatients were enrolled, and the data of 22 patients was analyzed. Clinical data and functional parameters were collected by Berg Balance scale (BBS), Barthel Index (BI), Fugl-Meyer scale (FM), Modified Rankin scale (mRS), and Technology Acceptance Model (TAM) questionnaire at baseline (T0), after treatment (T1), and at the 12-week follow-up (T2). Statistical tests were used to detect significant differences (P < .05), and Cohen's (Co) value was calculated. RESULTS: BI scores improved significantly after treatment (P = .036; Co 0.776, medium), as well as BBS scores (P = .008; Co 1.260, high). The results in FM scale (P = .003) and mRS scores (P = .047) were significant post treatment. Follow-up scores remained stable across all scales, except the BI. The A and C sub-scales of the TAM correlated significantly to only a T2 to T1 difference for BI scores with P = .021 and P = .042. CONCLUSION: Currently, the WeReha program is not the conventional therapy for stroke patients, but it could be an integrative telerehabilitative resource for such patients as a conventional exercise program-at-home.ClinicalTrials.gov identifier: NCT03964662.

Application of Bayes' Theorem in Valuating Depression Tests Performance.

The validity of clinical diagnoses is a fundamental topic in clinical psychology, because now there are some political administrations, as the IOM or the U.K. government, which are focusing on best evidence-based practice in clinical psychology. The most problematic issue in clinical psychology is to avoid wrong diagnoses which can have negative consequences on individual life and on the utility of clinical treatments. In the case of diagnoses based on self-report tests, the diagnostic decision about individual health is based on the comparison between its score and the cutoff, according to the frequentist approach to probability. However, the frequentist approach underestimates the possible risks of incorrect diagnoses based on cutoffs only. The Bayesian approach is a valid alternative to make diagnoses on the basis of the scores from psychological tests. The Bayes' theorem estimates the posterior probability of the presence of a pathology on the basis of the knowledge about the diffusion of this pathology (prior probability) and of the knowledge of sensitivity and specificity values of the test. With all this information, it is possible to estimate the diagnostic accuracy of some self-report tests used for assessing depression. We analyzed the diagnostic accuracy of the most used psychological tests of depression (Zung's Self-Rating Depression Scale, Hamilton Rating Scale for Depression, Center for Epidemiological Studies for Depression and the Beck Depression Inventory), together with a new scale (Teate Depression Inventory) developed with the IRT procedure, by analyzing the published works in which data about sensitivity and specificity of these scales are reported. Except the TDI, none of these scales can reach a satisfactory level of diagnostic accuracy, probably for the absence of an optimal procedure to select test items and subjects with clearly defined pathological symptoms which could allow the reduction of false positives in test scoring.

Using Overt and Covert Items in Self-Report Personality Tests: Susceptibility to Faking and Identifiability of Possible Fakers.

Self-report personality tests widely used in clinical, medical, forensic, and organizational areas of psychological assessment are susceptible to faking. Several approaches have been developed to prevent or detect faking, which are based on the use of faking warnings, ipsative items, social desirability scales, and validity scales. The approach proposed in this work deals with the use of overt items (the construct is clear to test-takers) and covert items (the construct is obscure to test-takers). Covert items are expected to be more resistant to faking than overt items. Two hundred sixty-seven individuals were presented with an alexithymia scale. Two experimental conditions were considered. Respondents in the faking condition were asked to reproduce the profile of an alexithymic individual, whereas those in the sincere condition were not asked to exhibit a particular alexithymia profile. The items of the scale were categorized as overt or covert by expert psychotherapists and analyzed through Rasch models. Respondents in the faking condition were able to exhibit measures of alexithymia in the required direction. This occurred for both overt and covert items, but to a greater extent for overt items. Differently from overt items, covert items defined a latent variable whose meaning was shared between respondents in the sincere and faking condition, and resistant to deliberate distortion. Rasch fit statistics indicated unexpected responses more often for respondents in the faking condition than for those in the sincere condition and, in particular, for the responses to overt items by individuals in the faking condition. More than half of the respondents in the faking condition showed a drift rate (difference between the alexithymia levels estimated on the responses to overt and covert items) significantly larger than that observed in the respondents in the sincere condition.

Psychometric Properties of the Italian Version of the Young Schema Questionnaire L-3: Preliminary Results.

Schema Therapy (ST) is a well-known approach for the treatment of personality disorders. This therapy integrates different theories and techniques into an original and systematic treatment model. The Young Schema Questionnaire L-3 (YSQ-L3) is a self-report instrument, based on the ST model, designed to assess 18 Early Maladaptive Schemas (EMSs). During the last decade, it has been translated and validated in different countries and languages. This study aims to establish the psychometric properties of the Italian Version of the YSQ-L3. We enrolled two groups: a clinical (n = 148) and a non-clinical one (n = 918). We investigated the factor structure, reliability and convergent validity with anxiety and depression between clinical and non-clinical groups. The results highlighted a few relevant findings. Cronbach's alpha showed significant values for all the schemas. All of the factor models do not seem highly adequate, even if the hierarchical model has proven to be the most significant one. Furthermore, the questionnaire confirms the ability to discriminate between clinical and non-clinical groups and could represent a useful tool in the clinical practice. Limitations and future directions are discussed.

Correlations Between Personality, Affective and Filial Self-Efficacy Beliefs, and Psychological Well-Being in a Sample of Italian Adolescents.

Adolescence is a critical period for the emergence of a balanced personality in adults. Extraversion, neuroticism, and affective self-efficacy beliefs in emotion regulation showed to be good predictors of psychological well-being in adolescents. We analyzed the association between affective self-efficacy beliefs, personality traits, and psychological well-being of 179 Italian adolescents. We also analyzed the connection between adolescents' filial self-efficacy beliefs and psychological well-being and possible moderating effects of self-efficacy beliefs on personality traits. Results show that extraversion, neuroticism, and self-efficacy beliefs in emotion regulation are correlated with psychological well-being, while filial self-efficacy does not. Self-efficacy beliefs do not show significant moderating effects on personality traits, even if self-efficacy beliefs in expressing positive emotions reduce negative characteristics of individuals with high level of psychoticism.

Psychometric properties of the Postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.

OBJECTIVE: impaired maternal bonding is a risk factor for problems with infant well-being and development. The investigation of perinatal variables related to disorders of the mother-infant relationship as well as the administration of reliable and valid screening tools to new mothers in the postpartum can help identify early signs of a disturbed mother-child relationship. The Postpartum Bonding Questionnaire (PBQ) has been shown to be a valid screening instrument, but its dimensional structure is still controversial. An analysis of the literature demonstrated the need for research into the perinatal correlates of the quality of mother-newborn bonding as measured by the PBQ, and for information about the reliability and validity of the Italian version of the questionnaire. AIM: to (a) carry out preliminary analysis of the psychometric properties of an Italian version of the PBQ and (b) explore how mother-infant disturbances are related to relevant perinatal psychological variables. DESIGN: the research design consisted of a prenatal and a postnatal phase. SETTING: prenatal education classes delivered in public and private institutions. PARTICIPANTS: 123 pregnant Italian women were recruited from prenatal education classes. MEASUREMENTS: in the prenatal period participants completed a questionnaire measuring maternal-fetal attachment; at the postnatal assessment (3 months postpartum) participants completed the Italian PBQ together with measures of mother-infant attachment, the couple's adjustment and maternal psychological well-being. Exploratory factor analysis was used to investigate the factor structure of the PBQ. Internal consistencies were evaluated using Cronbach's alpha. Nomological validity was assessed via Pearson correlations. FINDINGS: a three-factor model provided the most meaningful representation of the PBQ data, with one factor reflecting annoyance and anger towards the infant, another reflecting detachment and rejection and the third reflecting anxiety about infant care. Internal consistencies were good. Impaired mother-infant bonding was negatively correlated with prenatal and postnatal mother-infant attachment and couple adjustment, as well as being positively correlated with maternal depressive symptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the Italian PBQ is a reliable, valid screening instrument and can be used for research, including transcultural comparisons in perinatal psychiatry. It can also be used clinically to detect signs of a disordered mother-child relationship. Knowledge of the variables generally associated with mother-infant bonding problems combined with data from postpartum administration of the PBQ could be used in midwifery to develop preventive programmes based on the specific needs of new mothers.

Prenatal Attachment Inventory: expanding the reliability and validity evidence using a sample of Italian women.

BACKGROUND: The Prenatal Attachment Inventory (PAI) is a widely used questionnaire to measure prenatal attachment. However, its internal structure is controversial. None of the previous studies have investigated the dimensions of the Italian version of the scale using both an exploratory and a confirmatory approach. There is also a need to explore extensively the external validity of the Italian PAI. OBJECTIVE: We designed a study aimed at shedding further light on the dimensionality of the questionnaire and expanding the evidence of its reliability and validity. METHOD: Five-hundred and thirty-five Italian expectant mothers participated in the prenatal phase; a subsample of 100 women participated in the postnatal phase of the study. The PAI was administered together with other scales measuring maternal-fetal attachment, psychological wellbeing and relational variables. RESULTS: The hypothesised relationships with external criteria were substantiated overall. The five dimensions described in the Italian study by Barone, Lionetti, and Dellagiulia also emerged from our factor analyses, with the exception of two items. Internal consistency was adequate for the total scale and for four of the five subscales. CONCLUSION: As the Fantasy subscale showed poor internal consistency, we advise against its use as an independent measure. However, when used as a global score, the PAI is a reliable and valid measure of prenatal attachment in Italian women. Thus, it can be used for research purposes. The use of the PAI could also be very helpful in clinical settings, in order to identify expectant mothers who have difficulty in establishing an affective bond with their unborn infants. To this end, further research should study the characteristics of the PAI on high-risk groups and clinical samples in order to obtain clinical cut-offs.

Dissociative Experiences and Psychopathology Among Inmates in Italian and Portuguese Prisons.

The association between dissociation and psychopathological symptoms is well established, yet studies with inmates are lacking. If higher rates of dissociation and psychiatric symptoms are reported in inmate samples, it is not clear whether they represent two separate, albeit related, characteristics. We examined the association between dissociation and psychopathological symptoms among 320 Italian subjects (122 inmates and 198 community participants) and a Portuguese inmate sample ( n = 67). Then, we tested whether dissociation and psychopathology levels were higher among inmates. Both hypotheses were supported, confirming the relevance of dissociative, paranoid, and psychotic symptoms among inmates, as well as their interrelations. Notably, the group difference in dissociation remained significant after partialing out the variance associated with other psychopathological symptoms. Conversely, only the difference in paranoid symptoms remained-marginally-significant when controlling for the influence of dissociation. This finding suggests that dissociation may have unique relevance for the psychological functioning of inmates.