Relationship between parenting measures and parents and child psychopathological symptoms: a cross-sectional study.

BACKGROUND: Increasing evidence suggests a complex role of family influences, such as the exposure to parent psychopathology through parenting behavior, in parent-to-child psychopathology transmission. Parenting behaviour could represent a relevant target of psychoeducative intervention. Given these premises, we aimed to evaluate homotypic and heterotypic relationships between parent and child psychopathology, mediated by parenting behaviours, taking into account the constructs of parent and offspring internalizing and externalizing psychopathology. METHODS: Internalizing and externalizing symptoms in 272 clinically-referred subjects (mean age = 14.5 ± 2.3; F = 23.5%) and their parents (mothers n = 272, fathers n = 242) were assessed through the Child Behavior Checklist and the Adult Self Report; four areas of parenting behaviours were investigated through the Family Life Questionnaire. Multiple mediation models were built, considering mother and father psychopathology scales as independent variables, parenting measures and family functioning as mediators (Affirmation, Rules, Discipline and Special Allowances), child psychopathology scales as dependent variables and demographic variables as covariates. RESULTS: Regression models showed a significant effect of maternal internalizing symptomatology on child externalizing behavioral problems; high levels of maternal pathology predicted high levels of children's psychopathology. A total mediating effect of parenting measures was found: high levels of internalizing symptoms in mothers predicted low levels of affirmation, which in turn predicted high levels of externalizing psychopathology in children. CONCLUSIONS: Our study results confirmed the existence of interdependent links between mothers' psychiatric symptomatology, parenting behaviour and offspring outcomes, specifically in an Italian context. On a clinical and rehabilitation basis, this work offers suggestions about parenting practices, specifically maternal, involved in the maintenance of child psychopathology.

Validation of the Italian version of the Revised Prenatal Coping Inventory (NuPCI) and its correlations with pregnancy-specific stress.

BACKGROUND: Pregnancy is a period of happiness but also of physical and psychological changes that can lead to distress. Functional coping strategies can reduce the pregnancy specific-stress. This study aimed to assess the psychometric properties of the Revised Prenatal Coping Inventory (NuPCI) in an Italian sample and to investigate how coping strategies were associated with pregnancy-specific stress. METHODS: In this cross-sectional study, low-risk pregnant women (N = 211) were assessed with NuPCI, NuPDQ (Revised-Prenatal Distress Questionnaire), Brief-COPE (Coping Orientation to the Problems Experienced), and STAI (State-Trait Anxiety Inventory). The reliability of NuPCI was evaluated by assessing its internal consistency and factor structure (with a Confirmatory Factor Analysis, CFA). The concurrent validity between NuPCI and Brief-COPE and NuPDQ and STAI was investigated. Lastly, the relationship between NuPCI and NuPDQ was analyzed, as well as the ability of these scales to predict Apgar score at birth. RESULTS: Internal consistency of NuPCI scales was good for Planning-Preparation (ɑC=0.84) and Spiritual-Positive Coping (ɑC=0.81) scales, acceptable for Avoidance (ɑC=0.76) scale. Moreover, the original three-factor structure was confirmed using a CFA with 29 of the 32 items (χ2374 = 618.06; RMSEA = 0.056, 95% confidence interval: [0.048, 0.063]); CFI = 0.920; and TLI = 0.913). Statistically significant correlations between NuPCI scales and Brief-COPE subscales ranged between r = + 0.217 and r = + 0.624; also, NuPDQ score was positively correlated with STAI scales (State scale: r = + 0.539; Trait scale: r = + 0.462). Concurrent validity was confirmed reporting that NuPDQ score was predicted by NuPCI scores (R2 = 0.423, p < 0.001), positively by Avoidance (ß=+0.572) and Planning-Preparation (ß=+0.215) and negatively by Spiritual-Positive Coping (ß=-0.132). Finally, considering the stress, the effect of the Avoidance and Spiritual-Positive Coping scores respectively in decreasing (+ 155%) and increasing (+ 16%) the Apgar score became stronger. CONCLUSIONS: Italian NuPCI has sound psychometric properties and it is a useful coping measure. NuPDQ showed also a good validity. Our results may suggest a significant role for coping strategies, particularly in modulating the condition of the newborn at birth.

Reduced cortical thickness and increased gyrification in generalized anxiety disorder: a 3 T MRI study.

BACKGROUND: Although the study of the neuroanatomical correlates of generalized anxiety disorder (GAD) is gaining increasing interest, up to now the cortical anatomy of GAD patients has been poorly investigated and still no data on cortical gyrification are available. The aim of the present study is to quantitatively examine the cortical morphology in patients with GAD compared with healthy controls (HC) using magnetic resonance imaging (MRI). To the best of our knowledge, this is the first study analyzing the gyrification patterns in GAD. METHODS: A total of 31 GAD patients and 31 HC underwent 3 T structural MRI. For each subject, cortical surface area (CSA), cortical thickness (CT), gray matter volume (GMV), and local gyrification index (LGI) were estimated in 19 regions of interest using the Freesurfer software. These parameters were then compared between the two groups using General Linear Model designs. RESULTS: Compared with HC, GAD patients showed: (1) reduced CT in right caudal middle frontal gyrus (p < 0.05, Bonferroni corrected), (2) hyper-gyrification in right fusiform, inferior temporal, superior parietal and supramarginal gyri and in left supramarginal and superior frontal gyri (p < 0.05, Bonferroni corrected). No significant alterations in CSA and GMV were observed. CONCLUSIONS: Our findings support the hypothesis of a neuroanatomical basis for GAD, highlighting a possible key role of the right hemisphere. The alterations of CT and gyrification in GAD suggest a neurodevelopmental origin of the disorder. Further studies on GAD are needed to understand the evolution of the cerebral morphology with age and during the clinical course of the illness.

The mental simulation of state/psychological verbs in the adolescent brain: An fMRI study.

This fMRI study investigated mental simulation of state/psychological and action verbs during adolescence. Sixteen healthy subjects silently read verbs describing a motor scene or not (STIMULUS: motor, state/psychological verbs) and they were explicitly asked to imagine the situation or they performed letter detection preventing them from using simulation (TASK: imagery vs. letter detection). A significant task by stimuli interaction showed that imagery of state/psychological verbs, as compared to action stimuli (controlled by the letter detection) selectively increased activation in the right supramarginal gyrus/rolandic operculum and in the right insula, and decreased activation in the right intraparietal sulcus. We compared these data to those from a group of older participants (Tomasino et al. 2014a). Activation in the left supramarginal gyrus decreased for the latter group (as compared to the present group) for imagery of state/psychological verbs. By contrast, activation in the right superior frontal gyrus decreased for the former group (as compared to the older group) for imagery of state/psychological verbs.

Latent classes of emotional and behavioural problems in epidemiological and referred samples and their relations to DSM-IV diagnoses.

Researchers' interest have recently moved toward the identification of recurrent psychopathological profiles characterized by concurrent elevations on different behavioural and emotional traits. This new strategy turned to be useful in terms of diagnosis and outcome prediction. We used a person-centred statistical approach to examine whether different groups could be identified in a referred sample and in a general-population sample of children and adolescents, and we investigated their relation to DSM-IV diagnoses. A latent class analysis (LCA) was performed on the Child Behaviour Checklist (CBCL) syndrome scales of the referred sample (N = 1225), of the general-population sample (N = 3418), and of the total sample. Models estimating 1-class through 5-class solutions were compared and agreement in the classification of subjects was evaluated. Chi square analyses, a logistic regression, and a multinomial logistic regression analysis were used to investigate the relations between classes and diagnoses. In the two samples and in the total sample, the best-fitting models were 4-class solutions. The identified classes were Internalizing Problems (15.68%), Severe Dysregulated (7.82%), Attention/Hyperactivity (10.19%), and Low Problems (66.32%). Subsequent analyses indicated a significant relationship between diagnoses and classes as well as a main association between the severe dysregulated class and comorbidity. Our data suggested the presence of four different psychopathological profiles related to different outcomes in terms of psychopathological diagnoses. In particular, our results underline the presence of a profile characterized by severe emotional and behavioural dysregulation that is mostly associated with the presence of multiple diagnosis.

Normative data of the Magical Ideation Scale from childhood to adulthood in an Italian cohort.

The assessment of schizotypy allows to identify people at risk to develop psychosis. For this purpose, psychometric tools have been developed, such as the Magical Ideation Scale (MIS). This scale investigates attenuated forms of thought transmission experiences, thought withdrawal and aberrant beliefs, related to positive schizotypy. This study aims at providing an Italian version of the MIS and its normative data in the general population from childhood to adulthood, being the first study evaluating subjects under 17year-old. The Italian MIS version was translated by three independent operators and administered to 1378 non-clinical participants, stratified into four age groups (i.e., 8-13, 14-17, 18-24 and 25-34). The unidimensionality of the scale was supported, and its internal consistency was satisfactory (i.e., ordinal Cronbach's αs ranging from 0.86 to 0.90 in different age groups), as well as test-retest reliability (i.e., 1-month ICC of 0.82 in a retested sub-sample). Normative data for the age groups were provided. Specific gender and age-related differences in MIS score were found, i.e. females scored higher than males in the 25-34 age group, which in general, as a group, scored lower than all the other age groups. This study provided evidence of reliability for the Italian version of the MIS in childhood and adolescence, for the first time, as well as in adulthood, showing specific gender and age effects in the early adult cohort.

Exploring the effects of family and life events on genetic and environmental architecture of schizotypal and hypomanic dimensions: Insights from a twin study.

BACKGROUND: Strategies of prevention for psychiatric disorders need a deep understanding of the aetiological factors involved in the psychopathological processes. Our twin study aims at disentangling the contributions of genes and environment to schizotypal and hypomanic dimensions, considering the role of stressful life events (LEs) and the quality of family relationships. METHODS: The Magical Ideation Scale (MIS) and Perceptual Aberration Scale (PAS) were used to assess positive schizotypy, while Hypomanic Personality Scale (HPS) and its sub-scales were used to investigate proneness to affective disorders. 268 twins (54.5 % female; aged 18.0 ± 6.68) were included. Participants filled out a questionnaire on LEs and their parents provided an evaluation of intra-family relationship (Relationship Quality Index, RQI). Classic univariate twin models for quantitative traits were fitted for scales, and the effects of covariates (LEs and RQI) were assessed. RESULTS: For MIS, HPS and its sub-scales, significant common and unique environmental effects were detected, with genetic factors affecting only HPS Social Vitality sub-scale. Unique environment was the only source of variance of PAS score. The number of recent LEs influenced MIS and PAS models, while RQI score affected MIS model. LIMITATIONS: The main limitation of the study is the small sample size, which reduces statistical power and may potentially lead to an underestimation of heritability. Additionally, the cross-sectional design limits the possibility to draw causal considerations. CONCLUSIONS: Findings provide preliminary evidence for a significant environmental role in modulating states of vulnerability. Moreover, the expression of positive schizotypy resulted influenced by recent stressors and intra-family relationships.

Lessons Learnt From Running a Transition-Age Youth Mental Health Outpatient Clinic in Italy: The PRecocity of Intervention in Adolescent Medicine (PRIMA) Experience.

AIM: This study assessed whether transition age between adolescence and young adulthood poses a challenge for both patients and mental health services. METHODS: We retrospectively examined the baseline characteristics, diagnoses and treatments of 99 individuals aged 16-35 presenting to the PRecocity of Intervention in Adolescent Medicine (PRIMA) transition-age mental health outpatient clinic, Italy, over a 24-month period. RESULTS AND DISCUSSION: Most patients were female, aged 20 or younger, employed and did not experience impairment in daily autonomies. About half patients were referred by general practitioners or self-referred, often as initial contact with any adult mental health services, complaining with multiple symptoms (88%), mainly including anxiety, affective disturbances and insomnia. Most of them received a single diagnosis (68%), one out of three being diagnosed with a neurodevelopmental disorder. Patients presenting with anxiety (63% vs. 32%; OR = 3.55, p = 0.01) and affective symptoms (56% vs .23%; OR = 4.26, p = 0.01) and receiving multiple diagnoses (30% vs. 9%; χ2(2) = 19.7, p < 0.01) were more likely to be prescribed with psychopharmacological medication at the first visit. At a 6-month follow-up, one in two patients remained in PRIMA, while the others required different services tailored to their specific conditions, especially neurodevelopmental disorders. CONCLUSION: Findings from this study warrant the need for specialised mental healthcare facilities ensuring timely and high-quality interventions for adolescents transitioning into young adulthood.

The ability of CBCL DSM-oriented scales to predict DSM-IV diagnoses in a referred sample of children and adolescents.

The majority of studies examining associations between clinical-diagnostic and empirical-quantitative approaches have concentrated only on the target diagnosis without taking into account any possible co-variation of psychopathological traits, which is intrinsic to child psychopathology. The ability of child behaviour checklist (CBCL) DSM-oriented scales (DOSs) to predict target and other DSM diagnoses, taking into consideration the covariation of psychopathological traits, was analysed by logistic regression analysis. Corresponding odds ratio (OR) was used as indicator of the strength of the relationship between the clinical score in DOSs and the presence of DSM-IV diagnoses. Logistic regression allowed us to consider multiple scales simultaneously, thus addressing the problem of co-occurrence of psychopathological traits, and to include gender and age as covariates. The sample consisted of 360 children and adolescents aged 6-16 years, consecutively referred for behavioural and emotional problems. As a whole, the CBCL DOSs seem to be more specific but with a weaker association with DSM-IV diagnoses than syndrome scales, and with some distinctive features: clinical scores in the anxiety DOS suggest a diagnosis of both anxiety and mood disorder; clinical scores in the somatic problems DOS are very strong and specific predictors for diagnosis of separation anxiety disorder; clinical scores in the oppositional defiant problems DOS are not only predictors of the oppositional defiant disorder but are also strong predictors of generalized anxiety disorder; clinical scores in the conduct problems DOS are a specific and strong predictor for oppositional defiant disorder. Results confirm the clinical usefulness of CBCL and suggest using both syndrome and DOS scales for a complete and accurate assessment of children and adolescents.

Prevalence and Risk Factors for Absconding from an Open-Door, No-Restraint Inpatient Psychiatric Unit: A Single-Center Study in Italy.

Absconding from inpatient psychiatric services has been associated with poor outcomes, putting the patient and community at risk and prolonging the recovery process. A retrospective study investigated the absconding rates and risk factors among patients admitted to an open-door, no-restraint inpatient psychiatric unit. Overall, the absconding rate was 4.5%, and the relative risk of absconding was higher for male, younger, and non-Caucasian patients as well as for those who had already absconded, were unknown to health services, compulsorily admitted, admitted for substance abuse, and in the first days of hospitalization. The findings of this study may have important public health implications.

Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management.

Background: Mentalization is the ability to use internal mental states to manage and understand one's own and others' behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. Methods: Using the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., 'hypo-mentalization' or 'uncertainty': concrete thinking with poor attribution of mental states; 'hyper-mentalization' or 'certainty': rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). Results: Thirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients' mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. Conclusions: OA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.

Changes in Revolving-Door Mental Health Hospitalizations during the COVID-19 Pandemic: A 5-Year Chart Review Study.

This study assessed changes in revolving-door (RD) mental health hospitalizations during the COVID-19 pandemic. A 5-year retrospective hospital chart review was performed, collecting revolving-door hospitalization, sociodemographic, and clinical data. Out of 1036 patients, 5.69% had RD hospitalizations, which accounted for 10.38% of all recorded hospitalizations. Further, a higher number of RD hospitalizations occurred following the pandemic outbreak, which is unlikely to have been a result of the confounding effect of trimester and month of hospitalization. Finally, several sociodemographic and clinical characteristics recurred more frequently in the context of RD hospitalizations, such as being younger, being compulsorily admitted, being an absconding patient, and being referred by a public service. Certain diagnostic categories occurred more frequently among RD hospitalizations, including psychotic, personality, and substance use disorders, as well as intellectual disability. Patients with specific characteristics are more likely to incur in RD hospitalizations, requiring the implementation of supportive treatment plans, especially following the pandemic outbreak.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy.

Introduction: Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy. Methods: This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures. Results: In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures. Discussion: Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.

Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9-year chart review study.

Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre-existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty-nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9-year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)-10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between-group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = -1.962; χ2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis-inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.

Efficacy of a Group Psychoeducation Treatment in Binge Eating Disorder: An Open-Label Study.

Aims: To evaluate the effectiveness of a multidisciplinary group psychoeducation treatment (GPT) in patients with Binge Eating Disorder (BED). Methods: We designed an open-label efficacy study that included a population of 45 patients diagnosed with BED. A measure of eating attitudes and associated psychological constructs was obtained through the use of the self-report instruments Eating Disorder Inventory (EDI-3), Binge Eating Scale (BES) and Body Uneasiness Test (BUT). The Symptom Checklist-90 (SCL-90) was also administered to assess general psychopathology. All participants participated in 12 weekly group psychoeducational treatment meetings, 8 of which were conducted by mental health professionals, and a second module of 4 meetings, oriented on health and nutrition education topics, conducted by a dietician. Results: At the end of treatment, patients showed significant improvements in body mass index (BMI) and binge eating. Paired t-tests showed significant differences at p-value < 0.05 in all eating disorder risk scales and for most of the general psychological scales related to eating disorders. In addition, patients experienced an improvement in their perception of overall body image, a decrease in concerns about physical appearance and less body image avoidance. Finally, results showed that psychoeducation treatment was associated with significant improvements in interpersonal sensitivity. Conclusions: The results of this study may indicate that significant short-term improvements can be achieved through a psychoeducation group for BED patients. Although limited by the lack of a control condition, this study adds to a growing body of evidence with promising results, setting the stage for further case-control studies of BED treatment.

Language production impairments in patients with a first episode of psychosis.

Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations.

Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset.

OBJECTIVE: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. METHODS: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. RESULTS: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. CONCLUSIONS: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Prenatal Stress and Psychiatric Symptoms During Early Phases of the COVID-19 Pandemic in Italy.

PURPOSE: In February 2020, Italy became the first European country to face the coronavirus disease 2019 (COVID-19) outbreak. The concerns of infection, financial worries, loss of freedom, and isolation during the ongoing pandemic can lead to negative psychological effects, including anxiety, depression, and obsessive-compulsive disorder. The main aim of our study was to evaluate the relationship between pandemic-related stress and pregnancy-specific stress and assess their role in the development of psychiatric symptoms. We predicted that pregnancy-specific stress would mediate an association of pandemic-related stress with psychiatric symptoms. PATIENTS AND METHODS: A total of 258 pregnant women were assessed for general emotional symptoms with the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and an Obsessive-Compulsive Disorder screening (OCD). The Revised Prenatal Distress Questionnaire (NuPDQ) and the Pandemic-Related Pregnancy Stress Scale (PREPS) were administered as measures of pregnancy-specific stress (PSS and pandemic-related, respectively). Mediation effects by NuPDQ for PREPS stress scales on psychiatric outcomes were calculated, using regression series and correcting for general covariates. RESULTS: Almost a third of the sample reported clinically relevant anxiety levels (32.6%), 11.2% were positive for OCD screening and less than 5% were positive for depression screening. The stress related to feeling unprepared for delivery and postpartum (PREPS-PS) predicted PHQ-2 score, both directly and indirectly via PSS, and it predicted GAD-7 score only indirectly. The stress related to fear of infection (PREPS-PIS) was directly associated to GAD-7 score and - through PSS - to PHQ-2 score and OCD. CONCLUSION: The pandemic onset contributed to poor mental health, especially anxiety, in a substantial portion of Italian pregnant women. Our results emphasize the importance of strategies to reduce pregnancy-specific stress, as well as to diminish stress due to the pandemic. Identifying risk factors for psychological suffering is important to prevent potential long-term consequences for mothers and their offspring.

Psychometric properties of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and its correlation with anxiety and depression.

BACKGROUND: In the beginning of 2020, Italy was the first European country to face the COVID-19 outbreak. Restrictions imposed during the pandemic, social isolation, and the cancellation of medical appointments likely resulted in stress that may have affected pregnant women adversely. AIMS: To determine the psychometric validity of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) in assessing COVID-19-related stress in pregnant women and to examine correlations between PREPS scales and symptoms of anxiety and depression. METHODS: 232 pregnant women attending the Obstetric-Gynecologic Clinic of an Academic Hospital were assessed with the PREPS, the Revised Prenatal Distress Questionnaire (NuPDQ), the General Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-2 (PHQ-2). We analyzed the internal consistency and factor structure of the PREPS. Convergent validity was examined by comparison with the NuPDQ. PHQ-2 and GAD-7 were used to measure the association with depression and anxiety. RESULTS: Acceptable-to-good internal consistency was found for the three PREPS scales: Preparedness Stress (PS, α=0.760), Prenatal Infection Stress (PIS, α=0.857), and Positive Appraisal (PA, α=0.747). Correlations of the NuPDQ with both PREPS stress scale scores (PS and PIS) were statistically significant, but on multiple regression analysis only the PS scale was correlated with the NuPDQ. Prenatal infection stress predicted GAD-7 score, while Preparedness stress predicted PHQ-2 score. LIMITATIONS: The main limitations were the small sample size and the cross-sectional design of the study. CONCLUSION: The Italian PREPS exhibited good psychometric properties and associations with clinical symptoms of anxiety and depression.

Stress, Coping, and Psychiatric Symptoms in Pregnant Women in Outpatient Care During the 2021 Second-Wave COVID-19 Pandemic.

Aims: Women face many sources of stress throughout their lives, and some periods are particularly sensitive; pregnancy is one of them. The COVID-19 pandemic is a likely source of additional stress for pregnant women. Moreover, there is evidence that pregnant women have experienced high levels of anxiety and depression symptoms during the pandemic. Our study aimed to evaluate the association of pregnancy-specific stress, pandemic-related stress, and coping strategies with anxiety, depressive and obsessive-compulsive symptomatology in Italian women during the second wave of the COVID-19 pandemic (December 2020-June 2021). We also investigated whether there were differences in these levels of psychopathology compared to a prior study conducted during the first pandemic wave (April-August 2020) in Italian pregnant women. Methods: We assessed 325 pregnant women receiving outpatient prenatal care, using the Revised Prenatal Distress Questionnaire (NuPDQ), Pandemic-Related Pregnancy Stress Scale (PREPS), the Revised Prenatal Coping Inventory (NuPCI), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and Obsessive-Compulsive Disorder (OCD) screening. The main analysis was conducted comparing multiple logistic regression models predicting each psychopathological outcome from specific covariates and NuPDQ, PREPS, and NuPCI scores. Results: 42.8% of the sample reported significant levels of anxiety, while 10.3% was positive on depression screening and 13.1% on OCD screening. No significant difference was found in the prevalence of high anxiety, depression, or OCD screening scores compared with the first pandemic wave. Controlling for covariates, we found that GAD-7 and PHQ-2 scores were predicted by pregnancy-specific stress; positive OCD screening was not. The model of high anxiety was improved by adding pandemic-related stress as a predictor (in particular, feeling unprepared for delivery and postpartum). Finally, coping strategies (avoidance, spiritual coping, and planning-preparation) significantly improved prediction of all three psychopathological outcomes. Conclusions: The present study suggests the importance of pregnancy-related stress, COVID-19 pandemic stress, and of coping strategies in counteracting or contributing to psychiatric symptomatology during the current pandemic.