Autism and intention attribution test: a non-verbal evaluation with comic strips.

BACKGROUND: Despite autism spectrum disorder (ASD) and mentalization being two words often associated in the literature, the assessment of this ability in individuals with ASD in the clinical setting is still limited. Indeed, there are no standardized Theory of Mind (ToM) tests that are adaptable to different cognitive profiles, such as individuals with language poverty, and intellectual or memory impairments. This study proposes a non-verbal test (Intentions Attribution-Comic Strip Test; IA-CST) to evaluate the ability to infer the intentions of others, a basic component of ToM, in the clinical setting. METHOD: In Study 1, the test was administered to 261 healthy individuals and we performed structural validation using Exploratory Graph Analysis. In Study 2, the final version of the test was administered to 32 individuals with ASD to assess the known group validity of the measure by comparing their scores with a sample of IQ-matched controls. Moreover, we performed logistic regression and ROC curve to preliminarily assess the diagnostic performance of the IA-CST. RESULTS: The IA-CST resulted in a 3-dimension measure with good structural stability. Group comparison indicated that the ASD group shows significantly lower performance in intention attribution but not in inferring causal consequences. The test demonstrated known group validity and that, preliminarily, it is suitable for implementation within the clinical practice. CONCLUSIONS: The results support the IA-CST as a valid non-verbal task for evaluating intentions attribution in the clinical setting. Difficulties in ToM are early and relevant in ASD, so assessing these aspects is valuable for structuring individualized and evidence-based interventions.

On the Evaluation of Engagement in Immersive Applications When Users Are on the Autism Spectrum.

New generation wearable devices allow for the development of interactive environments tailored for Virtual Reality (VR)- and Augmented Reality (AR)-based treatment of Autism Spectrum Disorders (ASD). Experts agree on their potential; however, there is lack of consensus on how to perform trials and the need arises for evaluation frameworks, methods, and techniques appropriate for the ASD population. In this paper, we report on a study conducted with high-functioning ASD people in the 21-23 age range, with the objectives of (1) evaluating the engagement of two headsets offering distinct immersive experiences, (2) reasoning on the interpretation of engagement factors in the case of ASD people, and (3) translating results into general guidelines for the development of VR/AR-based ASD treatment. To this aim, we (1) designed two engagement evaluation frameworks based on behavioral observation measures, (2) set up two packages of reference immersive scenarios, (3) defined the association between metrics and scenarios, and (4) administered the scenarios in distinct sessions for the investigated headsets. Results show that the immersive experiences are engaging and that the apparent lack of success of some evaluation factors can become potential advantages within the framework of VR/AR-based ASD treatment design.

Are Autism Spectrum Disorder and Asexuality Connected?

Asexuality is a lack of sexual attraction to any gender. There is some evidence to suggest that many self-identified asexuals have a formal diagnosis of autism spectrum disorder which is characterized by deficits in social interaction and communication, as well as by restricted and repetitive interests and behaviors. Additionally, the literature shows that asexuality and lack of sexual attraction or low sexual interest is overrepresented in people with autism spectrum disorder compared with neurotypical samples. Nevertheless, no studies have been conducted to investigate the relationship between autism and asexuality in depth. We conducted a systematic review of the literature to examine whether asexuality and autism spectrum disorder are connected. We conclude that asexuality and autism share various aspects, such as a possible role of prenatal factors, reference to romantic dimensions of sexual attraction and sexual orientation, and non-partner-oriented sexual desire, but future research should explore and clarify this link.

Using the Griffiths Mental Development Scales to Evaluate a Developmental Profile of Children with Autism Spectrum Disorder and Their Symptomatologic Severity.

Early diagnosis is crucial for Autism spectrum disorder (ASD) and is achieved through a screening of developmental indicators to recognise children who are at risk of autism. One of the most widely used instruments in clinical practice for assessing child development is the Griffiths Mental Development Scale (GMDS). We sought (a) to assess longitudinally whether children diagnosed with ASD, with a mean age of 33.50 months (SD 7.69 months), show a developmental delay of abilities measured by the GMDS over time and (b) to analyse which skills of the GMDS could be associate to the symptomatologic severity of ASD. Our results showed lower scores of General Quotient and all sub-quotients of GMDS from first (T0) to second assessment (T1), except for the Performance sub-quotient. Three sub-quotients (Personal-Social, Hearing and Language and Practical Reasoning) also associate symptom severity at the time when the diagnosis of ASD is made.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study.

BACKGROUND: Interpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness. METHODS: The sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected. RESULTS: Both violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns. CONCLUSIONS: The main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

The role of sleep in aesthetic perception and empathy: A mediation analysis.

The ability to experience aesthetics plays a fundamental role in human social interactions, as well as the capacity to feel empathy. Some studies have shown that beauty perception shares part of the neural network underlying emotional and empathic abilities, which are also known to affect sleep quality and duration. In this study, we evaluated for the first time the effects of sleep on the relation between aesthetic perception and empathic abilities in healthy subjects using a mediation analysis approach. One-hundred and twenty-six subjects participated in this study. One-hundred and one subjects slept at home (Sleep Group). The remaining 25 subjects were tested as controls after 1 night of sleep deprivation to assess the effects of lack of sleep on aesthetic perception and empathy (Sleep-Deprived Group). All participants underwent one testing session in which they performed a battery of empathy tests and an aesthetic perception task (Golden Beauty). The results showed that sleep duration mediates the relationship between empathy and aesthetic perception in the sleep group. The mediation effect of sleep was more evident on the emotional empathy measures. Conversely, in the sleep deprivation group the lack of correlations among empathy, aesthetic perception and sleep variables did not allow to perform the mediation analysis. These results suggest that adequate sleep duration may play a significant role in improving cognitive and emotional empathic abilities as well as the capability to give accurate aesthetic judgements.

Effect of agomelatine treatment on C-reactive protein levels in patients with major depressive disorder: an exploratory study in "real-world," everyday clinical practice.

OBJECTIVE: Agomelatine is a newer antidepressant but, to date, no studies have been carried out investigating its effects on C-reactive protein (CRP) levels in major depressive disorder (MDD) before and after treatment. The present study aimed (i) to investigate the effects of agomelatine treatment on CRP levels in a sample of patients with MDD and (ii) to investigate if CRP variations were correlated with clinical improvement in such patients. METHODS: 30 adult outpatients (12 males, 18 females) with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of MDD were recruited in "real-world," everyday clinical practice and treated with a flexible dose of agomelatine for 12 weeks. The Hamilton Rating Scale for Depression (HAM-D) and the Snaith-Hamilton Pleasure Scale (SHAPS) were used to evaluate depressive symptoms and anhedonia, respectively. Moreover, serum CRP was measured at baseline and after 12 weeks of treatment. RESULTS: Agomelatine was effective in the treatment of MDD, with a significant reduction in HAM-D and SHAPS scores from baseline to endpoint. CRP levels were reduced in the whole sample, with remitters showing a significant difference in CRP levels after 12 weeks of agomelatine. A multivariate stepwise linear regression analysis showed that higher CRP level variation was associated with higher baseline HAM-D scores, controlling for age, gender, smoking, BMI, and agomelatine dose. CONCLUSIONS: Agomelatine's antidepressant properties were associated with a reduction in circulating CRP levels in MDD patients who achieved remission after 12 weeks of treatment. Moreover, more prominent CRP level variation was associated with more severe depressive symptoms at baseline.

[Neural activity related to emotional and empathic deficits in subjects with post-traumatic stress disorder who survived the L'Aquila (Central Italy) 2009 earthquake]. / Attività neurale correlata alle difficoltà emozionali ed empatiche in soggetti con disturbo post-traumatico da stress sopravvissuti al terremoto dell'Aquila del 2009.

Post-Traumatic Stress Disorder (PTSD) is a chronic anxiety disorder. The continued efforts to control the distressing memories by traumatized individuals, together with the reduction of responsiveness to the outside world, are called Emotional Numbing (EN). The EN is one of the central symptoms in PTSD and it plays an integral role not only in the development and maintenance of post-traumatic symptomatology, but also in the disability of emotional regulation. This disorder shows an abnormal response of cortical and limbic regions which are normally involved in understanding emotions since the very earliest stages of the development of processing ability. Patients with PTSD exhibit exaggerated brain responses to emotionally negative stimuli. Identifying the neural correlates of emotion regulation in these subjects is important for elucidating the neural circuitry involved in emotional and empathic dysfunction. We showed that PTSD patients, all survivors of the L'Aquila 2009 earthquake, have a higher sensitivity to negative emotion and lower empathy levels. These emotional and empathic deficits are accompanied by neural brain functional correlates. Indeed PTSD subjects exhibit functional abnormalities in brain regions that are involved in stress regulation and emotional responses. The reduced activation of the frontal areas and a stronger activation of the limbic areas when responding to emotional stimuli could lead the subjects to enact coping strategies aimed at protecting themselves from the re-experience of pain related to traumatic events. This would result in a dysfunctional hyperactivation of subcortical areas, which may cause emotional distress and, consequently, impaired social relationships often reported by PTSD patients.

[Sleep disturbances and spatial memory deficits in post-traumatic stress disorder: the case of L'Aquila (Central Italy)]. / Disturbi del sonno e della memoria spaziale nel disturbo post-traumatico da stress: il caso dell'Aquila.

Altered sleep is a common and central symptom of post-traumatic stress disorder (PTSD). In fact, sleep disturbances are included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for PTSD. However, it has been hypothesized that sleep disturbances are crucially involved in the aetiology of PTSD, rather than being solely a symptom arising secondarily from this disorder. Therefore, knowing the long-term effects of a trauma can be essential to establish the need of specific interventions for the prevention and treatment of mental disorders that may persist years after a traumatic experience. In one study we showed, for the first time, that even after a period of two years people exposed to a catastrophic disaster such as the L'Aquila earthquake continue to suffer from a reduced sleep quality. Moreover, we observed that sleep quality scores decreased as a function of the proximity to the epicentre, suggesting that the psychological effects of an earthquake may be pervasive and long-lasting. It has been widely shown that disruption of sleep by acute stress may lead to deterioration in memory processing. In fact, in a recent study we observed alterations in spatial memory in PTSD subjects. Our findings indicated that PTSD is accompanied by an impressive deficit in forming a cognitive map of the environment, as well as in sleep-dependent memory consolidation. The fact that this deterioration was correlated to the subjective sleep disturbances in our PTSD group demonstrates the existence of an intimate relationship between sleep, memory consolidation, and stress.

[Autism after an earthquake: the experience of L'Aquila (Central Italy) as a basis for an operative guideline]. / L'autismo nel post-terremoto: l'esperienza dell'Aquila come base per una linea guida operativa.

People with autism, their families, and their specialised caregivers are a social group at high health risk after a disruptive earthquake. They need emergency assistance and immediate structured support according to definite protocols and quality standards. We recommend to establish national guidelines for taking-in-charge people with autism after an earthquake. The adaptive behaviour of participants with autism declined dramatically in the first months after the earthquake in all the dimensions examined (i.e., communication, daily living, socialisation, and motor skills). After relatively stable conditions returned and with immediate and intensive post-disaster intervention, children and adolescents with autism showed a trend towards partial recovery of adaptive functioning. As to the impact on services, this study indicates the need for supporting exposed caregivers at high risk of burnout over the first two years after the disaster and for an immediate reorganisation of person-tailored services.

Alexithymia, responsibility attitudes and suicide ideation among outpatients with obsessive-compulsive disorder: an exploratory study.

AIMS: Obsessive-compulsive disorder (OCD) is psychiatric disorder with a significant suicide risk, and the presence of alexithymia may increase this risk. As several studies attribute an important role, in OCD, to responsibility, the aims of this study were to evaluate possible clinical differences between patients positive or not for alexithymia concerning disorder severity, responsibility attitudes and suicide ideation and investigate which variables were associated with increased suicide ideation. METHODS: 104 adult outpatients with OCD were recruited. Alexithymia was measured with Toronto Alexithymia Scale (TAS-20), attitude about responsibility was tested with Responsibility Attitude Scale (RAS), suicide ideation was assessed with Scale of Suicide Ideation (SSI) and depressive symptoms were evaluated with Montgomery Åsberg Depression Rating Scale (MADRS). Score of item #11 on the Y-BOCS was considered as a measure of insight. RESULTS: Patients positive for alexithymia showed higher responsibility attitudes and more severe suicide ideation. In a blockwise regression model, the presence of lower insight, higher RAS scores and difficulty in identifying feelings dimension of TAS-20 were associated with higher SSI scores. CONCLUSIONS: OCD patients with alexithymia may show higher disorder severity, lower insight and inflated responsibility, all related to suicide ideation, independently from depressive symptoms. Implications were discussed and study limitations considered and reported.

Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2).

OBJECTIVE: To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE). METHOD: The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS: In our sample (n=500, of whom, BD-I=329; BD-II=70; MDD=101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=82% and specificity=77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factors analyses. Item n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach's alphas were F1=.86 and F2=.60. LIMITATIONS: No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE. CONCLUSIONS: In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients.

Agomelatine beyond borders: current evidences of its efficacy in disorders other than major depression.

Agomelatine, a melatonergic antidepressant with a rapid onset of action, is one of the most recent drugs in the antidepressant category. Agomelatine's antidepressant actions are attributed to its sleep-promoting and chronobiotic actions mediated by MT1 and MT2 receptors present in the suprachiasmatic nucleus, as well as to its effects on the blockade of 5-HT2c receptors. Blockade of 5-HT2c receptors causes release of both noradrenaline and dopamine at the fronto-cortical dopaminergic and noradrenergic pathways. The combined actions of agomelatine on MT1/MT2 and 5-HT2c receptors facilitate the resynchronization of altered circadian rhythms and abnormal sleep patterns. Agomelatine appeared to be effective in treating major depression. Moreover, evidence exists that points out a possible efficacy of such drug in the treatment of bipolar depression, anxiety disorders, alcohol dependence, migraines etc. Thus, the aim of this narrative review was to elucidate current evidences on the role of agomelatine in disorders other than major depression.

Normative values and diagnostic optimisation of three social cognition measures for autism and schizophrenia diagnosis in a healthy adolescent and adult sample.

Awareness of the importance of assessing social cognition skills under conditions showing atypical social behaviours has increased over the years. However, the evaluation of the psychometric properties of the measures and the availability of normative values for the clinical context are still limited. This study aims to revise, provide normative values, and evaluate the clinical validity of the Italian version of three social cognition measures: Advanced Theory of Mind (A-ToM) task, the Emotion Attribution Task (EAT), and the Social Situation Task (SST). Measures were administered to 580 adolescents and adult healthy controls (age range 14-50). We performed differential item functioning and Rasch analysis to revise each task, so normative data of the revised measures were calculated. Moreover, the revised measures were administered to 38 individuals with autism spectrum disorder (ASD) and 35 individuals with schizophrenia spectrum disorders (SSD): ASD and SSD were matched by age, gender, and IQ with a control sample to evaluate clinical validity. ROC analysis showed that the SST is the best measure differentiating between healthy and clinical groups, compared to the A-ToM (AUCASD = 0.70; AUCSSD = 0.65) and EAT (AUCASD = 0.67; AUCSSD = 0.50), which showed poorer performance. For SSD diagnosis, two SST subscales (Violation and Gravity score) indicated the best accuracy (AUCs of 0.88 and 0.84, respectively); for the ASD diagnosis, we propose a combined score between the SST subscale and A-ToM (AUC = 0.86). The results suggest that the proposed measures can be used to support the diagnostic process and clinical practice.

Locomotion and Postural Control in Young Adults with Autism Spectrum Disorders: A Novel Kinesiological Assessment.

Background/Objectives: The purposes of the present study were to assess gait by using a novel approach that plots two adjacent joint angles and the postural control in individuals with autism (ASD) and individuals with typical neurodevelopmental (TD). Methods: The surface electromyography (sEMG) activity was measured synchronously with the other variables. Twenty young adult men, 10 with TD and 10 with a diagnosis of ASD, took part in this study. Results: There was a significant difference between ASD and TD groups in the area described by the knee-ankle diagram (p < 0.05). The sEMG activity recorded from the lateral gastrocnemius (LG) during the contact phase of gait was significantly lower in the ASD group compared with the TD group (p < 0.05). The sEMG activity recorded in the different postural conditions showed differences in LG and tibialis anterior (TA) between the ASD and TD groups (p < 0.05). Conclusions: The knee-ankle diagram provided a sensitive and specific movement descriptor to differentiate individuals with ASD from individuals with TD. The reduced LG activation is responsible for the reduced area in the knee-ankle diagram and 'toe-walking' in individuals with ASD and represents the common denominator of an altered ankle strategy during locomotion and postural control.

Atypical Time to Contact Estimation in Young Adults with Autism Spectrum Disorder.

Individuals with Autism Spectrum Disorder (ASD) present atypical sensory processing in the perception of moving stimuli and biological motion. The present study aims to explore the performance of young adults with ASD in a time to contact (TTC) estimation task involving social and non-social stimuli. TTC estimation involves extrapolating the trajectory of a moving target concealed by an occluder, based on the visible portion of its path, to predict the target's arrival time at a specific position. Sixteen participants with a diagnosis of level-1 ASD (M = 19.2 years, SE = 0.54 years; 3 F, 13 M) and sixteen participants with TD (M = 22.3 years, SE = 0.44 years; 3 F, 13 M) took part in the study and underwent a TTC estimation task. The task presented two object types (a car and a point-light walker), different object speeds, occluder lengths, motion directions and motion congruency. For the car object, a larger overestimation of TTC emerged for ASDs than for TDs, whereas no difference between ASDs and TDs emerged for the point-light walker. ASDs exhibited a larger TTC overestimation for the car object than for the point-light walker, whereas no difference between object types emerged for TDs. Our results indicated an atypical TTC estimation process in young adults with ASD. Given its importance in daily life, future studies should further explore this skill. Significant effects that emerged from the analysis are discussed.

Cognitive safety of focused ultrasound thalamotomy for tremor: 1-year follow-up results of the COGNIFUS part 2 study.

Introduction: In the COGNitive in Focused UltraSound (COGNIFUS) study, we examined the 6-month cognitive outcomes of patients undergoing MRgFUS thalamotomy. This study endorsed the safety profile of the procedure in terms of cognitive functions that cannot be evaluated in real-time during the procedure unlike other aspects. The aim of the COGNIFUS Part 2 study was to investigate the cognitive trajectory of MRgFUS patients over a 1-year period, in order to confirm long-term safety and satisfaction. Methods: We prospectively evaluated the cognitive and neurobehavioral profile of patients with essential tremor (ET) or Parkinson's Disease (PD) related tremor undergoing MRgFUS thalamotomy at 1 year-follow-up following the treatment. Results: The sample consists of 50 patients (male 76%; mean age ± SD 69.0 ± 8.56; mean disease duration ± SD 12.13 ± 12.59; ET 28, PD 22 patients). A significant improvement was detected at the 1 year-follow-up assessment in anxiety and mood feelings (Hamilton Anxiety rating scale 5.66 ± 5.02 vs. 2.69 ± 3.76, p ≤ <0.001; Beck depression Inventory II score 3.74 ± 3.80 vs. 1.80 ± 2.78, p = 0.001), memory domains (Rey Auditory Verbal Learning Test, immediate recall 31.76 ± 7.60 vs. 35.38 ± 7.72, p = 0.001 and delayed recall scores 5.57 ± 2 0.75 vs. 6.41 ± 2.48), frontal functions (Frontal Assessment Battery score 14.24 ± 3.04 vs. 15.16 ± 2.74) and in quality of life (Quality of life in Essential Tremor Questionnaire 35.00 ± 12.08 vs. 9.03 ± 10.64, p ≤ 0.001 and PD Questionnaire -8 7.86 ± 3.10 vs. 3.09 ± 2.29, p ≤ 0.001). Conclusion: Our study supports the long-term efficacy and cognitive safety of MRgFUS treatment for ET and PD.

Regional cerebral changes and functional connectivity during the observation of negative emotional stimuli in subjects with post-traumatic stress disorder.

Patients with post-traumatic stress disorder (PTSD) exhibit exaggerated brain responses to emotionally negative stimuli. Identifying the neural correlates of emotion regulation in these subjects is important for elucidating the neural circuitry involved in emotional dysfunction. The aim of this study was to investigate the functional connectivity between the areas activated during emotional processing of negative stimuli in a sample of individuals affected by PTSD compared to a group of healthy subjects. Ten subjects with PTSD (who survived the L'Aquila 2009 earthquake) and ten healthy controls underwent fMRI during which the participants observed 80 images: 40 pictures with negative emotional valence and 40 neutral (scrambled) stimuli. A higher activation was found in the left posterior (LP) insula for PTSD group and in the ventromedial prefrontal cortex (vmPFC) for the healthy group. Two sets of Granger causality modeling analyses were performed to examine the directed influence from LP-insula and vmPFC to other brain regions. Activity in the vmPFC in the healthy group while observing negative stimuli predicted activity in several subcortical regions and insula, while in the PTSD group the LP-insula exerted a positive directed influence on several cortical regions. The hyperactivation in PTSD subjects of subcortical areas such as the insula would underlie the emotional, social, and relational difficulties of PTSD patients.

A longitudinal study of quality of life of earthquake survivors in L'Aquila, Italy.

BACKGROUND: People's well-being after loss resulting from an earthquake is a concern in countries prone to natural disasters. Most studies on post-earthquake subjective quality of life (QOL) have focused on the effects of psychological impairment and post-traumatic stress disorder (PTSD) on the psychological dimension of QOL. However, there is a need for studies focusing on QOL in populations not affected by PTSD or psychological impairment. The aim of this study was to estimate QOL changes over an 18-month period in an adult population sample after the L'Aquila 2009 earthquake. METHODS: The study was designed as a longitudinal survey with four repeated measurements performed at six monthly intervals. The setting was the general population of an urban environment after a disruptive earthquake. Participants included 397 healthy adult subjects. Exclusion criteria were comorbidities such as physical, psychological, psychiatric or neurodegenerative diseases at the beginning of the study. The primary outcome measure was QOL, as assessed by the WHOQOL-BREF instrument. A generalised estimating equation model was run for each WHOQOL-BREF domain. RESULTS: Overall, QOL scores were observed to be significantly higher 18 months after the earthquake in all WHOQOL-BREF domains. The model detected an average increase in the physical QOL scores (from 66.6 ± 5.2 to 69.3 ± 4.7), indicating a better overall physical QOL for men. Psychological domain scores (from 64.9 ± 5.1 to 71.5 ± 6.5) were observed to be worse in men than in women. Levels at the WHOQOL domain for psychological health increased from the second assessment onwards in women, indicating higher resiliency. Men averaged higher scores than women in terms of social relationships and the environmental domain. Regarding the physical, psychological and social domains of QOL, scores in the elderly group (age > 60) were observed to be similar to each other regardless of the significant covariates used. CONCLUSIONS: WHOQOL-BREF scores of the psychological domain displayed trends conditioned by age and education: older subjects experienced less satisfaction with psychological health on average. Less-educated subjects always demonstrated the worst QOL scores. Gender, age and education impacted the variability of QOL in the environmental dimension in the elderly.

Acute stress reactions and associated factors in the help-seekers after the L'Aquila earthquake.

BACKGROUND: The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L'Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed. METHODS: For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies. RESULTS: Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by 'full' ASD, whereas 48 subjects (39.3%) could be considered affected by 'partial' ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting 'behavioural disengagement' or 'requesting emotional support from others' were found to increase the likelihood of a positive estimate of being an 'ASD case', while the adoption of an 'acceptance' coping style seemed to reduce the likelihood of the positive estimate of being an 'ASD case'. CONCLUSIONS: This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.