Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors.

OBJECTIVE: Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation. METHODS: In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected. RESULTS: 3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation. DISCUSSION: The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.

Migraine chronification as an allostatic disorder: a proof-of-concept study.

OBJECTIVE: The underpinning biologics of migraine chronification are not well understood. We aim to investigate the role of the cumulative burden of stress, namely the allostatic load, in migraine chronification. METHODS: This was a cross-sectional study. The allostatic load was measured with a composite multi-system score (BALI: Bologna Allostatic Load Index), evaluating 20 biomarkers representing four physiological systems: immune, metabolic, cardiovascular, and neuroendocrinological systems. BALI score was subdivided into high score and low score based on the distribution in controls. Migraine patients were included and subclassified into low-frequency episodic migraine group (low-EM group), high-frequency episodic migraine group (high-EM group), and chronic migraine group (CM group). RESULTS: The distribution of BALI high-score increased in parallel with headache attacks monthly frequency: 16% in low-EM group (n = 10), 24% in high-EM group (n = 12), and 40% in CM group (n = 21) (p = 0.017). In a multivariable analysis, the odds ratio of having a high-score BALI in CM patients (vs. low-EM patients) was 2.78 (95% CI 1.07-7.22; p = 0.036). Individual BALI biomarkers values which were significantly different among migraine subgroups included systolic blood pressure (p = 0.018), diastolic blood pressure (p < 0.001), and heart rate (p = 0.019). CONCLUSION: Our study substantiates this emerging concept of migraine chronification as an allostatic disorder.

The efficacy of a brief acceptance-based group intervention in a sample of female patients with fibromyalgia and comorbid obesity: a randomised controlled trial.

OBJECTIVES: A two-arm parallel randomised controlled trial was conducted to evaluate the efficacy of a group acceptance-based treatment (ABT) in improving pain acceptance, pain catastrophising, kinesiophobia, pain intensity and physical functioning compared to treatment as usual in patients with fibromyalgia (FM) and comorbid obesity. METHODS: Female individuals diagnosed with FM and obesity (n = 180) were randomly assigned to either a three-weekly group acceptance-based treatment plus treatment as usual (ABT+TAU) or only TAU. The variables of interest were assessed at baseline (T0) and after the interventions (T1). The treatment protocol for the ABT+TAU condition, designed for an inpatient rehabilitation context, is based on acceptance and commitment therapy but focuses specifically on pain acceptance, a crucial factor in fostering a more functional adaptation to chronic pain. RESULTS: Participants in the ABT+TAU group showed significant improvements in pain acceptance (i.e. the primary outcome), but also in pain catastrophising, kinesiophobia, and performance-based physical functioning (i.e. the secondary outcomes) compared to those in the TAU group. However, there were no significant differences in pain intensity between the two groups. CONCLUSIONS: These findings indicate that a brief group-based ABT intervention is effective in enhancing pain acceptance, reducing pain catastrophising and kinesiophobia, and improving performance-based physical functioning. Furthermore, the observed improvements in kinesiophobia and physical functioning may have particular relevance for individuals with comorbid obesity, as they can facilitate greater adherence to physical activity and promote weight loss.

Identification of psychological flexibility and inflexibility profiles during the COVID-19 pandemic.

BACKGROUND: The first coronavirus disease 2019 (COVID-19) wave and lockdown adversely affected the lives of people in diverse ways. AIMS: This study used a person-centered approach to identify patterns of engagement in the 12 psychological flexibility (PF) and inflexibility (PI) processes to manage the first COVID-19 wave and lockdown hardships. MATERIALS & METHODS: A total of 1035 Italian adults completed an online survey. RESULTS: Latent profile analyses conducted on the 12 PI/PF processes measured by the Multidimensional Psychological Flexibility Inventory identified five profiles; three reflected gradations of high to low PF with corresponding inverse levels of PI, while two represented more complex relationships between PI and PF. After controlling for relevant socio-demographic and COVID-19/lockdown factors, the five profiles differed in mental health (depression, anxiety, and COVID-19 distress). Essentially a gradient of progressive decreases in all PI processes (except experiential avoidance) corresponded with increments in mental health across all profiles. Two profiles, which evidenced the highest levels of mental health (highly flexible and moderately flexible profiles), also had the greatest proportion of the sample 56.42% (n = 584), and the highest levels of PF and experiential avoidance. DISCUSSION: Findings from this and similar studies suggest intersecting complex relationships among the PI/PF processes that are likely to shift in response to changing contexts. We suggest this network of relationships is better represented by a three-dimensional PF/PI hexaflex than a simplistic two-dimensional depiction of the model. CONCLUSION: Distinguishing different PF/PI profiles identified groups most at risk for the adverse mental health impacts of the pandemic and exposed variations in the mental health protective and risk roles of PF and PI processes, respectively, that can inform ACT-based mental health promotion interventions.

Illness unpredictability and psychosocial adjustment of adolescent and young adults impacted by parental cancer: the mediating role of unmet needs.

PURPOSE: Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. METHODS: A total of 113 AYAs (aged 11-24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). RESULTS: Higher offspring unmet needs were associated with lower health-related quality of life (r = -0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = -0.100* [-0.183, -0.018]) but not internalizing problems (standardized indirect effect = 0.067 [-0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (ß = 0.351**) which, in turn, predicted lower health-related quality of life (ß = -0.286**). CONCLUSION: These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer.

Medically unexplained symptoms and general practitioners: a comprehensive survey about their attitudes, experiences and management strategies.

Background: Medically unexplained symptoms (MUS) are common in primary care and are one of the most challenging clinical encounters for general practitioners (GPs). Objective: To assess GPs' clinical experience with MUS and its relationship with their gender, age and length of practice. Methods: Four hundred and thirty-three Italian GPs were invited to complete a questionnaire encompassing the following MUS-related features: workload, cognitive and emotional responses, management strategies, attitudes towards psychological interventions, sources of education and educational needs. Results: A total of 347 GPs (80.1%) participated in the study. About seven out of ten physicians spent 'much' or 'very much' time and energy for MUS during their daily practice. Fear of neglecting a medical disease was the most frequent (59.1%) response to MUS. Providing reassurance and support (73.8%) and listening to the patient (69.2%) were the most frequent management strategies. More than half of GPs rated psychological interventions as 'much' or 'very much' useful for MUS. However, only a third of GPs were well informed about the role of psychologists in MUS management. The main sources of education about MUS were scientific papers and continuing medical education courses. Most of GPs (77.5%) needed further education about MUS. GPs' younger age and lower length of practice were significantly associated with negative emotional responses to MUS. Conclusion: The introduction of guidelines for MUS in Italian primary care settings would promote a collaborative clinical approach to MUS and more formal training on this topic.

Smoking in Irritable Bowel Syndrome: A Systematic Review.

OBJECTIVE: The aim of this review was to examine (1) the prevalence of smoking in subjects with irritable bowel syndrome (IBS), (2) whether smoking prevalence significantly differs between subjects with and without IBS, and (3) whether smoking significantly predicts the presence or the development of IBS. METHODS: Articles were retrieved by systematically searching the Scopus, Web of Science, and PubMed electronic databases from inception to July 2016, using the keywords "smoking" and "tobacco" combined with "irritable bowel syndrome." Reference lists of included articles were also searched. Articles were included if they (1) reported data on smoking prevalence in subjects with IBS and/or on the association (assessed by means of multivariate analyses) between smoking and IBS, (2) identified IBS according to Manning criteria or Rome I-III criteria, (3) were English-language articles, and (4) involved only adult subjects. RESULTS: The electronic searches yielded a total of 1,637 records, and 42 articles met inclusion criteria. Another 13 articles were retrieved through manual search, leading to a total of 55 included articles. Smoking prevalence in subjects with IBS was assessed by 48 articles and ranged from 0% in university students to 47.1% in patients with microscopic colitis. Thirty-three articles compared smoking prevalence between subjects with and without IBS. In 25 articles no significant difference was found. In seven articles smoking was significantly more frequent in subjects with IBS compared to those without IBS, while one study found a significantly higher smoking prevalence in controls. Eighteen multivariate analyses assessing the association between smoking and IBS were presented in 16 articles. Only one study employed a prospective design. In 11 analyses, smoking was not significantly associated with IBS after adjusting for covariates. In seven studies smoking independently predicted the presence of IBS. CONCLUSIONS: According to the selected articles, a significant association between smoking and IBS cannot be confirmed. However, different shortcomings may hinder generalizability and comparability of many studies. A dimensional assessment of smoking, a prospective design, the differentiation between IBS subgroups, and the recruitment of patients in clinical settings, especially in primary care, are necessary to clarify the role of smoking in IBS.

The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis.

The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.

Protocol for a Randomized Controlled Trial Testing the Efficacy of a Transdiagnostic Virtual Reality-Based Intervention for the Reduction of Unhealthy Lifestyles and Behaviors in the General Population.

Virtual reality (VR) is a valuable tool for the treatment and prevention of psychiatric disorders and dysfunctional behaviors. Although VR software is mainly developed following a disorder-specific approach, this randomized controlled trial (RCT) will test the efficacy of a new transdiagnostic VR application (H.O.M.E. VR-based psychological intervention) in improving dysfunctional behaviors, three transdiagnostic factors concurrently (emotion regulation, experiential avoidance, and psychological flexibility), and stress. Three groups screened as at-risk for nicotine dependence, alcohol abuse, and eating disorders will be assigned to the H.O.M.E. VR intervention and compared to a waiting-list (WL) condition. Participants will be assessed before and after the H.O.M.E. intervention/WL and at the 3- and 6-month follow-ups in the levels of the displayed dysfunctional behavior, the three transdiagnostic factors, and stress. Changes in dysfunctional behaviors, transdiagnostic factors, and stress in each population VR group and differences in such improvements between each population of the VR and WL groups will be evaluated using mixed-model repeated measure analyses of variance. It is expected that, after the H.O.M.E. intervention and at follow-ups, participants will display improvements in physical and psychological health compared to controls. The H.O.M.E. protocol is expected to result in a cost-effective option to tackle cognitive-behavioral factors shared among several psychopathologies and dysfunctional behaviors.

Mental Pain, Psychological Distress, and Suicidal Ideation During the COVID-19 Emergency: the Moderating Role of Tolerance for Mental Pain.

The psychosocial stressors related to the ongoing COVID-19 pandemic and associated lockdowns have been shown to lead to an exacerbation of suicide risk. The present study aims to examine (a) the contribution of mental pain intensity to psychological distress and suicidal ideation during the COVID-19 pandemic and (b) the protective role of mental pain tolerance in buffering these adverse mental health effects. A total of 652 adults (74.2% female, M = 33.99 years, SD = 13.74) were assessed through an online survey during the first mandatory lockdown in Italy. Participants completed measures of mental pain intensity and tolerance, psychological distress, and suicidal ideation. Results showed that mental pain intensity significantly predicted increases in psychological distress and suicidal ideation while mental pain tolerance significantly buffered the adverse effects of mental pain intensity on psychological distress and suicidal ideation. The findings highlight that tolerance for mental pain may act as a powerful protective factor during the pandemic. Evidence-based public health interventions fostering tolerance for mental pain during a pandemic are needed in order to effectively reduce suicide in potential risk groups.

A Risk Profile for Disordered Eating Behaviors in Adolescents with Type 1 Diabetes: A Latent Class Analysis Study.

(1) Background: This multi-center study aimed to identify a risk profile for disordered eating behaviors (DEBs) in youth with type 1 diabetes (T1D) based on their dietary intake, lipid profile, body mass index (BMI-SDS), and glycometabolic control. (2) Methods: Adolescents aged 11 to 18 years from five centers across Italy were recruited. Lipid profile, HbA1c, BMI-SDS, and dietary intake data were collected. The risk for developing DEBs was assessed via the Diabetes Eating Problems Survey-R (DEPS-R) questionnaire. A latent class analysis (LCA) was performed using a person-centered approach. (3) Results: Overall, 148 participants aged 11-18 (12.1, ±3.34), 52% males with a mean diabetes duration of 7.2 (±3.4), were enrolled. Based on the results of the DEBS-R score, LCA allowed us to highlight two different classes of patients which were defined as "at-risk" and "not at-risk" for DEB. The risk profile for developing DEBs is characterized by higher BMI-SDS (23.9 vs. 18.6), higher HbA1c (7.9 vs. 7.1%), higher LDL cholesterol (99.9 vs. 88.8 mg/dL), lower HDL cholesterol (57.9 vs. 61.3 mg/dL), higher proteins (18.2 vs. 16.1%), and lower carbohydrates (43.9 vs. 45.3%). Adolescents included in the "at-risk" class were significantly older (p = 0.000), and their parents' SES was significantly lower (p = 0.041). (4) Conclusions: This study allowed us to characterize a risk profile for DEBs based on dietary behavior and clinical parameters. Early identification of the risk for DEBs allows timely intervention and prevention of behavior disorders.

Young Adult Carers during the Pandemic: The Effects of Parental Illness and Other Ill Family Members on COVID-19-Related and General Mental Health Outcomes.

The mental health impacts of the COVID-19 pandemic on young adult carers have been neglected. This study aimed to identify COVID-19 related risk factors for young adult carers and to investigate their mental health relative to non-carer peers. Of the 1823 Italians aged 18-29 who completed an online survey, 1458 reported no ill family member (non-carers). Young adult carers included 268 with an ill parent, and 97 with an ill non-parent family member. Two mental health outcome categories were measured: COVID-19-related (risky health behaviors, loneliness, home violence, fear of COVID-19) and general (anxiety, depression, wellbeing). Six COVID-19 related risk factors were significantly correlated with poorer mental health in young adult carers. These factors constituted a COVID-19 Context Index. Compared to non-carers, young adult carers reported poorer mental health across all outcomes, as expected. The prediction that young adult carers caring for an ill parent would report poorer mental health than those caring for ill non-parent family members was evident only for the COVID-19-related mental health outcomes. The elevated rates of clinically significant distress and pandemic-related mental health problems among young adult carers highlight this group as a priority for mental health promotion interventions and whole-of-family support across multiple sectors.

Caregiving Responsibilities and Mental Health Outcomes in Young Adult Carers during the COVID-19 Pandemic: A Longitudinal Study.

This study investigated caregiving responsibilities and associated mental health outcomes in young adult carers during the COVID-19 pandemic and had three aims: (1) to investigate differences in caregiving responsibilities across two groups of young adult carers (parental illness context vs. ill non-parent family member context) relative to non-carers, (2) to identify COVID-19/lockdown correlates of caregiving responsibilities, and (3) to examine the longitudinal associations between caregiving responsibilities and mental health outcomes. Of the 1048 Italians aged 18-29 (Mage = 24.48, SDage = 2.80; 74.33% female) who consented to complete online surveys at Time 1, 813 reported no ill family member (non-carers). Young adult carers included 162 with an ill parent and 73 with an ill non-parent family member. The study included 3 time points: 740 participants completed Time 2 assessment (Mage = 24.35, SDage = 2.81; 76.76% female), while 279 completed Time 3 assessment (Mage = 24.78, SDage = 2.72; 79.93% female). Key variables measured were 13 COVID-19/lockdown factors at Times 1 and 2, caregiving responsibilities at Time 2, and mental health outcomes at Time 3 (fear of COVID-19, anxiety, depression, wellbeing). Two COVID-19/lockdown factors were significantly correlated with higher caregiving responsibilities: insufficient home space, and greater time spent working and learning from home. As predicted, young adult carers reported higher caregiving responsibilities than non-carers, and this effect was greater in young adults caring for an ill parent compared to young adults caring for an ill non-parent family member. As expected, irrespective of family health status, caregiving responsibilities were longitudinally related to poorer mental health outcomes, operationalised as higher fear of COVID-19, anxiety, and depression, and lower wellbeing. Elevated young adult caregiving is an emerging significant public health issue that should be addressed through a multipronged approach that includes education about young adult carer needs for personnel across all relevant sectors and flexible care plans for ill family members that include a 'whole family' biopsychosocial approach.

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study.

BACKGROUND: Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles. METHODS: A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles. RESULTS: Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period. LIMITATIONS: A reliance on self-report measures and convenience sampling constitute key study limitations. CONCLUSIONS: Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Examination of the tripartite model of youth caregiving in the context of parental illness.

OBJECTIVE: This study refined the conceptualisation of youth caregiving by testing the tripartite model of youth caregiving proposed by Pakenham and Cox, comprising caregiving responsibilities, experiences, and tasks. We also investigated convergent validity of the model by examining the unique and joint contributions of the three youth caregiving components to youth adjustment outcomes. DESIGN: A total of 681 Italian youth, 325 young carers and 356 non-carers, aged 11 to 24 years participated in a cross-sectional study. MAIN OUTCOME MEASURES: Participants completed a questionnaire assessing demographics, youth caregiving, and psychosocial adjustment. RESULTS: Confirmatory factor analyses revealed that compared to a one-factor model, the three-factor youth caregiving model provided a better fit to the data in the young carer and non-carer subgroups. The three youth caregiving components predicted variations in youth adjustment. Caregiving experiences were the strongest predictor of poorer youth adjustment while caregiving tasks predicted improvement in two youth adjustment outcomes in diverse youth caregiving contexts. CONCLUSIONS: Findings support the validity of a three-factor model of youth caregiving, indicating that caregiving responsibilities, experiences, and tasks represent empirically distinct but related youth caregiving components. Interventions should mitigate the adverse and cultivate the positive effects of youth caregiving.

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility.

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale-Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

Validation of the Italian Young Carer of Parents Inventory-Revised (YCOPI-R).

PURPOSE: Parental illness or disability has wide ranging impacts on offspring. Due to the lack of an Italian contextually sensitive measure of youth caregiving, this study explored the factor structure, reliability, and validity of the Italian version of the Young Carer of Parents Inventory-Revised (YCOPI-R). MATERIALS AND METHODS: Seven hundred and seventy-four youth aged 11-24 (386 young carers and 388 young non-carers) completed a questionnaire regarding youth caregiving, parental illness, caregiving context variables, and youth adjustment. RESULTS: The Italian YCOPI-R demonstrated good psychometric properties. Part A factor structure was replicated while two new factors emerged for Part B: Caregiving Stigma and Caregiving Resentment. Discriminant and convergent validity were evinced by differentiation between young carers and non-carers and associations between YCOPI-R factors and measures of caregiving activities and caregiving context. Predictive validity was supported as most Italian YCOPI-R factors were related to poorer youth adjustment, while Caregiving Confidence and Worry about Parents predicted higher levels of health-related quality of life. CONCLUSIONS: The Italian YCOPI-R is a psychometrically sound measure of caregiving experiences in Italian youth. Findings confirm the multidimensional nature of youth caregiving, the mix of costs and rewards associated with it, and the link between youth caregiving and diverse adjustment outcomes.Implications for rehabilitationGiven the global rise in the number of youth caring for an ill or disabled family member and the association between youth caregiving and greater risks for mental and physical health problems, elevated youth caregiving is a significant public health issue.The Italian version of the YCOPI-R is a valid and reliable measure of youth caregiving experiences in the Italian context.The Italian YCOPI-R offers a promising tool for better identifying young carers who are at risk for adverse psychosocial outcomes and in evaluating young carer support services and preventive interventions.

Preliminary Results from the ACTyourCHANGE in Teens Protocol: A Randomized Controlled Trial Evaluating Acceptance and Commitment Therapy for Adolescents with Obesity.

The study shows preliminary results of "The ACTyourCHANGE in Teens" project, a Randomized Controlled Trial aimed at evaluating the efficacy of an Acceptance and Commitment Therapy-based intervention combined with treatment as usual (ACT+TAU) compared to TAU only, for improving psychological well-being, psychological distress, experiential avoidance and fusion, emotion dysregulation, and emotional eating in a sample of 34 in-patient adolescents with obesity (Body Mass Index > 97th centile). Mixed between-within 2 × 2 repeated-measures analyses of variances (ANOVAs) were carried out to examine the changes in psychological conditions of participants over time. Moderation analyses were also conducted to test whether pre-test anxiety, depression, stress, and experiential avoidance and fusion predicted emotional eating at post-test with groups (ACT+TAU vs. TAU only) as moderators. Only a significant interaction effect (time × group) from pre- to post-test (p = 0.031) and a significant main effect of time on anxiety (p < 0.001) and emotional eating (p = 0.010) were found. Only in the TAU only group were higher levels of depression (p = 0.0011), stress (p = 0.0012), and experiential avoidance and fusion (p = 0.0282) at pre-test significantly associated with higher emotional eating at post-test. Although future replication and improvements of the study may allow us to obtain more consistent results, this preliminary evidence is actually promising.

Kellner's emotional inhibition scale: a clinimetric approach to alexithymia research.

BACKGROUND: Emotional inhibition has been an enduring concept in the psychosomatic literature explaining the onset and course of medical disorders. Currently the personality style of alexithymia is a focus of this dimension in psychosomatic theory, while actual conscious emotional inhibition, which may overlap with alexithymia, has received less attention. In the early 80s Robert Kellner developed the Emotional Inhibition Scale (EIS), a self-rating scale for emotional inhibition based on clinimetric principles. In this study we explored whether the EIS differentiated a sample of cardiac recipients from normal controls, as well as the associations between the EIS and 2 measures of alexithymia, i.e. the Toronto Alexithymia Scale-20 (TAS-20) and the Diagnostic Criteria for Psychosomatic Research (DCPR). We also examined whether the EIS and the TAS-20 were differently related to depressive symptoms measured by the Symptom Questionnaire (SQ). METHODS: Ninety-five heart-transplanted patients and a sample of normal controls, matched for sociodemographic variables, were administered the EIS (total score and 4 subscales concerning 'verbal inhibition', 'timidity', 'disguise of feelings', and 'self-control'), the TAS-20, the SQ, and the Structured Interview according to the DCPR for alexithymia. RESULTS: Cardiac recipients did not display significant differences compared to normal controls in observer (DCPR) and self-rated (TAS-20) measures of alexithymia. There were, however, significant differences in EIS with regard to 'disguise of feelings'. In both groups the EIS 'verbal inhibition' and 'timidity' subscales were positively associated with the TAS-20, while the EIS 'disguise of feelings' and 'self-control' subscales were independent of alexithymia. Depressive symptoms were more related to TAS-20 than EIS total scores. CONCLUSIONS: Our results suggest that emotional inhibition and alexithymia are distinct phenomena even though they may share certain features. The EIS appears to be relatively independent of depressed mood and will be useful in assessing the individual's conscious management of affect in future psychosomatic research.

Personality characteristics and psychological distress associated with primary exercise dependence: an exploratory study.

The aim of this study was to assess personality characteristics and psychological distress associated with primary exercise dependence (ExeDepI) in a mixed gender sample. A cross-sectional study was carried out with adult habitual physical exercisers. A total of 79 participants voluntarily completed a package of self-report questionnaires including the Exercise Dependence Questionnaire (EDQ), the Eating Disorder Inventory II (EDI-2), the Temperament and Character Inventory (TCI), the Attitude Toward Self scale (ATS), and the Symptom Questionnaire (SQ). Significant differences were found on the EDQ exercise for weight control subscale with regard to gender, as well as on the EDI-2 total score and five of its subscales, with higher scores for females compared to males. Participants reporting primary exercise dependence (N=32) were more likely to present with disordered eating patterns than controls (N=47). They also showed higher levels of harm avoidance and persistence on the TCI, but lower self-directness and less mature character. Furthermore, ExeDepI group scored higher on the ATS dysmorphophobia subscale, as well as on the anxiety and hostility subscales of the SQ compared to the control group. These findings provide support to the idea that primary exercise dependence can be considered as a clinical syndrome associated with certain personality characteristics and psychological symptoms that might be accurately assessed in clinical settings.