Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant ...symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.
Abstract Introduction. The negative effects of climate change affect community subsistence models, thus determining an increase in social conflicts, a loosening of social capital, an increase in the ...incidence of traumas and diseases, and a push for migration. Aim. This exploratory research compares the perception of climate change, as well as the reduction of social capital and mental health, in two groups of migrants arriving in Italy from African countries with high or extreme vulnerability to climate change. Methods. The perception of climate change and the degree of social capital were assessed with a semi-structured interview. The psychological condition was investigated through a clinical psychological interview and tests. Results. The group of migrants coming from countries with extreme exposure to climate change perceive greater vulnerability of their country and reports a greater loss of social capital. The level of education does not seem to affect the ability to perceive climate change. In the entire sample, there is a strong correlation between the perception of change and the loss of social capital, and between the loss of social capital and emotional disorders. Conclusions. The study suggests that actions to preserve the social capital of a community strongly exposed to climate change can mitigate the impact of change on mental health.
Quarantine, loss of routine and social support can negatively impact mothers who have just given birth and their babies, generating concerns and reactions of intense fear. Following the COVID-19 ...emergency, we described a structured program for screening and treatment of perinatal depression and anxiety as a medium for constant monitoring of perinatal risk factors and early screening, which can also be implemented in emergencies with remote intervention methods, to offer women an appropriate, timely and effective treatment. In this scenario, it is desirable that the monitoring of the psychological well-being of women in postpartum is maintained over time, with the participation of all the professional figures with whom the woman comes into contact, to intercept any forms of psychological distress related to the epidemic and that could occur even after some time.
The perinatal depression is one of the leading pathologies in the world causing disabilities and represents an important public health problem. Since 2003, the Center for Behavioral Sciences and ...Mental Health (Istituto Superiore di Sanità - ISS) has promoted studies and research on the mental health of women, children, partners and family in the perinatal period, leading to the realization of a structured program adopted in many Italian services. In this article, we describe the feasibility and effectiveness of the perinatal mental health approach in Italian health services and discuss the progress and new challenges.
Cognitive behavioral assessment for outcome evaluation was developed to evaluate psychological treatment interventions, especially for counseling and psychotherapy. It is made up of 80 items and five ...scales: anxiety, well-being, perception of positive change, depression, and psychological distress. The aim of the study was to present the metric qualities and to show validity and reliability of the five constructs of the questionnaire both in nonclinical and clinical subjects.
Four steps were completed to assess reliability and factor structure: criterion-related and concurrent validity, responsiveness, and convergent-divergent validity. A nonclinical group of 269 subjects was enrolled, as was a clinical group comprising 168 adults undergoing psychotherapy and psychological counseling provided by the Italian public health service.
Cronbach's alphas were between 0.80 and 0.91 for the clinical sample and between 0.74 and 0.91 in the nonclinical one. We observed an excellent structural validity for the five interrelated dimensions. The clinical group showed higher scores in the anxiety, depression, and psychological distress scales, as well as lower scores in well-being and perception of positive change scales than those observed in the nonclinical group. Responsiveness was large for the anxiety, well-being, and depression scales; the psychological distress and perception of positive change scales showed a moderate effect.
The questionnaire showed excellent psychometric properties, thus demonstrating that the questionnaire is a good evaluative instrument, with which to assess pre- and post-treatment outcomes.
This study evaluates the effectiveness of a psychological intervention based on a brief cognitive behavioural and psycho-educational treatment for women suffering from post partum depression.
The ...sample was recruited within a programme of screening and early intervention for post partum depression risk. 1558 women were screened between the 6th and 12th week after birth. 110 (7.1%) of them resulted positive to the Edinburgh Postnatal Depression Scale (score ≥12) and 81 accepted a thorough clinical diagnostic examination through the administration of the Mini International Neuropsychiatric Interview and the self-assessment instruments Beck Depression Inventory, State-Trait Anxiety Inventory, Psychological Well-being Scales, Short-Form Health Survey and Positivity Scale. Women who had been confirmed with the diagnosis of major depression episode (N=65; 80.2%) were offered to follow the treatment (10 weekly sessions) and to fill in again the instruments at the end of the treatment and after six months. Out of the 81, 63 women accepted and begun the treatment.
56 (88.9%) women completed treatment and filled in the instruments. Most of them (N=43) completed the instruments even after 6 months. At the end of treatment and after 6 months significant improvements were found in all scores of the instruments used. Furthermore, up to 70% of women who had been treated showed a clinically significant improvement in one or more evaluated outcomes. Such improvements were persistent in women evaluated 6 months after the treatment.
The results of the study are consistent with studies that in other Countries evaluated, even experimentally, the same intervention or similar interventions with postnatal women and based on cognitive behavioural techniques. Such brief and structured interventions are most likely effective and easily accepted by women who suffer from post partum depression even in the routine practice of Italian health care services.
This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women.
The ...sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated.
Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them.
The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.
Aims: The main aim of this paper is to describe almost 30 years of work on psychological assessment using CBA, a research team, and to propose collaboration with Latin countries. Methods: The acronym ...CBA stands for Cognitive Behavioural Assessment and indicates both an overall approach to clinical assessment and a series of tests. Five general principles formed the basis on which the team developed their questionnaires: (1) assessment is not a passive collection of information, but an active process similar to problem-solving; (2) horizontal integration of questionnaires with other assessment methods; (3) vertical integration and hierarchical structure of assessment questionnaires; (4) idiographic perspective; (5) computer support. Results: The paper briefly presents the most important tests: CBA-2.0, a broad-spectrum Battery for patients who need counselling and/or psychotherapy; CBA-H (Hospital) for both in-patients and out-patients suffering from physical illnesses; CBA-SPORT for professional athletes; CBA-Y (young people) for adolescents and young adults; CBD-VE (treatment benefits) to assess the effectiveness of psychological treatment. Conclusion : These questionnaires have produced over 100 research works, published in Italian journals or presented in conferences. In the near future, we expect important, radical changes and hope to create an international research milieu. PUBLICATION ABSTRACT
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Background: Training patients in structured problem solving strategies is one of the oldest cognitive behavioural therapy methods. Recent social, psychological and neuropsychiatric research provides ...a multifactorial rationale for methods that strengthen patients' ability to carry out stepwise problem solving in their real life problems.
Aim: This paper reviews the rationale for Problem Solving Training with reference to recent biomedical and psychosocial research and describes several preliminary studies of its benefits.
Method: A four-phase programme of 24 weekly or bi-weekly lessons in small groups begins with patient's pratical everyday problems before moving to gradually more complex and emotionally charged interpersonal, personal and crisis issues in an attempt to restore generic problem solving abilities and improve long-term recovery from schizophrenia.
Results: Preliminary outcome studies show promising outcomes on a reduction in rehospitalizations as well as clinical, social and neurocognitive measures and a multi-centred randomized controlled study in progess.
Conclusions: Renewed interest in cognitive functioning, including social problem solving skills and social cognition in schizophrenia has led us to reconsider the potential value of cognitive-behavioural problem solving training as a rehabilitation strategy.
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