Anna Coluccia

Socio-economic factors and suicide rates in European Union countries

Are socio-economic factors valid determinants of suicide? The modern sociological theory of suicide is based on Durkheims studies. In addition to these fundamental social determinants, modern theorists have put more attention on economic factors. The purpose of the research is to determine the relationship between suicide rates and socio-economic factors, such as demography, economic development, education, healthcare systems, living conditions and labour market. All data were collected from a Eurostat publication and they concern 25 European Union countries. In order to test this relationship, a discriminant analysis was performed using an ordinal dependent variable and a set of independent variables concerning socio-economic factors. A dataset of 37 independent variables was used. We estimated a model with five variables: annual growth rates for industry, people working in S&T (% of total employment), at-risk-of-poverty rate, all accidents (standardized rates), and healthcare expenditures (% of GDP). Highly significant values of Wilks Lambda assess a good discriminating power of the model. The accuracy too is very high: all cases are correctly classified by the model. Countries with high suicide rate levels are marked by high levels of at-risk-of-poverty rates, high annual growth rates for industry and low healthcare expenditures.

Adult obsessive–compulsive disorder and quality of life outcomes: A systematic review and meta-analysis

In the current literature, there are no meta-analyses assessing quality of life (QOL) in patients with obsessive-compulsive disorder (OCD). Knowledge of QOL domains mainly impaired in OCD could provide specific areas for intervention. The current meta-analysis assessed differences in global, work and social, family, and emotional QOL outcomes between patients with OCD and heathy controls. Age, gender and OCD severity were examined as moderators. Case-control studies were included if patients with primary OCD were compared with controls on QOL outcomes. Electronic databases (1966-October 2014) were searched. Thirteen case-control studies were included (n=26,015). Patients with OCD had significantly lower scores on QOL relative to controls, with moderate effect sizes on global QOL and large effect size on work and social, emotional and family QOL outcomes. Studies using higher percentages of female patients and patients with less severe OCD symptoms reported significantly lower QOL outcomes for patients with OCD than controls. Studies comparing patients with OCD and patients with other psychiatric disorders were not included. Treatments should address QOL in OCD, particularly emotional QOL. Additional strategies targeting QOL should be implemented for female patients with less severe OCD symptoms.

Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

Purpose The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course. Patients and methods The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses. Results Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients. Conclusion The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.

Does higher severity really correlate with a worse quality of life in obsessive-compulsive disorder? A meta-regression

Background Obsessive–compulsive disorder (OCD) is one of the leading causes of disability and reduced quality of life (QOL), with impairment in a number of domains. However, there is a paucity of literature on the association between severity of OCD symptoms and QOL, and the data that do exist are inconsistent. In addition, the role of severity in QOL has not been summarized as yet from a cross-generational perspective (ie, across childhood/adolescence and adulthood). Through meta-regression techniques, the current study summarized evidence about the moderator role of severity of OCD symptoms on differences in global QOL between individuals with OCD and controls. Methods Online databases were searched, and cross-sectional case–control studies comparing participants of all ages with OCD with controls on self-report QOL measures were included. Random-effect meta-regression techniques were used to comment on the role of illness severity in global QOL in individuals with OCD. Results Thirteen studies were included. A positive significant association emerged between OCD severity and effect sizes on global QOL: in samples with higher severity, there were narrower differences in QOL between patients with OCD and controls than in samples with lower severity. Such positive association was confirmed by a sensitivity analysis conducted on studies including only adults, where the difference in QOL ratings between patients and controls was significantly narrower when OCD severity was higher. Conversely, a negative association between severity and QOL was found in those studies including only children/adolescents, where the difference in QOL was significantly larger between patients and controls when OCD severity was higher. Conclusion QOL remains an important issue to address in the management of OCD in all age groups, irrespective of illness severity. Even in those with lower severity ratings, QOL may be considered as an important marker of treatment response.

Quality of life in children and adolescents with obsessive–compulsive disorder: a systematic review and meta-analysis

Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been understudied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=−1.16, P<0.001), suggesting that individuals with OCD had lower global QOL than controls. Moderate effect sizes emerged for school (d=−0.61, P<0.01) and social QOL (d=−0.54, P<0.01), respectively, indicating worse QOL on these domains for individuals with OCD. For samples with higher OCD severity, global QOL of individuals with OCD was lower than that for controls (β=−0.02, P<0.05). For samples with lower percentages of females, global QOL of individuals with OCD was more impaired (β=0.02, P<0.001). Age was not correlated with effect sizes. Assessment and treatment should target QOL for young males suffering from more severe OCD. The small number of included studies highlighted that QOL is under-recognized. Future research should focus on additional QOL domains and compare which ones are impaired among individuals with OCD compared with other psychiatric conditions. Overall, the results pointed out the importance of addressing QOL in both practice and research on assessment and treatment of children/adolescents with this condition.

Practical guidance for prescribing trazodone extended-release in major depression

Abstract Introduction: Treatment of major depressive disorder aims for symptom remission and recovery of function, and involves a multifaceted approach including drug therapy, evidence-based psychotherapy, and electroconvulsive therapy, according to disease severity. Antidepressant monotherapy is generally the first-line approach for moderate to severe major depressive disorder (with or without psychotherapy). In some severe cases, patients may require the addition of antipsychotic therapy, electroconvulsive therapy, or antidepressant combination therapy. Areas covered: This article examines the use of trazodone in major depressive disorder, with a focus on practical guidance regarding the use of trazodone extended-release (Contramid®). Expert opinion: The extended-release once-a-day formulation of trazodone may provide a combination of efficacy and improved tolerability over other antidepressants and over the conventional immediate-release formulation.

Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm ones self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.

Obsessive-compulsive disorder and quality of life outcomes: Protocol for a systematic review and meta-analysis of cross-sectional case-control studies

Background. Obsessive-compulsive Disorder (OCD) is a chronic disabling psychological condition, which can severely affect quality of life (QOL). Growing interest has been dedicated to assessing which domains of QOL are more severely affected in patients with OCD. However, research yielded conflicting findings. Investigating QOL in OCD could suggest the need for integration of interventions aimed at improving those specific domains more severely impaired by obsessions and compulsions. Methods. We will conduct a systematic review of cross-sectional case-control studies according to PRISMA guidelines, where patients with a primary OCD diagnosis were compared on QOL outcomes with healthy controls. Primary objectives will be to examine differences in QOL outcomes between patients with OCD and healthy controls, and to assess which QOL domains are more severely impaired in patients compared with controls, particularly subjective well-being, social and interpersonal functioning, work functioning, and family functioning. Subsequently, the study will investigate potential moderators of QOL in OCD, including participants characteristics (age, sex, presence of comorbid personality disorders, OCD symptom severity, severity of concurrent depressive symptoms, duration of OCD symptoms, and generational cohort), and study characteristics (date of publication and methodological quality of the studies). Online databases will be searched (PsycINFO, PubMED, Science Direct, Cinahl, Biological Abstracts, Psyclit, Embase, The Cochrane Central Register of Controlled Trials, and Google Scholar). To locate unpublished records, conference abstracts, doctoral dissertations and theses will be handsearched, and experts will be contacted. Statistical analyses will be performed though random effect model meta-analysis. Risk of bias assessments will be conducted using the instrument Methodological Index for Non-Randomized Studies.

Using sertraline in postpartum and breastfeeding: balancing risks and benefits

ABSTRACT Introduction: The World Health Organization recommends newborns to be breastfed but this may be challenging if the mother needs to be treated for depression, since strong evidence to inform treatment choice is missing. Areas covered: We provide a critical review of the literature to guide clinicians who are considering sertraline for the management of depression during postpartum. Expert opinion: Sertraline is one of the safest antidepressants during breastfeeding. In most cases, women already taking sertraline should be advised to breastfeed and continue the medication. We recommend to begin with low doses and to slowly increase the dose up, with careful monitoring of the newborn for adverse effects (irritability, poor feeding, or uneasy sleep, especially if the child was born premature or had low weight at birth). The target dose should be the lowest effective. When feasible, child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak. A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully.

Urban safety: A re-reading of the sense of unsafety through individual and ecological dimensions

The issue of urban safety is a research topic that has attracted the attention of scholars for several years, particularly in relation to the effects of individual and environmental variables that influence the fear of crime. Some recent studies have redefined the study of fear of crime, widening it to a more general dimension represented by the perception of safety. However, no specific tool has been proposed to measure this construct. In this paper, a new assessment scale of the perception of unsafety has been used to examine the impact of individual factors (gender, age, etc.) and ecological factors (ethnic composition of the neighbourhood, residential stability, etc.) on the dimensions of the scale (general sense of unsafety, perception of physical and social disorder, collective efficacy perception and preoccupation with crime). Results showed a strong convergence with the existing evidence with regard to the ambiguous role of some individual variables, such as gender and age, and for the influence of the characteristics of the neighbourhood.