Antonella Gigantesco

Patients' and relatives' satisfaction with psychiatric services in a large catchment area in Rome.

OBJECTIVE To assess the satisfaction of patients and their relatives with psychiatric care and to identify variables associated with any dissatisfaction. METHODS The study was performed in a defined psychiatric catchment area in south Rome, Italy. All eligible patients and relatives who had contacts with services during a predefined period were asked to participate. Satisfaction with psychiatric services was measured with a previously validated questionnaire. RESULTS A total of 890 patients were asked to participate in the study and 855 (96%) accepted. Also, 270 relatives were asked to participate and 265 (98%) agreed. The satisfaction with services expressed by outpatients and their relatives was fairly good, with the exception of poor satisfaction with information about treatment and involvement in the treatment programme. The satisfaction of inpatients and their relatives was significantly lower, with the issue of information-giving by staff appearing particularly critical. Among patients, variables associated with dissatisfaction were being an inpatient, having a diagnosis of psychosis, being in contact with services for more than 6 years, and being single. Among relatives, being female and being the relative of an inpatient were associated with dissatisfaction. For both patients and relatives, receiving inpatient care was the strongest predictor of dissatisfaction. CONCLUSIONS The results suggest that inpatient care, especially for psychotic patients, needs to be improved and that special attention should be devoted to inform adequately and to engage in treatment both patients and their relatives. Lack of information appears to be a crucial determinant of dissatisfaction with psychiatric care among both patients and their relatives.

Genetic influences on alexithymia and their relationship with depressive symptoms.

OBJECTIVE The factors involved in the etiology of alexithymia are still unclear. While a few studies suggested substantial genetic influences on alexithymia, it remains to be determined if these influences are independent of genetic influences on other mental health variables correlated with alexithymia, such as depression. This study is aimed at confirming previous findings of a genetic contribution to alexithymia, examining whether there are genetic or environmental influences common to alexithymia facets, and investigating whether genetic influences on alexithymia are independent of genetic influences on depression. METHODS The 20-item Toronto Alexithymia Scale and a validated measure of depression were administered to a sample of 729 twins (45% males) aged 23-24 years drawn from the population-based Italian Twin Register. Genetic structural equation modeling was performed with the Mx program. RESULTS Genetic factors accounted for 42% of individual differences in alexithymia. Unshared environmental factors explained the remaining proportion of variance. There was a substantial (0.65) genetic correlation between alexithymia and depression. The inclusion of depression as a covariate in the genetic models reduced the heritability estimate for alexithymia to 33%. CONCLUSIONS Despite some limitations, this study corroborates the notion that genetic factors contribute substantially to individual differences in alexithymia, with unshared environmental factors also playing an important role. Also, it suggests a genetic link between alexithymia and depression.

Development, reliability and factor analysis of a self-administered questionnaire which originates from the World Health Organization's Composite International Diagnostic Interview – Short Form (CIDI-SF) for assessing mental disorders

BackgroundThe Composite International Diagnostic Interview – Short Form consists of short form scales for evaluating psychiatric disorders. Also for this version training of the interviewer is required. Moreover, the confidentiality could be not adequately protected.This study focuses on the preliminary validation of a brief self-completed questionnaire which originates from the CIDI-SF.Sampling and MethodsA preliminary version was assessed for content and face validity. An intermediate version was evaluated for test-retest reliability. The final version of the questionnaire was evaluated for factor exploratory analysis, and internal consistency.ResultsAfter the modifications by the focus groups, the questionnaire included 29 initial probe questions and 56 secondary questions. The test retest reliability weighted Kappas were acceptable to excellent for the vast majority of questions. Factor analysis revealed six factors explaining 53.6% of total variance. Cronbachs alpha was 0.89 for the questionnaire and 0.89, 0.67, 0.71, 0.71, 0.49, and 0.67, for the six factors respectively.ConclusionThe questionnaire has satisfactory reliability, and internal consistency, and might be efficient for using in community research and clinical practice. In the future, the questionnaire could be further validated (i.e., concurrent validity, discriminant validity).

Brief Report: Job Satisfaction Among Mental Health Professionals in Rome, Italy

Although various surveys on job satisfaction have been performed in mental health care settings, no studies have investigated in-depth the level of satisfaction with the various aspects of work in Italian mental health services. In the present study, all clinical mental health staff working in a large psychiatric catchment area in Rome were invited to anonymously complete a previously validated questionnaire designed to measure job satisfaction among mental health professionals. Of the total 236 health professionals, 196 (83%) agreed to participate. Most participants were not completely satisfied with many aspects of their job, and many were not even moderately satisfied. The level of satisfaction increased with age, and it was significantly lower among hospital-ward staff compared to the staff of outpatient clinics or residential facilities, even after adjusting for age, gender, profession, work setting, and time in current job, using a multiple logistic regression model. Our findings suggest that interventions aimed at increasing job satisfaction among Italian mental health professionals might be warranted, particularly among hospital-ward staff.

Process of Care in General Hospital Psychiatric Units: National Survey In Italy

Objective: To investigate the process of care in Italian public acute inpatient facilities. Method: Each facilitys head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Results: Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5±7.1 days, 37.0±55.3 days and 12.0±3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during mealtimes (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurst provision. Conclusions: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital–community mental health service interface.

Prevalence of Psychiatric Disorders in an Italian Town: Low Prevalence Confirmed with Two Different Interviews

Background: In Italy, few studies on the prevalence of psychiatric disorders have considered all of the most common disorders and very few have adopted the most common tools, that is, the Composite International Diagnostic Interview (CIDI) and the Present State Examination (PSE). The objective of the present study was to estimate the prevalence of psychiatric disorders and its correlates in the town of Jesi, Italy, using the PSE and CIDI, administered 7 years apart. Methods: The two surveys were conducted among adults in Jesi (central Italy), using the PSE in 1993 and the CIDI in 2000. Participants were randomly chosen from the patient lists of general practitioners. Results: The one-month prevalence of persons with a psychiatric disorder was 7.3% (95% CI: 4.4–11.6) in 1993 and 6.0% (95% CI: 3.5–9.5) in 2000. The lifetime and 1-year prevalence rates were 21.0 and 8.2%, respectively. The most common disorders were depressive and anxiety disorders. Mood and anxiety disorders were more common among women and unmarried persons. Conclusions: The prevalence is lower than that in most other areas of the world yet consistent with estimates for Italian populations reported by studies using the same (or similar) tools.

Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge

BackgroundThe aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements.MethodsAll patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed.ResultsNo overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge.ConclusionExtra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.

Psychological well-being (PWB): a natural life outlook? An Italian twin study on heritability of PWB in young adults.

BACKGROUND To date, the genetic and environmental architecture of the dimensions of psychological well-being (PWB) remains unexplored. METHOD PWB of 742 twins aged 23-24 years and enrolled in the Italian Twin Registry was assessed with the three-item version of Ryffs Scales of Psychological Well-Being (SPWB). These scales include items for evaluating the PWB dimensions of self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. A twin design was used to obtain correlations in the PWB dimensions for monozygotic (MZ) and dizygotic (DZ) twins and to estimate the contribution of genetic and environmental factors to variation and covariation in the dimensions. RESULTS Genetic factors explained moderate to substantial proportions of variance in the six SPWB dimensions, with heritability estimates between 37% and 64%. The estimates of genetic correlations were very high (range 0.77-0.99), indicating that genetic factors that influence the expression of the different dimensions of PWB may be shared to a large extent. Non-shared environmental correlations ranged from substantial to high, with the exception of the correlation between autonomy and the dimensions of purpose in life, self-acceptance and personal growth. CONCLUSIONS This study presents a twin analysis of PWB measured by the SPWB dimensions; it was found that both genes and non-shared environment play a role in individual differences. The genetic and non-shared environmental correlations between SPWB dimensions suggest that common underlying genetic and non-shared environmental factors influence the expression of the different facets of PWB.

Discriminant ability and criterion validity of the HoNOS in Italian psychiatric residential facilities

Background: The Health of the Nation Outcomes Scales (HoNOS) was developed as an inclusive and comprehensive instrument to assess patient outcomes in 4 main domains: behaviour, cognitive and physical impairment, symptoms and social functioning/context. Concerns about the reliability and validity of the HoNOS have been raised. The aim of this study was to further investigate the discriminatory ability of the HoNOS; criterion validity was also examined. Sampling and Methods: A broad sample of patients with psychotic disorders, admitted to 265 Italian residential facilities, were rated by trained research assistants and local staff on the HoNOS, Global Assessment of Functioning, Life Skills Profile, and Physical Health Index. Discriminant function analysis was used to examine the ability of the HoNOS items to correctly classify patients with positive symptoms, substantial psychosocial impairment or physical disability. The HoNOS criterion validity was also examined. Results: On the whole, the pattern of correlations between the HoNOS and the other corresponding measures was consistent. However, the majority of the correlations were only moderate. In discriminant function analysis, the classification procedure correctly classified 55.7% of the patients. Conclusions: Although the HoNOS has many advantages in its brevity, it may lack sufficient discriminatory ability for certain patient groups. Further, it correlates only moderately with measures of disability and physical health status. These findings suggest that the HoNOS alone might be insufficient for routine evaluation and should probably be supplemented by additional measures.

HoNOS-Rome: an expanded, customized, and longitudinally oriented version of the HoNOS

AIMS To clarify the acceptability, reliability and factorial validity of a new Italian version of the HoNOS called HoNOS-Rome. Its main innovations are both in design and in contents. METHODS Face validity was assessed by surveying 3 focus groups. Reliability was assessed in 8 different pairs of raters on a sample of 24 patients; construct validity was analysed by factor analysis using a sample of 187 patients at 6 day centres. Acceptability was investigated by means an anonymous questionnaire filled by professionals that were using the instrument. RESULTS Time of completion was low (range 4-12 minutes), the tool proved very acceptable and the reliability was good (weighted kappa > or = 0.71 for all items). Factor analysis was consistent with the division of HoNOS-Rome into four sensible factors accounting for 52% of the total variance. CONCLUSIONS The findings indicate that HoNOS-Rome has a satisfactory degree of acceptability, construct validity and reliability, and may promote the routine evaluation of outcomes in mental health services.