Antonino Tamburello

Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD=15.2; Min./Max.=19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH--the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

The association among food addiction, binge eating severity and psychopathology in obese and overweight patients attending low-energy-diet therapy.

Several studies have shown that food addiction (FA) is strongly related with psychopathology. However, this relationship may be partly mediated by the presence and severity of binge eating. The aim of the current study was to assess the strength of the association between FA and psychopathology, and whether this relationship was mediated by the presence and severity of binge eating. Participants were 112 patients seeking weight loss interventions. All the participants were administered the Yale Food Addiction Scale (YFAS), The Symptom Check list-90-R (SCL-90), and the Binge Eating Scale (BES). Thirty-eight (33.9%) individuals were diagnosed as having FA. FA severity was strongly associated with binge eating, whereas both FA and binge eating were positively and moderately associated with psychopathology. A mediational model analyzing direct and indirect (through the mediating role of binge eating) effects of FA on psychopathology indicated that the relation between FA and psychopathology was fully mediated by the severity of binge eating. This finding suggests that FA may contribute to the development of psychopathology through its effect on binge eating.

Inequalities in suicide rates in the European Union's elderly: trends and impact of macro-socioeconomic factors between 1980 and 2006.

Objective: To study suicide rates in elderly people in the former European Community, known as the European Union (EU) since late 1993, to identify differences between early members (admitted to the EU before 2004) and new members (admitted after 2004), and to evaluate the association between macro-socioeconomic variables and suicide rates. Method: We explored temporal trends in age-adjusted suicide rates for people aged 65 years and older residing in the EU from 1980 to 2006. Results: In the years examined in the study, there has been a general decrease in suicide rates in new and early members of the EU, although more slowly for elderly men than for women. The decrease in suicide rates of citizens aged 65 years and older was associated with a small but significant difference between new and early members of the EU (RR = 1.04, 95% CI 1.03 to 1.05; z = 11.95, P < 0.001). The macro-socioeconomic indices were strongly associated with age-adjusted suicide rates in EU senior citizens, except unemployment rates. Conclusions: Deaths by suicide in elderly people are declining in all EU nations, but inequalities in the suicide rates of men and women remain, especially in new EU members.

Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life–BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress.

Food Cravings Questionnaire–Trait (FCQ–T) Discriminates Between Obese and Overweight Patients With and Without Binge Eating Tendencies: The Italian Version of the FCQ–T

Food craving (FC) might play an important role in the course of eating disorders and obesity. The question of its measurement has particular importance in relation to the dramatic growth in obesity rates and its relevance for public health. The aim of this study was to investigate the psychometric properties of the Italian version of the Food Cravings Questionnaire–Trait (FCQ–T) in overweight and obese patients who were attending weight loss programs, and its efficiency in discriminating patients with binge eating. Participants were 497 (411 women, 86 men) overweight and obese patients in treatment with low-energy diet therapy. We used structural equation modeling to compare 3 factor models tested in previous studies (a 6-factor model, an 8-factor model, and a 9-factor model), which indicated that the 9-factor model has a better fit over the competing models. The FCQ–T had good internal consistency (Cronbachs α of.96 for the total score, and between.76 and.92 for subfactors), and was able to discriminate patients with clinical-level binge eating from those with probable and without binge eating with an efficiency of.74 (sensitivity =.64, specificity =.78). FCQ–T scores were sensitive to changes associated with treatment only for patients who started dietary restriction between the baseline and the follow-up assessment, but not for patients who were already observing dietary restrictions at the time of the baseline assessment. These results suggest that the FCQ–T could be a potentially useful measure for the screening of binge eating problems in overweight and obese patients while in treatment.

Biased processing of neutral facial expressions is associated with depressive symptoms and suicide ideation in individuals at risk for major depression due to affective temperaments

BACKGROUND To elucidate whether abnormal facial emotion processing represents a vulnerability factor for major depression, some studies have explored deficits in emotion processing in individuals at familial risk for depression. Nevertheless, these studies have provided mixed results. However, no studies on facial emotion processing have been conducted in at-risk samples with early or attenuated signs of depression, such as individuals with affective temperaments who are characterized by subclinical depressive moods, cognitions, and behaviors that resemble those that occur in patients with major depression. METHODS Presence and severity of depressive symptoms, affective temperaments, death wishes, suicidal ideation, and suicide planning were explored in 231 participants with a mean age 39.9 years (SD=14.57). Participants also completed an emotion recognition task with 80 emotional face stimuli expressing fear, angry, sad, happy, and neutral facial expressions. RESULTS Participants with higher scores on affective temperamental dimensions containing a depressive component, compared to those with lower scores, reported more depressive symptoms, death wishes, suicide ideation and planning, and an increased tendency to interpret neutral facial expressions as emotional facial expressions; in particular, neutral facial expressions were interpreted more negatively, mostly as sad facial expressions. However, there were no group differences in identification and discrimination of facial expressions of happiness, sadness, fear, and anger. CONCLUSIONS A negative bias in interpretation of neutral facial expressions, but not accuracy deficits in recognizing emotional facial expressions, may represent a vulnerability factor for major depression. However, further research is needed.

Psychometric Properties of the Attitudes toward Self-Revised in Italian Young Adults

Objectives and Methods. Several researchers have provided support for the critical role of cognitive vulnerabilities in the development of depression. The Attitudes toward Self-Revised (ATS-R) was designed to assess three potential self-regulatory vulnerabilities to depression: High Standards (HS), Self-Criticism (SC), and Negative Generalization (NG). The aim of the study was to assess the psychometric properties of the ATS-R in the Italian young adult population. The ATS-R, the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and the Teate Depression Inventory (TDI) were administered to 857 (320 men and 537 women) young adults. Results. The best-fitting solution for the ATS-R was a 2-factor model, which obtained satisfactory homogeneity of content (HS/SC: Cronbach α = 0.81; mean interitem correlation = 0.46. NG: Cronbach α = 0.75; mean interitem correlation = 0.43) and significant correlation with the BDI-II (NG: Pearson r = 0.29, P < 0.01), the TDI (HS/SC: Pearson r = −0.26, P < 0.01), and the BHS (HS/SC: Pearson r = −0.29, P < 0.01; NG: Pearson r = 0.22, P < 0.01). Conclusions. The Italian version of the ATS-R seems to be a valid instrument for the study of the role of cognitive tendencies as potential vulnerability for depression.

Gender differences in food craving among overweight and obese patients attending low energy diet therapy: a matched case–control study

This case–control study examined gender differences in food craving among a sample of overweight and obese patients attending low energy diet therapy. To disentangle the specific role of gender from the role of confounders, we paired groups for BMI, age and severity of binge eating as assed by the Binge Eating Scale (BES). The participants were 73 pairs of patients who were attending low energy diet therapy. All the participants were administered the State and Trait Food Cravings Questionnaire, trait version (FCQ-T) and the BES. Female patients had higher mean scores on six out of nine dimensions of the FCQ-T. When controlling for the effect of other variables, obese and overweight female patients were 1.1 times more likely to report higher anticipation of relief of negative states and feelings from eating than their male pairs. Obese and overweight female patients experience more cravings for food than their male pairs despite comparable severity of binge eating and obesity suggesting the need for tailored interventions.

Cognitive Vulnerabilities and Depression in Young Adults: An ROC Curves Analysis

Objectives and Methods. The aim of the present study was to evaluate, by means of receiver operating characteristic (ROC) curves, whether cognitive vulnerabilities (CV), as measured by three well-known instruments (the Beck Hopelessness Scale, BHS; the Life Orientation Test-Revised, LOT-R; and the Attitudes Toward Self-Revised, ATS-R), independently discriminate between subjects with different severities of depression. Participants were 467 young adults (336 females and 131 males), recruited from the general population. The subjects were also administered the Beck Depression Inventory-II (BDI-II). Results. Four first-order (BHS Optimism/Low Standard; BHS Pessimism; Generalized Self-Criticism; and LOT Optimism) and two higher-order factors (Pessimism/Negative Attitudes Toward Self, Optimism) were extracted using Principal Axis Factoring analysis. Although all first-order and second-order factors were able to discriminate individuals with different depression severities, the Pessimism factor had the best performance in discriminating individuals with moderate to severe depression from those with lower depression severity. Conclusion. In the screening of young adults at risk of depression, clinicians have to pay particular attention to the expression of pessimism about the future.

Cannabis use and the risk behavior syndrome in Italian university students: are they related to suicide risk?

The aim of this study was to examine the association of cannabis use with risky behaviors and suicide risk in university students. A convenience sample of 246 students was recruited from four universities in Rome during the 2004 academic year. Participants completed the Zung scales for anxiety and depression, the Suicide Score Scale, and an ad hoc questionnaire assessing risky behaviors. The findings indicated a widespread use of cannabis among students and its association with risky behaviors, anxiety and depression, and suicide risk. A regression tree analysis resulted in 3 splits indicating that the Zung Self-Rating Depression Scale is a good predictor of suicide risk, discriminating individuals at lower risk from those at higher risk. Individuals at higher risk for suicide could also be discriminated by self-reported lifetime drug use. Limitations of the study are related to the small sample size and use of a convenience sample.