G. Mattei

Short-term effects of the 2008 Great Recession on the health of the Italian population: An ecological study

PurposeTo report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities.MethodsThis is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions.ResultsAfter the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (−5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide.ConclusionsThe data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions.

International Study of Student Career Choice in Psychiatry (ISoSCCiP): Results from Modena, Italy

Abstract Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian final year medical students from the University of Modena and Reggio Emilia were asked to fill in an on-line questionnaire during the first semester of two consecutive academic years (2009–2010, 2010–2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate = 46.7%). Women constituted 66%, and mean age was 25.14 (SD = 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n = 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p = 0.01), believing that ‘the problems presented by psychiatric patients are often particularly interesting and challenging’ (p < 0.01), and by accounts of personal/family experience with physical illness (p < 0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specificities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry.

P-615 - How does economic recession in Italy affect the health of Italian people?

Introduction Since December 2007 all Western countries have fallen into a severe economic recession, that caused an increase in unemployment and a lowering of income. Main consequences on health reported from previous economic crises such as the ‘29 Great Depression, the Post-communist Depression in early 1990s or the East Asian financial crises in late 1990s were: 1) increase in overall mortality, 2) increase in day-time alcohol drinking, 3) increase in male suicides and 4) decrease in traffic fatalities. Aim To review the consistency of Italian data regarding the effects on health of the current economic recession with reference to effects of previous crises. Methods PubMed was searched for literature. Data on mortality, alcohol abuse and self-harm behaviours were obtained from the website of the Italian National Institute of Statistics (ISTAT). Results Overall mortality in Italy increased in years 2008 and 2009, this increase being more evident among women. Overall male suicides and attempted suicides increased in the same years as well. Male suicides potentially referred to economic reasons showed an alarming increase. Traffic fatalities decreased during the last decade. Contrary to the expectations, alcohol consumption diminished gradually after recession onset. Conclusions Italian data are consistent with expectations and previous findings. Other concomitant and not related events could be involved (such as decrease in traffic fatalities or steadiness in alcohol consumption, which might be related to the introduction of new laws), though it seems extremely suggestive that the socio-economic context has a deep impact on mental health of general population.

Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence

INTRODUCTION: Animal assisted therapy (AAT) is a structured form of animal assisted intervention (AAI), which specifically adopts animals in healthcare services and education facilities, to achieve therapeutic goals. Although such interventions are widely used, nowadays, evidence supporting them is still largely lacking. A previously published review of the literature highlighted some promising effects of AAT on people presenting psychiatric disorders, though the quality of the studies included was generally low. In order to provide an update of recent evidence, the aim of this study was to systematically review randomized controlled trials (RCTs) published since 2000, involving people affected by mental disorders and receiving AAT. EVIDENCE ACQUISITION: The following databases were searched: CINHAL, EBSCO Psychology and Behavioural Science Collection, PubMed and Web of Science. 115 papers were obtained and screened: 28 were from CINHAL, PsycINFO and Psychology and Behavioural Science Collection altogether, 15 from PubMed and 72 from Web of Science. In addition to this, grey literature and references of already published reviews and meta-analyses on the topic were searched, resulting in the addition of 6 further articles. After screening, 10 RCTs were included in this review. EVIDENCE SYNTHESIS: Studies involving outpatients were more frequent than those involving inpatients; sample size was generally low. The majority of studies adopted scales routinely used in clinical trials, with a good level of validity and reliability. Five out of ten studies reported significant differences in the main outcomes favouring AAT. Most of the studies did not include any follow-up; yet, where prospective data were available, the benefits of AAT appeared long lasting. Drop-out rates were higher in studies involving outpatients. However, the only trial which enrolled both inpatients and outpatients showed a higher drop-out rate among the inpatients group, possibly due to their more severe psychopathology. CONCLUSIONS: Though a paucity of available studies partly limits our findings, AAT seems to improve empathy, socialization and communication, and to favour therapeutic alliance among patients who have difficulties with therapeutic programs adherence. AAT appears to be a feasible and well-received intervention, potentially with few or no side effects reported. However there is a need for further studies with larger sample sizes and high-quality research standards. (Cite this article as: Spattini L, Mattei G, Raisi F, Ferrari S, Pingani L, Galeazzi GM. Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence. Minerva Psichiatr 2018;59:54-66. DOI: 10.23736/S0391-1772.17.01958-6)

Il disagio psichico nel mondo del lavoro. Convegno Multidisciplinare, Modena 25 ottobre 2017

Secondo l’Organizzazione Mondiale della Sanita (OMS) circa 300 milioni di persone nel mondo soffrono di depressione, ed i comuni disturbi mentali stanno diventando la principale causa di disabilita nella popolazione, specie negli adulti di mezza eta (1). [...]

Stakeholders’ views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians

BACKGROUND The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services. OBJECTIVES To explore the different points of views of stakeholders (namely, users and professionals) involved in VRPs developed inside an Italian Community Mental Health Center (CMHC). METHODS A sample of users, psychiatrists, educators and nurses of an Italian CMHC involved in VRPs took part in a focus group. Content analysis was performed with MAXQDA 12, by developing a hierarchical code system a posteriori (i.e., derived from the data). The respondent validation phase was carried out by means of a multiple-choice questionnaire, administered to all participants. RESULTS A total of 86 emerging issues were coded, divided into two macro-areas: Positive and Negative Reinforcements (48 contributions, 56%, and 38 contributions, 44%, respectively), further subdivided into three areas: professional (service) factors, personal (i.e, user-related) factors, and work environment features (including relationships in the workplace). Some contributions raised issues concerning occupational health protection (e.g. need of information about the rights and duties of the users-workers, as well as the risks they are exposed to in the workplace). CONCLUSIONS The analysis suggested to address specific issues concerning work and VRPs by means of psycho-education group interventions currently carried out at CMHCs, and pointed to the need to foster collaboration between mental health professionals and the occupational health physician of the company where the VRP is started and where the user might be employed.

Impact of the economic crisis on health-related behaviors in Italy:

Background: Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population. Aim: To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy. Methods: Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000–2015). Statistics performed by means of linear regression models. Results: Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11–20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p < .01) and mean number of smoked cigarettes per day (β = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (β = 0.91, p = .04), while the Italian families’ expenditure for alcoholic beverages decreased (β = –812.80, p = .01). Alcohol consumption decreased (β = –0.60, p < .01), especially in men (β = –0.95, p < .01); binge drinking increased in years 2009–2010. No change was noticeable in the diet indicators collected. Conclusion: The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Bridging the gap between clinical practice and research: The association for research in psychiatry

Clinical practice and research are frequently seen as two worlds apart, in psychiatry as in the vast majority of medical specialties. In order to bridge the gap between them, economic founds and grants are required, not always easy to obtain. In this contribution we report the birth of the Association for Research in Psychiatry (ARPSY) and its main activities. ARPSY was born in May 2016 thanks to a research prize assigned to dr. Giorgio Mattei by the eight Rotary Clubs of the Province of Modena, Italy (Rotary Club Modena, Mirandola, Carpi, Sassuolo, Vignola Castelfranco Bazzano, Frignano, Modena L.A. Muratori, Castelvetro di Modena Terra dei Rangoni, that altogether make up the so-called “Ghirlandina Group”). Aim of the association is to promote mental health among students and trainees, mental health professionals, patients and their families, and among the general population by means of fund raising, in order to finance research projects, clinical interventions and educational activities.

The Impact On Mental Health of the Economic Recession in the District of Sassuolo (Modena): Opinions of Local Occupational Physicians

Introduction The recent economic recession and the subsequent strategy of austerity have deceased the amount of resources devoted to health care. They may also have contributed to the deterioration of the population health. Aim To assess the impact on mental health of the economic recession in the district of Sassuolo (Modena), by collecting and analyzing opinions of local Occupational Physicians. METHODS Qualitative survey, by focus groups, conducted in Sassuolo (Modena), industrial center of ceramics, involving 8 Occupational Physicians active in the area. Rough descriptions analyzed independently by GU and GM using MAXQDA, with the independent supervision of a third researcher (SF), according to the principles of the General Grounded Theory. The second focus groupwas intendened as respondent validationof the first, yet it gathered further data, up to theortical saturation. Results Two focus groups, about one hour long, attended by 8 Occupational Physicians, 7 during the first focus group, 4 during the second (of these, 3 attending both focus groups). The coding process yielded 261 segments, divided into four main areas: “changes in contemporary world” (16 coded segments), “social area” (82 coded segments), “medical area” (94 coded segments), “working area” (69 coded segments). Conclusions The impact of the economic crisis on health produced mainly negative consequences, locally, consistently with national data. Psychiatrists should work together with Occupational Physicians to develop targeted interventions, addressing social, political and medical needs. A more structured liaisonbetween Psychiatry and Occupational Medicine is an interesting and useful tool for future action and advocacy.

Association Between Symptoms of Anxiety and Depression and BMI in Primary Care Patients: a Cross Sectional Study.

Introduction Recent research exploring the relationship between BMI and symptoms of anxiety and depression have reported conflicting results. Changes in common molecular pathways could be the basis of this association. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. Aim To measure the association between BMI and symptoms of anxiety and depression in primary care patients. Methods Cross-sectional study. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age 80; use of antidepressants or antipsychotics medication; previous stroke or heart attack; psychosis or major depression; obesity due to hereditary. Psychometric assessment: HADS (Hospital Anxiety and Depression Scale). Anthropometric measures: weight and height. Statistical analysis: SPSS. Whole sample stratified by age on the basis of literature data about the prevalence of obesity. Results 209 subjects examined (84 men and 125 women). Of those, 76 (36.7%) were overweight and 60 (29.1%) obese. BMI statistically correlated with anxiety (β(SE)=.54(.12), p=.00) and depressive symptoms (β(SE)=.32(.09), p=.03), also after stratification by age, especially in females. Conclusion - BMI has a critical value in predicting the presence of anxious and depressive symptoms, especially in females. Further studies could examine the pathophysiological reasons for such association.