Valeria Bianchini

Marked increase in substance use among young people after L’Aquila earthquake

Dear Sirs, On 3 December 2010, a remarkable piece published in the Financial Times reported that ‘‘eighteen months after an earthquake struck the heart of Abruzzo, Italy, killing 309 people, the region’s capital city, L’Aquila (town with a population of 72,000 and a health district of 103,788), is still a ghost town. Buildings and monuments have been secured and all the rubble removed, but the ‘‘red zone’’ in the 13th-century city centre is still a no-go area and its residents, relocated elsewhere, are starting to despair of ever returning’’. The 2009 L’Aquila earthquake (Richter magnitude 6.3) killing 309 residents, injuring over 2,500, leaving 28,000 homeless and 66,000 displaced, caused destruction or serious damage to between 3,000 and 11,000 buildings (the 65% of building and homes). Exposure to destruction and death caused by natural disasters has been shown to lead to psychological disorders and substance use as a byproduct of both the material and spiritual losses [1]. This study provides data on how patterns of substance use changed among young people who survived the earthquake that struck L’Aquila on 6 April 2009. A total of 1,078 young subjects (mean age 21.4 ± 5.6 years) participated in a mental health survey conducted between March and December 2010. They represent 8% of the population with the age range of 16–30 and 1.5% of the general population. They were recruited in different settings: 323 of them self referrals at ‘‘S.M.I.L.E.’’ (a psychiatric service for young people); 123 at SACS (a University Service of guidance and mentoring for students); the rest of them (632) were university and high school students, voluntarily enrolled to this survey. All subjects screened that resulted positive to both the Patient Health Questionnaire (PHQ-9) and the Self-rating Anxiety State (SAS), were further interviewed by a research psychiatrists and than, for some of them, consensus DSMIV diagnoses were made by project psychiatrists according to the Structured Clinical Interview for DSM-IV (SCID I). Of them, 314 (29.1%) had an ICD-10 diagnosis of anxiety disorders (43%), mood disorders (34%), post-traumatic stress disorder (16%), and psychosis (7%). There were 31 participants who had a personal or family history of physical trauma due to the earthquake. Increased substance use was assessed with one question per substance (alcohol, tobacco, cannabis) asking if the users had increased their use in the postearthquake compared with the preearthquake period. To this aim, a 4-point scale was used (none, less than before, equal to before, greater than before). The 12-item General Health Questionnaire (GHQ-12) was used for assessing perceived health. All participants provided their consent to participate in the study and the local ethical committee approved the study protocol. In persons with an ICD-10 diagnosis of psychiatric disorders (n = 314), the use of alcohol, tobacco, and cannabis was reported to be increased in the postearthquake period by 179 (57%), 128 (41%), and 69 (22%) subjects, respectively. Interestingly, none reported a reduced use of these substances following the disaster. In persons without an ICD-10 diagnosis of psychiatric disorders (n = 764), the use of alcohol, tobacco, and cannabis was reported to be increased in the postearthquake period by 374 (49%), 289 (38%), and 138 (18%) subjects, respectively. None of R. Pollice V. Bianchini R. Roncone M. Casacchia Department of Health Sciences, Psychiatric Unit, ‘San Salvatore’ Hospital, University of L’Aquila, L’Aquila, Italy

Is personal recovery in schizophrenia predicted by low cognitive insight

Recovery is a widely discussed concept in the field of research, treatment, and public policy regarding serious mental illness, and mainly schizophrenia. Aim of our study was to assess the relationship between personal recovery and prediction variables, as psychopathology, neurocognition, clinical and cognitive insight, and social functioning in inpatients affected by schizophrenia, with a special interest on cognitive insight. We assessed 76 inpatients affected by schizophrenia at their hospital discharge. Instruments included the Beck Cognitive Insight Scale, the Insight Scale and the Recovery Assessment Scale to assess the cognitive and clinical insight, and personal recovery. The neurocognitive assessment was represented by a single factor score produced by a principal components analysis of a neurocognitive test battery. Social functioning was measured also. Low self-reflectiveness of cognitive insight represented the best predictors of personal recovery. The relationship between cognitive insight and recovery found in this study may contribute to develop tailored interventions, taking into account the personal sense of recovery, despite the psychopathological evaluation.

Acute Stress Reactions and Associated Factors in the Help-Seekers after the L’Aquila Earthquake

Background: The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L’Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed. Methods: For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies. Results: Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by ‘full’ ASD, whereas 48 subjects (39.3%) could be considered affected by ‘partial’ ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting ‘behavioural disengagement’ or ‘requesting emotional support from others’ were found to increase the likelihood of a positive estimate of being an ‘ASD case’, while the adoption of an ‘acceptance’ coping style seemed to reduce the likelihood of the positive estimate of being an ‘ASD case’. Conclusions: This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.

Cognitive behavioral therapy for young people after l'aquila earthquake.

Objective: Cognitive behavior therapy (CBT) emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly associated with anxiety or mood disorders. The aim of this study was to evaluate the CBT efficacy among young people exposed to L’Aquila earthquake, in 2009. Methods: one year after the disaster, 39 young subjects as a case group (CBT treated) and 24 as a comparison group (no CBT treated) were evaluated with the Impact of Event Scale Revised (IES-R), the General Health Questionnaire-12 items (GHQ-12) and the Brief Cope. CBT was conducted in 12 sessions (once per week for 3 months). After CBT intervention, both groups were evaluated again with the same psychometric instruments. Results: our results show a significantly decrease in post traumatic symptoms and psychological distress severity in CBT group. It was attributable to an improvement in each of three PTSD dimensions (intrusion, avoidance, and arousal) and in the total score of IES-R (p< 0.04). Among CBT treated group, subjects that adopted “planning/problem solving” coping strategies (p < .02) and “religiosity” (p < .045) show higher improvement in psychological distress. Conclusions: our findings show the efficacy of CBT and the influence of individual coping strategies in the improvement of posttraumatic stress symptoms and psychological distress among young people seeking help from an outpatients service for young people with psychiatric problems (the SMILE) after the catastrophic disaster in L’Aquila.

Stress and Burnout in Health-Care Workers after the 2009 L’Aquila Earthquake: A Cross-Sectional Observational Study

Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L’Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12). Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97%) emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L’Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the disaster-affected community as survivors and serve as disaster relief workers at the same time.

Moderate Depression Promotes Posttraumatic Growth (PTG): A Young Population Survey 2 Years After The 2009 L’aquila Earthquake

Background: Earthquakes can result in a range of psychopathology and in negative and positive consequences for survivors. Objective: To examine the association between clinical aftereffects (anxiety and depressive symptoms) and post-traumatic growth (PTG) among young survivors of the 2009 L’Aquila earthquake, Italy. Method: 316 young earthquake survivors enrolled in the University of L’Aquila were evaluated two years after the natural disaster. Participants completed three main questionnaires, including Patient Health Questionnaire-9 items (PHQ-9), Self-Rating Anxiety Scale (SAS), and Posttraumatic Growth Inventory (PTGI). Results: 59.6% of the student sample showed different levels of depression, whereas 13.3% reported anxiety symptoms. In both clinical dimensions (anxiety and depression), gender differences were found: female gender was confirmed risk factor for a clinical post-traumatic response. Personal PTG, demonstrated by 18% of the L’Aquila youths included in our sample, was predicted by moderate levels of depression (O.R. 2.7). In our model, gender, age, and anxiety did not show any predictive value. Conclusion: In a post-traumatic setting, the development of individual cognitive strategies is crucial, whereas after a natural disaster, paradoxically, a moderate depressive condition and the related distress could promote the drive to overcome the psychological consequences of the traumatic event.

Preliminary study of effects on paranoia ideation and jumping to conclusions in the context of group treatment of anxiety disorders in young people

People with anxiety disorders tend to focus on unpleasant and threatening stimuli. Our aims were to evaluate: (1) the presence of paranoid ideation, and the jumping to conclusions (JTC) bias in young suffering from an anxiety disorder and (2) the effectiveness of a cognitive‐behavioural intervention (CBT) to manage anxiety combined with 2 modules to reduce the JTC bias.