Socio‐emotional, cognitive, affective disorders and substance use in a sample of students in first‐ and second‐grade high school in Italy: A comparison among students', parents', and teachers' perceptions

Abstract The closure of schools, social hubs, and extracurricular activities due to lockdown measures imposed to curb the spread of SARS‐CoV‐2, has increased the risk factors for students' mental health. This cross‐sectional study, conducted from March 2020 to March 2021, aimed to estimate socio‐emotional, cognitive, and affective disorders and substance use in a sample of first‐ and second‐grade high school students in Northern Italy. This study compared data from 284 Italian students' self‐perceptions along with the perceptions of their parents and teachers through a web‐based survey. The differences in the perceptions of the three groups (students, parents, and teachers) were analyzed using an analysis of variance test, applying a Bonferroni correction. The χ 2 test was used to assess the comparison between students, parents, and teachers in the substance use questions. The results showed statistically significant differences among the three groups. The most important outcomes were sociality, scholastic performance, extracurricular activity, emotional symptoms, affective disorders (depression and anxiety), and substance use. These findings could be interesting for the promotion of mental health and prevention of psychopathological risks in students

Poor social support is associated with preterm birth rather than maternal prenatal anxiety and depression: a retrospective case-control study

Maternal psychological adversities experienced during pregnancy appear to be associated with a trend towards suboptimal birth outcomes, including a shorter gestation period . Preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of neonatal morbidity and mortality, and is associated with adverse effects on mothers’ mental health as well as mother-child relationships . This indicates that preterm birth has a significant emotional impact on families, as well as economic implications for public-sector services. However, despite growing research on this topic, evidence of the specific effects of women’s prenatal mental health on birth outcomes remains unclear and conflicting at times. Therefore, we aimed to examine the impact of pregnant women’s psychosocial distress (specifically, anxiety, depressive symptoms, and level of perceived social support) on preterm birth. The sample for this retrospective case-control study included participants from a longitudinal investigation (2017–2018) of maternal perinatal mental health. Participant recruitment was carried out in perinatal health care centres, facilities associated with the Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, University of Brescia, Italy. This study was conducted in collaboration with the Italian National Institute of Health (Istituto Superiore di Sanità). The inclusion criteria were being pregnant or having a biological child aged ≤6 months, and being able to speak and read Italian. Exclusion criteria were being under 18 years of age, having current psychotic symptoms, or having issues with substance misuse. All participants provided written informed consent prior to entering the study. Before signing the consent form, a healthcare professional involved in the study provided each potential participant with detailed information about the study’s aims and methods, as well as the observational nature of the study. The participant information sheets and consent form made explicit the voluntary nature of their involvement and the right to wthdraw from the study at any time. Ethical approval for the study was obtained from the ethics committee of the Healthcare Centre of Bologna Hospital (Register Number: 0077805, June 27, 2017) The Psychosocial and Clinical Assessment (PCA) form was used to collect information about participants’ sociodemographic characteristics as well as obstetric, clinical, and treatment-related factors. An unstructured clinical interview was used to collect information on both past and current emotional and psychiatric conditions. Both, the PCA and the clinical interview, were administered in person by female clinical psychologists trained in perinatal mental health assessment. To compare categorical data, a X2 test or the exact Fisher’s test, whenever appropriate (n <5 in any cell), were used. All tests were two-tailed with statistical significance set at p = 0.05. All data were coded and analysed using the Statistical Package for the Social Sciences (SPSS, version 26 for Windows Chicago, Illinois 69606, USA). Two hundred and sixty-four Italian women (mean age: 34.2 years, SD: 4.8) were included in the analysis. The total sample comprised 43 mothers who had delivered preterm infants, born before 37 gestational weeks (i.e. cases), and 221 mothers who had had full-term deliveries (i.e. controls). The mean gestational age at delivery in the cases and controls was 34.4 ± 2.9 and 39.6 ± 1.1 weeks, respectively. The two groups did not differ in any sociodemographic characteristics (i.e. age, marital status, educational level, employment status, and socioeconomic status), excluding confounding for the main confounding variables, obstetric aspects (i.e. first pregnancy, history of abortions, and assisted reproductive technology), and mental health features (i.e. mild to severe anxiety or depressive symptoms during pregnancy and number of participants taking medication for anxiety or depression). Furthermore, the two groups did not differ in levels of perceived support from partners (it must be noted that more than 80% of full-term mothers and 90% of preterm mothers reported receiving enough or more than enough emotional as well as practical support from their partner). However, compared to the controls, the cases were significantly more likely to perceive less or no practical (X2 = 7.1, p = 0.029) and emotional (X2 = 6.2, p = 0.045) support from friends and relatives during pregnancy. This study contributed to the relatively scarce literature investigating the association between preterm birth and prenatal maternal mental health and social support characteristics. Our findings align with prior studies that indicated that poor social support enhanced expectant mothers’ stress levels [7], which is a significant predictive factor for preterm birth [8]. Furthermore, recent evidence suggests that support from friends attenuates pregnant women’s psychological stress across the transition to parenthood . Healthcare professionals engaged in providing care to pregnant women, such as medical general practitioners, gynaecologists, and mental health specialists need to assess the quantity and quality of future mothers’ social support (which is a factor that can affect stress levels in pregnant women), even if the pregnant woman does not have anxiety or depressive symptoms. This is necessary in order to help expectant mothers and to prevent possible adverse effects on the foetus and the neonate. In this sense, our findings can provide useful information to Italian health policy planners to consider developing cost-effective programs for the prevention of premature birth, focused on enhancing the levels of social support for pregnant women. In addition, this study may represent the first step to a more in-depth analysis investigating the perception of support from friends and relatives for mothers of preterm children. However, findings from the current study must be interpreted in light of three main limitations: i) a limited sample size, ii) lack of assessment of the level of prenatal psychological stress as a variable, and iii) lack of a structured diagnostic interview to diagnose anxiety and depressive symptoms according to DSM-5 criteria. However, it should be noted that the third limitation was attenuated by the fact that all participants were assessed by licensed clinical psychologists trained in perinatal mental health assessment. Poor social support appears to be a greater risk factor than maternal prenatal anxiety and depressive symptoms, for preterm birth. Thus, it is important for mental health specialists to consider the health and well-being of pregnant women and their future children beyond mental health symptomatology and diagnosis

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

Abstract Problem: The global coronavirus (COVID‐19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents. Methods: This cross‐sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID‐19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e‐research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale. Findings: A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide. Conclusions: This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathol ogies and the promotion of adolescent mental health due to the pandemic

A Brief Depression Screening Tool for Perinatal Clinical Practice: The Performance of the PHQ-2 Compared with the PHQ-9

Introduction There is ongoing interest in using brief screening instruments to identify perinatal depression in clinical practice. One ultra-brief screening instrument for depression is the Patient Health Questionnaire-2 (PHQ-2), but thus far its accuracy in perinatal clinical practice has been barely researched. In the present study, we aimed to assess the screening accuracy of the PHQ-2 against the Patient Health Questionnaire-9 (PHQ-9) in a large sample of perinatal women. Method A total of 1155 consecutive women attending 11 health care centers throughout Italy completed the PHQ-9 (which includes the PHQ-2) during pregnancy (27-40 weeks) or postpartum (1-13 weeks). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, and overall accuracy were calculated using cut points 3 or greater and 2 or greater. Results During pregnancy, PHQ-2 greater than or equal to 3 revealed low sensitivity (38.4%-44.7%) but high specificity (97.8%-99.3%). In postpartum, it revealed moderate sensitivity (56.9%-70.6%), high specificity (95.8%-99.8%), and fair overall accuracy in pregnancy (70%). The alternative threshold greater than or equal to 2 revealed very high sensitivity (pregnancy: 92.1%-95.2%; postpartum: 87.1%-95.2%), moderate specificity (pregnancy: 78.1%-83.2%; postpartum: 68.8%-81.1%) and good overall accuracy, both during pregnancy (87%) and postpartum (84%). Discussion The PHQ-2 provided acceptable accuracy for screening for depression compared with the PHQ-9. In perinatal screening practice, a threshold of 2 or greater should be preferred as this ensures high sensitivity, missing only approximately 6% to 8% of cases, and a false-positive rate (percentage of women classified as affected with depressive symptoms when they are not) of 19% to 25%

The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study

Background: At the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple—the baby dies and the couple’s plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief. Objective: The main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief. Methods: This longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases—a baseline and a follow-up after 6 months. Results: This protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation. Conclusions: This study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health. International Registered Report Identifier (IRRID): DERR1-10.2196/3886

The impact of the COVID-19 pandemic on perinatal loss among Italian couples: A mixed-method study

Background: Perinatal bereavement is an event that greatly impacts the emotional, psychological, and psychosocial aspects of those who want to have a child. Objectives: Since there are few studies on the psychological impact of the COVID-19 pandemic on couples grieving for perinatal loss, this research aimed to survey this experience. Participants: Between 2020 and 2021, in Italian provinces highly affected by the COVID-19 pandemic, 21 parents participated: 16 mothers (76%; mean age 36.2; SD: 3.1) and 5 fathers (24%; mean age 40.2; SD: 3.4), among which there were 4 couples. Methods: A mixed-method design was used through self-report questionnaires and in-depth interviews. Accompanied by a sociodemographic form, the following questionnaires were administered: Prolonged Grief-13, the Parental Assessment of Paternal Affectivity (PAPA) (to fathers), the Parental Assessment of Maternal Affectivity (PAMA) (to mothers), the Dyadic Adjustment Scale short version, the Daily Spiritual Experiences Scale, and the Impact of Event Scale-Revised. The texts obtained through the in-depth interviews underwent thematic analysis. Results: Fifty per cent of participants suffered from Post-Traumatic Stress Disorders (PTSD) symptoms and 20% suffered from relational dyadic stress. Four areas of thematic prevalence emerged: psychological complexity of bereavement, the impact of the COVID-19, disenfranchisement vs. support, and spirituality and contact with the lost child. Participants interpreted their distress as related to inadequate access to healthcare services, and perceiving the pandemic restrictions to be responsible for less support and lower quality of care. Furthermore, they needed psychological help, and most of them were unable to access this service. Spirituality/religiosity did not help, while contact with the fetus and burial did. Conclusion: It is important to implement psychological services in obstetrics departments to offer adequate support, even in pandemic situations

Development of a short version of the Spielberger state and trait anxiety inventory for pregnant women

The Spielberger state-trait anxiety inventory (STAI) is a widely recognized tool for assessing state and trait anxiety components in the general population. While reliable and valid, each scale in the STAI has 20 items, which limits its usability in certain real-world clinical settings. Additionally, certain items can inaccurately increase anxiety scores among expectant women. This study aimed to develop a concise yet dependable and valid version of these scales tailored for pregnant individuals. We engaged 1,158 expectant women who completed the STAI and other assessments to determine criterion validity. Our methodology incorporated item response theory to select the most discriminating items for pregnant people, confirmatory factor analysis to evaluate the fit of the factor solution for the abbreviated versions, and k-fold cross-validation to ensure the robustness of the models. Additionally, Bland-Altman regressions and plots assisted in gauging score accuracy, and receiver operating characteristic analyses determined discriminative validity. We also set clinical change benchmarks. The resulting five-item STAI short forms manifested robust psychometric attributes and reliability, providing a theoretically grounded and reliable anxiety assessment during pregnancy. This can be effectively applied in obstetric and gynecological settings, offering a streamlined response experience for expectant women

Prevalence of Maternal Postnatal Anxiety and Its Association With Demographic and Socioeconomic Factors: A Multicentre Study in Italy

Anxiety is a common perinatal disorder that can cause severe adverse consequences. This study (a) assesses the prevalence of maternal postnatal anxious symptomatology, and (b) analyses its association with demographic and socioeconomic variables as well as obstetric and other psychosocial variables. The assessment included 307 mothers aged ≥18 years with a biological baby aged ≤52 weeks and from seven Italian healthcare centres, evaluated using a Psychosocial and Clinical Assessment Form (also covering demographic and socioeconomic factors), and the state scale of the State-Trait Anxiety Inventory. We found an overall prevalence of self-reported postnatal anxious symptoms of 34.2%. More specifically, the prevalence was 34.5% at 1–24 weeks postpartum, and 30.8% at >24 weeks postpartum. No associations between postnatal anxious symptoms and demographic or socioeconomic variables were observed. As regards the other variables, the findings indicated antenatal depression or anxiety, parity, and current psychological support from the partner as having the strongest relationships

Estimating the impact of the COVID-19 pandemic on maternal and perinatal health care services in Italy: results of a self-administered survey

The coronavirus disease 2019 (COVID-19) pandemic is strongly changing the way most people live their lives, and disrupting specialist healthcare systems. Such public health disruptions have resulted in significant collateral damage with particular implications for vulnerable populations, including the perinatal population. This Study aims to estimate the impact of the COVID-19 pandemic on Italian maternal and perinatal health care services. A questionnaire was designed to evaluate the COVID-19 impact on Italian maternal and perinatal healthcare facilities and their activities and provision of services from March to May 2020. The survey was completed by hospital-based and community-based Italian maternal and perinatal healthcare facilities. Most of these were located in Lombardy or Veneto (the most affected Italian regions). 70% of all facilities reported that the first wave of the COVID-19 pandemic negatively influenced the functioning of one or more aspects of the perinatal service; only 28.4% of facilities all over the country continued to provide outpatient routine visits and examinations as usual; 23.4% of facilities became understaffed during the index period due to various reasons such as ward transfer and sick leave. This is the first Italian study, and among very few international studies that describe the effects of the COVID-19 pandemic on antenatal and postnatal healthcare facilities and their provision of activities and services. Our findings confirm that healthcare systems even in high-income countries were not entirely prepared to handle such a global health emergency; indeed, specialized maternal and perinatal healthcare services have been disrupted by this global health emergency

Prevalence and types of video gaming and gambling activities among adolescent public school students: findings from a cross-sectional study in Italy

Abstract Adolescence is characterized by emotional instability and risk-taking behaviours that can lead to, among other things, an increased risk of developing pathological video-gaming and gambling habits. The aim of this Study is to assess the prevalence and type of video gaming and gambling habits in adolescent students attending Italian upper-secondary schools. The cross-sectional study was conducted via an online survey using validated questionnaires. The primary outcome measures were the prevalence of past-year video gaming and gambling activities. The sample consisted of 502 adolescent students from frst- and second-grade secondary schools. A total of 40.8% of participants were video gamers, 4.8% were gamblers, 17.8% were both video gamers and gamblers, and the remaining 36.6% were not players. Among participants who reported video gaming activity (n=294), 68.0% were classifed as nonproblem gamers, 24.5% as at-risk gamers, and 7.5% as disordered video gamers. Among the participants who reported gambling activity (n=113), 85.8% were not problematic gamblers, 8.9% were at-risk gamblers, and 5.3% were pathological gamblers. Only 0.2% of all subjects met the criteria for both pathological gambling and pathological video game use. The fndings indicate that video gaming and gambling are common leisure times among adolescent students. However, a small but signifcant minority of these adolescents met the criteria for either severe problem gaming or gambling or bot