The clinical link between type D personality and diabetes

Introduction: Type D personality consists of a mixture of high levels of negative affectivity and social inhibition, resulting in a stable tendency to experience negative emotions, by inhibiting the expression of these emotions. We have reanalyzed the clinically relevant studies examining the role of this personality profile in diabetes, by providing a qualitative synthesis of the data. In this regard, the aim of this study is to provide a systematic review by evaluating the clinical link between Type D personality and diabetes. Method: When focusing on PRISMA guidelines, we have performed a comprehensive research of the literature on PubMed, Scopus, ScienceDirect, ISI Web of Science, PsycINFO, and Google Scholar by using search terms as "distressed personality" OR (i.e., Boolean operator) "Type D personality" combined with the Boolean "AND" operator with "diabetes." Results: A total of seven research studies were identified and included in the review. Type D was found to be more prevalent in diabetes patients than controls. As regards the specific association with diabetes variables, Type D personality is a significant predictor of both poor medication adherence and unhealthy behaviors, by predicting negative mental health consequences also (i.e., depressed mood, anhedonia, and anxiety). Conclusion: Our review emphasized for the first time that Type D personality affects clinical factors in patients with diabetes by provoking adverse outcomes. The core implication of the study comprises the clinical relevance to detect, from a clinimetric point of view, Type D personality in diabetes in order to prevent potentially negative clinical outcomes

The clinical consequence of positive mental health in psychotherapy

The current commentary is aimed at critically analyzing the document Psychotherapies for Anxiety and Depression: benefits and costs by focusing on specific theoretical concepts and empirical evidences arising from research studies fulfilled in the area of study of Clinical and Health Psychology. Specifically, the following were the main topics on which we are focused on: i) the clinical consequence potentially resulting from considering the psychological well-being and the euthymia condition as the main targets of a psychotherapeutic treatment; ii) a critical reappraisal of the clinical inadequacy of the evidence based model in psychotherapy; iii) clinimetrics as a clinically based measurement method for evaluating the psychological well-being of a patient after a psychotherapeutic intervention

Negative Affectivity Predicts Lower Quality of Life and Metabolic Control in Type 2 Diabetes Patients: A Structural Equation Modeling Approach

Introduction: It is essential to consider the clinical assessment of psychological aspects in patients with Diabetes Mellitus (DM), in order to prevent potentially adverse self-management care behaviors leading to diabetes-related complications, including declining levels of Quality of Life (QoL) and negative metabolic control.Purpose: In the framework of Structural Equation Modeling (SEM), the specific aim of this study is to evaluate the influence of distressed personality factors as Negative Affectivity (NA) and Social Inhibition (SI) on diabetes-related clinical variables (i.e., QoL and glycemic control).Methods: The total sample consists of a clinical sample, including 159 outpatients with Type 2 Diabetes Mellitus (T2DM), and a control group composed of 102 healthy respondents. All participants completed the following self- rating scales: The Type D Scale (DS14) and the World Health Organization QoL Scale (WHOQOLBREF). Furthermore, the participants of the clinical group were assessed for HbA1c, disease duration, and BMI. The observed covariates were BMI, gender, and disease duration, while HbA1c was considered an observed variable.Results: SEM analysis revealed significant differences between groups in regards to the latent construct of NA and the Environmental dimension of QoL. For the clinical sample, SEM showed that NA had a negative impact on both QoL dimensions and metabolic control.Conclusions: Clinical interventions aiming to improve medication adherence in patients with T2DM should include the psychological evaluation of Type D Personality traits, by focusing especially on its component of NA as a significant risk factor leading to negative health outcomes

Clinical Psychology in School and Educational Settings: Emerging Trends

Background: First clinical services in psychology have been established for educational purposes when Witmer founded its Psychological Clinic. Over the years, the educational dimension played a significant role in the development of new evaluation methods and intervention strategies for the pursuit of positive mental health. The present review aims to capture developments that have been considered emerging applications of clinical psychology in school and educational settings. Methods: We conducted a search of the literature on Scopus, PubMed and Web of Science. The following search terms were used and combined: “clinical”, “psychology”, “educational”, and “school”. Results: A total of 18 research articles were included and analyzed in the current review. A number of studies showed that school-based positive psychology interventions were effective not only in reducing symptoms of psychological distress (somatization, depression, and anxiety) but also in increasing levels of positive mental health (a sense of individual growth, self-esteem, self-efficacy and optimism). As to studies on evaluation methods, the WHO-5 and the psychological well-being subscale from the Kellner Symptom Questionnaire were found to be clinically valid self-rating scales for the assessment of positive mental health in children and adolescents. Conclusion: Studies demonstrated that promoting positive mental health is more beneficial in the long term than simply treating symptoms of psychological distress. In clinical psychology, time has come to move from a traditional psychopathology-based perspective to a positive clinical approach to be used for innovative interventions and assessment strategies in school and educational settings

Clinimetric properties of the 21-item Depression, Anxiety and Stress Scales (DASS-21)

Background: The Depression, Anxiety and Stress Scale-21 (DASS-21) is a widely used patient-reported outcome measure. While psychometric properties of the DASS-21 have been studied, insufficient attention has been devoted to the assessment of its clinimetric properties. This study verified the clinimetric properties of the Italian version of the DASS-21 according to Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria. Methods: This is a cross-sectional study involving 951 university students from April to September 2020. Participants were asked to fill in the DASS-21 via an online survey. Participation was voluntary. Item Response Theory (IRT) models were used to test dimensionality, scalability, and sensitivity of DASS-21. Results: IRT analyses showed that the DASS-21 total score was a multidimensional measure of psychological distress. Fit to the Rasch model was achieved after excluding five misfitting items and adjusting the sample size, resulting in a 16-item version of the DASS-21. The 16-item version entailed the clinimetric property of sensitivity but included inter-correlated items. Brief versions of the DASS-21 subscales of depression, anxiety, and stress, which did not include locally dependent items, fitted the Rasch model expectations, and had an acceptable unidimensionality and scalability, were identified. Conclusion: The 16-item version of the DASS-21 may be used as an overall indicator of dysthymia and should be supplemented with the brief versions of the depression, anxiety, and stress subscales, which were found to be valid clinimetric indices

Suppression Mental Questionnaire App: a mobile web service-based application for automated real-time evaluation of adolescent and adult suppression

The Suppression Mental Questionnaire System (mobile App, Web-Services, Cloud...) acts as a bridge among dynamic psychology, the cognitive studies, and modern information and telecommunication technologies (ICT). The adoption of digital tools speeds clinical investigations on defense mechanisms and makes clinical trials easier by reducing needed effort for manual scoring. It also enables faster and deeper research practices, also more appropriate to the times by enabling the real-time transfer of the results to digital archives  for statistical and psychometrical purposes. Reliability of the scale was evaluated by using Cronbach's alpha; this numerical coefficient of reliability was calculated for the three factors and for the two psychodiagnostic tools. The digital tool melts together scalability and availability provided by the mobile application, power and flexibility provided by Web 2.0 portal. The statistical analysis show a good reliability of the scale and of different factors. Differences related to the factors are considered possible on the basis of the current literature.Mobile Operating Systems, Internet, Web 2.0, and the considerable computing capabilities provided by Clouds are powerful combinations of tools able to provide real-time Open Data/Results to scientists and users, and to spread up the use of the questionnaire all over the world

Mental Pain as a Transdiagnostic Patient-Reported Outcome Measure

Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies

The Italian version of the Depressive Experiences Questionnaire: psychometric properties and validation in students, community, and clinical groups

The current study evaluated the psychometric properties of the Italian validation of the Depressive Experiences Questionnaire (DEQ), conceived as a measure of self-criticism and dependency, i.e. two personality factors acting, according to Blatt (2004), as risk factors for depression in particular and psychopathology in general. A series of standardized measures [Beck Depression Inventory-II (BDI-II), DEQ, Symptom Checklist-90-R (SCL-90-R), Millon Clinical Multiaxial Inventory, 3rd edition (MCMI-III)] was administered to three samples (i.e., students, community and clinical). Factorial validity was evaluated along with convergent and predictive validity. In order to evaluate the reliability and internal consistency, a specific subgroup of participants was retested on the DEQ and BDI-II. Results showed correlations between DEQ dimensions and some personality traits of the MCMI-III. The traditional three-factor model of the DEQ structure as identified by principal component analysis appears to be as stable factors as typically found in American samples, although some items showed elevated cross-loading or low loadings on any factor. Clinical and diagnostic implications of the findings will be discussed

Alexithymia in Gastroenterology and Hepatology: A Systematic Review

Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation.Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies.Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10–15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings.Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes