Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one\u2019s chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose

Altered Cognitive Function in Men Treated for Prostate Cancer with LHRH Analogues and Cyproterone Acetate: A Randomised Controlled Trial

Objective. Luteinising hormone releasing hormone (LHRH) analogues have been associated with memory impairments in women using these drugs for gynaecological conditions. This is the first systematic investigation of the cognitive effects of LHRH analogues in male patients. Methods. 82 men with non-localised prostate cancer were randomly assigned to receive continuous leuprorelin (LHRH analogue), goserelin (LHRH analogue), cyproterone acetate (steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before commencement of treatment (77) then 6 months later (65). Results. Compared with baseline assessments, men administered androgen suppression monotherapy performed worse in 2/12 tests of attention and memory. 24/50 men randomised to active treatment and assessed 6 months later demonstrated clinically significant decline in one or more cognitive tests but not one patient randomised to close monitoring showed a decline in any test performance. Conclusion. Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions

Specification of social support behaviours and network dimensions along the HIV continuum for gay men

This study aimed to investigate social supports that HIV-infected persons find helpful and unhelpful, and the size and composition of networks along the disease continuum. Ninety six HIV-infected and 33 seronegative gay men were interviewed. The HIV continuum was represented by seronegative, HIV asymptomatic and symptomatic groups. Emotional and physical support were the most frequently identified helpful supports. Symptomatic persons identified physical support as helpful more often than asymptomatic persons. Availability, acceptance and nurturing were the most frequently identified helpful emotional support behaviours, while domestic support was the most frequently identified physical support behaviour. The most frequently mentioned unhelpful support was overprotectiveness. Overall, HIV-infected people had adequate social networks. Composition of the networks of HIV-infected persons differed from that of seronegative participants, in that the former had markedly more professional and family persons and fewer friends in their network. HIV education and counselling interventions should provide emotional support, facilitate physical support for symptomatic persons, offer support that matches specific needs, include significant others, incorporate peer-help and be gay-sensitive. (C) 1998 Elsevier Science Ireland Ltd

Psychosocial adjustment along the hiv disease continuum

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage

Relationships Between Adjustment to HIV and Both Social Support and Coping

This study examined the relationships between HIV stage, social support, coping strategies, and adjustment to HIV. Ninety-six HIV-infected gay men and 33 seronegative comparison group participants participated in the study. In general, coping strategies and social support did not differ according to HIV stage. As predicted, adjustment was related to social support and coping strategies. Coping strategies were linked to psychosocial adjustment, whereas social support was more strongly associated with health-related variables. There was little evidence of buffering effects of either coping strategies or social support. Four coping strategies were related to low levels of psychological distress. Contrary to expectation, the relationships between coping strategies and adjustment did not vary as a function of HIV stage. However, the relationship between adjustment and some elements of social support varied as a function of HIV stage

A model of the effects of parental illness on youth adjustment and family functioning: The moderating effects of psychological flexibility on youth caregiving and stress

Parental chronic illness may adversely impact youth and family functioning. This study examined a moderated mediation model of the effects of parental illness on youth and family functioning derived from the Family Ecology Framework. Consistent with this model, we predicted that youth caregiving and stress would serially mediate the adverse impacts of parental illness on youth adjustment and family functioning and that psychological flexibility would moderate these media-tional mechanisms. A total of 387 youth, with parents affected by chronic illness, completed a questionnaire assessing parental illness severity, youth caregiving and stress, psychological flexibility, youth adjustment (i.e., internalizing and externalizing problems and psychological wellbeing), and family functioning. Path analyses indicated that the adverse effects of parental illness on youth adjustment and family functioning were serially mediated by youth caregiving and stress. Psychological flexibility buffered the adverse effects of these serial mediators on youth internalizing problems and psychological wellbeing. These findings identified three potential intervention targets: youth caregiving, related stress appraisals, and psychological flexibility. Given the large body of evidence showing that acceptance and commitment therapy fosters psychological flexibility, this intervention approach has the potential to address the psychosocial and mental health vulnerabilities of youth in the context of parental illness, which constitutes a serious public health issue

Validation of the Italian Young Carer of Parents Inventory-Revised (YCOPI-R)

Purpose: Parental illness or disability has wide ranging impacts on offspring. Due to the lack of an Italian contextually sensitive measure of youth caregiving, this study explored the factor structure, reliability, and validity of the Italian version of the Young Carer of Parents Inventory-Revised (YCOPI-R). Materials and methods: Seven hundred and seventy-four youth aged 11\u201324 (386 young carers and 388 young non-carers) completed a questionnaire regarding youth caregiving, parental illness, caregiving context variables, and youth adjustment. Results: The Italian YCOPI-R demonstrated good psychometric properties. Part A factor structure was replicated while two new factors emerged for Part B: Caregiving Stigma and Caregiving Resentment. Discriminant and convergent validity were evinced by differentiation between young carers and non-carers and associations between YCOPI-R factors and measures of caregiving activities and caregiving context. Predictive validity was supported as most Italian YCOPI-R factors were related to poorer youth adjustment, while Caregiving Confidence and Worry about Parents predicted higher levels of health-related quality of life. Conclusions: The Italian YCOPI-R is a psychometrically sound measure of caregiving experiences in Italian youth. Findings confirm the multidimensional nature of youth caregiving, the mix of costs and rewards associated with it, and the link between youth caregiving and diverse adjustment outcomes.Implications for rehabilitation Given the global rise in the number of youth caring for an ill or disabled family member and the association between youth caregiving and greater risks for mental and physical health problems, elevated youth caregiving is a significant public health issue. The Italian version of the YCOPI-R is a valid and reliable measure of youth caregiving experiences in the Italian context. The Italian YCOPI-R offers a promising tool for better identifying young carers who are at risk for adverse psychosocial outcomes and in evaluating young carer support services and preventive interventions