Exploiting network information to disentangle spillover effects in a field experiment on teens' museum attendance

Nudging youths to visit historical and artistic heritage is a key goal pursued by cultural organizations. The field experiment we analyze is a clustered encouragement design (CED) conducted in Florence (Italy) and devised to assess how appropriate incentives assigned to high-school classes may induce teens to visit museums in their free time. In CEDs, where the focus is on causal effects for individuals, interference between units is generally unavoidable. The presence of noncompliance and spillover effects makes causal inference particularly challenging. We propose to deal with these complications by creatively blending the principal stratification framework and causal mediation methods, and exploiting information on interpersonal networks. We formally define principal natural direct and indirect effects and principal controlled direct and indirect effects, and use them to disentangle spillovers from other causal channels. The key insights are that overall principal causal effects for sub-populations of units defined by the compliance behavior combine encouragement, treatment and spillovers effects. In this situation, a synthesis of the network information may be used as a possible mediator, such that the part of the effect that is channeled by it can be attributed to spillovers. A Bayesian approach is used for inference, invoking latent ignorability assumptions on the mediator conditional on principal stratum membership.Comment: Original article, 36 pages, 3 figure

Mental health, work and care: the value of multidisciplinary collaboration in psychiatry and occupational medicine

Objectives To investigate the relation between work and mental health in a multidisciplinary fashion. Methods This overview is based on books and articles purposely extracted from national and international literature published in the fields of psychiatry, occupational medicine, economics and labor law, written in Italian and English, without time limits; it is part of the BUDAPEST-RP Project launched in 2010 to study the effects of the economic crisis on the Italian population. Results Some features of work and the labour market in the context of the Fourth Industrial Revolution (desynchronization of time, increased external control, need of orderliness in the work relationships-i.e., decreased tolerance of work-conflicts, e.g., between the employer and the Unions-, hypernomia and heteronomy) mirror some psychopathological aspects of the pre-morbid personality prone to develop depression, and may act as environmental risk factors. This, coupled with increased unemployment and precariousness, especially affecting the young, prompt to finding evidence-based strategies to promote employment of people affected by mental disorders, seriously hit by unemployment in the years following the Great Recession. Conclusions Work organization is the common denominator between the work environment conceived as a risk or protective factor for psychiatric disorders and the use of work in the field of psychiatric rehabilitation, by means of vocational rehabilitation programs. Given the intrinsic complexity of this common ground, networking is required between professionals of different backgrounds, to develop a multidisciplinary approach in the fields of care, research and education, and to foster a better integration between occupational health and psychiatry

The burden of attempted suicide: The attitude of emergency services workers

Introduction The great global burden of suicide requires specific preventive strategies focused on emergency services (ES) workers, providing first aid after attempted suicide. Objectives To investigate the approach of ES workers toward attempted suicides, and to assess work-related stress and teamwork attitude as variables likely to influence suicide risk perception. Methods A total of 265 ES workers (73 medical doctors, 130 nurses, 62 health and social care workers) from 3 hospitals in the area of Modena (Northern Italy) were involved. In a group setting, titles from local newspapers reporting about suicides were read, and ES workers were asked to fill in 3 psychometric scale questionnaires (SUIATT, MBI and SAQ). Results The questionnaires returned were 88 (33%), 47% (n = 42) were filled by women, median age was 40 years. Doctors group had the highest response rate (60%). Burnout levels were intermediate at the Emotional Exhaustion subscale, severe at the Depersonalization subscale and mild at the Professional Efficacy subscale. Eighteen percent recorded a good team perception, 33% had a good perception of their work conditions. SUIATT subscales showed a restrictive attitude toward suicide, regardless of hospital and task. Discussion No associations emerged among SUIATT, MBI and SAQ subscales; male sex alone correlated to the SUIATT factor “rationality/ mental alteration”, suggesting more “tolerance” of suicidal behaviour. Conclusions It is crucial to raise awareness among ES workers on this issue, since those workers considering suicide as “more acceptable” are more likely to recognise its signs

Internet as a tool to estimate psychiatrists’ opinions on consultation activity in the Emergency Room: a mix-method survey

OBJECTIVES This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the Emergency Room (ER). Considerations and suggestions concerning the use of Internet-based surveys for research purposes are also offered. METHODS A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was made up of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Surveymonkey was used to collect responses. Data collection went on for two weeks, from June 1st until June 15th 2011. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency. RESULTS Out of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data for the research since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). Social emergencies were indicated as a rare cause of consultation (1.7%), yet they were considered particularly challenging by the 36.2% of psychiatrists. A large amount of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by the ER personnel, “poor autonomy of the personnel working in the ER” (38.2%), and “poor perceived safety” (30.9%) by the consultant. Yet, it is noticeable that the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER. CONCLUSIONS The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, though limited external validity might be a problem only partially addressed by adopting mixed-method strategies of research

Attempted suicide: Study of the phenomenon in a sample of patients in the province of Modena

Introduction Attempted suicide consists in a self-damaging nonfatal behaviour, with an explicit or implicit evidence of the intent to die. It has a multifactorial aetiology: presence of psychiatric disorder, particularly major depression and other non-psychiatric components, like a series of stressful events. Aim To describe suicidal behavior among patients who attempted suicide. Methods Cross-sectional study. Patients admitted to three hospitals in the Province ofModena(Italy) after having attempted suicide were enrolled. Observation time: August 2015\u2013August 2016 (13 months). Descriptive statistics made with STATA 13.0. Results A total of 187 subjects (female 65%) were enrolled in the period of time considered. Forty-one percent were aged 45\u201364; 43.7% had higher education; 50.4% were unemployed; 49.6% had regular income. Common means to attempt suicide were drugs (64%), weapons (11%), precipitation (10%), other (6%), choking (4%). Recent stressful events were reported by the 83.4% of respondents, namely: family conflicts (29%), economic problems (17%), personal health problems (11%), health problems affecting a family member (5%), emotional separation (9%), job loss (7%), other (22%), alcohol abuse (27%), substance abuse (4%). The main psychiatric diagnoses were: depressive disorder (56.67%), personality disorder (20%), psychotic disorder (6.67%), bipolar disorder (5.33%), behavioural disorders (2.67%), anxiety disorders (2%), dementia (1.33%). Conclusions Findings of the present study are consistent with available literature and could help to identify \u201chigh risk\u201d groups to plan future targeted programmes

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 group was intendened as respondent validation of 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 liaison between Psychiatry and Occupational Medicine is an interesting and useful tool for future action and advocacy

Impact of anxiety-depressive symptoms on outpatients\u2019 quality of life: Preliminary results from an Italian observational study

Introduction Several studies have shown an association between the Short-Form 36 (SF36) scores and anxiety-depressive symptoms, suggesting that depression in particular could reduce Quality of Life (QoL) to the same, and even greater, extent than chronic noncommunicable diseases, such as diabetes and hypertension. Aims To explore the relationshipamongQoL and anxiety, depressive and anxiety-depressive symptoms in an outpatient sample. Methods Cross-sectional study. Inclusion criteria: outpatients aged 6540 years, without history for cancer, attending colonoscopy after positive faecal occult blood test. Collected data: blood pressure, blood glucose, lipid profile. Psychometric test: Hospital Anxiety and Depression Scale (HADS). QoL was assessed with SF36. Statistics performed with STATA13. Results 54 patients enrolled (27 females). Sixteen patients (30.2%) were positive for anxiety symptoms, ten (18.9%) for depressive symptoms and five (9.4%) for anxiety-depressive symptoms. The perceived QoL was precarious in twelve subjects (22.2%): eight (15.9%) had low score ( 64 42) at \u201cMental Component Summary\u201d (MCS) subscale, three (5.7%) at the \u201cMental Health\u201d item and one patient (1.9%) at the \u201cVitality\u201d one. At the multiple regression analysis, depressive (OR = 28.63; P = 0.01) and anxiety-depressive symptoms (OR = 11.16; P = 0.02) were associated with MCS. Conclusions The association emerging from the present study between depressive/anxiety symptoms and the MCS component of SF36 is consistent with available literature. Study design and small sample size do not allow to generalize results, that need further studies to be confirmed

Stability of Psychiatric Diagnoses in Candidates to Liver Transplantation Referred to a Consultation-Liaison Psychiatry Service

Objective: To investigate the stability over time of the psychiatric diagnoses among candidates to liver transplantation referred to a consultation-liaison psychiatric service. Method: Descriptive study, carried out at the Consultation-Liaison Psychiatry Service (CLPS) placed at the Modena (Italy) General University Hospital. All patients waiting for liver transplantation and repeatedly referred to the CLPS were enrolled. The observation period was from 1 January 2008 to 31 December 2013. Pearson\u2019s coefficients were calculated to measure diagnostic stability (index referral vs. last referral). Results: One hundred patients were assessed (males 67%; mean age 53 \ub1 7 years old). The mean number of referrals for patients was 3 \ub1 2. The stability rate of psychiatric diagnosis was 64%. The following diagnoses or conditions were all significantly stable (i.e., all featured by r > 0.5 and p < 0.05): Adjustment disorder, depressive disorder, comorbid anxiety/depressive disorder, substance use disorder (including alcohol), absence of any disorder, and presence of any disorder. Conclusions: The good level of diagnostic stability displayed in the sample may be a function of the clinical and organizational \u201cstyle\u201d of the CLPS, namely the focus on identifying the prevailing personality traits, defensive mechanisms, and relational patterns