A case-control validation of Type D personality in Greek patients with stable coronary heart disease

BACKGROUND: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. METHODS: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Cronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. CONCLUSIONS: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality

Alexithymia in patients with psoriasis: a case control study

Psoriasis is a chronic inflammatory skin disease. Alexithymia and other psychological factors may affect the disease and lead to the aggravation of its symptoms. The aim of the current study in particular was to examine the association of psoriasis with alexithymia; i.e. the difficulty of psoriatic patients to identify and describe their feelings, as well as with other psychopathological factors. A total of 208 participants were included in the study: 108 patients with psoriasis and 100 healthy controls. Patients assessments included the following scales. Toronto Alexithymia Scale (TAS-20, alexithymia), Hospital Anxiety and Depression Scale (HADS, anxiety and depression), SCL-90-R (Symptom Checklist-90-Revised, psychopathology), Social Readjustment Scale (Stressful life events), Psoriasis Area and Severity Index (PASI, assessment of the extent and severity of psoriasis), and Alcohol Use Disorders Identification Test (AUDIT, detect abuse of alcohol-dependence disorders). Additionally, demographic data were collected and the smoking status of the patients was recorded. According to the results, although the total alexithymia did not appear to correlate with age (age was associated only with the dimension of the external orientation), sex or disease severity of psoriatic patients, it was found that alexithymia was affected by increased anxiety and depression. Regarding the dimensions of psychopathology in the patients’ group, it was found that women with psoriasis presented higher levels of somatization, depression, anxiety, phobic anxiety and psychotism than men. Moreover, the psoriatic patients with alexithymia presented higher levels of somatization, interpersonal sensitivity, anxiety and phobic anxiety. The severity of psoriasis was positively correlated with the dimension of interpersonal sensitivity. According to the results, smoking and alcohol did not constitute risk factors as concerns both the onset and the relapses of psoriasis. External orientation;one of alexithymia dimensions, seems to be a pathognomonic characteristic of this study’s sample. Regarding the statistical prediction of anxiety, depression, stress and psychological distress (HAD- Scale) from alexithymia and its dimensions, it was revealed that only alexithymia’s dimension “difficulty of describing feelings” (DDF) was the only dimension that contributed to the prediction of anxiety, with higher DDF levels indicating higher anxiety. Concerning the statistical prediction of the psychopathology dimensions (SCL-90-R) it emerged that the total score of alexithymia, contributed significantly to the prediction of somatization, interpersonal sensitivity, depression, anxiety and phobic anxiety, as well as to the Global Severity Index and the Positive Symptoms Total. Therefore, it could be suggested that alexithymia is a vulnerability factor for developing psychiatric disorders. Psychopathology and especially the alexithymia’s impact should be taken into consideration by the clinicians, as the implementation of the appropriate psychological interventions could possibly contribute to the reduction of psoriasis relapses and to the improvement of the progress of the disease.Η ψωρίαση αποτελεί μια χρόνια, φλεγμονώδη νόσο του δέρματος. H αλεξιθυμία, καθώς και άλλοι ψυχολογικοί παράγοντες δύνανται να επηρεάσουν αρνητικά τη νόσο και να προκαλέσουν επιδείνωση των συμπτωμάτων της. Σκοπός της παρούσας έρευνας ήταν να μελετηθεί ειδικότερα η σχέση της αλεξιθυμίας -της δυσκολίας δηλαδή που έχουν οι ασθενείς να αναγνωρίσουν και να περιγράψουν τα συναισθήματά τους- καθώς και άλλων ψυχοπαθολογικών παραγόντων με την ψωρίαση. Συνολικά μελετήθηκαν 208 άτομα: 108 ασθενείς με ψωρίαση και 100 υγιείς μάρτυρες. Χρησιμοποιήθηκαν οι κλίμακες Toronto Alexithymia Scale (TAS-20, αλεξιθυμία), Hospital Anxiety and Depression Scale (HADS, άγχος και κατάθλιψη), SCL-90-R (Symptom Checklist-90-Revised, ψυχοπαθολογία), Social Readjustment Scale (στρεσογόνα γεγονότα ζωής), Psoriasis Area and Severity Index (PASI, αξιολόγηση της έκτασης και της βαρύτητας της ψωρίασης) και Alcohol Use Disorders Identification Test (AUDIT, ανίχνευση διαταραχών κατάχρησης-εξάρτησης αλκοόλ), ενώ έγινε καταγραφή των δημογραφικών στοιχείων, καθώς και των ασθενών που κάπνιζαν. Σύμφωνα με τα αποτελέσματα της έρευνας, αν και εκ πρώτης όψεως η συνολική αλεξιθυμία δε φάνηκε να συσχετίζεται με την ηλικία (η ηλικία συσχετίστηκε μόνο με τη διάσταση του εξωτερικού προσανατολισμού), το φύλο ή τη βαρύτητα της νόσου των ψωριασικών ασθενών, βρέθηκε εντούτοις ότι η αλεξιθυμία επηρεάζεται κυρίως από το υψηλό άγχος και την κατάθλιψη. Αναφορικά με την αξιολόγηση των διαστάσεων ψυχοπαθολογίας στην ομάδα των ασθενών, βρέθηκε ότι οι γυναίκες με ψωρίαση υπερείχαν σε σχέση με τους άντρες στη σωματοποίηση, στην κατάθλιψη, στο άγχος, στο φοβικό άγχος και στον ψυχωτισμό. Επιπλέον, οι αλεξιθυμικοί ασθενείς παρουσίασαν υψηλότερη σωματοποίηση, διαπροσωπική ευαισθησία, άγχος και φοβικό άγχος συγκριτικά με τους μηαλεξιθυμικούς. Η βαρύτητα της ψωρίασης συσχετίστηκε θετικά με τη διάσταση της διαπροσωπικής ευαισθησίας. Φαίνεται ότι το κάπνισμα και το αλκοόλ δεν αποτελούν παράγοντες κινδύνου τόσο για την εμφάνιση της ψωρίασης όσο και για τις υποτροπές της. Ο εξωτερικός προσανατολισμός, μία από τις τρεις διαστάσεις της αλεξιθυμίας, φάνηκε να αποτελεί ένα παθογνωμομικό χαρακτηριστικό του δείγματος αυτής της έρευνας. Όσον αφορά στη στατιστική πρόβλεψη του άγχους, της κατάθλιψης, του στρες και της ψυχολογικής δυσφορίας από την αλεξιθυμία και τις διαστάσεις της, με βάση την κλίμακα HADS βρέθηκε ότι η διάσταση της αλεξιθυμίας «δυσκολία έκφρασης των συναισθημάτων», συνέβαλε μόνο στην πρόβλεψη του άγχους, με τα υψηλότερα επίπεδά της να συνδέονται με υψηλότερο άγχος. Αναφορικά με τη στατιστική πρόβλεψη των διαστάσεων της ψυχοπαθολογίας, με βάση το ερωτηματολόγιο SCL-90-R, βρέθηκε ότι η αλεξιθυμία συνέβαλε στην πρόβλεψη των διαστάσεων της σωματοποίησης, της διαπροσωπικής ευαισθησίας, της κατάθλιψης, του άγχους και του φοβικού άγχους, καθώς και του γενικού δείκτη συμπτωμάτων και του συνόλου των θετικών συμπτωμάτων όπως αυτά καταγράφονται από την συγκεκριμένη κλίμακα ψυχοπαθολογίας. Συμπεραίνεται λοιπόν, ότι η αλεξιθυμία στους ασθενείς με ψωρίαση αποτελεί παράγοντα ευαλωτότητας στην ανάπτυξη ψυχικών διαταραχών. Επομένως, η αλεξιθυμία και η ψυχοπαθολογία που ενδεχομένως συνδέεται με αυτήν, θα πρέπει να λαμβάνονται υπόψη από τους κλινικούς, καθώς η εφαρμογή των κατάλληλων ψυχολογικών παρεμβάσεων θα ήταν δυνατόν να συνεισφέρει στη μείωση των υποτροπών της ψωρίασης και στη βελτίωση της πορείας της ασθένειας

Raising Autism Awareness among Greek Teachers

A recent special education legislation reform in Greece puts emphasis on the inclusion of pupils with special educational needs into mainstream schools. The purpose of the present study was to investigate knowledge of ASD among 67 mainstream nursery and primary classroom teachers, and evaluate the effectiveness of a half-day ASD awareness seminar in increasing their knowledge of the disorder. A self-report ASD Knowledge Questionnaire (ASD-KQ), developed for the purpose of this study, was used before and after the ASD awareness seminar. The results indicated a significant shift from low to moderate/high level of ASD knowledge among teachers with no previous training in special education and/or autism (58.7%), whereas this shift did not reach significance level in the teacher’s group with previous training (16.7%) after the seminar. The present findings have important implications for the development of training programmes of practising teachers

Psychopathology and alexithymia in patients with psoriasis

BACKGROUND: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. OBJECTIVE: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. METHODS: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. RESULTS: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. STUDY LIMITATIONS: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. CONCLUSIONS: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis

A case-control study of hopelessness and suicidal behavior in the city of Athens, Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M=9) presented higher hopelessness than the controls (M=3). The patients' age positively correlated with hopelessness (r(s)=.35, p<.001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M=3) and after (M=3, p>.05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness

Alexithymia, anxiety and depression in patients with psoriasis: a case-control study

Background: Alexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. Methods: One hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients’ psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI). Results: Psoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well. Conclusions: The alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age

A case-control validation of Type D personality in Greek patients with stable coronary heart disease

Background: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. Methods: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). Results: Cronbach’s a coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA >= 10 and SI >= 10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. Conclusions: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality