RELATIONSHIPS BETWEEN FACTORS AFFECTING THE TRANSFER OF VOCATIONAL SAFETY TRAINING IN THE WORKPLACE: THE CASE STUDY OF ALUMINIUM OF GREECE

ABSTRACT The purpose of this research is to present the process of the transfer of safety training in the company "Aluminium of Greece". It presents initial attempts to identify key factors affecting transfer of training and the correlation between these factors. The questionnaires were distributed in several related seminars and programs which involved 150 employees of this company. The returned completed 88 questionnaires were then analyzed. The findings show that employees place great importance on safety training. In our study, motivation for learning and transfer, the opportunity for implementation and personal ambition were associated with some and / or all factors examined (age, experience, level of education, etc.). Additionally, the researchers identified the need for evaluation of education not only immediately after its end, but overall evaluation especially some time after the training, in order to examine the value of the transfer of safety training as an investment. Keywords: transferring training, workplace, safety, evaluation, motivation Vol. 5, No.2| December 2013| ISSN 2229-8932 Journal of Technical Education and Training (JTET) |37 INTRODUCTION Nowadays, the effects of the economic crisis are present in many areas of specialty. Consequently, a way to reduce costs in many fields is essential, without this resulting in lower quality of products and services. Staff training improves the work performance through cultivating knowledge, skills and attitudes of the trainees The purpose of this research is to extend the investigation of the transferring knowledge and examine the factors which affect it. We intend to evaluate the training when the employee has returned to the workplace and not immediately after the end of the training sessions. The timing of the examination is the most significant aspect of our research, due to the fact that the issue of sustainability is the most vulnerable point of all educational methods, as knowledge and skills acquired during training programs are slowly declined by the trainees in most cases LITERATURE REVIEW Evaluation of training in the workplace The current, rapidly changing conditions of labor lead the organizations in a constant search for competitive advantage Staff training, as a business practice, is internationally recognized as the most common strategy of Human Resource Management (HRM) in order to improve work performance Transfer of training is the degree to which trainees effectively integrate the knowledge, skills and attitudes acquired during the training in their work Academic education is known for its excessive preoccupation with tests, grades and evaluation. However, in vocational education and training the postgraduate evaluation is inadequate. In a survey on 611 organizations in 1988, it was proven that only few conduct a large scale evaluation of educational programs while half of them do not carry any evaluation at all. The lack of evaluation can be perceived by participants as a sign of low-value education. Trainees know that they will not face postgraduate assessment of their learning and they will not take any responsibility for the application of new skills; this results in reduction of their incentives Without actionable and evaluable data for the provided education, instructors are unable to improve their programs and justify the choices of decision-makers Relationship between training effectiveness and transfer of learning Nowadays, managers and consultants recognize that the evaluation process provides stability and reliability in all aspects of work performance Research has shown that from the skills acquired during the educational programs 40% are transferred directly to work, 25% are maintained for a period of six months and only 15% for one year Theories on transferring training Theories related to transferring training, as they occur in the majority of the literature, are two. Both models focus on factors that relate directly to the content of education or its results. Consequently, the transfer of training is addressed in an isolated way, regardless of the factors that affect the job performance In an attempt to summarize the factors alleged to influence the transfer of training to work, the majority of researchers result in three major categories: i. Those involving the learner, ii. With regard to instructional design and iii. Related to the framework factors which affect the transfer, the training and the trainee The following characteristics of the trainee affect the transfer of training: motivation to learn and transfer skills to work, opportunity to apply the new skills, personal career goals and ambition, perception about the fulfillment of career goals through education (useful in overall career) and about attainment of direct employment objectives (useful in daily work) and the commitment to the company The instructional design is divided in the design of the content and the teaching methods. The essential requirement for those who plan educational programs about transferring training is to concentrate on the transferring needs instead of the educational needs. This simply means providing postgraduate evaluations through work plans, counseling and teaching at work According to Safety at work The year 2009 was internationally dedicated to safety at work, which is a major issue for all stakeholders: employees, employers, state, European Union etc. Many measures to prevent / reduce occupational hazards have been proposed by different authorities. Some are: protection of engines, replacement of toxic substances, ventilation, personal protective equipment and training. Practice has proved that suitable equipment and detailed procedures should be provided to all workers, improving the safety consciousness and the daily experience Vol. 5, No.2| December 2013| ISSN 2229-8932 Journal of Technical Education and Training (JTET) |41 With this research we intend to evaluate the training when the employee has returned to his/her job for some time; not immediately after the end of the training sessions, but one year later. Research Methodology 3.1 The purpose of the research This research focuses on the evaluation of safety training in the company "Aluminium of Greece" and detects possible correlations between variables that affect the transfer of learning to the workplace. Consequently, we present the main research question that will occupy us; are there any correlations between the factors which influence the transfer of safety training in the workplace? Data collection Our research took place about a year after the completion of certain training programs in order to determine whether there was actually transfer of learning and what factors affected it. Therefore it is an ex post facto research, meaning it was conducted retrospectively. One group was used for the data collection, without the selection of a control group The attempted investigation, as ex post facto, has advantages and disadvantages. On the one hand, the direct control of independent variables is impossible and experimental groups cannot be defined while subjects cannot join groups with random sampling. As a result, there is the risk of erroneous interpretation of research findings, because the interpretation of the data is conducted retrospectively. However, an important advantage of the ex post facto research is that the questions which arise are usually not investigated by the experimental method due to the fact that variables are not controllable Research tools The main research tool is the questionnaire. The collected data is divided into social and professional background of the participants. The variables are categorized into dependent and independent. The independent variables are those that the researcher can control and / or manipulate. In this research independent variables are the: age of participants, years of experience in specific post, overall experience, level of education, job description and employment field. Dependent are the variables which measure specific influence of the independent variables handled by the researcher. In our research, dependent variables are the views of trainees to apply new knowledge, attitudes and skills in the workplace. The questionnaire contains closed questions. However, we provided space for recording participants' comments about something that may deem as necessary. The combination of open and closed questions is usually an advantage The questionnaire was created after extensive research of the existing literature and it includes the main variables that affect the transfer of learning: trainee's characteristics, instructional design and business climate. The questions of the final questionnaire consists of appropriately modified previous researches' questions Validation methods and techniques The questionnaire, as a research tool, has many advantages. The questions are the same for all participants and the answers are not susceptible to different interpretations. It is also efficient regarding time and resources. An additional advantage is that the questionnaire ensures anonymity, which is important in researches conducted in the workplace. Furthermore, the questionnaire practically eliminates the possibility of bias and prejudice on the part of the interviewer The sample The company "Aluminium of Greece" was founded in 1960 in order to establish trade agreements about the extensive Greek bauxite deposits. The company employs directly 1100 people and about 400 employees of associated companies. The annual turnover is more than 2.054 billion euros, representing 1.7% of the Greek Gross Domestic Product (GDP). During the period [2008][2009], approximately 150 employees were trained on safety in the workplace in related seminars and programs. 134 questionnaires were distributed and a total of 88 were returned. The return rate of the questionnaires is 65.67%, which can be considered as satisfactory for the purposes of this research, due to its localized character. 3.6 Validity and reliability Validity and reliability are major issues in any scientific research. The tools which were used were designed in order to reduce the errors. The information we requested was known to the participants and it was safe to be revealed. Keeping in mind the above, we conducted a smallscale pilot study, with employees of the company who attended the seminars in 2007. These employees were not included in the final sample of the research. This pilot study helped the researchers in spotting any ambiguities and reviewing the recommendations according to the population / target of the research. The processing of the questionnaires was conducted using the Statistical Package for the Social Sciences (SPSS), which is among the most widely used programs for statistical analysis in social science. The processing and the analysis of the collected data included frequencies, means and descriptive variables. To investigate possible correlations of the questionnaire's variables we used ordinal regression analysis with log -log link function and significance level 95%. It is worth noting that the potential correlations which are not mentioned were not found statistically significant. The results include the statistically important or marginally significant findings of the correlations, based on the questions and variables of the research

Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients’ lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg’s Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis

Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients’ lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg’s Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis

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

RELATIONSHIPS BETWEEN FACTORS AFFECTING THE TRANSFER OF VOCATIONAL SAFETY TRAINING IN THE WORKPLACE: THE CASE STUDY OF ALUMINIUM OF GREECE

The purpose of this research is to present the process of the transfer of safety training in the company “Aluminium of Greece”. Furthermore, it presents initial attempts to identify key factors affecting transfer of training and the correlation between these factors. The survey conducted among 88 employees using questionnaires. The findings show that employees place great importance on safety training. Motivation for learning and transfer, the opportunity for implementation and personal ambition were associated in our study with some and / or all factors examined (age, experience, level of education, etc.). Additionally, the researchers identified the need for evaluation of education not only immediately after its end, but overall evaluation especially some time after the training, in order to examine the value of education as an investment.&nbsp

A study of patients' adherence to hypertension therapy

Arterial hypertension, also known as high blood pressure, is a long-term medical condition which usually does not cause symptoms. Hypertension is a major risk for coronary heart disease, stroke, heart failure and renal failure and is associated with increased mortality risk. Adoption of a healthy lifestyle is critical for the prevention of high blood pressure and is an indispensable part of the management of hypertension. Furthermore, a large number of antihypertensive drugs are available for reducing blood pressure. Nevertheless, non adherence to treatment is a crucial barrier to successful blood control. This study examined hypertensive patients’ experiences regarding adherence to doctor’s recommendations for hypertension treatment. Semi structured interviews were conducted with 17 patients diagnosed with essential hypertension without physical or mental comorbidity. Transcripts were analyzed using Interpretative Phenomenological Analysis (IPA). Three super-ordinate themes arose from the data: i) causal attributions of hypertension, ii) the complex and multifactorial problem of adherence to treatment as perceived by the patients and iii) negotiating the diagnosis and treatment of a chronic health problem. These are discussed in relation to extant literature. Given that adherence to treatment is a major challenge for the management of high blood pressure, understanding how hypertensive patients experience their need for commitment to treatment can be helpful to clinicians.Η αρτηριακή υπέρταση είναι ένα από τα πλέον σημαντικά προβλήματα δημόσιας υγείας στις ανεπτυγμένες χώρες, καθώς αποτελεί ένα από τους κυριότερους παράγοντες κινδύνου στεφανιαίας νόσου, εγκεφαλικού επεισοδίου, καρδιακής ανεπάρκειας και νεφρικής ανεπάρκειας. Η ρύθμιση της αρτηριακής υπέρτασης μπορεί να πραγματοποιηθεί με τη χρήση τόσο φαρμακευτικών (αντι-υπερτασική αγωγή), όσο και μη φαρμακευτικών μέσων (υγιεινοδιαιτητικά μέτρα). Ωστόσο, παρά την ύπαρξη μέσων αντιμετώπισης, ένα από τα πλέον συνήθη εμπόδια στον αποτελεσματικό έλεγχο της αρτηριακής πίεσης είναι η απουσία πιστής τήρησης των θεραπευτικών οδηγιών από πλευράς των ασθενών. Σκοπός της παρούσας έρευνας ήταν η μελέτη του φαινομένου της τήρησης των θεραπευτικών οδηγιών για την αρτηριακή υπέρταση, έτσι όπως το αντιλαμβάνονται, το βιώνουν και το νοηματοδοτούν οι αμιγώς υπερτασικοί ασθενείς. Στην έρευνα συμμετείχαν 17 άτομα με πρωτοπαθή υπέρταση χωρίς σωματική ή ψυχική συννόσηση. Η συλλογή των δεδομένων πραγματοποιήθηκε μέσω ημιδομημένων συνεντεύξεων, ενώ η ανάλυσή τους με βάση τις αρχές της Ερμηνευτικής Φαινομενολογικής Ανάλυσης (Interpretative Phenomenological Analysis- IPA), η οποία κρίθηκε ως η πλέον κατάλληλη, καθώς ενσωματώνει στοιχεία που είναι απαραίτητα για τη διερεύνηση και κατανόηση των εμπειριών των ασθενών με υπέρταση. Από την ανάλυση των απομαγνητοφωνημένων συνεντεύξεων αναδύθηκαν τρία υπερ-θέματα, τα οποία αποτελούνταν από θέματα και υπο-θέματα. Κατά συνέπεια, τα αποτελέσματα που συζητούνται, υπό το πρίσμα της υπάρχουσας σχετικής βιβλιογραφίας, περιλαμβάνουν τις αιτιακές αποδόσεις της αρτηριακής υπέρτασης από πλευράς των ατόμων με υπέρταση, το σύνθετο πρόβλημα της τήρησης της θεραπείας έτσι όπως το αντιλαμβάνονται και το νοηματοδοτούν οι συμμετέχοντες, καθώς και τη διαπραγμάτευση με τα νέα δεδομένα και τη συνειδητοποίηση χρονιότητας που προκύπτουν από την ανάγκη μακροχρόνιας τήρησης των θεραπευτικών οδηγιών για την αντιμετώπιση της αρτηριακής υπέρτασης. Δεδομένου ότι η επίτευξη της σωστής τήρησης των θεραπευτικών οδηγιών αποτελεί σημαντική πρόκληση για την αντιμετώπιση της υπέρτασης, η κατανόηση του τρόπου με τον οποίο τα άτομα νοηματοδοτούν την προσήλωση στη θεραπεία δύναται να συμβάλλει καθοριστικά στη βελτίωσή της και κατ’ επέκταση στην αντιμετώπιση της υπέρτασης

Πορεία και πρόγνωση της ψυχωσικής κατάθλιψης: Συστηματική ανασκόπηση με μετα-ανάλυση

Σκοπός: Σκοπός της παρούσας εργασίας είναι να διερευνηθεί, μέσω συστηματικής ανασκόπησης και μετα-ανάλυσης, κατά πόσον οι ασθενείς με μονοπολική κατάθλιψη με ψυχωσικά συμπτώματα και με μονοπολική κατάθλιψη χωρίς ψυχωσικά συμπτώματα διαφέρουν ως προς τον κίνδυνο μετάπτωσης σε διπολική διαταραχή (bipolar switch). Επίσης, καθώς η μετάπτωση σε Διπολική Διαταραχή αφορά τη μετάπτωση σε Διπολική Διαταραχή τύπου Ι και τύπου ΙΙ (ανάλογα με το αν εμφανιστεί μανιακό ή υπομανιακό επεισόδιο αντίστοιχα στην πορεία της νόσου), εξετάζεται και ξεχωριστά για κάθε τύπο η πιθανή επίδραση της παρουσίας ψυχωσικών συμπτωμάτων. Μέθοδος: Πραγματοποιήθηκε συστηματική αναζήτηση σε ηλεκτρονικές βάσεις δεδομένων (Pubmed, Scopus), καθώς και σε βάσεις δεδομένων της λεγόμενης «γκρίζας βιβλιογραφίας» για την ανεύρεση μελετών που διερευνούσαν την μετάπτωση σε διπολική διαταραχή μεταξύ των ασθενών με μονοπολική κατάθλιψη με και χωρίς ψυχωσικά συμπτώματα και στη συνέχεια πραγματοποιήθηκε η ποσοτική σύνθεση των δεδομένων που αντλήθηκαν με μετα-ανάλυση. Αποτελέσματα: Συνολικά εντοπίστηκαν 16 μελέτες που πληρούσαν τα κριτήρια εισαγωγής, ωστόσο λόγω ετερογένειας, στη βασική μετα-ανάλυση που αφορά σε ενήλικο ή μεικτό πληθυσμό τελικά συμπεριλήφθηκαν 13 μελέτες με συνολικό δείγμα 72.574 ασθενείς με κατάθλιψη, μεταξύ των οποίων 3.482 ασθενείς με μετάπτωση σε διπολική διαταραχή. Οι ασθενείς με ψυχωσική κατάθλιψη παρουσιάζαν υψηλότερο κίνδυνο να αναπτύξουν διπολική διαταραχή σε σύγκριση με τους ασθενείς με κατάθλιψη χωρίς ψυχωσικά συμπτώματα. Ο συνοπτικός εκτιμητής και τα αντίστοιχα διαστήματα εμπιστοσύνης [Risk Ratio (95% Confidence Interval): RR(95% C.I.)] με βάση το μοντέλο των σταθερών επιδράσεων ήταν 1,78 [(1,61 – 1,98), p<0,001)], ενώ με βάση το μοντέλο των τυχαίων επιδράσεων ήταν 1,82 [(1,64 – 2,02), p<0,001)], ενώ δεν βρέθηκε σημαντική ετερογένεια μεταξύ των μελετών ( I2= 0,0%, 95%CI: 0%-57%, p=0,730). Όσον αφορά στις επιμέρους μετα-αναλύσεις που πραγματοποιήθηκαν για τη διερεύνηση της επίδρασης των ψυχωσικών συμπτωμάτων στην ανάπτυξη διπολικής διαταραχής τύπου Ι και τύπου ΙΙ, βρέθηκε ότι για τους ασθενείς με ψυχωσική κατάθλιψη σε σύγκριση με τους ασθενείς με κατάθλιψη χωρίς ψυχωσικά συμπτώματα ο κίνδυνος ανάπτυξης διπολικής διαταραχής τύπου Ι είναι περίπου 5,17 φορές [(3,01 -8,89), p<0,001) με βάση το μοντέλο τυχαίων επιδράσεων)] υψηλότερος, ενώ ο κίνδυνος ανάπτυξης διπολικής διαταραχής τύπου ΙΙ είναι περίπου 1,81 φορές [(1,16 – 2,84), p=0,009)] υψηλότερος. Συμπεράσματα: Η παρούσα μελέτη έδειξε ότι η ύπαρξη ψυχωσικών συμπτωμάτων στην μονοπολική κατάθλιψη είναι ένας σημαντικός παράγοντας κινδύνου για μετάπτωση σε διπολική διαταραχή, τόσο τύπου Ι όσο και τύπου ΙΙ. Τα ευρήματα αυτά αναδεικνύουν τη σημασία της σωστής διάγνωσης, παρακολούθησης και θεραπείας των ατόμων με ψυχωσική κατάθλιψη, ιδίως αυτών με νεαρότερη ηλικία.Objective: This study aimed to investigate, through systematic review and meta-analysis, whether patients with unipolar depression with psychotic symptoms (PMD) differ from patients with unipolar depression without psychotic symptoms (non-PMD) regarding bipolar switch risk. In addition, since the conversion to Bipolar Disorder (BD) refers to the conversion to BD Type I or Type II (depending on whether a manic or hypomanic episode occurs, respectively), the possible impact of psychotic symptoms' presence is considered separately for each BD Type. Method: A systematic search was conducted in electronic databases (Pubmed, Scopus), and “gray literature” for all studies providing data on bipolar switch in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. Results: A total of 16 studies met the inclusion criteria, however due to heterogeneity issues, the basic meta-analysis included 13 studies with a total sample of 72,574 patients with unipolar depression, of whom 3,482 patients converted to bipolar disorder. Patients with PMD presented a higher risk of developing bipolar disorder than patients with non-PMD with fixed-effect pooled Risk Ratio [(95% Confidence Interval), RR (95%CI)]: 1.78 [(1.61 - 1.98), p <0.001], and random-effect pooled RR 1.82 [(1.64 - 2.02), p <0.001], while no significant heterogeneity was found among the studies (I2 = 0.0%, 95%CI: 0% -57%, p = 0.730). Regarding the separate meta-analyses conducted to investigate the effect of psychotic symptoms on the development of BP Type I and Type II bipolar disorder, it emerged that patients with PMD compared to non PMD experienced a 5.17-fold higher risk [(3.01 -8.89), p<0.001, random effects model] for conversion to BP Type I and a 1.81-fold higher risk [(1.16 - 2.84), p = 0.009] for conversion to BP Type II. Conclusion: This study showed that the presence of psychotic symptoms in unipolar depression is an important risk factor for conversion to bipolar disorder, both of Type I and Type II. These findings highlight the importance of accurate diagnosis, follow-up and treatment of patients with psychotic depression, especially those of a younger age