The relationship between credit and suicide in Italy

OBJECTIVES: to analyse the association between suicide rates and credit to the economy in Italy, and the potential role of social protection measures (SPMs) as buffering mechanism. DESIGN: descriptive study. SETTING AND PARTICIPANTS: data were derived from the Italian National Institute of Statistics and from the Organisation for Economic Co-operation and Development. Fixed-effects panel regressions were run to test the association between male and female suicide rates and the rate of growth of the credit-to-GDP (CTG) ratio. The buffering role of social protection measures was investigated. The observation period was from 1990 to 2014. MAIN OUTCOME MEASURES: regional male and female rates of suicide. RESULTS: male suicide rate is influenced by the rate of growth of the CTG ratio: a one-unit decrease in the latter is associated with 1.26 more suicides every 10,000 people. This marginal effect was significant at 1% for men, but not significant for women. Unemployment rate and periods of mass job loss were not associated with the outcome. With respect to SPMs, only public unemployment spending was able to moderate the association between suicide rate and rate of growth of the CTG ratio. A one-unit increase in the rate of growth of public unemployment spending was associated with 0.12 less suicides every 10,000 people, but only among men. Younger and older men were more affected by credit reduction, namely those aged 15-44 years and 75 years or more. Differently, women were not influenced by credit reduction, but only by increased UR in the group aged 55-64 years. CONCLUSIONS: access to credit is a major determinant of psychological well-being for men, but not for women. The rate of growth of the CTG ratio may be more useful than other macroeconomic indicators at identifying the mental health outcomes of economic crises

Tako-Tsubo cardiomyopathy and psychiatric disorders: Review of comorbidity

Background: In recent times, the connections between mental health and cardiac outcomes have been under increasing investigation. Tako-Tsubo Cardiomyopathy (TTC) is also called “broken heart syndrome”, since it has been described to occur after emotionally stressful events; it presents as an acute reversible coronary syndrome due to a transient failure of the left ventricle, in the absence of obstructive coronary heart disease. It has a 10-timehigher prevalence in postmenopausal women and may have a strong correlation with biopsycho- social stress. Aim: To review existing studies on TTC in comorbidity with psychiatric disorders. Method: Four PubMed literature searches performed during January 2015 (search terms: tako-tsubo AND psy*; tako-tsubo AND anxiety; tako-tsubo AND depression; tako-tsubo AND mania) provided 9 references: 4 case reports, 2 reviews, 2 prospective studies and 1 case–control study. Results: Not only chronic psychological stress (present in 2/3 of these patients, on average), but also a high co-occurrence of anxiety and depression (from 50 to 70% of patients with this cardiopathy), panic attacks (diagnosed in almost 20% of women with tako-tsubo), subthreshold and full-blown PTSD (co-morbid in almost 40% of patients according to a 2-year prospective study) were associated with TTC. It has been suggested that changes in circulating levels of catecholamines combined to heart's abnormal response to these hormones could be at the pathophysiological basis for such associations. Conclusion: The present literature review confirms a high cooccurrence of comorbid conditions with increased sympathetic activity (in particular anxiety, depression and panic disorder), which could be risk factors for TTC. More studies, especially longitudinal ones, are needed to better clarify the causative pathways of this usually reversible, but potentially lethal, syndrome, especially among post-menopausal women

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

Neuroenhancer use amongst Italian medical students: a survey

Introduction. Increasing use of substances by university students to improve cognitive performance ('neuroenhacement') has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco, but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy. Aims. To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose. Methods An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363). Results 271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3% ) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036). Conclusions Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research

A theoretical guide for the integration of the clinical internships for interns and clinical tutors in the mental health professions

: The Degree Course in Psychiatric Rehabilitation Techniques from the University of Modena and Reggio Emilia (Italy) was established in 2001, with the aim of training health care workers with the competencies specified by the Ministerial Decree 182. Psychiatric Rehabilitation Technicians are graduated and qualified healthcare professionals who carry out rehabilitation and psychoeducational interventions with persons having mental health problems and related disabilities. The integration between theoretical knowledge and practical experimentation builds up professional competence and allows it to develop and consolidate profession-specific skills and to experiment with pre-socialisation for the job arena. Over the years, the necessity to develop an evaluation form of internship experience has arisen to provide detail in respect to the certification of competencies gained during the clinical internship, considering the complexity of the clinical services and of the service users that interns make contact with. The aim of this paper is to describe the Guide to Clinical Internships for Interns and Clinical Tutors, a useful instrument for interns to optimize their study and clinical internship experience for training as future mental health professionals with specific competencies in the technical and relational field and developing critical ability and autonomy of judgement

Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting

Background: Recent researches exploring the relationship between impaired glucidic tolerance, hyperglycemia or frank type II diabetes mellitus and symptoms of anxiety and depression, mostly conducted on in-patients or highly selected samples and on foreign populations, have reported conflicting results. Nevertheless, these medical and mental conditions are often comorbid in clinical practice. Chronic and systemic inflammation could represent the trait d\'union between these conditions. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. The aims of this research was to measure the association between hyperglycemia and symptoms of anxiety and/or depression in out-patients, and to fill the lack of studies on comorbidity between depression and anxiety disorders and medical conditions in Primary Care services. Method: The present was a cross-sectional study. We evaluated all consecutive patients undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis (schizophrenia, schizoaffective, bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major depression; pregnancy; previous stroke or heart attack; type I diabetes mellitus. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Blood Glucose measurements (BM) in the last 6 months were considered in our analysis. Hyperglycemia cutoff: blood glucose N100 mg/dl. The statistical analysis was performed using STATA with multiple linear regressions. Results: 209 subjects were recruited in our study (84 men and 125 women). Of those, 48 (22.9%) were affected by hyperglycemia: 22 were men and 26 women. Hyperglycemia was related to HADS-D score in the men sample (β = .44, p = .01). No association was found between hyperglycemia and HADS-A, either in men or in women. Conclusion: The presence of hyperglycemia, well-known cardiovascular risk factor, may have a clinical value in predicting the presence of depressive symptoms, especially in men. Further studies should examine whether our results are generalizable to other populations and whether they are applicable to clinical depression. Molecular researches could focus on clarifying the pathophysiological reasons for such association, also exploring reasons for sex differences

Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation