TELEPHONE COUNSELLING IN COPING WITH THE COVID-19 LOCKDOWN CONSEQUENCES: PRELIMINARY DATA

SCOPO DEL LAVORO: Stressful effects of COVID-19 lockdown measures adopted to restrict population movements to help curb the epidemic impacted on people's daily lives. Biella is Northern Italy province. For decades this province has had suicide rates higher than the Piedmonts and Italian average. In two most recent decades a positive correlation between financial stressors, 2008 economic crisis related, and suicide has been found. As the current economic crisis COVID-19 related is expected to exacerbate again the vulnerability to suicide of this province, during the first lockdown the Crisis Center for Suicide Prevention of Biella set up a telephone counselling service. We aimed to evaluate whether it represented a suitable and useful tool for suicidal crisis prevention. MATERIALI E METODI: We evaluated whether some techniques such as “emotional stabilization”, represented a suitable and useful tool for suicidal crisis prevention. Suitability and usefulness were assessed, based on caller feedback obtained during the first and last interviews using the so-called “thermometer of emotions”: callers were asked to describe (a) the intensity of their emotions with respect to stress, anxiety, depressed mood, anger, and sleep and (b) the need to manage these emotions. Callers were also asked to provide feedback regarding their overall satisfaction with the service on a scale from 0 to 10. The phones were attended by two psychologists and each intervention usually consisted of four phases: (i) psychoeducation, (ii) emotional stabilization, (iii) identification and reinforcement of personal resources, (iv) ending the telephone counselling session. RISULTATI: A total of 199 telephone counselling sessions were made involving 47 callers, about 87% of whom never had any previous contact with a mental health service. Ten callers went on to urgent outpatient psychiatric visit, while three cases required a network intervention involving their general practitioner and social services, guaranteeing a multidisciplinary continuity of care. During the telephone counselling sessions, callers described different conditions including fear of financial loss, family conflicts, agitation, depression, and suicide ideation. Through the use of the “thermometer of emotions”, callers who have undergone telephone interviews and interventions, have gradually provided lower scores both in the emotions intensity and in the need of managing them (data in elaboration). All callers reported a high level of satisfaction with the telephone counselling service (average rating of 9.5 out of 10). The phone service was closed in June 2020. CONCLUSIONI: The most innovative element of this project was that it proposed interventions for the emotional stabilization, something that is usually used in face- to-face sessions. Using the right protocols, it proved to offer continuity care and reduce pressure on hospital emergency departments while delivering good outcomes and patient satisfaction. Therefore, the COVID-19 pandemic provided an opportunity to overcome normative, technological, and cultural barriers regarding the use of remote healthcare services.

Hyper/neuroinflammation in COVID-19 and suicide etiopathogenesis: Hypothesis for a nefarious collision?

Accumulating scientific and clinical evidence highlighted pathological hyperinflammation as a cardinal feature of SARS-CoV-2 infection and acute COVID-19 disease. With the emergence of long COVID-19 syndrome, several chronic health consequences, including neuropsychiatric sequelae, have gained attention from the public and medical communities. Since inflammatory mediators have also been accredited as putative biomarkers of suicidal ideations and behaviors, hyper- and neuroinflammation might share some colliding points, overlapping and being interconnected in the context of COVID-19. This review aims to provide a summary of current knowledge on the molecular and cellular mechanisms of COVID-19-associated hyper/neuroinflammation with focus on their relevance to the inflammatory hypothesis of suicide development. Subsequently, strategies to alleviate COVID-19 hyper/neuroinflammation by immunomodulatory agents (many of which at experimental stages) as well as psychopharmacologic/psychotherapeutic approaches are also mentioned. While suicide risk in COVID-19 survivors - until now little known - needs further analysis through longitudinal studies, current observations and mechanistic postulates warrant additional attention to this possibly emerging mental health concern.

The experience of northern italy in elderly patients with COVID-19 infection and mental disorders

IntroductionIn December 2019, the first cases of Corona Virus Disease 2019 (COVID-19) outbreak related to acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported in the Chinese city of Wuhan. European countries experienced a tragic growth in the number of Covid-19 cases although several restrictions have been imposed.ObjectivesThe study is aimed to describe the first experience of the Hospital Papa Giovanni XXIII in the city of Bergamo, Northern Italy.MethodsThe most relevant clinical characteristics of aged patients with COVID-19 and mental disorders have been described.ResultsAccording to the experience of the Hospital Papa Giovanni XXIII, medical departments, after appropriate training of all healthcare workers, have been rapidly converted into specific units aimed at treating patients with COVID-19 infection. Specifically, we directly observed a rapidly growing request of psychiatric interventions in aged patients with COVID-19 infection due to the emergence of severe delirium (mainly hyperkinetic) which was reported in approximately 30−50% of cases increasing with age, psychomotor agitation, anxiety, and depressive symptoms. When compared with younger subjects, we found that subjects aged 65 or above with prolonged hospitalization in our hospital are more vulnerable to: 1) environmental factors (e.g., social isolation and distance from family members, stay in intensive/subintensive units, communication difficulties due to therapeutic devices);2) individual factors (e.g., COVID-19 possible neurotropic properties, impairments in insight and cognitive dysfunctions, comorbid medical conditions, and use of multiple medications).ConclusionsThe main implications of the present findings have been discussed.

Psychopathological consequences related to COVID-19 infection: The most relevant reactions of the general population

IntroductionAs a result of the emergence of coronavirus disease 2019 (COVID-19) outbreak caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Chinese city of Wuhan, a situation of socio-economic crisis and profound psychological distress rapidly occurred worldwide.ObjectivesThis work aimed to comprehensively review the current literature about the impact of COVID-19 infection on the mental health in the general population.MethodsA detailed review has been conducted in order to identify the main psychopatological consequences related to Covid-19 infection in the general population.ResultsVarious psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. The psychological impact of quarantine related to COVID-19 infection has been additionally documented together with the most relevant psychological reactions in the general population related to COVID-19 outbreak.ConclusionsThe role of risk and protective factors against the potential to develop psychiatric disorders in vulnerable individuals with Covid-19 infection need to be carefully addressed in the clinical practice.

COVID-19 lockdown: housing built environment’s effects on mental health

Background Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on March 11th, severe 'lockdown' measures have been adopted by the Italian Government. For over two months of stay-at-home, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures had on mental health and wellbeing. Methods We conducted a large web-based survey on 9261 subjects in Northern Italy, one of the Regions most heavily hit by the pandemic in Europe. Participants were recruited among university staff, faculty and students. The questions included socio-demographic features of the participants;international evaluation scales designed to recognize depressive-, anxiety- and sleep-related symptoms, impulsivity, quality of life;architectural parameters investigating housing physical characteristics. Results As emerges from our analysis poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments < 60 m2, with poor quality view and indoor area is associated with, respectively, 1.31 (95CI), 1.368 (95CI), and 2.253 (95CI) time the risk of moderate/severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95%CI). Conclusions Our findings suggest housing played a major role in influencing people mental health and wellbeing during COVID-19 pandemic. We argue strengthened multi-interdisciplinary approach involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to inform the planning implementation and monitoring of housing policies centered on population health. Key messages COVID-19 lockdown mitigation measures strongly impacted on Mental Health. Living in apartments < 60 m2, with poor quality view and indoor area significatively increase the risk of moderate and severe depressive symptoms.