The relationship between emotional self-awareness, emotion regulation, and diabetes distress among Italian and Dutch adults with type 1 diabetes.

Objective: Evidence suggests that many adults with type 1 diabetes (T1D) experience clinically relevant levels of diabetes distress, indicating coping difficulties. Studies have primarily focused on emotion regulation as a possible construct to be addressed in psychological interventions to alleviate diabetes distress. This study extends the literature by investigating the cross-sectional association between emotion regulation, diabetes distress and the construct of emotional self-awareness as an additional variable to be considered in potentially reducing diabetes distress. Methods: Via an online survey, data was collected on emotional self-awareness dimensions (attention to feelings, clarity of feelings), emotion regulation strategies (cognitive reappraisal, expressive suppression, mood repair) and diabetes distress, along with self-reported clinical and sociodemographic information. Multiple linear regression with stepwise backward method was used to examine associations, controlling for country. Results: N = 262 Italian and Dutch adults with T1D (80.5% women, M = 38.12 years, SD = 12.14) participated. Clarity of feelings was significantly negatively associated with diabetes distress, resulting in a medium effect size (ß = -0.22, p < 0.001). Likewise, mood repair was negatively related to diabetes distress, showing a small effect size (ß = -0.26, p < 0.001). Conclusion: These findings shed light on the importance of a dimension of emotional self-awareness, namely clarity of feelings. This represents the ability to identify one's emotional states and discriminate between them. Thus, it should be considered in psychological interventions, such as mentalization-based treatment, that might contribute to alleviating T1D-related distress.

Failure in reflective functioning as a key factor in the association between problematic social networking sites use, attachment and childhood maltreatment: A network analysis approach on gender differences.

Following a network analysis approach, the present study aims to explore the pattern of mutual relationships between failure in reflective functioning (RF) - defined as hypomentalization - problematic social networking sites use (PSNSU), attachment anxiety and avoidance, and childhood maltreatment among emerging adults, with a focus on gender differences. The study sample comprises N = 1,614 emerging adults (Mage = 23.84; SD = 3.21; 50% identified themselves as women) who completed online self-assessment measures. Results showed significantly greater PSNSU, hypomentalization, childhood emotional abuse, and both attachment avoidance and anxiety among women. Indeed, within the network analysis, performed separately for men and women, network-specific associative patterns were observed; yet also similarities have emerged. Within the women's network, differently from males, attachment avoidance connects, through attachment anxiety, to emotional abuse, mood modification related to PSNSU, and hypomentalization. Nonetheless, hypomentalization was central in both networks, functioning as a hub between attachment anxiety, the PSNSU cluster, and the childhood maltreatment cluster. These results shed light on the use of social network sites as a potential maladaptive emotion regulation strategy, particularly among women. In this regard, the role of RF should be considered as a key treatment target to reduce PSNSU and support the use of adaptive emotion regulation strategies.

Psychosocial predictors of trajectories of mental health distress during the COVID-19 pandemic: A four-wave panel study.

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.

Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis.

Aims: The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment. Methods: The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria). Results: Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77. Conclusion: The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.

Associations between disordered eating behaviour, diabetes distress and emotion regulation strategies in adults with type 1 diabetes: Results from a Dutch-Italian cross-sectional study.

AIMS: Disordered eating behaviour (DEB) and diabetes distress are prevalent in adults with type 1 diabetes (T1D). Emotion regulation strategies, such as cognitive reappraisal and expressive suppression, are associated with DEB and managing stress in general. Here we examine the associations between DEB, diabetes distress, and emotion regulation strategies in the context of T1D. METHODS: Adults with T1D in The Netherlands and Italy completed an online survey, covering DEB (DEPS-R), diabetes distress (PAID-5), and emotion regulation strategies (ERQ). Associations between DEB, diabetes distress, and emotion regulation strategies were examined using path analysis. RESULTS: N = 291 participants completed the survey (78.9% women, 39 ± 13 years, HbA1c : 55 ± 16 mmol/mol (7.2% [3.6%]); TIR: 66% ± 25). N = 79 participants (27.1%) reported DEB (DEPS-R ≥ 20) and n = 159 participants (54.6%) reported elevated diabetes distress (PAID-5 ≥ 8). The path analysis, with small-to-medium effect sizes, revealed that more diabetes distress was associated with more DEB (ß = 0.23, 95% CI [0.13, 0.34]). Less diabetes distress was associated with more use of cognitive reappraisal (ß = -0.24, 95% CI [-0.36, -0.12]). More DEB was associated with more use of expressive suppression (ß = 0.14, 95% CI [0.04, 0.24]). CONCLUSIONS: This cross-sectional study suggests an association between DEB and diabetes distress, between cognitive reappraisal and less diabetes distress and between expressive suppression and more DEB. The results suggest that it may prove beneficial to prioritize strengthening emotion regulation strategies in interventions for people with T1D and DEB. Future research should help clarify causality with regard to emotion regulation and DEB in adults with T1D.

The Efficacy of Digital Cognitive-Behavioral Interventions in Supporting the Psychological Adjustment and Sleep Quality of Pregnant Women with Sub-Clinical Symptoms: A Systematic Review and Meta-Analysis.

The present meta-analysis investigated the overall and differential efficacy of digital cognitive-behavioral therapies (CBTs) vs. third-generation CBTs deployed to pregnant women in reducing sub-clinical depression, anxiety, and stress symptoms while fostering sleep quality and quality of life. A PRISMA-guided systematic search was used, including randomized controlled trials (RCTs) evaluating the above-mentioned interventions. Data were pooled using either the mean difference (MD) or standardized MD (SMD). Sub-group analyses were carried out when appropriate. The primary outcomes were depression, anxiety, and stress symptoms, as well as sleep quality and quality of life. The interventions' acceptability was evaluated through the odds ratio (OR) of drop-out rates. Seven RCTs were included, comprising 1873 pregnant women. The results showed the interventions' efficacy in terms of reducing depression symptoms (SMD = -0.36, CI = 0.61, -0.11, k = 9) at the endpoint, although it was not maintained at follow-up during the postpartum period. The interventions' efficacy in terms of reducing anxiety symptoms (SMD = 1.96, CI = -2.72, -1.21, k = 3) at the endpoint was also significant, while having no effect on sleep quality. The interventions were well accepted (OR = 1.68; 95% CI = 0.84, 3.35; k = 7). Although no sound conclusions can be drawn concerning the joint or differential efficacy of the considered interventions, this study was useful in highlighting the need to develop evidence-based digital prevention programs for pregnant women with sub-clinical symptoms.

Attachment Style and Its Relationships with Early Memories of Separation Anxiety and Adult Separation Anxiety Symptoms among Emerging Adults.

Emerging adulthood concerns the transition from adolescence to adulthood. It foresees the separation from the family and the creation of new significant relationships, whereby specific attachment styles might be triggered when facing these challenges. The present study investigates the influence of retrospective memories associated with childhood separation anxiety symptoms upon emerging adults' romantic avoidant vs. anxious attachment styles including adult separation anxiety symptoms as mediators. Age and gender were included as covariates. A community sample of N = 394 Italian emerging adults (Mage = 23.64, SD = 4.00, 70% females) completed self-report measures. The results showed that the participants presented a greater anxious attachment rather than an avoidant attachment style. Moreover, both adult separation anxiety and the memories of early separation anxiety were positively and significantly associated with anxious attachment and not with avoidant attachment. A mediation model conducted and focused on anxious attachment showed that, although not directly associated, child separation anxiety did show a significant positive indirect effect on anxious attachment as mediated by adult separation anxiety symptoms. Thus, the findings highlighted the influence of adult separation anxiety symptoms and retrospective childhood memories of separation anxiety upon anxious adult romantic attachment, yet not on avoidant attachment style. Clinical implications are discussed and suggestions for future research are provided.

Perception of Changing Habits among Italian Children and Adolescents during COVID-19 Quarantine: An Epidemiological Study.

We used an epidemiological study to explore the perception of change in several psychosocial dimensions during the COVID-19 quarantine. We focused on emotions, use of social network sites (SNSs), family life, important relationships, body functions, and school life. Using snowball recruitment, N = 1047 Italian children, pre-adolescents, and adolescents (M = 13.74 ± 3.59) were selected to complete ad hoc online questionnaires. A differential semantic inventory plot was prepared to analyze the emotional experience of children, pre-adolescents, and adolescents during quarantine compared to the pre-quarantine period. The Kruskal-Wallis test was run to assess gender and age differences in emotions experienced, habitual SNS use, and the experience of attending classes remotely. A post hoc Wilcoxon test was performed to compare such differences. Results showed that most of the sample (93.1%) attended classes using technological devices and reported missing their classmates very much (59.3%). Adolescents experienced more negative emotions (M = 3.69 ± 1.33) than pre-adolescents (M = 4.64 ± 1.32), who experienced negative emotions more than children (M = 5.11 ± 1.24). Females were more prone to experience negative emotions compared to males. Adolescents were also the most prolific SNS users (78.1%), particularly female adolescents. Overall, these finding highlight the necessity of preserving the emotional state and relational well-being of youth in these developmental phases by considering their school and social lives.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

Early Development of a Virtual Coach for Healthy Coping Interventions in Type 2 Diabetes Mellitus: Validation Study.

BACKGROUND: Mobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients' health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients' self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective. OBJECTIVE: This study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients' (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users' role-playing is further analyzed. METHODS: This preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs' profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development. RESULTS: Both quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs' profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols. CONCLUSIONS: This study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing.

A Virtual Coach (Motibot) for Supporting Healthy Coping Strategies Among Adults With Diabetes: Proof-of-Concept Study.

BACKGROUND: Motivation is a core component of diabetes self-management because it allows adults with diabetes mellitus (DM) to adhere to clinical recommendations. In this context, virtual coaches (VCs) have assumed a central role in supporting and treating common barriers related to adherence. However, most of them are mainly focused on medical and physical purposes, such as the monitoring of blood glucose levels or following a healthy diet. OBJECTIVE: This proof-of-concept study aims to evaluate the preliminary efficacy of a VC intervention for psychosocial support before and after the intervention and at follow-up. The intent of this VC is to motivate adults with type 1 DM and type 2 DM to adopt and cultivate healthy coping strategies to reduce symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. METHODS: A total of 13 Italian adults with DM (18-51 years) interacted with a VC, called Motibot (motivational bot) using the Telegram messaging app. The interaction covered 12 sessions, each lasting 10 to 20 minutes, during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen. Motibot is developed within the transtheoretical model of change to deliver the most appropriate psychoeducational intervention based on the user's motivation to change. RESULTS: Results showed that over the 12 sessions, there were no significant changes before and after the intervention and at follow-up regarding psychosocial factors. However, most users showed a downward trend over the 3 time periods in depression and anxiety symptoms, thereby presenting good psychological well-being and no diabetes-related emotional distress. In addition, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of semistructured interviews, using a text mining approach, showed that most users reported a perceived reduction in anxiety, depression, and/or stress symptoms. Moreover, users indicated the usefulness of Motibot in supporting and motivating them to find a mindful moment for themselves and to reflect on their own emotions. CONCLUSIONS: Motibot was well accepted by users, particularly because of the inclusion of mindfulness practices, which motivated them to adopt healthy coping skills. To this extent, Motibot provided psychosocial support for adults with DM, particularly for those with mild and moderate symptoms, whereas those with severe symptoms may benefit more from face-to-face psychotherapy.

The Impact of the Covid-19 Pandemic on the Well-Being and Diabetes Management of Adolescents With Type 1 Diabetes and Their Caregivers: A Scoping Review.

The Covid-19 pandemic and its related restriction measures might negatively impact diabetes management and well-being of adolescents with Type 1 Diabetes Mellitus (T1DM) and their caregivers. Accordingly, the present scoping review is aimed at mapping the literature in line with the question "How has the Covid-19 influenced diabetes management and well-being of adolescents with T1DM and their caregivers?". A systematic search has been conducted through three academic databases. Studies carried out during the Covid-19 pandemic focused on adolescents aged between 10 and 19 years with T1DM and/or their caregivers were included. A total of 9 studies, performed between 2020 and 2021, have been identified. In particular, N = 305 adolescents with T1DM and N = 574 caregivers were considered. Overall, studies were not specific in reporting adolescents' age, and only 2 studies were primarily focused on the adolescent population with T1DM. In addition, studies were mainly focused on evaluating adolescents' glycemic control, which remained stable or has improved throughout the pandemic. Contrarily, psychosocial variables have been marginally considered. Indeed, only one study investigated adolescents' diabetes distress, which remained stable from pre-to during post-lockdown, albeit improving among girls, specifically. As regards caregivers of adolescents with T1DM, studies showed mixed results concerning their psychological state during the Covid-19 pandemic. Prevention measures, which are aimed at supporting adolescents with T1DM during the lockdown, were considered by one study only, showing the favorable role of telemedicine during lockdown for adolescents' glycemic control. Altogether, the current scoping review has identified many shortcomings of the available literature, which are given by the limited specificity of the age group considered and by the limited consideration of psychosocial variables, particularly their interplay with the medical ones.

Factors Related to Women's Psychological Distress during the COVID-19 Pandemic: Evidence from a Two-Wave Longitudinal Study.

BACKGROUND: A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women's mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women's psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women's psychological distress. METHODS: This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. RESULTS: No significant changes were found in women's psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. CONCLUSIONS: Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

Efficacy of eHealth Interventions for Adults with Diabetes: A Systematic Review and Meta-Analysis.

The aim is to provide meta-analytical evidence on eHealth interventions' efficacy in supporting the psychosocial and physical well-being of adults with type 1 or type 2 Diabetes Mellitus (DM), and to investigate differences in interventions primarily targeted at providing glycemic control vs. psychosocial support. A PRISMA-guided systematic search was conducted. Randomized Controlled Trials (RCTs) regarding eHealth interventions for adults (18-65 years) with DM were included. Data were pooled using Standard Mean Difference (SMD); sub-group analysis and meta-regressions were performed when appropriate. Outcomes were Hemoglobin A1c (HbA1c), diabetes distress, quality of life, anxiety, stress, and depression. Intervention acceptability was assessed performing the Odds Ratio (OR) of drop-out rates. Thirteen RCTs comprising 1315 participants were included (52.09% females; Mage = 46.18, SD = 9.98). Analyses showed intervention efficacy on HbA1c (SMD = -0.40; 95% CI = -0.70, -0.12; k = 13) and depressive symptoms (SMD = -0.18; 95% CI = -0.33, -0.02; k = 6) at RCTs endpoint and were well accepted (OR = 1.43; 95% CI = 0.72, 2.81; k = 10). However, efficacy on HbA1c was not maintained at follow-up (SMD = -0.13; 95% CI = -0.31, 0.05; k = 6). eHealth interventions providing medical support were acceptable and effective in fostering glycemic control and decreasing depressive symptoms in the short-term only. Digital solutions should be developed on multiple levels to fully support the psychophysical well-being of people with DM.

Separation anxiety in a community sample of Italian emerging adults and its relationship with dimensions of borderline personality.

Research studies focusing on separation anxiety and its relation with other measures of anxiety and personality-relevant variables in community samples are still scarce. This study aimed to describe in a dimensional perspective the relationship between separation anxiety symptoms, anxiety levels, and personality traits in a community sample of Italian emerging adults. A sample of 260 college students [mean age (Mage)=21.22, standard deviation (SD)=1.91, 79.6% females] completed the adult separation anxiety questionnaire-27 (ASA-27), the state and trait anxiety inventory-Y (STAI-Y), and the personality assessment inventory borderline scale (PAI-BOR). ASA-27 was significantly and positively correlated with the PAI borderline scale. The mediation model showed that ASA-27 influenced the PAI-BOR through trait anxiety. Clinical implications of the study for psychotherapy research are discussed.

Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study.

BACKGROUND: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. OBJECTIVE: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. METHODS: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale-Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. RESULTS: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. CONCLUSIONS: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

Assessment of Psychological Distress in Adults With Type 2 Diabetes Mellitus Through Technologies: Literature Review.

BACKGROUND: The use of technological devices can support the self-management of individuals with type 2 diabetes mellitus (T2DM), particularly in addressing psychological distress. However, there is poor consistency in the literature regarding the use of psychological instruments for the web-based screening of patients' psychological distress and subsequent monitoring of their psychological condition during digital interventions. OBJECTIVE: This study aims to review previous literature on the types of psychological instruments delivered in digital interventions for assessing depression, anxiety, and stress in patients with T2DM. METHODS: The literature review was conducted using the PsycINFO, CINAHL and PubMed databases, in which the following terms were considered: diabetes mellitus, measure, assessment, self-care, self-management, depression, anxiety, stress, technology, eHealth, mobile health, mobile phone, device, and smartphone. RESULTS: In most studies, psychological assessments were administered on paper. A few studies deployed self-reporting techniques employing automated telephonic assessment, a call system for screening and monitoring patients' conditions and preferences, or through telephone interviews via interactive voice response calls, a self-management support program leveraging tailored messages and structured emails. Other studies used simple telephone interviews and included the use of apps for tablets and smartphones to assess the psychological well-being of patients. Finally, some studies deployed mood rating scales delivered through tailored text message-based support systems. CONCLUSIONS: The deployment of appropriate psychological tools in digital interventions allows researchers and clinicians to make the screening of anxiety, stress, and depression symptoms faster and easier in patients with T2DM. Data from this literature review suggest that mobile health solutions may be preferred tools to use in such digital interventions.

Parental Stress, Anxiety and Depression Symptoms Associated with Self-Efficacy in Paediatric Type 1 Diabetes: A Literature Review.

Background: Parents play a significant role in the management and monitoring of their children's Type 1 diabetes mellitus (T1DM), being considered a family disease. The current review intends to investigate parental stress, depression and anxiety symptoms associated with self-efficacy referred to paediatric diabetes management. Method: A literature review was carried out using PsycINFO, Web of Science and PubMed where the following terms were considered: diabetes mellitus, paediatric, parent-child relationship, self-efficacy, parenting stress, perceived stress, stress, depression, anxiety. Standing a defined list of inclusion and exclusion criteria, a total of 33 papers were finally included. Results: Findings have shown that parents experience relatively high levels of anxiety, depression and stress symptoms related to managing a child with T1DM and are associated with parental self-efficacy. Parental stress predicts a worsening in the control of HbA1c levels, while parental diabetes-specific distress predicts an increase in children depression symptoms. High parental self-efficacy associates with better monitoring, allowing better adherence and more balanced HbA1c levels in the children. Conclusions: Interventions aimed at fostering social support, improving diabetes management, and decreasing perceived stress, might alleviate parents' psychological symptoms by focusing on increasing their self-efficacy. Digital interventions might also represent valuable solutions to support parents in the management of paediatric diabetes not presented and substantiated in the main text and should not exaggerate the main conclusions.

Mothers and Fathers Parenting Stress and Their Perception of Children's Psychosocial Functioning in Paediatric Diabetes: A Pilot Study.

(1) Background: In the context of a child with Type 1 Diabetes Mellitus (T1DM), the rearrangement of the family's lifestyle can account for an increased risk of experiencing psychosocial problems for both child and parents. Those few studies on pediatric diabetes, which focused on parents' perception of children's psychological strengths and weaknesses, reported significantly higher rates of children's emotional and conduct problems associated with an imbalance in the Hemoglobin A1c (HbA1c). The main aim of this paper was to assess the role of parental perception of children's psychosocial symptoms as a mediator of the perceived parenting stress, considering mother and father separately. (2) Methods: The study involved 12 parent couples (Mothers Mage = 40.25, SD = 6.58; Fathers Mage = 42.5, SD = 6.38) of children with T1DM aged between 7 and 11 years (Mage = 8.8, SD = 0.996). Parents completed questionnaires such as the Strengths and Difficulties Questionnaire for parents and their perspective of their child, and the Parenting Stress Index-Short Form. (3) Results: Mothers and fathers had significant differences in the perception of their child's internalizing symptoms. Specifically, mothers present a greater perception of the mentioned symptoms compared to fathers. Mediation models showed that only for fathers' perception of the child conduct problems has a significant role between the fathers' perception of dysfunctional interaction with the child and the HbA1c. (4) Conclusions: The current study provides useful evidence also for clinical settings, suggesting that an interesting interplay between parenting stress, perception of children's symptoms and glucometabolic control should be taken into consideration.

Predisposing and Motivational Factors Related to Social Network Sites Use: Systematic Review.

BACKGROUND: Social network sites (SNSs) have been defined as Web services that involve creating a private or semiprivate profile. Through these services, adolescents and adults can maintain and create new relationships. Adolescents, in particular, can be considered the main users of these sites as they spend a lot of time on SNSs. In using SNSs, individuals can exert greater control over the conversation and on the information shared, which is associated with a desire for self-presentation. Moreover, the need for self-presentation is related to personality traits such as those of the Big Five, namely extraversion, neuroticism, openness to experience, agreeableness, and conscientiousness, as well as emotional stability, introversion, narcissism, and motivational aspects. The latter are usually linked to an underlying social purpose that might predispose an individual to using SNSs, with the intent of satisfying particular needs, such as belongingness and interpersonal competency. OBJECTIVE: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, this study aimed to present a systematic review of the scientific literature regarding the predisposing factors related to the Big Five personality traits and motivational aspects associated with the use of SNSs, for both adolescents (12-19 years) and adults (>20 years). METHODS: A search ranging from 2007 to 2017 was conducted through the academic database of Google Scholar and PsycINFO, in which the following terms and their derivatives were considered: predisposing factors, personality traits, Big Five model, self-esteem, self-presentation, interpersonal competency, social network site, Facebook, motivation, five-factor model, use, abuse, and addiction. Based on a defined list of inclusion and exclusion criteria, a total of 9 papers were finally included in the review. RESULTS: Our findings identified 3 main personality traits to be of greater value: extraversion, neuroticism, and openness to experience. Extraversion was a good predictor of motivation and SNS use, whereas the latter trait showed relevance for age differences. All 3 features further played a role in gender differences. Apart from extraversion, the self-presentational motive was also related to narcissism, whereas the need to belong presented an association with agreeableness and neuroticism. Further underlining the social value behind SNS use, people perceived interpersonal competency as being related to Facebook use intensity. CONCLUSIONS: Extraversion was recognized as the main forerunner for SNS use and motivation for use. Neuroticism seems to be related to an attempt at compensating for difficulties in real-life social contexts. Openness to experiences has a strong valence for both adults and older adults since SNSs are still perceived as a novelty. Moreover, gender differences in SNS usage were observed to be the product of differences in motivation. Implications and limitations of the study were discussed.