Depression and quality of life in adults perceiving exposure to parental alienation behaviors.

BACKGROUND: The current study is aimed at examining the relationship between exposure to parental alienation (PA) behaviors, depression, and health-related quality of life (HRQoL) in Italian adults. METHODS: Four hundred ninety-one adults were tested. Participants filled out the following self-rating scales: The Baker Strategy Questionnaire (BSQ), the Beck Depression Inventory - II (BDI-II) and its brief version (6-item version of the BDI-II), the Short-Form 36 (SF-36) Health Survey for measuring HRQoL and its brief version including 3 items (WHO-3) of the 5-item World Health Organization Well-Being Index. RESULTS: Findings revealed statistically significant differences between participants who reported PA and those who did not. Participants who reported exposure to PA behaviors had higher scores on the original BDI-II and its 6-item version (p < 0.05, p < 0.01, respectively); they had also lower levels of HRQoL as resulting from 6 of the 8 SF-36 domains (at least p < 0.05), including lower scores on the WHO-3 (p < 0.01). Perceiving an exposure to PA behaviors significantly increased the likelihood of being above the clinical cut-off on the BDI-II (p < 0.01), the 6-item version of the BDI-II (p < 0.05), and the WHO-3 (p < 0.05). Moreover, perceiving an exposure to PA increased the odds of diminished HRQoL (OR = 2.43 and OR = 1.92 for general health and social functioning domains, respectively). CONCLUSIONS: Childhood exposure to PA was related to higher likelihood of depressive symptoms and diminished HRQoL in adulthood. Our findings suggest the need for preventive and clinical interventions to protect vulnerable children involved in PA from negative outcomes.

Cortical and Autonomic Stress Responses in Adults with High Versus Low Levels of Trait Anxiety: A Pilot Study.

Stress responses are mediated by complex patterns of cortical and autonomic activity. Earlier studies showed increased recruitment of the right prefrontal cortex (PFC) and parasympathetic withdrawal during a stress task; however, it remains unclear whether these responses change in relation to different levels of psychopathological symptoms, such as trait anxiety. The present study examines the effect of a mathematical task (with a control condition and a stressful/experimental condition) on the PFC and autonomic activity, using a two-channel near infrared spectroscopy (NIRS) and an ECG monitoring system. After a preliminary screening of 65 subjects, a sample of 12 individuals (6 with the highest and 6 with the lowest scores on an anxiety questionnaire, i.e. the STAI trait) was selected. The two groups were similar regarding demographic variables (age, sex, body mass index) and baseline STAI-state scores. Repeated measures ANOVAs were used to compare changes from baseline in oxyhemoglobin (oxy-Hb), heart rate (HR) and root mean square of successive differences (RMSSD) between the two groups. Individuals affected by high levels of trait anxiety showed a reduced bilateral PFC activity during the entire experimental procedure compared to those with low anxiety. No differences in NIRS channels were found between the two groups. During both conditions, RMSSD was lower among individuals affected by high levels of anxious symptoms. Finally, throughout the procedure, changes in HR were higher in the anxious group. Overall, these findings suggest a reduced PFC activity and a larger parasympathetic withdrawal during a stress task in individuals with high levels of trait anxiety compared to those with low anxiety. These results could represent a starting point for future NIRS and ECG studies on the relationship between mental disorders and acute stress responses.

Age-Related Changes in Physiological Reactivity to a Stress Task: A Near-Infrared Spectroscopy Study.

Aging is associated with changes in biological functions, such as reduced cardiovascular responses to stressful tasks. However, less is known about the influence of age on the reactivity of the prefrontal cortex (PFC) to acute stressors. Therefore, this study aimed to investigate the effects of a computerized-controlled stress task on the PFC and autonomic system activity in a sample of older and younger adults. We recruited a total of 55 healthy, right-handed persons (26 older adults with mean age 69.5, SD 5.8 years; and 29 younger adults with mean age 23.8, SD 3.3 years); groups were balanced for sex. Tasks included a control and an experimental condition: during both tasks individuals had to solve simple mental arithmetic problems. For the experimental condition, all participants were faced with a time limit that induced significant stress. Physiological indexes were collected continuously during the entire procedure using a 2-channel near infrared spectroscopy (NIRS) and an ECG monitoring system. Repeated measures ANOVA were used to assess changes in hemoglobin concentrations, and changes in both heart rate and performance outcomes. NIRS, ECG and performance data showed a significant interaction between the group and condition. Post-hoc analyses evidenced a significant increase in heart rate and Oxy-Hb concentration in the bilateral PFC between the control and experimental condition only in the younger group. Post-hoc analyses of behavioral data showed lower percentages of correct responses and higher response times in the older group. In summary, these results suggested that cardiovascular and cortical reactivity to stress tasks are a function of age. Older individuals seem to be characterized by blunted physiological reactivity, suggestive of impaired adaptive responses to acute stressors. Therefore, future studies should investigate the underlying physiological mechanisms of prefrontal and cardiovascular changes related to aging.

Relation Between Cognitive Function and Baseline Concentrations of Hemoglobin in Prefrontal Cortex of Elderly People Measured by Time-Resolved Near-Infrared Spectroscopy.

We evaluated relationship between cognitive function and cerebral blood oxygenation (CBO) of the prefrontal cortex (PFC) at rest in 113 adults (age 72.3 ± 12.0 years). We employed a two channel time-resolved near-infrared spectroscopy (TRS), which allows non-invasive measurements of baseline concentrations of oxyhemoglobin (oxy-Hb), deoxyhemoglobin (deoxy-Hb), total-hemoglobin (t-Hb) (µM) and oxygen saturation (SO2, %) of the bilateral PFC without any tasks. We examined cognitive functions using the Mini-Mental State Examination (MMSE) (range from 0 to 30) and the Touch M which evaluates working memory function semi-automatically on a touchscreen (range from 0 to 100); the mean MMSE and Touch M scores of all subjects were 24.8 ± 4.6 (mean ± SD; range 11-30) and 41.3 ± 22.1 (range 1-100), respectively. Employing Pearson's correlation analysis, we evaluated correlation between the TRS parameters and cognitive function. We found a significant positive correlation between the MMSE scores and SO2 (r = 0.24, p < 0.02). In addition, we observed significant positive correlations between Touch M scores and baseline concentrations of oxy-Hb (r = 0.26, p < 0.02), total-Hb (r = 0.23, p < 0.05), and SO2 (r = 0.23, p < 0.05). TRS allowed us to evaluate the relation between CBO in the PFC at rest and cognitive function.

Effects of Positive and Negative Mood Induction on the Prefrontal Cortex Activity Measured by Near Infrared Spectroscopy.

The neurophysiological mechanism of positive versus negative emotions is insufficiently understood. In the present study, we examined the effect of event recall tasks on the prefrontal cortex (PFC) activity using near infrared spectroscopy (NIRS). Nine healthy adults were instructed to recall episodes of their life associated with positive (happiness) and negative (anger) emotion, both silently and verbally. Heart rate (HR) changes were simultaneously measured. NIRS showed an increased oxyhemoglobin (oxy-Hb) in the bilateral PFC during silent and verbal recall of both positive and negative episodes. The changes of oxy-Hb in the bilateral PFC during silent recall of negative episodes were significantly larger than those during silent recall of positive episodes (p < 0.01). There was no difference in average changes of oxy-Hb between silent and verbal recall of negative episodes (p > 0.95), while changes of oxy-Hb during verbal recall of positive episodes were larger than those during silent recall of positive episodes (p < 0.05). Both verbal and silent recall of positive and negative episodes increased HR; however, verbal recall caused larger increases of HR than silent recall (p < 0.01). The present results suggest that recall of negative episodes affect the PFC activity, which plays a key role in cognitive control of emotions, more than positive episodes.

Personality, attrition and weight loss in treatment seeking women with obesity.

Studies on small samples or in single units applying specific treatment programmes found an association between some personality traits and attrition and weight loss in individuals treated for obesity. We aimed to investigate whether pre-treatment personality traits were associated with weight loss outcomes in the general population of women with obesity. Attrition and weight loss outcomes after 12 months were measured in 634 women with obesity (mean age, 48; body mass index (BMI), 37.8 kg m(-2)) seeking treatment at eight Italian medical centres, applying different medical/cognitive behavioural programmes. Personality traits were assessed with the Temperament and Character Inventory (TCI), eating disorder features with the Binge Eating Scale (BES) and Night Eating Questionnaire (NEQ). Within the 12-month observation period, 32.3% of cases were lost to follow-up. After adjustment for demographic confounders and the severity of eating disorders, no TCI personality traits were significantly associated with attrition, while low scores of the novelty seeking temperament scale remained significantly associated with weight loss ≥ 10% (odds ratio, 0.983; 95% confidence interval, 0.975-0.992). Additional adjustment for education and job did not change the results. We conclude that personality does not systematically influence attrition in women with obesity enrolled into weight loss programmes in the community, whereas an association is maintained between novelty seeking and weight loss outcome. Studies adapting obesity interventions on the basis of individual novelty seeking scores might be warranted to maximize the results on body weight.

Life experiences and coping strategies in adults with congenital heart disease.

Many adults with congenital heart disease (ACHD) have to face considerable psychosocial difficulties. The aim of this study was to explore the life experiences of ACHD patients, from when they become aware of having a condition, till after the open heart surgery they underwent. The study was conducted with the use of unstructured, in-depth interviews, performed on 11 patients (age ranging: 20 - 56 y) after they recovered from open heart surgery and a focus group, which included 16 participants (age ranging: 22 - 46 y). Both the interviews and the focus group were recorded, transcribed and analyzed according to Grounded Theory procedures. Our findings show that the condition of diversity is the core of the emotional experiences connected to ACHD. Feeling different and being perceived as being different are clearly interlinked and coping strategies adopted resulted as being influenced by this perception. This study also clearly outlines the importance of having an adequate perception of one's condition and the link between maladaptive coping strategies and an incorrect perception of one's heart condition. Results are discussed in order to promote psychosocial interventions within and outside of the hospital setting in order to improve the patients' emotional wellbeing.

Mindfulness trait, eating behaviours and body uneasiness: a case-control study of binge eating disorder.

BACKGROUND: Binge eating disorder (BED) is a complex and multifaceted eating disorder, and the literature indicates that BED patients show greater difficulty in identifying and making sense of emotional states, and that they have limited access to emotion regulation strategies. Findings show many links between mindfulness and emotional regulation, however there has been no previous research on mindfulness traits in BED patients. METHOD: One hundred fifty BED patients (N=150: women=98, men=52; age 49.3±4.1) were matched for gender, age, marital status and educational level with 150 non-bingeing obese and 150 normal-weight subjects. All were assessed with the Five Facet Mindfulness Questionnaire (FFMQ), Binge Eating Scale (BES), Objective bulimic episodes (EDE-OBEs) and Body Uneasiness Test (BUT). For all the participants past or current meditation experience was an exclusion criteria. RESULTS: Findings showed that Mindfulness-global, Non reactivity to experience, Acting with awareness, Describing with words and Observation of experience scores were significantly lower in BED than control groups (p<0.05). However, on the mindfulness measures, the obese control group did not differ from the normal weight control group. Moreover, correlations showed that mindfulness was more widely negatively correlated with the BED's OBEs, BES and BUT-GSI scores. Meanwhile, binge eating behaviours, frequency and severity (OBEs and BES) were more negatively correlated with action (Nonreactivity- to-experience and Acting-with-awareness scores). Body Uneasiness was more negatively correlated with mental processes (Describing-with-words and Observation-ofexperience) and mindfulness features. CONCLUSION: Implications on understanding of the mechanisms underlying the development and maintenance of problematic eating in BED were considered. Moreover, clinical considerations on treatment targets of mindfulnessbased eating awareness training were discussed.

Weight loss and clinical characteristics of young adults patients seeking treatment at medical centers: data from the QUOVADIS Study.

OBJECTIVE: To compare clinical characteristics, attrition, weight loss, and psychological changes of obese young adults and obese adults seeking treatment. MATERIALS AND METHODS: 1530 individuals seeking treatment in 18 Italian medical centers were evaluated. 382 cases (25%) were classified as young adults (age≤35 years), 1148 (75%) as adults (>35 years). Psychological distress, binge eating, body uneasiness, and attitude towards eating were evaluated, at baseline and after a 12-month weight-loss program, together with BMI changes. Weight-loss expectations and primary motivation for seeking treatment were also recorded. RESULTS: At baseline, young adults reported significantly higher BMI at age 20, weight loss expectations and body uneasiness scores than adults. A significantly higher percentage of young adults also reported improving appearance as primary reason for seeking treatment. The attrition rate was significantly larger in young adults. Among completers, the mean percent weight loss at 12 months and improvement of psychosocial variables were significantly higher in young adults than in adults. By intention to treat, BMI changes were no longer significant between groups. DISCUSSION: Obese young adults lose more weight and considerably improve psychological distress, but show a higher attrition rate after 12 months of continuous care in a real world medical setting.

Complexity of attrition in the treatment of obesity: clues from a structured telephone interview.

OBJECTIVES: To investigate the causes of attrition reported by obese patients treated by medical centres. DESIGN: Observational study. SETTING: Obese patients enrolled in a long-term study involving 18 Italian medical centres. PARTICIPANTS: A total of 940 obese patients (727 female; mean age, 49 years; mean BMI, 38.6 kg/m2). MEASUREMENTS: Causes of attrition reported by dropouts during a structured telephone interview. RESULTS: After a median observation period of 41 months (range, 25-50), 766 of 940 patients (81.5%) discontinued treatment. Sixty-two per cent of total dropout occurred in the first year of follow-up. Seventy-four per cent of dropouts reported a single primary reasons for treatment interruption. Two primary reasons were reported by 22.4% of patients, and three reasons by 3.4%. Practical difficulties, alone or in combination, were reported by more than half of dropouts (55%), and were the leading cause of attrition followed by perceived failure of treatment. Among practical difficulties, family problems or problems at work and logistics, coupled with health problems other than obesity, were the most frequent reasons of attrition, but also a perceived sense of abandonment or a bad interaction with therapists were frequently reported. CONCLUSION: Practical difficulties and psychological problems are the most important reasons of attrition reported by patients. A therapeutic alliance addressing these issues has a large potential to reduce treatment interruption and to improve outcome in obesity.