Googling for Suicide-Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis.

BACKGROUND: Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are "virtual pathways" facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. OBJECTIVE: The aim of this study is to characterize suicide-related webpages in the Italian language. METHODS: The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term "suicidio" (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument. RESULTS: A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword "suicide." CONCLUSIONS: Specialized mental health professionals should try to improve their presence online by providing high-quality material.

Trans-Cultural Validation of the "Academic Flow Scale" (Flow 4D 16) in Arabic Language: Insights for Occupational and Educational Psychology From an Exploratory Study.

Background: As an optimal psychological state, flow represents those moments when everything comes together for the performer. Flow is often associated with high levels of performance and is a positive psychological experience. Aim: Our study aimed to validate the "Academic Flow Scale" (Flow 4D 16) in Arabic language across Tunisian population, and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: The population is composed of 320 students (139 men and 181 women) belonging to the University of Sfax, with a mean age of 22.26 years. The students voluntarily responded to the scale of academic flow (Flow 4D 16). Both exploratory (EFA) and confirmatory (CFA) factor analyses were performed. Results: The four-dimensional alpha coefficients of the Flow 4D 16 indicate an excellent internal consistency, respectively, of 0.902 (Cognitive), 0.959 (Time), 0.974 (Ego) and 0.960 (Well-being). The CFA fit indices were satisfactory. Conclusion: In summary, the 16-items model (original version) showed for all the indices an excellent fit to the theoretical model, confirming the four-dimensional factor structure among Tunisian student population.

A reliability and content analysis of Italian language anorexia nervosa-related websites.

OBJECTIVE: Internet represents a major source of information related to health issues, increasingly used by providers. Indeed, there are numerous websites concerning eating and weight disorders, such as anorexia nervosa. The aim of the current investigation was to systematically perform a reliability and content analysis of Italian language anorexia nervosa-related websites. METHODS: Reliability of the anorexia nervosa website pages was assessed using the Health on the Net Foundation Code of Conduct Standards (HonCode®) certification mark. A comprehensive content analysis (thematic cluster analysis, correspondence analysis of emerging themes and topics, density and degree-centrality analysis, and co-word analysis) was performed using the commercial software T-Lab. RESULTS: 402 unique website pages were included and analyzed in the current study. Statistically significant differences related to the accomplishment or less to the items of the HonCode® certificate mark were found for all items, except for confidentiality and webmaster/additional contact. From the thematic cluster analysis, four clusters were identified: namely, treatment (26.6%), vomiting (24.7%), weight (24.4%) and onset-age (24.3%). Treatment (in particular, cognitive-behavioral psychotherapy) was the most represented theme (with a frequency of 97.76%, recurring in 393 websites). Pro-ana content characterized 147 website pages (with a frequency of 36.57%). CONCLUSION: The quality of Italian language anorexia nervosa-related websites was rather moderate-poor, being generally inconsistent with the principles of the HonCode® certification mark. Therefore, physicians and health authorities should be aware of such findings to provide their patients with proper answers and education.

Development and Preliminary Validation of the "Teacher of Physical Education Burnout Inventory" (TPEBI) in Arabic Language: Insights for Sports and Occupational Psychology.

Background: Burnout is an inappropriate response to chronic work stress, leading to emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA). Burnout can affect workers in the helping professions. To quantitatively assess the burnout level among teachers, Maslach has adapted the "Maslach Burnout Inventory" (MBI) to the educational environment (the so-called MBI Educators Survey version or MBI-ES). Among teachers, sports and physical education teachers may suffer from burnout due to high workload. Aims: No reliable psychometric tool in Arabic language exists that can be used to measure the burnout level among sports and physical education teachers. The objective of the present study was to develop a burnout measurement scale according to the Maslach's three-dimensional theoretical model for physical education teachers in Tunisia and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: A total of 525 Tunisian teachers teaching in secondary schools from different Tunisian governorates volunteered to participate in this study. The sample comprised of 285 males (54.3%) and of 240 females (45.7%). More in detail, 327 were teachers of primary school of physical education (62.3%) and 198 teachers of secondary school (37.7%). Teachers were administered both the ad hoc developed "Teacher of Physical Education Burnout Inventory" (TPEBI) and the MBI-ES. Both exploratory [principal component analysis (PCA)] and confirmatory factor analyses (CFAs) were performed. Results: The Cronbach's alpha coefficients were excellent (0.93, 0.94, and 0.91 for EE, D, and PA, respectively). The correlation matrix indicated significant correlations between the TPEBI and MBI-ED dimensions. However, CFA fit indices were not completely satisfactory. Conclusion: Given the good PCA factor loadings, the correlation matrix, the sensitivity analysis, and the excellent internal consistency, it can be concluded that the TPEBI is a reliable psychometric tool that can be used to quantitatively assess the burnout level among teachers of physical education in the Arabic-speaking world. However, considering the CFA fit indices, further modifications to fully support the model are warranted.

Psychometric properties of the Brief Symptom Inventory in nomophobic subjects: insights from preliminary confirmatory factor, exploratory factor, and clustering analyses in a sample of healthy Italian volunteers.

BACKGROUND: The Brief Symptom Inventory (BSI), developed by Derogatis in 1975, represents an important standardized screening instrument that enables one to quantitatively assess psychological distress and psychiatric disorders. The BSI is a 53-item self-report scale, measuring nine dimensions that can be summed up to reflect three global indices, including the General Severity Index (GSI). In the era of new information and communication technologies, nomophobia ("no mobile phobia") is an emerging disorder, characterized by the fear of being out of mobile phone contact. Nothing is known, however, about the factor structure and reliability of the BSI in a population of nomophobic subjects. This study aimed at addressing this gap in knowledge. METHODS: A sample of 403 subjects aged 27.91±8.63 years (160 males, 39.7% of the entire sample, and 243 females, 60.3%), recruited via snowball sampling, volunteered to take part in the study. The Italian versions of the Nomophobia questionnaire and the BSI were administered. Exploratory factor analyses, confirmatory factor analyses, and clustering analysis were carried out together with correlation analysis, analysis of variance, and multivariate regression analysis. RESULTS: For each BSI subscale, scores were significantly higher than the norms. The nine subscales exhibited acceptable-to-good Cronbach's alpha coefficients, varying from 0.733 for psychoticism to 0.875 for depression. Overall, the reliability of the entire instrument proved to be excellent (alpha coefficient=0.972). Furthermore, all BSI subscales as well as BSI synthetic indexes correlated with nomophobia in a significant way. Stratifying the population according to the severity of nomophobia (mild, 206 individuals, 51.1% of the sample; moderate, 167 subjects, 41.4%; and severe, 30 individuals, 7.4%), the GSI score could distinguish (P<0.001) between mild and moderate (0.99±0.71 vs 1.32±0.81) and between mild and severe (0.99±0.71 vs 1.54±0.79) nomophobia, although not between moderate and severe nomophobia (P>0.05). Similar patterns could be found for the other subscales of the BSI. Finally, looking at the fit indexes, the second-order 9-factor model best fit the data compared with the Derogatis 1-factor model. CONCLUSION: The findings of our study show that the BSI is a reliable and valid instrument with acceptable psychometric properties, and can be administered to populations of nomophobic subjects.

To fast or not to fast during the month of Ramadan? A comprehensive survey on religious beliefs and practices among Moroccan diabetic patients.

BACKGROUND: Diabetes represents a major public health concern. According to the International Diabetes Federation, about 8%-9% of the population have diabetes, and rates are even higher among Muslim communities. Despite the risks, about half (43%) with type 1 diabetes and most (86%) of those with type 2 diabetes fast during Ramadan. However, there is a dearth of information concerning the determinants that drive diabetic people to fast. Therefore, the present study was designed to fill this gap in knowledge. MATERIALS AND METHODS: A sample of 201 subjects volunteered to take part in this study. Mean age was 45.39±15.74 years. Most participants were female, married and had received at least primary education. They fasted for 22.98±8.53 days. RESULTS: For the overall questionnaire, the Cronbach's alpha coefficient was found to be excellent (α=0.910). The coefficient was good, yielding a value of 0.879, for the items concerning Ramadan fasting beliefs and practices, whereas the subscale for religious beliefs and practices obtained a score of 0.847. At the univariate analysis, patients with complicated diabetes (n=66, 32.8% of the sample) fasted for 20.77±9.21 days vs subjects with diabetes (n=135, 67.2% of the interviewees), who fasted for 24.05±7.99 days. The difference was statistically significant (P=0.014). The multivariate analysis indicated that religious beliefs and practices influenced the number of fasting days in a statistically significant way, after adjusting for confounders (beta coefficient =-0.199, t=-2.917, P=0.004). Another variable that impacted on the number of fasting days was the presence of complications (beta coefficient=-0.194, t=-2.775, P=0.006). CONCLUSION: Our results warrant further studies in the field.

Translation and Validation of the Nomophobia Questionnaire in the Italian Language: Exploratory Factor Analysis.

BACKGROUND: Nomophobia, which is a neologism derived from the combination of "no mobile," "phone," and "phobia" is considered to be a modern situational phobia and indicates a fear of feeling disconnected. OBJECTIVE: No psychometric scales are available in Italian for investigating such a construct. We therefore planned a translation and validation study of the Nomophobia Questionnaire (NMP-Q), which is an instrument developed by Yildirim and Correia. Subjects were recruited via an online survey using a snowball approach. METHODS: The NMP-Q was translated from English into Italian using a classical "backwards and forwards" procedure. In order to explore the underlying factor structure of the translated questionnaire, an exploratory factor analysis was carried out. A principal component analysis approach with varimax rotation was performed. Multivariate regression analyses were computed to shed light on the psychological predictors of nomophobia. RESULTS: A sample of 403 subjects volunteered to take part in the study. The average age of participants was 27.91 years (standard deviation 8.63) and the sample was comprised of 160 males (160/403, 39.7%) and 243 females (243/403, 60.3%). Forty-five subjects spent less than 1 hour on their mobile phone per day (45/403, 11.2%), 94 spent between 1 and 2 hours (94/403, 23.3%), 69 spent between 2 and 3 hours (69/403, 17.1%), 58 spent between 3 and 4 hours (58/403, 14.4%), 48 spent between 4 and 5 hours (48/403, 11.9%), 29 spent between 5 and 7 hours (29/403, 7.2%), 36 spent between 7 and 9 hours (36/403, 8.9%), and 24 spent more than 10 hours (24/403, 6.0%). The eigenvalues and scree plot supported a 3-factorial nature of the translated questionnaire. The NMP-Q showed an overall Cronbach alpha coefficient of 0.95 (0.94, 0.89, and 0.88 for the three factors). The first factor explained up to 23.32% of the total variance, while the second and third factors explained up to 23.91% and 18.67% of the variance, respectively. The total NMP-Q score correlated with the number of hours spent on a mobile phone. CONCLUSIONS: The Italian version of the NMP-Q proved to be reliable.

Ethnopsychiatry fosters creativity and the adoption of critical and reflexive thinking in higher education students: insights from a qualitative analysis of a preliminary pilot experience at the Faculty of Medicine and Surgery, University of Genoa, Italy.

Creativity is an ability that plays a major role in the modern economy and society. It should represent an important component of the medical syllabus. However, it is often overlooked by the formal courses at universities. The current study aimed at evaluating whether the interactive educational models, recently adopted by the Faculty of Medicine and Surgery, at the University of Genoa, Italy, would favor the adoption of critical thinking, attitudes to changes, cultural diversity acceptance, and the adoption of relational soft skills versus traditional and frontal didactic teaching. Thirty students, who attended the last year of health care professional course at the Faculty of Medicine, volunteered to take part in the study and were randomly allocated to two groups: one group receiving an innovative, interactive excellence course and the other group receiving a more traditional approach. Ethnopsychiatry was chosen as the topic since it was hypothesized that it would have contributed to generation of a new approach toward diseases and patients. The first group of students, exposed to interactive lectures with the aim of promoting the adoption of critical thinking, were more satisfied than the second group. Participants who were involved in an active manner and had to work in small groups, actively finding their own solutions to solve the problems, perceived the utilized teaching method and experience more stimulating, involving, and effective. Implications for education policy makers are also envisaged.

Data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of immigrants in Genoa (Italy).

This article reports the data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of 143 immigrants accessing an outpatient clinic or the general practitioners offices in Genoa (Italy) compared with 186 Italian patients. For further details and for the interpretation of the data, the reader is referred to the original publication "Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants" by Bragazzi et al. (2014) [1].

A proposal for including nomophobia in the new DSM-V.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered to be the gold standard manual for assessing the psychiatric diseases and is currently in its fourth version (DSM-IV), while a fifth (DSM-V) has just been released in May 2013. The DSM-V Anxiety Work Group has put forward recommendations to modify the criteria for diagnosing specific phobias. In this manuscript, we propose to consider the inclusion of nomophobia in the DSM-V, and we make a comprehensive overview of the existing literature, discussing the clinical relevance of this pathology, its epidemiological features, the available psychometric scales, and the proposed treatment. Even though nomophobia has not been included in the DSM-V, much more attention is paid to the psychopathological effects of the new media, and the interest in this topic will increase in the near future, together with the attention and caution not to hypercodify as pathological normal behaviors.

Investigating Aggressive Styles and Defense Mechanisms in Bipolar Patients and in their Parents.

Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions.

Panic attacks and possession by djinns: lessons from ethnopsychiatry.

This clinical case report shows how important it is for a psychiatrist to have a knowledge of the cultural and religious context of the patient, in order to understand fully his or her complaints. Culture and religion, in fact, are not neutral, but convey symbols, meanings, and myths that should be properly explored to shed light on the patient's inner world. Patient D was a 19-year-old Muslim Italo-Tunisian girl, who consulted a psychiatrist for anxiety and panic attacks, and reported being possessed by djinns (ie, "evil creatures", as described in the Qur'an). A culturally informed interview was carried out, together with administration of psychometric scales, including the Symptom Checklist-90 Revised and Psychological Measure of Islamic Religiousness. Based on her scores and the results of this multidimensional assessment, patient D was treated with transcultural psychotherapy and fluoxetine. After a year of follow-up, she reported no further episodes of panic disorder. For proper assessment and treatment, a combined anthropological, sociological, and psychopathological approach was necessary.