The Association between Grazing and Food Addiction: The Italian Version of the Repetitive Eating Questionnaire (Rep(Eat)-Q) and Its Relationships with Food Addiction Criteria.

BACKGROUND: Among the dysfunctional eating behaviors associated with excessive food intake, a construct that is gaining increasing attention is grazing-the constant, continuous, compulsive, and repetitive consumption of small/moderate amounts of food. Furthermore, in some cases, grazing seems to indicate a dependence on food and/or eating. Currently, the Repetitive Eating Questionnaire (Rep(Eat)-Q) appears to be the only questionnaire that comprehensively measures grazing, including its repetitive and compulsive eating component. Therefore, in a sample of individuals with severe obesity, the objective of this study was twofold: (A) to evaluate the psychometric properties of the Italian version of the Rep(Eat)-Q, and (B) to analyze the association between grazing and food addiction (FA). METHOD: A cross-sectional research design was used. A total of 402 inpatients with severe obesity (BMI > 35) were recruited. Participants underwent a series of questionnaires to investigate structural validity and convergent validity and association with FA criteria. RESULTS: The factorial structure of the Rep(Eat)-Q is robust and showed fit indexes: CFI = 0.973; RMSEA = 0.074; 90%CI [0.056-0.091]; and SRMR = 0.029. Also, it exhibited good internal consistency and convergent validity. Furthermore, logistic regression analysis highlights a specific association between certain FA criteria and grazing. CONCLUSIONS: The Rep(Eat)-Q can be considered to be a concise, robust, reliable, and statistically sound tool to assess repetitive eating, specifically grazing. Its strong psychometric properties offer significant advantages for both research and clinical applications. Furthermore, in a sample of individuals with severe obesity, the results suggest that individuals with problematic grazing exhibit a typical behavioral profile of subjects with FA, indicating that FA can manifest through problematic grazing as well.

Worry about the Future in the Climate Change Emergency: A Mediation Analysis of the Role of Eco-Anxiety and Emotion Regulation.

The climate change emergency is one of the most important challenges of our time, and its impact on mental health has been evident for years. It is very important for clinicians to delve deeper into these manifestations. There are a wide variety of constructs, symptoms, and scales to measure the impact of climate change on mental health. Eco-anxiety is one of the constructs that has specifically emerged, in association with worry, about the future. In mental health studies, it is important to explore the relationship between eco-anxiety and emotion regulation and how much this relationship leads to worry about the future in order to be able to offer clinical intervention recommendations. Indeed, the hypothesis of this study is that it is possible to develop worries about the future when symptoms of eco-anxiety and a poor ability to regulate emotions are present. Particularly, emotion dysregulation could increase eco-anxiety symptoms and generate worries about one's own future. For this reason, we have chosen to explore the relationships between these three constructs with the use of a mediation analysis. For this research, 351 participants were recruited in Italy. The proposed mediation model highlighted the findings that emotion dysregulation was positively related with eco-anxiety and that eco-anxiety predicts worry about the future. An association between emotion dysregulation and worry about the future was present. Eco-anxiety appeared to be an important mediator between emotional dysregulation and worry about the future. Emotion regulation could play a pivotal role in addressing concerns about the future. These findings could pave the way for exploring new research avenues and potential clinical interventions.

Measuring Motivations to Eat Palatable Foods: Adaptation and Psychometric Properties of the Italian Version of the Palatable Eating Motives Scale (PEMS-IT).

BACKGROUND: Gaining knowledge of the various reasons behind people's consumption of highly processed foods has the potential to enhance obesity prevention initiatives and open avenues to tailor treatment approaches for obesity and binge eating at a more personalized level. This contribution aimed to test the psychometric properties and factor structure of the Palatable Eating Motives Scale (PEMS-IT) in a community sample of Italian adults. METHODS: A confirmatory factor analysis was performed to test the factor structure of the Italian version of the PEMS (PEMS-IT) on a total of 616 respondents. Furthermore, the reliability and convergent validity analysis of the tool were evaluated. RESULTS: The analysis confirmed the four-factor structure of PEMS-IT [(YBχ2 (164) = 537.901; p < 0.001, the CFI = 0.918, RMSEA = 0.072; 90%CI [0.065-0.078]; p(RMSEA < 0.05) < 0.001, and SRMR = 0.080] and satisfactory reliability on its subscales (Cronbach's α: 0.745-0.917). Positive correlations were also found with food addiction and binge-eating symptoms, compulsive eating behavior, and uncontrolled and emotional eating. CONCLUSIONS: The PEMS-IT appears to be an instrument with promising psychometric properties and potential applications in clinical settings. However, it also has some limitations, and future studies could focus on improving the semantic content of the elements to increase the overall utility and precision of the instrument.

Validation of the Italian Version of the Web Screening Questionnaire for Common Mental Disorders.

BACKGROUND: The ever-increasing spread of Internet-based systems for common mental disorders has generated the need for brief online screening methods. This study aims to test the psychometric properties of the Web Screening Questionnaire (WSQ) to examine its suitability for screening for common mental health problems among a community sample of Italian adults. METHODS: A total of 1282 subjects (F = 819; mean age = 42.05) answered the WSQ. Its discriminant characteristics were examined with other validated selected scales for measuring mental health widely used in the Italian population using sensitivity, specificity, and area under the curve (AUC), as well as positive (PPV) and negative predictive values (NPV). RESULTS: Most of the WSQ subscales exhibited moderate to high specificity values. Specifically, the scales of 'agoraphobia' (0.947; 95%CI [0.934, 0.960]), 'anxiety' (0.959; 95%CI [0.946, 0.970]), and 'panic disorder' (0.973; 95%CI [0.964, 0.981]) showed the highest values whilst the 'obsessive-compulsive' dimension had the lowest value at 0.838, 95%CI [0.815, 0.861]. With exceptions observed for 'depression' (0.716; 95%CI [642, 798]) and 'alcohol abuse' (0.760; 95%CI [560, 920]), instead, the WSQ demonstrated critical sensitivity values (<0.6) in all dimensions. CONCLUSIONS: The WSQ was appropriate for discriminating between people with and without a psychiatric condition, as it helps to confirm the absence of disorders. However, further diagnostic procedures are required, in case of a positive WSQ screening result.

Cognitive restraint, uncontrolled eating, and emotional eating. The Italian version of the Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18): a three-step validation study.

BACKGROUND: The Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18) is an extensively used questionnaire to measure three transdiagnostic features of eating behavior: cognitive restraint, uncontrolled eating, and emotional eating. OBJECTIVE: This research aims to investigate the psychometric properties of the Italian version of the TFEQ-R-18 in three large community samples. METHOD: Cross-sectional research designs were employed. In Study 1 (N = 537), an exploratory graph analysis (EGA) was used to examine item clustering within the TFEQ-R-18. In Study 2 (N = 645), a confirmatory factor analysis (CFA) was conducted to test its structural validity. In Study 3 (N = 346), a MANOVA was employed assessing mean differences across eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating disorder). RESULTS: In Study 1, the EGA accurately identified the three original dimensions of the TFEQ-R-18. Study 2 showed that the Italian TFEQ-R-18 has good fit indexes (CFI = 0.989, RMSEA = 0.064; 90% CI [0.058, 0.070], SRMR = 0.062), and possesses robust psychometric properties. Study 3 reveals distinct, statistically significant differences among eating disorders. CONCLUSION: The TFEQ-R-18 proves to be a concise and precise tool for measuring transdiagnostic eating behaviors. Its applicability in the Italian context, supported by robust psychometric properties, suggests its utility for both research and clinical purposes. The findings affirm its potential to inform interventions aimed at enhancing psychological health. LEVEL OF EVIDENCE: Level V, descriptive study.

Understanding the role of self-esteem and emotion dysregulation in victims of intimate partner violence.

Self-esteem and emotion dysregulation appear to be important factors in the psychological well-being of trauma survivors. On the one hand, self-esteem may act as a shield against the psychological consequences of traumatic experiences; on the other hand, emotion regulation can affect the way individuals deal with post-traumatic affects (e.g., fear, terror, shame, and guilt). Consequently, the objective of this study was to investigate the role that emotion dysregulation and self-esteem play in the well-being of a sample of women after the traumatic experience of intimate partner violence (IPV). This study involved 282 women (meanage = 41.55, SD = 10.52) who experienced IPV in the last year. Conditional process analyses and Johnson-Neyman analysis for regions of significance were performed. The results showed that emotion dysregulation mediated the relationship between post-trauma affectivity (i.e., fear, terror, shame and guilt) and survivors' well-being. Furthermore, self-esteem negatively predicted lack of well-being and acted as a moderator of the relationship between emotion dysregulation and lack of well-being. In this regard, through the Johnson-Neyman analysis for regions of significance, it was possible to identify a cut-off value above which the relationship between emotion dysregulation and lack of well-being became non-statistically significant. This study contributed to understanding the role that emotion dysregulation and self-esteem play in the well-being of IPV survivors. In this regard, clinical implications will be presented.

The Italian version of the 16-item Prodromal Questionnaire (PQ-16) and its psychometric features in help-seeking ultra-high-risk subjects and in the general population.

BACKGROUND: Increasing attention to the early stages of psychosis and the identification of symptomatic prodromal states have led to the development of a growing number of screening tools. The 16-item version of the Prodromal Questionnaire (PQ-16) is a worldwide used self-administered tool for this purpose. However, to date, fundamental psychometric properties of PQ-16 were not thoroughly investigated. This study aimed to examine the structural validity, measurement invariance, reliability and other psychometrical properties of the Italian version of the PQ-16 (iPQ-16) in help-seeking individuals and in the general population. METHODS: The iPQ-16 was administered to 449 young outpatients attending six community mental health services and to 318 control participants enrolled in educational environment. Confirmatory factor analyses (CFAs), measurement invariance (MI) between the help-seeking group and the general population sample, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed. Lastly, the validity of the adopted PQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses was also tested. RESULTS: CFAs confirmed the single-factor structure for the iPQ-16 and scalar MI was reached. The iPQ-16 showed high internal consistency, test-retest reliability, convergent validity, and acceptable diagnostic accuracy. ROC analysis suggested a score of ≥4 as best cut-off. CONCLUSIONS: The iPQ-16 represents a valid and reliable questionnaire for the assessment of high mental risk in both Italian outpatients and general student population. It has good psychometric properties and is easy to implement as UHR screening for clinical as well as research purposes.

Dieting, obsessive-compulsive thoughts, and orthorexia nervosa: Assessing the mediating role of worries about food through a structural equation model approach.

BACKGROUND: Orthorexia Nervosa (ON) is a condition characterized by an obsessive focus on healthy eating, inflexible dietary rules, and persistent preoccupations with food. Despite it has been recently the subject of increasingly relevant studies, little is known about the mechanisms that might foster ON symptoms. OBJECTIVE: This study used a structural equation modeling approach to test the mediating effect of thoughts, worries, and preoccupations about food on the relationship that eating disorders (EDs) attitudes (e.g., dieting) and obsessive-compulsive thoughts and symptoms have with ON in a large community sample. It was hypothesized that the effect of dieting and obsessive-compulsive thoughts and symptoms on ON would be partially mediated by the presence of thoughts, worries, and preoccupations about food. METHODS: Data from a cross-sectional sample of 1328 participants (females = 976) recruited from the general population were asked to fill in an online survey comprising the Eating Attitude Test-26 (EAT-26), the Obsessive-compulsive subscale of the Symptom Checklist-90 Revised (SCL-90R-OC) and the Orthorexia Scale-15 (ORTO-15). RESULTS: Structural equation models indicated that both obsessive-compulsive thoughts and symptoms and dieting had a direct effect on ON and that food preoccupation partially mediated these relationships. CONCLUSION: These findings provide novel insight into the nature of ON that could aid its conceptualization and treatment.

The Role of Alexithymia and Impulsivity in Male Victims and Perpetrators of Intimate Partner Violence.

(1) Background: Alexithymia and impulsivity appear to represent risk factors for violence perpetration, while mixed results are present with respect to victimization experience. In light of this, the purpose of this study was to compare the roles of both alexithymia and impulsivity among three different samples of men: men who experienced partner victimization (IPVV); male intimate partner violence perpetrators (IPVP); and men from the general population (CG). (2) Methods: Participants were recruited from specialized centers in Italy. A profile analysis was conducted. (3) Results: The results showed that IPVV presented alexithymia and impulsivity comparable to the CG. Furthermore, differences were found between victims and perpetrators in terms of impulsivity and alexithymia. The IPVP group had higher levels of both impulsivity and alexithymia in comparison to IPVV. Moreover, the perpetrators exhibited significantly higher levels of alexithymia compared to the CG. However, despite the medium Cohen's d (d = 0.441) resulting from the analyses, IPVP's level of impulsivity was not statistically different from the CG. (4) Conclusion: Alexithymia and impulsivity appear to play a key role in violent behaviors and should be the focus of psychological interventions with perpetrators.

Eating Compulsivity in Inpatients with Severe Obesity and the General Population: The Italian Version of the Measure of Eating Compulsivity (MEC10-IT).

This study aimed to validate and investigate the psychometric properties of the Italian version of the Measure of Eating Compulsivity-10 (MEC10-IT) in a sample of inpatients with severe obesity (Study 1), and to test the measurement invariance of the measure across non-clinical and clinical samples (Study 2). In the first study, a confirmatory factorial analysis (CFA) was conducted among 452 patients in order to confirm the factorial structure of the MEC10-IT. In the second study, the psychometric properties of the MEC10-IT were tested on 453 inpatients with severe obesity and a community sample of 311 participants. The CFA confirmed the factorial structure of the MEC10-IT among an Italian sample of adult inpatients with severe obesity (Study 1). The MEC10-IT was also demonstrated to be invariant between the clinical and the community sample and to possess good psychometric properties, as well as excellent screening abilities for classifying individuals with problematic eating behaviors (Study 2). In conclusion, the MEC10-IT could be considered as a valid and reliable tool for the assessment of compulsive eating in both non-clinical and clinical samples and represents a psychometrically sound measure for clinical and research purposes.

An Attempt to Conceptualize the Phenomenon of Stigma toward Intimate Partner Violence Survivors: A Systematic Review.

The objectives of the present manuscript were to review the literature on stigma toward survivors of intimate partner violence (IPV) and to identify the most widely used assessment techniques to investigate this issue. The PRISMA guidelines were followed, and the systematic review was registered in PROSPERO, registration number: CRD42022327410. PsycINFO, Scopus, Web of Science, and PubMed were searched. Two authors selected and extracted data from eligible studies. In total, 4220 hits were returned from the database search, and of them, 24 articles met the inclusion criteria. The articles included in the review confirm the presence of stigma toward IPV survivors, which can be divided into public stigma and self-stigma. Specifically, 17 studies were related only to public stigma, 1 study focused only on self-stigma, and 6 articles investigated aspects related to both public and self-stigma. Both qualitative and quantitative studies have been conducted on this topic. The considerations on the methodologies and assessment measures used in the included studies will be discussed in the results section. Based on the research included, it was possible to develop a contribution to the definition of stigma, which will be discussed in the article.

Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder.

Objective. The present study employs a profile analysis to identify and compare psychological features and core eating disorder (ED) symptoms in clinical samples of patients with anorexia nervosa (AN) and binge eating disorder (BED) and the general population (GP). Methods. A sample comprising 421 participants (142 patients with AN; 139 patients with BED; and 140 participants from the GP) was surveyed with the Eating Disorder Inventory-3 (EDI-3). Individuals with AN and BED were recruited and tested during their first week of a multidisciplinary inpatient program for weight loss and rehabilitation at the 'Rete DCA USL Umbria 1' (Eating Disorders Services), Italy. Results. The findings suggest distinct patterns of symptom presentation between the three samples across all the EDI-3 dimensions-with both the AN and BED groups scoring significantly higher than the GP. Patients with AN registered greater scores in all the psychological trait scales and the drive for thinness ED-specific dimension of the EDI-3 compared with their BED counterpart-which, instead, scored higher in the bulimia and body dissatisfaction subscales. These data support the transdiagnostic nature of the main risk factors for the onset and maintenance of EDs-which would vary in severity levels-and the existence of disease-specific pathways giving rise to AN and BED. Conclusion. This study for the first time compares patients with AN and BED with a non-clinical sample on main ED psychological features. This might inform classification approaches and could have important implications for the development of prevention and early intervention programs.

Correction to: The Rising of the Shield Hero. Development of the Post-traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of Self-esteem from Trauma-related Anxiety and Depression.

[This corrects the article DOI: 10.1007/s40653-022-00503-z.].

Stigma toward internalizing and externalizing disorders: How do adolescents perceive their peers? A network analysis approach.

This study's first aim was to explore whether stigma's facets differ between internalizing and externalizing disorders in adolescence. The second aim was to compare the relationships among stigma's facets toward these disorders. Two vignettes depicting a peer with Major Depressive Disorder (MDD) or Attention-Deficit Hyperactivity Disorder (ADHD) were used with 616 adolescents in Italy. A Repeated measure MANOVA showed biogenetic causes, social distancing, and discomfort were more attributed to depression, while dangerousness to ADHD. Furthermore, a Psychometric Network Analysis showed no differences between these disorders in the relations among stigma's components. However, dangerousness seemed to be among the nodes with the highest levels of "strength," confirming previous literature that shows that dangerousness plays a major role in stigma.

A post hoc comparison between inpatients with obesity and healthy-weight subjects in the size estimation accuracy of shoulders, waist, and hips widths and circumferences.

PURPOSE: This post hoc study aimed to assess the hypothesis that subjects with obesity could underestimate their body size. METHODS: Data from a previous study with different aims were used to compare 22 female inpatients with obesity with 21 healthy-weight women in the size estimation accuracy of their shoulders, waist, and hips circumferences and widths. The body estimation task with an individualized metric methodology was used to collect data. Frequentist and Bayesian analyses were performed. RESULTS: Samples differed significantly in the accuracy measures of shoulders width and hips as well as waist circumferences: inpatients with obesity underestimated them, while healthy-weight subjects estimated shoulders width accurately but overestimated their hips and waist circumferences. Multiple regression showed that the between-group difference in the accuracy measure of shoulders width was explained by the individuals' education level, while the difference in the accuracy measure of waist circumference resulted to be independent of both age and education level. CONCLUSION: This post hoc study supports the hypothesis that female patients with obesity might underestimate their body size. If these results will be confirmed in future studies, interventions specifically designed to equalize estimations to match the real measures of body size may play a key role in weight-reduction programs for people with obesity. LEVEL OF EVIDENCE: Level III, evidence obtained from cohort or case-control analytic studies.

The Rising of the Shield hero. Development of the Post-Traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of self-esteem from trauma-related Anxiety and Depression.

Background: Adverse life events such as life-threatening accidents, domestic and/or sexual violence, organic diseases (i.e., cancer), or COVID-19 can have a strong traumatic impact - generating reactions as intrusive thoughts, hyperarousal, and avoidance. Indeed, the traumatic impact of COVID-19 seems to lead individuals to experience anxiety and depression. However, the Anxiety-Buffer Hypothesis suggests that self-esteem could be considered a shield (buffer) against traumatic experiences and their outcomes (i.e., anxiety and depression). The present study has two objectives. First, to develop a measure of the impact of the traumatic event considering the aforementioned reactions. Second, to test the process - triggered by COVID19-related traumatic experience - in which self-esteem buffers the path that leads to anxiety and depression. Method: In Study 1 (N = 353), the Post-Traumatic Symptom Questionnaire (PTSQ) was developed and a deep investigation of its psychometric properties was conducted. In Study 2 (N = 445), a structural equation model with latent variables was performed to assess the buffering effect of self-esteem. Results: The PTSQ has excellent fit indices and psychometric properties. According to the ABH, results confirm the buffering effect of self-esteem in the relationships between traumatic symptoms and both anxiety and depression. Conclusion: On the one hand, the PTSQ is a solid and reliable instrument. On the other hand, that self-esteem is a protective factor against anxiety and depression related to a traumatic experience - such as COVID-19. Targeted psychological interventions should be implemented to minimize the psychological burden of the illness while promoting adaptation and positive aspects of oneself. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00503-z.

Understanding stigma toward schizophrenia.

Schizophrenia is arguably one of the most stigmatized psychiatric disorders, with patients frequently seeing the burden of stigmatization as a "second illness." Thus, the purpose of this study was to investigate the relationships among the main aspects of the stigma toward schizophrenia. This study used a vignette methodology with 2053 individuals from the general population in Italy. The main aspects of stigma - causal beliefs, recommended treatments, social distance, perception of dangerousness, and avoidance - were investigated through participants' responses, and a latent variable structural equation model (SEM) approach was used to test the relationships among them. Perceived dangerousness predicts the desire for social distancing from an individual with schizophrenia, which predicts the desire for avoidance. In addition, biogenetic causal beliefs of schizophrenia and position on the appropriate medical treatment predict the perception of dangerousness and thus a greater desire for social distance. This study contributes to the literature on the stigmatization of mental health by improving our understanding of the phenomenon. Highlighting the relationships between aspects of stigma allows for a discussion of the implications for anti-stigma interventions.

Women's EmotionS, Trauma and EmpowErMent (W-ES.T.EEM) study protocol: a psychoeducational support intervention for victims of domestic violence - a randomised controlled trial.

INTRODUCTION: Intimate partner violence (IPV) is a widespread phenomenon that affects the physical and mental well-being of victims. Several barriers prevented sufferers from receiving face-to-face interventions. These obstacles increased with the advent of the COVID-19 pandemic, and online psychological intervention can represent a valid solution to increase the well-being of IPV victims. This manuscript describes the study protocol for a single blind randomised controlled trial that examines the efficacy of a web-based psychoeducational intervention for IPV victims that integrates dialectical behavioural therapy and the empowerment approach. METHODS AND ANALYSIS: Eighty-six women who were victims of IPV during the COVID-19 outbreak will be recruited by the Interdepartmental Center for Family Research (CIRF) staff from the several antiviolence centres located in Italy. Participants will be randomly allocated to the Women's EmotionS, Trauma and EmpowErMent experimental group or the treatment as usual control condition. Both interventions will be administered individually to each woman. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the University of Padua (protocol no 4300). Written informed consent will be obtained from all research participants before study entry. Study results will be published as peer-reviewed articles. Any relevant protocol changes will be reported in the published articles. The results will be reported anonymously. TRIAL REGISTRATION NUMBER: ISRCTN12880309.

Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study.

Introduction: Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Materials and methods: Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. Results: "Return to work activities/sport" was negatively predicted by the presence of a metabolic disorder (ß = -0.451; OR = 0.637) and 'open' surgery technique (ß = -0.389; OR = 0.678). "Medical complications" were significantly predicted by metabolic disorders (ß = 0.600 (0.198); OR = 1.822) and was negatively related to 'mini-invasive' surgery (i.e., not 'open' nor 'percutaneous') (ß = -0.621; OR = 0.537). "Immediate weightbearing" and "immediate walking without assistance" were negatively predicted by 'open' technique (ß = -0.691; OR = 0.501 and ß = -0.359 (0.174; OR = 0.698)). Conclusions: Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears.

Screening for Distress in Oncological Patients: The Revised Version of the Psychological Distress Inventory (PDI-R).

Background: Psychological research in oncological settings is steadily increasing and the construct of psychological distress has rapidly gained popularity-leading to the development of questionnaires aimed at its measurement. The Psychological Distress Inventory (PDI) is one of the most used instruments, but its psychometric properties were not yet deeply evaluated. The present studies aimed at investigating the psychometric properties of the PDI (Study 1) and providing a revised version of the tool (Study 2). Methods: Oncological outpatients were enrolled at the Department of Medical Oncology of the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. For the first study (N = 251), an Exploratory Graph Analysis was used to explore the item structure of the PDI. In the second study (N = 902), the psychometric properties of the revised PDI (PDI-R) were deeply assessed. Results: Study 1 showed that the PDI has a not clear structure and it should be reconsidered. On the opposite, Study 2 showed that the revised version (PDI-R) has a solid factorial structure, it is invariant across gender and age, and it has good psychometric properties. Conclusion: Results suggest that the PDI-R is a reliable measure of psychological distress in different samples of oncological patients, with stronger psychometric properties than the original version. Its use in the clinical and research field is therefore recommended to improve the quality of both assessment and treatment of psychological distress in patients with oncological problems.