Responding to the COVID-19 public health emergency: The usefulness of an online brief psychological intervention with Italian university students.

The COVID-19 pandemic has brought about new stressors on university students, with a negative impact on their mental health and well-being. The purpose of this study was to examine the usefulness of a brief psychodynamically oriented intervention on general functioning by investigating changes in symptoms of depression, anxiety, hopelessness, and burnout. The sample was comprised of 67 university students (22.4% males), with a mean age of 23.27 (standard deviation (SD) = 3.27), who asked for psychological help at a psychological university service. Pre- and posttreatment data showed a significant improvement in general functioning and symptom reduction due to the psychological intervention. The mean change was very high for depression (d = 1.11) and high for general functioning (d = 0.70) and anxiety (d = 0.69). Our findings showed the importance of considering university students a vulnerable population that requires specific services within the university context and underlined the fact that mental-health-promotion policies should be extensively implemented.

Patterns of internalizing symptoms and disability functioning in children and adolescents.

Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8-16 years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: "High somatic symptoms and average depression/anxiety"; cluster 2: "High somatic symptoms and high depression/anxiety"; cluster 3: "Average somatic symptoms and above average depression/anxiety"; and cluster 4: "Low somatic symptoms and low depression/anxiety". Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.

[Hikikomori: the silent suffering among young people]. / Hikikomori: la sofferenza silenziosa dei giovani.

The Japanese term hikikomori is used to describe young people who lives a condition characterized by social withdrawal and isolation for an extended period of time. It is a particularly widespread phenomenon in Japan, in particular among adolescents and adults, and it represented the focus of an increasing attention from mental health professionals in many other countries, including Italy. The aim of this paper review is to explore the concept of hikikomori within Japanese sociocultural context, epidemiological aspects, risk factors clinical characteristics. Moreover, some theoretical models are discussed which allow possible interpretations of this condition which characterizes young people who convey their suffering more and more silently. A detailed review of the phenomenon is given considering the lack of a clear definition of the hikikomori that doesn't allow to plan preventive interventions.

Adaptation and Psychometric Analysis of the Test of Mobile Phone Dependence-Brief Version in Italian Adolescents.

Since the diffusion of recent models of mobile phones, anyone with an internet connection can communicate continuously and search for information. This raises some questions about the possible consequences of problematic mobile phone use (PMPU) in a complex life phase such as adolescence. Therefore, we performed a psychometric analysis of the brief version of the Test of Mobile Phone Dependence (TMD) in Italy. The sample comprised 575 Italian adolescents aged 11 to 18 years. Data were collected using the TMD-brief, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Short Form. Regarding test dimensionality, the best-fit measurement model included four factors: "Abstinence"; "Abuse and interference with other activities"; "Tolerance"; and "Lack of control" (Satorra-Bentler χ2 (48) = 185.96, p < 0.01; robust root mean square error of approximation (RMSEA) = 0.079 (90% confidence interval (CI): 0.067; 0.091); robust TLI = 0.904; robust comparative fit index (CFI) = 0.930). The Italian version of the TMD-brief was found to have good reliability and psychometric properties, and a four-factorial structure. PMPU predicted significant sleep disturbances and this relationship was moderated by clinical personality traits. Findings from this study support the use of the Italian version of the TMD-brief as a screening tool to investigate PMPU in Italian adolescents.

Mental health of Italian adults during COVID-19 pandemic.

OBJECTIVES: On 31 January 2020, a new type of coronavirus was first confirmed in Italy and spread rapidly across the country leading to a national lockdown. The aim of this pilot study was to explore the impact of the public health emergency due to COVID-19 on individual's mental health among 299 Italian adults after a month of home isolation due to COVID-19. DESIGN: Cross-sectional study design. Adults of the general population were invited to a voluntary online health survey. METHODS: Hierarchical multiple regressions were used to examine diverse psycho-social and stressful contextual factors associated with symptoms of psychopathology. RESULTS: Results indicated that females reported higher symptoms of depression, anxiety and circadian rhythm dysregulation, than males. Age and the capacity to adapt to a new environment and to cope with illness were negatively associated with all symptoms of psychopathology. Conversely, engaging in verbally aggressive behaviours and having experienced stressful events related to COVID-19 were positively related to psychopathological symptoms. Finally, social support was negatively associated with depressive symptoms, and substance use during the past months was related to circadian rhythm dysregulation. CONCLUSIONS: The findings of this study raise particular concern about psychological well-being considering the negative associations between stressful events during the COVID-19 pandemic, symptoms of psychological distress, and perceived social support. These results have possible significant clinical implications.

The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach.

In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18 years (M age  = 13.80; SD = 2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.

Narcissistic traits as predictors of emotional problems in children with oppositional defiant disorder: A longitudinal study.

BACKGROUND: Children's self-views encompass two independent dimensions: self-esteem and narcissism, which recently have received growing attention from researchers and clinicians. The current study sought to test whether these dimensions might predict the developmental course of children with Oppositional Defiant Disorder diagnosis. METHOD: The sample (N = 64, M age = 10.1 years, 57 boys) included children with Oppositional Defiant Disorder diagnosis. We examined longitudinal relationships between self-views (both self-esteem and narcissism) and parent-reported internalizing and externalizing behavioral problems. RESULTS: The study spanned two time-points, spaced 12 months apart. None of the predictors were longitudinally associated with the levels of externalizing behavioral problems in children. However, narcissism predicted the levels of children's internalizing problems at the follow-up, whereas self-esteem did not. LIMITATIONS: The relatively small sample and the lack of assessing causality limit the generalizability of the findings. Results need to be replicated in larger samples. CONCLUSIONS: These findings illustrate the value of taking into account children's narcissistic traits in clinical assessment. By broadening knowledge of narcissistic traits in clinical samples of children, we hope to inform assessment procedures in standard clinical practice, as well as the development of tailored interventions to curb the emergence of later negative outcomes related to childhood narcissism, such as internalizing problems.

Alexithymic Traits and Somatic Symptoms in Children and Adolescents: a Screening Approach to Explore the Mediation Role of Depression.

The association among alexithymia, somatic symptoms and clinical correlates has been scantly investigated in children. The present study examined alexithymic features and somatic symptomatology in schoolchildren with high and low levels of depression, testing the role of depressive symptoms in mediating the associations between alexithymia and somatic symptoms. Seven-hundred schoolchildren were involved in this study and divided into two subgroups (8-10 years and 11-14 years) in order to test differences according to the age. Participants completed the Children's Somatization Inventory-24 for the assessment of somatic symptoms, the Alexithymia Questionnaire for Children to evaluate alexithymic features and the Children's Depression Inventory-2 to investigate depressive symptoms. Results showed that children with high levels of depression reported both higher alexithymia and somatic symptoms levels. Despite a direct effect of alexithymia on somatic symptoms, the mediation analyses also highlighted an indirect effect of alexythimia on somatic symptoms through depressive symptoms. Findings suggested that a depressive symptomatology may clarify why schoolchildren with high alexithymia scores tend to report higher levels of health problems. Results also support the possibility that depressive symptoms may contribute to the development of somatic symptomatology among schoolchildren in the presence of high levels of alexithymia.

Italian validation of the Children's Shyness Questionnaire: Exploring associations between shyness and psychosocial functioning.

BACKGROUND: In recent years, researchers have begun to explore the implications of shyness for the psychosocial wellbeing of children and adolescents, exploring its association with internalizing problems. Research in an Italian context is hindered by the lack of a validated self-report measure of shyness. We report two studies aimed to assess the psychometric properties of an Italian translation of the Children's Shyness Questionnaire (CSQ-it) and investigate its correlations with convergent and divergent constructs. The first study aimed to examine associations between CSQ-it and self-report measures of anxiety and somatic symptoms and attachment with parents and peers. The second study aimed to investigate its relations to internet addiction. METHODS: The self-report measures were completed by 550 participants in the first study and 131 participants in the second study. Parents provided information on their child's problems. Psychometric properties were assessed by Cronbach's alpha in both studies and by exploratory and confirmatory factor analysis in Study 1. The relations between shyness and measures of internalizing problems and attachments were analyzed by correlational methods. In Study 2 a moderated mediation model tested the hypothesis that the relationship between shyness and internet addiction is mediated by somatic symptoms and that shyness moderates the relationship between somatic symptoms and internet addiction. RESULTS: The reliability and validity of the Italian Version of the Children's Shyness Questionnaire were satisfactory. Results from confirmatory factor analyses confirmed the single-factor model of the questionnaire previously identified in North American and Chinese studies. There were significant correlations between shyness, anxious and somatic symptomatology, impaired psychosocial functioning and specific components of attachment relationships. In Study 2 the indirect effect of shyness on internet addiction through somatic symptoms was significant as well as significantly moderated for high shyness scores but not for low levels of shyness. CONCLUSION: To our knowledge this is the first study that explored the psychometric proprieties of the Children's Shyness Questionnaire in the Italian context. Findings demonstrated that this self-reported measure of shyness has sound psychometric properties and can be used as a sensitive and appropriate instrument for the assessment of shyness in children and adolescents.

The Role of Difficulty in Identifying and Describing Feelings in Non-Suicidal Self-Injury Behavior (NSSI): Associations With Perceived Attachment Quality, Stressful Life Events, and Suicidal Ideation.

Objective: Core alexithymic features, such as the difficulty in identifying and describing feelings, are associated with poor attachment styles and emotional trauma, which influence the capacity to regulate affect. Additionally, emotional regulation has been found to be the most commonly identified function associated with non-suicidal self-injury behavior (NSSI) in adolescents as they attempt to modulate strong emotions. However, few studies have examined the link between difficulty in identifying and describing feelings (core components of alexithymia), NSSI behaviors, quality of attachment, life stressors and suicidal ideation in healthy early adolescents. Consequently, this study aims to investigate these constructs and the relationship among them in a large non-clinical sample of adolescents. Methods: Seven hundred and nine middle school students (50.4% males), aged 10-15 years (M = 12.6; SD = 1.06) were involved in this study. In order to investigate the variables considered in the study, the following measures were administered: the Deliberate Self-Harm Inventory exploring non-suicidal self-injurious behaviors; the Alexithymia Questionnaire for Children examining difficulty in identifying and describing feelings; the Inventory of Parent and Peer Attachment assessing the quality of parental and peer attachment; the Life Stressor Checklist-Revised outlining stressful/traumatic events and the Children's Depression Inventory evaluating suicidal ideation. Results: We found significantly positive relationships among difficulty in identifying and describing feelings, NSSI behaviors, stressful events, and suicidal ideation. Data indicated a significant negative association of difficulty in identifying and describing feelings with quality of attachment to parents and peers. Further findings highlighted that difficulty in identifying and describing feelings significantly mediated the effect of quality of attachment (parent and peer) on NSSI and suicidal ideation. Conclusion: The ability to identify and describing feelings is important to managing emotional expression and understanding the feelings of others, both crucial in attaining successful interpersonal relationships. Our data revealed that, while controlling for stressful life events, low levels of attachment may increase adolescents' difficulty in identifying and describing their own feelings, which in turn may increase the risk of both NSSI and suicidal ideation.

A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children.

INTRODUCTION: Somatic symptoms are frequently reported by children with significant impairment in functioning. Despite studies on adult populations that suggest somatic symptoms often co-occur with difficulties in identifying and describing feelings, little research has been done in childhood. This study aimed to investigate the prevalence and frequency of somatic symptoms as well as to investigate the functional impairment in children with high number of self reported somatic symptoms versus those with fewer somatic symptoms. Additionally the parental perception of their children's somatic symptoms and functioning was explored. Finally, we explored the direct and indirect effects of difficulties in identifying feelings in predicting somatic symptoms and functional disability among school-aged children. METHODS: 356 Italian school-aged children and their mothers participated in this study. Children (mean age = 11.43; SD = 2.41) completed the Children's Somatization Inventory (CSI-24) to assess somatic symptoms, the Functional Disability Inventory (FDI) to assess physical and psychosocial functioning and the Alexithymia Questionnaire for Children (AQC) to evaluate alexithymic features. Mothers completed the parental forms of the CSI and the FDI. RESULTS: Among children, 66.3% did not declare somatic symptoms and 33.7% reported one or more somatic symptoms in the last two weeks. A significant positive correlation emerged between children's and mothers' CSI total scores. Both children's and mothers' FDI total scores were significantly correlated with CSI scores. A significant correlation was observed between somatic symptoms and alexithymic features. Furthermore, the data showed that somatic symptoms mediated the relationship between difficulties in identifying feelings and functional impairment. Finally, it was showed that alexithymia facet of difficulty in identifying feelings contributed in large part to the prediction of the somatic symptomatology (b = 0.978, p < 0.001; R2 = 0.164, F(5, 350) = 10.32, p < 0.001). CONCLUSIONS: Findings from this study provide evidence that a higher frequency of somatic symptoms is associated with functional disabilities and alexithymic facets in school-aged children.

The Potential Impact of Internet and Mobile Use on Headache and Other Somatic Symptoms in Adolescence. A Population-Based Cross-Sectional Study.

OBJECTIVE: The purpose of this cross-sectional study was to determine whether migraine or tension-type headaches are associated with abuse of the internet and/or mobile phones and to explore whether headache and the abuse of the two technologies are associated with sleep disturbances and other self-reported somatic symptoms. BACKGROUND: In the last several years, estimates indicate the increasing pervasiveness of the internet and other technologies in the lives of young people, highlighting the impact on well-being. DESIGN: A population-based cross-sectional study was conducted between February 2013 and June 2014. METHOD: The initial sample was composed of 1004 Italian students (aged 10-16 years) recruited within public middle schools not randomly selected in central Italy. The final convenience sample consisted of 841 students (Males = 51.1%; Females = 48.9%) who were included in the analysis. Data were collected using self-reported measures. RESULTS: Headache was reported by 28.0% of the total sample. A significant relationship was determined with gender (χ(2) (1) = 7.78, P < .01), with female students being overrepresented in the headache group. Approximately 39.6% of subjects were non-abusers of both technologies, internet and mobile. Mobile only abusers were approximately 26.0% of the study population; internet only abusers were approximately 14.9%; and abusers of both media were 19.5%. No significant relationship was found between students with and without headache with respect to the abuse of internet and mobile phone categories (headache was, respectively, the 26% in no abusers, the 30% in internet abusers, the 29% in mobile abusers, and the 29% in internet and mobile abusers, P = .86). Additionally, also by excluding the no headache group, the relationship between the two groups of headache (migraine and tension type headache) and the abuse of media (tension type headache was the 31% in no abusers, the 43% in internet abusers, the 49% in mobile abusers, and the 29% in internet and mobile abusers) is not statistically significant (P = .06). No significant relationship emerged between headache and the internet and mobile phone addiction groups (headache was the 28% in no addiction group, the 35% in mobile addiction group, the 25% of internet addiction group, and the 28% in mobile and internet addiction group, P = .57) as well as no significant relationship was found when only the different headache types were considered (tension type headache was the 39% in no addiction group, the 40% in mobile addiction group, the 32% in internet addiction group, and the 31% in mobile and internet addiction group, P = .71). Daily internet users reported higher median scores for somatic symptoms than the occasional internet users in the no-headache group (Kruskal-Wallis χ(2) (1) = 5.44, P = .02) and in the migraine group (Kruskal-Wallis χ(2) (1) = 6.54, P = .01). CONCLUSIONS: Results highlighted the potential impact of excessive internet and mobile use, which ranges from different types of headache to other somatic symptoms. Further studies are needed to confirm these findings and to determine if there is a need for promoting preventive health interventions, especially in school setting.

Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines: a case control study.

BACKGROUND: Headache is a common disorder affecting a growing number of children and adolescents. In recent years, there has been an increase in scientific interest in exploring the relationship between migraine and emotional regulation, and in particular, the impact of emotional dysregulation on mental and physical health. The present study aims to explore the relationship between migraine and alexithymia among adolescents and their mothers as well as the impact of this association on mental health. An additional aim is to verify whether alexithymia may be a predictor of psychopathological symptoms in adolescents and mothers with migraines. METHODS: A total of 212 subjects were involved in this study. The sample was divided into (a) Experimental Group (EG) consisting of 106 subjects (53 adolescents and 53 mothers) with a diagnosis of migraine according to International Classification of Headache Disorders (ICHD-3) and (b) Control Group (CG) including 106 subjects (53 adolescents and 53 mothers) without a diagnosis of migraine. All participants completed the Toronto Alexithymia Scale to assess alexithymia and the Symptom Checklist-90-R to assess psychopathological symptoms. RESULTS: Higher rates of alexithymia were found in the adolescents and mothers of the EG in comparison to the adolescents and mothers of the CG. Furthermore, adolescents and mothers experiencing both migraine and alexithymia, demonstrated a higher risk of psychopathology. CONCLUSIONS: Findings from this study provide evidence that the co-occurrence of migraine and alexithymia increases the risk of psychopathology for both adolescents and their mothers.