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PTSD and post-traumatic growth among healthcare workers during COVID-19
- C. Gesi, G. Cirnigliaro, R. Cafaro, M. Cerioli, F. Achilli, M. Boscacci, B. Dell’Osso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S208-S209
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Introduction
The COVID-19 pandemic has strongly impacted mental health outcomes of healthcare workers (HWs). In spite of the large literature reporting on Post-Traumatic Stress Disorder (PTSD) symptoms, only a few studies focused on potential positive aspects that may follow the exposure to the COVID-19 pandemic, namely post-traumatic growth (PTG) among HWs.
ObjectivesIn a large sample of Italian HWs, we aimed to investigate the prevalence of PTSD, its correlates and whether PTG dimensions independently affect the risk of PTSD during the first COVID-19 wave.
MethodsAn online self-report survey was submitted to HWs throughout physicians’ and nurses’ associations, social networks and researchers’ direct contacts, between April 4th and May 13th, 2020. Sociodemographic data, information about possible COVID-19 related stressful events, Impact of Event Scale-Revised (IES-R) and PTG Inventory-Short Form (PTGI-SF) scores were collected. IES-R and PTGI-SF scores were compared between subjects based on main sociodemographic, work- and COVID-19-related variables using the Student T-test or the one-way ANOVA where appropriate. Post-hoc comparisons were conducted using the Tukey test. Participants with total IES-R score >32 were assigned a provisional PTSD diagnosis and binary logistic regression analysis was conducted to investigate the contribution of each variable to the provisional PTSD diagnosis.
ResultsOut of 930 respondents, 256 (27,1%) reported a provisional PTSD diagnosis. Female sex (p<.001), separation from cohabiting family (p<.001), family members infected with (p<.05) or deceased due to (p<.05) COVID-19, increased workload (p<.05), relocation to a different work unit (p<.05) and unusual exposure to sufferance (p<.001) were significantly associated with higher IES-R mean scores. The median PTGI-SF score was 24. Factors associated with greater mean PTGI-SF scores were female gender (p<.001), being a nurse (p<.05), being older than 40 years (p<.05), and increased workload (p<.05). The logistic regression model showed that previous mental disorders (OR=1.65; 95% CI= 1.06-2.57) working in medical (OR=2.20; 95% CI=1.02-4.75), or service units (OR=2.34; 95% CI=1.10-4.98) (compared to frontline unit), relocation to a COVID-19 unit (OR=1.90; 95% CI=1.06-3.36), unusual exposure to sufferance (OR=2.83; 95% CI=1.79-4.48) and exposure to a traumatic event implying threat to self (compared to other work-related events) (OR=2.07; 95% CI=1.10, 3.89) significantly increase the risk of receiving a provisional diagnosis of PTSD, while the availability of personal protective equipment (OR=.61; 95% CI=.40-.94) and moderate or greater scores on PTGI-SF, particularly in the spiritual change domain (OR=.552; 95% CI=.35-.85), were found to be protective factors in relation to the PTSD diagnosis.
ConclusionsOur results shed light on possible protective factors against PTSD symptoms in HWs facing COVID-19 pandemic.
Disclosure of InterestNone Declared
The impact of lifestyle on adherence to treatment in a sample of patients with Major Depression
- D. Conti, N. Girone, S. Vanzetto, M. Cocchi, F. Achilli, S. Leo, M. Bosi, B. Benatti, B. Dell’Osso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S347
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Introduction
Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence.
ObjectivesAim of the present study was to assess potential differences in terms of clinical and socio-demographic characteristics specifically related to adherence to treatment features, medical comorbidities, and substance abuse in a sample of patients diagnosed with Major Depression in an Italian psychiatric department.
MethodsPatients with a DSM-5 diagnosis of Unipolar or Bipolar Major Depressive Episode, of either gender or any age were recruited from the Psychiatry Department of Luigi Sacco University Hospital in Milan. Main clinical and socio-demographic variables were collected reviewing patients’ medical records. Moreover, adherence to psychopharmacological treatment was assessed using the Clinician Rating Scale (CRS; Kemp et al, 1996; 1998). Adherence was defined as ratings of > or =5 on the CRS. Descriptive and association analyzes were performed, setting the significance level at p<.05.
Results80 patients with a diagnosis of Unipolar Major depressive episode (48.9%) and Bipolar Major Depressive Episode (51.1%) were included. For the purposes of the study, the total sample was divided into two subgroups based on adherence to pharmacological treatment (A+ vs A-). Significantly higher rates of inpatients from psychiatric ward were A- compared to A+ patients (84.6% vs 48.1%, p=.011). A- patients were significantly more unemployed (57.9% vs 23.8%, p=.015), were mostly living in their family of origin (50% vs 21.4%, p=.027), and had fewer years of education compared to A+ subgroup (10.52±3.28 vs 12.2±3.1 years, p=.053). Higher rates of Bipolar Depression diagnosis and a prevalent manic polarity lifetime emerged in A- compared to the A+ group (73.1% vs 42.3%, p=.010; 30.8% vs 3%, p=.011, respectively). Moreover, A+ reported significantly higher rates of depressive prevalent polarity lifetime (72.7% vs 30.8%, p=.011). A- reported significantly higher rates of comorbidity with alcohol or other substance use disorders lifetime (46.2% vs 5.7%, p=.006) and almost one involuntary commitment lifetime (23.1% vs 11.1%, p=.013).
ConclusionsIn our sample adherence to treatments showed significant differences in terms of clinical and socio-demographic characteristics. Low levels of adherence have been associated with higher hospitalization rates, involuntary commitments, greater comorbidity with alcohol or drugs. Our data therefore seem to suggest that less adherence leads to a worse disease course and a worse quality of life. It therefore appears useful to include an assessment of adherence in the clinical practice and implement interventions to improve therapeutic adherence and ensure a better quality of life.
Disclosure of InterestNone Declared
Criminal behaviors and substance abuse in psychiatric patients
- B. Benatti, F. Achilli, S. Leo, L. Molteni, E. Piccoli, D. Gobbo, B. M. Dell’Osso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S536-S537
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Introduction
People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.
ObjectivesIn order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.
MethodsThis is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.
ResultsData were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.
Table 1. Lifetime substance abusers (N=39) Non-lifetime substance abusers (N=37) Proportion Difference P-value N % N % Depot administration Yes 11 (28,9%) 0 (0%) 28,9% 0,02 Hospitalizations Four or more 25 (64,1%) 5 (33,3%) 30,8% 0,04 Economic crime Yes 15 (40,5%) 1 (6,7%) 33,8% 0,02 Previous crimes Yes 17 (51,4%) 2 (13,3%) 38,1% 0,02 ConclusionsData emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.
Disclosure of InterestNone Declared