Danilo Carrozzino

Fibromyalgia (FM) is a chronic, widespread pain disorder that severely impairs daily functioning and well-being. Beyond physical symptoms, social and cognitive factors such as illness invalidation and difficulties in acceptance may further hinder adaptation. This study examined whether positive mental health and subjective well-being mediate the relationship between these factors and functioning in women with FM. A total of 148 women aged 20–65 completed self-report measures of the study variables. Preliminary correlation analyses showed that positive mental health was unrelated to invalidation and was therefore excluded from the mediation model. Mediation analyses revealed that higher illness invalidation and greater difficulties in illness acceptance were associated with lower subjective well-being, which in turn related to poorer functioning. These findings highlight the central role of subjective well-being in linking psychosocial factors to functioning in women with FM. Illness invalidation, acceptance difficulties, and subjective well-being itself emerged as key therapeutic targets, underscoring the importance of integrated, acceptance-based, and patient-centered interventions that foster well-being and support adaptive functioning despite persistent symptoms.

This is the first critical review to assess the clinimetric properties, particularly the sensitivity (i.e., the ability to detect changes in clinical trials and yield clinical distinctions that may demarcate major prognostic and therapeutic differences), and to determine the clinical utility of instruments of illness denial in patients with medical disorders. A comprehensive search of the literature was performed on several databases. Patient‐reported outcome measures and clinician‐rated instruments of illness denial were identified and analysed. The findings indicate that the Acceptance and Action Diabetes Questionnaire and the Denial of Illness Scale can be used as screening tools to early detect diabetes and stroke patients at increased risk for clinical complications. The Diagnostic Criteria for Psychosomatic Research and the Levine Denial of Illness Scale are transdiagnostic instruments that are particularly suitable to identify the maladaptive manifestations of illness denial and its affective, behavioural and cognitive components. The Illness Denial Questionnaire, particularly the eight‐item version of the instrument, is another transdiagnostic measure that may be better suited for the evaluation of illness denial severity. The Denial of Cancer Interview can be used for a longitudinal monitoring of illness denial, whereas the Hackett–Cassem Denial Scale is recommended to assess the degree of illness denial in individuals with cardiac disorders. The use of instruments such as the Cardiac Denial of Impact Scale, the Denial Questionnaire and the Havik and Mæland Denial Scale, which were found to have considerable prognostic utility, may help patients promptly recognize and respond to life‐threatening diseases.

The assessment of psychological well-being has been largely neglected in clinical settings, particularly in patients with systemic sclerosis (SSc), where the focus of clinical attention was mainly on symptoms. This is the first study in which the validity, reliability, and sensibility of two patient-reported outcome measures (PROMs) of psychological well-being, the five-item World Health Organization Well-Being Index (WHO-5) and the six-item version of the Ryff's Psychological Well-Being Scales (PWB-6), have been tested according to clinimetric criteria to determine their current and potential clinical applications in SSc patients. A cross-sectional study was conducted involving 219 patients with a diagnosis of SSc. Rasch and Mokken analyses were performed to assess the clinimetric properties of the two PROMs and determine their clinical utility. All items of WHO-5 and PWB-6 fitted the Rasch model, had an optimal scalability, and the dimensionality analyses yielded less than 5% of significant t-tests, thus indicating that the two PROMs were unidimensional measures. Person separation reliability indices revealed acceptable internal consistency and inspection of the person-item distribution map showed that WHO-5 and PWB-6 were reasonably well-targeted for use with SSc patients. Findings indicate that WHO-5 and PWB-6 are valid indices of psychological well-being that may provide unique prognostic information and help researchers and clinicians tailor personalized treatment strategies. The two PROMs can be used jointly but for different clinical purposes. WHO-5 is particularly suitable to assess the degree of subjective vitality, a positive feeling of aliveness and energy that may help SSc patients cope with their illness. The PWB-6 can be used to identify unique experiences of psychological well-being that may help SSc patients not only cope with their feelings of loneliness and uncertainty but also experience a meaningful life despite the progression of disease. In clinical research and daily practice, the baseline and follow-up use of WHO-5 and PWB-6 may thus lead to a substantial improvement in the quality of care of patients with SSc. Given the cross-sectional design of the present investigation, future prospective studies are, however, recommended to further assess the predictive validity and prognostic utility of the two PROMs.

Introduction: The Mental Pain Questionnaire (MPQ) was developed using a clinimetric approach to bring together the key features of mental pain into a single, brief, transdiagnostic scale. The present study aims at extending the validation of the MPQ to people from three different clinical settings.Methods: A multicentre, cross‐sectional study on adults diagnosed with migraine (n = 256), systemic sclerosis (n = 219), or mental disorders (n = 138) was conducted. The MPQ was administered; Rasch and Mokken analyses were performed to assess clinimetric validity.Results: The overall fit to the Rasch model indicated a misfit, improved by the exclusion of a single item. MPQ showed to be unidimensional. MPQ total score and individual items scalability were optimal except for the same item. The total MPQ score showed an optimal scalability for the systemic sclerosis sample and an acceptable scalability for the migraine and mental disorders samples. Local dependency was found between two pairs of items. Person separation reliability indices (PSI 0.45) showed that the MPQ could not distinguish between groups with different levels of mental pain.Conclusion: Mental pain has the potential to serve as a truly generic patient‐centred outcome measure. Recommendations are made for revisions of the original MPQ, but these will require testing in further validation studies.

This retrospective observational study investigated hospital staff requests for job fitness visits, addressed to occupational medicine. Specific objectives were to analyze: (1) health workers’ requests, sociodemographic characteristics, psychiatric diagnoses, assigned doctor’s fit notes, and (orthopedic, psychiatric) limitations; (2) associations between psychiatric diagnoses, sociodemographic (sex, age), and work-related (job, department) characteristics; (3) associations between the same psychiatric diagnoses/orthopedic limitations, fit notes, and/or psychiatric limitations. Data of St. Orsola-Malpighi Polyclinic health workers (N = 149; F = 73.8%; mean age = 48 ± 9.6 years), visited by both the occupational medicine physician and psychiatrist (January 2016–May 2019), were analyzed. 83.2% of the sample presented with at least one psychiatric diagnosis, including mood (47%), anxiety (13.4%), and anxious-depressive (10.7%) disorders. Significant differences between psychiatric diagnoses according to sex and fit notes (both p < 0.01) have been found, whereas no significant associations based on age and work-related characteristics have been observed. Analysis of frequencies of participants with the same psychiatric diagnosis (orthopedic limitation being equal), according to doctor’s fit notes and psychiatric work limitations, showed a high heterogeneity of assignments. The current occupational medicine procedure for fit notes/job limitations assignments does not allow taking into consideration clinical factors possibly associated with more specific assignments. To standardize the procedure and translate the psychiatrist’s clinical judgment into practice, further studies to test the usefulness of clinimetrics, which might represent a reliable approach in considering different fit notes and job limitations, are needed.

Worldwide, the Satisfaction With Life Scale (SWLS) has become the most widely used measure of life satisfaction. Recently, an authorized Vietnamese-language version has been introduced. Using a convenience sample comprising community volunteers from Ho Chi Minh City (N = 1073), confirmatory support was found for the cross-national constancy of the one-dimensional structure underlying the SWLS. Corrected item–total polyserial correlations and Omega coefficient were satisfactory. Using multi-group confirmatory factor analysis, configural, metric, and scalar invariance of the SWLS factorial structure were tested by gender, age, marital status, income, and educational level. Strong evidence of scalar invariance was found for gender and education, on which relevant subgroups did not differ in terms of latent means. Partial scalar invariance was found for marital status (item 4 and 5) and income (item 4). Being involved in an intimate relationship or having a higher income were associated with higher latent means. Scalar invariance in relation to age was very poor. Accordingly, caution must be exerted when comparing age groups. A high SWLS score was predictive of good self-rated health. Implications of the findings are briefly discussed.

There has been concern about the impact of the COVID-19 outbreak on women’s mental health during the perinatal period. We conducted a cross-sectional web-based study aimed at evaluating the psychological impact (BSI-18) of the COVID-19 pandemic on this population and collecting information on the perinatal experiences (COPE-IS) during the second Italian wave. Overall, 1168 pregnant women, and 940 within the first six months after childbirth, were recruited in selected Italian Family Care Centers from October 2020 to May 2021. The prevalence of psychological distress symptoms during pregnancy was 12.1% and 9.3% in the postnatal group. Financial difficulties, a previous mood or anxiety disorder and lack of perceived social support and of support provided by health professionals were associated to psychological distress symptoms in both groups. A third of the women felt unsupported by their social network; 61.7% of the pregnant women experienced changes in antenatal care; 21.2% of those in the postnatal period gave birth alone; more than 80% of the participants identified access to medical and mental health care and self-help as important resources in the present context. Health services should assure enhanced support to the most vulnerable women who face the perinatal period during the pandemic.

Objective: This is the first study applying Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to evaluate the construct validity, sensitivity, and clinical utility of the SCL-90-R in patients with Parkinson’s disease (PD). Methods: A Rasch analysis was conducted using a sample of 488 PD outpatients. Results: Testing for dimensionality revealed that less than 5% of t-tests were significant, indicating that the SCL-90-R subscales entailed the property of construct validity. As to the total score, a Person Separation Reliability Index of .96 was found. Conclusions: The SCL-90-R total score is a sensitive screening measure that can be used not only to differentiate healthy stress reactions from symptoms of psychological distress but also to detect PD patients with an increased risk for psychiatric complications. As to the subscales, the brief versions that did not include misfitting items should be used to assess the severity of specific symptoms of psychological distress affecting PD patients.