Giulia Cossu

Background: The Sardinian Blue Zone is internationally recognized for exceptional longevity, particularly among men. The provinces encompassing this area also report elevated suicide mortality among older men. This paradox raises the question of whether older men recruited within the longevity area show increased depressive screening positivity or whether additional interacting mechanisms may contribute to suicide vulnerability. Objective: To examine whether the reported excess suicide mortality among older men in the provinces encompassing the Sardinian Blue Zone is accompanied by higher depressive screening positivity or PHQ-9 Item 9 scores in older men recruited within the longevity area, and to explore the distribution of subthreshold depressive symptoms. Methods: We conducted an exploratory secondary analysis of a population-based survey including Sardinian residents aged ≥60 years. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). The Blue Zone group was recruited from six municipalities within the longevity area in Nuoro and Ogliastra. Comparisons were stratified by sex and used two-sided Fisher exact tests and analysis of variance. Results: No statistically significant increase in screening positivity for probable depression or PHQ-9 Item 9 scores was observed in Blue Zone residents. Older men showed a higher prevalence of clinically relevant symptoms below the screening threshold for probable major depression (PHQ-9 5–9: 4/19 vs. 4/171; OR = 11.13; Fisher p = 0.00395). Among women, this symptom range was less frequent in the Blue Zone (5/34 vs. 77/208; Fisher p = 0.01077). Conclusions: The observed symptom distributions motivate examination of mechanisms extending beyond the prevalence of major depression alone. The male excess in subthreshold depressive symptoms, interpreted alongside independent evidence on activation, supports investigation of mood and rhythm dysregulation and culturally shaped responses to stress. The sociobiological framework generates testable hypotheses for longitudinal psychiatric and anthropological research.

Background: Patient safety culture (PSC) is a foundational component of quality health care. It is characterized by health care workers’ individual attitudes, team dynamics, and organizational practices that influence clinical outcomes. During the COVID-19 pandemic, hospitals worldwide faced sudden changes and crises. In this rapidly evolving environment, organizational models were revised, established procedures were challenged, and professional roles were redefined; therefore, many aspects of safety culture may have been reshaped and redefined by the pandemic. Despite a growing body of literature examining PSC during the COVID-19 era, no comprehensive synthesis has yet mapped how PSC was conceptualized, measured, operationalized, and sustained across hospital settings during the pandemic. This gap highlights the need for an integrated synthesis that captures the multiple dimensions of PSC as they were experienced and managed during the pandemic. Objective: This scoping review aims to map the literature on PSC in hospital settings during the COVID-19 pandemic. The specific objectives are to examine the theoretical frameworks and related constructs used to define and operationalize PSC during the pandemic; identify and categorize interventions implemented to strengthen or sustain PSC; describe monitoring activities, measurement instruments, and quality improvement approaches adopted in hospital settings; and synthesize the scope and characteristics of available evidence and identify knowledge gaps to inform future research and practice. Methods: This scoping review will follow the methodological framework developed by Arksey and O’Malley, as updated by the JBI, and will be reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The research question was formulated using the population, concept, and context framework. Searches were conducted in the PubMed, Embase, and PsycInfo databases for records published from January 1, 2020, onward. Eligible evidence sources will include peer-reviewed empirical, interventional, measurement, review, and theoretical or conceptual publications addressing PSC or safety climate in hospital care during the COVID-19 pandemic. A total of 2 independent reviewers will conduct a 2-stage screening process, initially evaluating titles and abstracts for potential relevance, followed by a full-text assessment to determine final eligibility. Results: This study commenced in April 2025 and is registered with the Open Science Framework. Database searches were completed in July 2025. Title and abstract screening commenced in July 2026. Full-text screening and data extraction are expected to be completed by September 2026, data synthesis by November 2026, and submission of the review findings in the fourth quarter of 2026. Conclusions: This scoping review will provide a structured overview of how PSC was maintained, adapted, or redefined in hospital settings during the COVID-19 pandemic. Mapping pandemic-era evidence on PSC may help hospitals translate crisis-related organizational learning into preparedness strategies, resilient safety systems, and quality improvement priorities for future public health emergencies.

Virtual Reality (VR) has been increasingly highlighted as a promising therapeutic tool for autistic individuals, with meta-analyses indicating significant benefits in social and emotional aspects. However, a substantial portion of this research has been conducted within a medical model of deficit correction, focused primarily on standardizing and normalizing autistic behavior. This article proposes a profound shift in this perspective, viewing VR as an environmental accessibility technology grounded in the Social Model of Disability. Supported by the principles of neurodiversity, we argue that the true utility of VR lies in reducing the barriers that generate disability, not in correcting neurological differences. A critical analysis of the safety literature examined here suggests that certain adverse effects appear to be overlooked or underreported in a substantial proportion of the studies reviewed. Symptoms such as cybersickness, sensory overload, anxiety, and post-session fatigue pose real and immediate risks when considering the sensory processing profiles of autistic individuals. Thus, to foster more ethical and sustainable practices, we propose four interconnected priorities: systematic safety research, participatory co-design led by the community itself, implementation science in real-world contexts, and outcome metrics that genuinely affirm neurodiversity. By redefining what constitutes success in an intervention, prioritizing environmental fit, autonomy, and quality of life over behavioral conformity, this shift aligns the development of immersive technologies with the lived experiences of the autistic community. In doing so, it transforms VR from a corrective mechanism into a tool for affirmation and ecological adaptation.

Assessing municipal implementation of the Convention on the Rights of Persons with Disabilities (CRPD) requires instruments that capture the perspectives of those involved in or affected by local governance. Developed for this purpose, the PICI-Q was evaluated in this cross-sectional study among 400 Italian stakeholders. Participants were randomly divided into two subsamples (n = 200 each) for exploratory and confirmatory factor analyses. Ordinal reliability and associations with external variables were also assessed. The findings yielded a provisional 19-item, three-factor solution comprising Institutional Support, Accessibility and Inclusion, and Protection from Discrimination. The correlated three-factor model was retained provisionally, although fit varied across indices and In-stitutional Support substantially overlapped with Accessibility and Inclusion. Internal consistency was good (ordinal alpha = .802–.898). Higher PICI-Q scores showed associa-tions with fewer depressive symptoms and better physical and mental health-related quality of life, with small correlations. Exploratory comparisons of observed scores in-dicated higher ratings among participants with administrative roles. Although these findings provide preliminary psychometric evidence regarding PICI-Q reliability, fac-torial structure, and selected aspects of construct validity in participating municipalities, further research should examine factor distinctiveness, temporal stability, responsiveness, measurement invariance, and cross-cultural validity before PICI-Q can be recommended for policy evaluation or longitudinal monitoring.

An extreme challenge can sometimes produce a rapid surge of energy that makes previously inaccessible resources available. We call this process Adaptive Hyper-Energy. Success is not its defining feature: Argentina’s contrasting performances at the 2026 FIFA World Cup illustrate that mobilisation when failure appears imminent may achieve the desired outcome but may also prove insufficient. Activation depends on the culturally, biographically, and socially constructed meaning of what is threatened. Hyper-energy enables extraordinary resource recruitment, whereas behavioural control and recovery determine whether the response remains adaptive and reversible. Success may reinforce and prime its reactivation in similar circumstances. The same process may therefore support exceptional performance or, when regulation and recovery fail, contribute to exhaustion, aggression, and persistent rhythm dysregulation.

Background: Effects of climate changes, through higher temperatures and sunlight intensity on elderly well-being other than skin cancer, are little studied. Generally, people with fair skin are educated to avoid sun exposure, but while aging, the positive effects of natural light on social biorhythms might be important to counteract depressive symptoms. The study aimed to explore the relationship between skin phototype, social rhythm dysregulation, depressive symptoms, and quality of life in older adults on a sample of old adult residents in Sardinia (Italy). Methods: A cross-sectional study recruiting people aged 65 years or more, without limitation by sex, living at home. The assessments were conducted in April, which represents a month of transition and maximum change in light and temperature in central Mediterranean areas. Results: The study recruited 117 individuals without major diseases, voluntarily participating to an intervention for active aging. Findings suggest that individuals with lighter skin phototypes (lower than IV) experienced a higher frequency of depressive episodes and lower quality of life compared to those with darker skin phototypes. No significant differences were found in social rhythm dysregulation. Conclusions: The findings highlight the potential vulnerability of elderly individuals with fair skin to the combined effects of climate change and avoidance of sun exposure, emphasizing the need for further investigation. The observation raises questions of interest for the implications in terms of public health, and educational campaign contents, that should consider the age of the recipients they are aimed at.

The global crisis of recent years, including pandemics, armed conflicts, climate emergencies, and economic instability, has disproportionately jeopardized the health and rights of persons with psychosocial disabilities, who remain among the most marginalized groups. In this context, promoting a rights-based approach to mental health care is both urgent and ethically imperative. Building on the United Nations (UN) Convention on the Rights of Persons with Disabilities and the World Health Organization (WHO) QualityRights initiative, this study aimed to identify expert-informed priorities for implementing recovery-oriented, coercion-free practices in consultation-liaison psychiatry within a general hospital in Italy, while also incorporating perspectives from international stakeholders. A two-round Policy Delphi study was conducted between December 2024 and May 2025 with 17 invited experts from diverse professional and cultural backgrounds. Nine completed both rounds. The Delphi approach was used to identify areas of convergence while also capturing the diversity of expert perspectives. No fixed consensus threshold was set, reflecting the view that in ethically and contextually complex domains such as human rights in mental health, divergent opinions can yield valuable insights. In Round 1, participants provided qualitative responses to four open-ended questions, which were analyzed thematically to generate items for Round 2. In Round 2, participants prioritized structured response options (n = 8 items) derived from the thematic analysis. Descriptive statistics summarized the response distributions. Round 1 revealed strong convergence on the importance of community inclusion, user participation, and professional training. Round 2 confirmed these priorities: 78% identified ‘mutual exchange and learning' as the main benefit of international collaboration, while 44% and 33% prioritized social inclusion and staff training, respectively, as essential for rights-based recovery. Reported barriers included control-oriented care cultures (33%) and insufficient training or tools (22% each). Experts envisioned future mental health care as fully integrated into community life (56%), with reduced reliance on institutional structures or technocratic solutions. This Delphi study underscores that rights-based, recovery-oriented mental health services must prioritize community inclusion, shared governance, and contextual adaptability. Experts cautioned against top-down or standardized reforms, favoring relational and participatory models. These findings provide actionable insights for developing coercion-free consultation-liaison psychiatry within general hospitals and can inform broader international efforts toward sustainable, rights-based mental health reform.

Background: COVID-19 increased psychological distress among healthcare workers. Italian studies have suggested lower distress levels among mental health professionals compared to hospital-based colleagues. Methods: In May 2025, we conducted a cross-sectional observational study in community mental health centers and non-psychiatric hospital outpatient departments in Sardinia, Italy, involving 101 professionals from three community mental health centers and 97 staff members from four non-psychiatric hospital outpatient departments. The SF-12 was used to assess health-related quality of life (HRQoL) and the PHQ-9 was used to assess depressive symptoms. Results were also compared with pre-pandemic community samples. Results: Mental health professionals reported fewer depressive symptoms and better quality of life than hospital-based colleagues: PHQ-9 ≥ 10: 10.9% vs. 35.0% (11/101 vs. 34/97) (OR = 0.23; 95%CI 0.11–0.47; p < 0.001); PHQ-9 ≥ 9: 14.8% vs. 38.1% (OR = 0.31; 95%CI 0.16–0.60; p < 0.001). Mean PHQ-9 score: 4.45 ± 3.51 vs. 8.35 ± 3.95 (p < 0.001). Low HRQoL (SF-12 ≤ 36): 34.6% vs. 62.9% (35/101 vs. 61/97) (OR = 0.31; 95%CI 0.19–0.52; p < 0.001). No significant within-group differences were found by sex, age, or professional role. Compared with pre-pandemic community data, the well-being of mental health professionals remained stable. Limitations: Cross-sectional design and convenience sampling limit causal inference and generalizability. Conclusions: The organizational structure, operational flexibility, and peer collaboration typical of community-based services may contribute to the sustained psychological well-being of mental health professionals. The community-based model deserves consideration for future reforms aimed at improving staff well-being.

Introduction: During the COVID-19 pandemic, healthcare workers (HCWs) faced intense and prolonged stress. This exposure increased their risk of burnout and mood disorders. The Dysregulation of Mood, Energy, and Social Rhythms (DYMERS) hypothesis suggests that instability in biological and social rhythms may precede the onset of mood dysregulation. This study examined rhythm disturbances among HCWs and explored the potential role of a rhythm-focused psychoeducational intervention. Methods: Ninety-seven HCWs from the University Hospital of Cagliari, Italy, participated in a cross-sectional study. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and rhythm regulation was evaluated through the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Data were compared with published findings from mood disorders, psychotic disorders, and community samples. Results: A current depressive episode with PHQ-9 score was identified in 35.1% of HCWs participants, with significantly higher prevalence ( p = 0.01) among women (42.7%) than men (14.7%). Mean BRIAN scores were 46.1 ± 11.0, significantly higher than those observed in psychotic disorder ( p = 0.04) and community samples ( p < 0.0001). Rhythm dysregulation scores approached values reported in bipolar disorder samples. Elevated BRIAN scores were also observed among non-depressed participants. Discussion: The elevated rhythm dysregulation scores observed in healthcare workers support the hypothesis that chronic occupational stress may disrupt biological and social rhythms, potentially increasing vulnerability to mood disorders. Conclusion: HCWs displayed pronounced rhythm dysregulation and high rates of depressive symptoms, highlighting occupational stress as a potential major risk factor and further supporting the DYMERS hypothesis. From both clinical and research perspectives, it could be essential to promote psychoeducational programs that target rhythm regulation, such as adaptations of Interpersonal and Social Rhythm Therapy, which may offer effective preventive strategies to enhance resilience and mental well-being in this population. However, the cross-sectional design, convenience sampling, limited socio-demographic data, and reliance on self-reported measures constrain generalizability and causal inference, underscoring the need for larger longitudinal studies to validate and extend these findings.

Background/Objectives: The COVID-19 pandemic severely impacted healthcare systems globally, with Italian healthcare professionals experiencing heightened stress, organizational challenges, and a significant psychological burden. This study investigates the frequency of depressive symptoms and health-related quality of life (H-QoL) among outpatient healthcare workers in Italy, comparing pre-pandemic (2017) and post-pandemic (2025) periods. Methods: A cross-sectional study was conducted in 2025, including 97 healthcare professionals from five outpatient departments at the University Hospital of Cagliari. Participants completed demographic surveys, the Short Form Health Survey (SF-12), and the Patient Health Questionnaire (PHQ-9) to assess H-QoL and depressive symptoms. Data were compared with previously published data from the same facility collected in 2017 and with pre-pandemic Italian community surveys. Results: Compared to 2017, there was a statistically significant increase in depressive episodes (38.1% vs. 33.2%, p = 0.01) and a higher proportion of individuals with low H-QoL (62.9% vs. 43.5%, p < 0.0001) in 2025. After age- and sex-standardization, both depressive symptoms and low H-QoL were significantly more prevalent among healthcare professionals in 2025 compared with the general population before the pandemic. Within the 2025 sample, non-medical healthcare workers showed a significantly higher prevalence of depressive symptoms than medical doctors, while female healthcare workers were more likely to report low H-QoL. Conclusions: Despite the pandemic’s end, healthcare workers, especially those in outpatient settings, continue to face elevated psychological distress. Specific professional and gender-related vulnerabilities persist, and structural challenges, such as staff shortages and organizational issues, may exacerbate this burden. Sustained mental health support and targeted systemic interventions remain crucial to mitigate the long-term impact on the healthcare workforce.