Giulia Ferrazzi

Thank you for the opportunity to read and review this manuscript. I suggest Major Revision. Bidirectionality is the main claim, but it is never tested. At a minimum, run separate analyses for participants who wish to be shorter (negative height disc...

Background: Sexual and gender minorities, collectively known as LGBTQIA+ individuals, experience disproportionate mental health disparities compared to their heterosexual/cisgender peers. Aims: The aim of this systematic review was to synthesize high-quality evidence from previously published systematic reviews on mental health in the LGBTQIA+ population. Method: PubMed was searched for systematic reviews on LGBTQIA+ mental health, published by September 1st, 2024. For each mental health outcome, a narrative synthesis of the findings was performed. Additionally, when included reviews reported case-control data suitable for pooled analysis, network meta-analyses with random-effects models were conducted to estimate the Odds Ratios (ORs) and 95% confidence intervals (95% CIs) for mental disorders across sexual and gender groups. Results: Twenty systematic reviews were included, accounting for 5,164,641 LGBTQIA+ individuals. These focused on the following mental health outcomes: major depressive disorder (MDD, n = 7), eating disorders (ED, n = 5), anxiety disorders (AD, n = 5), substance use disorder (SUD, n = 4), alcohol use disorder (AUD, n = 1), post-traumatic stress disorder (PTSD, n = 1), and suicidality ( n = 11), all resulting more prevalent among LGBTQIA+ individuals compared to the general population. Network meta-analysis was possible only for suicide attempts (SA), finding the highest risk among bisexual individuals (OR = 6.43, 95% CI [4.43; 9.34]), followed by lesbian and gay individuals (OR = 4.54, 95% CI [3.42, 6.03]), sexual and gender minorities analyzed together (OR = 4.32, 95% CI [3.52, 5.30]), and transgender individuals (OR = 3.61, 95% CI [2.78, 4.67]). Geographical differences were also found, with transgender individuals being the group with the highest SA risk in Europe (OR = 7.22, 95% CI [4.83, 10.81]) and the lowest SA risk in Asia (OR = 1.84, 95% CI [0.68, 5.03]), suggesting potential socio-cultural influences or differences in participant selection. Conclusions: LGBTQIA+ individuals experience significant mental health challenges compared to the general population. To reduce these disparities, more inclusive policies, supportive social environments, affirmative mental health care, and ongoing research into minority stressors and protective factors are essential.

INPLASY202590027 Pragmatic Competence and Theory of Mind Deficits in Neurodivergent Children and Adolescents: A Systematic Review Keywords: Pragmatic competence, Theory of Mind, Autism Spectrum Dis…

This study presents a research protocol employing the Delphi method to develop a consensus-based definition of the Life Project (LP) for autistic adults in the Italian context. LPs, conceived as individualized, person-centered plans, aim to promote autonomy, social inclusion, and quality of life through coordinated health and social care interventions. Despite recent legislative and policy advancements in Italy a unified operational definition and implementation framework for LPs remains lacking. The protocol outlines a three-round Delphi process engaging a panel of 50–80 experts across clinical, social, legislative, and experiential domains. The initial survey will elicit qualitative data regarding current practices, challenges, and priorities in LP development. Second and third rounds will refine emerging themes and evaluate consensus using Likert-scale ratings, with consensus defined as ≥80% agreement. Data will be analyzed through thematic and descriptive statistical methods. The study has received ethical approval from the Comitato Etico di Ateneo per la Ricerca of the University of Modena and Reggio Emilia (Protocol Approvation No. 46821; 17 March 2025). This protocol research is expected to produce a structured and actionable definition of the LP, as well as a consensus-based set of practices and principles to guide implementation. By involving stakeholders from diverse regions and disciplines, the study ensures ecological validity and responsiveness to local service delivery contexts. The outcomes aim to support LP practices across Italy and inform future research on their impact on the well-being of autistic adults.

Evidence about bone health in people affected by psychiatric disorders is limited. This narrative review aims to highlight what is known, up to the present time, about clinical connections between bone health and psychiatric disorders, particularly depressive disorders (DD) and bipolar disorders (BD), in terms of common biological pathways. Besides inflammation, we focused on two molecules of growing interest: neuropeptide Y (NPY) and the neuro-hormone melatonin. Also, the role of psychoactive drugs on bone tissue was explored. For the preparation of this narrative review, the scientific literature of the most recent 7 years from PubMed, Springer Nature, Science Direct (Elsevier), Wiley Online, ResearchGate, and Google Scholar databases was analyzed. Reviewed evidence reveals that people diagnosed with BD or DD have an increased risk of both fractures and osteoporosis; NPY reduces bone loss induced by longer periods of depression and “buffers” psychological stress effects on bone health. MLT shows beneficial effects in osteoporosis and bone healing. Lithium, a mood stabilizer, shows potential bone-protective activity, while antipsychotic and antidepressant treatments may increase the risk of bone tissue damage, though further investigation is needed.

The Italian version of the South Oaks Gambling Screen questionnaire (SOGS) and a socio-demographic questionnaire were administered to a sample of 275 healthcare professions students aged 19 to 58 years (mean age = 22.17; females = 81.1%) to address the research objectives: to examine the prevalence and correlates of problem gambling in a population of university healthcare professions students in Italy. Among the sample, 8.7% (n = 24) of participants showed problem gambling and 1.5% (n = 4) pathologic gambling. Lottery and scratch cards were the most frequent type of gambling in the sample, followed by cards and bingo. Compared to females, males tend to be more involved in problem gambling and pathological gambling. Males tend to be more involved than females in different types of gambling (such as cards, sports bets, gambling at the casino). Pathological gambling is positively associated with gender, being students lagging behind the regular schedule of exams and parents’ level of education. These findings have important implications in terms of prevention and intervention on gambling and pathological gambling. Universities should make available educational programs and counselling services to address this issue.