Publications by authors named "Dario Monzani"

37 Publications

How to Measure Propensity to Take Risks in the Italian Context: The Italian Validation of the Risk Propensity Scale.

Psychol Rep 2021 Dec 9:332941211054777. Epub 2021 Dec 9.

Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.

Risk propensity is a multifaced construct that influences many aspects of life, such as decision making. In the present study, the psychometric characteristics of the Risk Propensity Scale (RPS) have been explored for the first time in an Italian sample. The RPS is a 7 item self-report questionnaire measuring people's tendency to take risks. The English RPS has been translated following the forward-backwards translation method, and it was filled out by 199 participants. Since its dimensionality has never been explored before, its factor structure has been analysed with exploratory factor analysis that confirmed the one-factor structure of the questionnaire and the retention of all the items. The Italian version of the RPS has high internal consistency (Cronbach alphas .78), and almost all the items were positively and significantly correlated. The convergent and discriminant validity, analysed by considering the associations with decision-making styles and an implicit measure of risk propensity, were satisfactory. Overall, the Italian version of the RPS is a valid and quick questionnaire useful to measure propensity to take risks in the Italian context.
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http://dx.doi.org/10.1177/00332941211054777DOI Listing
December 2021

The Social Exclusion Bench Tool (SEBT): A visual way of assessing interpersonal social exclusion.

MethodsX 2021 20;8:101495. Epub 2021 Aug 20.

Department of Oncology and Hemato-Oncology, University of Milan, Italy.

People usually prefer to appear with an inclusive and positive attitude to others' eyes. For this reason, the self-report scales assessing social exclusion intentions are often biased by social desirability. In this work, we present an innovative graphical tool, named Social Exclusion Bench Tool (SEBT), for assessing social exclusion not influenced by social desirability. The tool is based on the consistency between social distance and physical distance evaluation. The results showed that in two samples of adults from Italy (N = 252) and the UK (N = 254), the SEBT positively correlated with self-report measures of social exclusion, but not with the social desirability measure. The tool has been preliminarily evaluated in the context of social exclusion toward migrant people, but it appears a promising instrument for assessing social exclusion intentions toward different social groups.•The self-report scales assessing social exclusion intentions are often biased by social desirability.•The Social Exclusion Bench Tool (SEBT) is an innovative visual instrument for assessing social exclusion that seems not to be influenced by social desirability.•The tool appears a promising instrument for assessing social exclusion intentions toward different social groups.
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http://dx.doi.org/10.1016/j.mex.2021.101495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563470PMC
August 2021

The Power of Odor Persuasion: The Incorporation of Olfactory Cues in Virtual Environments for Personalized Relaxation.

Perspect Psychol Sci 2021 Nov 9:17456916211014196. Epub 2021 Nov 9.

Department of Oncology and Hemato-Oncology, University of Milan.

Olfaction is the most ancient sense and is directly connected with emotional areas in the brain. It gives rise to perception linked to emotion both in everyday life and in memory-recall activities. Despite its emotional primacy in perception and its role in sampling the real physical world, olfaction is rarely used in clinical psychological settings because it relies on stimuli that are difficult to deliver. However, recent developments in virtual-reality tools are creating novel possibilities for the engagement of the sense of smell in this field. In this article, we present the relevant features of olfaction for relaxation purposes and then discuss possible future applications of involving olfaction in virtual-reality interventions for relaxation. We also discuss clinical applications, the potential of new tools, and current obstacles and limitations.
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http://dx.doi.org/10.1177/17456916211014196DOI Listing
November 2021

When in doubt, Google it: distress-related information seeking in Italy during the COVID-19 pandemic.

BMC Public Health 2021 10 20;21(1):1902. Epub 2021 Oct 20.

Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.

Background: Psychological health has been one of the aspects affected by the recent COVID-19 pandemic. We aim to evaluate the patterns of Google search for mental distress symptoms of Italian citizens during the various phases of the COVID-19 pandemic.

Methods: We assessed Google searches for psychological-health related words. We gathered and analyzed data on daily search queries on depression, anxiety, and insomnia from Google Trends, in a time ranging from the Pre-COVID phase (beginning 25th January 2020) up to the second wave phase (ending 17th October 2020). We performed three general linear models on search trends of the three words and tested whether and to what extent official data about new cases of COVID-19, information searching on new cases, and the government health measures impacted on these trends.

Results: Average daily search queries were higher for anxiety, followed by depression and insomnia. General linear models performed to assess differences in daily search queries for anxiety, depression and insomnia were significant, respectively [F(13, 253) = 6.80, P < .001]; [F(13, 253) = 10.25, P < .001]; [F(13, 253) = 6.61, P < .001]. Specifically, daily search queries differed among different phases of managing the COVID-19 outbreak: anxiety [F(5, 253) = 10.35, P < .001, [Formula: see text] = .17]; depression [F(5, 253) = 13.59, P < .001, [Formula: see text] = .21]; insomnia [F(5, 253) = 3.52, P = .004, [Formula: see text] = .07].

Conclusions: Our study contributed to the investigation of online information-seeking behaviors of Italians regarding mental health throughout the entire phase of the pandemic and provides insights on the possible future trends of mental distress during upcoming pandemic phases.
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http://dx.doi.org/10.1186/s12889-021-11887-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528555PMC
October 2021

Emotional Tone, Analytical Thinking, and Somatosensory Processes of a Sample of Italian Tweets During the First Phases of the COVID-19 Pandemic: Observational Study.

J Med Internet Res 2021 10 27;23(10):e29820. Epub 2021 Oct 27.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Background: The COVID-19 pandemic is a traumatic individual and collective chronic experience, with tremendous consequences on mental and psychological health that can also be reflected in people's use of words. Psycholinguistic analysis of tweets from Twitter allows obtaining information about people's emotional expression, analytical thinking, and somatosensory processes, which are particularly important in traumatic events contexts.

Objective: We aimed to analyze the influence of official Italian COVID-19 daily data (new cases, deaths, and hospital discharges) and the phase of managing the pandemic on how people expressed emotions and their analytical thinking and somatosensory processes in Italian tweets written during the first phases of the COVID-19 pandemic in Italy.

Methods: We retrieved 1,697,490 Italian COVID-19-related tweets written from February 24, 2020 to June 14, 2020 and analyzed them using LIWC2015 to calculate 3 summary psycholinguistic variables: emotional tone, analytical thinking, and somatosensory processes. Official daily data about new COVID-19 cases, deaths, and hospital discharges were retrieved from the Italian Prime Minister's Office and Civil Protection Department GitHub page. We considered 3 phases of managing the COVID-19 pandemic in Italy. We performed 3 general models, 1 for each summary variable as the dependent variable and with daily data and phase of managing the pandemic as independent variables.

Results: General linear models to assess differences in daily scores of emotional tone, analytical thinking, and somatosensory processes were significant (F=21.53, P<.001, R= .55; F=9.20, P<.001, R= .30; F=6.15, P<.001, R=.26, respectively).

Conclusions: The COVID-19 pandemic affects how people express emotions, analytical thinking, and somatosensory processes in tweets. Our study contributes to the investigation of pandemic psychological consequences through psycholinguistic analysis of social media textual data.
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http://dx.doi.org/10.2196/29820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552964PMC
October 2021

From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning.

Curr Psychol 2021 Aug 20:1-8. Epub 2021 Aug 20.

Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.

In recent years, virtual reality (VR) has been effectively employed in several settings, ranging from health care needs to leisure and gaming activities. A new application of virtual stimuli appeared in social media: in the documentary 'I met you' from the South-Korean Munhwa Broadcasting, a mother made the experience of interacting with the avatar of the seven-year-old daughter, who died four years before. We think that this new application of virtual stimuli should open a debate on its possible implications: it represents contents related to grief, a dramatic and yet natural experience, that can have deep psychological impacts on fragile subjects put in virtual environments. In the present work, possible side-effects, as well as hypothetical therapeutical application of VR for the treatment of mourning, are discussed.
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http://dx.doi.org/10.1007/s12144-021-02158-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376294PMC
August 2021

Patient Preferences for Lung Cancer Treatments: A Study Protocol for a Preference Survey Using Discrete Choice Experiment and Swing Weighting.

Front Med (Lausanne) 2021 2;8:689114. Epub 2021 Aug 2.

Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.

Advanced treatment options for non-small cell lung cancer (NSCLC) consist of immunotherapy, chemotherapy, or a combination of both. Decisions surrounding NSCLC can be considered as preference-sensitive because multiple treatments exist that vary in terms of mode of administration, treatment schedules, and benefit-risk profiles. As part of the IMI PREFER project, we developed a protocol for an online preference survey for NSCLC patients exploring differences in preferences according to patient characteristics (preference heterogeneity). Moreover, this study will evaluate and compare the use of two different preference elicitation methods, the discrete choice experiment (DCE) and the swing weighting (SW) task. Finally, the study explores how demographic (i.e., age, gender, and educational level) and clinical (i.e., cancer stage and line of treatment) information, health literacy, health locus of control, and quality of life may influence or explain patient preferences and the usefulness of a digital interactive tool in providing information on preference elicitation tasks according to patients. An online survey will be implemented with the aim to recruit 510 NSCLC patients in Belgium and Italy. Participants will be randomized 50:50 to first receive either the DCE or the SW. The survey will also collect information on participants' disease-related status, health locus of control, health literacy, quality of life, and perception of the educational tool. This protocol outlines methodological and practical steps to quantitatively elicit and study patient preferences for NSCLC treatment alternatives. Results from this study will increase the understanding of which treatment aspects are most valued by NSCLC patients to inform decision-making in drug development, regulatory approval, and reimbursement. Methodologically, the comparison between the DCE and the SW task will be valuable to gain information on how these preference methods perform against each other in eliciting patient preferences. Overall, this protocol may assist researchers, drug developers, and decision-makers in designing quantitative patient preferences into decision-making along the medical product life cycle.
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http://dx.doi.org/10.3389/fmed.2021.689114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365300PMC
August 2021

Perceived Onset Time of Medical Conditions: The Interplay Between Subjective Fear and Risk in Four Lifestyle Domains.

Psychol Rep 2021 Jul 29:332941211036028. Epub 2021 Jul 29.

Department of Oncology and Hemato-Oncology, University of Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.

Engaging in unhealthy behaviors (e.g., smoking, drinking) and not engaging in healthy ones (e.g., exercising, consuming fruit and vegetables) are both relatively prevalent among individuals despite the available information about their risks for health. People's perception of an event's time course can be used to gauge their risk perception for that event thus casting light on any possible misperception and suggesting directions for health-promoting interventions. This study investigates people's perception of the time of onset of 5 noncommunicable diseases (e.g., "having high blood pressure") associated with 4 health-related behaviors: Smoking, drinking, exercising, and eating fruit and vegetable. Participants from Italy ( = 214) and the UK ( = 151) gave onset time estimates of how long they thought it would take for 5 noncommunicable diseases to occur in the life of an 18-year-old person who starts or stops adopting those health-related behaviors. Results showed that participants who rated the noncommunicable diseases as more likely to themselves perceived the onset time of these diseases as more temporally proximal. Participants who were more afraid of developing the noncommunicable diseases estimated their onset time as delayed.
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http://dx.doi.org/10.1177/00332941211036028DOI Listing
July 2021

Does being involved by doctors satisfy patients' fundamental psychological needs? A study on a large European sample.

Psychol Health Med 2021 Jun 30:1-13. Epub 2021 Jun 30.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

The present work was aimed at investigating whether the patients' involvement by their healthcare providers may satisfy patients' fundamental psychological needs (i.e. self-esteem, belonging, control, meaningful existence), which in turn, can impact their psychological well-being. Based on the European Quality of Life Survey data, the sample included 10,427 European adults who, in the last 12 months, visited GP/family doctors and hospital/medical specialists. Among them, 51.3% declared to have a chronic disease. Results showed that the experience of being involved by GP/family doctors and hospital/medical specialists had a positive effect on psychological well-being and that this effect was mediated by the satisfaction of all four needs. Moreover, the results of the moderated mediation model showed that the indirect effect of the involvement by GP/family doctors and hospital/medical specialists on psychological well-being through belonging was moderated by the presence or absence of a chronic condition. The study provides a novel contribution in investigating the positive effects of the patient's involvement, emphasizing its importance for patient's needs satisfaction, and its role appears particularly beneficial for the ones living with a chronic condition.
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http://dx.doi.org/10.1080/13548506.2021.1946104DOI Listing
June 2021

Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies.

Patient Prefer Adherence 2021 18;15:1331-1345. Epub 2021 Jun 18.

Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.

Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients' preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.
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http://dx.doi.org/10.2147/PPA.S261615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219660PMC
June 2021

Thinking of future as an older individual increases perceived risks for age-related diseases but not for COVID-19.

Int J Psychol 2022 Feb 24;57(1):96-106. Epub 2021 Jun 24.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Actively thinking of one's future as an older individual could increase perceived risk and risk aversion. This could be particularly relevant for COVID-19, if we consider the common representation of the risk of being infected by COVID-19 as associated with being older. Increased perceived risk could bear consequences on the adoption of preventive behaviours. Thus, we investigated whether increasing the salience of individuals' future as an older adult would impact on their perceived risk for COVID-19 and medical conditions varying for age-relatedness. One hundred and forty-four Italian adults (M  = 27.72, range: 18-56) were randomly assigned to either a future as older adult thinking or control condition. Perceived risk for COVID-19 and other strongly, and weakly age-related medical conditions during the lifetime was measured. Results showed that thinking about the future as an older adult increased perceived risk for strongly and weakly age-related diseases, but not for COVID-19. The salience of the COVID-19 outbreak may have raised the perceived risks in both experimental conditions, making the manipulation ineffective. In conclusion, manipulating future-oriented thinking might be a successful communication strategy to increase people's perceived risk of common diseases, but it might not work for highly salient pathologies such as COVID-19.
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http://dx.doi.org/10.1002/ijop.12789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426922PMC
February 2022

A meta-analysis on heart rate variability biofeedback and depressive symptoms.

Sci Rep 2021 03 23;11(1):6650. Epub 2021 Mar 23.

Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.

Heart rate variability biofeedback (HRVB) has been used for a number of years to treat depressive symptoms, a common mental health issue, which is often comorbid with other psychopathological and medical conditions. The aim of the present meta-analysis is to test whether and to what extent HRVB is effective in reducing depressive symptoms in adult patients. We conducted a literature search on Pubmed, ProQuest, Ovid PsycInfo, and Embase up to October 2020, and identified 721 studies. Fourteen studies were included in the meta-analysis. Three meta-regressions were also performed to further test whether publication year, the questionnaire used to assess depressive symptoms, or the interval of time between T0 and T1 moderated the effect of HRVB. Overall, we analysed 14 RCTs with a total of 794 participants. The random effect analysis yielded a medium mean effect size g = 0.38 [95% CI = 0.16, 0.60; 95% PI =  - 0.19, 0.96], z = 3.44, p = 0.0006. The total heterogeneity was significant, Q = 23.49, p = 0.03, I = 45%, which suggested a moderate variance among the included studies. The year of publication (χ(1) = 4.08, p = 0.04) and the questionnaire used to assess symptoms (χ(4) = 12.65, p = 0.01) significantly moderated the effect of the interventions and reduced heterogeneity. Overall, results showed that HRVB improves depressive symptoms in several psychophysiological conditions in adult samples and should be considered as a valid technique to increase psychological well-being.
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http://dx.doi.org/10.1038/s41598-021-86149-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988005PMC
March 2021

Patient Preferences for Lung Cancer Treatment: A Qualitative Study Protocol Among Advanced Lung Cancer Patients.

Front Public Health 2021 5;9:622154. Epub 2021 Feb 5.

Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.

Lung cancer is the deadliest and most prevalent cancer worldwide. Lung cancer treatments have different characteristics and are associated with a range of benefits and side effects for patients. Such differences may raise uncertainty among drug developers, regulators, payers, and clinicians regarding the value of these treatment effects to patients. The value of conducting patient preference studies (using qualitative and/or quantitative methods) for benefits and side effects of different treatment options has been recognized by healthcare stakeholders, such as drug developers, regulators, health technology assessment bodies, and clinicians. However, evidence-based guidelines on how and when to conduct and use these studies in drug decision-making are lacking. As part of the Innovative Medicines Initiative PREFER project, we developed a protocol for a qualitative study that aims to understand which treatment characteristics are most important to lung cancer patients and to develop attributes and levels for inclusion in a subsequent quantitative preference survey. The study protocol specifies a four-phased approach: (i) a scoping literature review of published literature, (ii) four focus group discussions with stage III and IV Non-Small Cell Lung Cancer patients, (iii) two nominal group discussions with stage III and IV Non-Small Cell Lung Cancer patients, and (iv) multi-stakeholder discussions involving clinicians and preference experts. This protocol outlines methodological and practical steps as to how qualitative research can be applied to identify and develop attributes and levels for inclusion in patient preference studies aiming to inform decisions across the drug life cycle. The results of this study are intended to inform a subsequent quantitative preference survey that assesses patient trade-offs regarding lung cancer treatment options. This protocol may assist researchers, drug developers, and decision-makers in designing qualitative studies to understand which treatment aspects are most valued by patients in drug development, regulation, and reimbursement.
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http://dx.doi.org/10.3389/fpubh.2021.622154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900128PMC
May 2021

The Psychological Risks Associated With the Non-medical Switch From Biologics to Biosimilars.

Front Psychol 2021 27;12:605643. Epub 2021 Jan 27.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

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http://dx.doi.org/10.3389/fpsyg.2021.605643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873288PMC
January 2021

Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience.

Front Endocrinol (Lausanne) 2020 8;11:575152. Epub 2021 Jan 8.

Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.

Purpose: To report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacy.

Materials And Methods: From 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded.

Results: A total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5-12 months), no local recurrence or distant metastases were found.

Conclusions: Image guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.
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http://dx.doi.org/10.3389/fendo.2020.575152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820745PMC
June 2021

One-Year Quality of Life Trends in Early-Stage Lung Cancer Patients After Lobectomy.

Front Psychol 2020 10;11:534428. Epub 2020 Dec 10.

Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.

Quality of Life (QoL) is an important predictor of patient's recovery and survival in lung cancer patients. The aim of the present study is to identify 1-year trends of lung cancer patients' QoL after robot-assisted or traditional lobectomy and investigate whether clinical (e.g., pre-surgery QoL, type of surgery, and perioperative complications) and sociodemographic variables (e.g., age) may predict these trends. An Italian sample of 176 lung cancer patients undergoing lobectomy completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) at the pre-hospitalization (t0), 30 days (t1), 4 months (t2), 8 months (t3), and 12 months (t4) after surgery. Sociodemographic and clinical characteristics (age, gender, perioperative complications, and type of surgery) were also collected. The individual change over time of the 15 dimensions of the EORTC QLQ-C30 and the effects of pre-surgery scores of QoL dimensions, type of surgery, perioperative complications, and age on patients' QoL after surgery were studied with the individual growth curve (IGC) models. Patients had a good recovery after lobectomy: functioning subscales improved over time, while most of the symptoms became less severe over the care process. Perioperative complications, type of surgery, pre-surgery status, and age significantly affected these trends, thus becoming predictors of patients' QoL. This study highlights different 1-year trends of lung cancer patients' QoL. The measurement of pre- and post-surgery QoL and its clinical and sociodemographic covariables would be necessary to better investigate patients' care process and implement personalized medicine in lung cancer hospital divisions.
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http://dx.doi.org/10.3389/fpsyg.2020.534428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758417PMC
December 2020

Brief report - "Every little thing gonna be all right" (at least for me): Dispositional optimists display higher optimistic bias for infection during the Italian COVID-19 outbreak.

Pers Individ Dif 2021 Jan 7;168:110388. Epub 2020 Sep 7.

Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, 20122 Milan, Italy.

Dispositional optimism (DO) and optimistic bias (OB) in risk perception are two distinct phenomena and previous studies about their reciprocal relationship report contrasting results. In the present study, we focused on the relationship between DO and OB when reporting the personal and the other persons' risk about COVID-19. We hypothesized that, when facing a largely uncontrollable risky situation (like the recent pandemic), dispositional optimists would defensively increase their OB about the current risks. A convenience sample of 414 Italian participants aged 18 or older were recruited. They completed a questionnaire investigating past protective behaviors, DO, perceived personal and other persons' COVID-19-related risk. Results of the mixed regression model showed that more optimistic people were more likely to underestimate their COVID-19 personal risk over the other's person risk. These results shed light on the relationship between different forms of optimism and provide useful insight about the potential implications of risk communication approaches to face the current pandemic.
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http://dx.doi.org/10.1016/j.paid.2020.110388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476501PMC
January 2021

Patients' health locus of control and preferences about the role that they want to play in the medical decision-making process.

Psychol Health Med 2021 02 23;26(2):260-266. Epub 2020 Apr 23.

Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.

Health locus of control (HLOC) may influence people's behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC's relations with people's control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale - form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people's control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient's HLOC could help tailoring the decision-making process within the clinical context.
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http://dx.doi.org/10.1080/13548506.2020.1748211DOI Listing
February 2021

Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design.

Appl Psychol Health Well Being 2020 07 27;12(2):471-492. Epub 2020 Jan 27.

Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.

Background: Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability.

Methods: We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor.

Results: Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences.

Conclusions: In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.
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http://dx.doi.org/10.1111/aphw.12193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384069PMC
July 2020

Dimensionality and Measurement Invariance of the Italian Version of the EORTC QLQ-C30 in Postoperative Lung Cancer Patients.

Front Psychol 2019 8;10:2147. Epub 2019 Oct 8.

Department of Oncology and Hemato-Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.

Background: This study aims to validate and evaluate the psychometric properties and measurement invariance of the Italian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30), which is a measure of quality of life (QoL) for lung cancer patients after surgery.

Methods: A total of 167 lung cancer patients completed the Italian version of the EORTC QLQ-C30 questionnaire at 30 days after they received a lobectomy. The factor structure of this scale was assessed by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) due to age, gender, and type of surgery (i.e., robot- or not robot-assisted).

Results: The CFA demonstrated the validity of the factor structure of the EORTC QLQ-C30 in assessing overall health and eight distinct subscales of adverse events and functioning. Moreover, the results highlighted a minimal DIF with only trivial consequences on measurement invariance. Specifically, the DIF did not affect the mean differences of latent scores of QoL between patients undergoing robot-assisted surgery or traditional surgery.

Conclusion: These findings supported the validity and suitability of the EORTC QLQ-C30 for the assessment of QoL in lung cancer patients of diverse ages and genders undergoing lobectomy with or without robot-assisted surgery.
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http://dx.doi.org/10.3389/fpsyg.2019.02147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792474PMC
October 2019

Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer.

Health Qual Life Outcomes 2019 Aug 29;17(1):147. Epub 2019 Aug 29.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Background: This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite - Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients.

Methods: Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations.

Results: At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach's alphas could be classified as acceptable (i.e., above .65) except for low Cronbach's alpha for hormonal dysfunction at T1 (i.e., .638) and urinary irritation at both waves. (i.e., respectively .585 and .518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above .500) to good test-retest reliability (i.e. ICC for urinary incontinence = .764).

Conclusions: Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients.
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http://dx.doi.org/10.1186/s12955-019-1214-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716830PMC
August 2019

Predicting trajectories of recovery in prostate cancer patients undergone Robot-Assisted Radical Prostatectomy (RARP).

PLoS One 2019 4;14(4):e0214682. Epub 2019 Apr 4.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Objective: To identify trends of patients' urinary and sexual dysfunctions from a clinical and psychological perspective and understand whether sociodemographic and medical predictors could differentiate among patients following different one-year longitudinal trajectories.

Methods: An Italian sample of 478 prostate cancer patients undergone Robot-Assisted Radical Prostatectomy completed the EPIC-26 survey between July 2015 and July 2016 at the pre-hospitalization (T0), 45 days (T1) and 3 (T2), 6 (T3), 9 (T4), and 12 months (T5) after surgery. Sociodemographic and clinical characteristics (age, BMI, diabetes, nerve-sparing procedure) were also collected. Latent Class Growth Analysis was conducted separately for sexual dysfunction and urinary incontinence EPIC-26 subscales. The association between membership in the two longitudinal trajectories of urinary and sexual dysfunctions was assessed by considering Chi-square test and its related contingency table.

Results: People who have a high level of urinary incontinence at T1 are likely to have a worse recovery. Age, BMI and pre-surgical continence may affect the level of incontinence at T1 and the recovery trajectories. Patients with low and moderate sexual problems at T1 can face a moderate linear recovery, while people with high level of impotence immediately after surgery may take a longer period to solve sexual dysfunctions. Age and the pre-surgical sexual condition may impact the recovery. Finally, a great proportion of patients reported both steady problems in sexual function and constant high levels of urinary incontinence over time.

Conclusions: This study highlights different categories of patients at risk who may be important to know in order to develop personalized medical pathways and predictive models in a value-based healthcare.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214682PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448842PMC
January 2020

User-Centered Virtual Reality for Promoting Relaxation: An Innovative Approach.

Front Psychol 2019 12;10:479. Epub 2019 Mar 12.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Virtual reality has been used effectively to promote relaxation and reduce stress. It is possible to find two main approaches to achieve such aims across the literature. The first one is focused on generic environments filled with relaxing "narratives" to induce control over one's own body and physiological response, while the second one engages the user in virtual reality-mediated activities to empower his/her own abilities to regulate emotion. The scope of the present contribution is to extend the discourse on VR use to promote relaxation, by proposing a third approach. This would be based on VR with personalized content, based on user research to identify important life events. As a second step, distinctive features of such events may be rendered with symbols, activities or other virtual environments contents. According to literature, it is possible that such an approach would obtain more sophisticated and long-lasting relaxation in users. The present contribution explores this innovative theoretical proposal and its potential applications within future research and interventions.
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http://dx.doi.org/10.3389/fpsyg.2019.00479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423066PMC
March 2019

Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review.

JMIR Mhealth Uhealth 2019 03 19;7(3):e10855. Epub 2019 Mar 19.

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient's home.

Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients.

Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases.

Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention.

Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients.
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http://dx.doi.org/10.2196/10855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444278PMC
March 2019

A pilot study on aesthetic treatments performed by qualified aesthetic practitioners: efficacy on health-related quality of life in breast cancer patients.

Qual Life Res 2019 Jun 20;28(6):1543-1553. Epub 2019 Feb 20.

Department of Oncology and Hematoncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.

Purpose: Cancer treatments often produce undesirable side-effects, such as skin toxicity, impacting on everyday functioning and health-related quality of life (HRQoL). This experimental study sought to determine whether aesthetic products and treatments could significantly decrease perceived skin symptoms, psychological distress and improve skin-related QoL (SRQoL).

Methods: An experimental group composed of 100 breast patients was enrolled for specialized aesthetic treatments at the European Institute of Oncology (IEO) and compared to a control group of 70 breast patients who did not receive any aesthetic treatment. A measure of SRQoL (i.e., Skindex-16) and a distress thermometer were administered longitudinally at three time points: at baseline (T0), at 7 days from beginning of aesthetic treatment (T1) and at 28 days from beginning of aesthetic treatment (T2).

Results: Results demonstrated the efficacy of aesthetic treatment in reducing distress and improving SRQoL: while the experimental group showed significant improvements in all HRQoL areas, the control group worsened. Specifically, at T1 and T2 there were significant improvements on distress and Skindex subscales in the experimental group, with an almost complete remission of perceived symptoms at T2. Moreover, all reported cutaneous reactions significantly improved after the specialized treatments, with no differences in SRQoL in skin reaction type.

Conclusions: These findings demonstrate that aesthetic treatments for side-effects of cancer therapies can alleviate perceived distress and improve skin symptoms and HRQoL.
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http://dx.doi.org/10.1007/s11136-019-02133-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522456PMC
June 2019

Clustering of Lifestyle Risk Factors in Acute Coronary Syndrome: Prevalence and Change after the First Event.

Appl Psychol Health Well Being 2018 11 19;10(3):434-456. Epub 2018 Sep 19.

University of Milano - Bicocca, Italy.

Background: Healthy lifestyles are modifiable risk factors for acute coronary syndrome (ACS) onset and recurrence. While unhealthy lifestyles tend to cluster together within the general healthy population, little is known about the prevalence and clustering of these behaviours in people with ACS before and after the first acute event. The aim of this study was to identify lifestyle profiles of patients with ACS and to explore their change after their first coronary event.

Methods: Three hundred and fifty-six patients completed self-report measures of healthy habits at the beginning of cardiac rehabilitation and 6 months later. By adopting a person-oriented approach, we analysed lifestyle clustering and its change over time. Differences in depression, anxiety, and negative illness perception among lifestyle profiles were assessed.

Results: We identified seven profiles, ranging from more maladaptive to healthier clusters. Findings showed a strong interrelation among unhealthy habits in patients. We highlighted a moderate individual and group stability of cluster membership over time. Moreover, unhealthier lifestyle profiles were associated with higher levels of depression, anxiety, and negative illness perception.

Conclusion: These results may have implications for the development and implementation of multimodal interventions addressing wider-ranging improvement in lifestyles by targeting multiple unhealthy behaviours in patients with ACS.
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http://dx.doi.org/10.1111/aphw.12141DOI Listing
November 2018

Measuring dispositional optimism in patients with chronic heart failure and their healthcare providers: the validity of the Life Orientation Test-Revised.

Patient Prefer Adherence 2017 6;11:1497-1503. Epub 2017 Sep 6.

Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Montescano, Montescano, Italy.

The Life Orientation Test-Revised (LOT-R) measures dispositional optimism (DO) - an individual difference promoting physical and psychological well-being in healthy adults (HAs) as well as in patients with chronic heart failure (CHF) and healthcare providers (HPs). Controversy has arisen regarding the dimensionality of the LOT-R. Whereas DO was originally defined as a one-dimensional construct, empirical evidence suggests two correlated factors in the LOT-R. This study was the first attempt to identify the best factor structure of the LOT-R in patients with CHF and HPs and to evaluate its measurement invariance among subsamples of patients with CHF, HPs, and a normative sample of HAs. Its validity was also evaluated in patients with CHF. The sample comprised 543 participants (34% HAs; 34% HPs; and 32% CHF patients). Congeneric, two correlated factor, and two orthogonal factor models for the LOT-R were compared by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) among subsamples of HPs, patients with CHF, and HAs. In patients with CHF, validity was assessed by considering associations with anxiety and depression. The CFA demonstrated the superior fit of the two orthogonal factor model. Moreover, across patients with CHF, HPs, and HAs, the results highlighted a minimal DIF with only trivial consequences. Finally, negative but weak correlations of DO with anxiety and depression confirmed the validity of the LOT-R in patients with CHF. In summary, these findings supported the validity and suitability of the LOT-R for the assessment of DO in patients with CHF, HPs, and HAs.
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http://dx.doi.org/10.2147/PPA.S139522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593410PMC
September 2017

Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event.

PLoS One 2017 29;12(8):e0183905. Epub 2017 Aug 29.

Department of Psychology, University of Milan -Bicocca, Milan, Italy.

Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur.

Purpose: The aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach.

Methods: Two hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed.

Results: Patients' diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation.

Conclusions: Current findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183905PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574544PMC
October 2017

A longitudinal study on the information needs and preferences of patients after an acute coronary syndrome.

BMC Fam Pract 2016 09 20;17:136. Epub 2016 Sep 20.

Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.

Background: Research has shown that the provision of pertinent health information to patients with cardiovascular disease is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. Yet there is no clear knowledge on how to improve information pertinence. Identifying and meeting the information needs of patients and their preferences for sources of information is pivotal to developing patient-led services. This prospective, observational study was aimed at exploring the information needs and perceived relevance of different information sources for patients during the twenty-four months following an acute coronary syndrome.

Methods: Two hundred and seventeen newly diagnosed patients with acute coronary syndrome were enrolled in the study. The patients were primarily men (83.41 %) with a mean age of 57.28 years (range 35-75; SD = 7.98). Patients' needs for information and the perceived relevance of information sources were evaluated between 2 and 8 weeks after hospitalization (baseline) and during three follow-ups at 6, 12 and 24 months after baseline. Repeated measures ANOVA, Bonferroni post hoc tests and Cochran's Q Test were performed to test differences in variables of interest over time.

Results: Results showed a reduction in information needs, but this decrease was significant only for topics related to daily activities, behavioral habits, risk and complication. At baseline, the primary sources of information were specialists and general practitioners, followed by family members and information leaflets given by physicians. Relevance of other sources changed differently over time.

Conclusion: The present longitudinal study is an original contribution to the investigation of changes in information needs and preferences for sources of information among patients who are diagnosed with acute coronary syndrome. One of the main results of this study is that information on self-disease management is perceived as a minor theme for patients even two years after the event. Knowledge on how patients' information needs and perceived relevance of information sources change over time could enhance the quality of chronic disease management, leading health-care systems to move toward more patient-tailored care.
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http://dx.doi.org/10.1186/s12875-016-0534-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028970PMC
September 2016

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.

PLoS One 2016 2;11(9):e0161840. Epub 2016 Sep 2.

Department of Psychology, University of Milan "Bicocca", Milan, Italy.

Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161840PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010181PMC
August 2017
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