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Research evidence on bipolar disorder supports the importance of patients’ active role to improve outcome and the efficacy of a number of psychosocial interventions. The lower cost and potential ease of dissemination of group psychoeducation suggest that this should be a first line approach, with more complex interventions, requiring highly specialized skills, reserved to selected patients. However, to what extent research models can be transferred to everyday practice remains to be seen.
To explore the delivery of psychosocial interventions to bipolar disorders patients in routine mental health care.
To estimate the treated prevalence of bipolar disorders in Milan and to collect data about the variety of psychosocial interventions patients received by mental health services.
A survey of psychosocial interventions received by bipolar patients in three mental health services of Milan (catchment area 867,000 inhabitants) was conducted in 2009. Data from the Regional Mental Health Information System were retrieved to calculate the number of patients involved in psychosocial interventions and the kind of intervention provided.
The treated prevalence rate was low, showing a probable treatment gap. Only 20% of 636 bipolar patients received at least one psychosocial intervention. The interventions provided were: family psychoeducation (3,8%), individual social skills training (11,5%), group social skills training (1,4%), and relatives group (3,0%).
Few bipolar patients receive psychosocial interventions in the MHS of Milan. Moreover, the interventions received were not specifically designed for bipolar disorder. Treatment gap could be reduced providing psychoeducation especially designed for bipolar patients.
No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of ‘professional culture’ as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers.
The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design.
Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability.
This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.
The Functioning Assessment Short Test (FAST) is a useful instrument for the assessment of overall functioning of people with bipolar disorder, showing good psychometric properties. The aim of this study is to validate the Italian version of FAST.
Translation and back-translation of the original FAST Spanish version were performed. Participants with bipolar disorder (n = 132) and healthy controls (n = 132) completed the FAST as a part of an assessment package including the Montgomery–Asberg Depression Rating Scale and the Young Mania Rating Scale. Internal consistency, inter-rater reliability, construct and discriminant validity were assessed.
The FAST Italian version showed good internal consistency, inter-rater reliability and discriminant validity. The cut-off discriminating patients from controls was 15, with a sensitivity of 0.79 and a specificity of 0.80. Principal component analysis with oblique rotation showed factor loadings consistent with the a priori structure of the instrument.
This study confirmed the psychometric properties of FAST and extended its generalization and validity to the Italian population.
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