Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered.

2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk.

More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments.

Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.

The aim of the research is to study whether any differences exist in the rates and characteristics of suicide by ethnicity and sex in South Tirol, Italy.

Psychological autopsy interviews were conducted for suicides who died between March 1997 and July 2006.

332 individuals belonging to the three major South Tirolean ethnic groups (Germans, Italians, Ladins [Ladin is a Rhaeto-Romance language related to the Venetian and Swiss Romansh languages]) died by suicide. Around 23% of the victims had experienced suicidal behaviour among family members, and more than 31% of them had experienced trauma during their childhood. Germans were 1.37 times more at risk to commit suicide than Italians (95% CI: 1.04/1.80; z = 2.26, p < .05). 69% of the suicides had attended school for less than 8 years: Germans (OR = 4.62; 95% CI: 2.52/8.47; p < .001) and Ladins (OR = 11.24; 95% CI: 2.99/42.30; p < .001) were more likely to have lower education than Italians. There were several differences by ethnicity and sex but no sex-by-ethnicity interactions.

The study indicated that suicide, an alarming health and social problem in South Tirol, may require different preventive interventions for men and women and for those of different ethnicities.

Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly.

The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50–64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales.

Factor analysis supported the validity of both state–trait and cognitive–somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbach's α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples.

The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.

White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated.

Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17.

Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients.

Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.