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Major depressive disorder (MDD), especially in case of suicidal risk, is a psychiatric emergency, associated with high patient burden and healthcare resource utilization. Although active and urgent treatment is crucial, little is known on comprehensive care management of this condition in Italy.
Here we report the ARIANNA study [NCT04463108] interim results to primarily describe the treatment utilization pathways of patients with MDD and active suicidal ideation with intent in the current clinical practice in Italy.
This observational prospective cohort study included adult patients with a moderate-to-severe major depressive episode (MDE) and active suicidality from 24 Italian sites. Real-world data on patient characteristics, treatments, clinical outcomes, and healthcare utilization were collected during a 90-day follow-up. Data collection is still ongoing.
Sixty-four evaluable patients were considered for this interim analysis: 41 (64.1%) females, mean [SD] age 46.0 [15.4] years, a concomitant psychiatric diagnosis in 7 (10.9%), and other comorbidities in 26 (40.6%). The baseline mean [SD] MADRS total score was 37.5 [7.2], with severe MDE and prior suicidal behavior in 30 (46.9%) and 21 (32.8%) patients, respectively. Median [25th;75th percentiles] duration of current MDE was 1.1 [0.3;2.1] months. Acute inpatient hospitalization was provided for 43 (67.2%) patients. Antidepressant augmentation with mood stabilizers and/or antipsychotic drugs and optimization were the most frequent early standard-of-care treatment regimens in 32 (53.3%) and 24 (40.0%) patients with available data (N=60), respectively.
Our preliminary results suggest that initial treatment approaches in this critical population are mostly polypharmacological and delivered as inpatient care, with consequent intensive resource utilization.
The ARIANNA study was sponsored by Janssen-Cilag SpA, Italy. DD and MA are employees of Janssen-Cilag SpA. DA and BR are employees of MediNeos S.U.R.L., a company subject to the direction and coordination of IQVIA Solutions HQ Ltd.
People with serious mental illness exhibit higher morbidity and mortality rates of chronic diseases than the general population.
The aim of this study was to establish a dedicated clinic for patients with chronic mental illness to monitor physical health in accordance with best practice guidelines.
Patients were invited to attend the metabolic clinic. The following areas were examined: Personal and family history of cardiovascular disease, diet, exercise, smoking. Mental state examination, waist circumference, BP, pulse, ECG and BMI. Laboratory tests including U+E, LFTs, HbA1c, Lipid profile and other tests as appropriate such as serum lithium. AIMS scale, HoNOS and WHOQOL-BREF scales as additional indicators of global health.
A total of 80 patients attended during 3.5 years of clinic. Mean age was 54.9 years (SD:13.81) at first contact and 45% were females. Mean years in the service was 19.66 (SD:11.54) and mean number of previous hospital admissions was 4.4 (SD:5.63). Metabolic syndrome was present in 42% at first assessment and 20% had at least one new physical abnormality identified during the clinic. A statistically significant difference was found for the psychological domain of the WHOQOL-BREF and the HoNOs particularly at third assessment. (β=4.64, Wald x2=7.38, df:1, p=0.007, CI:1.3-8.1, β
=-.889, Wald x2=4.08, df:1, p=0.043, CI: -1.752 to-.026) respectively.
The results show a high prevalence of physical health conditions in this cohort, some of which represent a new diagnosis. This implicates better allocation of existing resources for screening and early detection, and potential to run joint clinics with primary care.
Since the emergence of the COVID-19 pandemic, there has been increased interest in identifying ways of protecting the mental well-being of healthcare workers (HCWs). Much of this has been directed towards promoting and enhancing the resilience of those deemed as frontline workers. Based on a review of the extant literature, this paper seeks to problematise aspects of how ‘frontline work’ and ‘resilience’ are currently conceptualised. Firstly, frontline work is arbitrarily defined and often narrowly focused on acute, hospital-based settings, leading to the needs of HCWs in other sectors of the healthcare system being overlooked. Secondly, dominant narratives are often underpinned by a reductionist understanding of the concept of resilience, whereby solutions are built around addressing the perceived deficiencies of (frontline) HCWs rather than the structural antecedents of distress. The paper concludes by considering what interventions are appropriate to minimise the risk of burnout across all sectors of the healthcare system in a post-pandemic environment.
Previous literature has highlighted high rates of burnout among doctors and nurses in healthcare settings. Non-clinical and support staff such as administrative, housekeeping and managerial staff are also exposed to the stressors of a health care setting, but fewer studies report on their experiences. Therefore, the aim of this research is to examine occupational stress in all staff working in Child and Adolescent Mental Health Services (CAMHS) in Ireland and identify risk and protective factors.
Fifty-nine clinical and non-clinical staff (44% response rate) were surveyed. Participants completed the Copenhagen Burnout Inventory (CBI) and the Effort Reward Imbalance scale, as well as survey-specific questions.
Both clinical and non-clinical staff were found to experience moderate or high rates of work-related, personal and patient-related burnout (57.6%, 52.2% and 50.8%, respectively). Univariate general linear modelling showed an association between total CBI scores and effort reward index (B = 64 306, t = 3.430, p = 0.001); overcommitment (B = 1.963, t = 3.061, p = 0.003); and an unwillingness to work in CAMHS (B = 28.429, t = 3.247, p = 0.002).
Pre-pandemic levels of stress were high among clinical and non-clinical staff surveyed. Given the anticipated increased demand on CAMHS post COVID-19, urgent action is needed to protect all staff from intolerable levels of occupational stress and burnout.
Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors.
This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants’ hospital admission.
Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70–97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium.
In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.
The Coronavirus Disease 2019 (COVID-19) has accounted for more than 25 000 cases in Ireland with approximately 28% of the clusters in nursing homes as of June 2020. The older population is the most vulnerable to serious complications from this illness and over 90% of deaths due to COVID-19 to date have been in patients over the age of 65. Continuing to provide routine care within nursing homes in these challenging times is an essential part of ensuring that presentations to hospitals for non-essential reasons are minimized. In this article, we describe a project being undertaken by a rural Psychiatry of Old Age Service in the northwest of Ireland. We aim to provide ordinary care in extraordinary times by using mobile tablets within the nursing homes and long-stay facilities in our region for remote video consultations during the COVID-19 crisis.
Psychopathological disturbances are common in the aftermaths of a disaster. The consequences of these disorders can be long lasting. In August of 2007 an intense and destructive wildfire broke out in the Peloponnesus peninsula in Greece.
To investigate psychological and psychiatric morbidity in individuals who had experienced severe exposure to a wildfire disaster in a part of Greece and to indentify risk factors for the post disaster psychological problems.
To investigate a broader spectrum of mid-term psychological and psychiatric morbidity in victims, to evaluate the proportion of psychopathology that could be accredited to the disaster, to estimate the association of losses with different psychological symptoms, to indentify risk factors for psychopathology.
A Cross sectional case control study of adult population (18–65 years old). Data collected among others were demographic, Symptom Checklist 90-Revised for assessment of psychological difficulties, type and number of losses.
Those damnified from the disaster scored significantly higher (p < 0.05) in the symptoms of somatisation, depression, anxiety, hostility, phobic anxiety, paranoia, and had significantly more symptoms (PST) and were more distressed by them (GSI) compared to controls. In addition risk factors for someone to be a psychiatric case were to be a victim from the fire, to have finished primary school, to be windowed and to have damages to his property.
Wildfires can cause considerable psychological symptoms in victims and there are reasons for public health policy makers to create services in order to help and improve the mental health of those affected.
The recent DSM-5 criteria for delirium can lead to different rates of delirium and different case identification.
The aims of this study were to determine how the new DSM-5 criteria might differ from the previous DSM-IV in detecting rates of delirium in elderly medical inpatients and to investigate the agreement between different methods, including the DSM III, DSM III-R, DSM-IV and DSM-5 criteria.
Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days using the DSM-5, and DSM-IV criteria plus the DRS-R98, CAM and MoCA scales.
The studied sample included 200 patients. The prevalence rates of delirium for each diagnostic system/scale were respectively for DSM-5 n=26 (13.0%), DSM-IV n=39 (19.5%), DRS-R98 n=27 (13.5%) and for CAM n=34 (17.0%). Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (rhotetr=0.64, SE= 0.1, p<0.0001). Similar significant agreement was found between the four methods.
DSM-IV identifies more delirium cases compared to any other method and DSM-5 is the more restrictive. These classification systems identify different cases of delirium. This could have clinical, financial and research implications. However, both classification systems (and their antecedents) have significant agreement in the identification of the same concept (delirium). Clarity of diagnosis is required for classification but also has implications for prediction of outcomes, further research looking at outcomes could assist a more in depth evaluation of the DSM-5 criteria.
Delirium is a common neuropsychiatric disorder. The natural course is of an acute, fluctuating and often transient condition; however, accumulating evidence suggests delirium can be associated with incomplete recovery. Despite the growing body of relevant research, a lack of clarity exists regarding definition and outcomes.
To clarify the definition of recovery of delirium used in the literature.
A Medline search was performed using relevant keywords. Studies were included if they were in English, provided any definition of recovery, and were longitudinal. Excluded articles were duplicated studies, case studies, review articles or articles related to alcohol, children, subsyndromal delirium only or those investigating core symptoms such as function.
Fifty-six studies met the inclusion criteria. Only 2 studies used clinical criteria alone for the diagnosis of delirium, most studies used at least one validated scale, either categorical or continuous severity scales. A variety of 16 different terms were used to define the 'recovery of delirium”. The definitions of each term also varied. Studies using severity scales used either cut-off points or percentage reduction between assessments while others using dichotomous scales (yes/ no) defined as recovery one or more days of negative delirium as the end point.
An agreed terminology to define recovery in delirium is required. A distinction should also be made between symptomatic and overall recovery as well as between long and short term outcomes. It is proposed that cognition recovery may be used as outcome to identify recovery of delirium.
Delirium is associated with poor outcomes and high mortality. Current research shows conflicting results regarding mortality rates in patients with delirium.
The aim was to examine the hazard risk associated with delirium in elderly medically ill patients at 1 year follow-up, controlling for baseline risk factors and interaction effects.
This was a prospective, observational, longitudinal study carried out in the medical wards of Sligo Regional Hospital. All acute medical admissions of patients 70 years old and over were approached. Each patient was assessed twice weekly for 2 weeks or until discharge. The following scales were used: CAM, DRS-98R, MoCA, Barthel Index, APACHE II. Primary outcome was time of death during 1 year. Cox proportional hazards were estimated and compared across patients who had delirium during hospitalisation and those who did not.
Two hundred patients agreed to take part in the study. The mean age of the studied sample was 81.13 (SD = 6.45; minimum 70 and maximum 100 years old) with 100 (50%) females. One hundred fifty four (77%) patients never developed delirium during hospitalization. Thirty four (17%) had delirium at admission and 12 (6%) developed prevalence delirium while inpatients. A total of 55 (27.5%) patients died during the one year follow-up. Significant risk factors for 1 year mortality were length of hospital staying, severity of illness (APACHE II), and cognition (MoCA).
Delirium was not found as an independent risk factor for 1 year mortality after controlling for other confounder variables.
Siblings’ relationships have been seen as determinants of emotional and personal development. Although Greece is assumed a country with strong family bonds there is not empirical research in this area. Similarly Ireland is traditionally viewed as a country with strong family values.
In an attempt to conduct a comparative study of siblings’ relations the lack of a Greek valid instrument was obvious. The Sibling Relationship Questionnaire (SRQ) is a widely used scale which is a self reported measurement of this relationship.
Thus, in an attempt to employ an easily administered and valid measure, to assess sibling relationships, but also to be able to compare the results across countries the SRQ was the scale of choice.
a random sample of 185 adolescents aged 13 to 18 years old. SRQ has been translated (forward and backwards) to Greek language. Concurrent validity, internal consistency, test-retest reliability and agreement between children-parents versions of the translated scale were investigated.
The concurrent validity ranged from 0.29 to 0.68, the overall internal consistency (Cronbach's alpha) was equal to 0.86 and the test-retest reliability (Spearman's rho) ranged from 0.58 to 0.78. Agreement between children-parents versions was significant only when mothers do the rating.
Thus it seems that the translated Greek version of SRQ is a valid and reliable instrument to be used in the measurement of sibling relationships in Greek population, and can be used as a measurement for multinational clinical research and comparison with findings from other countries.
Research across a range of disaster types has identified that psychological disturbances are common in the aftermath. The consequences of these disturbances can be long lasting.
This study assessed the long-term mental health effects of a wildfire disaster which happen in a rural area of Greece in 2007.
a) to assess the course of psychopathology associated with the disaster, b) to evaluate if there are differences in psychological distress between victims and controls 3 years after the disaster.
The population for this cross-sectional study was a random sample of adult population (18–65 years old) of victims and controls who had been assessed 2½ years before. The measured variables were: a) demographics b) Symptom Checklist 90-Revised (SCL-90-R).
530 participants (301 victims and 229 controls). Attrition rate: 13.8%. Psychological distress was significantly (p < 0.05) lower 3 years after the disaster compared to initial assessments. However, victims of the wildfires still had more distress compared to controls. Similarly, the number of caseness (as it is defined by the SCL-90-R) was significantly higher in the victims’ group compared to controls’. In contrast, there was a significant reduction of the rates of caseness in both victims and controls compared to initial assessments.
Most psychological problems decreased from the initial (6 months after the disaster) to the second survey (3 years after) among affected from the wildfires participants. Although their psychological problems decreased, victims still had more psychological problems (e.g. anxiety, somatisation, phobias) than the participants in the control group.
Despite the increase of research and awareness in delirium it remains underdiagnosed, protean, difficult to manager and more difficult to comprehend.
To find the clinical diagnosed rates of delirium, the possible aetiologies to describe treatment (psychotropics) and to investigate the reasons of referrals to Old age psychiatric team in relation to delirium in a general medical hospital.
Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during a 6 month time
156 files had a documentation of delirium (time prevalence 2%).
Mean age of the sample was 82 years old (SD=7.2), 66 (42%) were male.
69 (44.2%) of the total sample had a previous history of dementia, 57 (36.5%) had a previous history of delirium. In 62 (40%) the cause was infection while in 4 no specific cause was indentified.
90 (58%) referred to liaison service but only in the 26 (28.9%) the reason for referral was’acute confusion’ or’delirium’ while in a majority of referrals the reason was one of the affective disorders and more often depression. There were not any significant differences between delirium subtypes and referrals (χ2=3.868, df:3, p=0.28). Examination of the amount of antipsychotics prescribed pre during and after delirium shows that there was a significant increase of antipsychotics during the delirium (χ2=17.512, df:8, p=0.025) decrease of z-medication, (χ2=20.114, df:4, p<0.001) while benzodiazepines and antidepressants remained same.
Delirium is often misdiagnosed and unrecognized in hospital settings, however when is indentified the pharmacological management is rather optimal
Although disasters differ widely, they usually have some common psychological and social consequences. Psychological symptoms can range from mild and transient ones, such as altered behaviour or acute distress, to severe such as major depression and suicidality. Studies following those collective traumatic events have shown reduced levels of Quality of Life (QoL) in the affected populations.
To investigate the QoL in individuals who had experienced severe exposure to a wildfire disaster in a part of Greece three years after the disaster.
A) to examine the QoL of the victims, b) to compare the quality of life of those affected by the disaster (cases) with the quality of life of those who were not (controls) and c) to examine factors which may have a significant effect on the quality of life (psychological factors, losses, and demographics).
A Cross sectional case control study of adult population (18–65 years old). the measured variables were: A) quality of life using the WHOQOL-BREF measure, b) previous psychiatric caseness as identified using the SCL-90-R and c) demographics.
364 participants (184 victims and 180 controls).Victims of the wildfires had a statistically significant poorer quality of life in the three domains of physical health, psychological health, and environment compared to controls. After adjusting for other variables, the only difference between victims and controls was in the environment domain.
Disasters have long lasting effects on victims. Psychological and physical health may improve after some time but environmental quality of life may need longer.
Delirium is a common neuropsychiatric syndrome with considerable heterogeneity that includes a variety of clinical (motor) subtypes. Because delirium is typically highly fluctuating, understanding the longitudinal stability of subtypes is crucial to evaluating their relevance to treatment and outcome.
to examine the changes (variability) in motor subtype profile in patients with delirium over serial assessment using the Delirium Motor Subtype Scale, and to investigate predictors of variability.
We studied motor subtype profile of patients with delirium assessed daily over a week in elderly patients undergoing hip fracture surgery. A Generalized Estimating Equations Model examined possible predictors of change in motor subtype status, including baseline variables and delirium course.
We included 118 patients developing DSM-IV delirium after hip-surgery [mean age 87.0±6.5 years; range 65–102; 66% females]. At first assessment, hyperactive subtype was most common (49%), followed by hypoactive (31%) and mixed subtype (14%), with 6% of delirious patients not fulfilling criteria of any DMSS-defined motor subtype. Almost two-thirds (n=69) of these patients underwent at least one more assessment, and for these 45 (57%) remained stable in motor subtype over time, while the rest 34 (43%) underwent change. A range of baseline characteristics were not significant predictors of variability in subtype profile.
Motor subtype profile is typically stable for orthopaedic patients with delirium. Thus evidence from cross-sectional studies of motor subtypes can be applied to many patients with delirium. Further longitudinal studies can clarify the stability of motor subtypes across different clinical populations.
Cognitive impairment during acute illness in older patients is acknowledged, although factors that underpin this condition are less well studied.
To investigated the relationship between cognitive recovery and a range of clinical and biological variables.
Observational and longitudinal study. Participants were consecutive patients aged ≥70 years assessed within 3 days of their admission to elderly medical unit and re-assessed twice weekly with the DRS, CAM, MMSE, APACHE II, APS, Barthel index, frailty scale. Cytokines and APOE genotype were measured in a subsample.
142 patients were analysed [mean age 84.8±6.4; 47 (33%) male; 64, (45% with comorbid dementia]. 55 (39%) experienced cognitive improvement, of which 30 (54.5%) had delirium while 25 had non-delirious acute cognitive disorder. Using bivariate statistics, subjects with more severe acute illness, lower IGF-I levels and more severe delirium were more likely to experience ≥ 20% improvement in MMSE scores. When the criterion of cognitive improvement was a 3 point improvement in MMSE, those with more severe delirium, females and greater age were more likely to improve. Longitudinal analysis using any criterion of improvement indicated that improvement was significantly (p<0.05) predicted by higher levels of IGF-I, lower levels of IL-1 (alpha and beta), lack of APOE epsilon 4 allele, female gender and the interactions of APOE genotype with IGF-I, and dementia with IGF-I.
Cognitive recovery during admission is not exclusively linked to delirium status, but reflects a range of factors. The character and relevance of non-delirious acute cognitive disorder warrants further study
Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Rapid reliable identification of clinical subtypes can allow for more targeted and research efforts.
The aims of this study are to evaluate the concurrent validity (agreement) and reliability (internal consistency) of DMSS-4 in a new cohort of delirious hospitalised patients.
We explored the concordance in attribution of motor subtypes between the DMSS-4 and the original DMSS (assessed cross-sectionally) and subtypes defined longitudinally using the Delirium Symptom Interview (DSI) method.
We included 118 elderly patients developing DSM-IV delirium after hip-surgery [mean age 87.0±6.5 years; range 65–102; 66% females; 28 (23.7%) had no previous history of cognitive impairment]. Concordance was high for both the DMSS-4 and original DMSS (k=0.80), and for the DMSS-4 and DSI methods (k=0.82). The DMSS-4 also demonstrated high internal consistency (McDonald's omega = 0.78). The DMSS-11 and DMSS-4 had higher inclusion for motor subtypes than the DSI method.
The DMSS-4 provides an ultra-rapid means of identifying motor-defined clinical subtypes of delirium and is a reliable alternative to the more detailed and time-consuming original DMSS and DSI methods of subtype attribution. The DMSS-4 can be readily applied to further studies of causation, treatment and outcome in delirium.
The role of APOE in Alzheimer’s disease and other dementias has been intensively investigated. However APOE in delirium has only recently been investigated in studies with small samples. There is evidence that APOE relates to delirium by one or more of the following pathophysiological mechanism: a) inhibition of inflammation in the CNS during acute illness, with release of inflammatory mediators, b) modification of inflammatory responses in an isoform-specific manner, c) by blocking both nicotine and acetylcholine receptors causing the anticholinergic effect which is assumed in delirium.
A meta-analysis of the published pooled data seems timely to establish any relationship between APOE and delirium, and to determine further direction of research in this topic.
To find out if there is any direct relationship between the APOE epsilon 4 and the occurrence of delirium.
Pubmed, MEDLINE, EBSCOhost and Google Scholar have been searched with the relevant keywords, and from the references of relevant papers. Nine papers were found which examined the relationship between APOE and delirium. Data were extracted from 8 of them and were pooled for meta-analysis using random effects with R software.
Data from 1762 participants showed no heterogeneity (Q=13.55, df:7, p=0.06). The possession of the APOE epsilon 4 allele has a small (OR:1.17, CI:0.77-1.80), non-significant (p=0.45) effect in the presence of delirium.
There is no association between APOE and the occurrence of delirium. Confirmation and clarification in larger studies could have important clinical implications for predicting prognosis and for treatment of delirium.
The new version of DSM-5 provides nearly the same criteria as DSM-IV for delirium with an exception. The DSM-5 requires a disturbance in awareness while DSM-IV, a disturbance in consciousness.
Awareness is not the same as consciousness. In this study we examined the concordances between awareness and consciousness and the agreement between DSM-5 and DSM-IV.
All acute medical admissions 70 years and over. Exclusion criteria: terminal phase of illness, severe aphasia, intubated. Those included were assessed on Day 1, 3, 7, 10 of their admission. During the assessment each individual was tested with: MoCA, DRS-98R, CAM, RASS and the subscale of levels of consciousness and awareness of surroundings from RCDS; APACHE II, CAPE and BARTHEL index. Demographic data and a medication list were also recorded.
Mean age: 81.3 SD (6.7) range 70-100 years old
Delirium according CAM 21 (17.1%)
Delirium 23 (18.7%)
Subsyndromal delirium 28 (22.8%)
No delirium 72 (58.5%)
Previous cognitive decline: 76 (61.8%)
RCDS (awareness and consciousness)
Mean awareness: 0.4, SD (0.8)
Mean consciousness 0.4 SD (0.8).
Correlation (agreement) between awareness and consciousness Kendal's Tau =260, p=0.026
Using the awareness definition of delirium 8 participants with full awareness of surroundings have been indentified as delirious according to DRS 98, while using the consciousness definition 12 participants where indentify as delirious.
DSM-IV and DSM-5 detect two slightly distinct populations with delirium. Awareness and consciousness are not the same. DSM-5 is more restrictive in indentifying delirium.
The Family Assessment Device (FAD) is a self-report questionnaire, developed to assess the six dimensions of the McMaster Model of family functioning. It has been translated to the Greek language but never validated.
Aims and objectives
To evaluate the psychometric properties of the Greek version of FAD in a non-clinical sample.
In a sample of Greek families, FAD was administered together with the already validated Family Adaptability and Cohesion Evaluation Scale (FACES-III). In a subsample of 96 participants, the scales were administered again after 1 month.
A sample of 453 participants (194 children and 259 parents) had completed both questionnaires (151 families). Mean age of children was 23.62 (SD: 6.35), 68 (35%) were males. Mean age of parents was 51.4 (SD: 8.2), 117 (45.2%) males. All subscales of FAD had significant correlation (concurrent validity) with FACES-III (n = 453, P < 0.001). Test-retest reliability range from 0.58 to 0.82 (n = 96, P < 0.001). Internal consistency (Cronbach's alpha) range from 0.47 to 0.94. A model with the 6 factors had a good statistical fit but not all the items were loading in the same components as from the theory assumed.
The Greek FAD has good psychometric properties, although its factor structure might differ from the original version. Further evaluation of the Greek version of FAD in other settings and in different samples especially clinical remains a task for future research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.