The Hospital Anxiety and Depression Scale (HADS) is a widely used self-report measure to assess emotional distress in clinical populations. As highlighted in recent review studies, the latent structure of the HADS is still an issue. The aim of this study was to analyze the factorial structure of the HADS in a large community sample in Italy, and to test the invariance of the best fitting model across age and gender groups.

In this study we examined whether differences in the habitual use of mindfulness skills were associated with specific well-being and neuroticism aspects. Two hundred eleven volunteers aged 21–84 years completed measures of mindfulness, neuroticism, psychological well-being (PWB), and subjective well-being (SWB). Describing, observing, and acting with awareness (i.e., the mindfulness “what” skills) were positively correlated with personal growth, purpose in life, and autonomy (i.e., the “core” eudaimonic components of PWB). Nonreactivity and nonjudging (i.e., the mindfulness “how” skills) were negatively associated with neuroticism aspects, such as withdrawal (e.g., depression) and volatility (e.g., anger). Describing and nonreactivity were the only mindfulness skills significantly correlated with the SWB measures. Acting with awareness mediated the effect of both withdrawal and volatility on eudaimonic well-being outcomes. Describing had consistent mediation effects across all well-being measures, but only for the withdrawal aspect. Nonreactivity and nonjudging did not mediated withdrawal when considering eudaimonic well-being as outcomes. Mediation effects for nonjudging and nonreactivity were found between volatility and SWB markers as well as between volatility and self-acceptance, environmental mastery, and positive relations with others (i.e., the “other” eudaimonic PWB components). In sum, the mindfulness “what” skills were important for eudaimonic well-being, especially for internalizing individuals. Authors discuss the usefulness of a facet-level analysis of mindfulness for examining incremental validity of some facets over others in accounting for different well-being outcomes measures. Clinical implications are also discussed.

Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7–10 and 15–20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.

Background: Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review. Methods: A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach’s α was used to assess the reliability of the scale. Results: This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith. Conclusions: The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.