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Purpose: The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors., Methods: The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates., Results: The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree., Conclusions: Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.

Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017. We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented "Self-neglect", nursing diagnosis NANDA-I, and needed economic social service support. Multiple linear regression revealed that the presence of some variables as "many medical consultations", "economic social service support", "clinical interviews extended to institutional figures" were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.

Background: In Italy the Law 9/2012 prescribed the total closure of forensic psychiatric hospitals (OPGs) and the conversion to a care model based on residential units in the community employing only clinical personnel (Residenze per l'Esecuzione delle Misure di Sicurezza - REMS) and fully integrated in public mental health services. The aim of this study is to report sociodemographic, clinical and criminological characteristics of patients admitted in Volterra REMS since it opened on 01/12/15 up to 31/12/17., Methods: Sociodemographic and clinical information was collected from official documents (clinical files, ward reports) and from patients' personal health records. Psychiatric diagnoses were made by REMS psychiatrists according to the DSM-5 criteria. Criminological information was obtained from patients' criminal records., Results: Volterra REMS patients' characteristics are similar to those of samples of OPGs patients (unmarried socially disadvantaged males with an average age of 40, no offsprings, low education, high rates of Schizophrenia Spectrum Disorders and medical comorbidity). However, the REMS model presents a very high turnover rate: during the study period 61 patients were admitted while 32 were discharged. Being assisted by public mental health services before committing the crime increased the probability of discharge. In non-EU patients long acting injectable antipsychotics were used more frequently than in community ones. Substance-Related Disorders are the main psychiatric comorbidity and resulted as being more frequent in bipolar patients than in other patients., Conclusions: Due to the high patients' turnover, we expect a progressive change in sociodemographic, clinical and criminological features of the REMS population. The REMS model provides a return for mentally disordered criminals to the care of local public mental health services which are recovering after many years some of their most challenging patients ensuring their deinstitutionalization and reintegration into society., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Before its closure on April 1, 2015, the Castiglione delle Stiviere was the only maximum-security hospital in Italy that admitted women. In this context, the investigators examined factors related to psychopathy that were thought to be gender specific. Several prior investigations have reported a significant correlation between psychopathy and borderline personality disorder, a disorder thought to represent the phenotypical expression of psychopathy in women. The purpose of this research was to identify psychopathological and phenotypical gender-specific factors that are associated with psychopathy in women. The data appear consistent with that found in the recent international literature and also highlight the different phenotypical manifestation of psychopathy in the two genders. Whereas in males psychopathy is associated with antisocial personality disorder, in females psychopathy is associated with borderline personality disorder., (© 2018 American Academy of Psychiatry and the Law.)

Filling an alarming gap in evidence-based data on the post-1978 reformed Italian psychiatric system, two turn-of-millennium nationwide projects, Progetto Residenze (PROGRES) and PROGRES-Acute, provided detailed qualitative-quantitative information about care facilities. In 2000, there were 2.9 residential beds per 10,000 inhabitants, hospital care being delivered through small (15-bed) psychiatric units. Private inpatient facilities had proliferated, private inpatient beds per 10,000 inhabitants outnumbering public beds. In 2002, there were 1.7 acute inpatient beds per 10,000 inhabitants, one of Europe's lowest current ratios. The PROGRES and other subsequent projects showed marked nationwide variation in the provision of residential inpatient and outpatient care, grounds for concern about the quality of such care, and an uneven service use pattern. Although the Italian reform law produced a broad network of facilities to meet diverse mental health care needs, the present overview article confirms that further efforts are required to improve quality, balance public and private sectors, and coordinate resources and agencies.

Background: and, Aims: Immigrants in Europe appear at higher risk of psychiatric coercive interventions. No studies have investigated this issue in Italy. The aim of this study is to investigate whether the use of physical restraint, compulsory admission and other treatment characteristics differ in immigrated and Italian-born patients admitted to a psychiatric intensive care unit., Methods: One hundred first-generation immigrant patients were compared to 100 age-, gender- and diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Clinical data and treatment characteristics were collected., Results: Immigrant patients were more likely to be physically restrained as compared to Italian-born patients (11% vs 3%; χ (2) = 4.92; p = 0.027; RR = 3.67; 95% CI = 1.05-12.7). No differences in the proportion of involuntary treatment were found. Immigrant patients did not receive higher doses of antipsychotics or benzodiazepines, but they had a longer stay in the hospital., Conclusions: The higher rate of physical restraint among migrants may reflect cultural, ethnic and language differences leading to communication problems between immigrant patients and mental health professionals. Since coercive interventions can be harmful, specific strategies to prevent this phenomenon in immigrants are needed.

Purpose: The present study investigated: (i) the rate of prescription of antipsychotic (AP) polypharmacy (APP) in a large, representative sample of psychiatric inpatients; and (ii) the relationship between APP prescription and the characteristics of patients and facilities., Methods: The sample included 1022 psychiatric patients scheduled to be discharged from acute inpatient facilities with drug therapies including AP. Demographic and clinical data were obtained from the treating physician or retrieved from patients' records through a standardized Patient Form. Patients were administered the 24-item Brief Psychiatric Rating Scale. Three indicators were used to describe the process of care in the facilities: a Restrictiveness score, a Standardization score, and a Treatment score. A multilevel mixed-effect logistic regression was used to predict APP using patient and facility as the variables., Results: APP was prescribed to 333 (32.5%) patients, the most common patterns being a first-generation and a second-generation AP (n = 178, 17.6%) or of two first-generation APs (n = 80, 7.8%). Patients with a diagnosis of schizophrenia and poorer insight into illness at admission were significantly more likely to receive APP. The availability of more complex therapeutic interventions in the facility was also associated with APP., Conclusions: In our nationwide sample of psychiatric inpatients, APP was frequently prescribed to treat the more severe patients. However, it was also associated with process of care characteristics such as delivery of more complex therapeutic interventions, and was therefore not used only to control patient behavior., (Copyright © 2010 John Wiley & Sons, Ltd.)

Background: Interest in the history of psychiatry continues to grow, with an increasing emphasis on topics of current interest such as the history of nosology and the interplay between psychiatry and society., Aims: The present study was designed to investigate diagnoses and sociodemographic characteristics of patients during the course of the last century in a sample of Italian psychiatric inpatients. The study also throws light on changes in the practice of explaining and classifying mental disorders., Methods: This was a chart analysis of clinical records of 1334 patients hospitalized at "Santa Maria della Pietà" in Rome from 1920 to 1980. We chose every tenth year and the month of May because, on average, there was a reasonable number of admissions compared with the peak of admissions in August and an almost lack of admissions in January., Results: There were relevant differences in diagnostic nomenclature and course of illnesses from 1920 to 1980 in Italy. Schizophrenia was first diagnosed in 1930 and 1940 and then rapidly declined; melancholia was first diagnosed in 1930 but rapidly decreased, whereas dysthymia appeared later in 1960. Dysthymia, manic, and depressive disorders rapidly appeared since 1980. In the "other disorders" group category, there were three peaks in frequency--one in 1930, another in 1940, and the most frequent in 1980., Conclusions: The consistency in diagnosis and the organization of psychiatric services in the last century were quite poor. Improving psychiatric services and quality of care remain a relevant challenge for physicians.

The study takes a detailed look at psychiatric patient violence towards their psychiatrists. It takes into consideration the views and opinions of Italian psychiatrists, whether they have experienced violent behaviour first hand and, if so, which type of aggression and whether this caused them to modify their behaviour towards the patient and his or her treatment. A multiple-choice questionnaire is sent to all members of the Italian Society of Psychiatry, with 1,202 psychiatrists responding (20.23% of the sample). The data are evaluated using SPSS with chi-square test calculations for discrete and continuous variables and t-testing for independent samples (significance p < .05). Almost all psychiatrists (90.9%) have experienced verbal aggression; 72% have been threatened with dangerous objects and 64.58% have suffered physical aggression. Physical aggression experiences result in a 50% increase in the probability of modifying one's therapeutic behaviour. Significant differences emerge between the psychiatrists, according to differences in age and career experience. Psychiatrists state that they do not consider themselves to be adequately prepared to deal with the violence of patients, and almost all psychiatrists felt the need for specific training in how to manage such violence.

Background: Given the current tendency to shorten psychiatric hospitalization and change its organization, an issue could be raised regarding its outcomes., Purpose: To analyze features related to length of stay in a short-term inpatient treatment, to study outcomes and to evaluate the diagnosis-specific effects of hospitalization., Method: A sample of 310 consecutive hospitalized patients, with psychotic disorder, depressive disorder and bipolar disorder (DSM IV-TR), was recruited at the University Psychiatric Clinic, Service for Cognitive Disorders, Department of Neuroscience, University of Turin. Severity of illness was rated using the brief psychiatry rating scale (BPRS). We evaluated relations between length of stay and clinical and socio-demographic features (linear regression) and possible differences confronting BPRS scores at admission and discharge in the different diagnostic subgroups (ANOVA for repeated measures)., Results: All the sample of patients showed a significant improvement in symptomatology during hospitalization. Worse symptomatology in anxiety-depression domain of BPRS at admission in the whole sample was positively correlated with length of stay. A longer length of stay was also shown in patients with diagnosis of depressive disorder. Finally, a different pattern of improvement of BPRS (total score and domains) was shown between the different diagnostic groups., Conclusion: Brief hospitalization in our service was shown to be highly effective. Different diagnostic groups had different response to hospitalization, showing faster improvement in characteristic symptomatology, but the anxiety-depression domain showed the highest percentage of change for all the diagnostic groups. We therefore suppose that hospitalization has two effects: a specific (due to tailored therapies) and a non-specific one (due to non-specific therapy and to a placebo-like effect).

Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members. Variables associated with violent behavior were: male gender, <24 years of age, unmarried status, receiving a disability pension, having a secondary school degree, compulsory admission, hostile attitude at admission, and a diagnosis of schizophrenia, bipolar disorder, personality disorder, mental retardation, organic brain disorder or substance/alcohol abuse. Violent behavior during hospitalization was a predictive factor for higher Brief Psychiatric Rating Scale scores and for lower Personal and Social Performance scale scores at discharge. Despite the low percentage of violent and hostile behavior observed in Italian acute inpatient units, this study shed light on a need for the careful assessment of clinical and treatment variables, and greater effort aimed at improving specific prevention and treatment programs of violent behavior.

The aim of this study is to compare psychiatric patients' satisfaction with their treatment in Munich and in South Tirol. For this purpose, besides clinical and social-demographic factors, for each sample-group of patients, their general satisfaction, their valuation of the different aspects of hospital treatment and life quality were considered and compared. The relevance of these elements in the global satisfaction was examined with linear multiple regression models. The results of the research show a rather high level of global satisfaction in both sample-groups, even if statistically relevant differences occur in evaluations of several aspects of the treatment. In Munich's sample-group a higher rate of satisfaction emerged in relation with the treatment: the attitude of the medical staff, the psycho-pharmacological treatments, the clinic's image and the conduct of the nursing staff. In both groups the most relevant factor for patients' satisfaction, besides the positive results of the treatment, was the attitude of the doctor, and in particular way his empathy with the patient. In regard to the age, the diagnosis and the duration of the hospitalization, it was not possible to demonstrate, in both sample-groups, any statistically relevant connection with the general satisfaction rate, while a high rate of trust in the doctors and in the medicines was found to be, in each group, a significant condition for a positive evaluation of the treatment. The influence of the personal life-quality was proven statistically relevant but weak. Altogether, regardless of the medical structure that was examined, the results underline the predominant importance of the curing doctor's social and emotional skills for patients' satisfaction.

Background: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management)., Method: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO--Psychiatric EmeRgency Study and EpidemiOlogy)., Results: 253 FPA aged < or = 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers., Conclusion: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients.

Aims: This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health ("Progetto Obiettivo 1994-1996") ten years after its launch., Methods: The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents., Results: CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites., Conclusions: A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

Background: Since the 1978 Italian reform, an integrated network of community mental health services has been introduced. With few exceptions, research on determinants of mental health service use at the district level has focused on inpatient activities and social deprivation indicators. The European Psychiatric Care Assessment Team (EPCAT) standardized methodology allows for an evidence-based comparison of mental health systems between geographical areas., Aims: To compare service provision and utilization between local catchment areas; to explore quantitative relationships between residential and community service use and socio-demographic indicators at the ecological level., Methods: The European Socio-demographic Schedule (ESDS) was used to describe area characteristics, and the European Service Mapping Schedule (ESMS) to measure service provision and utilization in 18 catchment areas in Piedmont., Results: Substantial variation in service use emerged. Acute hospital bed occupancy rates were lower in areas with more intensive community continuing care service users and with a smaller percentage of the population living alone. The non-acute hospital bed occupancy rate was directly related to the percentage of the population living alone or in overcrowded conditions, and to the level of mobile continuing care service users. Community continuing care service use was highest in areas with a larger percentage of the population living alone., Discussion: Multiple regression models explained between 48 and 55% of the variation in inpatient and community service use between areas. Relationships based on ecological characteristics do not necessarily apply to the individual. This level of assessment, however, is necessary in evaluating mental health policy and service systems, and in allocating resources., Implications for Health Care Provision and Use: The distribution of mental health care resources should be weighted in terms of indicators of social deprivation shown to be important predictors of both inpatient and community service use, as these are likely to be related., Implications for Health Policies: To ensure horizontal equity in access to mental health care, particularly for people with severe mental illness, evaluation of mental health policy should be based on a concurrent evidence-based assessment of the organization and use of both residential and community services, in relation to area level indicators of social deprivation., Implications for Further Research: Cross-national research using an internationally standardized methodology should consider the influence of the social network independently of other socio-economic indicators, to verify the relative importance of this in predicting service use in southern and in northern European countries.

Of 550 mentally retarded patients in an Italian institution, 125 (23%) were found to be infected with intestinal parasites. The infections were most frequent in young men, those with severe mental retardation, the chronically institutionalized and those living in older wards. Ninety-four (75.2%) of the parasitised subjects were infected only with protozoa, 25 (20%) only with helminths, and six (4.8%) with protozoa and helminths. Entamoeba histolytica and E. dispar infections were detected, but at low prevalences; in-vitro culture in Robinson's medium and isoenzyme electrophoresis of the cloned amoebic isolates indicated one infection with E. histolytica (zymodeme XII) and two infections with E. dispar (zymodemes I and III). All three Entamoeba-positive subjects were asymptomatic cyst-passers. Antibodies to E. histolytica were detected in seven (1%) of the sera from the 550 patients examined; only one of these was a carrier of an E. dispar strain at the time of investigation. The low prevalences of all the parasitic infections and of the amoebic infections in particular (compared with those observed previously in institutions for the mentally retarded) reflect relatively good facilities and sanitary conditions, an adequate number of well trained staff and good control of the more susceptible subjects.

Objective: Following the introduction of guidelines of rational drug use, the pharmacoepidemiology of psychotropic drugs was investigated in a sample of long-stay patients living in a Italian psychiatric hospital., Design: A prospective, longitudinal two-year follow-up study was carried out. Information about sociodemographic and clinical characteristics of the inpatient population, and about medications prescribed, was collected at baseline and after one and two years of follow-up., Setting: Three wards of the psychiatric hospital of Milan., Main Outcome Measures: Number of patients taking psychotropic drugs, number of patients taking more than one neuroleptic or benzodiazepine, mean neuroleptic dose, psychopathological status according to the Brief Psychiatric Rating Scale (BPRS)., Results: 70 patients were recruited and followed for two years. At follow-up a reduction in the number of patients taking neuroleptic drugs was recorded, together with a 50% decrease in the number of patients taking more than one neuroleptic. A reduction in the use of depot formulations was in addition shown. Patients taking benzodiazepines decreased of 50%. According to the BPRS, no psychopatological changes were observed during the study., Conclusions: These data suggest that education in psychopharmacology may guide towards a more rational use of drugs; longitudinal clinical audits should be implemented to monitor everyday practice.

Background: This work followed a group of patients living in a psychiatric hospital in Central Italy in 1978 at the time of enforcement of the Italian reform law (No. 180) for closing down mental hospitals. The study had the following aims: a) to compare in terms of mortality patients discharged into the community with patients who did not experience deinstitutionalization; b) to determine the survival of the cohort of patients and to analyse prognostic risk factors for death; c) to analyse differences in mortality rates between psychiatric patients and the general population., Methods: The study was designed as an historical follow-up investigation. Univariate (product limit) and multivariate (proportional hazards model) methods were used to estimate prognostic variables and related death risks. Mortality was assessed using standardized mortality ratios (SMR) on the entire cohort as well as after stratification according to age, sex, cause of death and discharge status, assuming the Abruzzo Region's population as standard., Results: Length of hospitalization and discharge from hospital are prognostic variables for death risk, with relative risks respectively of 4.22 (95% confidence interval [CI]: 2.41-7.40) for a length of hospitalization of 10-25 years, and 8.13 (95% CI: 4.73-13.88) for non-discharge. The global SMR of the cohort was 2.68 (95% CI: 2.42-3.07). Non-discharged patients showed higher SMR than discharged. Excess mortality was found both in males and females for circulatory, respiratory and undefined diseases. A significantly lower mortality for cancer was observed in male patients. A strong excess mortality was observed in younger patients (20-29 years: SMRmales = 43.57; SMRfemales = 97.52)., Conclusions: Longer periods of hospitalization and non-discharge from hospital are the main risk factors for death in psychiatric patients, who globally experience higher death rates than the general population for a wide spectrum of causes of death, whatever their diagnosis or gender. These findings strongly suggest positive actions in order to overcome the effects of institutionalization.

The aim of this study was to explore the extent and the specific features of drop-out for patients having a first contact with an university psychiatric outpatient clinic in Italy over the course of 1 year and to determine which variables were associated with early termination of treatment. Of the 158 patients selected for this study, there was an overall 3-month drop-out rate following the first visit of 63%. Of the 59 patients who had returned once after the initial contact, 28 interrupted subsequently the treatment, although the therapist's plan included further visits. The overall drop-out rate at 3 months was thus 82%. The only 2 variables associated with drop-out rates were the patients' perception of the severity of their disorder and the psychiatric history: continuing patients were more frequently in agreement with the clinician's judgment as compared with those who dropped out and were more likely to have already been in psychiatric treatment.

The present research studies the evaluation in the Judicial Psychiatric Hospital of Castiglione delle Stiviere, as the treatment of the criminal mental illness (Psychopathology) has been evolving after the normative change that has abolished every form of legal presumption of social danger. Eighty-three files were analysed during the period January 1991 to March 1993 relative to the interns of the J.P. Hospital; particularly examined were the evaluation methods high-lighted by the observation group and the treatment called into use to supply an opinion on the dismissal of the (same) interns and on the consequences (or not) of admitting them into a form of outpatient treatment.

The psycho-social problems of a group of 365 Italian emigrants to Switzerland, admitted to psychiatric hospitals, were studied. It was found that non professional subjects (housewives, unemployed, retired) and manual workers (builders, waiters, factory workers) were more likely to suffer from psycho-social disorders. Only 11.1% of those studied had received a secondary education, therefore it could be assumed that subjects having a low technical and cultural level were less prepared, psychologically, for their new situation and were thus more susceptible to psycho-social disorders. The most frequent diagnoses were found to be: affective disorders, alcohol addiction, opiate addiction and schizophrenia. The study revealed that emigrants ran a greater risk of first time admittance to psychiatric wards whereas the local population had a greater number of relapses. In conclusion it is stressed that assistance with an aim to improve work, social and relationship conditions and to integrate the emigrants into their host society can reduce some forms of psycho-social disorders.