
==== Front
Clin Neuropsychiatry
Clin Neuropsychiatry
cn
Clinical Neuropsychiatry
1724-4935
2385-0787
Giovanni Fioriti Editore srl Italy

10.36131/cnfioritieditore20240403
Research Paper
Euthymia, Psychological Well-Being, and Professional Quality of Life in Health Care Workers
Merlo Emanuele Maria 1
Sicari Federica 2
Myles Liam Alexander MacKenzie 3
Settineri Salvatore 1
1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
2 Department of Cognitive Sciences, Education and Cultural Studies, University of Messina, Messina, Italy
3 Department of Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK.
Corresponding author Emanuele Maria Merlo E-mail: emerlo@unime.it
Citation: Merlo, E. M., Sicari, F., Myles, L. A. M., Settineri, S. (2024). Euthymia, psychological well-being, and professional quality of life in health care workers. Clinical Neuropsychiatry, 21(4),266-275.

Funding: None.

Competing interests: None.

Authors’ contribution: E.M.M and F.S. made significant contribution to the conception and design of the study. E.M.M, F.S. and L.A.M.M. made a significant contribution to the design of the protocol, statistical analysis of data, and drafting of the manuscript. E.M.M. and F.S. made a significant contribution to the interpretation of data and comparison with the literature. E.M.M, F.S., L.A.M.M. and S.S. revised the manuscript and gave their approval. All authors have read and agreed to the published version of the manuscript.

8 2024
21 4 266275
7 2023
7 2024
© 2024 Giovanni Fioriti Editore s.r.l.
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ CC BY-NC-SA This article is published under a Creative Commons license. For more information: https://creativecommons.org/licenses/by-nc-sa/4.0/
Objective

Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings.

Method

The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5).

Results

The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction.

Conclusions

Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals’ euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.

affectivity
clinical psychology
euthymia
mental health
mood
well-being
==== Body
pmc1. Introduction

Psychological well-being and Professional Quality of Life (ProQOL) represent domains of particular interest in literature (Cavanagh et al., 2020; Fitzgerald, 2020; Zhou et al., 2021). Given the relevance of work in the processes of adaptation of individuals and the issues related to various activities, these domains gain increasing scientific relevance (Boreham et al., 2016; Masci et al., 2022; Orlenko, 2023; Raccanello et al., 2023). In this sense, considering the psychological well-being and the quality of life of workers is fundamental, especially when these activities refer to clinical practice and the assistance of people suffering from serious and disabling diseases (Austin et al., 2017; Laverdière et al., 2019).

Current evidence suggests that the working life of caregivers and health care workers is influenced by several important factors (King & Fayers, 2008; Klein et al., 2018; Sprang et al., 2007). In this sense, the mental health of workers facing different types of diseases plays a central role (Cavanagh et al., 2020; Gabriel et al., 2020; Haber, 2013). These studies move both in terms of the recognition of adverse outcomes derived from work activities, and in terms of the various adaptation/maladjustment processes and intervention programs necessary to restore optimal levels of mental health. Risk factors, such as burnout, in this sense are many, although represented in the literature often neglected in local and territorial realities. These risks need to be given greater consideration in order to provide for their redeployment and the structuring of interventions (Ochoa et al., 2020; Ruiz-Fernández et al., 2020; Tawfik et al., 2021). Several studies have supported the transition from a static formulation to a more dynamic construct of mental health based on the ability to maintain or restore well-being and adaptation (Card, 2017; Leonardi, 2018; Myles, 2021a; Shilton et al., 2011).

With greater emphasis on well-being, the need to address mental health to the field of health promotion has been strongly recognized (Lara-Cabrera et al., 2020; Lindert et al., 2015; Linton et al., 2016). However, identifying positive feelings and functioning as key factors for mental health was more complex than expected (Galderisi et al., 2015). In their clinical judgment, psychiatrists still focus on evaluating participant’s maladjustment rather than positive characteristics (Aho, 2008; Double, 2002; Mellsop et al., 2007).

Currently, the assessment of psychological well-being requires an integrative framework that can be included in the concept of “euthymia”. Euthymia, as originally introduced by Fava and Bech (2016) and recently developed by Fava and Guidi (2020), refers to a transdiagnostic construct characterized not only by the lack of mood disorders but above all by the presence of positive affectivity, psychological flexibility, well-being and resilience. This psychological state can be described as a healthy level of functioning characterized by an optimal balance between affectivity and cognition. Psychopathology (affective) can be considered to be the result of a deviation from this condition (Garamoni et al., 1991; Myles, 2021a, 2021b).

According to these criteria, the evaluation of mental health must not be identified in the absence of disease but in positive characteristics such as autonomy (Myles, 2021b; Myles et al., 2020, 2021), environmental mastery, satisfying relationships, individual growth, self-realization and self-acceptance (Jahoda, 1958). These components represent relevant aspects that contribute to a variable extent to the state of balance of the participant, compensating for a deterioration in other aspects of mental functioning (Galderisi et al., 2015).

The need to promote positive mental health has extended beyond the clinical context and is finding recognition among healthy participants involved in the medical field (Esposito et al., 2024; Picco et al., 2017). Several studies have found that low levels of well-being compromise welfare activities, associated with lower satisfaction, lower quality of life, high turnover and the onset of physical issues deriving from psychological functioning as well as linked to chronic conditions for both health care workers and patients (Andò et al., 2021; Barchetta et al., 2021; Bochicchio et al., 2021; Conversano & Di Giuseppe, 2021; Di Giacomo et al., 2019; Di Giuseppe, 2024; Edwards & Burnard, 2003; Kanste, 2011; Marchini et al., 2021; Martino et al., 2021a, 2021b; Myles & Merlo, 2021; Orrù et al., 2021; Popoviciu et al., 2022; Ranieri et al., 2021; Ricciardi et al., 2023; Scanlan et al., 2013; Sergi et al., 2023; Vicario et al., 2023; Wright & Bonett, 2007).

This reference is classically oriented to psychological dynamics influencing and affecting physical domains (Baldino et al., 2023; Caputo et al., 2022; Conversano, 2019; Myers, 2020), whose impact is notoriously extended to lifespan sphere. Frequent mental health issues have also been found in these participants, with a high incidence of anxiety and depression (Letvak et al., 2012), Burnout syndrome or Secondary Traumatic Stress (STS) are capable of compromising the ability of the clinician to practice effectively (Conversano et al., 2020; Di Giuseppe et al., 2019; Gangemi et al., 2021; Gori et al., 2021; Merlo et al., 2020a, 2021b; Rahnea-Nita et al., 2021; Shanafelt et al., 2002; Tarcan et al., 2017; Urban & Urban, 2020).

Burnout concerns the broader consequences of a stressful environment, including emotional exhaustion, depersonalization, and a reduced sense of accomplishment (Stamm, 1997). It represents a gradual process that increases the risk of developing STS, a condition related to emotional symptoms and responses resulting from trauma exposure (Figley, 2013). Exposure to high levels of stress can determine the onset of the aforementioned conditions, if not balanced by the presence of adequate psychological resources. Psychological flexibility is identified as an essential component of euthymia and considered extremely relevant for maintaining well-being.

This ability allows the participant to adapt to various situations in order to preserve the overall functioning (Kashdan & Rottenberg, 2010). Psychological flexibility is directly related to the concept of resilience, defined as the ability to maintain or recover high well-being (Ryff et al., 1998). The integration of these factors, as showed by Jahoda (1958), in association with Compassion Satisfaction (CS), contributes to the safeguarding of mental health difficulties (Collins & Swartz, 2011; Devilly et al., 2009; Merlo et al., 2020b). Euthymia promotion and the use of an integrative approach can therefore reveal innovative and promising perspectives according to current evidence addressing euthymic components as protective factors, providing mental integrity, increasing tolerance and resistance to stress (Fava & Sonino, 2017; Fava & Tomba, 2009; Hasler, 2016; Ryff, 2014).

1.1. Objective and hypotheses

This study was aimed at highlighting the existing relation among euthymia components, psychological well-being, clinical satisfaction and the onset of psychopathology due to clinical assistance. In these terms, the participants involved in the study were health care workers working both in public health system and in private practice.

In this study we hypothesize that:

(1) There are significant correlations among euthymia and clinical outcomes variables. In particular, we hypothesize that euthymic variables are significantly and positively associated with clinical satisfaction and negatively associated with burnout and STS;

(2) There are significant and positive correlations among euthymia factors and well-being.

(3) There are significant correlations among well-being and satisfaction, burnout, STS. In particular we hypothesize that well-being is positively associated with clinical satisfaction but negatively associated with burnout and STS.

(4) There are significant relations among age, gender, WHO-5, ES-PS, ES-PWB (set of predictors) and clinical commitment quality indexes (dependent variables, respectively compassion satisfaction, burnout and secondary traumatic stress) highlighting the existing casual role of the predictive independent variables.

2. Materials and methods

2.1 Procedure and participants

The sample consisted of 177 healthy participants involved in clinical settings as health care workers, including 118 women (66.7%) and 59 men (33.3%). The age of participants ranged from 25 to 69 years (Mean age = 27.16; SD = 8.47). All the participants were involved in clinical activities as follows: 16,9 % of participants were hospital physicians, 71,8% of participants were in training physicians, 5,1% were post-graduate private practice nurses, 3,4% were private practice physicians, 2,3 % were retired nurses and 0,6% were retired physicians (these last two categories involved in activities of voluntary and informal health care providers).

Participants declared their consent to the study and specified some personal data such as age, gender, educational qualification and occupation. In compliance with the Italian government provisions relating to the Covid-19 pandemic, the participants filled out the protocols online.

Before providing informed consent, each participant was informed about the anonymous nature of the methods of data processing, as required by the procedures of the ethical committee and evidenced by the approval (University of Messina COSPECS Ethical Committee, number: COSPECS_14_2020).

2.2 Observation instruments

The protocol consisted of the following three tests that the participants had to fill out.

Euthymia Scale (ES) is a self-report scale consisting of 10 items for the evaluation of euthymia (Fava & Bech, 2016). Clinimetric analysis revealed the two-dimensional nature of the scale as the first 5 items assess psychological flexibility (Jahoda, 1958), whereas the last 5 items measure psychological well-being. In the Italian version of the Euthymia Scale (Carrozzino et al., 2019), each item is scored dichotomously as False (0) or True (1), resulting in an overall score ranging from 0 to 10, with higher scores indicating a more euthymic state. The weights of the items referred to the two factors provided for the following assignment: Factor 1, items 1, 2, 3, 4, 5; Factor 2, items 6, 7, 8, 9, 10. The clinimetric parameters for the validation of the scale are scalability and incremental validity, examined through Mokken analysis and hierarchical linear regression analysis. With reference to Mokken's analysis, the following parameters emerged from the studies conducted on healthy participants: .25 for the total score of Euthymia Scale; .28 for psychological flexibility (PS) and .30 for psychological well-being (PWB). The clinimetric properties of ES have been tested via the Item Response Theory (IRT) models that is Rasch and Mokken analyses (e.g., Sasaki & Carrozzino et al., 2021). The Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria has been applied to assess cross-cultural validity and sensitivity of the ES and WHO-5 (e.g., Carrozzino et al., 2022).

The Professional Quality of Life Scale (ProQOL-5) (Stamm, 2005) in its Italian adaptation (Palestini et al., 2009), is a self-report tool that evaluates the positive and negative aspects associated with clinical experience. This test evaluates three dimensions: Compassion Satisfaction concerns the positive effects related to the clinical assistance of traumatized or suffering people; Burnout is associated with a gradual and progressive malaise and exhaustion typical of those participants involved in the clinical field; Secondary Traumatic Stress concerns a condition of strong emotional load deriving from empathic involvement with victims of a trauma. ProQOL-5 consists of 30 items, based on an ordinal 5-point Likert scale. In the validation study, the reliability indicators were Compassion Satisfaction alpha = 0.88; Burnout, alpha = 0.75; Secondary traumatic stress, alpha = 0.81. The weights of the items referred to the three factors provided for the following assignment: Factor 1, items 3, 6, 12, 16, 18, 20, 22, 24, 27, 30; Factor 2, items 1, 4, 8, 10, 15, 17, 19, 21, 26, 29; Factor 3, items 2, 5, 7, 9, 11, 13, 14, 23, 25, 28.

The Well-Being Index scale (World Health Organization, 1998) is a self-report scale that contains five items evaluating psychological well-being through a 6-point Likert scale ranging from 5 (always) to 0 (never). The items cover positive mood, vitality and interest. The item scores were added to obtain an individual score ranging between 0 and 25, with higher scores indicating higher levels of well-being. Usually the WHO-5 score is multiplied by 4 to have a range 0-100. Several studies have reported internal consistency, with α coefficients ranging from 0.82 to 0.95 (Bech et al., 2003; Löwe et al., 2004). Mokken analysis demonstrates unidimensionality (Awata et al., 2007).

2.3 Statistical analysis

Numerical data were expressed as means and standard deviations and the categorical variables as numbers and percentages. After verifying and realizing that the distribution was not normal, the Spearman test was used to evaluate the correlations among variables of the following instruments. Linear hierarchical regressions were performed to evaluate the influence of a series of independent predictors (age, gender for the first step, age, gender and quality of life score for the second step, age, gender, quality of life, psychological flexibility and psychological well-being for the third step) on the ProQol variables. Statistical analyses were performed using SPSS 26 for Windows package. A p-value smaller than 0.050 was statistically significant.

3. Results

Descriptive statistics (mean and standard deviation) are reported in table 1, in order to highlight the presence of considered phenomena.

Table 1. Descriptive statistics for the sample

 	Mean	Standard deviation	
Age	27,16	8,47	
Euthymia Scale Total Score	6,74	2,16	
Euthymia Scale Psychological Flexibility	3,65	1,19	
Euthymia Scale Psychological Well-Being	3,08	1,41	
Compassion Satisfaction	39,79	5,25	
Burnout	23,23	4,93	
Secondary Traumatic Stress	23,72	5,96	
WHO-5	57.33	16.01	

Hierarchical linear regression analysis allowed the emergence of possible significant relations among the set of predictive variables (age, gender, WHO-5, ES-PS, ES-PWB) and clinical commitment outcomes (dependent variables: compassion satisfaction. burnout. secondary traumatic stress). Starting with age, no significant relations emerged through the three steps of the hierarchical linear regression model. Gender appeared to predict higher scores of compassion satisfaction along the tree steps. Considering these significant relations, female participants appeared to report higher rates of compassion satisfaction. WHO-5 predicted lower scores of secondary traumatization for both second and third steps, these relations were negative, demonstrating how well-being assumes an opposite direction with reference to compassion fatigue, predicting lower risk for secondary traumatic stress. Considering euthymia, psychological flexibility predicted lower scored of secondary traumatic stress, as well as psychological well-being predicted higher scores of compassion satisfaction. No significant relations emerged among the selected predictors and burnout.

Table 2. Correlation coefficients among ES, ProQol, WHO-5 variables

 	WHO-5	Compassion Satisfaction	Burnout	Secondary Traumatic Stress	
Compassion Satisfaction	.252**	-	-	-	
Burnout	-.518**	.173*	-	-	
Secondary Traumatic Stress	-.321**	-.082	.591**	-	
ES- Total Score	.583**	.205**	-.372**	-.343**	
ES – Psychological Flexibility	.350**	0.067	-.276**	-.351**	
ES Psychological Well-Being	.615**	.262**	-.228**	-.228**	
*p < 0.05 (two-tailed); **p < 0.01 (two-tailed). Bold values were the significant values.

Table 3. Hierarchical linear regression analysis

 	 	Compassion satisfaction	Burnout	Secondary traumatic stress	
 	 	B (CI)	p	B (CI)	p	B (CI)	p	
Step 1	Age	-.011 (-.102/.079)	.808	-.005-(.074/.063)	.878	-.026 (-.131/.078)	.621	
Gender	2.424 (.798/4.049)	.004*	.259 (-.973/1.490)	.679	1.675 (-.195/3.546)	.079	
F	 	4.399	.101	1.725	
Adjusted R2	 	.037	-.010	.008	
Step 2	Age	-.019 (-.107/.069)	.674	-.003 (-.071/.066)	.942	-.015 (-.114/ .084)	.767	
Gender	2.708 (1.125/4.291)	.001*	.153 (-1.078/1.384)	.806	1.252 (-.526/3.030)	.166	
WHO-5	.333 (.146/.520)	.001*	-.123 (-.269/.022)	.096	-.495 (-.705/.285)	<.001*	
F	 	7.230	1.003	8.495	
Adjusted R2	 	.096	.000	.113	
Step 3	Age	-.001 (-.088/.085)	.973	.009 (-.060/.078)	.804	.006 (-.091/.103)	.900	
Gender	2.859 (1.327/4.392)	<.001*	.157 (-1.068/1.383)	.800	1.178 (-.546/2.901)	.179	
WHO-5	.063 (-.169/.295)	.594	-.146 (-.331/.040)	.123	-.402 (-.663/.141)	.003*	
ES-PS	-.055 (-.712/.601)	.868	-.509 (-1.034/.015)	.057	-1.375 (-2.113/-.637)	<.001*	
ES-PWB	1.254 (.586/1.922)	<.001*	.319 (-.215/.853)	.240	.165 (-.586/.917)	.664	
F	 	7.487	.013	8.186	
Adjusted R2	 	.156	1.458	 	.170	 	
* p < 0.05; Bold values were the significant values

4. Discussions

The aim of our study was to examine the relationship between euthymia and psychological well-being, analyzing their association with various aspects relating to professional life. We focused in particular on the well-being of healthy participants involved in medical settings, figures particularly exposed to traumatization phenomena and high emotional loads.

As known in literature, the role of euthymia ensures optimal psychological welfare, owing to the presence of positive affect, flexibility and resilience (Jahoda, 1958). According to Fredrickson's model (1998), individuals experiencing positive emotions over time, gain personal gratification and satisfaction from their care activity (Radey & Figley, 2007). This can provide greater flexibility and innovative ideas concerning patient intervention, help to achieve high Compassion Satisfaction and reduce the risk of exposure to Secondary Traumatic Stress (Durkin et al., 2016; Maben et al., 2010; Stamm, 2005), as well as trauma-related phenomena in a broader sense (Edgelow et al., 2020; Granieri et al., 2018; Merlo et al., 2021a, 2021b, 2021c; Mezzalira et al., 2023; Midolo et al., 2020).

In line with results, higher levels of compassion satisfaction were predicted by the female gender and psychological well-being related to euthymia. Professionals with high levels of CS feel satisfied with their care activity and indeed a high correlation with the dimensions of well-being and with positive growth has been found in other studies (Gibbons et al., 2011; Zeidner & Hadar, 2014). In line with the findings in the literature, job satisfaction corresponds to high levels of individual well-being and can also affect productivity, performance, quality of care and patient safety (Emmanuel Olatunde & Odusanya, 2015; Healy & McKay, 2000; Murrells et al., 2008). Shanafelt et al. (2002) have proposed a definition of well-being that goes beyond the simple absence of distress and includes the possibility of achieving success in various aspects of personal and professional life.

In the present study, there were no significant results with regard to burnout, also considering that the model was weakly represented by the data. Secondary traumatic stress was predicted by lower levels of well-being and psychological flexibility related to euthymia. Adequate flexibility is relevant for health care professionals, in order to recognize the needs of the context, adopt functional strategies, mitigate the effects of care and preserve their well-being (Brooks et al., 2019; Kashdan & Rottenberg, 2010; Settineri et al., 2019; Sonnentag, 2015; Veage et al., 2014). As argued by Stanley et al. (2017), exposure to difficult life conditions can have an impact on mental and physical health. The presence of adequate resources helps individuals cope with stress and obtain rewards.

In particular, the lack of flexibility can produce states of depression, anxiety and the general tendency to experience negative emotions for prolonged periods, culminating in neurotic symptoms (Kashdan & Rottenberg, 2010; Klanker et al., 2013). These results suggest that working on increasing psychological well-being and euthymia in clinical practice can favor not only the reduction of symptoms but also the overall improvement of the participant's quality of life (Fava & Guidi, 2020; Sasaki et al., 2021).

Considering current trends in the field of professional life, the American College of Emergency Physicians (ACEP), has developed a multidimensional model of well-being, formed by occupational, emotional, physical, financial, social and intellectual components (Eckleberry-Hunt et al., 2009; Lall et al., 2019). In this model it is evident that these areas are interconnected and that any approach to wellbeing must incorporate the different psychosocial aspects that particularly affect the health participants involved in medical settings (Stang et al., 2024).

The effects of stress and low quality of life on health are well documented by field research which has found that stress levels and the presence of minor psychiatric disorders in individuals working in the health care setting are higher than in other occupational groups (Devilly et al., 2009; Huggard & Unit, 2013; Meadors et al., 2010).

In particular, secondary traumatization concerns the undesirable outcomes of working directly with traumatized populations and presents as negative transformative processes experienced by the health professionals when exposed to traumatized patients (Boscarino et al., 2004; Pearlman & Saakvitne, 1995). However, the data in the literature show how the operators who are more oriented towards the engagement and the centrality of patients and family members feel more gratified at work, report high indices of well-being and, in general, lower levels of burnout and STS (Barello et al., 2020). This study has allowed significant results to emerge in the field of clinical care. Based on the findings, it is possible to suggest significant clinical implications. Euthymia has emerged as a fundamental factor in the clinical activity of the participants involved. Given the findings, it is clear that good levels of euthymia correspond to a decrease in the risk of occurrence of secondary traumatization. In the opposite sense, the trend of euthymia and compassion satisfaction is homologous. Data have implications for understanding how maintaining or promoting euthymia is a relevant objective in the clinical field. In terms of both patients and health care professionals, maintaining positive and adaptive affectivity is an important health factor. Thus, well-being and euthymia emerged as relevant factors inspiring important reflections.

The assessment of the levels of euthymia and well-being of health workers is the first fundamental step in structuring psychological interventions. This necessity, based on the necessary psychological assessment procedures of health professionals, therefore represent the basis for evidence-based intervention practices.

5. Strengths and limitations

The study proposed the analysis of variables well represented in the literature. The instruments used were valuable and important components could be detected through their use. In this sense, the study has allowed the emergence of important data on the quality of life, well-being and affective functioning of participants. Despite the interesting and significant results, the study presents limitations. The sample is contained and there is a marked prevalence of female participants. The results obtained refer to self-report scales, so only the subjective representations of the members of the population examined could be considered. Although the participants involved were all engaged in assistance activities, the heterogeneity of the sample suggests the need to work through more homogeneous groups for further study. The results are in any case correlative, not fully causal. The possibility that a better professional quality of life can promote psychological well-being or that other unmeasured factors cause other effects cannot be excluded. This point requires further research in the clinical and care field.

6. Conclusions

The current study supports the early identification of professionals vulnerable to low satisfaction. Attention to the euthymic components and the use of techniques that focus on positive affectivity and psychological well-being can help professionals acquire a better evaluation of themselves and be protected from any trauma.

Research on euthymia in a clinical context can be conceived as a transdiagnostic strategy to be incorporated into a treatment plan, since although the evidence supporting its clinical value is still limited, current studies demonstrate its efficacy in promoting psychological well-being, through a reduction of vulnerability to relapse and an increase in the level of recovery.

Overall, based on our results, rather than evaluating the dysfunctions shown by participants operating in the medical field, it would therefore be more useful to work on psychological well-being, on positive affectivity and in general on the achievement of a euthymic condition. Such a method would not only favor an improvement in performance and gratification linked to the profession but would promote a global improvement in the quality of life of those involved in care activities.
==== Refs
References

Aho, K. (2008). Medicalizing mental health: A phenomenological alternative. Journal of Medical Humanities, 29 (4 ), 243-259. 10.1007/s10912-008-9065-1 18633696
Andò, A., Pignolo, C., Castelli, L., Ghiggia, A., Romeo, A., Tesio, V., Carfona Lettieri, S., & Zennaro, A. (2021). Assessing the Personality Profile of Patients with Fibromyalgia Syndrome: A Rorschach Study. Mediterranean Journal of Clinical Psychology, 9 (3 ). 10.13129/2282-1619/mjcp-3140
Austin, C. L., Saylor, R., & Finley, P. J. (2017). Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychological Trauma: Theory, Research, Practice, and Policy, 9 (4 ), 399. 10.1037/tra0000201 27797570
Awata, S., Bech, P., Koizumi, Y., Seki, T., Kuriyama, S., Hozawa, A., Ohmori, K., Nakaya, N., Matsuoka, H., & Tsuji, I. (2007). Validity and utility of the Japanese version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly community residents. International Psychogeriatrics, 19 (1 ), 77. 10.1017/s1041610206004212 16970832
Baldino, G., Mondello, C., Sapienza, D., Stassi, C., Bottari, A., Gualniera, P., Asmundo, A., & Ventura Spagnolo, E. (2023). Suicide, depression and thyroid dysregulation: An unusual case of unplanned complex suicide. Legal Medicine, 61 , 102187. 10.1016/j.legalmed.2022.102187 36580793
Barchetta, S., Martino, G., Craparo, G., Salehinejad, M. A., Nitsche, M. A., & Vicario, C. M. (2021). Alexithymia is linked with a negative bias for past and current events in healthy humans. International Journal of Environmental Research and Public Health, 18 (13 ), 6696. 10.3390/ijerph18136696 34206284
Barello, S., Palamenghi, L., & Graffigna, G. (2020). Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry research, 290 , 113129. 10.1016/j.psychres.2020.113129 32485487
Bech, P., Olsen, L. R., Kjoller, M., & Rasmussen, N. K. (2003). Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five well-being scale. International journal of methods in psychiatric research, 12 (2 ), 85-91. 10.1002/mpr.145 12830302
Bochicchio, V., Winsler, A., Pagliaro, S., Pacilli, M. G., Dolce, P., & Scandurra, C. (2021). Negative afectivity, authoritarianism, and anxiety of infection explain early maladjusted behavior during the COVID-19 outbreak. Frontiers in psychology, 12 . 10.3389/fpsyg.2021.583883
Boreham, P., Povey, J., & Tomaszewski, W. (2016). Work and social well-being: the impact of employment conditions on quality of life. The International Journal of Human Resource Management, 27 (6 ), 593-611. 10.1080/09585192.2015.1027250
Boscarino, J. A., Figley, C. R., & Adams, R. E. (2004). Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. International journal of emergency mental health, 6 (2 ), 57. 10.1037/0002-9432.76.1.103 15298076
Brooks, S. K., Rubin, G. J., & Greenberg, N. (2019). Traumatic stress within disaster-exposed occupations: overview of the literature and suggestions for the management of traumatic stress in the workplace. British Medical Bulletin, 129 (1 ), 25-34. 10.1093/bmb/ldy040 30544131
Caputo, A., Vicario, C. M., Cazzato, V., & Martino, G. (2022). Editorial: Psychological Factors as Determinants of Medical Conditions, Volume II. Frontiers in Psychology, 13 . 10.3389/fpsyg.2022.865235
Card, A. J. (2017). Moving Beyond the WHO Definition of Health: A New Perspective for an Aging World and the Emerging Era of Value-Based Care: Redefining Health. World Medical & Health Policy, 9 (1 ), 127-137. 10.1002/wmh3.221
Carrozzino, D., Christensen, K. S., Patierno, C., Woźniewicz, A., Møller, S. B., Arendt, I.-M. T. P., Zhang, Y., Yuan, Y., Sasaki, N., Nishi, D., Berrocal Montiel, C., Ceccatelli, S., Mansueto, G., & Cosci, F. (2022). Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis. Journal of Afective Disorders, 311 , 276-283. 10.1016/j.jad.2022.05.111
Carrozzino, D., Svicher, A., Patierno, C., Berrocal, C., & Cosci, F. (2019). The Euthymia Scale: A Clinimetric Analysis. Psychotherapy and Psychosomatics, 88 (2 ), 119-121. 10.1159/000496230 30699426
Cavanagh, N., Cockett, G., Heinrich, C., Doig, L., Fiest, K., Guichon, J. R., Page, S., Mitchell, I., & Doig, C. J. (2020). Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nursing ethics, 27 (3 ), 639-665. 10.1177/0969733019889400 31829113
Collins, L. G., & Swartz, K. (2011). Caregiver care. American family physician, 83 (11 ), 1309-1317.21661713
Conversano, C. (2019). Common Psychological Factors in Chronic Diseases. Frontiers in Psychology, 10 . 10.3389/fpsyg.2019.02727
Conversano, C., & Di Giuseppe, M. (2021). Psychological Factors as Determinants of Chronic Conditions: Clinical and Psychodynamic Advances. Frontiers in Psychology, 12 . 10.3389/fpsyg.2021.635708
Conversano, C., Marchi, L., & Miniati, M. (2020). Psychological distress among healthcare professionals involved in the COVID-19 emergency: Vulnerability and resilience factors. Clinical Neuropsychiatry, 17 (2 ). 10.36131/CN20200212
Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? Efect of trauma therapy on mental health professionals. Australian & New Zealand Journal of Psychiatry, 43 (4 ), 373-385. 10.1080/00048670902721079 19296294
Di Giacomo, D., Ranieri, J., Perilli, E., Cannita, K., Passafiume, D., & Ficorella, C. (2019). Psychological impact of clinical treatment after breast cancer diagnosis in younger patients (38–50 age range): An explorative 3-year observational study. Neurology, Psychiatry and Brain Research, 32 , 85-90. 10.1016/j.npbr.2019.05.001
Di Giuseppe, M. (2024). Transtheoretical, transdiagnostic, and empirical-based understanding of defense mechanisms. Mediterranean Journal of Clinical Psychology 12 (1 ). 10.13129/2282-1619/mjcp-4036
Di Giuseppe, M., Ciacchini, R., Piarulli, A., Nepa, G., & Conversano, C. (2019). Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals. European Journal of Oncology Nursing, 40 , 104-110. 10.1016/j.ejon.2019.04.003 31229199
Double, D. (2002). The limits of psychiatry. Bmj, 324 (7342 ), 900-904. 10.1136/bmj.324.7342.900 11950743
Durkin, M., Beaumont, E., Hollins Martin, C. J., & Carson, J. (2016). A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses. Nurse Education Today, 46 , 109-114. 10.1016/j.nedt.2016.08.030 27621200
Eckleberry-Hunt, J., Van Dyke, A., Lick, D., & Tucciarone, J. (2009). Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. Journal of Graduate Medical Education, 1 (2 ), 225-230. 10.4300/jgme-d-09-00026.1 21975983
Edgelow, M., Harrison, L., Miceli, M., & Cramm, H. (2020). Occupational therapy return to work interventions for persons with trauma and stress-related mental health conditions: A scoping review. Work, 65 (4 ), 821-836. 10.3233/WOR-203134 32310212
Edwards, D., & Burnard, P. (2003). A systematic review of stress and stress management interventions for mental health nurses. Journal of advanced nursing, 42 (2 ), 169-200. 10.1046/j.1365-2648.2003.02600.x 12670386
Emmanuel Olatunde, B., & Odusanya, O. (2015). Job satisfaction and psychological well-being among mental health nurses. Int. J. Transl. Community Med, 3 , 64-70. 10.19070/2333-8385-1500012
Esposito, G., Totaro, S., Di Maro, A., & Passeggia, R. (2024). The role of epistemic trust in the relationship between attachment and mentalization: a systematic review. Mediterranean Journal of Clinical Psychology, 12 (1 ). 10.13129/2282-1619/mjcp-4041
Fava, G. A., & Bech, P. (2016). The concept of euthymia. Psychotherapy and Psychosomatics, 85 (1 ), 1-5. 10.1159/000441244 26610048
Fava, G. A., & Guidi, J. (2020). The pursuit of euthymia. World Psychiatry, 19 (1 ), 40-50. 10.1002/wps.20698 31922678
Fava, G. A., & Sonino, N. (2017). From the Lesson of George Engel to Current Knowledge: The Biopsychosocial Model 40 Years Later. Psychotherapy and Psychosomatics, 86 (5 ), 257-259. 10.1159/000478808 28903100
Fava, G. A., & Tomba, E. (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of personality, 77 (6 ), 1903-1934. 10.1111/j.1467-6494.2009.00604.x 19807860
Figley, C. (2013). Compassion fatigue. New York: Routledge. 10.4324/9780203777381
Fitzgerald, A. (2020). Professional identity: A concept analysis. Nursing Forum, 55 (3 ), 447-472. 10.1111/nuf.12450 32249453
Fredrickson, B. L. (1998). What Good Are Positive Emotions? Review of General Psychology, 2 (3 ), 300-319. 10.1037/1089-2680.2.3.300 21850154
Gabriel, I., Creedy, D., & Coyne, E. (2020). A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers. Nursing open, 7 (5 ), 1299-1312. 10.1002/nop2.543 32802350
Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J., & Sartorius, N. (2015). Toward a new definition of mental health. World Psychiatry, 14 (2 ), 231-233. 10.1002/wps.20231 26043341
Gangemi, S., Ricciardi, L., Caputo, A., Giorgianni, C., Furci, F., Spatari, G., & Martino, G. (2021). Alexithymia in an unconventional sample of Forestry Oficers: a clinical psychological study with surprising results. Mediterranean Journal of Clinical Psychology, 9 (3 ). 10.13129/2282-1619/mjcp-3245
Garamoni, G. L., Reynolds, C. F., III, Thase, M. E., Frank, E., Berman, S. R., & Fasiczka, A. L. (1991). The balance of positive and negative afects in major depression: A further test of the states of mind model. Psychiatry Research, 39 (2 ), 99-108. 10.1016/0165-1781(91)90079-5 1798819
Gibbons, S., Murphy, D., & Joseph, S. (2011). Countertransference and positive growth in social workers. Journal of Social Work Practice, 25 (1 ), 17-30. 10.1080/02650530903579246
Gori, A., Topino, E., Craparo, G., Lauro Grotto, R., & Caretti, V. (2021). An empirical model for understanding the threat responses at the time of COVID-19. Mediterranean Journal of Clinical Psychology, 9 (1 ). 10.6092/2282-1619/mjcp-2916
Granieri, A., Guglielmucci, F., Costanzo, A., Caretti, V., & Schimmenti, A. (2018). Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning. Frontiers in Psychiatry, 9 . 10.3389/fpsyt.2018.00206
Haber, Y. (2013). Predictors of professional quality of life among physicians in a conflict setting: the role of risk and protective factors. Israel Journal of Psychiatry, 50 (3 ), 174.24622476
Hasler, G. (2016). Well-being: an important concept for psychotherapy and psychiatric neuroscience. Psychotherapy and psychosomatics, 85 (5 ), 255-261. 10.1159/000447268 27509027
Healy, C. M., & McKay, M. F. (2000). Nursing stress: the efects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of advanced nursing, 31 (3 ), 681-688. 10.1046/j.1365-2648.2000.01323.x 10718888
Huggard, P., & Unit, G. (2013). A systematic review of the measurement of compassion fatigue, vicarious trauma, and secondary traumatic stress in physicians. Australasian Journal of Disaster and Trauma Studies, 1 , 2013-1.
Jahoda, M. (1958). Current concepts of positive mental health. 10.1037/11258-000
Kanste, O. (2011). Work engagement, work commitment and their association with well-being in health care. Scandinavian Journal of Caring Sciences, 25 (4 ), 754-761. 10.1111/j.1471-6712.2011.00888.x 21564150
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical psychology review, 30 (7 ), 865-878. 10.1016/j.cpr.2010.03.001 21151705
King, M. T., & Fayers, P. M. (2008). Making quality-of-life results more meaningful for clinicians. The Lancet, 371 (9614 ), 709-710. 10.1016/S0140-6736(08)60324-4
Klanker, M., Feenstra, M., & Denys, D. (2013). Dopaminergic control of cognitive flexibility in humans and animals. Frontiers in Neuroscience, 7 . 10.3389/fnins.2013.00201
Klein, C. J., Riggenbach-Hays, J. J., Sollenberger, L. M., Harney, D. M., & McGarvey, J. S. (2018). Quality of life and compassion satisfaction in clinicians: A pilot intervention study for reducing compassion fatigue. American Journal of Hospice and Palliative Medicine®, 35 (6 ), 882-888. 10.1177/1049909117740848 29169248
Lall, M., Gaeta, T., Chung, A., Chinai, S., Garg, M., Hussain, A., Kanter, C., Khandelwal, S., Rublee, C., Tabatabai, R., Takayesu, J., Zaher, M., & Himelfarb, N. (2019). Assessment of Physician Well-being, Part Two: Beyond Burnout. Western Journal of Emergency Medicine, 20 (2 ), 291-304. 10.5811/westjem.2019.1.39666 30881549
Lara-Cabrera, M. L., Mundal, I. P., & De Las Cuevas, C. (2020). Patient-reported well-being: psychometric properties of the world health organization well-being index in specialised community mental health settings. Psychiatry Research, 291 , 113268. 10.1016/j.psychres.2020.113268 32629296
Laverdière, O., Ogrodniczuk, J. S., & Kealy, D. (2019). Clinicians' Empathy and Professional Quality of Life. Journal of Nervous & Mental Disease, 207 (2 ), 49-52. 10.1097/nmd.0000000000000927 30672878
Leonardi, F. (2018). The definition of health: towards new perspectives. International Journal of Health Services, 48 (4 ), 735-748. 10.1177/0020731418782653 29902944
Letvak, S., Ruhm, C. J., & McCoy, T. (2012). Depression in hospital-employed nurses. Clinical Nurse Specialist, 26 (3 ), 177-182. 10.1097/NUR.0b013e3182503ef0 22504476
Lindert, J., Bain, P. A., Kubzansky, L. D., & Stein, C. (2015). Well-being measurement and the WHO health policy Health 2010: systematic review of measurement scales. The European Journal of Public Health, 25 (4 ), 731-740. 10.1093/eurpub/cku193 25616594
Linton, M.-J., Dieppe, P., & Medina-Lara, A. (2016). Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time. BMJ Open, 6 (7 ), e010641. 10.1136/bmjopen-2015-010641
Löwe, B., Spitzer, R. L., Gräfe, K., Kroenke, K., Quenter, A., Zipfel, S., Buchholz, C., Witte, S., & Herzog, W. (2004). Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. Journal of affective disorders, 78 (2 ), 131-140. 10.1016/S0165-0327(02)00237-9 14706723
Maben, J., Cornwell, J., & Sweeney, K. (2010). In praise of compassion. Journal of Research in Nursing, 15 (1 ), 9-13. 10.1177/1744987109353689
Marchini, F., Langher, V., Napoli, A., Balonan, J. T., Fedele, F., Martino, G., Amorosi, F. R., & Caputo, A. (2021). Unconscious loss processing in diabetes: associations with medication adherence and quality of care. Psychoanalytic Psychotherapy, 35 (1 ), 5-23. 10.1080/02668734.2021.1922492
Martino, G., Caputo, A., Vicario, C. M., Feldt-Rasmussen, U., Watt, T., Quattropani, M. C., Benvenga, S., & Vita, R. (2021a). Alexithymia, emotional distress, and perceived quality of life in patients with Hashimoto’s thyroiditis. Frontiers in psychology, 12 , 667237. 10.3389/fpsyg.2021.667237 34045997
Martino, G., Caputo, A., Vicario, C. M., Feldt-Rasmussen, U., Watt, T., Vita, R., Quattropani, M.C., & Benvenga, S. (2021b). Interrelations between mental health, generic and thyroid-related quality of life in patients with Hashimoto’s thyroiditis receiving levothyroxine replacement. Mediterranean journal of Clinical Psychology, 9 (2 ). 10.13129/2282-1619/mjcp-3072
Masci, F., Spatari, G., Bortolotti, S., Giorgianni, C. M., Antonangeli, L. M., Rosecrance, J., & Colosio, C. (2022). Assessing the Impact of Work Activities on the Physiological Load in a Sample of Loggers in Sicily (Italy). International Journal of Environmental Research and Public Health, 19 (13 ), 7695. 10.3390/ijerph19137695 35805360
Meadors, P., Lamson, A., Swanson, M., White, M., & Sira, N. (2010). Secondary Traumatization in Pediatric Healthcare Providers: Compassion Fatigue, Burnout, and Secondary Traumatic Stress. OMEGA - Journal of Death and Dying, 60 (2 ), 103-128. 10.2190/om.60.2.a
Mellsop, G., Menkes, D., & El-Badri, S. (2007). Releasing psychiatry from the constraints of categorical diagnosis. Australasian Psychiatry, 15 (1 ), 3-5. 10.1080/10398560601083134 17464624
Merlo, E. M., McNabney, S. M., Frisone, F., Sicari, F., Paunica, M., Motofei, C., & Settineri, S. (2020a). Compassion and suppression in caregivers: twin masks of tragedy and joy of caring. Journal of Mind and Medical Sciences, 7 (1 ), 61-68. 10.22543/7674.71.P6168
Merlo, E. M., Sicari, F., Frisone, F., Alibrandi, A., Settineri, S. (2021a). Burden and professional quality of life of caregivers: the role of suppression and resilience. Life Span and Disability, 24 (1 ).
Merlo, E. M., Stoian, A. P., Motofei, I. G., & Settineri, S. (2021a). The Role of Suppression and the Maintenance of Euthymia in the Clinical Settings. Frontiers in Psychology, 12 , 1534. 10.3389/fpsyg.2021.677811
Merlo, E. M., Stoian, A., Motofei, I. G., & Settineri, S. (2020b). Clinical Psychological Figures in Healthcare Professionals: Resilience and Maladjustment as the" Cost of Care". Frontiers in Psychology, 11 , 3166. 10.3389/fpsyg.2020.607783
Merlo, E.M., Sicari, F., Frisone, F., Costa, G., Alibrandi, A., Avena, G., & Settineri, S. (2021c). Uncertainty, alexithymia, suppression and vulnerability during the COVID-19 pandemic in Italy. Health Psychology Report, 9 (2 ). 10.5114/hpr.2021.104078
Mezzalira, S., Santoro, G., Bochicchio, V., & Schimmenti, A. (2023). Trauma and the Disruption of Temporal Experience: A Psychoanalytical and Phenomenological Perspective. The American Journal of Psychoanalysis, 83 (1 ), 36-55. 10.1057/s11231-023-09395-w 36918715
Midolo, L. R., Santoro, G., Ferrante, E., Pellegriti, P., Russo, S., Costanzo, A., & Schimmenti, A. (2020). Childhood trauma, attachment and psychopathology: A correlation network approach. Mediterranean Journal of Clinical Psychology, 8 (2 ).
Murrells, T., Robinson, S., & Griffiths, P. (2008). Job satisfaction trends during nurses' early career. BMC nursing, 7 (1 ), 1-13. 10.1186/1472-6955-7-7 18205930
Myers, L. (2020). Adherance to Treatment in Medical Conditions. CRC Press. 10.1201/9781003072348
Myles, L. A. M. (2021a). The Emerging Role of Computational Psychopathology in Clinical Psychology. Mediterranean Journal of Clinical Psychology, 9 (1 ). 10.6092/2282-1619/mjcp-2895
Myles, L. A. M. (2021b). Using Prediction Error to Account for the Pervasiveness of Mood Congruent Thoughts. Mediterranean Journal of Clinical Psychology, 9 (2 ). 10.13129/2282-1619/mjcp-3130
Myles, L. A. M., & Merlo, E. M. (2021). Alexithymia and physical outcomes in psychosomatic participants: a cross-sectional study. Journal of Mind and Medical Sciences, 8 (1 ), 86-93. 10.22543/7674.81.P8693
Myles, L. A. M., Connolly, J., & Stanulewicz, N. (2020). The Mediating Role of Perceived Control and Desire for Control in the Relationship between Personality and Depression. Mediterranean Journal of Clinical Psychology, 8 (3 ). 10.6092/2282-1619/mjcp-2589
Myles, L. A. M., Merlo, E. M., & Obele, A. (2021). Desire for Control Moderates the Relationship between Perceived Control and Depressive Symptomology. Journal of Mind and Medical Sciences, 8 (2 ), 299-305. 10.22543/7674.82.p299305
Ochoa, C. Y., Buchanan Lunsford, N., & Lee Smith, J. (2020). Impact of informal cancer caregiving across the cancer experience: A systematic literature review of quality of life. Palliative and Supportive Care, 18 (2 ), 220-240. 10.1017/s1478951519000622 31588882
Orlenko, I. (2023). Psychological factors of the structure of social maladjustment of the individual in modern society. Modern approaches to the development of relevant competencies in the socio-cultural environment, 35-61. 10.36074/madrcsce-monograph.2023.2
Orrù, G., Marzetti, F., Conversano, C., Vagheggini, G., Miccoli, M., Ciacchini, R., Panait, E., & Gemignani, A. (2021). Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak. International Journal of Environmental Research and Public Health, 18 (1 ), 337. 10.3390/ijerph18010337 33466346
Palestini, L., Prati, G., Pietrantoni, L., & Cicognani, E. (2009). La qualità della vita professionale nel lavoro di soccorso: Un contributo alla validazione italiana della Professional Quality of Life Scale (ProQOL). Psicoterapia Cognitiva e Comportamentale, 15 (2 ), 205-227.
Pearlman, L. A., & Saakvitne, K. W. (1995). Treating therapists with vicarious traumatization and secondary traumatic stress disorders. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 23 , 150-177.
Picco, L., Yuan, Q., Vaingankar, J. A., Chang, S., Abdin, E., Chua, H. C., Chong, S. A., & Subramaniam, M. (2017). Positive mental health among health professionals working at a psychiatric hospital. PloS one, 12 (6 ), e0178359. 10.1371/journal.pone.0178359 28591203
Popoviciu, M. S., Marin, V. N., Vesa, C. M., Stefan, S. D., Stoica, R. A., Serafinceanu, C., Merlo, E. M., Rizvi, A. A., Rizzo, M., Busnatu, S., & Stoian, A. P. (2022). Correlations between Diabetes Mellitus Self-Care Activities and Glycaemic Control in the Adult Population: A Cross-Sectional Study. Healthcare, 10 (1 ), 174. 10.3390/healthcare10010174 35052337
Raccanello, D., Rocca, E., Barnaba, V., Vicentini, G., Hall, R., & Brondino, M. (2023). Coping Strategies and Psychological Maladjustment/Adjustment: A Meta-Analytic Approach with Children and Adolescents Exposed to Natural Disasters. Child & Youth Care Forum, 52 (1 ), 25-63. 10.1007/s10566-022-09677-x 35221639
Radey, M., & Figley, C. R. (2007). The social psychology of compassion. Clinical Social Work Journal, 35 (3 ), 207-214. 10.1007/s10615-007-0087-3
Rahnea-Nita, G., Badiu, D.-C., Popescu, C. G., Grigorean, T. G., Serban, Smarandache, C. G., Rahena-Nita, R.-A., Ciuhu, A.-N., Mandu, M., Andronache, L.-F., & Stoian, A.-R. (2021). The impact of Coronavirus disease 2019 pandemic on the treatment of cancer patients: the first steps in this fight. Mediterranean Journal of Clinical Psychology, 9 (2 ). 10.13129/2282-1619/mjcp-3011
Ranieri, J., Guerra, F., Perilli, E., Cilli, E., & Di Giacomo, D. (2021). Metacognitions and quality of life in survivorship after breast cancer diagnosis. Rivista di Psichiatria, 56 (4 ), 217-222. 10.1708/3654.36350 34310580
Ricciardi, L., Spatari, G., Vicario, C. M., Liotta, M., Cazzato, V., Gangemi, S., & Martino, G. (2023). Clinical Psychology and Clinical Immunology: is there a link between Alexithymia and severe Asthma?. Mediterranean Journal of Clinical Psychology, 11 (3 ). 10.13129/2282-1619/mjcp-3704
Ruiz-Fernández, M. D., Ortega-Galán, Á. M., Fernández-Sola, C., Hernández-Padilla, J. M., Granero-Molina, J., & Ramos-Pichardo, J. D. (2020). Occupational factors associated with health-related quality of life in nursing professionals: A multi-centre study. International journal of environmental research and public health, 17 (3 ), 982. 10.3390/ijerph17030982 32033257
Ryf, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and psychosomatics, 83 (1 ), 10-28. 10.1159/000353263 24281296
Ryf, C. D., Love, G. D., Essex, M. J., & Singer, B. (1998). Resilience in Adulthood and Later Life. Handbook of Aging and Mental Health, 69-96. 10.1007/978-1-4899-0098-2_4
Sasaki, N., Carrozzino, D., & Nishi, D. (2021). Sensitivity and Concurrent validity of the Japanese Version of the Euthymia Scale: A Clinimetric Analysis. 10.21203/rs.3.rs-146117/v1
Scanlan, J. N., Meredith, P., & Poulsen, A. A. (2013). Enhancing retention of occupational therapists working in mental health: Relationships between wellbeing at work and turnover intention. Australian occupational therapy journal, 60 (6 ), 395-403. 10.1111/1440-1630.12074 24299478
Sergi, A., Messina, A., Vicario, C. M., & Martino, G. (2023). A Quantum–Classical Model of Brain Dynamics. Entropy, 25 (4 ), 592. 10.3390/e25040592 37190380
Settineri, S., Frisone, F., Alibrandi, A., & Merlo, E. (2019). Vulnerability and physical well-being of caregivers: what relationship? Journal of Mind and Medical Sciences, 95-102. 10.22543/7674.61.p95102
Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Back, A. L. (2002). Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Annals of Internal Medicine, 136 (5 ), 358. 10.7326/0003-4819-136-5-200203050-00008 11874308
Shilton, T., Sparks, M., McQueen, D., Lamarre, M. C., & Jackson, S. (2011). Proposal for new definition of health. Bmj, 343 . 10.1136/bmj.d5359
Sonnentag, S. (2015). Wellbeing and burnout in the workplace: Organizational causes and consequences. International encyclopedia of the social & behavioral sciences, 25 (2 ), 537-540. 10.1016/B978-0-08-097086-8.73021-2
Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion fatigue, compassion satisfaction, and burnout: Factors impacting a professional's quality of life. Journal of loss and trauma, 12 (3 ), 259-280. 10.1080/15325020701238093
Stamm, B. H. (1997). Work-related secondary traumatic stress. PTSD research quarterly, 8 , 1-7. 10.1037/e572172010-002
Stamm, B. H. (2005). The ProQOL manual: The professional quality of life scale: Compassion satisfaction, burnout & compassion fatigue/secondary trauma scales. Baltimore, MD: Sidran.
Stang, P., Köllner, M. G., Weiss, M. (2024). Social support and attachment in persons diagnosed with psychotic spectrum disorders. Mediterranean Journal of Clinical Psychology 12 (1 ). 10.13129/2282-1619/mjcp-4055
Stanley, S., Balakrishnan, S., & Ilangovan, S. (2017). Psychological distress, perceived burden and quality of life in caregivers of persons with schizophrenia. Journal of Mental Health, 26 (2 ), 134-141. 10.1080/09638237.2016.1276537 28385096
Tarcan, G. Y., Tarcan, M., & Top, M. (2017). An analysis of relationship between burnout and job satisfaction among emergency health professionals. Total Quality Management & Business Excellence, 28 (11-12 ), 1339-1356. 10.1080/14783363.2016.1141659
Tawfik, D. S., Shanafelt, T. D., Dyrbye, L. N., Sinsky, C. A., West, C. P., Davis, A. S., Su, F., Adair, K. C., Trockel, M. T., Profit, J., & Sexton, J. B. (2021). Personal and Professional Factors Associated With Work-Life Integration Among US Physicians. JAMA Network Open, 4 (5 ), e2111575. 10.1001/jamanetworkopen.2021.11575 34042994
Urban, M., & Urban, K. (2020). What can we learn from gritty persons? Coping strategies adopted during COVID-19 lockdown. Mediterranean Journal of Clinical Psychology, 8 (3 ). 10.6092/2282-1619/mjcp-2518
Veage, S., Ciarrochi, J., Deane, F. P., Andresen, R., Oades, L. G., & Crowe, T. P. (2014). Value congruence, importance and success and in the workplace: Links with well-being and burnout amongst mental health practitioners. Journal of Contextual Behavioral Science, 3 (4 ), 258-264. 10.1016/j.jcbs.2014.06.004
Vicario, C. M., Scavone, V., Lucifora, C., Falzone, A., Pioggia, G., Gangemi, S., Craparo, G., & Martino, G. (2023). Evidence of abnormal scalar timing property in alexithymia. Plos one, 18 (1 ), e0278881. 10.1371/journal.pone.0278881 36689490
World Health Organization. Regional Office for Europe, Psychiatric Research Unit. (1998) World Health Organization info package: mastering depression in primary care. Frederiks Borg.
Wright, T. A., & Bonett, D. G. (2007). Job satisfaction and psychological well-being as nonadditive predictors of workplace turnover. Journal of management, 33 (2 ), 141-160. 10.1177/0149206306297582
Zeidner, M., & Hadar, D. (2014). Some individual difference predictors of professional well-being and satisfaction of health professionals. Personality and Individual Differences, 65 , 91-95. 10.1016/j.paid.2014.01.032
Zhou, Z., Wang, Y., Feng, P., Li, T., Tebes, J. K., Luan, R., & Yu, Y. (2021). Associations of caregiving knowledge and skills with caregiver burden, psychological well-being, and coping styles among primary family caregivers of people living with schizophrenia in China. Frontiers in psychiatry, 12 , 631420. 10.3389/fpsyt.2021.631420 34122169
