Titolo della tesi: EFFICACIA E CORRELATI EPIGENETICI DEGLI INTERVENTI PSICOLOGICI IN DIVERSI CONTESTI: TRE METANALISI CON REVISIONI SISTEMATICHE
Objective: The purpose of the work is to define and identify, through meta-analysis and
systematic reviews, the most effective psychological intervention on traumatic events in the
context of migration, in the context of organ transplantation and in the context of epigenetic
mechanisms on the lines of bringing a more "contextual" mentality in the implementation of
interventions for health and psychological well-being within the contexts of higher density
of individuals.
Method: All meta-analyses and systematic reviews submitted in this work adhere to the
PRISMA guidelines, to Cochrane and New Castle Ottawa bias scales and GRADE
assessment guidelines, and their protocols are systematized in PROSPERO. Both
randomized and observational research designs are taken into consideration and are
subjected to meta-analysis and systematic review according to a perspective of statistical
analysis of both quantitative and qualitative type. The papers included collect from a
minimum of 14 studies to a maximum of 52 studies.
Results: Regarding Migrants, all treatments reported significant effects on depression,
anxiety, and somatization, and the cognitive-behavioral treatment appeared to be the most
effective intervention. Refugee status versus asylum seeker status appears to have a large
effect on treatment effectiveness. Regarding the organ transplant setting, the main findings
showed that psychosocial interventions were effective on depression and anxiety in kidney
recipients and anxiety in heart recipients, mainly when administered after surgery and that
dynamic therapies were the most effective in the observational studies. In addition, the
results showed a lack of studies on the effectiveness of the psychosocial intervention on organ
functioning. With respect to the contest of epigenetic changes, the results showed that,
subjects who responded to therapy were associated with specific hypo- or hypermethylation,
and that in subjects who did not respond to therapy it was associated in an opposite way.
Meta-analysis showed significant hypermethylation of the MAOA gene after cognitive-behavioral symptom-focusing therapy only in participants with anxiety.
Discussion and Conclusions: An analytical synthesis of the various results shows that the
most investigated outcomes, in all works, were depression and anxiety and that the cognitive
behavioral treatment seemed to be the intervention of choice applied and studied in most
settings. This work could be a precious contribution in practice especially because it
raises questions to be explored in future research. Future perspectives could focus on
deepening the application of psychotherapies in asylum seekers, with regard to the migratory
context; on deepening the adherence to treatment and the functionality of transplanted solid
organs, for surgery contexts. It would be interesting, moreover, to examine the epigenetic
effects after the application of other psychotherapies in addition to cognitive-behavioral
treatments, and finally, to increase the use and application of dynamic psychotherapies in
more contexts in order to verify their actual effectiveness.