Effect of Mindfulness-Based Protocols on Psychological Parameters and Biological Markers in Populations Exposed to Conditions of Persistent Distress

To assess cortisol levels, at baseline (T0), T1, and T2, saliva samples will be collected using Salivettes (Sarstedt) 30 minutes after waking up. Participants will be instructed not to drink, eat, chew gum, or brush their teeth in the 30 minutes preceding the sample collection. To collect the saliva, participants will be advised to rinse their mouth with water for 30 seconds, wait 10 minutes, and then remove the swab from the Salivette and chew it for about 2 minutes to stimulate salivation. The swab will be reinserted into the Salivette, frozen at -20°C and stored at the Laboratory of the AUSL Piacenza Centre. Then, sample will be shipped to the University of Siena for further analysis. Upon arrival at the laboratory, the samples will be thawed and centrifuged at 2000 × g for 5 minutes at 4°C. Salivary cortisol levels will be assayed by an Enzyme Immunoassay kit (Arbor Assays Inc., Ann Arbor, Michigan, USA).

The IANUS consists of 15 items for measuring 4 main factors. Items are scored on a Likert-type response scale (never=1; sometimes=2; often=3; almost always=4). The score of the Job Strain 5-item subscale ranges from 0 to 100 [sum of item scores *100/(4*5)], with higher values corresponding to greater job strain.

The IANUS consists of 15 items for measuring 4 main factors. Items are scored on a Likert-type response scale (never=1; sometimes=2; often=3; almost always=4). The score of the Positive Meaning 4-item subscale ranges from 0 to 100 [sum of item scores *100/(4*4)], with higher values corresponding to greater positive meaning of work by the partecipant.

The IANUS consists of 15 items for measuring 4 main factors. Items are scored on a Likert-type response scale (never=1; sometimes=2; often=3; almost always=4). The score of the Emotional Fatigue 3-item subscale ranges from 0 to 100 [sum of item scores *100/(4*3)], with higher values corresponding to greater emotional fatigue of the partecipant.

The IANUS consists of 15 items for measuring 4 main factors. Items are scored on a Likert-type response scale (never=1; sometimes=2; often=3; almost always=4). The score of the Relational Difficulty 3-item subscale ranges from 0 to 100 [sum of item scores *100/(4*3)], with higher values corresponding to greater relational difficulties by the partecipant.

The PSS measures the degree to which situations in a person's life are appraised as stressful. Each item was rated by the subject on a scale ranging from 0 (never) to 4 (very often). The scale values range from 0 to 40, with a higher score indicating a higher degree of subjective stress. Total scores 0-13 are considered low perceived stress, 14-26 as moderate perceived stress, and 27-40 as high perceived stress.

The MAAS is a 15-item scale investigating awareness and attention to what is happening in the present. The MAAS is a 15-item self-report instrument designed to measure dispositional mindfulness, specifically the frequency of open or receptive attention to and awareness of present-moment experiences. Participants rate each item (e.g., "I find it difficult to stay focused on what's happening in the present") on a 6-point Likert scale ranging from 1 (almost always) to 6 (almost never), with higher scores indicating greater mindfulness. The MAAS has demonstrated high internal consistency and good psychometric properties in both clinical and non-clinical populations.

PGWB-S is a 6-item, rated on a 6-point scale, health-related Quality of Life questionnaire derived from the 22-item Psychological General Well-Being Index, developed in the United States. It produces a self-perceived evaluation of psychological well-being expressed by a summary score, which reaches a maximum of 30 points, representing the best achievable "well being".

The PGWB-S showed good acceptability and validity for use in various settings in Italy.