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Chukwuma OV, Ezeani EI, Fatoye EO, Benjamin J, Okobi OE, Nwume CG, Egberuare EN. A Systematic Review of the Effect of Stigmatization on Psychiatric Illness Outcomes. Cureus 2024; 16:e62642. [PMID: 39036187 PMCID: PMC11258934 DOI: 10.7759/cureus.62642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
A significant proportion of individuals with psychiatric disorders face dual challenges such as managing the symptoms and disabilities of their conditions and enduring stigma arising from misconceptions about mental illness. This stigma denies them quality-of-life opportunities, such as access to satisfactory healthcare services, better employment, safer housing, and social affiliations. This systematic review aims to evaluate the effect of stigmatization on psychiatric illness outcomes, particularly its influence on treatment adherence, treatment-seeking behavior, and care outcomes. We conducted a systematic review of 39 studies published between 2010 and 2024, focusing on the effects of stigmatization on psychiatric illness outcomes. The review utilized robust methodology following Cochrane guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from 2010 to 2024 obtained from databases such as PubMed, Embase, Google Scholar, Web of Science, and SCOPUS. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies, with most studies rated as moderate to high quality. The findings indicate that stigma in psychiatric illness is closely associated with several factors, including illness duration (mean effect size = 0.42, p < 0.05), frequency of clinic visits (mean reduction = 2.3 visits/year), and diagnosis of psychotic disorders (OR = 1.78, 95% CI: 1.20-2.65). Stigma manifests through misinformation, prejudice, and discrimination, leading to significant barriers to accessing and adhering to psychiatric treatment, thereby worsening health outcomes. It leads to delays in accessing healthcare, poor adherence to medication and follow-up, and negative psychiatric health outcomes, including disempowerment, reduced self-efficacy, increased psychiatric symptoms, and decreased quality of life. Also, stigma extends to caregivers and healthcare professionals, complicating care delivery. This review highlights the need for effective interventions and strategies to address stigma, emphasizing the importance of educational interventions to mitigate the adverse effects of public stigma. Understanding the multifaceted nature of stigma is crucial for developing targeted approaches to improve psychiatric care outcomes and ensure better mental health services for individuals with mental illnesses.
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Affiliation(s)
| | - Esther I Ezeani
- Family Medicine, Indiana Regional Medical Center (IRMC), Indiana, USA
- Primary Care, Lifebridge Health, Baltimore, USA
| | | | - Janet Benjamin
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Chuka G Nwume
- Family Medicine, University of Port Harcourt, Port Harcourt, NGA
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Ellsworth BL, Solano QP, Evans J, Bidwell SS, Byrnes M, Sandhu G. Medical students' perception of their 'distance travelled' in medical school applications. MEDICAL EDUCATION 2024; 58:204-215. [PMID: 37485787 DOI: 10.1111/medu.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Within medical school's holistic review of applicants includes a review of their distance travelled to get to this point in their education. The AAMC defines distance travelled (DT) as, 'any obstacles or hardships you've overcome to get to this point in your education or any life challenges you've faced and conquered'. What medical students consider as their distance travelled has not been explored. The authors sought to identify the factors medical students perceive are important for medical school admissions to consider when assessing someone's 'distance travelled' by asking current medical students to share their DT experiences along with the barriers and facilitators they encountered on their medical school journey. METHODS The authors conducted semi-structured interviews with US medical students through purposeful sampling methods. The social-ecological model framework was used to develop questions to elicit participants' experiences that contributed to their distance travelled. Interviews were conducted in 2021 and ranged from 60-75 minutes. Transcribed interviews were qualitatively analysed using interpretive description. RESULTS A total of 31 medical students from seven medical schools were included in the study. Overall, participants defined distance travelled as an applicant's hardships (e.g. being the primary caregiver for a family member) and privileges (e.g. having physician parents) they experienced. Three major themes were identified: (1) individual-level characteristics and factors, (2) interpersonal relationships and (3) aspects of the participants' community and society. DISCUSSION Our findings show that medical school applicants considered DT to be a valuable component of a holistic medical school admission process. Participants' experiences of DT were varied and complex. Our research suggests that admissions teams for medical schools should incorporate more comprehensive recruitment practices and inclusive methodological frameworks to accurately capture the diversity of identities and experiences of medical school applicants and to consider the factors that shape their journey to medical schools.
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Affiliation(s)
| | | | - Julie Evans
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mary Byrnes
- Department of Surgery and Center for Healthcare Outcomes and Policy, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- Department of Surgery and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Lawrence ER, Parekh BJ, Owusu-Antwi R, Newman N, Russell CB, Beyuo TK, Yeboah M, Oppong SA, Moyer CA. "If You Need a Psychiatrist, It's BAD": Stigma Associated with Seeking Mental Health Care Among Obstetric Providers in Ghana. Int J Womens Health 2024; 16:131-141. [PMID: 38283998 PMCID: PMC10822084 DOI: 10.2147/ijwh.s440224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024] Open
Abstract
Purpose Globally, the COVID-19 pandemic has brought attention to the impact of negative patient outcomes on healthcare providers. In Ghana, obstetric providers regularly face maternal and neonatal mortality, yet limited research has focused on provision of mental health support for these providers. This study sought to understand how obstetric providers viewed seeking mental health support after poor clinical outcomes, with a focus on the role of mental health stigma. Patients and Methods Participants were 52 obstetric providers (20 obstetrician/gynecologists and 32 midwives) at two tertiary care hospitals in Ghana. Five focus groups, led by a trained facilitator and lasting approximately two hours, were conducted to explore provider experiences and perceptions of support following poor maternal and neonatal outcomes. Discussions were audiotaped and transcribed verbatim, then analyzed qualitatively using grounded theory methodology. Results Most participants (84.3%, N=43) were finished with training, and 46.2% (N=24) had been in practice more than 10 years. Emerging themes included pervasive stigma associated with seeking mental health care after experiencing poor clinical outcomes, which was derived from two overlapping dimensions. First, societal-level stigma resulted from a cultural norm to keep emotions hidden, and the perception that psychiatry is equated with severe mental illness. Second, provider-level stigma resulted from the belief that healthcare workers should not have mental health problems, a perception that mental health care is acceptable for patients but not for providers, and a fear about lack of confidentiality. Despite many providers acknowledging negative mental health impacts following poor clinical outcomes, these additive layers of stigma limited their willingness to engage in formal mental health care. Conclusion This study demonstrates that stigma creates significant barriers to acceptance of mental health support among obstetric providers. Interventions to support providers will need to respect provider concerns without reinforcing the stigma associated with seeking mental health care.
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Affiliation(s)
- Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Bela J Parekh
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ruth Owusu-Antwi
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology/ Psychiatry Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Noah Newman
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Colin B Russell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Titus K Beyuo
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Michael Yeboah
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Jansen W, Lockett L, Colville T, Uldahl M, De Briyne N. Veterinarian-Chasing A Dream Job? A Comparative Survey on Wellbeing and Stress Levels among European Veterinarians between 2018 and 2023. Vet Sci 2024; 11:48. [PMID: 38275930 PMCID: PMC10820604 DOI: 10.3390/vetsci11010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Whilst recognizing the abundantly positive aspects within the different domains of the veterinary profession, the challenging socio-economic and cultural working climate has been identified as a source of veterinary mental wellbeing issues. This mixed methods study provides an overview of the mental state of veterinarians across Europe via two cross-sectional surveys in 2018/2019 (n = 14,559 veterinarians) and in 2022/2023 (n = 12,393 veterinarians). Mental wellbeing was assessed using 3 indicators: self-reported stress levels, the need for medical leave due to reduced mental wellbeing (22% and 23%, resp., in 2018/2019 and 2022/2023) and the seven-question Warwick-Edinburgh Mental Wellbeing Scale (2018/2019: 25, 2022/2023: 24.8). In both surveys, important differences were spotlighted between countries, but early-career veterinarians and female veterinarians were most at risk of decreased mental wellbeing all over Europe for all indicators. In conclusion, stress levels and need for medical leave due to reduced mental wellbeing remained at comparatively high levels across the two surveys and standardized mental wellbeing scores remained equally low. Notwithstanding the increased attention given to veterinary wellbeing in the last decade, our results underline that major efforts remain necessary, by creating more supportive and attractive workplaces that prioritize wellbeing, a good work/life balance, and providing job satisfaction.
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Affiliation(s)
- Wiebke Jansen
- Federation of Veterinarians of Europe, Rue Victor Oudart 7, 1030 Brussels, Belgium
| | - Lizzie Lockett
- Royal College of Veterinary Surgeons, The Cursitor, 38 Chancery Lane, London WC2A 1EN, UK;
| | - Tricia Colville
- Vets Now Emergency Limited, Penguin House, Castle Riggs, Dunfermline KY11 8SG, UK;
| | - Mette Uldahl
- Vejle Hestepraksis, Fasanvej 12, 7120 Vejle, Denmark;
| | - Nancy De Briyne
- Federation of Veterinarians of Europe, Rue Victor Oudart 7, 1030 Brussels, Belgium
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Al-Hourani ZA, Almhdawi KA, AlBakri IA, Alibrahim AN, Obeidat D. The health and quality of life of dental workers in jordan during COVID-19: A cross-sectional study. Work 2024; 79:15-23. [PMID: 38251081 DOI: 10.3233/wor-220458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Dental team members are susceptible to high mental and physical stress levels, which could have increased during the Coronavirus disease 2019 (COVID-19). OBJECTIVE This study aimed to evaluate Jordanian dental workers' health-related quality of life (HRQoL) and determine its predictors during the COVID-19 Pandemic. METHODS This was a cross-sectional survey study conducted on dental team members, namely; Dentists, dental Assistants, and Dental Technicians. The survey questionnaire was composed of questions related to stress during COVID-19, a short-form survey of 12 items (SF-12), a Depression, Anxiety, and Stress scale (DASS-21), and a Nordic musculoskeletal disorder questionnaire (NMQ). Descriptive analyses were used to describe the main outcome measures, and multiple variable regression analysis was conducted to identify the quality of life predictors. RESULTS Participants' HRQoL measured by SF-12 showed a mean±SD score of 67.1±17.19 for the physical component and 54.51±20.27 for the mental component. The Nordic scale showed symptoms of lower back pain as 63.9% over 12 months, 32% over 12 months' functional limitation symptoms, and 45% in 7 days The regression model was found strong for our study with 53.8% variations (r2 = 0.538, F = 43.739, P < 0.001) in health-related quality of life. CONCLUSIONS Our study concluded that the level of HRQoL among Jordanian dental specialists during COVID-19 was observed to impact levels of physical and mental well-being which negatively influence the quality of life. Predictive factors like depression, stress, anxiety, musculoskeletal health, and individual everyday quality of life significantly affect the HRQoL of dental specialists.
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Affiliation(s)
- Zeid A Al-Hourani
- Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khader A Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Isra A AlBakri
- Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas N Alibrahim
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Donia Obeidat
- Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid, Jordan
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Rees A, Cuthbert C, Shah V, Rong L, Peh D, Baptista A, Smith S. Medical student perceptions of mental illness: a cross-sectional transnational study in two medical schools. BMC MEDICAL EDUCATION 2023; 23:981. [PMID: 38124141 PMCID: PMC10731839 DOI: 10.1186/s12909-023-04962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite shifting global attitudes, mental illness remains highly stigmatised amongst practicing doctors. This has wider implications on doctors' training to care for patients with mental illness. There is need for exploration of the presence and mitigation of stigma in early medical education to prevent such attitudes propagating into clinical practice. Thus, this study explores whether stigmatising attitudes are detectable amongst medical students in London and Singapore and examines whether they are ameliorated by specific curricular and welfare features of formal medical education, utilising the Mental Illness Stigma Framework (MISF). METHODS A mixed-methods approach was adopted. Medical students at Imperial College London (UK; n = 211) and Nanyang Technological University (Singapore; n = 141) completed a validated scale (the OMS-HC-15) to assess attitudes towards mental illness. Semi-structured interviews were conducted (Imperial: n = 12, NTU: n = 8) until theoretical saturation was reached. Quantitative data were analysed descriptively and comparatively using SPSS and interview data subjected to inductive thematic analysis. RESULTS Total OMS-HC-15 scores ranged from 19-51 for Imperial (n = 211) and 16-53 for NTU (n = 141). No significant differences in overall stigma scores were found between the two schools (p = 0.24), nor when comparing year groups within each school. Four themes were identified across interview data: student perceptions, impacts of medical school culture, university support, and curricular impacts on mental illness perceptions. Themes allowed identification of aspects of medical school that were well-received and warranted further emphasis by students, alongside areas for improvement. CONCLUSION Mental health stigma was identified in two medical schools, with differing cultures. Mean stigma scores obtained were comparable between both UK and Singaporean medical students. Nuanced differences were identified via subgroup analysis, and the MISF identified both shared and country-specific drivers for this stigma across the qualitative data. Actionable recommendations to mitigate this were hypothesised. Curricular improvements such as earlier psychiatric teaching and sharing of personal stories may improve future stigma scores as students' progress through the course. Specific welfare-based changes to formal support systems were also deemed to be beneficial by students. The impacts of welfare and curricular redesign in relation to societal influence on students' attitudes warrants further investigation, as does medical students' self-stigma.
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Affiliation(s)
- Annie Rees
- School of Medicine, Imperial College London, London, UK.
| | | | - Viraj Shah
- School of Medicine, Imperial College London, London, UK
| | - Lim Rong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Daniel Peh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ana Baptista
- School of Medicine, Imperial College London, London, UK
- Medical Education Research Unit, Faculty of Medicine, Imperial College London, London, UK
| | - Susan Smith
- Medical Education Research Unit, Faculty of Medicine, Imperial College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Ranasinghe PD, Zhou A. Women physicians and the COVID-19 pandemic: gender-based impacts and potential interventions. Ann Med 2023; 55:319-324. [PMID: 36594806 PMCID: PMC9815224 DOI: 10.1080/07853890.2022.2164046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: These are extraordinary times caused by the first global pandemic in our modern era. Physicians and other frontline healthcare providers face unique challenges, for which they have had little formal preparation. This combination of challenge and deficit leads to significant negative impacts, not only on what medical practices and health care systems can deliver to the public, but also on the individual healthcare providers themselves.Methods: In this essay, we specifically address women physicians, and explore the considerable impact they bear from the COVID-19 pandemic, particularly in the contexts of response to stress, social isolation, work-life integration, and autonomy. Because the language we use is important, we think it necessary to clarify that when we refer to 'women physicians,' we are referring to physicians that self-identify as women, and we acknowledge that not all the references we cite may use the same definition.Results: We offer several potential interventions that turn the challenges women physicians are facing into opportunities to address longstanding inequity. These interventions include tackling barriers to work-life balance, addressing gender and maternal bias, and promoting women physician representation in leadership.Conclusion: The COVID-19 pandemic is likely to become a chronic part of our lives; protecting vulnerable populations, such as women physicians, through thoughtful intervention is paramount.KEY MESSAGESWomen physicians experience considerable adversity during the COVID-19 pandemic, particularly in the contexts of response to stress, social isolation, work-life integration, and autonomy.These challenges create opportunities for interventions to improve equity in medicine during the COVID-19 pandemic and in the long-term, including tackling barriers to work-life balance, addressing gender and maternal bias, and promoting women physician representation in leadership.
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Affiliation(s)
| | - Ashley Zhou
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Jenkins TM. Physicians as shock absorbers: The system of structural factors driving burnout and dissatisfaction in medicine. Soc Sci Med 2023; 337:116311. [PMID: 37857243 DOI: 10.1016/j.socscimed.2023.116311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
American physicians disproportionately suffer from burnout. Despite calls for systemic solutions, however, few studies have actually examined how 'the system' works-i.e. how structural factors intersect in real-time as a system to shape wellbeing. I borrow a systems theoretical approach, which explicitly recognizes the dynamic relationships and interdependencies between different actors and factors in healthcare, to examine how structural factors work together to shape physicians' wellbeing. Drawing on an eight-month ethnography in a pediatrics clinic, I show how respondents experienced pressures from multiple structural levels: societal (including broader social inequality and changing doctor-patient relationships); organizational (centralized decision-making, economic pressures, and unresponsive leadership); and professional (specialty cultures and unhealthy norms). I find that individual physicians effectively served as shock absorbers, routinely absorbing countless, interconnected structural demands ("shocks") and converting them into competent medical care, at significant cost to their mental health. In so doing, I intervene in sociological debates about the broader fate of the medical profession and conclude that if medicine remains resilient against threats to its dominance, it may well be at the expense of individual physicians' mental wellbeing.
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Affiliation(s)
- Tania M Jenkins
- Department of Sociology, The University of North Carolina - Chapel Hill, 155 Pauli Murray Hall CB #3210 UNC-CH, Chapel Hill, NC, 27599-3210, USA.
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Del Bene VA, Geldmacher DS, Howard G, Brown C, Turnipseed E, Fry TC, Jones KA, Lazar RM. A rationale and framework for addressing physician cognitive impairment. Front Public Health 2023; 11:1245770. [PMID: 37693707 PMCID: PMC10485616 DOI: 10.3389/fpubh.2023.1245770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Medical error is costly, in terms of the health and wellbeing of the patient, their family, and the financial burden placed on the medical system. Reducing medical error is paramount to minimizing harm and improving outcomes. One potential source of medical error is physician cognitive impairment. Determining how to effectively assess and mange physician cognitive impairment is an important, albeit difficult problem to address. There have been calls and attempts to implement age-based cognitive screening, but this approach is not optimal. Instead, we propose that neuropsychological assessment is the gold standard for fitness-for-duty evaluations and that there is a need for the development of physician-based, normative data to improve these evaluations. Here, we outline the framework of our research protocol in a large, academic medical center, in partnership with hospital leadership and legal counsel, which can be modeled by other medical centers. With high rates of physician burnout and an aging physician population, the United States is facing a looming public health crisis that requires proactive management.
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Affiliation(s)
- Victor A. Del Bene
- Department of Neurology, Division of Neuropsychology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - David S. Geldmacher
- Department of Neurology, Division of Neuropsychology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Howard
- School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Catherine Brown
- Nursing Academic Affairs, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Elizabeth Turnipseed
- Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - T. Charles Fry
- University of Alabama Health Services Foundation, P.C., Birmingham, AL, United States
| | - Keith A. Jones
- University of Alabama Health Services Foundation, P.C., Birmingham, AL, United States
- Department of Anesthesiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Neurobiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ronald M. Lazar
- Department of Neurology, Division of Neuropsychology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Neurobiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
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Isbell LM, Graber ML, Rovenpor DR, Liu G. Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment. Diagnosis (Berl) 2023; 10:257-266. [PMID: 37185165 DOI: 10.1515/dx-2020-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/22/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Patients with mental illness are less likely to receive the same physical healthcare as those without mental illness and are less likely to be treated in accordance with established guidelines. This study employed a randomized experiment to investigate the influence of comorbid depression on diagnostic accuracy. METHODS Physicians were presented with an interactive vignette describing a patient with a complex presentation of pernicious anemia. They were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. RESULTS Fifty-nine physicians completed the study. The patient with comorbid depression was less likeable than the control patient (p=0.03, 95 % CI [0.09, 1.53]). Diagnostic accuracy was lower in the depression compared to control condition (59.4 % vs. 40.7 %), however this difference was not statistically significant χ2(1)=2.035, p=0.15. Exploratory analyses revealed that patient condition (depression vs. control) interacted with the number of diagnostic tests ordered to predict diagnostic accuracy (OR=2.401, p=0.038). Accuracy was lower in the depression condition (vs. control) when physicians ordered fewer tests (1 SD below mean; OR=0.103, p=0.028), but there was no difference for physicians who ordered more tests (1 SD above mean; OR=2.042, p=0.396). CONCLUSIONS Comorbid depression and related behaviors lowered diagnostic accuracy when physicians ordered fewer tests - a time when more possibilities should have been considered. These findings underscore the critical need to develop interventions to reduce diagnostic error when treating vulnerable populations such as those with depression.
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Affiliation(s)
- Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mark L Graber
- Society to Improve Diagnosis in Medicine, Plymouth, MA, USA
- Stony Brook University, NY, USA
| | | | - Guanyu Liu
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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12
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Smith NE, Sierra T, Brown H. Acknowledging the risk of suicidal ideation, depression, and anxiety in PAs. JAAPA 2023; 36:33-38. [PMID: 36913609 DOI: 10.1097/01.jaa.0000921264.94152.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
ABSTRACT The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.
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Affiliation(s)
- Noël E Smith
- Noël E. Smith is senior director of PA and industry research and analysis at the American Academy of Physician Associates in Alexandria, Va. Talia Sierra is an associate professor in the PA program at Idaho State University in Caldwell, Idaho. Heidi Brown practices in psychiatry in Oregon, Idaho, and Utah, and is an affiliate faculty member in the PA program at Idaho State University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Brandenburg JE, Schultz BA, Prideaux CC, Driscoll SW. Physician distress: Where are we and what can be done. J Pediatr Rehabil Med 2023; 16:435-442. [PMID: 37718875 DOI: 10.3233/prm-230032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Depression, suicidal ideation, burnout, and moral injury are on the rise among physicians. Depression and suicidal ideation are mental health disorders that result from multiple interacting factors including biological vulnerabilities and acute stressors. Medical treatment for depression and suicidal ideation is critical to interrupt the potentially deadly progression to suicide that occurs when one's ability to find hope and other solutions is clouded by despair. Yet, stigma and perceived stigma of seeking treatment for mental health disorders still plagues medical providers. Transitions during medical training and practice can be particularly vulnerable time periods, though newer evidence suggests that overall, physicians are not at an increased risk of suicide compared to the general population. While burnout and moral injury are common among rehabilitation physicians, unlike depression, they are not directly associated with suicidal ideation. Opportunities for continued improvement in mental health resources and institutional support exist across the spectrum from medical student to staff physician. With wellness now increasingly supported and promoted by various medical organizations and recognition of the importance of access to effective mental health treatment, regaining hope and positivity while restoring resiliency in physicians, trainees, and medical students is possible.
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Affiliation(s)
- Joline E Brandenburg
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Billie A Schultz
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Cara C Prideaux
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sherilyn W Driscoll
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Winder GS, Clifton EG, Perumalswami P, Mellinger JL. The art of interprofessional psychosocial communication: Optimizing patient interfaces with psychiatric specialists in liver transplantation. Transplant Rev (Orlando) 2022; 36:100728. [DOI: 10.1016/j.trre.2022.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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Abraham AE, Busch CA, Brownell SE, Cooper KM. Should I write about mental health on my med school app? Examining medical school admissions committee members' biases regarding mental health conditions. ADVANCES IN PHYSIOLOGY EDUCATION 2022; 46:526-539. [PMID: 35900355 DOI: 10.1152/advan.00094.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Mental health conditions can impact college students' academic achievements and experiences. As such, students may choose to disclose mental illnesses on medical school applications. Yet, no recent studies have investigated to what extent disclosure of a mental health condition may impact whether an applicant is accepted to medical school. We conducted an audit study to address this gap and surveyed 99 potential medical school admissions committee members from over 40 M.D.-granting schools in the United States. Participants rated a fictitious portion of a single medical school application on acceptability, competence, and likeability. They were randomly assigned to a condition: an application that explained a low semester grade-point average due to 1) a mental health condition, 2) a physical health condition, or 3) offered no explanation. After rating their respective application, all committee members were asked about when revealing a mental health condition would be beneficial and when it would be detrimental. Using ANOVAs, multinomial regression, and open coding, we found that medical school admissions committee members do not rate applications lower when a mental health condition is revealed. Committee members highlighted that revealing a mental health condition to demonstrate resiliency could be beneficial, but if the reference is vague or the condition is not being managed, it could be detrimental to a student's application. This work indicates that medical school admissions committee members do not exhibit a bias against mental health conditions and provides recommendations on how to discuss mental illness on medical school applications.
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Affiliation(s)
- Anna E Abraham
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Carly A Busch
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Sara E Brownell
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Katelyn M Cooper
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, Arizona
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Berliant M, Rahman N, Mattice C, Bhatt C, Haykal KA. -Barriers faced by medical students in seeking mental healthcare: A scoping review. MEDEDPUBLISH 2022; 12:70. [PMID: 37435431 PMCID: PMC10331850 DOI: 10.12688/mep.19115.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 09/22/2024] Open
Abstract
Background: Medical students commonly exhibit mental health issues. Despite the availability of professionals on medical campuses, seeking help continues to be a challenge for some students. Our review aimed to identify the barriers medical students face when seeking professional mental healthcare. Methods: A Medical Subject Headings (MeSH) search was created for articles using PubMed, Embase, and PsychINFO databases to identify articles specifically about medical students and their barriers to professional mental healthcare. Inclusion criteria included articles in which barriers to mental healthcare were either the primary variable or one of multiple study results. No date limits were imposed. Reviews, pilot projects, or articles that did not address barriers to mental healthcare faced by medical students or focused on veterinary or dental students were excluded. A total of 454 articles were identified and screened by title/abstract and then full text. Data were extracted from 33 articles using an independent framework. Barriers identified were compiled and reported. Results: From a total of 33 articles, the most identified barriers were fear of negative effect on residency/career opportunities, fear of confidentiality breach, stigma and fear of shaming from peers, lack of perceived seriousness/normalization of symptoms, lack of time, and fear of documentation on academic record. Students also preferred to seek care outside of their institution from fear of their provider being an academic preceptor. Conclusions: Many of the barriers to mental healthcare faced by medical students relate to a fear of academic and career reprisal, and fear of confidentiality breach. It appears that despite recent efforts to decrease stigma surrounding mental illness, many medical students struggle to seek appropriate support. Access to mental healthcare can be improved by increasing transparency regarding what information will be displayed on academic records, dispelling common myths about mental healthcare, and increasing awareness about resources available for medical students.
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Affiliation(s)
- Maria Berliant
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Nabiha Rahman
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | | | - Chirayu Bhatt
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Kay-Anne Haykal
- Family Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
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Keyworth C, Alzahrani A, Pointon L, Hinsby K, Wainwright N, Moores L, Bates J, Johnson J. Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study. Front Psychol 2022; 13:1008913. [DOI: 10.3389/fpsyg.2022.1008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundInternational efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.MethodsTwenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.ResultsFour key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.DiscussionOur findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.
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Manzoor F, Wei L, Zia ul Haq M, Rehman HU. Assessment of Mental Health of Medical Personnel during COVID-19: Insights from Pakistan. Heliyon 2022; 8:e11824. [DOI: 10.1016/j.heliyon.2022.e11824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/11/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Burzee Z, Bowers C, Beidel D. A re-evaluation of Stuart's police officer stigma scale: Measuring mental health stigma in first responders. Front Public Health 2022; 10:951347. [PMID: 36203658 PMCID: PMC9530805 DOI: 10.3389/fpubh.2022.951347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/16/2022] [Indexed: 01/24/2023] Open
Abstract
Stigma about mental illness is often identified as one of the most prominent obstacles to seeking mental health services. This seems to be particularly true among first responders. Unfortunately, the research regarding stigma in first responders is lacking. This may be due, in part, to the absence of appropriate measurement tools to allow such research. Police Officer Stigma Scale (POSS) has recently been developed to address this issue, but its psychometric properties have gone largely untested. Therefore, this study sought to identify the underlying factor structure and internal consistency of the POSS. This paper used a sample of 135 first responders. Using factor analysis with an orthogonal rotation on Stuart's 11-item POSS, the participant's results revealed two main components, accounting for a total of 72.79% of the overall variance. Factor one is "maltreatment of colleagues with a mental disorder," and is associated with six of the 11 items on the scale, such as "Most police officers believe that a colleague who has had a mental illness is not trustworthy." Factor two is "fear of disclosing a mental disorder." It includes items such as "Most police officers would not disclose to a supervisor/manager if they were experiencing a mental illness." Findings from this research are similar to the results of previous studies with components such as unwillingness to disclose a mental health condition, fear of how the public will treat an individual with a mental disorder, and anger toward those who decide to seek treatment or get diagnosed with a mental illness. These findings imply that Stuart's POSS is reliable but needs to include two components rather than one. With the two main components, further research can now be conducted to understand why and ultimately mitigate maltreatment or stigma against first responders with a mental health condition.
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Affiliation(s)
- Zachery Burzee
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Clint Bowers
- Department of Psychology, University of Central Florida, Orlando, FL, United States
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Deborah Beidel
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
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Meyer ML, Louder CN, Self KJ, Nicolas G. Investigating the Psychological Impact of COVID-19 on Healthcare Professionals: Implications and Recommendations. JOURNAL OF PREVENTION AND HEALTH PROMOTION 2022; 3:327-346. [PMID: 38603384 PMCID: PMC9294614 DOI: 10.1177/26320770221091735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Public health crises that increase the demand for healthcare professionals (HCPs) often result in increased mental distress in HCPs. The current study investigated the specific mental health ramifications of the COVID-19 pandemic on HCPs and perceived support from their places of work. Data was collected from US-based HCPs (N = 325) working as physicians (21.8%), nurses (26.8%), mental health professionals (MHPs; 30.5%), and allied healthcare professionals (AHPs; 20.9%) from April 2020 to April 2021 amidst the COVID-19 pandemic, using an online self-report survey. Descriptive and correlational statistical analyses assessed worry, stressors, psychological functioning, and perceived support. A majority of participants expressed worry about the pandemic broadly (93%), and approximately half (50.5%) indicated that their degree of worry was moderate to extreme. Respondents worried most about the risk of infection for family and relatives. HCPs reported not having been able to enjoy daily activities (66.9%), losing sleep (43.1%), and feeling constantly under strain (66.9%), compared to usual. Most HCPs indicated a strong desire for clear communication regarding the pandemic and psychological support from their workplaces. This paper provides recommendations to support HCP mental health by both ameliorating distress caused by the COVID-19 pandemic as well as protecting the health and wellness of HCPs more generally. HCPs and institutions that employ them should seek out or provide access to mental health resources and services, engage with or provide opportunities and activities to actively address mental health, and improve communication regarding COVID-19 or other topics HCPs demonstrate interest in.
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22
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Mediavilla R, Monistrol-Mula A, McGreevy KR, Felez-Nobrega M, Delaire A, Nicaise P, Palomo-Conti S, Bayón C, Bravo-Ortiz MF, Rodríguez-Vega B, Witteveen A, Sijbrandij M, Turrini G, Purgato M, Vuillermoz C, Melchior M, Petri-Romão P, Stoffers-Winterling J, Bryant RA, McDaid D, Park AL, Ayuso-Mateos JL. Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis. Front Public Health 2022; 10:956403. [PMID: 35968478 PMCID: PMC9363705 DOI: 10.3389/fpubh.2022.956403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs. Materials and methods Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health). Results We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels. Conclusions In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Anna Monistrol-Mula
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Kerry R. McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Audrey Delaire
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | | | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Hospital Universitario La Paz, Madrid, Spain
| | - Anke Witteveen
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Giulia Turrini
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Research Team on Social Epidemiology, Paris, France
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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Attardi SM, Gould DJ, Pratt RL, Roach VA. YouTube-based course orientation videos delivered prior to matriculation fail to alleviate medical student anxiety about anatomy. ANATOMICAL SCIENCES EDUCATION 2022; 15:685-697. [PMID: 34048140 DOI: 10.1002/ase.2107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Gross anatomy is a source of anxiety for matriculating medical students due to the large volume of information presented in a truncated timeline, and because it may be their first exposure to human cadavers. This study aimed to assess if video-based resources would affect matriculating medical students' anatomy state anxiety levels. Videos were designed to be short, YouTube-based units that served to provide orientation information about the anatomy course, dissection facilities, and available study resources to dispel anxiety around beginning their anatomy studies. To evaluate the impact of the videos, students in two consecutive matriculating years (2018 and 2019) completed the validated State-Trait Anxiety Inventory and a demographic questionnaire. The 2019 cohort (n = 118) served as the experimental group with access to the videos; while the 2018 cohort (n = 120) without video access served as a historical control. Analyses revealed that the groups were equivalent in terms of trait anxiety (P = 0.854) and anatomy state anxiety even when student video exposure was controlled (P = 0.495). Anatomy state anxiety was only significantly lower in students with prior formal anatomy exposure (P = 0.006). Further inquiry into students' prior anatomy experience identified that individuals with post-secondary dissection experience were significantly less anxious than those without formal anatomical experience (P = 0.023). These results may serve as a cautionary tale to educators; while preference for video-based instructional materials is prevalent in the literature, videos delivered on public social media platforms fail to prepare students for the psychological impact of studying human anatomy.
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Affiliation(s)
- Stefanie M Attardi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Douglas J Gould
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Rebecca L Pratt
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Victoria A Roach
- Division of Healthcare Simulation Science, Department of Surgery, University of Washington, Seattle, Washington, USA
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Roškar S, Kralj D, Andriessen K, Krysinska K, Vinko M, Podlesek A. Anticipated Self and Public Stigma in Suicide Prevention Professionals. Front Psychiatry 2022; 13:931245. [PMID: 35836667 PMCID: PMC9273872 DOI: 10.3389/fpsyt.2022.931245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stigma about mental illness-both public and self-is one of the most important factors hindering help-seeking. Stigma can occur during an acute episode of mental illness or be anticipatory. One group affected by stigma, but often neglected, is mental health professionals. This study examined the anticipated form of mental-illness and help-seeking self-stigma and the anticipated form of public stigma of suicidal behavior among members of the International Association for Suicide Prevention. We hypothesized that suicidologists with a history of suicidality or mental illness would anticipate greater stigma from the public and self. Methods The study received ethical approval from the Commission for Medical Ethics of the Republic of Slovenia. Data from 83 participants who completed an online survey (February to May 2020) with informed consent were analyzed using path analysis. We tested a model predicting help-seeking self-stigma based on (i) personal experience of mental illness using anticipated self-stigma of mental illness as a mediating variable and (ii) history of suicidal behavior using anticipated public stigma of suicidal behavior as a mediating variable. Results Personal experience of mental illness predicted anticipation of self-stigma of mental illness (β = 0.26). History of suicidality predicted anticipation of public stigma of suicidal behavior (β = 0.29). Anticipated self-stigma of mental illness proved to be a stronger predictor of help-seeking self-stigma (β = 0.40) than anticipated public stigma of suicidal behavior (β = 0.07). Conclusions It is important to intentionally support the mental health of suicide prevention professionals, as they are not immune to mental illness or various types of stigma. Because our sample was small and diverse, further research to better understand stigma concepts in this population is warranted.
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Affiliation(s)
- Saška Roškar
- Department for Health Research and Development, National Institute of Public Health, Ljubljana, Slovenia
| | - Domen Kralj
- Department for Health Research and Development, National Institute of Public Health, Ljubljana, Slovenia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Matej Vinko
- Department for Health Research and Development, National Institute of Public Health, Ljubljana, Slovenia
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
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Bartholomew A, Sanatkar S, Counson I, Harvey SB. Junior doctors' mental health and coronavirus disease safety concerns. Aust N Z J Public Health 2022; 46:307-313. [PMID: 35238447 PMCID: PMC9968570 DOI: 10.1111/1753-6405.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This article aims to assess whether caring for COVID-19 patients impacted junior doctors' COVID-19-related anxieties, general anxiety and depression, and the relative impact of depression, general anxiety and specific COVID-19 anxiety on work and social functioning during the COVID-19 pandemic in 2020. METHODS Recruitment occurred between June and August 2020 in New South Wales, Australia. Demographic information, symptoms of depression (PHQ-9), generalised anxiety (GAD-7), and COVID-19-related anxieties around infections, help-seeking behaviours, and work and social functioning (WSAS) were collected. RESULTS About one third (n=73, 33%) had cared for a patient with overt or covert COVID-19 in the previous month. However, the extent of COVID-19-related anxiety symptoms was largely unrelated to caring for COVID-19 patients. Instead, the presence of other COVID-19 concerns and gender predicted variations in COVID-19 concerns for one's own safety and the safety of loved ones. CONCLUSION COVID-19 anxiety symptoms were largely unrelated to caring for COVID-19 patients, while COVID-19-related anxiety around the safety of family and friends added to impaired functioning in addition to the established impact of depression and general anxiety. IMPLICATIONS FOR PUBLIC HEALTH Provided the replicability of these findings, this research highlights the importance of addressing pandemic-related anxieties in junior doctor populations.
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Affiliation(s)
- Alexandra Bartholomew
- Black Dog Institute, UNSW Sydney, New South Wales,Correspondence to: Ms Alexandra Bartholomew, Black Dog Institute, Hospital Road, Sydney 2031
| | - Samineh Sanatkar
- Black Dog Institute, UNSW Sydney, New South Wales,School of Psychiatry, UNSW Sydney, New South Wales
| | - Isabelle Counson
- Black Dog Institute, UNSW Sydney, New South Wales,School of Psychiatry, UNSW Sydney, New South Wales
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Peck JA, Porter TH. Pandemics and the Impact on Physician Mental Health: A Systematic Review. Med Care Res Rev 2022; 79:772-788. [PMID: 35549938 DOI: 10.1177/10775587221091772] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physician mental health is a major area of concern with physician burnout on the rise, while at the same time pandemics are becoming more frequent and serious in nature. This combination of physician burnout and pandemics has the potential for serious negative implications for physicians, patients, and health care organizations. Thus, we conduct a systematic review that examines the effect of pandemics on physician mental health using the burnout cascade as a framework. We identified 30 quantitative studies for inclusion. We find that Stages 4 and 5 of the burnout cascade are particularly troublesome with physicians experiencing high levels of anxiety and depression. Furthermore, we find in the degradation phase that physicians experience stigma which may intensify other negative effects. Physicians who are women, younger, and have less training are more susceptible to the negative effects of pandemics. We discuss overall implications and recommendations for future research.
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Gaudet CE, Del Bene VA. Neuropsychological Assessment of the Aging Physician: A Review & Commentary. J Geriatr Psychiatry Neurol 2022; 35:271-279. [PMID: 34018429 DOI: 10.1177/08919887211016063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late-career physicians (LCPs) are at risk for cognitive changes that may affect their ability to practice medicine. This review aggregates and discusses research that has examined cognitive functioning among physicians, typically when clinically referred for various medical and psychological reasons that may interfere with their ability to practice medicine. Special consideration is devoted to the role of approaches for examining cognitive functioning (e.g., cognitive screening, cognitive testing, & neuropsychological assessment), normative challenges, and cultural factors that should be considered when evaluating a physician. Based on published studies, there is evidence supportive of the use of cognitive testing and neuropsychological assessment among physicians in a fitness for duty setting. However, prospective studies designed to identify physicians at-risk (i.e., to prevent medical error) are lacking. Additional research is warranted to establish physician-based normative reference groups and aid in test interpretation and prognostication. Moreover, given limitations associated with cognitive testing in isolation, there is a potential role for comprehensive neuropsychological assessment to identify cognitive changes in physicians and provide a supportive pathway to preserve physicians' ability to practice medicine.
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Affiliation(s)
- Charles E Gaudet
- Department of Psychology, University of Rhode Island, Kingston, RI, USA.,Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Victor A Del Bene
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA
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The "Healthcare Workers' Wellbeing [Benessere Operatori]" Project: A Longitudinal Evaluation of Psychological Responses of Italian Healthcare Workers during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11092317. [PMID: 35566442 PMCID: PMC9103992 DOI: 10.3390/jcm11092317] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: COVID-19 forced healthcare workers to work in unprecedented and critical circumstances, exacerbating already-problematic and stressful working conditions. The “Healthcare workers’ wellbeing (Benessere Operatori)” project aimed at identifying psychological and personal factors, influencing individuals’ responses to the COVID-19 pandemic. Methods: 291 healthcare workers took part in the project by answering an online questionnaire twice (after the first wave of COVID-19 and during the second wave) and completing questions on socio-demographic and work-related information, the Depression Anxiety Stress Scale-21, the Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait Anger Expression Inventory-2, the Maslach Burnout Inventory, the Multidimensional Scale of Perceived Social Support, and the Brief Cope. Results: Higher levels of worry, worse working conditions, a previous history of psychiatric illness, being a nurse, older age, and avoidant and emotion-focused coping strategies seem to be risk factors for healthcare workers’ mental health. High levels of perceived social support, the attendance of emergency training, and problem-focused coping strategies play a protective role. Conclusions: An innovative, and more flexible, data mining statistical approach (i.e., a regression trees approach for repeated measures data) allowed us to identify risk factors and derive classification rules that could be helpful to implement targeted interventions for healthcare workers.
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Irigoyen-Otiñano M, Castro-Herranz S, Romero-Agüit S, Mingote-Adán JC, Garrote-Díaz JM, Matas-Aguilera V, López-Ordoño GJ, Puigdevall-Ruestes M, Alberich S, González-Pinto A. Suicide among physicians: Major risk for women physicians. Psychiatry Res 2022; 310:114441. [PMID: 35183987 DOI: 10.1016/j.psychres.2022.114441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS . Suicide is higher among physicians than the general population and affects female physicians significantly more.
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Affiliation(s)
- M Irigoyen-Otiñano
- Psychiatrist, former Secretary General of the Medical Association Lérida. University Hospital Santa Maria, Lérida. Spain.
| | - S Castro-Herranz
- Forensic Doctor, national representative of physicians in Public Administrations at CGCOM. Spain
| | - S Romero-Agüit
- Family Doctor, former President General Council of Medical Associations of Spain (CGCOM). Spain
| | | | - J M Garrote-Díaz
- Family Doctor, former Secretary General of the General Council of Medical Associations of Spain (CGCOM). Spain
| | - V Matas-Aguilera
- Family Doctor, national representative of Urban Primary Health Care at CGCOM. Spain
| | - G J López-Ordoño
- General Surgeon, National representative of Hospitals at CGCOM. Spain
| | | | - S Alberich
- Mathematician, Araba Univesity Hospital-Santiago. Bioaraba. CIBERSAM. UNED. Spain
| | - A González-Pinto
- Psychiatrist. Professor of Psychiatry University of the Basque Country. President of the Spanish Foundation of Mental Health. CIBERSAM. Spain
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Individuals to Systems: Methodological and Conceptual Considerations for Addressing Mental Illness Stigma Holistically. Int J Ment Health Addict 2022; 20:3368-3380. [PMID: 35345872 PMCID: PMC8944180 DOI: 10.1007/s11469-022-00801-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
Mental illness stigma is a complex public health issue that creates barriers for clients needing access to quality mental health services. Most research focuses on interpersonal stigma with emerging research examining intrapersonal and structural stigma in the healthcare setting. This commentary focuses on how to address the gaps in the existing research to elicit greater organizational/structural change in healthcare systems and positive health outcomes. It describes key components of a 5-year multiphase study that aims to explore and address multiple levels of stigma holistically among stakeholders including physicians, nurses, protective services staff, and patients/families in an emergency department setting. Unique to this study is the inclusion of a patient research partner who will be positioned as a co-designer throughout the project. The goal of this study will be to explore, address, understand, and evaluate interventions that mitigate stigma in healthcare at both the individual and structural/organizational levels.
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Khadilkar A. A Conversation About Suicide During Medical Training. JAMA Neurol 2022; 79:439-440. [PMID: 35285876 DOI: 10.1001/jamaneurol.2022.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mohamed Asif S, Ibrahim Assiri K, Mohammed Al Muburak H, Hamid Baig FA, Abdullah Arem S, Arora S, Mohammed Shamsudeen S, Shariff M, Shamsuddin S, Mohammed Lahiq AA. Anxiety and Depression Among Dentists in the Kingdom of Saudi Arabia. Risk Manag Healthc Policy 2022; 15:497-507. [PMID: 35321270 PMCID: PMC8935081 DOI: 10.2147/rmhp.s350277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Dentists face a great deal of professional stress, in dental school and in practice. Their personal, as well as professional lives, get affected negatively by stress and poor mental health. This study aims to evaluate anxiety and depression among dentists of Abha in kingdom of Saudi Arabia. Materials and Methods A cross-sectional study was carried out among 246 registered dentists of Abha to assess anxiety and depression. Participants willing to participate, and completely filled questionnaire were included in study. Data regarding demography, work-related characters, lifestyle and self-reported physical and mental status were collected. Mental status was measured by using pre validated questionnaire Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Data were analyzed using Statistical Package for Social Sciences (SPSS 20) by IBM. Descriptive statistics, Pearson correlation, independent t test and one way ANOVA were used to analyze the data at the significant interval of p≤0.05. Results Different levels of anxiety and depression were noticed both in males and female dentist. There was no statistical difference in the mean scores between males and females. There was a statistical difference of anxiety and depression scores noticed among dentist working in government institution, with five to ten years of experience. Habits of smoking were shown to significantly affect the risk of anxiety and depression scores. Conclusion Dentist due to nature of the practice are prone for anxiety and clinical depression. Stress coping methods should be included in dental curriculum which would indirectly improve professional abilities and personal life.
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Affiliation(s)
- Shaik Mohamed Asif
- Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
- Correspondence: Shaik Mohamed Asif, Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia, Tel +966 557361821, Email
| | - Khalil Ibrahim Assiri
- Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Hussain Mohammed Al Muburak
- Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Fawaz Abdul Hamid Baig
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Saeed Abdullah Arem
- Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Shaik Mohammed Shamsudeen
- Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mansoor Shariff
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Shaheen Shamsuddin
- Department of Orthodontics, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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Bourne T, Kyriacou C, Shah H, Ceusters J, Preisler J, Metzger U, Landolfo C, Lees C, Timmerman D. Experiences and well-being of healthcare professionals working in the field of ultrasound in obstetrics and gynaecology as the SARS-CoV-2 pandemic were evolving: a cross-sectional survey study. BMJ Open 2022; 12:e051700. [PMID: 35121598 PMCID: PMC8819548 DOI: 10.1136/bmjopen-2021-051700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Assess experience of healthcare professionals (HCPs) working with ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 pandemic, given the new and unprecedented challenges involving viral exposure, personal protective equipment (PPE) and well-being. DESIGN Prospective cross-sectional survey study. SETTING Online international survey. Single-best, open box and Hospital Anxiety and Depression Scale (HADS) questions. PARTICIPANTS The survey was sent to 35 509 HCPs in 124 countries and was open from 7 to 21 May 2020. 2237/3237 (69.1%) HCPs from 115 countries who consented to participate completed the survey. 1058 (47.3%) completed the HADS. PRIMARY OUTCOME MEASURES Overall prevalence of SARS-CoV-2, depression and anxiety among HCPs in relation to country and PPE availability. ANALYSES Univariate analyses were used to investigate associations without generating erroneous causal conclusions. RESULTS Confirmed/suspected SARS-CoV-2 prevalence was 13.0%. PPE provision concerns were raised by 74.1% of participants; highest among trainees/resident physicians (83.9%) and among HCPs in Spain (89.7%). Most participants worked in self-perceived high-risk areas with SARS-CoV-2 (67.5%-87.0%), with proportionately more trainees interacting with suspected/confirmed infected patients (57.1% vs 24.2%-40.6%) and sonographers seeing more patients who did not wear a mask (33.3% vs 13.9%-7.9%). The most frequent PPE combination used was gloves and a surgical mask (22.3%). UK and US respondents reported spending less time self-isolating (8.8 days) and lower satisfaction with their national pandemic response (37.0%-43.0%). 19.8% and 8.8% of respondents met the criteria for moderate to severe anxiety and depression, respectively. CONCLUSIONS Reported prevalence of SARS-CoV-2 in HCPs is consistent with literature findings. Most respondents used gloves and a surgical mask, with a greater SARS-CoV-2 prevalence compared with those using 'full' PPE. HCPs with the least agency (trainees and sonographers) were not only more likely to see high-risk patients but also less likely to be protected. A fifth of respondents reported moderate to severe anxiety.
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Affiliation(s)
- Tom Bourne
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christopher Kyriacou
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Harsha Shah
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jolien Ceusters
- Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, KU Leuven, Leuven, Belgium
| | - Jessica Preisler
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago de Chile, Chile
- Facultad de Medicina, Clínica Alemana, Hospital Clínico de la Universidad de Chile José Joaquín Aguirre, Santiago, Chile
| | - Ulrike Metzger
- Département d'échographie en Gynécologie et Obstétrique, Centre d'Échographie de l'Odéon, Paris, France
| | - Chiara Landolfo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Christoph Lees
- Centre for Fetal Care, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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34
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Affiliation(s)
- Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
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35
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Martindale SL, Shura RD, Cooper MA, Womack SF, Hurley RA, Vair CL, Rowland JA. Operational Stress Control Service: An Organizational Program to Support Health Care Worker Well-Being. J Occup Environ Med 2022; 64:64-70. [PMID: 34387285 PMCID: PMC8715925 DOI: 10.1097/jom.0000000000002352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This manuscript details the methods, outcomes, and lessons learned from a successful multi-dimensional, interdisciplinary, institutional response to HCW well-being during the COVID-19 pandemic. METHODS Operational Stress Control Service (OSCS) is a model for the prevention and management of stress and trauma implemented within an occupational system. Communication, Employee Wellness, and Intervention were targeted program aspects, adapted from an established US military protocol. RESULTS Since April 2020, OSCS has received 4660 unique survey responses; reached 1007 employees in-person; informed 125 leadership-hosted videoconferences; and assisted 13 departments with grief and morale-related challenges. CONCLUSIONS OSCS improved communication across the organization and allowed for rapid deployment of solutions to maintain effective operations. Results highlight the benefit of multiple avenues of frequent, bottom-up, and top-down communication. Creating such services during times of normalcy might be considered in preparation for future crisis.
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Affiliation(s)
- Sarah L Martindale
- W. G. (Bill) Hefner VA Health Care System, Salisbury, North Carolina (Dr Martindale, Dr Shura, Dr Cooper, Ms Womack, Dr Hurley, Dr Vair, and Dr Rowland); Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Martindale, Dr Shura, Dr Cooper, Dr Hurley, and Dr Rowland); Edward Via College of Osteopathic Medicine, Blacksburg, Virginia (Dr Cooper); Baylor College of Medicine, Houston, Texas (Dr Hurley); Veterans Affairs Mid-Atlantic Health Care Network, Durham, North Carolina (Dr Vair)
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Petrie K, Deady M, Lupton D, Crawford J, Boydell KM, Harvey SB. 'The hardest job I've ever done': a qualitative exploration of the factors affecting junior doctors' mental health and well-being during medical training in Australia. BMC Health Serv Res 2021; 21:1342. [PMID: 34906133 PMCID: PMC8672528 DOI: 10.1186/s12913-021-07381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training. Method Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach. Results Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being. Conclusion The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07381-5.
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Affiliation(s)
- Katherine Petrie
- School of Psychiatry, University of New South Wales, Sydney, NSW, 2000, Australia. .,Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia.
| | - Mark Deady
- School of Psychiatry, University of New South Wales, Sydney, NSW, 2000, Australia.,Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
| | - Deborah Lupton
- Vitalities Lab, Centre for Social Research in Health and Social Policy Research Centre, University of New South Wales, Sydney, NSW, 2000, Australia
| | - Joanna Crawford
- Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
| | | | - Samuel B Harvey
- Black Dog Institute, Hospital Rd, Randwick, NSW, 2031, Australia
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Counson I, Bartholomew A, Crawford J, Petrie K, Basarkod G, Moynihan V, Pires J, Cohen R, Glozier N, Harvey S, Sanatkar S. Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing. JMIR Form Res 2021; 5:e26370. [PMID: 34860662 PMCID: PMC8686399 DOI: 10.2196/26370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/09/2021] [Accepted: 10/21/2021] [Indexed: 01/20/2023] Open
Abstract
Background Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were—needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians’ needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale.
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Affiliation(s)
- Isabelle Counson
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | | | - Joanna Crawford
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | - Katherine Petrie
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | - Geetanjali Basarkod
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, Australia
| | | | | | | | - Nicholas Glozier
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Samuel Harvey
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia
| | - Samineh Sanatkar
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia
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Zara G, Settanni M, Zuffranieri M, Veggi S, Castelli L. The long psychological shadow of COVID-19 upon healthcare workers: A global concern for action. J Affect Disord 2021; 294:220-226. [PMID: 34303300 PMCID: PMC8433601 DOI: 10.1016/j.jad.2021.07.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/08/2021] [Accepted: 07/10/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The outbreak of COVID-19 has posed unprecedented psychological pressure upon every National Health Service in the world. In Piedmont, one of the most affected areas in Italy, 4550 healthcare workers were assessed online in May-June 2020, after the acute outbreak of March-April 2020, that compelled the Italian government to enforce, what was then, the first total lockdown in the Western world. METHODS Socio-demographic information of healthcare workers was gathered along with responses to: General Anxiety Disorder-7, Impact of Event Scale-Revised, Beck Depression Inventory-II, Peritraumatic Dissociative Experiences Questionnaire. Information about the need for psychological support was also gathered. RESULTS The regression models predicted the presence of moderate to severe symptoms for all the conditions assessed. Almost half of healthcare workers presented at least one clinically relevant symptom, and among them one in every four expressed the need of receiving psychological support. CONCLUSIONS Evidence calls for an increase of psychological services within the National Health System in Italy so as to guarantee for healthcare workers the psychological support necessary to cope with the long shadow of COVID-19, whose long-term impact is likely to reveal itself more strongly the more the acute stage of it is passed. LIMITATIONS The assessment of the psychological symptoms was performed without knowing the life and professional situations of the sample, and their medical records. Healthcare workers from only one region in Italy were involved, and some professionals (e.g. self-employed healthcare workers) were not included.
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Affiliation(s)
- Georgia Zara
- Department of Psychology, University of Turin, Italy.
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Brandão MP, Romani AQ, Sudzina F, Bo IG, Mikkelsen BE. Is health behavior among university students determined by actual body shape or by body image? A European study. Work 2021; 70:937-944. [PMID: 34744040 DOI: 10.3233/wor-213613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Appropriate body image self-perceptions provide a good help to increase the feeling of personal well-being, thus having an important impact on health. Universities, having an important role in shaping of the future workers, represent an important setting to approach health issues. OBJECTIVE This study determined to what extent different types of students in higher education (four categories of students were created: "self-secure", "perfect", "destructive" and "apologetic") are likely to adopt different health risk behaviors. METHODS A cross-sectional study in a sample of students from five European Universities in the 2016/2017 academic year was conducted. Based on the combination of body image perception and body mass index, four types of students were identified: "self-secure" (overweight students with a good self-esteem); "perfect" (underweight students with a good self-esteem); "destructive" (overweight students with a poor self-esteem); "apologetic" (underweight students with a poor self-esteem). RESULTS The study reveals that the defined types of students differed in terms of risk behavior. When the control was included, the "self-secure" student type had a reduced likelihood of being on a diet (22.3%) and physically active (17.8%) than other students (p < 0.001). CONCLUSIONS The results of this paper raise concerns about the future because the body dissatisfaction of the college student could be a big impact in long term whether at collective, personally or even professionally.
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Affiliation(s)
- Maria Piedade Brandão
- School of Health Sciences, University of Aveiro, Portugal.,Centre for Health Technology andServices Research, University of Porto, Porto, Portugal
| | | | - Frantitsek Sudzina
- Department ofBusiness and Management, Aalborg University, Aalborg, Denmark
| | - Inger Glavind Bo
- Department of Sociology and Social Work, AalborgUniversity, Aalborg, Denmark
| | - Bent Egberg Mikkelsen
- Department of Geosciences and Natural Resource, University of Copenhagen, Copenhagen, Denmark
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Hudson E, Arnaert A, Lavoie-Tremblay M. Healthcare professional disclosure of mental illness in the workplace: a rapid scoping review. J Ment Health 2021:1-13. [PMID: 34582294 DOI: 10.1080/09638237.2021.1979485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/06/2021] [Accepted: 08/19/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although mental health difficulties are common among healthcare professionals (HCP), little research exists exploring the decision to disclose these difficulties in the healthcare context. AIMS This rapid scoping review aims to explore HCP disclosure of mental health difficulties in the workplace. METHODS The methodological framework was based on rapid and scoping review guidelines. A thematic synthesis approach was used for data analysis. RESULTS Seventeen articles were included. Disclosure was found to be a process that starts with weighing its pros ("personal benefits", "personal beliefs", and "professional responsibility") and cons ("fears related to professional identity", "fears related to employment", "risk of stigmatization", and "personal experiences with mental health difficulties"). A decision-making process then occurs to help HCPs figure out how to disclose. Situations of nonconsensual disclosure can transpire through "third party disclosure" or "inadvertent disclosure". Disclosure results in outcomes including "positive experiences", "negative personal consequences" and "negative consequences related to others". CONCLUSION Disclosure in healthcare and other workplaces is a complex process with few benefits and many potential repercussions. However, there is an opportunity to improve. Recognizing the value of and educating the workforce about HCPs with mental health difficulties will help work environments become safer for disclosure.
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Affiliation(s)
- Emilie Hudson
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montréal, Canada
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Snavely C, Romeo M, Ciardiello A, Mojica M. The pandemic of workplace violence: the gendered experience of emergency medicine trainees. AEM EDUCATION AND TRAINING 2021; 5:e10630. [PMID: 34471789 PMCID: PMC8325433 DOI: 10.1002/aet2.10630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Many health care providers experience physical and verbal abuse from patients and their visitors. This abuse is a form of workplace violence and likely has negative implications for the providers well-being. The objective of our study was to determine the rates of nonphysical workplace violence against emergency medicine (EM) trainees with a focus on prevalence by provider gender. METHODS This was a single-center prospective cohort study using tally counters to track occurrences of nonphysical workplace violence perpetrated by patients and their visitors against EM trainees in the adult emergency department. RESULTS There were a total of 39 completed responses submitted by 22 respondents. Of the 22 respondents, 14 identified as women and eight identified as men. On average, both men and women experienced near daily occurrences of nonphysical workplace violence. However, women experienced higher rates compared to their colleagues who are men with a mean of three occurrences per day versus 0.9, respectively. CONCLUSION We found that women trainees were more likely to experience nonphysical workplace violence from patients and their visitors.
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Affiliation(s)
- Cheyenne Snavely
- Emergency MedicineNew York University Langone HealthNew YorkNew YorkUSA
- Emergency MedicineBellevue Hospital CenterNew YorkNew YorkUSA
| | - Michelle Romeo
- Emergency MedicineNew York University Langone HealthNew YorkNew YorkUSA
- Emergency MedicineBellevue Hospital CenterNew YorkNew YorkUSA
| | - Amber Ciardiello
- Emergency MedicineNew York University Langone HealthNew YorkNew YorkUSA
- Emergency MedicineBellevue Hospital CenterNew YorkNew YorkUSA
| | - Michael Mojica
- Emergency Medicine and PediatricsNew York University Langone HealthNew YorkNew YorkUSA
- Emergency Medicine and PediatricsBellevue Hospital CenterNew YorkNew YorkUSA
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Brower KJ. Professional Stigma of Mental Health Issues: Physicians Are Both the Cause and Solution. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:635-640. [PMID: 33885412 PMCID: PMC8078109 DOI: 10.1097/acm.0000000000003998] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author's institution showed that depression decreased respondents' willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.
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Affiliation(s)
- Kirk J. Brower
- K.J. Brower is professor, Department of Psychiatry, and chief wellness officer, University of Michigan Medical School, Ann Arbor, Michigan
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Fu C, Wang G, Shi X, Cao F. Social support and depressive symptoms among physicians in tertiary hospitals in China: a cross-sectional study. BMC Psychiatry 2021; 21:217. [PMID: 33926402 PMCID: PMC8082214 DOI: 10.1186/s12888-021-03219-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Social support is an important factor for individual's mental health. However, the association between social support and depressive symptoms among physicians in China' tertiary hospitals has not been explored. This study aimed to investigate its association among physicians stratifying by sex. METHODS Six hundred fifty-six physicians were enrolled from 12 tertiary hospitals of Shandong Province, China. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social support was evaluated using the Social Support Rating Scale. Multiple linear regression analysis was used to examine the relationship between social support and depressive symptoms among physicians. RESULTS The prevalence of depressive symptoms was 42.3% and the average social support score was 38.82 ± 7.53 among physicians. Lower subjective social support scores (male: β = - 0.317, p < 0.001; female: β = - 0.241, p < 0.001) and lower objective social support scores (male: β = - 0.218, p = 0.038; female: β = - 0.277, p = 0.035) were associated with high depressive symptoms among physicians. Lower support utilization scores (β = - 0.472, p < 0.001) were associated with high depressive symptoms among male physicians. CONCLUSIONS Chinese physicians had a higher prevalence of depressive symptoms and lower social support than the Chinese general population. Objective and subjective social support were inversely associated with depressive symptoms among male and female physicians while support utilization was inversely associated with depressive symptoms among male rather than female physicians. It is critical to improve physicians' mental health through strengthening social support in China.
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Affiliation(s)
- Chang Fu
- grid.27255.370000 0004 1761 1174Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhuaxilu Rd, Jinan, 250012 Shandong China
| | - Guowen Wang
- grid.460018.b0000 0004 1769 9639Department of Education, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqilu Rd., Jinan, 250021 Shandong China
| | - Xiuxin Shi
- Office of Medical Quality Control, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 Wenhuaxilu Rd, Jinan, 250012 Shandong China
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhuaxilu Rd, Jinan, 250012, Shandong, China.
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Lovegrove Lepisto B. Encouraging a Little Help from Our Friends: Resident Physician Burnout & Peer Communication Curriculum. Spartan Med Res J 2021; 6:22044. [PMID: 33870005 PMCID: PMC8043911 DOI: 10.51894/001c.22044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Resident physician burnout and depression rates are increasing faster than in the non-physician workforce. To foster a supportive community where such concerns may be addressed, residents can be educated in identification and first-line support of burnout in fellow residents. The literature has not described peer roleplaying applied toward aiding fellow residents with burnout. METHOD This pilot study evaluated an educational component aimed at fostering a strong emotional and informational social support system. The curriculum used peer roleplaying to develop self-awareness and social support, improve communication skills, and teach about existing mental health resources, thereby encouraging intervention. Residents listed behavioral manifestations of burnout and dysphoria that we developed into real-life scenarios. During experiential workshops, residents roleplayed "distressed" and "helper" residents and practiced communicating empathy. To tackle mental health stigma, all were required to practice expressing distress and seeking help. Residents completed a pre-roleplaying questionnaire, curriculum satisfaction questionnaire, and reflection essay. RESULTS All 42 Internal Medicine and Transitional Year residents (69% male, 93% international medical graduates) participated. Resident-reported comfort, competence, confidence, and knowledge increased, as did positive appraisals of the clinical teaching environment representing a safe atmosphere. Six themes were cited in >25% of essays: knowledge of communication techniques, knowledge of approach tactics or strategies, knowledge of hospital resources, commitment to helping colleagues, importance of burnout, and belief this training produced a better understanding of oneself. CONCLUSION As first-witnesses of resident physician distress, peers occupy an underutilized, yet crucial preventive and supportive role in burnout and mental health intervention, especially during times of shared crises such as the coronavirus pandemic. Creating roleplays from personal experiences facilitated meaningful discussion of burnout and dysphoric emotions. Roleplaying offered a low-cost, effective method to destigmatize and encourage discussion of burnout, educate on signs and symptoms, and learn available resources to offer an afflicted colleague in osteopathic and allopathic residency programs.
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Affiliation(s)
- Brenda Lovegrove Lepisto
- Family Medicine, McLaren Greater Lansing; College of Osteopathic Medicine, Michigan State University
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Lorello GR, Gautam M, Barned C, Peer M. Impact of the intersection of anaesthesia and gender on burnout and mental health, illustrated by the COVID-19 pandemic. Anaesthesia 2021; 76 Suppl 4:24-31. [PMID: 33682104 PMCID: PMC8251311 DOI: 10.1111/anae.15360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.
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Affiliation(s)
- G. R. Lorello
- Department of Anesthesiology and Pain MedicineUniversity of TorontoTorontoONCanada
- Department of Anesthesiology and Pain MedicineUniversity Health NetworkToronto Western HospitalTorontoONCanada
| | - M. Gautam
- Department of PsychiatryUniversity of OttawaOttawaONCanada
| | - C. Barned
- University Health NetworkToronto Western HospitalTorontoONCanada
- Pragmatic Health Ethics Research UnitInstitut de recherches cliniques de MontrealMontrealQCCanada
| | - M. Peer
- Department of Anesthesiology and Pain MedicineUniversity Health NetworkToronto Western HospitalTorontoONCanada
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Sunjaya DK, Herawati DMD, Siregar AYM. Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia. BMC Public Health 2021; 21:227. [PMID: 33509159 PMCID: PMC7840791 DOI: 10.1186/s12889-021-10299-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health care personnel (HCP) who demonstrated close contact with Corona virus disease (COVID-19) patients might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among HCP with a higher risk for psychological trauma. METHODS This study was a cross-sectional study using secondary data from an online assessment, which was conducted 1 month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from HCP in the higher risk group and the lower risk group were analyzed. RESULTS A higher percentage of HCP experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group's HCP to present with moderate and severe depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 2.01-13.89; p < 0.05), 1.36 (CI: 0.09-1.96; p > 0.05), and 3.92 (CI: 2.08-7.40; p < 0.05) times higher, respectively. The probability for patient-induced burnout is 2.13 (CI: 1.51-3.007; p < 0.05) times higher and highest among the other burn out dimensions. The depressive symptoms complained were similar between groups: loneliness, sleep disturbances, difficulty concentrating, and inability to initiate activities. Loneliness demonstrates the highest logit value among the symptoms. CONCLUSIONS HCP with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Psychological well-being should be considered for high-risk HCP. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.
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Affiliation(s)
- Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java 40161 Indonesia
| | - Dewi Marhaeni Diah Herawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java 40161 Indonesia
| | - Adiatma Y. M. Siregar
- Department of Economic, Faculty of Economic and Business, Universitas Padjadjaran, Bandung, West Java 40161 Indonesia
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Munisami T, Namasivayam RK, Annamalai A. Mental-Illness-Related Stigma in Health Care in South India: Mixed-Methods Study. Indian J Psychol Med 2021; 43:58-64. [PMID: 34349308 PMCID: PMC8295582 DOI: 10.1177/0253717620932244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stigma related to mental illness is a reality among health care providers. This study is an attempt to understand the attitudes of doctors from different specialties toward mental illness and the stigma related to it. METHODS We used a concurrent nested mixed-methods approach to understand and identify the various factors of mental-illness-related stigma in medical practitioners. Between November 2018 and March 2019, 100 medical practitioners from South India were administered a self-reporting OMS-HC (Opening Minds Scale for Health Care Providers), followed by in-depth interviews among 25 of the 100 participants selected using purposive sampling. Quantitative surveys were analyzed using SPSSv23. In-depth interviews were transcribed as extended notes, translated, and initially explored using focused coding and the constant comparative method. RESULTS Though findings from quantitative analysis show low to moderate stigma (Mean = 53.52, SD = 7.61), the qualitative study revealed unintended and covert negative attitude toward mental illness. CONCLUSION As stigma occurs at various levels-structural, institutional, interpersonal, and personal-anti-stigma measures also need to be systematically designed. Qualitative studies give more insight regarding the nature of stigma in medical practitioners toward mental illness.
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Affiliation(s)
- Thenral Munisami
- Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kanchipuram, Tamil Nadu, India
| | - Rajesh Kannan Namasivayam
- Government Institute of Psychiatric Medicine, Research and Rehabilitation, Government Theni Medical College & Hospital, Theni, Tamil Nadu, India
| | - Arunkumar Annamalai
- LAMED, Center for Interdisciplinary Research on Language Acquisition and Allied Sciences, Chennai, Tamil Nadu, India
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Brown A, Alas H, Bortz C, Pierce KE, Vasquez-Montes D, Ihejirika RC, Segreto FA, Haskel J, Kaplan DJ, Segar AH, Diebo BG, Hockley A, Gerling MC, Passias PG. Patients with psychiatric diagnoses have increased odds of morbidity and mortality in elective orthopedic surgery. J Clin Neurosci 2020; 84:42-45. [PMID: 33485597 DOI: 10.1016/j.jocn.2020.11.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/28/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).
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Affiliation(s)
- Avery Brown
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Haddy Alas
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Cole Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Rivka C Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Jonathan Haskel
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Daniel James Kaplan
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Anand H Segar
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Aaron Hockley
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
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Elyamani R, Hammoud H. Mental Health Literacy of Healthcare Providers in Arab Gulf Countries: A Systematic Review. J Prim Care Community Health 2020; 11:2150132720972271. [PMID: 33179551 PMCID: PMC7675914 DOI: 10.1177/2150132720972271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concept of Mental Health Literacy (MHL) relies on our capacity to understand and recognize mental illnesses and the ability to maintain and promote a positive mentality for ourselves and others. In our review, we aim to examine the level of MHL among healthcare providers in the Arab Gulf States. METHODS PubMed, PsycINFO, Medline were searched till August 2019. Studies were included if at least one of the main components of mental health literacy was reported, including (a) knowledge of mental illnesses, (b) stigma toward mental illnesses, (c) confidence in helping patients, and (d) behavior of helping patients, regardless of study design. The risk of bias was rated according to the modified Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies. RESULTS Seven studies were included in the review; all of them were cross-sectional, with a total of 3516 participants from the healthcare system. Overall most of the studies claimed limited knowledge, negative attitudes, behavior and/or confidence among nurses, pharmacists, and physicians, especially juniors. However, the overall quality of all outcomes was relatively very low. CONCLUSION More high-quality evidence and in-depth qualitative studies are required to bridge the gap between mental health needs and services delivered by healthcare providers in the Gulf Arab region.
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Rajwa P, Przydacz M, Zapała P, Wieckiewicz G, Ryszawy J, Chorągwicki D, Drobot RB, Radziszewski P, Paradysz A, Chłosta PL. How has the COVID-19 pandemic impacted Polish urologists? Results from a national survey. Cent European J Urol 2020; 73:252-259. [PMID: 33133649 PMCID: PMC7587496 DOI: 10.5173/ceju.2020.0252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Poland was initially less affected by the coronavirus disease 2019 (COVID-19) pandemic, however, severe restrictions, and health care restructuration have impacted all areas of medicine, including urology. Therefore, we aimed, via an online survey, to examine the impact of the COVID-19 pandemic on Polish urologists and urology residents. MATERIAL AND METHODS Between May 15 and June 6, 2020, 229 (28.63% response rate) urologists and urology residents responded to a 28-question online survey. The questionnaire analyzed basic demographic and professional characteristics, and the impact of the COVID-19 pandemic on physicians' everyday work, mental status as well as private life. We further compared the differences between the selected subgroups. RESULTS Nearly all (96.5%) responders claimed that the pandemic had a moderate to high impact on their everyday clinical practice with the majority of the residents (62.0%) believing that the COVID-19 pandemic will harm their training. Most responders (86.9%) reported over 25% declines in outpatient clinic consultations and 55.9% claimed that their income dropped over 25%. Only 38.9% wanted telemedicine to permanently replace some of the consultations after the pandemic, with residents being significantly more positive about this modality (51.4% vs. 33.1%; p = 0.01). Interestingly, 79.9% noticed the negative psychological effect of the pandemic on their colleagues, and 57.6% felt increased anxiety, sadness, or stress. CONCLUSIONS This study revealed the complaints and needs of Polish urologists and urology residents after the first wave of the COVID-19 pandemic. There was a significantly negative impact on their work, mental health, and private life.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Gniewko Wieckiewicz
- Chair and Clinical Department of Psychiatry, Medical University of Silesia, Katowice, Poland
| | - Jakub Ryszawy
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Dominik Chorągwicki
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Rafał B. Drobot
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Międzylesie, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Piotr L. Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
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