Integrating mental and physical health assessment in a neuro-otology clinic: feasibility, acceptability, associations and prevalence of common mental health disorders

Mental Health Education and Utilization Among Patients with Vestibular Disorders

To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.

Physiotherapists often encounter clients disclosing suicidal thoughts and behaviors: a cross-sectional survey of Australian physiotherapists

BACKGROUND

All health professionals have a role in suicide prevention, although little is known about physiotherapists' contact with clients experiencing suicidal thoughts and behaviors.

OBJECTIVE

The aims of this study were to investigate physiotherapists' self-reported frequency of contact with clients who disclose suicidal thoughts and behaviors and to identify potential factors associated with frequency of contact.

METHODS

Three-hundred and thirty-eight Australian physiotherapists were surveyed using an online questionnaire, with an estimated response rate of 6.1%. Data were analyzed using descriptive analysis and logistic regression.

RESULTS

Over half the respondents (52.1%) reported encountering clients at least once a year who disclosed suicidal thoughts, and nearly half (49.4%) reported having received at least one disclosure of a suicide plan at some point in their career. Among those working in the public sector, 67.5% of respondents reported having received a disclosure of a suicide plan, and almost all physiotherapists working in pain management reported having received such a disclosure (93.8%). The binary logistic regression model explained approximately 39.7% of the variance in whether a physiotherapist had a client disclose a plan for suicide at some point in their career or not.

CONCLUSION

The results highlight that all physiotherapists should receive training in suicide prevention.

Association of burnout and harassment among cardiology trainees: Pakistan's perspective

OBJECTIVE

This study explores the relationship between sexual harassment and burnout among cardiology trainees, shedding light on the prevalence and impact of these experiences in medical practice.

METHODS

A cross-sectional online survey was conducted among 518 respondents, with 420 responding to the Sexual Experience Questionnaire (SEQ). The survey measured harassment experiences and their impact on burnout, especially among female physicians. Correlations were analyzed to understand the association between these variables.

RESULTS

Out of 1,375 invitees, we received 671 (48.8 %) responses. The study population was divided into two main groups: males (359) and females (312). The study identified a high prevalence of sexual harassment experiences among female physicians, with incidents occurring primarily during training. Moderate to large correlations were observed between SEQ subscales related to colleagues and patients and their families. While sexual harassment was not significantly related to burnout, this study suggests the need for interventions to create a safer medical workplace. Approximately 22 % of male participants (n = 359) reported career-related inappropriate sexual incidents, with 28 % of male physicians experiencing weekly burnout. Among female participants (n = 312), around 37 % reported inappropriate incidents, while 42 % of female physicians felt weekly burnout.

CONCLUSION

Sexual harassment in medicine is a pervasive issue with potential implications for physician well-being. Initiatives aimed at changing the organizational response and fostering a more equitable environment are warranted to address this critical concern.

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.

Study protocol for a case series: implementation and evaluation of an integrated mental and physical healthcare programme to screen for mental health symptoms in people with epilepsy

INTRODUCTION

The prevalence of mental health symptoms in people with epilepsy (PWE) is elevated compared with that of the general population. These symptoms can negatively impact epilepsy management and patient outcomes but can be treated once recognised. It is, therefore, important to screen for these symptoms to identify needs and put in place appropriate support. Unfortunately, mental health symptoms are rarely addressed in epilepsy services due to time constraints, lack of resources and communication between psychological and medical professionals. These barriers can result in diagnostic overshadowing, where symptoms may be attributed to the disease and reduce the level of support PWE receive. Implementing an online screening tool embedded in the electronic health record (EHR) platform with supported referral pathways may remove some of these barriers.

METHODS AND ANALYSIS

We will follow the Integrating Mental and Physical Healthcare: Research Training and Services framework, which is a routine clinical data collection tool used by clinical teams to electronically screen psychological symptoms among patients with long-term physical health conditions. Patient outcomes including mental health, physical health and psychosocial outcomes will be collected and uploaded to the EHR platform in real-time. An appropriate referral pathway will be recommended depending on severity of the outcome scores. We will initially pilot the tool for individuals aged 13 years and above through epilepsy clinics at King's College Hospital. Following this, the acceptability and feasibility of the tool will be assessed at baseline, 6 and 12 months.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the National Health Service Research Ethics Committee of South Central-Oxford C, reference: 21/EM/0205. This study is expected to inform the use of integrated electronic mental health screening for youth in epilepsy clinics and improve access to psychological support. The findings will be disseminated through academic peer-reviewed journals, poster presentations and scientific meetings.

Healthcare utilization and costs in chronic cough

BACKGROUND

Chronic cough is a common reason for medical consultations and is associated with considerable physical and psychological morbidity. This study investigated healthcare use and cost in chronic cough and assessed its relationship with cough severity, health status, objective cough frequency (CF), and anxiety and depression.

METHODS

This was a prospective study of consecutive patients with chronic cough from a specialist clinic who completed a cough severity visual analogue scale (VAS), cough-specific health status (Leicester Cough Questionnaire; LCQ) and general health status EuroQol EQ-5D-5L, Generalized Anxiety Disorder (GAD7), Patient Health Questionnaire (PHQ9), and 24-hour objective CF monitoring with Leicester Cough Monitor (LCM). Case notes were reviewed for cough-specific healthcare use 12 months before and after the first cough clinic consultation. Resource use included general practitioner and hospital clinic visits, investigations, and treatments. Unit costs for healthcare use were derived predominantly from National Health Service Reference Costs.

RESULTS

One hundred participants with chronic cough were recruited (69% female, median duration 3 years, mean age 58 years). The diagnoses of cough were unexplained (57%), refractory (27%), and other (16%). Cough severity, health status, and CF were: median (IQR) VAS = 59.5 (30-79) mm, mean (SD) LCQ = 11.9 (4.0), mean (SD) EQ-5D-5L = 0.846 (0.178), and geometric mean (SD) CF = 15.3 (2.5) coughs/hr, respectively. The mean (SD) total cost per individual for cough-related healthcare utilization was £1,663 (747). Diagnostic investigations were the largest contributor to cost (63%), followed by cough clinic consultations (25%). In multivariate analysis, anxiety (GAD7) and cough-related health status (LCQ) were associated with increased cost (p ≤.001 and .037).

CONCLUSION

Healthcare cost associated with chronic cough are largely due to diagnostic investigations and clinic consultations. The predictors of costs were health status (LCQ) and anxiety. Further studies should investigate the optimal management protocols for patients with chronic cough.

Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders

Purpose

To contrast the quality of life (QoL) impairment and depression scores of patients suffering from different vestibular disorders.

Methods

301 patients were examined due to vertiginous complaints at the Neurotology Centre of the Department of Otolaryngology and Head and Neck Surgery of Semmelweis University. These patients completed the Hungarian version of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory, and the Symptom Checklist-90-Revised questionnaires.

Results

According to neurotological examination, the distribution of the different diagnoses was as follows: Menière’s disease (n = 101), central vestibular disorders (n = 67), BPPV (n = 47), vestibular neuritis (n = 39), other unilateral peripheral vestibulopathy (n = 18), PPPD (Persistent Postural-Perceptual Dizziness) (n = 16), vestibular migraine (n = 8), and vestibular Schwannoma (n = 5). The results of the DHI questionnaire have indicated worsened QoL in 86.4%, out of which 33.6% was defined as severe. The Beck scale has shown depressive symptoms in 42.3% of the cases, with severe symptoms in 6.3%. Significantly higher total DHI and Beck scale results were observed in patients with central vestibular disorders, vestibular migraine, PPPD and peripheral vestibulopathy, contrasted to the results of the other four diagnosis groups. The onset of the symptoms did not significantly affect the severity of QoL worsening and depression symptoms.

Conclusion

In this study, the QoL of vertiginous patients was worse in general, with the occurrence of depression symptoms. A difference was observed in the case of the values of patients with different vestibular disorders, indicating the importance of different factors, e.g., central vestibular compensation, behavioural strategies and psychological factors.

Validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) in Patients With Dizziness

HYPOTHESIS

The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) will be a valid and reliable combined measure of depression and anxiety in people with vertigo and dizziness.

BACKGROUND

Co-occurrence of depressive, anxiety, and somatic symptoms are common. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7) measure symptoms of depression and anxiety respectively, although measuring them separately may be suboptimal in people who have illness-related distress. There is some evidence that these scales can be combined in long-term conditions resulting in the PHQ-ADS, but validity is yet to be determined in people with vertigo and dizziness.

METHODS

Two separate datasets from a tertiary vestibular clinic were analyzed where the PHQ-ADS was completed at initial clinical assessment (n = 624) and while on a waiting list (n = 185). A cross-sectional design was used to examine the factor structure (confirmatory factor analysis), internal consistency (omega index), and construct validity (Pearson correlation coefficient) of the PHQ-ADS. Construct validity was determined against the dizziness handicap inventory (DHI).

RESULTS

A bi-factor PHQ-ADS model had good fit to the data (χ2 = 397.163, 249.763; comparative fit index [CFI] = 0.954, 0.919; Tucker-Lewis index [TLI] = 0.938, 0.892; root mean squared error of approximation [RMSEA] = 0.076, 0.098). The general distress factor explained 81 to 85% of the common variance between items. There were moderate to large significant positive correlations between the PHQ-ADS and DHI.

CONCLUSION

The PHQ-ADS appears to have good structural validity in patients with vertigo and dizziness. Clinicians and researchers can use this scale where a composite psychological measure is desired.

Research policy for people with multiple long-term conditions and their carers

People with multiple long-term conditions (MLTC) are a growing population, not only in the United Kingdom but internationally. Health and care systems need to adapt to rise to this challenge. Policymakers need to better understand how medical education and training, and service configuration and delivery should change to meet the needs of people with MLTC and their carers. A series of workshops with people with MLTC and carers across the life-course identified areas of unmet need including the impact of stigma; poorly coordinated care designed around single conditions; inadequate communication and consultations that focus on clinical outcomes rather than patient-oriented goals and imperfectly integrate mental and physical wellbeing. Research which embeds the patient voice at its centre, from inception to implementation, can provide the evidence to drive the change to patient-centred, coordinated care. This should not only improve the lives of people living with MLTC and their carers but also create a health and care system which is more effective and efficient. The challenge of MLTC needs to be bought to the fore and it will require joint effort by policymakers, practitioners, systems leaders, educators, the third sector and those living with MLTC to design a health and care system from the perspective of patients and carers, and provide practitioners with the skills and tools needed to provide the highest quality care.