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Podubinski T, Jessup B, Obamiro K, Hoang H, Bourke L. An exploration of mental health, stress and well-being concerns among health students undertaking rural placements in Australia during the early stages of the COVID-19 pandemic. Aust J Rural Health 2023; 31:914-920. [PMID: 37491797 DOI: 10.1111/ajr.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The emergence of COVID-19 in 2020 led to an increase in stressors for students on rural placements, but little is known about how this impacted their mental health and well-being. OBJECTIVE To explore self-reported mental health, stress and well-being concerns among allied health, nursing and medical students who completed a scheduled University Department of Rural Health (UDRH)-faciliated rural placement in Australia between February and October 2020 (n = 1066). DESIGN Cross-sectional design involving an online survey measuring mental health, stress and well-being concerns. The survey was distributed via email by the 16 UDRHs across Australia. FINDINGS A total of 42.9%, 63.8% and 41.1% of survey respondents reported concerns about their mental health, levels of stress and well-being, respectively, during the early stages of the pandemic. Multiple logistic regression models found clinical training, course progression and financial concerns were predictive of negative mental health, increased stress and reduced well-being, while feeling connected was predictive of positive mental health, reduced stress and increased well-being. DISCUSSION Universities, UDRHs and health placement sites all have a responsibility to support the mental health and well-being of students undertaking rural placements. This support needs to encompass strategies to reduce financial stress, protect learning opportunities and increase connectedness. Ensuring adequate resourcing and support for those providing rural placement opportunities will safeguard quality rural placements during times of pandemic disruption.
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Affiliation(s)
- T Podubinski
- Department of Rural Health, The University of Melbourne, Wangaratta, Victoria, Australia
| | - B Jessup
- Centre for Rural Health, The University of Tasmania, Launceston, Tasmania, Australia
| | - K Obamiro
- Centre for Rural Health, The University of Tasmania, Launceston, Tasmania, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
| | - H Hoang
- Centre for Rural Health, The University of Tasmania, Launceston, Tasmania, Australia
| | - L Bourke
- Department of Rural Health, The University of Melbourne, Wangaratta, Victoria, Australia
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
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Sheepway L, Jessup B, Podubinski T, Heaney S, Bailie J, Hoang H, Bourke L. A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. Aust J Rural Health 2022; 31:294-307. [PMID: 36444653 PMCID: PMC9878096 DOI: 10.1111/ajr.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. SETTING Australia. PARTICIPANTS Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. DESIGN Semi-structured interviews (n = 29) with data thematically analysed. RESULTS Five main themes emerged from student experiences: (1) 'Do we go? Don't we go? Like how much risk is involved?' related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) 'We are sort of just standing at the door trying to watch' encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) 'I, as a student, sort of fell under the radar' related to student perceptions of suboptimal supervision; (4) 'It was a bit more difficult to engage with that wider community' recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) 'We felt like we got something that is more than we expected' emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. CONCLUSIONS Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.
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Affiliation(s)
- Lyndal Sheepway
- La Trobe Rural Health SchoolLa Trobe UniversityWodongaVictoriaAustralia
| | - Belinda Jessup
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Tegan Podubinski
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Susan Heaney
- The University of Newcastle Department of Rural HealthThe University of NewcastlePort MacquarieNew South WalesAustralia
| | - Jodie Bailie
- University Centre for Rural HealthThe University of SydneyLismoreNew South WalesAustralia
| | - Ha Hoang
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Lisa Bourke
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
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Jessup B, Hoang H, Podubinski T, Obamiro K, Bourke L, Hellwege B, Jatrana S, Heaney S, Farthing A, Sheepway L, Rasiah R. 'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19. Aust J Rural Health 2022; 30:238-251. [PMID: 35229400 PMCID: PMC9111257 DOI: 10.1111/ajr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.
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Affiliation(s)
- Belinda Jessup
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Ha Hoang
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Tegan Podubinski
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Kehinde Obamiro
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Lisa Bourke
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Barbara Hellwege
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote HealthJames Cook UniversityMount IsaQueenslandAustralia
| | - Susan Heaney
- The University of Newcastle Department of Rural HealthThe University of NewcastlePort MacquarieNew South WalesAustralia
| | - Annie Farthing
- Centre for Remote HealthFlinders UniversityAlice SpringsNorthern TerritoryAustralia
| | - Lyndal Sheepway
- La Trobe Rural Health SchoolLa Trobe UniversityWodongaVictoriaAustralia
| | - Rohan Rasiah
- Western Australian Centre for Rural HealthThe University of Western AustraliaKarrathaWestern AustraliaAustralia
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McCann L, Thompson SC, Rolf F, Podubinski T. Police, permits and politics: Navigating life on Australia's state borders during the COVID-19 pandemic. Aust J Rural Health 2022; 30:363-372. [PMID: 35229397 PMCID: PMC9111201 DOI: 10.1111/ajr.12845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
Objective To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives. Design Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis. Setting Interviews of people across Australia. Participants Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life. Main outcome Measure Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020). Results Policy changes surrounding border closures negatively impacted people’s wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures. Conclusion Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people’s physical, financial, and emotional state.
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Affiliation(s)
- Lily McCann
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Floraidh Rolf
- Southern Queensland Rural Health, University of Queensland, Charleville, Queensland, Australia
| | - Tegan Podubinski
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
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Hoang H, Jessup B, Obamiro K, Bourke L, Hellwege B, Podubinski T, Heaney S, Sheepway L, Farthing A, Rasiah R, Fitzroy R, Jatrana S, Argus G, Knight S. Impact of COVID-19 on rural and remote student placements in Australia: A national study. Aust J Rural Health 2022; 30:197-207. [PMID: 35103353 DOI: 10.1111/ajr.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/04/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN A mixed-method design comprising an online survey and semi-structured interviews. SETTING Australia. PARTICIPANTS Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.
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Affiliation(s)
- Ha Hoang
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Belinda Jessup
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Barbara Hellwege
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Tegan Podubinski
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Susan Heaney
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle Department of Rural Health, Port Macquarie, NSW, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Vic., Australia
| | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Rohan Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, WA, Australia
| | - Robyn Fitzroy
- Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Geoff Argus
- Southern Queensland Rural Health, Cranley, QLD, Australia
| | - Sabina Knight
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
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Podubinski T, Townsin L, Thompson SC, Tynan A, Argus G. Experience of Healthcare Access in Australia during the First Year of the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:10687. [PMID: 34682432 PMCID: PMC8535411 DOI: 10.3390/ijerph182010687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022]
Abstract
Changes in health-seeking behaviours and challenges in accessing care have been reported during the COVID-19 pandemic. This qualitative study examines Australian experiences related to healthcare access during the early months of the pandemic. The study aimed to identify key areas of concern as well as opportunities for services to prevent, manage and treat health concerns when normal access was disrupted. Fifty-nine semi-structured interviews were analysed. Participants were interviewed between August and December in 2020 over telephone or Zoom and were located across Australia. Rapid identification of themes with an audio recordings technique was used to generate themes from the data. Participants described a variety of influences on their health-seeking behaviours, resulting in decisions to delay care or being unable to reach care. Many individuals accessed health services via telehealth and offered a range of perceptions and views on its effectiveness and appropriateness. The findings illustrate that maintenance of health and access to healthcare and psychosocial support were compromised for some individuals, leading to negative impacts on both mental and physical health. This highlights the need to provide mechanisms to facilitate a person's ability to access care in a timely manner during a pandemic.
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Affiliation(s)
- Tegan Podubinski
- Department of Rural Health, The University of Melbourne, Wangaratta, VIC 3677, Australia
| | - Louise Townsin
- Research Office, Torrens University Australia, Adelaide, SA 5000, Australia;
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6531, Australia;
| | - Anna Tynan
- Darling Downs Health, Toowoomba, QLD 4350, Australia;
- Southern Queensland Rural Health, The University of Queensland, Toowoomba, QLD 4350, Australia;
| | - Geoff Argus
- Southern Queensland Rural Health, The University of Queensland, Toowoomba, QLD 4350, Australia;
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Podubinski T, Glenister KM. The Pandemic Is Not Occurring in a Vacuum: The Impact of COVID-19 and Other Disasters on Workforce Mental Health in Australia. Disaster Med Public Health Prep 2021; 17:e25. [PMID: 34296670 PMCID: PMC8446584 DOI: 10.1017/dmp.2021.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/30/2021] [Accepted: 07/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Prior to coronavirus disease (COVID-19), many Australians experienced extreme bushfires, droughts, and floods. A history of experiencing these events might be a risk factor for increased psychological distress during COVID-19. This study aimed to provide insight into the mental health of Australian workers during the initial COVID-19 outbreak, with an additional focus on whether previous disaster exposure and impact from that disaster is a risk factor for increased psychological distress. METHODS A snowball recruitment strategy was used. Participants (n = 596) completed an online survey, which included the Depression Anxiety Stress Scales-21, and questions related to mental health and disaster exposure. RESULTS Overall, 19.2%, 13.4%, and 16.8% of participants were experiencing moderate to extremely severe depression, anxiety, and stress symptoms, respectively. Multiple regression found that higher depression, anxiety, and stress symptoms were associated with a pre-existing mental health diagnosis; only higher stress symptoms were associated with having experienced a disaster, with impact, in addition to COVID-19. CONCLUSIONS People who have experienced impact from an additional disaster might need additional support to protect their mental health during COVID-19. A focus on the cumulative mental health impacts of multiple disasters and the implications for organizational communities where recovery work is undertaken, such as schools and workplaces, is needed.
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Affiliation(s)
- Tegan Podubinski
- Department of Rural Health, University of Melbourne, Wangaratta, Victoria, Australia
| | - Kristen M. Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Victoria, Australia
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Podubinski T, Lee S, Hollander Y, Daffern M. Patient characteristics associated with aggression in mental health units. Psychiatry Res 2017; 250:141-145. [PMID: 28161609 DOI: 10.1016/j.psychres.2017.01.078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/08/2016] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
Aggression in mental health units is a significant and pervasive problem. However, the characteristics of patients associated with increased aggression propensity remain unclear and there are few attempts to expand understanding of these characteristics by drawing upon contemporary aggression theory. This study assessed the influence of interpersonal (hostile-dominance) and personality (psychopathy), General Aggression Model-specified (aggressive script rehearsal, attitudes towards violence, and trait anger), and clinical (psychiatric symptoms) factors on aggression during psychiatric hospitalization in 200 inpatients (132 men and 68 women; 19-64 years, M=38.32 years, S.D.=11.13 years). Patient characteristics were assessed on admission using structured interviews and self-report psychological tests. Patients' files were reviewed and nurses were interviewed after patients were discharged to establish whether patients were aggressive during their hospital stay. Results of univariate analyses showed that higher levels of interpersonal hostile-dominance, psychopathy and aggressive script rehearsal, positive attitudes towards violence, trait anger, and disorganized and excited type psychiatric symptoms all predicted aggression. In the final multivariable logistic regression model, only hostile-dominance remained as a significant predictor of aggressive behavior. This important personality characteristic should be considered in violence risk assessments and aggression prevention strategies.
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Affiliation(s)
- Tegan Podubinski
- Monash Alfred Psychiatry Research Centre, the Alfred and Monash University Central Clinical School, Melbourne, Australia; Victorian Institute of Forensic Mental Health, Melbourne, Australia
| | - Stuart Lee
- Monash Alfred Psychiatry Research Centre, the Alfred and Monash University Central Clinical School, Melbourne, Australia; Victorian Institute of Forensic Mental Health, Melbourne, Australia
| | - Yitzchak Hollander
- Monash Alfred Psychiatry Research Centre, the Alfred and Monash University Central Clinical School, Melbourne, Australia; Swinburne University of Technology, Melbourne, Australia; Victorian Institute of Forensic Mental Health, Melbourne, Australia
| | - Michael Daffern
- Swinburne University of Technology, Melbourne, Australia; Victorian Institute of Forensic Mental Health, Melbourne, Australia.
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Podubinski T, Lee S, Hollander Y, Daffern M. An examination of the stability of interpersonal hostile-dominance and its relationship with psychiatric symptomatology and post-discharge aggression. Aggress Behav 2016; 42:324-32. [PMID: 26440449 DOI: 10.1002/ab.21628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/09/2022]
Abstract
The relevance of interpersonal hostile-dominance (HD) to post-discharge aggression in mental health patients is unclear. This study assessed whether (1) HD is stable over time; (2) the relationship between HD and positive, negative, disorganized, and excited symptoms is consistent over time; and (3) HD is related to aggression post-discharge. Two hundred psychiatric inpatients were recruited on admission to hospital; 41 were available for follow-up at 6 months post-discharge, including 29 men and 12 women, with an age range of 19-63 (M = 39.63 years, SD = 12.69 years). Psychiatric symptomatology and interpersonal style were assessed at recruitment and follow-up; aggression in the community post-discharge was measured at follow-up. Results showed that (1) HD was stable over time despite an overall reduction in psychiatric symptoms, (2) HD was positively correlated with symptom severity at both time points, and (3) higher HD, excited symptoms, and positive symptoms measured in the community, and more severe positive symptoms measured in hospital, were associated with aggressive behavior post-discharge. These results suggest that HD is a risk factor for more severe psychopathology. Furthermore, HD, positive symptoms, and excited symptoms measured in the community act as risk factors for aggressive behavior post-discharge. As such, treatment planning and risk assessment should consider HD. Aggr. Behav. 42:324-332, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Tegan Podubinski
- School of Psychological Sciences; Monash University; Melbourne Australia
| | - Stuart Lee
- Monash Alfred Psychiatry Research Centre; The Alfred and Monash University Central Clinical School; Melbourne Australia
| | - Yitzchak Hollander
- Alfred Psychiatry Intensive Care Statewide Service; The Alfred; Melbourne Australia
- The Alfred; Melbourne Australia
- Department of Psychology; Swinburne University of Technology; Melbourne Australia
| | - Michael Daffern
- School of Psychological Sciences; Monash University; Melbourne Australia
- Centre for Forensic Behavioural Science; Swinburne University of Technology; Melbourne Australia
- Victorian Institute of Forensic Mental Health; Melbourne Australia
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Abstract
OBJECTIVE This study assessed the extent to which psychiatric symptoms and aggression-related personality as well as cognitive and affective variables predicted interpersonal hostile-dominance (HD) in psychiatric inpatients. METHOD Two hundred patients admitted to hospital for psychiatric treatment were recruited, including 132 men and 68 women, with an age range of 19-64 years (M = 38.32 years, SD = 11.13 years). Each participant was assessed within five days of admission using the Impact Message Inventory-Circumplex (IMI-C), the Psychopathy Checklist: Screening Version (PCL:SV), the State-Trait Anger Expression Inventory-2 (STAXI-2), the Schedule of Imagined Violence (SIV), the Measures of Criminal Attitudes and Associates (MCAA), and the Positive and Negative Syndrome Scale (PANSS). Hierarchical multiple regression was used to assess the ability of psychiatric symptoms to predict HD, after controlling for the influence of psychopathy (Factor 1 [F1] and Factor 2 [F2]), trait anger, aggressive script rehearsal, and normative beliefs supporting aggression. RESULTS Psychopathy (F1 and F2), the tendency to rehearse aggressive scripts, and psychiatric symptomatology (PANSS Positive, Negative, Disorganized, and Excited) all predicted HD, with the final model explaining 71.30% of the variance in HD. Trait anger, positive attitudes toward violence, and PANSS Emotional Distress did not predict HD. CONCLUSIONS HD reflects a characteristic tendency toward interpersonal, affective, and behavioral problems marked by hostility and dominance, combined with a tendency toward frequent aggressive script rehearsal and more severe psychiatric symptomatology.
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Daffern M, Thomas S, Ferguson M, Podubinski T, Hollander Y, Kulkhani J, Decastella A, Foley F. The impact of psychiatric symptoms, interpersonal style, and coercion on aggression and self-harm during psychiatric hospitalization. Psychiatry 2010; 73:365-81. [PMID: 21198388 DOI: 10.1521/psyc.2010.73.4.365] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interpersonal style, a key component of personality and personality disorder, has emerged as an important characteristic that is relevant to aggressive behavior by patients in psychiatric hospitals. However, studies examining the relationship between interpersonal style and aggression have thus far only been conducted with patients with personality disorder and/or mild and stable symptoms of mental illness. This study explored the relative importance of patients' interpersonal style, psychiatric symptoms, and perceptions of staff coercion on aggression and self-harm during acute psychiatric hospitalization. One hundred and fifty-two patients (M = 38.32 years, SD = 12.06; 56.8% males and 43.2% females) admitted for short-term assessment and treatment to the acute units of a civil and a forensic psychiatric hospital were administered the Brief Psychiatric Rating Scale, Impact Message Inventory, and MacArthur Admission Experience Survey. Participants' files were reviewed and nursing staff were interviewed at the end of each patient's hospital stay to determine whether participants had self-harmed or acted aggressively towards others. Initial univariate analyses showed that thought disorder and dominant and hostile-dominant interpersonal styles predicted aggression. Using multiple regression and controlling for gender and age, only a hostile-dominant interpersonal style predicted aggression (β = .258, p < .05). No factors were significantly related to self-harm. These results suggest that measures of interpersonal style are sensitive to those aspects of interpersonal functioning that are critical to patient's responses to the demands of psychiatric in-patient treatment. Procedures to assess risk and engage and manage potentially aggressive patients, including limit-setting styles and de-escalation strategies, should take into account the interpersonal style of patients and the interpersonal behavior of staff.
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Affiliation(s)
- Michael Daffern
- Centre for Forensic Behavioral Science, School of Psychology and Psychiatry, Monash University, Clayton, Melbourne, Australia.
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