Grace Under Pressure: a mixed methods impact assessment of a verbatim theatre intervention to improve healthcare workplace culture

BACKGROUND

Healthcare workplace mistreatment has been documented globally. Poor workplace behaviour, ranging from incivility to bullying and harassment, is common in healthcare, and contributes significantly to adverse events in healthcare, poor mental health among healthcare workers, and to attrition in the healthcare workforce, particularly in junior years. Poor workplace behaviour is often normalised, and is difficult to address. Verbatim theatre, a form of research informed theatre in which plays are created from informants' exact words only, is particularly suited to facilitating workplace culture change by raising awareness about issues that are difficult to discuss. The objective of this study was to assess the impact of the verbatim theatre play 'Grace Under Pressure' on workplace culture in NSW hospitals.

METHODS

The intervention was conducted in 13 hospitals from 8 Local Health Districts (LHDs) in NSW, Australia, in October and November 2019, with aggregated impact across all sites measured by a bespoke survey ('Pam McLean Centre (PMC) survey') at the conclusion of the intervention. This study was conducted in 3 Local Health Districts (one urban, one regional, one remote), with data collection conducted in November-December 2019 and December 2020. The study design was a mixed methods assessment of the play's impact using (1) validated baseline measures of psychosocial risk, analysed descriptively, (2) overall findings from the PMC survey above, analysed descriptively, (3) interviews conducted within a month of the intervention, analysed thematically and (4) interviews conducted one year later, analysed thematically.

RESULTS

Half (51.5%) of the respondents (n = 149) to the baseline survey had scores indicating high risk of job strain and depressive symptoms. Of 478 respondents to the PMC survey (response rate 57%), 93% found the play important, 92% recommended others see the play, 89% considered that it stimulated thinking about workplace behaviour, and 85% that it made discussing these issues easier. Thematic analysis of interviews within one month (n = 21) showed that the play raised awareness about poor workplace behaviour and motivated behaviour change. Interviews conducted one year later (n = 6) attributed improved workplace culture to the intervention due to improved awareness, discussion and capacity to respond to challenging issues.

CONCLUSIONS

Verbatim theatre is effective in raising awareness about difficult workplace behaviour in ways that motivate behaviour change, and hence can be effective in catalysing real improvements in healthcare workplace culture. Creative approaches are recommended for addressing similarly complex challenges in healthcare workforce retention.

Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study

Aim and background

Satisfaction with the quality of work life reflects the inadequate distribution of the workforce in critical care units and is not enough; on many occasions, they work in precarious conditions and with high levels of physical, emotional, spiritual, and social demands, impacting the quality of care.

Aim

To identify predictors of the quality of work life of healthcare workers in adult critical care units (ACCU).

Materials and methods

Quantitative study, cross-sectional analytical design with stratified two-stage sampling; three instruments were applied to 209 healthcare professionals in adult critical care units in different sites in a region of Colombia, concerning Quality of Life at Work-GOHISALO, Copenhagen Psychosocial Questionnaire-COPSOQ and Professional Quality of Life-ProQoL V. Multiple ordinal logistic regression was performed with exposure variables from the COPSOQ and ProQoL domains; the outcome variables were the dimensions of the Quality of Work Life instrument. Ethical standards for research involving human subjects were ensured.

Results

According to the results of the multiple logistic models, quality of work life is predicted by job integration and predictability (OR = 6.93; 95% CI = 3.6-13.9), leisure time management and double presence (OR = 4.5; 95% CI = 1.22-8.79). Both job satisfaction and job security are related to leadership quality (OR=3.82; 95% CI = 2.27-6.55 and OR = 3.18; 95% CI = 1.22-8.79), respectively.

Conclusions

The quality of work life of healthcare workers in adult intensive care units is predicted by quantitative demands, double presence, emotional demands, work pace, predictability, vertical trust, and quality of leadership.

How to cite this article

Quinones-Rozo LP, Canaval-Erazo GE, Sandoval-Moreno LM. Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study. Indian J Crit Care Med 2024;28(4):355-363.

Improving Work-life Balance and Satisfaction to Improve Patient Care

How to cite this article: Mitra LG, Sharma J, Walia HS. Improving Work-life Balance and Satisfaction to Improve Patient Care. Indian J Crit Care Med 2024;28(4):326-328.

Utilizing directional preference in the management of cervicogenic headache: a case series

BACKGROUND/PURPOSE

Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache.

CASE DESCRIPTION

This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or 'other' and then received intervention based on directional preference.

OUTCOMES

Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01).

DISCUSSION/CONCLUSION

The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient's response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH.

Adaptation and pilot implementation of the Psychosocial Assessment Tool for Autism Spectrum Disorders (PAT-ASD)

Recognizing the multifaceted and chronic demands on families of children with Autism Spectrum Disorder (ASD) and challenges in providing care matched to need, we adapted the Psychosocial Assessment Tool (PAT), a brief caregiver-report screener of family psychosocial risk, for this population. Study methods included literature review, focus groups with providers, and feedback from caregivers. The PAT-ASD is consistent with the original PAT, with new items reflecting core behavioral manifestations of ASD and parent and family challenges associated with chronicity. The PAT-ASD was implemented in a four-month pilot and was completed online by 59% of families. Although further testing of its validity is necessary, the PAT-ASD is a promising means of assessing family psychosocial risk for families of children with ASD.

Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients

OBJECTIVE

The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns.

METHODS

Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn.

RESULTS

The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively.

CONCLUSION

The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.

Weighing psychosocial factors in relatives for the risk of psychopathology: a study of patients with depressive and anxiety disorders and their siblings

PURPOSE

Siblings of probands with depressive and anxiety disorders are at increased risk for psychopathology, but little is known about how risk factors operate within families to increase psychopathology for siblings. We examined the additional impact of psychosocial risk factors in probands-on top of or in combination with those in siblings-on depressive/anxious psychopathology in siblings.

METHODS

The sample included 636 participants (Mage = 49.7; 62.4% female) from 256 families, each including a proband with lifetime depressive and/or anxiety disorders and their sibling(s) (N = 380 proband-sibling pairs). Sixteen psychosocial risk factors were tested. In siblings, depressive and anxiety disorders were determined with standardized psychiatric interviews; symptom severity was measured using self-report questionnaires. Analyses were performed with mixed-effects models accounting for familial structure.

RESULTS

In siblings, various psychosocial risk factors (female gender, low income, childhood trauma, poor parental bonding, being single, smoking, hazardous alcohol use) were associated with higher symptomatology and likelihood of disorder. The presence of the same risk factor in probands was independently associated (low income, being single) with higher symptomatology in siblings or moderated (low education, childhood trauma, hazardous alcohol use)-by reducing its strength-the association between the risk factor and symptomatology in siblings. There was no additional impact of risk factors in probands on likelihood of disorder in siblings.

CONCLUSION

Our findings demonstrate the importance of weighing psychosocial risk factors within a family context, as it may provide relevant information on the risk of affective psychopathology for individuals.

Impact of psychosocial risk on intention to leave work during COVID-19 in Indonesia: The mediatory roles of burnout syndrome and job satisfaction

The COVID-19 pandemic intensified the complexity of work in the health sector, leading to an increase in the intention to leave work (ITL) in Indonesia. Previous research has revealed a theoretical gap in investigating the roles of burnout syndrome (BS) and job satisfaction (JS) as mediators of the effect of psychosocial risk (PR) on ITL. This research study aimed to fill this gap by examining the effect of PR on ITL during the COVID-19 pandemic, with BS and JS as mediators. Data was collected from 306 health workers in public and private hospitals of Central Jakarta, Indonesia. This data was analyzed as part of a cross-sectional research study involving the partial least square-structural equation modeling (PLS-SEM) method and using SmartPLS software. The questionnaire was based on the Copenhagen Psychosocial Questionnaire (COPSOQ) III short version, the Burnout Assessment Tools (BAT), and a modified Turnover Intention. The findings revealed that, within the direct effect pathways, JS was the highest predictor of health workers' ITL, and workplace PR significantly impacted employees' JS and BS. Another notable finding was related to the research gap vis-a-vis the indirect effect pathways: it showed that JS and BS had partial mediatory power over the relationship between PR and ITL. BS and JS were found to have a high and significant impact on employees' ITL. Therefore, this research study has contributed to the model's novelty in measuring ITL mediated by JS and BS.

The relationship between depression, anxiety, quality of life levels, and the chronic kidney disease stage in the autosomal dominant polycystic kidney disease

PURPOSE

Decreased quality of life, anxiety, depression, and other negative psychosocial factors in autosomal dominant polycystic kidney disease (ADPKD) may lead to the patient's attitudes that reduce treatment effectiveness. We aimed to evaluate the relationship between the depression, anxiety, perceived social support, genetic psychosocial risk and quality of life levels, and chronic kidney disease (CKD) stage in ADPKD and to investigate the relationship between these variables/parameters and the dietary compliance that is an essential factor in the course of the disease.

METHODS

100 ADPKD patients were enrolled in this cross-sectional study. EuroQol-5D-3L (EQ-5D-3L) health-related quality of life ındex, EuroQol-5D-3L visual analog scale (EQ-5D-3L VAS), multidimensional scale of perceived social support (MSPSS), patient health questionnaire (PHQ)-9, and genetic psychosocial risk ınstrument (GPRI) were applied to the patients.

RESULTS

There is a relationship with negative regression coefficient between the CKD stage and the total scores of the EQ-5D-3L and EQ-5D-3L VAS scales (p < 0.000 and β =  - 5.355, p < 0.000, and β =  - 8.394, respectively). There is a relationship with positive regression coefficient between the CKD stage and MSPSS total score and level (p < 0.000 and β = 0.364, p < 0.000 and β = 0.331, respectively). There is no relationship between the CKD stage and GPRI total score (p = 0.800). In addition, there is a relationship with positive regression coefficient between the dietary compliance and EQ-5D and EQ-5D VAS total scores (p = 0.006 and β = 2.687, p = 0.004 and β = 3.148, respectively). There is a relationship with negative regression coefficient between the dietary adherence and PHQ-9 total score and CKD stage (p = 0.003, p = 0.006, and β =  - 0.692, respectively).

CONCLUSION

As the CKD stage increases in the ADPKD patients, the quality of life decreases, whereas the level of anxiety and depression increases. It has been seen that the ADPKD patients with more depressive complaints have less dietary compliance. In this particular patient group, the early detection and treatment of psychosocial difficulties and the work to improve the quality of life that affect the course of the ADPKD may be as important as the medical treatment. To determine the needs of ADPKD patients with multiple physical and psychosocial difficulties and to perform appropriate interventions, we think that there is a necessity for a specific scale that evaluates these effective components together in the ADPKD process.

Profiles of women who have suffered occupational accidents in cleaning: perceived health, psychosocial risks, and personality variables

PURPOSE

The main goal was to identify the variables (sociodemographic, work, psychosocial, perceived health, and personality) associated with occupational accidents suffered in the past by women in the cleaning sector.

METHODS

A sample of 455 women was evaluated.

RESULTS

A total of 23.5% of the workers (n = 107) had suffered an occupational accident with medical leave. In general, women who had suffered some accident in their life had a worse situation in all areas evaluated. Two subsamples of women had a greater association with accidents. Specifically, the presence of work accidents was 15.9 times higher among those who presented a worse perception of their physical effort and a greater tendency towards risky behaviours and 13.5 times higher among those who had a moderate perception of physical exertion and a disability.

CONCLUSION

In general, the characteristics of female workers were found to be associated with different accident rates. Preventive actions should be designed individually.

Health outcomes and psychosocial risk exposures among healthcare workers during the first wave of the COVID-19 outbreak

The aim is to describe the health and psychosocial risk factors of Spanish healthcare workers during the COVID-19 pandemic.

METHODS

A cross-sectional study by means of an online questionnaire (April-May 2020). The data comes from the database resulting from the COTS project "Working conditions, insecurity, and health in the context of the COVID-19 pandemic". The sample consisted of 1989 health care workers.

RESULTS

Women, young people (doctors and nurses) and the middle-aged (assistants) had poorer health and greater exposure to psychosocial risks. Geriatric assistants were the most-affected occupational group.

CONCLUSIONS

gender, occupation, and age are focuses of inequality in the exposure of health care workers to psychosocial risks.

Correlation between psychosocial work factors and the degree of stress

BACKGROUND

Psychosocial risks and work-related stress are one of the most complex, most significant and most challenging problems that organizations around the world are facing. Stress negatively affects all participants in the organization and significantly contributes to negative health consequences and economic outcomes.

OBJECTIVE

With timely identification and adequate assessment of psychosocial risks, it is possible to create healthy workplaces and healthy organizations where employees are satisfied and motivated. The paper will present the results of the research of psychosocial risks on a large sample of respondents in the Republic of Serbia.

METHODS

A questionnaire was distributed to 1,212 participants of which 1,140 answered all the questions asked. Data from the questionnaire were analyzed using multiple regression analysis, Kolmogorov-Smirnov test, Spearman's correlation coefficient and Pearson's chi-square test (χ2).

RESULTS

The results of multiple regression analysis showed that all psychosocial risks taken together are statistically significantly (p < .001) and explain 24%of the variance of the criteria.

CONCLUSIONS

Psychosocial risks identified as statistically significant predictors are Labor Demands, Interpersonal Relations, Lack of Support, Work Role and Job Uncertainty. All predictors are statistically significant predictors at the level.01.

Improving classification based on physical surface tension-neural net for the prediction of psychosocial-risk level in public school teachers

BACKGROUND

Psychosocial risks, also present in educational processes, are stress factors particularly critical in state-schools, affecting the efficacy, stress, and job satisfaction of the teachers. This study proposes an intelligent algorithm to improve the prediction of psychosocial risk, as a tool for the generation of health and risk prevention assistance programs.

METHODS

The proposed approach, Physical Surface Tension-Neural Net (PST-NN), applied the theory of superficial tension in liquids to an artificial neural network (ANN), in order to model four risk levels (low, medium, high and very high psychosocial risk). The model was trained and tested using the results of tests for measurement of the psychosocial risk levels of 5,443 teachers. Psychosocial, and also physiological and musculoskeletal symptoms, factors were included as inputs of the model. The classification efficiency of the PST-NN approach was evaluated by using the sensitivity, specificity, accuracy and ROC curve metrics, and compared against other techniques as the Decision Tree model, Naïve Bayes, ANN, Support Vector Machines, Robust Linear Regression and the Logistic Regression Model.

RESULTS

The modification of the ANN model, by the adaptation of a layer that includes concepts related to the theory of physical surface tension, improved the separation of the subjects according to the risk level group, as a function of the mass and perimeter outputs. Indeed, the PST-NN model showed better performance to classify psychosocial risk level on state-school teachers than the linear, probabilistic and logistic models included in this study, obtaining an average accuracy value of 97.31%.

CONCLUSIONS

The introduction of physical models, such as the physical surface tension, can improve the classification performance of ANN. Particularly, the PST-NN model can be used to predict and classify psychosocial risk levels among state-school teachers at work. This model could help to early identification of psychosocial risk and to the development of programs to prevent it.

Supporting routine psychosocial assessment in the perinatal period: The concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised

BACKGROUND

Australian clinical practice guidelines support comprehensive psychosocial assessment as a routine component of maternity care.

AIM

To examine the concurrent and predictive validity of the Antenatal Risk Questionnaire-Revised (ANRQ-R) when used across the perinatal period.

METHODS

Women completed the ANRQ-R and a diagnostic reference standard (SAGE-SR) in the second and third trimesters and at 3-months postpartum. ANRQ-R test performance for cut-off scores at each time-point was assessed using Receiver Operator Characteristic (ROC) analysis.

FINDINGS

Overall sample sizes were N=1166 (second trimester), N=957 (third trimester) and N=796 (3-month postpartum). 6.5%, 5.6% and 6.2% of women met SAGE-SR criteria for any depressive or anxiety disorder at these time-points ('cases'), respectively. ROC analysis yielded acceptable areas under the curve (AUC) when the ANRQ-R was used to detect current (AUC=0.789-0.798) or predict future (AUC=0.705-0.789) depression or anxiety. Using an example cut-off score of 18 or more, the ANRQ-R correctly classified 72-76% of concurrent 'cases' and 'non-cases' (sensitivity=0.70-0.74, specificity=0.72-0.76) and correctly predicted 74-78% of postnatal 'cases' and 'non-cases' (sensitivity=0.52-0.72, specificity=0.75-0.79). Completion of the ANRQ-R earlier in pregnancy yielded greater positive likelihood ratios for predicting depression or anxiety at 3-months postpartum (cut-off ≥18: second trimester=3.8; third trimester=2.2).

CONCLUSION

The ANRQ-R is a structured psychosocial assessment questionnaire that can be scored to provide an overall measure of psychosocial risk. Cut-off scores need not be uniform across settings. Such decisions should be guided by factors including diagnostic prevalence rates, local needs and resource availability.

The impact of our images: psychological implications in expectant parents after a prenatal diagnosis

Parents are at heightened risk for perinatal depression, anxiety and traumatic stress after receiving a prenatal diagnosis of a congenital anomaly. Identifying patients at risk and implementing effective support is crucial to optimizing care in this vulnerable population. A multidisciplinary care team with embedded psychosocial support services can be utilized to evaluate and address the needs of pregnant women and their families, not only at the time of diagnosis, but throughout the course of the pregnancy and postpartum period. Provider awareness helps to facilitate expedited referral to psychosocial services to provide comprehensive care to the patient and family unit.

Does prenatal cocaine exposure predict adolescent substance use?

Prenatal cocaine exposure (PCE) has rarely been examined as a predictor of substance use during late adolescence, and few studies have examined both the initiation of substance use and current substance use as outcomes. The present longitudinal study examined PCE, other prenatal exposures, and psychosocial risk factors for their association with substance use in mid to late adolescence. Adolescents (n = 150) followed since birth reported on their use of alcohol, cigarette, and cannabis every 6 months from age 15.0 to 17.5 using a computer-assisted self-administration version of the Youth Risk Behavior Survey. PCE did not predict substance use in a series of growth curve analyses. Several psychosocial risk factors were associated with adolescents' substance use. Having friends who use substances predicted past month cigarette and cannabis use as well as initiation of alcohol and cannabis use, while depressive symptoms predicted initiation of alcohol, cigarette, and cannabis use. The current findings suggest that more proximal psychosocial factors may play a greater role in adolescent substance use than prenatal substance exposure.

How effective is the early support program Babylotse-Plus for psychosocially burdened mothers and their infants? A comparative intervention study

Objectives

Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden.

Methods

All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized ‘early support’ institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.

At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders.

Results

The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the ‘early support’ intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07–0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10–1.14) and reported reduced stress due to the child’s demands (0.40, 0.15–1.10) compared to the control group. Childcare indicators did not differ between the 2 groups.

Conclusions

In mothers at high psychosocial risk, the ‘early support’ intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year.

Longitudinal interplay of young children's negative affectivity and maternal interaction quality in the context of unequal psychosocial resources

Interaction quality and child temperament predict early and later child development. Research hints at transactional interrelations of both aspects but lacks adequate data to examine this assumption. Maternal psychosocial resources are suspected moderators in this context but rarely taken into account. Drawing on data of the German National Educational Panel Study we conducted a cross-lagged panel analysis on the longitudinal interplay of maternal interaction quality and children's negative affectivity at 6-8, 16-18, and 25-27 months and compared mothers with and without accumulated strains. Both variables showed moderate to high structural and rank order stability over time and low but increasing connections. In the case of accumulated stress factors, interaction quality is clearly impaired and high negative affectivity acts as an additional burden while low negative affectivity helps strained mothers to maintain higher interaction quality but only in the first year of life.

Psychosocial risk and management of physical diseases

During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.

The perception of psychosocial risks through the HSE questionnaire of a population of neurophysiology technicians: a cross-sectional study

OBJECTIVES

The Neurophysiopathology Technicians (NTs) are exposed to psychosocial risks, exposure to psychosocial risks that cause related work stress has been related to numerous physical and mental illnesses. The aim of this study is to evaluate the perception of psychosocial risks in a population of this population.

MATERIALS AND METHODS

54 technicians of Neurophysiopathology were enrolled, consisting of 23 males (42,6 %) and 31 females (57,4 %). All subjects were administered the HSE questionnaire developed by the Health and Safety Executive. the statistical analysis provided for the assessment of the reliability of the questionnaires and the non-parametric analysis of gender differences.

RESULTS

In the total population emerges as critical the perception of the domain "Managers' Support" with Cronbach's alpha values for total males and females respectively of 0,87, 0,85, 0,88. In the female population is added the critical perception of the "Peer Support" domain (p=0,026), shows that the employees indicated that they do not receive adequate information and support from their colleagues.

DISCUSSION

The study highlights the exposure to psychosocial risks by technicians of neurophysiopathology able to mediate the phenomenon of WRS. The HSE questionnaire represents a tool capable of highlighting specific risks to which workers are exposed. Furthermore, its ability to capture elements of the work context significantly increases if an analysis is carried out that takes into account the worker's gender.

Clinically Significant Psychological and Emotional Distress in 32% of Adolescent Idiopathic Scoliosis Patients

STUDY DESIGN

Prospective study of 92 patients.

OBJECTIVES

To determine if the incidence of clinically significant psychological and emotional distress in adolescent idiopathic scoliosis (AIS) patients is higher than the general population and if this correlates with deformity severity.

SUMMARY OF BACKGROUND DATA

Adolescents with scoliosis may exhibit a less positive outlook on life, suffer from lower self-esteem, and have more difficulty connecting with peers; however, there is conflicting evidence whether different stages of treatment prompt different psychological problems and the long-term psychological effect of scoliosis.

METHODS

Patients aged 12-21 years with a diagnosis of AIS were included. The Behavioral Assessment System for Children, Second Edition (BASC-2), is a validated 139-item survey normed on more than 1 million children in the United States. It can detect clinical and subclinical levels of psychosocial problems in five domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. The BASC-2 self-report form was completed by 92 adolescents with AIS (mean age = 14 years; range 12-18) and a parent. BASC-2 scale scores were compared to validated age-matched normative data. Comparisons were made between those undergoing surgery (n = 31), bracing (n = 31), or observation (n = 30) at the start of treatment.

RESULTS

32% (29/92) of patients scored in the clinically significant range in at least one of the subscales. There were no clinically significant emotional or behavioral differences when stratified by treatment type (p = .560), Cobb angle (0.630), or age (0.313). Twenty-one percent (19/92) of parent responses deemed their kids as having clinically significant emotional or behavioral differences. In only 34% (10/29) of the cases did children and parent concurrently report clinically significant psychological difficulties, such that 66% of parents were unaware that their child has clinically significant emotional or behavioral problems.

CONCLUSIONS

AIS patients undergoing observation, bracing, and surgery are all at risk for clinically significant psychological symptoms.

LEVEL OF EVIDENCE

Level II.

Psychosocial risks and stress as predictors of burnout in junior doctors performing emergency guards

Objective

To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout.

Methods

Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21).

Results

78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p < 0.003) and stress scores (ß = 0.451; p < 0.001) significantly predict emotional exhaustion (r² = 0.443). Finally, 38% of junior doctors experienced a threat/aggression during their work in the emergency ward urgencies.

Conclusion

Junior doctors develop its professional activity under adverse circumstances probably due to the high psychosocial risk associated to the job. Psychological demands are suggested as the main predicting factor of burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward.

Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.

Delusional ideation during the perinatal period in a community sample

BACKGROUND

Despite the prevalence of mental health problems during the perinatal period, little research has examined psychotic symptoms in a community sample across pregnancy and the postpartum. Exposure to environmental risk factors, and immigration in particular, are associated with increased risk for psychotic disorders. The current investigation examined whether psychosocial risk and immigrant status would predict levels of delusional ideation across the perinatal period when controlling for depression, anxiety, and demographic factors.

METHODS

A community sample of 316 pregnant women was assessed at 12-14 and 32-34weeks gestation during routine clinic visits, and at 7-9weeks postpartum during a home visit. Measures included self-report ratings of psychosocial risk (e.g., history of mental health problems or abuse, stressful life events, lack of social support), pregnancy-related anxiety, depressive symptomatology, and delusional ideation.

RESULTS

There was less delusional ideation during the postpartum period than during early pregnancy. Across all time points, levels of delusional ideation were lower than in the general population. Analyses using multilevel modeling indicated significant fixed-effects for the variables time, age, partnership, being religious and prenatal anxiety, but not depressive symptomatology, on delusional ideation. Immigrant status moderated the effect of psychosocial risk such that greater psychosocial risk predicted more symptoms of delusional ideation among immigrants, but not non-immigrants.

CONCLUSION

Psychosocial risk factors place immigrant women at an increased likelihood for experiencing delusional ideation during the perinatal period.

[Obstacles for the use of early childhood prevention services : The role of expected ability to control sources]

BACKGROUND

It is well established that preventive measures for pregnant women and families with small children do not reach all families alike. Often enough, it is those families, who due to heightened stresses and strains might gain the most from these measures, who cannot be reached (dilemma of prevention).

GOAL

This investigation explores whether parents can be grouped according to their views on health, prevention and measures available to young families, and whether belonging to one of the identified groups explains differences in the use of (primary and secondary) preventive measures for pregnant women and young families.

METHOD

In the context of home visits, parents of children aged two to four years (N = 273) completed questionnaires. Additionally, 203 parents took part in qualitative interviews.

RESULTS AND DISCUSSION

Based on interview data, parents from different sociocultural backgrounds could be grouped along their expected ability to control sources for parental support (Steuerungskompetenz). Parents high and low in Steuerungskompetenz differ regarding their knowledge of, use of, and satisfaction with (primary) preventive measures. Steuerungskompetenz explains the use of primary preventive measures above and beyond socioeconomic control variables as well as family stresses and strains. The use of secondary preventive measures is better explained by family stresses and strains. Results are discussed in terms of untapped services, needs and possibilities of target group-oriented approach.

Working conditions and occupational risk exposure in employees driving for work

INTRODUCTION

An analysis of the occupational constraints and exposures to which employees facing road risk at work are subject was performed, with comparison versus non-exposed employees. Objective was to improve knowledge of the characteristics of workers exposed to road risk in France and of the concomitant occupational constraints. The descriptive study was based on data from the 2010 SUMER survey (Medical Monitoring of Occupational Risk Exposure: Surveillance Médicale des Expositions aux Risques professionnels), which included data not only on road risk exposure at work but also on a range of socio-occupational factors and working conditions.

MATERIALS AND METHODS

The main variable of interest was "driving (car, truck, bus, coach, etc.) on public thoroughfares" for work (during the last week of work). This was a dichotomous "Yes/No" variable, distinguishing employees who drove for work; it also comprised 4-step weekly exposure duration: <2h, 2-10h, 10-20h and ≥20h.

RESULTS

75% of the employees with driving exposure were male. Certain socio-occupational categories were found significantly more frequently: professional drivers (INSEE occupations and socio-occupational categories (PCS) 64), skilled workers (PCS 61), intermediate professions and teaching, health, civil service (functionaries) and assimilated (PCS 46) and company executives (PCS 36). Employees with driving exposure more often worked in small businesses or establishments. Constraints in terms of schedule and work-time were more frequent in employees with driving exposure. Constraints in terms of work rhythm were more frequent in non-exposed employees, with the exception of external demands requiring immediate response. On the Karasek's Job Demand-Control Model, employees with driving exposure less often had low decision latitude. Prevalence of job-strain was also lower, as was prevalence of "iso-strain" (combination of job-strain and social isolation). Employees with driving exposure were less often concerned by hostile behavior and, when they did report such psychological violence (inspired on the Leymann questionnaire), it was significantly more frequently due to clients, users or patients.

DISCUSSION

Employees with driving exposure at work showed several specificities. The present study, based on a representative nationwide survey of employees, confirmed the existence of differences in working conditions between employees with and without driving exposure at work. In employees with driving exposure, constraints in terms of work-time and rhythm increased with weekly exposure duration, as did tension at work and exposure to hostile behavior.

Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit

This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant attachment-would also enhance our ability to tailor therapeutic interventions.

Psychosocial adversity, delinquent pathway and internalizing psychopathology in juvenile male offenders

The main aim of the present study was to investigate the presence of a set of risk factors relating to childhood life events and other psychosocial factors that may be associated with criminal indicators and with the prevalence of internalizing psychopathology in a sample of adolescent offenders. Fifty male adolescents in the custody of the Portuguese Juvenile Justice System participated in the study (M=15.8 years of age). The Adolescent Psychopathology Scale - Short Form (APS-SF) was administered in a structured interview format, and the sociodemographic, family and criminal data questionnaire was filled in by the justice professional after consulting the adolescent's file. Forty-six percent of all subjects had previous delinquent behavior. About 32% of the boys had committed violent offenses and 88% acted with peers. Also, the persistence of the delinquent behavior (50% of the offenders), coupled with the increase in the severity of the crimes committed (38% of the sample), suggests that these adolescents were at risk for serious and chronic delinquency at the time of the intervention. About 32% of the participants reported posttraumatic stress disorder symptoms, 20% had suicide ideation, and a lower percentage reported other internalizing problems. Institutionalization, maltreatment and conduct problems in childhood, and family risk factors (parental conflict, absence of a father figure, lack of parental control and family substance addiction) were related with the report of internalizing problems. Moreover, the increase in the severity of criminal offenses and living in a correctional facility were associated with higher levels of posttraumatic stress, interpersonal problems, anxiety and depression. This study draws attention to the importance of assessing indicators of psychopathology and of psychosocial risk in intervention programs with young offenders, but also to the need of family focused interventions in order to help prevent recidivism.

Understanding workplace violence: the value of a systems perspective

Workplace violence is a leading form of occupational injury and fatality, but has received little attention from the ergonomics research community. The paper reports findings from the 2012 New Zealand Workplace Violence Survey, and examines the workplace violence experience of 86 New Zealand organisations and the perceptions of occupational health and safety professionals from a systems perspective. Over 50% of respondents reported violence cases in their organisation, with perpetrators evenly split between co-workers and external sources such as patients. Highest reported levels of violence were observed for agriculture, forestry and construction sectors. Highest risk factor ratings were reported for interpersonal and organisational factors, notably interpersonal communication, time pressure and workloads, with lowest ratings for environmental factors. A range of violence prevention measures were reported, although most organisations relied on single control measures, suggesting unmanaged violence risks were common among the sample.