Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders.
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ABSTRACT:
SUBMITTER: Lyra RL
PROVIDER: S-EPMC8087020 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This study employed an independent-groups design (4 conditions) to investigate possible biases in the suicide risk perception of mental health professionals. Four hundred participants comprising doctors, nurses and social workers viewed a vignette describing a fictitious patient with a long-term mental illness. The case was presented as being drawn from a sample of twenty similar clinical case reports, of which 10 were associated with an outcome of suicide. The participant tasks were (i) to decide whether the presented vignette was one of those cases or not, and (ii) to provide an assessment of confidence in that decision. The 4 conditions were used to investigate whether the presence of an associated face, and the nature of the emotional state expressed by that face, affected the response profile. In fact, there were no significant differences between conditions, but there was a significant bias across all conditions towards associating the vignette with suicide, despite the base rate being pre-determined at 50%. The bias was more pronounced in doctors and in male respondents. Moreover, many participants indicated substantial confidence in their decisions. The results are discussed in terms of availability bias and over-confidence bias.
| S-EPMC4766090 | biostudies-other
Project description:BackgroundThe COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.ObjectivesExamine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.DesignObservational, self-report, single time-point online assessment.ParticipantsA total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic.Main outcomes and measuresCROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents' likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.ResultsCROS total scores correlated significantly with all four psychiatric symptom domains (R's = .42-.53), likelihood of leaving one's current occupation (R = .18), and trouble doing usual work (R = .28), all p's < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.Conclusions and relevanceThese results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.
| S-EPMC8675543 | biostudies-literature
Project description:The objective of this phenomenological study was to describe families' experiences of supporting veterans and emergency service first responders (ESFRs) (known also as public safety personnel) to seek help for a mental health problem. In-depth semi-structured open-ended interviews were undertaken with 25 family members of Australian veterans and ESFRs. Fourteen participants were family members of police officers. Data were analysed thematically. Participants described a long and difficult journey of supporting the person's help-seeking across six themes. Traumatic exposures, bullying in the workplace and lack of organisational support experienced by veterans/ESFRs caused significant family distress. Families played a vital role in help-seeking but were largely ignored by veteran/ESFR organisations. The research provides a rich understanding of distress and moral injury that is experienced not only by the service members but is transferred vicariously to their family within the mental health help-seeking journey. Veteran and ESFR organisations and mental health services need to shift from a predominant view of distress as located within an individual (intrapsychic) towards a life-course view of distress as impacting families and which is more relational, systemic, cultural and contextual.
| S-EPMC10084143 | biostudies-literature
Project description:BackgroundThe widely established treatment for psychosis is long-term antipsychotic medication. However, many people stop taking this treatment, and request other options. There are also growing concerns about adverse effects, but currently no professional guidelines to support reducing or stopping these drugs. The views and experiences of individual mental health professionals around reducing and stopping antipsychotics are therefore crucial in treatment decisions.MethodsWe conducted 7 focus groups with prescribing psychiatrists and other members of community-based statutory mental health services in London. Participants discussed their views about, experiences, and processes of antipsychotic reduction and discontinuation. Data were analysed using thematic analysis.ResultsParticipants acknowledged that antipsychotics can have severe adverse effects. They were generally supportive of trying to reduce these drugs to the lowest effective dose, although stopping antipsychotics was less acceptable. Prior experiences of adverse events after reduction or discontinuation meant that both were approached with caution. Reduction was also reported to be hampered by organisational and knowledge barriers. Lack of resources, pressure to discharge, and poor continuity of care were seen as organisational barriers. Knowledge barriers included inadequate evidence about who might be best suited to reduction, and lack of guidance about how this could be done safely. This meant that reduction was often prompted by patients, and sometimes actively discouraged, and stability with maintenance treatment was often favoured.ConclusionsConcerns about risk and other barriers means that clinicians are often reluctant to implement reduction or discontinuation of antipsychotic medication. In order to increase the treatment options available to service users, more research and guidance on how to minimise the risks of antipsychotic reduction and discontinuation is required to enable clinicians to engage more constructively with service users requests, offering people more choice and control in managing their mental health condition.
| S-EPMC6586401 | biostudies-literature
Project description:PURPOSE:Stigma is a common barrier to mental health professionals (MHPs) seeking help for occupational stress and burnout, although there is a lack of psychometrically sound tools to measure this construct. The current study aimed to develop and validate a scale (the Mental Health Professional Stigma Scale; MHPSS) for this purpose. METHODS:The MHPSS and related measures were completed by 221 Australian MHPs via online survey, with a subsample completing the MHPSS again 2 weeks after initial completion. RESULTS:Exploratory factor analysis revealed a four-factor solution, comprising of 13 items and accounting for 50.16% of variance. Factors were Perceived Other Stigma, Perceived Structural Stigma, Personal Stigma, and Self stigma. The internal consistency, test-retest reliability, and validity of the scale were supported. CONCLUSIONS:The MHPSS has utility to capture stigmatising attitudes and beliefs related to occupational stress and burnout among MHPs. It may be used to assist in the development and evaluation of initiatives to reduce stigma and increase help-seeking among MHPs.
| S-EPMC7224121 | biostudies-literature
Project description:ObjectivesFirst responders are at elevated risk for psychological distress from frequent exposure to potentially traumatic events. Self-compassion may buffer against the negative impact of these stressors, and the potential emotional challenges of having high levels of compassion for others. However, little is known about the psychological impact of compassion in first responders. We examined how self-compassion, compassionate love for others, and service role interacted to predict mental health in a diverse group of first responders.MethodsFirst responders (N = 171) with both traditional and emotional support roles completed an online survey including measures of self-compassion, compassionate love, psychological distress, post-traumatic stress, secondary traumatic stress, burnout, resilience, compassion satisfaction, and life satisfaction.ResultsGreater self-compassion and compassionate love both independently predicted less depersonalization (|β|s ≥ .18, ps < .01). Greater self-compassion predicted less general psychological distress, post-traumatic stress, secondary traumatic stress, and emotional exhaustion, as well as greater resilience and life satisfaction (|β|s ≥ .35, ps < .001). Greater compassionate love predicted greater personal accomplishment and compassion satisfaction for all first responders (|β|s ≥ .30, ps < .001); for traditional first responders only, greater self-compassion predicted greater personal accomplishment and compassion satisfaction (role x self-compassion; |β|s ≥ .16, ps < .05). Emotional support first responders reported less emotional exhaustion and greater resilience than traditional first responders (|β|s ≥ .21, ps < .05).ConclusionsSelf-compassion and compassionate love each play important roles in promoting mental health among first responders. Programs designed to increase compassion could be beneficial in this population.Supplementary informationThe online version contains supplementary material available at 10.1007/s12671-020-01527-y.
| S-EPMC7662019 | biostudies-literature
Project description:ObjectiveTo examine the association between a number of negative COVID-19 occupational experiences and probable anxiety, depression, and PTSD among physicians.MethodsCross-sectional examination of longitudinal registry data consisting of physician personal and occupational well-being. Multivariable logistic regressions were performed to determine the association between negative COVID-19 experiences and outcomes.ResultsOf the 620 eligible physicians, approximately half were female (49%), and 71% white with a mean age of 46.51 (SD = 13.28). A one-point increase in negative experience score was associated with a 23% increase in probable anxiety (OR = 1.23, 95% CI: 1.14-1.34), a 23% increase in probable depression (OR = 1.23, 95% CI: 1.13-1.33), and a 41% increase in probable PTSD (OR = 1.41, 95% CI: 1.30-1.52).ConclusionsNegative pandemic experiences were strongly associated with adverse mental health outcomes while greater resilience was protective.
| S-EPMC8808755 | biostudies-literature
Project description:BackgroundHealth policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment.MethodsWe conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis.ResultsParticipants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable.ConclusionsParticipants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures.Trial registrationClinicalTrials.gov identifier: NCT03624829.
| S-EPMC7487713 | biostudies-literature
Project description:BACKGROUND:The transition period between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) has been identified as an especially critical time for patients with anorexia nervosa. In the present study, to better facilitate patients' recovery process, we explored the experiences of professionals concerning the transition from CAMHS to AMHS. METHOD:A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and two individual interviews with eight experienced health care professionals. Together they had experience with treating patients with AN and the transition from CAMHS to AMHS, both from specialized eating disorder units, specialized mental health care units, and from a school nurse context. Service users with parents` perspectives and patients' perspectives were involved in all steps of the research process. RESULTS:Barriers experienced during the transition process were classified into four categories: (1) different treatment cultures that describe differences in how parents are included in CAMHS and AMHS; (2) mistrust between CAMHS and AMHS that can create a lack of collaboration and predictability for the patients' transition; (3) Clinicians` factors such as lack of professional self-confidence can influence continuity of care for patients; and (4) lack of trust between services and not enough focus on building a new alliance in AMHS negatively influences the transition. CONCLUSIONS:The present study revealed four important categories that professionals needs to consider when participating in the transition for patients with AN from CAMHS to AMHS. Awareness of these challenges might improve the transition process for patients with AN.
| S-EPMC7507603 | biostudies-literature
Project description:Most occupational health research is conducted with the so-called "standard employment relationship" in mind, which entails ongoing, full-time employment for a single employer. Yet mounting evidence suggests the way work is organized is increasingly deviating from this standard model, and that work arrangements themselves-the terms and conditions of employment such as contract type and the extent of directive control over tasks-are important determinants of worker health and safety. However, a lack of clear conceptual definitions or taxonomic system defining the wide variety of economic work arrangements in the contemporary workplace hampers rigorous investigation of their relationship to health. The various forms of "non-standard" employment arrangements-also called non-traditional, alternative, flexible, fissured, precarious, contingent, temporary, atypical, or gig work-may have overlapping attributes, yet ambiguity regarding the character of these arrangements obscures mechanisms that lead to increased health and safety risks. Here, we attempt to clarify work arrangements as a workplace exposure, deserving of specific attention within occupational health and safety research, practice, and policy. We argue that, at minimum, three key features of work arrangements need to be considered: (1) whether an arrangement is permanent or temporary; (2) whether a worker is a contractor or an employee; and (3) whether an arrangement involves more than one firm. We further propose mechanisms linking work arrangements to increased work-related health risks to better inform strategies aimed at protecting the growing non-standard workforce.
| S-EPMC7438943 | biostudies-literature