ObjectiveThe objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians’ professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being.MethodsA sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization’s abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale.ResultsPrincipal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen’s d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8–40) change in sleep-related impairment.ConclusionsPFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.

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The promise of smartphone applications and connected technologies for mental health to advance diagnosis, augment treatment, and expand access has received much attention. Mental health disorders represent the leading cause of the loss of years of life because of disability and premature mortality and also contribute to employee absenteeism and lost productivity in economically established countries such as the United States. The potential of smartphone applications to offer new, at-your-fingertips tools and resources for mental health care is frequently cited.But this potential is not the only reason why it is hard to ignore smartphone applications. The reality of applications for clinical care is already here. More than 10 000 mental health-related applications are available to download, and that number increases daily. As smartphones become increasingly inexpensive and available to the entire population, including those with mental illness, the accessibility, immediacy, affordability, and bold marketing claims of applications will drive more patients to use them.This new reality is worrisome: studies suggest that most mental health apps in commercial marketplaces do not conform to clinical guidelines. Some may even offer dangerous recommendations, such as one application that advises people experiencing a bipolar manic episode to drink hard alcohol before bedtime to assist with sleeping. 2 It is likely that most of these nonevidencebased applications may distract patients and potentially cause them to delay seeking care. Many applications do not respect the privacy of personal health information, and the price of a free application is often buried in a complex privacy policy requiring college reading comprehension-that price being the right to market and sell your data. 3 Certainly there are exceptions, as a handful of safe, evidence-based, and useful applications exist. Still, these helpful applications may be to difficult to find among hundreds of more problematic applications. Finding these valuable applications, furthermore, is a challenge for both patients and clinicians.Mental health technologies like smartphone applications have not been thoroughly investigated through clinical science or overseen through regulatory control. Instead, there is a void in which the potential and preshpent reality of health applications are confusing, marred

Roughly 15 million of the 62 million rural U.S. residents struggle with mental illness and substance abuse. These rural dwellers have significant health care needs but commonly experience obstacles to obtaining adequate psychiatric services. Important but little-recognized ethical dilemmas also affect rural mental health care delivery. Six attributes of isolated settings with limited resources appear to intensify these ethical dilemmas: overlapping relationships, conflicting roles, and altered therapeutic boundaries between caregivers, patients, and families; challenges in preserving patient confidentiality; heightened cultural dimensions of mental health care; "generalist" care and multidisciplinary team issues; limited resources for consultation about clinical ethics; and greater stresses experienced by rural caregivers. The authors describe these features of rural mental health care and provide vignettes illustrating dilemmas encountered in the predominantly rural and frontier states of Alaska and New Mexico. They also outline constructive approaches to rural ethical dilemmas in mental health care.

The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development. Untreated mental conditions contribute to economic loss because they increase school and work absenteeism and dropout rates, healthcare expenditure, and unemployment. Addressing unmet mental health needs will require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.