Differences in Physicians’ and Nurses’ Recent Suicide Attempts: An Exploratory Study

Braquehais, María Dolores; Eiroá-Orosa, Francisco José; Holmes, Kristin; Lusilla, P.; Bravo, María del Mar Pastor; Mozo, Xulián; Mezzatesta, Marcela; Casanovas, Marta; Pujol, Tània; Sher, Leo

doi:10.1080/13811118.2014.996693

Cited by 26 publications

(22 citation statements)

References 16 publications

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“…Interventions that created a people-focused working culture that recognised this important link between doctors' and patients' health and well-being, balanced positive and negative performance and promoted doctors' learning from both. In addition, acknowledging the positive and negative aspects of a medical career helped doctors to thrive at work and deal with work pressures (this was demonstrated in context-mechanism-outcome configurations [12][13][14][15]. Finally, we found that the way that interventions were implemented was critically important.…”

Section: Resultsmentioning

confidence: 92%

“…11 In the UK, the mental health of the NHS workforce, including that of doctors, is of great concern. [12][13][14][15][16] In 2015, the Head of Thought Leadership at The King's Fund declared that stress levels among NHS staff are 'astonishingly high' and need to be treated as 'public health problem'. 17 In the 2018 NHS staff survey, 39.8% of respondents indicated that they had been unwell in the previous 12 months because of work-related stress.…”

Section: Discussionmentioning

confidence: 99%

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Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

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Background The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem. Objectives Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Design Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards. Data sources Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites. Review methods We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations. Results A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective. Limitations Variable quality of included literature; limited UK-based studies. Future work Use this evidence synthesis to refine, implement and evaluate interventions. Study registration This study is registered as PROSPERO CRD42017069870. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

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Section: Resultsmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

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“…Some GPs in this study who recognised the importance of their symptoms were, however, prompted by this to seek help. Given the high rates of suicide among doctors in general and GPs in particular, 9 it is imperative that UK GPs are given the support they need so that they can access appropriate help before they reach this crisis point.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…6,7 Additional pressures for GPs in the UK come from sources such as the Quality and Outcomes Framework (QOF) and the implications of future cuts in NHS funding. 6 Reports of GPs feeling dissatisfied, 6 distressed, anxious, 7,8 and suicidal 9 are rising. Some GPs report misuse of substances, 7 while others feel exhausted, 'grumpy', and have feelings of hatred towards their work.…”

Section: Introductionmentioning

confidence: 99%

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

Spiers¹,

Buszewicz²,

Chew‐Graham

et al. 2017

Br J Gen Pract

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BackgroundGPs are under increasing pressure due to a lack of resources, a diminishing workforce, and rising patient demand. As a result, they may feel stressed, burnt out, anxious, or depressed.AimTo establish what might help or hinder GPs experiencing mental distress as they consider seeking help for their symptoms, and to explore potential survival strategies.Design and settingThe authors recruited 47 GP participants via e-mails to doctors attending a specialist service, adverts to local medical committees (LMCs) nationally and in GP publications, social media, and snowballing. Participants self-identified as either currently living with mental distress, returning to work following treatment, off sick or retired early as a result of mental distress, or without experience of mental distress. Interviews were conducted face to face or over the telephone.MethodTranscripts were uploaded to NVivo 11 and analysed using thematic analysis.ResultsBarriers and facilitators were related to work, stigma, and symptoms. Specifically, GPs discussed feeling a need to attend work, the stigma surrounding mental ill health, and issues around time, confidentiality, and privacy. Participants also reported difficulties accessing good-quality treatment. GPs also talked about cutting down or varying work content, or asserting boundaries to protect themselves.ConclusionSystemic changes, such as further information about specialist services designed to help GPs, are needed to support individual GPs and protect the profession from further damage.

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“…Las anfetaminas hasta un 10% y la cocaína entre un 3% y un 5% Como el resto de colectivo médico, los residentes presentan dificultades a la hora de pedir ayuda cuando sufren un trastorno mental. Estas dificultades son incluso mayores si han desarrollado una adicción (Braquehais et al, 2016). A la cultura de invulnerabilidad asociada al ejercicio de la Medicina, inculcada desde el pregrado, se suma también el estigma asociado al padecimiento mental o emocional, mayor aún, si cabe, entre los profesionales de la salud.…”

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Diagnóstico dual en médicos residentes: una revisión sistemática

et al. 2020

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ResumenAbstract original adicciones vol. xx, nº x · 2020 El período de preparación como médico residente (en español, MIR) suele asociarse a una elevada sobrecarga emocional tanto por las nuevas exigencias profesionales como por otros factores psicosociales. El objetivo de este estudio es conocer las características del diagnóstico dual en los MIRs. Se llevó a cabo una revisión sistemática de las bases de datos MEDLINE (PubMed), Web of Science y Google Scholar, seleccionando artículos publicados en inglés y español entre 1984 y 2017. Se obtuvieron 2.415 artículos: se excluyeron 2.276 por título, 105 por el contenido del resumen y 17 por el contenido del artículo. En la revisión final se incluyeron 17 artículos. La prevalencia de clínica depresiva varía del 10,2% al 70%, de ansiedad entre 13,2% y 33,9%, de ideación suicida entre 6,7% y 25% mientras que el consumo de riesgo de alcohol se encuentra aproximadamente en torno al 20%, entre 2% y 13,4% se auto-prescriben medicamentos psicótropos y del 2,7% al 14% consumen otras sustancias. La mayoría de los estudios analizados adolecen de limitaciones metodológicas importantes lo que dificulta una adecuada comprensión del fenómeno. Las variaciones en las cifras de prevalencia tienen que ver con la disparidad de escalas y de criterios diagnósticos empleados, entre otros factores. Aún así, los estudios muestran que el consumo de alcohol y/u otras sustancias se correlacionan positivamente con el malestar emocional en los MIRs. Se hace necesario mejorar el conocimiento del diagnóstico dual en este grupo profesional para que se puedan prevenir y tratar sus consecuencias de manera más eficaz. Palabras clave: Médico residente; Trastorno por uso de sustancias; Trastornos mentales; Diagnóstico dual; Auto-tratamiento. The post-graduate period as a resident doctor (MIR, in Spanish) is usually associated with high emotional distress due to new professional demands and to other psychosocial factors. The objective of this study is to determine the characteristics of dual diagnosis among MIRs. A systematic review was carried out in MEDLINE (PubMed), Web of Science and Google Scholar databases, selecting articles published in English and Spanish between 1984 and 2017. A total of 2,415 articles were obtained: 2,276 were excluded by their title, 105 by the abstract and 17 after a complete review of the article; 17 papers were finally included. The prevalence of depressive symptoms among MIRs ranges from 10.2% to 70%, while the prevalence of anxious symptoms varies from 13.2% to 33.9%, from 6.7% to 25% reported suicidal ideation, 20% hazardous drinking, 2%-13.4% self-prescribed psychotropics, and 2.7%-14% used other drugs. Most studies present important methodological limitations, thus complicating adequate understanding of the phenomenon. High variations in prevalence data are related to differences in the psychometric scales and to disparity in diagnosis criteria, among other limitations. However, most studies report that alcohol and drug use is correlated with severe distress among MIRs...

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Differences in Physicians’ and Nurses’ Recent Suicide Attempts: An Exploratory Study

Cited by 26 publications

References 16 publications

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

Diagnóstico dual en médicos residentes: una revisión sistemática

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