US Surgeons Are Killing Themselves at an Alarming Rate

Christina Frangou

The Guardian

Originally published 26 Sept 23

Here is an excerpt:

Fifty years ago, in a landmark report called The Sick Physician, the American Medical Association declared physician impairment by psychiatric disorders, alcoholism and drug use a widespread problem. Even then, physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.

The report called for better support for physicians who were struggling with mental health or addictions. Too many doctors hid their ailments because they worried about losing their licenses or the respect of their communities, according to the medical association.

Following the publication, state medical societies in the US, the organizations that give physicians license to practice, created confidential programs to help sick and impaired doctors. Physician health programs have a dual purpose: they connect doctors to treatment, and they assess the physician to ensure that patients are safe in their care. If a doctor’s condition is considered a threat to patient safety, the program may recommend that a doctor immediately cease practice, or they may recommend that a physician undergo drug and alcohol monitoring for three to five years in order to maintain their license. The client must sign an agreement not to participate in patient care until their personal health is addressed.

In rare and extreme cases, the physician health program will report the doctor to the state medical board to revoke their license.

The info is here.

Here is my summary:

The article sheds light on a distressing phenomenon in the United States: an alarming increase in suicide rates among surgeons. It underscores the severity of this issue by featuring a courageous surgeon who has taken the initiative to address it openly. The article suggests that the mental health and well-being of surgeons are under significant strain, potentially due to the demanding nature of their profession, and it calls for greater awareness and support to tackle this growing crisis. The featured surgeon's decision to speak out serves as a poignant reminder of the urgent need to address the mental health challenges faced by medical professionals.

The article underscores the critical issue of high suicide rates among U.S. surgeons, with a particular focus on the brave act of a surgeon who has chosen to raise awareness about this problem. It highlights the pressing need for comprehensive mental health support within the medical community to address the unique stressors that surgeons encounter in their line of work.

Burnout Is About Your Workplace, Not Your People

Jennifer Moss

Harvard Business Review

Originally posted 11 December 2019

We tend to think of burnout as an individual problem, solvable by “learning to say no,” more yoga, better breathing techniques, practicing resilience — the self-help list goes on. But evidence is mounting that applying personal, band-aid solutions to an epic and rapidly evolving workplace phenomenon may be harming, not helping, the battle. With “burnout” now officially recognized by the World Health Organization (WHO), the responsibility for managing it has shifted away from the individual and towards the organization. Leaders take note: It’s now on you to build a burnout strategy.

The Non-Classification Classification

The term “burnout” originated in the 1970s, and for the past 50 years, the medical community has argued about how to define it. As the debate grows increasingly contentious, the most recent WHO announcement may have caused more confusion than clarity. In May, the WHO included burnout in its International Classification of Diseases (ICD-11) and immediately the public assumed that burnout would now be considered a medical condition. The WHO then put out an urgent clarification stating, “Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, not a medical condition… reasons for which people contact health services but that are not classed as illnesses or health conditions.”

Although the WHO is now working on guidelines to help organizations with prevention strategies, most still have no idea what to do about burnout. Since it was explicitly not classified as a medical condition, the case is less about liability for employers and more about the impact on employee well-being and the massive associated costs.

The Emotional and Financial Toll

When Stanford researchers looked into how workplace stress affects health costs and mortality in the United States (pdf), they found that it led to spending of nearly $190 billion — roughly 8% of national  healthcare outlays — and nearly 120,000 deaths each year. Worldwide, 615 million suffer from depression and anxiety and, according to a recent WHO study, which costs the global workforce an estimated $1 trillion in lost productivity each year. Passion-driven and caregiving roles such as doctors and nurses  are some of the most susceptible to burnout, and the consequences can mean life or death; suicide rates among caregivers are dramatically higher than that of the general public — 40% higher for men and 130% higher for women.

The info is here.

Summary: Burnout is a serious problem that can have a significant impact on individuals and organizations. It is important to understand that burnout is not just about the individual, but also about the workplace environment. There are a number of factors that can contribute to burnout, including unfair treatment, unmanageable workload, lack of role clarity, lack of communication and support from managers, and unreasonable time pressure.

Why some mental health professionals avoid self-care

Dattilio, F. M. (2023).

Journal of Consulting and Clinical Psychology, 

91(5), 251–253.

https://doi.org/10.1037/ccp0000818

Abstract

This article briefly discusses reasons why some mental health professionals are resistant to self-care. These reasons include the savior complex, avoidance, and lack of collegial assiduity. Several proposed solutions are offered.

Here is an excerpt:

Savior Complex

One hypothesis used to explain professionals’ resistance is what some refer to as a “savior complex.” Certain MHPs may be engaging in the cognitive distortion that it is their duty to save as many people from suffering and demise as they can and in turn need to sacrifice their own psychological welfare for those facing distress. MHPs may be skewed in their thinking that they are also invulnerable to psychological and other stressors. Inherent in this distortion is their fear of being viewed as weak or ineffective, and as a result, they overcompensate by attempting to be stronger than others. This type of thinking may also involve a defense mechanism that develops early in their professional lives and emerges during the course of their work in the field. This may stem from preexisting components of their personality dynamics. 

Another reason may be that the extreme rewards that professionals experience from helping others in such a desperate state of need serve as a euphoric experience for them that can be addictive. In essence, the “high” that they obtain from helping others often spurs them on.

Avoidance

Another less complicated explanation for MHPs’ blindness to their own vulnerabilities may be their strong desire to avoid admitting to their own weaknesses and sense of vulnerability. The defense mechanism of rationalization that they are stronger and healthier than everyone else may embolden them to push on even when there are visible signs to others of the stress in their lives that is compromising their functioning. 

Avoidance is also a way of sidestepping the obvious and putting it off until later. This may be coupled with the need that has increased, particularly with the recent pandemic that has intensified the demand for mental health services.

Denial

The dismissal of MHPs’ own needs or what some may term as, “denial” is a deeper aspect that goes hand-in-hand with cognitive distortions that develop with MHPs, but involve a more complex level of blindness to the obvious (Bearse et al., 2013). It may also serve as a way for professionals to devalue their own emotional and psychological challenges. 

Denial may also stem from an underlying fear of being determined as incapacitated or not up to the challenge by their colleagues and thus prohibited from returning to their work or having to face limitations or restrictions. It can sometimes emanate from the fear of being reported as having engaged in unethical behavior by not seeking assistance sooner. This is particularly so with cases of MHPs who have become involved with illicit drug or alcohol abuse or addiction. 

Most ethical principles mandate that MHPs strive to remain cognizant of the potential effects that their work has on their own physical and mental health status while they are in the process of treating others and to recognize when their ability to be effective has been compromised. 

Last, in some cases, MHPs’ denial can even be a response to genuine and accurately perceived expectations in a variety of work contexts where they do not have control over their schedules. This may occur more commonly with facilities or institutions that do not support the disclosure of vulnerability and stress. It is for the aforementioned reasons that the American and Canadian Psychological Associations as well as other mental health organizations have mandated special education on this topic in graduate training programs (American Psychiatric Association, 2013; Maranzan et al., 2018).

Lack of Collegial Assiduity

A final reason may involve a lack of collegial assiduity, where fellow MHPs observe their colleagues enduring signs of stress but fail to confront the individual of concern and alert them to the obvious. It is often very awkward and uncomfortable for a colleague to address this issue and risk rebuke or a negative outcome. As a result, they simply avoid it altogether, thus leaving the issue of concern unaddressed.

The article is paywalled here, which is a complete shame.  We need more access to self-care resources.

‘What if Yale finds out?’

William Wan

The Washington Post

Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.

Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

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In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

The info is here.

About one-fifth of lawyers and staffers considered suicide at some point in their careers, new survey says.

Debra Cassens Weiss

American Bar Association Journal

Originally posted 10 MAY 22

A new survey of lawyers and staff members hailing mostly from BigLaw has found that anxiety, depression and isolation remain at concerning levels, despite a slight decrease in the percentages since the survey last year.

The Mental Health Survey by Law.com and ALM Intelligence found that 67% of the respondents reported anxiety, 35% reported depression and 44% reported isolation, according to an article by Law.com.

The survey, conducted in March and April, asked respondents from around the world about their mental health and law firm environments in 2021.

The percentage of respondents who contemplated suicide at some point in their professional careers was 19%, the article reports.

In addition, 2.4% of the respondents said they had a drug problem, and 9.4% said they had an issue with alcoholic drinking.

About 74% of the respondents thought that their work environment contributed to their mental health issues. When asked about the factors that had a negative impact on mental health, top concerns were always being on call (72%), billable hour pressure (59%), client demands (57%), lack of sleep (55%) and lean staffing (49.5%).

The survey asked about the impact of remote work for the first time. About 59% said remote work increased their quality of life; about 62% said it increased the quality of home-based relationships; about 54% said it led to an increase in their billable hours; and 50% said it improved personal finances. But 76% said remote work hurt the quality of interpersonal relationships with colleagues.

The info is here.

A well being toolkit for lawyer and legal employers is here.

How Other- and Self-Compassion Reduce Burnout through Resource Replenishment

Kira Schabram and Yu Tse Heng

Academy of Management Journal, Vol. 65, No. 2

Abstract

The average employee feels burnt out, a multidimensional state of depletion likely to persist without intervention. In this paper, we consider compassion as an agentic action by which employees may replenish their own depleted resources and thereby recover. We draw on conservation of resources theory to examine the resource-generating power of two distinct expressions of compassion (self- and other-directed) on three dimensions of burnout (exhaustion, cynicism, inefficacy). Utilizing two complementary designs—a longitudinal field survey of 130 social service providers and an experiential sampling methodology with 100 business students across 10 days—we find a complex pattern of results indicating that both compassion expressions have the potential to generate salutogenic resources (self-control, belonging, self-esteem) that replenish different dimensions of burnout. Specifically, self-compassion remedies exhaustion and other-compassion remedies cynicism—directly or indirectly through resources—while the effects of self- and other-compassion on inefficacy vary. Our key takeaway is that compassion can indeed contribute to human sustainability in organizations, but only when the type of compassion provided generates resources that fit the idiosyncratic experience of burnout.

From the Discussion Section

Our work suggests a more immediate benefit, namely that giving compassion can serve an important resource generative function for the self. Indeed, in neither of our studies did we find either compassion expression to ever have a deleterious effect. While this is in line with the broader literature on self-compassion (Neff, 2011), it is somewhat surprising when it comes to other-compassion. Hobfoll (1989) speculated that when people find themselves depleted, giving support to others should sap them further and such personal costs have been identified in previously cited research on prosocial gestures (Bolino & Grant, 2016; Lanaj et al., 2016; Uy et al., 2017). Why then did other-compassion serve a singularly restorative function? As we noted in our literature review, compassion is distinguished among the family of prosocial behaviors by its principal attendance to human needs (Tsui, 2013) rather than organizational effectiveness, and this may offer an explanation. Perhaps, there is something fundamentally more beneficial for actors about engaging in acts of kindness and care (e.g. taking someone who is having a hard time out for coffee) than in providing instrumental support (e.g. exerting oneself to provide a friendly review). We further note that our study also did not find any evidence of ‘compassion fatigue’ (Figley, 2013), identified frequently by practitioners among the social service employees that comprised our first sample. In line with the ‘desperation corollary’ of COR (Hobfoll et al., 2018), which suggests that individuals can reach a state of extreme depletion characterized by maladaptive coping, it may be that there exists a tipping point after which compassion ceases to offer benefits. If there is, however, it must be quite high to not have registered in either the longitudinal or diary designs. 

The research is here, behind a paywall.

What predicts suicidality among psychologists? An examination of risk and resilience

S. Zuckerman, O. R. Lightsey Jr. & J. White

Death Studies (2022)

DOI: 10.1080/07481187.2022.2042753

Abstract

Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

From the Discussion section:

Contrary to hypotheses, however, resilience did not consistently buffer the relationship between vulnerability factors and suicidality. Indeed, resilience appeared to strengthen the relationships between having a family history of suicide and suicidality. It is plausible that psychologists may overestimate their resilience or believe that they “should” be resilient given their training or their helping role (paralleling burnout-related themes identified in the culture of medicine, “show no weakness” and “patients come first;” see Williams et al., 2020, p. 820). Similarly, persons who believe that they are generally resilient may be demoralized by their inability to prevent family history of suicide from negatively affecting them, and this demoralization may result in family history of suicide being a particularly strong predictor among these individuals. Alternatively, this result could stem from the BRS, which may not measure components of resilience that protect against suicidality, or it could be an artifact of small sample size and low power for detecting moderation (Frazier et al., 2004). Of course, interaction terms are symmetric, and the resilience x family history of suicide interaction can also be interpreted to mean that family history of suicide strengthens the relationship between resilience and suicidality: When there is a family history of suicide, resilience has a positive relationship with suicidality whereas, when there is no family history of suicide, resilience has a negative relationship with suicidality.

The research is here.

Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience

Hagerty, S. L., & Williams, L. M. (2022)

Clinical Psychological Science. 

https://doi.org/10.1177/21677026211057554

Abstract

The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.

From the General Discussion

A subset of respondents added context to their experiences of moral injury in the form of narrative responses. These powerful accounts of the lived experiences of health-care workers provided us with a richer understanding of the construct of moral injury, especially as it relates to the novel context of the pandemic. Although betrayal is a known facet of moral injury from prior work (Bryan et al., 2016), our qualitative analysis suggests that dehumanization may also be a key phenomenon that underlies pandemic-related moral injury. Given our findings, we suggest that it may be important to attend to both betrayal and dehumanization when researching or intervening on the psychological sequelae of the pandemic. Our results support this because experiences of dehumanization in our sample were associated with greater symptoms of traumatic stress.

Another lens through which to view the experiences of health-care workers in the pandemic is through unsatisfied basic human motivations. Given the obvious barriers the pandemic presents to human connection (Hagerty & Williams, 2020), we had an a priori interest in studying loneliness. Our results indeed suggest that need of social connection appears relevant to the mental-health experiences of health-care workers during the pandemic such that loneliness was associated with greater traumatic stress, moral injury, and suicidal ideation. Echoing the importance of this social factor are findings from prior research suggesting that social connectedness buffers the association between moral injury and suicidality (Kelley et al., 2019) and buffers the impact of PTSD symptoms on suicidal behavior (Panagioti et al., 2014). Thus, our work further highlights lack of social connection as possible risk factor among individuals who face moral injury and traumatic stress and demonstrates its relevance to the mental health of health-care workers during the pandemic.

The research is here.

The Political is Personal: Daily Politics as a Chronic Stressor

Feinberg, M., Ford, et al.

(2020, September 19).

https://doi.org/10.31234/osf.io/hdz97

Abstract

Politics and its controversies have permeated everyday life, but the daily impact of politics is largely unknown. Here, we conceptualize politics as a chronic stressor with important consequences for people’s daily lives. We used longitudinal, daily-diary methods to track U.S. participants as they experienced daily political events across two weeks (Study 1: N=198, observations=2,167) and, separately, across three weeks (Study 2: N=811, observations=12,790) to explore how daily political events permeate people’s lives and how they cope with this influence of politics. In both studies, daily political events consistently evoked negative emotions, which corresponded to worse psychological and physical well-being, but also increased motivation to take political action (e.g., volunteer, protest) aimed at changing the political system that evoked these emotions in the first place. Understandably, people frequently tried to regulate their politics-induced emotions; and successfully regulating these emotions using cognitive strategies (reappraisal and distraction) predicted greater well-being, but also weaker motivation to take action. Although people can protect themselves from the emotional impact of politics, frequently-used regulation strategies appear to come with a trade-off between well being and action. To examine whether an alternative approach to one’s emotions could avoid this trade-off, we measured emotional acceptance in Study 2 (i.e., accepting one’s emotions without trying to change them) and found that successful acceptance predicted greater daily well-being but no impairment to political action. Overall, this research highlights how politics can be a chronic stressor in people’s daily lives, underscoring the far-reaching influence politicians have beyond the formal powers endowed unto them.

Conclusion

In all, our research bridges political psychology and affective science theory and methods, and highlights how these distinct literatures can intersect to answer important, unexplored questions. Our findings show that the political is very much personal–a pattern with powerful consequences for people’s daily lives. More generally, by demonstrating how political events personally impact the average citizen, including their psychological and physical health, our study reveals the far-reaching impact politicians have, beyond the formal powers endowed unto them.

Active shooter drills may do more harm than good, study shows

Katie Camero
Miami Herald

Originally posted 3 September 20

Here is an except:

The research team discovered that social media posts alone displayed a 42% increase in anxiety and stress from the 90 days before active shooter drills to the 90 days after them. The frequent use of words such as “afraid, struggling and nervous” served as evidence, according to the report.

Signs of depression increased by 39% based on posts that featured the words “therapy, cope, irritability and suicidal” following drill events. Concerns about friends grew by 33%, concerns about social situations rose by 14% and concerns about work soared by 108%, the researchers found.

“I can tell you personally, just as an educator, we were not okay [after drills]. We were in bathrooms crying, shaking, not sleeping for months. The consensus from my friends and peers is that we are not okay,” one anonymous K-12 teacher wrote on social media, according to the report.

Worries over health also jumped by 23% while fears about death rose by 22%. “The analysis revealed words like blood, pain, clinics, and pills came up with jarring frequency, suggesting that drills may have a direct impact on participants’ physical health or, at the very least, made it a persistent topic of concern,” the researchers wrote.

An anonymous parent tweeted, “my kindergartener was stuck in the bathroom, alone, during a drill and spent a year in therapy for extreme anxiety. in a new school even, she still has to use the bathroom in the nurses office because she has ptsd from that event.”

The info is here.

Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action

June Gruber et al.
American Psychologist. 
Advance online publication.
http://dx.doi.org/10.1037/amp0000707

Abstract

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.

(cut)

Concluding Comments

Clinical psychological science is needed more than ever in response to both the acute and enduring psychological effects of COVID-19 (Adhanom Ghebreyesus, 2020). This article is intended to inspire dialogue surrounding the challenges the field faces and how it must adapt to meet the mental health demands of a rapidly evolving psychological landscape. Of course, sustained change will require strong advocacy to ensure that mental health research funding is available to understand and address mental health challenges following COVID-19. To secure a leadership role, clinical psychological scientists must be prepared to raise their voices not only within scientific outlets, but also in public discussions on the airwaves (radio, cable news), alongside colleagues in other scientific fields. Sustained effort, collaboration with other disciplines, and unity within psychology will be necessary to address the multifaceted impacts of COVID-19 on humanity.

HR researchers discovered the real reason why stressful jobs are killing us

Arianne Cohen
fastcompany.com
Originally posted 20 May 20

Your job really might kill you: A new study directly correlates on-the-job stress with death.

Researchers at Indiana University’s Kelley School of Business followed 3,148 Wisconsinites for 20 years and found heavy workload and lack of autonomy to correlate strongly with poor mental health and the big D: death. The study is titled “This Job Is (Literally) Killing Me.”

“When job demands are greater than the control afforded by the job or an individual’s ability to deal with those demands, there is a deterioration of their mental health and, accordingly, an increased likelihood of death,” says lead author Erik Gonzalez-Mulé, assistant professor of organizational behavior and human resources. “We found that work stressors are more likely to cause depression and death as a result of jobs in which workers have little control.”

The reverse was also true: Jobs can fuel good health, particularly jobs that provide workers autonomy.

The info is here.

In the face of Covid-19, the U.S. needs to change how it deals with mental illness

Jeffrey Geller
STAT NEWS
Originally posted 29 May 20

Here are two excerpts:

Frontline physicians, nurses, and other health care workers are looking death in the face every day. Shift workers in economically treacherous situations are forced to risk their health for a paycheck. Millions of Americans have lost their jobs. Still more are separated from the people they love, their daily routines have been disrupted, and they are making anxious choices every day that affect their physical and mental health.

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Second, Covid-19 has laid bare the severe doctor shortage across the United States, and that shortage includes psychiatrists. While every kind of mental health professional is necessary and indeed critical to responding to the crisis, psychiatrists bring unique expertise in serving some of the most severely compromised patients in psychiatric units and hospitals, long-term care facilities, homeless shelters, and jails and prisons. Forgiving some of the debt that students amass during medical school would incentivize more individuals to serve in these capacities, as would lifting caps on federal funding for new residency slots.

Third, we needed more psychiatric beds in hospitals before Covid-19, and need even more now as physical distancing continues — yet some hospitals have decreased the number of psychiatric beds by converting them to beds for individuals with Covid-19. Patients in psychiatric units who contract Covid-19 need to be separated from other patients. We currently do not have enough beds to treat everyone for the length of time they need. Without federal funding for psychiatric beds, we will have an increase in deaths from the mental health sequelae of Covid-19.

The info is here.

My Bedside Manner Got Worse During The Pandemic. Here's How I Improved

Shahdabul Faraz
npr.org
Health Shots
Originally published 16 May 20

Here is an excerpt:

These gestures can be as simple as sitting in a veteran's room for an extra five minutes to listen to World War II stories. Or listening with a young cancer patient to a song by our shared favorite band. Or clutching a sick patient's shoulder and reassuring him that he will see his three daughters again.

These gestures acknowledge a patient's humanity. It gives them some semblance of normalcy in an otherwise difficult period in their lives. Selfishly, that human connection also helps us — the doctors, nurses and other health care providers — deal with the often frustrating nature of our stressful jobs.

Since the start of the pandemic, our bedside interactions have had to be radically different. Against our instincts, and in order to protect our patients and colleagues, we tend to spend only the necessary amount of time in our patients' rooms. And once inside, we try to keep some distance. I have stopped holding my patients' hands. I now try to minimize small talk. No more whimsical conversational detours.

Our interactions now are more direct and short. I have, more than once, felt guilty for how quickly I've left a patient's room. This guilt is worsened, knowing that patients in hospitals don't have family and friends with them now either. Doctors are supposed to be there for our patients, but it's become harder than ever in recent months.

I understand why these changes are needed. As I move through several hospital floors, I could unwittingly transmit the virus if I'm infected and don't know it. I'm relatively young and healthy, so if I get the disease, I will likely recover. But what about my patients? Some have compromised immune systems. Most are elderly and have more than one high-risk medical condition. I could never forgive myself if I gave one of my patients COVID-19.

The info is here.

Hospitals prepare for wave of mental health disorders among their workers

Del Quentin Wilber
The Los Angeles Times
Originally posted May 6, 2020

Here is an excerpt:

Mental health practitioners pointed to the suicide late last month of Dr. Lorna Breen as a warning flare. Colleagues said the 49-year-old Breen, an emergency room physician at NewYork-Presbyterian Allen Hospital in Manhattan, took her life after becoming overwhelmed by the volume of coronavirus patients who died on her watch.

“People at these elite medical institutions are talented, disciplined, strong and resilient,” said Dr. Jeffrey Lieberman, the chair of psychiatry at Columbia University Medical Center, where Breen was an assistant professor of emergency medicine. “But everyone has a breaking point. Tragically, in her case, her dedication pushed her past the breaking point.”

Healthcare professionals said the potential for trouble is particularly acute in New York, which has emerged as ground zero in the U.S. for COVID-19, the disease caused by the coronavirus.

Its hospitals have been crushed by an onslaught of severely ill patients. With no proven treatments or cures, physicians and nurses say they have often felt powerless to prevent the sickest from dying. Nearly 14,000 people have perished from the disease in the city, health officials say. During the height of the outbreak a month ago, doctors at Mt. Sinai Hospital were reporting at least 20 deaths a day. Typically, the hospital has one or two.

“The mortality that even veteran clinicians are witnessing has been massive and devastating to healthcare workers,” Lieberman said.

The info is here.

How stress influences our morality

Lucius Caviola and Nadira Faulmüller
Oxford Martin School

Abstract

Several studies show that stress can influence moral judgment and behavior. In personal moral dilemmas—scenarios where someone has to be harmed by physical contact in order to save several others—participants under stress tend to make more deontological judgments than nonstressed participants, i.e. they agree less with harming someone for the greater good. Other studies demonstrate that stress can increase pro-social behavior for in-group members but decrease it for out-group members. The dual-process theory of moral judgment in combination with an evolutionary perspective on emotional reactions seems to explain these results: stress might inhibit controlled reasoning and trigger people’s automatic emotional intuitions. In other words, when it comes to morality, stress seems to make us prone to follow our gut reactions instead of our elaborate reasoning.

From the Implications Section

The conclusions drawn from these studies seem to raise an important question: if our moral judgments are so dependent on stress, which of our judgments should we rely on—the ones elicited by stress or the ones we come to after careful consideration? Most people would probably not regard a physiological reaction, such as stress, as a relevant normative factor that should have a qualified influence on our moral values. Instead, our reflective moral judgments seem to represent better what we really care about. This should make us suspicious of the normative validity of emotional intuitions in general. Thus, in order to identify our moral values, we should not blindly follow our gut reactions, but try to think more deliberately about what we care about.

For example, as stated we might be more prone to help a poor beggar on the street when we are stressed. Here, even after careful reflection we might come to the conclusion that this emotional reaction elicited by stress is the morally right thing to do after all. However, in other situations this might not be the case. As we have seen we are less prone to donate money to charity when stressed (cf. Vinkers et al., 2013). But is this reaction really in line with what we consider to be the morally right thing to do after careful reflection? After all, if we care about the well-being of the single beggar, why then should the many more people’s lives, potentially benefiting from our donation, count less?

The research is here.

Managing mental health challenges faced by healthcare workers during COVID-19 pandemic

Greenberg N., & others
BMJ 2020; 368 :m1211

Here is an excerpt:

Moral injury

Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.1 Unlike formal mental health conditions such as depression or post-traumatic stress disorder, moral injury is not a mental illness. But those who develop moral injuries are likely to experience negative thoughts about themselves or others (for example, “I am a terrible person” or “My bosses don’t care about people’s lives”) as well as intense feelings of shame, guilt, or disgust. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation. Equally, some people who have to contend with significant challenges, moral or traumatic, experience a degree of post-traumatic growth,3 a term used to describe a bolstering of psychological resilience, esteem, outlook, and values after exposure to highly challenging situations. Whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported before, during, and after a challenging incident.

Moral injury has already been described in medical students, who report great difficulty coping with working in prehospital and emergency care,4 where they were exposed to trauma that they felt unprepared for. This may be similar to the unprecedented nature of the challenges healthcare staff are currently facing. In the UK, most NHS staff may have felt, with some justification, that with all its faults, the NHS gives the sickest people the greatest chance of recovery. As such, staff should and usually do feel that it is something to be proud of.

The huge current effort to ensure adequate staffing and resources may be successful, but it looks likely that during the covid-19 outbreak many healthcare workers will encounter situations where they cannot say to a grieving relative, “We did all we could” but only, “We did our best with the staff and resources available, but it wasn’t enough.” That is the seed of a moral injury. Not all staff members will be adversely affected by the challenges ahead (table 1) but no one is invulnerable, and some healthcare workers will hurt, perhaps for a long time, unless we begin now to prepare and support our staff.

The info is here.

Italian nurse with coronavirus dies by suicide over fear of infecting others

Yaron Steinbuch
nypost.com
Originally published 25 March 20

A 34-year-old Italian nurse working on the front lines of the coronavirus pandemic took her own life after testing positive for the illness and was terrified that she had infected others, according to a report.

Daniela Trezzi had been suffering “heavy stress” amid fears she was spreading the deadly bug while treating patients at the San Gerardo Hospital in Monza in the hard-hit region of Lombardy, the Daily Mail reported.

She was working in the intensive care unit while under quarantine after being diagnosed with COVID-19, according to the UK news site.

The National Federation of Nurses of Italy expressed its “pain and dismay” over Trezzi’s death, which came as the country’s mounting death toll surged with 743 additional fatalities Tuesday.

“Each of us has chosen this profession for good and, unfortunately, also for bad: we are nurses,” the federation said.

The info is here.

Stressed Out at the Office? Therapy Can Come to You

Rachel Feintzeig
The Wall Street Journal
Originally published 31 Jan 20

Here is an excerpt:

In the past, discussion of mental-health issues at the office was uncommon. Workers were largely expected to leave their personal struggles at home. Crying was confined to the bathroom stall.

Today, that’s changing. One reason is a broadening of the popular understanding of “mental health” to encompass anxiety, stress and other widespread issues.

It’s also a reflection of a changing workplace. Younger workers are more comfortable talking about their struggles and expect their employers to take emotional distress seriously, says Jeffrey Pfeffer, a professor of organizational behavior at the Stanford Graduate School of Business.

Senior leaders are responding, rolling out mental-health services and sometimes speaking about their own experiences. Lloyds Banking Group Plc chief executive António Horta-Osório has said publicly in recent years that the pressure he felt around the bank’s financial situation in 2011 dominated his thoughts, leaving him unable to sleep and exhausted. He took eight weeks off from the company to recover, working with a psychiatrist. The psychiatrist later helped him devise a mental-health program for Lloyds employees.

Brynn Brichet, a lead product manager at Cerner Corp., a maker of electronic medical-records systems, said she sometimes returns from her counseling appointments with an on-site therapist red-faced from crying. (The therapist sits a few floors down.) If colleagues ask, she tells them that she just got out of an intense therapy session. Some are taken aback when she mentions her therapy, she said. But she thinks it’s important to be open.

“We all are terrified. We all are struggling,” she said. “If we don’t talk about it, it can run our lives.”

The info is here.

Physician Burnout Is Widespread, Especially Among Those in Midcareer

Brianna Abbott
The Wall Street Journal
Originally posted 15 Jan 20

Burnout is particularly pervasive among health-care workers, such as physicians or nurses, researchers say. Risk for burnout among physicians is significantly greater than that of general U.S. working adults, and physicians also report being less satisfied with their work-life balance, according to a 2019 study published in Mayo Clinic Proceedings.

Overall, 42% of the physicians in the new survey, across 29 specialties, reported feeling some sense of burnout, down slightly from 46% in 2015.

The report, published on Wednesday by medical-information platform Medscape, breaks down the generational differences in burnout and how doctors cope with the symptoms that are widespread throughout the profession.

“There are a lot more similarities than differences, and what that highlights is that burnout in medicine right now is really an entire-profession problem,” said Colin West, a professor of medicine at the Mayo Clinic who researches physician well-being. “There’s really no age group, career stage, gender or specialty that’s immune from these issues.”

In recent years, hospitals, health systems and advocacy groups have tried to curb the problem by starting wellness programs, hiring chief wellness officers or attempting to reduce administrative tasks for nurses and physicians.

Still, high rates of burnout persist among the medical community, from medical-school students to seasoned professionals, and more than two-thirds of all physicians surveyed in the Medscape report said that burnout had an impact on their personal relationships.

Nearly one in five physicians also reported that they are depressed, with the highest rate, 18%, reported by Gen Xers.

The info is here.