Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Stressors. Show all posts
Showing posts with label Stressors. Show all posts

Saturday, February 24, 2024

Living in an abortion ban state is bad for mental health

Keren Landman
vox.com
Originally posted 20 Feb 24

Here is an excerpt:

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.


Here is the citation to the study:

Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294–301. doi:10.1001/jama.2023.25599

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

Tuesday, October 25, 2022

More than a quarter of U.S. adults say they’re so stressed they can’t function

American Psychological Association
Press Release
Originally posted 19 OCT 22

Americans are struggling with multiple external stressors that are out of their personal control, with 27% reporting that most days they are so stressed they cannot function, according to a poll conducted for the American Psychological Association.

A majority of adults cited inflation (83%), violence and crime (75%), the current political climate (66%), and the racial climate (62%) as significant sources of stress.

The nationwide survey, fielded by The Harris Poll on behalf of APA, revealed that 70% of adults reported they do not think people in the government care about them, and 64% said they felt their rights are under attack. Further, nearly half of adults (45%) said they do not feel protected by the laws in the United States. More than a third (38%) said the state of the nation has made them consider moving to a different country.

More than three-quarters of adults (76%) said that the future of our nation is a significant source of stress in their lives, while 68% said this is the lowest point in our nation’s history that they can remember.

Various disparities in stressors emerged among population subgroups. For example, 72% of the members of the LGBTQIA+ community reported feeling as if their rights are under attack, which is a higher proportion than non-LGBTQIA+ adults (64%). Younger adult women (ages 18 to 34) were more likely to report that most days their stress is completely overwhelming, in comparison with older women (62% vs. 48% 35–44; 27% 45–64; 9% 65+) and men ages 35 or older (62% vs. 48% 35–44; 21% 45–64; 8% 65+). Seventy-five percent of Black adults said that the racial climate in the U.S. is a significant source of stress, while 70% of Latino/a adults, 69% of Asian adults and 56% of white adults reported the same.

Furthermore, Latinas were most likely, among racial/ethnic groups, to cite significant sources of stress related to violence, including violence and crime (89% Latinas; 80% Black women; 79% Asian women; 77% Latinos; 75% Black men; 73% white women; 72% white men; 70% Asian men), mass shootings (89% Latinas; 78% Latinos; 77% Black women; 77% Asian women; 73% white women; 71% Black men; 67% Asian men; 66% white men) and gun violence (87% Latinas; 83% Black women; 77% Asian women; 76% Latinos; 75% Black men; 69% white women; 68% white men; 63% Asian men).

“It’s clear that the impacts of uncontrollable stressors are profound for most Americans, but psychological science shows us that there are effective ways to talk about and cope with this type of stress,” said Arthur C. Evans Jr., PhD, APA’s chief executive officer. “Focusing on accomplishing goals that are in our control can help prevent our minds from getting overwhelmed by the many uncertainties in life. From using our breathing to slow racing thoughts, to intentionally limiting our social media consumption, or exercising our right to vote, action can be extremely empowering.”

Adults reported that stress has had an impact on their health; 76% of adults reported they had experienced at least one symptom in the last month as a result of stress—such as headache (38%), fatigue (35%), feeling nervous or anxious (34%) and feeling depressed or sad (33%). Seven in 10 adults (72%) experienced additional symptoms in the last month, including feeling overwhelmed (33%), experiencing changes in sleeping habits (32%), and/or worrying constantly (30%).

Tuesday, September 6, 2022

Confronting Health Worker Burnout and Well-Being

V. Murthy
NEJM, July 13, 2022
DOI: 10.1056/NEJMp2207252

Here is an excerpt:

Burnout manifests in individuals, but it’s fundamentally rooted in systems. And health worker burnout was a crisis long before Covid-19 arrived. Causes include inadequate support, escalating workloads and administrative burdens, chronic underinvestment in public health infrastructure, and moral injury from being unable to provide the care patients need. Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.

These systemic shortfalls have pushed millions of health workers to the brink. Some 52% of nurses (according to the American Nurses Foundation) and 20% of doctors (Mayo Clinic Proceedings) say they are planning to leave their clinical practice. Shortages of more than 1 million nurses are projected by the end of the year (U.S. Bureau of Labor Statistics); a gap of 3 million low-wage health workers is anticipated over the next 3 years (Mercer). And we face a significant shortage of public health workers precisely when we need to strengthen our defenses against future public health threats. Health worker burnout is a serious threat to the nation’s health and economic security.

The time for incremental change has passed. We need bold, fundamental change that gets at the roots of the burnout crisis. We need to take care of our health workers and the rising generation of trainees.

On May 23, 2022, I issued a Surgeon General’s Advisory on health worker burnout and well-being, declaring this crisis a national priority and calling the nation to action with specific directives for health systems, insurers, government, training institutions, and other stakeholders. The advisory is also intended to broaden awareness of the threat that health worker burnout poses to the nation’s health. Public awareness and support will be essential to ensuring sustained action.

Addressing health worker well-being requires first valuing and protecting health workers. That means ensuring that they receive a living wage, access to health insurance, and adequate sick leave. It also means health workers should never again go without adequate personal protective equipment (PPE) as they have during the pandemic. Current Biden administration efforts to enhance domestic manufacturing of PPE and maintain adequate supplies in the Strategic National Stockpile will continue to be essential. Furthermore, we need strict workplace policies to protect staff from violence: according to National Nurses United, 8 in 10 health workers report having been subjected to physical or verbal abuse during the pandemic.

Second, we must reduce administrative burdens that stand between health workers and their patients and communities. One study found that in addition to spending 1 to 2 hours each night doing administrative work, outpatient physicians spend nearly 2 hours on the electronic health record and desk work during the day for every 1 hour spent with patients — a trend widely lamented by clinicians and patients alike. The goal set by the 25×5 initiative of reducing clinicians’ documentation burden by 75% by 2025 is a key target. To help reach this goal, health insurers should reduce requirements for prior authorizations, streamline paperwork requirements, and develop simplified, common billing forms. Our electronic health record systems need human-centered design approaches that optimize usability, workflow, and communication across systems. Health systems should regularly review internal processes to reduce duplicative, inefficient work. One such effort, Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program, has saved 1700 nursing hours per month across the health system.

Sunday, May 29, 2022

Unemployment, Behavioral Health, And Suicide

R. Ramchand, L. Ayer, & S. O'Connor
Health Affairs
Originally posted 7 APR 22

Key Points:
  • A large body of research, most of which is ecological, has investigated the relationship between job loss or unemployment rates and mental health, substance use, and suicide.
  • Groups historically experiencing health disparities (for example, Black and Hispanic populations and those without a high school or college degree) have been differently affected by unemployment during the COVID-19 pandemic. Similarly, preliminary evidence from three states suggests that suicide has disproportionately affected Americans who are members of racial and ethnic minority groups over the course of the pandemic.
  • COVID-19 has affected the workforce in unique ways that differentiate the pandemic from previous economic downturns. However, previous research indicates that increases in suicide rates associated with economic downturns were driven by regional variation in unemployment, availability of unemployment benefits, and duration and magnitude of changes in unemployment.
  • Policy mitigation strategies may have offset the potential impact of unemployment fluctuations on suicide rates during the pandemic. Policies include expanded unemployment benefits and food assistance, as well as tax credits and subsidies that reduced child care and health care costs.
  • Research is needed to disentangle which populations experienced the most benefit when these strategies were present and which had the greatest risk when they were discontinued.
  • Evidence-based strategies that expand the mental health workforce and integrate mental health supports into employment and training settings may be promising ways to help workers as they navigate persistent changes to workforce demands.

Suicide In The United States

A recent Health Affairs Health Policy Brief provides an overview of suicide in the United States. In 2019, 47,511 Americans intentionally ended their lives, making suicide the tenth leading cause of death. This is likely an underestimate—in 2019, 75,795 Americans died of poisonings, the majority of which were drug poisonings categorized as unintentional, although some were likely suicide overdoses that were misclassified.

Suicide is a growing national concern despite the fact that the national suicide rate decreased between 2018 and 2019 and again in 2020. This decrease comes after nearly twenty years of the national suicide rate increasing annually, and it was not observed in some minority racial and ethnic groups. In addition, although suicide rates decreased between 2018 and 2020, the drug overdose death rate increased.

Friday, May 27, 2022

What to Do If Your Job Compromises Your Morals

R. Carucci and L. N. Praslova
Harvard Business Review
Originally posted 29 APR 22

Here are two excerpts:

The emerging scholarship on reconciling the various terms used to describe responses to moral events points toward a continuum of moral harm. Of course, the complexity and variety of moral situations make any classification imperfect. Situations involving committing moral transgressions are more likely to lead to shame and guilt, while being a victim of betrayal is more likely to result in anger or sadness. In addition, there are also individual differences in sensitivity to morally distressing events, which can be determined by both biology and experience. Nevertheless, here is a useful summary:

  • Moral challenges are isolated incidents of relatively low-stakes transgressions. For example, workers might be instructed to use lower-quality materials in creating a product (e.g., substituting a non-organic product when running out of organic). A manager may require an employee to stay late, as a rare exception. This may result in a somewhat distressing but transitory “moral frustration,” with moderate levels of anger or guilt.
  • Moral stressors can lead to more significant moral distress. This may involve more substantial and/or regular moral transgressions — for example, a manager pushing employees to stay late several times every month, or an HR professional administering a morale survey knowing that the results will never be used, just like all the previous surveys. A dental practice may upsell patients on unnecessary, but not harmful treatments. This may result in negative moral emotions that are bothersome and might be lasting, but do not interfere with daily functioning. (However, in some nursing research, the experience referred to as “moral distress” is seen as very intense, possibly meeting the criteria for moral injury).
  • Injurious events are the most egregious. Executives could pressure a manager into manipulating burned-out employees to regularly sacrifice their time off and well being, while the organization intentionally keeps positions open for months. A health care worker might be required to provide medical treatments that are likely to lead to more treatments even though a cure is available. Situations like these could result in a highly distressing moral injury in which negative moral emotions are sufficiently intense and frequent to interfere with daily functioning. In particular, a person may experience intense shame leading to self-isolation or self-harm, or may quit their job in disgust. This level of moral stress response is similar to and at least partially overlaps with post-traumatic stress disorder (PTSD).
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Moral injuries can leave lasting impacts on our psyche, but they don’t have to remain debilitating. Like other trauma and hurt, we can grow from them. We can find the resilience we need to rise above the injury and restore our moral centers. Sometimes we’re able to take the environments along on that journey, and sometimes we have to leave them. Either way, if you’re carrying the weight of moral injury, don’t wait until it overtakes your whole outlook on life, and yourself. Find the courage to face what you’ve experienced and done, and with it, reclaim the values you hold most dear.

Thursday, May 5, 2022

USS George Washington sailors detail difficult working conditions after string of suicides

Melissa Chan
NBCNews.com
Originally posted 28 APR 22

Here are two excerpts:

Crisostomo and several other George Washington sailors said their struggles were directly related to a culture where seeking help is not met with the necessary resources, as well as nearly uninhabitable living conditions aboard the ship, including constant construction noise that made sleeping impossible and a lack of hot water and electricity. 

Since Crisostomo’s attempt, at least five of her shipmates on the George Washington have died by suicide, including three within a span of a week this April, military officials said. The latest cluster of suicides is under investigation by the Navy and has drawn concern from the Pentagon and Rep. Elaine Luria, D-Va., who served in the Navy for two decades.

On April 15, Master-at-Arms Seaman Recruit Xavier Hunter Sandor died by suicide onboard the George Washington, according to the Navy and the state chief medical examiner’s office. He had been working on the warship for about three months, his family said.

His death came five days after Natasha Huffman, an interior communications electrician, died by suicide off-base in Hampton, officials said.

The day before, Retail Services Specialist 3rd Class Mika’il Rayshawn Sharp also died by suicide off-base in Portsmouth, said his mother, Natalie Jefferson. 

“Three people don’t just decide to kill themselves in a span of days for nothing,” said Crisostomo, who left the Navy in October 2021, on an honorable discharge with a medical condition following her suicide attempt.

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When asked about mental-health resources, Smith told sailors that the Navy would put more chaplains on smaller ships for the first time, but that it’s not easy to hire more psychologists, psychiatrists, and other mental health care workers, because they’re not “out there in abundance.”

“You can’t just snap your fingers and grow a psychiatrist,” he said, adding that the sailors should be “each other’s counselors.”

Myers said a larger Navy team is being built to assess quality-of-life conditions on aircraft carriers undergoing overhauls. 

“Their recommendations will inform potential future action, identify areas for improvements, and propose mitigation strategies to optimize [quality of life],” he said.

In 2020, the most recent year for which full data is available, 580 military members died by suicide, a 16 percent increase from 2019, when 498 died by suicide, according to the Defense Department. Nineteen out of every 100,000 sailors died by suicide in 2020, compared to members of the Army, which had the highest rate, at about 36 per 100,000, Pentagon statistics show.

Tuesday, September 25, 2018

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

Thursday, September 6, 2018

When Doctors Struggle With Suicide, Their Profession Often Fails Them

Blake Farmer
NPR.org
Originally posted July 31, 2018

Here is an excerpt:

A particular danger for doctors trying to fend off suicidal urges is that they know exactly how to end their own lives and often have easy access to the means.

Wenger remembers his friend and colleague as the confident professional with whom he had worked in emergency rooms all over Knoxville — including the one where she died. That day three years ago still makes no sense to him.

"She was very strong-willed, strong-minded, an independent, young, female physician," says emergency doctor Betsy Hull, a close friend. "I don't think any of us had any idea that she was struggling as much personally as she was for those several months."

That day she became part of a grim set of statistics.

A harsh reality

An estimated 300 to 400 doctors kill themselves each year, a rate of 28 to 40 per 100,000 or more than double that of general population. That is according to a review of 10 years of literature on the subject presented at the American Psychiatry Association annual meeting in May.

The information is here.

Sunday, September 28, 2014

Why Do Doctors Commit Suicide?

By Pranay Sinha
The New York Times
Originally posted September 4, 2014

The statistics on physician suicide are frightening: Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts). Some 400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.

The entire article is here.

Sunday, September 29, 2013

Can Emotional Intelligence Be Taught?

By Jennifer Kahn
The New York Times
Originally published September 15, 2013

Here is an excerpt:

For children, Brackett notes, school is an emotional caldron: a constant stream of academic and social challenges that can generate feelings ranging from loneliness to euphoria. Educators and parents have long assumed that a child’s ability to cope with such stresses is either innate — a matter of temperament — or else acquired “along the way,” in the rough and tumble of ordinary interaction. But in practice, Brackett says, many children never develop those crucial skills. “It’s like saying that a child doesn’t need to study English because she talks with her parents at home,” Brackett told me last spring. “Emotional skills are the same. A teacher might say, ‘Calm down!’ — but how exactly do you calm down when you’re feeling anxious? Where do you learn the skills to manage those feelings?”

A growing number of educators and psychologists now believe that the answer to that question is in school. George Lucas’s Edutopia foundation has lobbied for the teaching of social and emotional skills for the past decade; the State of Illinois passed a bill in 2003 making “social and emotional learning” a part of school curriculums. Thousands of schools now use one of the several dozen programs, including Brackett’s own, that have been approved as “evidence-based” by the Collaborative for Academic, Social and Emotional Learning, a Chicago-based nonprofit. All told, there are now tens of thousands of emotional-literacy programs running in cities nationwide.

The theory that kids need to learn to manage their emotions in order to reach their potential grew out of the research of a pair of psychology professors — John Mayer, at the University of New Hampshire, and Peter Salovey, at Yale.

The entire story is here.

Tuesday, August 23, 2011

Professional Competence in the Face of Life-Threatening Illness

The new issue of *Professional Psychology* includes an article: "Preventing Problems of Professional Competence in the Face of Life-Threatening Illness."

The authors are W. Brad Johnson & Jeffrey E. Barnett.

Psychologists are human. Like our clients, we are nearly certain to encounter difficult life stressors such as relational break-downs, emotional low points, phase-of-life problems, serious medical challenges, or the onset of cognitive decline. Sadly, being a psychologist does little to insulate us from life's tribulations.

At some point during his or her career, nearly every mental health professional will confront a significant health problem. Medical issues may run the gamut from relatively minor (e.g., pneumonia, minor surgery, thyroid dysfunction) to life-threatening (e.g., cardiovascular disease requiring open heart surgery, neuromuscular disorders with a short life-expectancy, various forms of cancer).

Because many psychologists expect to work beyond the typical retirement age, with nearly a fifth reporting that they plan to work until death (Guy, Stark, Poelstra, & Souder, 1987), the probability of life-threatening medical diagnoses occurring during the course of one's career are significant.

But even early career psychologists are vulnerable to life-altering and potentially fatal medical problems (Philip, 1993).

Recent epidemiologic data for U. S. adults between the ages of 45 and 64 indicate that 13% suffer from some form of heart disease and 9.4% have been diagnosed with cancer; between the ages of 65 and 74, these numbers jump to 25.8% for heart disease and 22.5% for cancer (Centers for Disease Control & Prevention, 2010).

Although practitioner emotional health is considered essential and fundamental to the delivery of competent services (Vasquez, 1992), few things may threaten a psychologist's emotional stability more acutely than the diagnosis of a life-threatening illness.

Unfortunately, psychologists are not always effective when it comes to accepting their own vulnerabilities, taking time for self-care, and identifying decrements in their own competence due to either emotional or physical distress (Barnett & Johnson, 2008).

In this article, we direct our focus to the prospect of a life-threatening illness in the psychologist and the subsequent implications for professional competence.

By life-threatening we mean a terminal disease or a progressive medical condition leading to increasing disability and, in most cases, premature death.

Although psychologists are enjoined by the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association; APA, 2010) to ensure their own competence, psychologists struggling with life-altering medical problems may be especially vulnerable to problems in this area.

We highlight how seriously ill and subsequently distressed psychologists may be ineffective at self-assessing and monitoring their professional competence, as well as in making essential decisions about continued clinical practice.

We conclude with numerous recommendations for psychologists designed to both prevent and manage threats to professional competence caused by a life-threatening illness.

Thanks to Ken Pope for this information.