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Depressive disorder (DD) shortens a healthy and productive human life, has significant public health costs is and associated with high suicide rates. In depression sadness and emotional misery manifest in facial expressions, as psychomotor slowing, lack of energy, high tension, and attenuated sensory perception. Loss of appetite, changes to the taste of food, and the loss of pleasure in eating are important criteria in the diagnosis of DD. We hypothesized that a patient's facial expressions and emotional responses to different tastes can be used as the diagnostic moderators for the development of a new contactless, computer-based method for diagnosis of DD. The confirmation of this hypothesis can shed a new perspective on early contactless, computer-based psychiatric diagnostic strategies and early identification of DD symptoms, as DD is an important issue in public mental health. The benefits of this method are evidence from several perspectives (I) patients can use a self-rating instrument to assess DD symptoms; this may act as an incentive to seek professional help; (II) family and community can use an instrument for early recognition of DD symptoms and suicidal tendencies, making it possible to encourage the individual to seek professional health care; (III) general practitioners have a reliable instrument for preliminary diagnosis of DD in primary care, thus saving the time and resources; (IV) public health benefits include early diagnosis and treatment of DD and better outcomes, reductions in disability-adjusted life years and the global burden of the disease. It is nevertheless important to recognize the limitations and risks of contactless diagnosis of DD. As it is a self-assessment method it is not possible to rule out false positives and false negatives. However, this method might be used for early diagnosis of DD symptoms. Also, it should be mentioned that further evaluation and an experts opinion about this method is needed. The clinical diagnosis of DD should continue to be made by healthcare professionals. Finally, this method may perspectively predict DD at an early stage and may ensure a higher quality of the patients' primary care in the public health system.
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PMID:The Perspectives Associated With the Computer-Based Diagnostic Method of Depressive Disorder. 3076 Oct 24

Background: Compassion fatigue, or the physical, mental, and emotional state experienced by professionals that assist others in distress, has been well documented in several caring professions such as nurses, firefighters, and emergency medical technicians. Until the current study, it has only rarely been examined in police samples despite their high rates of stress and suicide which is a likely result of a depletion of compassion satisfaction, or the pleasure an officer gets from relating to and helping others. Aim: This study documents findings from an ongoing study of compassion fatigue amongst a sample of US urban police officers which suggests the possibility of a future risk for high burnout. Conclusion: Very low levels of compassion fatigue were found in the sampled police officers in comparison to what would be expected from the general population. Where compassion fatigue was found in the sampled police, it was significantly correlated to the level of compassion satisfaction. A potential cause for concern is that the incidence of levels of reported compassion satisfaction were also low in the sample (in the bottom quartile compared to the general population). This suggests a possibility of higher numbers of burnout in the future given the role of compassion satisfaction as a buffer against compassion fatigue in policing.
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PMID:An Exploratory Study of Police Officers: Low Compassion Satisfaction and Compassion Fatigue. 3074 83

Compassion is a complex abstract concept and is generally perceived as an emotional reaction to another person's vulnerability and suffering that motivates an individual wanting the best for the one who is suffering. It is seen as a virtuous and an inherent quality of nursing care. Nurses are exposed to various work stressors caused by myriads of complex professional and organizational challenges. In response, some nurses have developed coping mechanisms exemplified by detachment and distance in the caring relationship, whereas others have fallen victim to compassion fatigue or burnout, stressors that may increase the risk for suicide. There is a direct cost to health care organizations when the staff begin to show signs of burnout and fatigue. It is incumbent on health care leaders to establish assistance programs to improve the quality of work life of caregivers, prevent and remove work stressors to reduce turnover, and retain talent.
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PMID:Compassion Fatigue and Burnout, One Institution's Interventions. 3077 7

Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread and persistent musculoskeletal pain and other frequent symptoms such as fatigue, insomnia, morning stiffness, cognitive impairment, depression, and anxiety. FMS is also accompanied by different comorbidities like irritable bowel syndrome and chronic fatigue syndrome. Although some factors like negative events, stressful environments, or physical/emotional traumas may act as predisposing conditions, the etiology of FMS remains unknown. There is evidence of a high prevalence of psychiatric comorbidities in FMS (especially depression, anxiety, borderline personality, obsessive-compulsive personality, and post-traumatic stress disorder), which are associated with a worse clinical profile. There is also evidence of high levels of negative affect, neuroticism, perfectionism, stress, anger, and alexithymia in FMS patients. High harm avoidance together with high self-transcendence, low cooperativeness, and low self-directedness have been reported as temperament and character features in FMS patients, respectively. Additionally, FMS patients tend to have a negative self-image and body image perception, as well as low self-esteem and perceived self-efficacy. FMS reduces functioning in physical, psychological, and social spheres, and also has a negative impact on cognitive performance, personal relationships (including sexuality and parenting), work, and activities of daily life. In some cases, FMS patients show suicidal ideation, suicide attempts, and consummated suicide. FMS patients perceive the illness as a stigmatized and invisible disorder, and this negative perception hinders their ability to adapt to the disease. Psychological interventions may constitute a beneficial complement to pharmacological treatments in order to improve clinical symptoms and reduce the impact of FMS on health-related quality of life.
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PMID:Psychological impact of fibromyalgia: current perspectives. 3085 40

Generalized anxiety disorder (GAD) is a common and disabling illness that is often underdiagnosed and undertreated. Patients with GAD are at increased risk for suicide as well as cardiovascular-related events and death. Most patients can be diagnosed and managed by primary care physicians. Symptoms include chronic, pervasive anxiety and worry accompanied by nonspecific physical and psychological symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances). Effective treatments include psychotherapy (often cognitive behavioral therapy) and pharmacotherapy, such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors.
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PMID:Generalized Anxiety Disorder. 3093 83

In this early study, written in 1985, I examined six of the most important personality traits of Sylvia Plath, the poet and writer (1). Sylvia oscillated between positions of dependency and independence; she was characterised by sexual inhibition and promiscuity, writer's block and an explosion of writing, achievement con- straint and liberation from the constraint, emotional dependence and independence. Paradoxically, she committed suicide when far more things (children, productive creative period, publication of her novel) tied her to life than was the case before her first suicide attempt (2). Her life was spent in the perspective of death; death was her main point of reference, and at the same time was a constantly present alternative solution (3). Her neurasthenic, sometimes bipolar mode of existence determined her everyday behaviour: fatigue, irritability, a low ability to tolerate failure, a tendency to somatisation, anxious attitude, low self-esteem (4). She lived between extremes: insensitivity and over-sensitivity, bad and good moods, ego systole and ego diastole, ambivalence towards close family members (father, mother, Ted), relationship fluctuating between adoration and hate (5). Her poetry persona was characterised by object phobia: in her poems objects become hooks, loops, traps (6). She was ambivalent towards both women and men: she hated women, while her effective therapist was a woman; she was jealous of men, she was not capable of a symmetrical partner relationship, she was either subordinate or superior. In Plath's poetry the incompatible dichotomy of soft worm and hard mask refers to the irreconcilable contradiction between the male and female world.
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PMID:[On Sylvia Plath's Personality]. 3141 5

Burnout and compassion fatigue describe the state of health care professionals' extended stress, emotional states, and prolonged duress after events. In the past few decades, burnout and compassion fatigue have received increased focus and attention. This article summarizes the evolution in moving from viewing burnout as an individual's problem to understanding burnout as an occupational phenomenon, additionally recognizing the powerful role secondary trauma contributes to compassion fatigue. As such, the causes and addressing the solutions of burnout are multifaceted and complex. Causes of burnout stem from external pressure of caring for patients and pressure from organizational policy and practices, including unhealthy work environments, poor communication, stigma, and more. The harm from burnout and secondary trauma in health care professionals can be profound, impacting a significant portion of the workforce and manifesting in real suffering, including depression, emotional trauma, and suicide. As health care professionals are daily at risk, the need to recognize, address, and treat burnout is a priority. Both personal resilience building activities for effective stress reduction in clinicians and system-level solutions to address root causes must be utilized to address burnout.
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PMID:Burnout, Compassion Fatigue, and Secondary Trauma in Nurses: Recognizing the Occupational Phenomenon and Personal Consequences of Caregiving. 3178 80

Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients' quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain's lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals' well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.
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PMID:Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art. 3180 61

The present study aimed to examine the associations of suicidality with psychological distress, somatic symptoms, and stressors in medical school students. We conducted a cross-sectional survey of medical students at a large, top-ranked medical school. A total sample of 662 medical students (269 men) completed a battery of self-reported questionnaire. Of the respondents, 136 (20.5%) reported having suicidal ideation, 40 (6.0%) reported having planned suicide, and 10 (1.5%) reported having attempted suicide during the previous year. Students from rural areas and the 3rd year of study reported higher levels of suicidal ideation than their counterparts. General pain/fatigue was associated with suicidal ideation and planning, while interpersonal difficulties were associated only with suicidal ideation. This study provides evidence linking severe psychological distress, general pain/fatigue, interpersonal stress and psychosocial factors with suicide risk among Chinese medical students which provides targets for future psychological interventions.
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PMID:Associations of Suicidality with Adverse Life Events, Psychological Distress and Somatic Complaints in a Chinese Medical Student Sample. 3191 57

Objective The first objective of this study was to assess the associations between individual, community and hospital factors with emotional exhaustion (EE) among rural Australian doctors in training (DITs); the second objective was to apply criteria from an international standard that measures sustainable employability in organisations. Methods A cross-sectional study of 70 DITs was conducted. Odds ratios (ORs) with 95% confidence intervals (CIs) of EE across individual, community and organisational factors were calculated. Results DITs with poor or moderate ability to cope with mental work demands had higher odds of being emotionally exhausted (OR 8.273; 95% CI 1.693-40.423), as did DITs with sleep disturbance (OR 6.187; 95% CI 1.721-22.242). Higher psychological distress (OR 1.701; 95% CI 1.286-2.249), more hours worked on-call (OR 1.052; 95% CI 1.011-1.094) and increased presenteeism (OR 1.285; 95% CI 1.049-1.576) were associated with being emotionally exhausted. Those who felt ambivalent or unsatisfied with hospital support networks had threefold higher odds of EE (OR 3.323; 95%CI 1.191-9.273). All metrics associated with the International Organisation for Standardisation (ISO) sustainable employability guidelines were significantly associated with EE; DITs who thought the hospital did not promote physical (OR 5.489; 95%CI 1.494-20.162) or mental health behaviours (OR 4.750; 95%CI 1.228-18.406) and those who did not perceive DITs overall well-being to be prioritised had higher odds of EE (OR 8.800; 95% CI 1.920-40.336). Conclusions When DITs perceive the hospital promotes and prioritises well-being measures and provides a supportive environment, they are less likely to experience EE. This pilot study demonstrated the value of using an international standard to measure sustainable employability in hospitals. What is known about the topic? Doctors are an at-risk population with increased rates of suicide, depression and anxiety compared with other professions. Junior doctors and regional DITs experience a greater burden of psychological distress, burnout and compassion fatigue than non-training, urban-based doctors. Regional and rural communities are often characterised by fewer doctors per head of population and workforce shortage, with an identified need to optimise the mental well-being of rural doctors to retain the medical workforce and ensure they continue to meet the needs of these rural communities. What does this paper add? This paper adds to the evidence about the well-being of regional DITs. This pilot study is unique in its demonstration of the relationship between EE and sustainable employability factors within hospitals. The use of an international standard to measure elements of sustainable employability at the organisational level in relation to well-being can potentially be further tested and replicated across the whole organisation and in other healthcare organisations and professions. What are the implications for practitioners? Rural hospital administrators and policy makers can potentially use the results to guide hospital interventions aimed at alleviating EE in DITs. It appears that supportive hospital environments are key factors to consider when developing these interventions. The international standard guidelines on sustainable employability can be used by top management and human resource managers to develop sustainable employability metrics.
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PMID:Emotional exhaustion among regional doctors in training and the application of international guidelines on sustainable employability management for organisations. 3218 38


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