The Overdose Conundrum

The article discusses the impact of patients' overdose on psychiatrists. It discusses the case of a 45-year-old woman with an opioid addiction and anxiety who was enrolled in an addictions treatment program. Topics covered include how the psychiatrists cope with patient suicide or overdose, how to promote honesty about recurrence of substance use and how psychiatrists can find the right balance in setting boundaries.

"I have nothing more to give": Disparities in burnout and the protective role of immigrant status during the COVID-19 pandemic.

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August-November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work and home related changes due to COVID-19. The association between life changes due to COVID-19 and odds of burnout was estimated by logistic regression. Complementary analysis was performed to determine factors most associated with burnout. 352 respondents were analyzed. There was a high prevalence of burnout. Over half of individuals reported a high degree of emotional exhaustion (EE) (56%). 83% of individuals reported at least one life factor changed due to COVID-19. Home-related life changes due to COVID-19 were associated with 143% higher odds of emotional burnout [adjusted odds ratio (aOR) 2.43; 95% confidence interval (CI) 1.49, 3.98] after covariate adjusted analysis. High EE was most evident when there were three or more life changes, suggesting a cumulative effect. First-generation immigrants, older physicians, and trainees were identified as protective factors. Although female gender was identified as a factor related to EE through forward selection, this was not statistically significant (aOR 1.34; 95% CI 0.80, 2.24). Burnout remains pervasive among physicians. We highlight new risk factors for EE (home-life changes due to COVID-19), and protective factors (first-generation immigrants) not previously explored. Understanding burnout and its disparities allows for improved mitigation strategies, decreasing its deleterious effects.

“I have nothing more to give”: Disparities in burnout and the protective role of immigrant status during the COVID-19 pandemic

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August–November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work and home related changes due to COVID-19. The association between life changes due to COVID-19 and odds of burnout was estimated by logistic regression. Complementary analysis was performed to determine factors most associated with burnout. 352 respondents were analyzed. There was a high prevalence of burnout. Over half of individuals reported a high degree of emotional exhaustion (EE) (56%). 83% of individuals reported at least one life factor changed due to COVID-19. Home-related life changes due to COVID-19 were associated with 143% higher odds of emotional burnout [adjusted odds ratio (aOR) 2.43;95% confidence interval (CI) 1.49, 3.98] after covariate adjusted analysis. High EE was most evident when there were three or more life changes, suggesting a cumulative effect. First-generation immigrants, older physicians, and trainees were identified as protective factors. Although female gender was identified as a factor related to EE through forward selection, this was not statistically significant (aOR 1.34;95% CI 0.80, 2.24). Burnout remains pervasive among physicians. We highlight new risk factors for EE (home-life changes due to COVID-19), and protective factors (first-generation immigrants) not previously explored. Understanding burnout and its disparities allows for improved mitigation strategies, decreasing its deleterious effects.

Evolution of Mood Symptomatology Through the COVID-19 Pandemic: Findings From the CovidSense Longitudinal Study.

Background The severe acute respiratory syndrome coronavirus 2 global pandemic, with its associated coronavirus disease 2019 (COVID-19) illness, has led to significant mental, physical, social, and economic hardships. Physical distancing, isolation, and fear of illness have significantly affected the mental health of people worldwide. Several studies have documented the cross-sectional elevated prevalence of mental anguish, but due to the sudden nature of the pandemic, very few longitudinal studies have been reported, especially covering the first phase of the pandemic. CovidSense, a longitudinal adaptive study, was initiated to answer some key questions: how did the pandemic and related social and economic conditions affect depression, which groups showed more vulnerability, and what protective factors emerged as the pandemic unfolded? Methodology CovidSense was deployed from April to December 2020. The adaptive design enabled adaption to fluctuating demographics/health status. Participants were regularly queried via SMS messages about their mental health, physical health, and life circumstances. The study included 1,190 participants who answered a total of 18,783 survey panels. This was a prospective longitudinal cohort study following adult participants in the general population through the COVID-19 pandemic. The participant cohort reported self-assessed measures ranging from subjective mood ratings and substance use to validated questionnaires, such as the Quick Inventory of Depressive Symptoms (QIDS) and Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Results Participants with pre-existing physical (especially pulmonary) or mental conditions had overall higher levels of depression, as measured by the QIDS and self-reported mood. Participants with pre-existing conditions also showed increased vulnerability to the stress caused by watching the news and the increase in COVID-19 cases. Younger participants (aged 18-25 years) were more affected than older groups. People with severe levels of depression had the most variation in QIDS scores, whereas individuals with none to low depressive scores had the most variability in self-reported mood fluctuations. Conclusions The effects of pandemic-related chronic stress were predominant in young adults and individuals with pre-existing mental and medical conditions regardless of whether they had acquired COVID-19 or not. These results point to the possibility of allocating preventive as well as treatment resources based on vulnerability.

Burnout and Suicide Among Physicians During Times of Stress

Burnout is a significant problem for health care professionals. Burnout, which consists of exhaustion, detachment/cynicism, and reduced sense of personal efficacy, can render the practice of medicine untenable and lead to job turnover, medical errors, and instability in the medical system. Moreover, burnout can develop into depression and lead to suicide. The burnout rate for practicing physicians in the United States was already high before the coronavirus 2019 pandemic, and the pandemic has exacerbated the factors underlying burnout by increasing isolation, workload, and uncertainty, as well as a potential clash of organizational decisions with personal safety. Achieving effective strategies to combat burnout and protecting physicians and health care workers from depression and suicide should be a priority for all systems. Early detection and referral to treatment as well as de-stigmatization of treatment are crucial. Additionally, expanding the conversation about the role of structural and organizational changes in promoting wellness is essential, as effective and consistent leadership can help tremendously when combined with individual efforts toward work-life balance. [Psychiatr Ann. 2020;50(12):536–541.]

The New Game of Microbiology Clue: The Who, When, Where, & Why of the Novel Coronavirus

The article offers information on the 2019 novel coronavirus (COVID-19) that started in Wuhan, China and resulted in a global outbreak. Topics mentioned include similarity of global climate factors to viral mutations linked to pandemic capacity, vulnerability of certain populations to COVID-19, and recommendations provided by the World Health Organization for disinfecting surfaces.