Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention.

PURPOSE: Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. RECENT FINDINGS: We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.

The Impact of COVID-19 Lockdowns in a Sample of Outpatients in a Mental Health Department of a Metropolitan Hospital in Milan.

Background and Objectives: Italy was the first country in Europe to face the coronavirus 2019 (COVID-19) pandemic and its consequences, which led to two phases of severe restrictions for its population. This study aims to estimate the connections between the trauma of the COVID-19 emergency and the clinical features of a sample of outpatients in a Milan Community Mental Health setting, comparing the first (April 2020) and second lockdowns (November 2020). Materials and Methods: The sample included 116 consecutive outpatients recruited in April 2020 and 116 in November 2020. The subjects were evaluated with Clinical Global Impression Severity (CGI-S), Brief Psychiatric Rating Scale (BPRS-18), and Impact of Event Scale-Revised (IES-R). Results: The IES-R identified 47.4% participants in April and 50% in November with clinical scores over the cut-off. The network analysis of BPRS-18 and IES-R depicted the connection among different symptoms; in April, Unusual Thought Content, Anxiety, and Somatic Concern represented the most central items, and the strongest connections were found between Uncooperativeness and Hostility, Blunted Affect and Emotional Withdrawal, and IES-Intrusion and IES-Arousal. In the November group, the most central items were represented by Conceptual Disorganization and Emotional Withdrawal, whereas the strongest connections were found between IES-Arousal and IES-Intrusion, Excitement and Grandiosity, and Unusual Thought Content and Conceptual Disorganization. Conclusions: Our findings show continued high distress levels and increased psychological burdens during the second phase of restrictions; this could be described as "pandemic fatigue", a general psychological weariness due to pandemic-related restrictions, as well as a lack of motivation to comply with them. As mental health professionals, our mission during these difficult times has been to keep community psychiatry services accessible, with particular regard to vulnerable and marginalized populations.

The impact of the COVID-19 emergency in a community mental health setting of a metropolitan hospital

Objectives: To evaluate the relationship between traumatic aspects of the COVID-19 emergency and clinical correlates in a sample of consecutive outpatients in a Community Mental Health setting in Milan, Italy. Methods: One hundred and forty subjects aged between 18 and 75 years were assessed with the Clinical Global Impression-Severity (CGI-S), Brief Psychiatric Rating Scale (BPRS-18), the 22-item Impact of Event Scale-Revised (IES-R) and the Self Report Questionnaire (SRQ-20). Data analysis were performed using SPSS version 16.0. Basic statistics were used to describe the demographic and clinical characteristics of the participants. The associations between sociodemographic and clinical variables were explored first by performing Pearson's correlation analysis followed by multivariate regression. IES-R total score was used as the dependent variable while sociodemographic variables, SRQ-20, CGI-S and BPRS total score were used as independent variables. Results: A considerable proportion of participants reported symptoms of distress measured by IES-R: 47 (33.6%) mild, 45 (32.1%) moderate and 37 (26.4%) severe. SRQ-20 total score was positive in 82 (58.6%) patients, particularly in the female population (p = 0.009) with an age between 45-65 years (p = 0.020). In multiple regression analysis, being actively working (Beta = 0.15, p = 0.03) and SRQ-20 (Beta = 0.56, p = 0.00) significantly predicted IES-R total score. Conclusions: Our data evidenced high level of distress among patients in contact with mental health services during Covid-19 emergency period suggesting the importance of maintaining continuous monitoring for a careful assessment of their condition from both a psychopathological and medical point of view. (PsycInfo Database Record (c) 2021 APA, all rights reserved)