Occupational, academic, and personal determinants of wellbeing and psychological distress in residents: results of a survey in Lyon, France.

Introduction: The mental health of residents is a growing significant concern, particularly with respect to hospital and university training conditions. Our goal was to assess the professional, academic, and psychological determinants of the mental health status of all residents of the academy of Lyon, France. Materials and methods: The Health Barometer of Lyon Subdivision Residents (BASIL) is an initiative which consists in proposing a recurrent online survey to all residents in medicine, pharmacy, and dentistry, belonging to the Lyon subdivision. The first of these surveys was conducted from May to July 2022. Participants should complete a series of validated questionnaires, including the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and the Kessler Psychological Distress Scale (K6), respectively, and ad-hoc questions assessing their global health and hospital and academic working conditions. A Directed Acyclic Graph (DAG) analysis was conducted prior to multivariable analyses, to explore the determinants associated with low wellbeing (WEMWBS <43) and high psychological distress (K6 ≥ 13). Results: A total of 904 residents (response rate: 46.7%) participated in the survey. A low level of wellbeing was observed in 23% of participants, and was significantly associated to job strain (OR = 2.18; 95%CI = [1.32-3.60]), low social support (OR = 3.13; 95%CI = [2.05-4.78]) and the experience of very poor university teaching (OR = 2.51; 95%CI = [1.29-4.91]). A high level of psychological distress was identified for 13% of participants, and associated with low social support (OR = 2.41; 95%CI = [1.48-3.93]) and the experience of very poor university teaching (OR = 2.89, 95%CI = [1.16-7.21]). Conclusion: Hospital working conditions, social support, and the perception of teaching quality, were three major determinants of wellbeing and psychological distress among health profession residents. Demographic determinants, personal life and lifestyle habits were also associated. This supports a multilevel action in prevention programs aiming to enhance wellbeing and reduce mental distress in this specific population and local organizational specificities.

Cingulo-opercular network activity maintains alertness.

Previous investigations of alertness have confounded it with selective attention because targets were highly predictable. To truly isolate alertness we devised a sparse event-related design with many different randomly appearing and interleaved auditory and visual targets, thereby rendering prediction inefficient. Using functional magnetic resonance imaging, we then analyzed the influence of local brain activity variations prior to task appearance on reaction times, thus avoiding signal contributions from stimulus-driven attention. Higher pre-stimulus activity in a cingulo-opercular network, and the default mode network, resulted in faster response speed but only the former network showed task-positive responses. Conversely, dorsal attention network pre-stimulus activity was overall irrelevant and on auditory trials even detrimental to performance. Thus, in a paradigm where no information predicted timing, modality or properties of a subsequent stimulus, our results dissociate alertness, both anatomically and functionally, from attention and establish the central role of the cingulo-opercular network for sustaining alertness.

Ongoing brain activity fluctuations directly account for intertrial and indirectly for intersubject variability in Stroop task performance.

Recent studies have established a relation between ongoing brain activity fluctuations and intertrial variability in evoked neural responses, perception, and motor performance. Here, we extended these investigations into the domain of cognitive control. Using functional neuroimaging and a sparse event-related design (with long and unpredictable intervals), we measured ongoing activity fluctuations and evoked responses in volunteers performing a Stroop task with color-word interference. Across trials, prestimulus activity of several regions predicted subsequent response speed and across subjects this effect scaled with the Stroop effect size, being significant only in subjects manifesting behavioral interference. These effects occurred only in task relevant as the dorsal anterior cingulate and dorsolateral prefrontal cortex as well as ventral visual areas sensitive to color and visual words. Crucially, in subjects showing a Stroop effect, reaction times were faster when prestimulus activity was higher in task-relevant (color) regions and slower when activity was higher in irrelevant (word form) regions. These findings suggest that intrinsic brain activity fluctuations modulate neural mechanisms underpinning selective voluntary attention and cognitive control. Rephrased in terms of predictive coding models, ongoing activity can hence be considered a proxy of the precision (gain) with which prediction error signals are transmitted upon sensory stimulation.