Mental Health and Social Care Professionals After a Patient Suicide: Interrelation Between Support Needed, Sought, and Received.

This article investigates the support needed, sought, and received by professionals following a patient suicide. A self-administered questionnaire about the consequences of patient suicide and support issues was completed by 704 professionals. Profiles of support were defined using a 3-dimensional, 8-fold typology based on need for, search for, and sufficiency of support. Stress reactions, professionals' characteristics, relationship with the patient, training, and providers of support were used to characterize the profiles. Most professionals acknowledged receiving sufficient support to manage the aftermath of patient suicide. Almost two thirds of the respondents who received sufficient support reported either not needing or seeking support or both needing and seeking support. Almost 1 in 10 respondents who reported needing and seeking support received insufficient support. Stress reactions were highest among professionals who needed but did not receive sufficient support. Professionals who did not need or seek support were less often in a relationship with the patient at the time of the suicide and less frequently felt close to or responsible for the patient than those who needed and sought support. Trained professionals were overrepresented among those who reported receiving sufficient support while they were less likely to report needing and seeking support or receiving insufficient support. Findings concerning support and its relationship to risk and protective factors suggest the need to adopt a multidimensional approach that distinguishes among support needed, sought, and received. Although an association may exist between perceived stress and need for support, involvement of professionals in the patient relationship may also be linked with the search for support, while training may be associated with receipt of sufficient support.

The Impact of Patient Suicide on the Professional Practice of Swiss Psychiatrists and Psychologists.

OBJECTIVES: Many psychiatrists and psychologists are likely to experience a patient suicide at a point in their professional career. The present paper examines the effects of patient suicide on psychiatrists' and psychologists' professional reactions and working practices and investigates factors that may affect the severity of repercussions on their professional lives. METHOD: Data from 271 psychiatrists and psychologists working in various institutional settings and in private practice in French-speaking Switzerland were collected by a written questionnaire. RESULTS: Psychiatrists and psychologists reported a range of professional reactions and changes in working practices following a patient suicide. Professional reactions and changes in working practices were more significant among women. The length of therapy and the emotional closeness with the deceased patient were predictive of a greater impact. In contrast, social and psychological support served as a protective factor by reducing negative repercussions on professional practice. Finally, the impact of losing a patient to suicide did not differ between psychiatrists and psychologists in institutional settings and those in private practice. CONCLUSION: Although patient suicide affected the professional life of psychiatrists and psychologists, it also encouraged them to review and adjust their working practices.

Stress reactions after a patient suicide and their relations to the profile of mental health professionals.

BACKGROUND: Patient suicide is a professional hazard for mental health professionals and an event likely to trigger stress reactions among them. This study aimed to identify typical profiles of professionals after a patient suicide to address the severity of stress reactions and its discriminant variables. METHODS: Mental health professionals (N = 666) working in institutional settings or private practice in the French-speaking part of Switzerland filled out a self-administered questionnaire including the IES-R (Impact of Event Scale-Revised). Profiles were identified by cluster analysis. RESULTS: The interplay of variables pertaining to the relationship to the patient, exposure to suicide, support and training contributed to explaining the severity of stress reactions after a patient suicide. Five profiles of professionals were identified. Low-impacted professionals (55.8% of the sample) were characterised either by high support and anticipation (anticipators with support), emotional distance to the patient (distant professionals) or no contact with the patient at the time of death (no more contact with patient professionals). Emotional closeness to, and responsibility for the patient were typical of moderately-impacted professionals (36.6%, concerned professionals), while highly-impacted professionals felt emotionally close to the patient and lacked support although more than half of them sought it (7.7%, unsupported professionals). CONCLUSIONS: Differences in the professionals' profiles relate prominently to the interplay between risk and protective factors. Professionals who were appropriately supported, i.e., according to their risk profile, were able to cope with the event. Taking into account the profiles of professionals and the severity of stress reactions may enable the screening of those professionals most in need of support. Those most impacted sought out help more frequently. However, only a minority of them were offered sufficient support. Institutional or vocational bodies should take measures to ensure that professionals seeking help find it easily and promptly. The combination of training and support seems to be crucial for mitigating risk factors since the three low impacted subgroups had received the most training and support.

Health Professionals Facing Burnout: What Do We Know about Nursing Managers?

Objective. To address the degree of burnout in nursing managers in hospitals of Western Switzerland, including comparison with medical managers, and its relationship with personal, work-related, and organizational characteristics. Methods. Statistical analysis of the scores of the Maslach Burnout Inventory-Human Services Survey from 257 nursing managers who answered a standardized electronic questionnaire. Results. Nursing managers showed a low degree of burnout, which was similar to that of medical managers. Most of them had a low level of emotional exhaustion and a low level of depersonalization, while personal accomplishment was contrasted. Only 2.3% had a high degree of burnout. These findings challenge the hypothesis of high stress being associated with high burnout, as nursing managers can be supposed to have a highly demanding job due to their intermediary position within the hospital hierarchy. Variations of burnout by personal, work-related, and organizational characteristics mainly concerned emotional exhaustion. Conclusion. Though nursing managers face a highly demanding job, they may benefit from resources (including coping strategies and empowerment) which help counterbalance job stress. Unequal distribution of resources may play a central role when facing burnout.

[Communication among hospital leaders]. / L'enjeu communicationnel dans le système hospitalier.

New management styles imposed on hospital institutions in recent years, have fundamentally changed the organization of the latter. Many texts discuss the consequences, specifically on the field of communication. The aim of this study was to understand the real impact of new management methods on communication by managers in hospital, but also on care teams in termes of satisfaction and/or stress. This two-year study was conducted among 900 executives in hospitals in Western Switzerland using a mixed methodology. A first phase of questionnaires highlighted the problematic areas, while a second phase in the form of organized group interviews in each hospital, had the objective of achieving a better understanding of the relationship between management and communication. The latter proved to be particularly significant in terms of results, and this is the one we focused on in this article.These results indeed show that a crucial role is given to communication by carers, and, at the same time a lessening of the time devoted to relationships, both among peers and with patients. Frustration then arises, which is not without consequences both for the management of patients and the institutions themselves. It is by means of these results that awareness is raised of the omnipresence of communication at all levels and the major advantages that positive dynamic supports. And, on the contrary, of the serious problems which may arise from management practice that do not give due importance to the dimension of communication, present in all sectors of the hospital.

Changes in the prevalence of overweight and obesity: some evidence from the Swiss Health Surveys 1992/93 and 2002.

BACKGROUND: This study examines changes in the prevalence of overweight and obesity in the Swiss general population from 1992/93 to 2002 and their relationship with changes in the distribution and effect of socioeconomic and health behavioural risk factors. METHODS: Cross-sectional data from telephone interviews of the non-institutionalized Swiss population aged 19 years and more were obtained from the Swiss Health Study 1992/93 (n = 13798) and 2002 (n = 17677). Binary logistic regression was used to address changes in overweight and obesity, defined as body mass index 25.0 kg/m(2) or more. The expected prevalence of overweight and obesity under adjusted models was computed to demonstrate the influence of changes in risk factors. RESULTS: The prevalence of overweight and obesity rose from 22.8% in 1992/93 to 30.9% in 2002 among women and from 41.1% to 48.1% among men. In international comparison, the increase in the overall prevalence of overweight and obesity in Switzerland was lower. Contrary to similar studies from other countries, the increase in prevalence was lower among men than that among women, possibly because of an increased protective effect of the observed health behavioural factors among men and unobserved behavioural factors among middle-aged men. CONCLUSION: Public health action should consider the potential of changing health behavioural factors in subgroups with a higher prevalence of overweight and obesity. Measures that stimulate, for instance, light physical activity or healthy diet, to be supported by changes in the obesogenic environment, should be encouraged. More evidence is needed for gender-specific approaches.

The impact of patient suicide on the professional reactions and practices of mental health caregivers and social workers.

BACKGROUND: Mental health and social professionals are at high risk of experiencing at least one patient suicide during their career. AIMS: This paper investigates the impact of patient suicide on the reactions and working practices of mental health and social professionals. It also examines how such an impact may vary depending on the professionals' characteristics, their relationship with the patient, as well as the institutional setting in which they work. METHODS: 275 professionals working in sociomedical institutions in French-speaking Switzerland completed a questionnaire. RESULTS: Patient suicide can cause a wide range of long-lasting reactions and changes in the working practices of mental health and social professionals. Professional's gender, place of suicide, as well as responsibility for and emotional attachment to the patient significantly influence the impact that a patient suicide has on such professionals. Professional's age, the type of profession, the number of suicides experienced, and previous suicide attempts by the deceased patient were also found to play a significant role with regard to changes in working practices. CONCLUSIONS: Beyond the emotional and professional impact, patient suicide may have also a formative influence, encouraging professionals to review and improve their working practices. Recommendations to help mental health and social professionals who have experienced a patient suicide are discussed.

Exploring daily variations of drinking in the Swiss general population. A growth curve analysis.

This study aims to address the underlying trajectories of weekly individual drinking patterns by growth models and to relate differences in drinking patterns to socio-demographic and drinking characteristics of respondents. Data came from a two-stage stratified random subsample of 747 persons aged 15 years or more from a Swiss study on alcohol consumption using a within-subject design conducted between March 1999 and July 1999. Beverage specific assessment of daily alcohol consumption was obtained by a weekly drinking diary and other characteristics via telephone interviews. The diary had to be filled out on seven consecutive days. The growth models accounted for up to 37.6% of the initial error variance and provided evidence for two distinct, negatively correlated underlying trajectories of drinking patterns. The first trajectory described an increase in consumption from Monday to Sunday. The second trajectory was about a specific weekend consumption culminating on Saturday with a significantly higher growth rate among young people and heavy episodic drinkers than in other subgroups. Therefore, young and heavy episodic drinkers may be exposed to sudden adverse consequences of alcohol consumption during the weekend. Prevention efforts which are targeted to this subgroup should take its specific drinking pattern into account.

Estimating regression to the mean and true effects of an intervention in a four-wave panel study.

OBJECTIVES: First, to analyse whether a taxation-related decrease in spirit prices had a similar effect on spirit consumption for low-, medium- and high-level drinkers. Secondly, as the relationship between baseline values and post-intervention changes is confounded with regression to the mean (RTM) effects, to apply different approaches for estimating the RTM effect and true change. SAMPLE: Consumption of spirits and total alcohol consumption were analysed in a four-wave panel study (one pre-intervention and three post-intervention measurements) of 889 alcohol consumers sampled from the general population of Switzerland. METHODS: Two correlational methods, one method quantitatively estimating the RTM effect and one growth curve approach based on hierarchical linear models (HLM), were used to estimate RTM effects among low-, medium- and high-level drinkers. RESULTS: Adjusted for RTM effects, high-level drinkers increased consumption more than lighter drinkers in the short term, but this was not a persisting effect. Changes in taxation affected mainly light and moderate drinkers in the long term. All methods concurred that RTM effects were present to a considerable degree, and methods quantifying the RTM effect or adjusting for it yielded similar estimates. CONCLUSION: Intervention studies have to consider RTM effects both in the study design and in the evaluation methods. Observed changes can be adjusted for RTM effects and true change can be estimated. The recommended method, particularly if the aim is to estimate change not only for the sample as a whole, but for groups of drinkers with different baseline consumption levels, is growth curve modelling. If reliability of measurement instruments cannot be increased, the incorporation of more than one pre-intervention measurement point may be a valuable adjustment of the study design.

Spreading interviews over time in health surveys: do temporal variations of self-reported alcohol consumption affect measurement?

OBJECTIVE: To address systematic variations related to the day of the interview in self-reports of alcohol consumption in telephone health surveys. The investigations include temporal clustering effects, prediction of alcohol consumption and variations across days by characteristics of respondents and interviewing period, and sensitivity to variations of measurements instruments. METHOD: Data at baseline collected in Spring 1999 from 2846 participants in a longitudinal probabilistic general-population survey in Switzerland were used. The study is representative for drinkers in Switzerland. Alcohol consumption measures include a 6-month quantity frequency and a 1-week graduated frequency measure. RESULTS: Evidence for systematic variations in self-reports related to the day of interview was found on the graduated-frequency measure even after controlling for sample characteristics. Similar variations on the quantity frequency measure were found, but were no longer significant after statistical control of the sample characteristics. CONCLUSIONS: Statistical inference in alcohol survey research by telephone interviews based on graduated-frequency measures with short reference period may be plagued with errors related to clustering effects of the day of the interview. Temporal aspects of conducting the fieldwork should therefore be accounted for in statistical analysis.

Measuring alcohol consumption: a comparison of graduated frequency, quantity frequency, and weekly recall diary methods in a general population survey.

OBJECTIVE: The objective of this study is to compare self-reports of alcohol consumption obtained by graduated frequency (GF), quantity frequency (QF), and prospective weekly diary methods in a Swiss general population survey using a within-subject design. Another objective is to examine the consumption means, ranking order, and drinking classifications and to relate differences in consumption means and classification inconsistencies to social and drinking characteristics. METHOD: The data came from the first wave of a longitudinal study on changes in alcohol consumption. A subsample of 767 respondents who completed the three measures was examined. The sample design was accounted for. RESULTS: Weekly drinking diary (WDD) yielded over 50% more alcohol consumption than the QF and GF measures did. Measures on quantity and graduated frequencies did not differ significantly. There were more light drinkers found on QF and more harmful drinkers on the WDD. Classification inconsistencies between GF and the weekly drinking diary were significantly related to gender and problematic drinking.

Decreased taxation, spirits consumption and alcohol-related problems in Switzerland.

OBJECTIVE: The spirits market in Switzerland was reformed in 1999 in accordance with the World Trade Organization agreement. The resulting tax reform and increased competition have resulted in markedly reduced prices for foreign spirits, and a previous study showed that spirits consumption increased significantly after the tax reform. The present study examined whether alcohol-related problems also increased at follow-up and if they did, whether the increase was the result of increased spirits consumption. Further correlates of alcohol-related problems were also explored. METHOD: Data were obtained from a longitudinal study on changes in alcohol consumption in Switzerland. The baseline survey was conducted 3 months before the tax reform, and the follow-up was conducted 28 months after the tax reform. A randomly selected sample of 4,007 residents aged 15 years or older participated in the baseline survey, and 73% of this sample participated in the follow-up survey. Alcohol consumption was measured on the basis of a graduated frequency, and alcohol-related problems were measured by items taken from the Alcohol Use Disorder Identification Test (AUDIT). RESULTS: Findings indicate that alcohol-related problems increased significantly at follow-up. The significance disappeared, however, after controlling for spirits consumption, indicating that the increase of alcohol-related problems at follow-up was mainly mediated through increased consumption of spirits. The multiple regression models showed that spirits, beer and wine consumption, gender, Age*Spirits Consumption interaction, region, smoking status, heavy-drinking frequency and average number of drinks were significant correlates of alcohol-related problems. CONCLUSIONS: Alcohol-related problems increased at the follow-up, particularly among younger age groups who consumed more spirits. Prevention programs on alcohol-related problems should target young people.

Changes in alcohol consumption following a reduction in the price of spirits: a natural experiment in Switzerland.

AIMS: To discover what changes in alcohol consumption had occurred in subgroups defined by age, sex, volume of drinking and drinking occasions, following a reduction in the price of spirits in Switzerland in July 1999. DESIGN: Quasi-experimental. Longitudinal general-population survey with baseline 3 months before and follow-up 3 months after price change. PARTICIPANTS: Probabilistic telephone sample of 1347 individuals with at least monthly consumption on average in the previous 6 months at both interviews. The response rate at baseline was 74,8% and the attrition rate from baseline to follow-up 20.2%. MEASUREMENTS: Alcohol consumption was assessed by means of a beverage-specific graduated-frequency measure. High volume of drinking was defined as 40 + g/day for men and 20 + g/day for women. Binge drinking was defined as six + drinks on an occasion for men and four + drinks for women. FINDINGS: Spirits consumption increased significantly (by 28.6%) in the total sample, and specifically in young males and in individuals who were low-volume drinkers at baseline. Consumption of alcohol overall, or of wine or beer, did not change significantly. No indication of effects of substitution was found. CONCLUSIONS: Spirits consumption showed price-responsiveness in the early postintervention period. This finding is of particular interest, as (a) the increase in spirits consumption took place at a time of generally declining consumption of alcohol in Switzerland; and (b) in contrast to the findings of most studies, the intervention, namely price reduction, increased availability.

Does price matter? The effect of decreased price on spirits consumption in Switzerland.

BACKGROUND: On July 1st, 1999, the spirits market in Switzerland was reformed based on the World Trade Organization (WTO) agreement. The tax reform, in addition to increased competition, has resulted in a 30-50% decrease in price for foreign spirits (liquor). The purpose of the present study is to examine whether decreased prices due to the tax reform and the liberalized spirits market in Switzerland have had an effect on spirits consumption, and whether the effect differs by demographic and other correlates. METHODS: The present study uses data from a longitudinal study on changes in alcohol consumption in Switzerland's resident population. The baseline survey was conducted 3 months before the tax reform and the follow-up was conducted 28 months after the tax reform. A randomly selected sample of 4007 residents aged 15 years or older participated in the baseline survey and 73% in the follow-up survey. The data were obtained by computer-assisted telephone interview, including detailed questions on alcohol consumption, drinking habits, problem drinking, purchase of spirits and socio-demographic characteristics. RESULTS: Consumption of spirits increased after the price of spirits decreased. The increase in spirits consumption was consistent across subgroups, with the exception of the group aged 60 or older. Moreover, the increase in spirits consumption persisted even after adjustment for significant correlates of spirits consumption. Apart from age, there was no evidence that the increase in spirits consumption differed between subgroups as defined by sex, region, working status, education, smoking, drinking frequency, or average number of drinks. CONCLUSIONS: The findings demonstrate that younger people are more affected by price than older persons. This study demonstrated that price should be considered an effective policy to reduce alcohol misuse and alcohol-related problems, especially among the younger population.