Workplace stress, mental health, and burnout of veterinarians in Australia.

OBJECTIVE: To determine the frequency of the states of depression, anxiety, stress and burnout using internationally validated methods and to relate these to the demographic characteristics of veterinarians in Australia. METHODS: A postal survey of registered veterinarians with at least one year's experience and whose address was available; 1947 returned the questionnaire providing data for analysis. RESULTS: Overall, veterinarians describe higher levels of depression, anxiety, stress and burnout than the general population. The severity of these states was determined by gender, background, type of practice and years after graduation. CONCLUSIONS: Modifying the curricula of veterinary schools to include the teaching of personal cognitive and coping skills to undergraduate veterinary students, the provision of the opportunity to enhance these skills throughout their veterinary career and changes in the veterinary workplace could result in improved mental health, increased job engagement and work satisfaction.

Setting up a health education website: practical advice for health professionals.

Recently, both popular and professional publications about health care have begun to express enthusiasm for the Internet as a source of medical information and possibly of psychological support for those with serious illnesses. However, there are pitfalls for practitioners and researchers who seek to capitalise on these patient education possibilities. We describe here the process and mixed outcomes of the efforts of a multidisciplinary team to set up and evaluate a website for rural women with breast cancer. We provide recommendations for other health professionals contemplating similar ventures, and also identify some future steps to develop and research this potentially valuable form of patient education and support.

Determinants of adherence in adults with cystic fibrosis.

Cystic fibrosis (CF) is now as much a disease of adults as of children and adolescents. An important focus of recent research has been the impact of the complex, expensive, and time consuming routine of self-care and medical treatment that is required by adults with CF to maintain health. A growing concern for medical and allied health teams is the issue of patient adherence to prescribed health management plans. A summary of the particular medical and treatment context of CF is followed by a review of adherence measurement issues and the determinants of adherence to treatment regimens in people with CF, primarily adults. Evidence for factors which influence adherence decisions of people with CF is examined. The medical and psychological aspects of this complex problem have not been adequately addressed because of difficulties with definition and measurement. Only a small proportion of the variance in adherence has been accounted for in the literature. New measurement technologies and new theoretical directions offer promise for a better understanding of this complex and important issue and may result in more effective intervention strategies to improve adherence.

Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase?

BACKGROUND: While the literature shows the clinical value for medical practitioners of skill in communicating with patients in an empathetic manner, objective evaluations of methods to teach empathy are few. PURPOSES: This paper describes a method of teaching entry-level medical students the elements of effective communication with patients, in preparation for their first practical exercises. The paper focuses on how the outcomes of the teaching were evaluated with special attention to empathy. METHODS: Student evaluative ratings were collected after training, and students also completed a pencil-and-paper test of empathy, both before and after the training. While all data were anonymous, student pre- and post-training empathy scores could be compared to assess individual changes in knowledge of empathy after training. RESULTS: Most students (81%) felt better prepared to interview after the training. The pencil-and-paper measure of empathy has good reliability, both internal (alpha 0.83 and 0.91) and inter-rater (kappa 0.96). Overall, students made significant gains in their ability to make empathetic responses, although some (30%) showed no gains. CONCLUSIONS: Further research is required to identify students who fail to acquire skill in expressing empathy after undergoing training, and to validate the pencil-and- paper measure of empathy against real-life performance.

Predicting work stress compensation claims and return to work in welfare workers.

Occupational stress is prevalent in work areas in which there is high contact with distressed or dependent members of the public. However, little is known about the prediction and management of stress-related compensation claims, which can be expensive for employers. The authors interviewed all staff members of a large public sector welfare agency who had made a compensation claim for work-related stress during a 12-month period (N = 19) and obtained in-depth information from 16 of the 17 who were still available. A clear relationship was found between type of stress precipitant and length of stress-related leave, suggesting that the organizational response to specific stressful incidents was much more effective than its response to chronic work stressors. Demographic data for all 19 claimants showed that they had taken twice as many days of sick leave as the organizational average in the year preceding their claim. There are important implications for personnel management practices that may reduce and prevent work stress for vulnerable workers.

Coping strategies for people who care for a relative with chronic mental illness.

To study the coping strategies in use by family members (N = 36) who had remained involved with and supportive of their mentally ill relative, we used both a checklist of questions about relevant coping behaviours and group discussions about caregivers' methods of taking care of themselves. Results invite further exploration.

Counselling work in normal general practice: an analysis of Australian consultations.

As counselling is potentially an area of overlap between the functions of medical practitioners and of clinical health psychologists, it is important to know exactly what counselling encompasses in primary health care. A set of 68 counselling consultations were identified from collected transcripts of normal general practice work; seven representative examples are described and analysed in this article. The major purpose of three consultations was for the general practitioner (GP) to help the patient with psychological illness or behaviour disorder, and the question of most interest was how the parties negotiated this topic and how the GPs provided help. In four other consultations the major purpose was for the GP to answer the patient's questions. The results have implications for the delivery of primary health care and the work satisfaction of GPs, as well as for the collaborative relationships which may develop between GPs and clinical health psychologists.

The usefulness of distinguishing different types of general practice consultation, or are needed skills always the same?

We hypothesized that it might be important to distinguish different types of consultation in order to understand better how help is delivered in general practice. This paper provides preliminary data on the ways that consultations can differ in how they unfold, and on how such differences might affect the helping process and the outcomes of each consultation. Several types of general practice consultation were noticed amongst 210 transcripts. Having established adequate inter-rater reliability of the classification system, we explored the differences between consultations of three broad types: Psychosocial, Complex, and Straightforward. Some of the questions asked in this preliminary study included: 1) do certain sorts of doctor, or patient, engage in certain sorts of consultation? 2) are there any relationships between the type of consultation and its length, patient-centredness or outcomes? 3) are the correlations between process and outcome clearer within categories of consultation than they are if consultations are treated as homogeneous? Findings provide a foundation for further investigations.

Process and outcomes in general practice consultations: problems in defining high quality care.

In order to explore the relationships between the verbal interactions of the consultation and several outcomes (patient health change, patient compliance and the satisfaction of both doctor and patient), 21 General Practitioners contributed ten audiotaped consultations each, from consecutive consenting adult patients. The effects of GP sex and postgraduate training were also investigated, but were found to be minimal. Patient health change was most clearly related to acuteness of symptoms at presentation, whereas reported compliance was predicted by patient satisfaction after the consultation. Different consultations were maximally satisfying for doctors and for patients, and patient and doctor satisfaction with specific consultations showed little correlation. This result implies that the measurement of quality of care, in general practice at least, is a more complex task than has been assumed, and in turn raises issues about whose definition of outcome is relevant in discussing quality of care.

Client and worker satisfaction in a child protection agency.

Client and staff satisfaction with the workings of a multidisciplinary child protection agency were investigated using interviews and standard questionnaires. The goal was to discover the nature and strength of the helping relationship between service-recipients and providers. Current clients (N = 24) expressed a great deal of satisfaction with the staff and services. The agency staff (N = 21, with 11 employed at least half-time to work directly with families) were relatively satisfied with their jobs, and showed little evidence of the burnout which has been recognized as a risk for child protection workers. They were able to relate empathically to clients and felt enthusiasm for the work. Taking account of possible bias in both sets of answers, there is still evidence that the agency is succeeding in creating a necessary precondition for therapeutic change: the development of accepting and positive worker-client relationships.

Tertiary prevention in mental health care: effects of group meetings for family caregivers.

Several series of discussion groups were conducted for people caring for relatives who suffer from chronic schizophrenia. Groups aimed to provide information from both experts and fellow caregivers about the illness and about coping techniques, and to foster emotional support within the peer group. Owing to the small number of subjects, statistical power was inadequate to test effects quantitatively; however, the responses of the family caregivers to structured follow-up questions indicated many gains from group attendance. Attendance and participation rates were high once subjects were engaged; positive outcomes were reported by the carers, and they actively sought feedback of their dissatisfactions with mental health services to the relevant decision-makers. The results are relevant both in the area of preventive mental health care for carers, and in promoting collaboration between carers and professionals.

Differences according to recruitment method in subjects who care for a relative with schizophrenia.

With growing emphasis on community mental health care, there is increased research interest in the needs of people who care for a relative suffering from chronic mental illness. This methodological note examines the differences between two samples of caregivers for schizophrenia sufferers. The two samples were recruited by different methods from different sources: one a mail survey of a self-help group and the other through patients at psychiatric hospitals and outreach clinics. Differences were minimal and recruitment through self-help groups is advocated as the more cost effective method.

Needs of family caregivers in chronic schizophrenia.

The goals of the study were to describe (1) the tasks undertaken by people who care for a relative with chronic schizophrenia, according to their level of contact with the patient; and (2) any needs for further help that these caregivers might experience. Interviews and standardized questionnaires were used to collect information from 121 family caregivers whose relatives had been diagnosed an average of 14 years previously. Burden in the sense of interference in caregivers' daily lives was most marked for caregivers in high contact with the patients. Patients whom the caregivers regarded as enjoyable to live with had greater self-care and communication skills. Caregivers preferred that patients low in these skills or high in disruptive behavior live in supervised settings. Caregivers expressed particular support for earlier professional intervention in episodes of illness, information about how to lobby politicians for resources, and information about schizophrenia. These results can be used to plan interventions to reduce caregiver stress.

Determinants of psychological distress in relatives of people with chronic schizophrenia.

Research shows that the relatives of people with chronic schizophrenia suffer psychological distress and interference in daily life from the burdens of caregiving. In this study, members of a self-help group for the relatives of schizophrenia sufferers provided information through a mail survey, using standardized measures of psychological distress and burden, and severity of the sufferer's illness. Caregiver psychological distress was high compared with test norms, and the level of behavioral disturbance in the sufferer was found to contribute to caregiver distress after controlling for the caregiver's age, sex, and social supports. An unexpected finding was that those caring for female sufferers reported greater distress than those caring for males.

Verbal interactions in general practice. Information, support and doctor satisfaction.

OBJECTIVE: The general practice encounter can be seen as an exchange of information aimed at relief of the patient's presenting symptoms, and it is acknowledged that this goal can most effectively be achieved within the context of the professional's emotional support of the patient. We sought to describe the processes of information exchange and emotional support in detail, and to explore any differences in the speech pattern which were related to the doctors' lesser satisfaction with some consultations. DESIGN: Transcripts of general practice consultations (n = 143) from five medical practitioners were coded and analysed. MAIN OUTCOME MEASURES: The verbal interactions of the consultation were described in categories: for doctors, emotional support, informational support, and diagnostic activity; and for patients, relationship oriented and task oriented. Doctors also rated their satisfaction with each consultation. RESULTS: About two-thirds of the speech by both parties was found to be devoted to information exchange in the forms of diagnosis and medical advice, and the rest to the relationship between the participants. Doctors' satisfaction ratings (extremely satisfactory or otherwise) could be predicted from speech and activity variables by means of logistic regression. CONCLUSIONS: This study describes the verbal interaction which is the vehicle for medical helping in general practice, and it forms a foundation for needed research on how certain features of the verbal interaction are related to quality of care.

Substantiation of reported child abuse or neglect: predictors and implications.

Underreporting and overreporting of suspected child abuse and neglect cases reduce the efficiency of child protection services. We used all the reports in South Australia for 1988-1989 (N = 3,228) to study the determinants of the decision by child protection workers to register a reported incident as being one of child abuse and neglect. Logistic regression showed that registration (substantiation) was predictable from two variables: the age of the alleged victim and the caseworker's estimate of severity. This latter variable needs investigation, as despite its crucial role we have no information on how caseworkers form a judgment about severity.

Psychological attributes of young adult smokers.

To study the psychological aspects of cigarette-smoking in community adults, we examined longitudinal data from a sample of young people (from age 15 to 23 years). Questions on smoking behavior had been asked during the last five years of the study, and information on self-esteem, depressive affect, negative mood, hopelessness, psychological disturbance, locus of control, social alienation and health was also available. Current smokers in the last year of the study had differed from nonsmokers nine years previously by having more external locus of control and now were less likely to report their health as excellent. Most smokers also drank alcohol, but cigarette consumption did not differ for drinkers and nondrinkers. Contrary to expectations, current smokers showed no distinctive psychological attributes, and those who started or stopped smoking were similarly undistinctive in psychological terms. Results suggest that efforts to stress the self-destructive or antisocial nature of tobacco use have not been accepted by the smokers in this age group (M = 23.6 yr.).

Psychological correlates of the level of alcohol consumption in young adults.

OBJECTIVE: To assess the psychological condition of young adults who drank no alcohol, moderate, or excessive amounts of alcohol. DESIGN: Subjects from a longitudinal study of the school-to-work transition supplied information by postal questionnaire, and others matched for age were interviewed. PARTICIPANTS: A sample of adults of average age 24 years. The 483 in the longitudinal study had been students at 12 metropolitan high schools in 1980, and had been followed annually from then until 1988; the 111 who were interviewed were mature-aged university students. Sex ratios and the proportion employed were similar in the two samples. MAIN OUTCOME MEASURES: The General Health Questionnaire was used to measure psychological disturbance in both samples, and alcohol consumption was measured by self-report in terms of number of glasses of beer, wine, spirits and fortified wine taken during the preceding week. RESULTS: Higher levels of disturbance were shown by men who drank excessively in the first study, and who abstained from alcohol in the second study. The latter result was related to the poorer health of abstainers. Women showed no psychological differences according to level of alcohol consumption. CONCLUSIONS: The inconsistent results for men in the two studies suggest that research methodology influences results in ways that are important for researchers in this field to take into account. The lack of disturbance in moderate drinkers of both samples indicates the social acceptability of responsible alcohol consumption in Australia, and supports efforts to educate the public and their medical advisors so that well-informed decisions can be made about alcohol use.