A longitudinal study of stress and psychological distress in nurses and nursing students.

AIM: The aim of this study was to investigate how differences in life events and stress contribute to psychological distress in nurses and nursing students. BACKGROUND: Stress is an issue for nursing students and qualified nurses leading to psychological distress and attrition. DESIGN: A longitudinal study using four time waves was conducted between 1994-1997. METHODS: Measures were taken of stress, life events and psychological distress in addition to a range of demographic data. Data were analysed using descriptive statistics, linear modelling and mixed-effects modelling. The study was set in Scotland, UK and used newly qualified nurses and nursing students from four university departments of nursing over four years. The study was initiated with 359 participants (147 nurses and 212 nursing students) and complete data were obtained for 192 participants. RESULTS: Stress levels, psychological distress and life events are all associated within time and across time. At baseline, life events and stress contributed significantly to psychological distress. The pattern of psychological distress differed between the nursing students and the newly qualified nurses with a high level in the nurses after qualifying and starting their career. CONCLUSION: Stress, individual traits, adverse life events and psychological distress are all interrelated. Future lines of enquiry should focus on the transition between being a nursing student and becoming a nurse. RELEVANCE TO CLINICAL PRACTICE: Stress and psychological distress may have negative outcomes for the retention of nursing students in programmes of study and newly qualified nurses in the nursing workforce.

Adolescent-onset psychosis: prevalence, needs and service provision.

BACKGROUND: Little is known of the epidemiology and care needs of people with adolescent-onset psychosis. AIMS: To examine prevalence and the cross-sectional disability, needs and service provision for adolescent-onset psychosis in areas of central Scotland with a total population of 1.75 million. METHOD: We identified and contacted 103 young people using an opt-out research design. Fifty-three participants and their carers and keyworkers were interviewed using a modified version of the Cardinal Needs Schedule. RESULTS: The 3-year prevalence was 5.9 per 100,000 general population. Twenty-one (20%) adolescents were not in contact with mental health services; 80% of first admissions were to adult acute psychiatric wards. Those interviewed had high levels of morbidity: 29 (55%) had serious to pervasive impairment of functioning; there were relatively high levels of side-effects, negative symptoms, anxiety, occupational, friendship and family difficulties. Care provision was better for'clinical'than for'social'domains; 20% had five or more unmet needs; 17% had at least one intractable problem. CONCLUSIONS: This low-prevalence disorder requires an assertive multi-agency approach in the context of a national planning framework.

Improving the recognition of depression in adolescence: can we teach the teachers?

This study evaluated the effectiveness of a schools-based psychoeducational intervention designed to help teachers recognize the symptoms of clinical depression in their adolescent pupils. Around 151 teachers in eight high schools in Scotland, UK were randomly assigned to experimental and control groups and all received training on depression. The ability of the experimental teachers to report which pupils were depressed was compared with the control group whose reporting task occurred before they had received training. The teachers were reporting on 2262 pupils who had been independently screened for clinical depression using a two-stage screening procedure with the Mood and Feelings Questionnaire (MFQ) and semi-structured clinical interview (K-SADS). Systematic evaluation showed that training teachers with this package did not improve their ability to recognize their depressed pupils. Recognizing depressive illness in adolescence is one of the main public health challenges for adolescent mental health services and this study adds to the growing literature on the difficulties in achieving this.

Morale among general practitioners: qualitative study exploring relations between partnership arrangements, personal style, and workload.

OBJECTIVES: To explore general practitioners' experiences of wellbeing and distress at work, to identify their perceptions of the causes of and solutions to distress, and to draw out implications for improving morale in general practice. DESIGN: Three stage qualitative study consisting of one to one unstructured interviews, one to one guided interviews, and focus groups. SETTING: Fife, Lothian, and the Borders, South East Scotland. PARTICIPANTS: 63 general practitioner principals. RESULTS: Morale of general practitioners was explained by the complex interrelations between factors. Three key factors were identified: workload, personal style, and practice arrangements. Workload was commonly identified as a cause of low morale, but partnership arrangements were also a key mediating variable between increasing workload and external changes in general practice on the one hand and individual responses to these changes on the other. Integrated interventions at personal, partnership, and practice levels were seen to make considerable contributions to improving morale. Effective partnerships helped individuals to manage workload, but increasing workload was also seen to take away time and opportunities for practices to manage change and to build supportive and effective working environments. CONCLUSIONS: Solutions to the problem of low morale need integrated initiatives at individual, partnership, practice, and policy levels. Improving partnership arrangements is a key intervention, and rigorous action research is needed to evaluate different approaches.