Depression and suicidality among psychiatric residents - results from a multi-country study.

BACKGROUND: Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors. METHODS: A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively. RESULTS: The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n = 280) of residents met criteria for depression, 12.3% (n = 225) reported active suicide ideation, and 0.7% (n = 12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training. LIMITATIONS: Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%. CONCLUSION: Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society.

The impact of delivering GP training on the clinical high risk and first-episode psychosis on referrals and pathways to care.

AIM: This project explored the impact of a general practitioner (GP) training programme on referrals and pathways to care for people at high clinical risk of psychosis or with a first-episode psychosis. The resources needed to deliver the training were measured to help inform other teams considering this approach. Satisfaction with the training was also explored. METHODS: All of the GP (48) practices in the London Borough of Southwark were approached. Presentations were given on the symptoms of a clinical high-risk state and the first signs of psychosis alongside information on how to access the teams. Referrals to the prodromal and first-episode teams 6 months before and after the training were recorded. Resources needed to deliver the training in terms of staff time were recorded. A questionnaire on attendees' satisfaction with the training was given. RESULTS: Sixty percent of eligible practices received education. On average, it took 2 h for every two staff members each to deliver the training. Over the 12-month period, the teams received 148 referrals. The training led to a significant increase in referrals to the two specialized teams and a significant increase in direct referrals to the teams from GPs. Attendees were satisfied with the training. CONCLUSIONS: This study indicates that GP education programmes are a viable and acceptable way of increasing the identification of young people at high clinical risk for psychosis or with a first-episode psychosis and increasing direct referrals to specialist teams.

Psychiatry training in Europe: views from the trenches.

BACKGROUND: In the majority of European countries, postgraduate psychiatry training schemes are developed and evaluated by national bodies in accordance with national legislation. In order to harmonise training in psychiatry across Europe, the European Union of Medical Specialists (UEMS) issued a number of recommendations for effective implementation of training programs in psychiatry. AIMS: To describe the structure and quality assurance mechanisms of postgraduate psychiatric training in Europe. METHOD: The European Federation of Psychiatry Trainees (EFPT) conducted a survey, which was completed by the representatives of 29 member national psychiatric associations. RESULTS: In most countries (N = 19), the duration of the training programme is 5 years or more. Twenty-six countries have adapted a basic training programme that includes the 'common trunk' (according to UEMS definition) or a modified version of it. In 25 countries, trainees are evaluated several times during their training with a final exam at the end. In 25 countries, official quality assurance mechanisms exist. However, results demonstrate great variations in their implementation. CONCLUSIONS: Overall, psychiatric training programmes and assessment methods are largely compatible with one another across Europe. Quality assurance mechanisms, however, vary significantly. These should receive adequate attention by national and international educational policy makers.