Gender Differences in Demographic and Clinical Features of Physicians Admitted to a Program for Medical Professionals with Mental Disorders.

OBJECTIVE: To examine the demographic and clinical differences between men and women admitted to a Physicians' Health Programme (PHP). METHOD: Retrospective chart review of 778 medical records of physicians admitted to the Barcelona PHP from February 1, 1998 until December 31, 2015. RESULTS: Women admitted to the Barcelona PHP were younger than men, were more likely to be self-referred and to be admitted for a non-addictive mental disorder. Prevalence of unipolar affective disorders (60.1 vs. 37.6%), adjustment disorders (62.4 vs. 37.6%), and obsessive-compulsive disorder (61.1 vs. 38.9%) was significantly higher among women, whereas prevalence of alcohol use disorders was lower (32.7 vs. 67.3%). Nevertheless, both groups were similar with regard to medical specialty, working status, length of their first treatment episode, and presence of hospitalization during that episode. After multivariate analysis, age, type of referral, and main diagnosis (addictive disorders vs. other mental disorders) discriminated the differences between groups. CONCLUSION: Women physicians seem to be more prone to voluntarily ask for help from PHPs and are more likely to suffer from mood and anxiety disorders compared to men. However, mental disorders' severity may be similar in both groups. More studies are needed to clarify the gender factors related to this behavior.

Dual diagnosis among physicians: a clinical perspective.

Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.

Inpatient physicians and nurses with dual diagnosis: an exploratory study.

OBJECTIVE: This study explored the clinical features of physicians and nurses with dual diagnosis.   METHODS: We conducted a retrospective review of 150 medical records of physicians (n = 120) and nurses (n = 30) admitted from February 2008 to February 2011 to the Barcelona Psychiatric Inpatient Unit for Health Professionals. Routine intake included the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) and a clinical interview.   RESULTS: The mean age of participants was 48.59 (SD = 8.9) years and 57.3% were male. Patients experienced substance dependence with alcohol (n = 112, 74.7%), sedatives (n = 59, 39.3%), cocaine (n = 24, 16%), other stimulants (n = 15, 10%), and opiates other than heroin (n = 16, 10.7%). About 41% (n = 61) also met criteria for a mental health disorder, mainly major depressive disorder (n = 42, 28%), while 8% (n = 12) had attention deficit hyperactivity disorder. A high proportion of physicians (n = 95, 79.2%) and nurses (n = 25, 83.3%) had nicotine dependence. The most common comorbidity was alcohol dependence and major depressive disorder. No differences were found between groups in the prevalence of substance use disorders, mental health disorders, and dual diagnosis.   CONCLUSIONS: Dual diagnosis is a common condition among inpatient physicians and nurses with substance use disorders and its clinical presentation may be similar in both groups.

Doctors admitted to a Physicians' Health Program: a comparison of self-referrals versus directed referrals.

OBJECTIVE: To compare the profile of doctors with mental disorders admitted to a Physicians' Health Program (PHP) depending on their type of referral. DESIGN: Retrospective chart review. METHOD: We analysed 1545 medical records of doctors admitted to the Barcelona PHP (PAIMM) from 1 February 1998 to 31 December 2012. RESULTS: Most doctors (83.2%) were self-referred to the programme. Patients non-self-referred were older ([Formula: see text]=55 vs [Formula: see text]=49.6 years; t=6.96, p<0.01) than those self-referred and there were more men (68.3%) than women (45.8%; OR=0.39; 95% CI 0.29 to 0.52). Self-referrals were more frequent among patients with non-addictive disorders (84.6% vs 15.4%; OR=4.52; 95% CI 3.23 to 28.45). Self-referred patients needed less inpatient admissions (16.8% vs30.9%; OR=2.22; 95% CI 1.63 to 3.01) and the length of their treatment episodes was shorter ([Formula: see text]=24.3 vs [Formula: see text] = 32.4 months; t=3.34; p<0.01). Logistic regression showed a significant model (χ(2)=67.52; df=3; p<0.001). Age, gender and diagnosis were statistically associated with type of referral to the programme. CONCLUSIONS: Type of referral to a PHP may be influenced not only by sick doctors' personal traits but also by each programme's design and how it is perceived by service users. Our findings should be taken into account when designing treatment and preventive interventions for this professional group.

Promoting voluntary help-seeking among doctors with mental disorders.

OBJECTIVES: To explore if the Barcelona Integral Care Program for Doctors with mental disorders (PAIMM, in Catalan) has achieved its goal of enhancing earlier and voluntary help-seeking amongst sick doctors. MATERIAL AND METHODS: We conducted a retrospective chart review of 1363 medical records of physicians admitted to the inpatient and outpatient units of the PAIMM from February 1st, 1998 until December 31st, 2011. The sample was divided into 3 time periods: 1998-2004, 2005-2007 and 2008-2011 (477, 497, and 389 cases, respectively). RESULTS: The mean age at admission decreased (F = 77.57, p < 0.001) from the first period (x = 54.18; SD = 10.28 years) to the last period (x = 44.81; SD = 10.65 years), while voluntary referrals increased from 81.3% to 91.5% (Chi(2) = 17.85, p < 0.001). Mental disorders other than substance use disorders grew from 71% during the 1998-2003 period, to 87.4% (2004-2007), and 83.9% in the last period (Chi2 = 29.01, p < 0.001). Adjustment disorders increased their prevalence, while inpatient treatment progressively represented less of the overall clinical activity. CONCLUSIONS: Sick doctors may feel encouraged to seek help in non-punitive programs specially designed for them and where treatment becomes mandatory only when there is risk or evidence of malpractice.

El Programa de Atención Integral al Médico Enfermo de Barcelona: salud mental para una buena praxis / The integral care program for sick doctors of Barcelona: mental health for a good clinical practice

La prevalencia de los problemas de salud mental en los médicos es similar y en algunos casos superior (p. ej. suicidio) a la de la población general. Dichos problemas pueden comportar serias implicaciones no solo para el bienestar psicofísico del médico y su entorno sino también para la seguridad de su práctica clínica. En España, los Programas para la Atención Integral del Médico Enfermo (PAIME) se han desarrollado con la finalidad de promocionar la petición voluntaria de ayuda y para promover la prevención, diagnóstico y tratamiento de estos problemas en entornos especializados que garanticen la confidencialidad. En este estudio describimos cómo funciona el PAIME de Barcelona desde su creación en 1998. También presentamos los principios generales de su filosofía, requisitos de entrada, vías de acceso y distintas áreas de intervención. Por último, presentamos cómo un contrato terapéutico específico permite el manejo de los casos que suponen un riesgo para la praxis(AU)

The prevalence of mental disorders among physicians is similar and, in some cases, such as suicide, is greater than that of the general population. Those problems may lead to serious consequences, not only for the psycho-physical wellbeing of the doctor and of his/her environment but also for the safety of his/her clinical practice. In Spain, the Integral Care programs for Sick Doctors (ICID) have been developed in order to promote voluntary help seeking, and to enhance prevention, early diagnosis and appropriate treatment of those problems in specialised treatment settings. In this study, we describe how the ICID of Barcelona has worked since it was created in 1998. We also describe the main principles, means of access, inclusion criteria and main service areas of this program. Finally, we present how a specific “therapeutic contract” tries to manage the cases in which there is a risk of malpractice(AU)