Longitudinal assessment of psychological distress and its determinants in a sample of firefighters based in Montreal, Canada.

Introduction: Firefighters face elevated risks of common mental health issues, with distress rates estimated at around 30%, surpassing those of many other occupational groups. While exposure to potentially traumatic events (PTEs) is a well-recognized risk factor, existing research acknowledges the need for a broader perspective encompassing multidimensional factors within the realm of occupational stress. Furthermore, this body of evidence heavily relies on cross-sectional studies. This study adopts an intensive longitudinal approach to assess psychological distress and its determinants among firefighters. Methods: Participants were recruited from 67 fire stations in Montreal, Canada, meeting specific criteria: full-time employment, smartphone ownership, and recent exposure to at least one PTE, or first responder status. Subjects underwent a telephone interview and were directed to use an app to report depressive, post-traumatic, and generalized anxiety symptoms every 2 weeks, along with work-related stressors, social support, and coping styles. Analyses involved 274 participants, distinguishing between those exceeding clinical thresholds in at least one distress measure (the "distressed" subgroup) and those deemed "resilient." The duration and onset of distress were computed for the distressed group, and linear mixed models were employed to evaluate determinants for each psychological distress variable. Results: Clinical psychological distress was observed in 20.7% of participants, marked by depressive, post-traumatic, and anxiety symptoms, often within the first 4-week reference period. Contextual factors (operational climate, social support, solitude) and individual factors (coping style, solitude and lifetime traumatic events in private life) exhibited more significant impacts on psychological distress than professional pressures within the firefighters' work environment. Discussion: This study reports lower rates of psychological distress than previous research, possibly attributable to sample differences. It highlights that reported symptoms often represent a combined and transient layer of distress rather than diagnosable mental disorders. Additionally, determinants analysis underscores the importance of interpersonal relationships and coping mechanisms for mental health prevention interventions within this worker group. The findings carry implications for the development of prevention and support programs for firefighters and similar emergency workers.

[Using Technology to Optimize the Training of Mental Health Providers in Evidence-Based Treatment: State of Knowledge]. / L'utilisation des technologies pour optimiser la formation des intervenants en santé mentale aux traitements fondés sur les données probantes : où en sommes-nous ?

Massive training of mental health providers is one of the proposed means of improving access to evidence-based treatment for a variety of common mental disorders. While communication and knowledge dissemination technologies (videoconferencing, web platforms) can help make training more accessible in time and space, their contribution to the development of skills among providers needs to be carefully evaluated. Objectives Establish how technologies are used to optimize the training of practitioners and what are the effects of online training on the acquisition of clinical knowledge and skills. Method A quick review of the literature was conducted. In order to be included, studies had to concern online training intended for providers in active clinical practice, deal with the treatment of a common mental disorder or addiction, and include an objective measure of clinical knowledge or skills. The studies were analyzed and compared in terms of learning methods and activities incorporating digital technologies. Results Twenty studies were identified. Passive learning methods, involving little or no interactivity, are predominant in asynchronous mode online training (AOT), while activities that allow a high level of interaction with the trainer, such as role-playing or supervision, are found in synchronous mode training. Knowledge acquisition: AOTs appear to be effective in improving the knowledge of the trainees for at least six months. Classroom training or the addition of supervision does not produce learning outcomes that are superior to the AOT. Skill acquisition: No conclusions can be drawn about the effects of online, asynchronous, synchronous or blended training, as the results are mixed or even contradictory. Conclusion Considering the low methodological quality of the studies analyzed, which limits the nature and scope of the conclusions of this review, the results of the studies suggest that AOTs that include basic interactive technologies, such as online quizzes, can be a simple and effective way to improve clinical knowledge of mental health practitioners.

Hypnosis for burn wound care pain and anxiety: A systematic review and meta-analysis.

BACKGROUND: Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications. OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury. DATA SOURCES: Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients. DATA SYNTHESIS: Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3. RESULTS: For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD=-8.90, 95% CI -16.28, -1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD=-21.78, 95% CI -35.64, -7.93) and no difference in medication usage (MD=-0.07, 95% CI -0.32, 0.17). CONCLUSION: These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature.

Anxiety, depression and PTSD-related symptoms in spouses and close relatives of burn survivors: When the supporter needs to be supported.

OBJECTIVES: The aim of the study was to assess the prevalence of anxiety, depression and PTSD-related symptoms reported by spouses and close relatives of adult burn survivors. Potential associations between these symptoms and variables such as the severity of the burn were also explored. METHOD: Participants were spouses (n=31) and close relatives (n=25) of hospitalized patients with acute burns. Anxiety and depression symptoms were assessed by the Hospital Distress Anxiety and Depression Scale and PTSD-related symptoms by the Modified PTSD Symptom Scale at both admission to and discharge from the burn unit. RESULTS: At admission, 77% of spouses and 56% of close relatives of burn patients reported anxiety, depression or PTSD-related symptoms in the clinical range. While spouses had higher scores than close relatives on symptom measures, significant differences were only established for anxiety symptoms (p<.02). A significant effect was found for gender, with women reporting more anxiety (p=.01) and depression (p=.02) symptoms than men. Results also showed a main effect for time, with anxiety (p<.0001), depression (p<.0001) and PTSD-related (p<.0001) symptoms being higher at admission than at discharge. Variables associated with the index patient, such as total body surface area burned, length of stay, number of ventilated days, facial burns, or level of care at admission, were not associated with outcome measures. CONCLUSIONS: Spouses and close relatives of burn survivors showed high levels of psychological distress in the first few days following admission, and more than a quarter still reported symptoms in the clinical range at discharge. Our analysis points to the need to offer psychological support and guidance to family members so that they can in turn provide effective support to the burn survivor.

Cognitive causes of social phobia: a critical appraisal.

This review examined critically studies issuing from the cognitive therapy (CT) model claiming to have unveiled cognitive causal factors of social phobia. Additionally, it examined outcome studies of CT-inspired interventions and other treatments having included measurements of cognitive constructs. Overall, we found no evidence consistently supporting the claim that social phobics are characterized by typical cognitive processes. Moreover, we found neither corroborating evidence for a controlling effect of such cognitive processes on social phobic conduct, nor consistent indications that cognitive therapies or techniques effect cognitive changes differently than other approaches. The evidence suggests rather, that cognitive factors change concurrently with other features of psychopathology as part of an overall improvement during or after effective therapy, regardless of therapeutic approach.