Improving resistance and resiliency through crisis intervention training.

To our knowledge no research has been done on the impact of crisis intervention training programs on resistance and resiliency. This paper describes the use of a localized crisis intervention course and its impact on resistance and resiliency in the participants after 2 days of training. Participants attending the localized version of ICISF Individual Crisis Intervention and Peer Support courses participated in a pre-course quiz and a post-course quiz. The overall resistance and resiliency scores improved at the end of the localized 2-Day Individual Crisis Intervention and Peer Support course. Organizations should view the training of employees in mental health and crisis intervention as contributing to the overall resiliency of the organization, in addition to providing services that facilitate the resilience and recovery of employees affected by personal or workplace stress or critical incidents.

Awareness and utilization of peer support programs in Singapore public general hospitals.

To address the effects of acute, chronic and cumulative stress in the healthcare environment in Singapore, the Ministry of Health provided funding to develop a comprehensive crisis response management system (peer support programs/PSPs) that increases mental health awareness, provides emotional support to affected staff during work-related critical incidents and assists hospital management to better understand the emotional needs of the employees. This paper reports the awareness and utilization of PSPs in Singapore public general hospitals about one year after they were set up.

Genetic analysis of the thermolabile methylenetetrahydrofolate reductase variant in schizophrenia and mood disorders.

OBJECTIVE: An elevated homocysteine level has been reported for patients with schizophrenia and depression. We investigated the frequency of the common C667 T variant of the enzyme methylenetetrahydrofolate reductase in controls and patients of Chinese descent. METHODS: Controls with no history of mental disorder and patients diagnosed with schizophrenia, bipolar and unipolar disorders were recruited. Genomic DNA from all were genotyped for the C667 T polymorphism by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: There was no significant difference in genotype distributions or allele frequencies between controls and any of the diagnostic groups, although the frequency of the T allele was higher for all diagnostic groups and for both the male and female genders. When data was analyzed with the minor T allele as dominant, there was an excess of the T-containing genotypes in each of the patient groups compared with controls. For the difference between controls and all cases combined it almost reached statistical significance (P=0.077), with an odds ratio of 1.46 (95% confidence interval, 0.96-2.22). CONCLUSIONS: Although there was no significant association as measured by the P value, the odds ratio and confidence interval provided some evidence of increased risk for individuals with the T-containing genotypes. A minor role for this polymorphism in the pathogenesis of schizophrenia and depression could not be ruled out and would warrant further investigation.

Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore.

AIMS: To describe the psychological impact of severe acute respiratory syndrome (SARS) on health care workers in a regional general hospital 2 months post-outbreak. METHOD: Doctors and nurses were encouraged to participate. The survey consisted of self-report measures: demographics, the General Health Questionnaire (GHQ) 28 and Impact of Events Scale (IES). A questionnaire enquiring about changes in life's priorities due to SARS and circumstances that helped with coping was used. Participation was strictly voluntary and responses anonymous. RESULTS: In total 177 out of 661 (27%) participants [40 out of 113 (35%) doctors and 137 out of 544 (25%) nurses] had a GHQ 28 score >or=5. Doctors [P = 0.026, odds ratio (OR) = 1.6 and 95% confidence interval (CI) = 1.1-2.5] and single health care workers were at higher risk (P = 0.048, OR = 1.4 and 95% CI = 1.02-2.0) compared to nurses and those who were married. Approximately 20% of the participants had IES scores >or=30, indicating the presence of post-traumatic stress disorder (PTSD). Four areas were classified as more important using factor analysis: health and relationship with the family, relationship with friends/colleagues, work and spiritual. The areas for coping strategies were clear directives/precautionary measures, ability to give feedback to/obtain support from management, support from supervisors/colleagues, support from the family, ability to talk to someone and religious convictions. Support from supervisors/colleagues was a significant negative predictor for psychiatric symptoms and PTSD. Work and clear communication of directives/precautionary measures also helped reduce psychiatric symptoms. CONCLUSIONS: Many health care workers were emotionally affected and traumatized during the SARS outbreak. Hence, it is important for health care institutions to provide psychosocial support and intervention for their health care workers.

Influence of work environment on emotional health in a health care setting.

BACKGROUND: Radical changes are taking place in health care services and might be expected to cause job dissatisfaction, absenteeism, somatic complaints and mental health problems. Research in this area is limited and focused primarily on nurses. AIM: To understand the impact of the work environment on the emotional health of doctors and nurses in a general hospital setting. METHODS: Cross-sectional study using self-reported questionnaires including the General Health Questionnaire, the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians, the Trauma Experiences and Work Environment Scale. RESULTS: The response rates for the study were 28% (60) for doctors and 54% (431) for nurses. Whilst the prevalences of psychiatric disorder, anxiety, depression and PTSD were higher for doctors compared with nurses, this was not statistically significant. Both groups reported witnessing someone badly injured or killed as their most distressing experience (doctors 46% versus nurses 41%). Using multiple logistic regression, significant predictors of emotional health was task orientation for doctors (OR = 1.96, 95% CI = 1.1-3.6), and PTSD (OR = 17.2, 95% CI = 6.0-49.6), work pressure (OR = 1.2, 95% CI = 1.01-1.4) and innovation (OR = 0.81, 95% CI = 0.70-0.94) for nurses. CONCLUSION: The prevalence of psychiatric disorder among the doctors and nurses was similar to that in Britain. Elements of the work environment did impact on the emotional health of health care workers. Organizational development initiatives should include employee mental health issues in order to create a more positive work environment.

Case-control and linkage disequilibrium studies of the tryptophan hydroxylase gene polymorphisms and major depressive disorder.

OBJECTIVES: Alterations in the level of the serotonin, serotonin uptake and the number of binding sites have been linked to affective illness. We investigated the association of tryptophan hydroxylase gene polymorphisms and unipolar depression in a case-control study design. METHODS: Patients and ethnically matched controls were genotyped for three polymorphisms of the tryptophan hydroxylase gene. RESULTS Significant difference in genotype frequency between patient and control groups was observed for the IVS7+218A >C polymorphism but not for the two promoter polymorphisms -1067G >A and -347T >G. Strong linkage disequilibrium among the three polymorphisms was also observed. CONCLUSIONS: As the sample size was small, the positive association would need to be replicated by family-based association studies or in a larger set of samples. As our results did not indicate association with either of the two promoter polymorphisms, there is a need to continue the search for the causative variant directly involved in the susceptibility to unipolar depression in Chinese as this polymorphism within the intron might not be the true susceptibility variant.

Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South australia.

BACKGROUND: Motor vehicle accident studies thus far have focused primarily on psychiatric consequences and outcomes and medicolegal and treatment aspects, particularly of posttraumatic stress disorder (PTSD). This study aimed to determine the impact of motor vehicle accident-related psychiatric disorders on health and economic costs in quantitative terms. METHOD: Of the 3088 victims of motor vehicle accidents who made a claim through the State Insurance Commission, South Australia, between November 27, 1996, and March 23, 1999, 391 responded to the study and were assessed using the 28-item General Health Questionnaire, the PTSD Checklist-Civilian Version, and the Dissociative Experiences Scale. At the end of the study period, computerized cost records and accounting data on the health and economic costs incurred were obtained for each of the subjects. RESULTS: The total health and economic cost in Australian dollars for the 391 motor vehicle accident victims was A$6,369,519.52. At about 9 months after the accident, of the 391 subjects who replied to the questionnaires, 31% were identified as depressed and 62% as anxious, while 29% met criteria for PTSD. PTSD cases incurred significantly higher health care costs compared with non-PTSD cases (p <.001). Untreated PTSD cases incurred significantly higher economic losses compared with treated PTSD and non-PTSD cases (p <.05). CONCLUSION: The health and economic costs associated with motor vehicle accidents are enormous. Psychiatric morbidity among victims was high, and motor vehicle accident-related PTSD significantly contributed to increased overall health care and economic costs.