Workplace harassment, active coping, and alcohol-related outcomes.

PURPOSE: While sexual harassment and generalized workplace abuse (GWA) have been linked with alcohol use and abuse, active problem-focused coping has been shown to lessen vulnerability to deleterious mental health consequences of varied social stressors. At the same time, active coping is relatively more efficacious in response to stressors, which are amenable to change by personal actions. However, the moderating role that coping plays in relation to harassment and drinking is unknown. METHOD: Using data from a two-wave survey of university employees (N=2038), we addressed the extent to which (1) active coping was utilized by harassed and abused employees, (2) whether coping impacted on the continuation or cessation of harassment and abuse, and (3) the extent to which nonsuccessful coping was predictive of alcohol use and abuse. RESULTS: Active coping had no significant impact on the ability to end harassing or abusive experiences. Moreover, the use of problem-focused coping that was unsuccessful predicted some drinking outcomes for both men and women, controlling for Wave I drinking and sociodemographic characteristics. IMPLICATIONS: The data suggest that increased institutional attention to the prevention of workplace harassment and abuse might impact on decreasing alcohol use and abuse.

Reengineering clinical psychiatry in academic medical centers: processes and models of change.

Managed care poses a major threat to the future of clinical psychiatry in academic settings. High costs and an aversion to the business aspects of service delivery have left academic departments at a disadvantage in the marketplace. However, numerous departments have attempted to adapt to the current health care environment. On the basis of a review of these efforts, the authors identify the processes of change and seven models of change being employed to reengineer psychiatry within academic medical centers. The models are labeled transform, build, manage, buy, partner or affiliate, sell or lease, and consult. The authors discuss the strengths and weaknesses of these efforts and suggest three approaches to establishing the unique value of academic clinical services for purchasers and for the public. The first is to enhance productivity and clinical effectiveness through greater integration of clinical care, research, and training. The second is to take a leadership role in managing care, and the third is to advance the integration of behavioral health care with primary medical care and other specialties in the medical center.

Effectiveness of coerced addiction treatment (alternative consequences): a review of the clinical research.

Of central importance is that our clinical experience and treatment outcome studies to date strongly suggest that coercion is fundamental to addiction treatment and favorable outcomes from therapeutic interventions. Often the alcoholic/drug abuser must be given an opportunity to feel, face, or experience the "consequences" of their alcohol and drug addiction before the denial of their illness can be penetrated and motivation for treatment to recover from addictive illness can be developed. Continued use of alcohol and drugs is an unhealthy and dangerous state for those who are addicted and for others who are affected by their addictive illnesses. Effective therapeutic interventions and long-term recovery are more likely to succeed if avoiding "alternative consequences" are contingent on continued compliance with addiction treatment by those who suffer from addictive illnesses.

Chronicity of sexual harassment and generalized work-place abuse: effects on drinking outcomes.

AIMS: This study examined the impact of two forms of interpersonal conflict in the work-place, sexual harassment (SH) and generalized work-place abuse (GWA), on drinking outcomes. We hypothesized that SH and GWA would be associated more strongly with negative outcomes than task-related work stressors, especially when SH and GWA were chronic problems. DESIGN: This was a two-wave panel study. SETTING: The study was conducted at an urban university in the United States. PARTICIPANTS: Participants were 2038 university employees in four occupational groups (faculty, student, clerical and service workers) who responded to both waves of the survey. MEASUREMENTS: Data on SH, GWA, task-related stressors and drinking outcomes were gathered from self-report mail questionnaires. Data from 1880 non-abstaining respondents were included in the analyses. FINDINGS: SH and GWA experiences were widespread, typically chronic, and tended to co-occur. In regression analyses controlling for demographics, occupational group, prior drinking and task-related stress, GWA chronicity was linked to increased odds of reporting one or more indicators of problem drinking at time 2, in contrast to onset and remission. SH chronicity coupled with no GWA experiences was also significantly related to increased drinking variability. Task-related stressors generally did not explain significant variance in drinking outcomes. CONCLUSIONS: SH and GWA may be better predictors of drinking behavior compared to task-related stressors, particularly when harassment is chronic. Increased attention to conflictual relationships in the work-place, the relationship between SH and GWA and the dynamic nature of stressors in general is necessary in future research on drinking behavior.

Sexual harassment and generalized workplace abuse among university employees: prevalence and mental health correlates.

OBJECTIVES: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. METHODS: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. RESULTS: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. CONCLUSIONS: Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies.

Use of psychiatric services by homeless veterans.

Patients treated in a Department of Veterans Affairs (VA) emergency room were evaluated to delineate the differences in use of services between homeless and domiciled veterans who have mental disorders. Data were obtained and compared on DSM-III-R diagnoses, number of hospitalizations, lengths of stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders were significantly more likely to have emergency visits and psychiatric admissions in the preceding 12 months than were the domiciled veterans. However, the average length of stay was shorter for the homeless group. These differences must be accounted for in the design of programs targeting homeless veterans with mental illness.

Prevalence of depression and alcohol and other drug dependence in addictions treatment populations.

The diagnosis of depression has been viewed as an important factor in the treatment response for those who have alcohol and other drug dependence. The objective of the study was to examine the prevalence of a lifetime history of major depression in inpatients with a substance use disorder in addictions treatment. An evaluation study of 6,355 patients was conducted in inpatient and outpatient addictions treatment programs from 41 sites. Subjects were required to have a substance use disorder and to be evaluated for a lifetime diagnosis of major depression according to DSM-III-R criteria. The rate of a lifetime diagnosis of major depression was 43.7%. The most common diagnosis was alcohol dependence, followed by cocaine dependence, and cannabis dependence). Depression was associated in significantly greater numbers with diagnoses involving drugs other than alcohol, in females greater than in males, with number and frequency of use, and in inpatient programs more than outpatient programs. The rates for continuous abstinence at one year did not differ between those with and without a lifetime history of depression.

Perceived workplace harassment experiences and problem drinking among physicians: broadening the stress/alienation paradigm.

Sociologists who embrace the stress or alienation paradigms generally focus on explaining problem drinking in low status occupations. By contrast, this paper argues that a broadened conceptualization of stress and alienation which incorporates abusive work relationships has utility for explaining male and female drinking outcomes in both high and low status occupations. We provide empirical data on the relationship between perceived abusive experiences and drinking outcomes in a cohort of male and female physicians in their internship year of training. The data show that perceived sexual harassment, discriminatory treatment and psychological humiliation relate to various drinking outcomes in men and women, controlling for drinking prior to the internship year. While females were more likely to report experiencing abuse, these perceived experiences had deleterious effects on drinking outcomes for both genders. Personal vulnerability (narcissism) brought into the training environment somewhat influenced the later reporting of abusive experiences by males but not by females. Regression analyses showed that, for both males and females, work-place abusive experiences in interaction with personality vulnerability best explained drinking outcomes. The implications of these results for the design of future alcohol-related work-place studies are discussed.

The effect of non ionising electromagnetic radiation on RAAF personnel during World War II.

Did exposure to non ionising electromagnetic radiation during World War II in the short term have a stimulating effect on the anterior pituitary gland, and in turn on the gonads of both sexes, since the figures obtained appeared to affect the sexes equally? Is it that the long-term effect of microwave radiation on personnel is to cause adenoma and carcinoma? Is this long-term effect similar to the long-term effect of X-rays on infants, children and adolescents? According to Harrison's Principles of Internal Medicine 1980 (page 1710): "X-rays to the head and neck in infancy, childhood or adolescence is associated with a high incidence of thyroid disease later in life. Nodular disease is found to be particularly common on 20% of patients at risk, and may not be apparent until 30 years or more after exposure. One-third of the nodular type are found to be carcinomatous." The effect of non ionising electromagnetic and microwave radiation on those who work in these fields certainly needs much more investigation. What will be the long-term effect of using micro-ovens on the rising generation?

Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies?

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as "the yuppie flu," similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community "true" prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease.

Substance use and addiction among medical students, residents, and physicians.

When turning to our original questions, we offer the following tentative conclusions: 1. Although medical students as a group have a slightly higher percentage of use of alcohol, the pattern and prevalence of alcohol dependence is very consistent with their age mates in the general population. 2. There appears to be a pattern of increased alcohol problems with age among physicians and attorneys, as opposed to the general US population, which shows a diminution of alcohol-related problems over time. 3. There is no evidence for a marked increase in drug addiction and use of other prescription drugs among physicians. In fact, with the exception of tranquilizers and alcohol and psychedelics, which were used equally by physicians, medical students, residents, and their age mates, most other drug usage was slightly more prevalent in the general population than among students and residents. 4. Of particular concern is the finding of a lack of gender differences in problematic drinking with the pattern of female drinking rates for women approximating that of men by the end of medical school. 5. The most consistent predictive factor in alcoholism among physicians is the same as that in the general population: a family history of alcoholism. 6. Additional predictive factors of physician alcohol-related problems include a narcissistic type personality style that endorses the exploitation of others, a perception of low parental warmth in childhood, and particular stressors in the working or student environment such as being abused by others. Further predictive factors related to occupational stress await the results of ongoing perspective studies. 7. Physicians as a group probably respond more favorably to alcohol and drug addiction programs than do members of the general population. To a great extent, this is directly or indirectly due to the dire consequences of continued use, which include loss of hospital privileges and state licensure. It also would appear that required treatment and monitoring for alcohol and substance abuse has a positive effect on abstinence rates.

Emergency psychiatry training and the decision to hospitalize : a longitudinal study of psychiatric residents.

To assess the impact of a 6-month emergency psychiatry training program on emergency psychiatric decision making, we studied 577 emergency psychiatric patient evaluations conducted by 15 first-year psychiatry residents. By their fifth month of training, the residents' rates of emergency patient hospitalization declined from 33% to 19%. For residents in the early training phase, various clinical features, including psychosis, thought disorder, schizophrenic diagnosis, dangerousness, and overall symptoms, were associated with higher rates of patient hospitalization. By the end of training, only dangerousness and overall symptoms remained significantly related to the hospitalization decision. Specific training in emergency psychiatry may affect psychiatric decision-making practices as early as the first year of residency training.

Mental health consequences and correlates of reported medical student abuse.

OBJECTIVE: To assess the prevalence, correlates, and mental health consequences of reported medical training-related abuses. DESIGN: A longitudinal cohort study of 137 students surveyed from medical school entrance (time 1) through the winter of the fourth training year (time 4). SETTING: A state college of medicine. OUTCOME MEASURES: Reported training-related abuses (measured at time 4) and mental health status measured at times 1 and 4 (depressive and anxiety symptoms, hostility, problem drinking, escapist drinking, alcohol consumption levels, and gender role orientations). RESULTS: Seventy-two percent of students reported at least one abusive experience during medical training. Females were significantly more likely than males to report gender discrimination, exclusion from informal settings, discomfort from sexual humor, and unwanted sexual advances. Abuse was significantly related to most psychopathological outcomes, controlling for pre-existing psychopathology. Males low in masculinity and females low in femininity were most likely to report abuse. CONCLUSIONS: The data provide further support for the assumption that a high proportion of medical students not only experience the training process as abusive in nature but also suffer measurable psychopathological consequences. Efforts should be made to reform medical education, with a prominent focus on gender role-related issues.

Shifts in problem drinking during a life transition: adaptation to medical school training.

This study addresses the course of alcohol-related problems in future physicians from the perspectives of occupational stress versus selection and life-span developmental frameworks. A cohort of medical students was surveyed at medical school entrance and during the early fall of the second training year. Self-report questionnaires assessed: alcohol-related problems (using a modified time-linked version of the MAST), pretraining psychosocial and psychopathological characteristics and experiences (symptomatic distress, motivations for drinking, personality attributes/deficits, familial history of problem drinking, family disruption and earlier parental bonding) and medical-training characteristics (perceived stressors and levels of social support). On the basis of MAST scores, respondents manifested the following drinking patterns: consistent nonproblem drinking (67.4%), problem exit or remission during medical training (19.4%), problem entrance or onset during medical training (6.3%) and problem chronicity involving problems before and during medical training (6.9%). Female students were overrepresented in the consistent nonproblem group. The major predictors of Time 2 problem onset and chronicity as opposed to problem remission involved pretraining factors: familial history of alcohol problems, Time 1 symptomatic distress and escape motives for drinking. Future reports will depict the prevalence and etiology of problem drinking manifested during the clinical portion of medical training.

A biopsychosocial treatment approach to the management of diabetes mellitus.

The relationship among recent life stress, social support, a patient's locus of control, and the control of blood glucose is evaluated in persons with diabetes mellitus, using objective measures of these psychosocial variables. Short-term [fasting blood sugar (FBS)] and long-term [glycosylated hemoglobin (Hgb A-1C)] control measures are taken at two points in time in order to evaluate the effects of the psychosocial variables on change in diabetes control. For life events, a significant positive association was found between the number of recent life events and blood glucose control. Decrease in social support predicted a worsening of longer-term (Hgb A-1C) control over time. An external locus of control within the patient was associated both with poor short-term control at time one and prediction of poorer long-term control over time. The implications of these findings are discussed in support of a biopsychosocial approach to the management of diabetes mellitus.

Psychosocial assets and mental health of minority medical students.

In this study, black, white, and Hispanic medical students are compared in terms of their psychosocial assets and mental health status when they entered medical school and after a year of medical training. The data show that the minority students entered medical school with some distinct advantages over the white students. The minority students reported greater social supports, higher self-esteem, lower anxiety, and more internal locus of control. After one year, however, the blacks manifested slightly lower self-esteem and higher levels of hostility and external locus of control. The Hispanics continued to report higher self-esteem and greater social supports but showed increased external locus of control and higher alcohol consumption. Policy implications for improvements in pre-entrance enrichment programs are discussed.