Confidentiality as a barrier to support seeking among physicians: the influence of psychosocial work factors in four European hospitals (the HOUPE study).

BACKGROUND: Concerns about protecting patient's privacy can interfere with proper stress adaptation which is associated with physician's health. It is important to investigate relevant organizational confounders to this phenomenon to enable interventions that can ameliorate the subjective burden of patient confidentiality. OBJECTIVES: This study investigates factors in the psychosocial work environment that can explain patient confidentiality's prominence in social support seeking among physicians, and if these factors covary differently with support seeking according to country. PARTICIPANTS: University hospital physicians in four European cities (N=2095) in Sweden, Norway, Iceland and Italy participated in a cross-sectional survey. METHODS: Questionnaire comprised items on psychosocial work environment, basic socio-demographics, presence of formal and informal meetings at work, and measurement of confidentiality as a barrier for support. RESULTS: High role conflict, availability of formal or informal meetings, lack of control over decisions, and lack of control over work pace were predictors of confidentiality as a barrier to support. There were differences between countries in how these factors covaried with confidentiality as a barrier to support. High role conflict was the strongest predictor of confidentiality as a barrier to support across all samples. CONCLUSIONS: Psychosocial work factors predicted confidentiality as a barrier to support seeking among physicians. It is important to create routines and an organizational framework that ensures both the patient's right to privacy and physician's ability to cope with emotional demanding situations from work.

Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study.

BACKGROUND: Male and female physicians are at elevated suicide risk. The work environment has become a focus of attention as a possible contributor to this risk. The potential association between work environment and suicidal thoughts has been examined among female physicians in several countries, and significant findings have been reported. OBJECTIVE: The purpose of this study was to examine the role of the work environment in relation to suicidal thoughts among male university hospital physicians in 2 European countries. METHODS: Cross-sectional multivariate analysis was performed to identify significant associations between work-related factors and suicide risk among male physicians from the Health and Organization among University Hospital Physicians in Europe (HOUPE) study. The dependent variable was termed recent suicidal thoughts, which includes having thought about suicide and/or having thought about specific ways to commit suicide within the previous year. Adjusted odds ratios (ORs) and CIs are reported. RESULTS: Of the 456 Swedish (56%) and 241 Italian (39%) male physicians who participated, 12% of the physicians from each country reported affirmatively regarding recent suicidal thoughts. Degrading work experiences were associated with recent suicidal thoughts for the Swedish and Italian physicians (OR = 2.1; 95% CI, 1.01-4.5; OR = 3.3; 95% CI, 1.3-8.0, respectively). Role conflict was associated with recent suicidal thoughts among the Swedish physicians (OR = 1.6; 95% CI, 1.1-2.2). Support at work when difficulties arose appeared to be protective for the Swedish physicians (OR = 0.7; 95% CI, 0.5-0.96). Italian physicians with little control over working conditions had an increased risk of recent suicidal thoughts, whereas confidential discussions about work experiences appeared to be protective (OR = 0.6; 95% CI, 0.4-0.9). CONCLUSION: Attention should be paid to the work environment as it relates to suicide risk among male university hospital physicians, particularly to bolstering social support and preventing harassment.

How the psychiatrists of a mental health department managed their patients before an attempted suicide.

AIMS: The aim of this survey was to describe patients in care at a large mental health department in northern Italy who attempted suicide, and the clinical management adopted by their psychiatrists before the event. METHODS: Data collection was based on a questionnaire administered to the reference psychiatrists. RESULTS: Over a period of 12 months, 166 catchment area residents attempted suicide. Sixty-six (40%) had contacted the mental health department in the previous two years and completed data were obtained on 63. Twenty-nine (46%) suffered from mood, 26 (41%) from personality and 11 (18%) from schizophrenic disorders. Thirty-four attempts occurred within one year of psychiatric ward discharge, mostly in the first quarter. The reference psychiatrists reported that, at the last evaluation, 38 of 63 patients (60%) presented no change in clinical conditions, and 41 of 63 (68%) were considered at no immediate risk of suicide. Most of the attempted suicides in question (45, 72%) were judged to be unpreventable. In the two logistic regression analyses carried out, no independent variables were able to statistically significantly explain the variance in judged suicidal risk or the preventability of the index attempted suicide. CONCLUSIONS: According to the psychiatrists' descriptions of their last contact with the patients, most attempted suicides have not been preceded by a change in clinical conditions. Moreover, psychiatrists, irrespective of their age and gender, and of patient diagnosis, frequently judged the attempts to have been unpreventable.

Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors.

BACKGROUND: Suicide rates among physicians are higher than in the general population, and rates among female physicians are particularly high. More female than male physicians report suicidal thoughts, with suicidal ideation being a well-recognized precursor of suicide. The urgent need to find the reasons for suicide risk in female physicians is underscored by society's increasing dependence on this group of health care providers. OBJECTIVE: The aim of this paper was to identify potential risk and protective factors associated with recent suicidal ideation in female physicians. METHODS: A cross-sectional survey analysis of work-related health, organizational culture, career paths, and working conditions was performed among permanently employed female physicians from the HOUPE (Health and Organisation among University Physicians in four European countries) study: 385 in Sweden and 126 in Italy. The main outcome measure was recent (within the prior 12 months) suicidal thoughts. RESULTS: Overall, 13.7% and 14.3% of the participants from Sweden and Italy, respectively, reported suicidal thoughts within the prior 12 months. Among the physicians from Sweden, the most powerful multivariate model for such thoughts included 2 independent variables related to work: degrading experiences/harassment at work (odds ratio [OR], 3.03; 95% CI, 1.48-6.23), and work meetings to discuss stressful situations (OR, 0.36; 95% CI, 0.19-0.69). The model included self-diagnosis and self-treatment as a significant factor. Work meetings to discuss stressful situations were also in the multivariate model for the Italian physicians (OR, 0.21; 95% CI, 0.05-0.86), together with being given work assignments without adequate resources (OR, 5.0; 95% CI, 1.32-18.8). Significant non-work-related factors in the Italian model were younger age and seeking professional help for depression or burnout. CONCLUSIONS: In both Sweden and Italy, work stressors have been identified that may increase the risk for suicide for female physicians. A potential protective factor was meetings to discuss stressful work experiences. These findings suggest that such meetings should be more broadly implemented.

Death ideas, suicidal thoughts, and plans among nursing home residents.

Recent studies have shown that suicides are at least as frequent among Nursing Home (NH) residents as they are among older people in the general population. The objective of the present study was to evaluate the prevalence of death- and/or suicidal feelings, thoughts, and plans and any attempted suicides in a random, unselected sample (N=288) of individuals aged 65-years-and-over, living in NHs located in the Veneto Region (the Italian North-East). One hundred seventy-two participants were surveyed with a response rate of 59.7%. Five sample questions were asked to investigate the presence of death- and suicidal thoughts, plans and behaviors in different time periods. Among the NH residents, 30.8% admitted having had death or suicidal thoughts or plans during the month prior to the interview. The oldest-old residents (85+y) more frequently reported death-suicide ideation. This high frequency of death and/or suicidal feelings and thoughts among older NH residents should be carefully considered when planning and implementing health care programs in these facilities.

Accident proneness and impulsiveness in an Italian group of burn patients.

There is controversy about the existence of a predisposition to burn incidents (accident proneness). Our objective was to examine, in a group of burn patients, the conditions or "unconscious" subjective predisposition, the presence of impulsiveness that may have contributed to bringing about the "burn" event, and to assess the presence of psychiatric diagnoses and specific characteristics of temperament. 25 consecutive burn patients were interviewed by using specific psychometric tests. The sample was divided into two groups: "control" group (N=10), composed of subjects who had accidentally been involved in the incident and "case" group (N=15) composed of subjects who had very likely and more or less "knowingly" put themselves at risk of injury. We observed a marked statistically significant difference with case group subjects appearing to be more impulsive than the ones in control group. Higher levels of impulsiveness may predispose case group patients to a greater risk of burn. Our survey also seems to reveal a relationship between impulsiveness and the proneness of some subjects to burns.

[Heterogeneity of the Departments of Mental Health in the Veneto Region ten years after the National Plan 1994-96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project]. / Eterogeneità dei DSM veneti a dieci anni dal Progetto Obiettivo "Tutela Salute Mentale 1994-96". Quali implicazioni per la pratica clinica? Indagine sui servizi partecipanti al Progetto PICOS-Veneto.

AIMS: This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health ("Progetto Obiettivo 1994-1996") ten years after its launch. METHODS: The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. RESULTS: CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. CONCLUSIONS: A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

Suicidal behaviour in nursing homes: a survey in a region of north-east Italy.

OBJECTIVE: To assess suicide and attempted suicide (AS) rates and their characteristics among older residents in Nursing Homes (NHs) of the Veneto region, in the North-East of Italy. METHOD: The complete list of NHs was provided by the Regional Department of Health. Structured interviews were completed with NH managers, inquiring about NH, staff and management characteristics, mental health care available and the number of completed and attempted suicides (AS) in 2001 made by residents older than 65 years, occurring either inside or outside NHs. All facilities which reported suicidal events were asked additional information. RESULTS: In the study period, five completed suicides and eight AS were reported, i.e. a rate of 18.6/100,000 and of 29.7/100,000 respectively. All but one suicides and one AS had a history of mental disorders. Seven subjects had been living in a NH for less than one year. There were no significant differences in the frequency of suicidal events between the facilities which employed or did not employ mental health workers. CONCLUSION: The suicide rate found in this facility sample is much higher than the rate reported by the Italian National Statistic Institute for the over-65-year-old population of the Veneto Region in 2001, and is similar to the rate reported in a previous study conducted in another country. In Veneto NHs behavioural control of residents, lack of access to a variety of means used for suicidal purposes and medical supervision does not seem to have protected the NH population from suicidal risks.

Paroxetine versus amitriptyline in patients with recurrent major depression: A double-blind trial.

INTRODUCTION: Long-term exposure to antidepressants is required to prevent relapses and recurrences in patients with recurrent major depression. Furthermore, a good pharmacological compliance is the key to successful long-term treatment. Since the early phases of a treatment influence long-term compliance and compliance is adversely affected by poorly tolerated treatments, efficacy and tolerability of paroxetine and amitryptiline over 12 weeks were compared as an introduction to the issue of long-term compliance to these two agents. METHOD: A 12-week, randomized, double-blind, doubledummy, parallel-group trial which involved 129 patients with recurrent major depression. RESULTS: Both paroxetine and amitriptyline were effective in controlling the symptoms of depression, as shown by the reduction in HAMD total score and CGI severity-of-illness score at endpoint compared to baseline. There was no statistically or clinically significant difference between the two treatments in terms of efficacy. However, marked numerical differences were noted in tolerability: the percentage of patients who reported treatment-emergent adverse experiences was greater in the amitriptyline group (40.0% vs 28.1%). This difference was mainly due to anticholinergic adverse events, which were six times more frequent with amitriptyline than with paroxetine. CONCLUSION: When compared with amitriptyline, paroxetine should allow patients with recurrent major depression to receive an equally effective treatment with a relatively lower incidence of adverse experiences.