Ashley Weinberg

Stress and psychiatric disorder in healthcare professionals and hospital staff

BACKGROUND Previous studies of stress in healthcare staff have indicated a probable high prevalence of distress. Whether this distress can be attributed to the stressful nature of the work situation is not clear. No previous study has used a detailed interview method to ascertain the link between stress in and outside of work and anxiety and depressive disorders. METHODS Doctors, nurses, and administrative and ancillary staff were screened using the general health questionnaire (GHQ). High scorers (GHQ>4) and matched individuals with low GHQ scores were interviewed by means of the clinical interview schedule to ascertain definite anxiety and depressive disorders (cases). Cases and controls, matched for age, sex, and occupational group were interviewed with the life events and difficulties schedule classification and an objective measure of work stress to find out the amount of stress at work and outside of work. Sociodemographic and stress variables were entered into a logistic-regression analysis to find out the variables associated with anxiety and depressive disorders. FINDINGS 64 cases and 64 controls were matched. Cases and controls did not differ on demographic variables but cases were less likely to have a confidant (odds ratio 0.09 [95% CI 0.01-0.79]) and more likely to have had a previous episode of psychiatric disorder (3.07 [1.10-8.57]). Cases and controls worked similar hours and had similar responsibility but cases had a greater number of objective stressful situations both in and out of work (severe event or substantial difficulty in and out of work-45 cases vs 18 controls 6.05 [2.81-13.00], p<0.001; severe chronic difficulty outside of work-27 vs 8, 5.12 [2.09-12.46], p<0.001). Cases had significantly more objective work problems than controls (median 6 vs 4, z=3.81, p<0.001). The logistic-regression analyses indicated that even after the effects of personal vulnerability to psychiatric disorder and ongoing social stress outside of work had been taken into account, stressful situations at work contributed to anxiety and depressive disorders. INTERPRETATION Both stress at work and outside of work contribute to the anxiety and depressive disorders experienced by healthcare staff. Our findings suggest that the best way to decrease the prevalence of these disorders is individual treatment, which may focus on personal difficulties outside of work, combined with organisational attempts to reduce work stress. The latter may involve more assistance for staff who have a conflict between their managerial role and clinical role.

Stress in turbulent times

The Fall Of Capitalism? Why Are These Times So Stressful? The Nature Of Stress In Turbulent Times What Do The Sources Of Pressure Mean To Us? Dealing With Stress In The Workplace: The Options For Organizations And Their Employees Coping With Turbulent Times: A Survival Kit For The Individual

What is Stress

To successfully manage a stress situation, we must first define what we mean by “stress” and identify what causes it in order to recognize the effects of exposure to stress. We have already examined the deleterious costs of mismanaged stress in Chapter 1, and acknowledged the implications of the stress litigation process and the consequences of increased employers’ liability insurance in Chapter 2. Now, we need to understand how and why stress is damaging in its consequences.

The Impact of Counsellor Training on Emotional Intelligence.

ABSTRACT This study evaluated the impact of counsellor training on emotional intelligence (EI) in 45 undergraduates and 58 postgraduates. Significant improvements were recorded by students on completion of both programmes, suggesting that these were attributable to training which enhanced intra- and interpersonal aspects of emotional functioning. As a group, postgraduates were older than undergraduates, and at the outset of the study, EISAQ scores were comparable; however, at follow-up, undergraduates recorded significantly higher EISAQ scores. Students’ EI was not significantly related to their age, and these findings indicate the potential for effective EI-skills training which is unrelated to quantity of life experiences. It is hoped that this study contributes to a growing quantitative evidence base from which the counselling profession can evaluate its training profile.

Psychological Considerations in Attending for Mammography Screening

The UK NHS Breast Screening Programme has set a national minimum rate for uptake of routine invitations at 70 % [1]. In 2012–2013, 2.32 million women aged 50–70 were invited to attend for a routine mammogram, 72.2 % of whom complied. This represented a further decrease from previous years in which uptake of routine invitations had fallen (73.4 % in 2010–11 and 73.1 % in 2011–12 [1]). Breast cancer is the most common cancer in women in the UK [2], with more than 80 % survival 5 years after diagnosis [3]. Screening can help reduce breast cancer mortality [4], so why would 27.8 % of women in 2012–2013 fail to accept an invitation for a routine mammogram which may ultimately help to save their lives?

The fall of capitalism

‘I am living in a country which has seen its financial system reach meltdown; there have been mass protests on the streets by an angry public facing an uncertain future; there is widespread disenchantment with politicians and parts of the media and law enforcement; and regular allegations of corruption, cover-up or greed are leveled at organizations which should have known better. Where am I?’

What do the sources of pressure mean to us

This chapter examines three aspects of life affected by turbulent times and the psychological challenges which can follow from each aspect: namely, work, home life and finance. During the usual course of things, we can expect to face difficulties in each of these areas, but a common consequence of widespread economic, political or environmental change is that problems can arise simultaneously in more than one domain. This creates an increased likelihood that we will struggle with multiple demands across key aspects of our lives (see Figure 4.1). This is a bit like the physical phenomenon of the impact of sound waves on a glass when they synchronize, so that greater and greater vibrations can eventually cause it to shatter. Hopefully, as humans we do not reach ‘breaking point’, but it can help to recognize where sources of pressure are coming from so that we can anticipate the potential impact and seek the best survival strategies before disaster strikes, even where there are no ideal solutions. By taking work, home life and finance in turn, this chapter will look at potential sources of pressure and the ways in which these can undermine our sense of well-being. The following chapters look at potential strategies for dealing with these challenges.

The nature of stress in turbulent times

Since gaining popularity in the 1970s and 1980s, the concept ‘stress’ has achieved the status of an overused term. It is readily identifiable as a state of being which is usually less than desirable and describes our state of physical and psychological arousal when pressures bear down on both our daily existence and our sense of well-being. In the context of turbulent times, this is highly relevant to many of us. The first part of this chapter will clarify what is meant by stress, highlighting the emotional and bodily experiences which are consistent with it as well as the impact on organizations and individuals.

Why are these times so stressful

Mismatched expectation is the enemy of happiness. Psychologically speaking, anything around which we anchor our existence can become such a core part of how we see the world that when it ceases to be, we experience loss and are left ‘wandering’. At a personal level the reaction of grief to loss is a natural one and can have far-reaching effects on emotions and well-being as it affects our lives on many different levels. Most readily we can relate this to bereavement, to the break-up of a meaningful relationship and also to losing a job. However, we can also experience a lesser form of loss in our daily lives as disappointment or disillusionment when plans, communications or events do not go as well as expected. Indeed, we base our lives around assumptions about what we will be doing, about the expectations others have of us and those we have of ourselves. This could be termed a ‘psychological contract’, which is made up of an unwritten set of expectations existing between us and those who have a stake in these sets of expectations. Where either party fails to match these expectations, then there is the potential for unhappiness, disagreement and even poorer health. In the shifting environment created by uncertain economic times, there is far greater likelihood that our expectations will not be matched.

Dealing with stress in the workplace: The options for organizations and their employees

In turbulent times, we all need a survival kit, and the organization is no different from the individual in this regard. Whereas some organizations previously felt that the psychological wellbeing of its staff was either a given or a luxury, the full weight of taking for granted this aspect of our working lives has already become apparent. Those employers who have taken an active interest in their employees’ psychological health will be in a far better position to withstand the stress of these times. Research has shown that in organizations in which workers feel engaged in their work, not only are profit margins better, in the first instance (Towers Perrin, 2006), but psychological strain is lower when staff perceive they are supported by their employers (Rhoades and Eisenberger, 2002). According to an annual report in The Sunday Times, ‘The Top Companies to Work For’ tend to be those which already integrate supportive management practices into the way they operate. Since having the support of your line manager is possibly the single mostimportant predictor of your mental health at work, then this support cannot be underestimated.