Brit Haver

Self-development groups reduce medical school stress: a controlled intervention study

BackgroundHigh stress levels and mental health problems are common among medical students and there is a lack of studies on group interventions that aim to reduce such distress during medical school.MethodsA full class of students (n = 129) participated in group sessions during their third year of medical school in Bergen, Norway. The subsequent third-year class (n = 152) acted as control group, in order to create a quasi-experimental design. Two types of group intervention sessions were offered to the first class. One option was self-development groups led by trained group psychotherapists. Alternatively, students could choose discussion groups that focused on themes of special relevance to doctors, led by experienced general practitioners. The intervention comprised of 12 weekly group sessions each lasting 90 minutes. Data were gathered before the intervention (T1), and three months post intervention (T2). Distress was measured using the Perceived Medical School Stress (PMSS) and Symptom Check List-5 (SCL-5) assessments.ResultsThe intervention group showed a significant reduction in PMSS over the observation period. The subsequent year control group stayed on the same PMSS levels over the similar period. The intervention was a significant predictor of PMSS reduction in a multiple regression analysis adjusted for age and sex, β = -1.93 (-3.47 to -0.38), P = 0.02. When we analysed the effects of self-development and discussion groups with the control group as reference, self-development group was the only significant predictor of PMSS reduction, β = -2.18 (-4.03 to -0.33), P = 0.02. There was no interaction with gender in our analysis. This implicates no significant difference between men and women concerning the effect of the self-development group. There was no reduction in general mental distress (SCL-5) over this period.ConclusionA three-month follow-up showed that the intervention had a positive effect on perceived medical school stress among the students, and further analyses showed this was due to participation in self-development groups.

Personality traits predict job stress, depression and anxiety among junior physicians

BackgroundHigh levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation.MethodsMedical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper’s Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25.ResultsExtroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = −.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52).ConclusionsCertain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.

Comorbid Psychiatric Disorders Predict and Influence Treatment Outcome in Female Alcoholics

Drinking patterns, psychiatric comorbidity and personality disorders (PD) at intake and at a 2-year follow-up were studied in 120 female alcoholics early in their treatment career. At follow-up, the women had improved their drinking patterns, but their mental health still differed significantly from women of the general population. Psychiatric comorbidity at intake correlated with a significantly worse drinking and mental health outcome. Subjects with high scores on phobias more frequently dropped out of treatment and thereby had a worse drinking outcome. Subjects with depression at follow-up also had a poorer drinking outcome, as well as subjects with schizoid PD. When tested by multivariate analyses, only depression at follow-up contributed significantly to the increased explained variance in drinking outcome when controlling for drinking pattern and treatment duration.

Phobic anxiety and depression as predictor variables for treatment outcome. A LISREL analysis on treated female alcoholics

The study focuses on the relationship between phobic anxiety and depression, alcohol abuse, treatment and drinking outcome in female alcoholics. A structural equation analysis (LISREL) was used to test the strength and direction of predictor variables, enabling the development of models for the process of change taking place following treatment. Participants were patients attending a specific treatment programme for women with alcohol problems at Karolinska Hospital, Stockholm, Sweden. One hundred and twenty female alcoholics consecutively admitted during 1991–1993 were followed up 2 years after treatment. The Alcohol Use Inventory (AUI) and Symptom Check List-90 were used at intake and follow-up. Duration of problem drinking and depression at follow-up affected drinking outcome directly and negatively, whereas duration of treatment affected drinking outcome directly and positively in all our models. Phobic anxiety on the other hand affected drinking outcome negatively and indirectly, via shorter treatment duration and higher depression at follow-up. Using different outcome variables as an end product resulted in only minor changes. Thus, the model presented is viewed as robust and clinically meaningful. The results underscore the importance of phobic anxiety and recurrent or sustained depression – in addition to the pre-treatment duration of problem drinking – for the drinking outcome among female alcoholics.

Female alcoholics V: The relationship between family history of alcoholism and outcome 3–10 years after treatment

ABSTRACT— In a long‐term follow‐up study of 44 female alcoholics, a family history of alcoholism was related to younger age of onset of problem drinking, but did not necessarily imply a poorer outcome within this highly selected group of individuals. Alcoholism in father and his family was not related to either antisocial or borderline personality disorder nor outcome. However, alcoholism in mother and her family correlated with both borderline personality disorder and a significantly poorer outcome. The findings are discussed within different frames of reference, considering genetic mechanisms, psychodynamic factors and family systems theory.

Improving the usefulness of the Karolinska Psychodynamic Profile in research: proposals from a reliability study

The interrater reliability of data obtained by use of the Karolinska Psychodynamic Profile (KAPP) was tested among 60 women seeking treatment for drinking problems. The first rater had a psychodynamic background but was minimally trained rating the KAPP subscales and performing KAPP interviews. Independent, blind ratings of audiotaped interviews by an experienced KAPP rater revealed that 8 of the subscales obtained satisfactory reliability, whereas 6 subscales showed unsatisfactory reliability. Furthermore, data for one subscale (normopathy) showed a zero correlation between raters, probably due to the novelty of the construct. Additionally 3 subscales related to bodily aspects were of little clinical significance among the present study group. Our data were compared with data from previous KAPP reliability studies, and the reasons for similarities and discrepancies of results are discussed.

Female alcoholics: III. Patterns of consumption 3-10 years after treatment

ABSTRACT— In a follow‐up study of 55 female alcoholics, 44 women (80%) were interviewed on an average of 6.5 years after treatment. According to the reported quantity and frequency of drinking the year prior to follow‐up, eight women (18%) were classified as abstainers, nine (20%) as light drinkers, ten (22%) as moderate drinkers, and 17 (39%) as heavy drinkers. In a longitudinal perspective, four main patterns of outcome could be discriminated: long‐term abstinence, short‐term abstinence intermingled with drinking, asymptomatic drinking and continuous heavy drinking. Most of the asymptomatic drinkers reported a consumption of very small amounts of alcohol, avoiding becoming intoxicated. Those women who reported consumption of more than 2/3 of a bottle of spirits on any single drinking day or consumed more than 7 liters of pure alcohol annually, usually satisfied the DSM‐III criteria for alcohol abuse or alcohol dependence.

Level and Change in Alcohol Consumption, Depression and Dysfunctional Attitudes among Females Treated for Alcohol Addiction

Aims: To examine whether individual changes in alcohol consumption among female alcoholics under treatment are predicted by level of and changes in depression and dysfunctional attitudes. Method: A total of 120 women who were treated for alcohol addiction at the Karolinska Hospital in Stockholm (Sweden) were assessed twice over a 2-year period using the Depression scale from the Symptom Checklist-90, the Alcohol Use Inventory and the Dysfunctional Attitude Scale (DAS). Latent growth curve analysis was used. Results: Decrease in alcohol consumption, depression and dysfunctional attitude variables were found at group level. The results also showed significant individual variation in change. Changes in alcohol consumption were predicted by baseline alcohol drinking, as well as by level and changes in depression. Stronger reduction in depression was related to higher level of depression at baseline, and with reduction in dysfunctional attitudes. Different DAS sub-scales resulted in different magnitude of the model relations. Good treatment compliance was related to lower baseline level in depression, but also with higher baseline level in dysfunctional attitudes, and predicted stronger reduction in alcohol consumption. Conclusion: This paper shows the importance of incorporating both individual level and change in depression as predictors of change in alcohol consumption among subjects treated for alcohol addiction. Also, dysfunctional attitudes are both indirectly and directly related to treatment outcome. By incorporating alcohol consumption, depression and dysfunctional attitudes as targets of intervention, treatment compliance and outcome may be enhanced.

The Karolinska Project for Early Treatment of Women with Alcohol Addiction

The article reviews a treatment program – the Karolinska project for Early treatment of Women with Alcohol Addiction (EWA) – located at the Magnus Huss Clinic, Karolinska Hospital, Stockholm, Sweden.

Early Treatment for Women with Alcohol Addiction (EWA) Reduces Mortality: A Randomized Controlled Trial with Long-Term Register Follow-up

Aims: To compare the mortality of female alcoholics randomly assigned to the woman-only programme ‘Early treatment for Women with Alcohol Addiction’ (EWA) versus those who received mixed gender ‘Treatment As Usual’ (TAU). Methods: Randomized controlled trial involving 2-year follow-up by personal interview and mortality register data through 27 years of 200 women first time treated for alcohol use disorder (AUD; EWA, n = 100 and TAU, n = 100), who were consecutively recruited during 1983–1984. Data from the Causes of Death Register were used to test for mortality differences related to group interaction predictors such as age, inpatient versus outpatient status at intake and 2-year drinking outcome. Results: Significantly lower mortality was found among younger women who participated in EWA compared with those who received TAU. This difference lasted nearly 20 years after intake to treatment. For women who only needed outpatient treatment, reduced mortality was found in the EWA group, even for older women. Increased mortality was found for TAU women who did not attend the 2-year follow-up compared with those who attended; no such difference was found for EWA women. This indicates different attrition mechanisms in the two groups. Thus, previously reported treatment effects may have been underestimated. EWA was a more comprehensive programme than TAU while also being single gender. Conclusions: EWA, specifically developed to meet a broad spectrum of problems among women with AUDs, was more effective than TAU, a mixed gender programme. It was not possible to separate whether this was in part because it was a more comprehensive programme, as well as being single gender.