Denis J. Lynch

A Wellness Program for First Year Medical Students

Entering medical students experience distress symptoms due to the demands of the intensive curriculum, adjustment to new environments and increased responsibilities. The purpose of this controlled, randomized study was to determine the effects of a structured wellness program on measures of anxiety, depression and frequency of acute illness in 449 first year medical students. The effects of eight sessions of stress management were compared to a wait list control group. High risk students were identified based on scores on psychological inventories and number of recent life events (WLE). Results showed that depression, anxiety scores and frequency of acute illness were higher in women than in men, and were higher in students with multiple life events. Significant decreases were observed in depression in the intervention group students when WLE was the covariate (pxa0=xa0.045). Further, the high risk group showed consistently lower depression scores after the intervention compared to high risk wait list controls (pxa0=xa0.003), and these changes were maintained at the end of school year. There were no significant changes in anxiety or frequency of acute illness. Wellness programs can be implemented in medical school and may be particularly useful for entering students with elevated psychological distress.

Stress Management Intervention for First Year Medical Students

Numerous studies have demonstrated the deleterious psychological and physical effects medical school has on students. There are, however, only a few intervention studies that have focused on improving medical students’ ability to cope with this intense stress. This article describes an eight-session stress management program that can be implemented with first-year medical students. The program was designed based on a review of the literature regarding typical sources of stress during the first year of medical school. Each session was interactive and focused on improving skills to manage stress. Medical students who agreed to participate filled out a program evaluation upon completion of the program. Overall, 80% of students were satisfied with the program, and 76% percent would recommend it to other students. Our findings show that it is both beneficial and feasible to offer a stress management intervention to first-year medical students.

Effects of Wellness Programs in Family Medicine

The objective of this research was to determine the effects of wellness programs on quality of life and utilization in an academic family medicine practice in two small controlled studies. One offered stress management and problem solving; the second offered a broader wellness intervention. Outcome measures consisted of scores on the Beck Anxiety Inventory, Hamilton Depression Inventory, CES-D (depression), Health Related Quality of Life, SF-12, and the number of office visits in 6xa0months. Subjects were randomly assigned to intervention or control groups. Statistical analysis compared pre-test and post-test values of the dependent variables between groups. In study one, where the focus was on relaxation, significant differences between groups were observed in anxiety at post-test (pxa0<xa0.03); the intervention group had lower anxiety levels. In study two which had a more general focus, significant group differences were found in days of poor mental health and number of days of depressed mood; the intervention group had fewer days of poor mental health (pxa0<xa0.05) and depression (pxa0<xa0.05) at post-test. No differences were found in utilization in either study. Based on the results of this research, short term wellness programs can be implemented in family practice and are effective in improving quality of life, but not in deceasing utilization in family practice patients. Matching the design of the program to specific patient needs may increase retention and effectiveness.

Rorschach suicide predictors: A crossvalidational study†

Attempted to replicate previously reported findings that individuals who commit suicide give a greater number of transparency and cross-sectional responses on the Rorschach than matched nonsuicidal Ss. In addition, a variety of other scoring categories reported in the literature as being more frequent in suicidal Ss were compared for suicidal individuals and their matched controls. However, neither the transparency and cross-sectional category nor the other response classifications differentiated the groups. Social class and/or IQ differences in the samples used were suggested as a reason for the failure to replicate the earlier study on cross-sectional and transparency scores.

Developmental Changes in Response to Frustration among Physically Handicapped Children

Summary Methods of coping with frustration were examined in handicapped and nonhandicapped children at three different age levels, by means of the Rosenzweig P-F Study. While an extrapunitive approach was predominant in both groups and did not differ between the groups, significant differences were found in the use of secondary coping strategies. When compared with nonhandicapped counterparts, handicapped six year olds were more likely to minimize or deny frustration. At 10 years, handicapped Ss were more likely than nonhandicapped Ss to be intropunitive or self-blaming. There was a developmental tendency for handicapped Ss to make greater use of intropunitive responses with increasing age.

Integration of positive emotional experiences as part of a recreation program

Participants were children, aged 9–12, in a summer recreation program administered by a neighborhood settlement house. One group was given small group experiences to enhance self-acceptance and acceptance of others, while the other group participated in the usual recreation activities. Special experience participants demonstrated a significantly greater decrease on self-reported anxiety and impulsivity measures. There were no significant differences between the groups on measures on self-concept and ideal self, nor on social adjustment ratings made by the staff. Six months after the program ended, there were no differences between the groups on either the anxiety and impulsivity measures or the self-concept and ideal self measures. However, teachers ratings at the follow-up favored the special experience group as regards the ability to get along well with others, exert self-control and assume responsibility for their work.

Managing Antidepressants in Primary Care: Physicians' Treatment Modifications

To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI–II), the Patient Health Questionnaire–9 (PHQ–9), and a demographic survey. Participants mean age was 50.7 yr. and 80% were women. Patients charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.

Prescription Drug Monitoring Programs: Relationships Among Program Awareness, Use, and State Mandates

Abstract The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. The current study used a self-report survey instrument that was administered to 223 participant physicians. The goal of the study was to compare awareness and use of the PDMP in a state that mandates use (Ohio) with one that does not (North Carolina). Although awareness was not significantly different between respondents from the two states, self-reported use was significantly higher in the state mandating use (Ohio post-mandate vs. Ohio pre-mandate: 64% vs. 51%; χ2u2009=u200915.66, Pu2009<u2009.0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2u2009=u200912.76, Pu2009<u2009.0001). Based on these results, mandating use may be an effective method to increase PDMP utilization.

A Stress Management Program for Higher Risk Medical Students: Preliminary Findings

Approximately 10xa0% of first year medical students have clinically relevant anxiety or depression which may affect academic success and quality of life. This study tested the effects of a stress management intervention on indicators of anxiety, depression and self-efficacy in self-selected first year medical students. Forty two medical students volunteered to participate and provided informed consent. An eight session intervention was offered and focused on building relaxation skills, adaptive coping, and basic nutrition. Anxiety, depression, and self-efficacy were assessed pre and post intervention. This group of students had significantly higher baseline values of depression and anxiety but lower self-efficacy compared to a previous study of medical students at the same institution (pxa0<xa00.03). After the intervention, statistically significant improvements were observed in anxiety (pxa0<xa00.05), and self-efficacy (pxa0<xa00.05), but not in depression. The entering levels of anxiety and depression in this group suggested that these students were at risk for later clinical syndromes. Intervention directed to decreasing the effects of stress was associated with improvement in indicators of distress and may modify the longer term risk.

Giving Bad News: Comparing First- and Third-Year Medical Student Performance

Giving bad news has been identified by physicians as a difficult task. This study compares the skills of first-year medical students to those of third-year students that had received training in giving bad news using role-play with standardized patients. Observers completed a checklist developed to determine student skill level.