Susan Klein

The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months

Objective  To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.

Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims

Objectives: To investigate the long term psychological sequelae of treating multiple victims of traumatic incidents, such as violent crime and motor vehicle accidents, and to assess staff exposure to violent patients in the emergency department. Methods: A self administered questionnaire booklet was distributed to all full time and part time staff working within the Johannesburg Hospital Trauma Unit during September 2002. Participation was voluntary. The questionnaire was specifically designed for the study as no relevant, validated questionnaire was found to be suitable. Psychological assessment comprised two standardised measures, the impact of event scale-revised and the Maslach burnout inventory. Results: Thirty eight staff members completed the questionnaire, a response rate of 90%. Over 40% of respondents had been physically assaulted while at work and over 90% had been verbally abused. Staff reported a significant level of post-traumatic symptoms, evaluated by the impact of event scale-revised (median = 17.5, range = 0–88), as a result of critical incidents they had been involved in during the previous six months. At least half of the respondents also reported a “high” degree of professional burnout in the three sub-scales of the Maslach burnout tnventory—that is emotional exhaustion, depersonalisation, and personal accomplishment. Conclusions: Preventative measures, such as increased availability of formal psychological support, should be considered by all trauma units to protect the long term emotional wellbeing of their staff.

First responders after disasters: a review of stress reactions, at-risk, vulnerability, and resilience factors

Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities. The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, it is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfill their roles. This review will explore these themes by highlighting important findings and areas of uncertainty.

Biochemical terrorism: too awful to contemplate, too serious to ignore: subjective literature review.

Background It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues. Aims To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues. Method Literature survey. Results Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multi-disciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology. Conclusions We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. Awell-designed, well-coordinated and rehearsed strategy based on empirical evidence will do much to reduce public anxiety and increase professional confidence.

Body image, shape, and volumetric assessments using 3D whole body laser scanning and 2D digital photography in females with a diagnosed eating disorder: Preliminary novel findings

We piloted three-dimensional (3D) body scanning in eating disorder (ED) patients. Assessments of 22 ED patients (including nine anorexia nervosa (AN) patients, 12 bulimia nervosa (BN) patients, and one patient with eating disorder not otherwise specified) and 22 matched controls are presented. Volunteers underwent visual screening, two-dimensional (2D) digital photography to assess perception and dissatisfaction (via computerized image distortion), and adjunctive 3D full-body scanning. Patients and controls perceived themselves as bigger than their true shape (except in the chest region for controls and anorexia patients). All participants wished to be smaller across all body regions. Patients had poorer veridical perception and greater dissatisfaction than controls. Perception was generally poorer and dissatisfaction greater in bulimia compared with anorexia patients. 3D-volume:2D-area relationships showed that anorexia cases had least tissue on the torso and most on the arms and legs relative to frontal area. The engagement of patients with the scanning process suggests a validation study is viable. This would enable mental constructs of body image to be aligned with segmental volume of body areas, overcoming limitations, and errors associated with 2D instruments restricted to frontal (coronal) shapes. These novel data could inform the design of clinical trials in adjunctive treatments for eating disorders.

Good grief: a medical challenge

Management of the bereaved is an important element in trauma care. Clinicians need to be familiar with the features of normal and pathological grief reactions. The latter have important implications for the physical and mental welfare of the bereaved. Trauma staff are not expected to provide specialist bereavement care for bereaved relations and families, but there is much they can do by way of providing information for the bereaved as well as through their attitudes and behaviour toward them. What happens in the immediate aftermath of the patient’s death is likely to influence the outcome for the bereaved. We need also to remember that grief itself is not a clinical pathology and that most individuals do learn to adjust satisfactorily without specialist help. Indeed, many will come through a bereavement the stronger.

An evaluation of patient satisfaction with an information leaflet for trauma survivors.

A new leaflet that provided information about posttraumatic reactions and how to deal with them was distributed within 14 days of attendance at the Accident and Emergency Department (ED), Aberdeen Royal Infirmary, to a heterogeneous sample of trauma patients (N = 222). An evaluation form to assess satisfaction with the leaflet was also mailed with the leaflet. A sample of 98 (44%) of the initial patient group responded, and 96% of them reported the leaflet as either very helpful or helpful. Satisfaction with the leaflet was not affected by age, by gender, or by the type of trauma encountered. Overall, the findings confirmed that such a leaflet is well received by trauma patients attending an ED.

The use of theory in research.

All researchers should consider the theoretical basis for their studies very early on in the planning stage. The aim of this paper is to describe and discuss how theory (a ‘comprehensive explanation of some aspect of nature that is supported by a body of evidence’) can inform and improve the quality and relevance of pharmacy-based research. Theories can be applied at many stages of quantitative and qualitative (and mixed) research processes, including: providing rationale for the study; defining the aim and research questions; considering the methodological stance; developing data collection and generation tools; providing a framework for data analysis, and interpretation. The focus of the paper is on the use of theoretical lenses, their selection and application. Two key theoretical lenses and their potential applications are described: the Theoretical Domains Framework in studies of behavioural change, and Normalization Process Theory in implementing, embedding and integrating interventions.

Evaluating the effectiveness of a web‐based intervention to promote mental wellbeing in women and partners following miscarriage, using a modified patient preference trial design: an external pilot

Please cite this paper as: Klein S, Cumming G, Lee A, Alexander D, Bolsover D. Evaluating the effectiveness of a web‐based intervention to promote mental wellbeing in women and partners following miscarriage, using a modified patient preference trial design: an external pilot. BJOG 2012;119:762–767.

The costs of conflict: Meeting the mental health needs of serving personnel and service veterans

Abstract Military mental health has, until recently, been a neglected and marginalized area of interest and although both World Wars saw important advances, in peacetime we typically forget lessons learned in earlier conflicts. Since 2003 however, with high intensity war-fighting on two fronts involving the service personnel of many nations, attention has, once again focused on the immediate and long-term emotional and psychological impact of combat. Whilst we know a lot about posttraumatic stress disorder (PTSD), much less attention has been paid to a variety of other equally, if not more salient yet superficially less dramatic problems facing service personnel deployed on operations, but which are much more likely to lead to mental disorder than traumatic events and the ‘horrors of war’. This article describes some of these broader yet less tangible and under-researched issues and discusses the provision of services for the burgeoning veteran community. The mental health of service personnel and veterans is politically sensitive and attracts significant public and media interest. Understanding and responding appropriately to the needs of this group should be of concern to all mental health professionals and it has important consequences, not only for affected individuals but, for the public perception of mental health services as a whole.