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INTRODUCTION: The DoD has prioritized programs to optimize readiness by enhancing resilience of its service members. Problematic anger in the military is an issue that impacts psychological well-being and resilience. Leader support is a potential tactic for reducing anger and its effects. Currently military resilience training is focused on individual level resilience. A gap exists in such training and there is a need to train leaders to provide mental health and resilience support to their subordinates. The present study developed and tested a theory-based training aimed at platoon leaders that focused on how to engage in proactive and responsive mental health and resilience-supportive behaviors through guided discussion, scenarios, and computer-based training with embedded quizzes. MATERIALS AND METHODS: We conducted an Institutional Review Board-approved cluster randomized controlled trial to test the effects of a leadership training with Army platoon leaders (n = 99) and soldiers (n = 276) in 2 brigades at an active duty military installation in the USA. Training was conducted in person with a computer-based component. Soldiers completed online surveys 1 month prior and again 3 months after the leader training. RESULTS: Post-training results demonstrated significant leader learning effects (Cohen's d = 1.56) and leader positive reactions to the training information, with leaders reporting the information as useful and relevant to their work. Service members in the treatment group reported significantly lower levels of anger at time 2 (b = -0.18, SE = 0.06, P = .002, pseudo ΔR2 = 0.01; d = 0.27) compared to the control group. We also found an indirect effect of the intervention on increased life satisfaction at time 2 via decreased anger (b = 0.035, SE = 0.023, 95% CI = [0.004-0.24]). CONCLUSIONS: This study provides an initial evaluation of training for platoon leaders that educates them on proactive and responsive behavioral strategies to support the mental health and resilience of their service members via decreased problematic anger and increased well-being. Further adaptations and evaluations should be conducted with other military branches and civilian occupations, as the benefits of the relatively brief and noninvasive training could be widespread.
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Ira , Liderança , Militares , Resiliência Psicológica , Humanos , Militares/psicologia , Militares/estatística & dados numéricos , Masculino , Adulto , Feminino , Inquéritos e Questionários , Saúde Mental , Estados UnidosRESUMO
The high, and still rising, rate of loneliness is a threat to public health (Office of the Surgeon General, 2023), with negative mental and physical health consequences (e.g., Holt-Lunstad, 2021). Given that loneliness is a risk factor for poor mental health, efforts to address loneliness are urgently needed. Workplaces can facilitate an employee's social connection through supervisor support training, which can help mitigate loneliness. Among occupational groups, the military is at higher risk for mental health disorders, suicide, and loneliness (Fikretoglu et al., 2022; Naifeh et al., 2019). This study evaluated the efficacy of an evidence-based supportive-leadership training intervention targeting active-duty U.S. Army platoon leaders and targeting both proactive support behaviors that help bolster employee social connection and responsive support behaviors, including destigmatizing mental health. Ninety-nine platoon leaders (69.7% of eligible leaders) completed the 90-min training that consisted of both in-person and computer-based components. Using a cluster-randomized controlled trial design, intervention effects were tested using an intent-to-treat approach and revealed a significant effect, whereby loneliness of service members whose leaders were randomized to the intervention group (N = 118) was significantly reduced compared to loneliness reports for service members in the control group (N = 158). Additionally, service members with higher baseline loneliness were more strongly and positively impacted by the supervisor training, reporting higher levels of supportive behaviors from their leaders at 3 months postbaseline. In sum, these results suggest how workplaces, especially those that are considered high-risk occupations, and their leaders play a critical role in a national strategy to address Americans' well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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OBJECTIVE: To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue. METHOD: EP ( n = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (National Emergency Department Overcrowding Scale) per shift was calculated. Shift demands were assessed at the end of each shift. RESULTS: Multilevel models revealed that shift demands, National Emergency Department Overcrowding Scale, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic. CONCLUSIONS: Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.
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Esgotamento Profissional , COVID-19 , Aglomeração , Serviço Hospitalar de Emergência , Hidrocortisona , Médicos , Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Masculino , COVID-19/psicologia , COVID-19/epidemiologia , Feminino , Adulto , Aglomeração/psicologia , Esgotamento Profissional/epidemiologia , Médicos/psicologia , Médicos/estatística & dados numéricos , Hidrocortisona/análise , Pessoa de Meia-Idade , SARS-CoV-2 , Saliva/química , Fadiga/epidemiologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , Carga de Trabalho/psicologia , Jornada de Trabalho em Turnos/psicologiaRESUMO
During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.
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Esgotamento Profissional , COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Adaptação Psicológica , Blogging , Pessoal de SaúdeRESUMO
WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT: INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM: To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD: A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS: Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION: The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE: To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.
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Pacientes Internados , Saúde Mental , Humanos , Política Organizacional , Atenção à Saúde , Assistência à Saúde Culturalmente CompetenteRESUMO
Leader support for psychological health (LSPH) has been identified as an important factor in the prediction of mental health symptoms among warfighters. Although research has examined the relationship between LSPH and mental health symptoms, the extent to which this relationship is bidirectional has been underexplored. Consequently, the present study examined the longitudinal relationships between perceived LSPH and mental health symptoms (depression and PTSD) among military personnel over a 5-month period. We found that perceived LSPH at Time 1 (T1) was associated with fewer mental health symptoms at Time 2 (T2); however, mental health symptoms at T1 were also associated with lower perceptions of LSPH at T2. The results differed slightly based on the type of symptoms experienced, but the relationships between perceived LSPH and symptoms did not vary based on whether soldiers had been exposed to combat. However, it is important to note that the overall sample had low combat experience. Despite this, these findings may suggest that the assumption that leader support can enhance soldier mental health may fail to consider that the symptoms themselves may also affect how leaders are perceived. Therefore, organizations such as the military should consider both directions to optimally understand the relationship between leaders and subordinate mental health.
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Militares , Transtornos de Estresse Pós-Traumáticos , Humanos , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Militares/psicologiaRESUMO
Benefit finding has been identified as a buffer of the combat exposure-PTSD symptom link in soldiers. However, benefit finding may have a limited buffering capacity on the combat-PTSD symptom link over the course of a soldier's post-deployment recovery period. In the present study, soldiers returning from Operation Iraqi Freedom (OIF) were surveyed at two different time periods post-deployment: Time 1 was 4 months post-deployment (n = 1,510), and Time 2 was at 9 months post-deployment (n = 783). The surveys assessed benefit finding, PTSD symptoms, and combat exposure. Benefit finding was a successful buffer of the cross-sectional relationship between combat exposure and PTSD reexperiencing symptoms at Time 1, but not at Time 2. In addition, the benefit finding by combat interaction at time 1 revealed that greater benefit finding was associated with higher symptoms under high combat exposure at Time 2 after controlling for PTSD arousal symptoms at Time 1. The results of the present study indicate that benefit finding may have a buffering capacity in the immediate months following a combat deployment, but also indicates that more time than is allotted during the post-deployment adjustment period is needed to enable recovery from PTSD. Theoretical implications are discussed.
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Adaptação Psicológica , Distúrbios de Guerra , Transtornos de Estresse Pós-Traumáticos , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Humanos , Masculino , Feminino , Guerra do Iraque 2003-2011 , Inquéritos e Questionários , Aprendizagem da Esquiva , Nível de Alerta , Adolescente , Adulto Jovem , Adulto , Correlação de Dados , Análise de RegressãoRESUMO
Research has shown that shiftworkers experience poor sleep and high levels of fatigue. Although considerable research has been performed on fatigue within many shift-work occupations, very little has been done with emergency physicians (EPs). This qualitative study was conducted with the goal of gaining insight into EPs' perceptions of fatigue at work. Twenty EPs from an academic medical center participated in virtual interviews, with nine open-ended questions asked in a semi-structured interview format. Twelve common topics with four main themes emerged from the interviews. Three of these common themes included sources of fatigue (including both work- and home-related sources), consequences of fatigue (including impacts on individuals and performance), and prevention and mitigation strategies to cope with fatigue. The fourth main theme was the belief in the inevitability of fatigue due to high cognitive load, emotionally taxing work experiences, work unpredictability, and the 24/7 shift-work nature of emergency medicine. EPs' experiences with fatigue are consistent with but extend those of other types of shiftworkers. Our findings suggest that EPs tend to incorporate the inevitability of fatigue at work into their identity as EPs and experience a sense of learned helplessness as a result, suggesting areas for future interventions.
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Workaholism is increasingly recognized as a potential threat to occupational health. Although most research has conceptualized workaholism as a trait, some research suggests that it may also fluctuate from day to day. Moreover, the effects of the dynamic properties of workaholism on work and family outcomes may be contingent on one's economic situation. Therefore, the aim of the present study was to test the interactive effect of workday workaholism and economic resources on nightly work-family conflict and family engagement. Using experience sampling methodology, we demonstrated that workaholism fluctuates from one day to the next and has detrimental short-term effects on work-family conflict. Additionally, our findings indicated that the interaction between workday workaholism and perceived income adequacy predicted both nighty work-family conflict and family engagement. While the association between workday workaholism and work-family conflict was stronger for those who experienced low income adequacy, the relationship between workaholism and family engagement was stronger for those who exhibited high income adequacy. Similarly, job security buffered the effect of workaholism on work-family conflict. We discuss the theoretical and practice implications of this study as well as recommend future research directions.
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Comportamento Aditivo , Saúde Ocupacional , Humanos , Conflito Familiar , Avaliação Momentânea EcológicaRESUMO
OBJECTIVES: Fatigue is a state of physical and mental exhaustion in which people feel exhausted or drained of energy. Shift workers are highly vulnerable to fatigue, and this is especially true of emergency physicians (EPs). Shift scheduling (shift hours, frequency/length of breaks, time of shift, and number of hours off between shifts) can affect levels of fatigue in EPs. When EPs are fatigued, they experience decrements in cognition, resulting in an increased risk of errors. This study assessed the state of fatigue in EPs in the emergency department of a large, urban hospital using objective measures (sleep metrics and shift scheduling) over multiple months. METHODS: Seventeen EPs, nine females, wore wrist-activity monitors called ReadiBands for 2 months. The ReadiBand is an objective actigraphy measure that communicates with a smartphone application to quantify sleep metrics and predict future fatigue. RESULTS: Throughout the 3083 on-shift hours of data, analyses revealed that EPs have poor sleep quality (mean ± SD 7.71 ± 1.84/10) and sleep quantity (mean ± SD 6.77 ± 1.66 h), with sleep efficiency within "normal" ranges (mean ± SD 87.26 ± 9.00). Participants spent 725 h (23.52%) on shifts with fatigue scores indicative of significant impairment (equivalent to BAC of .08%). In addition, results indicated that shift type (day, evening, night) was significantly associated with fatigue score, where night shifts were associated with higher fatigue scores. CONCLUSIONS: Fatigue is an issue for many EPs. The present study addressed the percentage of time EPs are in a fatigued state when on shift over an extended duration of time. More research is needed to examine system-level interventions for reducing fatigue in EPs.
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Medicina de Emergência , Médicos , Feminino , Humanos , Tolerância ao Trabalho Programado , Sono , Fadiga/diagnóstico , Fadiga/etiologiaRESUMO
PURPOSE: Recent findings have suggested that physicians who spend more time participating in their most meaningful job activities (e.g. teaching) are less likely to experience burnout. The current study aimed to expound upon this finding, focusing specifically on the role of teaching in promoting meaning and preventing burnout. METHOD: A total of 428 physicians at a large academic healthcare institution completed an online survey that included measures of burnout and other relevant variables. In the second part of this study, 20 physicians participated in interviews with the aim of expounding upon and contextualizing the findings from Part 1. RESULTS: Results from Part 1 suggested that although meaningfulness derived from teaching was associated with reduced burnout, this association was only true for those who indicated that clinical teaching was among the most meaningful parts of being a physician. In addition, physicians were less likely to spend time working on their most meaningful job activity when it was teaching. Part 2 illustrated why teaching in the clinical environment can be so meaningful and protective against burnout. CONCLUSIONS: Many physicians are unable to teach due to the increasing demands of medical institutions, which may contribute to the increasing levels of burnout in healthcare providers.
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Esgotamento Profissional , Médicos , Esgotamento Profissional/prevenção & controle , Humanos , Satisfação no Emprego , Inquéritos e QuestionáriosRESUMO
The COVID-19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020-December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross-level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.
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Esgotamento Profissional , COVID-19 , Adaptação Psicológica , Esgotamento Profissional/epidemiologia , Pessoal de Saúde , Humanos , Saúde Mental , Princípios Morais , Pandemias , SARS-CoV-2RESUMO
Barriers to mental healthcare services are reported among military service members. However, little is known about these barriers among the spouses of military personnel, who face unique stressors and may subsequently be at high-need for mental health services. Understanding barriers to care among this vulnerable population may help improve access to psychological services. The current study utilized data from the Millennium Cohort Family Study. Participants were referred by their military spouses or through targeted mailers. Participants completed self-report measures of mood, psychosocial functioning, and perceived barriers to mental healthcare via web- or paper-based surveys. A factor analysis was conducted to identify subscales of the barriers to mental healthcare measure, and logistic regressions were conducted adjusting for relevant sociodemographic variables, to determine psychosocial factors associated with likelihood of reporting barriers to mental healthcare. The sample comprised 9,666 military spouses (86% female; Mage: 27.73 ± 5.09; 29.2% racial/ethnic minority; 19.5% with prior/current military service). Logistic factors were the most frequently reported barrier to care (63%), followed by negative beliefs about mental healthcare (52%), fear of social/occupational consequences (35%), and internalized stigma (32%). Spouses with prior or current military service themselves and individuals with a psychiatric condition were most likely to report barriers to mental healthcare. A preponderance of military spouses reported barriers to mental healthcare services. Prospective data are needed to elucidate the associations between barriers to care and mental healthcare utilization. Efforts may be warranted to improve access to mental healthcare among the spouses of military personnel. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Serviços de Saúde Mental , Militares , Etnicidade , Feminino , Humanos , Masculino , Militares/psicologia , Grupos Minoritários , Estudos Prospectivos , Cônjuges/psicologiaRESUMO
The present research examined social connection as a mediator through which perceived resilience prior to a combat deployment predicts fewer posttraumatic stress disorder (PTSD) symptoms for soldiers exposed to high levels of combat. Soldiers (N = 1,222) completed the Brief Resilience Scale (BRS) and a measure of PTSD symptoms prior to deploying to Afghanistan (Time 1) and measures of combat exposure and social connection immediately after the deployment (Time 2). Soldiers then completed measures of PTSD symptoms at 3 months (Time 3) and 10-12 months (Time 4) following the deployment. Within the context of the Conservation of Resources (COR) model, perceived resilience and social connection represented personal and social resources that allow military personnel to demonstrate better mental health when confronted with the traumatic stressor of combat exposure. Perceived resilience prior to the deployment interacted with combat exposure to predict PTSD symptoms at Time 3 and Time 4 after controlling for baseline PTSD symptoms. Perceived resilience was more strongly related to PTSD symptoms under higher levels of combat exposure. Moderated mediation models provided support for social connection as a mediator of the relationship between perceived resilience at baseline and PTSD symptoms at Time 3 and 4 under higher levels of combat exposure. The results provide some of the first empirical evidence regarding the predictive value of perceived resilience prior to potentially traumatic exposure and document social connection as an important resource linking perceived resilience to positive adaptation after adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Militares , Transtornos de Estresse Pós-Traumáticos , Humanos , Saúde MentalRESUMO
Successfully embedding researchers in a health care setting brings unique challenges and opportunities. Through a joint clinical and academic partnership, we have developed a novel approach to problem-solving in the health care context, by employing a model for leading through change to embed researchers in transformative initiatives. Using the model, we have been able to leverage our local environment and resources to engage multi-disciplinary researchers in solving complex issues. An example is our initiative, Enhancing the Practice of Medicine, to address burnout among health care providers. Through this work, we have identified 3 primary factors critical to the successful deployment of embedded researchers. First and foremost, a multi-disciplinary team with diverse expertise is necessary to truly understand the root causes and potential solutions for complex issues. Second, this diverse team of embedded researchers must be involved from the initial stages of project design and have a voice throughout all phases of planning and assessing the initiative. Finally, embedded researchers will be most successful when they are supported to build relationships, navigate the system, and conduct research as part of an integrated and comprehensive effort that aligns with health system priorities.
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Atenção à Saúde , Pesquisadores , Programas Governamentais , HumanosRESUMO
The present article examines how job demands and resources are related to indices of strain among healthcare professionals during virus pandemics. The article also presents the results of a study examining the relationships between COVID-19 demands (e.g., lack of personal protective equipment, concerns about infecting family members), resources (meaningful work, social support), and mental health strain within a sample of emergency medicine personnel over six consecutive weeks. COVID-19-related demands and hours worked were hypothesized to be positively related to mental health strain, whereas meaningful work and social support were hypothesized to be negatively related to mental health strain. Hours worked the prior week were hypothesized to exacerbate the positive relationships between COVID-19 demands and mental health strain, whereas the resources of meaningful work and social support were expected to buffer the relationships. Multilevel models controlling for mental health strain the prior week revealed that COVID-19 demands, along with hours worked, were each related to higher mental health strain during the week. Hours worked magnified the within-person relationship between personal COVID-19 demands and mental health strain. In contrast to the hypotheses, social support and meaningful work were not related to mental health strain. Discussion focuses on the implications of the findings for healthcare professionals.
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While researchers have begun to investigate theory and methods related to attenuating stress-related issues at work, one underexplored area is a barrier to reporting stress-related concerns in the workplace. Research on organizational climate broadly covers psychosocial safety at work. However, the literature has not examined other, more specific factors such as stigma towards reporting stress-related concerns in the workplace. Using a prospective design, the current study examined the distinction between psychosocial safety climate (PSC) and stigmas surrounding reporting stress that may exist in organizations. Furthermore, we investigated whether PSC would buffer against the effects of such stigmas. The findings of this study indicate that stigma and PSC are distinct and can independently predict psychosocial outcomes. The results also indicate that PSC may play a role in attenuating the effects of these stigmas on some psychosocial outcomes. Implications and potential avenues for future research in this area are discussed.
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Estresse Ocupacional , Local de Trabalho , Humanos , Estresse Ocupacional/psicologia , Cultura Organizacional , Estudos Prospectivos , Estigma Social , Local de Trabalho/organização & administração , Local de Trabalho/psicologiaRESUMO
Workers bear a heavy share of the burden of how countries contend with COVID-19; they face numerous serious threats to their occupational health ranging from those associated with direct exposure to the virus to those reflecting the conflicts between work and family demands. Ten experts were invited to comment on occupational health issues unique to their areas of expertise. The topics include work-family issues, occupational health issues faced by emergency medical personnel, the transition to telework, discrimination against Asian-Americans, work stressors, presenteeism, the need for supportive supervision, safety concerns, economic stressors, and reminders of death at work. Their comments describe the nature of the occupational health concerns created by COVID-19 and discuss both unanswered research questions and recommendations to help organizations reduce the impacts of COVID-19 on workers.