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Coercive, controlling behavior toward intimate partners correlates with physical intimate partner violence (IPV). We examined whether it also predicts subsequent IPV or other aggression. We conducted a secondary analysis of self-reports by 1,039 women and 509 men who participated in the first two waves of the Interpersonal Conflict and Resolution Study (Mumford et al., 2019). We defined coercive control as any reported perpetration at Wave 1 of threat to physically harm, threat to use information to control, or put down or disrespect their partner. The participants also reported perpetration of verbal abuse and physical or sexual aggression against intimate partners. We tested correlations of these behaviors with similar acts toward nonintimates (friends or unfamiliar persons) in Wave 1 and the prediction of physical violence in Wave 2, approximately 5 months later. Coercive control (14% of men, 26% of women) was correlated with physical or sexual IPV (8% of men, 15% of women) in both women and men and with physical violence and coercive control to nonintimates. In logistic regressions entering Wave 1 physical IPV on the first step, Wave 1 coercive control was a significant independent predictor of Wave 2 physical IPV overall, and for men but not women. Coercive control did not independently predict nonintimate physical violence. Coercive control toward an intimate partner is a unique predictor of physical IPV among men. Future research should use improved measures of coercive control and further examine coercive control as an indicator of general antisociality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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OBJECTIVE: This scoping review aims to provide a comprehensive summary of the biological, psychological, and sociological risk factors for intimate partner violence (IPV) victimization and perpetration reported after the onset of the COVID-19 pandemic. INTRODUCTION: IPV is a significant public health concern, characterized by various forms of violence inflicted by intimate partners. The onset of the COVID-19 pandemic significantly increased the global prevalence of IPV. While prior research has identified factors linked to IPV, the risk factors reported in the literature during this period have not been systematically mapped. Additionally, the similarities and differences in risk factors between perpetration and victimization have not been well delineated. INCLUSION CRITERIA: This review will focus on individuals aged 12 years or older involved in dyadic romantic relationships. Primary studies and systematic reviews published from the year 2020 will be included. Full-text papers, preprints, theses, and dissertations published in English will be included. Studies focusing on factors unrelated to IPV risk will be excluded. Non-systematic reviews, opinion pieces, and protocols will also be excluded. METHODS: Following the JBI methodology for scoping reviews, systematic searches will be conducted for both peer-reviewed and gray literature. Independent reviewers will screen records, select eligible studies, and extract data using a standardized form. Key risk factors will be mapped to explore their interplay. REVIEW REGISTRATION: Open Science Framework https://osf.io/c2hkm.
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COVID-19 , Vítimas de Crime , Violência por Parceiro Íntimo , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Violência por Parceiro Íntimo/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Fatores de Risco , Vítimas de Crime/psicologia , Adolescente , AdultoRESUMO
BACKGROUND: The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period. METHODS: We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum). RESULTS: A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively. INTERPRETATION: Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.
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Purpose: Children exposed to domestic violence are at risk of adverse short- and long-term psychosocial effects and of being abused themselves. However, mothers and children face systemic gaps when seeking safety from domestic violence services and police. Safety planning typically focuses on women, overlooking their multiple social identities and excluding their children. We explored safety strategies used by mothers and children coping together with severe domestic violence. Method: Interviews with 30 mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood were qualitatively analyzed using thematic analysis, revealing five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence. Results: Interpreting participants' experiences in terms of the mother-child dyad, we found that mothers and their children worked together to reassure each other, keep each other safe, and make plans to leave their abuser. Conclusions: Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage.
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BACKGROUND: Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services. METHODS: We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression. RESULTS: One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness. CONCLUSIONS: The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.
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Experiências Adversas da Infância , Lesões Encefálicas , Transtornos Mentais , Masculino , Humanos , Hospitais Psiquiátricos , Estudos Retrospectivos , Transtornos Mentais/epidemiologia , Ontário/epidemiologiaRESUMO
Navigating the coronavirus disease-2019 (COVID-19, now COVID) pandemic has required resilience and creativity worldwide. Despite early challenges to productivity, more than 2,000 peer-reviewed articles on islet biology were published in 2021. Herein, we highlight noteworthy advances in islet research between January 2021 and April 2022, focussing on 5 areas. First, we discuss new insights into the role of glucokinase, mitogen-activated protein kinase-kinase/extracellular signal-regulated kinase and mitochondrial function on insulin secretion from the pancreatic ß cell, provided by new genetically modified mouse models and live imaging. We then discuss a new connection between lipid handling and improved insulin secretion in the context of glucotoxicity, focussing on fatty acid-binding protein 4 and fetuin-A. Advances in high-throughput "omic" analysis evolved to where one can generate more finely tuned genetic and molecular profiles within broad classifications of type 1 diabetes and type 2 diabetes. Next, we highlight breakthroughs in diabetes treatment using stem cell-derived ß cells and innovative strategies to improve islet survival posttransplantation. Last, we update our understanding of the impact of severe acute respiratory syndrome-coronavirus-2 infection on pancreatic islet function and discuss current evidence regarding proposed links between COVID and new-onset diabetes. We address these breakthroughs in 2 settings: one for a scientific audience and the other for the public, particularly those living with or affected by diabetes. Bridging biomedical research in diabetes to the community living with or affected by diabetes, our partners living with type 1 diabetes or type 2 diabetes also provide their perspectives on these latest advances in islet biology.
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COVID-19 , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Células Secretoras de Insulina , Ilhotas Pancreáticas , Animais , Camundongos , Biologia , Diabetes Mellitus Tipo 1/metabolismo , Insulina/metabolismo , Células Secretoras de Insulina/metabolismo , Ilhotas Pancreáticas/metabolismo , HumanosRESUMO
Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.
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Esgotamento Profissional , Estresse Ocupacional , Transtornos de Estresse Pós-Traumáticos , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Esgotamento Psicológico , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologiaRESUMO
The demand for forensic psychiatric beds is increasing, while many individuals are "stuck" in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.
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Psiquiatria Legal , Transtornos Mentais , Agressão , Medicina Legal , Humanos , Masculino , Transtornos Mentais/psicologia , ViolênciaRESUMO
Health care organizations are obligated to provide safe and effective treatment to their patients and also protect the safety of their workers. This paper analyzes the tensions arising from legislative regimes that, respectively, protect privacy and workplace safety, using a large, tertiary high-secure forensic psychiatric hospital in Ontario, Canada, as an example. In Ontario, the Personal Health Information Protection Act (PHIPA) prohibits personal health information (PHI) from being disclosed to individuals who fall outside the "circle of care," including nonclinical employees who have direct involvement with patients and may be at risk of violence. PHIPA permits the disclosure of information where there is a risk of violence, but the statute's scheme for privacy protection was not designed to address, and may not be compatible with, the operations and requirements of high-secure forensic and other psychiatric hospitals. At the same time, the Occupational Health and Safety Act (OHSA) creates a regulatory framework that sets health and safety standards, including an employer's duty to disclose the risk of violence. OHSA prosecutions and proceedings demonstrate how these duties have been enforced against psychiatric hospitals. We examine this regulatory backdrop, explaining that PHIPA provides little guidance to psychiatric hospitals, where the risk of violence is elevated. We also discuss issues of dual compliance that arise from a hospital's legal obligations under PHIPA and OHSA. Finally, we turn to the ongoing clinical and operational challenges, suggesting strategies for increasing staff safety. These include strengthening the therapeutic alliance and providing patients with the option of consenting to disclosure of PHI to those outside the circle of care.
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Hospitais Psiquiátricos , Privacidade , Humanos , Ontário , Local de TrabalhoRESUMO
Suicide is a leading cause of death in custody. Although previous studies with prison inmates suggest a strong relation between childhood adversity and suicidal behavior, as well as between childhood adversity and antisociality, this has not been explored in the forensic psychiatric system. We compared 211 men admitted to a forensic hospital having a lifetime history of suicide attempts with 275 men with no suicide history in the same institution. Data were retrospectively coded from information gathered during their assessment and medical records. We examined associations of adverse childhood events and antisociality with suicide attempt history in a series of regression analyses. Childhood adversity was present in majority of individuals and significantly more common for individuals with a history of suicide attempts (76.8%) than those with no suicide attempts (63.3%). The suicide attempt group also experienced a greater number of adverse childhood events. Physical abuse, parental separation, and parental psychiatric history during childhood were associated with suicide attempts. Men with a suicide attempt history had higher antisociality scores than the comparison group and adult antisocial behavior partially mediated the relationship between adverse childhood experiences and suicide attempts. Men in forensic hospital who have suffered multiple experiences of childhood adversity are at increased risk for exhibiting antisocial behavior and engaging in suicidal attempts. Early interventions targeted toward antisociality and trauma-informed care in the forensic hospital are needed to support the mental health of the forensic population.
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Experiências Adversas da Infância , Tentativa de Suicídio , Adulto , Transtorno da Personalidade Antissocial , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIM: We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. BACKGROUND: Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. METHODS: We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. RESULTS: We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. CONCLUSION: Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.
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Fadiga de Compaixão , Enfermagem Psiquiátrica , Violência no Trabalho , Fadiga de Compaixão/etiologia , Hospitais Psiquiátricos , Humanos , Inquéritos e Questionários , Local de Trabalho/psicologia , Violência no Trabalho/psicologiaRESUMO
OBJECTIVES: The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions. BACKGROUND: A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted. METHODS: We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet. RESULTS: From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises. CONCLUSIONS: This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations. RELEVANCE TO CLINICAL PRACTICE: This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.
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Militares , Atenção Plena , Transtornos de Estresse Pós-Traumáticos , Hospitais , Humanos , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Local de TrabalhoRESUMO
WHAT IS KNOWN ON THE SUBJECT?: Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics. We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provide training in risk assessment and violence prevention to psychiatric nurses. Offer mental health support to those exposed to violence, especially with cumulative exposure. ABSTRACT: Introduction Psychiatric nurses are at risk of workplace violence and post-traumatic stress disorder (PTSD). There is limited understanding of pre-trauma and post-trauma risk factors. Aim Our aim was to review factors associated with workplace PTSD in psychiatric nurses. Method We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full-text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best-fit framework synthesis, we identified workplace violence, pre-trauma and post-trauma risk factors. Results Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study ("promising": severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others ("suggestive": gender, poor training, any physical aggression exposure, compassion fatigue). Discussion Pre-trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research. Implications for Practice Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals.
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Enfermagem Psiquiátrica , Transtornos de Estresse Pós-Traumáticos , Violência no Trabalho , Humanos , Fatores de Risco , Local de Trabalho , Violência no Trabalho/psicologiaRESUMO
Actuarial scales provide a relatively objective and reliable assessment of individuals' risk of recidivism. Recent research has explored how graphs can improve quantitative risk communication. We tested whether graphs can improve understanding and perception of sexual violence risk when matched with risk metric. Participants (N = 676) were recruited from Amazon's MTurk platform and read a brief description of a man convicted of a sexual offense, including results of a fictional sexual recidivism risk scale. In Study 1, absolute risk of recidivism enabled participants to distinguish between individuals with relatively high and low risk of sexual recidivism. In Study 2, this distinction was enhanced by adding a graph, especially when percentiles were communicated. Risk ratios increased perceived risk. Objective numeracy increased understanding and reduced perceived risk. We recommend that risk communication assumes limited statistical numeracy, and further research with practitioners to test the effect of graphs and risk metrics on forensic/judicial decisions.
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Reincidência , Delitos Sexuais , Comunicação , Humanos , Masculino , Medição de Risco , Comportamento SexualRESUMO
Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.
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Estresse Ocupacional , Transtornos de Estresse Pós-Traumáticos , Violência no Trabalho , Humanos , Percepção , Local de TrabalhoRESUMO
The Risk-Need-Responsivity (RNR) principles of effective correctional service that are well supported in the general offending literature have less often been applied to the assessment and treatment of intimate partner violence (IPV). Well validated IPV risk assessment tools are now widely available, and IPV treatment programs that match treatment intensity to assessed risk have shown promising pre-to-post treatment effects. The present study builds on the study of RNR principles in IPV by exploring criminogenic needs and their relation to recidivism and to recently proposed treatment intensity categories derived from an IPV risk assessment tool. We reanalyzed data from 1,421 men with a police report of IPV in the original Ontario Domestic Assault Risk Assessment (ODARA) dataset, to explore the prevalence of antisocial personality traits, procriminal attitudes, substance use, poor relationships, and work/school problems and their relation to IPV recidivism and ODARA-based treatment intensity categories. Needs were present in 17% (procriminal attitudes) to 42% (substance use) of men. All needs except poor relationships were positively related to IPV recidivism; in logistic regression analyses, antisocial personality traits (OR = 1.80) and poor relationships (OR = 0.61) incrementally predicted IPV recidivism over the ODARA (OR = 1.40). Men placed in higher treatment intensity categories based on the risk assessment score had more criminogenic treatment needs. Findings support using the ODARA to select individuals for the most intensive IPV treatment, and suggest that assessing and treating criminogenic needs may improve IPV treatment outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Violência por Parceiro Íntimo , Reincidência , Transtorno da Personalidade Antissocial , Humanos , Masculino , Medição de Risco , Fatores de RiscoRESUMO
The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.
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Pessoal de Saúde/psicologia , Comportamento de Busca de Ajuda , Saúde Mental/educação , Serviços de Saúde do Trabalhador/métodos , Saúde Ocupacional/estatística & dados numéricos , Violência no Trabalho/psicologia , Local de Trabalho/psicologia , Humanos , Transtornos Mentais , Serviços de Saúde Mental , Motivação , Pesquisa Qualitativa , Estigma SocialRESUMO
Workplace factors associated with the development of posttraumatic stress disorder (PTSD) in inpatient psychiatric settings have received limited attention. In this study, we examined critical exposures, patient care stressors, and aspects of workplace environment that are potentially associated with PTSD symptoms in a sample of 633 clinical staff (68% nursing staff, 70% female) who provided direct day-to-day care for patients, and indicated they worked in either forensic (57%) or nonforensic units (43%). Forensic staff reported more direct exposure (74%) to a wider variety of potentially traumatic events and chronic stressors than nonforensic staff (66%). Forensic staff also endorsed more PTSD symptoms. Using the PTSD Checklist for DSM-5 (PCL-5; Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, DSM-5), 22% of forensic staff and 11% of nonforensic staff met the screening cut-off for possible PTSD; PTSD symptom scores were predicted both by direct exposure and unit type. Additionally, workplace environment and organizational trust were negatively correlated with PTSD symptom scores, where forensic staff reported a greater degree of incongruence with their workplace and lower levels of trust in management, compared with nonforensic staff. These results offer a snapshot of the more adverse work environment and associated risks faced by clinical staff on forensic units compared with nonforensic settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Transtornos de Estresse Pós-Traumáticos , Lista de Checagem , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Pacientes Internados , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Local de TrabalhoRESUMO
BACKGROUND AND METHODS: In this study, we surveyed 761 psychiatric hospital staff (69% women, 71% full-time, 56% nursing) regarding their exposure to trauma in the workplace; symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety; help seeking; and perceived barriers for help seeking. RESULTS: Significant proportions of staff met the screening cutoffs for probable PTSD (16%), depression (20%), and anxiety (16%). Comorbidity was high, with approximately half of those meeting the screening cutoff for PTSD also meeting the cutoffs for depression or anxiety. Only PTSD symptoms were uniquely associated with exposure to trauma in the workplace, but both PTSD and depression symptoms significantly predicted help seeking. Staff who met one or more screening cutoffs perceived more barriers to help seeking such as difficulty with accessing services. CONCLUSION: Implications for supporting psychiatric staff exposed to trauma are discussed.