Financial and caregivers' stressors in Australian law students - a qualitative analysis.

Australian law students exhibit high levels of psychological distress compared to the general population. In 2013, The University of Sydney Law School conducted a survey to examine the level of distress in students, what factors were associated with their distress and what strategies might mitigate student distress. This article reports on the survey's qualitative findings relating to financial stressors and care-giving responsibilities. The findings provide further insights into the context of financial stressors for law students and how they may undermine students' candidacy. The study found that financial stress, work commitments, caring for dependents, illnesses and death in the family can be potential reasons for students suspending studies or withdrawing from their studies altogether. In view of the findings, possible solutions to alleviate stress and support students with their work-study and care-giving concerns are discussed.

Physician perception regarding side-effect profile at the onset of antidepressant treatment: a survey of Israeli psychiatrists and primary care physicians.

BACKGROUND: One of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to the onset of treatment. METHODS: A cross-sectional questionnaire survey was conducted among PC physicians (N = 123) and psychiatrists (N = 105). Questionnaires were distributed using a mixed-modality design, combining a web survey and in-person delivery of questionnaires. RESULTS: A significant percentage of our respondents reported that they rarely discuss psychological (60 %) or severe (29 %) SEs of SSRIs. Nearly half (41 %) admitted to avoiding discussion of impact on suicidal ideation. Specialists were noted to discuss and evaluate SEs significantly more than residents, and Psychiatrists more than PC physicians. Specifically, psychiatrists more often discussed the possibility of sexual dysfunction (t (225) = 2.23; p < 0.05) and suicidal ideation (t (225) = 2.11; p < 0.05). CONCLUSIONS: It seems that PC physicians and psychiatrists surveyed in this study do not share sufficient information regarding the SEs of SSRIs with their patients at the onset of treatment. In improving this practice, the integration of proper SE management into educational interventions has potential in enhancing compliance and improving expertise and level of care.

Ethical use of the media by psychiatrists: towards an antipodean formulation of the "Goldwater Rule".

OBJECTIVES: To review the ethical problems posed by the participation of psychiatrists in various forms of lay media and propose a method of resolving quandaries in this area. CONCLUSIONS: We review the potential ethical problems that arise when psychiatrists make contributions to the lay media, particularly when commentary and opinion reflects the views of the individual rather than the profession. The issues raised by the North American injunction known as the "Goldwater Rule" are pertinent to Australasia, particularly when media statements made by psychiatrists may seem to diminish the profession through politicisation, polemic, or bringing the profession and the field into disrepute. We propose a series of reflective questions to assist psychiatrists in Australasia to deliberate on the potential ethical problems arising from their participation in media activities. We conclude that it is for the Royal Australian and New Zealand College of Psychiatrists to formulate an approach to situations where the media activities of Fellows raise such problems.

Psychiatry and the 'Gay Holocaust' - the lessons of Jill Soloway's Transparent.

OBJECTIVE: We aim to consider issues relevant to psychiatry raised by the television series, Transparent. CONCLUSIONS: Psychiatry's disturbing history regarding the lesbian, gay, bisexual, transgender and intersex (LGBTI) community shares many aspects with the group's persecution by the National Socialist regime in Germany. The medicalised 'otherness' conferred on LGBTI patients, latent homophobia and transphobia, and lack of culturally sensitive clinical services for these people represent a major ethical challenge for modern Australasian psychiatry.

Experiences of Psychological Distress and Sources of Stress and Support During Medical Training: a Survey of Medical Students.

OBJECTIVE: The authors examine the prevalence of psychological distress, the stressors experienced, and the supports used by medical students and residents during their medical training at a Canadian university. METHOD: This study used an online survey that included a standardized instrument to evaluate psychological distress (Kessler-10) and Likert-based survey items that examined stress levels related to family relationships, living accommodations, commuting, finances, and program requirements. Depressive symptoms, substance use, and suicidal ideation were also measured, as were supports accessed (e.g., counseling) and students' perceptions of the overall supportiveness of the university. Non-parametric descriptive statistics were used to examine the prevalence of psychological distress, sources of stress, and supports accessed. RESULTS: Surveys were received from 381 students (37% response). Most students (60%) reported normal levels of psychological distress on the K10 (M = 19.5, SD = 6.25), and a subgroup reported high to very high levels of psychological distress. A small number also reported substance use, symptoms of depression, and/or suicidal ideation. CONCLUSION: These results indicate that students experience psychological distress from a number of stressors and suggest that medical schools should act as key partners in supporting student well-being by promoting self-care, educating students on the risks of burnout, and developing programs to support at-risk students.

An examination of envy and jealousy in nursing academia.

AIM: To discuss envy and jealousy and how their positive and negative aspects among nurse academics affect the workplace. BACKGROUND: In nursing academia, jealousy and envy are common emotions, engendered by demands for high productivity, intense competition for limited resources, preferences for particular assignments and opportunities for promotions. When these feelings are moderate and part of everyday rivalry, competition and ambition benefit the organisation. However, jealousy and envy can have serious consequences including damaged relationships and communication, and the undermining of colleagues' performance. DISCUSSION: Strategies are recommended to provide opportunities for self-reflection and consideration of how the workplace affects nursing academics' wellbeing and professional performance. CONCLUSION: Jealousy and envy can be damaging emotions in the workplace. The embittered, hostile person can undermine and damage relationships, disrupt teams and communication, and undermine organisational performance. Discussing the positive and negative effects of envy and jealousy provides an opportunity for nursing academics to self-reflect and to consider others and their own personal and professional performance. IMPLICATIONS FOR PRACTICE: Understanding how jealousy and envy impact on the work environment, workplace relationships and individual/team performance is important especially for early career and seasoned nursing academics alike.

Attention improves after clinical improvement in acutely depressed adolescents.

In recently depressed adolescents, attention and emotional reactivity improved significantly compared with baseline. Working memory did not improve. This supports the position that, in adolescent depression, attention is state dependent compared with other executive functions that are trait dependent.

Arrogance in the workplace: implications for mental health nurses.

Cultures of performativity may contribute to organizational and individual arrogance. Workplace organizations have individuals who at various times will display arrogance, which may manifest in behaviours, such as an exaggerated sense of self-importance, dismissiveness of others, condescending behaviors and an impatient manner. Arrogance is not a flattering label and irrespective of the reason or the position of power, in the context of organizational behaviors, may not be useful and may even be detrimental to the work environment. Thus, it is timely to reflect on the implications of arrogance in the workplace. Advocacy and empowerment can be undermined and relationships adversely impacted, including the achievement of positive consumer outcomes. This paper provides an introduction to arrogance, and then discusses arrogance to promote awareness of the potential consequences of arrogance and its constituent behaviors.

Predicament suicide: an update.

OBJECTIVE: We aim to outline the notion of predicament suicide and progress in the field. CONCLUSION: The term predicament suicide was initially applied when the individual without mental disorder completed suicide to escape intolerable circumstances. Subsequently, painful untreated or unresponsive mental disorder was conceptualized as an internal predicament and the term was applied to all suicide. It continues to be used in both the restricted and broad forms. Our group has substantiated the restricted form by describing suicide in the setting of financial loss, forced marriage and other predicaments. The broad form gave rise to the Operationalized Predicaments of Suicide tool for use in quantitative research. Some literature from other workers supports the general thrust of the notion.

Childhood cancer in the cinema: how the celluloid mirror reflects psychosocial care.

OBJECTIVE: This study aims to evaluate the childhood cancer experience in commercially produced, readily available films that include a character with childhood cancer, with a particular focus on psychosocial care. METHODS: We reviewed 29 films, using quantitative and qualitative content analysis, to identify the medical and psychosocial characteristics of the cinematic childhood cancer experience. We rated psychosocial support on a 5-point scale (0 to 4) based on the availability and efficacy of support characters in the categories of nonprofessional internal (eg, parent), nonprofessional external (eg, friend), professional medical (eg, oncologist), and professional psychosocial (eg, social worker) supports. RESULTS: Film depicts an unrealistic, bleak picture of childhood cancer, with a 66% mortality rate among the 35 characters evaluated. Psychosocial supports portrayed in film are generally limited to resources already available to families before the cancer diagnosis: mean ratings across films were 2.4 for both nonprofessional, 1.6 for professional medical, and 0.3 for professional psychosocial supports (Kruskal-Wallis χ3=43.1051, P<0.0001). Seven main themes emerged: disruption, social impact, psychological impact, physical toll, struggle/war/fight, coping, and barren landscape. Film generally depicts images of an isolated family courageously battling cancer alone with limited support from a treatment team solely dedicated to medical care. CONCLUSIONS: Commercially available films minimize the importance of the psychosocial dimension of care, which can perpetuate stigma around psychosocial needs and interventions. These films can be used to encourage discussion about how to optimize psychosocial care in pediatric oncology so that such care is not abandoned in actual practice as it is, for entertainment purposes, on the screen.

A validated questionnaire to assess the knowledge of psychiatric aspects of alcohol use disorder.

BACKGROUND: To the best of our knowledge, there is no validated instrument for measuring knowledge of psychiatric aspects of alcohol use disorder (AUD) amongst medical students. Our aim was to develop an instrument for this purpose and to describe the instrument's psychometric properties. We also investigated whether the instrument could demonstrate a significant change in scores following an educational intervention consisting of a 60-minute PowerPoint lecture on AUD, associated handouts, and role-plays. METHODS: The Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) was developed from the Kaplan and Saddock textbook synopsis chapter on alcohol related disorders. The questionnaire included 6 categories of clinically relevant material: metabolism of alcohol, short-term effects of alcohol, long-term effects of alcohol, AUD, alcohol withdrawal, and alcohol use in pregnancy. The KPAAQ was administered to 75 medical students in Years 4 and 5 from the Hebrew University in Jerusalem, Israel, during a relevant clinical rotation. Following the initial administration of the KPAAQ, the students attended a 60-minute lecture (in Hebrew) based on material from the University of Sydney's learning module on alcohol. The KPAAQ was readministered to the students immediately following the lecture. RESULTS: The KPAAQ demonstrated good reliability (Cronbach α =.92 for all questions) and validity r(209) =.674, P <.001. Knowledge of alcohol and alcoholism significantly increased after the educational intervention (F(2, 154) = 151.60, P <.001). Post hoc comparisons using the Scheffe test revealed a significant positive change in knowledge after students received the intervention (mean difference = 33, P <.001). CONCLUSIONS: These initial findings suggest that the KPAAQ is a reliable and valid instrument for assessing medical student knowledge of psychiatric aspects of AUD over 6 clinical categories.

Recovery and the role of humility: insights from a case study analysis.

When the individuals comprising a profession are focused more on competition rather than service to others, and when holding a significant place on the world stage is held in higher esteem than meaningful collaboration with the disempowered, is it possible to be truly consumer-centred? This article considers the notion of humility in the context of recovery and the challenges to the effective implementation of recovery-oriented services that have been identified. Insights are drawn from a case study analysis of the implementation of recovery approaches to health care into a publicly-funded mental health service located in Australia. While challenges to the operationalization of recovery are complex, we argue that the professional quality of humility provides an important means by which genuine and meaningful collaboration can be achieved among health professionals, consumers, carers, and other stakeholders.

Primary health care in the mental health workplace: insights from the Australian experience.

In Australia, Primary Health Care and the mental health sector have always shared a philosophy. In 1978, Primary Health Care was first put forward as a strategy to improve "health for all." Recently, the Australian Government included mental health as a national health priority, identifying six strategies consistent with a Primary Health Care approach to address the mental health of all Australians. Throughout this time, Primary Health Care has been highlighted in all models of care. However, in reality, it appears that in mental health services, mental health nurses, despite good intentions, are not delivering care in a planned or systematised way and that much needs to be done to further improve the situation for individuals accessing the health care system. Services currently focus on those identified as seriously mentally unwell; in order to really make an impact it is argued that services should be broader, offered to the population at large and, further, that the emphasis on case work at an individual level should be changed to an approach that considers prevention, maintenance, and follow-up as well as crisis intervention. This article reflects the Australian experience and offers some insights from that experience.

The correlation between impaired attention and emotional reactivity in depressed adolescent patients.

A group of 20 drug-naïve depressed adolescents and 20 matched controls underwent cognitive evaluations and assessment of emotional reactivity. Emotional reactivity correlated only with attention and only in depressed patients. The cognitive-emotional construct may enhance the understanding of adolescent depression and aid diagnosis.

Four centuries of suicide in opera.

OBJECTIVE: To describe the depiction of completed suicide, non-fatal suicidal acts and suicidal thought in Western opera over the past four centuries. DESIGN AND SETTING: Examination of synopses all of the operas listed in a recent monograph covering a selection of operas written in the period 1607-2006. MAIN OUTCOME MEASURES: Frequency of completed suicides, non-fatal suicidal acts and suicidal thoughts over the entire 400-year period and in separate 100-year periods (1607-1706, 1707-1806, 1807-1906 and 1907-2006); circumstances of suicides; sex of the suicidal characters; and, for completed suicide, the method. RESULTS: There were 337 operas in total. In 112 (33%), there was completed suicide alone, non-fatal suicidal acts or suicidal thoughts alone, or both. There was at least one suicide in 74 operas (22%); female characters accounted for 56% of these. Non-fatal suicidal acts or suicidal thoughts were found in 48 operas (14%); male characters accounted for 57% of these. Suicide, non-fatal acts and suicidal thoughts always followed an undesirable event or situation. Cutting or stabbing was the most common method of suicide (26 cases). Other methods included poisoning (15 cases), drowning (10 cases), hanging (four cases), asphyxiation (four cases), "supernatural" methods (four cases), immolation (three cases), jumping from a height (two cases), shooting (one) and blunt trauma (one). Mass suicide occurred on two occasions. CONCLUSIONS: Over several centuries in opera, suicide has been frequently represented as an option when characters have been faced with a distressing event or situation. Historical fluctuations in the frequency of suicidal behaviour in opera may be explained by changes in attitudes towards suicide and its conceptualisation.

Medical students' subjective ratings of stress levels and awareness of student support services about mental health.

PURPOSE: To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. STUDY DESIGN: From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. RESULTS: 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. CONCLUSIONS: Despite widespread awareness of appropriate support services, a large proportion of students felt they needed to conceal mental and emotional problems. Overall treatment rates for students who were greatly concerned about their mental and emotional state appeared modest, and, although comparable with those of similarly aged community populations, may reflect undertreatment. It would be appropriate for universities to address stressors identified by students. Strategies for encouraging distressed students to obtain appropriate assessment and treatment should also be explored. Those students who do seek healthcare are most likely to see a primary care physician, suggesting an important screening role for these health professionals.

Problematic internet use in childhood and youth: evolution of a 21st century affliction.

OBJECTIVE: To describe the emergence of, and myriad issues pertaining to, problematic internet use in childhood and youth. In this overview and appraisal of a uniquely 21st century affliction, the focus is on youth and less on young adult perspectives. CONCLUSIONS: We employed relevant literature-search methodology though EMBASE, Psychinfo and Web of Science, utilising the key terms of PIU, internet addiction and youth mental health, and present a selection of the pioneering and important research developments both nationally and internationally. We focused on the literature from the past 10 years, but we also included relevant early developments in the field going back to the 1990s. We also made reference, where appropriate, to major considerations of relevance to the general public, where these were reported in reputable international news and media organisations. The authors utilised common internet search engines to access these news reports. It was found that the complex, novel and at times controversial concept of 'problematic internet use' (PIU)--often popularly dubbed 'internet addiction'--has attracted much public, media and research interest, particularly over the past decade. In common with many other afflictions that have a prominent 'pop-cultural' component, often the commentary and debate has been polarising, unclear and sensationalist. At times, more light than heat appears to be generated.

Does art imitate death? Depictions of suicide in fiction.

OBJECTIVE: To determine whether fiction (narrative products) deals with the issue of suicide and, if so, what it tells us about suicide "drivers". METHOD: Accounts of suicide in narrative products were sought through web-based lists, book club members, other active readers and a prize-winning film writer and producer. RESULTS: Seventy-one depictions of fictional suicidal events were identified. In 12 suicides, the author appeared to indicate that the death was directly or indirectly due to mental disorder. In 15 suicides, the motivation could not be determined by the reader, and in 44 cases the motivation was social/situational factors. CONCLUSIONS: Suicidal events are depicted in fiction, and the features are broadly similar to the features of suicide in the real world. Should it be determined that cultural influences, including fiction, are important in suicide, any preventive activities aimed at modifying cultural influences will need to consider all forms of narrative product.

The mental health consequences of student "Holocaust memorial journeys".

OBJECTIVE: Our aim was to study the mental health consequences of Israeli adolescents' 8-day "Holocaust memorial journey" to Poland. METHOD: A survey to ascertain the experience of Israeli child and adolescent psychiatrists and residents in the specialty was conducted. Participants were asked about referrals regarding the memorial journey, and to compare these cases with referrals for other potentially traumatic events, including school "sleep-out" trips. RESULTS: Fifty child and adolescent psychiatrists and residents participated. According to their collective experience, the adolescents' memorial journey triggered a variety of mental health problems, including psychosis, but only one case of post-traumatic stress disorder (PTSD). Judging by the number of referrals, there was a higher rate of mental health problems following the memorial journey than after the annual sleep-out school trip. CONCLUSIONS: Although it may seldom lead to PTSD, the Holocaust memorial journey can be a major stressor for some participating teenagers. Evaluating "high risk" adolescents prior to their planned exposure to likely stressors and conducting large, prospective studies that examine the impact of pre-planned stressors on the lives of adolescents are warranted. Providing support to all adolescents before, during and after exposure to anticipated stressors is important.

An overview of the clubhouse model of psychiatric rehabilitation.

OBJECTIVE: The aim of this article is to provide an overview of the clubhouse model and its capacity to assist people with severe mental illness. METHOD: The paper uses a sample vignette (with all identifying information removed) and survey of literature describing clubhouses over the last 15 years. RESULTS: Strengths of the clubhouse model include its ability to provide a safe environment, supportive relationships and supported employment activities. Criticisms include its failure to provide onsite psychiatry clinics and a risk of promoting service dependence. CONCLUSIONS: Modern clubhouses continue to provide useful models of psychiatric rehabilitation which are popular worldwide. Studying and describing the model is challenging due to its complexity. Mixed methodological approaches and recovery-orientated measurement tools may assist future research and development.