Objective assessment of sleep and fatigue risk in emergency medicine physicians.

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.

Daily expression of workaholism and family outcomes: The buffering and magnifying effects of economic resources.

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.

Job Demands and Resources among Healthcare Professionals during Virus Pandemics: A Review and Examination of Fluctuations in Mental Health Strain during COVID-19.

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.

Testing the effects of using a behavioral health provider to deliver a routine post-deployment assessment for soldiers returning from combat.

Studies indicate that changes in postdeployment behavioral health care delivery are necessary to improve symptom-reporting and treatment-seeking. The present study compared two behavioral health strategies implemented during the Post-Deployment Health Assessment (PDHA) with soldiers within the first months of returning from a combat deployment. A quasi-experimental, longitudinal study compared soldiers (N = 1,612) interviewed by a behavioral health (BH) provider and soldiers (N = 1,326) interviewed by a primary care provider using the standard PDHA procedure. Surveys pre- and post-PDHA and four months later assessed treatment-seeking attitudes; PDHA data and BH clinic use were compiled and compared by each interview strategy. Soldiers interviewed by a BH provider rated interview usefulness, quality, and comfort reporting BH concerns more positively than soldiers interviewed by a primary care provider using the standard procedure. However, there were no differences in treatment-seeking attitudes, provider referral rates, or use of BH services in the 4 months after the PDHA. Although there were initial positive reports of the interview with the BH Provider, there was no evidence BH provider interviews resulted in any lasting improvements in treatment-seeking or long-term treatment attitudes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Enhancing the Meaningfulness of Work for Astronauts on Long Duration Space Exploration Missions.

INTRODUCTION: Numerous authors have identified the stressors likely to be encountered on long duration space exploration missions (e.g., to Mars), including the possibility of significant crises, separation from family, boredom/monotony, and interpersonal conflict. Although many authors have noted that meaningful work may be beneficial for astronauts on these missions, none have detailed the sources of meaningful work for astronauts and how these sources may differ between astronauts. The present article identifies how engagement in meaningful work during long duration missions may mitigate the adverse effects of demands and increase the potential for benefits resulting from the missions. METHOD: Semistructured interviews were conducted with nine NASA personnel, including astronauts, flight directors, and flight surgeons. Questions addressed sources of meaning for astronauts, characteristics of tasks that enhance vs. detract from meaning, and recommendations for enhancing meaning. RESULTS: Personnel mentioned contributing to humanity and the next generation, contributing to the mission, and exploration as the most meaningful aspects of their work. Characteristics of tasks that enhanced meaning included using a variety of skills, feeling personal control over their schedule, autonomy in the execution of tasks, and understanding the importance of the experiments conducted on the mission. Top recommendations to sustain meaning were insuring social needs were met through such activities as the strategic use of social media, giving astronauts autonomy as well as structure, and conducting training during transit. DISCUSSION: Implications are addressed for tailoring meaning-based interventions for astronauts participating on long duration missions and assessing the effectiveness of these interventions.Britt TW, Sytine A, Brady A, Wilkes R, Pittman R, Jennings K, Goguen K. Enhancing the meaningfulness of work for astronauts on long duration space exploration missions. Aerosp Med Hum Perform. 2017; 88(8):779-783.

Impediments to mental health treatment as predictors of mental health symptoms following combat.

This longitudinal study examined whether impediments to mental health treatment would predict changes in mental health symptoms (posttraumatic stress disorder [PTSD] and depression) in the months following soldiers returning from combat. Three-hundred ten combat veterans completed measures of impediments to treatment and measures of PTSD and depression symptoms at 2, 3, and 4 months following a 15-month combat deployment. Structural equation modeling revealed that greater impediments (a latent variable indexed by stigma, practical barriers, and negative treatment attitudes) at 2 months predicted increased PTSD and depression symptoms from 2-3 months (ß = .14) and greater impediments at 3 months predicted increased symptoms from 3-4 months (ß = .26). In contrast, evidence was not obtained for the opposite causal direction of symptoms predicting higher levels of impediments at the different periods. Possible mechanisms for the predictive effects of impediments are discussed.