Implementing Longitudinal Wellbeing Interventions and Evaluation Among Midwestern Healthcare Workers During COVID-19.

BACKGROUND: The impact of the COVID-19 pandemic on the mental health of healthcare workers throughout the world has been reported, but most studies have been cross-sectional and excluded the Midwestern U.S. healthcare workforce. OBJECTIVE: This study aimed to longitudinally assess the psychological wellbeing and wellness strategies used by a Midwestern academic health system's workforce at multiple points throughout waves of the COVID-19 pandemic to inform ongoing implementation of appropriate wellness activities. METHODS: An anonymous REDCap survey linked within our team-developed wellness education was posted in the employee online newsletter in April (T1), July (T2), October 2020 (T3), and May 2021 (T4). Surveys were open to all employees (approx. 9000) for approximately 12 days at each time point. Anxiety, depressive symptoms, stress, self-efficacy, and self-care activities were assessed. Following each data collection, team members discussed findings and planned wellness education implementation. RESULTS: Response ranged from n = 731 (T1) to n = 172 (T4). Moderate to severe stress was reported by 29.5% (n = 203) of respondents at T1 and 34.0% (n = 108) at T2. At T3, all psychological symptoms significantly increased (p < .001) as COVID-19 surged, with 48.5% (n = 141) of respondents reporting moderate to severe stress. At T4, stress significantly declined (p < .001). Exercise was the most frequently reported coping strategy. CONCLUSIONS: Mental health symptoms reported by a Midwestern healthcare workforce increased during surges of COVID-19 hospitalizations. Individuals in non-patient contact roles experienced symptom levels similar to and at times with greater severity than healthcare personnel with patient contact roles.

Understanding Formal Caregiver Burden in Nursing Assistants in Nursing Homes: A Mixed Methods Approach.

The current study aimed to describe formal caregiver burden of nursing assistants in nursing homes. A descriptive, cross-sectional, convergent mixed methods approach identified attributes of formal caregiver burden using phenomenological interviews and established self-report measures. Themes included nursing assistants' experiences of stress, close relationships, extensive assistance of residents, balancing needs and routines, and feeling accomplished. Self-report measures demonstrated moderate stress, moderate caring behaviors, responsibility, and competence. MDS 3.0 results showed moderate cognitive impairment, minimal depressive symptoms, and decreased functional status of residents. The mixed methods synthesis confirmed the presence of five attributes of formal caregiver burden: perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Burnout was not confirmed. Future investigation of attributes among a larger, diverse sample of nursing assistants, residents, and nursing homes will advance knowledge and inform research design and methods of interventions. [Research in Gerontological Nursing, 16(5), 231-240.].

Student Perceptions of a Reflective Writing-based Wellness Course: "Good in Theory, But..."

To offset disconcerting trends showing alarming rates of burnout and other types of psychological distress among medical students, many medical schools have implemented wellness initiatives for first year students as they are first adjusting to the rigors of medical school. This study examines students' attitudes toward a reflective writing-based wellness course. We conducted a thematic analysis of 97 writings that students wrote in response to a prompt asking them what they thought of the wellness course at an American Midwestern medical school. The most consistent perception that students expressed was that while they were deeply appreciative of the effort to integrate wellness into the curriculum (what we call Good in Theory…), they did not think it was implemented efficaciously and even, in some cases, felt that the wellness course contributed to their distress rather than alleviated it (what we call …But…). Specifically, while the wellness course helped them prioritize wellness and fostered connection between fellow medical students, it also conflicted with their individualized notions of health and was a burden on their limited time. We discuss the findings in the context of their implications for medical education and argue that the implicit messages students internalized from the mere existence of a wellness program-that the university/faculty cares about them, they do not need to feel guilt when taking a break from medicine, they are not alone, and it is acceptable to express emotions-are all important for their professional socialization and personal well-being.

A platform for nursing research on spirituality and religiosity: definitions and measures.

Spirituality or religiousness is important across the health trajectory, from promoting health and preventing disease, to coping with illness and end of life. Research on the relationship of religiousness or spirituality to health spans more than one discipline and applies many definitions and measures. The purpose of this multidisciplinary work is to facilitate research by nurses who seek to investigate the relationship between health and religiousness or spirituality, and provide evidence-based guidance for nursing practice. Senior researchers summarize the history of inquiry on this topic, discuss particular and persistent challenges posed by definitions of religion and spirituality, describe selected measures that have enjoyed wide application, and make recommendations for consideration by nurse researchers. Use of existing knowledge to select variables, definitions, and measures, and to link research questions and findings to the larger body of current inquiry, will advance nursing practice closer to fulfilling Nightingale's ideals for effective care.

Methylphenidate for apathy and functional status in dementia of the Alzheimer type.

OBJECTIVE: Apathy is the most common behavioral problem in persons with dementia of the Alzheimer type (DAT). Treatment of apathy in DAT is not systematically studied. The purpose of this study was to evaluate the response of apathy to methylphenidate treatment and to examine whether functional status improved. METHODS: The authors conducted a 12-week open-labeled study with immediate release formulation of methylphenidate. Twenty-three patients with DAT scoring >40 on the Apathy Evaluation Scale (AES) were recruited. Repeated measures analysis of variance and correlation analysis were performed. RESULTS: None of the patients dropped out of the study because of adverse events. Significant improvement in apathy was noted during 12 weeks. Significant improvement was also noted in depression, Mini-Mental State Examination score, and functional status. There was no correlation between changes in the AES and depression scores. CONCLUSIONS: Methylphenidate was well tolerated in these patients with DAT. Apathy improved with the use of methylphenidate.

Impact of problem alcohol use on patient behavior and caregiver burden in a geriatric assessment clinic.

There has been a growing interest in understanding issues surrounding alcohol use in late life. Information about the relationship of alcohol use to behavioral problems in older persons living in the community is particularly limited. This study used information obtained from an outpatient geriatric assessment clinic to study this relationship and the effects of these behaviors on caregivers. Data on alcohol use, problem behaviors, and caregiver burden were collected prospectively in consecutive patients undergoing geriatric assessment primarily for cognitive problems over a 3-year period. All patients were evaluated by a multidisciplinary team, which included a geriatric psychiatrist. The evaluation screened for current and/or past alcohol use through interviews with the patient and a collateral source. The collateral source also completed the Neuropsychiatric Inventory and the Family Burden Scale. Subjects were classified into 2 groups: those with a current or past alcohol problem and those with no alcohol problem. A total of 349 patients were evaluated, with 17.8% being designated as having a current or past alcohol problem. This subgroup represented 35% of the men and 9% of the women from the study population. Approximately half of the subgroup was actively drinking alcohol. Patients with a history of problem alcohol use, regardless of current use and cognitive status, exhibited more behavioral disturbances including agitation, irritability, and disinhibition. Their caregivers reported significantly higher caregiver distress. Current or past alcohol problem use was frequent in this population of frail, older adults undergoing geriatric assessment. Regardless of current alcohol use, these patients displayed more behavioral disturbances than those without a history of problem drinking, and their caregivers experienced significantly more burden. A history of problem drinking appears to be a significant marker for behavioral disturbances in late life and merits further study.

Escitalopram: better treatment for depression is through the looking glass.

Depression remains a common and often devastating illness. With the introduction of the selective serotonin reuptake inhibitors in the 1980s, patients were afforded treatment for depression that was both safer and better tolerated than any prior treatment modality offered. Although selective serotonin reuptake inhibitors quickly became the most widely used medications for the treatment of depression, no single agent has been recognized as an obvious first-line choice. Chirality potentially offers one method to improve upon the selective serotonin reuptake inhibitor class. For racemic compounds that differ in stereospecificity, separation into single enantiomers can result in significant changes in potency, tolerability and efficacy. One of the most widely prescribed selective serotonin reuptake inhibitors is citalopram, which exists as a racemic mixture of R- and S-enantiomers. The S-enantiomer escitalopram (Cipralex, Lundbeck) is the therapeutically active portion of the parent compound and has a proven antidepressant efficacy. The R-enantiomer lacks activity as an antidepressant and has been shown to inhibit the effect of the S-enantiomer when the two are combined. Escitalopram is the most selective member of its class and with minimal effects on the cytochrome P450 system, has a negligible potential for drug-drug interactions. In placebo-controlled trials, escitalopram has consistently demonstrated symptomatic improvement as early as the first to second week of treatment. In addition to antidepressant efficacy, escitalopram also appears to exhibit significant anxiolytic properties. It has also shown efficacy in treating panic disorder and generalized and social anxiety disorders. This is advantageous as many patients who suffer from depression also experience comorbid anxiety disorders.

Late-life mood disorders.

Mental disorders are not uncommon in late life. Although most psychiatric disorders occur less frequently in older populations compared with populations of younger adults, more than 10% of older adults have one or more psychiatric disorders. In addition, many older adults present with symptoms that do not meet the criteria for a specific disorder but nevertheless are clinically significant and affect quality of life. In this article the authors summarize the epidemiologic data for five psychiatric disorders and their subclinical forms: depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders.

The "ER" Seminar: Teaching Psychotherapeutic Techniques to Medical Students.

The challenge of teaching good communication skills and psychotherapy to medical students was addressed through development of a clerkship seminar that stressed the practical application of psychotherapeutic techniques to the difficult and/or psychiatric patient. Clinical vignettes from television programs such as "ER" were used to illustrate encounters with extremely emotional or personality-disordered patients. Students also examined the dynamic meaning of these encounters, their own countertransference, and their ability to tolerate emotional interchanges with such patients. In addition, the vignettes were used to examine and apply Buckman's model for breaking bad news to patients who have undergone a significant loss. Seventy-two third-year medical students participated and completed pre- and post-seminar questionnaires to assess their knowledge and attitudes toward psychotherapeutic techniques. Students significantly improved in knowledge of countertransference, boundary setting, and how to break bad news. Attitudes toward breaking bad news and recognizing strong countertransference also improved. Some differences in post-seminar knowledge and attitudes were found between male and female students.

A Comparison of Two Depression Scales in a Geriatric Assessment Clinic.

Two commonly used geriatric depression rating scales are the Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CS). The GDS is a self-rating scale used to identify depressed older adults, whereas the CS is used to assess severity of depression based on a clinical interview. Because the scales may thus be complementary, their use was examined in 182 patients undergoing an outpatient geriatric assessment. Geriatric psychiatrists, blind to the results of the GDS, completed the CS and assigned clinical diagnoses. Both scales distinguished depressed from nondepressed individuals by means of ROC-generated cutoff scores relative to a clinical diagnosis of depression. The scores on the depression scales were not affected by cognitive status as measured by the Mini-Mental State Examination. The mean GDS scores did not vary by geriatric psychiatrist. The mean CS scores, however, did significantly differ across psychiatrists despite the fact that the psychiatrists were not blind to patients' clinical diagnosis.

Serotonin Reuptake Inhibitors for the Treatment of Coexisting Depression and Psychosis in Dementia of the Alzheimer Type.

Four patients, ages 75 to 92 years, with a dementia of the Alzheimer type, presented with accompanying depression and psychosis. In these patients, treatment with a selective serotonin reuptake inhibitor resulted in a dramatic clearing of not only the depressive symptoms but the psychosis as well. Treatment was well tolerated in all cases.

A Collateral Source Version of the Geriatric Depression Rating Scale.

One hundred ninety-four patients undergoing comprehensive geriatric assessment completed the Geriatric Depression Scale (GDS), and their collateral source (CS) completed a CS version of the GDS (CS-GDS). The results were compared with the blind, prospective diagnoses made by geriatric psychiatrists. The CSs reported the presence of 28 of 30 symptoms significantly more often than the patients. Receiver operating characteristic curve analyses showed good agreement among the clinical diagnoses and both the patient-completed GDS and the CS-completed CS-GDS. At cutoff scores used in prior studies of the GDS, the CS-GDS had limited specificity and poor positive predictive value.