Well-being and burnout in medical students: challenges and solutions.

Medicine (like many others) can be an extremely stressful profession. The pressures faced by clinicians are often related to 'life and death' situations that can lead to high levels of stress and distress. Students and trainees in a variety of allied health professions face similar pressures related to study or work environments. The practice of medicine continuously evolves and changes, and so too do the pressures. If the correct support is not accessible, this can result in burnout. Medical students are generally at a vulnerable stage in life (18-24 years) when they are more likely to develop mental health problems. A recent focus on the mental health and well-being of medical students has highlighted various worrying trends with a series of studies from around the world highlighting surprisingly high rates of stress and burnout among medical students, and fairly similar contributory factors. Despite the challenge of defining and measuring burnout, these studies indicate an urgent need for changes in methods of teaching, alongside rapid access to support. In this editorial, we make some proposals that could help the next generation of doctors to look after themselves and their patients. Medical schools have a moral and ethical obligation to ensure the well-being of their students in these stressful times.

Relationship between family history of alcohol problems and different clusters of depressive symptoms.

OBJECTIVES: Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms. METHODS: Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations. RESULTS: There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters. CONCLUSION: FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.

Racism and mental health and the role of mental health professionals.

The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.

Sexuality in the 21st Century: Sexual Fluidity.

Sexuality is a vital component of human life. Sexuality deals with procreation and pleasure. Sexual behaviours and orientations vary and may be related to mental health. Some sexual orientations may be discriminated or censored by religious or political beliefs, and this has a big impact on sexual variations. Frequently, sexual variations are considered to be pathological and need to be medically treated. However, it should be accepted that sexuality includes a continuum of behaviours, thoughts, fantasies, acts, and attractions that are beyond procreation. Modern sexology introduced the concept of gender identity and sexual fluidity to describe how gender and sexual orientation vary and are flexible over time. Healthcare professionals and policy makers should be aware of these new definitions in order to meet health needs of sexually variant people and prevent sexuality discrimination.

Attitude of Medical Students in Paraguay Towards Homosexuality.

INTRODUCTION: The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality. METHODS: This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality. RESULTS: A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001). CONCLUSION: Education about health issues of homosexuals is needed for medical students in Paraguay.

Attitude of Indian Medical Students Towards Homosexuality.

INTRODUCTION: It is important to understand the attitude of medical students towards homosexuality, as this may affect patient care. METHODS: Year 2 and 3 students at Calcutta National Medical College, Kolkata, India were asked to selfadminister an 18-item questionnaire anonymously. Internal consistency of the questionnaire statements was high (Cronbach's alpha of 0.91). There were five responses for each statement: strongly agree, generally agree, unsure, generally disagree, and strongly disagree. RESULTS: Of 290 students, 270 (93.1%) [148 males and 122 females] completed the questionnaire and were included in the analysis. Overall, 55.6% strongly disagreed that homosexuality was an illness; 70.8% agreed that homosexuals were capable of forming stable relationships. Only 31.1% believed that homosexual doctors would better understand homosexual patients. About 71.8% reported that talking about homosexuality did not embarrass them, and 81.8% believed that problems associated with homosexuality could be reduced if society was more liberal. Nonetheless, negative attitudes were reflected in the stereotypical image of homosexuality. About 15.9% of respondents believed that homosexuality was an illness; 24.8% considered homosexuals neurotic, 28.1% considered homosexuals promiscuous; and 8.2% thought that they posed a danger to children. CONCLUSION: Although the overall attitude of Indian medical students towards homosexuality is positive, the percentage of students with negative attitudes remains quite high. Further work on the medical curriculum is needed to change these negative attitudes so that patients receive appropriate care.

Depression, Anxiety, and Stress Symptoms in Menopausal Arab Women: Shedding More Light on a Complex Relationship.

BACKGROUND: The association between depression, anxiety, and stress among Arab menopause and postmenopausal women have been explored in detailed. AIM: The objective of this study was to determine the correlation between depression, anxiety, and stress in menopausal and postmenopausal women and shedding more light on a complex relationship. SUBJECTS AND METHODS: A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian women at the primary health care centers in Qatar. A representative sample of 1468 women aged 45-65 years were approached during July 2012 and May 2014 and 1101 women agreed to participate (75.0%) and responded to the study. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scales 21. Data on body mass index (BMI), clinical and other parameters were used. Univariate, multivariate, and matrix correlation analysis were performed for statistical analysis. RESULTS: A total of 1101 women agreed to participate after informed consent was obtained. The mean age and standard deviation (SD) of the menopausal age were 49.55 (3.12), the mean and SD of postmenopausal age was 58.08 (3.26) (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Furthermore, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure (BP), Vitamin D deficiency, and diseases. Depression and anxiety were more common among postmenopause women. Furthermore, there were no differences between the groups regarding the frequency of certain levels of stress among menopause and postmenopause. The multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were a predictor for depression. Meanwhile, diastolic BP, occupation, and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation, and sheesha smoking habits were considered as the main risk factors associated with stress. CONCLUSION: A large number of factors were associated with experiencing menopausal and psycho-social problems and which had negative effects on the quality of life among Arabian women. Depression, anxiety, and stress should be considered as important risk factors for osteoporosis.

Descartes' dogma and damage to Western psychiatry.

René Descartes described the concept of mind-body dualism in the 16th century. This concept has been called his error but we prefer to call it his dogma because the error was recognised much later. We studied the original writings translated by various scholars. We believe that his dogma has caused tremendous amount of damage to Western psychiatry. This dualism has created boundaries between mind and body but as we know they are inextricably interlinked and influence each other. This has affected clinical practice and has increased the dichotomy between psychiatric services and the physical health care services in the West at least. This dualism has also contributed to stigma against mental illness, the mentally ill and the psychiatric services. We propose that it is time to abandon this mind-body dualism and to look at the whole patient and their illness experiences as is done in some other health care systems such as Ayurveda.

EPA guidance on the role and responsibilities of psychiatrists.

Psychiatry is that branch of the medical profession, which deals with the origin, diagnosis, prevention, and management of mental disorders or mental illness, emotional and behavioural disturbances. Thus, a psychiatrist is a trained doctor who has received further training in the field of diagnosing and managing mental illnesses, mental disorders and emotional and behavioural disturbances. This EPA Guidance document was developed following consultation and literature searches as well as grey literature and was approved by the EPA Guidance Committee. The role and responsibilities of the psychiatrist include planning and delivering high quality services within the resources available and to advocate for the patients and the services. The European Psychiatric Association seeks to rise to the challenge of articulating these roles and responsibilities. This EPA Guidance is directed towards psychiatrists and the medical profession as a whole, towards other members of the multidisciplinary teams as well as to employers and other stakeholders such as policy makers and patients and their families.

EPA guidance on how to improve the image of psychiatry and of the psychiatrist.

Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.

Mistrust of mental health services: ethnicity, hospital admission and unfair treatment.

AIMS: To explore the role of psychiatric admission, diagnosis and reported unfair treatment in the relationship between ethnicity and mistrust of mental health services. METHODS: The Mental Illness-Related Investigations on Discrimination (MIRIAD) study was a cross-sectional study of 202 individuals using secondary mental health services in South London. Two structural equation models were estimated, one using Admission (whether admitted to hospital for psychiatric treatment in the past 5 years) and one using involuntary admission to hospital in the past 5 years. RESULTS: Increased mistrust was directly associated with the latent variable 'unfair treatment by mental health services and staff' and with Black or mixed ethnicity in both models. Those with a diagnosis of schizophrenia spectrum (as compared to depression and bipolar disorder) had a lower average score on the latent variable, suggesting that on average they reported less unfair treatment. We found evidence of increased reporting of unfair treatment by those who had an admission in the past 5 years, had experienced involuntary admission, and for people of Black of mixed Black and White ethnicity. CONCLUSIONS: Neither prevalence of schizophrenia spectrum nor rates of hospital admission explained the greater mistrust of mental health services found among people of Black and mixed Black and White ethnicity compared with White ethnicity. Rather, people of Black and mixed Black and white ethnicity may be more likely to experience unfair treatment, generating mistrust; furthermore, this group is more likely to express mistrust even after accounting for reporting of unfair treatment by mental health services and staff.

Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children.

BACKGROUND: It has been reported that ferritin and iron deficiency may be related to the path physiology of attention deficit hyperactivity disorder (ADHD). AIM: The aim of this study was to determine the association between iron deficiency and ADHD and the impact and role of iron deficiency on the development of ADHD in children. SUBJECTS AND METHODS: The study based on the case-control study age- and sex-matched control and conducted at the School Health and Primary Healthcare Clinics, Qatar. A total of 630 children with ADHD aged 5-18 and 630 controls aged 5-18 years old. Sociodemographic and clinical data were collected, including physician diagnosis. The health status of the subjects was assessed by ascertaining clinical presentations and symptoms, family history, body mass index (BMI), iron deficiency, ferritin, serum 25-hydroxyvitamin D, calcium, magnesium, and phosphorus levels. Descriptive, univariate, and multivariate statistical analysis were performed. RESULTS: Mean age (standard deviation [SD] in years) for ADHD and control children were 11.54 (3.83) versus 11.50 (3.62). There were statistically significant differences between ADHD versus control children for vitamin D [16.81 (7.84) vs. 22.18 (9.00) ng/ml], serum iron [82.11 (13.61) vs. 85.60 (12.47) ng/ml], ferritin [36.26 (5.93) vs. 38.19 (5.61) ng/ml], hemoglobin [12.02 (2.13) vs. 12.89 (2.02) g/dL], magnesium [0.82 (0.08) vs. 0.88 (0.06) mmol/L], serum calcium level [2.35 (0.12) vs. 2.39 (0.14) mmol/L], and phosphorous [1.47 (0.30) vs. 1.54 (0.26) mmol/L]. Of total 630 of ADHD children, 116 (18.4%) had severe vitamin D deficiency (<10 ng/ml). Multivariate logistic regression analysis revealed that serum vitamin D level, serum iron, ferritin, serum calcium level, physical activity, nervous behavior, consanguinity, BMI, and child order were considered as the main factors associated with the ADHD after adjusting for age, gender, and other variables. CONCLUSION: The study indicates that low serum iron, ferritin levels, and vitamin D deficiency may be associated with ADHD.