The Psychological and Wellbeing Impacts of Quarantine on Frontline Workers during COVID-19 and Beyond.

OBJECTIVE: The current study investigated the experiences, wellbeing impacts, and coping strategies of frontline workers who participated in "Hotels for Heroes", an Australian voluntary hotel quarantine program during the COVID-19 pandemic. The program was open to those who were COVID-19 positive or exposed to COVID-19 as part of their profession. METHODS: Frontline workers who had stayed in voluntary quarantine between April 2020 and March 2021 were invited to participate in a voluntary, anonymous, cross-sectional online survey including both quantitative and qualitative responses. Complete responses were collected from 106 participants, which included data on sociodemographic and occupational characteristics, experiences of the Hotels for Heroes program, and validated mental health measures. RESULTS: Mental health problems were prevalent amongst frontline workers (e.g., moderate anxiety symptoms, severe depression symptoms, and greater than usual impact of fatigue). For some, quarantine appeared to be helpful for anxiety and burnout, but quarantine also appeared to impact anxiety, depression, and PTSD negatively, and longer stays in quarantine were associated with significantly higher coronavirus anxiety and fatigue impacts. The most widely received support in quarantine was from designated program staff; however, this was reportedly accessed by less than half of the participants. CONCLUSIONS: The current study points to specific aspects of mental health care that can be applied to participants of similar voluntary quarantine programs in the future. It seems necessary to screen for psychological needs at various stages of quarantine, and to allocate appropriate care and improve its accessibility, as many participants did not utilise the routine support offered. Support should especially target disease-related anxiety, symptoms of depression and trauma, and the impacts of fatigue. Future research is needed to clarify specific phases of need throughout quarantine programs, and the barriers for participants receiving mental health supports in these contexts.

Twelve tips for performing well in vivas.

The viva examination is a common method of assessment in medical education. It is, in essence a performance given by candidates to examiners, and as such, candidates would be well advised to optimize their performance. Knowledge and skills are essential to passing the viva, but they alone are not sufficient. The process of the performance is also important, but it is not often made explicit in feedback during viva practice. Moreover, there are many aspects to the performance process that can be worked on to improve candidates' chances of passing. Here we present 12 tips focused on performance processes, for use by supervisors and their trainees.

Teaching psychological processes and psychotherapy to medical students.

OBJECTIVE: Psychiatrists are in a key position to teach medical students about psychotherapy. Whilst at first it may appear a formidable task, it need not be so. It should however, have applicability to the bulk of students, who will not go on to psychiatry training. CONCLUSIONS: We outline some potentially useful strategies to help clinicians teach aspects of psychotherapy to students: making it easy and relevant, illustrating the broad applications of psychological concepts, introducing cultural references, as well as appreciating that assessment can drive learning.

Formulation for beginners.

OBJECTIVE: Developing a formulation is an important method of understanding the people we treat. Writing a formulation need not be seen as burdensome or difficult. Our objective is to provide a framework for the formulation process to make it more accessible for beginners. CONCLUSION: We describe a method that beginners can adopt easily and then build upon as their experience and knowledge broadens.

Disability after injury: the cumulative burden of physical and mental health.

CONTEXT: Injury is one of the leading contributors to the global burden of disease. The factors that drive long-term disability after injury are poorly understood. OBJECTIVE: The main aim of the study was to model the direct and indirect pathways to long-term disability after injury. Specifically, the relationships between 3 groups of variables and long-term disability were examined over time. These included physical factors (including injury characteristics and premorbid disability), pain severity (including pain at 1 week and 12 months), and psychiatric symptoms (including psychiatric history and posttraumatic stress, depression, and anxiety symptoms at 1 week and 12 months). DESIGN, SETTING, AND PARTICIPANTS: A multisite, longitudinal cohort study of 715 randomly selected injury patients (from April 2004 to February 2006). Participants were assessed just prior to discharge (mean = 7.0 days, SD = 7.8 days) and reassessed at 12 months postinjury. Injury patients who experienced moderate/severe traumatic brain injury and spinal cord injury were excluded from the study. MAIN OUTCOME MEASURE: The World Health Organization Disability Assessment Schedule 2.0 was used to assess disability at 12 months after injury. RESULTS: Disability at 12 months was up to 4 times greater than community norms, across all age groups. The development and maintenance of long-term disability occurred through a complex interaction of physical factors, pain severity across time, and psychiatric symptoms across time. While both physical factors and pain severity contributed significantly to 12-month disability (pain at 1 week: total effect [TE] = 0.2, standard error [SE] < 0.1; pain at 12 months: TE = 0.3, SE < 0.1; injury characteristics: TE = 0.3, SE < 0.1), the total effects of psychiatric symptoms were substantial (psychiatric symptoms 1 week: TE = 0.30, SE < 0.1; psychiatric symptoms 12 months: TE = 0.71, SE < 0.1). Taken together, psychiatric symptoms accounted for the largest proportion of the variance in disability at 12 months. CONCLUSIONS: While the physical and pain consequences of injury contribute significantly to enduring disability after injury, psychiatric symptoms play a greater role. Early interventions targeting psychiatric symptoms may play an important role in improving functional outcomes after injury.

Stepped early psychological intervention for posttraumatic stress disorder, other anxiety disorders, and depression following serious injury.

The best approach for implementing early psychological intervention for anxiety and depressive disorders after a traumatic event has not been established. This study aimed to test the effectiveness of a stepped model of early psychological intervention following traumatic injury. A sample of 683 consecutively admitted injury patients were screened during hospitalization. High-risk patients were followed up at 4-weeks postinjury and assessed for anxiety and depression symptom levels. Patients with elevated symptoms were randomly assigned to receive 4-10 sessions of cognitive-behavioral therapy (n = 24) or usual care (n = 22). Screening in the hospital identified 89% of those who went on to develop any anxiety or affective disorder at 12 months. Relative to usual care, patients receiving early intervention had significantly improved mental health at 12 months. A stepped model can effectively identify and treat injury patients with high psychiatric symptoms within 3 months of the initial trauma.

Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk?

BACKGROUND: This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission. METHODS: A two-group (those admitted to the ICU vs. those not admitted to ICU), prospective, cohort study of 829 randomly selected injury patients from five major trauma hospitals across Australia. We collected information on factors that may increase risk for PTSD including demographic variables (gender, age, income, education, and marital status), preinjury mental health status (prior trauma, psychiatric history, and prior social support), and injury characteristics (mild traumatic brain injury, injury severity, length of hospital admission, discharge destination, pain, and perceived threat). PTSD was measured at 12 months by structured clinical interview. RESULTS: ICU patients were significantly more likely to have PTSD at 12 months than trauma controls (17% vs. 7%). Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic, preinjury mental health status, and injury characteristic variables. CONCLUSIONS: Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.

Hereditary osteodystrophy with multiple hormone resistance--a case report.

Hereditary Osteodystrophy, also called pseudohypoparathyroidism, Type 1A (PHP), is a very rare condition composed of a heterogeneous group of autosomal dominant disorders with the common feature of organ resistance to multiple hormones. These patients produce the right amount of hormones but there is resistance to its effect. PHP is difficult to diagnose and the lack of diagnosis may have serious implications for the patient. We report a case of PHP, diagnosed by the dentist, due to the dental and jaw manifestations.

The role of post-traumatic stress disorder and depression in predicting disability after injury.

OBJECTIVES: To examine the relationship between psychological response to injury at 1 week and 3 months, and disability at 12 months. DESIGN: Multisite, longitudinal study. PARTICIPANTS AND SETTING: 802 adult patients admitted to trauma services at four Australian hospitals from 13 March 2004 to 21 February 2006 were assessed before discharge and followed up at 3 and 12 months. MAIN OUTCOME MEASURE: Disability, measured with the 12-item version of the World Health Organization Disability Assessment Schedule II. RESULTS: Logistic regression identified the degree to which high levels of depression and post-traumatic stress disorder (PTSD) at 1 week and at 3 months predicted disability at 12 months. After controlling for demographic variables and characteristics of the injury, patients with PTSD or subsyndromal PTSD at 1 week were 2.4 times more likely, and those with depression at 1 week were 1.9 times more likely to have high disability levels at 12 months. PTSD at 3 months was associated with 3.7 times, and depression at 3 months with 3.4 times the risk of high disability at 12 months. CONCLUSIONS: PTSD and depression at 1 week and at 3 months after injury significantly increased the risk of disability at 12 months. Routine assessment of symptoms of depression and PTSD in patients who have been physically injured may facilitate triage to evidence-based treatments, leading to improvement in both physical and psychological outcomes.

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

Depression and anxiety: pharmacological treatment in general practice.

BACKGROUND: Depression and anxiety are common presentations in general practice and medications are one of the key treatment strategies. OBJECTIVE: This article provides an overview of important practical issues to consider when prescribing medications for anxiety and depression. DISCUSSION: Key questions for the general practitioner to consider are: Are medications the best option? Which is the best medication for this patient? What are the practical aspects of prescribing this medication? What is the next step if it doesn't work?

Data collection in consultation-liaison psychiatry: an evaluation of Casemix.

OBJECTIVE: To evaluate the usefulness of Casemix as a data collection system for consultation-liaison psychiatry services. METHOD: Health information staff were requested to code psychiatric assessments and diagnosis prospectively for admissions to the Alfred Hospital, Melbourne, between July 2002 and June 2004 using Casemix. RESULTS: Psychiatric assessments were requested on 2.5% of all hospital admissions (n = 2575). Casemix provided extensive demographic and hospital unit data for referred patients, is easy to set up, and is cost-free for the psychiatry service. CONCLUSIONS: Casemix can provide extensive meaningful data for consultation-liaison psychiatry services that could assist in the argument for greater funding of these services.