A Model for Providing Psychological Support to Healthcare Leaders and Teams in Times of Crisis.

OBJECTIVE: Pre-pandemic, the healthcare workforce was already at risk for higher burnout than the general population and, in some roles (e.g., physicians, nurses), at higher risk for clinical distress and suicide. Studies of healthcare workforce well-being during and after past pandemics reflect that distress can persist after a pandemic subsides, if adequate support within the workplace is not forthcoming and accessible. The current report presents the rationale for and development of a wellness consult service to provide support to leaders and teams in an academic medical center during the COVID-19 pandemic and now as teams work to recover and rebuild after years of significant pandemic and other stressors. METHODS: Healthcare workers who participated in supportive Listening Sessions or Interactive Workshops facilitated by the wellness consult service were invited to complete an anonymous post-session survey. RESULTS: Between March 2020 and November 2022, 185 leaders and teams participated in 342 supportive Listening Sessions and Interactive Workshops. Of the respondents to the post-session survey (N = 701), 89% rated the intervention as "good to excellent" and 84% were likely or very likely to recommend this service. Leaders rated the experience more highly than non-leaders (F (1,307) = 13.99, p < 0.001) and were more likely to report feeling emotionally supported (F (1,304) = 19.836, p < 0.001). CONCLUSIONS: Supporting leader and team well-being may be critical to post-pandemic recovery of the healthcare workforce. The current report presents a feasible, theory-driven model for doing so, which was rated as highly satisfactory by participants.

Protecting the Well-Being of Medical Residents and Faculty Physicians During the COVID-19 Pandemic: Making the Case for Accessible, Comprehensive Wellness Resources.

Accounts of frontline health care workers experiencing distress in the midst of the COVID-19 pandemic highlight the need for accessible psychological support for them. Prior to the pandemic, medical residents and physicians often experienced difficulty receiving counseling due to concerns about confidentiality, stigma, cost, time, and reportability to licensure/credentialing bodies. Since 2004, the OHSU Resident and Faculty Wellness Program (RFWP) team has sought to reduce these barriers by providing on-site free, confidential, individual counseling and medication management. Utilization of this program is high with over 500 physicians a year seeking care; 38% of all OHSU residents/fellows and 7% of all faculty eligible for our services participated in 2019-20. In the present essay, we describe how our model of care for trainees and faculty was a key wellness resource during COVID-19. Similar to other accounts of lower help-seeking by health professionals initially during the pandemic, we experienced a slight downturn in utilization rates during the initial weeks of when the pandemic struck our area, but quickly returned to normal and exceeded prior levels. All appointments shifted to telehealth visits and a number of physicians expressed gratitude for the opportunity to talk through concerns and strengthen coping. A number of physicians requested medication consultations to address severe insomnia, anxiety, and depression. We hope that being present in our physicians' lives when they are exposed to COVID-related stress or trauma will keep them safe, help them cope with difficult experiences and losses, and ultimately facilitate both recovery and post-traumatic growth.

Feasibility of a Comprehensive Wellness and Suicide Prevention Program: A Decade of Caring for Physicians in Training and Practice.

BACKGROUND: Comprehensive treatment models reduce distress and suicide risk in military, university, and community populations, but are not well studied with in medical trainees and physicians in practice. Physicians face unique internal and external barriers that limit access to psychological or psychiatric treatment, which may contribute to higher rates of burnout, depression, and suicide. OBJECTIVE: Our goal is to report on the feasibility and utilization of a wellness and suicide prevention program for residents, fellows, and faculty in an academic health center. METHODS: The program provides individual counseling, psychiatric evaluation, and wellness workshops for residents/fellows (N = 906) and faculty (N = 1400). Demand for services is demonstrated by the participation rate of eligible trainees. Acceptability within the target population is examined in a 2011 survey in which trainees (N = 116, 97% participation) and program directors (N = 23, 88% participation) rated their satisfaction. Start-up costs and funding sources to sustain a wellness program are outlined. RESULTS: Over 10 years, utilization of services grew from 5% in the program's first year (2004-2005) to a high of 25% of eligible trainees for 2013-2014, and faculty utilization grew to 6% to 8% for 2014-2015. Trainees and program directors reported a high level of satisfaction with this wellness program. Funding for clinic space and clinical staff is provided by the hospital via the graduate medical education budget. CONCLUSIONS: Increased utilization over 10 years, high satisfaction, and consistent institutional support suggest that this comprehensive model of care is feasible and valued.

"If you build it, they will come": attitudes of medical residents and fellows about seeking services in a resident wellness program.

BACKGROUND: High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling. INTERVENTION: A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services. METHODS: In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP. RESULTS: Of the 88% of trainees who knew about the RWP, 87% indicated they would be very likely or somewhat likely to seek out services. Time remained the biggest barrier for residents to getting help. Being male (odds ratio [OR]  =  0.54, 95% confidence interval [CI] 0.34-0.84) or an ethnic/racial minority (OR  =  0.49, 95% CI 0.28-0.85) was associated with greater unwillingness to seek counseling. Reluctance to access the RWP was associated with concerns about helpfulness, confidentiality, being unable to take a break, and stigma. Women (OR  =  1.60, 95% CI 1.06-2.42) and primary care residents (OR  =  1.58, 95% CI 0.98-2.54) were more likely to be concerned about taking a break. Men were more likely to question the helpfulness of counseling (OR  =  0.55, 95% CI 0.36-0.85). CONCLUSIONS: The RWP removed barriers of cost and knowledge about counseling services. More educational outreach is needed to address sex and ethnic differences about RWP utilization and attitudes in medical culture about a physician's right to address personal health care needs.

A new measure of children's optimism and pessimism: the youth life orientation test.

BACKGROUND: Optimism and pessimism are positive and negative expectations linked with well-being in adults. Research on the importance of optimism and pessimism in children is limited by the lack of a developmentally appropriate measure of children's expectations. METHOD: Based upon the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994), the Youth Life Orientation Test (YLOT) is a sixteen-item self-report measure of children's optimism and pessimism. RESULTS: Reliability and validity of the YLOT was found with 204 3rd-6th graders. Optimism also predicted fewer child-reported depressive symptoms and parent-reported behavior problems assessed three months later. Pessimism predicted more child-reported anxiety symptoms and parent-reported social and academic deficits.

Predictors of smoking intentions and smoking status among nonsmoking and smoking adolescents.

PURPOSE: To examine predictors of smoking intentions among current adolescent nonsmokers and smokers as well as risk factors associated with smoking status. METHODS: Adolescents (N=237), ages 12 through 18 years, were asked to complete a questionnaire that assessed smoking behavior and variables thought to be related to smoking. Cognitive-motivational variables including perceived vulnerability and optimism, not previously examined in adolescent smoking studies, were also included. RESULTS: Parental smoking, higher perceived instrumental value, higher risk taking/rebelliousness, higher perceived vulnerability, and older age increased the odds of an adolescent being a smoker. Greater intentions to smoke among nonsmokers was best predicted by peer influences, less knowledge, and higher perceived instrumental value. Smokers with lower intentions to quit perceived greater instrumental value of smoking. CONCLUSIONS: There are important distinctions between the factors that prompt intentions to smoke and to quit smoking. Smoking prevention/cessation programs will need to address specific factors that distinguish adolescents at varying stages of risk.

Psychometric properties of optimism and pessimism: results from the Girls' Health Enrichment Multisite Studies.

UNLABELLED: Background. This study investigated the relationships among optimism, pessimism, physical activity, and dietary behaviors among 8- to 10-year-old African-American girls in the Girls' Health Enrichment Multisite Studies (GEMS). Methods. Ninety-two girls were randomly assigned to a 12-week physical activity and diet intervention or comparison group and completed psychosocial assessments including the Youth Life Orientation Test (YLOT) of optimism and pessimism, physical performance self-concept, physical activity self-efficacy, physical activity outcome expectancies, and physical activity and sedentary preferences. Also, preferences for bottled water and sweetened beverages were assessed. Physical activity and dietary intake were assessed by self-report and parent-report at baseline and follow-up. Also, physical activity was objectively assessed by wearing an accelerometer for 3 days. The psychometric properties of the optimism-pessimism subscales were analyzed. Results. The measures of optimism and pessimism in children were reliable (r = 0.75-0.82). In the multiple regression analyses without the intervention interaction terms, pessimism was positively and significantly related to increases in MET-adjusted usual activity (P = 0.008) and sedentary behaviors (P = 0.0004). Additionally, a negative (P = 0.026) pessimism by intervention interaction term for MET-adjusted usual activity was found such that the intervention group had a lower change in physical activity per unit increase in pessimism compared to the control group. CONCLUSIONS: Among 8- to 10-year-old African-American girls, pessimism was related to increased sedentary behaviors and usual activity. Previous studies have reported relationships between optimism and health-compromising behaviors. This study found that pessimism may positively or negatively influence efforts to increase health-promoting behaviors. Future research should confirm and clarify the meaning of these findings.

Stress and psychopathology in children and adolescents: is there evidence of specificity?

Research on the relations between specific stressors and specific psychological outcomes among children and adolescents is reviewed. Specificity, the notion that particular risk factors are uniquely related to particular outcomes is discussed from a theoretical perspective, and models of specificity are described. Several domains of stressors are examined from a specificity framework (e.g., exposure to violence, abuse, and divorce/marital conflict) in relation to broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted within the past 15 years are examined, and definitional problems are highlighted. Little evidence for specificity was found. Methodological problems in the literature and the lack of theory-driven specificity research are discussed, and directions for future research are identified.