Before and During the First COVID-19 Surge: Work Conditions, Burnout, and Mental Health Among Resident Physicians in a Department of Psychiatry in the USA.

OBJECTIVE: Resident physicians are critical frontline workers during pandemics, and little is known about their health. The study examined occupational and mental health risks among US psychiatry residents before and during the first COVID-19 surge. METHODS: Longitudinal data were collected from a cohort of US psychiatry residents at one academic medical center in October 2019, before the pandemic, and April 2020 after the initiation of a state-level stay-at-home order. Primary outcome measures were psychological work empowerment, defined as one's self-efficacy towards their work role, and occupational burnout. A secondary outcome was mental health. In May and June 2020, resident engagement sessions were conducted to disseminate study findings and consider their implications. RESULTS: Fifty-seven out of 59 eligible residents participated in the study (97%). Half the study sample reported high burnout. From before to during the first COVID-19 surge, psychological work empowerment increased in the total sample (p = 0.03); and mental health worsened among junior residents (p = 0.004), not senior residents (p = 0.12). High emotional exhaustion and depersonalization were associated with worse mental health (p < 0.001). In engagement sessions, themes related to residents' work conditions, COVID-19, and racism emerged as potential explanations for survey findings. CONCLUSIONS: The study is exploratory and novel. During early COVID, psychiatry residents' well-being was impacted by occupational and societal factors. Postpandemic, there is a growing psychiatrist shortage and high demand for mental health services. The findings highlight the potential importance of physician wellness interventions focused on early career psychiatrists who were first responders during COVID.

Prevalence of Screening High Risk of Obstructive Sleep Apnea Among Urogynecology Patients.

OBJECTIVES: There is limited knowledge on the prevalence of obstructive sleep apnea (OSA) among urogynecology patients. The aim of this study was to determine the prevalence of screening high risk of OSA (HR-OSA) in an ambulatory urogynecology clinic. METHODS: Women presenting for a new patient visit to a single outpatient urogynecology clinic for any indication were screened for eligibility. Patients were included if they were 18 years or older, English speaking, nonpregnant, and not using treatment for OSA. Participants completed the STOP-BANG questionnaire to screen for OSA and additional questionnaires to assess the presence and classification of nocturia and urinary incontinence. RESULTS: Among 130 participants, the prevalence of screening HR-OSA was 38.5%. Characteristics associated with screening HR-OSA included hypertension (P < 0.001), diabetes (P=0.003), untreated sleep apnea (P < 0.001), body mass index ≥30 kg/m (P < 0.001), and age >50 years (P < 0.001). Participants who screened HR-OSA were more likely to have bothersome bladder symptoms of nocturia (P < 0.001), nocturnal enuresis (P < 0.001), higher urinary distress inventory scores (P < 0.001), and incontinence severity index scores (P < 0.001). On multivariable analysis, age >50 years (odds ratio [OR], 7.54), hypertension (OR, 4.04), body mass index ≥30 kg/m (OR, 3.98), and nocturial enuresis (OR, 2.26) remained significantly associated with screening HR-OSA. Average time to complete the STOP-BANG was 1.2 minutes. CONCLUSIONS: The prevalence of OSA among urogynecology patients is high, and screening is not time prohibitive. Patients who screen HR-OSA have more bothersome bladder symptoms. Providers should consider screening urogynecology patients for OSA, especially patients who are 50 years or older, are obese, and have nocturnal enuresis.

Personal trauma among healthcare providers: implications for screening practices.

Screening rates for trauma are low in health care settings. We examined the association between health care providers' (HCPs) experience of physical or sexual trauma and their screening of female patients for trauma. HCPs at an urban academic medical institution were surveyed from September through November 2016. The Brief Trauma (BTQ) and Sexual and Physical Abuse History Questionnaires (SPAHQ) assessed their own experiences of trauma. The Screening Practices Questionnaire (SPQ) assessed HCPs trauma screening. Multiple regression analyses were performed. Among 212 respondents aged 22-67 years, most were female (78.3%) and white (76.1%). Nurses (41.0%) were the largest occupational group. Overall, 85.8% reported having experienced trauma. No significant difference was observed in median SPQ scores between HCPs who had experienced trauma (3.88 [Interquartile Range (IQR) 3.44-4.31]) and those who had not (4.00 [IQR 3.47-4.33], p = .645). In an adjusted model, screening policy awareness and having an obstetrics & gynecology or psychiatry specialty were associated with higher SPQ scores (p < .001). The prevalence of trauma experience in this sample was high, but not associated with screening. Screening policy awareness and practice specialty were associated with screening. HCP factors associated with greater trauma screening should be explored.