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Schwartz M, Berkowitz J, McCann-Pineo M. Understanding the Role of Empathy and Gender on EMS Clinician Occupational Stress and Mental Health Outcomes. PREHOSP EMERG CARE 2024; 28:635-645. [PMID: 38359401 DOI: 10.1080/10903127.2024.2319139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Emergency Medical Service (EMS) clinicians experience high levels of occupational stress due to long hours, short staffing, and patient deaths, among other factors. While gender has been partially examined, little is known regarding the role of empathy on occupational stress and mental health (MH) outcomes among EMS clinicians. Therefore, the current study examines the moderating role of empathy and, separately, gender on associations between occupational stress and mental health. METHODS A cross-sectional examination of EMS clinician occupational and personal wellbeing was conducted via an anonymous, electronic survey. Information on clinician demographics, and validated measures of occupational stress, burnout, and MH outcomes were collected. Empathy was assessed using the Toronto Empathy Scale (TEQ). Descriptive/bivariate statistics were conducted for variables of interest. Separate multivariable regression models evaluated associations between occupational stress and mental health outcomes. Empathy and gender were examined as potential moderators using interactions. RESULTS A total of 568 EMS clinicians completed the survey. High levels of mental health difficulties were reported (34.0% anxiety, 29.2% depression, 48.6% burnout). Increased occupational stress was associated with increased anxiety (OR =1.08, 95% CI 1.05-1.10), depression (OR = 1.09, 95% CI 1.06-1.10), and burnout (OR = 1.10, 95% CI 1.07-1.12). No moderation analyses were significant. Greater resilience was associated with lower depression, anxiety, and burnout. CONCLUSION EMS clinicians, much like other first responders, experience considerable occupational stress, of which is associated with mental health difficulties and burnout. Findings underscore the need for intervention programs aimed at reducing the impact of occupational stress and the promotion of resilience. Continuing to understand the full scope of EMS mental health, including the role of resilience, is imperative, particularly in light of future public emergencies.
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Affiliation(s)
| | - Jonathan Berkowitz
- Northwell, New Hyde Park, New York, USA
- Department of Emergency Medicine, Northshore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Molly McCann-Pineo
- Northwell, New Hyde Park, New York, USA
- Department of Emergency Medicine, Northshore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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McCann-Pineo M, Keating M, McEvoy T, Schwartz M, Schwartz RM, Washko J, Wuestman E, Berkowitz J. The Female Emergency Medical Services Experience: A Mixed Methods Study. PREHOSP EMERG CARE 2024; 28:626-634. [PMID: 38266147 DOI: 10.1080/10903127.2024.2306248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Emergency Medical Services (EMS) is a challenging profession. Little is known if there are gender differences in the experiences among EMS clinicians. Therefore, our aim was to understand and characterize the occupational experiences of female EMS clinicians. METHODS A mixed methodological study was conducted among currently licensed female EMS clinicians via focus group and self-report survey data. Three focus groups (n = 5, 4, 13, respectively) were conducted with participants purposively recruited from primarily Northeastern EMS agencies. Through ongoing collaborations, a recruitment advertisement was provided to EMS leadership at respective agencies for distribution among their female staff. Sessions were recorded and transcribed for thematic analysis. A six-phase inductive analytical approach was utilized to evaluate focus group data. Qualitative findings were utilized to inform a cross-sectional, self-report survey consisting of occupational specific experiences, such as harassment and pregnancy, and validated measures of mental wellbeing. Descriptive statistics were used to describe the study sample and female EMS clinician occupational and personal experiences. RESULTS A total of 22 female EMS clinicians participated across the three focus group sessions. Four major themes were identified: 1) the female EMS experience; 2) impact on personal wellbeing; 3) impact on occupational wellbeing; and 4) coping mechanisms. Each theme had multiple subthemes. There were 161 participants that attempted the 72-item survey, 13 partial and 148 competed surveys. Median age was 32 years (IQR: 25-42), and the majority were EMT-Bs (55.1%). Approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout. Almost 73.0% reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Over 61.0% reported reconsideration of their career in EMS. Overall, survey data indicated interactions with peers and leadership, and social support were positive. CONCLUSIONS Findings highlight the need to improve the occupational experiences of female EMS clinicians to preserve and encourage the continuation of their participation in this workforce. Specifically tailored interventions aimed at protecting and improving their overall wellbeing are critical, particularly considering the increased occupational burden resulting from the pandemic. Future research should aim to understand specific predictors of adverse mental health outcomes among this population.
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Affiliation(s)
- Molly McCann-Pineo
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, New York
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Manhasset, New York
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Meghan Keating
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, New York
| | - Tara McEvoy
- Cancer Institute, Northwell Health, Manhasset, New York
| | - Mikayla Schwartz
- The Feinstein Institutes for Medical Research, Manhasset, New York
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Manhasset, New York
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jonathan Washko
- Center for Emergency Medical Services, Northwell Health, Syosset, New York
| | - Elizabeth Wuestman
- Center for Emergency Medical Services, Northwell Health, Syosset, New York
| | - Jonathan Berkowitz
- Center for Emergency Medical Services, Northwell Health, Syosset, New York
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Chow PI, Shaffer KM, Lohman MC, LeBaron VT, Fortuna KL, Ritterband LM. Examining the relationship between changes in personality and depression in older adult cancer survivors. Aging Ment Health 2020; 24:1237-1245. [PMID: 30939904 DOI: 10.1080/13607863.2019.1594158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Despite widespread agreement that personality traits change across the lifespan into older adulthood, the association between changes in personality and depression among older adult cancer survivors is unknown. It was hypothesized that older adults with (vs. without) a past cancer diagnosis would experience an increase in neuroticism, and decreases in conscientiousness, agreeableness, openness, and extraversion, and that changes in these traits would mediate the relationship between receiving a cancer diagnosis and change in depression. Two hypotheses were tested in a cancer survivor sample. First, that increased chronic stressors and decreased physical health would mediate the link between personality change and increased depression. Second, that personality change would mediate the link between changes in chronic stressors/health and increased depression.Method: Secondary data analysis utilizing three waves of data from the Health and Retirement Study. Data was compiled from 5,217 participants, among whom 707 received a cancer diagnosis.Results: Older adults with (vs. without) a cancer diagnosis decreased in conscientiousness, which was associated with increased depression. Among cancer survivors, worsening chronic stressors/health mediated many pathways between personality change and an increased depression. Increased neuroticism mediated the link between worsening health/chronic stressors and increased depression.Conclusion: With the exception of conscientiousness, changes in personality did not mediate the link between cancer survivor status and depression. Among older adult cancer survivors, changes in personality traits may increase depression through worsening physical health and chronic stressors, potentially informing targeted interventions. Interventions that target increased neuroticism may be particularly useful in older adult cancer survivors.
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Affiliation(s)
- Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Kelly M Shaffer
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Matthew C Lohman
- Arnold School of Public Health, University of South Carolina, Charleston, SC, USA
| | - Virginia T LeBaron
- University of Virginia, School of Nursing, Acute and Specialty Care, Charlottesville, VA, USA
| | - Karen L Fortuna
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
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Filler T, Dunn S, Grace SL, Straus SE, Stewart DE, Gagliardi AR. Multi-level strategies to tailor patient-centred care for women: qualitative interviews with clinicians. BMC Health Serv Res 2020; 20:212. [PMID: 32169069 PMCID: PMC7071699 DOI: 10.1186/s12913-020-05082-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered care (PCC) is one approach for ameliorating persistent gendered disparities in health care quality, yet no prior research has studied how to achieve patient-centred care for women (PCCW). The purpose of this study was to explore how clinicians deliver PCCW, challenges they face, and the strategies they suggest are needed to support PCCW. METHODS We conducted semi-structured qualitative interviews (25-60 min) with clinicians. Thirty-seven clinicians representing 7 specialties (family physicians, cardiologists, cardiac surgeons, obstetricians/gynecologist, psychiatrists, nurses, social workers) who manage depression (n = 16), cardiovascular disease (n = 11) and contraceptive counseling (n = 10), conditions that affect women across the lifespan. We used constant comparative analysis to inductively analyze transcripts, mapped themes to a 6-domain PCC conceptual framework to interpret findings, and complied with qualitative research reporting standards. RESULTS Clinicians said that women don't always communicate their health concerns and physicians sometimes disregard women's health concerns, warranting unique PCC approaches.. Clinicians described 39 approaches they used to tailor PCC for women across 6 PCC domains: foster a healing relationship, exchange information, address emotions/concerns, manage uncertainty, make decisions, and enable self-management. Additional conditions that facilitated PCCW were: privacy, access to female clinicians, accommodating children through onsite facilities, and flexible appointment formats and schedules. Clinicians suggested 7 strategies needed to address barriers of PCCW they identified at the: patient-level (online appointments, transport to health services, use of patient partners to plan and/or deliver services), clinician-level (medical training and continuing professional development in PCC and women's health), and system-level (funding models for longer appointment times, multidisciplinary teamwork to address all PCC domains). CONCLUSIONS Our research revealed numerous strategies that clinicians can use to optimize PCCW, and health care managers and policy-makers can use to support PCCW through programs and policies. Identified strategies addressed all domains of an established PCC conceptual framework. Future research should evaluate the implementation and impact of these strategies on relevant outcomes such as perceived PCC among women and associated clinical outcomes to prepare for broad scale-up.
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Affiliation(s)
- Tali Filler
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | | | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.,York University, Toronto, Canada
| | | | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
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Gagliardi AR, Dunn S, Foster AM, Grace SL, Khanlou N, Stewart DE, Straus SE. Is patient-centred care for women a priority for policy-makers? Content analysis of government policies. Health Res Policy Syst 2020; 18:23. [PMID: 32070365 PMCID: PMC7029558 DOI: 10.1186/s12961-020-0533-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how government policies recognise and promote PCC for women (PCCW). METHODS We analysed the content of English-language policies published in Canada from 2010 to 2018 on depression and cardiac rehabilitation - conditions featuring known gendered inequities - that were identified on government websites. We extracted data and used summary statistics to enumerate mentions of PCC and women's health. RESULTS We included 30 policies (20 depression, 10 cardiac rehabilitation). Of those, 20 (66.7%) included any content related to PCC (median 1.0, range 0.0 to 5.0), most often exchanging information (14, 46.7%) and making decisions (13, 43.3%). Less frequent domains were enabling self-management (8, 26.7%), addressing emotions (6, 20.0%) and fostering the relationship (4, 13.3%). No policies included content for the domain of managing uncertainty. A higher proportion of cardiac rehabilitation guidelines included PCC content. Among the 30 policies, 7 (23.3%) included content related to at least one women's health domain (median 0.0, range 0.0 to 3.0). Most frequently included were social determinants of health (4, 13.3%). Fewer policies mentioned any issues to consider for women (2, 28.6%), issues specific to subgroups of women (2, 28.6%) or distinguished care for women from men (2, 28.6%). No policies included mention of abuse or violence, or discrimination or stigma. The policies largely pertained to depression. Despite mention of PCC or women's health, policies offered brief, vague guidance on how to achieve PCCW; for example, "Patients value being involved in decision-making" and "Women want care that is collaborative, woman- and family-centered, and culturally sensitive." CONCLUSIONS Despite considerable evidence of need and international recommendations, most policies failed to recognise gendered disparities or promote PCC as a mitigating strategy. These identified gaps represent opportunities by which government policies could be developed or strengthened to support PCCW. Future research should investigate complementary strategies such as equipping policy-makers with the evidence and tools required to develop PCCW-informed policies.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto and Women's College Research Institute, Toronto, M5S1B2, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, K1N6N5, Canada
| | - Sherry L Grace
- York University and University Health Network, Toronto, M3J1P3, Canada
| | | | - Donna E Stewart
- University of Toronto, Toronto General Hospital Research Institute, Toronto, M5G2C4, Canada
| | - Sharon E Straus
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B1W8, Canada
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La dépression chez les proches de patients souffrant de schizophrénie : effets longitudinaux sur 8 mois du programme ProFamille. Encephale 2018; 44:128-133. [DOI: 10.1016/j.encep.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
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Ebert DD, Buntrock C, Reins JA, Zimmermann J, Cuijpers P. Efficacy and moderators of psychological interventions in treating subclinical symptoms of depression and preventing major depressive disorder onsets: protocol for an individual patient data meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e018582. [PMID: 29549201 PMCID: PMC5857689 DOI: 10.1136/bmjopen-2017-018582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The long-term effectiveness of psychological interventions for the treatment of subthreshold depression and the prevention of depression is unclear and effects vary among subgroups of patients, indicating that not all patients profit from such interventions. Randomised clinical trials are mostly underpowered to examine adequately subgroups and moderator effects. The aim of the present study is, therefore, to examine the short-term and long-term as well as moderator effects of psychological interventions compared with control groups in adults with subthreshold depression on depressive symptom severity, treatment response, remission, symptom deterioration, quality of life, anxiety and the prevention of major depressive disorder (MDD) onsets on individual patient level and study level using an individual patient data meta-analysis approach. METHODS AND ANALYSIS Systematic searches in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials were conducted. We will use the following types of outcome criteria: (A) onset of major depression; (B) time to major depression onset; (C) observer-reported and self-reported depressive symptom severity; (D) response; (E) remission; (F) symptom deterioration; (G) quality of life, (H) anxiety; and (I) suicidal thoughts and behaviours. Multilevel models with participants nested within studies will be used. Missing data will be handled using a joint modelling approach to multiple imputation. A number of sensitivity analyses will be conducted in order test the robustness of our findings. ETHICS AND DISSEMINATION The investigators of the primary trials have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment.This study will summarise the available evidence on the short-term and long-term effectiveness of preventive psychological interventions for the treatment of subthreshold depression and prevention of MDD onset. Identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised interventions for patients with subthreshold depression. PROSPERO REGISTRATION NUMBER CRD42017058585.
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Affiliation(s)
- David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Jo Annika Reins
- Institute of Psychology, Leuphana University of Luneburg, Luneburg, Germany
| | - Johannes Zimmermann
- Chair for Psychological Methods and Diagnostics, Psychologische Hochschule Berlin, Berlin, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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