Resilience, stress, and coping among Canadian medical students

Background: Numerous studies have established that medical school is a stressful place but coping styles and resilience have not been adequately addressed as protective factors.Method: Using a cross-sectional design, 155 students were surveyed using the Connor-Davidson Resilience Scale, Perceived Stress Scale, and the Canadian Community Health Survey Coping Scale.  Mean scores were compared by gender and between our sample and normative scores using t-tests.  Multivariate linear regression was performed to examine whether stress levels were related to coping and resilience.Results:  Medical students had higher perceived stress, negative coping, and lower resilience than age and gender-matched peers in the general population.   Male medical students had higher positive coping scores than general population peers and higher resilience, and lower perceived stress than female medical students. Coping scores did not vary by gender in our sample.  The multivariate model showed that resilience and negative, but not positive coping, predicted stress.Conclusions: Medical students are neither more resilient nor better equipped with coping skills than peers in the population.  Greater emphasis on self-care among medical trainees is recommended.  Emphasizing the importance of self-care during medical training, whether by formal incorporation into the curriculum or informal mentorship, deserves further study

Affective instability and impulsivity predict nonsuicidal self-injury in the general population : a longitudinal analysis

Background Impulsivity and affective instability are related traits known to be associated with nonsuicidal self-injury, although few longitudinal studies have examined this relationship. The purpose of this study was to determine if impulsivity and affective instability predict future nonsuicidal self-injury in the general population while accounting for the overlap between these traits. Methods Logistic regression analyses were conducted on data from 2344 participants who completed an 18-month follow-up of the 2000 British National Psychiatric Morbidity Survey. Affective instability and impulsivity were assessed at baseline with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Nonsuicidal self-injury was assessed at baseline and follow-up during semi-structured interviews. Results Affective instability and impulsivity predicted the onset of nonsuicidal self-injury during the follow-up period. Affective instability, but not impulsivity, predicted the continuation of nonsuicidal self-injury during the follow-up period. Affective instability accounted for part of the relationship between impulsivity and nonsuicidal self-injury. Conclusions Affective instability and impulsivity are important predictors of nonsuicidal self-injury in the general population. It may be more useful to target affective instability over impulsivity for the treatment of nonsuicidal self-injury

The effect of socio-demographic factors on mental health and addiction high-cost use : a retrospective, population-based study in Saskatchewan

Objective: A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. Methods: We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009–2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study (‘persistent high-cost use’). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. Results: The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~$19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. Conclusion: Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability

Chronic Pain and Fatigue: Associations with Religion and Spirituality

BACKGROUND: Conditions with chronic, non-life-threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individual’s spirituality and/or religion may be one such factor that can influence the experience of chronic pain or fatigue

Suicide Prevention through Shared Information

ABSTRACT Objectives Although mental health clinicians are in the best position to assess a person’s risk for suicide, people at imminent risk may first seek the help of crisis workers, the police, hospital staff, or family members. The present project will use international (UK Biobank), provincial, and local crisis line data to elucidate imminent risks for suicide. An interdisciplinary team will discuss whether a common protocol for handling acute cases is warranted. The possibility of sharing a minimal set of information across services will also be discussed. Approach The conceptual framework is that suicide is a probabilistic outcome of risks (comprised of inherited traits, habits, and environmental stressors) that can be put in temporal order as distal, proximate, and immediate antecedents. Local, provincial, and international data will be mined for risks corresponding to each epoch. The evidence will be assessed by an interdisciplinary team composed of patient advocates, psychiatrists, the police service, community health workers and academic researchers with the objective of reaching an agreement on a common protocol for suicidality assessment. The possibility of sharing a minimal dataset that is relevant to saving the lives of people at imminent risk of suicide will be explored. Finally, the efficacy of coordinated care across services will be evaluated by comparing suicide and self-harm rates will be assessed by comparing suicide and self-harm rates before and after the adoption of the protocol. Results An interdisciplinary team has been formed and funding for the project is being sought. An application for data access to the UK Biobank received preliminary approval and is being evaluated by the scientific committee. Applications for access to provincial administrative data as well as telephone crisis line data for the last 10 years are being prepared. Conclusion Routinely collected administrative data is a resource for the collective decision-making of an interdisciplinary team of experts and patient advocates. The ability of critical information to flow across organizational boundaries may be an important tool in suicide prevention. Dialogues regarding the ethical dilemma between potentially saving lives and potentially breaking privacy may need to happen

The European research and development operations of Japanese multinationals

SIGLEAvailable from British Library Document Supply Centre-DSC:3597.94803(237) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

How Spiritual Values and Worship Attendance Relate to Psychiatric Disorders in the Canadian Population

Objective: Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method: In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results: Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders. Conclusion: This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders. </jats:sec