Doctors’ perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional survey of the UK physicians

ObjectiveHow adverse outcomes and complaints are managed may significantly impact on physician well-being and practice. We aimed to investigate how depression, anxiety and defensive medical practice are associated with doctors actual and perceived support, behaviour of colleagues and process issues regarding how complaints investigations are carried out.DesignA survey study. Respondents were classified into three groups: no complaint, recent/current complaint (within 6 months) or past complaint. Each group completed specific surveys.SettingBritish Medical Association (BMA) members were invited to complete an online survey.Participants95 636 members of the BMA were asked to participate. 7926 (8.3%) completed the survey, of whom 1780 (22.5%) had no complaint, 3889 (49.1%) had a past complaint and 2257 (28.5%) had a recent/current complaint. We excluded those with no complaints leaving 6144 in the final sample.Primary outcomes measuresWe measured anxiety and depression using the Generalised Anxiety Disorder Scale 7 and Physical Health Questionnaire 9. Defensive practice was assessed using a new measure for avoidance and hedging.ResultsMost felt supported by colleagues (61%), only 31% felt supported by management. Not following process (56%), protracted timescales (78%), vexatious complaints (49%), feeling bullied (39%) or victimised for whistleblowing (20%), and using complaints to undermine (31%) were reported. Perceived support by management (relative risk (RR) depression: 0.77, 95% CI 0.71 to 0.83; RR anxiety: 0.80, 95% CI 0.74 to 0.87), speaking to colleagues (RR depression: 0.64, 95% CI 0.48 to 0.84 and RR anxiety: 0.69, 95% CI 0.51 to 0.94, respectively), fair/accurate documentation (RR depression: 0.80, 95% CI 0.75 to 0.86; RR anxiety: 0.81, 95% CI 0.75 to 0.87), and being informed about rights (RR depression 0.96 (0.89 to 1.03) and anxiety 0.94 (0.87 to 1.02), correlated positively with well-being and reduced defensive practice. Doctors worried most about professional humiliation following a complaint investigation (80%).ConclusionPoor process, prolonged timescales and vexatious use of complaints systems are associated with decreased psychological welfare and increased defensive practice. In contrast, perceived support from colleagues and management is associated with a reduction in these effects.

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Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study

BMJ Open ◽

10.1136/bmjopen-2019-030968 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030968 ◽

Cited By ~ 5

Author(s):

Tom Bourne ◽

Harsha Shah ◽

Nora Falconieri ◽

Dirk Timmerman ◽

Christoph Lees ◽

...

Keyword(s):

Medical Practice ◽

Maslach Burnout Inventory ◽

Well Being ◽

Survey Study ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Obstetrics And Gynaecology ◽

Quality Of Patient Care ◽

The Uk

ObjectivesTo determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being.DesignNationwide online cross-sectional survey study; December 2017–March 2018.SettingHospitals in the UK.Participants5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists.Primary and secondary outcome measuresPrevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being.Results3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout.ConclusionsHigh levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.

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Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study (Preprint)

10.2196/preprints.24776 ◽

2020 ◽

Author(s):

Khanh Ngoc Cong Duong ◽

Tien Nguyen Le Bao ◽

Phuong Thi Lan Nguyen ◽

Thanh Vo Van ◽

Toi Phung Lam ◽

...

Keyword(s):

Psychological Distress ◽

General Population ◽

Psychological Health ◽

Online Survey ◽

Survey Study ◽

Limited Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Event Scale ◽

The Impact

BACKGROUND The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. OBJECTIVE This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. METHODS We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. RESULTS A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). CONCLUSIONS The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. CLINICALTRIAL

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Survey of young people in one region of the UK on accessing COVID-19 information (SOCIAL)

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000942 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000942

Author(s):

Oliver G P Lawton ◽

Sarah A Lawton ◽

Lisa Dikomitis ◽

Joanne Protheroe ◽

Joanne Smith ◽

...

Keyword(s):

Social Media ◽

Young People ◽

Significant Role ◽

Online Survey ◽

Descriptive Statistics ◽

Sources Of Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Education Gaps ◽

The Uk

COVID-19 has significantly impacted young people’s lives yet little is known about the COVID-19 related sources of information they access. We performed a cross-sectional survey of pupils (11–16 years) in North Staffordshire, UK. 408 (23%) pupils responded to an online survey emailed to them by their school. Descriptive statistics were used to summarise the data. Social media, accessed by 68%, played a significant role in the provision of information, despite it not being considered trustworthy. 89% felt that COVID-19 had negatively affected their education. Gaps in the provision of information on COVID-19 have been identified.

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Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002619 ◽

2021 ◽

pp. bmjspcare-2020-002619

Author(s):

Marcus Sellars ◽

Julien Tran ◽

Linda Nolte ◽

Ben White ◽

Craig Sinclair ◽

...

Keyword(s):

Decision Making ◽

Online Survey ◽

Public Knowledge ◽

Cross Sectional Survey ◽

Medical Decisions ◽

Cross Sectional ◽

Minimal Support ◽

Substitute Decision Maker ◽

Final Sample ◽

Advance Care

ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.ConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

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Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD

Journal of Psychopharmacology ◽

10.1177/0269881120967878 ◽

2021 ◽

pp. 026988112096787

Author(s):

Alan K Davis ◽

Frederick S Barrett ◽

Sara So ◽

Natalie Gukasyan ◽

Thomas C Swift ◽

...

Keyword(s):

Life Satisfaction ◽

Longitudinal Research ◽

Psychological Flexibility ◽

Well Being ◽

Survey Study ◽

Strongly Correlated ◽

Strong Correlations ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Therapeutic Outcomes

Background: Several measures have been developed to examine acute psychedelic effects (e.g. mystical-type and challenging experiences), but no measure assesses acute psychologically insightful experiences that may occur during psychedelic experiences. Aim: The purpose of this study was to develop and examine the psychometric properties of the Psychological Insight Questionnaire. Method: A cross-sectional survey study among psilocybin and LSD users. Respondents ( n=1661; Mage=22.9, standard deviation=8.5; Caucasian/White=83%; non-Hispanic=91%; men=72%; United States resident=66%) completed an Internet-based survey. Results: The Psychological Insight Questionnaire consists of 23 items with two subscales: (a) Avoidance and Maladaptive Patterns Insights and (b) Goals and Adaptive Patterns Insights. Construct validity of the Psychological Insight Questionnaire was supported by strong correlations of the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores with the insight subscale of the Session Impacts Scale, and weak-to-moderate correlations with the Mystical Experiences and Challenging Experiences Questionnaires. Furthermore, Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores were moderately-to-strongly correlated with retrospectively reported increases in psychological flexibility, and well-being/life satisfaction that were attributed to a memorable psychedelic experience. Lastly, incremental validity was established showing that the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights subscale) scores predict unique variance in changes in psychological flexibility, and Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores predict changes in well-being and life satisfaction, beyond measures of acute mystical-type and challenging effects. Conclusions: The Psychological Insight Questionnaire has the potential to extend the understanding of the acute and enduring effects of psychedelics. Further longitudinal research is necessary to determine the long-term predictive validity of the Psychological Insight Questionnaire and to examine the role of psychological insight in predicting therapeutic outcomes.

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Use of online cultural content for mental health and well-being during COVID-19 restrictions: cross-sectional survey

BJPsych Bulletin ◽

10.1192/bjb.2021.103 ◽

2021 ◽

pp. 1-10

Author(s):

Rebecca J. Syed Sheriff ◽

Helen Adams ◽

Evgenia Riga ◽

Andrew K. Przybylski ◽

Laura Bonsaver ◽

...

Keyword(s):

Mental Health ◽

Well Being ◽

Vulnerable Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Online Culture ◽

Reported Data ◽

June July ◽

The Uk ◽

Health And Well Being

Aims and method To gain a deeper understanding of the use of online culture and its potential benefits to mental health and well-being, sociodemographic characteristics and self-reported data on usage, perceived mental health benefits and health status were collected in an online cross-sectional survey during COVID-19 restrictions in the UK in June–July 2020. Results In total, 1056 people completed the survey. A high proportion of participants reported finding online culture helpful for mental health; all but one of the benefits were associated with regular use and some with age. Reported benefits were wide-ranging and interconnected. Those aged under 25 years were less likely to be regular users of online culture or to have increased their use during lockdown. Clinical implications There may be benefits in targeting cultural resources for mental health to vulnerable groups such as young adults.

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Resilience, well-being, depression symptoms and concussion levels in equestrian athletes

Journal of Public Mental Health ◽

10.1108/jpmh-08-2020-0110 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Annika McGivern ◽

Stephen Shannon ◽

Gavin Breslin

Keyword(s):

Mental Health ◽

Online Survey ◽

Well Being ◽

Depression Symptoms ◽

Physical And Mental Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Content Type ◽

Mental Health Support ◽

History Of

Purpose This paper aims to conduct the first cross-sectional survey on depression, Resilience, well-being, depression symptoms and concussion levels in equestrian athletes and to assess whether past concussion rates were associated with depression, resilience and well-being. Design/methodology/approach In total, 511 participants from Canada, Republic of Ireland, UK, Australia and USA took part in an international cross-sectional, online survey evaluating concussion history, depression symptoms, resilience and well-being. Findings In total, 27.1% of athletes met clinically relevant symptoms of major depressive disorder. Significant differences were shown in the well-being and resilience scores between countries. Significant relationships were observed between reported history of concussion and both high depression scores and low well-being scores. Practical implications Findings highlight the need for mental health promotion and support in equestrian sport. Social implications Results support previous research suggesting a need for enhanced mental health support for equestrians. There is reason to believe that mental illness could still be present in riders with normal levels of resilience and well-being. Originality/value This study examined an understudied athlete group: equestrian athletes and presents important findings with implications for the physical and mental health of this population.

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A survey of clinical opinions and preferences on the non-surgical management of intermittent exotropia in China

10.1101/2021.04.13.21255451 ◽

2021 ◽

Author(s):

Yidong Wu ◽

Tingting Peng ◽

Jinjing Zhou ◽

Meiping Xu ◽

Yi Gao ◽

...

Keyword(s):

Surgical Management ◽

Online Survey ◽

Randomized Clinical Trials ◽

Treatment Guidelines ◽

Survey Study ◽

Cross Sectional Survey ◽

Intermittent Exotropia ◽

Cross Sectional ◽

Surgical Interventions ◽

Surgical Options

Purpose: Intermittent exotropia (IXT) is the most common form of childhood exotropia. Currently, controversies exist regarding its management and non-surgical options in particular. This study reports clinical opinions and preferences on the non-surgical management among practitioners in China. The opinions within and between ophthalmologists and optometrists were also compared. Design: Cross-sectional survey study. Methods: An online survey was developed and distributed through professional bodies. The study was conducted from July 25th to August 3rd, 2019. A total of 300 ophthalmologists and 188 optometrists responded. Results: Of 488 participants, 257 (53%) considered fusion defects as the main cause of IXT, and 299 (61%) took IXT as a progressive disorder. Two hundred and seventy-one (56%) participants considered orthoptic exercises as the most effective non-surgical intervention for IXT. Likewise, 245 (50%) participants reported that orthoptic exercises was their most frequent non-surgical option, followed by observation (178, 37%). There are discrepancies between ophthalmologists and optometrists. A greater proportion of ophthalmologists (201, 67%) shared the view that IXT worsens over time compared with optometrists (98, 52%) (p = 0.001). Additionally, ophthalmologists (121, 40%) tended to prefer observation compared with optometrists (57, 30%) (p = 0.021). Conclusions: This study shows that there is no general consensus on the non-surgical management of IXT in China. Given the lack of robust evidence, the findings from this study not only show the current clinical opinions but also highlight the need for future randomized clinical trials to validate the effectiveness of non-surgical interventions, orthoptic exercises in particular, and to establish treatment guidelines accordingly.

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The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study (Preprint)

10.2196/preprints.22142 ◽

2020 ◽

Author(s):

Jean C J Liu ◽

Eddie M W Tong

Keyword(s):

Protective Factor ◽

Psychological Symptoms ◽

Well Being ◽

Primary Outcome Measure ◽

World Health ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Global Pandemic ◽

Health Organization

BACKGROUND In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. OBJECTIVE In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. METHODS Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government’s WhatsApp channel; and (3) their demographics. RESULTS Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=–0.07, t[863]=–2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government’s WhatsApp messages (b=–0.05, t[863]=–2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. CONCLUSIONS Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an “infodemic.” CLINICALTRIAL ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574

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Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

BMJ Open ◽

10.1136/bmjopen-2019-030262 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030262 ◽

Cited By ~ 3

Author(s):

Rachel Stockley ◽

Rosemary Peel ◽

Kathryn Jarvis ◽

Louise Connell

Keyword(s):

Upper Limb ◽

Online Survey ◽

Current Therapy ◽

Future Research ◽

Evidence Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Constraint Induced Movement Therapy ◽

Therapy Interventions ◽

The Uk

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.

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