Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards

In a previous study we found a very high prevalence of psychological distress in mothers of children admitted to a nutritional rehabilitation unit (NRU) in Malawi, Africa. The objective of this study was to compare the prevalence and severity of maternal distress within the NRU with that in other paediatric wards. Given the known association between poor maternal psychological well-being and child undernutrition in low- and middle-income countries, we hypothesised that distress would be higher among NRU mothers. Mothers of consecutive paediatric inpatients in a NRU, a high-dependency (and research) unit and an oncology ward were assessed for psychological distress using the Self-Reporting Questionnaire (SRQ). Two hundred sixty-eight mothers were interviewed (90.3% of eligible). The prevalence of SRQ score ≥8 was 35/150 {23.3% [95% confidence interval (CI) 16.8- 30.9%]} on the NRU, 13/84 [15.5% (95% CI 8.5-25.0%)] on the high-dependency unit and 7/34 [20.6% (95% CI 8.7-37.9%)] on the oncology ward (χ(2)  = 2.04, P = 0.36). In linear regression analysis, the correlates of higher SRQ score were child diarrhoea on admission, child diagnosed with tuberculosis, and maternal experience of abuse by partner; child height-for-age z-score fell only just outside significance (P = 0.05). In summary, we found no evidence of greater maternal distress among the mothers of severely malnourished children within the NRU compared with mothers of paediatric inpatients with other severe illnesses. However, in support of previous research findings, we found some evidence that poor maternal psychological well-being is associated with child stunting and diarrhoea.

A comparison of theoretical Mg VI emission line strengths with active-region observations from SERTS

R-matrix calculations of electron impact excitation rates in N-like Mg VI are used to derive theoretical electron-density-sensitive emission line ratios involving 2s²2p³ - 2s2p⁴ transitions in the 269-403 Å wavelength range. A comparison of these with observations of a solar active region, obtained during the 1989 flight of the Solar EUV Rocket Telescope and Spectrograph (SERTS), reveals good agreement between theory and observation for the 2s²2p^{3 4}S - 2s2p ^{4 4}p transitions at 399.28, 400.67, and 403.30 Å, and the 2s²2p^{3 2}p - 2s2p^{4 2}D lines at 387.77 and 387.97 Å. However, intensities for the other lines attributed to Mg VI in this spectrum by various authors do not match the present theoretical predictions. We argue that these discrepancies are not due to errors in the adopted atomic data, as previously suggested, but rather to observational uncertainties or mis-identifications. Some of the features previously identified as Mg VI lines in the SERTS spectrum, such as 291.36 and 293.15 Å, are judged to be noise, while others (including 349.16 Å) appear to be blended.

Effective collision strengths for election impact excitation of Cl III

Effective collision strengths for electron-impact excitation of the phosphorus-like ion Cl III are presented for all fine-structure transitions among the levels arising from the lowest 23 LS states. The collisional cross sections are computed in the multichannel close-coupling R-matrix approximation, where sophisticated configuration-interaction wave functions are used to represent the target states. The 23 LS states are formed from the basis configurations 3s²3p³, 3s3p⁴, 3s²3p²3d, and 3s²3p²4s, and correspond to 49 fine-structure levels, leading to a total possible 1176 fine-structure transitions. The effective collision strengths, obtained by averaging the electron collision strengths over a Maxwellian distribution of electron velocities, are tabulated in this paper for all 1176 transitions and for electron temperatures in the ranges T(K)=7500-25,000 and log T(K)=4.4-5.4. The former range encompasses the temperatures of particular importance for application to gaseous nebulae, while the latter range is more applicable to the study of solar and laboratory-type plasmas. © 2001 Academic Press.

Effective collision strengths for forbidden transitions among the 3s23p3 fine-structure levels of Cl III

Effective collision strengths for the 10 astrophysically important fine-structure forbidden transitions among the ⁴S^o, ²D^o and ²P^o levels in the 3s²3p³ configuration of Cl III are presented. The calculation employs the multichannel R-matrix method to compute the electron-impact excitation collision strengths in a close-coupling expansion, which incorporates the lowest 23 LS target eigenstates of Cl III. These states are formed from the 3s²3p³, 3s3p⁴, 3s²3p²3d and 3s²3p²4s configurations. The Maxwellian-averaged effective collision strengths are presented graphically for all 10 fine-structure transitions over a wide range of electron temperatures appropriate for astrophysical applications [log T(K) = 3.3 - log T(K) = 5.9]. Comparisons are made with the earlier seven-state close-coupling calculation of Butler & Zeippen, and in general excellent agreement is found in the low-temperature region where a comparison is possible [log T(K) = 3.3 - log T(K) = 4.7]. However, discrepancies of up to 30 per cent are found to occur for the forbidden transitions which involve the ⁴S^o ground state level, particularly for the lowest temperatures considered. At the higher temperatures, the present data are the only reliable results currently available.

Effective collision strengths for fine-structure forbidden transitions among the 2s22p3 levels of S x

Effective collision strengths for electron-impact excitation of the N-like ion S x are calculated in the close-coupling approximation using the multichannel R-matrix method. Specific attention is given to the 10 astrophysically important fine-structure forbidden transitions among the ⁴S^O, ²D^o and ²P^o levels in the 2s²2p³ ground configuration. The total (e^- + ion) wavefunction is expanded in terms of the 11 lowest LS eigenstates of S x, and each eigenstate is represented by extensive configuration-interaction wavefunctions. The collision strengths obtained are thermally averaged over a Maxwellian distribution of velocities, for all 10 fine-structure transitions, over the range of electron temperatures log T(K) = 4.6-6.7 (the range appropriate for astrophysical applications). The present effective collision strengths are the only results currently available for these fine-structure transition rates.

Effective collision strengths for fine-structure forbidden transitions among the 2s22p3 levels of Ne IV

Effective collision strengths for electron-impact excitation of the N-like ion NeIV are calculated in the close-coupling approximation using the multichannel R-matrix method. Specific attention is given to the 10 astrophysically important fine-structure forbidden transitions among the ⁴S^o, ²D^o and ²P^o levels in the 2s²2p³ ground-state configuration. The expansion of the total wavefunction incorporates the lowest 11 LS eigenstates of NeIV, consisting of eight n = 2 terms with configurations 2s²2p³, 2s2p⁴ and 2p⁵, together with three n = 3 states of configuration 2s²2p²3s. We present in graphical form the effective collision strengths obtained by thermally averaging the collision strengths over a Maxwellian distribution of velocities, for all 10 fine-structure transitions, over the range of electron temperatures log T(K) = 3.6 to log T(K) = 6.1 (the range appropriate for astrophysical applications). Comparisons are made with the earlier, less sophisticated close-coupling calculation of Giles, and excellent agreement is found in the limited temperature region where a comparison is possible [log T(K) = 3.7 to log 7(K) = 4.3]. At higher temperatures the present data are the only reliable results currently available.

Effective collision strengths for fine-structure forbidden transitions among the 3s 23p 3 levels of Ar IV

The multichannel R-matrix method is used to compute electron impact excitation collision strengths in Ar IV for all fine-structure transitions among the ⁴S°, ²D° and ²P° levels in the 3s ²3p ³ ground configuration. Included in the expansion of the total wavefunction are the lowest 13 LS target eigenstates of Ar iv formed from the 3s ²3p ³, 3s3p ⁴ and 3s ²3p ²3d configurations. The effective collision strengths, obtained by averaging the electron collision strengths over a Maxwellian distribution of electron velocities, are presented for all 10 fine-structure transitions over a wide range of electron temperatures of astrophysical interest (T _e = 2000-100 000 K). Comparisons are made with an earlier 7-state close-coupling calculation by Zeippen, Butler & Le Bourlot, and significant differences are found to occur for many of the forbidden transitions considered, in particular those involving the ⁴S° ground state, where discrepancies of up to a factor of 3 are found in the low-temperature region. © 1997 RAS.

Psychological determinants of consumer acceptance of personalised nutrition in 9 European countries

OBJECTIVE: To develop a model of the psychological factors which predict people's intention to adopt personalised nutrition. Potential determinants of adoption included perceived risk and benefit, perceived self-efficacy, internal locus of control and health commitment.

METHODS: A questionnaire, developed from exploratory study data and the existing theoretical literature, and including validated psychological scales was administered to N=9381 participants from 9 European countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway).

RESULTS: Structural equation modelling indicated that the greater participants' perceived benefits to be associated with personalised nutrition, the more positive their attitudes were towards personalised nutrition, and the greater their intention to adopt it. Higher levels of nutrition self-efficacy were related to more positive attitudes towards, and a greater expressed intention to adopt, personalised nutrition. Other constructs positively impacting attitudes towards personalised nutrition included more positive perceptions of the efficacy of regulatory control to protect consumers (e.g. in relation to personal data protection), higher self-reported internal health locus of control, and health commitment. Although higher perceived risk had a negative relationship with attitude and an inverse relationship with perceived benefit, its effects on attitude and intention to adopt personalised nutrition was less influential than perceived benefit. The model was stable across the different European countries, suggesting that psychological factors determining adoption of personalised nutrition have generic applicability across different European countries.

CONCLUSION: The results suggest that transparent provision of information about potential benefits, and protection of consumers' personal data is important for adoption, delivery of public health benefits, and commercialisation of personalised nutrition.

O ajustamento de crianças com doença crónica e o brincar no hospital

Este trabalho procura averiguar o impacte das doenças crónicas no ajustamento psicológico das crianças, tendo em conta diferentes tipos de doenças, as suas características e a perceção dos pais acerca das mesmas. Para além disso procura perceber a perceção dos pais e dos profissionais de saúde em relação à importância atribuída ao brincar em contexto hospitalar. A amostra é constituída por 176 crianças, dos 3 aos 10 anos, distribuídas por quatro grupos: crianças com asma, crianças com cancro, crianças com patologia uro-nefrológica e crianças sem doença. A recolha de dados teve lugar nas salas de espera de consulta externa de Pediatria do Hospital Infante D. Pedro e de Oncologia Médica do Hospital Pediátrico de Coimbra. Este estudo recorreu a metodologia quantitativa e qualitativa. Desta forma os instrumentos utilizados foram a Escala de Observação do Brincar (POS), alguns itens do Revised Illness Perception Questionnaire (IPQ-R), o Questionário de Capacidades e de Dificuldades (SDQ) e a entrevista semi-estruturada. O ajustamento psicológico foi avaliado através de questionários aplicados aos pais mas também através da observação direta do brincar da criança, colmatando assim uma das principais lacunas nesta área – o acesso a uma única fonte de informação e forma de avaliação. A análise dos resultados permitiu perceber que não existe uma relação linear entre o ajustamento psicológico das crianças e a presença de uma doença crónica e que a avaliação do ajustamento da criança através da observação direta do brincar nem sempre é coincidente com a perspetiva dos pais acerca desse ajustamento. Tanto os pais como os profissionais de saúde reconhecem ainda inúmeras vantagens na utilização do brincar em crianças com doença crónica.

A Psychological Exploration of Long-Term LSD Users

All research involving the psychoactive compound lysergic acid diethylamide (LSD) was terminated globally following its prohibition more than 50 years ago, though illicit use remained fairly stable. A considerable resurgence of research interest in LSD has received considerable attention in various publications and professional fora. One of the main applications considered is LSD-assisted psychotherapy to address a number of difficulties like end-of-life anxiety, addiction/alcoholism, post-traumatic stress, and depression. However, due to the highly contradictory nature of early research findings and division in the literature, one is left uncertain as to whether psychology as a profession is currently equipped to critically evaluate these advances, let alone embrace them. The purpose of the present study was to contribute to current psychological knowledge on long-term LSD use. A group of long-term LSD users who claimed beneficial use were the focus here. A mixed methods design was employed. 110 users completed an online survey assessing for demographics, patterns of use, and specific personality traits through three psychometric measures, Big Five Inventory (BFI), General Self Efficacy scale (GSE) and Satisfaction With Life Scale (SWLS). Eight individual interviews were also conducted and analysed by Thematic Analysis (TA). Gaining different perspectives on reality and increasing self- awareness appeared to be essential elements of the belief system that these non-problematic long-term LSD users adopted in order to make sense of their LSD use. Qualitative findings also suggested the existence of a common set of life values, rules and the adoption of a hierarchical system between LSD users. Novices appeared to be tutored and guided by elders whose presence and input was valued and who were listened to and respected. A role for ‘wiser/elder’ users as those imparting valuable knowledge to novices was therefore also suggested. The underlying aim may possibly be an attempt to minimise risks and maximise potential benefits of LSD use. A prospective role for LSD as a deterrent of substance misuse, a ‘gateway drug to no drugs’ was also hinted and remains in need of iv further investigation. Claims regarding beneficial LSD use and ‘change’ through LSD use were confirmed by the participant sample. No noteworthy differences between psychometric scores of the LSD-using group and those of the general population (as suggested by normative data comparisons) were found, possibly due to methodological limitations, especially considering the highly subjective nature of the LSD experience and its effects. The determining role of extra-pharmacological variables or ‘set and setting’ in the outcome of LSD use suggested in earlier literature was re-validated. Knowledge on their specific components was enriched, and a potentially significant value for adopting a flexible, adaptable and solution-focused mind-set in order to better manage the effects of LSD was highlighted. Due to the highly selected nature of the participant sample, present findings should serve as suggestions for further research in order to clarify the aforementioned issues and to make explicit the mechanisms by which they operate. The complex nature of LSD, its use and its effects have been re-confirmed here. It is imperative that the current knowledge base on the substance is enriched before LSD is introduced in a clinical psychology professional context.

“I used to think that they were all abnormal. And I was the normal one”: conceptualizing mental health and mental health treatment under Improving Access to Psychological Therapies (IAPT)

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT programme impacted on patients’ understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyse six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologising those who are dependent on people and services requires further commentary and action. Declaration of interest: The first author was employed by the same organisation that delivered the IAPT service, although through a separate staffing and management line.