Early screening spots emergency workers at greater risk of mental illness


Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News


Are You Stressed? Do You Suffer from Workplace Anxiety?

Name: Stress

Name: Stress

This year’s stress awareness day bases itself around workplace wellbeing and how this can be beneficial for your business. According to the Health and Safety Executive for Britain, workplace stress is responsible for the loss of 9.9 million working days or 43% of absenteeism and 35% of work related ill health in 2014/15.

In the right amounts, pressure can sustain motivation, and drive personal performance, but if the pressure is too much it can lead to demoralisation and under performance. Certain businesses have take much more criticism than others, indeed the banking industry and other city jobs often being singled out as high pressure environments with alarmingly high suicide rates. Long hours, work overload and highly competitive work relationships can all lead to workplace stress and poor mental health.

Social anxiety can also be a major cause of stress. The need to have a partner, a family, or even a large social media presence with lots of Facebook friends where one can advertise their successful social lives, all trigger stress and anxiety. The idea of maintaining or increasing your social status can create a stressful environment outside of work. Other causes of stress have been attributed to living in a city. Urbanisation with its loud noises, busy streets and general ‘hustle and bustle’ can also lead to higher stress levels.

Stress itself is not a medical diagnosis; however it can lead to depression, anxiety or more severe mental health issues and be a symptom of a more serious condition or disease. Even so, the majority of people do not see stress as a genuine illness and often do not take it seriously. General awareness around its symptoms and consequences can help prevent it from being a gateway to more serious health concerns.

Here you can find a general guide to identifying your personal stress symptoms, and useful tips for managing your stress.

– James Jarvis





Obsessive Compulsive Disorder Awareness Week

11-17 October was OCD awareness week, a week dedicated to educating the general populace about the true nature of obsessive compulsive disorder in order to challenge its relative trivialisation in contemporary culture. However this week kicked off with exactly the type of problematic stereotyping demonstrated in Michelle Mone’s interview on Good Morning Britain which drew a lot of criticism. Watchers were quick to take issue with her self-diagnosis, as well as her description of the disorder as merely reinforcing the trivial stereotype of being neat and organised, even suggesting that this has helped her in business.  What made the whole episode more controversial was that GMB consulted OCD UK about the piece only for their suggested interviewees to be ignored in favour of a more mild option.

The World Health Organisation has actually ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life. You can see why an enormously successful business woman talking openly about her self-diagnosed ‘struggles’ on TV, whilst simultaneously announcing her upcoming appointment as a baroness was branded as distasteful. Maybe Mone does have a mild form of OCD, and she would be right in speaking out about her own struggles.  However her self-diagnosis makes a lot of what she says seem invalid, especially as OCD is only actually diagnosed when the problem is either ‘causing them overwhelming distress, and/or when their compulsions take so much time that they can’t get to work or school or do the things they want to do in their daily life.’ (Telegraph)

OCD is a severe and specific anxiety disorder characterised by upsetting, unwanted and inappropriate thoughts. Linked to this is the urge to carry out repetitive actions in order to relieve the anxiety created by the unwanted thoughts. These thoughts can range from feeling dirty, irrational fears over your house being burgled, to graphic sexual contemplations. Following this, people suffering from OCD, might wash their hands so compulsively that they spend hours in the shower, or actually damage their skin in the process. For example, someone might check the locks in their house several times to prevent a burglary. Perhaps what is most frustrating for OCD sufferers is the conscious knowledge that what they are doing is irrational, but nonetheless they cannot control the compulsive urge because of the temporary relief it provides.

In response to the Twitter storm, Mone did allude to an OCD spectrum which certainly exists. However this spectrum is much more to do with the different types of OCD that exist. Often not included in the stereotypes and clichés is that OCD can manifest itself as ‘pure O’ as Rose Bretécher has recently spoken out about this particular form of OCD in a series of articles for the Guardian. Within this, people experience disturbing, unwanted obsessions without observable behavioural compulsions. This might be questioning your relationship and the value of your feelings towards another person, your sexual orientation, your religion, or the obsession of doing harm to others. Other parts of the OCD spectrum goes as far as including phobias, hypochondria and panic attacks.

The idea of an OCD spectrum, as well as ‘mild’ and severe cases, means that the line between real and stereotyped OCD behaviours becomes blurred. It’s certainly not helped by celebrities ‘coming out’ about their OCD. Other than Michelle Mone, Paul Hollywood of the Great British Bake Off, recently spoke out  about his problems, which included the compulsive cleaning of his brand new Aston Martin, which to anyone who has recently bought a new car, seems logical rather than obsessive or compulsive.  Even more high profile was David Beckham’s supposed OCD organisation of coke cans in his fridge.  While no one really knows the extent of their condition, the idea of a celebrity coming out about their struggles seems oxymoronic due to their professional success. There will always be that question of what OCD has done to debilitate their careers, and hence a question over the sincerity in their claims. On our TV screens there are mixed portrayals as well.  The Huffington Post has compiled a list of characters from TV shows with ‘OCD’, some are merely yet more stereotypes, however some are extremely accurate and thought provoking (it might be best to avoid Sheldon Cooper’s portrayal from the Big Bang Theory and concentrate more on Michael J Fox’s performance in Scrubs, or Leonardo Di Caprio’s portrayal of Howard Hughes in the Aviator).

So yes, Mone’s interview seemed to reinforce inaccurate stereotypes and quirks of OCD, but is this a case of ‘any publicity is good publicity’? There are no doubts that writers and the general Twittersphere have reacted by posting various articles and facts explaining what OCD really is. The interview from Mone has, at the very least, given OCD awareness week a focal point for discussion. Indeed even this blog post is a consequence of that, and what’s more the whole episode has probably allowed people to educate themselves on the issue. Although people have been quick to condemn Mone and Good Morning Britain, at least people are talking about it, which has saved it from being OCD unawareness week.

-Written by James Jarvis


Rose Bretécher –  http://www.theguardian.com/profile/rose-bretecher

Camilla Tominey – http://www.express.co.uk/comment/columnists/camilla-tominey/612778/Camilla-Tominey-Celebrities-OTT-OCD

Jenni Goodchild – http://www.telegraph.co.uk/news/health/11935833/No-OCD-is-not-all-about-cleaning-and-believe-me-you-dont-wish-you-had-it.html

Linda Blair – http://www.telegraph.co.uk/wellbeing/mood-and-mind/mind-healing–how-do-you-know-if-you-have-ocd-/

Dr. Max Pemberton – http://www.dailymail.co.uk/health/article-3258316/DR-MAX-hate-stars-joke-having-OCD.html

OCD LA http://ocdla.com/ocspectrumdisorders

OCD UK http://www.ocduk.org/ocd; http://www.ocduk.org/good-morning-britain-ocd-feature

40% of women with severe mental illness are victims of rape or attempted rape

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Women with severe mental illness are up to five times more likely than the general population to be victims of sexual assault and two to three times more likely to suffer domestic violence, reveals new research led by UCL and King’s College London funded by the Medical Research Council and the Big Lottery.

The study found that 40% of women surveyed with severe mental illness had suffered rape or attempted rape in adulthood, of whom 53% had attempted suicide as a result. In the general population, 7% of women had been victims of rape or attempted rape, of whom 3% had attempted suicide. 12% of men with severe mental illness had been seriously sexually assaulted, compared with 0.5% of the general population.

The findings are based on a survey of 303 randomly-recruited psychiatric outpatients who had been in contact with community services for a year or more, 60% of whom had a diagnosis of schizophrenia. They were interviewed using the British Crime Survey questionnaire for domestic and sexual violence, and their responses were compared to those from 22,606 respondents to the 2011/12 national crime survey. The results were adjusted for a wide range of socio-economic factors including age, ethnicity and marital status.

“The number of rape victims among women with severe mental illness is staggering,” says lead author Dr Hind Khalifeh of UCL’s Division of Psychiatry. “At the time of the survey, 10% had experienced sexual assault in the past year, showing that the problems continue throughout adulthood. Considering the high rate of suicide attempts among rape victims in this group, clinicians assessing people after a suicide attempt should consider asking them if they have been sexually assaulted. Currently this is not done and so patients may miss opportunities to receive specialist support.”

Men and women with mental illness were also found to be more likely to be victims of domestic violence than the general population. Domestic violence includes emotional, physical and sexual abuse. 69% of women and 49% of men with severe mental illness reported adulthood domestic violence.

Domestic violence from family members (other than partners) made up 63% of total domestic violence cases against psychiatric patients compared with 35% of the general population.

“Most domestic violence prevention policies for adults focus on partner violence, but this study shows that interventions for psychiatric patients also need to target family violence,” says Dr Khalifeh.

The study shows a strong association between mental illness and sexual and domestic violence, but the direction of causality is not certain. In some cases, experiences of violence may have contributed to the onset of mental illness. However, violence experienced in the past year would have been after diagnosis of severe mental illness since all participating patients had been under the care of mental health services for at least a year.

The results were adjusted for drug and alcohol use in the past year, but this did not significantly affect the outcomes and causality is hard to determine. Drug and alcohol use may increase the risk of being a victim, but equally victims of violence may turn to drugs or alcohol as a way of coping.

Senior author Louise Howard, Professor in Women’s Mental Health at King’s College London, says: “This study highlights that patients with severe mental illness are at substantially increased risk of being a victim of domestic and sexual violence. Despite the public’s concern about violence being perpetrated by patients with severe mental illness, the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”

Read the full Open Access paper, “Domestic and sexual violence against patients with severe mental illness”, published in Psychological Medicine, free of charge here.


This post is taken from the press release issued by UCL.


‘Classic.’ A book which people praise but don’t read—Mark Twain

Blog Post by James Amos, MD, The University of Iowa Hosp and Clinics

When I announced the publishing of our book, Psychosomatic Medicine, An Introduction to Consultation-Liaison Psychiatry,  someone said that it’s good to finally get a book into print and out of one’s head.  The book in earlier years found other ways out of my head, mainly in stapled, paper clipped, spiral bound, dog-eared pages of  homemade manuals, for use on our consultation serviceIt’s a handbook and meant to be read of course, but quickly and on the run. As I’ve said in a previous blog, it makes no pretension to being the tour de force textbook in  America  that inspired it. However, any textbook can evolve into an example of Twain’s definition of a classic.  The handbook writer is a faithful and humble steward who can keep the spirit of the classic lively. Read more of this post

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