Ethical and research dilemmas arising from a questionnaire study of psychological morbidity among general practice managers. (49/2544)

A questionnaire-based research project enquiring into the psychological health of general practice managers found that 5% of managers admitted to suicidal ideas. This paper explores the moral issues raised when research conducted at a distance uncovers information about participants which indicates that they may be at increased risk of harm. It examines whether the authors of such studies have responsibilities towards their research participants beyond those of analysing and properly interpreting the data supplied to them. The paper is an exercise in self-reflection and self-criticism; not all the questions posed and explored by it can be answered definitively. Implications for planning studies of this kind are discussed.  (+info)

Psychological distress and quality of life in drug-using and non-drug-using HIV-infected women. (50/2544)

BACKGROUND: Quantitative research on women infected with human immunodeficiency virus (HIV) has predominantly involved drug users. The present study assessed the psychosocial burden of HIV infection and identified some possible determinants in both drug-using and non-drug-using women. METHOD: Twenty-three hard-drug-using and 55 non-using HIV-positive women aged 18-64 years participated. Psychological distress (SCL-90, with eight scales and total score) and health-related quality of life (Rand SF-36, with eight scales and physical and psychosocial dimension) were measured. A cross-sectional comparison with reference groups (female general population, female psychiatric patients and HIV-positive homosexual men) was made. For analysis the t-test and multiple regression analysis were used. RESULTS: Compared to the general population, both HIV-positive groups had higher (i.e. unfavourable) SCL total scores (t = 8.33 and p < 0.001 and t = 4.97 and p < 0.001) and lower (i.e. unfavourable) Rand SF-36 scores (p < 0.001 on seven or more scales). Compared to psychiatric patients, drug users had similar (n.s.) and non-drug users had lower (t = -9.09 and p < 0.001) SCL scores. Both groups had lower SF-36 scores (p < 0.001 on seven or more scales). Compared to HIV-positive homosexuals, drug users had higher (t = 2.88 and p < 0.01) and non-drug users had similar SCL scores (n.s.). Psychosocial illness burden (SCL and Rand psychosocial dimension) was associated with low self-esteem, poverty, ethnic minority membership and illness stage (Rand only). Child care, drug use/prostitution and illness stage predicted high physical illness burden. CONCLUSION: Women with HIV/AIDS (acquired immune deficiency syndrome) experience considerable distress and poor quality of life, but drug users do more so than non-users. Drug- and gender-related lifestyles affect illness burden.  (+info)

Housework, paid work and psychiatric symptoms. (51/2544)

OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio - PR=2.04, 95% confidence interval - CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.  (+info)

Longitudinal cohort study of childhood IQ and survival up to age 76. (52/2544)

OBJECTIVES: To test the association between childhood IQ and mortality over the normal human lifespan. DESIGN: Longitudinal cohort study. SETTING: Aberdeen. SUBJECTS: All 2792 children in Aberdeen born in 1921 and attending school on 1 June 1932 who sat a mental ability test as part of the Scottish mental survey 1932. MAIN OUTCOME MEASURE: Survival at 1 January 1997. RESULTS: 79.9% (2230) of the sample was traced. Childhood mental ability was positively related to survival to age 76 years in women (P<0.0001) and men (P<0.0001). A 15 point disadvantage in mental ability at age 11 conferred a relative risk of 0.79 of being alive 65 years later (95% confidence interval 0.75 to 0.84); a 30 point disadvantage reduced this to 0.63 (0.56 to 0.71). However, men who died during active service in the second world war had a relatively high IQ. Overcrowding in the school catchment area was weakly related to death. Controlling for this factor did not alter the association between mental ability and mortality. CONCLUSION: Childhood mental ability is a significant factor among the variables that predict age at death.  (+info)

Homelessness and health. (53/2544)

Homelessness affects tens of thousands of canadians and has important health implications. Homeless people are at increased risk of dying prematurely and suffer from a wide range of health problems, including seizures, chronic obstructive pulmonary disease, musculoskeletal disorders, tuberculosis, and skin and foot problems. Homeless people also face significant barriers that impair their access to health care. More research is needed to identify better ways to deliver care to this population.  (+info)

Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia. (54/2544)

OBJECTIVE: To determine the prevalence of depression and burnout among family physicians working in British Columbia's Northern and Isolation Allowance communities. Current level of satisfaction with work and intention to move were also investigated. DESIGN: Cross-sectional, mailed survey. SETTING: Family practices in rural communities eligible for British Columbia's Northern and Isolation Allowance. PARTICIPANTS: A random sample of family physicians practising in rural BC communities. Initial response rate was 66% (131/198 surveys returned); excluding physicians on leave and in temporary situations and those who received duplicate mailings gave a corrected response rate of 92% (131/142 surveys returned). MAIN OUTCOME MEASURES: Demographics; self-reported depression and burnout; Beck Depression Inventory and Maslach Burnout Inventory scores; job satisfaction; and intention to leave. RESULTS: Self-reported depression rate was 29%; the Beck Depression Inventory indicated 31% of physicians suffered from mild to severe depression. About 13% of physicians reported taking antidepressants in the past 5 years. Self-reported burnout rate was 55%; the Maslach Burnout Inventory showed that 80% of physicians suffered from moderate-to-severe emotional exhaustion, 61% suffered from moderate-to-severe depersonalization, and 44% had moderate-to-low feelings of personal accomplishment. Depression scores correlated with emotional exhaustion scores. More than half the respondents were considering relocation. CONCLUSION: Physicians working in these communities suffer from high levels of depression and very high levels of burnout and are dissatisfied with their current jobs. More than half are considering relocating. Intention to move is strongly associated with poor mental health.  (+info)

The explanatory models of mental health amongst low-income women and health care practitioners in Lusaka, Zambia. (55/2544)

There is currently much debate about the cultural construction and specificity of mental health. It is thus not surprising that explanatory models, which look at the meaning of illness for those suffering from it, have been widely used within the mental health field. This paper considers the significance of explanatory models and presents a study comparing the explanatory models of mental ill health used by urban women in low-income groups and local health care practitioners in ZAMBIA: To measure mental ill-health status, an instrument recommended by the World Health Organization was used - the Self Reporting Questionnaire, 20 items (SRQ 20). To obtain explanatory models, Kleinman's classic eight questions were adapted. The terms used by the practitioners to define and explain the mental health problems of women in low-income groups were 'stress and depression', with these two concepts being used interchangeably. In contrast, the phrase most frequently used by the women was 'problems of the mind'. The professionals regarded the experience of depression itself as a manifestation of ill health. For the women, however, only the physical symptoms were defined as ill health. There was a common agreement, however, that the women's socioeconomic situation as a major causal factor. Both groups identified the home environment as a key determinant, particularly the quality of marital relationships. Greater awareness of explanatory models may have beneficial effects on mental health policy and planning, both at national levels (where recognition of the true prevalence and burden of mental ill health should have an impact on public health policy) and at the level of local implementation (where training of health professionals to take patients' explanatory models into account might contribute towards the diagnosis of mental health problems).  (+info)

Integrated estimation of the effect of physical factors on human functional state during mental work. (56/2544)

The purpose of this study was to develop a model for an integrated estimation of the functional state of the human organism (FSHO) and an integral estimation of physical factors (PF) for hygienic rating. Tests were performed twice with 3 men in 0.7-clo clothing during 4-hr mental work with 9 combinations of 4 PF: wideband noise (55- 83 dB(A)), whole-body vibration (6 Hz, a(z) = 0.2-1.8 ms(-2)), air temperature (18-30 degrees C), and illumination (1, 3, 5 lx). Thermoregulatory, cardiovascular, and psychophysiological reactions and temporary threshold of hearing (TTS2) shifts were studied. For the integral estimation of PF influence on FSHO the model F(y1,y2..........ym) = f(x1,x2,.......xn) was used, relating both FSHO and PF sets. The most important physiological parameters in creating FSHO are defined and the contribution of individual parameters of FSHO and PF is found.  (+info)