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Background Studies have shown that staff who support adults with intellectual disabilities (ID) are exposed to challenging behaviour in their work including client aggression. Exposure to aggressive behaviour has been associated with staff stress and burnout. Study samples have been small however, and there has been very little data exploring this issue among North American staff. Methods A cross-sectional survey which included demographics, measures of frequency and severity (including perceived severity and a standardised severity score) of exposure to client aggression and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was completed by 926 community staff who support adults with ID in Ontario, Canada. Relationships between demographic variables and exposure to aggression were examined with descriptive statistics. Pearson correlations were used to analyse exposure variables and MBI-HSS scores. Results Nearly all staff reported being exposed to client aggression in the prior 6 months. Mean MBI-HSS scores were comparable to previously published data in similar populations with the exception of a higher score in the personal accomplishment domain. All measures of exposure to aggression were significantly positively correlated with MBI-HSS scores in the emotional exhaustion and depersonalisation dimensions of burnout. Conclusions The prevalence of burnout in this North American sample is comparable to what has been reported in similar populations in other locations, although these staff may have a higher sense of accomplishment with regard to their work. Findings from this large sample support the evidence that exposure to client aggression affects staff emotional well-being but is by no means the only important factor. Further study is needed to explore the differences and similarities reported here as well as other contributing factors which will guide the implementation of effective strategies to improve staff well-being. Language: en

Background Psychological morbidity following trauma occurring in the workplace can impact return to work but few studies have investigated this. Methods This study was a secondary analysis of administrative data from a specialized workers' compensation board psychological trauma program in Toronto, Canada. Unadjusted and adjusted logistic regression analyses were used to examine factors associated with working status at the time of assessment for workers referred within 1 year of traumatic event. Results Having a disrupted marriage (OR = 3.06, 95% CI 1.14–8.20), sustaining a permanently impairing physical injury (OR = 2.76, 95% CI 1.01–7.55) and the presence of secondary psychiatric diagnoses (OR = 2.55, 95% CI 1.34–4.83) were significantly associated with not working at the time of assessment. When the analyses were subset to workers without permanently impairing physical injuries, only the presence of additional psychiatric diagnoses was significantly associated with not working (OR = 3.81, 95% CI 1.48–9.83). Conclusions Return to work after trauma can be a complicated and difficult to treat problem. Social supports, physical rehabilitation and treatment of complex mental health problems likely play a crucial role in improving outcomes. Am. J. Ind. Med. 54:552–559, 2011. © 2011 Wiley-Liss, Inc.

Studies completed outside of Canada have reported a high rate of mental illness and psychotropic medication use among bariatric surgery candidates with variable impacts on surgical and mental health outcomes. To our knowledge, there has been no published Canadian data on this issue. We conducted a secondary analysis of de-identified data from the Ontario Bariatric Registry for all individuals who completed both a baseline and psychological assessment between April 1, 2010, and February 9, 2015 (N = 10,698). We determined the rates of reported mental illness and psychotropic medication use overall and by fiscal year of assessment. A past or present mental illness, most commonly depression, was recorded for 51 % of individuals. At baseline, 38 % were taking at least one psychotropic medication, most commonly antidepressants. Only a small proportion of the population were taking psychotropic medications known to be associated with high potential for weight gain. Although the prevalence of mental illness increased steadily from 35 % in 2010/2011 to 63 % in 2014/2015, there was no corresponding increase in reported medication use. Of those taking psychotropic medications, 13 % did not have a recorded history of mental illness. Consistent with other international studies, our results indicate a high prevalence of mental illness and psychotropic medication use among people referred for bariatric surgery in Ontario, Canada. This supports that accurate screening practices, knowledge about how to manage psychotropic medication pre- and post-operatively and recognition for opportunities to change medications that may be associated with weight gain are required.

Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.

Diverse studies have shown that magnetic fields can affect behavioral and physiological functions. Previously, we have shown that sinusoidal extremely low frequency magnetic fields and specific pulsed magnetic fields (Cnps) can produce alterations in the analgesia-related behavior of the land snail. Here, we have extended these studies to show an induction of analgesia in mice equivalent to a moderate dose of morphine (5 mg/kg), and the effect of both Cnp exposure and morphine injection on some open-field activity. Cnp exposure was found to prolong the response latency to a nociceptive thermal stimulus (hot plate). Cnp+morphine offset the increased movement activity found with morphine alone. These results suggest that pulsed magnetic fields can induce analgesic behavior in mice without the side effects often associated with opiates like morphine.

There is evidence to suggest that people with serious mental illness (SMI) have lower access to tertiary care than patients without SMI, particularly when care is complex. Barriers are present at the level of the individual, providers, and the health care system. High levels of co-morbidity and the associated health care costs, along with a growing focus on facilitating equal access to quality care for all, urges health care systems to address existing gaps. Some interventions have been successful at improving access to primary care for patients with SMI, but relatively little research has focused on access to complex interventions. This paper summarizes the scope of the problem regarding access to complex tertiary medical care among people with SMI. Barriers are discussed and potential solutions are proposed. Policies and programs must be developed, implemented, and evaluated to determine cost-effectiveness and impact on outcomes.

The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood.Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client-key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa.At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ 0.4) was found in the domains of psychological distress, sexual expression, company, daytime activities and intimate relationships.While congruence is present in concrete domains, there is substantial variability in how clients and their key workers perceive need in more personal areas. The initial focus of care may necessarily be on needs such as shelter, food and treatment; however, subsequent care should incorporate a shared assessment of need to support strong relationships with providers and ongoing engagement in treatment.

AIMS AND OBJECTIVES: To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities (ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. BACKGROUND: Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. DESIGN: This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. METHODS: Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. RESULTS: Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion (EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. CONCLUSIONS: Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. RELEVANCE TO CLINICAL PRACTICE: There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe. Language: en

BackgroundWith rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom.ObjectiveTo examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns.MethodsWe conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication.ResultsRespondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact.ConclusionsA high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.

Over the past decade, growing attention has been paid to the mental health of workers and its effects on the workplace. For example, the European Ministers of Health have advocated that employers include mental health programs as part of occupational health and safety (World Health Organization, 2005). The Australian Human Rights Commission (2010) acknowledged the need for workplaces to support workers with mental illnesses. Similar interests have taken root in the USA and Canada. In the USA, the President’s New Freedom Commission on Mental Health (2003) suggested that employment for people with mental illnesses should be a national goal. The Canadian Standing Senate Committee on Social Affairs, Science and Technology (2006) raised prevention, promotion and treatment of mental illness as critical national issues. They identified the workplace as the intersection where “the human and economic dimensions of mental health and mental illness come together most evidently.”

BACKGROUND: Psychological trauma in the workplace is gaining recognition as an important cause of workplace disability but little is known about the workers who are affected. The Psychological Trauma Program (PTP) in Toronto (Canada) is a specialized provincial worker's compensation board assessment programme for workers with psychological sequelae of workplace trauma. AIMS: To characterize workers presenting to the PTP in terms of demographic, occupational, traumatic exposure and diagnostic variables. METHODS: A retrospective secondary analysis of all workers referred to the PTP for assessment within 1 year of traumatic event between 1999 and 2006. RESULTS: Five hundred and thiry-one referred workers were included in the study. Most workers were working-age male (76%), married (65%) and labourers (43%). Nearly half were born outside Canada. Post-traumatic stress disorder was the primary diagnosis in 44%. Fifty-eight percent had one or more secondary diagnoses. For just over half of the workers, the traumatic event resulted in a permanent physical impairment. CONCLUSIONS: Specialist referral may be indicated for workers experiencing prolonged recovery following workplace trauma. Male workers and those with co-morbidities or permanent injuries may be more likely to require referral. Individualized treatment approaches are likely important; however, more research is needed to guide future interventions. Language: en

Background Rural regions of industrialized nations are experiencing a crisis in health care access, reflecting a high disease burden and a low physician supply. The maldistribution of physicians stems partly from the low rate of entry into medical school of applicants from rural backgrounds. Methods We analyzed applicants to the University of Toronto medical school in 2005 (n = 2052) to test for possible institutional bias against rural applicants and possible applicant bias against the institution. The designation of rurality was assigned using the Statistics Canada classification of residential postal codes to detect residence in communities with a population of fewer than 10,000 people. Results Consistent with past reports, rural applicants were under-represented (n = 93, 4.5% of applicants relative to 20% of baseline population). Rural applicants, on average, were equally competitive with urban applicants as measured by grades, test scores, and interviews. Rural applicants were just as likely as urban applicants to be offered admission (17% vs 14%, p = 0.43), indicating no large bias from the institution. Rural applicants, however, were more than twice as likely to decline the admission offer (69% vs 24%, p < 0.001), indicating a large bias against the institution. This discrepancy was not explained by financial disparity and was not confined to those applicants most likely to receive invitations to other schools. Conclusions Programs to increase physician supply in rural areas need to address students' concealed preferences that are established before enrolment. Medical schools, in particular, need to encourage more rural students to apply and to persuade those offered admission to accept.

Background In adult correctional facilities, correctional officers (COs) are responsible for the safety and security of the facility in addition to aiding in offender rehabilitation and preventing recidivism. COs experience higher rates of job stress and burnout that stem from organizational stressors, leading to negative outcomes for not only the CO but the organization as well. Effective interventions could aim at targeting organizational stressors in order to reduce these negative outcomes as well as COs’ job stress and burnout. This paper fills a gap in the organizational stress literature among COs by systematically reviewing the relationship between organizational stressors and CO stress and burnout in adult correctional facilities. In doing so, the present review identifies areas that organizational interventions can target in order to reduce CO job stress and burnout. Methods A systematic search of the literature was conducted using Medline, PsycINFO, Criminal Justice Abstracts, and Sociological Abstracts. All retrieved articles were independently screened based on criteria developed a priori. All included articles underwent quality assessment. Organizational stressors were categorized according to Cooper and Marshall’s (1976) model of job stress. Results The systematic review yielded 8 studies that met all inclusion and quality assessment criteria. The five categories of organizational stressors among correctional officers are: stressors intrinsic to the job, role in the organization, rewards at work, supervisory relationships at work and the organizational structure and climate. The organizational structure and climate was demonstrated to have the most consistent relationship with CO job stress and burnout. Conclusions The results of this review indicate that the organizational structure and climate of correctional institutions has the most consistent relationship with COs’ job stress and burnout. Limitations of the studies reviewed include the cross-sectional design and the use of varying measures for organizational stressors. The results of this review indicate that interventions should aim to improve the organizational structure and climate of the correctional facility by improving communication between management and COs.