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Background The coronavirus disease 2019 (COVID-19) pandemic is likely to lead to a significant increase in mental health disorders among healthcare workers (HCW). Aims We evaluated the rates of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a population of HCW in the UK. Method An electronic survey was conducted between the 5 June 2020 and 31 July 2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: the 4-item Patient Health Questionnaire(PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations between 24 independent variables and anxiety, depressive or PTSD symptoms. Results There were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 years, interquartile range: 32–51). The rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5%, respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio (OR) = 2.3, 95% CI 1.9–2.7, P < 0.001), depression (OR = 2.5, 95% CI 2.1–3.0, P < 0.001) and PTSD (OR = 2.1, 95% CI 1.7–2.5, P < 0.001). The availability of adequate personal protective equipment (PPE), well-being support and lower exposure to moral dilemmas at work demonstrated significant negative associations with these symptoms (P ≤ 0.001). Conclusions We report higher rates of clinically significant mental health symptoms among hospital HCW following the initial COVID-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to well-being support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.

BackgroundThe Covid-19 pandemic is likely to lead to a significant increase in mental health disorders amongst healthcare workers (HCW).AimsWe evaluated the prevalence of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a HCW population in the United Kingdom (UK), to identify subgroups most at risk.MethodsAn electronic survey was conducted between the 05/06/2020 and 31/07/2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations.ResultsThere were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 [IQR: 32-51] years). The prevalence rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5% respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio 2.3 [95% CI 1.9–2.7]; pppp≤0.001).ConclusionsWe report a high prevalence of clinically significant symptoms of anxiety, depression and PTSD in hospital HCW following the initial Covid-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to wellbeing support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.

Background: Repeated exposure to stress increases the risk of acute stress response (ASR) and post-traumatic stress disorder (PTSD). Aims: The authors aimed to investigate ASR/PTSD symptoms among a multidisciplinary population of frontline health professionals who care for injured and critically unwell patients. Methods: A voluntary, anonymous questionnaire included an Impact of Events Scale-revised (IES-R) assessment, addressed stressors, teamwork, and mentorship. An IES-R score of >33 indicated symptoms in keeping with ASR (lasting 1 month). Findings: 15% (27/181) of returned questionnaires had an IES-R score >33; 19 had symptoms >1 month. Seven participants with IES-R >33 group had sought professional help. Less than half knew of a mentorship programme at their place of work. Conclusion: There is a hidden, untreated burden of stress symptoms among frontline emergency healthcare providers, and a variable environment of mentorship and teamwork. Attention is warranted if patient safety is to be optimised.

Introduction Beliefs about one’s illness or ‘illness perceptions’ are central to the experience of treatment, engagement with treatment and quality of life (QOL).1 The Personal Beliefs about Illness Questionnaire revised (PBIQ-R)2 is a self-report measure designed to assess the impact of psychosis upon patient’s perception of their social rank, or the value they consider themselves to have compared to others because of their psychosis. Aim To compare illness perceptions in patients with severe asthma presenting to psychology to those with psychosis using the PBIQ-R Method The 20 item PBIQ-R has 5 subscales. The British Psychological Society asthma network considered these subscales to be highly relevant to the severe asthma population. The subscale scores from people in severe asthma psychology were compared to scores of people with psychosis with/without depression from the PBIQ-R reliability and validity data. Patients were recruited from two severe asthma psychology services between June 2017–May 2018. Results Forty sequential patients with confirmed asthma following systematic assessment completed the PBIQ-R in relation to their asthma (mean age: 41, range: 18–65, females: 73%, White British: 70%, Asian: 18%, Black: 5%, Other ethnicity: 7%; 38% were prescribed a maintenance dose of oral corticosteroids). All subscales except for social marginalisation are higher (more problematic) in severe asthma than in those with psychosis, or psychosis plus depression (see table 1). Losses in functioning and future possibilities were highly endorsed, (88% endorsed ‘My illness stops me doing the things I want to do’; 65% ‘my asthma is too brittle/delicate for me to work’ and 60% reported embarrassment because of their asthma). Additionally, 77% reported that their asthma frightens them. Conclusion These results highlight the potential psychological impact of living with severe asthma. Given illness perceptions impact QOL and treatment, routine assessment of illness perceptions may identify suitable patients for psychosocial interventions. References Petrie, KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical conditions. Curr Opin Psychiatry2007;20(2):163–7. Birchwood M, Jackson C, Brunet K, Holden J, Barton K. Personal beliefs about illness questionnaire-revised (PBIQ-R): Reliability and validation in a first episode sample. Br J Clin Psychol2012;51(4):448–58.

Introduction and objectives Inducible Laryngeal Obstruction (ILO) is paradoxical laryngeal closure during respiration resulting in airway obstruction at glottic and/or supraglottic level causing breathing difficulties and distress. There are no disease-specific psychological outcome measures for assessing experienced distress and impact upon quality of life (QoL) for those with ILO. This research provides preliminary findings assessing the reliability and validity of an ILO Quality of Life questionnaire (ILOQoL). Methods This research included item refinement and psychometric validation. Item refinement involved cognitive debriefing, which was undertaken with ten participants. Psychometric validation was undertaken with 31 participants with nasendoscopy diagnosed with ILO, who had undergone Speech and Language Therapy and were six months post discharge. Participants were posted a questionnaire pack including ILOQoL, Depression Anxiety Stress Scales (DASS-21), the activities sub-section of the Mini Asthma Quality of Life Questionnaire AQLQ) and the Vocal Cord Dysfunction Questionnaire (VCDQ). No appropriate measure of trauma associated with a breathing condition could be found so convergent validity for part 2 was not measured. Two weeks later the same questionnaire pack was repeated, along with a Global Assessment Rating Scale. Results The ILOQoL demonstrated adequate psychometric properties. The questionnaire had strong internal consistency (α ≥0.07 for each sub-scale total and overall ILOQoL total), weak convergent validity (p≤0.05) and adequate test retest reliability (p≤0.05 for two subscales and overall ILOQoL total). Additionally, the questionnaire had strong content validity and no floor or ceiling effects. Mean Anxiety score on the DASS-21 was ‘extremely severe’ – much higher than reported scores in other chronic health conditions.1 Further details of results are shown below. Conclusions Preliminary findings indicate that the ILOQoL has potential as an outcome measure during therapeutic interventions by measuring QoL. Larger scale study is warranted. Reference Singh RPB, Singh H, Singh CJ, Kaur KT. Screening of psychological distress in cancer patients during chemotherapy: a cross-sectional study. Indian Journal of Palliative Care2015;21(3):305–310.

Inducible Laryngeal Obstruction (ILO), also known as Vocal Cord Dysfunction is a medical condition where the vocal cords adduct, causing significant difficulties with breathing and speaking. There are no current disease-specific psychological outcome measures for assessing experienced distress and impact upon quality of life for those with ILO. This research provides preliminary findings assessing the reliability and validity of a Inducible Laryngeal Obstruction Quality of Life (ILOQoL) questionnaire. This research included item refinement and psychometric validation. Item refinement involved cognitive debriefing, which was undertaken with ten participants. Psychometric validation was undertaken with 31 participants diagnosed with ILO, who were six months’ post discharge from Speech and Language Therapy. Participants were posted a questionnaire pack which included a ILOQoL, Depression Anxiety Stress Scales, the activities sub-section of the Mini Asthma Quality of Life Questionnaire and the Vocal Cord Dysfunction Questionnaire. Two weeks later the same questionnaire pack was repeated, along with a Global Assessment Rating Scale. The ILOQoL demonstrated adequate psychometric properties. The questionnaire had strong internal consistency (α = >.07 for each sub-scale total and overall ILOQoL total), weak convergent validity (p = .05 for two subscales and overall ILOQoL total). Additionally, the questionnaire had strong content validity and no floor or ceiling effects. These preliminary findings indicate that the ILOQoL has the potential to be used as a routine outcome measure during therapeutic interventions by measuring QoL.

Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks. © 2013 Primary Care Respiratory Society UK. All rights reserved.

Experiences of actual/threatened death or serious injury to patients are commonplace in surgery. Pathological symptoms following stress may lead to Acute Stress Reaction (ASR) and Post-Traumatic Stress Disorder (PTSD). PTSD symptoms of insomnia, anger, poor concentration, hyper-vigilance and exaggerated startle have implications for patient safety. The current study investigates the prevalence of occult, untreated psychological morbidity amongst surgical trainees.A web-based survey of UK surgical trainees based upon the Impact of Events Scale-Revised (IES-R) was distributed using social media platforms and email. A score of ≥33 was indicative of ASR or PTSD (the former lasting1 month, the latter1 month). Additional questions concerned chronicity of symptoms, mentorship, team-working and access to support.For 167 returned surveys the mean age was 32.7 (SD 3.6) years; 102/167 (61%) were male. Mean years in training were 6.1 (SD 3.6). Median IES-R score was 14 (IQR 7-23.5). Of 144 respondents who answered about stress symptoms, 23/144 (16%) had IES-R score ≥ 33; 6 of these had symptoms 1 month (suggesting ASR); 17 had symptoms lasting1 month (suggesting PTSD). Those with IES-R ≥ 33 group were more likely to have repeated years of training, and have witnessed severe pain, traumatic injury, and acute haemorrhage. Seven with score ≥ 33 had sought support.Occult psychological morbidity amongst surgical trainees may be higher than in the general population. Recognition and management of this risk is important for the mental health of trainees and the safety of patients.

Objective: This paper provides for the first time cases of individual psychological therapy undertaken in tertiary, difficult to treat asthma services using "third wave" Cognitive Behavioural Therapy (CBT) approaches. Methods: These cases were selected to represent common psychological presentations in difficult to treat asthma clinics, namely denial of severity and over-identification with asthma. Assessment, formulation, intervention and results are outlined. Results: Case 1 demonstrated change from severe to mild depression and anxiety, reduction in shame and improved well-being. Case 2 demonstrated improvements in well-being and psychological symptoms. Both interventions were experienced by the patients as highly satisfactory. Conclusions: It is concluded that a psychological understanding of patients' presentations can open up new avenues for intervention. Further research into the potential utility of third wave cognitive therapies in difficult to treat asthma is warranted.

Introduction Vocal cord dysfunction (VCD) can have a significant impact on breathing ability and quality of life. 1 Psychological factors can contribute to the onset and maintenance of the condition. 2 Little has been written about the patient experience of VCD; therefore this study sought to understand what it is like to live with the condition and develop a preliminary model of VCD. Methods Six adults diagnosed with VCD were interviewed and full transcripts of each interview were analysed via Interpretive Phenomenological Analysis. 3 Six themes were generated reflecting the experiences of living with VCD. Next, the relationships between the themes were explored diagrammatically for each participant. Key phenomena or processes were fed into a summary cross-case diagram, which hypothesised how common aspects of the VCD experience may affect quality of life. Results It is theorised that three key elements are interacting to influence quality of life: (1) bodily sensations, such as throat tightening, wheeze and cough can feed into a cycle of panic that exacerbates symptoms; (2) unpleasant or traumatic memories can lead to hyper-vigilance for symptoms, worry and social withdrawal; (3) enabling patients to understand, prepare and cope with the physical and mental aspects of VCD can reduce the impact of VCD on quality of life. Furthermore, environmental factors, such as the general lack of knowledge about the condition, can exacerbate negative experiences of VCD. Conclusions We posit a biopsychosocial model of VCD which requires multidisciplinary treatment. In addition to speech and language therapy for throat-based symptoms, psychological interventions should be considered to address both thoughts about VCD and unpleasant memories. There is also an urgent need to improve and disseminate knowledge of the condition generally amongst medical professionals. References 1 Mansur AH. Vocal cord dysfunction. In: Palange P, Simonds AK, eds. European respiratory society handbook : Respiratory medicine. 2nd edn. Sheffield, England: European Respiratory Society, 2013: 274–279 2 Morris MJ, Oleszewski RT, Sterner JB, Allan PF. Vocal cord dysfunction related to combat deployment. Mil Med . 2013; 178 (11):1208–12 3 Willig C. Introducing qualitative research in psychology . Buckingham: Open University Press, 2009

Background: This pilot study explored factors associated with stress in medical students during their initial clinical contact with cancer patients, in particular identifying stress levels and coping strategies used. Methods: A total of 80 medical students at The University of Birmingham Medical School, UK, completed retrospective self-report questionnaires measuring socio-demographics, potential stressors and coping strategies (using the Brief COPE inventory). Statistical analysis followed data collection. Findings: Of all socio-demographic categories, female gender correlated with the highest stress score (p

Asthma attacks occur across all subtypes and severities of disease. Accurate quantification of asthma attack risk would enable targeting of interventions with a potential reduction in morbidity, mortality, and costs. We aimed to develop a risk assessment questionnaire underpinned by a systematic literature review. We searched major databases up to February 2012 using the terms: asthm* AND (exacerbati* OR admission) AND (risk OR predic* OR associat*) NOT review. Included studies were those in individuals >12 years old with doctor-diagnosed asthma on treatment. Outcomes were asthma attacks defined as: deterioration of symptoms, fall in objective measures of airflow, and need for a short course of augmented asthma therapy OR admission to hospital OR attendance at emergency department. Statistical analysis was carried out using RevMan 5 and SPSS 19. 3536 unique publications were retrieved. After title screening and comparison of abstracts against a standard checklist and age criteria, data extraction was undertaken in duplicate on the remaining 143 papers (see figure). Of 18 major research themes identified, 8 factors had a consistent and clinically important (OR>1.25) association with asthma attacks across publications free from major bias. The questionnaire derived from these factors is shown below. Simplified weighting is proportional to the effect size when expressed as an odds ratio (in brackets). I smoke (3) I take fewer than 8 out of 10 prescribed doses of my regular preventer medication (3) In the last month I have used my reliever inhaler more than once per day on average (3) I sneeze, or get a runny, or a blocked nose when I do not have a cold (2) In the last 5 years, I have attended a hospital emergency department or been admitted to hospital because of asthma (2) I have a body mass index of ≥ 30 (1) I have not received asthma related education or a written asthma management plan (1) I left school before sitting my A-levels/highers (1) In summary, we systematically identified factors from the literature that are independently associated with the risk of asthma attack. These factors inform a questionnaire which will require validation and subsequent impact assessment.