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Biomedical subjects

J Firth-Cozens

Publications and source records attributed to J Firth-Cozens.

At least 37 records · Page 2Linked to original sources
PubMed1998

Individual and organizational predictors of depression in general practitioners.

BACKGROUND: High levels of stress and depression are seen in both general practitioners (GPs) and hospital doctors, and this has implications for patient care. It is therefore important to discover the individual and organizational causes of elevated symptoms so they can be tackled. AIM: To discover the relative importance of individual characteristics measured 10 years earlier compared with current organizational stressors in predicting depression in GPs. METHOD: Longitudinal questionnaire study, using data from those of the original cohort of 318 medical students who are now GPs (n = 131), considering perceptions of current stressors and comparing through regression analyses the relative strength of early personality and mood with current organizational factors of sleep, hours worked, and practice size in predicting current depression levels. RESULTS: There were 22 (17%) stressors scoring above threshold for depression. Relationships with senior doctors and patients are the main reported stressors, followed by making mistakes and conflict of career with personal life. The predictors of symptom levels varied for men and women. In men, depression and self-criticism as students, and current sleep levels; and in women, sibling rivalry and current alcohol use, were the main predictors: in men, 27% of the variance was accounted for by early dispositional factors alone compared with 14% in women. A model is suggested linking sleep loss with workplace stressors, self-critical cognitions, and depression. CONCLUSION: Interventions can be made throughout training, targeting self-criticism and recognizing early depression, while later addressing the organizational stressors, particularly work relationships and sleep patterns.

Cohort Studies↗
PubMed1997

Doctors' perceptions of the links between stress and lowered clinical care.

We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of doctors, despite their stress levels being particularly high. This study explores the doctors' views on this using anonymous questionnaires from a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress symptom) made, and the effect it had. Half of these effects concerned lowered standards of care; 40% were the expression of irritability or anger; 7% were serious mistakes which still avoided directly leading to death; and two resulted in patient death. The attributions given for these were largely to do with tiredness (57%) and the pressure of overwork (28%), followed by depression or anxiety (8%), and the effects of alcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care for patients. It presumes that these incidents had been previously unreported and talks about the effects this secrecy has on the emotional state of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners.

Alcohol Drinking↗
PubMed1997

Dependency and self-criticism as predictors of depression in young doctors.

Brief measures of depression and of dependency and self-criticism, personality factors believed to convey vulnerability to depression, were administered to 318 medical students. Depression was subsequently measured 2 years later (in the highly stressful 1st postgraduate year) and 10 years later when careers were established. When initial symptom levels and concurrent workload were controlled, dependency and, more particularly, self-criticism were significant predictors of depression for male doctors in the 1st postgraduate year. For female doctors, self-criticism was the only significant predictor. Ten years later, the predictive effects for male doctors were similar, but rather weaker, whereas none of the variables predicted depression in female doctors. Implications for preventive interventions are discussed.

Adult↗
PubMed1992

Self-criticism in adulthood and recalled childhood experience.

We investigated in a sample of 75 medical students the hypothesis that higher levels of self-criticism, a major vulnerability factor for depression, are related to retrospective reports of less satisfactory parenting, even when the potentially confounding factors of mood state and social desirability response set are controlled. At each of 2 measurement times, there were significant cross-sectional correlations between parental ratings and both depression and self-criticism, but the associations with self-criticism were no longer significant when depression was controlled. However, even after controlling for the effects of mood state and social desirability, persons with high levels of self-criticism at both measurement points (high trait self-criticism subjects) reported significantly worse relationships with their mothers than did the remaining subjects. They were also more likely to report below average relationships with both parents jointly.

Adult↗
PubMed1992

Registrars' and senior registrars' perceptions of their audit activities.

OBJECTIVES: To ascertain the level and quality of audit activity among junior doctors, their attitudes to audit, and their views on its educational value. DESIGN: Postal questionnaire survey in April 1991. SETTING: Yorkshire region. SUBJECTS: All 610 registrars and senior registrars recorded as employed in the region. MAIN MEASURES: Grade, current specialty, details of last audit participated in and its educational usefulness, and attitude to audit. RESULTS: 255 (41.8%) completed questionnaires were returned, 148 from registrars and 101 from senior registrars; grade was not indicated in six. 27 respondents were in general medicine, 26 in general surgery, 30 in anaesthetics, and 36 in psychiatry; other specialties had fewer than 20 respondents. About a fifth (54) of respondents, most in psychiatry (19/36, 53%), had not participated in audit. Among the 201 who had participated, the audit topics covered most components of care (access to services (47, 23%), communication (51, 25%), and appropriateness (158, 79%) and effectiveness (157, 78%) of treatment); only 84 (41%) audits set standards, and in only half of them had the doctors been involved in doing so. Doctors responsible for gathering data and those responsible for collating and reporting data found their experience significantly less useful than those who were not. 172 (86%) respondents considered that audit had helped patient care. Suggested improvements to the educational value of audit were mostly for better methods but included requests for less "witch hunting," better feedback, more training, more time, and more participation by consultants. CONCLUSIONS: The educational value of audit to junior doctors could be improved by better audit methods, guidance, and feedback.

Attitude of Health Personnel↗
PubMed1991

Fear of death and strategies for coping with patient death among medical trainees.

This paper describes a longitudinal study of fear of death following up fourth-year medical students in their junior house officer year. It confirms previous findings that the fear of death is and remains multidimensional, with fear of being dead having the lowest score on both occasions and fear of someone close dying being consistently the highest. Fear of death reduces on each dimension over time, though not significantly. An analysis of descriptions of strategies used by students to cope with patient death showed that passive acceptance through rationalizing was the most commonly used, especially by men, followed by supporting the patient emotionally or clinically, which was used especially by women. The highest fear and stress scores were associated with avoidance, dismissal and seeking advice, while the lowest were shown by those who rationalized the event. The paper goes on to describe the relationship of fear of death to various individual differences including empathy, gender, parental death, parental anxiety, and stress.

Adaptation, Psychological↗
PubMed1990

Source of stress in women junior house officers.

OBJECTIVE: To determine the causes of stress in women doctors and relate these to levels of depression. DESIGN: Questionnaire study. SUBJECTS: Of 92 women doctors who had graduated from the universities of Leeds, Manchester, and Sheffield in 1986 and had been working as junior house officers for eight months 70 (76%) returned completed questionnaires. MAIN RESULTS: Mean score on the general health questionnaire was 13.79 (SD 5.20) and on the symptom checklist for depression was 1.43 (0.83). The scores of 32 subjects (46%) were above the criterion for clinical depression. Overwork was perceived as creating the most strain, followed by effects on personal life, serious failures of treatment, and talking to distressed relatives. Both stress and depression were related to effects on personal life, overwork, relations with consultants, and making decisions. Sex related sources of stress were conflicts between career and personal life, sexual harassment at work, a lack of female role models, and prejudice from patients. In addition to these, discrimination by senior doctors was related to depression. CONCLUSION: Changes are needed in the career paths of women doctors, and could be implemented.

Decision Making↗
PubMed1990

Two-year follow-up of the Sheffield Psychotherapy Project.

Of 40 depressed and anxious patients who received treatment during the Sheffield Psychotherapy Project, 31 completed the BDI and SCL-90 at two-year follow-up. At both group and individual levels, outcomes were very similar to those obtained at the completion of treatment. Substantial minorities of patients reported major life events and seeking further help for psychological problems during the two years, but these reports were not reliably associated with symptoms at follow-up. Patients recalled very different elements in prescriptive and exploratory therapies as helpful, with a notable emphasis upon prescriptive therapy's relaxation and anxiety management as a source of problem solution.

Adult↗