Review

Review

Improving Mental Health in Health Care Practitioners

An Article Review

Cheng, S.T., Tsui, P.K., & Lam, J. (2015). Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention. Journal of Counseling and Clinical Psychology, 83(1), 177-186. doi:10.1002/gps.1314

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Health care practitioners are at elevated risk for burnout, depression, and suicide (Fahrenkopf et al., 2008; Schernhammer & Colditz, 2004; West et al., 2006). Moreover, a practitioner’s occupational stress can contribute to impaired concentration and decision making and in turn have a negative impact on patient care (Barger et al., 2006; Fahrenkopf et al., 2008; West, et al., 2006). Unfortunately, practitioners seldom seek help and some of the attempts to self-manage are maladaptive (e.g., substance abuse; Boyd & Knight, 2008; Center et al., 2003; Devi, 2011).

Cheng, Tsui, and Lam (2015) sought to explore whether writing in a diary would impact stress levels in healthcare workers.  Participants were randomly assigned to one of three experimental conditions – gratitude, hassle, and control. The gratitude and hassle groups were asked to write in a diary twice a week about their experiences at work while the control group did not maintain a diary. The gratitude group was instructed to write events they were thankful for while the hassle group wrote about events that led to annoyance. Depressive symptoms and perceived stress were measured at baseline, post-treatment, and a three-month follow-up using self-administered questionnaires.

Using a sample of 102 physicians, nurses, physiotherapists, and occupational therapists, Chung and colleagues (2015) found the following:

  • The Gratitude Diary Group and the Hassle Diary Group differed significantly in the themes that they wrote about. Specifically, the themes seen in the Gratitude Diary Group included writing about good relationships with colleagues and having a “not busy” day. In contrast, the themes seen in the Hassle Diary Group included writing about problems with colleagues, excessive work demands, and physical and emotional exhaustion.
  • Significant differences between the groups in perceived stress and depressive symptoms were also observed at post-treatment and follow-up (see figure for direction of the differences).

Cheng and colleagues (2015) results suggest that:

  • The themes that were observed in the hassle diaries likely reflected the same daily concerns that practitioners generally experience.
  • The events focused on by practitioners in the two diary groups were similar in topic area, but opposite in valences.
  • The perceived stress score for each diary group was maintained from the post-treatment to the three-month follow-up, suggesting a lasting impact of the diary writing.
  • Depressive symptoms in the gratitude group continued to show decline over time.

Thus, based on the results of this study it appears that writing in a diary can be helpful for healthcare providers, but only if the writing focuses on gratitude and positive events. Further, the benefits of reviewing grateful events can have both short and long term impacts in perceived stress and depressive symptoms.

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Cite This Article

Rodriguez, T., & Slavin-Mulford, J. (2018, February). Improving mental health in health care practitioners [Web article] [Review of the article Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention, by S. T. Cheng, P. K. Tsui, & J. H. M. Lam]. Retrieved from http://societyforpsychotherapy.org/improving-mental-health-in-health-care-practitioners

References

Barger, L. K., Ayas, N. T., Cade, B. E., Cronin, J. W., Rosner, B., Speizer, F. E., & Czeisler, C. A. (2006). Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. Plos Medicine, 3, 2440–2448. doi:10.1371/journal.pmed.0030487

Boyd, J. W., & Knight, J. R. (2008). Substance use disorders among physicians. In M. Galanter & H. D. Kleber (Eds.), The American Psychiatric Publishing textbook of substance abuse treatment (4th ed., pp. 609 – 620). Arlington, VA: American Psychiatric Publishing.

Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., … Silverman, M. M. (2003). Confronting depression and suicide in physicians: A consensus statement. Journal of the American Medical Association, 289, 3161–3166. doi:10.1001/jama.289.23.3161

Cheng, S.T., Tsui, P.K., & Lam, J. (2015). Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention. Journal of Counseling and Clinical Psychology, 83(1), 177-186. doi:10.1002/gps.1314

Devi, S. (2011). Doctors in distress. The Lancet, 377, 454 – 455. doi: 10.1016/S0140-6736(11)60145-1

Fahrenkopf, A. M., Sectish, T. C., Barger, L. K., Sharek, P. J., Lewin, D., Chiang, V. W., … Landrigan, C. P. (2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. British Medical Journal, 336, 488 – 491. doi:10.1136/bmj.39469 .763218.BE

Schernhammer, E. S., & Colditz, G. A. (2004). Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). The American Journal of Psychiatry, 161, 2295–2302. doi:10.1176/appi.ajp .161.12.2295

West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., & Shanafelt, T. D. (2006). Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. Journal of the American Medical Association, 296, 1071– 1078. doi:10.1001/jama.296.9.1071

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