High Rates Of Stress Research Articles

Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients.

Background: Frailty is an important prognostic factor in patients with cardiovascular diseases (CVD), and patients with CVD have a high rate of concurrent psycho-emotional stress, as well as depressive mood and anxiety symptoms. Despite this, few reports have examined the effects of the efficacy of Phase II cardiac rehabilitation (CR) in frail patients, including improvements in anxiety levels.Methods and Results: In all, 137 patients (mean [±SD] age 65.8±13.0 years; 71% male) who participated in Phase II CR and were assessed after CR completion were included in this study. Patients were evaluated using the Kihon Checklist (KCL) form at the beginning of CR and were divided into the 3 groups according to KCL scores: frail (n=34, 25%), pre-frail (n=40, 29%), and non-frail (n=63, 46%). Physical function and anxiety levels were compared among the 3 groups. The pre-frail and frail groups had significantly higher state anxiety and trait anxiety than the non-frail group (P<0.01). At the end of Phase II CR, all 3 groups showed significant improvements in the 6-min walking distance (P<0.05). State anxiety improved significantly in the non-frail and pre-frail groups, whereas trait anxiety only improved in the non-frail group.Conclusions: Physical function was improved in frail patients who participated in Phase II CR. However, there was no significant improvement in their level of anxiety.

The Rising Toll of Public Mental Health Work.

Back to table of contents Next article Taking IssueFull AccessThe Rising Toll of Public Mental Health WorkMark Baptiste, M.D., and Rachel Talley, M.D.Mark BaptisteSearch for more papers by this author, M.D., and Rachel TalleySearch for more papers by this author, M.D.Published Online:1 Jul 2022https://doi.org/10.1176/appi.ps.22073007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Severe mental health workforce shortages and high rates of health care worker burnout have been highlighted as key priority areas to address the U.S. national mental health crisis. Briana S. Last and colleagues (1) present timely findings that underscore the urgency of these priorities. The authors elucidate several facets of the emotional and financial strain experienced by public mental health workers in Philadelphia and demonstrate an inverse association between level of education debt and frequency of evidence-based intervention (EBI) delivery. These findings are alarming but not surprising based on our frontline experience providing clinical care and training in multidisciplinary public mental health settings. Consistent with this study’s findings, we have found that low compensation, high workload driven by volume-based payer incentives, and constant exposure to psychosocially complex and chronically traumatized populations are the ingredients for burnout and high turnover. Despite the best efforts of frontline clinicians and local behavioral health and payer authorities such as those in Philadelphia, these forces can become unsurmountable barriers to sustained uptake of EBIs in settings where they are most needed.Most clinicians in this study needed to work an additional job to supplement their income and carried significant education debt. The authors rightly highlight the crippling effect of low Medicaid reimbursement rates and fee-for-service (FFS) payment models on financial stability and ability to provide appropriate compensation in public mental health settings. Further, FFS financially incentivizes and rewards volume, potentially sacrificing quality. Continuously embedding an EBI can require both initial short-term training/supervision and longer-term, “refresher” venues for training, particularly with staff turnover. In overburdened and understaffed public FFS settings, consistently protecting clinician time for training in EBI is hardly feasible; these tasks compete with the pressure to generate billable encounters. Time and volume demands are uniquely burdensome in public settings because clinicians are charged with applying EBIs from research study conditions to complex populations with multiple comorbid clinical and psychosocial issues. When system financial constraints limit case management access, patients often look to clinicians to assist, further absorbing clinical time. These conditions make the consistent delivery of EBI impossible.Higher rates of reimbursement, increased use of episode-of-care payments with appropriate rates, and increased use of value- and performance-based payment rewarding evidence-based care are critically needed to increase the financial ability of public mental health systems to properly compensate their staff and align payment incentives with delivery of EBI. In addition to these system-level solutions, we applaud Ms. Last and colleagues for suggesting how increased financial resources could be prioritized to directly benefit individual clinicians. We underscore Last and colleagues’ suggestions of compensated ongoing consultation in EBI on the job and wage incentives for use of EBI. Well-intentioned efforts to implement new clinical interventions often do not account for the extra time and energy clinicians require to learn and effectively use these strategies.When a precarious personal financial situation combines with the volume-focused pressure of FFS and the complex conditions of patients in public mental health settings, seeing clinicians experience burnout and secondary stress response is not surprising. High rates of secondary traumatic stress, burnout, and posttraumatic stress disorder in the study’s sample are particularly alarming when coupled with clinician-reported difficulties in affording mental health care. Staff burnout and resultant turnover complicate the ability of public mental health systems to provide consistent long-term provider-patient relationships and care, whether evidence based or not. Beyond the authors’ suggestions of increased peer and supervisory support, benefits covering mental health care and robust employee assistance programs with trauma-informed resources should be considered a mandatory part of trauma-focused EBI intervention, just as is training in the intervention itself. The increased move toward hiring independent contractors removes critical mental health supports for employees.Despite the passion and dedication of frontline public mental health workers, the current financial and emotional toll of their work settings not only stymies sustained uptake of EBI but also threatens the sustainability of this work as a long-term career path. Without significant investment in the financial and emotional well-being of this workforce, we fear a continued migration of talented public mental health clinicians to the private sector.Department of Psychiatry, University of Pennsylvania, Philadelphia.Send correspondence to Dr. Baptiste ([email protected]).Reference1 Last BS, Schriger SH, Becker-Haimes EM, et al.: Economic precarity, financial strain, and job-related stress among philadelphia’s public mental health clinicians. Psychiatr Serv 2022; 73:774–786Abstract, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 73Issue 7 July 2022Pages 721-721 Metrics PDF download History Published online 1 July 2022 Published in print 1 July 2022

709-P: Persons with High-Risk Diabetes, Depression, and Stress Using a Digital Health Platform Experience an Improvement in Glycemic Management

Introduction: As the prevalence of type 2 diabetes (T2D) continues to grow worldwide, individuals struggle with how to integrate diabetes self-management into their lives. This is complicated by the high rate of depression and stress among persons with T2D. A multicondition behavior change-oriented digital therapeutic platform may alleviate the burdens faced by persons with comorbid diabetes and mental health conditions. Objective: To investigate blood glucose levels outcomes in persons with T2D and comorbid depression and stress who used a multicondition digital therapeutic to manage their blood glucose levels. Method: We performed a retrospective data analysis on the DarioTM database using users who activated the mobile app during 2019-2021 and who self-reported stress and depression in the App questionnaire. Participants who took at least 5 measurements at 1st and 12th month with Dario and who started with an average blood glucose &amp;gt;180 mg/dL were termed “high-risk.” The ratios assessed were average blood glucose and high blood glucose (&amp;gt;180 mg/dL) readings ratio over a year. Results: The high-risk group of 491 users significantly reduced their average blood glucose by 13% (204±60 vs. 234±55) (P&amp;lt;0.001) . A subset of high-risk users with type 2 (N=379) was also evaluated and significantly reduced their average blood glucose by 14% (P&amp;lt;0.001) (201±66 vs. 233±53) . Moreover, their high glucose events ratio (&amp;gt;180 mg/dL) was significantly reduced from 69.4% to 46.9% over a full year usage (P&amp;lt;0.001) . Conclusion: The use of a multicondition digital therapeutic platform may be associated with improved glucose management for persons with “high risk” glycemia who cope with depression and stress. The present study revealed that the digital multicondition platform has the potential to enhance self-care behaviors among people with diabetes that suffer from stress and depression. Disclosure Y.Hershcovitz: None. M.Tamir: None. M.D.Ritholz: Advisory Panel; DarioHealth Corp. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study

(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind–body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = −0.497, p ≤ 0.01) and mental well-being and DBP (r = −0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (β = −0.42, 95% CI (−0.69–0.15)) and a 1.10 unit decrease in MAP (β = −1.10, 95% CI (−1.99–0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.

Teacher well-being in the classroom: A micro-longitudinal study

Given the high stress and attrition rate among teachers, there is a need to expand knowledge on situational experiences that contribute to teacher well-being. We investigated the links between student lesson-specific behaviour (disruptive behaviour, engagement), teachers' lesson-specific (positive, negative) emotions, daily (morning and end-of-working), and personal general well-being of 20 Taiwanese primary school teachers using a micro-longitudinal approach. By specifying multilevel structural equation models (MSEM), we found student behaviour predicts teachers' lesson-specific emotions, and this association varied across days and teachers. Teachers' lesson-specific positive emotions predict teachers’ well-being, suggesting positive emotions can be a protective factor for teachers.

A cross-sectional study of the COVID-19 pandemic impacts among Brazilian sexual and gender minorities

The COVID-19 pandemic exerted major impacts on the entire population, but some groups such as sexual and gender minorities have been disproportionately affected. Therefore, we aim at assessing the impacts on the social life and mental health of Brazilian sexual and gender minorities during the COVID-19 pandemic. This is a cross-sectional nationwide study conducted between September and October 2020. Participants were recruited through convenience sampling (snowball), being invited to answer an online questionnaire. The participants were invited to participate by social networks and websites directed to the LGBT+ population over 18 years old. This study included 659 sexual and gender minorities from all five Brazilian regions. The main impacts caused by the COVID-19 pandemic reported by the participants were anxiety (73.5%), stress (71%), loneliness (59.6%), sleep pattern changes (69%) and income reduction (36.9%). Participants with low educational level presented higher income reduction than participants with high educational level (0.61, 95% CI 0.48-0.77) and high income (0.46, 95% CI 0.34-0.62). Low income (1.14, 95% CI 1.03-1.26) and being lesbian (1.13, 95% CI 1.01-1.26) are related to changes in sleep patterns. Totally isolated participants presented high stress rates. The LGBT+ population presented high economic and emotional impacts during COVID-19 pandemic. The results of this study highlight the need for heath public policies directed for sexual and gender minorities.

Scale-out of a Total Worker Health\xae approach for designing interventions to reduce teacher stress: pilot implementation evaluation

BackgroundTeachers have high rates of daily stress and the majority of available interventions are focused at the teacher-level. Yet, best practices in Total Worker Health® approaches indicate organization-level interventions identified using a participatory approach are most effective. We conducted an exploratory scale-out pilot study to examine the adoption of the Healthy Workplace Participatory Program (HWPP), an evidence-based, Total Worker Health approach to engage employees (e.g., teachers) and supervisory personnel (e.g., administrators) in the design and implementation of workplace well-being interventions within two elementary schools.MethodsWe evaluated the program both quantitatively and qualitatively collecting implementation outcome data (i.e., fidelity, acceptability, understanding, feasibility, system alignment) as well as data-driven adaptations using the Framework for Reporting Adaptations and Modifications-Expanded. Data from the first school informed scale-out adaptation of the HWPP intervention, HWPP-Education, within the second school. We compared implementation outcomes between Pilot Schools 1 and 2 to evaluate improvements in the adapted HWPP.ResultsAdaptations to HWPP program content and process were suggested to increase feasibility and contextual fit. Acceptability, understanding, and feasibility ratings showed statistically significant improvements comparing School 1 to School 2 which implemented the improved HWPP-Education. Furthermore, users reported adaptations including shorter meeting design and faster process were feasible within their work context.ConclusionThis pilot study is the first attempt to scale out the HWPP to educators, and while not intended to confirm efficacy, it showed promising results for scale-out. Results from Pilot Schools 1 and 2 suggest systematic use of quantitative and qualitative implementation data can effectively inform scale-out efforts that increase critical outcomes such as fidelity, acceptability, understanding, feasibility, system alignment, and leader engagement as well as decrease the extent of system resources needed. As such, this scale-out process may be a feasible approach on which to base large-scale implementation efforts of the HWPP among educators.

Parents of young infants report poor mental health and more insensitive parenting during the first Covid-19 lockdown

BackgroundThe Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown.AimTo investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown.MethodsThe Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data.ResultsParents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers.ConclusionsThe results emphasize the strain of the pandemic on young fathers’ and mothers’ mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation.

Effectiveness of a multi-modal hospital-wide doctor mental health and wellness intervention

BackgroundDoctors report high rates of workplace stress and are at increased risk of mental health disorders. However, there are few real-world studies evaluating the effectiveness of interventions aimed at addressing workplace risk factors and improving doctors’ mental health in a hospital setting. This study was conducted over two years (2017–2019) to assess the effects of a multi-modal intervention on working conditions doctors’ mental health and help-seeking for mental health problems in two Australian teaching hospitals.MethodsThe multimodal intervention consisted of organisational changes, such as reducing unrostered overtime, as well as strategies for individual doctors, such as mental health training programs. Hospital-based doctors at all career stages were eligible to participate in two cross-sectional surveys. 279 doctors completed the baseline survey (19.2% response rate) and 344 doctors completed the follow-up survey (31.3% response rate). A range of workplace risk and protective factors, mental health (psychological distress and suicidal ideation) and help-seeking outcomes were assessed.ResultsThere were significant improvements in key workplace protective factors, with small effects found for doctors’ job satisfaction, stress, work-life balance and perceived workplace support and a significant reduction in workplace risk factors including a moderate reduction in reported bullying behaviour between baseline to follow-up (job satisfaction p < 0.05, all other outcomes p < 0.01). However, no significant changes in doctors’ mental health or help-seeking outcomes were found over the intervention period.ConclusionFollowing the implementation of individual and organisational-level strategies in two Australian tertiary hospitals, doctors reported a reduction in some key workplace stressors, but no significant changes to their mental health or help-seeking for mental health problems. Further research is warranted, particularly to determine if these workplace changes will lead to improved mental health outcomes for doctors once maintained for a longer period.

160 Sustaining community engagement during COVID-19: High stress and loneliness reported

OBJECTIVES/GOALS: COVID-19 has taken a big toll on health, mental health and community well-being. COVID-19 has also presented unique opportunities for community engagement programs to sustain their work within communities. Low-tech methods of engagement might provide opportunities for success. METHODS/STUDY POPULATION: When we could not be in the field due to COVID-19, we recontacted our 12.4k HealthStreet members by phone and in 12 months successfully contacted 3.2k. By contrast, over the two COVID affected years (2019 &amp; 2020), our in-person recruitment efforts in the community fell to 832 from 1817 in the two prior years (2017 &amp; 2018). Reconnecting with existing members is an important aspect of sustainable community engagement. RESULTS/ANTICIPATED RESULTS: While 8/10 of the 3.2 K sample had internet access in their homes, 9/10 said having it was somewhat to very important. Importantly, 1 in 3 people who had additional needs or suggestions were looking for better COVID-19 knowledge or ways to reduce the threat of illness, 1 in 4 wanted resources; and 1 in 5 encouraged us to keep doing what we were doing. Among recontacted members, 30.2% indicated a high stress level (8 &amp; over on a 10 point scale) while 15.2% reported a high level of loneliness (8 &amp; over on a 10 point scale). High stress was significantly more likely among those identifying as African American (23.1%) compared to non-African American (16.6%). Loneliness did not vary (10.1% among both). DISCUSSION/SIGNIFICANCE: Sustainable community engagement was important to reach community members during the pandemic, especially given the high rates of stress and loneliness among members contacted. In-person connections were reduced, but phone contact provided an opportunity for successful engagement.

The impact of workplace safety and customer misbehavior on supermarket workers' stress and psychological distress during the COVID-19 pandemic

PurposeEssential frontline workers in the retail sector face increased exposure risks to coronavirus disease 2019 (COVID-19) due to frequent interactions with the general public. Often these interactions are fraught with controversies over public safety protocols. The purpose of this study is to examine the impacts of frontline workers' perceptions of workplace safety and customer misbehaviors on their stress and psychological distress to inform managing workplace health and safety during public health crises.Design/methodology/approachThe authors conducted an online survey of 3,344 supermarket workers in the state of Arizona (US) during the state's first COVID-19 pandemic wave in July 2020. Measures included mental health distress, and perceptions of workplace safety and customer behaviors. The authors utilized a mixed-methods approach combining multiple regression analyses with qualitative analyses of open-ended comments.FindingsWorkers reported high rates of stress and psychological distress. Increases in mental health morbidity were correlated with perceptions of being unsafe in the workplace and concerns about negative customer encounters. Qualitative analyses reveal frustration with management's efforts to reduce risks intertwined with feelings of being unsafe and vulnerable to threatening customer encounters.Practical implicationsThe findings highlight the need to provide and enforce clear safety guidelines, including how to manage potential hostile customer interactions, to promote positive health workplace management during a pandemic.Originality/valueThis study is among the first to assess the COVID-19 pandemic's impact on the mental health of non-health care frontline essential workers and presents novel insights regarding perceived customer misbehavior and need for management support and guidance in a public health crisis.

Cohort-Based Education and Other Factors Related to Student Peer Relationships: A Mixed Methods Social Network Analysis

Graduate students face a variety of stressors that relate to poor academic performance, lower completion rates, and high rates of depressive symptoms, anxiety, and stress. Student peers provide supports for coping with these stressors and succeeding academically. However, graduate students may find it difficult to form relationships with their peers. This mixed method social network analysis (MMSNA) examines graduate student perceptions of their peer relationships and the factors associated with peer friendships in a program that placed students in cohorts for the first semester of a two-year Master of Social Work program. Findings from three student focus groups include four main themes related to the cohort system and the tendency for students to gravitate to others who were similar to them (i.e., homophily). Focus group findings informed model specification for a curved exponential family model of student friendships at the end of the third semester of the program (N = 70) that identified correlates of student friendships including statistically significant direct and homophily effects for age, gender, and race/ethnicity. First-semester relationships and shared classes in subsequent semesters also increased the likelihood of friendships in the third semester. Findings emphasize the value of cohorts and a diverse student body for peer relationships.

130. Mindfulness Techniques for Stress and Anxiety in Adolescents with Type 1 Diabetes

Type 1 diabetes mellitus (T1D) is one of the most prevalent chronic conditions in adolescents. Adolescents with T1D have higher rates of stress and anxiety than the general adolescent population. Mindfulness techniques, such as guided meditation, yoga, and body scan, are an evidence-based method of reducing stress and anxiety symptoms. However, these techniques have not been operationalized in adolescents with T1D. The purpose of this qualitative descriptive study was to provide an in-depth description of the perception and current use of mindfulness techniques to manage stress and anxiety in adolescents with T1D.

Stress and the gig economy: it's not all shifts and giggles.

Gig work is a type of contingent work which has increased markedly in recent times, and is characterised by uncertainty, unpredictability, and instability of both schedules and income earned. Gig workers are also likely to work for multiple platforms and/or employers. These work characteristics mean that performing gig work is associated with higher rates of stress than the general population (Madden et al. Pers Rev 2017). However, it is not currently known which strategies gig workers use to cope with this stress - including which strategies are likely to be effective. The aim of this study was to understand the relationship between coping strategies, number of employers and stress in gig workers. An online survey was completed by 49 gig workers. Validated questionnaires were administered to measure coping strategies (Brief COPE) and stress (Perceived Stress Scale-14). Approach coping strategies (active, planning, and social support) were associated with reduced stress (p<0.05), whereas the avoidant coping strategy of self-blame was associated with increased stress (p<0.05). No differences in stress were seen between gig workers with one employer and those with multiple employers. Findings suggest that some coping strategies may lower stress in gig workers, though long-term outcomes should be considered in future research.

Teacher stress and burnout in Australia: examining the role of intrapersonal and environmental factors

Concerns regarding high rates of teacher stress and burnout are present globally. Yet there is limited current data regarding the severity of stress, or the role of intrapersonal and environmental factors in relation to teacher stress and burnout within the Australian context. The present study, conducted over an 18-month period, prior to the COVID pandemic, surveyed 749 Australian teachers to explore their experience of work-related stress and burnout; differences in stress and burnout across different demographic groups within the profession; as well as the contributing role of intrapersonal and environmental factors, particularly, emotion regulation, subjective well-being, and workload. Results showed over half of the sample reported being very or extremely stressed and were considering leaving the profession, with early career teachers, primary teachers, and teachers working in rural and remote areas reporting the highest stress and burnout levels. Conditional process analyses highlighted the importance of emotion regulation, workload and subjective well-being in the development of teacher stress and some forms of burnout. Implications for educational practice are discussed.

Financial stress among skin cancer patients: a cross-sectional review of the 2013-2018 National Health Interview Survey.

Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer patients from both healthcare and non-healthcare factors. Therefore, the present study sought to perform a retrospective cross-sectional review of the 2013–2018 cycles of the National Health Interview Survey (NHIS) to determine the prevalence, at-risk groups, and predictive factors of skin cancer patient financial stress. Survey responses estimated that 11.45% (95% Cl 10.02–12.88%) of skin cancer patients experience problems paying medical bills, 20.34% (95% Cl 18.97–21.71%) of patients worry about the medical costs, 13.73% (95% Cl 12.55–14.91%) of patients worry about housing costs, and 37.48% (95% Cl 35.83–39.14%) of patients worry about money for retirement. Focusing on at-risk groups, black patients, uninsured patients, and patients with low incomes (< 200% poverty level) consistently experienced high rates of financial stress for each of the four measures. Multivariable logistic regression revealed low education, lack of insurance, and low income to be predictive of financial stress. These findings suggest that a considerable proportion of skin cancer patients experience financial stress related to both healthcare and non-healthcare factors. Where possible, the additional intricacy of treating patients at risk of high financial stress may be considered to optimize patient experience and outcomes.

Lawyering While Black: Perceived Stress as a Mediator of Impostor Feelings, Race-Related Stress and Mental Health Among Black Attorneys

Attorneys suffer from high rates of stress and mental health problems, and Black attorneys, who make up only five percent of all attorneys in the United States, are especially vulnerable due to underrepresentation and experiences of bias. The present study examined perceived stress as a mediator of the impostor phenomenon, race-related stress, and mental health among a sample of 142 Black attorneys (114 women, 25 men). Gender, age, impostor phenomenon, race-related stress, and perceived stress accounted for 51% and 57% of the variance in depression and anxiety, respectively. Perceived stress fully mediated the links between the impostor phenomenon and depression, cultural racism and depression, and impostor feelings and anxiety and partially mediated the link between cultural racism and anxiety. Results suggest that perceived stress is an important mechanism for understanding why the impostor phenomenon and race-related stress negatively impact the mental health of Black attorneys.

Super-insulated, flexible, and high resilient mullite fiber reinforced silica aerogel composites by interfacial modification with nanoscale mullite whisker

Fiber-reinforced aerogel composites are extensively used in thermal insulation and energy-saving fields, while the inherently weak interface combination between fiber and aerogel undermines the effect of fiber reinforcement . To deal with this problem, mullite whiskers were in-situ synthesized on the surface of alumina silicate fiber through a facile and environmentally benign method. The nanoscale mullite whiskers growing on the fiber strengthen the interfacial bonding , thereby improving the mechanical properties of the composite. The alumina silicate fiber/mullite whisker/silica aerogel composites delivered ultrahigh compression stress and modulus of 6.45 MPa and 69.74 MPa at 50% strain, which is 6.14 times and 9.07 times higher than those of bare fiber reinforced silica aerogel . Meanwhile, the composite maintained a high retention rate of maximum stress of 97.8% after being compressed at 30% strain for 200 cycles. Moreover, the composite exhibits an ultralow thermal conductivity of 27.5 mW m −1 K −1 and a low density of 0.26 g cm −3 . The strong, resilient, lightweight composite with ultralow thermal conductivity is applicable for heat preservation and energy saving. • Mullite nanowhiskers were in-situ synthesized on alumina silicate fiber without F catalysts contaminating environment. • The stress (6.45 MPa) and modulus (69.74 MPa) at 50% strain increased dramatically due to interfacial enhancement. • The tough and resilient composite can be compressed at 30% strain for 200 cycles. • The composite also exhibited a low density (0.26 g cm −3 ) and a low thermal conductivity (27.5 mW m −1 K −1 ).

Well-being in the Intensive Care Unit: Looking Beyond COVID-19.

Burnout among critical care personnel has increased due to the additional psychological and physical demands of caring for critically ill patients with limited resources. Factors that increase the risk of burnout include compassion fatigue, lack of control over the work environment, difficult interpersonal relationships, and constant exposure to end-of-life issues. Organizational commitment to physician wellbeing depends on improving workplace efficiency, recognizing stressors in the critical care environment, and providing resources to help manage staffing shortages. Community building, training in communication, and team-building strategies are important steps in building collaboration and camaraderie in the workplace.

Changing self-concept in the time of COVID-19: a close look at physician reflections on social media

BackgroundThe COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may have profound effects on their mental and physical health, personal relationships and professional efficacy.MethodsWith mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria.ResultsA total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms.ConclusionIt is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures.