The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

Do stigma and its psychosocial impact differ between Asian-born Chinese immigrants and Western-born Caucasians with head and neck cancer?

Stigma appears to influence emotional distress and well-being in cancer survivors, but cross-cultural differences have been ignored. Previous studies suggest that stigma may be especially relevant for survivors of Asian origin. However, their study designs (e.g. focused on female cancers, qualitative designs, and an absence of comparison groups) limit the strength of this conclusion. We hypothesized that (1) Asian-born Chinese immigrants (AI) would report more perceived cancer-related stigma than Western-born Caucasians (WBC); and (2) the impact of stigma on emotional distress and well-being would be greater in AI as compared to WBC. Head and neck cancer survivors (n = 118 AI and n = 404 WBC) completed measures of well-being, emotional distress, and a three-item indicator of stigma in structured interviews. The majority of respondents (59%) reported one or more indicators of stigma. Stigma correlated significantly with emotional distress (r = .13, p = .004) and well-being (r = ?.09, p = .032). Contrary to our hypotheses, WBCs and AIs did not differ in reported stigma nor did we detect differences in its psychosocial impact. Stigma exerts a deleterious psychosocial impact on head and neck cancer survivors. It did not differ significantly between AI and WBC survivors.     

Job characteristics,well-being and risky behaviour amongst pharmacists

Healthcare practitioners’ fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual’s fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.     

An exploration of health-seeking behaviours among Nigerian Christians in the UK: towards enhanced health services utilisation

Migration from different cultures carries with it some acclimatisation challenges. This study explored various health-seeking behaviours and potential barriers to healthcare utilisation among Nigerian Christians in the UK. This qualitative study involved 10 adult male and female participants, with both interviews and focus group discussion (FG) for data collection (Interviews: n?=?4, FG: n?=?6). Thematic analysis revealed that religious and cultural beliefs were barriers to healthcare utilisation. The implication is that further research on cultural matching between care providers and service users is needed; where religious leaders and health providers from Nigeria can influence health decisions among this migrant community. Limitations of the current study are discussed, with directions for further research identified.     

Cultural aspects of mental health and mental health service delivery with a focus on Nigeria within a global community

With an endless range of subgroups and individual variations, culture bears upon what all people bring to the clinical setting. Culture could account for health-seeking behaviour, type of services and support system and variations in how people communicate their health concerns. Culture may underlie presentation of sets of symptoms that are peculiar to certain societies – culture-bound syndromes. Culture also influences the meanings that people impart to their illness and also stigma associated with such illnesses. Culture must be viewed from the patients, clinicians and health system dimensions. Changes in mental health service delivery in last few decades have yielded culturally competent mental health services. The aim of this paper was to discuss culture and mental health with a focus on Nigeria and from a global perspective.     

Chinese are more loss averse than British

This research investigates how culture might influence loss aversion. Chinese were expected to be more loss averse than British because of cultural differences in regulatory focus. Study 1 reveals that compared with British participants, Chinese participants were less likely to give up gifts they had received in exchange for new gifts. In Study 2, Chinese and British participants imagined buying a computer which either had a high specification and a high price tag (high reference), or a basic specification and a low price tag (low reference). Participants were informed that the (reference) computer was unavailable, and they had to choose between two available computers, which were both cheaper and less powerful than the high reference computer, and more expensive and more powerful than the low reference computer. The results reveal that the difference in price tag between the two available computers had a bigger impact on Chinese buying decisions than on British buying decisions when it was viewed as a loss. Furthermore, both promotion focus and prevention focus mediated the influence of culture on buying decisions in the low reference condition. No cross‐cultural difference was found in the high reference condition.     

Too individualistic for safety culture? Non-traffic related work safety among heavy goods vehicle drivers

IntroductionThis article reports on a study of non-traffic related work safety among drivers of heavy goods vehicles in Denmark. In the heavy goods vehicle transport (HGV) sector only 6.4% of workplace accidents involving drivers are traffic related. HGV work is characterised by solitary work, as drivers tend to work at a physical distance from their own company and their working environment is also influenced by the working environment of other companies e.g. the places where they deliver goods. This study focuses on an analysis of HGV drivers’ and managers’ differentiated understandings of risk and safety and its management within an organisational context. The situational focus involves viewing HGV drivers’ working environment as a part of the organisational structure as well as of other social relationships. An understanding of safety culture as practice is applied with the view of identifying values and attitudes as well as organisational and technical aspects in relation to how individualist or collectivist understandings of risk and safety influence the working environment in HGVs.MethodThe study applied a mixed methods approach and in this article the qualitative interviews conducted with drivers and managers is the primary data source.ResultsThis study suggests a widespread understanding of drivers as being individually oriented in their work, from drivers and management alike. However, the study also demonstrates that, in conducting their work, the drivers are actually interdependent, and share knowledge frequently, albeit informally. The organisational structure of the company shapes their individual attitudes towards safety but they also report being dependent on relationships with, and information from, their fellow colleagues, former colleagues and friends who shape their understandings and attitudes towards hazards and safety practices. The analysis points to risk-taking and unsafe practices as prevalent among HGV drivers, who often refer to risk as trivial and the management of such risks as one’s own responsibility. Knowledge of how to manage risks in everyday practice is shown to be principally related to personal experiences but also to the good advice and examples of fellow drivers.ConclusionsThe analysis points to interdependent and collectivist practices among HGV drivers even though they are perceived as being individualistically oriented when it comes to safety. Therefore, non-traffic related safety practices, in this case the loading and unloading of vehicles, occur in the grey zone of organisational safety management. Despite the fact that organisational safety initiatives are initiated, the management sees limited possibilities for enforcing them and hence safety practice is often left to the individual driver.Practical applicationsA safety culture perspective might enhance work safety among HGV drivers if we are able to understand workplace culture in a pluralistic way. Collectivist practice among the drivers can be utilised in order to improve knowledge sharing and situational safety practices. The informal communication identified among the drivers might offer a new model for safety initiatives based on more collectivist, albeit informal, safety culture practices on behalf of HGV companies.     

La relation entre la culture organisationnelle et les agressions au travail

This study aimed to determine how perceptions of group, developmental, hierarchical and rational organizational culture contribute to workplace aggressions. Aggressions included low intensity incivilities to violent physical acts. Data came from the SALVEO surveys containing a sample of 1942 workers employed in 63 workplaces. Multilevel analyses revealed that the perception of the group culture is associated with lower levels of incivilities while the developmental culture is associated with higher levels of incivilities.     

Workplace ethics culture and work engagement: The mediating effect of ethical leadership in a developing world context

This study examined the mediating effect of ethical leadership on the relationship between workplace ethics culture and work engagement among employees in a railway transport organisation in the Democratic Republic of the Congo (DRC). The sample consisted of permanently employed staff in a railway organisation in the DRC (n = 839; females = 32%). The employees were required to complete the Ethical Leadership Scale (ELS), the Ethical Corporate Virtue model (ECV) and the Utrecht Work Engagement Scale (UWES). Mediating regression analyses were conducted to predict work engagement from workplace ethics culture, partialling out ethical leadership. The results show that workplace ethics culture had a significantly positive effect on work engagement. The results further indicated that workplace ethics culture, through the mediation of perceived ethical leadership, had a significantly positive effect on the work engagement dimensions of vigour, dedication and absorption. The findings provide evidence that ethical leadership plays a crucial role in shaping workplace ethics culture and employees’ level of work engagement in an emerging country work setting.