How professional pilots perceive interactions of working conditions,rosters, stress,sleep problems,fatigue and mental health. A qualitative content analysis

IntroductionSo far, no qualitative content analysis (QCA) has analysed pilots’ experiences and perceptions regarding weaknesses of fatigue risk management (FRM), flight time limitations (FTL), rosters, fatigue-severity, sleep problems, and how they relate to pilots’ mental health and well-being.ObjectiveThis research analyses pilots’ described perceptions of stress, fatigue, aviation safety and how regulations like FTL can affect their health and well-being.MethodIn total, 119 international pilots described their perceptions of FTL, rosters, aviation safety, and how they relate to fatigue and health. The QCA was conducted to analyse interactions of working conditions, stressors, fatigue, sleep problems and mental health of EASA-based and Australian pilots.ResultsAlthough pilots were rostered for only 60.8% to 62.5% of the legally allowed duty and flight hours/month, 78.6% reported severe or very high fatigue, 22.8% significant depression, 12.3% significant anxiety symptoms, 10.5% reported significant depression and anxiety symptoms. Pilots uttered severe concerns about FTL, sleep restrictions associated with early starts, minimum rest, etc. Pilots also expressed distinct fears regarding more fatigue-related crashes, and how adverse working conditions, work-related and psychosocial stress could impair their health.ConclusionsThis QCA provided valuable insights into interactions of working conditions, fatigue, sleep restrictions, physical and mental health. Progressive health impairment due to lack of sleep and accumulated fatigue promote burnout, mental and physical health problems, which not only threaten flight safety, but also sustainability of aviation.     

城镇化进程中离乡农民心理健康特点调查及心理素质、相对剥夺感的影响机制

为探讨城镇化进程中离乡农民的心理健康特点以及心理素质、相对剥夺感对其的影响,通过量表对1339名城乡居民进行调查。结果发现:离乡与留乡农民在幸福感、拥有生命意义感、感知控制感、心理素质方面显著低于城镇居民,在状态焦虑方面显著高于城镇居民; 离乡农民在抑郁上显著高于城镇居民,在感知控制感上显著高于留乡农民,在心理素质上显著低于留乡农民; 留乡农民在相对剥夺感上显著高于城镇居民; 离乡农民的幸福感、拥有生命意义感、感知控制感态与相对剥夺感呈显著负相关,与心理素质呈显著正相关; 离乡农民的抑郁、状态焦虑与相对剥夺感呈显著正相关,与心理素质呈显著负相关; 离乡农民的相对剥夺感与心理素质之间呈显著负相关。心理素质除了可以直接预测心理健康各项指标,还可以通过相对剥夺感的中介作用,间接预测幸福感、抑郁及状态焦虑。提升心理素质和降低相对剥夺感是离乡农民心理健康服务的重要切入点。     

Digital Mental Health Services: Moving From Promise to Results

The papers in this special series make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers’ contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS.     

Digital Mental Health Interventions for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.     

Coping strategies: A prospective study of patterns,stability, and relationships with psychological distress

The aims of this article are: (1) to explore patterns (clusters) of coping strategies; (2) to examine the stability of individual coping strategies and patterns of coping over time; and (3) to establish long term associations between coping and psychological distress. Coping strategies were assessed with the Brief Cope questionnaire, whereas psychological distress was measured with the ten‐item version of the Hopkins Symptom Checklist, in a two‐year prospective sample comprising 3,738 employees. Based on TwoStep cluster analysis of the Brief Cope, three different coping patterns were identified: low coping, engagement coping, and disengagement coping. Analyses of long‐term stability indicated malleable properties for the individual coping strategies as well as the three clusters. Disengagement coping strategies in the form of self‐blame and self‐distraction were most strongly associated with distress at follow‐up, whereas baseline distress was related to increased use of these strategies two years later. Coping patterns at baseline had no main effects on later levels of distress, but levels of distress at baseline predicted subsequent use of engagement and disengagement coping patterns. The finding that specific coping strategies are malleable suggests that it is possible to modify and develop dysfunctional strategies. The associations between disengagement coping strategies and distress indicate that this kind of coping is especially problematic with regard to mental health problems. A main contribution of this study is that it establishes cluster analytic techniques as beneficial in the assessment of coping.     

A qualitative study of citizens' experience of participating in health counseling

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi‐structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short‐term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.