In the United States there has been an increased interest in the development of treatment programs that admit chemically dependent women with their children. The Salvation Army Family Treatment Services in Honolulu, Hawaii has had a long history of admitting women both with and without their children to long-term residential treatment. This has provided an opportunity to study the differences in treatment retention between these two groups. Subjects were 130 females who participated in treatment between 1988 and 1993. Analyses were conducted to determine whether there were different outcomes for women with children in treatment and women without children in treatment, with regard to type of discharge and length of time in treatment. Results were significant and clearly indicated better retention rates for women who participated in treatment with their children.
Background Graduate medical education is demanding, and many residents eventually experience a reduced sense of well-being. Interventions are in development, but knowledge gaps remain in terms of time commitment and efficacy. Objective To evaluate a mindfulness-based wellness program for residents—PRACTICE (Presence, Resilience, and Compassion Training in Clinical Education). Methods PRACTICE was delivered virtually by the first author in the winter and spring of 2020-2021. The intervention totaled 7 hours delivered over 16 weeks. An intervention group of 43 residents (19 primary care and 24 surgical) participated in PRACTICE. Program directors electively enrolled their programs, and PRACTICE was integrated into residents' regular educational curriculum. The intervention group was compared to a non-intervention group of 147 residents whose programs did not participate. Repeated measure analyses were conducted before and after the intervention using the Professional Fulfillment Index (PFI) and Patient Health Questionnaire (PHQ)-4. The PFI measured professional fulfillment, work exhaustion, interpersonal disengagement, and burnout; the PHQ-4 measured depression and anxiety symptoms. A mixed model was used to compare scores between the intervention and non-intervention groups. Results Evaluation data were available from 31 of 43 (72%) residents in the intervention group, and from 101 of 147 (69%) residents in the non-intervention group. Significant and sustained improvements were demonstrated in professional fulfillment, work exhaustion, interpersonal disengagement, and anxiety in the intervention group versus the non-intervention group. Conclusions Participation in PRACTICE resulted in improvements in measures of resident well-being that were sustained over the 16-week duration of the program.
The tendency of emergency psychiatrists to make alcohol- and drug-related diagnoses was examined before and after the addition of a standardized psychoactive substance use questionnaire. The addition of the questionnaire resulted in a significant increase in the number of psychoactive-substance-induced organic mental disorder (substance-induced disorder) diagnoses. The questionnaire selectively increased the recognition of nonalcoholic substance-induced disorders while not significantly increasing the diagnoses of alcohol-induced disorders when alcohol was used alone. This suggests that nonalcoholic substance-induced disorders are underdiagnosed in emergency psychiatry. With the increase in the diagnoses of substance-induced disorders, there was a significant decrease in the frequency of psychotic disorder diagnoses and a significant increase in the frequency of adjustment disorder diagnoses. The clinical impact of underdiagnosing and misdiagnosing substance-induced disorders is discussed. Overall, the findings suggest that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room. Follow-up studies using urine drug screening are recommended.
Background Residents’ well-being tends to decline in the course of training, yet research on preventive and restorative interventions for residents is limited. Mindfulness-based interventions have been successfully employed to support well-being in practicing physicians, but their impacts on residents are not well established. Objective This paper describes the structure, content, and evaluation of a pilot mindfulness-based intervention program designated PRACTICE (presence, resilience and compassion training in clinical education) that was designed specifically to support resident well-being. Methods A combined sample of 14 postgraduate year one residents from two residency training programs participated in a four-session (8 h) mindfulness-based intervention in the Fall/Winter of 2018. Participants were surveyed before, after, and at 3 months postintervention, on measures of wellness (Professional Fulfillment Index) and mental health (Patient Health Questionnaire-4), along with measures of program engagement. Results Participants demonstrated a significant reduction in burnout at the conclusion of the program. Depression and anxiety screening scores also trended toward improvement. However, participants were not able to sustain these gains. Three months after the conclusion of the program wellness measures had returned to preintervention levels. Conclusions The results of this study support the use of mindfulness-based interventions in resident wellness programs. The lack of an enduring effect indicates the need for a maintenance phase intervention.
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