Faculty Bibliography

Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013⁻2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28⁻51 years vs. 52.0 (IQR 32⁻52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be "walk-in" or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07⁻1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome "seen by a psychiatrist", especially for men in the 16⁻25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22⁻5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization.

Cognitive models suggest that posttraumtic stress disorder (PTSD) is maintained, in part, as a result of an individual's maladaptive beliefs about one's ability to cope with current and future stress. These models are consistent with considerable findings showing a link between low levels of self-efficacy and PTSD. A growing body of work has demonstrated that perceptions of self-efficacy can be enhanced experimentally in healthy subjects and participants with PTSD, and increasing levels of self-efficacy improves performance on cognitive, affective, and problem-solving tasks. This study aimed to determine whether increasing perceptions of self-efficacy in participants with PTSD would be associated with changes in neural processing. Combat veterans (N = 34) with PTSD were randomized to either a high self-efficacy (HSE) induction, in which they were asked to recall memories associated with successful coping, or a control condition before undergoing resting state fMRI scanning. Two global network measures in four neural circuits were examined. Participants in the HSE condition showed greater right-lateralized path length and decreased right-lateralized connectivity in the emotional regulation and executive function circuit. In addition, area under receiver operating characteristics curve (AUC) analyses found that average connectivity (.71) and path length (.70) moderately predicted HSE group membership. These findings provide further support for the importance of enhancing perceived control in PTSD, and doing so may engage neural targets that could guide the development of novel interventions.

BACKGROUND AND OBJECTIVES: Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film. METHODS: In Experiment I, healthy student participants received a self-efficacy manipulation consisting of the recall of autobiographical memories of success (high self-efficacy condition), failure (low self-efficacy condition) or 'important' memories (control condition). Afterwards, they viewed a trauma film and recorded their intrusions of the film in the following week. In Experiment II the self-efficacy manipulation was given after the film. RESULTS: In contrast to expectations, the high self-efficacy condition reported a higher number of intrusions relative to the low self-efficacy condition in both experiments. LIMITATIONS: The trauma film provides experimental control but precludes generalization to real-life trauma. The effect of the experimental manipulation was small. The control condition also affected mood and confidence. CONCLUSIONS: The results suggest that the relation between self-efficacy and intrusions development is causal, but not straightforward. Recalling personal memories of success before or after a traumatic event may increase the risk of developing intrusions, at least under some circumstances. Conversely, recalling past failure experiences may be protective, perhaps by preparing the individual for adversity, or prompting them to search for coping strategies that have been successful in the past. Overall, autobiographical recall involves complex processes related to the self that could be useful but need to be more fully understood.

INTRODUCTION/BACKGROUND:Negative workplace behaviour, especially negative communication is a recognised problem in many organisations and is known to have serious impact on workplace performance, productivity and personal wellbeing. Emergency Departments (ED) can be high stress environments in which communication and perceptions of respect between physicians and other staff may underlie individual functioning. We conducted a study to estimate the influence of incivility (ICV) among physicians in the ED. METHODS:We developed an online survey to assess workplace incivility in the ED. We focussed on frequency, origin, reasons and situations where ICV was reported. To measure the levels and the potential influence of ICV on psychological safety, social stress and personal wellbeing we correlated our questionnaire to standard psychological scales. Statistical analysis included Students t-test, chi squared distribution and Pearson correlation coefficient. RESULTS:We invited all seventy-seven ED physicians to participate in our survey. Among those that completed (n = 50, 65%) the survey, 9% of ED physicians reported frequent (1/week) and 38% occasional (1/month) incidents of ICV. 28% of physicians reported experiencing ICV once per quarter and 21% reported a frequency of only once per year, no physician reported ICV on a daily basis. Levels of ICV were significantly higher in interactions with specialists from outside then within the ED (p<0.01). ICV was perceived particularly during critical situations. Our findings showed a significant correlation between internal (within the ED team) ICV and psychological safety. To ED physicians internal ICV was associated with lower levels of psychological safety (p<0.01). ICV displayed from sources outside the ED team was not associated with psychological safety, but we found a significant influence of external ICV on personal irritability and reduced wellbeing (p<0.01). DISCUSSION/CONCLUSIONS:The incidence of incivility was high among the ED physicians. Although this was a small sample, the association between workplace ICV and psychological safety, personal irritation as well personal comfort suggests that ICV may be an important variable underlying ED team performance. These findings further underscore the need to foster a culture of respect and good communication between departments, as levels of ICV were highest with physicians from outside the ED. Future research would benefit from examining strategies to prevent and reduce ICV and identify reasons for personal variation in perception of ICV. During critical situations and in general collaboration with specialists, awareness of ICV and countermeasures are important to avoid decreased performance and negative impact on staff and patient.

The self is a multi-faceted and temporally dynamic construct reflecting representations and beliefs about identity in the past, present, and future. Clinical studies have shown that individuals with Posttraumatic Stress Disorder (PTSD) and Social Anxiety Disorder (SAD) exhibit alterations in self-related processing but these studies have focused primarily on memory. Few studies in PTSD and SAD have examined self-related processing for the present and future, and no studies have directly compared these processes across these two disorders. Individuals diagnosed with PTSD (n=21), SAD (n=21), and healthy controls (n=21) completed cognitive tasks related to the past, present, and future. Disorder congruent temporal alterations were found across both disorders. Further, regression analyses revealed that trauma-related memories were significantly predicted by future goals related to the trauma, whereas social anxiety-related recall was predicted by current socially anxious self-views. Thus, although self-related processing may be common in PTSD and SAD, those aspects of the self most strongly associated with disorder-congruent recall differ by disorder. Self-alterations may be modifiable and developing a better understanding of past, present, and future self-processing might aid in the development of interventions that target these process.