Significance in the increase of women psychiatrists in Korea

The number of female doctors has increased in Korea; 18.9% (13,083) of the total medical doctors registered (69,097) were women in 2006, compared to 13.6% (2,216) in 1975. The proportion of female doctors will jump up by 2010 considering that nearly 40% of the medical students are women as of today. This trend has had strong influence on the field of psychiatry; the percentage of women psychiatrists rose from 1.6 (6)% to 18% (453), from 1975 to 2006 and now women residents comprise 39% (206) of all. This is not only a reflection of a social phenomenon of the increase in professional women but also attributed to some specific characteristics of the psychiatry. Psychiatric practice may come more natural to women. While clinical activities of women psychiatrists are expanding, there are few women leaders and much less women are involving in academic activities in this field as yet. Though there is less sexual discrimination in the field of psychiatry, women psychiatrists are still having a lot of difficulties in balancing work and family matters. Many women psychiatrists also report they've ever felt an implied discrimination in their careers. In this study, we are to identify the characteristics of women psychiatrists and to explore the significance of the increase in women psychiatrists in Korea and the situation in which they are.     

Suicide patterns among physicians related to other academics as well as to the general population. Results from a national long-term prospective study and a retrospective study

In the present study, we have followed a national cohort of physicians, academics and the general population (part of the compulsory census in 1960) for a period of 10 years and identified all cases of suicide during the period 1961-1970. Furthermore, we have carried out a retrospective study of suicides among the four major medical specialist groups (general practitioners, internists, psychiatrists and general surgeons) and compared these rates with other medical specialists. Results show an elevated standardized mortality ratio (SMR) for suicide among female physicians compared to other academics as well as to the general population. Furthermore, male doctors exhibit an elevated suicide rate only when compared to other academics. Among the various specialists, general surgeons alone exhibited a significantly elevated suicide rate. The study clearly shows that female physicians are more prone to suicide than most other women, but that male physicians are also at risk compared to other male academics. Furthermore, at least in Sweden, general surgeons, not psychiatrists, have the highest suicide rate of all physicians.     

Knowledge and attitudes of doctors toward the sexuality of older people in Turkey

ABSTRACTBackground: Few studies have looked at healthcare professionals' knowledge of and attitudes to later life sexuality in both Western and Eastern cultures. Here we examine the attitudes and knowledge of Turkish medical doctors toward sexuality in older people.Method: Eighty-seven doctors, from various specialties, who were directly involved in the care of older people, were contacted by post and asked to complete the Turkish version of the Aging Sexual Knowledge and Attitudes Scale (ASKAS).Results: A majority of physicians indicated that they had limited information and knowledge regarding sexual health issues in older people (69%). Although a small percentage (14.5%) reported that they "always" discuss sexuality and sexual problems with older patients, the majority (69%) indicated that they "sometimes" raise questions about sexuality with these patients. A high percentage (81%) stated that they would be helpful and receptive should an elderly patient initiate a discussion about sexual issues. Most participants (77%) thought that the patient's gender was of no importance when taking a sexual history. Overall, the responses to ASKAS showed that physicians had limited knowledge but their attitude was positive toward sexuality in the elderly. Female physicians had less knowledge than males and had more negative attitudes toward sexuality in this age group. Total and knowledge subscale scores of ASKAS showed that older physicians had more knowledge than younger physicians but similar attitudes. A comparison of the knowledge and attitude scores of psychiatrists, surgeons and non-surgeons showed no significant difference among the three groups.Conclusion: This study identified a low level of awareness of later life sexuality among Turkish medical doctors. These findings identify a need to improve the education and training of doctors at both undergraduate and postgraduate levels to enable them to provide better sexual health care to older people.     

50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study

OBJECTIVE: The aim of the study was to determine incidence and prevalence rates and long-term trends in incidence of anorexia nervosa by identifying all persons residing in the community of Rochester, Minn., during the 50-year period 1935 through 1984 who had the disorder. METHOD: From a community-based epidemiologic resource, 13,559 medical records with diagnoses of amenorrhea, starvation, weight loss, anorexia nervosa, or other conditions were screened to identify true cases of anorexia nervosa determined by using standard diagnostic criteria. RESULTS: One hundred eighty-one residents (166 female and 15 male) fulfilled the diagnostic criteria for anorexia nervosa; these were the incidence cases. Due to a quadratic trend in the rates for girls 10-19 years old, the incidence rate among female residents fell from 16.6 per 100,000 person-years in the 1935-1939 period to a low of 7.0 in 1950-1954 and increased to 26.3 in 1980-1984. The incidence rates for women 20 years old and older and for males remained constant. For females 15-24 years old, there was a linear increase. The overall age-adjusted incidence rate per 100,000 person-years was 14.6 for females and 1.8 for males. The prevalence rate per 100,000 population was 269.9 for females and 22.5 for males. CONCLUSIONS: Anorexia nervosa is more common than previously recognized. Among girls 15-19 years old it is a very common chronic illness. Its incidence has increased among females 15-24 years old but not among older women or among males.     

Gender differences in the annual income of psychiatrists

OBJECTIVE: Female physicians have traditionally earned less than their male counterparts, even after adjustment for specialty, workload, and physician characteristics. In the 1980s female psychiatrists earned incomes that were 13% lower than those of their male counterparts; however, important explanatory variables for such differences were not incorporated into that analysis. This study examined whether a gender income gap among psychiatrists persisted in the 1990s. METHODS: Survey responses were used that were obtained between 1992 and 2001 from 976 actively practicing white psychiatrists (weighted N=941). Because of low numbers of black respondents to the surveys, we were unable to examine the influence of race on psychiatrists' incomes. Linear regression modeling was performed to determine the association between gender and annual incomes after controlling for workload, provider characteristics, and practice characteristics. RESULTS: Among white psychiatrists, women reported working 13% fewer annual hours than their male counterparts, and women had practiced medicine for fewer years than men. Also, women were more likely to be employees of the practice, as opposed to having an ownership interest in the practice, and were more likely to be board certified, although these findings were not significant. After adjustment for workload, provider characteristics, and practice characteristics, the mean annual income for women was $140,615, or $31,962 (19%) lower than that of men (95% confidence interval of $41,834-$22,090 lower, p<.001). CONCLUSIONS: During the 1990s female gender was associated with lower annual incomes among white psychiatrists; compared with previous reports from earlier periods the income disparity appears to be widening. These findings warrant further exploration.     

Women psychiatrists and research: so far, no further? An Australasian perspective on factors that encourage and hinder women psychiatrists' involvement in research

OBJECTIVE: Relatively few women psychiatrists conduct research during their careers. Little is known as to what accounts for this consistent finding. We sought to ascertain factors that might be pertinent among women Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Our long-term goal is to identify measures that could boost the proportion of women who become involved in research. METHOD: We submitted a questionnaire to the 670 women Fellows of the RANZCP in which we asked them whether they participated in research and what factors they considered helpful or detrimental to the pursuit of an interest in research. RESULTS: Of the 375 (56%) respondents, 116 (31%) could be assigned to a researcher group (RG). Members of the RG more often identified features in their professional environment and access to mentors as facilitating research involvement compared to the non-researcher group (NRG). The RG had dedicated more time to research as well as to teaching, and less to clinical practice, compared to the NRG. Although family obligations affected both groups, the RG cited these as exerting less of an impact on their career than their non-researching colleagues. CONCLUSIONS: Given the factors that distinguish researching from non-researching Fellows, attention needs to be paid to the ethos of the professional environment, mentoring, and training opportunities in research in order to increase the recruitment of women investigators.     

The tipping point from private practice to publicly funded settings for early- and mid-career psychiatrists

OBJECTIVE: Practice settings for American psychiatrists were examined for recent trends. METHODS: Surveys were conducted in 1996 (N=970) and 2002 (N=917) among members of the American Psychiatric Association. RESULTS: Between 1996 and 2002 the percentage of direct patient care hours in publicly funded settings increased from 40 to 50 percent for early-career psychiatrists and from 29 to 44 percent for mid-career psychiatrists. By 2002 the percentage of direct patient care hours was higher in publicly funded settings than in solo office practices for early-career psychiatrists (50 percent versus 17 percent) and mid-career psychiatrists (44 percent versus 29 percent). CONCLUSIONS: The popular image of the psychiatrist sitting in a private office does not conform with current survey data, which show that psychiatric practice is increasingly taking place in publicly funded settings. Because it extends to mid-career psychiatrists, the shift from private office practice to publicly funded settings is not just a manifestation of early-career psychiatrists' earning a salary while building up their private practices but is a more enduring change in the landscape of psychiatric practice. The authors discuss the implications of these findings with regard to professional identity and training of psychiatrists.     

Trends in psychiatric practice, 1965-1980

The authors compare the results of a study of the practice activities of psychiatrists conducted in 1979-1980 with one conducted in 1965. Although office-based practice has remained the core activity of the profession, psychiatrists in 1979 had a greater tendency to divide their time among multiple practice sites and activities during the work week. As a consequence, the percentage of practitioners working part-time in a variety of organized care settings has increased substantially. These findings support a view of psychiatry as a profession that is far more diversified than it was 15 years ago. The authors discuss major factors affecting trends in psychiatric practice.     

Who became revolving door patients?

A cohort representing all first-time admissions to Danish psychiatric institutions during the period April 1, 1970 to March 31, 1971 was followed for 10 years in the psychiatric register. The cohort comprised 5,881 males and 6,856 females aged 15 years or above. The revolving door population was delineated as (1) patients with minimum four admissions and no admission or discharge period lasting for more than one fourth of the observation period or (2) patients with minimum four admissions during the first one fourth of the observation period. The incidence rate was 3.14 males and 3.55 females per 1,000. Revolving door patients were younger than others, single or divorced, and lived in larger cities. They were more frequently referred to out-patient aftercare and discharged to their own home. A male diagnostic profile of schizophrenia, demential or organic psychoses, personality disorders and abuse emerged together with a female profile of manic depressive and psychogenic psychosis and neurosis. Twenty-one point nine percent of males and 13.0% of females had more than 10 admissions and 4.5% of males and 3.7% of females spent more than 5 years in hospital. High risk groups were 15-24 years old as 21% and 13% of young males respectively females became revolving door patients, and schizophrenics, as 46% of male and 30% of female schizophrenics became revolving door patients.     

Elderly suicide in Alberta: difference by gender.

OBJECTIVE: To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor. METHOD: This study included completed suicides of individuals aged 55 years and over during 1984-1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners. RESULTS: Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men. CONCLUSIONS: Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide.     

Significant difference in knowledge between English and Danish psychiatrists.

PURPOSE: The purpose of the study was to investigate if differences in levels of knowledge existed between Danish and English training and specialist psychiatrists. This is important in the context of the free (and growing) movement of the medical workforce across European Union (EU) countries' borders. METHODS: A complete balanced two-way factorial study design was used. Ten training and ten specialist psychiatrists were recruited in each country from reputable, university hospitals. They answered 50 multiple choice questions (MCQs), translated into the appropriate language, consisting of four subcategories of questions: psychology (15 MCQs), psychopharmacology (10 MCQs), neuroscience (five MCQs) and psychopathology (20 MCQs). No memory or other types of aids were allowed at the knowledge test. A two-way analysis of variance was used to analyse the total knowledge score (number of correct answers) and the component subscores. Levene's test of equality of error variances was used to test for variance homogeneity. RESULTS: There were significant differences in total knowledge and psychology knowledge by country and level of training. UK doctors scored 3.10 points higher than Danish doctors, with 95% confidence interval (0.97, 5.23). The knowledge of the specialists was also significantly superior to that of the training psychiatrists, with 2.30 higher score, 95% confidence interval (0.17, 4.43). In the sub-categories only the scores in the psychology section were significantly different. UK doctors scored 2.30 higher than Danish doctors, with 95% confidence interval (1.15, 3.45). Specialists scored 1.20 higher than non-specialists with 95% confidence interval (0.05, 2.35). CONCLUSIONS: The results indicate that there is a significant difference in level of knowledge between psychiatrists in these two EU-countries, England and Denmark. This difference seemed to be chiefly the result of different knowledge of psychology. The disparity could be a result of the fundamentally different post-graduate training system in psychiatry in the two countries. Surprisingly, the differences in total knowledge and psychology knowledge between countries were larger than the differences between levels of training. The difference in knowledge is worrying taking into consideration that there is free movement of the workforce, including doctors, across the EU. The results here need further confirmation in future studies with greater numbers, more countries involved and perhaps additional measurements to MCQs.     

New Zealand's psychiatrist workforce: profile, recruitment and retention

OBJECTIVE: New Zealand is suspected of sharing other countries' difficulties of having inadequate numbers of practising psychiatrists and attracting psychiatrists to work outside its main urban centres, but there is no contemporary data on the socio-demographic and professional practice profile of its psychiatrists. This paper highlights some interesting trends about New Zealand's psychiatric workforce. METHOD: A postal questionnaire was sent to all actively practising vocationally registered psychiatrists with a New Zealand mailing address requesting information about basic demographic data, professional training experiences, current professional status, practise intentions, why they chose to work where they do and what factors might influence them to leave for another region of New Zealand or overseas. RESULTS: Of the 277 doctors on the vocational register for psychiatry, 159 responded, giving a response rate of 59.8%. Most psychiatrists were male (n = 102; 64.2%), European (n = 144; 90.6%), aged between 41 and 60 (69.2%), born overseas (n = 90; 56%), had English as their primary language (n = 142; 89.3%) and were in a long-term relationship with dependent children (n = 99; 62.3%). Nearly all (n = 149; 95%) did their psychiatry training in a metropolitan area and most (n = 108; 67.9%) held the Fellowship of the Royal Australian and New Zealand College of Psychiatry (FRANZCP). Most worked in a metropolitan area (n = 136; 85.5%) and either wholly or partly in the public sector (n = 145; 93%). Nearly one-quarter expected to retire over the next decade. Professional factors were rated more important as a reason for staying by metropolitan psychiatrists compared with their non-metropolitan counterparts (p < 0.001). Psychiatrists who did not have an FRANZCP (57%vs. 27%, p = 0.05), those who had spent more than 50% of their professional life in New Zealand (86%vs. 74%, p = 0.02) or those who had obtained their primary medical degree outside New Zealand were more likely to be in non-metropolitan areas (81%vs. 49%, p = 0.04). Metropolitan psychiatrists rated personal and social reasons more highly than non-metropolitan psychiatrists did for factors which might induce them to leave for another area, whereas professional development was ranked lower. CONCLUSIONS: This is the first contemporary study of New Zealand's psychiatric workforce and it highlights some interesting trends and has significant implications for those concerned with the recruitment and retention of psychiatrists. Further investigation is suggested, as a more complete picture of New Zealand's specialist psychiatric workforce would be gained by including psychiatrists who are not vocationally registered.     

A program of research training in psychiatry: ten-year evaluation and follow-up.

Nineteen psychiatrists who participated in the research training program at Boston University School of Medicine from July 1962 to June 1972 were surveyed by questionnaire to determine how participation in the training program may have affected their subsequent professional careers. Results indicate that-probably via a happy combination of self-selection, screening, and the actual experience of research training-these 19 psychiatrists constitute an impressive group who are active in research, publish extensively, and assume substantial teaching responsibilities at medical schools. The authors suggest tha a postresidency program in research training can be extremely important to the development of careers in psychiatric research and to a more scientifically grounded profession.     

The schizophrenia diagnosis in Denmark. A register-based investigation

Patients, Danish citizens only, admitted for the first time in 1972 to a Danish psychiatric institution were selected from the national psychiatric register. To be included, the probands had to have been diagnosed as schizophrenics at least once in the period from their first admission to 1 September 1983. The study comprised 370 males and 217 females with a total of 5,298 admissions. The probands' diagnostic pattern during the above period was investigated. More males (51.9%) than females (39.2%) (P less than 0.01) were diagnosed as schizophrenics during their first admission. The average period from a patient's first contact with an in-patient institution until schizophrenia was diagnosed for the first time was 2.2 years for females and 1.7 years for males (P less than 0.05). Personality disorders, reactive psychoses, and not classifiable psychoses were the most frequent diagnoses prior to the first schizophrenia diagnosis. The diagnostic stability of schizophrenia as main diagnosis, after its first application, was 73.6% for males among a total of 2,539 admissions and 71.2% for females among 1,141 admissions. There was greater correlation between the latest and former diagnoses than between the first and subsequent diagnoses. This is valid both when distinguishing between schizophrenia and non-schizophrenia and when focusing on schizophrenia subtypes. The results are discussed, particularly the problem concerning the selection of representative cohorts for schizophrenia research projects.     

Epilepsy in Individuals with a History of Asperger’s Syndrome: A Danish Nationwide Register-Based Cohort Study

We performed a nationwide, register-based retrospective follow-up study of epilepsy in all people who were born between January 1, 1980 and June 29, 2006 and registered in the Danish Psychiatric Central Register with Asperger’s syndrome on February 7, 2011. All 4,180 identified cases with AS (3,431 males and 749 females) were screened through the nationwide Danish National Hospital Register (DNHR) with respect to epilepsy. Mean age at follow-up was 18.1 years (range 4–31 years). Of the 4,180 individuals with AS, 164 (3.9 %) were registered with at least one epilepsy diagnosis in the DNHR, which is significantly increased (p < 0.0001) relative to the same age group in the general population, where an estimate is about 2.0 %.     

Implementation of a rational pharmacotherapy intervention for inpatients at a psychiatric department

The objective of the study was to develop, implement and evaluate two treatment algorithms for schizophrenia and depression at a psychiatric hospital department. The treatment algorithms were based on available literature and developed in collaboration between psychiatrists, clinical pharmacologists and a clinical pharmacist. The treatment algorithms were introduced at a meeting for all psychiatrists, reinforced by the project psychiatrists in the daily routine and used for educational purposes of young doctors and medical students. A quantitative pre-post evaluation was conducted using data from medical charts, and qualitative information was collected by interviews. In general, no significant differences were found when comparing outcomes from 104 charts from the baseline period with 96 charts from the post-intervention period. Most of the patients (65% in the post-intervention period) admitted during the data collection periods did not receive any medication changes. Of the patients undergoing medication changes in the post-intervention period, 56% followed the algorithms, and 70% of the patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms. All of the 10 interviewed doctors found the algorithms useful. The treatment algorithms were successfully implemented with a high degree of satisfaction among the interviewed doctors. The majority of patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms.     

Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future

OBJECTIVE: To examine the levels of satisfaction and stress of Australian psychiatrists. METHOD: A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire. RESULTS: The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas. CONCLUSION: Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind.     

Current status of research activity in American child and adolescent psychiatry: Part I

A survey of research activity of American academic child psychiatrists was completed in February, 1989. The survey demonstrated an increase in research activity since the 1983 report in the Current Status of Child Psychiatry. A definition of a researcher was derived from a study of internists and general psychiatrists and applied to the 488 respondents (78.5% of sample), and it was found that males outnumber females and that researchers contribute significantly more to the literature and education than nonresearchers. Early research exposure and mentoring are important influences on a research career. Recommendations by researchers for future training of researchers are presented. Periodic surveys are encouraged.     

Implementation of a rational pharmacotherapy intervention for inpatients at a psychiatric department

The objective of the study was to develop, implement and evaluate two treatment algorithms for schizophrenia and depression at a psychiatric hospital department. The treatment algorithms were based on available literature and developed in collaboration between psychiatrists, clinical pharmacologists and a clinical pharmacist. The treatment algorithms were introduced at a meeting for all psychiatrists, reinforced by the project psychiatrists in the daily routine and used for educational purposes of young doctors and medical students. A quantitative pre–post evaluation was conducted using data from medical charts, and qualitative information was collected by interviews. In general, no significant differences were found when comparing outcomes from 104 charts from the baseline period with 96 charts from the post-intervention period. Most of the patients (65% in the post-intervention period) admitted during the data collection periods did not receive any medication changes. Of the patients undergoing medication changes in the post-intervention period, 56% followed the algorithms, and 70% of the patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms. All of the 10 interviewed doctors found the algorithms useful. The treatment algorithms were successfully implemented with a high degree of satisfaction among the interviewed doctors. The majority of patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms.     

Explanations of mental health symptoms by the Bedouin-Arabs of the Negev.

Sixty Bedouin-Arab patients (36 females, 24 males) referred to the psychiatric clinic of the Soroka Medical Centre in the Negev, Israel were interviewed before they met with the psychiatrists and again two weeks later. An open-ended questionnaire was administered during three month period, to examine the patients' explanations of their mental health symptoms. Findings revealed that all patients, male and female alike, perceived and explained their symptoms as being caused by supernatural powers. There were gender differences, however, regarding the perceived nature of, and behaviour of, these supernatural powers. Males explained their symptoms as caused by God's will, whether directly through Him, or indirectly through evil-spirits. In both instances, human behaviour was not a primary concern. In contrast, 97% of the female patients explained their symptoms as a result of sorcery, a phenomenon which integrates human behaviour with supernatural powers. Cultural and language differences between the patients and psychiatrists were also found to cause miscommunications and inappropriate treatment, with the result that 50% of the sample terminated psychiatric treatment after two sessions.