Now researchers from the University of Cincinnati (UC) suggest that religious and spiritual characteristics of residents may influence their risk for depressive symptoms. Data collected through a survey suggested that the risk for significant depressive symptoms was greater among respondents who reported negative religious coping mechanisms, poorer spiritual well-being and the need for more spiritual support.
The study, which appears in the March-April 2006 edition of Ambulatory Pediatrics, found that 25 percent of 227 primary-care residents surveyed reported a number of symptoms associated with depression such as irritability, sense of isolation and hopelessness, and fear.
"Research from the last two decades has shown the prevalence of significant depressive symptoms among residents to be in the range of 20 percent," said principal investigator Michael Yi, MD. "We might have expected that number to fall after the Accreditation Council for Graduate Medical Education (ACGME) implemented work-hour restrictions in 2003, but our study found the level to be pretty consistent with earlier data."
Of the four residency programs evaluated--pediatrics, internal medicine, family medicine and the combined internal medicine/pediatrics program--the researchers found that residents in certain programs reported higher rates of significant depressive symptoms.
"Mood or other psychological problems among primary-care residents, or any other health-care provider for that matter, could negatively affect patient care," said Dr. Yi. "Our findings suggest that screening residents for depression and other mood problems may be warranted."
"In addition, addressing the spiritual needs of residents at greater risk for mood problems may help them cope with the stresses associated with their training."
Coauthors include: Sara Luckhaupt, MD, Joseph Mrus, MD, Caroline Mueller, MD, Amy Peterman, PhD, Christina Puchalski, MD, and Joel Tsevat, MD.
Several studies have shown that preventive removal of the unaffected breast reduces the risk of cancer and may improve survival. In an earlier study involving this same group of patients, the researchers found that women who had the mastectomy had a 97 percent lower risk of developing cancer in both breasts than women who had only the affected breast removed. (Since it is impossible to remove 100 percent of the breast tissue, even after a mastectomy, there is a small risk of cancer developing.)
However, until the current study, there was little information on the psychological and social outcomes of the mastectomy.
"Our research suggests that preventive mastectomy prevents future breast cancer and that women's psychosocial outcomes are driven more strongly by issues related to aging and surviving breast cancer than by their preventive mastectomy," said Geiger. "Nevertheless, it is important to remember that preventive mastectomy is a major surgical procedure likely appropriate for a very small percentage of women with breast cancer. We encourage women with breast cancer to carefully consider their treatment options in consultation with their physicians, family and friends."
Co-researchers were Larissa Nekhlyudov, M.D., and Suzanne Fletcher, M.D., of Harvard Pilgrim Health Care, Lisa Herrinton, Ph.D., and Andrea Altschuler, Ph.D., of Kaiser Permanente Northern California, Sharon Rolnick, Ph.D., of HealthPartners Research Foundation, Emily Harris, Ph.D., of Kaiser Permanente Northwest, Sarah Greene, M.P.H., of Group Health Cooperative, Joann Elmore, M.D., of the University of Washington, Karen Emmons, Ph.D., of Dana Farber Cancer Institute, and Carmen West, M.S., and Amy Liu, M.S., of Kaiser Permanente Southern California. West is now with the University of Southern California.