Jo Daniels

Background: Doctors working in UK emergency departments face high workloads, stretched resources and threats to career sustainability. Prolonged stress in the context of high workloads is associated with the development of psychological occupational syndromes such as burnout and compassion fatigue. Aims: This scoping review aimed to map the existing literature available to provide an understanding of the psychological occupational syndromes experienced by UK doctors working in emergency medicine. Methods: A systematic search was conducted using PubMed, Embase, APA Psycnet and CINAHL. Reference lists and supplementary searches were also conducted. Results: Seventeen papers were eligible for inclusion in this review. Factors highlighted as relevant to the experience of psychological occupational syndromes included organizational barriers, team functioning, personal and demographic factors, and the nature of the emergency department environment. No research identified in this review looked at whether issues of equality, diversity or inclusion (EDI) were related to the experience of psychological occupational syndromes. Conclusions: There are similarities across psychological occupational syndromes in terms of how they are experienced by emergency medicine doctors and their consequences; however, there is a lack of research determining causality over time, looking at multiple psychological occupational syndromes together and considering EDI factors, which limits the ability to draw firm conclusions. The findings of this review align with existing research and identify gaps in the evidence base that should be addressed with future research.

Purpose: Chronic pain impairs work participation. Psychological interventions can support people with chronic pain to work, yet little is known about which components are most effective. A systematic review and meta‐analysis assessed the effectiveness of interventions targeting sick leave, return to work, work ability and work‐related self‐efficacy in chronic pain populations. Intervention content was analysed to identify effective components. Methods: A search strategy was developed and applied to six databases from inception until 2nd March 2023, being updated in December 2024: PsychInFO, Medline, Cinahl, Web of Science, Cochrane Library and Embase. Intervention descriptions were coded for intervention functions, theoretical domains and behaviour change techniques. Risk of bias was assessed using the ROB‐2 tool. Results: 51 randomized controlled trials were identified. Study quality was poor overall. Meta‐analysis showed that psychological interventions were complex, that is, contained multiple components delivered alongside other interventions, which together were associated with reduced sick leave (SMD −.41, 95% CI: −.64 to −.18) and a small increase in those working at long‐term follow‐up (>12 months) (RR 1.03, 95% CI: 1.01–1.06; I ² = 0%) but not work ability/capacity (SMD −.02, 95% CI: −.12–.08, I ² = 0%) or return to work (RR .98, 95% CI: .91–1.05, I ² = 0%). No intervention components appeared most effective, but five common components were identified: education, skills/training, social support, emotional regulation, and confidence building. Conclusion: Complex psychological interventions can positively influence work outcomes for people with chronic pain. Future research should prioritize high‐quality studies and incorporate the five components to enhance work‐focussed support.

Objectives: This study aimed to explore the impact of shielding amongst immunocompromised individuals following the COVID‐19 pandemic. Design: This study used a cross‐sectional exploratory qualitative design. Methods: A national survey was launched in July 2023 aiming to collect information on the lived experience of individuals who were still shielding. The final question to this study was ‘what has been the worst aspect of shielding for you?’. In total, 457 individuals (57%) responded to this question. Data were analysed using thematic analysis. Results: Three themes were identified, associated with the impact of shielding: (1) Navigating risk: including fear of infection, distrust in institutional guidance and measures. (2) Loss and longing: including profound isolation, grieving lost time, loss of freedom and relationships. (3) Betrayed and forsaken: a sense of intentional abandonment by government and lack of understanding from loved ones, causing distress and mistrust. Conclusion: The findings from this study indicate that individuals who are shielding continue to experience profound difficulties that require attention. Measures must be introduced to mitigate the impact of COVID in the immunocompromised, including improving public health messaging and strategies to tackle isolation. Given the high likelihood of future pandemics, it is imperative that strategies are developed to address the needs of its most vulnerable populations. Patient or Public Contribution: Patient and public contribution has formed an integral part in the assignment of this study. The rationale and design of this study was created in partnership with Forgotten Lives UK and the National Clinical Expert Group, who represent 125 clinicians, across 4 nations and 17 medical specialities treating immunocompromised patients.

Background: Health anxiety by proxy (HAP) refers to parents’ worries about their child’s health. Research into HAP is in its infancy, but it is known that the children of those with HAP and the broader family system are affected by these elevated health concerns. Aims: This study aimed to explore factors associated with HAP in parents of children with cancer, and parents of ‘well’ children, particularly parental health anxiety (HA), social support, and illness characteristics. Method: Cross-sectional online questionnaire design using social media and NHS paediatric oncology services to recruit parents of children with cancer ( n =41) and parents of ‘well’ children ( n =79). Results: HAP (but not HA) was significantly higher in parents of children with cancer than those with ‘well’ children ( p < .001). HAP was negatively associated with social support in parents of ‘well’ children only ( p =.002), but both groups demonstrated a positive association between social support and HA ( p= .006). Both HA ( B= .588; p < .001) and health status of child ( B= –30.281; p < .001) were significant independent predictors of HAP (controlling for interactions between group and variables) in a hierarchical regression. Conclusions: Parents of children with cancer have higher rates of HAP (but not HA), with HAP associated with lower levels of social support in both groups. Parental HA and child health status are key to understanding HAP. Further research is needed to establish underlying mechanisms and vulnerability to HAP to inform development of effective interventions for this group.

Raynaud’s Phenomenon is a condition characterised by vasoconstriction of the extremities and can have a detrimental impact on people’s lives. The treatment options for patients currently offered through healthcare services, e.g., in the United Kingdom (UK), are insufficient. This study provides a theoretical basis for future interventions by presenting insights into experiences of living with Raynaud’s. Using an inductive-deductive approach, our thematic analysis of 19 semi-structured interviews with people living with Raynaud’s in the UK was informed by the common-sense model of self-regulation. Three interrelated themes were generated to capture the illness experiences of people with Raynaud’s: 1) Illness representations, 2) Coping response, and 3) Advice and guidance. Together, these themes provide insight into illness perceptions, coping styles and factors that may contribute to adherence to self-management. The findings suggest that a stepped care approach to managing Raynaud’s may be beneficial.

The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis (n=115), myalgic encephalomyelitis/chronic fatigue syndrome (n=84) and chronic pain (n=116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations. Key learning aims: (1) To gain insights into the presentation of health anxiety in medical conditions. (2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings. (3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.

People with Raynaud’s phenomenon (RP) experience poorer mental health and quality of life than the general population, and there is limited evidence for treatment options in RP. The Common Sense Model of illness representations (CSM) is a well-established theoretical model, which has not yet been robustly investigated in RP, but may provide potential avenues for psychological interventions with the ability to explore perceptions and beliefs, such as cognitive behavioural therapy (CBT). The study aims were to investigate illness perceptions and examine the relationship between illness perceptions and symptom severity and quality of life in RP to explore a theoretical basis for potential treatment avenues. A cross-sectional online questionnaire design was employed and 169 adults with RP (primary or secondary) were analysed. Illness perceptions significantly differed between primary and secondary RP types on all but one domain (p < .05). Hierarchical multiple regressions indicated that illness perception subscales made a significant unique contribution to the models explaining 65% variance in symptom severity (R² = .65, p < .001) and 30% variance in quality of life (R² = .30, p < .001). This novel study provides preliminary evidence regarding the applicability of the CSM to RP in a clinically meaningful way. CBT, which can specifically target illness perceptions within a wider psychological formulation, may be helpful for individuals with RP who are experiencing psychological distress in relation to symptom severity. Further work is needed to develop outcome measures specific to RP and tailor interventions to manage distress and impaired quality of life. Key learning aims: (1) The Common Sense Model is applicable and relevant to Raynaud’s phenomenon (RP) and there are important differences between illness perceptions in those with primary and secondary RP subtypes. (2) Findings show that illness-specific cognitions make a significant contribution to the variance in symptom severity and quality of life in those with both subtypes of RP, which has notable implications for the assessment, formulation and treatment of psychological difficulties in RP. (3) This offers a basis for further replication and development and adaptation of an intervention for this group, drawing on the evidence base for long-term conditions.

Chronic pain is common and debilitating, and recommended treatments are only moderately effective for pain relief. Focus has shifted to refining targets for change within psychological therapy to improve pain management. Evidence has shown the role of intrusive images in many psychological disorders. However, only a few studies have advanced our knowledge of the presence and impact of mental imagery in chronic pain. This exploratory study aimed to increase our understanding of how people with chronic pain perceive intrusive visual images to influence their daily life. The study employed a qualitative design, using semi-structured interviews to explore the content, emotional valence, cognitive and behavioural impact of pain-related visual images of ten participants with self-reported diagnosis of chronic pain. Data analysis was conducted by performing an inductive thematic analysis. Three key themes were identified: (1) ‘I start to create images in my head’: pain-related mental images, which revolves around descriptions of participants’ most significant visual image; (2) metaphors for pain, related to the imagery as a means to conceptualise and give meaning to the pain; and (3) “With the pain comes the image”: a companion to pain, which focuses on the role of intrusive images in the experience of pain. Results show that pain-related mental imagery appeared to be an intrusive, uncontrollable, and vivid cognitive accompaniment for many pain sufferers. The findings suggest that mental images may serve as an additional target in cognitive behavioural therapy to enhance individuals’ cognitive, behavioural and emotional change. Key learning aims: (1) To understand the role of mental imagery in the daily life of individuals with chronic pain. (2) To examine the impact of intrusive images on the emotions, cognitions, and behaviours of people with chronic pain. (3) To consider clinical implications for CBT interventions targeting pain-related mental images to manage chronic pain.

Purpose: Chronic pain is a highly prevalent and distressing condition with limited treatment efficacy. Prior research reports associations between the experience of mental imagery about chronic pain and pain itself, particularly in those with anxiety and depression. However, many aspects of these associations remain unexplored. A better understanding could help improve cognitive-behavioural therapies for chronic pain. This study aimed to describe the prevalence of intrusive pain-related mental imagery in a sample of people with chronic pain, examine the extent to which this imagery explained variation in pain intensity and disability, and examine the association between negative interpretations of imagery and pain. Method: A cross-sectional online survey was conducted. Participants with chronic pain (n = 151) completed standardised measures of anxiety, depression, health anxiety, general imagery use, and an adapted questionnaire about intrusive pain-related imagery. Results: Intrusive pain-related imagery was present in 52.3% of the sample. Demographic variables, anxiety, depression, and health anxiety significantly explained 19% (p < .001) of the variation in pain intensity and 20.2% (p < .001) in pain disability. The presence/absence of intrusive pain-related imagery did not significantly explain any additional variance for either outcome. However negative interpretations of imagery explained additional variance in pain disability. Intrusive imagery was interpreted negatively, experienced as moderately distressing, and was associated with higher rates of anxiety, depression and health anxiety. Conclusions: Experiencing intrusive imagery about pain is common, but its presence or absence appears to have no direct relationship on pain intensity or disability. The relationship is likely to be more complex, warranting further investigation. Negative interpretations of imagery represent a potential treatment target amenable to intervention.

Background: Despite emotional stress being recognised as a key trigger for Raynaud’s phenomenon episodes, research in the area is still in its infancy.Aims: This study investigated the role of psychological factors relating to symptom severity and quality of life, and differences between Raynaud’s types (primary and secondary) to further inform the development of intervention in this field.Method: A cross-sectional design was used. Two hundred and ten adults with Raynaud’s completed an online questionnaire measuring stress, anxiety, depression, anxiety sensitivity, beliefs about emotions, symptom severity and quality of life.Results: Primary and secondary Raynaud’s groups differed in anxiety (p < .004), symptom severity (p < .001) and quality of life (p < .001). Stepwise multiple regressions indicated anxiety and Raynaud’s type explained 23% variance in hand symptom severity (p < .001); anxiety, Raynaud’s type and anxiety sensitivity explained 29% variance in symptom severity (global impact, p < .001); depression, Raynaud’s type and anxiety sensitivity explained 32% variance in quality of life (p < .001).Conclusions: Results highlight the importance of psychological factors in Raynaud’s phenomenon, indicating possible targets for treatment. Interventions such as cognitive behavioural therapy, which target both physical and psychological wellbeing, bear some promise as an adjuvant therapy for this group.