is Program Director, Emeritus, Riverside Community Hospital Emergency Medicine Residency, and Professor of Emergency Medicine, University of California Riverside, Riverside, California, USA.
is Professor of Psychology, Division of Behavioral and Organizational Science, Claremont Graduate University, Claremont, California, USA.
J Grad Med Educ. 2024 Apr;16(2):195-201. doi: 10.4300/JGME-D-23-00460.1. Epub 2024 Apr 15.
Residents report high levels of distress but low utilization of mental health services. Prior research has shown several barriers that prevent residents from opting into available mental health services. To determine the impact of a mental health initiative centered around an opt-out versus an opt-in approach to help-seeking, on the use of psychotherapy. Resident use of psychotherapy was compared between 2 time frames. During the first time frame (July 1, 2020 to January 31, 2021), residents were offered access to therapy that they could self-initiate by calling to schedule an appointment (opt-in). The second time frame (February 1, 2021 to April 30, 2021) involved the switch to an opt-out structure, during which the same residents were scheduled for a session but could choose to cancel. Additional changes were implemented to reduce stigma and minimize barriers. The outcome was psychotherapy use by residents. Of the 114 residents, 7 (6%) self-initiated therapy during the opt-in period. When these same residents were placed in an opt-out context, 59 of the remaining 107 residents (55%) kept their initial appointment, and 23 (39%) self-initiated additional sessions. Altogether, across both phases, a total of 30 of the 114 residents initiated therapy (ie, 7 during the opt-in and 23 during the opt-out). The differences in therapy use between the 2 phases are statistically significant (<.001 by McNemar's test). There was a substantial increase in residents' use of psychotherapy after the opt-out initiative that included efforts to reduce stigma and encourage mental health services.
住院医师报告称他们感到高度困扰，但很少利用心理健康服务。先前的研究表明，有几个障碍阻止住院医师选择现有的心理健康服务。为了确定以选择退出或选择加入的方式寻求帮助为中心的心理健康计划对心理治疗使用的影响，比较了两个时间框架内住院医师的心理治疗使用情况。在第一个时间框架（2020 年 7 月 1 日至 2021 年 1 月 31 日），住院医师可以通过打电话预约来获得他们可以自行发起的治疗（选择加入）。第二个时间框架（2021 年 2 月 1 日至 2021 年 4 月 30 日）涉及到选择退出结构的转变，在此期间，相同的住院医师被安排参加会议，但可以选择取消。还实施了其他更改以减少污名化并减少障碍。结果是住院医师使用心理治疗。在 114 名住院医师中，有 7 名（6%）在选择加入期间自行发起了治疗。当这些相同的住院医师被置于选择退出的环境中时，在剩下的 107 名住院医师中，有 59 名（55%）保留了最初的预约，有 23 名（39%）自行增加了额外的治疗次数。总的来说，在两个阶段中，共有 114 名住院医师中的 30 名开始了治疗（即，选择加入时有 7 名，选择退出时有 23 名）。两个阶段之间的治疗使用差异具有统计学意义（McNemar 检验<.001）。在包括减少污名和鼓励心理健康服务在内的选择退出计划后，住院医师对心理治疗的使用显著增加。
