Alice Parfitt - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: self-compassion
OCD
doctors
healthcare barriers
disclosure
mental health
quality of life
treatment readiness
kidney disease
illness perceptions
help-seeking
dialysis
IAPT
quality improvement

Project 1.
Background: Doctors experience high rates of mental ill-health. Effective treatments and specialist services exist, yet there are significant barriers to disclosure and help- seeking. These barriers are concerning given the negative impact on doctors’ health and recovery, staff turnover and the quality of care provided. It is therefore important to understand these barriers and facilitators in more detail to improve access to support and services.
Objectives: To ascertain barriers and facilitators to mental health disclosure and help- seeking among UK doctors.
Data sources: PubMed, Embase, PsycInfo and CINAHL
Study eligibility criteria: Studies were eligible if they referred to i. doctors working in the UK NHS ii. experiences of disclosure or help-seeking for mental health difficulties and iii. facilitators or barriers to this. Studies had to be published in a peer- reviewed journal between 2000-2022. Studies with medical students or other health professionals were excluded.
Participants: UK doctors of all specialties and grades (from foundation training to consultants). Study appraisal/ synthesis methods: A systematic mixed studies review was conducted. The quality of included studies was assessed and a narrative synthesis conducted to synthesise both qualitative and quantitative findings.
Results: A total of 3650 studies were identified; 29 meeting inclusion criteria (10 quantitative, 17 qualitative and 2 mixed). The most common barrier to disclosure and help-seeking was the professional medical culture (including perceived stigma). Other themes included doctors’ difficulty recognizing/accepting illness in themselves, reactions from others and inadequate services.
Conclusions: Significant barriers remain to doctors disclosing and help-seeking for mental health difficulties. There is need to shift the professional medical culture (including doctors’ perceived sense of invulnerability to illness), strengthen support from colleagues to create an approachable workplace for disclosing difficulties and further promote the availability of specialist services.
Project 2.
Introduction: Depression and anxiety are prevalent among those with chronic kidney disease (CKD) and lead to delay starting dialysis and poor prognosis. The current study assessed the prevalence of these difficulties among patients in Oxford and five satellite Low Clearance Clinics (LCCs), identified why patients experience difficulties transitioning to dialysis and explored how services can best support with managing this transition.
Method: Twenty-nine patients completed self-report questionnaires on mood (PHQ- 9, GAD-7), quality of life (KDQoL) and illness perceptions (IPQ-R). Self-reported numbers of missed appointments and kidney-related hospitalisations were collected. Eight carers completed a qualitative survey on their loved one’s experiences of transitioning to dialysis. Interviews were also conducted with seven patients and six staff on their experiences of approaching dialysis and supporting patients respectively.
Results: On the self-report measures 55% of patients (n=16) reported low mood and 28% reported anxiety (n=8). Illness perceptions were similar to previous findings, however the current sample experienced a higher emotional impact of living with CKD. Nonetheless, numbers of missed appointments and hospitalisations were low. Qualitative experiences reported by patients, staff and carers included fear/denial and difficulties adjusting to the lifestyle changes involved. Reasons for delay in starting dialysis included a lack of knowledge about symptoms/ dialysis, being torn about the need for dialysis with good/ bad symptom days and at times ‘just following medical advice’. All groups provided recommendations for service provision including the importance of family involvement in pre-dialysis support, the pros/ cons of peer support and need for appropriately tailored information.
Discussion: Recommendations for psychological support in LCCs are suggested. Therapeutic approaches focused on (i) adjusting to CKD (such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy), (ii) symptom reduction (e.g. pain-management or mindfulness-based interventions) and (iii) systemic-focused interventions may be particularly helpful.
Project 3.
Introduction: Despite readily available and effective treatments for Obsessive Compulsive Disorder (OCD) there are still barriers to treatment readiness, engagement and outcomes. Past studies indicate self-compassion correlates with OCD symptom severity. The current study therefore explored whether those low v high in self-compassion differed on readiness to engage in treatment and treatment outcomes. It also assessed whether self-compassion predicted treatment readiness and outcomes above other factors such as symptom severity.
Method: Eighty patients were recruited from the OCD treatment waiting list in three Improving Access to Psychological Therapies (IAPT) services. They completed study questionnaires on their obsessive beliefs (OBQ), treatment readiness (TAQ) and self- compassion (SCS). IAPT routine measures were also collated on low mood (PHQ-9), anxiety (GAD-7) and OCD (OCI) symptom severity; subscale scores were not available. A median split was used to create 2 groups (those low in self-compassion v high in self-compassion). The 2 groups were compared on readiness to engage in treatment. A hierarchical regression examined whether self-compassion predicted treatment readiness above initial low mood/ anxiety/ OCD symptom severity.
Results: Those low in self-compassion rated themselves as significantly less ready to engage in treatment (with greater concerns about starting treatment). They also experienced significantly higher symptom severity and obsessive beliefs. Self- compassion significantly predicted readiness to engage in treatment, even after accounting for symptom severity on the OCI, PHQ-9 and GAD-7. It explained 6.1% additional variance in treatment readiness.
Discussion: Future research is needed to investigate additional factors which might contribute to explaining variance in treatment readiness and explore whether baseline low self-compassion/ treatment readiness predicts later treatment outcomes.