P051 Barriers and facilitators to eliciting and reporting of mental health symptoms in rheumatology: a mixed methods study
Bibliographic record
Abstract
Abstract Background/Aims Mental health (MH) symptoms are common in rheumatology patients, yet greatly under-reported and therefore under-treated. Our INSPIRE project identified that >50% of patients had never/rarely reported mental health symptoms to clinicians. We undertook a follow-on study to investigate clinician and patient experiences and views regarding the eliciting and reporting of MH symptoms. Methods This study employed mixed methods. Co-designed surveys included: views and experiences of stigma, and reasons for non-reporting (patients) or non-eliciting (clinicians) of MH symptoms. Survey responses received from n = 1853 rheumatology patients and n = 400 clinicians are being analysed and compared using t tests and chi-squared tests. Qualitative analysis was thematic. Results Initial themes generated include the following: Time, prioritisation and multiplicity of symptoms: Time constraints, combined with rheumatology patients often experiencing numerous and diverse symptoms, led to clinicians and patients having to prioritise which symptoms to discuss. Joint symptoms were often prioritised, with MH/psychiatric symptoms the least discussed. For example, 85% of rheumatologists said they always/usually explicitly enquire about joint pains with SLE patients, yet for depression and hallucinations these proportions reduced to 24% and 5% respectively. Limited support for patients and clinicians: Almost all clinicians expressed a strong desire to improve understanding and support of patients’ MH needs, but identified that it also required institutional change, more education, adequate funding, improved inter-disciplinary working and a pathway for referrals: “I feel like a failure all the time in this arena. Even when we do discuss and identify a significant problem, it is very difficult to get professional help” (Ppt 76, Rheumatologist) Fear of repercussions: Patients feared clinician judgement and that future rheumatological disease symptoms would be misattributed to a primary MH condition if they reported MH symptoms. This theme also included clinicians’ fear of uncovering symptoms that they had limited experience and time to manage. One psychiatrist suggested that this has engendered a widespread “collusion of silence”. Perceived, anticipated and experienced stigma were explored. Clinicians gave significantly higher ratings (out of 5) than patients for agreeing there was stigma about MH among society (4.17 vs 3.93) and among clinicians (3.59 vs 3.29) (both p < 0.01). Normalisation and mutual trust: Facilitators of enquiring about MH symptoms included normalising neuropsychiatric symptoms and a history of a close, secure, medical relationship. The latter was typically secured by clinicians being accessible in a crisis and listening with empathy. This encouraged openness and trust, and enabled clinicians to notice changes. Conclusion This research will inform clinicians, patients and policy makers of the multiple challenges faced by both parties in the patient-clinician relationship in discussing mental health symptoms, and help address the unmet mental health needs of rheumatology patients. Disclosure M. Sloan: None. T. Pollak: None. M. Bosley: None. A. Tunks: None. W. Diment: None. M. Ubhi: None. F. Naughton: None. M. Piper: None. S. Taylor: None. C. Barrere: None. J. Brimicombe: None. J.A. Bourgeois: None. L. Andreoli: Consultancies; Consultancy fees from Eli Lilly, Glaxo Smith Kline, Janssen, Novartis, UCB, and Werfen Group. D. D’Cruz: Corporate appointments; Leadership position on the APS charity board. Consultancies; consultancy/speaker fees from GSK, Eli Lilly, Vifor and UCB.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".