Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Psychotropic medication discontinuation
Psychotropic medications have been a central pillar of mental health treatment for several decades, although little is known about the complex reasons why people often choose to stop taking them. A recent Irish systematic review sought to shed light on this, synthesising findings from 14 studies that were conducted between 2004 and 2019 in a variety of countries (UK, Norway, Sweden, Israel, Iran, Ethiopia, Australia, Canada, and the US).1 They found that, rather than a perceived lack of insight due to ‘mental illness’, stopping medication is typically a decision influenced and driven by a variety of personal, health, social, and environmental factors. Some of these factors are common to most individuals, such as a desire to live free from adverse side effects, while others are specific to an individual’s personal life goals, such as regaining a sense of self and independence.
Post-migration stressors
The experience of a wide range of stressors associated with the migration journey, including pre-migration, during migration, settlement, and integration in host countries, have been reported as risk factors for mental health issues. A recent study from South Australia explored the views and experiences of African migrants about the post-migration stressors they faced in resettlement.2 The findings suggest that family-related issues, such as separation from family members, spousal separation, and difficulties in parenting, including effectively managing their child’s behaviours at school, were mental health stressors. In addition, poor economic conditions related to the limited employment opportunities led to poor fulfilment of family needs, including servicing loans and mortgages. The authors suggest social support around childcare and employment opportunities were the most important targets for policymakers.
Suicide prevention
Given that a large proportion of people who die by suicide have had contact with primary care clinicians in the weeks and months prior to their deaths, the role of primary care in suicide prevention policymaking has received much attention recently. However, much of the work has focused on doctors, leading a Swedish team to instead examine the valuable perspectives of primary care nurses on this topic.3 They found that nurses may avoid asking questions about suicidality for fear of what to do with the answer. There was a lack of clarity about who is carrying responsibility for the patient, and it turned out to be difficult to help the patient move further to the next care institution. The authors recommend that guidelines are needed to support nurses and, particularly, to help them understand how they can collaborate with other agencies and healthcare providers.
Role modelling
The influence of role models on the choice of medical career has long been recognised, although the literature of specific relevance to role modelling in specialty has not been systematically explored. In order to fill this evidence gap, a research team from Newcastle upon Tyne in the UK synthesised findings from 46 studies in their systematic review.4 They identify the powerful impact of denigration of general practice from role models in both primary and secondary care, and the perceived lack of intellectual challenge and research opportunities in the specialty. They also highlight the importance of students being exposed to GP role models, ideally through high-quality, longitudinal placements. They describe the importance of the GP role model in developing professional identity in future doctors, shaping their understanding of the values of the specialty, development of humanism, and leadership and communication skills.
Podcast of the month
As we are thrown into yet another global financial disaster, it’s an ideal time to start listening to the money-saving master of the modern world — The Martin Lewis Podcast: https://www.bbc.co.uk/programmes/p02pc9xt.
- © British Journal of General Practice 2022
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