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Migration of mental health professionals is an important phenomenon influencing mental health services of host and donor countries. Data on medical migration in Europe is very limited, particularly in the field of young doctors and psychiatry. To research this hot topic, the European Federation of Psychiatric Trainees (EFPT) conducted the EFPT Brain Drain Survey.
To identify the impact of previous short-term mobility on international migration and to understand characteristics, patterns and reasons of migration.
In this cross-sectional European multicentre study, data were collected from 2281 psychiatric trainees across 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on migration.
Two-thirds of the trainees had not had a short-mobility experience in their lifetime, but those that went abroad were satisfied with their experiences, reporting that these influenced their attitude towards migration positively. However, the majority of the trainees had not had a migratory experience of more than 1 year. Flows showed that Switzerland and United Kingdom have the greatest number of immigrant trainees, whereas Germany and Greece have the greatest number of trainees leaving. ‘'Pull factors'’ were mostly academic and personal reasons, whereas ‘'push factors'’ were mainly: academic and financial reasons. Trainees that wanted to leave the country were significantly more dissatisfied with their income.
The majority of the trainees has considered leaving the country they currently lived in, but a lower percentage has taken steps towards migration.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.
Autism spectrum disorders (ASD) are complex psychiatric disorders, with both genetic and environmental factors implicated in their etiology. Recent studies suggest the prenatal and early postnatal genesis of ASD, therefore, understanding the effect of environmental risk factors could be important for prevention and treatment of ASD.
The aim of this study was to determine the association of prenatal factors and perinatal complications with ASD.
Our study included 102 subjects with ASD (80% boys) aged 9.35 ± 5.85, and 107 age and sex matched healthy controls (77% boys). For the diagnosis of ASD, we used the ICD-10 criteria and Autism Diagnostic Interview-Revised (ADI-R). A questionnaire regarding prenatal and perinatal factors/complications was administered to all subjects.
Logistic regression model of having autism vs. being a control subject included gender, age, maternal and paternal age at birth, pregnancy order, smoking in pregnancy, number of medication during pregnancy (mostly tocolytics, antihypertensives, antiarrhythmics), and early postnatal complications (mostly prematurity, low birth weight, hyperbilirubinaemia). The model was significant, explaining about the third of variance, with number of medication during pregnancy and having an early postnatal complication as significant predictors.
Our study has shown a significant association of specific prenatal and perinatal factors and ASD, even after controlling for other potential confounding variables. Identifying specific risk factors is important for prevention of ASD. It is also the first step in defining basis of the gene–environment interaction mechanism, which might enable development of an individualised therapeutic approach for this group of disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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