大连市4所综合性医院480名职工心理健康状况调查 医院等级、不同岗位及其性别对结果的影响

Mental health status of 480 employees in 4 comprehensive hospitals of Dalian city: Influence of rank of hospital, different post and gender on the results

目的:探讨大连市不同等级医院职工的心理健康状况及相关因素。方法:于2004-03/06随机抽取大连市市内四区4所综合性医院的480名医院职工作为调查对象,其中包括2所三级甲等医院和2所二级甲等医院。医院职工的基本情况通过自制一般调查问卷获得,内容有自然、经济状况,工作满意度,收入满意度,医患关系,同事团队精神,对领导满意度及医院文化建设情况等23个问题。采用症状自评量表(包括躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐惧、偏执、精神病性等9个因子),使用5级评分,1,2,3,4,5分别表示无、轻、中、重、极重,以因子分作为评价指标,评估参与者的心理健康水平)。生活事件量表(含有48条中国较常见的生活事件,包括家庭生活方面28条,工作学习方面13条,社交及其他方面7条。记录一年内的事件)。由填写者根据自身的实际感受而不是按常理或伦理道德观念去判断那些经历过的事件对本人来说是好事或是坏事生活事件总分越高反映个体承受的精神压力越大。填表前采用统一指导语,并嘱其独立完成。填写者须仔细阅读和领会指导语,然后逐条过目。问卷及量表采用无记名方式进行。主要观察①医院职工症状自评量表的评分与国内常模的比较。②不同性别、工作岗位、不同级别医院职工症状自评量表的评分及自评好坏事件数。③对工作满意度、症状自评量表评分的Logistic多元逐步回归分析。采用t检验,χ2检验,方差分析Logistic多元逐步回归分析。结果:发放问卷及量表480份,收回合格问卷及量表412份,有效率85.8%。①医院职工的症状自评量表总分及各项因子分与国内常模比较,除躯体化因子外其他各因子分均显著低于常模(P<0.05)。②医院男性职工在症状自评量表的总分,强迫、人际关系、焦虑、敌对、偏执、精神病性因子分均显著高于女性(P<0.05)。男性自评生活中好事件数总量高于女性(P=0.018)。③不同工作岗位职工的症状自评量表总评分及各因子分接近(P>0.05)。生活事件的自评好事件数具有差异(P<0.05),以机关工作人员自评好事件数为最多。④不同级别医院职工症状自评量表的总分、强迫症、抑郁得分、恐怖、偏执和精神病性具有差异(P<0.05),以二级甲等A医院职工的评分为高。不同等级医院生活事件总量具有显著差异(P<0.05),好坏事件的总量最高者是二级甲等A医院,其次是三级甲等A医院。⑤以对于工作的满意度为因变量,进入回归方程的有年龄、收入、团队精神、对领导的满意度、人际关系、敌对、恐怖和自评好事的件数。⑥以症状自评量表得分为因变量,性别、婚姻状况、对工作满意度、对院领导满意度为自变量,揭示婚姻状态、对工作的满意度和对领导的满意度与症状自评量表评分相关(相关系数为0.000,0.005,0.003,P<0.05)。结论:医院职工心理健康状况较常模人群要好,男性医务工作者心理健康状况较女性差;不同等级医院职工之间,在抑郁、恐惧、强迫、偏执、精神病性等心理状况差异显著;影响职工心理健康状况的危险因素是自身婚姻状态、对工作满意度和对领导的满意度;本次调查中不同岗位职工的调查结果与现实状况不太接近,其原因待进一步分析。

AIM： To investigate the mental health Status of employees in hospital of different rank in Dalian city, and discuss the related factors.METHODS： Between March and June 2004, totally 480 employees were randomly selected from 4 comprehensive hospitals in the 4 districts of Dalian city, including two rank A hospitals of grade 3 and 2 rank A hospitals of grade 2. Their general information was investigated with the self-designed general questionnaires, including 23 items of natural and economic status, satisfactory degrees to occupation and income,relationship between patients and staffs, team work spirit with partner,satisfactory degree to leadership, hospital cultures, etc. Their mental health levels were evaluated with the symptom checklist-90 （consisted of 9 factors of somatization, obsession-compulsion, interpersonal sensitivity, depression,anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism： The 5-grade scoring was used： 1, 2, 3, 4 and 5 represented none, mild,moderate, severe and quite severe respectively, and the factor scores were taken as the indexes of evaluation）. Life events scale （consisted of 48 common life events in China, including 28 items about family life, 13 items of working and learning, and 7 items of social intercourse and others）was used to record the events in one year. Whether the experienced events were good or bad to themselves were judged according to their own actual feeling but nor by convention or moral concept; The higher the total score of life events, the greater the mental stress of the individuals. The instructions were unified before filling the questionnaires, and they were asked to finish it independently. The subjects should read carefully and understand the instruction, and then read the items one by one. The questionnaire and scale were finished without recording the names. The followings were mainly observed： ① Comparison ot the score ot symptom checklist-90 between the hospital employees and national norms; ②Comparison of the score of symptom checklist-90 and number of selfevaluated good and bad events between employees of different gender,different post and those in hospitals of different rank;③ Logistic multivariate regression analysis between satisfactory degree to work and score, of symptom checklist-90. The t test, Chi-square test, analysis of variance and Logistic multivariate regression analysis were used.RESULTS： Totally 480 questionnaires and scales were sent out, and 412 qualified ones were collected, the effective rate was 85.8%. ① Comparison of the total score and factor scores of symptom checklist-90 between hospital employees and national norms： Except somatization, all the factor scores were significantly lower in the hospital employees than the national norms （P 〈 0.05）. ② The total score and factor scores of obsessioncompulsion, interpersonal sensitivity, anxiety, hostility, paranoid ideation and psychoticism in symptom checklist-90 were all significantly higher in male hospital employees than in female ones （P 〈 0.05）; The total number of good events was higher in males than in females （P=0.018）. ③ There were no significant differences in the total score and factor scores of symptom checklist-90 between employees of different posts （P 〉 0.05）;There was significant difference in the number of self-evaluated good events （P 〈 0.05）, and the number was the most in office workers. ④total score and scores of obsession-compulsion, depression, anxiety,hostility, paranoid ideation and psychoticism in symptom checklist 90 were different among employees in hospitals of different rank （P 〈 0.05）, the scores were higher in the employees in hospitals of rank A grade 2; The total numbers of life events were significantly different among employees in hospitals of different rank （r=-0.000,0.005,0.003, P 〈 0.05）.CONCLUSION：Hospital staffs have better psychological health than general people. Male is bad than female about psychological health. There are significant different during the differ level hospital in the depressive,obsessive- compulsive, phobia, paranoid and psychosis factors. Important factors are marry stat, satisfaction for occupation and satisfaction for leader.