医务人员工作中社会心理因素与抑郁症状的关系

Association between social psychological factors and depressive symptoms among healthcare workers

目的 探讨医务人员工作上的付出-获得不平衡与抑郁症状之间的关系.方法 付出-获得不平衡采用付出-获得不平衡（the Effort-Reward Imbalance,ERI）量表测量,抑郁情绪调查采用美国流调中心的抑郁自评（Center of Epidemiology Survey Depression,CES-D）量表测量医务人员的抑郁症状.研究对象来自在浙江大学6个附属医院工作的1 179名医务人员.调查表包括ERI量表、CES-D量表和一些基本特征.使用Spearman相关分析、Mann-Whitney检验、Pearson χ^2检验或似然比χ^2检验进行单因素分析;用多元Logistic回归方法分析医务人员中工作上的付出-获得不平衡与抑郁症状之间的关系.结果 医务人员抑郁症状的阳性率为48.12%（95% CI：45.08%～51.16%）,护士抑郁症状的阳性率为52.40%（95%CI：47.87%～56.93%）,较医生抑郁症状的阳性率[44.70%（95%CI：10.64%～48.77%）]高,差异有统计学意义（χ^2=6.077,P=0.014）.工作高付出-低获得和超负荷是医务人员抑郁症状发生的相关因素（OR=1.859,95%CI：1.337～2.585;OR=2.207,95%CI：1.656～2.942）.结论 医务人员抑郁症状的发生与工作高付出-低获得、超负荷有关.

Objective To explore the association between the effort-reward imbalance at work and depressive symptoms among healtheare workers. Methods The effort-reward imbalance at work was conceptualized in terms of the Chinese version of the effort-reward imbalance（ERl） model. Depressive symptoms were assessed by the Chinese version of the Center of Epidemiology Survey Depression（CES-D） scale. The data came from the cross-sectional survey of 1 179 healthcare workers aged between 18 and 73 employed in 6 affiliated hospitals of Zhejiang University.The questionnaire comprised questions on the effort-reward at work, over-commitment, the full CES-D scale of depression and a range of other characteristics. Univariate analyses were used with Spearman＇ s correlation, Mann-Whitney test, Pearson Z2 test and likelihood X2 test. Multivariate logistic regression analyses was used to discover factors associated with depressive symptoms. Results The prevalence of depressive symptoms among healthcare workers was 48.12% （95% CI ：45.08% to 51.16% ）. The prevalence of depressive symptoms among nurses was 52. 40% （95%CI： 47. 87% to 56. 93%） higher than doctors＇ 44. 70% （95% CI ： 10. 64% to 48.77% ） with the significant difference （ X^2 = 6.077, P = 0.014）. Positive associations were found between the high effort-low reward, level of work-related over commitment and depressive symptoms （ OR = 1. 859, 95 % CI： 1. 337 to 2. 585 ; OR = 2. 207, 95 % CI： 1. 656 to 2. 942 ） among healthcare workers, respectively. Conclusion The high effort-low reward and the work-related over-commitment have a negative impact on healthcare workers＇ health.