医护人员职业紧张源、紧张反应及抑郁症状关系的研究

Study on Relationship Among Occupational Stress、Personal Strain and Depressive Symptoms in the Hospital Staffs

目的探讨医护人员职业紧张源、紧张反应及抑郁症状的关系。方法 2008年5～6月,采用横断面调查方法,随机抽取辽宁省20所综合医院工作6个月以上的4602名医护人员进行自填式问卷调查,有效回收率为75.5%。应用职业紧张量表(OSI-R)及流调用抑郁自评量表(CES-D),采用多元线性回归分析方法验证紧张反应在职业紧张源对抑郁症状影响中的作用。以医护人员的职业紧张源为自变量,紧张反应为中介变量,抑郁症状为因变量,建构职业紧张源、紧张反应及抑郁症状关系的理论模型,应用结构方程模型验证该模型,分析变量间的直接效应及间接效应。结果医生的最终模型拟合效果指标分别为:RMSEA=0.028,SRMR=0.050,CFI=0.912,TLI=0.901,IFI=0.913。护士为:RMSEA=0.025,SRMR=0.048,TLI=0.900,CFI=0.911,IFI=0.912,本研究所建构的模型拟合效果良好。医生任务冲突对抑郁症状的效应最大,护士任务过重对抑郁症状的效应最大。结论医护人员紧张反应在职业紧张源对抑郁症状影响中起中介作用;职业紧张源对抑郁症状的影响即有直接效应又有间接效应。

Objective To explore the relationship among occupational stress personal strain,and depressive symptoms.Methods A crosssectional study was conducted during the period of May-July 2008.The study population comprised 4602 hospital staffs worked more than 6 months from twenty hospitals of Liaoning province,effective rate was 75.5%.The questionnaires of（Occupational Stress Inventory Revised Edition,（OSI-R）and（Center for Epidemiologic Studies Depression Scale,CES-D）were used in this study.The multiple linear regression analysis was applied to verify the effect of personal strain in occupational stress affecting depressive symptoms.Occupational stress as dependent variable,personal strain as a mediator and depressive symptoms as independent variable,built theory model of relationship among occupational stress influencing depressive symptoms,used SEM to verify the model,and analysed the direct and indirect effects.Results The final fitting indicators are：RMSEA=0.028,SRMR=0.050,CFI=0.912,TLI=0.901,IFI=0.913 in doctors and RMSEA=0.025,SRMR=0.048,TLI=0.900,CFI=0.911,IFI=0.912 in nurses.It showed that fitting effect of theory model was good.Role boundary in doctors and role overload in nurses were the most important factors associated with depressive symptoms.Conclusion Personal strain was a mediator in occupational stress affecting depressive symptoms.The direct and indirect effects were shown in occupational stress affecting depressive symptoms.