三甲医院医务人员职业应激与隐性缺勤的关联研究

Association between occupational stress and presenteeism among medical staff at grade A tertiary hospitals in Shanghai, China

目的了解三甲医院医务人员职业应激和隐性缺勤现况，分析职业应激与隐性缺勤之间的关联。方法2012年5至6月，采用分层随机抽样的方法对上海8家三甲医院的2356名医务人员进行调查，所有调查对象知情同意并自主完成问卷填写。职业应激由职业应激核心问卷进行评估，隐性缺勤采用斯坦福隐性缺勤问卷评定。结果调查对象中隐性缺勤得分均分为15．23±3．89，72．5％的调查对象自评为职业应激。不同年龄组、学历、岗位、工龄、职称、倒班组间隐性缺勤差异有统计学意义（均P〈0．05）。不同职业应激指标中工作要求、自主性、社会支持及工作要求与自主比值组间隐性缺勤得分和高隐性缺勤率间差异均有统计学意义（P〈0．01）。高工作要求、高工作要求与自主比值是高隐性缺勤的危险因素，OR值分别为2．56（95％CI=2．01—3．27）、1．53（95％CI=1．23～1．90）；而高社会支持是高隐性缺勤的保护因素，OR值为0．23（95％CI=0．18～0．29）。结论上海三甲医院医务人员职业应激程度越高，隐性缺勤程度越高，呈正相关。需要加大社会支持，以减少隐性缺勤所致工作效率损失。

Objective To investigate the current status of occupational stress and presenteeism among medical staff at grade A tertiary hospitals in Shanghai, China, and to analyze the association between occupational stress and presenteeism. Methods A total of 2356 healthcare workers from eight grade A tertiary hospitals in Shanghai were investigated by stratified random sampling. All the subjects were asked to complete self-administered questionnaires with informed consent. The occupational stress was assessed by the occupational stress core questionnaire. The presenteeism was evaluated by the Stanford Presenteeism Scale. Results In all subjects, the average score of presenteeism was 15.23±3.89, and 72.5% felt occupational stress in self-evaluation. There were significant differences in the score of presenteeism between subjects with different ages, education levels, occupations, lengths of service, job titles, and shifts （all P〈0.05）. There were significant differences in the score of presenteeism and the rate of high presenteeism between subjects with different indices of occupational stress, including job demand, control, social support, and demand-control ratio （P〈0.01）. High job demand and high demand-control ratio were risk factors for high presenteeism （OR =2.56, 95% CI=2.01-3.27; OR=1.53, 95% CI =1.23-1.90）. High social support was a protective factor for high presenteeism （OR=0.23, 95% CI=0. 18-0.29）. Conclusion The intensity of occupational stress in medical staff from grade A tertiary hospitals is positively correlated with the level of presenteeism. It is important to promote social support to reduce the loss of work efficiency due to presenteeism.