精神科专科医院与综合医院医师工作倦怠及相关因素分析

Analysis on occupational burnout of psychiatrists in psychiatry hospitals and doctors in general hospitals

目的调查精神科专科医院及综合医院医务人员工作压力状况，并探讨不同专科医师工作压力与功能性躯体不适及健康相关行为的关系。方法应用Maslach工作倦怠量表通用版（MBI—GS）、患者健康问卷（PHQ-15），对112名精神科医师（专科组）和121名非精神科医师（非专科组）进行抽样测试研究。结果专科组倦怠率为89．3％，非专科组倦怠率为99．2％；非专科组MBI—GS总分及情感衰竭、成就感低落维度分显著高于专科组（P〈0．001）；专科组体育锻炼参与度显著优于非专科组，吸烟行为少于非专科组，饮食规律优于非专科组（P〈0．05，P〈0．001）；非专科组PHQ-15总分及胃病、四肢或关节痛、胸痛、心悸、气促、性生活异常、大便异常、消化系不适、疲劳感和睡眠困难症状分均高于专科组（P〈0．05，P〈0．001）；体育锻炼与MBI总分及情感衰竭维度呈负相关，PHQ总分与情感衰竭维度呈正相关；多元线性回归分析显示，MBI总分（β=0．375，95％CI：2．85—3．09）、情感衰竭（β=0．273，95％CI：3．11～3．47）和性别（β=0．218，=95％CI：1．38～1．51）进入回归模型，为功能性躯体不适的预测因素（R2=0．102）。结论综合医院医师较精神科专科医院医师有更高程度的工作倦怠及功能性躯体不适症状，情感衰竭维度是功能性躯体不适症状的预测因素，健康的生活方式可能对减轻倦怠程度有一定作用。

Objective To investigate the characteristics of occupational burnout of psychiatrists in psychiatry hos- pitals and doctors in general hospitals, and to explore the association between work stress and somatization, as well as health - related behaviors. Methods A cross - sectional study was implemented. 121 psychiatrists and 121 doctors filled out the Maslaeh Burnout Inventory -General Survey （MBI -GS） and Patient Health Questionnaire（ PHQ -15 ） to explore the level of job burnout and somatic complains. Results There were 89.3 % of psychiatrists and 99.2% of doctors suffer- ing from burnout. Doctors in general hospitals yielded higher scores of burnout, exhaustion and reduced personal accom- plishment （ P 〈 0. 001 ）. Psychiatrists more often engaged in physical exercise, smoke less, and kept a better dietary rou- tine than doctors in general hospitals （P 〈 0. 05 or P 〈 0. 001 ）. The PHQ - 15 total scores, stomach pain, back pain, pain in arms/legs/joints, chest pain, palpitation, shortness of breath, sexual problems, abnormal bowel movement, diges- tive discomfort, tiredness and sleep difficulties were notably higher in doctors in general hospital（ P 〈 0. 05 or P 〈 0. 001 ）. Engagement in physical exercise was negatively correlated with exhaustion, while overall PHQ score was positively correla- ted with exhaustion. Results from multiple linear regression showed that MBI - GS score （β = 0. 375, 95% CI： 2. 85 - 3.09）, exhaustion （β= 0. 273,95 % CI： 3. 11 - 3.47 ） and gender （β= 0. 218,95 % C1： 1.38 - 1.51 ） were potential risk factors of somatic complains（R2 = 0. 102）. Conclusion There are higher burnout level and more somatic complains in doctors in general hospitals. Exhaustion is a predictive factor of somatic symptoms, and a healthy lifestyle may have some effects on reducing burnout.