一线抗疫医务人员应激障碍现状及影响因素

Status quo and influencing factors of post-traumatic stress disorder among front-line anti-epidemic medical staff

[背景]一线医务人员是抗击新型冠状病毒肺炎(COVID-19)疫情的重要群体,其心理健康不容忽视。[目的]了解COVID-19疫情流行期间一线抗疫医务人员的创伤后应激障碍(PTSD)现状及影响因素。[方法] 2020年5月采用方便抽样法从湖北省某市内3所三级甲等医院和4所二级甲等医院中抽取曾参与抗疫的一线医务人员作为研究对象,以创伤后应激障碍检查量表-平民版(PCL-C)为主要调查工具,采用网络电子问卷调查抗疫医务人员发生PTSD的现状及特征。共计回收问卷1 120份,其中有效问卷1 071份,有效率95.6%。[结果]纳入调查对象1 071名,平均年龄为(32.59±5.21)岁;男女比例为1:5.02;医护比例为1:5.8;三甲医院员工近7成;已婚者占75.4%;本科及以上居多(86.5%);党员占比22.9%;初级职称者占50.9%;工龄多在5~10年(42.8%);自愿参与抗疫者超过80.0%;95.1%的医务人员获得了家人的支持;参与抢救者占43.0%;78.1%的医务人员在本院参与抗疫;超过6成者认为工作量比原科室大;抗疫总时长多在2~4周(34.4%),其次是6周以上(23.5%)。PTSD症状阳性(PCL-C总分≥38分)者111例,阳性率为10.4%;其中再体验[1.40(1.00,1.80)分]和高警觉症状得分[1.40(1.00,2.00)分]高于回避症状得分[1.14(1.00,2.57)分]。单因素结果显示不同年龄、政治面貌、工作年限、抗疫地点、抗疫时长、是否有子女、是否自愿参与、家人是否支持、家人是否参与抗疫、是否参与抢救的医务人员PTSD发生情况不同(P <0.05)。logistic回归分析发现,年龄介于31~40岁(OR=0.346,95%CI:0.164~0.730)和≥41岁(OR=0.513,95%CI:0.319~0.823)医务人员的PTSD发生率比20~30岁低;党员身份(OR=0.499,95%CI:0.274~0.909)、自愿参与抗疫(OR=0.584,95%CI:0.360~0.945)和家人支持(OR=0.453,95%CI:0.222~0.921)的医务人员PTSD发生率低于非党员身份、非自愿参与和缺乏家人支持者(P <0.05);有子女(OR=2.372,95%CI:1.392~4.042)、有家人参与抗疫(OR=1.709,95%CI:1.135~2.575)和参与抢救(OR=1.705,95%CI:1.133~2.565)的医务人员PTSD发生率比无子女、无家庭成员参与抗疫和未参与抢救者高(P <0.05)。[结论]一线抗疫医务人员PTSD的阳性率为10.4%;年龄、政治面貌、是否自愿参与、家人是否支持、有无子女、有无家人参与抗疫以及是否参与抢救可能是其发生PTSD的影响因素。

[Background] Front-line medical staff are an important group in fighting against Coronavirus Disease 2019(COVID-19), and their mental health should not be ignored.[Objective] This study investigates the current situation and influencing factors of posttraumatic stress disorder(PTSD) among front-line anti-epidemic medical staff during COVID-19 epidemic.[Methods] Medical staff who had participated in fighting against the COVID-19 epidemic wereselected from three grade Ⅲ Class A hospitals and four grade Ⅱ Class A hospitals in a city of Hubei Province by convenient sampling method in May 2020. The survey was conducted online using the Post-traumatic Stress Checklist-Civilian Version(PCL-C) as the main survey tool to investigate current situation and characteristics of PTSD among these participants. A total of 1 120 questionnaires were collected, of which 1 071 were valid, and the effective rate was 95.6%.[Results] Of the 1 071 participants, the average age was(32.59±5.21) years;the ratio of male to female was 1: 5.02;the ratio of doctor to nurse was 1:5.8;nearly 70% participants came from grade Ⅲ Class A hospitals;married participants accounted for 75.4%;most of them held a bachelor degree or above(86.5%);members of the Communist Party of China(CPC) accounted for 22.9%;50.9% had junior titles;the working years were mainly 5-10 years(42.8%);more than 80.0% participants volunteered to join the front-line fight;95.1%participants received family support;43.0% participated in rescue missions;78.1% participants fought the epidemic in their own hospitals;more than 60% participants considered the workload was greater than before;34.4% participants fought in the front-line for2-4 weeks, and 23.5% participants did for more than 6 weeks. There were 111 cases of positive PTSD syndromes(PCL-C total score ≥38)with an overall positive rate of 10.4%, and the scores of reexperience [1.40(1.00, 1.80)] and hypervigilance [1.40(1.00, 2.00)] were higher than the score of avoidance [1.14(1.00, 2.57)]. The results of univariate analysis revealed that PTSD occurred differently among participants grouped by age, political affiliation, working years, anti-epidemic activities location, accumulated working hours in fighting against COVID-19, having child parenting duty, voluntariness, family support, whether family members participated in front-line activities, and rescue mission assignment(P < 0.05). The results of logistic regression analysis showed that the incidence rates of reporting PTSD syndromes in medical personnel aged 31-40 years(OR=0.346, 95% CI: 0.164-0.730) and aged 41 years and above(OR=0.513, 95% CI: 0.319-0.823) were lower than that in those aged 20-30 years;the incidence rates of reporting PTSD syndromes in medical staff who were CPC members(OR=0.499, 95% CI: 0.274-0.909), volunteered to participate(OR=0.584, 95% CI: 0.360-0.945), and received family support(OR=0.453, 95% CI: 0.222-0.921) were lower than those did not(P < 0.05);the incidence rates of reporting PTSD syndromes among medical workers who had child parenting duty(OR=2.372, 95% CI: 1.392-4.042), whose family members participated in front-line activities(OR=1.709, 95% CI: 1.135-2.575), and who participated in rescue missions(OR=1.705, 95% CI: 1.133-2.565) were higher than those who did not(P < 0.05).[Conclusion] The positive PTSD syndrome rate is 10.4% in the front-line anti-epidemic medical staff. Age, political affiliation,voluntariness, family support, having child parenting duty, with a family members participating in the fight, and rescue mission assignment are the influencing factors of PTSD.