不同等级医院各层级护理人员职业生涯期间自杀意念及其影响因素分析

Analysis of suicide ideation and its influencing factors among nursing staff of different grades in different hospitals during their career

目的分析山东省不同等级医院各层级护理人员职业生涯期间自杀意念流行现状和相关因素,并分析相关因素之间的作用关系。方法于2020年6至7月,用多阶段分层整群抽样调查山东省1644名护理人员,用自杀意念筛查问题调查护理人员的自杀意念,用《领悟社会支持量表》(PASS)和《Kessler 10量表》分别测量社会支持情况和心理健康状况。用《简易应对方式量表》(SCSQ)评价研究对象遇到问题时所采用的应对方式。用logistic回归分析自杀意念的影响因素,应用Amos软件建立自杀意念相关因素的路径模型,并采用最大似然估计检验路径模型系数。结果二级医院护理人员职业生涯期间自杀意念发生率为8.44%,三级医院自杀意念发生率为11.66%。二级医院中各层级护理人员自杀意念差异无统计学意义(P>0.05),自杀意念的相关因素主要有未婚及其他(OR=0.362,95%CI=0.155,0.844,P=0.019),社会支持(OR=1.084,95%CI=1.059,1.109,P=0.000)和心理健康状况(OR=0.921,95%CI=0.890,0.953,P=0.000)。三级医院中熟练期护理人员自杀意念高于其他层级(P<0.05),自杀意念的相关因素主要有未婚及其他(OR=0.369,95%CI=0.214,0.636,P=0.000),夜班(OR=1.889,95%CI=10.57,3.377,P=0.032),自评社会地位一般(OR=2.377,95%CI=1.031,5.483,P=0.042),躯体疾病(OR=2.747,95%CI=1.601,4.714,P=0.000),社会支持(OR=0.960,95%CI=1.042,1.077,P=0.000)和心理健康状况(OR=0.942,95%CI=0.922,0.963,P=0.000)。社会支持和心理健康状况对自杀意念具有直接作用,自评社会地位、社会支持和躯体疾病可通过影响心理健康状况对自杀意念产生影响。结论应加强对不同等级医院各层级护理人员职业生涯期间心理健康状况的关注,提高其社会支持水平,改善其对执业环境的认知。

Objective To analyze the prevalence and related factors of suicide ideation among nurses in different levels of hospitals in Shandong Province,and to analyze the relationship between them.Methods From June to July 2020,1644 nurses in Shandong Province were surveyed by multi-stage stratified cluster sampling.The suicidal ideation of nurses was investigated by suicidal ideation screening.Social support and mental health were measured by the perceived social support scale(pass)and kessler10 scale respectively.The simple coping style scale(SCSQ)was used to evaluate the coping styles of the subjects when they encountered problems.Logistic regression was used to analyze the influencing factors of suicidal ideation,Amos software was used to establish the path model of suicidal ideation related factors,and the maximum likelihood estimation was used to test the path model coefficient.Results The incidence of suicidal ideation among nurses in secondary hospitals during their career was 8.44%,and that in tertiary hospitals was 11.66%.There was no significant difference in suicidal ideation among nurses at all levels in secondary hospitals(P>0.05).The main factors related to suicidal ideation were unmarried and others(OR=0.362,95%CI=0.155,0.844,P=0.019),social support(OR=1.084,95%CI=1.059,1.109,P=0.000)and mental health status(OR=0.921,95%CI=0.890,0.953,P=0.000).The suicide ideation of skilled nurses in tertiary hospitals was higher than that of other levels(P<0.05).The related factors of suicide ideation mainly included unmarried and others(OR=0.369,95%CI=0.214,0.636,P=0.000),night shift(OR=1.889,95%CI=10.57,3.377,P=0.032),general self-rated social status(OR=2.377,95%CI=1.031,5.483,P=0.042),physical disease(OR=2.747,95%CI=1.601,4.714),P=0.000),Social support(OR=0.960,95%CI=1.042,1.077,P=0.000)and mental health status(OR=0.942,95%CI=0.922,0.963,P=0.000).Social support and mental health have a direct effect on suicidal ideation.Self-assessment of social status,social support and physical disease can affect suicidal ideation by affecting mental health.Conclusion It is necessary to pay more attention to the mental health status of nurses at different levels in different hospitals during their career,improve their social support level,and improve their cognition of the practice environment.