应对突发卫生事件中的医护人员压力:压力源、心理健康的风险和保护因素、干预建议

Stress of Health Care Workers in Emergencies: Stressors, Risks and Protective Factors for Mental Health, and Suggestions for Psychological Intervention

本文通过整理既往针对重大灾难后医务人员的心理健康调查和心理干预研究的文献,结合2019冠状病毒病疫情中的官方报道,详细总结了医护人员面对重大恶性传染病疫情时所面临的主要心理压力,如疫情暴发初期的应对不足、同情倦怠持续恶化、自己和同伴所受的生命威胁、救援过程中的环境压力、多重身份带来的心理冲突、社会支持系统的不完善等;梳理了文献中所报告的一线医护人员可能由此产生的心理问题,例如易怒、抑郁、焦虑、失眠、噩梦、惶恐、闪回、警觉性增高、躯体化不适、情感麻木等;以及与这些健康问题相关的风险因素和保护因素,其中风险因素包括经验不足、消极压力应对方式、与患者高频接触和风险感知、过往创伤经历和心理障碍病史、精神紧张程度高、生活质量评价低等;保护因素包括积极应对方式、社会支持、自尊、高工作满意度等。最后,我们结合以往研究和现在正在进行的心理干预经验提出了对一线医护人员进行心理干预工作的建议。

By sorting out a large number of literature on mental health investigation and psychological intervention of medical staff after major disasters, and combining with the actual situation in the epidemic situation of COVID-19, this paper reports in detail the main psychological stress faced by medical staff in the face of major malignant infectious diseases, including inadequate response in the early stage of the outbreak, persistent deterioration of compassion fatigue, life threats to themselves and their peers, environmental pressure in the rescue process, psychological conflict caused by multiple identities, imperfect social support system, etc. Health problems such as irritability, depression, anxiety, insomnia, nightmares, panic, flashback, increased alertness, somatization discomfort, emotional numbness, PTSD and severe suicidal tendencies were reviewed. On this basis, the relevant risk factors and protective factors are summarized, among which risk factors include young age, negative stress coping style, exposure to relevant patients and perception of relevant risk levels, past traumatic experience and history of mental or emotional disorders, high level of mental stress, low quality of life evaluation, etc.;protective factors include positive coping style, social support, self-esteem, high job satisfaction, etc. Finally, the suggestions of follow-up psychological intervention are put forward in combination with previous studies.