广州市1 545名医务人员职业紧张、职业倦怠和抑郁症状的关系研究

  目的  探讨医务人员职业紧张、职业倦怠和抑郁症状的关系，为促进医务人员身心健康提供理论指导。
  方法  采用整群随机抽样方法，选取广州市三家医院的1 545名医务人员为研究对象，应用付出-回报失衡问卷、职业倦怠通用量表和病人健康问卷抑郁量表对其职业紧张、职业倦怠和抑郁症状水平进行自填式问卷调查。采用逐步回归方法，以职业紧张为自变量，职业倦怠为中介，抑郁症状为因变量构建多元线性模型，分析医务人员职业紧张、职业倦怠和抑郁症状的关系。
  结果  1 545名医务人员平均年龄（34.2 ±8.8）岁，平均岗位工作时间（7.6 ±6.8）年。其职业紧张付出、回报、内在投入维度平均得分分别为（3.0 ±0.8）分、（3.9 ±0.6）分、（2.5 ±0.8）分，付出-回报失衡指数平均得分为0.8 ±0.4，检出付出-回报失衡模式高职业紧张308人，检出率为19.9%；职业倦怠得分为（1.8 ±1.1）分，情绪耗竭、人格解体、工作成就感各维度得分分别为（2.2 ±1.6）分、（1.5 ±1.4）分、（4.4 ±1.5）分，检出有职业倦怠感133人，检出率为8.6%；抑郁症状得分为（7.8 ±4.5）分，检出有抑郁症状者391人，检出率为25.3%。Pearson相关分析显示，医务人员职业倦怠得分与职业紧张的付出、内在投入维度以及抑郁症状得分均呈正相关（r_s=0.412、0.542、0.667，P < 0.01）；抑郁症状得分与职业紧张的付出、内在投入维度得分均呈正相关（r_s=0.436、0.542，P < 0.01），与职业紧张的回报维度得分呈负相关（r_s=-0.514，P < 0.01）。多元分层回归分析显示，职业紧张、职业倦怠对抑郁症状的预测作用均有统计学意义（P < 0.01），职业紧张和职业倦怠对抑郁症状变化解释量分别为33.2%和13.9%。
  结论  广州市医务人员的职业紧张对其抑郁症状具有直接作用；职业倦怠作为职业紧张的负面结果，在职业紧张影响抑郁症状中发挥部分中介作用；减轻医务人员职业倦怠，有助于改善抑郁症状。

Relationship among occupational stress,job burnout and depression of 1 545 medical staff in Guangzhou

  Objective  To explore the relationship among occupational stress, job burnout and depressive symptoms of medical staff in Guangzhou, and to provide theoretical guidance for promoting their physical and mental health.  Methods  The occupational stress, the job burnout and the depressive symptoms of 1 545 medical staff from 3 hospitals in Guangzhou were surveyed with the Basic Situation Questionnaire, the Pay-Return Imbalance Questionnaire, the General Job Burnout Scale and the Patient Health Questionnaire Depression Scale. A multiple linear model was constructed by the stepwise regression with occupational stress as independent variable, occupational burnout as mediator and depressive symptoms as dependent variable to evaluate their relationship.  Results  The average age of these medical staff was(34.2 ±8.8) years old and their employment time was(7.6 ±6.8) years. The dimensions scores of pay, return and internal input in occupational stress were 3.0 ±0.8, 3.9 ±0.6, and 2.5 ±0.8, respectively. The mean of effort-reward imbalance(ERI) index was(0.8 ±0.4) and 308 medical staff (19.9%) were diagnosed with high occupational stress basing on the ERI model. The job burnout score was 1.8 ±1.1;the dimension scores of emotional exhaustions, depersonalization, job satisfaction were 2.2 ±1.6, 1.5 ±1.4, and 4.4 ±1.5, respectively. There were 133 medical staff (8.6%) suffering from job burnout. The depressive symptoms score was 7.8 ±4.5, and 391 medical staff (25.3%) with depressive symptoms were detected. Pearson correlation analysis showed that the job burnout was positively correlated with the pay and internal input of the occupational stress and the depressive symptoms (r_s=0.412, 0.542 and 0.667 respectively, P < 0.01). The depressive symptoms were also positively correlated with the pay and internal input of the occupational stress(r_s=0.436 and 0.542, respectively, P < 0.01), while it was negatively correlated with the reward of the occupational stress(r_s=-0.514, P < 0.01). Furthermore, multivariate linear model indicated that the occupational stress and the job burnout had significant predictive effects on depressive symptoms (P < 0.01), which could explain the changes of the depressive symptoms by 33.2% and 13.9%, respectively.  Conclusions  In the group of medical staff in Guangzhou, occupational stress had a direct effect on depressive symptoms; as a negative result of occupational stress, job burnout played a partial mediating role in the effect of occupational stress on depressive symptoms. Relieving job burnout could alleviate depressive symptoms.