医生职业紧张、职业倦怠和抑郁倾向的研究
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摘要
近年来,医生因职业紧张所致的职业倦怠和抑郁问题越来越引起学界和社会的广泛关注。医生群体的健康状况下降势必导致其工作绩效和医疗服务质量的下降。国外一些研究表明,医生的职业紧张和职业倦怠程度较高,抑郁倾向明显。国内对职业紧张研究起步较晚,近年来的研究发现医生的职业紧张、职业倦怠和抑郁的发生呈现升高趋势,但对于三者间相互作用的研究不多。本课题组在2008年对辽宁省5城市20家医院4000余名医务人员的调查中发现,职业紧张源、职业紧张反应和抑郁症状之间存在直接和间接作用关系。
本研究目的是分析医生职业紧张和职业倦怠的影响因素,阐明医生职业倦怠、职业紧张和抑郁倾向之间的相互作用机制,研究结果对于促进我国职业心理学发展具有重要的理论意义,对于有效预防医生因职业紧张、职业倦怠和抑郁倾向,提高医疗服务质量具有一定的现实意义。
本研究根据以往的文献分析和课题组前期研究基础提出如下假设模型：
假设1：医生职业紧张变量对职业倦怠各个维度有显著的主效应,工作自主,社会支持和回报对医生职业倦怠和抑郁倾向具有调节作用：
假设2：医生工作要求—自主和付出—回报失衡变量组合对职业倦怠和抑郁倾向具有预测作用；
假设3：医生职业倦怠在职业紧张和抑郁倾向的关系中起着中介作用。
按照假设模型和前期工作基础,本次调查设计内容包括医生的一般情况调查、职业紧张、职业倦怠、抑郁倾向、工作满意度和焦虑的调查,本文主要针对医生的职业紧张、职业倦怠和抑郁倾向调查结果,依照“职业紧张-职业倦怠的中介影响-抑郁倾向”的假设思路,建构“职业紧张—职业倦怠—抑郁倾向”理论模型,并通过结构方程模型对理论假设模型进行验证。
对象与方法
以辽宁省6个城市7所三甲和二甲医院的1300名医生为研究对象,应用工作内容问卷(JCQ)、付出—回报失衡问卷(ERI)、工作倦怠问卷(MBI)和流调用抑郁自评量表(CES-D)测量医生的职业紧张、职业倦怠和抑郁倾向,采用医生基本情况调查问卷收集人口统计学信息。使用Epidata3.0软件进行数据的统一录入,采用SPSS 13.0统计软件进行数据整理和统计分析,利用分层回归分析,多元logistic回归分析确定各个自变量对因变量的解释力,应用结构方程模型(SEM)软件Lisrel8.70验证职业倦怠在职业紧张和抑郁倾向之间的中介作用。
结果
人口统计学变量在职业紧张—职业倦怠—抑郁倾向的关联关系中并无显著作用。医生的工作要求、付出与超负荷对职业倦怠和抑郁倾向具有显著的主效应；工作自主、社会支持和回报对职业倦怠和抑郁倾向具有显著的调节作用。低要求—低自主和高要求—低自主(紧张型),低付出—低回报和高付出—低回报(紧张型)以及高负荷,均与抑郁倾向的发生具有显著的关联(OR值分别为1.468,1.417,1.494,1.606和2.191)。在控制了职业倦怠各维度的影响后,抑郁倾向发生的相对危险度显著降低。工作自主—控制模式(JDC)和付出—回报失衡模式(ERI)联合应用对职业紧张对职业倦怠和抑郁倾向有较好的预测作用。结构方程模型分析结果显示,职业倦怠在职业紧张和抑郁的关系中起到了中介作用。
结论
职业紧张变量对职业倦怠各个维度有显著的影响,调节变量可以缓解并降低职业倦怠和抑郁倾向。工作要求过高、付出过多以及工作超负荷均会增加医生职业倦怠和抑郁倾向的发生。提高医生的工作自主度,增加对医生的社会支持以及提升医生的成就感,对职业倦怠与抑郁倾向有显著的调节作用。
工作要求—自主模式和付出—回报失衡模式联合应用对职业倦怠和抑郁倾向有较好的预测作用。
职业倦怠在职业紧张和抑郁倾向的关系中起着中介作用。通过调节职业倦怠,可以显著降低医生抑郁倾向的发生。作为职业紧张可能的负面结果,职业倦怠对抑郁倾向的发生有显著的负面效应,在抑郁倾向的发生过程中起了中介作用。
Introduction
Resent years, the acdemic and society have paid a lot of attensions to the problems of job burnout and depression symptoms which are caused by occupational stress. The quality of medical care and job performance will be bound to deciline under the circumstances of the declining of mental health and the physical health. There are foreign researches indicated that physicians are sustaining higher levels of occupational stress and job burnout and the problem of depression symptom appears. Resent studies showed that the occupational stress, job burnout and depression symptoms occur in an increasing trend and because the late study of occupational stress in China, the research of relationship among occupational stress, job burnout and depression symptoms is also rare. This study found that there was direct and indirect relationships among occupational stress, job burnout and depression symptoms after investigated the 1500 medical staffs from twenty hospitals in 6 cities of Liaoning province,2008.
The aim of this study is to developing the occupational psychology, preventing the occupational stress, job burnout and depresssion symptoms and improving the quality of medical care in China after researching the occupational stress, job burnout and depression symptoms, investigating the influnecing factors and analysing the interaction mechanism of the three.
Based on reviewing the documents and the former investigates, we propose these three hypotheses:
H1:The job burnout and depression symptoms will increasingly happen after excessive psychological job demands、effort and overcommitment. There is significant adjustment to job burnout and depression symptoms after improving the decision latitude、social support and personal accomplishment.
H2:There is preferable predictions of job demand-control model and effort-reward imbalance model to job burnout and depression symptoms.
H3:Job burnout plays part in the development and has a significant passive influence on depression symptoms.
Based on the former research foundations and the models assumed, this design included demographic research, occupational stress, job burnout, depression symptoms, job satisfaction and anxiety investigations. This study mainly focus on the research of occupational stress, job burnout and depression symptoms. According to analysising occupational stress, job burnout and depression symptoms, construct the model of "occupational stress-the intermediation of job burnout-depression symptoms" theory based on "stress reaction-the influence of intermediation of job burnout-depression symptom".
Objects and Methods
This research investigated 1300 physicians from 7 hospitals of 6 cities included both grade two and grade three hospitals, access occupational stress by the Job Content Questionnaire (JCQ)and Effort-Reward Imbalance(ERI), define job burnout as measured by the Maslach Burnout Inventory-General Survey(MBI-GS), and to evaluate the depression symptoms with the Centre of Epidemiology Studies-Depression scale(CES-D), gathered the demographic statistics with the Physicians' basic information questionnaire. Data was entered with Epidata3.0 software, analysed by SPSS 13.0 statistics software. Hierarchical multiple regression and multi-logistic regression were used to explore the explanatory of the independent variables to the dependent variables. Structural equation model (SEM) was used to test and verify the mediating effect of job burnout between occupational stress and depression symptoms.
Results
There is no significant difference in the relation of occupational stress-job burnout-depression symptoms between different demographic groups. Occupational factors included psychological job demands, effort and overcommitment have main effect to the three dimensions of job burnout (emotional exhaustion, depersonalization and personal accomplishment), while decision latitude, social support and reward have significant moderating effects after hierarchical multiple regression. Low demand-low decision latitude and high demand-low reward(stressful types), low effort-low reward and high effort-low reward (stressful types) and high levels of overcommitment all have a high correlation with the appearance of depression symptoms(OR:1.468,1.417, 1.494,1.606 and 2.191). As a final result, the relative risk of depression symptoms evidently reduced after controlling the three dimensions of job burnout. The job demand-control model and effort-reward imbalance model both have better predict to the relation of "occupational stress-job burnout-depression symptoms". And the result of the SEM indicated that job burnout played a mediating effect between occupational stress and depression symptoms.
Conlusion
The occupational stress independent variables have mainly effects to all the three dimensions of job burnout, while the moderating variables have significant moderating effect. The job burnout and depression symptoms will increasingly happen after excessive occupational stress. There is significant moderating effects to job burnout and depression symptoms after improving the decision latitude、social support and personal accomplishment.
Both of job demand-control model and effort-reward imbalance model have preferable predictions to job burnout and depression symptoms.
Job burnout plays a mediating effect part among the relationship of occupational stress and job burnout. Depression symptoms among doctors can be significantly declined after adjusting job burnout. Job burnout, as a possible negative result, plays part in the development and has a significant passive influence on depression symptoms.
本研究目的是分析医生职业紧张和职业倦怠的影响因素,阐明医生职业倦怠、职业紧张和抑郁倾向之间的相互作用机制,研究结果对于促进我国职业心理学发展具有重要的理论意义,对于有效预防医生因职业紧张、职业倦怠和抑郁倾向,提高医疗服务质量具有一定的现实意义。
本研究根据以往的文献分析和课题组前期研究基础提出如下假设模型：
假设1：医生职业紧张变量对职业倦怠各个维度有显著的主效应,工作自主,社会支持和回报对医生职业倦怠和抑郁倾向具有调节作用：
假设2：医生工作要求—自主和付出—回报失衡变量组合对职业倦怠和抑郁倾向具有预测作用；
假设3：医生职业倦怠在职业紧张和抑郁倾向的关系中起着中介作用。
按照假设模型和前期工作基础,本次调查设计内容包括医生的一般情况调查、职业紧张、职业倦怠、抑郁倾向、工作满意度和焦虑的调查,本文主要针对医生的职业紧张、职业倦怠和抑郁倾向调查结果,依照“职业紧张-职业倦怠的中介影响-抑郁倾向”的假设思路,建构“职业紧张—职业倦怠—抑郁倾向”理论模型,并通过结构方程模型对理论假设模型进行验证。
对象与方法
以辽宁省6个城市7所三甲和二甲医院的1300名医生为研究对象,应用工作内容问卷(JCQ)、付出—回报失衡问卷(ERI)、工作倦怠问卷(MBI)和流调用抑郁自评量表(CES-D)测量医生的职业紧张、职业倦怠和抑郁倾向,采用医生基本情况调查问卷收集人口统计学信息。使用Epidata3.0软件进行数据的统一录入,采用SPSS 13.0统计软件进行数据整理和统计分析,利用分层回归分析,多元logistic回归分析确定各个自变量对因变量的解释力,应用结构方程模型(SEM)软件Lisrel8.70验证职业倦怠在职业紧张和抑郁倾向之间的中介作用。
结果
人口统计学变量在职业紧张—职业倦怠—抑郁倾向的关联关系中并无显著作用。医生的工作要求、付出与超负荷对职业倦怠和抑郁倾向具有显著的主效应；工作自主、社会支持和回报对职业倦怠和抑郁倾向具有显著的调节作用。低要求—低自主和高要求—低自主(紧张型),低付出—低回报和高付出—低回报(紧张型)以及高负荷,均与抑郁倾向的发生具有显著的关联(OR值分别为1.468,1.417,1.494,1.606和2.191)。在控制了职业倦怠各维度的影响后,抑郁倾向发生的相对危险度显著降低。工作自主—控制模式(JDC)和付出—回报失衡模式(ERI)联合应用对职业紧张对职业倦怠和抑郁倾向有较好的预测作用。结构方程模型分析结果显示,职业倦怠在职业紧张和抑郁的关系中起到了中介作用。
结论
职业紧张变量对职业倦怠各个维度有显著的影响,调节变量可以缓解并降低职业倦怠和抑郁倾向。工作要求过高、付出过多以及工作超负荷均会增加医生职业倦怠和抑郁倾向的发生。提高医生的工作自主度,增加对医生的社会支持以及提升医生的成就感,对职业倦怠与抑郁倾向有显著的调节作用。
工作要求—自主模式和付出—回报失衡模式联合应用对职业倦怠和抑郁倾向有较好的预测作用。
职业倦怠在职业紧张和抑郁倾向的关系中起着中介作用。通过调节职业倦怠,可以显著降低医生抑郁倾向的发生。作为职业紧张可能的负面结果,职业倦怠对抑郁倾向的发生有显著的负面效应,在抑郁倾向的发生过程中起了中介作用。
Introduction
Resent years, the acdemic and society have paid a lot of attensions to the problems of job burnout and depression symptoms which are caused by occupational stress. The quality of medical care and job performance will be bound to deciline under the circumstances of the declining of mental health and the physical health. There are foreign researches indicated that physicians are sustaining higher levels of occupational stress and job burnout and the problem of depression symptom appears. Resent studies showed that the occupational stress, job burnout and depression symptoms occur in an increasing trend and because the late study of occupational stress in China, the research of relationship among occupational stress, job burnout and depression symptoms is also rare. This study found that there was direct and indirect relationships among occupational stress, job burnout and depression symptoms after investigated the 1500 medical staffs from twenty hospitals in 6 cities of Liaoning province,2008.
The aim of this study is to developing the occupational psychology, preventing the occupational stress, job burnout and depresssion symptoms and improving the quality of medical care in China after researching the occupational stress, job burnout and depression symptoms, investigating the influnecing factors and analysing the interaction mechanism of the three.
Based on reviewing the documents and the former investigates, we propose these three hypotheses:
H1:The job burnout and depression symptoms will increasingly happen after excessive psychological job demands、effort and overcommitment. There is significant adjustment to job burnout and depression symptoms after improving the decision latitude、social support and personal accomplishment.
H2:There is preferable predictions of job demand-control model and effort-reward imbalance model to job burnout and depression symptoms.
H3:Job burnout plays part in the development and has a significant passive influence on depression symptoms.
Based on the former research foundations and the models assumed, this design included demographic research, occupational stress, job burnout, depression symptoms, job satisfaction and anxiety investigations. This study mainly focus on the research of occupational stress, job burnout and depression symptoms. According to analysising occupational stress, job burnout and depression symptoms, construct the model of "occupational stress-the intermediation of job burnout-depression symptoms" theory based on "stress reaction-the influence of intermediation of job burnout-depression symptom".
Objects and Methods
This research investigated 1300 physicians from 7 hospitals of 6 cities included both grade two and grade three hospitals, access occupational stress by the Job Content Questionnaire (JCQ)and Effort-Reward Imbalance(ERI), define job burnout as measured by the Maslach Burnout Inventory-General Survey(MBI-GS), and to evaluate the depression symptoms with the Centre of Epidemiology Studies-Depression scale(CES-D), gathered the demographic statistics with the Physicians' basic information questionnaire. Data was entered with Epidata3.0 software, analysed by SPSS 13.0 statistics software. Hierarchical multiple regression and multi-logistic regression were used to explore the explanatory of the independent variables to the dependent variables. Structural equation model (SEM) was used to test and verify the mediating effect of job burnout between occupational stress and depression symptoms.
Results
There is no significant difference in the relation of occupational stress-job burnout-depression symptoms between different demographic groups. Occupational factors included psychological job demands, effort and overcommitment have main effect to the three dimensions of job burnout (emotional exhaustion, depersonalization and personal accomplishment), while decision latitude, social support and reward have significant moderating effects after hierarchical multiple regression. Low demand-low decision latitude and high demand-low reward(stressful types), low effort-low reward and high effort-low reward (stressful types) and high levels of overcommitment all have a high correlation with the appearance of depression symptoms(OR:1.468,1.417, 1.494,1.606 and 2.191). As a final result, the relative risk of depression symptoms evidently reduced after controlling the three dimensions of job burnout. The job demand-control model and effort-reward imbalance model both have better predict to the relation of "occupational stress-job burnout-depression symptoms". And the result of the SEM indicated that job burnout played a mediating effect between occupational stress and depression symptoms.
Conlusion
The occupational stress independent variables have mainly effects to all the three dimensions of job burnout, while the moderating variables have significant moderating effect. The job burnout and depression symptoms will increasingly happen after excessive occupational stress. There is significant moderating effects to job burnout and depression symptoms after improving the decision latitude、social support and personal accomplishment.
Both of job demand-control model and effort-reward imbalance model have preferable predictions to job burnout and depression symptoms.
Job burnout plays a mediating effect part among the relationship of occupational stress and job burnout. Depression symptoms among doctors can be significantly declined after adjusting job burnout. Job burnout, as a possible negative result, plays part in the development and has a significant passive influence on depression symptoms.
引文
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4 X.yang, C.Ge, B Hu, et al. Relationship between quality of life and occupational stress among teachers. The Royal Society of Public Health.2009; 123(11):750-5.
5 Hui Wu, Tie-Shuang Chi, Li Chen, et al. Occupational stress among hospital nurses: cross-sectional survey. Journal of Advanced Nursing.2010; 66(3):627-634.
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7 Belkic K, Landsbergis PA, Schnall PL, et al. Is job strain a major source of cardiovascular Disease risk [J]? Scand. J Work Environ. Health.2004; 30(2):85-128.
8 Tsutsumi A, Kayaba K, Tsutsumi K, et al. Association between job strain and prevalence of hypertension:a cross sectional analysis in a Japanese working Population with a wide range of occupations:the Jichi Medical School cohort study. Occup Environ Med.2001; 58:367-373.
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11 Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Publc Health.1994; 15:381-411.
12 Muntaner C, Li Y, Xue X, et al. Work Organization, Area Labor-market Characteristics, and Depression among U.S. Nursing Home Workers:A Cross-classified Multilevel Analysis. International Journal of Occupational and Environmental Health.2004; 10(4):392-400.
13 Wang Z.M., Lan Y.J., Wang M.Z., et al.Correlation analysis of occupational stress and work ability in teachers. Chinese Journal of Industrial Medicine.2001;14:200-202.
14 Ahola K, Toppinen-Tanner S, Huuhtanen P, et al. Occupational burnout and chronic work disability:an eight-year cohort study on pensioning among Finnish forest industry workers. J Affect Disord.2009; 115(1-2):150-9.
15 Shin-Goo Park, Kyoung-Bok Min, Sei-Jin Chang. Hwan-Cheol Kim.Jin-Young Min. Job stress and depressive symptoms among Korean employees:the effects of culture on work. Int
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30 Li J, Yang W, Liu P, et al. Psychometric evaluation of the Chinese (mainland) version of Job Content Questionnaire:a study in university hospitals. Ind Health,2004; 42 (2):260-267.
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35 张明园.正常人群中的抑郁倾向的调查和CES-D的应用.中华神经精神科杂志.1987：20：67-71.
36 吴文源.量表评定在神经症行抑郁中的应用.中华神经精神科杂志.986：19：339-341.
37 朱守民,夏昭林.职业紧张与健康.工业卫生与职业病.2003；29(6)：375-377.
38 焦玲艳,陈景武.结构方程模型在科技人员人格特征研究中的应用.中国卫生统计.2008,25(3)：253-259.
39 温忠麟,侯杰泰,马什赫伯特.结构方程模型检验：拟合指数与卡放准则.心理学报.2004；36(2)：186-194.
40 Maslach C, Schaufeli WB, Leiter MP. Leiter. Job Burnout. Annu. Rev. Psychol.2001; 52:397-422.
41 李永鑫.工作倦怠的心理学研究.2008；80-81.
42 Maslach C. Burnout:The Cost of Caring. Englewood Cliffs.1982; NJ:Prentice-Hall.
43 Karin E Isaksson Rφ, Tore Gudel, Olaf G Aasland. Does a self-referral counselling program reach doctors in need of help? A comparison with the general Norwegian doctor workforce. BMC Public Health.2007; 7:36.
44 Jurado D, Gurpegui M, Moreno O, et al. Association of personality and work conditions with depressive symptoms. European Psychiatry.2005; 20:213-222.
45 戴俊明.职业紧张健康效应的流行病学研究.[博士论文].复旦大学.2006.
46 Johannes Siegrist. Chronic psychosocial stress at work and risk of depression:evidence from prospect studies. Eur Arch Psychiatry Gin Neurosci.2008; 258:115-119.
47 Schulz M, Damkroger A, Heins C, et al. Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings. J Psychiatr Ment Health Nurs.2009; 16(3):225-33.
1 Houtman IL, Goudswaard A, Dhondt S, et al. Dutch monitor on stress and physical load:risk factors, consequences, and preventive action. Occup Environ Med.1998; 55(2):73-83.
2 Shellenbarger S. Are saner workloads the unexpected key to more productivity? Wall Street J, 1999; 10. B1.
3 Carl Zenz. Occupational Medicine.3rd Ed Mosby. Year Book Inc. St. Louis 1994; 945.
4 National Institute for Occupational Safety and Health. STRESS…AT WORK. (DHHS Publication No.99-101), Cincinnati OH:NOISH.1999.
5 Steve L Alves, CRNA. A study of occupational stress, scope of practice, and collaboration in nurse anesthetists practicing in anesthesia care team settings. AANA Journal.2005; 73(6):443-452.
6 刘宝英,任南,杨华,等.职业紧张与多发多种心血管疾病关系的研究.卫生研究.2006；35(4)：489-491.
7 高炜.职业紧张与冠心病的相关性研究现状.北京大学学报(医学版).2007；39(6)：559-561.
8 Vidal A. Gomez-Gil E, Sans M, et al. Health-related quality of life in inflammatory bowel disease patients:the role of psychopathology and personality. Inflamm Bowel is.2008 Jul; 14(7):977-83.
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