Weinberg A, Creed F
Faculty of Health Care and Social Work Studies, University of Salford, UK.
Lancet. 2000 Feb 12;355(9203):533-7. doi: 10.1016/S0140-6736(99)07366-3.
Previous studies of stress in healthcare staff have indicated a probable high prevalence of distress. Whether this distress can be attributed to the stressful nature of the work situation is not clear. No previous study has used a detailed interview method to ascertain the link between stress in and outside of work and anxiety and depressive disorders.
Doctors, nurses, and administrative and ancillary staff were screened using the general health questionnaire (GHQ). High scorers (GHQ>4) and matched individuals with low GHQ scores were interviewed by means of the clinical interview schedule to ascertain definite anxiety and depressive disorders (cases). Cases and controls, matched for age, sex, and occupational group were interviewed with the life events and difficulties schedule classification and an objective measure of work stress to find out the amount of stress at work and outside of work. Sociodemographic and stress variables were entered into a logistic-regression analysis to find out the variables associated with anxiety and depressive disorders.
64 cases and 64 controls were matched. Cases and controls did not differ on demographic variables but cases were less likely to have a confidant (odds ratio 0.09 [95% CI 0.01-0.79]) and more likely to have had a previous episode of psychiatric disorder (3.07 [1.10-8.57]). Cases and controls worked similar hours and had similar responsibility but cases had a greater number of objective stressful situations both in and out of work (severe event or substantial difficulty in and out of work-45 cases vs 18 controls 6.05 [2.81-13.00], p<0.001; severe chronic difficulty outside of work-27 vs 8, 5.12 [2.09-12.46], p<0.001). Cases had significantly more objective work problems than controls (median 6 vs 4, z=3.81, p<0.001). The logistic-regression analyses indicated that even after the effects of personal vulnerability to psychiatric disorder and ongoing social stress outside of work had been taken into account, stressful situations at work contributed to anxiety and depressive disorders.
Both stress at work and outside of work contribute to the anxiety and depressive disorders experienced by healthcare staff. Our findings suggest that the best way to decrease the prevalence of these disorders is individual treatment, which may focus on personal difficulties outside of work, combined with organisational attempts to reduce work stress. The latter may involve more assistance for staff who have a conflict between their managerial role and clinical role.
先前针对医护人员压力的研究表明，苦恼的患病率可能较高。这种苦恼是否可归因于工作环境的压力性质尚不清楚。此前尚无研究采用详细的访谈方法来确定工作内外的压力与焦虑症和抑郁症之间的联系。
使用一般健康问卷（GHQ）对医生、护士、行政及辅助人员进行筛查。对高分者（GHQ>4）以及与之匹配的低GHQ分数者，通过临床访谈表进行访谈，以确定是否患有明确的焦虑症和抑郁症（病例组）。将年龄、性别和职业组相匹配的病例组和对照组，采用生活事件与困难程度分类表以及工作压力客观测量法进行访谈，以了解工作内外的压力程度。将社会人口统计学和压力变量纳入逻辑回归分析，以找出与焦虑症和抑郁症相关的变量。
匹配了64例病例和64例对照。病例组和对照组在人口统计学变量上无差异，但病例组拥有知己的可能性较小（优势比0.09 [95%可信区间0.01 - 0.79]），且既往有精神疾病发作史的可能性更大（3.07 [1.10 - 8.57]）。病例组和对照组工作时长相似，职责相当，但病例组在工作内外面临的客观压力情况更多（工作内外的严重事件或重大困难——45例病例组对18例对照组，6.05 [2.81 - 13.00]，p<0.001；工作外的严重慢性困难——27例对8例，5.12 [2.09 - 12.46]，p<0.001）。病例组的客观工作问题显著多于对照组（中位数6对4，z = 3.81，p<0.001）。逻辑回归分析表明，即使考虑到个人易患精神疾病的因素以及工作外持续的社会压力的影响，工作中的压力情况仍会导致焦虑症和抑郁症。
工作内外的压力都会导致医护人员出现焦虑症和抑郁症。我们研究结果表明，降低这些疾病患病率的最佳方法是个体化治疗，可能侧重于解决工作外的个人困难，同时组织方面努力减轻工作压力。后者可能包括为管理角色与临床角色存在冲突的员工提供更多帮助。
