Dahlin Marie E, Runeson Bo
Department of Clinical Neuroscience, Division of Psychiatry St. Göran, Karolinska Institutet, Stockholm, Sweden.
BMC Med Educ. 2007 Apr 12;7:6. doi: 10.1186/1472-6920-7-6.
Mental distress among medical students is often reported. Burnout has not been studied frequently and studies using interviewer-rated diagnoses as outcomes are rarely employed. The objective of this prospective study of medical students was to examine clinically significant psychiatric morbidity and burnout at 3rd year of medical school, considering personality and study conditions measured at 1st year.
Questionnaires were sent to 127 first year medical students who were then followed-up at 3rd year of medical school. Eighty-one of 3rd year respondents participated in a diagnostic interview. Personality (HP5-i) and Performance-based self-esteem (PBSE-scale) were assessed at first year, Study conditions (HESI), Burnout (OLBI), Depression (MDI) at 1st and 3rd years. Diagnostic interviews (MINI) were used at 3rd year to assess psychiatric morbidity. High and low burnout at 3rd year was defined by cluster analysis. Logistic regressions were used to identify predictors of high burnout and psychiatric morbidity, controlling for gender.
98 (77%) responded on both occasions, 80 (63%) of these were interviewed. High burnout was predicted by Impulsivity trait, Depressive symptoms at 1st year and Financial concerns at 1st year. When controlling for 3rd year study conditions, Impulsivity and concurrent Workload remained. Of the interviewed sample 21 (27%) had a psychiatric diagnosis, 6 of whom had sought help. Unadjusted analyses showed that psychiatric morbidity was predicted by high Performance-based self-esteem, Disengagement and Depression at 1st year, only the later remained significant in the adjusted analysis.
Psychiatric morbidity is common in medical students but few seek help. Burnout has individual as well as environmental explanations and to avoid it, organisational as well as individual interventions may be needed. Early signs of depressive symptoms in medical students may be important to address. Students should be encouraged to seek help and adequate facilities should be available.
医学生的精神困扰屡有报道。职业倦怠的研究并不常见，且很少采用访谈者评定诊断作为研究结果。这项针对医学生的前瞻性研究的目的是，在医学院校学习的第三年，考虑一年级时测量的人格和学习条件，研究具有临床意义的精神疾病发病率和职业倦怠情况。
向127名一年级医学生发放问卷，随后在医学院校学习的第三年对他们进行随访。三年级的81名受访者参加了诊断访谈。一年级时评估人格（HP5-i）和基于表现的自尊（PBSE量表），一、三年级时评估学习条件（HESI）、职业倦怠（OLBI）、抑郁（MDI）。三年级时使用诊断访谈（MINI）评估精神疾病发病率。通过聚类分析定义三年级时的高职业倦怠和低职业倦怠。采用逻辑回归分析确定高职业倦怠和精神疾病发病率的预测因素，并对性别进行控制。
98名（77%）学生两次都做出了回应，其中80名（63%）接受了访谈。高职业倦怠的预测因素为冲动特质、一年级时的抑郁症状和一年级时的经济担忧。在控制三年级学习条件后，冲动性和同期工作量仍然存在。在接受访谈的样本中，21名（27%）有精神疾病诊断，其中6人寻求过帮助。未经调整的分析表明，精神疾病发病率的预测因素为一年级时基于表现的高自尊、脱离和抑郁，在调整分析中只有后者仍然显著。
精神疾病在医学生中很常见，但很少有人寻求帮助。职业倦怠有个体和环境方面的原因，为避免职业倦怠，可能需要组织和个体层面的干预措施。医学生抑郁症状的早期迹象可能需要加以关注。应鼓励学生寻求帮助，并提供适当的设施。
