Ito Makoto, Seo Emiko, Ogawa Ryoko, Sanuki Masaru, Maeno Takami, Maeno Tetsuhiro
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Med Educ. 2015 Feb;49(2):215-23. doi: 10.1111/medu.12620.
Depression among medical residents is a very serious problem. It is, however, very difficult to detect signs of depression early, despite the severity and frequency of depression. We designed a nationwide longitudinal study to investigate whether the Sense of Coherence (SOC) Scale, an indicator of ability to cope with stress, could predict future depressive symptoms among medical residents.
We distributed self-administered questionnaires to first-year residents in 251 postgraduate education hospitals just before the start of their clinical training. The questionnaire contained the Center for Epidemiologic Studies Depression (CES-D) Scale (a screening tool for depression), the SOC Scale, and items on demographic factors. After 3 months, we again distributed questionnaires to residents who had responded to the first survey. The second questionnaire contained the CES-D Scale and items on the respondents' working conditions. We categorised respondents into three groups according to their SOC scores and analysed the relationships between the three SOC groups (low, middle and high scores) and the occurrence of depressive symptoms at the follow-up survey.
In all, 1738 of 2935 residents (59.2%) responded to the first survey. Of these, 1245 residents (71.6%) also responded to the follow-up survey. A total of 189 residents were excluded because they screened positive for depressive symptoms at the first survey. Data for a further 36 were excluded because they were incomplete. At the follow-up survey, 238 of the remaining 1020 residents (23.3%) had new-onset depressive symptoms. These included 61 (41.2%) respondents in the low SOC group, 159 (22.3%) in the middle SOC group, and 18 (11.3%) in the high SOC group (p < 0.01). The odds ratio of the low SOC group for new-onset depressive symptoms, adjusted for demographic factors, baseline CES-D score and mean working time, was 3.11 (95% confidence interval 1.48-6.53), using the high SOC group as the reference.
The SOC score was significantly related to future depressive symptoms among medical residents. The SOC Scale might be a useful and easy-to-use predictor of future depression.
住院医师的抑郁症是一个非常严重的问题。然而，尽管抑郁症的严重程度和发生率较高，但早期发现抑郁症迹象却非常困难。我们设计了一项全国性的纵向研究，以调查应对压力能力的指标——连贯感（SOC）量表是否能够预测住院医师未来的抑郁症状。
在251家研究生教育医院的一年级住院医师开始临床培训前，我们发放了自填式问卷。问卷包含流行病学研究中心抑郁量表（CES-D量表，一种抑郁症筛查工具）、SOC量表以及人口统计学因素相关项目。3个月后，我们再次向首次调查的受访者发放问卷。第二次问卷包含CES-D量表以及受访者工作条件相关项目。我们根据受访者的SOC得分将其分为三组，并分析了三个SOC组（低分、中分和高分）与随访调查中抑郁症状发生情况之间的关系。
总共2935名住院医师中有1738名（59.2%）对首次调查做出了回应。其中，1245名住院医师（71.6%）也对随访调查做出了回应。共有189名住院医师因在首次调查中抑郁症状筛查呈阳性而被排除。另有36名住院医师因数据不完整被排除。在随访调查中，其余1020名住院医师中有238名（23.3%）出现了新发抑郁症状。其中，低分SOC组有61名（41.2%）受访者，中分SOC组有159名（22.3%）受访者，高分SOC组有18名（11.3%）受访者（p<0.01）。以高分SOC组为参照，在对人口统计学因素、基线CES-D得分和平均工作时间进行调整后，低分SOC组出现新发抑郁症状的比值比为3.11（95%置信区间为1.48 - 6.53）。
SOC得分与住院医师未来的抑郁症状显著相关。SOC量表可能是一种有用且易于使用的未来抑郁症预测指标。
