Jackson Eric R, Shanafelt Tait D, Hasan Omar, Satele Daniel V, Dyrbye Liselotte N
E.R. Jackson is a third-year medical student, Mayo Medical School, Rochester, Minnesota. T.D. Shanafelt is professor of medicine, Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. O. Hasan is vice president for improving health outcomes, American Medical Association, Chicago, Illinois. D.V. Satele is statistician, Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. L.N. Dyrbye is professor of medicine, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Acad Med. 2016 Sep;91(9):1251-6. doi: 10.1097/ACM.0000000000001138.
To explore the relationship between alcohol abuse/dependence with burnout and other forms of distress among a national cohort of medical students.
In 2012, the authors completed a national survey of medical students from the American Medical Association's Physician Masterfile containing validated items assessing alcohol abuse/dependence, burnout, depression, suicidality, quality of life (QOL), and fatigue. Descriptive and comparative statistical analyses were computed, including chi-square and multivariate logistic regression, to determine relationships between variables.
Of the 12,500 students, 4,402 (35.2%) responded. Of these, 1,411 (32.4%) met diagnostic criteria for alcohol abuse/dependence. Students who were burned out (P = .01), depressed (P = .01), or reported low mental (P =.03) or emotional (P = .016) QOL were more likely to have alcohol abuse/dependence. Emotional exhaustion and depersonalization domains of burnout were strongly associated with alcohol abuse/dependence. On multivariate analysis, burnout (OR 1.20; 95% CI 1.05-1.37; P < .01), having $50,000 to $100,000 (OR 1.21 versus < $50,000; CI 1.02-1.44; P < .05) or > $100,000 (OR 1.27 versus < $50,000; CI 1.08-1.48; P < .01) of educational debt, being unmarried (OR 1.89; CI 1.57-2.27; P < .001), and being younger (for every five years, OR 1.15; CI 1.02-1.28; P = .01) were independently associated with increased risk for alcohol abuse/dependence.
Burnout was strongly related to alcohol abuse/dependence among sampled medical students and increased educational debt predicted a higher risk. A multifaceted approach addressing burnout, medical education costs, and alcohol use is needed.
探讨美国一群医学生中酒精滥用/依赖与职业倦怠及其他形式的困扰之间的关系。
2012年，作者对来自美国医学协会医师主文件中的医学生进行了一项全国性调查，其中包含评估酒精滥用/依赖、职业倦怠、抑郁、自杀倾向、生活质量（QOL）和疲劳的有效项目。进行了描述性和比较性统计分析，包括卡方检验和多因素逻辑回归，以确定变量之间的关系。
12500名学生中，4402名（35.2%）做出了回应。其中，1411名（32.4%）符合酒精滥用/依赖的诊断标准。职业倦怠的学生（P = 0.01）、抑郁的学生（P = 0.01）或报告心理（P = 0.03）或情绪（P = 0.016）生活质量低的学生更有可能存在酒精滥用/依赖。职业倦怠的情感耗竭和去个性化维度与酒精滥用/依赖密切相关。多因素分析显示，职业倦怠（比值比[OR]1.20；95%置信区间[CI]1.05 - 1.37；P < 0.01）、教育债务在50000美元至100000美元之间（OR 1.21，与低于50000美元相比；CI 1.02 - 1.44；P < 0.05）或超过100000美元（OR 1.27，与低于50000美元相比；CI 1.08 - 1.48；P < 0.01）、未婚（OR 1.89；CI 1.57 - 2.27；P < 0.001）以及年龄较小（每小五岁，OR 1.15；CI 1.02 - 1.28；P = 0.01）与酒精滥用/依赖风险增加独立相关。
在抽样的医学生中，职业倦怠与酒精滥用/依赖密切相关，教育债务增加预示着更高的风险。需要采取多方面的方法来解决职业倦怠、医学教育成本和酒精使用问题。
