Schäfer Sarah K, Lass-Hennemann Johanna, Groesdonk Heinrich, Volk Thomas, Bomberg Hagen, Staginnus Marlene, Brückner Alexandra H, Holz Elena, Michael Tanja
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
Department of Anesthesiology and Intensive Care, Saarland University Medical Center, Homburg, Germany.
Front Psychiatry. 2018 Sep 19;9:440. doi: 10.3389/fpsyt.2018.00440. eCollection 2018.
Hospitals, and particularly intensive care units (ICUs), are demanding and stressful workplaces. Physicians and nurse staff are exposed to various stressors: emergency situations, patients' deaths, and team conflicts. Correspondingly, several studies describe increased rates of PTSD symptoms and other mental health problems in hospital staff. Therefore, it is important to identify factors that lower the risk of psychopathological symptoms. High levels of sense of coherence (SOC) and general resilience as well as an internal locus of control (LOC) have already been identified as important health-benefitting factors in medical staff. The current study aimed to evaluate their unique impact in an ICU and an anesthesiology unit. The cross-sectional online survey investigated SOC, LOC, general resilience, general mental health problems as well as PTSD symptoms in nurses and physicians within an ICU and an anesthesiology unit ( = 52, 65.4% female). General mental health problems were assessed using the ICD-10-Symptom-Rating (ISR) and PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). The Sense of Coherence Scale (SOC-L9) assessed SOC, the Resilience Scale (RS-11) measured general resilience, and LOC was determined using a 4-item scale for the assessment of control beliefs (IE-4). As expected, SOC, = -0.72, < 0.001, general resilience, = -0.46, < 0.001, and internal LOC, = -0.51, < 0.001, were negatively correlated with general mental health problems while an external LOC showed a positive association, = 0.35, = 0.010. However, in a multiple regression model, = 53.9%, = 13.73, < 0.001, only SOC significantly predicted general mental health problems by uniquely accounting for 13% of the variance. For PTSD symptoms, which were highly correlated with general mental health problems, a similar pattern of results was found. SOC was found to be the most important correlate of both general mental health problems and PTSD symptoms in an ICU and an anesthesiology unit. Thus, if further evidenced by longitudinal studies, implementing interventions focusing on an enhancement of SOC in training programs for ICU and anesthesiology unit staff might be a promising approach to prevent or reduce psychopathological symptoms.
医院，尤其是重症监护病房（ICU），是要求严苛且压力巨大的工作场所。医生和护士会面临各种压力源：紧急情况、患者死亡以及团队冲突。相应地，多项研究表明医院工作人员中创伤后应激障碍（PTSD）症状及其他心理健康问题的发生率有所上升。因此，识别降低精神病理症状风险的因素很重要。较高水平的连贯感（SOC）、总体心理韧性以及内控点（LOC）已被确定为对医务人员有益健康的重要因素。当前研究旨在评估它们在ICU和麻醉科的独特影响。这项横断面在线调查研究了ICU和麻醉科护士及医生的SOC、LOC、总体心理韧性、总体心理健康问题以及PTSD症状（n = 52，女性占65.4%）。使用国际疾病分类第10版症状评定量表（ISR）评估总体心理健康问题，使用《精神疾病诊断与统计手册》第5版创伤后应激障碍检查表（PCL - 5）测量PTSD症状。连贯感量表（SOC - L9）评估SOC，心理韧性量表（RS - 11）测量总体心理韧性，使用一个4项量表评估控制信念（IE - 4）来确定LOC。正如预期的那样，SOC（r = - 0.72，p < 0.001）、总体心理韧性（r = - 0.46，p < 0.001）和内控LOC（r = - 0.51，p < 0.001）与总体心理健康问题呈负相关，而外控LOC呈正相关（r = 0.35，p = 0.010）。然而，在多元回归模型中（R² = 53.9%，F = 13.73，p < 0.001），只有SOC通过独特地解释13%的方差显著预测了总体心理健康问题。对于与总体心理健康问题高度相关的PTSD症状，也发现了类似的结果模式。在ICU和麻醉科，SOC被发现是总体心理健康问题和PTSD症状的最重要相关因素。因此，如果纵向研究进一步证实，在ICU和麻醉科工作人员培训项目中实施侧重于增强SOC的干预措施，可能是预防或减少精神病理症状的一种有前景的方法。
