减轻医生常见精神障碍症状和自杀意念的干预措施：一项系统评价和荟萃分析。

Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis.

作者信息

Petrie Katherine, Crawford Joanna, Baker Simon T E, Dean Kimberlie, Robinson Jo, Veness Benjamin G, Randall Janette, McGorry Patrick, Christensen Helen, Harvey Samuel B

机构信息

Black Dog Institute, University of New South Wales, Randwick, NSW, Australia.

School of Psychiatry, University of New South Wales Sydney, Kensington, NSW, Australia; Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia.

出版信息

Lancet Psychiatry. 2019 Mar;6(3):225-234. doi: 10.1016/S2215-0366(18)30509-1. Epub 2019 Feb 8.

DOI:10.1016/S2215-0366(18)30509-1

PMID:30744997

Abstract

BACKGROUND

An increased prevalence of common mental disorders and suicide has been reported among physicians worldwide. We aimed to assess which, if any, interventions are effective at reducing or preventing symptoms of common mental health disorders or suicidality in physicians.

METHODS

For this systematic review and meta-analysis MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL (database inception to March 26, 2018), reference lists of included studies, and additional sources were systematically searched and screened by two independent reviewers. We included randomised controlled studies or controlled before-after studies of interventions to reduce depression, anxiety, or suicidality in physicians, as assessed by a validated outcome measure. Both organisation-level and physician-directed interventions were considered. Our primary outcome was differences in symptoms of common mental health disorders following intervention. We used random-effects modelling for the main meta-analyses and planned subgroup and sensitivity analyses. The study protocol is registered with PROSPERO, number CRD42018091646.

FINDINGS

We identified 2992 articles for screening, of which eight were included in the systematic review (n=1023 physicians) and seven in the meta-analysis. Results indicated a moderate effect in favour of the physician-directed interventions for reduction in symptoms of common mental health disorders (standardised mean difference 0·62; 95% CI 0·40-0·83; p<0·0001). Separate analyses showed physician-directed interventions resulted in reductions of symptoms of depression, anxiety, and suicidality. No evidence of significant heterogeneity was found (Q=3·78; p=0·44).

INTERPRETATION

Physician-directed interventions are associated with small reductions in symptoms of common mental health disorders among physicians. Research regarding organisational interventions aimed at improving physicians' mental health via modification of the work environment is urgently needed.

FUNDING

Health Workforce Programme, Commonwealth Department of Health, Australian Government, iCare Foundation, and NSW Health.

摘要

背景

据报道，全球范围内医生中常见精神障碍和自杀的患病率有所上升。我们旨在评估哪些干预措施（如果有的话）在减少或预防医生常见心理健康障碍症状或自杀倾向方面有效。

方法

对于这项系统评价和荟萃分析，我们由两名独立审阅者对MEDLINE、EMBASE、PsycINFO和Cochrane CENTRAL（数据库创建至2018年3月26日）、纳入研究的参考文献列表以及其他来源进行了系统检索和筛选。我们纳入了通过有效结局测量评估的、关于减少医生抑郁、焦虑或自杀倾向的干预措施的随机对照研究或前后对照研究。组织层面和针对医生的干预措施均在考虑范围内。我们的主要结局是干预后常见心理健康障碍症状的差异。我们对主要荟萃分析采用随机效应模型，并计划进行亚组分析和敏感性分析。该研究方案已在PROSPERO注册，注册号为CRD42018091646。

结果

我们识别出2992篇文章进行筛选，其中8篇纳入系统评价（n = 1023名医生），7篇纳入荟萃分析。结果表明，针对医生的干预措施在减少常见心理健康障碍症状方面有中等效果（标准化均数差0·62；95%CI 0·40 - 0·83；p<0·0001）。单独分析显示，针对医生的干预措施可减少抑郁、焦虑和自杀倾向症状。未发现显著异质性证据（Q = 3·78；p = 0·44）。