Linzer Mark, Stillman Martin, Brown Roger, Taylor Sam, Nankivil Nancy, Poplau Sara, Goelz Elizabeth, Sinsky Christine
Hennepin Healthcare and University of Minnesota, Minneapolis; University of Wisconsin School of Nursing, Madison; and American Medical Association, Chicago, IL.
Mayo Clin Proc Innov Qual Outcomes. 2021 Feb 2;5(1):127-136. doi: 10.1016/j.mayocpiqo.2021.01.005. eCollection 2021 Feb.
To assess the impact of the COVID-19 crisis on physician stress and mental health.
The 10-item Coping With COVID survey assessed stress among 2373 physicians from April 4 to May 27, 2020. A stress summary score with 4 items (a single-item [overall] stress measure, fear of exposure, perceived anxiety/depression due to COVID, and work overload, each scored 1-4) ranged from 4 to 16. Hypothesized stress mitigators included enhanced purpose and feeling valued by one's organization. Multilevel linear regression tested associations of variables with overall stress and stress summary scores.
In 2373 physicians in 17 organizations (median response rate of 32%), mean stress summary score was 9.1 (SD 2.6). Stress was highest among women (stress summary score, 9.4 [SD 2.5] vs 8.7 [SD 2.6] in men; <.001), inpatient physicians (stress summary score, 9.4 [SD 2.8] vs 8.9 [SD 2.5] in outpatient physicians; <.001), early- and mid-career physicians (stress summary score, 9.5 [SD 2.6] vs 8.6 [SD 2.5] in late-career physicians; <.001), and physicians in critical care (stress summary score, 10.8), emergency departments (10.2), and hospital medicine (10.1). Increases in perceived anxiety/depression (regression coefficient, 0.30), workload (0.28), and fear (0.14) were associated with higher overall stress ( values <.001). Increases in feeling valued were associated with lower stress summary scores (regression coefficient, -0.67; <.001) and explained 11% of stress summary score variance at the physician level and 31% of variance at the organizational level.
Mental health support, modulation of workload, and noting physicians' organizational value should be explored as means to reduce COVID-related stress.
评估2019冠状病毒病（COVID-19）危机对医生压力和心理健康的影响。
“应对COVID调查”中的10项内容评估了2020年4月4日至5月27日期间2373名医生的压力状况。一个包含4项内容的压力综合评分（一项单项[总体]压力指标、对暴露的恐惧、因COVID导致的感知焦虑/抑郁以及工作负荷过重，每项评分1至4分）范围为4至16分。假定的压力缓解因素包括目标感增强以及得到所在组织的重视。多水平线性回归检验了各变量与总体压力及压力综合评分之间的关联。
在17个组织中的2373名医生（中位应答率为32%）中，压力综合评分均值为9.1（标准差2.6）。女性的压力最高（压力综合评分，9.4[标准差2.5]，男性为8.7[标准差2.6]；P<.001），住院医生（压力综合评分，9.4[标准差2.8]，门诊医生为8.9[标准差2.5]；P<.001），职业生涯早期和中期的医生（压力综合评分，9.5[标准差2.6]，职业生涯后期的医生为8.6[标准差2.5]；P<.001），以及重症监护医生（压力综合评分，10.8）、急诊科医生（10.2）和医院内科医生（10.1）。感知焦虑/抑郁增加（回归系数，0.30）、工作量增加（0.28）和恐惧增加（0.14）与更高的总体压力相关（P值<.001）。得到重视的感觉增加与更低的压力综合评分相关（回归系数，-0.67；P<.001），并解释了医生层面压力综合评分方差的11%以及组织层面方差的31%。
应探索提供心理健康支持、调整工作量以及关注医生的组织价值，作为减轻与COVID相关压力的手段。
