Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Psychiatry, The Third People's Hospital of Qujing, Qujing, Yunnan, China.
Ann Med. 2024 Dec;56(1):2433030. doi: 10.1080/07853890.2024.2433030. Epub 2024 Nov 28.
Chinese resident physicians confront challenges such as staff shortages and heavy workloads, leading to a heightened prevalence of mental distress. This study aims to investigate the symptom network of stress, burnout, anxiety, depression (SBAD) and adverse personal outcomes in this cohort.
From October 2020 to April 2022, 994 physicians were recruited across China through snowball sampling. Stress, burnout, anxiety and depression were assessed using the 10-item Perceived Stress Scale, a two-item burnout questionnaire, Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation) were collected. We constructed and visualized two networks, calculating expected influence (EI) and bridge EI indices to identify central and bridge symptoms.
In the SBAD network, perceived helplessness was the most central and critical bridge symptom connecting stress and mental distress, with emotional exhaustion identified as the secondary bridge symptom. Perceived helplessness, perceived self-efficacy and emotional exhaustion exhibited the highest negative correlations with QOL. Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlated with suicidal ideation. The estimated SBAD network showed excellent stability and accuracy.
Our study emphasizes that perceived helplessness may be a high-priority target for preventing and intervening in mental distress and improving QOL among residents. Burnout transcends workplace problems and is widely connected to depression, anxiety and QOL. Implementing early detection and intervention measures at three levels-the individual physician, health system and professional colleges, and external regulators-is crucial for preventing and alleviating stress and mental distress among residents.
中国住院医师面临人员短缺和工作量大等挑战，导致精神困扰的患病率升高。本研究旨在调查该队列中压力、倦怠、焦虑、抑郁（SBAD）症状网络与不良个人结局的关系。
本研究采用滚雪球抽样方法，于 2020 年 10 月至 2022 年 4 月期间在中国招募了 994 名住院医师。使用 10 项感知压力量表、倦怠问卷的两个条目、广泛性焦虑症量表-7 项和患者健康问卷-9 项分别评估压力、倦怠、焦虑和抑郁。收集不良个人结局（生活质量低和自杀意念）的数据。我们构建并可视化了两个网络，计算了预期影响（EI）和桥接 EI 指数，以确定中心和桥接症状。
在 SBAD 网络中，无助感是连接压力和精神困扰的最中心和关键的桥接症状，情绪衰竭被确定为次要桥接症状。无助感、自我效能感和情绪衰竭与生活质量呈最强的负相关。无价值（PHQ6）和运动（PHQ8）症状与自杀意念呈强相关。估计的 SBAD 网络具有良好的稳定性和准确性。
本研究强调，无助感可能是预防和干预住院医师精神困扰和提高生活质量的重点目标。倦怠不仅与工作场所问题有关，还与抑郁、焦虑和生活质量广泛相关。在个体医生、卫生系统和专业学院以及外部监管者三个层面实施早期检测和干预措施对于预防和减轻住院医师的压力和精神困扰至关重要。
