Wang Qiaochu, Ding Jiayun, Dai Yiming, Yang Sijia, Zhou Zhijun
Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, No. 130 Dong'an Road, Shanghai 200032, China.
Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No. 138 Yixueyuan Road, Shanghai 200032, China.
Healthcare (Basel). 2025 Jul 3;13(13):1600. doi: 10.3390/healthcare13131600.
: Occupational burnout and fatigue are critical issues affecting the health and performance of healthcare workers (HCWs) globally. These outcomes are often driven by complex and overlapping work-related stressors, which remain insufficiently understood in combination. : To investigate the associations of multiple work-related stressors with occupational burnout and fatigue, and to identify distinct stress patterns and critical stressors among HCWs. : A cross-sectional survey was conducted using a self-administered electronic questionnaire among 2695 HCWs in Shanghai, China. Validated questionnaire scales were used to assess work-related stress (self-developed occupational stress scale for medical staff, CSSM), occupational burnout (Maslach Burnout Inventory-General Survey, MBI-GS), and fatigue (Fatigue Scale-14, FS-14). Latent profile analysis (LPA) was employed to identify distinct work-related stress patterns. Generalized linear models (GLMs) were used to explore the associations between individual stressors, stress patterns, and occupational burnout and fatigue. Additionally, weighted quantile sum (WQS) models were utilized to evaluate the combined effects of multiple stressors and identify the main contributors. : In this study, 77.0% and 71.2% of participants were classified as experiencing occupational burnout and fatigue, respectively. A strained doctor-patient relationship was the highest-rated work-related stressor. All work-related stressors, including career development, interpersonal relationships, work-life imbalance, physical environment, doctor-patient relationship, social environment, and workload, were significantly associated with burnout (β: 0.4440.956, < 0.001) and fatigue (β: 1.3843.404, < 0.001). WQS assigned higher weights to career development and workload for burnout, and to workload and work-life imbalance for fatigue. LPA identified two distinct occupational stress patterns. HCWs characterized by higher stress levels in physical environment, career development, workload, and interpersonal relationships exhibited significantly higher burnout scores (β = 0.325, 95% CI: 0.122, 0.528), particularly in the reduced personal accomplishment (PA) dimension (β = 1.003, 95% CI: 0.746, 1.259). : This study highlighted the high prevalence of occupational burnout and fatigue among HCWs in Shanghai, China. Occupational stressors were associated with both burnout and fatigue, with higher workload, work-life imbalance, and poorer career development showing particularly significant contributions. These findings emphasized the urgent need for targeted interventions, including workload management, career development programs, and mental health support, to reduce occupational stress and mitigate its adverse effects on HCWs.
职业倦怠和疲劳是影响全球医护人员健康和工作表现的关键问题。这些结果往往由复杂且相互重叠的工作相关压力源驱动，而这些压力源综合起来仍未得到充分理解。
调查多种工作相关压力源与职业倦怠和疲劳之间的关联，并识别医护人员中不同的压力模式和关键压力源。
在中国上海对2695名医护人员进行了一项横断面调查，使用自行填写的电子问卷。采用经过验证的问卷量表评估工作相关压力（自行编制的医护人员职业压力量表，CSSM）、职业倦怠（马氏职业倦怠量表通用版，MBI-GS）和疲劳（疲劳量表-14，FS-14）。采用潜在类别分析（LPA）识别不同的工作相关压力模式。使用广义线性模型（GLMs）探索个体压力源、压力模式与职业倦怠和疲劳之间的关联。此外，使用加权分位数和（WQS）模型评估多种压力源的综合影响并确定主要影响因素。
在本研究中，分别有77.0%和71.2%的参与者被归类为经历职业倦怠和疲劳。医患关系紧张是评分最高的工作相关压力源。所有工作相关压力源，包括职业发展、人际关系、工作生活失衡、物理环境、医患关系、社会环境和工作量，均与倦怠（β：0.4440.956，P<0.001）和疲劳（β：1.3843.404，P<0.001）显著相关。WQS对职业倦怠中职业发展和工作量赋予较高权重，对疲劳中工作量和工作生活失衡赋予较高权重。LPA识别出两种不同的职业压力模式。在物理环境、职业发展、工作量和人际关系方面压力水平较高的医护人员表现出显著更高的倦怠得分（β = 0.325，95%CI：0.122，0.528），特别是在个人成就感降低（PA）维度（β = 1.003，95%CI：0.746，1.259）。
本研究强调了中国上海医护人员中职业倦怠和疲劳的高患病率。职业压力源与倦怠和疲劳均相关，工作量大、工作生活失衡和职业发展较差的影响尤为显著。这些发现强调了迫切需要采取针对性干预措施，包括工作量管理、职业发展计划和心理健康支持，以减轻职业压力并减轻其对医护人员的不利影响。
