文献基本信息
期刊：Annalsof Medicine
文章名称：Interrelationshipsof stress, burnout, anxiety, depression, quality of life andsuicidality among Chinese residents under Standardized ResidencyTraining: a network analysis
作者：ZejunLi, Min Wu等
DOI:https://doi.org/10.1080/07853890.2024.2433030
发表时间：2024年11月28日
文献摘要
Background:Chinese resident physicians confront challenges such as staffshortages and heavy workloads, leading to a heightened prevalence ofmental distress. This study aims to investigate the symptom networkof stress, burnout, anxiety, depression (SBAD) and adverse personaloutcomes in this cohort.
Methods:From October 2020 to April 2022, 994 physicians were recruited acrosschina through snowball sampling. Stress, burnout, anxiety anddepression were assessed using the 10-item Perceived stress scale, atwo-item burnout questionnaire, Generalized anxiety Disorder scale-7and the Patient health Questionnaire-9, respectively. Data on adversepersonal 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 identifycentral and bridge symptoms.
Results:In the SBAD network, perceived helplessness was the most central andcritical bridge symptom connecting stress and mental distress, withemotional exhaustion identified as the secondary bridge symptom.Perceived helplessness, perceived self-efficacy and emotionalexhaustion exhibited the highest negative correlations with QOL.Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlatedwith suicidal ideation. the estimated SBAD network showed excellentstability and accuracy.
Conclusions:Our study emphasizes that perceived helplessness may be ahigh-priority target for preventing and intervening in mentaldistress and improving QOL among residents. Burnout transcendsworkplace problems and is widely connected to depression, anxiety andQOL. Implementing early detection and intervention measures at threelevels—the individual physician, health system and professionalcolleges, and external regulators—is crucial for preventing andalleviating stress and mental distress among residents.
背景
中国住院医师面临着人员短缺和工作量繁重等挑战，导致其精神疾病的发生率增加。本研究旨在调查中国住院医师群体中压力、职业倦怠、焦虑、抑郁（SBAD）的症状网络以及个人不良结局。
方法
从2020年10月到2022年4月，通过滚雪球式抽样在中国各地招募了994名医生。压力、职业倦怠、焦虑和抑郁分别通过10项感知压力量表、2项职业倦怠问卷、广泛性焦虑症量表-7和患者健康问卷-9进行评估。本研究还收集了有关个人不良结局（生活质量低下【QOL】和自杀倾向）的数据，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，以确定中心症状和桥接症状。
结果
在SBAD网络中，无助感是压力和精神痛苦的最核心、最关键的桥接症状，情绪耗竭是次要的桥梁接症状。无助感、自我效能感和情绪耗竭是QOL负向最相关的因素。无价值感（PHQ6）和运动症状（PHQ8）与自杀意念密切相关。
结论
本研究发现表明，无助感可能是预防和干预住院医师精神痛苦并改善其QOL的优先目标。职业倦怠超越了工作场所问题，与抑郁、焦虑和QOL广泛相关。在医生个人、医疗系统和专业学会以及外部监管机构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痛苦至关重要。
Figure1. network structure of stress, burnout, depression and anxietysymptoms in resident physicians.
Figure2. The central and bridge symptoms of thestress-burnout-anxiety-depression (SBAD) network.
Figure3. The stability and accuracy of the SBAD network.
Figure4. Flow network of adverse personal outcomes for resident physicians.
