全科住院医师规范化培训学员心理健康状况及其影响因素分析:一项混合方法研究  

Mental Health Status and Factors Associated with Psychological Problems among Trainees Attending the Standardized General Practice Residency Program:a Mixed-method Study

作　　者：夏瑀 林齐睿 郑芳芳 张锦枝[3] XIA Yu;LIN Qirui;ZHENG Fangfang;ZHANG Jinzhi(General Practice Department,Peking University Shenzhen Hospital,Shenzhen 518036,China;Hepatobiliary Surgery Department,Peking University Shenzhen Hospital,Shenzhen 518036,China;Scientific Research and Teaching Department,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院全科医学科,广东省深圳市518036 [2]北京大学深圳医院肝胆外科,广东省深圳市518036 [3]北京大学深圳医院科研教学部,广东省深圳市518036

出　　处：《中国全科医学》2022年第16期2028-2035,共8页Chinese General Practice

基　　金：北京大学深圳医院教育教学研究基金资助项目(JX202006)。

摘　　要：背景近年来,全科住院医师规范化培训(简称住培)学员的心理健康逐渐受到重视,心理问题被认为是导致其无法完成规定时长培训的主要原因之一。因此,了解全科住培学员心理健康状况并探讨其出现心理问题的影响因素,对住培政策及方案的制定有着重要的指导意义。目的了解全科住培学员心理健康状况,并从受访者处对其心理问题产生的原因进行挖掘,旨在提高住培管理者及社会对住培学员心理健康的关注程度。方法本研究采用基于解释性序列设计的混合研究方法。于2021年1月,采用方便抽样法,选取北京大学深圳医院全体在岗全科住培学员为研究对象,采用自设问卷〔内容包括一般资料调查表、症状自评量表(SCL-90)〕对其进行调查。分析全科住培学员SCL-90总得分及各因子得分情况,比较不同年级全科住培学员SCL-90各因子得分及总症状指数的差异。2021年2—6月,采用现象学研究法,目的性、异质性抽取已接受心理健康评估的全科住培学员作为访谈对象,对其进行“一对一”的半结构化深度访谈,以了解诱发情绪或心理问题的主要生活事件及其与住培或专业之间的联系、全科住培学员希望得到的帮助及其对住培方案的建议。应用NVivo 12软件对访谈内容进行编码、归类;采用Colaizzi七步分析法对资料进行整理、分析,并提炼访谈主题。结果共回收有效问卷84份,有效问卷回收率100.0%。84例全科住培学员SCL-90平均总得分为(149.61±50.55)分,平均总症状指数为(1.66±0.56)。其中29例(34.5%)总分≥160分;分别有45例(53.6%)、33例(39.3%)、29例(34.5%)、22例(26.2%)、19例(22.6%)、18例(21.4%)、16例(19.0%)、12例(14.3%)、12例(14.3%)全科住培学员的强迫症状、抑郁、人际关系敏感、焦虑、偏执、敌对、精神病性、躯体化及恐怖因子分≥2分。不同年级全科住培学员抑郁因子分比较,差异有统计学意Background The mental health of trainees receiving the three-year standardized general practice residency program(SGPRP)has been valued recently,and psychological problems are considered to be one major type of causes of their failure to complete the full training.So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.Objective To explore the mental health status and causes of psychological problems in GP trainees of SGPRP,improving the attention of SGPRP managers and the society given to the mental health of GP trainees.Methods This was a mixedmethod sequential explanatory study.In January 2021,by use of convenience sampling,all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90(SCL-90).The total score and domain scores of the SCL-90 were analyzed overall,then were compared among the trainees by grade.For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty,and GP trainees'preferred assistance as well as suggestions for the development of SGPRP,from February to June 2021,purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth,semi-structured interview using phenomenological research procedure.The interview results were recorded,and transcribed,then coded using NVivo 12,and analyzed using Colaizzi's seven-step analysis and thematic analysis.Results All GPs(n=84)responded to the survey,with a 100%response rate.The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were(149.61±50.55),and(1.66±0.56),respectively.Of them,29(34.5%)had a total score≥160.The prevalence of obsessive-compulsive,depression,interper

关 键 词：全科医学 住院医师规范化培训 心理健康 影响因素分析 混合方法研究 

分 类 号：R192[医药卫生—卫生事业管理] R-05[医药卫生—公共卫生与预防医学]