| [Objective]1.Occupational stress is a common state in the work of workers.Compared with other occupations,the high intensity of work and the increasingly tense doctor-patient relationship of medical staff in China are more likely to produce occupational stress.at present,there are few studies on the relationship between occupational stress,job burnout and depressive symptoms in China,and there are some defects such as small sample size in the existing survey design.2.This study aimed to understand the level of occupational stress,job burnout and depressive symptoms of medical staff in three hospitals in Guangzhou,and to analyze the main influencing factors of occupational stress,job burnout and depressive symptoms.Also,we analyzed the effect of job burnout on the relationship between occupational stress and depressive symptoms.3.The effects of occupational stress and depression on the levels of interleukin-6(IL-6)and interleukin-2(IL-2)were detected to explore the indicative effect of serum level of interleukin on the change of mental health level of medical staff,so as to provide basis and reference for the study of biomarkers related to occupational stress in medical staff.[Methods]1.Questionnaire surveyWe recruited 1 545 medical staffs from 3 hospitals in Guangzhou City by cluster random sampling.The levels of the occupational stress,the job burnout,and the depressive symptoms were investigated by the Basic Situation Questionnaire,the Pay-Return Imbalance Questionnaire,the General Job Burnout Scale,and the Patient Health Questionnaire Depression Scale.A multiple linear model was constructed by the stepwise regression with occupational stress as independent variable,occupational burnout as mediator,and depressive symptoms as the dependent variable to evaluate the relationship among the three.2.Determination of Interleukin-6(IL-6)and Interleukin-2(IL-2)concentrationBlood samples were collected from 217 medical workers who agreed to participate in the study,and their serum IL-6 and IL-2 levels were measured by enzyme-linked immunosorbent assay(ELISA).T-test or one-way ANOVA was used to compare the differences of IL-6 and IL-2 concentrations among different demographic and occupational characteristics groups.Pearson correlation analysis was applied to analyze the relationship between the scores of different dimensions of the occupational stress questionnaire,depressive symptoms and the level of IL-6 and IL-2.[Results]1.Current situation and influencing factors of occupational stress in medical staff.In these 1545 medical staffs,the dimensions scores of pay,return,and internal input in occupational stress are 3.0±0.8,3.9±0.6,and 2.5±0.8,respectively.The mean of effort-reward imbalance(ERI)index was 0.8±0.4;a total of 308 medical staffs were diagnosed with high occupational stress basing on the ERI model,counting the detection rate was 19.9%.The job burnout score was 1.8±1.1;the dimensions scores of emotional exhaustion,depersonalization.The ERI index of 35～<45 year-old group was higher than that in<25 year-old group;the ERI index of the widowed group was higher than the other four groups;the ERI indexes in the groups of nurse,management,and logistics were lower than clinician group,the ERI index of<5year-old group was lower than other three groups,and the ERI index of week working time>70 hours group was higher than other four groups(P<0.05).The ERI index of the shift+night shift group was higher than the other two groups(P<0.05).2.Current situation and influencing factors of job burnout of medical staffThe job burnout score was 1.8±1.1;the dimensions scores of emotional exhaustion,depersonalization,job satisfaction are 2.2±1.6,1.5±1.4,and 4.4±1.5,respectively.There were 133 medical staffs suffering from job burnout with a detection rate of 8.6%.The scores of job burnout in the≥45 year-old group were lower than those in the other three groups(P<0.05).The scores of job burnout in the widowed group were higher than those in the married cohabitation,married separation and divorce groups(P<0.05).The scores of job burnout in the group with a monthly income≥11000 yuan were lower than those in the group with 3000 yuan(P<0.05).The scores of job burnout in the working age of 10～<15 years group and≥15 years group were lower than those in the 5～<10 years group(P<0.05).The score of job burnout in the group with a weekly working time≤40 hours was lower than that in the other four groups(P<0.05).The scores of job burnout in the shift+night shift group were higher than those in the other two groups(P<0.05).3.Depressive symptoms of medical staff and its influencing factorsThe score of depressive symptoms in 1545 medical staff was 7.8±4.5,and 391patients with depressive symptoms were detected,with a detection rate of 25.3%.The scores of depressive symptoms in≥45 year-old group were lower than those in the<25 year-old group and 25～<35 years old group(P<0.05).The scores of depressive symptoms in the widowed group were higher than those in the other four groups(P<0.05).The scores of depressive symptoms in the management and logistics group were lower than those in the other three groups(P<0.05).The score of depressive symptoms in the working week≤40h group was lower than that in the other three groups(P<0.05).The score of depressive symptoms in the shift+night shift group was higher than that in the other two groups(P<0.05).4.The relationship between occupational stress and the levels of IL-6 and IL-2The average concentrations of IL-6 and IL2 in 217 medical workers were(4.52±3.27)pg/ml,IL-2 and(11.46±6.78)pg/ml in the range of 1.02-32.31pg/ml and6.26-65.58 pg/ml respectively.There were significant differences in the concentrations of IL-6 and IL-2 among medical workers with different degrees of occupational stress.The concentration of IL-6 in the high occupational stress group was higher than that in the non-high occupational stress group,and the level of IL-2 in the high occupational stress group was lower than that in the non-high occupational stress group.The IL-6 level of medical staff was positively correlated with the dimensions of pay and internal input(r_s=0.401,r_s=0.412,P<0.01),and negatively correlated with the dimension of return(r_s=-0.655,P<0.01).The IL-2 level of medical staff was negatively correlated with the dimensions of pay and internal input(rs=-0.616,r_s=-0.414,P<0.01),and positively correlated with the dimension of return(r_s=0.542,P<0.01).5.The relationship between depressive symptoms and IL-6、IL-2The levels of IL-6 and IL-2 were significant differences among medical workers with different depressive symptoms.The level of IL-6 in the high occupational stress group was higher than that in the non-high occupational stress group(t=3.988,P<0.001).The level of IL-2 in the high occupational stress group was lower than that in the non-high occupational stress group(t=3.426,P<0.001).There was no correlation between the scores of depressive symptoms and the levels of IL-6 and IL-2 in medical staff(r_s=0.074,r_s=0.042,P>0.05).6.The relationship between occupational stress,job burnout and depressive symptoms.The scores of job burnout of medical staff were positively correlated with the scores of occupational stress pay,intrinsic input and depression symptoms(r_s=0.412,0.542,0.667).The scores of depressive symptoms were positively correlated with the scores of occupational stress pay and internal input(r_s=0.436,0.542)and negatively correlated with the score of return dimension of occupational stress(r_s=-0.514,P<0.01).Job burnout plays an intermediary role in the relationship between occupational stress and depressive symptoms;that is,occupational stress can predict depressive symptoms directly but also affect depressive symptoms indirectly through the job burnout.[Conclusions]1.Age,sex,marital status,current working position,length of service,working hours and shifts are the influencing factors of occupational stress of medical staffs;age,marital status,monthly income,current post,length of service,weekly working hours and shift status are the influencing factors of job burnout of medical staffs;age and weekly working hours are the main influencing factors of depressive symptoms of medical staffs.2.Occupational stress of medical staffs can not only directly predict depressive symptoms,but also indirectly affect depressive symptoms through job burnout.3.The levels of IL-6 and IL-2 of medical staff are affected by occupational stress,the level of IL-6 is positively correlated with occupational stress,and there is a negative relationship between the level of IL-2 and occupational stress.The concentrations of IL-6 and IL-2 are expected to be regarded as early predictors of occupational stress of medical staff However,this result should has been further verified. |
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