The Job Stress And Depressive Symptom Of Physicians In Children's Hospital And Countermeasures

ObjectivesThe objectives of this research are to understand the physicians' job stress, mental health and their relationship, and to further explore the related factors which induce the job stress and psychological problems. It is aimed to provide the basis for psychological assessment and mental health care for the crowd, as well as provide scientific suggestions for human resources management and policy-making in the hospitals, especifically for the pediatrics under today's health care system.Methods1. Literature Survey: Based on the literature survey about job stress and mental health of physicians in China and abroad, the basic theories about physicians' job stress status and mental health are studied and summaried.2. Practical Research: According to the related literatures and "effort more than reward" tables, a new questionnaire was designed indepedently. From November 2008 to February 2009, the physicians in the Children's Hospital of School of Medicine, Zhejiang University and the Children's Hospital of Chongqing Medical University are surveyed in the way of purposive sampling. The questionnaire includes four parts: the physicians' socio-demographic characteristics and other variables, the extent of job stress, the depression symptoms, as well as the source of job stress. Among them, the extent of job stress on the physicians including three parts: effort, reward and overcommitment.3. Data Anaysis: After verifications, all survey data was analyzed by SPSS15.0 for Windows software package. In this study, count data was analyzed by proportion or rate, the comparison of proportion or rate between two groups or among several groups was analyzed by x~2 Testing, single-factor analysis, multi-Logistic regression analysis methods, et al. P<0.05 was considered significant statistical difference. Measurement data was expressed by (x|-)±SD , the difference between two groups or among several groups was analyzed by ANOVA.Results1. The total effective objects surveyed are 291 physicians, who came from different clinical departments and medical technology departments, including internal medicine, surgery, emergency, radiology, anesthesia, etc. Among these objects, 137 physicians were positive for "depressive symptoms", with the rate of 47.08%; 57 physicians were in an "effort more than reward" state (E/R value> 1), with the ratio of 24.36%; 84 physicians were positive for "overcommitment", with the ratio of 28.87%; in particular, the average CES-D score of 16.95, much higher than the national norm score of 11.52.2. In the items of whether "effort-reward imbalance", the statistically difference is significant among the physicians with different genders, different departments, different positions; in the items of whether "overcommitment", the statistically difference is significant among the physicians with different genders, different ages and the physicians with or without chronic diseases; in the items of whether having "depressive symptoms", there are several or more of the congnitive differences among physicians with different genders, different ages, different department, different positions and different titles.3. In the items of "effort -reward iimbalance" extent, the statistically difference is significant among the physicians with different genders, different ages, different departments, different positions; in the items of "overcommitment" extent, the statistically difference is significant among the physicians with different genders, different ages, different titles and the physicians with or without chronic diseases; in the items of "depressive symptoms" extent, there are several or more of the congnitive differences among physicians with different genders, different ages, different department, different positions and different titles.4. Logistic regression analysis showed that the main factors which affect the depressive symptoms of pediatrician include: age, marriage, department, and whether in the effort-reward imbalance.5. According to the contral studies, there are no statistically differences between the physicians from the clinical and the medical technical departments in the items of whether having chronic diseases, whether "effort-reward" imbalance and whether overcommitment. However, in the item of "overcommitment" extent, the statistically difference is significant. And also, in the item of "reward money and status", the statistically difference is significant. Generally, the situations of physicians from the clinical departments are worse in the "overcommitment" extent item and better in "reward money and status" item than the counterparts from the medical technical departments.6. In the aspects of stress sources, in terms of medical risk, patients and their families, work load and time, professional work, interpersonal relationship and social support, the objects survyed feel stress in different extent in the following aspects: be warried about medical accident, the suddent death of patients, the high requirement from the patients and their families, un-cooperation from the patients, too heavy research or teaching taskes, too little labors, too much workload, promotion, bad work environment, too little understanding and support from the management of the hospital, the rigor comments from the social media. On the other hand, there are significant statistically differences between the physicians having different stress extent. Among the physicians who chose "the largeest stress" and "the second largest stress", the ratio of physicians who have depressive symptoms is significantly larger than that who have no depressive symptoms.Conclusions:1. Compared with the general population, the overall depressive symptoms of physicians surveyed were worse. Because there is no norm of Effort-Reward scale, so the job stress degree of physicians surveyed can not be compared with general population.2. Except marriage and education, There is a one more of the congnitive differences among physicians of different demographic characteristics in the items of whether there is depressive symptom, whether in the "effort -reward imbalance" state, whether in the overcommitment state; Except marriage and education, There is a one more of the congnitive differences among physicians of different demographic characteristics in the following items: the extent of effort more than reward, the extent of overcommitment, the extent of depressive symptom.3. The main factors affect the depressive symptoms of physician include: age, marriage, department, whether in the effort -reward imbalance state; Therefore, the extent of job stress is one of the factors affecting the depressive symptoms of physicians.4. There are no statistically differences between the physicians from the clinical and the medical technical departments in the items of whether in "effort-reward imbalance", whether overcommitment, whether in depressive symptom. In the item of "overcommitment" extent, the statistically difference is significant.5. In the aspects of stress sources, in terms of medical risk, patients and their families, work load and time, professional work, interpersonal relationship and social support, the objects survyed feel "largest stress" or "the second largest stress". On the other hand, there are significant statistically differences between the physicians having different stress extent. Among the physicians who chose "the largeest stress" and "the second largest stress", the ratio of physicians who have depressive symptoms is significantly larger than those have no depressive symptoms.6. The Government, the society and the hospital should be support from the aspects of policy, public opinion, management measures, etc. to create conditions to reduce the physicians' job stress; Physicians also should strengthen their own professional knowledge and self-cultivation, be serious and responsible in their work, and be in a good mentality to increase their capacity to cope with various pressures.