研究生: |
張寧潔 Chang, Ning-Chieh |
---|---|
論文名稱: |
年輕醫師的心理與身體健康:以全國代表性資料的世代研究 Mental and Physical Health of Young Physicians:A Population-Representative Database Cohort Study |
指導教授: |
李子奇
Lee, Tzu-Chi |
學位類別: |
碩士 Master |
系所名稱: |
健康促進與衛生教育學系 Department of Health Promotion and Health Education |
論文出版年: | 2019 |
畢業學年度: | 107 |
語文別: | 英文 |
論文頁數: | 59 |
中文關鍵詞: | 年輕醫師 、全民健康保險資料庫 、世代研究 、焦慮症 、憂鬱症 、失眠 、高血壓 、高血脂 、糖尿病 、消化性潰瘍 、肌肉骨骼疾病 |
英文關鍵詞: | young physician, National Health Insurance Research Database, cohort study, anxiety, depression, insomnia, hypertension, hyperlipidemia, diabetes mellitus, peptic ulcer, musculoskeletal disorders |
DOI URL: | http://doi.org/10.6345/NTNU201900466 |
論文種類: | 學術論文 |
相關次數: | 點閱:266 下載:0 |
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目的:醫療工作場所環境複雜且高壓力,年輕醫生的新進訓練期可能對醫師心理與身體健康產生影響,降低其所提供之醫療服務品質與病人健康。本研究的目的是藉由台灣全民健康保險資料庫分析年輕醫生和非醫事人員之間的輕度精神疾病與慢性病之發病率。
研究設計:本研究以全國代表性資料庫進行世代研究。經醫事人員基本資料檔,篩選從2000年1月1日至2012年12月31日間,初次執業登記之醫師且年齡小於35歲者,共991位。將這些醫師與一般人口,依性別、年齡、居住地與投保薪資做配對,得到991位非暴露組。採用國際疾病診斷分類碼第九版(ICD-9-CM)定義心理與生裡慢性疾病,心理疾病包含焦慮症、憂鬱症與失眠;生理慢性疾病包含高血壓、高血脂、消化性潰瘍與肌肉骨骼疾病等,追蹤研究對象其心理與生理疾病狀況,至其退保或2013年12月31日止。統計分析以卡方檢定來評估暴露組與非暴露組間人口學特徵之差異,Cox廻歸分析來探討年輕醫師罹患心理與生理慢性疾病之風險。
研究結果:991名年輕醫生平均年齡為27.45±2.47歲,與非醫事人員相比,研究發現年輕醫生罹患焦慮症風險是一般人的3.06倍(adjusted aHR=3.06, 95% CI=1.49-6.26, P=0.002)及失眠症風險是一般人的6.21倍(aHR=6.21, 95% CI=3.36-11.48, P <0.001)。
結論:年輕醫生有較高的風險罹患焦慮症和失眠症。我們沒有找到證據表明年輕醫生罹患抑鬱症,慢性病(高血壓、高脂血症、糖尿病、消化性潰瘍和肌肉骨骼疾病)比非醫事人員高。
Objective: The effects of the attending of new young physicians on patient care have been reported. The period at which medical graduates become trainees, they are under high stress in the complex workplace. Physicians' health status may affect healthcare service quality and patient’s health. The aims of this study were to investigate mild mental disorders and chronic disease incidence between young physicians and non-health caregivers by using National Health Insurance Research Database(NHIRD) in Taiwan.
Methods: We included young physicians who first practice time aged fewer than 35 years and in our study. The index date was first medical license date 2000-2012, and followed. We included physicians with index date withdrew from NHIR program or December 31, 2013. The young physician and non-health caregivers participants were exact matched at a ratio 1:1 by sex-, age-, residence-, and insurance premium. Chi-Square test was used to examine the differences in characteristics distributions for participants. Cox regression used to investigate the incidence of disease for young physicians compared to the unexposed.
Results: A total 991 physicians (mean age 27.45±2.47) included in this study compared with unexposed, young physicians associated with a higher incidence of anxiety (adjusted hazard ratios, aHR=3.06, 95% confidence intervals, CI=1.49-6.26, P=0.002), insomnia (aHR=6.21, 95% CI=3.36-11.48, P <0.001). We had no enough evidence to show the association between young physicians and depression, hypertension, hyperlipidemia, diabetes mellitus, peptic ulcer, and musculoskeletal disorders.
Conclusions: Young physicians have associated with anxiety disorder and insomnia disorder, we have no evidence to show depression disorder, chronic disease (hypertension, hyperlipidemia, diabetes mellitus, peptic ulcer, and musculoskeletal disorders) have an association between young physicians and non-health caregivers.
1.Wrenn K, Lorenzen B, Jones I, Zhou C, Aronsky D. Factors affecting stress in emergency medicine residents while working in the ED. The American journal of emergency medicine. 2010;28(8):897-902.
2.Lue B-H, Chen H-J, Wang C-W, Cheng Y, Chen M-C. Stress, personal characteristics and burnout among first postgraduate year residents: a nationwide study in Taiwan. Medical teacher. 2010;32(5):400-407.
3.Boissy A, Windover AK, Bokar D, et al. Communication skills training for physicians improves patient satisfaction. Journal of general internal medicine. 2016;31(7):755-761.
4.Abdulghani HM, Al-Harbi MM, Irshad M. Stress and its
association with working efficiency of junior doctors during three postgraduate residency training programs. Neuropsychiatric disease and treatment. 2015;11:3023.
5.Yusoff MSB, Rahim AFA. Prevalence and sources of stress among postgraduate medical trainees: initial findings. ASEAN Journal of Psychiatry. 2010;11(2):180-189.
6.Parsa-Parsi RW. The revised declaration of geneva: A modern-day physician’s pledge. Jama. 2017;318(20):1971-1972.
7.Paiva CE, Martins BP, Paiva BSR. Doctor, are you healthy? A cross-sectional investigation of oncologist burnout, depression, and anxiety and an investigation of their associated factors. BMC cancer. 2018;18(1):1044.
8.Monrouxe LV, Bullock A, Tseng H-M, Wells SE. Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: a longitudinal cohort study. BMJ open. 2017;7(12):e017942.
9.Gunasingam N, Burns K, Edwards J, Dinh M, Walton M. Reducing stress and burnout in junior doctors: the impact of debriefing sessions. Postgraduate medical journal. 2015;91(1074):182-187.
10.Dyrbye LN, West CP, Satele D, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Academic Medicine. 2014;89(3):443-451.
11.Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annual review of psychology. 2001;52(1):397-422.
12.Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, de Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PloS one. 2017;12(10):e0185781.
13.Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. Jama. 2018;320(11):1131-1150.
14.Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA internal medicine. 2018;178(10):1317-1331.
15.West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. Jama. 2011;306(9):952-960.
16.Liu S-H, Li T-H, Lin Y-L, et al. Lower morbidity and disease risk among the Chinese medicine physicians in Taiwan. The Tohoku journal of experimental medicine. 2009;219(3):207-214.
17.Shen H-N, Lu C-L, Li C-Y. Do physicians have lower risk of severe sepsis and associated mortality? A matched cohort study. Critical care medicine. 2014;42(4):816-823.
18.Chen Y-t, Huang C-C, Weng S-F, et al. Acute myocardial infarction: a comparison of the risk between physicians and the general population. BioMed research international. 2015;2015.
19.Lin CM, Yang CH, Sung FC, Li CY. Risks and causes of hospitalizations among physicians in Taiwan. Health services research. 2008;43(2):675-692.
20.Huang CL-C, Weng S-F, Wang J-J, Hsu Y-W, Wu M-P. Risks of treated insomnia, anxiety, and depression in health care-seeking physicians: a nationwide population-based study. Medicine. 2015;94(35).
21.Kao L-T, Chiu Y-L, Lin H-C, Lee H-C, Chung S-D. Prevalence of chronic diseases among physicians in Taiwan: a population-based cross-sectional study. BMJ open. 2016;6(3):e009954.
22.Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1545-1602.
23.Saipanish R. Stress among medical students in a Thai medical school. Medical teacher. 2003;25(5):502-506.
24.Resnick ML. The effect of affect: Decision making in the emotional context of health care. Paper presented at: Proceedings of 2012 Symposium on Human Factors and Ergonomics in Health Care2012.
25.Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama. 2016;316(21):2214-2236.
26.Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. Jama. 2015;314(22):2373-2383.
27.Monrouxe L, Bullock A, Cole J, et al. How prepared are UK medical graduates for practice. Final report from a programme of research commissioned by the General Medical Council Cardiff: General Medical Council. 2014.
28.Mousa OY, Dhamoon MS, Lander S, Dhamoon AS. The MD blues: under-recognized depression and anxiety in medical trainees. PloS one. 2016;11(6):e0156554.
29.Lundin RM, Bashir K, Bullock A, et al. “I’d been like freaking out the whole night”: exploring emotion regulation based on junior doctors’ narratives. Advances in Health Sciences Education. 2018;23(1):7-28.
30.Baxter A, Scott K, Vos T, Whiteford H. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine. 2013;43(5):897-910.
31.Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
32.Cunnington D, Junge MF, Fernando AT. Insomnia: prevalence, consequences and effective treatment. Med J Aust. 2013;199(8):S36-40.
33.Hsieh Y-H, Hsu C-Y, Liu C-Y, Huang T-L. The levels of stress and depression among interns and clerks in three medical centers in Taiwan-a cross-sectional study. Chang Gung Med J. 2011;34(3):278-285.
34.Wu S-I, Tsay W-I, Wu M-H. Current controlled drug regulation in Taiwan. Acta Anaesthesiologica Taiwanica. 2015;53(2):51-54.
35.Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry. 2013;35(1):45-49.
36.Dailey SF, Gill CS, Karl SL, Minton CAB. DSM-5 learning companion for counselors. John Wiley & Sons; 2014.
37.Babu GR, Jotheeswaran A, Mahapatra T, et al. Republished: is hypertension associated with job strain? A meta-analysis of observational studies. Postgraduate medical journal. 2014;90(1065):402-409.
38.Lin H-Y, Weng S-F, Lin H-J, et al. Peptic ulcer disease in healthcare workers: a nationwide population-based cohort study. PloS one. 2015;10(8):e0135456.
39.Nyberg ST, Fransson EI, Heikkilä K, et al. Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women. Diabetes care. 2014;37(8):2268-2275.
40.Sui H, Sun N, Zhan L, Lu X, Chen T, Mao X. Association between work-related stress and risk for type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. PloS one. 2016;11(8):e0159978.
41.Knutsson A. Health disorders of shift workers. Occupational medicine. 2003;53(2):103-108.
42.Hsu JH, Wu YS. Survey of perceptions of safety and health in the work environment in 2010 Taiwan. Council of Labor Affairs (Taiwan), Institute of Occupational Safety & Health, Taipei (in Chinese). 2011.
43.Lin MH, Kuo CY. Survey of perceptions of safety and health in the work environment in 2013 Taiwan. Council of Labor Affairs (Taiwan), Institute of Occupational Safety & Health, Taipei (in Chinese). 2014.
44.Yung DE, Banfi T, Ciuti G, Arezzo A, Dario P, Koulaouzidis A. Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert review of gastroenterology & hepatology. 2017;11(10):939-947.
45.Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian journal of occupational and environmental medicine. 2014;18(2):75.
46.Administration NHI. 2016-2017 National Health Insurance Annual Report. Taipei: National Health Insurance Administration; 2016.
47.Liu C-Y, Hung Y-T, Chuang Y-L, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag. 2006;4(1):1-22.
48.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases. 1987;40(5):373-383.
49.Yu-Tseng Chu S-CW. A Review of claims-based Comorbidity Measures. Taiwan Journal of Public Health. 2010;29(1):8-21.
50.Lin Y-C, Lai C-C, Chien C-C, et al. Is insomnia a risk factor for new-onset asthma? A population-based study in Taiwan. BMJ open. 2017;7(11):e018714.
51.Chung Y-C, Hung C-T, Li S-F, et al. Risk of musculoskeletal disorder among Taiwanese nurses cohort: a nationwide population-based study. BMC musculoskeletal disorders. 2013;14(1):144.
52.Wang SY, Liu LC, Lu MC, Koo M. Comparisons of musculoskeletal disorders among ten different medical professions in Taiwan: a nationwide, population-based study. PLoS One. 2015;10(4):e0123750.
53.Clement S, Schauman O, Graham T, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine. 2015;45(1):11-27.
54.Francis MN, Wishart IM, Williamson T, Iverach R. Use of Pharmacologic Sleep Aids and Stimulants Among Emergency Medicine Staff Physicians in a Canadian Tertiary Care Setting: A Web-Based Survey. Annals of emergency medicine. 2019;73(4):325-329.
55.Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep medicine. 2019;55:40-47.
56.Peisah C, Latif E, Wilhelm K, Williams B. Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors. Aging and Mental Health. 2009;13(2):300-307.
57.Link BG, Phelan J. Social conditions as fundamental causes of disease. Journal of health and social behavior. 1995:80-94.
58.Bor J, Cohen GH, Galea S. Population health in an era of rising income inequality: USA, 1980–2015. The Lancet. 2017;389(10077):1475-1490.
59.Cockerham WC, Hamby BW, Oates GR. The social determinants of chronic disease. In: Elsevier; 2017.
60.Farris SG, Legasse AJ, Uebelacker LA, et al. Anxiety Sensitivity is Associated with Lower Enjoyment and an Anxiogenic Response to Physical Activity in Smokers. 2019;43(1):78-87.
61.Zinonos S, Zachariadou T, Zannetos S, Panayiotou AG, Georgiou AJTid. Smoking prevalence and associated risk factors among healthcare professionals in Nicosia general hospital, Cyprus: a cross-sectional study. 2016;14(1):14.
62.Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use disorders among American surgeons. Archives of surgery. 2012;147(2):168-174.
63.Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. The American journal on addictions. 2015;24(1):30-38.
64.Blumenthal H, Taylor DJ, Cloutier RM, Baxley C, Lasslett HJBt. The links between social anxiety disorder, insomnia symptoms, and alcohol use disorders: findings from a large sample of adolescents in the United States. 2019;50(1):50-59.
65.Aalto A-M, Heponiemi T, Josefsson K, Arffman M, Elovainio M. Social relationships in physicians’ work moderate relationship between workload and wellbeing—9-year follow-up study. European journal of public health. 2018;28(5):798-804.