Survey and analysis of mental health status of general practitioner training and interns in Yunnan Province
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摘要:
目的 了解云南省全科医师的心理健康状况，为促进全科医师心理健康提供一定的依据。 方法 采用微信问卷星小程序，用症状自评量表(SCL-90)对云南省三甲医院全科规培医师及全科实习医师行问卷调查，采用SPSS 23.0统计学软件行数据分析。 结果 调查总人数为323人，其中全科规培医师254人(78.6%)、全科实习医师69人(21.4%), 全科规培医师和实习医师除躯体化、人际关系、偏执、敌对因子外，总均分及剩余因子分均明显高于常模(均P＜0.05)；不同性别、医师类别、学历状态以及毕业后定点服务医院级别比较差异无统计学意义(均P＞0.05), 不同年龄阶段躯体化差异有统计学意义(P＜0.05)；除去未正式参加规培的全科实习医师，按住培基地所在地分组，地市级住培基地全科医师总分及各个因子的评分均高于省级全科医师，躯体化、恐怖因子的差异有统计学意义(均P＜0.05)。全科规培、实习医师总分评分＞160分的有73人(22.6%)；依据SCL-90总均分对规培医师的自我症状程度进行评价，没有症状的206人(63.8%)，自觉有症状但并无实际影响的94人(29.1%)，自觉有症状并有一定影响的17人(5.3%)，自觉有症状并有相当程度的影响的4人(1.2%)，自觉症状的频度和强度都十分严重的2人(0.6%)。 结论 全科规培和实习医师存在一定的心理健康问题，可能需要对其开展有针对性的心理健康教育工作。 Abstract:Objective To investigate the mental health status of general practitioners in Yunnan province, and to provide a basis for promoting their mental health. Methods Symptom check list-90 (SCL-90) was used to conduct an online questionnaire survey among trained general practitioner training and interns in Yunnan Province by WeChat questionnaire. SPSS 23.0 was used for statistical analysis of data. Results A total of 323 participants were involved, including 254 general practitioners training (78.6%) and 69 interns (21.4%). Except for somatization, interpersonal relationship, paranoia and hostility, the total mean score and other factors were significantly higher than the normed-reference control (all P<0.05). There were no significant differences in gender, category of doctors, educational status and level of designated service hospital after graduation (all P>0.05). The differences of somatization factors at different ages were statistically significant (P<0.05). Among different working hospitals group, the total score and the scores of each factor of the general practitioners who were trained in the municipal grade hospitals were higher than those in the provincial hospitals, and the differences in somatization and phobia factors were statistically significant (P<0.05). There were 73 (22.6%) general practitioners training and interns with a total score rating >160. There were 206 participants (63.8%) with no symptoms, 94 (29.1%) with tiny symptoms, 17 (5.3%) with symptoms, 4 (1.2%) with relative obvious symptoms, and 2 (0.6%) reported severe symptoms appearing frequently. Conclusion There are some mental health problems in general practitioners training and interns. It is necessary to carry out targeted mental health intervention for them. -
Key words:
- General practitioner training /
- Mental health /
- Symptom check list-90
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表 1 云南省全科规培及实习医师与全国常模SCL-90评分比较(x±s，分)
Table 1. Comparison of standard SCL-90 scores between general practitioners trained in Yunnan Province and the national norm(x±s, points)
项目 全科规培及实习医师(n=323) 全国常模
(n=1 388)t值 P值 躯体化 1.43±0.59 1.37±0.48 1.933 0.053 强迫 1.77±0.72 1.62±0.58 3.988 <0.001 人际关系 1.59±0.71 1.65±0.51 1.435 0.152 抑郁 1.61±0.74 1.50±0.59 2.867 0.004 焦虑 1.51±0.68 1.39±0.43 3.988 <0.001 敌对 1.48±0.63 1.48±0.56 <0.001 0.999 恐怖 1.34±0.60 1.23±0.41 3.940 <0.001 偏执 1.35±0.58 1.43±0.57 2.240 0.338 精神病性 1.35±0.58 1.29±0.42 2.137 0.033 
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表 2 不同性别SCL-90总均分及各因子分比较[M(P25, P75)，分]
Table 2. Comparison of total mean score and each factor score of SCL-90 of different genders [M(P25, P75), points]
项目 男性(n=120) 女性(n=203) Z值 P值 总均分 1.3(1.0, 1.7) 1.3(1.1, 1.7) -0.832 0.405 躯体化 1.2(1.0, 1.6) 1.3(1.1, 1.6) -0.971 0.331 强迫 1.6(1.1, 2.1) 1.6(1.2, 2.2) -1.226 0.220 人际关系 1.3(1.0, 1.9) 1.3(1.0, 2.0) -0.568 0.570 抑郁 1.4(1.0, 1.9) 1.3(1.1, 1.9) -0.513 0.608 焦虑 1.2(1.0, 1.7) 1.3(1.1, 1.6) -0.673 0.501 敌对 1.2(1.0, 1.7) 1.3(1.2, 1.7) -0.767 0.443 恐怖 1.0(1.0, 1.4) 1.0(1.0, 1.4) -0.161 0.872 偏执 1.2(1.0, 1.5) 1.2(1.0, 1.5) -0.062 0.950 精神病性 1.1(1.0, 1.5) 1.1(1.0, 1.5) -0.555 0.579 其他均分 1.3(1.0, 1.9) 1.3(1.0, 1.7) -0.161 0.872
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表 3 不同年龄SCL-90总均分及各因子分比较[M(P25, P75)，分]
Table 3. Comparison of total mean score and each factor score of SCL-90 at different ages[M(P25, P75), points]
项目 20~25岁
(n=190)26~30岁
(n=133)Z值 P值 总均分 1.2(1.1, 1.7) 1.3(1.1, 1.8) -1.868 0.062 躯体化 1.2(1.0, 1.5) 1.3(1.1, 1.7) -2.510 0.012 强迫 1.6(1.2, 2.1) 1.7(1.2, 2.2) -1.286 0.199 人际关系 1.2(1.0, 1.9) 1.3(1.0, 2.1) -0.929 0.353 抑郁 1.3(1.0, 1.9) 1.4(1.2, 2.0) -1.960 0.050 焦虑 1.2(1.0, 1.6) 1.3(1.1, 1.8) -1.547 0.122 敌对 1.2(1.0, 1.7) 1.3(1.2, 1.7) -1.595 0.111 恐怖 1.0(1.0, 1.4) 1.0(1.0, 1.7) -1.395 0.163 偏执 1.0(1.0, 1.5) 1.2(1.0, 1.5) -1.362 0.173 精神病性 1.1(1.0, 1.4) 1.1(1.0, 1.6) -1.960 0.050 其他均分 1.3(1.0, 1.7) 1.4(1.0, 1.9) -1.394 0.163
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表 4 不同医师类别SCL-90总均分及各因子分比较[M(P25, P75)，分]
Table 4. Comparison of total mean score and each factor score of SCL-90 among different physician categories[M(P25, P75), points]
项目 全科规培医师
(n=245)全科专业实习医师
(n=69)全科研究生
(n=9)χ2值 P值 总均分 1.3(1.1, 1.8) 1.3(1.1, 1.7) 1.1(1.0, 1.4) 3.767 0.152 躯体化 1.3(1.1, 1.7) 1.2(1.0, 1.5) 1.1(1.0, 1.3) 4.955 0.084 强迫 1.6(1.2, 2.2) 1.6(1.1, 2.1) 1.3(1.1, 1.8) 2.730 0.255 人际关系 1.3(1.0, 2.0) 1.3(1.0, 2.0) 1.1(1.0, 1.8) 1.272 0.530 抑郁 1.3(1.1, 2.0) 1.3(1.0, 1.8) 1.2(1.0, 1.7) 4.379 0.112 焦虑 1.3(1.1, 1.7) 1.2(1.0, 1.7) 1.1(1.0, 1.3) 3.851 0.146 敌对 1.3(1.2, 1.7) 1.2(1.0, 1.7) 1.0(1.0, 1.3) 3.716 0.156 恐怖 1.0(1.0, 1.4) 1.1(1.0, 1.4) 1.0(1.0, 1.4) 0.373 0.830 偏执 1.2(1.0, 1.5) 1.0(1.0, 1.5) 1.0(1.0, 1.2) 3.905 0.142 精神病性 1.1(1.0, 1.5) 1.1(1.0, 1.5) 1.0(1.0, 1.6) 1.369 0.504 其他均分 1.3(1.0, 1.9) 1.3(1.0, 1.7) 1.1(1.0, 1.3) 4.619 0.099
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表 5 不同学历状态SCL-90总均分及各因子分比较
Table 5. Comparison of total mean score and each factor score of SCL-90 of different educational status
项目 本科在读
(n=69)本科已毕业
(n=254)Z值 P值 总均分 1.3(1.1, 1.7) 1.3(1.1, 1.7) -1.210 0.226 躯体化 1.2(1.0, 1.5) 1.3(1.1, 1.7) -1.276 0.202 强迫 1.6(1.1, 2.1) 1.6(1.2, 2.1) -0.936 0.349 人际关系 1.3(1.0, 2.0) 1.3(1.0, 2.0) -0.289 0.773 抑郁 1.3(1.0, 1.8) 1.3(1.1, 2.0) -1.581 0.114 焦虑 1.2(1.0, 1.7) 1.3(1.1, 1.6) -1.043 0.297 敌对 1.2(1.0, 1.7) 1.3(1.2, 1.7) -0.627 0.531 恐怖 1.1(1.0, 1.4) 1.0(1.0, 1.4) -0.497 0.619 偏执 1.0(1.0, 1.5) 1.2(1.0, 1.5) -0.916 0.360 精神病性 1.1(1.0, 1.5) 1.1(1.0, 1.5) -0.579 0.562 其他均分 1.3(1.0, 1.7) 1.3(1.0, 1.9) -1.410 0.159
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表 6 不同毕业后定点服务医院级别SCL-90总均分及各因子分比较[M(P25, P75)，分]
Table 6. Comparison of total mean score and each factor score of SCL-90 in different designated service hospitals after graduation[M(P25, P75), points]
项目 无单位
(n=27)省市级医院
(n=13)县级医院
(n=25)乡镇卫生院
(n=64)社区服务中心
(n=194)χ2值 P值 总均分 1.3(1.1, 1.8) 1.0(1.0, 1.4) 1.3(1.1, 2.0) 1.3(1.1, 1.6) 1.3(1.1, 1.8) 6.915 0.140 躯体化 1.3(1.0, 1.5) 1.1(1.0, 1.6) 1.3(1.1, 1.7) 1.3(1.1, 1.6) 1.2(1.1, 1.6) 2.091 0.719 强迫 1.4(1.1, 2.1) 1.2(1.0, 1.8) 1.6(1.2, 2.4) 1.6(1.2, 1.9) 1.6(1.2, 2.2) 4.701 0.319 人际关系 1.3(1.0, 2.0) 1.0(1.0, 1.4) 1.2(1.0, 2.1) 1.3(1.0, 1.8) 1.3(1.1, 2.1) 6.533 0.163 抑郁 1.4(1.1, 1.9) 1.0(1.0, 1.2) 1.2(1.1, 2.1) 1.3(1.1, 1.7) 1.4(1.1, 2.0) 8.987 0.061 焦虑 1.2(1.0, 1.8) 1.1(1.0, 1.4) 1.4(1.1, 2.0) 1.2(1.1, 1.5) 1.3(1.0, 1.7) 4.588 0.332 敌对 1.2(1.0, 1.7) 1.0(1.0, 1.3) 1.2(1.2, 1.7) 1.3(1.2, 1.6) 1.3(1.2, 1.7) 7.158 0.128 恐怖 1.0(1.0, 1.6) 1.0(1.0, 1.1) 1.0(1.0, 1.6) 1.0(1.0, 1.4) 1.0(1.0, 1.4) 2.614 0.624 偏执 1.2(1.0, 1.5) 1.0(1.0, 1.3) 1.2(1.0, 1.4) 1.2(1.0, 1.3) 1.2(1.0, 1.5) 2.342 0.673 精神病性 1.0(1.0, 1.6) 1.0(1.0, 1.1) 1.1(1.0, 1.6) 1.1(1.0, 1.4) 1.1(1.0, 1.5) 4.993 0.288 其他均分 1.3(1.0, 1.9) 1.0(1.0, 1.4) 1.3(1.0, 1.9) 1.4(1.0, 1.7) 1.3(1.0, 1.9) 4.119 0.390
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表 7 云南省全科地市级医院及省级医院规培医师SCL-90评分比较[M(P25, P75)，分]
Table 7. Comparison of SCL-90 scores of trained physicians in general hospitals and provincial hospitals in Yunnan Province[M(P25, P75), points]
项目 地市级医院规培医师(n=93) 省级医院规培医师(n=161) Z值 P值 总分 125(98, 169) 111(99, 149) -1.306 0.192 总均分 1.4(1.1, 1.9) 1.2(1.1, 1.7) -1.306 0.192 躯体化 1.3(1.1, 2.0) 1.2(1.1, 1.5) -2.487 0.013 强迫 1.8(1.2, 2.3) 1.6(1.2, 2.0) -0.995 0.320 人际关系 1.3(1.0, 2.1) 1.3(1.0, 1.8) -0.785 0.432 抑郁 1.5(1.1, 2.2) 1.3(1.1, 1.8) -1.182 0.237 焦虑 1.4(1.1, 2.0) 1.2(1.1, 1.6) -1.930 0.054 敌对 1.3(1.2, 1.8) 1.2(1.2, 1.7) -1.401 0.161 恐怖 1.1(1.0, 1.7) 1.0(1.0, 1.3) -2.300 0.021 偏执 1.2(1.0, 1.8) 1.2(1.0, 1.3) -1.742 0.082 精神病性 1.2(1.0, 1.8) 1.1(1.0, 1.5) -1.895 0.058 其他均分 1.4(1.0, 2.0) 1.3(1.0, 1.7) -1.423 0.155
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