Association of work-family conflict with suicidal ideation among medical staff: a cross-sectional survey in Shandong province
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摘要:
目的 探讨医务人员工作家庭冲突与自杀意念的关系，为预防和减少医务人员自杀意念和自杀行为的产生并采取有针对性的干预措施提供参考依据。 方法 于2018年11月 — 2019年1月，采用多阶段分层随机抽样方法抽取山东省3 426名医务人员，采用自杀意念筛查问题（终生和1年自杀意念）、医生工作 – 家庭冲突量表和流调中心抑郁量表（CES-D）进行调查。 结果 终生自杀意念和1年自杀意念的报告率分别为9.1%和7.0%；多因素logistic 回归分析结果显示，男性（OR = 0.54，P < 0.001）是医务人员终生自杀意念的保护因素，受教育程度为博士（OR = 4.32，P < 0.001）、有躯体疾病（OR = 1.58，P < 0.01）、工作家庭冲突（OR = 1.03，P < 0.01）和抑郁症状（OR = 1.09，P < 0.001）是医务人员终生自杀意念的危险因素。男性（OR = 0.46，P < 0.001）是医务人员1年自杀意念的保护因素，受教育程度为博士（OR = 4.21，P < 0.01）、有躯体疾病（OR = 1.51，P < 0.05）、工作家庭冲突（OR = 1.02，P < 0.05）和抑郁症状（OR = 1.10，P < 0.001）是医务人员一年自杀意念的危险因素。中介效应检验结果显示，抑郁症状在工作家庭冲突和终生自杀意念和1年自杀意念之间存在中介效应，中介效应值分别为0.0237和0.0265，分别占总效应比45.84%和53.64%。 结论 医务人员工作家庭冲突对自杀意念有直接影响，并通过增加抑郁症状的发生率正向影响自杀意念的产生。 Abstract:Objective To explore the association of work-family conflict with suicidal ideation among medical staff for developing relevant interventions to prevent suicidal ideation and behavior in the population. Methods A face-to-face questionnaire survey was conducted among 3 426 medical staff recruited at 12 general hospitals in 12 districts/counties of Shandong province from November 2018 through January 2019. The participants were asked to answer questions on lifetime and past one year suicidal ideation and scales including Center for Epidemiological Studies Depression (CES-D), Perceived Social Support Scale (PSSS), Simplified Coping Style Questionnaire (SCSQ), and the Work-Family Conflict Scale developed by domestic researchers. Results Of all the participants, 9.1% and 7.0% reported lifetime and one-year suicidal ideation. Multivariate logistic regression analysis revealed following risk factors for lifetime and one-year suicidal ideation: higher education (doctor vs. below undergraduate: odds ratio [OR] = 4.32, P < 0.001 and OR = 4.21, P < 0.01), suffering physical illness (OR = 1.58, P < 0.01 and OR = 1.51, P < 0.05), with work-family conflict (OR = 1.03, P < 0.01 and OR = 1.02, P < 0.05), and having depressive symptoms (OR = 1.09 and OR = 1.10, both P < 0.001); while, male gender was a protective factors against lifetime and one-year suicidal ideation (OR = 0.54, and OR = 0.46, both P < 0.001). Mediation effect analysis demonstrated that depressive symptoms has a mediating effect on the correlation between work-family conflict and lifetime and one-year suicidal ideation, with the effect values of 0.0237 and 0.0265, accounting for 45.84% and 53.64% of the total effect, respectively. Conclusion Among medical stuff, work-family conflict exerts a direct impact on suicidal ideation and depressive symptoms mediate the promotion effect of work-family conflict on suicidal ideation. -
Key words:
- work-family conflict /
- suicidal ideation /
- depressive symptom /
- medical staff
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表 1 不同特征医务人员终生和1年自杀意念报告率比较
Table 1. Lifetime and one-year suicidal ideation by gender, age, marital status, education, job category, professional title, management duty, and physical disease among 3 426 medical staff in Shandong province
变量 分类 终生自杀意念 1年自杀意念 有 % χ2 值 P 值 有 % χ2 值 P 值 性别 男性 66 7.18 5.62 0.018 47 5.11 6.71 0.010 女性 246 9.81 192 7.66 年龄（岁） ≤ 30 105 8.72 7.63 0.054 88 7.31 3.97 0.265 31～40 146 10.38 105 7.46 41～50 50 8.36 37 6.19 > 50 11 5.07 9 4.15 婚姻状况 未婚 69 11.96 6.82 0.033 56 9.71 7.97 0.019 已婚 239 8.53 180 6.43 其他 4 8.51 3 6.38 受教育程度 博士 12 21.43 12.24 0.007 9 16.07 10.20 0.017 硕士 54 9.61 45 8.01 本科 214 9.04 162 6.84 其他 32 7.27 23 5.23 工作类别 医生 112 8.83 0.18 0.913 83 6.55 1.09 0.581 护士 157 9.26 126 7.43 医技 43 9.29 30 6.48 职称 正高 7 6.42 3.10 0.377 5 4.59 3.29 0.349 副高 21 6.93 16 5.28 中级 112 9.57 79 6.75 初级/其他 172 9.33 139 7.54 管理职务 有 45 6.83 5.12 0.024 35 5.31 3.49 0.062 否 267 9.65 204 7.37 躯体疾病 是 75 16.41 33.99 0.000 58 12.69 26.55 0.000 否 237 7.98 181 6.10 
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表 2 不同自杀意念医务人员不同量表得分情况比较
Table 2. Mean scores of scales on social support, coping style, work-family conflict and depression symptoms for medical stuff (n = 3 426) with or without lifetime and one-year suicidal ideation
量表 终生自杀意念 1年自杀意念 有 无 t 值 P 值 有 无 t 值 P 值 社会支持 56.94 ± 14.65 63.01 ± 13.61 – 7.45 0.000 55.90 ± 15.02 62.95 ± 13.60 – 7.67 0.000 应对方式 30.81 ± 10.17 30.61 ± 9.79 0.35 0.727 30.86 ± 9.88 30.61 ± 9.82 0.39 0.700 工作家庭冲突 32.85 ± 8.41 29.30 ± 8.19 7.30 0.000 32.80 ± 8.46 29.38 ± 8.21 6.20 0.000 抑郁症状 24.77 ± 11.64 13.71 ± 9.69 18.85 0.000 26.26 ± 11.70 13.85 ± 9.74 18.71 0.000
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表 3 终生和1年自杀意念相关影响因素多因素logistic回归分析（后退法）
Table 3. Influences of gender, education, physical disease, work-family conflict and depression symptom on lifetime and one-year suicidal ideation among medical stuff in Shandong province: multivariate logistic regression analysis
变量 比较组 参照组 终生自杀意念 1年自杀意念 P 值 OR 值 95%CI P 值 OR 值 95%CI 性别 男性 女性 0.000 0.54 0.39～0.74 0.000 0.46 0.32～0.66 受教育程度 博士 其他 0.000 4.32 1.93～9.63 0.002 4.21 1.69～10.49 硕士 0.156 1.43 0.87～2.34 0.042 1.79 1.02～3.15 本科 0.352 1.22 0.81～1.84 0.272 1.31 0.81～2.12 躯体疾病 有 无 0.005 1.58 1.15～2.16 0.022 1.51 1.06～2.15 工作家庭冲突 有 无 0.001 1.03 1.01～1.05 0.018 1.02 1.00～1.04 抑郁症状 有 无 0.000 1.09 1.08～1.10 0.000 1.10 1.09～1.12
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