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

張寧潔(Chang Ning-Chieh)

指導教授 ： 李子奇

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/碩士(2019年)

https://doi.org/10.6345/NTNU201900466

摘要

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。

關鍵字

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

並列摘要

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.

並列關鍵字

young physician ； National Health Insurance Research Database ； cohort study ； anxiety ； depression ； insomnia ； hypertension ； hyperlipidemia ； diabetes mellitus ； peptic ulcer ； musculoskeletal disorders

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