上海市远郊社区全科医师职业倦怠状况及影响因素分析
Prevalence and Influencing Factors for Job Burnout among General Practitioners in Community Health Centers in Outskirts of Shanghai

目的：了解上海市奉贤区社区全科医生工作倦怠现状及影响因素。方法：于2019年3月至9月，对奉贤区社区卫生服务中心的全科医生开展问卷调查，内容包括基本情况、焦虑、抑郁情绪和职业倦怠状况，其中焦虑情绪调查采用广泛焦虑量表(GAD-7)，抑郁情绪调查采用PHQ-9抑郁症筛查量表，职业倦怠情况调查采用22项汉化版马斯勒倦怠量表–服务行业版(MBI-HSS)。采用二分类logistic后退法回归分析全科医生职业倦怠的影响因素，采用累积logistic回归分析各维度的影响因素。结果：242例全科医生(100%)的问卷被有效回收。职业倦怠症状检出率为66.5% (161人)，其中情感耗竭、去人格化和个人成就感低的检出率分别为18.6% (45人)，51.2% (124人)和16.5% (40人)。多因素logistics回归分析结果显示，职称、工作压力和抑郁情绪是职业倦怠及职业倦怠各维度发生的主要危险因素(P < 0.05)。结论：上海市奉贤区社区卫生服务中心全科医生职业倦怠较为严重，尤其是去人格化。缺乏合理的晋升机制、较大的工作压力和抑郁情绪，收入不高可能是影响全科医生的主要危险因素。建议建立科学的晋升机制，优化全科医生工作任务分配，重视全科医生抑郁情绪，提高收入，从而缓解全科医师职业倦怠。
Objective: To investigate the prevalence of job burnout of general practitioners in community health centers of Fengxian District in Shanghai and exploring its influencing factors. Methods: A questionnaire survey was conducted in general practitioners in community health centers of Fengxian district between March, 2019 and September, 2019. The information about sociodemo-graphic characteristics, depressive symptom, and anxiety symptom and job burnout status of the subjects was collected. The anxiety symptom, depressive symptom and job burnout symptom was assessed by GAD-7 scale, PHQ-9 scale and revised version of the Chine sized 22-item Maslach Burn-out Inventory-Human Services Survey (MBI-HSS), respectively. Associated factors with burnout and its subscales among GPs were estimated using a backward binary logistic regression and cumula-tive logistic regression model, respectively. Results: A total of 242 (100%) general practitioners returned responsive questionnaires. The survey results showed that the overall detection rate of job burnout symptom was 66.5% (161), with 18.6% for emotional exhaustion (EE), 51.2% for de-personalization (DP) and 16.5% for low personal accomplishment (PA), respectively. Multivariate logistic regression analysis revealed that the title, work stress, depression were the factors signifi-cantly associated with the risk of job burnout and subscale symptoms (P < 0.05). Conclusion: The prevalence of job burnout among general practitioners in community health center is high, which is often manifested as DP. Lack of effective promotion program, high work stress and depressive moods may be the major risk factors of job burnout. Actions such as building more rational promo-tion program, optimizing the work hours and attaching importance to the depressive moods are needed to relieve the job burnout of the medical works in community health center.