工作壓力源、職業倦怠與動脈硬化之相關性研究- 以醫療人員為例

Abstract

Background: A great deal of research has indicated that long-term exposure to job stressors can lead to burnout. Research and epidemiologic evidence indicate cardiovascular disease (CVD) is associated with risk factors and unhealthy behaviors. However, the evidence of relationship between job stressors and CVD is still inconsistence. Purposes: The aims of this study were to achieve three goals: (1) to explore the relationships between job stressors and burnout among medical professional; (2) to elucidate the associations of job stressors with arteriosclerosis, which represents a pre-clinical CVD; (3) to investigate the relationship between job stressors and cardiovascular health status among medical professional. Methods: This is a cross-sectional study design. The participants’ profiles were obtained from the database of a health promotion survey at Sin-Lau Hospital in 2012. A total of 1,329 participants were recruited, including 101 physicians, 570 nurses, 68 physician assistants, 216 medical technicians, and 374 administrators. The survey achieved an 89% response rate. The questionnaire used in the study included socio-demographic information, working conditions, level of burnout, job stress, mental health, and lifestyle behaviors. Validated tools included the Chinese version of the Job Content Questionnaire, the Chinese version of the Copenhagen Burnout Inventory, and the Taiwan Depression Questionnaire. Some of the data were matched with the employees’ health profiles, including the measurement of arteriosclerosis by brachial-ankle pulse wave velocity (baPWV). Seven aggregated ideal cardiovascular health factors included 4 health behaviors (non-smoker, ideal body mass index, healthy diet, and physical activity achieved to goal) and 3 health factors (blood pressure < 120/80 mmHg, fasting sugar < 100 mg/dL, and total cholesterol < 200 mg/dL). Statistical methods included descriptive, bivariate, and multivariate analysis. Results: Hierarchical regression analysis indicated that job strain, over-commitment, and low social support explained the most variance (32.6%) of burnout. Physician assistant (61.8%) is an emerging high-burnout group; its severity is similar to nurse (66%) and far more than physician (38.6%), administrative staff (36.1%), and medical technician (31.9%). The baPWV was associated with gender, age, medical profession, work hours, work type, mental health, body mass index, systolic and diastolic blood pressures, fasting glucose, and cholesterol. However, after being fully adjusted by these factors, only sleep duration of less than 6 hours and weekly work hours longer than 60 hours were significantly associated with an increased risk of arteriosclerosis. The conditions of job demands, job control, job strain, social support, shift work, and mental ill-health all showed no significant association with baPWV. The prevalence of cardiovascular health among studying sample who were characterized as ideal was only 0.2%, intermediate 20.6% and poor 79.2%. There were significantly higher percentages of poor health in workers with high strain (85.1%), and the professions of nurse (85.3%) and physician assistant (83.1%). By multivariate analysis, the only significant factor correlated with job strain was physical inactivity. After being adjusted, workers with high strain and active strain possessed a higher prevalence of physical inactivity compared to those with low strain (odds ratio 1.9, 95% CI 1.38-2.81; odds ratio 1.4, 95% CI 1.00-2.03). Conclusions: Job stressors are associated with burnout, mental ill-health, and poor cardiovascular health. Additionally, arteriosclerosis is related to longer work hours and shorter sleep duration, but not relating to other psychosocial hazards. Employees with high job strain, being nurse, and physician assistant are high risk groups for poor cardiovascular health. These findings may help facilitate the development of health promotion programs in the future. However, further prospective follow up is warranted to elucidate the relationship between job stressors and arteriosclerosis.