基于生物-心理-社会模型的住培学员心理健康的影响因素分析

doi:10.3760/cma.j.cn115259-20260320-00374

摘要/Abstract

摘要： 目的基于生物-心理-社会(biopsychosocial model,BPS)模型分析住院医师规范化培训(简称住培)学员心理健康的影响因素,为制定针对性的心理干预措施提供依据。方法 2024年2至3月,采用分层整群抽样方法,选取浙江省温州地区2家住培基地的327名学员进行问卷调查。基于BPS模型设计“住培学员一般情况与BPS相关因素调查表”,使用抑郁-焦虑-压力量表(depression anxiety stress scale-21)评估抑郁、焦虑和压力状况。采用卡方检验和多因素二分类Logistic回归分析生物、心理和社会因素与住培学员心理健康的关联。结果住培学员抑郁、焦虑和压力症状的检出率分别为29.2%(95/325)、28.9%(94/325)和15.1%(49/325)。多因素二分类Logistic回归分析结果显示:①生物因素中,睡眠规律的住培学员检出抑郁症状的可能性是不规律者的0.253倍(95%CI:0.136～0.469),检出焦虑症状的可能性是不规律者的0.337倍(95%CI:0.183～0.621),均P＜0.05;饮食规律的住培学员检出压力症状的可能性是不规律者的0.223倍(95%CI:0.102～0.491),P＜0.05;②心理因素中,职业认同感高的住培学员检出抑郁、焦虑、压力症状的可能性分别是一般者的0.277倍(95%CI:0.155～0.496)、0.307倍(95%CI:0.170～0.554)和0.108倍(95%CI:0.043～0.268),均P＜0.05;存在发展困惑的住培学员检出抑郁、焦虑、压力症状的可能性分别是无困惑者的1.874倍(95%CI:1.062~3.306)、2.827倍(95%CI:1.555～5.139)和2.327倍(95%CI:1.111～4.877),均P＜0.05;培训负荷高的住培学员检出焦虑、压力症状的可能性分别是一般者的2.055倍(95%CI:1.072～3.938)和2.369倍(95%CI:1.054～5.325),均P＜0.05;③社会因素中,人际关系良好的住培学员检出抑郁、焦虑、压力症状的可能性分别是一般者的0.385倍(95%CI:0.214～0.691)、0.443倍(95%CI:0.247～0.792)和0.404倍(95%CI:0.196～0.832),均P＜0.05;第二年住培学员检出抑郁症状的可能性是第一年住培学员的0.406倍(95%CI:0.194～0.853,P=0.003)。结论住培学员心理健康与生物、心理、社会三维因素均存在关联。高职业认同感、良好人际关系与三类症状的较低检出率均相关,是核心保护性因素;睡眠规律主要与抑郁和焦虑的较低检出率相关,饮食规律主要与压力的较低检出率相关,呈现症状特异性关联模式。建议从保障规律作息、培育职业认同、优化人际生态三方面构建分层干预体系。

关键词: 问卷调查, 住院医师规范化培训, 心理健康, 生物-心理-社会模型, 影响因素, 抑郁-焦虑-压力量表

Abstract: Objective To analyze factors influencing the mental health of residents undergoing standardized residency training based on the Biopsychosocial (BPS) model, and inform subsequent targeted psychological interventions. Methods From February to March 2024, a stratified cluster sampling method was used to select 327 residents from two standardized training bases in Wenzhou for a questionnaire survey. A self-designed ″General Information and BPS-Related Factors Questionnaire for Standardized Training Residents″ was administered based on the BPS model, and the Depression, Anxiety and Stress Scale-21 (DASS-21) was used to assess depression, anxiety, and stress levels. Chi-square tests and multivariate binary logistic regression were employed to examine the associations of biological, psychological, and social factors with mental health. Results The detection rates of depressive, anxiety, and stress symptoms among the residents were 29.2% (95/325), 28.9% (94/325), and 15.1% (49/325), respectively. Multivariate binary logistic regression analysis showed: (1) In terms of biological factors, residents with regular sleep patterns were 0.253 times as likely to report depressive symptoms (95%CI: 0.136-0.469) and 0.337 times as likely to report anxiety symptoms (95%CI: 0.183-0.621) as those with irregular patterns (all P<0.05); those with regular dietary habits were 0.223 times as likely to report stress symptoms as those with irregular habits (95%CI: 0.102-0.491), P<0.05. (2) In terms of psychological factors, residents with high professional identity were 0.277 times (95%CI: 0.155-0.496), 0.307 times (95%CI: 0.170-0.554), and 0.108 times (95%CI: 0.043-0.268) as likely to report depressive, anxiety, and stress symptoms, respectively, as those with moderate identity (all P<0.05); those with career development confusion were 1.874 times (95%CI: 1.062-3.306), 2.827 times (95%CI: 1.555-5.139), and 2.327 times (95%CI: 1.111-4.877) as likely to report the three types of symptoms, respectively, as those without such confusion (all P<0.05); those with high training load were 2.055 times (95%CI: 1.072-3.938) and 2.369 times (95%CI: 1.054-5.325) as likely to report anxiety and stress symptoms, respectively, as those with moderate load (all P<0.05). (3) In terms of social factors, residents with good interpersonal relationships were 0.385 times (95%CI: 0.214-0.691), 0.443 times (95%CI: 0.247-0.792), and 0.404 times (95%CI: 0.196-0.832) as likely to report depressive, anxiety, and stress symptoms, respectively, as those with moderate relationships (all P<0.05); second-year residents were 0.406 times as likely to report depressive symptoms as first-year residents (95%CI: 0.194-0.853, P=0.003). Conclusions The mental health of residents is associated with biological, psychological, and social factors. High professional identity and good interpersonal relationships were associated with lower detection rates of all three types of symptoms, serving as core protective factors. Regular sleep was mainly associated with lower detection rates of depression and anxiety, while a regular diet was mainly associated with lower detection rates of stress, demonstrating a symptom-specific association pattern. It is recommended to develop a stratified intervention system focusing on ensuring regular routines, cultivating professional identity, and optimizing interpersonal ecology.

Key words: Questionnaires, Standardized residency training, Mental health, Biopsychosocial model, Influencing factors, Depression anxiety stress scale-21

中图分类号:

许方泳, 李明玮, 丁晓慧, 张慧和, 张单单, 张济周. 基于生物-心理-社会模型的住培学员心理健康的影响因素分析[J]. 中华医学教育杂志, 2026, 46(10): 743-750, DOI: 10.3760/cma.j.cn115259-20260320-00374.

Xu Fangyong, Li Mingwei, Ding Xiaohui, Zhang Huihe, Zhang Dandan, Zhang Jizhou. Analysis of influencing factors on the mental health of residents in standardized training based on the BPS model[J]. Chinese Journal of Medical Education, 2026, 46(10): 743-750, DOI: 10.3760/cma.j.cn115259-20260320-00374.

参考文献

[1] 梁瀛, 周庆涛, 沈宁, 等. 是否完成规范化培训对住院医师心理健康状态影响的研究[J].中华医学教育杂志,2019,39(9):662-667. DOI: 10.3760/cma.j.issn.1673-677X.2019.09.005.
[2] 孙晔, 刘思遥, 陈世裕, 等. 住院医师规范化培训学员考前焦虑抑郁情况调查及影响因素分析[J].中华全科医学,2024,22(8):1424-1427,1432. DOI: 10.16766/j.cnki.issn.1674-4152.003651.
[3] 罗佳荟, 杨伶俐, 王瑞珩, 等. 住院医师规范化培训学员心理健康影响因素的调查分析[J].中华医学教育杂志,2023,43(4):293-297. DOI: 10.3760/cma.j.cn115259-20220617-00796.
[4] 夏瑀, 林齐睿, 郑芳芳, 等. 全科住院医师规范化培训学员心理健康状况及其影响因素分析:一项混合方法研究[J].中国全科医学,2022,25(16):2028-2035. DOI: 10.12114/j.issn.1007-9572.2022.0153.
[5] Bolton D. A revitalized biopsychosocial model: core theory, research paradigms, and clinical implications[J]. Psychol Med, 2023,53(16):7504-7511. DOI: 10.1017/S0033291723002660.
[6] 许超,张迪.抑郁-焦虑-压力量表中文版在住院医师规范化培训生中的信效度研究[J].武汉大学学报(医学版),2020,41(5):828-831.DOI:10.14188/j.1671-8852.2019.1020.
[7] 傅小兰,张侃,陈雪峰,等.中国国民心理健康发展报告(2021～2022)[M].北京:社会科学文献出版社,2023:7.
[8] 陈辉, 李小飒, 王艺, 等. 规范化培训住院医师倦怠焦虑抑郁发生率meta分析[J].青岛大学学报(医学版),2023,59(4):601-606. DOI: 10.11712/jms.2096-5532.2023.59.112.
[9] 刘春晓, 吴婧, 周洪敏, 等. 住院医师规范化培训中医师心理健康状况影响因素与改善对策[J].中国毕业后医学教育,2017,1(1):23-25,29.
[10] Wang K, Shi HS, Geng FL, et al. Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China[J]. Psychol Assess, 2016,28(5):e88-e100. DOI: 10.1037/pas0000207.
[11] Bautista J, Hidalgo-Tinoco C, Di Capua Delgado M, et al. The gut-brain-circadian axis in anxiety and depression: a critical review[J]. Front Psychiatry, 2025,16:1697200. DOI: 10.3389/fpsyt.2025.1697200.
[12] Choshen-Hillel S, Ishqer A, Mahameed F, et al. Acute and chronic sleep deprivation in residents: cognition and stress biomarkers[J]. Med Educ, 2021,55(2):174-184. DOI: 10.1111/medu.14296.
[13] Ring M. An integrative approach to HPA axis dysfunction: from recognition to recovery[J]. Am J Med, 2025,138(10):1451-1463. DOI: 10.1016/j.amjmed.2025.05.044.
[14] 丁宁, 王彬, 闻德亮. 自我决定理论对医师职业精神培养的启示[J].中华医学教育杂志,2017,37(3):333-336. DOI: 10.3760/cma.j.issn.1673-677X.2017.03.003.
[15] Neufeld A. The calling-cost paradox: when identity-driven motivation becomes a risk in medical training[J]. Clin Teach, 2025,22(5):e70187. DOI: 10.1111/tct.70187.
[16] 周爱保, 周鹏生. 人际交往的不确定性减少理论(URT)述评[J].心理科学,2008,31(6):1499-1501.
[17] 梁玲. 基于压力过程理论探究压力事件与研究生新生焦虑和抑郁的关联[D]. 武汉:华中科技大学,2024.
[18] Cohen S, Wills TA. Stress, social support, and the buffering hypothesis[J]. Psychol Bull, 1985,98(2):310-357.
[19] Corbin CM, Alamos P, Lowenstein AE, et al. The role of teacher-student relationships in predicting teachers′ personal accomplishment and emotional exhaustion[J]. J Sch Psychol, 2019,77(6):1-12. DOI: 10.1016/j.jsp.2019.10.001.