Influencing Factors Analysis Of Residents’ Depressive And Anxiety Symptoms And Its Underlying Mechanism

Objectives:Residents,as a special sub-group of physicians,are most likely to be the ones who make the closest contact with patients.Their main jobs include managing a large number of patients under the supervision of superior doctors,medical history writing,on duty in wards,participating in the surgical operations and other multiple operations.Besides their physician identities,residents are also medical trainees.In most cases,residents are not official employee in the hospitals,who have to face various issues,such as low income,intense work load,being worried about the countless examinations and hunting for a full-time job.Therefore,residents are more vulnerable to mental illnesses.It has only been 5 years since the standardized training for residents was established in China.The quality of healthcare service varies in different training centers.The set up and arrangement of training programs,the management of training differ as well.In addition,residents also have different perceptions and understandings of training.Considering the factors,including their special identities,unstable state,inexperienced skills,lack of clinical experiences and doctor-patient communication skills,short of sense of belonging,the mental health state of residents is a matter of concern.Consequently,in the early phase of establishing the standardized training system for residents,it is essential to investigate the mental health status and its influential factors in residents,in order to gain a better understanding of the residents training state,spotting the problems existed within,which is of value in theory and application to promote the development of the standardized training system for residents.Depression and anxiety are most common mental disorders in modern society.A number of studies have demonstrated that physicians are at greater risk of suffering depression symptoms or anxiety symptoms than a general population.Compared with physicians,residents are more susceptible to depression and anxiety symptoms.Therefore,systematical learning the prevalence of depression and anxiety symptoms in residents and risk factors in China is critical to better understand the psychological health state in residents.Among a number of risk factors,sleep disturbance confers a robust risk factor for depression development in the general population,suggesting that poorly sleeping trainees may be more vulnerable to depression in response to the stressful transition to internship.Night shift,long work hours,urgently being needed to show up anytime,being stressed out may contribute to sleep loss in residents,leading to further unhealthy mental state.Up to date,no known research has been carried out to investigate the association between sleep quality and depression and anxiety symptoms,and the potential underlying mechanisms still remains unclear.Therefore,the present study is to enroll a great number of residents who are currently taking the standardized training for residents,and investigate the prevalence of depression and anxiety symptoms in residents,and analyzing the demographic characteristics,training status and psychological affecting factors,eventually elaborate the impact of sleep quality on depression and anxiety symptoms from the physiological and mental levels and its potential underlying mechanisms,in order to provide the evidence for the management and intervention of mental health of residents in China at current stage.Methods:Based on the cohort study of Natural Population in Northeast China,over1000 participants from eight different training center in Shenyang,Dalian,Jinzhou and Fushun of Liaoning Province were enrolled in our study.A total of 1050 copies of questionnaires were distributed,including social demographic information,training information,sleep status,exercise,organization support,psychological capital,job satisfaction,depressive and anxiety symptoms.962 copies were returned with an effective returning rate of 91.62%.Four hundred and sixty two residents received health examinations,blood collection and biochemical test,which included C reaction protein,interlukin 6,cortisol levels,white blood cells,neutrophils,monocytes,lymphocytes and other inflammatory index.IBM SPSS Statistics22.0 and SAS 9.3(SAS Institute Inc.,Cary,NC,USA)were used to carry out statistical analysis.A significance threshold of P<0.05 was used.Descriptive analysis,internal consistency,t-test,c~2tests,logistic regression,step-wise regression,receiver operating characteristic curve analysis,hierarchical regression,simple slope analysis,progressive resampling strategy were used in data processing.Results:The scales employed in our study had a robust reliability.Our data showed that the prevalence of depression and anxiety symptoms were 44.08%and 32.32%respectively in residents.Senior year of training,low quality of sleep were risk factors of depression symptoms and anxiety,whereas psychological capital and job satisfaction were protective factors of depression and anxiety symptoms.After adjusting multiple factors,such as social demographic factors,training factors,organizational behavior factors and psychological factors,it was noted that low quality sleep was positively associated with the prevalence of depression symptoms and anxiety.The higher the score was in seven different parts of the scale of sleep quality,the higher prevalence of depression symptoms and anxiety was.We also found out that monocytes might play an moderating effect in the relationship of sleep quality and depression and anxiety symptoms.Organization support,psychological capital(self-efficacy,hope,resilience,optimism)and job satisfaction may act as mediating effect in the relationship of sleep quality and anxiety symptoms.Psychological capital(self-efficacy and hope)might play moderating effect in the relationship of sleep quality and anxiety symptoms.Conclusion:The present study indicates that the prevalence of depression and anxiety symptoms are higher than that in a general population and in other countries.Senior years of training,sleep quality,psychological capital and job satisfaction are closely associated with the occurrence of depression and anxiety symptoms.The worse the sleep quality is,the higher the prevalence of depression and anxiety symptoms in residents is.Therefore,improving the sleep quality might be an effective measure in the prevention of depression and anxiety symptoms.In addition,monocytes,perceived organization support,psychological capital and job satisfaction are likely to play a mediating or moderating role in the link of sleep quality and depression and anxiety symptoms,providing insight into the potential underlying mechanisms of the impact of sleep quality on depression and anxiety symptoms,and scientific proof for the management and intervention of mental health of residents in China.