Background

There is now a wealth of evidence showing that work is a major determinant of physical and mental health. Recent studies have suggested increased rates of depression in healthcare workers (HCWs) in the context of the Covid-19 pandemic, with direct impact on care quality and productivity.

Aim

To determine the rate of clinical depression in a national sample of HCWs in France during the post-Covid-19 area and to identify related factors (professional, individual and health-related risk behaviors) using a structural equation modeling analysis.

Method

A survey comprising a number of standardized scales was sent to public and private national healthcare facilities through the mail or disseminated through emails from professional associations and social networks.

Results

10,325 participants were recruited; 3122 (30.2%, 95% confidence interval [29.4–31.1]) met likely diagnostic criteria for clinical depression. Professional factors had the largest total effect (β = 0.57) (burn-out: β = 0.74, sustained bullying at the workplace β = 0.48 and decision-making latitude β = − 0.47), followed by individual factors (β = 0.30) (the main individual factor was recurrent major depression, path coefficient = 0.67).

Professional factors had both a direct (path coefficient = 0.38) and indirect (through health risk behaviors, path coefficient = 0.19) effect on depression. Individual factors had a direct (path coefficient 0.21) and indirect (through health risk behaviors (path coefficient = 0.09) effect on depression. Health risk behaviors had a direct effect on depression (path coefficient = 0.31).

Interpretation

These results provide potential explanations for the likely causes of poor psychological health among HCWs. We propose several potential interventions related to professional factors and health risk behaviors. Our results suggest that improving organizational issues, reducing exposure to potentially morally injurious events, promoting brief naps at work and provision of evidence-based prevention approaches have been reported to be helpful in supporting the mental health of hospital staff (not only relaxation or stress management but training in leadership aspects, increasing the knowledge and practice of giving efficient performance feedback, reducing conflicting demands and peer support programs such as Trauma Risk Management. Our data suggest that developing caregivers reported experience and outcome measures (CREMs/CROMs) would be helpful to monitor work environment and its effect on depression in healthcare workers.

中文翻译：

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医护人员的抑郁：全国 AMADEUS 调查的结果

背景

现在有大量证据表明，工作是身心健康的主要决定因素。最近的研究表明，在 Covid-19 大流行的背景下，医护人员 (HCW) 的抑郁症发生率增加，直接影响护理质量和生产力。

目的

确定后 Covid-19 地区法国全国卫生保健工作者样本中的临床抑郁症发生率，并使用结构方程模型分析确定相关因素（职业、个人和健康相关风险行为）。

方法

一项包含许多标准化量表的调查通过邮件发送到公共和私人国家医疗保健机构，或通过专业协会和社交网络的电子邮件传播。

结果

招募了 10,325 名参与者；3122（30.2%，95% 置信区间 [29.4–31.1]）符合临床抑郁症的可能诊断标准。职业因素的总体影响最大（β = 0.57）（职业倦怠：β = 0.74，工作场所持续欺凌 β = 0.48 和决策自由度 β = −  0.47），其次是个人因素（β = 0.30）（主要个体因素为复发性重性抑郁，路径系数=0.67）。

职业因素对抑郁有直接（路径系数 = 0.38）和间接（通过健康风险行为，路径系数 = 0.19）影响。个体因素对抑郁有直接（路径系数 0.21）和间接（通过健康风险行为（路径系数 = 0.09））影响。健康风险行为对抑郁有直接影响（路径系数 = 0.31）。

解释

这些结果为医护人员心理健康状况不佳的可能原因提供了可能的解释。我们提出了几种与职业因素和健康风险行为相关的潜在干预措施。我们的研究结果表明，据报道，改善组织问题、减少接触潜在的道德伤害事件、提倡在工作中小睡和提供循证预防方法有助于支持医院工作人员的心理健康（不仅是放松或压力管理）但在领导方面进行培训，增加提供有效绩效反馈的知识和实践，减少冲突需求和同伴支持计划，如创伤风险管理。