第一年住院醫師之工作壓力與心理困擾之關係：探討因應策略、睡眠剝奪及知覺組織支持的調節效果

醫師，是許多人的夢想志業，穿上白袍，似乎是擁有較高知識水平與社會地位的象徵。然，近年來的研究卻顯示，他們在臨床工作中承受高工作壓力，更是過勞、睡眠問題、精神科問題或適應障礙的高風險族群。特別是住院醫師又為醫師層級中工時最長，值班數最多，工作壓力、睡眠問題最嚴重的一群人。他們被視為醫院中的主要照護人力，也將開始接受住院（專科）醫師訓練。再者，不少研究討論因應策略、睡眠剝奪及知覺組織支持分別對工作壓力和心理健康的影響，然其中的交互關係，仍有待深入了解。故本研究聚焦在第一年住院醫師（以下簡稱R1）之心理適應情形，旨在探討R1之工作壓力與心理困擾之關係，同時分析因應策略、睡眠剝奪及知覺組織支持的調節效果。 本研究採用橫斷式研究，便利抽樣選取中、南部三間教學醫院之兩年度R1，共蒐集115份有效問卷。問卷內容包含背景變項、醫師職場壓力量表、簡式症狀量表、簡明工作因應量表、睡眠剝奪量表、精簡版知覺組織支持量表。使用SPSS 25.0進行統計分析。先檢視主要研究變項在不同人口學變項上的差異；再使用皮爾森積差相關分析年齡、工時與主要研究變項間的相關情形；最後使用多元階層迴歸分析工作壓力對心理困擾的影響及因應策略、睡眠剝奪、知覺組織支持的調節效果。 本研究結果顯示，R1每日平均工時為11.34小時；主要工作壓力源為需要應付突發狀況、處理生死攸關的問題、責任重、輪班以及耗費體力；約四成R1處於輕度至中度心理困擾。工作壓力正向預測心理困擾程度，然因應策略、睡眠剝奪、知覺組織支持不具顯著調節效果。據此，研究者建議，提升R1之心理健康，要先從降低工作壓力、提升心理適應開始著手，也呼籲未來研究者進一步探討R1工作壓力下，可能降低心理困擾、提升心理健康的關鍵因素。

Many people dream of becoming a medical doctor, and wearing a white robe seems to symbolize a higher level of knowledge and social status. However, recent studies have shown that medical doctors are at high risk for burnout, sleep problems, psychiatric problems, and adjustment disorders due to the high stress they experience in clinical work. In particular, residents have the longest working hours, the largest number of on-call duties, and the most serious work stress and sleeping problems among medical doctors. They are the primary caregivers in hospitals and will begin training as specialists. In addition, many studies have discussed the effects of coping strategies, sleep deprivation, and perceived organizational support on work stress and mental health, respectively, but the interactions between them need to be clarified. Therefore, this study focuses on the psychological adjustment of first-year residents (R1) and aims to investigate the relationship between work stress and psychological distress in R1, and to analyze the moderating effects of coping strategies, sleep deprivation, and perceived organizational support. This study employed a cross-sectional research design and utilized convenience sampling to recruit R1s from three teaching hospitals in the central and southern regions of Taiwan. A total of 115 valid questionnaires were collected over two years. The questionnaires included background variables, the Physician’s Job Stress Questionnaire, BSRS-5, The Brief COPE, the Sleep Deprivation Scale, and the Brief Perceived Organizational Support Scale. Statistical analyses were conducted using SPSS 25.0. We first examined the differences in the demographic variables of the main study variables, then analyzed the correlation between age, working hours and the main study variables by using Pearson correlation. At last, the effects of work stress on psychological distress and the moderating effects of coping strategies, sleep deprivation, and perceived organizational support were analyzed using multiple regression analysis. The results showed that the average daily working hours of R1s were 11.34 hours; the main sources of work stress were the need to cope with emergencies, life-and-death issues, heavy responsibilities, shift work, and physical exertion; about 40% of R1s had mild to moderate psychological distress; and about 40% of R1s suffered from sleep deprivation during working days. Work stress positively associated with psychological distress, but coping strategies, sleep deprivation, and perceived organizational support did not show a significant moderating effect. Accordingly, the researchers indicate that to improve the mental health of R1s, it is necessary to start with reducing work stress and improving psychological adaptation. This study also calls for future researchers to further explore key factors that may reduce psychological distress and improve mental health under the work stress faced by R1.