內憂外患：新冠肺炎疫情於各階段對台灣中部某區域教學醫院之醫療工作者的心理衝擊之探討

研究目的：諸多研究證實COVID-19疫情對醫療工作者會產生負面心理衝擊。台灣至今共三波不同嚴重度且間隔數個月零確診的疫情，明顯不同於其他國家。本研究探索在疫情期間，有哪些內外在因素影響了醫療工作者心理壓力（如焦慮、憂鬱、失眠及孤獨感）? 此疫情對國內醫療工作者心理衝擊與其他國家的情形是否有不同?不同階段的疫情發展，對國內醫療工作者心理衝擊是否有顯著差異？研究方法：此研究為橫斷面之問卷調查，於2021年11月至2022年2月對中台灣某區域教學醫院第一線醫療工作者進行問卷施測。總計發放270份問卷，有效回卷數231份，有效回卷率86%。研究結果：不論疫情第一波或第二波，皆有近七成的醫療工作者感到焦慮，近六成感到憂鬱，近一半受失眠所困擾，約三成自覺社會支持匱乏，而有高度孤獨感，這些心理壓力不低於其它國家或地區。第二波疫情時醫療工作者感到更多的工作內容與工時變化，更高的自覺感染風險，焦慮程度顯著增加，但認同有更好的公共衛生政策及資訊明確性。不同階段的疫情發展，醫療工作者對外在因素感受影響程度有所不同。外在因素中，工作內容與工時變化及自覺感染風險正向顯著影響焦慮、憂鬱與失眠，職場關係與家庭支持度負向顯著影響憂鬱與孤獨感，而家庭支持亦負向影響焦慮與失眠。內在因素分析顯示：女性、任職於加護病房或急診及使用菸酒習慣正向顯著影響焦慮程度，任職於加護病房正向顯著影響憂鬱程度。年資負向顯著影響失眠程度，而任職於加護病房、使用菸酒習慣、有精神疾病則正向顯著影響失眠。年資、女性及職位為醫師皆正向顯著影響社會支持程度，護理師的社會支持顯著匱乏。結論：疫情明顯對醫療工作者產生心理衝擊。早期辨識危險因子並且提供心理支持及治療有助於減緩因防疫及醫療工作所帶來的心理壓力。

Objective: numerous studies proved stress from coronavirus disease-2019 (COVID-19) pandemic had adverse psychological impact on health care workers (HCW). Different to many countries, Taiwan had three waves of infections, with intervals of months without new infected cases. This study aims to explore intrinsic and extrinsic factors that affect psychological impacts (such anxiety, depression, insomnia and loneliness) of the pandemic on Taiwanese HCW, to compare its differences to other countries, and, to determine differences on levels of psychological impact between first waves and second wave of pandemic. Method: this was a cross sectional survey to first line HCW on prevention and treatment of COVID-19 during November 2021 to February 2022. 270 paper questionnaires were issued, 231 were valid responses, which valid response rate was 86%. Results: regardless of waves of infections, nearly 70% of HCW had anxiety, nearly 60% felt depressed, half of them suffered from insomnia, one in three felt insufficient social support, which means high level of loneliness. These proportions are not less than many other countries where the pandemic is much more severe. During second wave, HCW felt significant changes of working schedule and duties, with higher level of perception on risk of infection, these factors induced higher level of anxiety, but they manifested better satisfaction on public health policies and informations provided by hospital and government. Analysis on the intrinsic factors showed female HCW, those working at intensive care unit and emergency room, smokers and alcohol consumers are positive predictive factors of anxiety. Working at intensive care unit positively predicts depression as well insomnia. Personnel of lower seniority, smokers, alcohol comsumers and those with psychiatric disorders suffer more from insomnia. Senior staff, woman and physicians are positive factors to social support, nurses poses poorer social support. Analysis on the extrinsic factors proved changes on working schedule or duties positively relates to level of anxiety and insomnia. The risk of infection enhances sense of anxiety and depression. Social support is empowered by workplace relationship and family support. A positive workplace relationship ameliorates level of depression and insomnia. A negative family support is related to all aspects of adverse psychological impact. Conclusion: The pandemic had negative psychological impact on HCW. Early recognition of groups in high risk, timely adjustment on mentioned significant extrinsic factors, providing psychological support and therapy, are helpful strategies on reducing the adverse psychological effect under stress from COVID-19 pandemic.