Anesth Analg：麻醉科医生抑郁患病率高或影响病人安全

　　近期PubMed网络版发布的一项针对美国麻醉科住院医的横断面调查的结果显示，倦怠、抑郁及自杀意念在麻醉科住院医中非常普遍，这些不良精神状态不仅影响医生的健康，或许也会对病人的治疗和安全造成不良影响。

　　为确定倦怠与抑郁在麻醉科住院医中的患病率，并对住院医的倦怠或抑郁是否会影响患者的治疗与安全进行评估，研究者假设存在高倦怠与/或抑郁风险的住院医呈报的医疗差错较多，履行麻醉科最佳操作规范的比例较低。

　　研究共向全美2773名麻醉科住院医发出调查问卷。调查问卷分为5部分，对实习医生的人口统计学因素、倦怠（Maslach倦怠量表）及抑郁（哈佛抑郁量表）进行评估。其中10个问题评估麻醉科最佳操作，7个问题评估自我呈报的错误。分别在倦怠高风险组，抑郁高风险组，倦怠抑郁双重高风险组，倦怠抑郁低风险组的受试者间对最佳操作率和自我呈报的错误率进行比较。成对比较的显著性为P<0.004，置信区间（CIs）为99.6%。

　　共有1508（54%）名住院医回应此次调查，41%（575/1417）的受访者存在高倦怠风险，周工作时间>70小时，每周饮酒次数>5次，且其中女性住院医的倦怠风险较高。22%（298/1384）的受试者抑郁筛查结果为阳性，周工作时间>70小时、吸烟、女性及每周饮酒次数>5次与抑郁风险的增高有关。240名（17%）受访者的倦怠和抑郁风险评分均较高，321（23%）名存在高倦怠风险，58（4%）名存在单纯的高抑郁风险，764（56%）名存在低倦怠和抑郁风险。高倦怠风险住院医的最佳操作评分中值（99.6% CI, -1 to -2; P < 0.001)，倦怠和抑郁双重高风险的住院医（99.6% CI, -3 to -6; P < 0.001)，前两者评分均低于低倦怠或抑郁风险的住院医。33%倦怠和抑郁双重高风险的受访者在过去一年报告过各种医疗差错，这个比例在低风险受访者中仅为7%（P<0.001)。

The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees.
BACKGROUND
The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.
METHODS
A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees' demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.
RESULTS
There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference -2; 99.6% CI, -1 to -2; P < 0.001) or high risk of burnout and depression (difference -4; 99.6% CI, -3 to -6; P < 0.001) were lower than scores of residents at low risk for burnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).
CONCLUSION
Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.