受外傷工作者之心理變化與復工影響之追蹤性研究

Abstract

背景目的： 受外傷後工作者的心理狀態變化是近年來職業衛生關注的議題，而復工則是做為衡量工作者在傷後恢復的重要指標，在林冠含等人的研究中，發現職傷的工作者在3個月時有17.8%的人精神症狀嚴重度偏高，事件後1年仍有13.5%的人精神症狀嚴重度偏高，且在3個月時精神症狀嚴重度偏高者，到1年時仍有50%的人無法復工。但在受傷後到3個月之間心理變化與復工的影響目前國內仍無相關研究，故本研究的目的為：一、調查受傷後1週與3個月時心理狀態處嚴重程度的發生率；二、了解受傷後1週的心理狀態可否預測3個月時的心理狀態；三、了解受傷後1週的心理狀態可否預測3個月時的復工。 研究方法： 本研究於民國101年4月1日至102年12月31日於某教學醫院之外科系病房，與受外傷的工作者共80位進行接觸，分別以中文版事件影響量表修訂版（Chinese version of the Impact of Event Scale-Revised, CIES-R）和簡式精神症狀自陳量表（Brief Symptom Rating Scale, BSRS-50），做為受傷後1週與3個月的心理狀態評估工具，本研究共分為二階段，於受傷後1週時與工作者接觸，3個月時再進行追蹤，以線性迴歸模式、邏輯斯迴歸模式、後向逐步迴歸模式、比例危險模式進行統計檢定，以確立預測3個月心理變化與復工的危險因子。 結果： 本研究在第一階段共有73位工作者同意參與（填答率91.3%），第二階段則有63位工作者完成第二次追蹤（填答率86.3%）。結果在受傷後1星期有24.7%的工作者在CIES-R的三症狀分項中有至少一項達嚴重程度，3個月時則有25.4%的工作者在BSRS-50的十個症狀分項中至少一種精神症狀達嚴重程度。而受傷後1週時CIES-R的過度警覺是預測3個月時BSRS-50之綜合嚴重指數、焦慮、憂鬱、敵意和強迫性的重要變項（p < 0.05），以及受傷後1週時CIES-R的侵擾是預測3個月時BSRS-50之附加症狀、畏懼、人際敏感和身體化症狀的重要變項（p < 0.05）。但受傷後1週時的心理狀態無法預測3個月的復工。 結論： 本研究為國內第一次探討外傷工作者之心理狀態於1週對3個月心理狀態與復工影響之研究，發現在受傷後早期的心理狀態可影響3個月的心理狀態，且數據顯示有約25%的工作者有潛在的心理困擾，以做為第一線的醫療從業人員參考，並提高敏感度以盡早介入或轉介相關單位及資源提供受傷工作者即時的協助，並可做為中央主管機關後續進行職災工作者保護計畫之年度規畫中的重要議題。

Background: The mental condition of injured workers is an important issue in occupational psychiatry, and return-to-work (RTW) is the important outcome to reflect the workers recovery. Previous studies in Taiwan showed that among injured workers requiring hospitalization, 7.5% and 5.1% had psychiatric disorders at 3 months and 12 months after the injury, respectively. The main psychiatric conditions were post-traumatic stress disorder (PTSD) and/or major depression. Psychological symptoms at 3 months after injury predicted poor capability of RTW at 12 months. However, acute psychological responses to injury have not been described within 3 months. Aim: The aim of the study was to determine the prevalence of poor mental conditions at 1 week and 3 months after injury by and to understand whether psychological symptoms of acute stress in injured workers predict psychological conditions and RTW at 3 months. Method: From 2012/4/1 to 2013/12/31, we recruited injured workers admitted to a tertiary referral center in northern Taiwan. Psychological symptoms were assessed at 1 week after injury by the Chinese version of Impact of Event Scale–Revised (CIES-R). At 3 months, self-administered questionnaire was used for data collection, including RTW and Brief Symptom Rating Scale (BSRS-50). Multiple regression and backward stepwise model were performed to examine the association between CIES-R and BSRS-50, adjusting for potential covariates. Cox proportional hazard model was used to test the association between RTW and CIES-R, adjusting for potential covariates. Results: There were 73 injured workers participated our study and completed the first stage questionnaire and a total of 63 injured workers completed our two-stage investigation. There were 24.7% and 25.4% had high psychological symptoms at 1 week and 3 months after injury, respectively. Hyperarousal was an important psychological symptom at 1week after injury to predict global severity index, anxiety, depression, hostility and obsessive-compulsive by BSRS-50 at 3 months after injury. Intrusion was another acute important psychological symptom to predict additional symptom, phobic-anxiety, interpersonal sensitivity and somatization by BSRS-50 at 3 months after injury. RTW at 3 months was not related to CIES-R score. Conclusion: Psychological symptoms were found in a quarter of injured hospitalized workers at 1 week and 3 months after injury, the symptoms of acute stress predicted psychological conditions at 3 months, especially for the scores of hyperarousal and intrusion. Psychological symptoms at 3 months has good prediction for RTW at 12 months, strategy should be developed for early assistance to the injured workers with high CIES-R scores.