職業駕駛的精神疾病探討

Abstract

背景與目的：精神疾病是一個日益重要的全球性問題。每八個人就會有其中一人可能會有精神疾病，全球大約有9.7億的人因精神疾病而困擾，其中約3億的人有焦慮症、2.8億的人有憂鬱症，目前造成精神疾病的原因非常的多，包括遺傳背景、其他疾病的影響，廣泛的環境因素等等…，在工作環境的影響下交通運輸業的員工得到精神疾病的比例比其他行業來的高，其中男性員工有憂鬱症的盛行率約2.5%-13.3%。交通運輸司機的心理健康可能比其他通運輸業的員工的影響更大，尤其是公車司機，公車司機的精神疾病不僅影響駕駛表現，也可能對乘客安全造成危險。本研究目的是以公車司機世代串聯健保資料庫，進行長時間的追蹤研究探討各項因子與精神疾病的關聯性。 方法:本研究針對公車司機與精神疾病的相關性，分為三部分做探討: 1) 將公車司機行業別及使用傾向分數匹配性別、年齡、工作年資、開始工作年取得1:4的對照族群後，再利用個人身份證號串聯到健保資料庫中的門急診及住院資料，以追蹤2005年至2016年的新發生病例，預期的病例是透過使用特定年齡 25-64歲（每5年一組）和每年的疾病發生率，參照2000年WHO年中標準人口來計算，標準化發生率（SIR）及標準化率比(SRR)。另外也進行前瞻性世代研究比較兩個世代精神疾病得病的風險2) 進行前瞻性世代研究，探討公車司機工作環境中的危險因子，包含工作壓力、慢性疲勞與精神疾病之關係; 3) 進行前瞻性世代研究，公車司機睡眠時，夜間間歇性缺氧指標以存活分析 探討與精神疾病發生的危險比。 結果: 1) 以公車司機行業別，無論男性或女性計算2005年至2016年的標準化發生率，發現在總精神疾病、焦慮、情感性、焦慮或情感性、睡眠障礙等五大分類，結果顯示在這五大類中SRR (SIR公車司機/ SIR 參考族群) 皆大於1，表示公車司機的風險較高。另在12年的追蹤也發現在這五大分類精神疾病中公車司機的得病風險都比參考族群高2) 研究世代在九年的追蹤中，分析了896名公車司機，有85人被新診斷出患有精神疾病。工作壓力量表JCQ分數與發展精神疾病的風險無關聯，但職業疲勞量表SOFI-C分數高（≥5）的公車司機罹患焦慮或情感性疾病的風險升高（風險比3.35，95%信賴區間1.23–9.09）。3) 研究世代在九年的追蹤後，在820名公車司機中，有80人被新診斷出患有精神疾病。發現ODI4與精神疾病有關聯，尤其是與發展焦慮或情感性疾病的風險增加。Log2ODI4增加的罹患焦慮或情感性疾病風險也隨之升高(風險比1.42，95%信賴區間1.05–1.92)。對於ODI4 ≥3（事件/小時）的公車司機罹患焦慮或情感性疾病的風險升高(風險比3.61，95%信賴區間1.31–9.09)。 結論: 這項研究追蹤了臺灣公車司機與其他職業精神疾病的標準化發生率，臺灣公車司機的精神疾病發病率較高。根據研究結果針對公車司機族群制定身心理健康管理系統有迫切需求。未來的研究更應該探討各種因素，以應對公車司機所面臨的心理健康挑戰。而台灣的公車司機普遍存在職業相關的疲勞。根據本研究降低職業疲勞(SOFI-C)與注意夜間間歇性缺氧等因素（ODI4），這些早期的干預及偵測可能對於防止公車司機發生焦慮或情感性疾病是非常重要的因子。

Background and Objectives: Mental illness is an increasingly significant global concern, affecting approximately one in eight individuals. Globally, around 970 million people are troubled by mental disorders, with approximately 300 million experiencing anxiety and 280 million experiencing depression. The causes of mental illness are diverse, including genetic factors, the influence of other diseases, and a wide range of environmental factors. Employees in the transportation industry, particularly in the context of the impact of the work environment, exhibit a higher prevalence of psychiatric disorders compared to other industries. The prevalence of depression among male transportation industry workers ranges from 2.5% to 13.3%. The mental health of transportation workers has potentially higher impacts than other workers, especially bus drivers. Mental illnesses among bus drivers not only affect driving performance but may also pose a danger to the passengers or public property. This study aims to conduct a long-term follow-up investigation, utilizing the National Health Insurance Research Database to explore the associations between various factors and psychiatric disorders among bus drivers. Methods: This study, focusing on the correlation between bus drivers and psychiatric disorders, is divided into three parts: 1) The exposed group comprises 49,160 bus drivers identified under the industry code ''H4931''. Unexposed (working, never been bus drivers): Also identified from the same database, propensity score matching (1:4) was applied, considering factors such as age, gender, year of initial employment, and salary for insurance coverage. This unexposed group was randomly chosen from individuals classified under the ''Non-H code'' category, who were employed and not associated with the industry code H4931, during the period from 2005 to 2016. Medical records, derived from the National Labor Insurance Research Database (NLIRD) and linked with the National Health Insurance Research Database (NHIRD), were analyzed over the 2005-2016 period. The expected incidence was calculated based on age 25-64 years old (in 5-year intervals) and calendar time-specific incidence rates of psychiatric disorders, referencing the World Health Organization''s (WHO) general population data from the year 2000, to calculate Standardized Incidence Rates (SIR) and compared the SIR among two groups to estimate Standardized Rate Ratio (SRR) that would help determine if there is a notable difference in the standardized incidence rates. 2) The prospective cohort study, linked to the National Health Insurance Database, tracked the incidence of psychiatric disorders among bus drivers and investigated the relationship between occupational risk factors in the work environment, including job stress and job fatigue, during the period from 2007 to 2016. 3) This prospective cohort study linked bus drivers cohort to the National Health Insurance Database and used survival analysis to adjust for confounding factors to examine the relationship between the nocturnal intermittent hypoxia index (ODI4) during night sleep and the risk of psychiatric disorders among bus drivers. Results: 1) The analysis revealed a statistically significant increase in the SRR for total psychiatric disorders, anxiety, mood disorders, and comorbid anxiety or mood disorders, as well as sleep disorders among bus drivers compared to the reference group. After a 12-year follow-up, bus drivers exhibited higher risk in total psychiatric disorders, anxiety, mood disorders, comorbid anxiety or mood disorders, as well as sleep disorders. Stratification by gender, indicated a significantly elevated risk of mood disorders in both males (HR 1.70, 95% CI 1.56-1.84) and females (HR 2.31, 95% CI 2.01-2.65). 2) In a ten-year follow-up of 896 bus drivers, 85 were newly diagnosed with psychiatric disorders. Job Content Questionnaire (JCQ) scores for work stress were not associated with the risk of developing psychiatric disorders. However, bus drivers with high Scores on Fatigue Individual Characteristics (SOFI-C) scores (≥5) had an increased risk of developing anxiety or mood disorders (Hazard Ratio 3.35, 95% Confidence Interval 1.23–9.09). 3) In a ten-year follow-up of 820 bus drivers, 80 were newly diagnosed with psychiatric disorders. The ODI4 was associated with psychiatric disorders, especially with an increased risk of developing anxiety or mood disorders. The risk of developing anxiety or mood disorders increased with the Log2ODI4 (Hazard Ratio 1.42, 95% Confidence Interval 1.05–1.92). For ODI4 ≥3 (events/h), the risk of developing anxiety or mood disorders increased (Hazard Ratio 3.61, 95% Confidence Interval 1.31–9.09). Conclusion: This study found a statistically higher incidence of psychiatric disorders among Taiwanese bus drivers as compared to non-bus drivers. The findings emphasize the urgent need for a tailored mental health management system for this population. Future research should explore contributing factors to address the specific mental health challenges faced by bus drivers. The study indicates that work-related fatigue is prevalent among bus drivers in Taiwan. According to the findings, reducing occupational fatigue (SOFI-C) and addressing factors such as nocturnal intermittent hypoxia (ODI4) through early intervention and detection may be crucial in preventing anxiety or mood disorders in bus drivers.