Parro-Pires, Daniela Betinassi; Nogueira-Martins, Luiz Antônio; Citero, Vanessa de Albuquerque

doi:10.1590/1806-9282.64.09.806

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Revista da Associação Médica Brasileira

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Sumário

ORIGINAL ARTICLES • Rev. Assoc. Med. Bras. 64 (9) • Set 2018 • https://doi.org/10.1590/1806-9282.64.09.806 copiar

Interns’ depressive symptoms evolution and training aspects: a prospective cohort study

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

OBJETIVO

Estudar a incidência de sintomas depressivos em residentes de medicina de 1⁰ ano e sua correlação com características ocupacionais, satisfação e estresse no programa.

MÉTODOS

Coorte prospectivo realizado na Escola Paulista de Medicina, Universidade Federal de São Paulo. Foram convidados 166 médicos residentes do hospital universitário para responder ao Inventário de Depressão Beck (BDI) e a um questionário ocupacional num estudo prospectivo longitudinal. O escore da variação do BDI foi relacionado com aspectos sociodemográficos e características ocupacionais usando um modelo de regressão linear.

RESULTADOS

Cento e onze sujeitos participaram (67%); o escore do BDI aumentou em oito meses (média = 2,75 ± 3,29 vs. 7,00 ± 5,66; p<0,0001). A incidência dos sintomas depressivos foi de 9,01% (escore>15). A variação do escore do BDI teve média = 4,25 ± 4,93 (de –8 a 28). Residentes não satisfeitos com o treinamento profissional (β = 3,44; p = 0,004), com a vida pessoal (β = 2,97; p = 0,001) ou que se sentem estressados na relação com residentes seniores (β = 2,91; p = 0,015) apresentaram 3 pontos a mais do escore do BDI depois de oito meses em comparação com aqueles sem tais percepções; estar insatisfeito com a equipe de enfermagem aumentou o escore do BDI em 2 pontos (β = 1,95; p = 0,025).

CONCLUSÃO

Entre os fatores que interferem na depressão em residentes estão as características ocupacionais que podem ser melhoradas no treinamento. Esclarecer tais pontos pode ajudar a instituição a prover um melhor cuidado em saúde mental.

Depressão; Internato e residência; Estresse psicológico; Saúde mental; Educação médica

		N	%
Residency Programs	Surgical	43	38.7
	Clinical	68	61.3
Medical School	The same that the subject is intern	68	61.3
Medical School	Other	43	38.7
Marital status	Single	106	95.5
Years living in São Paulo (city where the university is)	< 6 years	40	36.7
Years living in São Paulo (city where the university is)	≥ 6 years	69	63.3
Place where the resident lives during the training	Parent/ relative house	52	46.8
Place where the resident lives during the training	Dormitory/ own or rental apartment	59	53.2
Current Medical Treatment	No treatment	91	82.0
Current Medical Treatment	Under psychiatric medication	4	3.6
Mental health treatment (present or previous)	Never	88	79.3
	Psychotherapy	14	12.6
	Medication and psychotherapy	9	8.1
Family Psychiatric History	Presence in any relative	34	30.6
Family Psychiatric History	Presence in father or mother	17	15.3

		T1		T2
		Mean ± SD	P	Mean ± SD	P
Gender	Male	2.85 ± 3.38	.663	6.91 ± 5.79	.841
Gender	Female	2.64 ± 3.22	.663	7.09 ± 5.88	.841
Residency Programs	Clinical	2.78 ± 3.35	.887	6.25 ± 5.63	.026
Residency Programs	Surgical	2.70 ± 3.23	.887	8.19 ± 5.57	.026
Medical School	The same that the subject is intern	2.59 ± 3.09	.382	7.29 ± 5.99	.618
Medical School	Other	3.09 ± 3.58	.382	6.53 ± 5.14	.618
Years living in São Paulo	≥ 6 years	2.39 ± 3.05	.063	6.99 ± 5.12	.568
Years living in São Paulo	< 6 years	3.48 ± 3.64	.063	7.10 ± 6.10	.568
Place where the resident lives during the training	Parent/Relative house	1.96 ± 2.92	.005	7.48 ± 5.26	.466
Place where the resident lives during the training	Dormitory/ own or rental apart	3.44 ± 3.46	.005	6.58 ± 5.78	.466
Marital status	Single/Divorced	2.65 ± 3.24	.135	6.91 ± 1.00	.129
Marital status	Married	4.80 ± 4.15	.135	9.00 ± 1.00	.129

	Univariate Model	Multivariate Model
		Initial Model (Method “Enter”)		Final Model (Method “Backward”)
	Coefficient (CI95%)	P	Coefficient (CI95%)	P	Coefficient (CI95%)	P
Gender male (ref. = female)	-0.39 (-2.26 ; 1.47)	0.678	-0.90 (-2.62 ; 0.81)	0.299	-	NS
Medical Specialty surgical (ref. = clinical)	2.02 (0.14 ; 3.89)	0.035	1.48 (-0.42 ; 3.39)	0.126	-	NS
Age (years)	0.09 (-0.64 ; 0.82)	0.803	0.07 (-0.55 ; 0.70)	0.812	-	NS
How unsatisfied are you with the professional training you are acquiring?	3.88 (1.46 ; 6.30)	0.002	3.21 (0.2 ; 6.22)	0.037	3.44 (1.16 ; 5.72)	0.004
How unsatisfied are you with the amount of leisure time you have?	3.37 (1.47 ; 5.27)	0.001	1.99 (-0.13 ; 4.1)	0.065	-	NS
How unsatisfied are you with your personal life (time spent with family, romantic relationship and friends)?	3.55 (1.75 ; 5.35)	<0.001	1.87 (-0.11 ; 3.85)	0.064	2.97 (1.24 ; 4.70)	0.001
How unsatisfied are you with your personal health habits (time for sports, healthy	2.34 (-0.1 ; 4.77)	0.060	-0.56 (-2.97 ; 1.86)	0.648	-	NS
How unsatisfied are you with the school faculty?	0.27 (-1.75 ; 2.29)	0.790	-2.97 (-5.25 ; -0.70)	0.011	-	NS
How unsatisfied are you with the nursing team that works with you?	1.89 (-0.03 ; 3.80)	0.053	1.62 (-0.23 ; 3.46)	0.085	1.95 (0.25 ; 3.65)	0.025
How unsatisfied are you with residency colleagues from all programs that you work with?	-1.15 (-5.26 ; 2.97)	0.582	-1.88 (-6.27 ; 2.51)	0.396	-	NS
During these 8 months of residency, how unsatisfied are you with your own performance?	5.99 (2.94 ; 9.04)	<0.001	0.88 (-2.9 ; 4.65)	0.645	-	NS
How difficult for you is to deal with patients?	-0.58 (-3.36 ; 2.20)	0.680	-2.37 (-5.41 ; 0.66)	0.124	-	NS
How difficult for you is to deal with patient’ family?	-0.33 (-2.80 ; 2.14)	0.792	0.86 (-2.48 ; 4.20)	0.609	-	NS
How stressful is giving bad news for patients and their families?	1.13 (-0.72 ; 2.98)	0.230	1.04 (-0.76 ; 2.84)	0.253	-	NS
How well oriented are you by the school faculty?	0.62 (-1.57 ; 2.82)	0.574	0.00 (-2.25 ; 2.25)	0.999	-	NS
How well respected are you by the school faculty?	-0.73 (-2.93 ; 1.47)	0.511	-1.10 (-3.33 ; 1.13)	0.330	-	NS
How stressful is the relationship with the nurse team and other health professionals in the hospital?	1.75 (-0.54 ; 4.04)	0.132	1.21 (-1.01 ; 3.42)	0.281	-	NS
How stressful is the relationship with 1st year residents?	0.18 (-2.97 ; 3.32)	0.910	1.11 (-2.20 ; 4.42)	0.507	-	NS
How stressful is the relationship with 2^nd, 3^rd and 4^th year residents?	3.24 (0.71 ; 5.76)	0.013	3.43 (0.78 ; 6.08)	0.012	2.91 (0.58 ; 5.25)	0.015
How stressful is the relationship with undergraduate medical students?	1.04 (-3.96 ; 6.03)	0.682	-1.95 (-6.32 ; 2.42)	0.376	-	NS
How many hours per week are you working at this rotation (including nightshifts)?	0.05 (0.00 ; 0.10)	0.041	-0.01 (-0.06 ; 0.04)	0.732	-	NS
How many hours per week are you working outside the university this month (including nightshifts)?	0.10 (-0.02 ; 0.22)	0.118	0.04 (-0.07 ; 0.15)	0.475	-	NS

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[1] CORRESPONDING AUTHOR: Daniela Betinassi Parro Pires. Rua Botucatu, 529 - São Paulo (SP) - Brasil - Zip Code: 04023-061 Phone: (+5511) 5576-4848 Voip: 1260 E-mail: danibpp@gmail.com nogmartins.luizantonio@gmail.com citero@huhsp.org.br