工作組織社會心理特質與自評健康：比較DC與ERI工作壓力模式對醫師族群之適用性

Psychosocial Work Environment and self-rated Health: A Comparative Study of DC and ERI Models in a Sample of Medical Specialists

10.6288/TJPH2006-25-02-02

陳端容(Duan-Rung Chen)

醫師健康 ； 工作組織 ； 負荷控制模式 ； 付出報酬失衡模式 ； physicians' health ； work organizations ； Demand Control model ； Effort Reward Imbalance model

台灣公共衛生雜誌

25卷2期（2006 / 04 / 01）

93 - 106

繁體中文

目標：本研究以職業壓力文獻中兩個主要工作壓力模式「負荷控制模式」(Demand Control model)與「付出報酬失衡模式」(Effort Reward Imbalance Model)檢驗131位心臟科醫師工作組織社會心理特質與自評健康之關係，並比較兩個模式適用性。方法：結構式問卷包括DC及ERI模式量表及其他工作變項，以郵寄問卷收集資料。結果：「付出報酬失衡」與「高負荷低控制」對壓力引起的心身症狀(psychosomatic symptoms)有部分解釋力，然「付出報酬失衡」對輕度心理憂鬱傾向相關較強，高負荷低控制的工作壓力與醫師自評健康相關性較強，推測前者因著重組織與員工社會交換的心理變項，對屬於整體而較抽象的心理健康層次變項心理憂鬱傾向可以提供較佳解釋，而「高負荷低控制」模式測量每天皆會經歷而相當具體的工作狀況，與直接評量當下健康狀況的自評健康較有關。結論：對高度專業且受雇於大型醫院的醫師而言，雖然執行相同的醫療工作，但卻因為工作組織環境與工作條件不同，對健康形成不同程度的危害，顯示工作組識社會心理環境的重要性，高負荷低控制或是付出報酬失衡的工作處境對醫師因壓力引起的病態可以提供部分解釋力，值得進一步討論。

Objectives: To compare the predictive validity of the demand/control and effort reward/imbalance models for self-reported health status and minor mental distress in a sample of Taiwanese cardiologists. Methods: A standardized questionnaire including working characteristics, DC and ERI questionnaires were mailed to physicians registered as cardiology specialists. A total of 131 physicians responded to this study. Results: Effort-reward imbalance at work was relatively more associated with minor mental distress, and job strain is associated with self-reported health. However, both effort-reward imbalance at work and job strain can explain part of the adverse effect of stress on health. One personality variable, need for approval is also associated with the chance of being in minor mental distress. It suggests that different dimensions of intrinsic effort need to be further explored. Physicians who have administrative positions tend to show ill health, and this indicates that dual role responsibility may increase health risks. Conclusion: The results suggest that both DC and ERI models can explain aspects of psychosocial environment of working organizations for professional groups. It calls for attention to the heterogeneity of organizational contexts for organized professions.

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