In the current study, we totally interviewed 3,426 medical staff in Shandong province, China. The estimated lifetime and one-year prevalences of suicidal ideation were 9.1% (312/3,426) and 7.0% (239/3,426), respectively. The detailed distribution was shown in the second column in Table 1. In Table 1, we also conducted single analyses to compare the differences in suicidal ideation for each variable. For lifetime suicidal ideation, the associated factors were gender, married status, education, manager, physical disease, work-family conflict, social support, and depression. For the one-year suicidal ideation, the associated factors were gender, age, married status, education, physical disease, work-family conflict, social support, and depression.
In Table 2, backward logistic regressions were used to identify the factors associated with lifetime and one-year prevalence of suicidal ideation among medical staff. As the importance of depression in suicidal ideation, we analyzed the factors without depression in Model A1 and B1. However, when depression was added into the regressions, social support and age disappeared in the regressions. The associated factors for lifetime suicidal ideation were male (OR=0.54), doctor (OR=4.32), physical disease (OR=1.58), work-family conflict (OR=1.03), and depression (OR=1.09). The associated factors for one-year suicidal ideation were male (OR=0.46), doctor (OR=4.21), master (OR=1.79), physical disease (OR=1.51), work-family conflict (OR=1.02), and depression (OR=1.10).
To further understand the mechanism of work-family conflict, depression, social support, and suicidal ideation, conditional process analysis was used to analyze the relationships among them. As the illustration in the Introduction section, we built the models as shown in Fig. 1 and 2. After controlling gender, age, married status, education, and physical disease, the coefficients were displayed in Fig 1 and 2. In Table 3, we listed the direct and indirect effect of work-family conflict, depression, and social support on lifetime and one-year suicidal ideation. The results supported that work-family conflict had an indirect effect (48.0%, 0.0255/0.0531) on lifetime suicidal ideation. For one-year suicidal ideation, the percentage of the indirect effect of work-family conflict was 55.8% (0.0285/0.0511), and the number was 68.7% (-0.0244/-0.0355) for social support.
Table 1: Lifetime and 1-year prevalence of suicidal ideation among medical staffs [n (%)/Mean±SD]
|
Total
|
Lifetime prevalence
|
|
One-year prevalence
|
Yes
|
No
|
t/ 2
|
Yes
|
No
|
t/ 2
|
All
|
3426 (100.0)
|
312 (9.1)
|
3114 (90.9)
|
--
|
|
239 (7.0)
|
3187 (93.0)
|
--
|
Gender
|
|
|
|
5.62*
|
|
|
|
6.71**
|
Male
|
919 (26.8)
|
66 (21.2)
|
853 (27.4)
|
|
|
47 (19.7)
|
872 (27.4)
|
|
Female
|
2507 (73.2)
|
246 (78.8)
|
2261 (72.6)
|
|
|
192 (80.3)
|
2315 (72.6)
|
|
Age
|
35.14±8.42
|
34.30±7.22
|
35.23±8.53
|
-1.85
|
|
34.08±7.40
|
35.22±8.49
|
-2.03*
|
Married Status
|
|
|
|
6.82*
|
|
|
|
7.97*
|
Single
|
577 (16.8)
|
69 (22.1)
|
508 (16.3)
|
|
|
56 (23.4)
|
521 (16.3)
|
|
Married
|
2802 (81.8)
|
239 (76.6)
|
2563 (82.3)
|
|
|
180 (75.3)
|
2622 (82.3)
|
|
Others
|
47 (1.4)
|
4 (1.3)
|
43 (1.4)
|
|
|
3 (1.3)
|
44 (1.4)
|
|
Education
|
|
|
|
12.24**
|
|
|
|
10.20*
|
Doctor
|
56 (1.6)
|
12 (3.8)
|
44 (1.4)
|
|
|
9 (3.8)
|
47 (1.5)
|
|
Master
|
562 (16.4)
|
54 (17.3)
|
508 (16.3)
|
|
|
45 (18.8)
|
517 (16.2)
|
|
Bachelor
|
2368 (69.1)
|
214 (68.6)
|
2154 (69.2)
|
|
|
162 (67.8)
|
2206 (69.2)
|
|
Others
|
440 (12.8)
|
32 (10.3)
|
408 (13.1)
|
|
|
23 (9.6)
|
417 (13.1)
|
|
Types of medical staff
|
|
|
|
0.18
|
|
|
|
1.09
|
Doctor
|
1268 (37.0)
|
112 (35.9)
|
1156 (37.1)
|
|
|
83 (34.7)
|
1185 (37.2)
|
|
Nursing
|
1695 (49.5)
|
157 (50.3)
|
1538 (49.4)
|
|
|
126 (52.7)
|
1569 (49.2)
|
|
Medical technician
|
463 (13.5)
|
43 (13.8)
|
420 (13.5)
|
|
|
30 (12.6)
|
433 (13.6)
|
|
Professional title
|
|
|
|
3.10
|
|
|
|
3.29
|
Senior
|
109 (3.2)
|
7 (2.2)
|
102 (3.3)
|
|
|
5 (2.1)
|
104 (3.3)
|
|
Vice-senior
|
303 (8.8)
|
21 (6.7)
|
282 (9.1)
|
|
|
16 (6.7)
|
287 (9.0)
|
|
Intermediate
|
1170 (34.2)
|
112 (35.7)
|
1058 (34.0)
|
|
|
79 (33.1)
|
1091 (34.2)
|
|
Junior and others
|
1844 (53.8)
|
172 (55.1)
|
1672 (53.7)
|
|
|
139 (58.2)
|
1705 (53.5)
|
|
Manager
|
|
|
|
5.12*
|
|
|
|
3.49
|
Yes
|
659 (19.2)
|
45 (14.4)
|
614 (19.7)
|
|
|
35 (14.6)
|
624 (19.6)
|
|
No
|
2767 (80.8)
|
267 (85.6)
|
2500 (80.3)
|
|
|
204 (85.4)
|
2563 (80.4)
|
|
Physical disease
|
|
|
|
33.99***
|
|
|
|
26.55***
|
Yes
|
457 (13.3)
|
75 (24.0)
|
382 (12.3)
|
|
|
58 (24.3)
|
399 (12.5)
|
|
No
|
2969 (86.7)
|
237 (76.0)
|
2732 (87.7)
|
|
|
181 (75.7)
|
2788 (87.5)
|
|
Work-family conflict
|
29.62±9.28
|
32.85±8.41
|
29.30±8.19
|
7.30***
|
|
32.80±8.46
|
29.38±8.21
|
6.20***
|
Social support
|
62.46±13.82
|
56.94±14.65
|
63.01±13.61
|
-7.45***
|
|
55.90±15.02
|
62.95±13.60
|
-7.67***
|
Coping skill
|
30.63±9.83
|
30.81±10.17
|
30.61±9.79
|
0.35
|
|
30.86±9.88
|
30.61±9.82
|
0.39
|
Depression
|
14.72±10.38
|
24.77±11.64
|
13.71±9.69
|
18.85***
|
|
26.26±11.70
|
13.85±9.74
|
18.71***
|
Note: SD refers to standard deviation. * means p<0.05. ** means p<0.01. *** means p<0.001.
Table 2: Backward logistic regression analysis for the Lifetime and 1-year prevalence of suicidal ideation among medical staffs [OR (95% CI)]
|
Lifetime prevalence
|
|
One-year prevalence
|
Model A1#
|
Model A2
|
|
Model B1#
|
Model B2
|
Male
|
0.65 (0.48, 0.88)**
|
0.54 (0.39, 0.74)***
|
|
0.58 (0.41, 0.82)**
|
0.46 (0.32, 0.66)***
|
Age
|
0.98 (0.96, 0.98)**
|
--
|
|
0.97 (0.95, 0.99)**
|
--
|
Married status (Ref.=others)
|
|
|
|
|
|
Single
|
--
|
1.76 (0.56, 5.60)
|
|
--
|
1.88 (0.51, 6.98)
|
Married
|
--
|
1.16 (0.37, 3.62)
|
|
--
|
1.16 (0.32, 4.20)
|
Education (Ref.=others)
|
|
|
|
|
|
Doctor
|
3.78 (1.75, 8.19)***
|
4.32 (1.93, 9.63)***
|
|
3.65 (1.52, 8.79)**
|
4.21 (1.69, 10.49)**
|
Master
|
1.36 (0.84, 2.18)
|
1.43 (0.87, 2.34)
|
|
1.66 (0.97, 2.85)
|
1.79 (1.02, 3.15)*
|
Bechelor
|
1.16 (0.78, 1.73)
|
1.22 (0.81, 1.84)
|
|
1.24 (0.78, 1.97)
|
1.31 (0.81, 2.12)
|
Physical disease
|
2.14 (1.58, 2.91)***
|
1.58 (1.15, 2.16)**
|
|
2.16 (1.54, 3.02)***
|
1.51 (1.06, 2.15)*
|
Work-family conflict
|
1.05 (1.04, 1.07)***
|
1.03 (1.01, 1.05)***
|
|
1.05 (1.03, 1.07)***
|
1.02 (1.00, 1.04)*
|
Social support
|
0.97 (0.96, 0.98)***
|
--
|
|
0.97 (0.96, 0.98)***
|
--
|
Depression
|
--
|
1.09 (1.08, 1.10)***
|
|
--
|
1.10 (1.09, 1.12)***
|
Constant
|
0.21**
|
0.01***
|
|
0.24**
|
0.004***
|
R2
|
0.10
|
0.20
|
|
0.10
|
0.22
|
Note: #: the models were analyzed without depression. Ref. means reference. * means p<0.05. ** means p<0.01. *** means p<0.001.
Table 3: Direct and indirect effect of work-family conflict, social support, and depression on suicidal ideation among medical staffs
|
Lifetime suicidal ideation
|
|
One-year suicidal ideation
|
Direct effect
|
Indirect effect
|
Total effect
|
Direct effect
|
Indirect effect
|
Total effect
|
Work-family conflict
|
0.0276
|
0.0255
|
0.0531
|
|
0.0226
|
0.0285
|
0.0511
|
Social support
|
-0.0087
|
-0.0218
|
-0.0305
|
|
-0.0111
|
-0.0244
|
-0.0355
|
Depression
|
0.0816
|
--
|
0.0816
|
|
0.0911
|
--
|
0.0911
|