Trần Bình Thắng, Võ Văn Thắng, Michael P Dunne, Trần Quỳnh Anh.Nghiên cứu năm 2013. Hội nghị khoa học quận Thủ Đức, thành phố Hồ Chí Minh. Y học thực hành (880).Nghiên cứu mô tả cắt ngang về trầm cảm, ý định tự sát và lo âu ở sinh viên đa khoa Y1, Y3, Y5 trường Đại học Y Dược Huế sử dụng bộ công cụ CESD.Các yếu tố liên quan sử dụng hồi quy tuyến tính đa biến rút gọn (Linear Multiple Regression).
Trang 1TRAM CAM, Y DINH TV' SAT vA LO AU (y SINH VIEN Y KHOA
TRAN SINH THANG
ITNghifH] c~u SiPckh6e ct;mg dong, TrU'iYng f)H YDLJ'ClC Hue
. VO VAN THANG - TrU'iYng f)~i h9C Y DLJ'ClC Hue MICHAEL P DUNNE - f)~i h9C Cong ngh~ Queensland, Uc
TRAN QUYNH ANH - f)~i h9C YHil NOi
TOM TAT
M~c tieu: Nhi~u tr.U ' &ng d<;lihoc iren the giai c6 nniem VI,1cham s6c sinh vien kll ca nhO'nfj sinh v ien c6 nhO'ng kh6 khan ve tam ty Te! Vi~t Nam va cac nuoc vung Mekong khac, cac djch VI,1tir van va cham s6c s(PC; khOe t6ng quat cho sinh vien con rat it Nghien cuu nay nhiim cet thi~n b~ng chl fng v~ dau hi~u trem cam va ytU'&ng tl)' sat dll giai tbieu cac diet: VI,1cham s6c s(PC; kh6e tam th~n cho sinh vien tnrcnq y
PhU'O'ng phap nghien CLPu:Nghien cou dt ngang vo! 267 sinh vien bee s9da khoa truong y nem thL f
nMt , ttur ba va thl f nem , nghien cou tei truong f)<;lihoc YDuQ'C Hue Cec lap auoc chon ngau nhien, tat
ca sinh vien caclap duQ'C Il) ' a chon thu(jn tien tham gia nghien cou nay Bang h6i dau ten, tir di~n duQ'c dung dll kMo sat cac yeu to enn huang ntur te :ganh n~ng hoc t(jp , cac sir ki~n gay stress do i voi ooi song ca nnen sinh vien , nhO'ng tienn vi nguy co anh huang den sue khOe va Il) ' a chon ngh~ nghi~p Cec
mo hinh hai quy ae bien duQ'c dung dll kMo sat moi quan MgiO'a cac bien doc I~ p va trem cam va 10au ,
killm soet cac yeu to nhi{JU Ket qua: mot trong seu sinh vien billu hi~n toi thieu c6 mot so tri~u ch( f ng trem cem va/ho~c 10 au Trong nem voe qua sinh vien c6 y dinh , c6 ke hoech va co g~ng iir tir chiem
giai tinh ntr , cha me Iy dj hoec Iy than , ngh~ nghi~p cue me (nong dan) , hoc trong thai gian dai , oil3m hoc thap, cacsir ki~n gay stress trong 12thang vtre qua va b! eo buoc Il)'a chon ngh~ y (do nhO ' ng eo luc ben ngoai) Ket lu~n: M~c du oay la mot cM d~ mo! trong h~u Mt cac truong d<;lihoc a Vi~t Nam , nghien cuu nay khtJng dinh l<;linhO ' ng xu huang menq tinh quoc te Nhi~u sinh vien cniu dl) ' ng ganh n~ng tam th~n nghiem tronq 10% c6ydjnh tl)' tir trong nsm voe qua , Y2c6 ydinh tir tir ciaten ke noecn Cec yeu t6 lien quan voi soc khoe tam th~n kern bao gam ganh n~ng hoc t(jp va viec dang ky vao nqenh Ykh6ng pMi te mong muon cue ho (thU ' &ng la dll aep teisir mong dQ ' i cue bo me)
TCPkh6a: Tr~m cem , 10 au , ytU ' &ng tl) ' sat
SUMMARY
Objectives: Universities worldwide have a duty to care for their students , including those who suffer psychological difficulties Unfortunately in Vietnam and some other Mekong countries , there are few functioning counseling and general health services for university students This study was undertaken to improve the evidence base for the introduction of mental health services for students in medical universities Methods: Across-sectional survey was conducted with 267undergraduate medical students
in the first, third and fifth years of their course in April 2013 at Hue University of Medicine and Pharmacy
Classes were randomly selected and all students attending classes on survey days participated The anonymous , self-completed questionnaire explore a wide range of potential influential factors , such as study burden , stressful life events, health risk behaviors and career preferences Multivariable regression models were used to examine associations between the independent variables and depression and anxiety , controlling for confounding factors Results: Approximately one in every six students reports at least some symptoms of depression and/or anxiety Past year suicidal thoughts, planning and attempts were reported by 10 5% , 4.5% and 1.5% respectively Factors associated with depression symp t oms
i ncluded female gender , parental divorce/separation , occupation of mother (farmer), long study hour s , low GPA , multiple stressful life events in the past 12months , and studying medicine as an unwanted ca r eer choice (due to external pressure) Similar though fewer factors correlated with anxiety , including female gender, minority ethnicity , multiple stressful life event in the past 12months, illness in the past 4 weeks ,
and occupation of mother (farmer) Conclusions: Although still a new topic in most unive r sities in Vietnam , this study confirms trends observed worldwide Many students carry with them a significant mental health burden In this study for example, about 10% had thought about suicide in the past year ,
and half that number had made a plan Factors significantly correlated with poor mental health i n cl u ded
study burden and enrolment to study medicine that was somewhat against their own preference ( u su a l y
to meet parental expectations) Further research relevant to mental health promotion should focus on th e relationships between the student and family factors , academic burden and recent stressful life events
Keywords (3-5): Depression , anxiety , suicidal behaviors.
Trang 2Sinh vien dai hoc la nhCrng.ngll'ai tre phai doi
mat voi kho khan v~ earn xuc va hanh vi cua qua
trlnh chuyen doi hi vi thanh nien den tuoi trU'6>ng
thanh, d$c blet la thai gian anh hll'6>ng cua cac ap
il,l'cdo Trang so cac sinh vien dai hoc, sinh vien Y
khoa thll'a g chiu nhieu ap il,l'choc tap cao hon so
voi cac nqanh khac b >ithai gian keo d i 6 narn va
ch onq trlnh dao tao kha n n 3 nquyen nhan
g y nen cac ap lu'c Ion cho sinh vien Y khoa nhu
cac ky thi, Ill'O'ng kien t huc Ion v~ cac linh vue
danh cho bac sy da khoa va rat it co thai gian de
xem kien thuc da hoc NhCrng thanh to do qop
phan lam cho cac sinh vien qua tai cac kien thuc
can hoe va van d~ thicu TCr nhCrng van d~ do dan
d n lam cho cac sinh vien earn thay hut hang, that
voriq, n Crng canq thang theo suet ho trong 6
nam, Trang cac nghien ciru gan day chi ra rang ty
1 v~ cac 10 au tam 1'1(10 I~ng tam 1'1la mot khai
niern rong bao gom 10au, cang thang, tram earn va
cac van d~ lie quan den sue kh6e tam than 6
.sinh vien dai hoc 6>cac truonq d<;lihoc va cac vien
tr n the gioi tren the gioi dao dong trong khoanq
21 den 56% [13] a nhieu nuoc , honmot phan tu
tr thanh thieu nien da tCrng co cac trieu chling
tram earn va khoanq 15%-20% thinh thoanq hoac
tram earn SLPdunq thang do CESD (diem cat 16)
tr nq 1 nghien c uu tong quan he thong dua vao
thang do CESD cua tac gia Ahmed K Ibrahim va
cong s u cho thay rang ty 1$tram earn trong khoanq
3 ,2 - 38,4 [8] hay nqhien cuu tong quan h$ thong
khac tren sinh vien Y khoa My va Canada cho ty 1$
15 - 19% [7] Cac van d~ v~ 10 au, trong nqhien
cuu cua Chandavarkar va cs chi ra rang co toi
11,5% bi roi loan 10 au trong qua trlnh hoc [5] va
tac gia Smith va cs 11314.4% [11] Tl,'tli dll'O'c biet
d n nhu 113mot trong 3 nquyen nhan dan dau tli
vong 6>doi tU'O'ngvi thanh nien va ngll'ai tre tuoi
Doi voi sinh vien Y khoa thl mot vai nqhien ci ru 6
chau A (Ha Ouoc, Trung Ouoc va Hong Kong) 6>
n ll'ai tr tuoi cho thay rang ty 1$co 'I dinh v~ tl,J'tli
tr n 20%, trong mot nghien cuu cua nhorn tac gia
Blum Rva cs thuc hien 6>Viet Nam, Trung Ouoc
va Dai Loan thl ty 1$ co y dinh va co g~ng tl,l'tli
chung 6>3 quoc gia 1138,4% va 2,5% [4] Trong
khao sat SAVY2 co do tuoi tCr 14-25 ty 1$co hanh
vi tl,J' tli 11312,21 % trong khao sat SA VY 1 113
5,28% [9] hay mot vai nghien cliu gan day khac 6>
cac khu Vl,lCHa Noi, Hai Dll'O'n ,Tp HCM ty 1$d~u
dll'oi 10% NhCrngphan tich tren d~u minh chling
cho thay nhCrng ganh n$ng cua van d~ slic kh6e
tarn than IEmnhCrng ngll'ai tre tuoi d$c bi$t doi
tlO'ng sin vien y khoa, no co the dan den nhCrng
h~u qua lau dai, nhCrn a h hll'6 ng v~ ngh~ nghi$p
tll'O'ng lai cua hO.Cac yeu to qua tong quan y van
cho thay rang cac yeu to nhu gia hoc 1'1thuyet, lam sang , cac yeu to ca nhan (gioi, narn hoc),
gia dlnh (ngh~ nqhiep, Sl,J'ky vonq cua bo me, hen nhan bo me) va cac va chan trong thai gian gan day dll'O'c ghi nhan nhu cac yeu to lien dean co lien quan gan den cac van de sue kh6e tam nhu
tram earn, 10 au va tl,l tli Tuy v~y, theo cac y van thl nqhien cuu tren sinh vien Y khoa con rat it va
han che 6>Viet Nam, d$c biet tren doi tll'O'ng sinh
vien Y da khoa Cac dich vu cham soc, tu van ve van de sue kh6e tam tri 6 sinh vien dai hoc con la cau h6i Ion cho chinh sach va cac dich vu cham see sue kh6e tam tri Nghien cuu nay nha"m rnuc dich tlm ra cac bang chling co tinh khoa hoc nharn cai thien va xay dl,l'ng cac dich vu cham soc sue kh6e cho sinh vien trU'ang Y khoa 6>Mien trung noi rieng va cac sinh vien dai hoc, cao dang _noi Chung Nghifm ClPU v60i muc W~U xac dinh ty
1$ tram earn, 10 au va 'I dinh tl,l' tli 6>sinh vien Y khoa va xac dlnh cac yeu to lien doan lien quan den tram earn va 10au
II PHU'O'NG PHAp NGHIEN ciru
2.1 Thi~t k~ nghifm ClPU: Day la mot nghien cuu cat ngang, theo do, cac doi tuonq nqhien cuu dll'O'c ph6ng van tai mot thai diem
2.2.ThOi di~m nghien cuu: tCr thanq 3 den thanq 4 narn 2013
2.3 Dia ban nghien ClPu: tal trll'ang d<;lihoc Y Dll'O'C Hue, thanh pho Hue, Mien trung Vi$t Nam
Cong trlnh nghien cuu duoc su phe chuan cua hQi dong Y dlic true thuoc trU'ang D<;Ii hoc Y Dll'O'C Hue Tat ca cac doi tll'O'ng tlnh nquyen tham gia vao chuonq trlnh nqhien cuu deu dll'O'c giai thich rnuc lieu va phuonq phap nghien cuu theo dung quy dinh cua To chuc Y te the gioi va ky vao ban
tl,l' nquyen,
2.4 D6i tU'Q'ng nghien ClPu: Doi tll'O'ng nghien cuu dll'O'c chon ngau nhien cac khoi lop Y da khoa nam 1, nam 3 va nam 5 Chung toi lien lac cac em
duoc ngoi each biet 1 ban va dien phieu dll'oi Sl,l' hll'ong dan va giam sat cua 3 can bo nghien ciru
va tro 1'1nghien c u u Dua vao y van ty 1$tram earn thanh nien Viet Nam Chung toi tinh duoc doi
tll'O'ng nghien cliu la 267 ngll'ai de ll'oc Ill'O'ng ty 1$
voi khoang tin c~y 95%
2.5 PhU'O'ng philp thu th~p thong tin: Mot bO
cau h6i tl,l'dien dll'O'c thiet ke de thu th~p cac dCr
li$u lien quan nhll' thong tin Chung: tuoi, gioi, khoi
lop, hO khau trU'oc khi nMp trll'ang (thanh thi/nong
thon), nghe nghi$p cua cha/me Ap dl,lng Thang
do cua Trung tam nghien ClPU dich te hQc
(CES-D: The Center for Epidemiological
Studies-Depression Scale) thu9C Trung tam phOng ngCra
va kiem soat b$nh t~t cua My da dll'O'c kiem dinh
va sli dl,lng rat nhieu trong cac dieu tra cong dong
voi doi tlO'ng vi thanh nien 6>nhieu quae gia tren
Trang 3thlP 5, cac sinf vien c6 nhieu trai nghi$m tot hon de lPng ph6 v6'i nhCrngcang th~ng trong hoc tap, KE qua nay tU'O'ngtl,J'v6'i ket qua cua Surbhi Sidana nqhien ClPUtren sinh vien Y khoa An f)o [12]
3.2 Tj I~10au - tt,J'tt 'P
trlnh hoc [5] va tac gia Smith va cs 11314.4% [11] Theo diem cat thang diem 10 au ;:: 26 thl ty 1$ 10a
chung trong nqhien ClPUnay (18,73%) cao hon TY 1$theo gi6'i va khoi lop duoc m6 ta b~ng bieu d6 nh
tr am earn
YtU'&ng tt,J'tir:
Su y n h r tu l it
2 2
~
L en k h ac h I\ t lit csgA n tvtit
l~
12
10
S ()
4
1 0
o
Bitw cia 2:Phan bo tj I~ sinh vien co ycijnh tt,J'tt 'Ptheo gi(Yi
Thea cac nqhien ClPUcua mot nh6m tac gia nqhien ClPUtren doi tU'Q'ng vj thanh nien va thanh nien v
ty 1$ c6 y dinh tl,J'tLY(y cac nuoc Han Ouoc, Trung Ouoc, f)ai Loan ty 1$ deu tren 20% so sanh voi
nghien ClJU(y Viet nam duoc thuc hi$n (y Ha NOi, Tp H6 Chi Minh, Hai DU'O'ng ty 1$ nay chi dao don dU'6'i 10% Ket qua nqhien ClPUcua chunq t6i cOng 113mot minh chlPng ro rang khi h6i sinh vien trong von
12 thanq qua va ty 1$tra l6'i co chiern 10,49% Khi h6i ve lap ke hoach thl c6 toi 4,49% va 1,50% cac sin
vien da tung co gc)ng tl,J'tLY
Bang 1:,M6 hinh h6i quy tuven tfnh da bien rut qon (Linear Multiple Regression
Ref : tham chi~u ; * : p co y nghia thong ke voi tr ur c y nghia <0 , 05 {3 : M so h6i qui tuy~n tint: ChL
Trang 4Trong phan tlch hoi quy tuyen tlnh don bien
chung tei li$t ke ra dU'Q'c 20 bien so co y nghia
thong ke: Trong me hinh hoi quy tuyen tlnh da bien
(rut qon tren) chi ra cac yeu to lien quan den tram
earn: gi&i tlnh (nu'); hen nhan bo me (Iy dilly than);
nghe ~hi$p me (neng dan); diem tong ket narn
hoc; nhCl'ng Sl,l' ki$n cang th~ng trong cuoc song,
tharn choi (thinh thoanq)
Trong me hinh hoi quy tuyen tfnh da bien chunq
tei cang dua vao 18 bien so c6 y nghia trong me
hinh don bien va ket qua rut ra tli me hinh tren cac
yeu to lien quan den 10 au: gi&i tinh (nu') nghe
nghi$p me (neng dan); nhCrng sv kien cang thang
trong cuoc song, tharn choi (thinh thoanq); bi dau
dau/dau lU'ng/dau bunq/dau tay/dau chan gay
can treYconq viec (c6 dau mot chut, c6 dau vua
phai, dau kha kha)
Ket qua tli me hinh cho thay rang cac yeu to
gia dl nh va nhCrng su kien sang chan trong 12
thanq qua c6 lien quan den tram earn va 10au Ket
qua nghien cuu nay cung tuonq dong voi mot so
nghien cuu hien nay tren the gi&i [10] Tuy nhien
trong boi canh cua Viet Nam thl can c6 nhieu
nqhien cuu sau hon di sau vao van de nay
Cac yeu to ve su mong dQ'i tli gia dinh ve
nqanh nghe, mac du c6 y nghia don bien nhtrnq
trong me hinh da bien thl kheng c6 M~c du v$y,
day la mot trong nhCrng han che cua nqhien cuu
khi cO' mau nho, can cac nqhien ctru tU'O'ng laican
di sau hon
IV, K~T LuAN
- TY 1$ tram' earn, 10 au chiem ty 1$ 18,73% eY
sinh vien Y khoa Ty 1$ sinh vien c6 y dinh tl,l' tCP:
Suy nghi tl,ltCP10,49%; ve lap ke hoach 4,49% va
1,50% da tling co gcf!ngtl,l' tCP
- Cac yeu to lien quan den tram earn: gi&i tlnh
(nCr);hen nhan bo me (Iy dilly than); nghe nghi$p
me (neng dan): diem tong ket narn hoc; nhCrng str
kien cang th~ng trong cuoc song Cac yeu to lien
quan den 10 au: gi&i tinh (nCr); nghe nqhiep me
(nonq dan): nhCrng Sl,l' kien cang th~ng trong cuoc
song; bi dau dau/dau lU'ng/dau bunq/dau tay/dau
1 Nguyen D(Pc Thanh, Le Cl,I' Linh (2010) "Gia
tr], do tin c$y cua thang do tram earn cua vi thanh
nien va thanh nien va mot so yeu to lien quan t<;3i
huyen Chi Linh, Hai DU'O'ng narn 2006 " Tf)p chi Y
ttJ Gong Gong 33 (26), tr 33-41
2 Nguyen Thanh HU'O'ng,Le va Anh, Michael
Dunne (2007) "Gia tri va do tin c$y cua hai thang
do tram earn va 10 au sCPdl,lng nqhien cuu cong
dong v&i doi tU'Q'ng vi thanh nien " Tf)p chi Y ttJ
Gong cong 25 (7), tr.25-31
3 Khadijah Shamsuddin, Fariza Fadzil, Wan Salwina Wan Ismail, Shamsul Azhar Shah, Khairani Omar, Noor Azimah Muhammad, Aida Jaffar, Aniza Ismail, Raynuha Mahadevan (2013)
"Correlates of depression, anxiety and stress among Malaysian university students" Asian Journal of Psychiatry, 6 (4),318-323
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5 U Chandavarkar, A Azzam, C A Mathews (2007) "Anxiety symptoms and perceived performance in medical students" Depress Anxiety, 24 (2), 103-11
6 Vuong Diem Khanh Doan (2011) What Explains the Association between Socioeconomic status &Depression in Vietnamese Adults?
, Faculty of Health, Queensland University of Technology,
7 L N Dyrbye, M R Thomas, T D Shanafelt (2006) "Systematic review of depression, anxiety, and other indicators of psychological distress among U.S and Canadian medical students"
Acad Med , 81 (4), 354-73
8 A K Ibrahim, S J Kelly, C E Adams, C Glazebrook (2013) "A systematic review of studies
of depression prevalence in university students" J Psychiatr Res , 47 (3), 391-400
9 M T Le, H T Nguyen, T D Tran, J R
Fisher (2012) "Experience of low mood and suicidal behaviors among adolescents in Vietnam: findings from two national population-based
surveys" J Adolesc Health, 51 (4), 339-48
10 X C Liu, S Oda, X Peng, K Asai (1997)
"Life events and anxiety in Chinese medical students" Soc Psychiatry Psychiatr Epidemio/ , 32
(2), 63-7
11 C K Smith, D F Peterson, B F Degenhardt, J C Johnson (2007) "Depression, anxiety, and perceived hassles among entering medical students" Psychol Health Med , 12 (1),
31-9
12 1 Jugal Kishore Surbhi Sidana, 1 Vidya Ghosh, 1 Divyansh Gulati, 1 RC Jiloha, 2 and Tanu Anand 1 (2012) "Prevalence of depression in students of a medical college in New Delhi: A cross-sectional study" Australasian Medical Journal, 5 (5), p.247-250
13 M S Yusoff, A F Abdul Rahim, A A
Baba, S B Ismail, M N Mat Pa, A R Esa (2013)
"Prevalence and associated factors of stress, anxiety and depression among prospective medical students" Asian J Psychiatr , 6 (2), 128-33