Trầm cảm, ý định tự sát và lo âu ở sinh viên y khoa miền trung Việt Nam: Tỷ lệ và các yếu tố liên quan

TRAM CAM,
Y
DINH TV' SAT
vA
LO AU
(y
SINH VIEN Y KHOA
MIEN TRUNG VII;T NAM: TY Le
vA
cAc YEU TO LIEN QUAN
TRAN SINH THANG
IT
NghifH]
c~u
SiPc
kh6e ct;mg dong, TrU'iYng f)H
Y
DLJ'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
Y
Hil NOi
TOM TAT
M~c tieu: Nhi~u tr.U'&ng d<;lihoc iren the giai c6 nniem
VI,1
cham s6c sinh vien kll ca nhO'nfj sinh vien
c6 nhO'ng kh6 khan ve tam
ty.
Te! Vi~t Nam va cac nuoc vung Mekong khac, cac djch
VI,1
tir
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
y
tU'&ng tl)'
sat
dll giai tbieu
cac
diet:
VI,1
cham s6c
s(PC;

kh6e tam th~n cho sinh vien tnrcnq
y.
PhU'O'ngphap nghien CLPu:Nghien cou dt ngang vo! 267 sinh vien bee s9 da khoa truong
y
nem thLf
nMt, ttur ba
va
thl.f nem, nghien cou tei truong f)<;lihoc
Y
DuQ'CHue. Cec lap
auoc
chon ngau nhien, tat
ca sinh vien
cac
lap 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 doi 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
M

giO'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(fng
trem cem va/ho~c 10au. Trong nem voe qua sinh vien c6
y
dinh, c6 ke hoech
va
co g~ng
iir
tir chiem
10,5%, 4,5%
va
trong thai gian g~n day la 5%.
ceo
yeu to lien quan den trieu cturnq trem cem bao gam
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, cac
sir
ki~n gay stress trong
12
thang 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%
c6
y
djnh tl)' tir trong nsm voe qua,
Y2
c6
y
dinh
tir
tir
cia
ten 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
Y
kh6ng
pMi te mong muon cue ho (thU'&ng la dll aep tei sir mong dQ'icue bo me).
TCPkh6a: Tr~m cem, 10au,
y
tU'&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: A cross-sectional survey was conducted with 267 undergraduate 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 symptoms
included female gender, parental divorce/separation, occupation
of
mother (farmer), long study hours, low
GPA, multiple stressful life events in the past
12
months, and studying medicine
as
an unwanted career
choice (due to external pressure). Similar though fewer factors correlated with anxiety, including female
gender, minority ethnicity, multiple stressful life event in the past

12
months, illness in the past
4
weeks,
and occupation
of
mother (farmer). Conclusions: Although still
a
new topic in most universities 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 included
study burden and enrolment to study medicine that was somewhat against their own preference (usually
to meet parental expectations). Further research relevant to mental health promotion should focus on the
relationships between the student and family factors,academic burden and recent stressful life events.
Keywords (3-5): Depression, anxiety, suicidal behaviors.
216
YHTH (880) - HOI NGH! KHOA HOC
B~NHVI~N
QUAN THO
oec
TP. H6 CHI MINH
I.D~TVAND~
Sinh 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'c do. Trang so cac sinh vien dai hoc, sinh vien Y

khoa thll'ang chiu nhieu ap il,l'c hoc tap cao hon so
voi cac nqanh khac b6>ithai gian keo dai 6 narn va
chuonq trlnh dao tao kha n$ng. 3 nquyen nhan
gay nen cac ap lu'c Ion cho sinh vien Y khoa nhu
cac ky thi, Ill'O'ng kien thuc Ion v~ cac linh vue
danh cho bac sy da khoa va rat it co thai gian de
xem kien thuc da hoc. NhCrng thanh to do qop
phan lam cho cac sinh vien qua tai cac kien thuc
can hoe va van d~ thi
cu.
TCr nhCrng van d~ do dan .
den lam cho cac sinh vien earn thay hut hang, that
voriq, nhCrng canq thang theo suet ho trong 6
nam, Trang cac nghien ciru gan day chi ra rang ty
1$v~ cac 10au tam 1'1(10 I~ng tam 1'1la mot khai
niern rong bao gom 10au, cang thang, tram earn va
cac van d~ lien quan den
sue
kh6e tam than 6>
.sinh vien dai hoc 6>cac truonq d<;lihoc va cac vien
tren the gioi tren the gioi dao dong trong khoanq
21 den 56% [13].
a
nhieu
nuoc, hon
mot phan
tu
tre thanh thieu nien da tCrng co cac trieu chling
tram earn va khoanq 15%-20% thinh thoanq hoac
thuonq xuyen co 'I nghi v~ tl,l' sat.

TY
1$ rieng v~
tram earn SLPdunq thang do CESD (diem cat 16)
tronq 1 nghien cuu tong quan he thong dua vao
thang do CESD cua tac gia Ahmed K. Ibrahim va
cong su cho thay rang ty 1$tram earn trong khoanq
35,2 - 38,4 [8] hay nqhien
cuu
tong quan h$ 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,I' tli dll'O'c biet
den nhu 113mot trong 3 nquyen nhan dan dau tli
vong 6>doi tU'O'ng vi thanh nien va ngll'ai tre tuoi.
Doi voi sinh vien Y khoa thl mot vai nqhien
ciru
6>
chau A (Han Ouoc, Trung Ouoc va Hong Kong) 6>
ngll'ai tre tuoi cho thay rang ty 1$co
'I
dinh v~ tl,J'tli
tren 20%, trong mot nghien cuu cua nhorn tac gia
Blum R va cs thuc hien 6>Viet Nam, Trung Ouoc
va Dai Loan thl ty 1$ 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 SAVY 1 113
5,28% [9] hay mot vai nghien cliu gan day khac 6>
cac khu Vl,l'CHa Noi, Hai Dll'O'ng, Tp HCM ty 1$d~u
dll'oi 10%. NhCrng phan tich tren d~u minh chling
cho thay nhCrng ganh n$ng cua van d~ slic kh6e
tarn than IEm nhCrng ngll'ai tre tuoi d$c bi$t doi
tll'O'ng sinh vien y khoa, no co the dan den nhCrng
h~u qua lau dai, nhCrng anh hll'6>ng v~ ngh~ nghi$p
tll'O'ng lai cua hO. Cac yeu to qua tong quan y van
cho thay rang cac yeu to
nhu
gia hoc 1'1thuyet,
lam sang , cac yeu to ca nhan (gioi, narn hoc),
gia dlnh (ngh~ nqhiep, Sl,J'ky vonq cua bo me, hen
nhan bo me) va cac va chan trong thai gian gan
day dll'O'c ghi nhan
nhu
cac yeu to lien dean co
lien quan gan den cac van de sue kh6e tam nhu
tram earn, 10au va tl,l' tli. Tuy v~y, theo cac y van
thl nqhien cuu tren sinh vien Y khoa con rat it va
han che 6>Viet Nam, d$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, 10au 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 cuu 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 ClPUdich te hQc (CES-
D: The Center for Epidemiological Studies-
Depression Scale) thu9C Trung tam phOng ngCra
va kiem soat b$nh t~t cua My da dll'O'c kiem dinh
va sli dl,lng rat nhieu trong cac dieu tra cong dong
voi doi tll'O'ng vi thanh nien 6>nhieu quae gia tren
YHTH (880) - HOI NGH! KHOA HQC B~NH VI~N QU';N THO
DUC
TP. H6 CHf MINH
217
thlP 5, cac sinf vien c6 nhieu trai nghi$m tot hon de lPng ph6 v6'i nhCrng cang 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~
10
au - tt,J'tt.'P
La
au: Theo nh6m tac gia Chandavarkar va Cs chi ra r~ng c6 t6'i 11,5% bj roi loan 10 au trong qu
trlnh hoc [5] va tac gia Smith va cs 11314.4% [11]. Theo diem cat thang diem 10au ;:: 26 thl ty 1$ 10
a
chung trong nqhien ClPUnay (18,73%) cao
hon.
TY
1$theo gi6'i va khoi
lop duoc
m6 ta b~ng bieu d6 nh
tram earn.
Y
tU'&ng tt,J'tir:
Suy nghr tu lit
2.26
~
Len k~ hoach I\t lit
cs
gAng
tv
tit
l~
12
10 .
S
()

4
12.03
o
Bitw cia
2:
Phan
bo
tj I~ sinh
vien
co
y cijnh 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.
3.3.
cae
y~u
t6
lie':1
quan
Bang 1:,M6 hinh h6i quy tuven tfnh da bien rut qon (Linear Multiple Regression
Bien so

Gia tri bien Tram earn
La au
13
SE
13
SE
Gi6'i
Nam
Ref
-
NO>
0,28*
0,10 0,12* 0,03
Song cunq voi nhau
Ref
-
Hon nhan bo me Ly d] /Ly than
0,57*
0,36
G6a
-0,13 0,21
CB Ref
-
Ref
-
Tl,I'lam chu
-0,07 0,17 0,02
0,05
Nghe nghi$p me
Nonq can

0,27* 0,12
0,08* 0,03
That nqhiep
0,48 0,42
0,08 0,11
NOitro
-0,01 0,14 0,03 0,04
Gi6'hoc
Iv
thuvet & 16'0
Gi6' hoc
Iv
thuvet & 16'0
-0,01 0,01
<5,5 ref
5,5-6,4
-0,65
0,45
£)iemtong ket narn hoc
6,5-7,4
-0,86
0,48
7,5-8,4
-0,95*
0,48
8,5-8,9
-0,65* 0,52
NhO>nQSl,I'kien cane thane tronq cuoc sonq -0,11*
0,03
-0,02*

0,01
Tatca
2,42
0,68
Tham choi
rr-'-
2,33* 0,68
Mot it*\'-) 2,49
0,67
NO'icono tac sau ra truono
0,60 0,26
KhOngbi dau gl
Ref
-
B]daudau/dau lU'ng/dau
C6 dau mot chut 0,08* 0,03
bl,mg/dau tay/dau chan
C6 dau vua phai 0,11* 0,04
gaycantr& cong viec
Dau kha kha
0,13* 0,05
Dau nohiern trono
0,17
0,14
Ref: tham chi~u;
*:
p co
y
nghia thong ke voi trurc
y

nghia <0,05.
{3:
M
so
h6i qui tuy~n
tint:
ChL
chu~n h6a; SE: sai
so
chuen
YHTH(880)- HOI NGH! KHOA HOC B~NH VI~N QUAN THO m1c TP. H6 CHI MINH
2
Trong
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$y,
day la mot trong nhCrng han che cua nqhien
cuu
khi cO' mau nho, can cac nqhien ctru tU'O'ng lai can
di sau hon.
IV, K~T LuAN
- TY
1$ 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,l' tCP10,49%; 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
chan gay can treYceng viec.

TAl
ueu
THAM KHAo
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.

4. R. Blum, M. Sudhinaraset, M. R. Emerson
(2012) "Youth at risk: suicidal thoughts and
attempts in Vietnam, China, and Taiwan". J
Adolesc Health, 50 (3 Suppl), S37-44.
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.
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