背景：精神疾病之致病因素具多元性，一個患者的發病通常有多項原因所引起。因此，要判斷精神疾患是否因工作相關壓力所引起，需對「工作相關的壓力」、「非工作相關的壓力」以及「個別因素」等做一綜合評估。為使我國因工作壓力而引起精神疾病的勞工能夠獲得一致性的認定，客觀評估各種壓力事件的強弱程度，製訂一客觀、具體、標準化之評估工具與認定流程有其必要性。
目的：本研究計畫的目的在於建立可行之「工作相關心理壓力事件引起精神疾病認定參考指引」及本土職業性精神疾病的流行病學資料。
方法：集合國內職業醫學專科醫師、精神科專科醫師、及相關領域之專家規劃「工作相關心理壓力事件引起精神疾病認定參考指引草案」及可行之運作模式流程。透過職業傷病診治中心、某精神疾病專科醫院、以及勞工保險局收集確定診斷為具憂鬱症狀，且發病前六個月內曾工作之勞工80名為病例組，另選不具憂鬱症狀而於收案前六個月內曾工作之勞工80名為對照組，由精神科專科醫師依據「非因工作造成的心理負荷評估表」、由職業醫學專科醫師依據「工作場所中的心理壓力評估表」實施評估。參與計畫之各職業傷病診治與防治中心依「工作相關心理壓力事件引起精神疾病認定參考指引草案」進行個案判定。回溯性收集的個案則由職業醫學專科醫師進行資料的整理後擷取與本計畫有關的資訊，以建構本土職業性精神疾病的流行病學資料。
結果：本研究計畫共收集了80位病例組及80位對照組成員。80位病例組成員中，由勞工保險局給付資料收集的有17位，其中有14位被認定為與職業相關，而以工作相關的腦部受傷所致的器質性精神疾病合併有憂鬱症狀之診斷者佔絕大多數(11位，78.6 %)。其他63位病例組由醫師認定與工作相關者有13位，約占病例組其他成員的20.6%。總計工作相關者共27位，扣除11人因腦部外傷造成，共16人(占69位非器質性之精神疾病之23.2%)，原因包括創傷後壓力症候群，遭受嚴重的惡意刁難、欺侮以及暴力行為，發生影響公司營運狀況的重大工作疏失，遭到裁員，顧客或客戶所提出的無理要求，自己升職、進階，工作內容與工作量發生重大變化，超時工作，工作型態改變，及被要求在正式場合發表。依「工作場所中的心理壓力評估表」評估，其中壓力強度屬「Ⅲ」者有10人(62.5%)，強度屬「Ⅱ」者有3人(18.8%)，強度屬「Ⅰ」者有2人(12.5%)，超時工作直接判定相關者1人(6.2%)。
結論：以往我國勞工獲得工作相關精神疾病的勞工保險給付的個案極少，受到認定的對象以意外腦傷害所致的器質性精神疾病佔絕大多數，建立「工作壓力引起精神疾病認定參考指引」將有助於職業性精神疾病的認定，讓更多勞工取得補償。本計畫結果顯示，依據現有參考指引強度判定，可包含九成以上工作相關精神疾病，但仍有少數例外，需進一步的探討。建議先以現行的參考指引為暫行指引，並持續收集國內案例資料以便做修正之參考。由於非屬現行綜合判斷等級為強之個案，仍有被判定為職業相關精神疾病的情形，因此有疑義之個案，建議組成專家會議評定，或進一步研究修訂心理壓力評估表之壓力強度。

Background Mental disorders generally have multifactorial etiology, and many factors may play a role in a patient’s disease. Therefore, determining whether a specific case is caused by work-related stress requires a general assessment of occupational stressors, non-occupational stressors, and personal factors. In order to provide consistent identification of workers who suffer from mental disorders caused by occupational stress and evaluate objectively the effects of various stressful events, it is necessary to construct objective, solid, and standardized evaluation tool and procedure.

Objective Construct an applicable “Suggested Diagnostic Guidelines for Mental Disorders Caused by Work-related Stressful Events” and an epidemiology database of work-related mental disorders in Taiwan.

Methods Through the collaboration of occupational medicine specialists, psychiatrists, and other experts of related fields, this project drafted the Diagnostic Guidelines for Mental Disorders Caused by Work-related Stressful Events and constructed a feasible framework of the diagnostic procedure. We recruited workers who are confirmed patients with depression symptoms and had worked during the six-month period before the diagnosis as the case group through the Diagnostic and Treatment Centers for Occupational Diseases and Injuries and a psychiatry specialty hospital. The case groups also included patients with depression symptoms who were compensated by the Bureau of Labor Insurance. We also recruited 80 workers without depression symptoms who had worked during the six-month period before the recruitment as the control group. For each participant, an Evaluation Chart for Non-occupational Mental Stress will be applied by a psychiatrist, and an Evaluation Chart for Occupational Mental Stress was applied by an occupational medicine specialist. The participating Centers made diagnosis according to the draft Diagnostic Guidelines for Mental Disorders Caused by Work-related Stressful Events, and the draft will be revised according to the results of data analyses and discussion of an expert panel. Information on cases compensated by the labor insurance system was reviewed and abstracted to construct an epidemiology database.

Results We have enrolled 160 participants as planned, including 80 each in the case and control groups. In the case group, work-related depression was recognized in 14 of the 20 cases from the Bureau of Labor Insurance database, including 11 (78.6%) from work-related brain injuries. In the other 63 cases, 13 (20.6%) were recognized as work-related. Altogether, there were 27 work-related cases. Except for the 11 cases due to brain traumas, the causes of the remaining 16 cases (23.2% in the 69 cases without organic damages) included post-traumatic stress disorder, being severely abused, causing major loss to the company, being fired from work, promotion, working overtime, changes in the job, and being asked to make presentations in the public. According to the guidelines, 10 (62.5% of the work related mental disorder without brain injury) cases had Grade III stressor, 3 (18.8%) had Grade II stressor, 2 (12.5%) had Grade I stressor, and 1 (6.2%) worked overtime.

Conclusion Most cases compensated by the Bureau of Labor Insurance in the past were organic brain syndrome from work-related injuries, indicating the importance of diagnostic guidelines for cases related to mental stress. The construction of the diagnostic guidelines is helpful to the determination of work-related mental disorders and can facilitate the compensation of workers. We found that the current scoring system for stressors can be applied to more than 90% of cases, and the remaining small portion need to be studied further. We suggest adopting the current diagnostic guidelines and for the time being and continuing collection of cases in our country, so that we can make changes to the diagnostic guidelines in the future. For the work-related cases who were not recognized as having strong stressors, we suggest evaluations by an expert panel.

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