The mental health of trainees receiving the three-year standardized general practice residency program (SGPRP) has been valued recently, and psychological problems are considered to be one major type of causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological problems in these GP trainees are of important significance for the development of residency training policies and programs.

To explore the mental health status and causes of psychological problems in GP trainees of SGPRP, improving the attention of SGPRP managers and the society given to the mental health of GP trainees.

This was a mixed-method sequential explanatory study. In January 2021, by use of convenience sampling, all in-service GP trainees of SGPRP were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic Questionnaire compiled by our research team and the Symptom Checklist 90 (SCL-90) . The total score and domain scores of the SCL-90 were analyzed overall, then were compared among the trainees by grade. For understanding the main life events triggering emotional or psychological problems and their associations with residency training program or specialty, and GP trainees' preferred assistance as well as suggestions for the development of SGPRP, from February to June 2021, purposive and heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth, semi-structured interview using phenomenological research procedure. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using Colaizzi's seven-step analysis and thematic analysis.

All GPs (n=84) responded to the survey, with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were (149.61±50.55) , and (1.66±0.56) , respectively. Of them, 29 (34.5%) had a total score≥160. The prevalence of obsessive-compulsive, depression, interpersonal sensitivity, anxiety, paranoid ideation, anger-hostility, psychoticism, somatization and phobic-anxiety (prevalence of symptoms in each domain was defined as domain score≥2) was 53.6% (45/84) , 39.3% (33/84) , 34.5% (29/84) , 26.2% (22/84) , 22.6% (19/84) , 21.4% (18/84) , 19.0% (16/84) , 14.3% (12/84) , and 14.3% (12/84) , respectively. The depression domain score varied significantly across GP trainees by grade (P<0.05) . The prevalence of depression was 48.4% (15/31) in grade 2 GP trainees. In total, 21 GP trainees attended the interview, 14 (66.7%) of whom had a total SCL-90 score≥160. Four themes emerged from the analysis: impact of personal problems on psychological status; harm and benefits caused by interpersonal interactions at work; psychological stress related to the residency base; lack of confidence related to specialty choice.

The high prevalence of psychological problems in GP trainees may be closely related to personal factors and problems encountered during residency training. In view of this, psychological guidance and crisis intervention should be listed as an important part of residency training management, and efforts should be made to enhance the trainees' sense of existence and belonging as well as self-confidence, thereby helping them to successfully complete the training.

近年来，全科住院医师规范化培训（简称住培）学员的心理健康逐渐受到重视，心理问题被认为是导致其无法完成规定时长培训的主要原因之一。因此，了解全科住培学员心理健康状况并探讨其出现心理问题的影响因素，对住培政策及方案的制定有着重要的指导意义。

了解全科住培学员心理健康状况，并从受访者处对其心理问题产生的原因进行挖掘，旨在提高住培管理者及社会对住培学员心理健康的关注程度。

本研究采用基于解释性序列设计的混合研究方法。于2021年1月，采用方便抽样法，选取北京大学深圳医院全体在岗全科住培学员为研究对象，采用自设问卷〔内容包括一般资料调查表、症状自评量表（SCL-90）〕对其进行调查。分析全科住培学员SCL-90总得分及各因子得分情况，比较不同年级全科住培学员SCL-90各因子得分及总症状指数的差异。2021年2—6月，采用现象学研究法，目的性、异质性抽取已接受心理健康评估的全科住培学员作为访谈对象，对其进行"一对一"的半结构化深度访谈，以了解诱发情绪或心理问题的主要生活事件及其与住培或专业之间的联系、全科住培学员希望得到的帮助及其对住培方案的建议。应用NVivo 12软件对访谈内容进行编码、归类；采用Colaizzi七步分析法对资料进行整理、分析，并提炼访谈主题。

共回收有效问卷84份，有效问卷回收率100.0%。84例全科住培学员SCL-90平均总得分为（149.61±50.55）分，平均总症状指数为（1.66±0.56）。其中29例（34.5%）总分≥160分；分别有45例（53.6%）、33例（39.3%）、29例（34.5%）、22例（26.2%）、19例（22.6%）、18例（21.4%）、16例（19.0%）、12例（14.3%）、12例（14.3%）全科住培学员的强迫症状、抑郁、人际关系敏感、焦虑、偏执、敌对、精神病性、躯体化及恐怖因子分≥2分。不同年级全科住培学员抑郁因子分比较，差异有统计学意义（P<0.05），其中48.4%（15/31）的二年级学员抑郁因子分≥2分。最终对21例全科住培学员进行半结构化访谈，其中14例（66.7%）SCL-90总得分≥160分。共提炼出4个主题：个人问题对心理状况的影响、工作中人际交往带来的伤害与益处、与住培基地相关的心理压力、与专业选择相关的信心缺乏。

全科住培学员心理问题阳性率较高，可能与个人因素、住培期间遇到的问题紧密相关。应将心理疏导和危机干预作为住培管理工作的重要组成部分，着力提升全科住培学员的存在感、归属感和自信心，进而助力其顺利完成培训。