Where first-year residents train affects their risk of becoming depressed, study suggests

Although intern year is known to be a stressful time, first-year residents’ experiences in different programs vary dramatically. Where an intern trains may impact their chances of developing depression, according to a new study from Academic Medicine, which found four factors of residency programs that are associated with trainees becoming depressed.

Researchers surveyed more than 1,270 internal medicine interns in 54 residency programs quarterly throughout their intern year. Administered between 2012 and 2015, the survey used the Patient Health Questionnaire-9 (PHQ-9) to assess the prevalence of depression among participants. A PHQ-9 score of 10 or greater indicates high likelihood of major depressive disorder.

From zero to 80 percent

Researchers looked at the average PHQ-9 score in all residents in the same program to develop scores for each program. Before intern year started, the mean program score was 2.3; it rose to 5.5 by the end of intern year.

The mean prevalence of depression within a given program was roughly 36 percent, though prevalence rates ranged from zero to 80 percent across various programs.

“We found that rates of depression between internal medicine residency programs vary widely,” the study’s authors noted. “Importantly, we also found that the rate of depression among interns within programs is relatively consistent across independent cohorts of interns, providing additional evidence that programs play an important role in the development of resident depression.”

Four specific factors within residency programs were most strongly associated with trainees developing depression during intern year:

1. A lack of timely and appropriate faculty feedback: Interns’ perceptions of faculty feedback were the biggest predictor of changes in depression symptoms at the program level, the study found.

2. Working longer hours: Other studies have also found that the more hours residents work, the greater their risk of developing depression, the researchers noted.

3. A negative learning experience during inpatient rotations.

4. A higher research ranking: The study’s authors used Doximity’s residency program research rankings and found that interns in programs with higher rankings were more likely to become depressed, independent of other variables. They speculate that these programs may prioritize research at the expense of clinical care or exert more pressure on residents to excel at both research and patient care.

“These findings suggest that the residency program environment plays a central role in the mental health of medical interns,” the authors wrote. “These program-level factors can inform changes to residency programs that may reduce the risk of depression in resident physicians.”

To learn more, see the full study in Academic Medicine.

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