Prevalence and factors associated with depression and anxiety among medical trainees in the united states during coronavirus disease 2019 (covid-19) pandemic

ABSTRACT

Rationale Medical trainees are at risk of psychological and emotional distress during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to assess the prevalence and explore the factors associated with depression and anxiety among medical trainees taking care of patients with COVID-19 in the United States (US). Methods: The study is cross-sectional, anonymous, web-based survey of medical trainees distributed in the US via email and social media between April 14, 2020 and May 5, 2020. Participants were stratified based on whether they were in a residency or fellowship program. Practice settings were stratified based on hospital type (academic or community-based) and location. Study outcomes were prevalence and factors associated with depression and anxiety using the 9-item Patient Health Questionnaire (PHQ-9;range 0- 27) and the 7-item Generalized Anxiety Disorder (GAD 7;range 0-21) questionnaires, respectively. Univariate analysis utilizing summary statistics and Chi-square test were performed to show the association of covariates with outcomes. We performed a multivariate analysis with logistic regression for each outcome. A p-value < 0.05 was considered significant. Results: In all, 239 trainee submitted surveys, predominantly females (51.9%), aged 31-40 (52.3%), and non-Hispanic White (59.8%). Overall, the prevalence for both depression and anxiety was 45.6%. Higher likelihood of depression and anxiety was observed among medical trainees who have COVID-19 exposure, those uncomfortable with infection control policies, and those not provided adequate PPE. Trainees who reported increased stress due to didactics, and those who had continued didactics once a week, also had a higher likelihood of depression and anxiety. Depression alone was more common in those who provided service in emergency department (ED).Multivariate analysis (Table 1) revealed greater odds of depression among females (odds ratio [OR] = 1.95;95% confidence interval [CI] = 1.01-3.74), and those who reported increased stress due to didactics (OR = 4.1;95% CI = 2-8.4). Similarly increased odds for anxiety were observed among medical trainees, and those who reported increased stress due to didactics (OR = 2.6;95% CI = 1.3-5.2). Conclusion: The majority of trainees surveyed had a high burden of depression and anxiety early in the COVID- 19 pandemic in the US, which was associated with increased stress due to didactics. Organizations and institutions will need to develop preventive and management strategies to optimize and sustain the mental health of medical trainees, particularly under pandemic conditions.