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Residency Program Factors Associated with Depressive Symptoms in Internal Medicine Interns

A Prospective Cohort Study

Pereira-Lima, Karina, MSc; Gupta, Rahael R., MS; Guille, Constance, MD, PhD; Sen, Srijan, MD, PhD

doi: 10.1097/ACM.0000000000002567
Research Report: PDF Only

Purpose: This study investigated the associations between program-level variables such as organizational structure, workload, and learning environment and residents’ development of depressive symptoms during internship.

Method: Between 2012 and 2015, 1,276 internal medicine interns from 54 U.S. residency programs completed the Patient Health Questionnaire (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionnaire (RQ) and average weekly work hours. The authors gathered program structural variables from the American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA online); and program research rankings from Doximity. Associations between program-level variables and change in depressive symptoms were determined using stepwise linear regression modeling.

Results: Mean program PHQ-9 scores increased from 2.3 at baseline to 5.9 during internship (mean difference 3.6, SD 1.4, P < .001), with the mean increase ranging from -0.3 to 8.8 (interquartile range 1.1) among the programs included. In multivariable models, faculty feedback (β -0.37, 95% CI -0.62, -0.12, P = .005), learning experience in in-patient rotations (β -0.28, 95% CI -0.54, -0.02, P = .030), work hours (β 0.34, 95% CI 0.13, 0.56, P = .002), and research ranking position (β -0.25, 95% CI -0.47, -0.03, P = .036) were associated with change in depressive symptoms.

Conclusions: Poor faculty feedback and inpatient learning experience, long work hours, and high institutional research rankings were associated with increased depressive symptoms among internal medicine interns. These factors may be potential targets for interventions to improve wellness and mental health among these professionals.

K. Pereira-Lima is a research scholar, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; and a Ph.D. candidate, Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

R.R. Gupta is an M.D. candidate, University of Michigan Medical School, Ann Arbor, Michigan.

C. Guille is assistant professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.

S. Sen is research associate professor, Molecular and Behavioral Neuroscience Institute, and associate professor, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.

Supplemental digital content for this article is available at

Acknowledgments: The authors acknowledge and thank the interns who took part in this study.

Funding/Support: This research was supported by the National Institute of Mental Health with a R01 grant MH101459 (S. Sen) and a K23 grant MH095109 (S. Sen). K. Pereira-Lima is the recipient of a research fellowship abroad from the São Paulo Research Foundation (FAPESP; grant 2016/13410-0). The funding/support sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Other disclosures: None reported.

Ethical approval: The Intern Health Study protocol was approved by the University of Michigan Institutional Review Board.

Disclaimers: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding source.

Correspondence should be addressed to Srijan Sen, Molecular and Behavioral Neuroscience Institute, 205 Zina Pitcher Pl, Ann Arbor, MI 48109-5720; telephone (734) 764-5192; e-mail:

© 2019 by the Association of American Medical Colleges