Residency Program Factors Associated with Depressive Symptoms in Internal Medicine Interns: A Prospective Cohort Study

Abstract

Purpose To investigate 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-9 (PHQ-9) before internship, and then quarterly throughout the internship. The training environment was assessed via a resident questionnaire 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