Mental health and the COVID-19 pandemic: a study of medical residency training over the years

Mendonça, Vitor S.; Steil, Amanda; Góis, Aécio F.T.

doi:10.6061/clinics/2021/e2907

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ORIGINAL ARTICLE • Clinics 76 • 2021 • https://doi.org/10.6061/clinics/2021/e2907 copy

Mental health and the COVID-19 pandemic: a study of medical residency training over the years

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

This study aims to assess the symptoms of burnout, depression, and anxiety in Brazilian medical residents during the COVID-19 pandemic and to compare residents’ beliefs and clinical practices related to COVID-19 patients among all six years of medical residency training in Brazil.

METHODS:

A quantitative study was conducted in April 2020 with a convenience sample of medical resident volunteers from an anonymous online survey. This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression, and the General Anxiety Disorders (GAD-7) to measure generalized anxiety disorder. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents’ beliefs and clinical practices related to COVID-19 patients.

RESULTS:

Our sample comprised 3071 respondents. Depressive symptoms were the most common among second-year residents (70.5%), followed by anxiety symptoms (56.0%) and burnout (55.2%) among fourth-year residents. We also observed burnout symptoms (55.1%) among second-year residents.

CONCLUSION:

The COVID-19 pandemic increased the risk of mental illnesses in some years of residency. Our study could not conclude the reasons why the incidence varies among levels of physician training. Final year medical residents have avoided seeing COVID-19 patients.

Medical Residency; Mental Health; COVID-19

		Years of medical residency
		R1 n=1121		R2 n=976		R3 n=600		R4 n=277		R5 n=83		R6 n=14		Total n=3071
Descriptive		n	%	n	%	n	%	n	%	n	%	n	%	n	%	p-value
Gender																>0.05
	Male	283	25.2	219	22.4	156	26.0	61	22.0	33	39.7	8	57.1	760	24.7
	Female	838	74.7	757	77.5	444	74.0	216	78.0	50	60.2	6	42.8	2311	75.3
Ethnicity																>0.05
	White	883	78.7	761	78.0	457	76.1	203	73.2	70	84.3	12	85.7	2386	77.7
	Non-white	238	21.2	215	22.0	143	23.8	74	26.7	13	15.6	2	14.2	665	22.3
Region of Brazil																>0.05
	Southeast	705	62.8	603	61.7	378	63.0	194	70.0	68	81.9	13	92.8	1961	63.8
	South	168	15.0	160	16.3	96	16.0	28	10.1	10	12.0	-	-	462	15.0
	Northeast	142	12.6	103	10.5	63	10.5	33	11.9	5	6.0	1	7.1	347	12.0
	Midwest	85	7.5	75	7.6	46	7.6	17	6.1	-	-	-	-	223	7.2
	North	21	1.8	35	3.5	17	2.8	5	1.8	-	-	-	-	78	2.5
Hospital nature																<0.05
	Public	952	84.9	827	84.7	527	87.8	247	89.1	64	77.1	11	78.5	2628	85.6
	Private	169	15.0	149	15.2	73	12.1	30	10.8	19	22.8	3	21.4	443	14.4
Specialty^a a as described in the Methods section.																<0.05
	Clinical specialties	755	67.3	649	66.4	331	55.1	221	79.7	48	57.8	5	35.7	2009	65.4
	Surgical specialties	343	30.5	293	30.0	219	36.5	51	18.4	33	39.7	8	57.1	947	30.8
	Diagnostic and therapeutic support	41	3.6	34	3.4	38	6.3	1	0.3	1	1.2	-	-	115	3.7
Has contact with COVID-19 patients																<0.05
	Yes	719	64.1	646	66.1	358	59.6	152	54.8	45	54.2	6	42.8	1926	62.7
	No	402	35.8	330	33.8	242	40.3	125	45.1	38	45.7	8	57.1	1145	37.2

		Years of medical residency
		R1 n=1121		R2 n=976		R3 n=600		R4 n=277		R5 n=83		R6 n=14		Total n=3071
Mental Health		n	%	n	%	n	%	n	%	n	%	n	%	n	%	p value
Depression^a a according to the Patient Health Questionnaire - 9;																<0.05
	absent or mild	382	34.0	287	29.4	198	33.0	89	32.1	29	34.9	7	50.0	992	32.3
	moderate	326	29.0	280	28.6	142	23.6	67	24.1	22	26.5	4	28.5	841	27.4
	severe	413	36.8	409	41.9	260	43.3	121	43.6	32	38.5	3	21.4	1238	40.3
Anxiety^b b according to the General Anxiety Disorder - 7;																<0.05
	absent or mild	554	49.4	448	45.9	271	45.1	122	44.0	44	53.0	9	64.2	1448	47.2
	moderate or severe	567	50.5	528	54.0	329	54.8	155	56.0	39	47.0	5	35.7	1623	52.8
Burnout^c c according to the Oldenburg Burnout Inventory.																<0.05
	absent or mild	658	58.6	438	44.8	305	50.8	124	44.7	43	51.8	11	78.5	1579	51.4
	moderate or severe	463	41.3	538	55.1	295	49.1	153	55.2	40	48.1	3	21.4	1492	48.6

		Years of medical residency
		R1 n=1121		R2 n=976		R3 n=600		R4 n=277		R5 n=83		R6 n=14		Total n=3071
COVID-19 clinical practice and beliefs		n	%	n	%	n	%	n	%	n	%	n	%	n	%	p value
	Feel prepared to treat patients of COVID-19	319	28.4	336	34.4	491	81.8	113	40.7	51	61.4	9	64.2	1319	43.0	<0.05
	Avoiding seeing patients with confirmed or suspected cases of COVID-19	351	31.3	223	22.8	298	49.6	94	33.9	64	77.1	11	78.5	1041	33.9	<0.05
	Supervisors do not provide the necessary support for the treatment of COVID-19 patients	429	38.2	314	32.1	287	47.8	107	38.6	72	86.7	4	28.5	1213	39.4	<0.05
	Work in a wing with high risk of contamination with COVID-19	834	74.3	694	71.1	452	75.3	176	63.5	47	56.6	2	14.2	2205	71.8	<0.05
	Hospital provides personal protection equipment	477	42.5	259	26.5	217	36.1	155	55.9	59	71.0	7	50.0	1174	38.2	>0.05
	Afraid of getting COVID-19 and transmitting it to my significant ones	1104	98.4	931	95.3	538	89.6	198	71.4	57	68.6	12	85.7	2840	92.5	>0.05
	Personal relationships impaired since the pandemic	947	84.4	601	65.1	505	84.1	192	69.3	55	66.2	3	21.4	2303	75.0	<0.05

		Years of medical residency
		R1 n=1121		R2 n=976		R3 n=600		R4 n=277		R5 n=83		R6 n=14		Total n=3071
		n	%	n	%	n	%	n	%	n	%	n	%	n	%	p value
Mental Health Care^a a multiple responses.																<0.05
	talk with friends/family	937	44.1	678	39.0	401	33.5	152	27.8	24	13.1	3	14.2	2195	37.8
	support team	607	28.5	328	18.9	104	8.7	112	20.5	23	12.5	-	-	1174	20.2
	physical activity	140	6.5	276	15.9	221	18.5	103	18.8	72	39.3	9	42.8	821	14.1
	nothing	293	13.7	217	12.5	144	12.0	41	7.5	25	13.6	7	33.3	727	12.5
	psychotherapy	95	4.4	142	8.1	116	9.7	71	13.0	23	12.5	-	-	447	7.7
	others	52	2.4	94	5.4	208	17.4	66	12.2	16	8.7	2	9.5	438	7.5
Total responses		2124	36.6	1735	29.9	1194	20.6	545	9.4	183	3.1	21	0.3	5802	100.0

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[1] *Corresponding author. E-mail: vitor.mendonca@usp.br