Medical residents’ mental distress in the COVID-19 pandemic: An urgent need for mental health care

Purpose

Medical residents’ mental health is currently an issue of concern for medical educators worldwide. The COVID-19 pandemic has raised the greatest concerns given the psychological effects of this scenario on medical residents on the frontlines of the pandemic. To assess the psychological impact of the COVID-19 pandemic on physicians in residency training, the collective symptoms of burnout, depression and anxiety are used to identify the residents’ beliefs and clinical practices related to COVID-19 patients and their behaviors concerning disease prevention.

Method

This observational study involved 3071 medical residents from all regions of Brazil. An online questionnaire assessed the presence of burnout using the Oldenburg Burnout Inventory, depressive symptoms using the Patient Health Questionaire-9, anxiety symptoms using the Generalized Anxiety Disorder-7, and COVID-19 Impact Questions to assess the residents’ beliefs and clinical practices related to COVID-19 patients. Exploratory analyses, logistic regression and multinomial regression analysis were performed in this investigation.

Results

Moderate and severe depressive symptoms were the most common (67.7%) followed by anxiety symptoms (52.8%) and burnout (48.6%). The difference between residents with or without contact with COVID-19 patients was significant increased when analyzing different aspects of clinical practice, behavior, substance use and mental health.

Conclusions

These results suggest an increase in depression and anxiety symptoms among medical residents dealing with COVID-19, upstaging previous concerns about medical residents’ mental health. The prevalence of burnout is similar to that of a nonpandemic scenario. Considering the severity of the pandemic scenario and the overburden of healthcare services, medical residents’ mental health deserves special care.

COVID-19 pandemic in São Paulo: a quantitative study on clinical practice and mental health among medical residency specialties

BACKGROUND

2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic.

OBJECTIVE

To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties.

DESIGN AND SETTING

Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020.

METHODS

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 Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients.

RESULTS

The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties.

CONCLUSION

Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.

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

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.

Prevenção quaternária e educação médica: Uma revisão integrativa após as Diretrizes Curriculares Nacionais do Curso Medicina de 2014

Introdução: De acordo com a Resolução nº 3, de 2014, que institui as Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina, o(a) graduando(a) em Medicina deve ter formação geral, humanista, crítica, reflexiva e ética, com capacidade para atuar nos diferentes níveis de atenção à saúde, dentre estes, a prevenção. A investigação diagnóstica deve ser realizada com base nas melhores evidências científicas e conforme as necessidades da pessoa. Nesse sentido, a prevenção quaternária e seus princípios têm relação com os objetivos da DCN. Objetivos: Realizar a intersecção a partir de periódicos científicos brasileiros entre a prevenção quaternária e o ensino médico após a implantação da DCN de 2014. Métodos: Revisão integrativa dos artigos disponíveis nas plataformas da CAPES, Scielo, PubMed e Google Acadêmico, a partir do ano de 2014 até outubro de 2017, por meio das palavras chave “prevenção quaternária” e “educação”. Critérios de exclusão: artigos patrocinados por indústrias farmacêuticas, indisponíveis na íntegra, sem resumo e estrangeiros. Resultados: Foram encontrados 33 documentos e 9 artigos selecionados para análise, voltados principalmente para a prática da prevenção quaternária. Apenas 3 estudos fazem alusão à educação médica. Conclusão: A prevenção quaternária é um tema de grande relevância na prática médica, entretanto, ainda é deficiente na graduação, baseado nas restritas produções disponíveis. Apesar da nova DCN do curso de medicina, o ensino médico no cenário atual é predominantemente voltado para especialidades, dificultando a atuação integral e centrada na pessoa.