Cleary Jennifer L, Pereira-Lima Karina, Ma Xianda, Chen Lihong, Burmeister Margit, Meeks Lisa M, Zhao Zhuo, Ye Jun, Fang Yu, Wu Zhenke, Frank Elena, Zhang Ruyuan, Zeng Suhua, Zhao Qian, Mata Douglas A, Bohnert Amy, Li Weidong, Sen Srijan
Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
medRxiv. 2025 Mar 17:2025.03.09.25323517. doi: 10.1101/2025.03.09.25323517.
In the general population, depression increased with the onset of the COVID-19 pandemic. In addition to the general pandemic impact, training physicians faced many sudden and dramatic changes in their training environment. However, the effects of these changes on the mental health of training physicians remains unknown.
To identify change in depression risk among training physicians with the onset of the COVID-19 pandemic and factors associated with risk.
Prospective cohort study.
University- and community-based health care institutions in the United States and Shanghai, China.
First-year resident physicians (interns) serving during the 2018-19 (n=1844), 2019-20 (n=1201), and 2020-21 (n=2448) academic years (U.S. sample); interns serving during the 2021-22 academic year (n=471) (Shanghai sample).
Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) and work hours were assessed quarterly for all U.S. cohorts. The 2019-20 cohort completed supplemental surveys of these measures in April and May 2020. Shanghai sample interns were assessed for depressive symptoms (PHQ-9) and work hours quarterly before, during, and after the 2022 lockdown.
Within the 2019-20 U.S. cohort, depressive symptom scores decreased from the pre-pandemic (September, December) to the pandemic period (April, May, June) (5.5 [3.9] vs. 4.9 [4.3], <0.001). In causal mediation analysis, 62% of this change was mediated through work hours (0.62, 95% CI [0.44-1.00]). Descriptive comparisons of this cohort with cohorts training immediately before (2018-19) and after (2020-21) the pandemic onset demonstrated that both work hours and depressive symptoms were significantly lower in spring 2020, but returned to pre-pandemic levels by fall 2020. In the parallel Shanghai cohort serving during the April 2022 lockdown, we found a similar magnitude drop in depressive symptoms (5.6 [3.3] vs. 4.9 [4.8], p=0.005), with 64% of the effect mediated through work hours (0.64, 95% CI [0.24-1.84]).
Interns experienced a 11% decrease in depressive symptoms with the onset of the pandemic, which was primarily driven by reduced work hours. The identified associations between work hours and depressive symptoms early in the pandemic may inform strategies to support physician wellness moving forward.
在普通人群中，抑郁症随着新冠疫情的爆发而增加。除了疫情的普遍影响外，培训医生在其培训环境中面临着许多突然而巨大的变化。然而，这些变化对培训医生心理健康的影响仍不明确。
确定随着新冠疫情爆发，培训医生中抑郁风险的变化以及与风险相关的因素。
前瞻性队列研究。
美国和中国上海的大学及社区医疗保健机构。
在2018 - 19学年（n = 1844）、2019 - 20学年（n = 1201）和2020 - 21学年（n = 2448）服务的一年级住院医师（实习生）（美国样本）；在2021 - 22学年服务的实习生（n = 471）（上海样本）。
对所有美国队列每季度评估抑郁症状（患者健康问卷 - 9 [PHQ - 9]）和工作时长。2019 - 20队列在2020年4月和5月完成了这些指标的补充调查。对上海样本实习生在2022年封锁前、封锁期间和封锁后每季度评估抑郁症状（PHQ - 9）和工作时长。
在2019 - 20美国队列中，抑郁症状评分从疫情前（9月、12月）到疫情期间（4月、5月、6月）下降（5.5 [3.9] 对 4.9 [4.3]，<0.001）。在因果中介分析中，这一变化的62%通过工作时长介导（0.62，95% CI [0.44 - 1.00]）。将该队列与疫情爆发前（2018 - 19）和疫情爆发后（2020 - 21）立即培训的队列进行描述性比较表明，2020年春季工作时长和抑郁症状均显著降低，但到2020年秋季恢复到疫情前水平。在2022年4月封锁期间服务的上海平行队列中，我们发现抑郁症状有类似程度的下降（5.6 [3.3] 对 4.9 [4.8]，p = 0.005），其中64%的影响通过工作时长介导（0.64，95% CI [0.24 - 1.84]）。
随着疫情爆发，实习生的抑郁症状下降了11%，这主要是由工作时长减少驱动的。在疫情早期确定的工作时长与抑郁症状之间的关联可能为支持医生健康的未来策略提供信息。
