The Silent Struggle: Depression During Residency

James A. Miller, MD


September 21, 2015

Although some causes of depression among residents are expected, others are surprising. Long work hours and sleep deprivation seem like likely candidates, but evidence tells a different story as well. For example, surveys before and after the institution of the 2011 duty-hour restrictions showed no change in burnout or tiredness.[5] This suggests that workload alone can't be responsible.

Emotional exhaustion is an important indicator of depression among residents.[6] Poor work/home interface, low job satisfaction, lack of autonomy, and hostile work environments all create emotional exhaustion.

Of these, poor work/home interface is commonly discussed as a primary concern. The tendency for work responsibilities to creep into home life creates a setting in which depression can develop. Residents frequently find that a supposed 12-hour shift can quickly expand to include an expectation to answer pages, text messages, and emails at home. These expectations add to family strain and may go a long way toward explaining the number of divorces experienced by medical residents. The effects of residency on family life are so profound that, contrary to the experiences of the general population, having a spouse or dependent children is actually considered to be a risk factor for depression among residents.[7]

Poor financial compensation can also add to the difficulty of maintaining a family life during residency. Residency salaries have not nearly kept pace with the skyrocketing levels of student debt that most residents carry; the result is that many residents now face significant financial hardship along with their work demands.[8]

Poor job satisfaction and lack of autonomy are closely related for residents. As residents, we are frequently given huge amounts of responsibility on our medical teams, but little or no role in directing patient care. Lack of autonomy goes further than simply bruising a resident's pride. We may frequently find ourselves in situations where we are expected to fall into line with practices and standards of care that fall below our personal standards of patient care. These feelings of moral compromise can be powerful sources of emotional exhaustion, leading to depression.

In addition, hostile work environments are, unfortunately, still a fact of life for many residents. Mistreatment of trainees remains the norm rather than the exception. Furthermore, this pattern of treatment starts early in training. A survey of medical students at over 24 medical schools indicated that most students had experienced at least one incident of mistreatment.[9] By the time of residency, most of us realize that a mistake made in the presence of the wrong attending, fellow, or nurse could result in threats, public humiliation, or professional reprisals. It is not difficult to see how such a work environment contributes to depression.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.