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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 97-103

Prevalence of depression and anxiety and their associated factors among ministry of health programs residents from different specialties in Abha City, Saudi Arabia


1 Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Ministry of Health, Aseer, Saudi Arabia

Date of Submission15-Jun-2022
Date of Decision10-Oct-2022
Date of Acceptance26-Oct-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Mohammed Abadi Alsaleem
King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/KKUJHS.KKUJHS_24_22

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  Abstract 

Background: Identifying the magnitude and the determinants of stress-related disorders will help to improve the work environment besides minimizing its drawback on residents' medical care performance. Aim: This study aims to assess the prevalence of depression and anxiety and their associated factors among Ministry of Health (MOH) programs residents. Methodology: This cross-sectional survey targeted all MOH residents from different specialties in Abha city. The questionnaire included resident's sociodemographic information, specialty, duration, seniority, workload, shifts, and number of cared patients per shift. Resident's depression was assessed using Depression Patient Health Questionnaire-9 and anxiety was assessed using the anxiety Generalized Anxiety Disorder-7 Scale. The data were analyzed using SPSS version 21. Results: A total of 370 residents were included. Residents' age ranged from 20 to 35 years, with a mean age of 27.6 ± 6.7 years. Nearly 61.1% of residents were males and 58.6% were married. About 66.2% of the residents were normal (no depression), while 15.1% experienced minimal depression, 13% had mild depression, and 4.3% had severe depression. Considering anxiety, 85.9% of the residents showed no/minimal anxiety levels, while 7.8% had mild, 4.9% had moderate, and 1.4% showed severe anxiety levels. Conclusions: The study showed that psychological health, including depression and anxiety, was satisfactory among the study residents, where the majority of them were free of both issues. Further nationwide studies are required to assess additional factors such as work environment and autonomy.

Keywords: Anxiety, depression, medical residents, mental health, prevalence, risk factors, Saudi Arabia


How to cite this article:
Alsaleem MA, Wasili FM, Alsaleem SA. Prevalence of depression and anxiety and their associated factors among ministry of health programs residents from different specialties in Abha City, Saudi Arabia. King Khalid Univ J Health Sci 2022;7:97-103

How to cite this URL:
Alsaleem MA, Wasili FM, Alsaleem SA. Prevalence of depression and anxiety and their associated factors among ministry of health programs residents from different specialties in Abha City, Saudi Arabia. King Khalid Univ J Health Sci [serial online] 2022 [cited 2023 Jan 30];7:97-103. Available from: https://www.kkujhs.org/text.asp?2022/7/2/97/365756


  Introduction Top


Medical residents are continuously exposed to stressful situations regardless of their age, gender, or seniority during work.[1],[2],[3] Physicians' workload and personalities can both positively or negatively affect stress-related mood and can affect their personal or professional life.[4],[5],[6] Residents are more prone to develop mental disorders.[7],[8] Their training is the main cause of stress due to increased responsibilities. The residents perform multiple roles, such as involvement in clinical duties, education, research, and administration.[9] Long work shifts, increased workload, and less control over the job may lead to stress, depression, anxiety, fatigue, irritability, and sleep deprivation.[10] Sleep deprivation also may push residents to medical errors, injuries, substance abuse, and conflicts with work-related staff.[11] Resident physicians have self-reported higher rates of depression than the public.[12],[13],[14]

Residents with mental health disorders have been found to commit a significantly higher rate of medication errors than their normal peers.[15] More than half of resident's self-reporting a major medical error during the past 3 months showed significant depression symptoms.[16] Therefore, recognizing the factors associated with their mental illness is a vital public health issue. The current study assessed the prevalence of depression and anxiety and their associated factors among residents from different specialties enrolled in the Ministry of Health (MOH) programs in Abha city.


  Methodology Top


This descriptive cross-sectional study was conducted at Aseer Central Hospital and Abha Maternity and Children Hospital. Furthermore, residents in the primary health-care centers were included due to the convenience of data collection. The study targeted all MOH program residents in all specialties during the study period. A residency period of at least 1 month was required to be included in the study. Residents with chronic psychological or mental disorders were excluded from the study. A total sample of 200 residents is required based on the results of a systematic review, which reported that, on average, 20% of the residents had one of the psychological problems with a precision of 5% at a 95% confidence level.[17] The researchers initiated the survey tool after an intensive literature review and expert consultation. Three experts specialized in the field reviewed the initial tool to assess clarity, applicability, and content validity. The tool included the following data: Resident's sociodemographic data, residency data including specialty, duration, seniority, and how to be included, resident's workload, shifts, number of cared patients per shift, Resident's depression was assessed using Depression Patient Health Questionnaire-9 (PHQ-9). Residents' anxiety was assessed using the Generalized Anxiety Disorder Assessment (GAD-7) scale. This seven-item instrument is used to measure or assess the severity of generalized anxiety disorder. Each item asks the individual to rate the severity of his or her symptoms over the past 2 weeks. Response options include “not at all,” “several days,” “more than half the days,” and “nearly every day.”[18] Scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate, and severe anxiety, respectively. When used as a screening tool, further evaluation is recommended when the score is 10 or greater. Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a specificity of 82% for GAD. It is moderately good at screening panic disorder (sensitivity 74% and specificity 81%), social anxiety disorder (sensitivity 72% and specificity 80%), and posttraumatic stress disorder (sensitivity 66% and specificity 81%).[18]

Data analysis

The data were analyzed using the the Statistical Package for Social Sciences (SPSS) program (V. 16.0, SPSS Inc., Chicago, IL, USA). All statistical methods used were two-tailed with an alpha level of 0.05, considering significance if the P ≤ 0.05. As for PHQ-9, the overall score was obtained by summing all discrete scores for the items, which ranged from 0 to 27 points. PHQ-9 scales 0–4 were normal, 5–9 for mild depression, 10–14 for moderate depression, 15–19 for moderately severe, and 20–27 for severe depression.[19] Descriptive analysis was done by prescribing frequency distribution and percentage for study variables, including residents' data, residency program, specialty data, work-related data, PHQ-9 and GAD-7 items, while anxiety and depression prevalence and severity were graphed. Cross tabulation for showing the distribution of residents' depression and anxiety by their sociodemographic and work data was carried out with the Pearson Chi-square test for significance and the exact probability test for small frequency distributions.


  Results Top


The total number of residents who participated was 370. Residents' were aged from 20 to 35 years with a mean age of 27.6 ± 6.7 years old. Nearly 61.1% of residents were males and 58.6% were married. As for specialty, 100 (27%) were at internal medicine residency, 66 (17.8%) at family medicine residency, 32 (8.6%) at pediatrics medicine residency, and 29 (7.8%) at obstetrics and gynecology residency, and 28 (7.6%) at general surgery residency. A total of 99 (26.8%) residents were in their 3rd residency year, 92 (24.9%) were in their 2nd year and 74 (20%) were in their 1st residency year. A total of 188 (50.8%) selected their specialty after family advice, while 125 (33.8%) selected their specialty as their interest. Monthly income was insufficient among 177 (47.8%) residents and it was just sufficient among 165 (44.6%). A total of 30 (8.1%) residents were from outside Abha [Table 1].
Table 1: Personal data of Ministry of Health programs residents from different specialties in Abha city, Southern of Saudi Arabia

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[Table 2] shows work data of MOH Programs Residents from Different Specialties in Abha City. A total of 217 (58.6%) residents reported working for 6–7 days/week, and 315 (85.1%) work mixed shifts. As for workload, 266 (71.9%) reported caring for 50–100 patients per shift and 102 (27.6%) care for <50 patients per shift. Nearly 37% had extra work hours and 172 (46.5%) care for COVID-19 cases. Residency admirative problems were reported among 155 (41.9%).
Table 2: Work data of Ministry of Health programs residents from different specialties in Abha city, Southern of Saudi Arabia

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[Table 3] shows psychological health (depression and anxiety) among MOH Programs Residents from Different Specialties in Abha City. Regarding PHQ-9, 28.4% of residents had little interest or pleasure in doing things, 26.5% had trouble falling or staying asleep or sleeping too much, and 26.2% experienced trouble concentrating on activities, such as reading the newspaper or watching television, 25.4% felt down, depressed, or hopeless, and 18.9% had poor appetite or overeating while 18.4% felt tired or having little energy. Considering GAD-7, 22.7% of the residents felt nervous, anxious, or on edge, 18.1% could not stop or control worrying, 15.9% were worried excessively, and 15.4% became easily annoyed or irritable, and 14.6% had trouble to relax.
Table 3: Psychological health (depression and anxiety) among Ministry of Health programs residents from different specialties in Abha city, Southern of Saudi Arabia

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[Figure 1] shows overall psychological health (depression and anxiety) level among MOH Programs Residents from Different Specialties in Abha City. As for depression, 66.2% of the residents were normal (no depression), while 15.1% experienced minimal depression, 13% had mild depression, and 4.3% had severe depression. Considering anxiety, 85.9% of the study residents showed no/minimal anxiety levels, while 7.8% had mild, 4.9% had moderate, and 1.4% had severe anxiety levels.
Figure 1: Overall psychological health (depression and anxiety) level among MOH programs residents from different specialties in Abha city, Southern of Saudi Arabia. MOH: Ministry of Health

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[Table 4] shows the distribution of residents' psychological health (depression and anxiety) by their related biodemographic and work data. As for depression, it was significantly higher among female residents (26.4%; P = 0.002), among divorced residents (50%; P = 0.001), residents in medicine specialties (27.8%; P = 0.001), residents who had residency specialty by their decision (34.4%; P = 0.001), residents with sufficient income (35.7%; P = 0.017), residents who cover morning shifts (34.5%; P = 0.001), and residents who had no extra work hours (22.3%; P = 0.018). About anxiety, it was significantly higher among female residents (21.5%; P = 0.001), divorced/widow residents (35.7%; P = 0.002), residents in medicine specialties (21.4%; P = 0.001), residents who selected the specialty (26.4%; P = 0.001), residents with sufficient income (32.1%; P = 0.001), residents working at morning shifts (27.3%: P = 0.002), residents who care for <50 patients (27.5%), and residents who care for COVID cases (18; P = 0.041).
Table 4: Distribution of resident's psychological health (depression and anxiety) by their related biodemographic and work data

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  Discussion Top


Medical residents are continuously exposed to stress and shock situations during work.[13] Resident's stress-associated mood is positively or negatively affected by resident's workload and personality, which may adjust their impact on the person or their life.[20],[21] Recently, research showed a higher likelihood of having mental disorders among medical staff, including residents.[2] Residency training is the chief issue responsible for stress due to extended expectations and duties. Studies have reported higher depression rates among resident physicians than the general population.[22],[23] Resident's depression may affect the quality of the delivered patient care with more incident medical errors. The prevalence of depression or its symptoms varies from 3% to 60%.[24],[25]

Most of the study residents were males, married, and in medical specialties, and only one-third of them were in the residency program they chose, while half of them joined the program after their family's advice. Nearly half of the residents had insufficient monthly income, and one-third had extra work hours as the vast majority covered mixed shifts. Less than three-quarters of the residents reported caring for 50–100 patients daily, which is a very high workload and 46% care for COVID-19 patients.

As for psychological health, about one-third of the study residents (33.8%) had some degree of depression which was minimal to mild among 28% of them. About one-quarter of the residents were not interested in doing things, had sleep disturbances, experienced trouble in concentration while reading or watching television, and also felt down, depressed, or hopeless. Nearly 14.1% of the residents had an anxiety disorder which was mild to moderate for most of the anxious residents. About 18.1% were always worried, 15.9% worried a lot, 15.4% became easily annoyed or irritable, and 14.6% had trouble relaxing. Similar findings have been reported among UK medical students, where 37%, 31%, and 22% had poor mental health in the 1st, 4th, and 5th years, respectively. About 13% of Swedish medical students were depressed.[26] Earle and Kelly found that 20% of Ontario family medicine residents had depressive disorders, of which 13% were major depressive disorders.[27] Generalized anxiety disorder was diagnosed among 12% and the panic syndrome was observed in 2% of residents. Similar findings were reported by Goebert et al. where 12% of medical residents had severe and 9.2% had mild/moderate depression.[28] There was a significant association between depression with trainee level and female gender. In addition, around 6% had suicidal ideation. In Germany, Bernburg et al. observed that about 17% of the physicians reported high levels of occupational distress and 9% had high levels of depressive symptoms.[29] About 11% of hospital physicians scored low in workability. Similar findings in Brazil were reported by Pasqualucci et al. where 19% of the medical residents experienced depression and 16% had anxiety, whereas stress symptoms were detected in 17.7% of the residents.[30] Burnout Syndrome was reported among 63% of the study residents. In Tunisia, about three-quarters (74%) of the medical residents complained of anxiety, while 62% had depression, and 20% had both definite anxiety and definite depression.[31] Depression was observed in 75.8% of the physician residents in Jeddah, which is much higher than the estimated level in the current study.[32] Furthermore, AlShamlan et al., in the Eastern province, reported that 39.3% of the medical residents showed depression symptoms.[33] The high variabilities in the estimated psychological disorders among medical residents may be due to the high variability like the residency program, region, culture, work duties, and finally, the method used to assess psychological health.


  Conclusions and Recommendations Top


Psychological health, including depression and anxiety, was satisfactory among the study residents where; the majority of them were free of both issues. Even those who had depression or anxiety symptoms were at mild-to-moderate levels, with very few percent, complained of severe levels. High variability regarding the estimated rate of psychological and mental health disorders among residents in different regions was estimated due to personal, cultural, and tool variabilities. More studies should assess other factors, such as work environment and autonomy. Most studies' have used self-reported instruments. Other types of mental health assessments, improved personal and organizational conditions may strengthen the study assessment ability.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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