Depression Risk and Work Hours in Training Physicians Before and During the COVID-19 Pandemic.

Importance: 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. Objective: To identify change in depression risk among training physicians with the onset of the COVID-19 pandemic and factors associated with risk. Design: Prospective cohort study. Setting: University- and community-based health care institutions in the United States and Shanghai, China. Participants: 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). Main Outcomes and Measurements: 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. Results: 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], Conclusions and Relevance: 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.