Burnout, depression, and suicidal ideation among Chinese hospital physicians: prevalence and the distinct roles of research and teaching pressure.

Background: Physician mental health is a global concern, but comprehensive data from China, the home to one of the world's largest medical workforces, remains limited. We assessed the prevalence of burnout, depression, and suicidal ideation among Chinese hospital physicians and examined their comorbidity patterns, instrument concordance, and associated occupational factors. Methods: We conducted a cross-sectional study from September to November 2025 across four selected regions in China using purposive sampling. A total of 961 physicians completed validated mental health assessments. Burnout was assessed with the Professional Fulfillment Index (PFI) as the primary instrument and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for cross-validation. We measured depression using the four-item Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Short Form (T-scores calibrated to the USA reference population), and past-year suicidal ideation with a validated single-item measure. We used multivariable logistic regression to identify independent correlates of each outcome. Results: Of 961 physicians, 644 (67.0%) met PFI criteria for high burnout and 529 (55.0%) met MBI-HSS criteria; instrument agreement was moderate (Cohen's kappa = 0.55). Moderate-to-severe depression (PROMIS T-score ≥60) affected 363 (37.8%) physicians, and 41 (4.3%) reported past-year suicidal ideation. Research pressure and teaching pressure were both independently associated with burnout but showed divergent patterns: research pressure was associated with emotional exhaustion and appeared more evident among junior physicians, whereas teaching pressure was associated with depersonalisation and was significantly associated with burnout among senior physicians in Fujian-inclusive analyses. Income satisfaction was the strongest modifiable protective factor against both burnout and depression. Conclusions: In this purposive multi-region sample, burnout and depression were common, and prevalence estimates were instrument dependent. The divergent association patterns of research and teaching pressure across burnout dimensions and career stages suggest that future studies should test whether targeted, stage-specific institutional reforms are warranted. Income dissatisfaction warrants attention as a potentially modifiable risk factor in future longitudinal research.