The effect of stress-related factors on depressive state among medical residents

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Shoji Yokoya Emiko Seo Ryoko Ogawa Ayumi Takayashiki Tetsuhiro Maeno


Background: Medical residents are at a high risk of depression. The National Institute for Occupational Safety and Health (NIOSH) job stress model explains that job stressors, buffer factors, and individual factors are related to worker health, including depression. This study investigated which job stressors and buffer factors influence depression in residents, independent of individual factors.

Methods: A self-administered questionnaire was distributed to second-year residents at 251 teaching hospitals. The questionnaire contained the Brief Scales for Job Stress (BSJS), the Sense of Coherence (SOC) Scale, the Center for Epidemiologic Studies Depression (CES-D) Scale, and questions on working hours and demographic characteristics. The BSJS is composed of six subscales including workload, mental workload, problems in personal relationships, job control, reward from work, and support from colleagues and superiors. The SOC includes individual factors about life stressors and health. We analyzed the relationship between depressive symptoms and these factors.

Results: Among 1,121 second-year residents who responded (64.5% response rate), 274 (24.4%) had depressive symptoms. In the multivariable analysis, depressive symptoms were significantly associated with SOC-13 score (p < 0.001), mental workload (p < 0.01), problems in personal relationships (p < 0.001), and reward from work (p < 0.01). Depressive symptoms were not significantly associated with mean number of hours worked per week.

Conclusion: Mental workload and problems in personal relationships are job stressors and reward from work is a buffer factor associated with depressive symptoms in medical residents. These findings can help residency programs support mental health of residents more effectively.

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How to Cite
YOKOYA, Shoji et al. The effect of stress-related factors on depressive state among medical residents. Medical Research Archives, [S.l.], v. 4, n. 6, oct. 2016. ISSN 2375-1924. Available at: <>. Date accessed: 23 july 2024.
Medical Residents; Depression; Job Stress; Sense of Coherence
Research Articles


Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res. 2003; 12(1):3-21.
Antonovsky H, Sagy S. The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol. 1986; 126(2):213-25.
Beckman TJ, Reed DA, Shanafelt TD, West CP. Resident physician well-being and assessments of their knowledge and clinical performance. J Gen Intern Med. 2012; 27(3):325-30.
Belmaker RH, Agam G. Major depressive disorder. The New England journal of medicine. 2008; 358(1):55-68.
Bernburg M, Vitzthum K, Groneberg DA, Mache S. Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals. BMJ Open. 2016; 6(6):e011369.
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, Shanafelt TD. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014; 89(3):443-451.
Eriksson M, Lindstrom B. Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of epidemiology and community health. 2005; 59(6):460-6.
Eriksson M, Lindström B. Antonovsky’s sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health. 2006; 60(5):376-81.
Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ (Clinical research ed). 2008; 336(7642):488-91.
Gilbar O. Do attitude toward cancer, sense of coherence and family high risk predict more psychological distress in women referred for a breast cancer examination? Women Health. 2003; 38(2):35-46.
Gong Y, Han T, Chen W, et al. Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study. PLoS One. 2014; 9(7):e103242.
Haoka T, Sasahara S, Tomotsune Y, Yoshino S, Maeno T, Matsuzaki I. The effect of stress-related factors on mental health status among resident doctors in Japan. Med Educ. 2010; 44(8):826-834.
Horinouchi H, Tokuda Y, Nishimura N, et al. Influence of Residents' Workload, Mental State and Job Satisfaction on Procedural Error: a prospective daily questionnaire-based study. General Medicine. 2008; 9(2):57-64.
Hurrell JJ, Jr., McLaney MA. Exposure to job stress--a new psychometric instrument. Scand J Work Environ Health. 1988; 14 Suppl 1:27-8.
Ito M, Seo E, Ogawa R, Sanuki M, Maeno T, Maeno T. Can we predict future depression in residents before the start of clinical training? Med Educ. 2015; 49(2):215-23.
Kato R, Haruyama Y, Endo M, Tsutsumi A, Muto T. Heavy overtime work and depressive disorder among male workers. Occup Med (Lond). 2014; 64(8):622-8.
Kawada T, Ueda H, Hayashi M, et al. Relationship among workload, health complaints, and depressive state of workers as revealed using a questionnaire survey. Work (Reading, Mass). 2010;37(4):333-9.
Kikuchi Y, Nakaya M, Ikeda M, Okuzumi S, Takeda M, Nishi M. Sense of coherence and personality traits related to depressive state. Psychiatry journal. 2014; 2014:738923.
Kleppa E, Sanne B,Tell GS.Working overtime is associated with anxiety and depression: the Hordaland Health Study. J Occup Environ Med 2008; 50:658–666.
Lee KH, Kim JE, Kim YK, et al. Long working hours and emotional well-being in korean manufacturing industry employees. Annals of occupational and environmental medicine. 2013; 25(1):38.
Levey RE. Sources of stress for residents and recommendations for programs to assist them. Acad Med. 2001; 76(2):142-50.
Maeno T, Nakamura A, Maeno T, Ozaki M, Kimura T, Tomita E, Sasahara S, Matsuzaki I. Resident stress in the new postgraduate clinical training system. Igaku Kyoiku. 2008; 39(3):175-182(in Japanese).
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015; 314(22):2373-2383.
NIOSH working group. Stress at work. Cincinnati, OH: National Institute for Occupational Safety and Health (NIOSH). 1999: 8.
Nishikido N, Kageyama T, Kobayashi T, Haratani T. Assessment of job-stress using a brief questionnaire: its relations to depression among male workers of an information processing company. Sangyo Seishin Hoken (Occup Ment Health). 2000; 8(2):73–82 (in Japanese).
Pereira-Lima K, Loureiro SR, Crippa JA. Mental health in medical residents: relationship with personal, work-related, and sociodemographic variables. Revista brasileira de psiquiatria. 2016.
Radloff, L. The CES-D scale: A new self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1(3): 385–401.
Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). The American journal of psychiatry. 2004; 161(12):2295-302.
Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry. 2010; 67(6):557-65.
Shima S, Shikano T, Kitamura T, Asai M. New Self-Rating Scale for Depression. Seishin Igaku. 1985; 27(6):717-723 (in Japanese).
Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996; 1(1):27-41.
Smith JW, Denny WF, Witzke DB. Emotional impairment in internal medicine house staff. Results of a national survey. JAMA : the journal of the American Medical Association. 1986; 255(9):1155-8.
Taniguchi K, Sasahara S, Maeno T, Yoshino S, Tomotsune Y, Tomita E, Usami K, Haoka T, Doki S, Matsuzaki I. Working environment, job stress factor and mental health among Japanese medical residents and supervisors. Journal of Physical Fitness, Nutrition and Immunology. 2007; 17:223–229.
Togari T, Yamazaki Y. Examination of the reliability and factor validity of 13-item five-point version Sense of Coherence Scale. Minzoku Eisei. 2005; 71(4):168-182(in Japanese).
Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N. Working hours, occupational stress and depression among physicians. Occup Med (Lond). 2011; 61(3):163-70.
Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study. Med Educ. 2000; 34(5):374-84.
Urakawa K, Yokoyama K, Itoh H. Sense of coherence is associated with reduced psychological responses to job stressors among Japanese factory workers. BMC Res Notes. 2012; 5:247.
Virtanen M, Stansfeld SA, Fuhrer R, Ferrie JE, Kivimaki M. Overtime work as a predictor of major depressive episode: a 5-year follow-up of the Whitehall II study. PLoS One. 2012; 7(1):e30719.
Wada K, Sakata Y, Fujino Y, Yoshikawa T, Tanaka K, Miyajima E, Aizawa Y. The association of needlestick injury with depressive symptoms among first-year medical residents in Japan. Ind Health. 2007; 45(6):750-755.
West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA : the journal of the American Medical Association. 2006; 296(9):1071-8.
Yoshino S, Sasahara S, Maeno T, et al. Relationship between mental health of Japanese residents and the quality of medical service. Journal of Physical Fitness, Nutrition and Immunology. 2007; 17(1):3-11.