Coping Strategies, Depression, and Anxiety Among Ontario Family Medicine Residents

Objective: To assess the current prevalence of depression and anxiety among Ontario family medicine residents, and to describe their coping strategies.

Design: Surveys mailed to residents integrated DSM-IV diagnostic criteria and a previously validated Patient Health Questionnaire.

Setting: Ontario family medicine programs from June to August 2002.

Participants: Residents entering, advancing in, or graduating from residency programs: approximately 216 yearly for a total of 649 residents.

Main Outcome Measures: Types and frequency of coping skills used by residents; prevalence of depressive and anxiety disorders.

Results: Response rate for residents entering programs was 46% and for graduating residents was 30% (37% response rate overall). Prevalence of depressive disorders was 20% (13% major depressive disorders, 7% other depressive syndromes)(odds ratio [OR] 3.4, confidence interval [CI] 2.7 to 7.5, P < .001). Prevalence of generalized anxiety disorder was 12%, and 2% of residents met criteria for panic syndrome (OR 4.3, CI 1.6 to 11.8, P = .002). Rates were similar for men and women. Medical training was commonly identified as a negative influence on the mental health of troubled residents. Residents most often turned to family and friends when they needed help (43.7% of respondents). About 17.3% saw their family doctors, 15.4% counselors, and 7.9% psychiatrists. Some residents (13.4%) used medication to deal with their affective symptoms, 7.1% underwent cognitive-behavioural therapy, and 8.3% required a leave of absence from their programs. More than half (61.8%) indicated recreational use of alcohol and drugs, 1.2% identified use due to addiction, and 5.9% used drugs to help cope with their problems. Four respondents admitted concern that they might commit suicide during residency; a different three had made previous attempts.

Conclusion: Affective disorders (both depression and anxiety syndromes) are three to four times more common among Ontario family practice residents than in the general population; male and female residents are equally affected. Most residents with these problems report negative effects on their function at work. Medical training is the most commonly identified negative influence on mental health. While residents most often obtain help from family members and friends, many seek professional help.