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The impact of gender and institutional factors on depression and suicidality in urology residents
Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Dec 2020 (Vol. 27, Issue 6, Pages( 10471 - 10479)
PMID: 33325351

Abstract

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  • INTRODUCTION Surgical trainees experience high rates of depression and suicidal ideation (SI). However, there remain a gap in knowledge on the drivers of depression and SI in trainees, especially within the field of urology.

    MATERIALS AND METHODS:

    We conducted a national study of urology trainees using a 50-item questionnaire in May 2018. The survey included demographic, depression (Patient Health Questionnaire-9 (PHQ-9)), burnout (Maslach Burnout Inventory (MBI)), and quality of life (QoL) questions.

    RESULTS:

    Overall, 37 (17.6%) endorsed depression; 24 residents endorsed SI (11%). SI was higher in those with depression (p < 0.001). Burnout was also higher among depressed residents (97.3% versus 61.8%, p < 0.001) and those endorsing SI (16.1% versus 1.5%, p < 0.001). Depression was associated with female gender (29.2% versus 12.4%, p = 0.005), fatigue (29.5% versus 7.8%, p < 0.001), and lack of structured mentorship (23.7% versus 9.8%, p = 0.010). Access to mental health services was protective (p = 0.016). Older age, low QoL, dissatisfaction with work-life-balance (WLB), and fatigue were associated with SI. On adjusted analysis, gender (OR 3.1 [95%CI 1.4-6.9], p = 0.006), fatigue (OR 3.8[95%CI 1.6-9.0], p = 0.002), and burnout (OR 16.7 [95%CI 2.2-127.5], p = 0.007) increased the odds of depression. On exploratory analysis, self-reported burnout alone was predictive of SI (OR 7.6 [95%CI 2.5-23]), and performed similarly to an adjusted model (AUC Area 0.718 [95%CI 0.634-0.802] versus 0.825 [0.753-0.897]).

    CONCLUSIONS:

    Urology trainees experience high rates of depression and SI. Female residents have significantly higher risk of depression. A single-item appears useful to screen for SI. Further investigation is needed to understand and promote urology resident wellness.

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