152
ORIGINAL ARTICLE
Anxiety and Depression Symptoms and Associated
Factors Among Medical-Surgical Specialty
Students at a University: A Descriptive Study
Carmenza Ricardo-Ramirez1 , María Camila Bedoya-Zapata2 ,
Valeria Piedrahita-Villada2 , Juan Pablo Zapata-Rodriguez2 , Santiago Zapata-Loaiza2 ,
Matilde Ligia Álvarez-Gómez3 , Libia María Rodríguez-Padilla4
1 Psychiatry Department, School of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia.
2 Research Seedbed Student, School of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia.
3 School of Nursing, Universidad Pontificia Bolivariana, Medellin, Colombia.
4 School of Nursing, Universidad Pontificia Bolivariana, Medellin, Colombia.
ARTICLE INFORMATION
Keywords
Anxiety;
Depression;
Internship and Residency;
Risk Factors
Received: December 2, 2022
Accepted: April 21, 2023
Correspondence:
Carmenza Ricardo-Ramírez. Department of
Psychiatry, Universidad Pontificia Bolivariana.
Carrera 72 a 78 B 50, Medellín, Colombia.
Telephone: +57 3006119813
carmenza.ricardo@upb.edu.co
How to cite: Ricardo-Ramirez C, Bedoya-Za-
pata MC, Piedrahita-Villada V, Zapata-Rodriguez
JP, Zapata-Loaiza S, Álvarez-Gómez ML, et al.
Anxiety and Depression Symptoms and Asso-
ciated Factors Among Medical-Surgical Special-
ty Students at a University: A Descriptive Study.
Iatreia [Internet]. 2024 Apr-Jun;37(2):152-162.
https://doi.org/10.17533/udea.iatreia.223
Copyright: © 2024
Universidad de Antioquia.
ABSTRACT
Introduction: Medical residents commonly experience depressive and
anxiety symptoms at higher rates compared to the general population.
These symptoms have been associated with various sociodemographic risk
factors as well as academic and healthcare demands.
Objective: To determine the frequency of depressive or anxiety symptoms
and associated factors among medical-surgical specialty students.
Methods: A cross-sectional study was conducted in 2021, involving resi-
dents in medical-surgical specialties at a university in Medellín. Participants
provided informed consent to participate. Three instruments were used: a
sociodemographic and clinical survey, the Beck Anxiety Inventory, and the
Beck Depression Inventory-II. Chi-square or Fisher’s exact tests were used
to explore associations, and prevalence ratios (PR) with 95% confidence in-
tervals were estimated. Multivariate analysis using binomial regression was
also performed.
Results: The study included 80 residents, of whom 57.5% were female. The
median age was 28 (27-30 years). 17.5% had a personal history of mental
illness, and 33.8% had a family history of mental illness. 72.5% consumed
alcohol. 40% had depressive symptoms, and 11.3% had both anxiety and
depressive symptoms. Factors associated with depressive symptoms were
mistreatment, long working hours, and sleep disturbances. In the multiva-
riate analysis, only sleep disturbance remained significantly associated (PR
8.7; 95% CI 1.2-63.2; p = 0.03). The variable associated with anxiety symp-
toms was mistreatment (PR 4.2; 95% CI 1.2-15.7; p = 0.02).
Conclusion: A higher prevalence of depressive symptoms, contrary to ex-
pectations, was found compared to anxiety symptoms. The variables asso-
ciated with depressive or anxiety symptoms were consistent with previous
reports.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
ORIGINAL ARTICLE
Anxiety and Depression Symptoms and Associated
Factors Among Medical-Surgical Specialty
Students at a University: A Descriptive Study
Carmenza Ricardo-Ramirez1 , María Camila Bedoya-Zapata2 ,
Valeria Piedrahita-Villada2 , Juan Pablo Zapata-Rodriguez2 , Santiago Zapata-Loaiza2 ,
Matilde Ligia Álvarez-Gómez3 , Libia María Rodríguez-Padilla4
1 Psychiatry Department, School of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia.
2 Research Seedbed Student, School of Medicine, Universidad Pontificia Bolivariana, Medellin, Colombia.
3 School of Nursing, Universidad Pontificia Bolivariana, Medellin, Colombia.
4 School of Nursing, Universidad Pontificia Bolivariana, Medellin, Colombia.
ARTICLE INFORMATION
Keywords
Anxiety;
Depression;
Internship and Residency;
Risk Factors
Received: December 2, 2022
Accepted: April 21, 2023
Correspondence:
Carmenza Ricardo-Ramírez. Department of
Psychiatry, Universidad Pontificia Bolivariana.
Carrera 72 a 78 B 50, Medellín, Colombia.
Telephone: +57 3006119813
carmenza.ricardo@upb.edu.co
How to cite: Ricardo-Ramirez C, Bedoya-Za-
pata MC, Piedrahita-Villada V, Zapata-Rodriguez
JP, Zapata-Loaiza S, Álvarez-Gómez ML, et al.
Anxiety and Depression Symptoms and Asso-
ciated Factors Among Medical-Surgical Special-
ty Students at a University: A Descriptive Study.
Iatreia [Internet]. 2024 Apr-Jun;37(2):152-162.
https://doi.org/10.17533/udea.iatreia.223
Copyright: © 2024
Universidad de Antioquia.
ABSTRACT
Introduction: Medical residents commonly experience depressive and
anxiety symptoms at higher rates compared to the general population.
These symptoms have been associated with various sociodemographic risk
factors as well as academic and healthcare demands.
Objective: To determine the frequency of depressive or anxiety symptoms
and associated factors among medical-surgical specialty students.
Methods: A cross-sectional study was conducted in 2021, involving resi-
dents in medical-surgical specialties at a university in Medellín. Participants
provided informed consent to participate. Three instruments were used: a
sociodemographic and clinical survey, the Beck Anxiety Inventory, and the
Beck Depression Inventory-II. Chi-square or Fisher’s exact tests were used
to explore associations, and prevalence ratios (PR) with 95% confidence in-
tervals were estimated. Multivariate analysis using binomial regression was
also performed.
Results: The study included 80 residents, of whom 57.5% were female. The
median age was 28 (27-30 years). 17.5% had a personal history of mental
illness, and 33.8% had a family history of mental illness. 72.5% consumed
alcohol. 40% had depressive symptoms, and 11.3% had both anxiety and
depressive symptoms. Factors associated with depressive symptoms were
mistreatment, long working hours, and sleep disturbances. In the multiva-
riate analysis, only sleep disturbance remained significantly associated (PR
8.7; 95% CI 1.2-63.2; p = 0.03). The variable associated with anxiety symp-
toms was mistreatment (PR 4.2; 95% CI 1.2-15.7; p = 0.02).
Conclusion: A higher prevalence of depressive symptoms, contrary to ex-
pectations, was found compared to anxiety symptoms. The variables asso-
ciated with depressive or anxiety symptoms were consistent with previous
reports.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
153
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
ARTÍCULO ORIGINAL
Síntomas ansiosos, depresivos y factores
asociados en estudiantes de especialidades médico-
quirúrgicas en una universidad: estudio descriptivo
Carmenza Ricardo-Ramirez 1 , María Camila Bedoya-Zapata2 ,
Valeria Piedrahita-Villada2 , Juan Pablo Zapata-Rodriguez2 , Santiago Zapata-Loaiza2 ,
Matilde Ligia Álvarez-Gómez3 , Libia María Rodríguez-Padilla4
1 Departamento de Psiquiatría. Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
2 Estudiante Semillero de Investigación, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
3 Facultad de Enfermería, Universidad Pontificia Bolivariana Medellín, Colombia.
4 Docente de Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
INFORMACIÓN ARTÍCULO
Palabras clave
Ansiedad,
Depresión,
Internado y Residencia,
Factores de Riesgo
Recibido: diciembre 2 de 2022
Aceptado: abril 21 de 2023
Correspondencia:
Carmenza Ricardo-Ramírez. Departamento de
Psiquiatría, Universidad Pontificia Bolivariana.
Carrera 72 a 78 B 50, Medellín, Colombia.
Teléfono: +57 3006119813
carmenza.ricardo@upb.edu.co
Cómo citar: Ricardo-Ramirez C, Bedoya-
Zapata MC, Piedrahita-Villada V, Zapata-
Rodriguez JP, Zapata-Loaiza S, Álvarez-
Gómez ML, et al. Síntomas ansiosos,
depresivos y factores asociados en estudian-
tes de especialidades médico-quirúrgicas
en una universidad: estudio descriptivo. Ia-
treia [Internet]. 2024 Abr-Jun;37(2):152-162.
https://doi.org/10.17533/udea.iatreia.223
Copyright: © 2024
Universidad de Antioquia.
RESUMEN
Introducción: los médicos residentes presentan con mayor frecuencia sín-
tomas depresivos y ansiosos comparados con la población general, los cua-
les se han asociado a factores de riesgo sociodemográficos y a la demanda
académica y asistencial.
Objetivo: determinar la frecuencia de síntomas depresivos o ansiosos y
factores asociados en estudiantes de especialidades médico-quirúrgicas.
Métodos: estudio transversal que incluyó residentes de especialidades
médico-quirúrgicas de una universidad de Medellín en 2021. Se aplicaron
tres instrumentos: encuesta sociodemográfica y clínica, el inventario de an-
siedad de Beck y el inventario de depresión de Beck-II. Se utilizó la prueba
chi cuadrado o Fisher para explorar asociaciones, se estimaron razones de
prevalencia (RP) con intervalos de confianza del 95 % y análisis multivariado
por regresión binomial.
Resultados: se incluyeron 80 residentes, de los cuales, el 57,5% eran mu-
jeres; la mediana de edad fue 28 (27 - 30 años); 17,5% tenían algún ante-
cedente personal y el 33,8% tenía un antecedente familiar de enfermedad
mental; 72,5% consumían alcohol; 40% presentaron síntomas depresivos,
y 11,3% sintomatología ansiosa y depresiva. Los factores asociados a sín-
tomas depresivos fueron: maltrato, jornada laboral extensa y alteración del
sueño. Este último fue el único factor que permaneció asociado en el análi-
sis multivariado (RP 8,7; IC 95% 1,2 – 63,2; p =0,03). La variable asociada con
síntomas ansiosos fue el maltrato (RP 4,2; IC 95% 1,2 – 15,7; p = 0,02).
Conclusión: se encontró mayor prevalencia de sintomatología depresiva
que ansiosa, contrario a lo esperado; las variables asociadas a sintomatolo-
gía depresiva o ansiosa son similares a lo reportado previamente.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
ARTÍCULO ORIGINAL
Síntomas ansiosos, depresivos y factores
asociados en estudiantes de especialidades médico-
quirúrgicas en una universidad: estudio descriptivo
Carmenza Ricardo-Ramirez 1 , María Camila Bedoya-Zapata2 ,
Valeria Piedrahita-Villada2 , Juan Pablo Zapata-Rodriguez2 , Santiago Zapata-Loaiza2 ,
Matilde Ligia Álvarez-Gómez3 , Libia María Rodríguez-Padilla4
1 Departamento de Psiquiatría. Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
2 Estudiante Semillero de Investigación, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
3 Facultad de Enfermería, Universidad Pontificia Bolivariana Medellín, Colombia.
4 Docente de Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
INFORMACIÓN ARTÍCULO
Palabras clave
Ansiedad,
Depresión,
Internado y Residencia,
Factores de Riesgo
Recibido: diciembre 2 de 2022
Aceptado: abril 21 de 2023
Correspondencia:
Carmenza Ricardo-Ramírez. Departamento de
Psiquiatría, Universidad Pontificia Bolivariana.
Carrera 72 a 78 B 50, Medellín, Colombia.
Teléfono: +57 3006119813
carmenza.ricardo@upb.edu.co
Cómo citar: Ricardo-Ramirez C, Bedoya-
Zapata MC, Piedrahita-Villada V, Zapata-
Rodriguez JP, Zapata-Loaiza S, Álvarez-
Gómez ML, et al. Síntomas ansiosos,
depresivos y factores asociados en estudian-
tes de especialidades médico-quirúrgicas
en una universidad: estudio descriptivo. Ia-
treia [Internet]. 2024 Abr-Jun;37(2):152-162.
https://doi.org/10.17533/udea.iatreia.223
Copyright: © 2024
Universidad de Antioquia.
RESUMEN
Introducción: los médicos residentes presentan con mayor frecuencia sín-
tomas depresivos y ansiosos comparados con la población general, los cua-
les se han asociado a factores de riesgo sociodemográficos y a la demanda
académica y asistencial.
Objetivo: determinar la frecuencia de síntomas depresivos o ansiosos y
factores asociados en estudiantes de especialidades médico-quirúrgicas.
Métodos: estudio transversal que incluyó residentes de especialidades
médico-quirúrgicas de una universidad de Medellín en 2021. Se aplicaron
tres instrumentos: encuesta sociodemográfica y clínica, el inventario de an-
siedad de Beck y el inventario de depresión de Beck-II. Se utilizó la prueba
chi cuadrado o Fisher para explorar asociaciones, se estimaron razones de
prevalencia (RP) con intervalos de confianza del 95 % y análisis multivariado
por regresión binomial.
Resultados: se incluyeron 80 residentes, de los cuales, el 57,5% eran mu-
jeres; la mediana de edad fue 28 (27 - 30 años); 17,5% tenían algún ante-
cedente personal y el 33,8% tenía un antecedente familiar de enfermedad
mental; 72,5% consumían alcohol; 40% presentaron síntomas depresivos,
y 11,3% sintomatología ansiosa y depresiva. Los factores asociados a sín-
tomas depresivos fueron: maltrato, jornada laboral extensa y alteración del
sueño. Este último fue el único factor que permaneció asociado en el análi-
sis multivariado (RP 8,7; IC 95% 1,2 – 63,2; p =0,03). La variable asociada con
síntomas ansiosos fue el maltrato (RP 4,2; IC 95% 1,2 – 15,7; p = 0,02).
Conclusión: se encontró mayor prevalencia de sintomatología depresiva
que ansiosa, contrario a lo esperado; las variables asociadas a sintomatolo-
gía depresiva o ansiosa son similares a lo reportado previamente.
154Ricardo-Ramírez et al.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
INTRODUCTION
High frequencies of psychiatric disorders have been reported globally in the adult population, de-
pression and anxiety being the most prevalent. These disorders are a significant cause of disability
in terms of loss of healthy life years (1), thus they are considered public health issues. According to
the World Health Organization (WHO), the global prevalence of depressive disorder is 4.4% (2), and
for anxiety disorders, it is 3.6% (2). In Colombia, these figures are similar, with an estimated 4.7% of
the population suffering from depression and 5.8% from anxiety (3).
Among university students aged 18 to 24, up to 41.9% exhibit various mental disorders affec-
ting numerous aspects, including academic performance, with a predominance of depression and
anxiety symptoms, especially in medical residency students. Risk factors for depression and anxiety
identified include female gender, academic pressure, and financial difficulties (1,4–7).
Medical residents experience a higher frequency of depression and depressive symptoms (25-
79.6%), as well as anxiety and anxiety symptoms (39-69.9%) (8) due to factors such as their medical
specialty, the year of their residency, gender, and the assessment scale used (6,9). Various risk factors
have been associated with these symptoms in students of medical-surgical residencies, including
personal history of mental disorders, psychoactive substance use, marital status, interpersonal con-
flicts, financial burden, academic semester, high academic demand, academic achievements, and
the specialty chosen (9–11).
The aim of the present study was to determine the frequency of depressive and anxiety
symptoms, and the associated factors in residents of medical-surgical specialties at a university in
Medellín.
METHODS
An analytical cross-sectional observational study targeting the full population of medical-surgical
specialty residents at a private institution in Medellín, selected based on eligibility criteria, was con-
ducted. It encompassed students from any medical-surgical specialty who were in the latter half of
their first year or in their second, third, or fourth year of residency during the first semester of 2021
and agreed to participate through informed consent. Exclusions were made for participants who
improperly or incompletely filled out the requested survey information.
Following approval from the institution’s managers, a pilot test was conducted to evaluate and
adjust the survey before distribution to all potential participants. The survey, designed to be self-
administered and anonymous, queried variables obtained from participant responses:
I. Sociodemographic, epidemiological, and clinical characteristics: age, sex, marital status, so-
cioeconomic status, family type, presence of children, economic resources and residency
financing, year of residency, medical-surgical specialty, personal and family history of de-
pression and anxiety, psychoactive substance use, alcohol consumption, cigarette smoking,
medication use (opioids, antidepressants, anxiolytics, mood stabilizers, among others), and
factors reported as associated with the development of depressive and anxiety symptoms
(work hours, sleep disturbances, and any form of mistreatment received during residency).
The residency year variable was converted into residency stage: first year = beginning, se-
cond year = intermediate, and third or fourth year = end.
II. Anxiety symptoms scale (Beck Anxiety Inventory, BAI): a score >16 on this scale was consi-
dered indicative of anxiety symptoms (12).
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
INTRODUCTION
High frequencies of psychiatric disorders have been reported globally in the adult population, de-
pression and anxiety being the most prevalent. These disorders are a significant cause of disability
in terms of loss of healthy life years (1), thus they are considered public health issues. According to
the World Health Organization (WHO), the global prevalence of depressive disorder is 4.4% (2), and
for anxiety disorders, it is 3.6% (2). In Colombia, these figures are similar, with an estimated 4.7% of
the population suffering from depression and 5.8% from anxiety (3).
Among university students aged 18 to 24, up to 41.9% exhibit various mental disorders affec-
ting numerous aspects, including academic performance, with a predominance of depression and
anxiety symptoms, especially in medical residency students. Risk factors for depression and anxiety
identified include female gender, academic pressure, and financial difficulties (1,4–7).
Medical residents experience a higher frequency of depression and depressive symptoms (25-
79.6%), as well as anxiety and anxiety symptoms (39-69.9%) (8) due to factors such as their medical
specialty, the year of their residency, gender, and the assessment scale used (6,9). Various risk factors
have been associated with these symptoms in students of medical-surgical residencies, including
personal history of mental disorders, psychoactive substance use, marital status, interpersonal con-
flicts, financial burden, academic semester, high academic demand, academic achievements, and
the specialty chosen (9–11).
The aim of the present study was to determine the frequency of depressive and anxiety
symptoms, and the associated factors in residents of medical-surgical specialties at a university in
Medellín.
METHODS
An analytical cross-sectional observational study targeting the full population of medical-surgical
specialty residents at a private institution in Medellín, selected based on eligibility criteria, was con-
ducted. It encompassed students from any medical-surgical specialty who were in the latter half of
their first year or in their second, third, or fourth year of residency during the first semester of 2021
and agreed to participate through informed consent. Exclusions were made for participants who
improperly or incompletely filled out the requested survey information.
Following approval from the institution’s managers, a pilot test was conducted to evaluate and
adjust the survey before distribution to all potential participants. The survey, designed to be self-
administered and anonymous, queried variables obtained from participant responses:
I. Sociodemographic, epidemiological, and clinical characteristics: age, sex, marital status, so-
cioeconomic status, family type, presence of children, economic resources and residency
financing, year of residency, medical-surgical specialty, personal and family history of de-
pression and anxiety, psychoactive substance use, alcohol consumption, cigarette smoking,
medication use (opioids, antidepressants, anxiolytics, mood stabilizers, among others), and
factors reported as associated with the development of depressive and anxiety symptoms
(work hours, sleep disturbances, and any form of mistreatment received during residency).
The residency year variable was converted into residency stage: first year = beginning, se-
cond year = intermediate, and third or fourth year = end.
II. Anxiety symptoms scale (Beck Anxiety Inventory, BAI): a score >16 on this scale was consi-
dered indicative of anxiety symptoms (12).
Ricardo-Ramírez et al.155IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
III. Depression symptoms scale (Beck Depression Inventory-II, BDI-II): Scores allowed for classi-
fication of depression symptom severity into: any depressive symptom (0–13 points), mild
(14–19 points), moderate (20–28 points), and severe (29–63 points) (11).
The information collected was entered into an electronic form designed in Excel with validated
fields to restrict value entry, thus preventing data entry errors.
Statistical Analysis
Qualitative variables were expressed through absolute and relative frequencies, and quantitative
variables were analyzed using the median and interquartile range due to the assumption of non-
normality not being met. The chi-square test or Fisher’s test was used for comparing qualitative
variables between students with and without depressive or anxiety symptoms. To estimate the as-
sociation magnitude between factors and depressive or anxiety symptoms, prevalence ratios (PR)
and their 95% confidence intervals (CI95%) were calculated. Multivariate binomial regression was
performed to adjust the results for potential confounding variables, including only those variables
that showed a p value <0.25 in the bivariate analysis. All data were processed using the IBM SPSS
statistical package, version 25.
Ethical Considerations
The study was conducted in accordance with the ethical principles outlined in the 2013 amend-
ment of the Helsinki Declaration. Classified as minimal risk research according to resolution 8430 of
1993 by the Colombian Ministry of Health and Social Protection for inquiring into sensitive aspects,
approval was sought from the institution’s Ethics Committee and informed consent was obtained
from all participants.
RESULTS
The study aimed to include 113 residents from various medical-surgical specialties. Of these, 82
agreed to participate, but two were excluded due to improper survey completion, resulting in a
final sample of 80 residents. Among the respondents, 46 (57.5%) were women, with a median age
of 28 years (IQR: 27-30 years), and 57 (71.2%) of the residents were from socioeconomic levels 4 and
5 (Table 1). Thirty-two residents (40%) exhibited symptoms of depression of varying severity, and
9 (11.3%) displayed anxiety symptoms (Figure 1), all of whom also had depressive symptoms. The
prevalence of anxiety symptoms was consistent across the beginning (11.1%), middle (13.3%), and
end (8.7%) of residency with a p value of 0.869. Similarly, the frequency of depressive symptoms was
comparable at all residency stages—beginning: 40.7%, middle: 36.7%, end: 43.5%, with a p value
of 0.878.
III. Depression symptoms scale (Beck Depression Inventory-II, BDI-II): Scores allowed for classi-
fication of depression symptom severity into: any depressive symptom (0–13 points), mild
(14–19 points), moderate (20–28 points), and severe (29–63 points) (11).
The information collected was entered into an electronic form designed in Excel with validated
fields to restrict value entry, thus preventing data entry errors.
Statistical Analysis
Qualitative variables were expressed through absolute and relative frequencies, and quantitative
variables were analyzed using the median and interquartile range due to the assumption of non-
normality not being met. The chi-square test or Fisher’s test was used for comparing qualitative
variables between students with and without depressive or anxiety symptoms. To estimate the as-
sociation magnitude between factors and depressive or anxiety symptoms, prevalence ratios (PR)
and their 95% confidence intervals (CI95%) were calculated. Multivariate binomial regression was
performed to adjust the results for potential confounding variables, including only those variables
that showed a p value <0.25 in the bivariate analysis. All data were processed using the IBM SPSS
statistical package, version 25.
Ethical Considerations
The study was conducted in accordance with the ethical principles outlined in the 2013 amend-
ment of the Helsinki Declaration. Classified as minimal risk research according to resolution 8430 of
1993 by the Colombian Ministry of Health and Social Protection for inquiring into sensitive aspects,
approval was sought from the institution’s Ethics Committee and informed consent was obtained
from all participants.
RESULTS
The study aimed to include 113 residents from various medical-surgical specialties. Of these, 82
agreed to participate, but two were excluded due to improper survey completion, resulting in a
final sample of 80 residents. Among the respondents, 46 (57.5%) were women, with a median age
of 28 years (IQR: 27-30 years), and 57 (71.2%) of the residents were from socioeconomic levels 4 and
5 (Table 1). Thirty-two residents (40%) exhibited symptoms of depression of varying severity, and
9 (11.3%) displayed anxiety symptoms (Figure 1), all of whom also had depressive symptoms. The
prevalence of anxiety symptoms was consistent across the beginning (11.1%), middle (13.3%), and
end (8.7%) of residency with a p value of 0.869. Similarly, the frequency of depressive symptoms was
comparable at all residency stages—beginning: 40.7%, middle: 36.7%, end: 43.5%, with a p value
of 0.878.
156Ricardo-Ramírez et al.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Table 1. Sociodemographic Background of Residents in Medical-Surgical Specialties
Characteristics N=80
(%n)
Female Gender 46 (57.5)
Age (years) * 28 (27 - 30)
Marital Status
Single
Married
Common-law partnership
63 (78.8)
10 (12.5)
7 (8.8)
With children 7 (8.9)
Family Type
Nuclear
Extended
Blended
Other †
66 (82.5)
7 (8.8)
4 (5.0)
3 (3.8)
Socioeconomic Level
3
4
5
6
4 (5.0)
23 (28.7)
34 (42.5)
19 (23.8)
Study Financing
First-degree family
Self-financing
Bank loan
Other sources ‡
36 (45)
15 (18.8)
17 (21.3)
9 (11.3)
Specialty
Internal Medicine
Gynecology and Obstetrics
Orthopedics
Pediatrics
Anesthesia
Dermatology
Psychiatry
Ophthalmology
Physical Medicine and Sports
General Surgery
Pain and Palliative Care
Radiology
14 (17.7)
10 (12.7)
8 (10.1)
8 (10.1)
6 (7.6)
6 (7.6)
6 (7.6)
5 (6.3)
5 (6.3)
4 (5)
4 (5)
3 (3.8)
* Median and Interquartile range
† Other (single-person, single-parent)
‡ Other sources (ICETEX, Fondos Sapiencia)
Source: authors’ creation
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Table 1. Sociodemographic Background of Residents in Medical-Surgical Specialties
Characteristics N=80
(%n)
Female Gender 46 (57.5)
Age (years) * 28 (27 - 30)
Marital Status
Single
Married
Common-law partnership
63 (78.8)
10 (12.5)
7 (8.8)
With children 7 (8.9)
Family Type
Nuclear
Extended
Blended
Other †
66 (82.5)
7 (8.8)
4 (5.0)
3 (3.8)
Socioeconomic Level
3
4
5
6
4 (5.0)
23 (28.7)
34 (42.5)
19 (23.8)
Study Financing
First-degree family
Self-financing
Bank loan
Other sources ‡
36 (45)
15 (18.8)
17 (21.3)
9 (11.3)
Specialty
Internal Medicine
Gynecology and Obstetrics
Orthopedics
Pediatrics
Anesthesia
Dermatology
Psychiatry
Ophthalmology
Physical Medicine and Sports
General Surgery
Pain and Palliative Care
Radiology
14 (17.7)
10 (12.7)
8 (10.1)
8 (10.1)
6 (7.6)
6 (7.6)
6 (7.6)
5 (6.3)
5 (6.3)
4 (5)
4 (5)
3 (3.8)
* Median and Interquartile range
† Other (single-person, single-parent)
‡ Other sources (ICETEX, Fondos Sapiencia)
Source: authors’ creation
Ricardo-Ramírez et al.157IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Figure 1. Frequency of Anxiety and Depressive Symptoms in 80 Medical-Surgical Specialty Residents
Source: authors’ creation
Regarding the participants’ backgrounds, 14 (17.5%) had a personal history of mental illness, pri-
marily depression and anxiety; 58 (72.5%) consumed alcohol; 56 (70.0%) experienced sleep distur-
bances; 23 (28.7%) reported mistreatment with verbal harassment being the most common form of
mistreatment, reported by 19 (86.2%), followed by bullying, reported by 7 (30.4%) (Table 2).
Table 2. Clinical and Epidemiological Background
Characteristics (%n/N)
History of mental illness 14/80 (17.5)
Type of mental illness*
Anxiety
Depression
ADHD
Bipolar disorder
Insomnia
Binge eating disorder
Executive dysfunction
10/80 (12.5)
4/80 (5.0)
2/80 (2.5)
1/80 (1.25)
1/80 (1.25)
1/80 (1.25)
1/80 (1.25)
Psychiatric medications
Prescribed by:
Specialist
Self-medication
18/80 (22.5)
16/18 (88.9)
2/18 (11.1)
Family history of mental illness 27/80 (33.8)
Alcohol consumption 58/80 (72.5)
Cigarette smoking 4/80 (5.0)
General medical diagnosis
Medications for general medical condition
Prescribed by:
Specialist
General practitioner
Not reported
24/80 (30.0)
13/24 (54.2)
11/13(84.6)
1/13(7.7)
1/13(7.7)
Long working hours 65/80 (81.3)
Figure 1. Frequency of Anxiety and Depressive Symptoms in 80 Medical-Surgical Specialty Residents
Source: authors’ creation
Regarding the participants’ backgrounds, 14 (17.5%) had a personal history of mental illness, pri-
marily depression and anxiety; 58 (72.5%) consumed alcohol; 56 (70.0%) experienced sleep distur-
bances; 23 (28.7%) reported mistreatment with verbal harassment being the most common form of
mistreatment, reported by 19 (86.2%), followed by bullying, reported by 7 (30.4%) (Table 2).
Table 2. Clinical and Epidemiological Background
Characteristics (%n/N)
History of mental illness 14/80 (17.5)
Type of mental illness*
Anxiety
Depression
ADHD
Bipolar disorder
Insomnia
Binge eating disorder
Executive dysfunction
10/80 (12.5)
4/80 (5.0)
2/80 (2.5)
1/80 (1.25)
1/80 (1.25)
1/80 (1.25)
1/80 (1.25)
Psychiatric medications
Prescribed by:
Specialist
Self-medication
18/80 (22.5)
16/18 (88.9)
2/18 (11.1)
Family history of mental illness 27/80 (33.8)
Alcohol consumption 58/80 (72.5)
Cigarette smoking 4/80 (5.0)
General medical diagnosis
Medications for general medical condition
Prescribed by:
Specialist
General practitioner
Not reported
24/80 (30.0)
13/24 (54.2)
11/13(84.6)
1/13(7.7)
1/13(7.7)
Long working hours 65/80 (81.3)
158Ricardo-Ramírez et al.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Table 2. Clinical and Epidemiological Background (continuation)
Characteristics (%n/N)
Sleep disturbances
Increase
Decrease
56/80 (70)
16/56 (28.6)
40/56 (71.4)
Restorative sleep 37/80 (46.3)
Mistreatment
Type of mistreatment
Verbal harassment
Bullying
Time abuse
Sexual harassment
Emotional harassment
Psychological harassment
23/80 (28.7)
19/23 (82.6)
7/23 (30.4)
1/23 (4.3)
1/23 (4.3)
1/23 (4.3)
1/23(4.3)
* Some participants had multiple psychiatric comorbidities.
ADHD: Attention Deficit Hyperactivity Disorder
Source: authors’ creation
The factors associated with depressive symptoms were long working hours, sleep disturbances,
and mistreatment. In the multivariate analysis, the only factor that remained significant was sleep
disturbances (PR 8.7; 95% CI 1.2 - 63.2; p = 0.03) (Table 3). Regarding factors related to anxiety symp-
toms, a statistically significant association was observed with mistreatment, even in the presence of
other variables (RP 4.2; 95% CI 1.2 – 15.7; p = 0.02) (Table 4).
Table 3. Demographic and Clinical Factors and Their Relationship With Depressive Symptoms
Factors
Depressive Symptoms Bivariate Analysis Multivariate Analysis
n Yes
(%n)
No
(%n) PR (IC 95%) P value PR (IC 95%) P value
Sex
Male
Female
34
46
12 (35.3)
20 (43.5)
22 (64.7)
26 (56.5)
0.8 (0.5 – 1.4) 0.46
Family history of
mental illness
Yes
No
27
53
13 (481)
19 (35.8)
14 (51.9)
34 (64.2)
1.3 (0.7 – 2.2) 0.28
Children
Yes
No
7
73
3 (42.9)
29 (39.7)
4 (57.1)
44 (60.3)
1.1 (0.4 – 2.6) 0.87
Long working hours
Yes
No
65
15
31 (47.7)
1 (6.7)
34 (52.3)
14 (93.3)
7,2 (1.1 – 48.3) 0.003 2,2 (0.4 – 11.4) 0.34
Sleep disturbances
Yes
No
56
24
31 (55.4)
1 (4.2)
25 (44.6)
23 (95.8)
13.3 (1.9 – 91.8) <0.001 8.7 (1.2 – 63.2) 0.03
Mistreatment
Yes
No
23
57
14 (60.9)
18 (31.6)
9 (39.1)
39 (68.4)
1.9 (1.2 – 3.2) 0.016 1.3 (0.8 – 2.1)
0.15
PR: Prevalence Ratio
Source: Authors’ creation
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Table 2. Clinical and Epidemiological Background (continuation)
Characteristics (%n/N)
Sleep disturbances
Increase
Decrease
56/80 (70)
16/56 (28.6)
40/56 (71.4)
Restorative sleep 37/80 (46.3)
Mistreatment
Type of mistreatment
Verbal harassment
Bullying
Time abuse
Sexual harassment
Emotional harassment
Psychological harassment
23/80 (28.7)
19/23 (82.6)
7/23 (30.4)
1/23 (4.3)
1/23 (4.3)
1/23 (4.3)
1/23(4.3)
* Some participants had multiple psychiatric comorbidities.
ADHD: Attention Deficit Hyperactivity Disorder
Source: authors’ creation
The factors associated with depressive symptoms were long working hours, sleep disturbances,
and mistreatment. In the multivariate analysis, the only factor that remained significant was sleep
disturbances (PR 8.7; 95% CI 1.2 - 63.2; p = 0.03) (Table 3). Regarding factors related to anxiety symp-
toms, a statistically significant association was observed with mistreatment, even in the presence of
other variables (RP 4.2; 95% CI 1.2 – 15.7; p = 0.02) (Table 4).
Table 3. Demographic and Clinical Factors and Their Relationship With Depressive Symptoms
Factors
Depressive Symptoms Bivariate Analysis Multivariate Analysis
n Yes
(%n)
No
(%n) PR (IC 95%) P value PR (IC 95%) P value
Sex
Male
Female
34
46
12 (35.3)
20 (43.5)
22 (64.7)
26 (56.5)
0.8 (0.5 – 1.4) 0.46
Family history of
mental illness
Yes
No
27
53
13 (481)
19 (35.8)
14 (51.9)
34 (64.2)
1.3 (0.7 – 2.2) 0.28
Children
Yes
No
7
73
3 (42.9)
29 (39.7)
4 (57.1)
44 (60.3)
1.1 (0.4 – 2.6) 0.87
Long working hours
Yes
No
65
15
31 (47.7)
1 (6.7)
34 (52.3)
14 (93.3)
7,2 (1.1 – 48.3) 0.003 2,2 (0.4 – 11.4) 0.34
Sleep disturbances
Yes
No
56
24
31 (55.4)
1 (4.2)
25 (44.6)
23 (95.8)
13.3 (1.9 – 91.8) <0.001 8.7 (1.2 – 63.2) 0.03
Mistreatment
Yes
No
23
57
14 (60.9)
18 (31.6)
9 (39.1)
39 (68.4)
1.9 (1.2 – 3.2) 0.016 1.3 (0.8 – 2.1)
0.15
PR: Prevalence Ratio
Source: Authors’ creation
Ricardo-Ramírez et al.159IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Table 4. Sociodemographic and Clinical Factors and Their Relationship With Anxiety Symptoms
Factors
Anxiety Symptoms Bivariate Analysis Multivariate Analysis
n Yes
(%n)
No
(%n) PR (CI 95%) P value PR (CI 95%) P value
Sex
Male
Female
34
46 2 (5.9)
7(15.2)
32 (94.1)
39 (84.8) 0.4 (0.9– 1.7) 0.19 0.5 (0.1-2.1) 0.39
Family history of
mental illness
Yes
No
27
53 6 (22.2)
3 (5.7)
21 (77.8)
50 (94.3) 3.9 (1.0-14.4) 0.02 3.5 (1.1-11.9) 0.04
Children
Yes
No
7
73 1 (14.3)
8(11.0)
6 (85.7)
65 (89.0) 1.3 (0.2-8.9) 0.8
Long working hours
Yes
No
65
15 8 (12.3)
1(6.7)
57 (87.7)
14 (93.3) 1.8 (0.2- 13.6) 0.5
Sleep disturbances
Yes
No
56
24 8 (14.3)
1 (4.2)
48 (85.7)
23 (95.8) 3.4 (0.4 -25.9) 0.2 1.9 (0.2 -15.1) 0.54
Mistreatment
Yes
No
23
57 6 (26.1)
3 (5.3)
17 (73.9)
54 (94.7) 4.9 (1.3 -18.2) 0.01 4.2 (1.2-15.7) 0.02
PR: Prevalence Ratio
Source: Authors’ creation
When only the results of residents without a history of mental illness were evalua-
ted (n = 66), the same pattern was observed. The following factors were associated with
depressive symptoms: long working hours (PR: 11.6; 95% CI 0.8 - 178.3; p = 0.003), sleep
disturbances (PR: 11.5; 95% CI 1.7 - 79.7; p < 0.0001) and experiencing mistreatment (PR:
2.0; 95% CI: 1.1 - 3.7). Regarding anxiety symptoms, the only factor that showed a trend
of association was mistreatment (PR: 5.1; 95% CI: 0.94 - 27.8; p = 0.073).
DISCUSSION
The training period for medical residents is marked by increased stress and emotional issues, poten-
tially leading to negative impacts on cognitive functioning. This study offers insights into the mental
health status regarding anxiety and depression symptoms among residents across various medical-
surgical specialties. There is a noted scarcity of evidence on this issue within our context.
In this study, medical resident students, when compared to the general population, exhibited
a higher frequency of anxiety and depressive symptoms (8). Moreover, a greater frequency of de-
pressive symptoms over anxiety symptoms was observed, aligning with other studies that reported
prevalence rates between 19% and 43.2%. Such varied outcomes could be attributed to the use of
different scales for symptom measurement or the specific academic period of the residents. Despite
reports that prevalence increases as residency progresses (5,6,8,12,13), our study did not observe
this trend.
Table 4. Sociodemographic and Clinical Factors and Their Relationship With Anxiety Symptoms
Factors
Anxiety Symptoms Bivariate Analysis Multivariate Analysis
n Yes
(%n)
No
(%n) PR (CI 95%) P value PR (CI 95%) P value
Sex
Male
Female
34
46 2 (5.9)
7(15.2)
32 (94.1)
39 (84.8) 0.4 (0.9– 1.7) 0.19 0.5 (0.1-2.1) 0.39
Family history of
mental illness
Yes
No
27
53 6 (22.2)
3 (5.7)
21 (77.8)
50 (94.3) 3.9 (1.0-14.4) 0.02 3.5 (1.1-11.9) 0.04
Children
Yes
No
7
73 1 (14.3)
8(11.0)
6 (85.7)
65 (89.0) 1.3 (0.2-8.9) 0.8
Long working hours
Yes
No
65
15 8 (12.3)
1(6.7)
57 (87.7)
14 (93.3) 1.8 (0.2- 13.6) 0.5
Sleep disturbances
Yes
No
56
24 8 (14.3)
1 (4.2)
48 (85.7)
23 (95.8) 3.4 (0.4 -25.9) 0.2 1.9 (0.2 -15.1) 0.54
Mistreatment
Yes
No
23
57 6 (26.1)
3 (5.3)
17 (73.9)
54 (94.7) 4.9 (1.3 -18.2) 0.01 4.2 (1.2-15.7) 0.02
PR: Prevalence Ratio
Source: Authors’ creation
When only the results of residents without a history of mental illness were evalua-
ted (n = 66), the same pattern was observed. The following factors were associated with
depressive symptoms: long working hours (PR: 11.6; 95% CI 0.8 - 178.3; p = 0.003), sleep
disturbances (PR: 11.5; 95% CI 1.7 - 79.7; p < 0.0001) and experiencing mistreatment (PR:
2.0; 95% CI: 1.1 - 3.7). Regarding anxiety symptoms, the only factor that showed a trend
of association was mistreatment (PR: 5.1; 95% CI: 0.94 - 27.8; p = 0.073).
DISCUSSION
The training period for medical residents is marked by increased stress and emotional issues, poten-
tially leading to negative impacts on cognitive functioning. This study offers insights into the mental
health status regarding anxiety and depression symptoms among residents across various medical-
surgical specialties. There is a noted scarcity of evidence on this issue within our context.
In this study, medical resident students, when compared to the general population, exhibited
a higher frequency of anxiety and depressive symptoms (8). Moreover, a greater frequency of de-
pressive symptoms over anxiety symptoms was observed, aligning with other studies that reported
prevalence rates between 19% and 43.2%. Such varied outcomes could be attributed to the use of
different scales for symptom measurement or the specific academic period of the residents. Despite
reports that prevalence increases as residency progresses (5,6,8,12,13), our study did not observe
this trend.
160Ricardo-Ramírez et al.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Regarding the severity of depression symptoms, mild forms were most common, followed by
moderate and severe, akin to Ahmed I et al., who reported 27.3% with mild symptoms, 10.1% mo-
derate, and 1.3% severe (14), contrary to Olum R et al., who noted a predominance of moderate
depressive symptoms in their population (15).
The perception of sleep disturbances remained uniquely associated with depressive symp-
toms, reflecting similar findings in other studies that evaluated sleep problems in terms of reduced
(63.49%) or excessive (44.44%) hours (1,11). Although extended working hours and mistreatment
were not associated with depressive symptoms following multivariate analysis, there is evidence
suggesting these factors are linked to both depressive and anxiety symptoms (5).
The frequency of anxiety symptoms was found to be lower than depressive symptoms, aligning
with other studies that reported higher levels of psychological stress, burnout, and anxiety symp-
toms (3,5,8). This finding contrasts with the study by Aguirre-Hernández R et al., which reported
a higher prevalence of anxiety (59.1%) compared to depressive symptoms (32.3%) (16).
Additionally, our study found that all residents with anxiety symptoms also suffered from depressi-
ve symptoms, consistent with previous research where anxiety symptoms have been correlated or
associated with the presence of depressive symptomatology (14,17).
A significant portion of participants (17.5%) had a history of mental illness, prompting a post-
hoc analysis in the subgroup of residents without such a history to examine if excluding residents
diagnosed with any mental illness would affect the results. This subgroup displayed the same
outcomes as the entire sample, suggesting that the observed effects might be attributed to factors
inherent to the medical residency period, despite the reduced sample size.
In our study, residents who experienced mistreatment reported more anxiety symptoms, mirro-
ring findings from other studies where mistreatment and abuse, along with factors like long hours,
high workload, and patient suffering exposure, have been linked to such symptoms. Furthermore,
academic pressure, low remuneration, and personal aspects such as age, gender, experiences lived,
and family relationships have been associated with depressive symptoms (5,11,12,18).
An important aspect to consider is that this study was conducted during the second year of the
COVID-19 pandemic, which limited sample recruitment due to difficulties accessing various practice
sites where the residents were located. Nevertheless, 72.5% of potential participants were recruited.
Despite employing various strategies for sample recruitment, some specialties were not represen-
ted in this group of residents, limiting the generalizability of the findings and the ability to establish
a relationship between specialty type and depression and anxiety symptoms. Similarly, the context
of the pandemic period must be taken into account when interpreting the results, as it could have
influenced the depressive and anxiety symptoms exhibited by the residents.
One of the strengths of our study is the exploration of a relatively unexamined population, as
determined by our literature review. The significance of our findings is amplified by the fact that
early diagnosis and intervention in resident physicians can lead to personal benefits for the students
and enhance patient care by reducing the likelihood of medical errors and improving patient safety
and care.
CONCLUSIONS
In this group of residency students, an increased frequency of depression and anxiety symptoms
was observed during their training process compared to the general population, aligning with
international findings. It is essential for medical specialty programs in our environment to deve-
lop strategies that positively impact the mental health of their students. Additionally, addressing
psychological aspects to reduce the risk of developing more significant mental disorders is crucial.
IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
Regarding the severity of depression symptoms, mild forms were most common, followed by
moderate and severe, akin to Ahmed I et al., who reported 27.3% with mild symptoms, 10.1% mo-
derate, and 1.3% severe (14), contrary to Olum R et al., who noted a predominance of moderate
depressive symptoms in their population (15).
The perception of sleep disturbances remained uniquely associated with depressive symp-
toms, reflecting similar findings in other studies that evaluated sleep problems in terms of reduced
(63.49%) or excessive (44.44%) hours (1,11). Although extended working hours and mistreatment
were not associated with depressive symptoms following multivariate analysis, there is evidence
suggesting these factors are linked to both depressive and anxiety symptoms (5).
The frequency of anxiety symptoms was found to be lower than depressive symptoms, aligning
with other studies that reported higher levels of psychological stress, burnout, and anxiety symp-
toms (3,5,8). This finding contrasts with the study by Aguirre-Hernández R et al., which reported
a higher prevalence of anxiety (59.1%) compared to depressive symptoms (32.3%) (16).
Additionally, our study found that all residents with anxiety symptoms also suffered from depressi-
ve symptoms, consistent with previous research where anxiety symptoms have been correlated or
associated with the presence of depressive symptomatology (14,17).
A significant portion of participants (17.5%) had a history of mental illness, prompting a post-
hoc analysis in the subgroup of residents without such a history to examine if excluding residents
diagnosed with any mental illness would affect the results. This subgroup displayed the same
outcomes as the entire sample, suggesting that the observed effects might be attributed to factors
inherent to the medical residency period, despite the reduced sample size.
In our study, residents who experienced mistreatment reported more anxiety symptoms, mirro-
ring findings from other studies where mistreatment and abuse, along with factors like long hours,
high workload, and patient suffering exposure, have been linked to such symptoms. Furthermore,
academic pressure, low remuneration, and personal aspects such as age, gender, experiences lived,
and family relationships have been associated with depressive symptoms (5,11,12,18).
An important aspect to consider is that this study was conducted during the second year of the
COVID-19 pandemic, which limited sample recruitment due to difficulties accessing various practice
sites where the residents were located. Nevertheless, 72.5% of potential participants were recruited.
Despite employing various strategies for sample recruitment, some specialties were not represen-
ted in this group of residents, limiting the generalizability of the findings and the ability to establish
a relationship between specialty type and depression and anxiety symptoms. Similarly, the context
of the pandemic period must be taken into account when interpreting the results, as it could have
influenced the depressive and anxiety symptoms exhibited by the residents.
One of the strengths of our study is the exploration of a relatively unexamined population, as
determined by our literature review. The significance of our findings is amplified by the fact that
early diagnosis and intervention in resident physicians can lead to personal benefits for the students
and enhance patient care by reducing the likelihood of medical errors and improving patient safety
and care.
CONCLUSIONS
In this group of residency students, an increased frequency of depression and anxiety symptoms
was observed during their training process compared to the general population, aligning with
international findings. It is essential for medical specialty programs in our environment to deve-
lop strategies that positively impact the mental health of their students. Additionally, addressing
psychological aspects to reduce the risk of developing more significant mental disorders is crucial.
Ricardo-Ramírez et al.161IATREIA. Vol. 37 Núm. 2. (2024). DOI 10.17533/udea.iatreia.223
AKNOWLEDGEMENTS
To the resident doctors who kindly collaborated and to the rotation sites that provided the time and
space to conduct the surveys.
FUNDING
The study received partial funding from the Universidad Pontificia Bolivariana.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
REFERENCES
1. Martínez-Martínez MC, Muñoz-Zurita G, Rojas-Valderrama K, Sánchez-Hernández JA. Prevalence of de-
pressive symptoms of undergraduate medicine students from Puebla, Mexico. Aten Fam [Internet].
2016;23(4):145–9. https://doi.org/10.1016/j.af.2016.10.004
2. Organización Mundial de la Salud. Depresión y otros trastornos mentales comu-
nes [Internet]. Organización Panamericana de la Salud [Internet]. 2017. Disponible en:
http://iris.paho.org/xmlui/bitstream/handle/123456789/34006/PAHONMH17005-spa.pdf
3. Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disor-
ders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety [Internet].
2018;35(3):195–208. https://doi.org/10.1002/da.22711
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5. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of
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73. https://doi.org/10.1097/00001888-200604000-00009
6. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of Depres-
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https://doi.org/10.1001/jama.2015.15845
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8. Jiménez-López JL, Arenas-Osuna J, Angeles-Garay U. Síntomas de depresión, ansiedad y riesgo de suicidio
en médicos residentes durante un año académico. Rev Med Inst Mex Seguro Soc [Internet]. 2015;53(1):20–
8. Disponible en: https://www.medigraphic.com/pdfs/imss/im-2015/im151d.pdf
9. Lin DT, Liebert CA, Esquivel MM, Tran J, Lau JN, Greco RS, et al. Prevalence and predic-
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https://doi.org/10.1016/j.amjsurg.2016.10.017
10. Jiménez-López JL, Arenas-Osuna J, Angeles-Garay UÁ. Diferencias entre síntomas de depresión y tras-
torno depresivo en médicos residentes. Salud(i)Ciencia [Internet]. 2016;22(3):279–81. Disponible en:
https://www.siicsalud.com/dato/sic/223/152635.pdf
11. Montiel-Jarquín ÁJ, Torres-Castillo ME, Herrera-Velasco MG, Ahumada-Sánchez ÓO, Barragán-Her-
vella RG, García-Villaseñor A, et al. Current state of depression and anxiety in residents of Orthope-
dics and Traumatology in a Third Level Medical Facility. Educ Medica [Internet]. 2015;16(2):116–25.
https://doi.org/10.1016/j.edumed.2015.09.006
AKNOWLEDGEMENTS
To the resident doctors who kindly collaborated and to the rotation sites that provided the time and
space to conduct the surveys.
FUNDING
The study received partial funding from the Universidad Pontificia Bolivariana.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
REFERENCES
1. Martínez-Martínez MC, Muñoz-Zurita G, Rojas-Valderrama K, Sánchez-Hernández JA. Prevalence of de-
pressive symptoms of undergraduate medicine students from Puebla, Mexico. Aten Fam [Internet].
2016;23(4):145–9. https://doi.org/10.1016/j.af.2016.10.004
2. Organización Mundial de la Salud. Depresión y otros trastornos mentales comu-
nes [Internet]. Organización Panamericana de la Salud [Internet]. 2017. Disponible en:
http://iris.paho.org/xmlui/bitstream/handle/123456789/34006/PAHONMH17005-spa.pdf
3. Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disor-
ders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety [Internet].
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