Depressive Symptoms and Associated Factors among Obstetrics and Gynecology First-Year Residents

BACKGROUND:Medical training is a high-stress period, and residents in surgical specialties face elevated risk for depression due to demanding schedules, intensity of training, persistent mistreatment, and long work hours. Obstetrics and gynecology is the only surgical specialty predominantly composed of women, who face higher rates of depression than men and greater increases in depressive symptoms during internship. These challenges, compounded by work-family conflict and policy pressures, contribute to workforce strain in a specialty already facing a projected shortage. Understanding the mental health burden is critical to supporting both trainee well-being and long-term workforce sustainability, yet depressive symptoms, risk factors, and treatment-seeking have not been systematically studied in obstetrics and gynecology trainees. OBJECTIVE:To assess the prevalence of depressive symptoms and mental health treatment-seeking among obstetrics and gynecology first-year residents and identify associated demographic, psychological, and workplace factors. STUDY DESIGN:First-year obstetrics and gynecology residents enrolled in the longitudinal Intern Health Study between 2009 and 2024 completed surveys at enrollment and quarterly throughout internship. Depressive symptoms were measured using the 9-item Patient Health Questionnaire. Pearson correlations, χ2 tests, stepwise linear regression, and generalized estimating equation models were used to identify baseline and internship-related predictors of depressive symptoms. Sample weights were applied to address nonrepresentative sampling and attrition biases. RESULTS:Of 1603 enrolled obstetrics and gynecology interns (86.5% women; median age 27 years), 1271 (79.3%) completed at least one internship assessment and were included in the analysis. During internship, 35.6% screened positive for depression on the 9-item Patient Health Questionnaire at one or more assessments, yet less than one-third of those affected sought mental health treatment. Baseline predictors of increased depressive symptoms included history of depression, higher baseline depressive symptoms, neuroticism, a difficult early family environment, and not being in a committed relationship. Internship-related factors associated with worsening symptoms included fewer sleep hours, longer work hours, and reported medical errors. CONCLUSION:More than one-third of obstetrics and gynecology residents screened positive for depression on the 9-item Patient Health Questionnaire during their first year, yet treatment-seeking remained critically low. Both preexisting vulnerabilities and modifiable workplace stressors contributed to depressive symptoms. These findings are particularly notable given the female-predominant composition of the obstetrics and gynecology field and the growing representation of women in surgical specialties. The low treatment-seeking rate highlights the urgent need for improved mental health access, including opt-out service models. Structural interventions targeting workload and sleep are essential to support trainee well-being and long-term workforce sustainability in obstetrics and gynecology.