Prevalence and Predictors of Depression among Training Physicians in China: A Comparison to the United States

Resident physician training is associated with a substantial increase in depression in the United States, with rates increasing from about 4% before internship to 35% at least once during the first year of residency[1][1]. Here, we sought to assess whether the rate of depression among residents in China are similar to their US counterparts and identify the common and differential predictors of depression in the two training systems. We assessed 1006 residents across three cohorts (2016-2019) at 16 affiliated hospitals of Shanghai Jiao Tong University and Peking Union Medical College. In parallel, we assessed three cohorts of 7028 residents at 100+ US institutions. At the Chinese institutions, similarly, the proportion of participants who met depression criteria increased from 9% prior to residency to 35% at least once during the first year of residency (P<0.0001), an increase similar in magnitude to residents during internship in US institutions. Among factors assessed before residency, prior history of depression and depressive symptom score at baseline were common factors associated with depression during residency in both China and the US. In contrast, neuroticism and early family environment were strongly associated with depression risk in the US but not in China. Young age was a predictor of depression in China but not in the US sample. Among residency training factors, long duty hours and reduced sleep duration emerged as predictors of depression in both China and the US. To gain insight into whether differences in personal predictors between the residents in China compared to the US residents were driven more by differences between cohorts, or by training system differences, we compared US residents of East Asian descent to other US and Chinese residents. We found that for most predictors (age, Neuroticism, early family environment), US residents of East Asian descent were more similar to other US residents than to the residents training in China. Overall, the magnitude of depression increase and work-related drivers of depression were similar between China and the US, suggesting a need for system reforms, and that the types of effective reforms may be similar across the two systems. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study in the US was funded in China by Shanghai Jiao Tong University - University of Michigan Collaborative Research Grant, Program of Shanghai Subject Chief Scientist 17XD1401700, Shanghai Education Commission Research and Innovation Program, “Eastern Scholar” and “111” Project. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data will be available upon request as long as legally and ethically appropriate. [1]: #ref-1