Disability, mental health symptom recognition, and treatment-seeking in resident physicians with depressive symptoms

Resident physicians are at high-risk for depressive symptoms, yet most of those meeting depression criteria do not seek care. Resident physicians with disabilities are at higher risk for depressive symptoms. However, their mental health treatment-seeking behaviours remain poorly understood. This study investigates associations between self-identified disability-status, mental health symptom recognition, and treatment-seeking among first-year residents with depressive symptoms.

We analysed data from the 2020-2022 cohorts of the Intern Health Study, a longitudinal study of first-year resident physicians. Depressive symptoms were assessed quarterly with the Patient Health Questionnaire (PHQ-9); scores ≥10 indicated a positive depression screen. Residents who screened positive at least once during internship and identified their disability-status were included. Mental health symptom recognition and treatment-seeking were assessed via quarterly surveys throughout the first residency year. Associations between disability-status, symptom recognition, and treatment-seeking were examined using weighted logistic regression adjusting for sex and specialty-type. Post-stratification and attrition weights addressed nonrepresentative sampling and loss to follow-up. Sensitivity analyses excluded interns reporting psychological disabilities.

Of 5,062 interns, 1,386 (27.4%) screened positive for depression during internship; 940 identified their disability-status and were included (127 [13.5%] with disabilities). Compared to nondisabled interns, those with disabilities were significantly more likely to recognise mental health symptoms (adjusted weighted-OR = 4.5, 95% CI: 1.8-14.7) and seek treatment (adjusted weighted-OR = 3.2, 95% CI: 2.1-5.0). Results remained significant in sensitivity analyses excluding psychological disabilities.

Among depressed first-year residents, self-identified disability-status was associated with significantly greater symptom recognition and treatment-seeking. These findings suggest disability-related experiences may be associated with reduced normalisation of depressive symptoms in residency, offering insights for reducing stigma and treatment barriers in medical training.