Prevalence of and risk factors for depression, anxiety, and burnout in U.S. neurosurgery residents

Background: There are no published data on what drives depression/anxiety in U.S. neurosurgery residents. We aimed to characterize the prevalence of and risk/protective factors for depression, anxiety, and burnout in this population. Methods: A cross-sectional study analyzing responses to a 28-question survey (including patient health questionnaire-9 [PHQ-9] and generalized anxiety disorder-7 [GAD-7] screening questions) from March to May 2023 distributed to U.S. neurosurgery residents. PHQ-9 and GAD-7 scores >5 defined at least mild depression/anxiety, respectively. Results: One hundred responses were included. Forty-six percent screened positive for at least mild depression, 41% for at least mild anxiety, and 45% reported feeling burnout. Strikingly, 10% of residents endorsed thoughts of self-harm/suicide. On multivariate analysis, risk factors for mild depression included female gender (OR = 4.3; P = 0.005), junior residency (OR = 3.1; P = 0.015), and being on a neurosurgical service (OR = 4.6; P = 0.01). The only risk factor for mild anxiety was female gender (OR = 3.3; P = 0.031), while being married (OR = 0.2; P = 0.006), protected didactic time (OR = 0.2; P = 0.003), and department wellness initiatives (OR = 0.3; P = 0.031) were protective factors. Finally, being on a neurosurgical service was a risk factor for burnout (OR 2.5; P = 0.032), while department-sponsored wellness initiatives were protective (OR = 0.2; P = 0.001). Conclusion: Nearly half of the participants screened positive for depression, anxiety, and burnout, while 10% recently had suicidal thoughts. Overall, female gender, being on a neurosurgical service, and junior residency were risk factors associated with depression, anxiety, and/or burnout. By contrast, department-sponsored wellness, being married, and protected didactic time were protective against one or multiple of these mental health disorders.