DOI: 10.6084/m9.figshare.27929431.v1
title: Interrelationships of stress, burnout, anxiety, depression, quality of life and suicidality among Chinese residents under Standardized Residency Training: a network analysis

description: Chinese resident physicians confront challenges such as staff shortages and heavy workloads, leading to a heightened prevalence of mental distress. This study aims to investigate the symptom network of stress, burnout, anxiety, depression (SBAD) and adverse personal outcomes in this cohort. From October 2020 to April 2022, 994 physicians were recruited across China through snowball sampling. Stress, burnout, anxiety and depression were assessed using the 10-item Perceived Stress Scale, a two-item burnout questionnaire, Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation) were collected. We constructed and visualized two networks, calculating expected influence (EI) and bridge EI indices to identify central and bridge symptoms. In the SBAD network, perceived helplessness was the most central and critical bridge symptom connecting stress and mental distress, with emotional exhaustion identified as the secondary bridge symptom. Perceived helplessness, perceived self-efficacy and emotional exhaustion exhibited the highest negative correlations with QOL. Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlated with suicidal ideation. The estimated SBAD network showed excellent stability and accuracy. Our study emphasizes that perceived helplessness may be a high-priority target for preventing and intervening in mental distress and improving QOL among residents. Burnout transcends workplace problems and is widely connected to depression, anxiety and QOL. Implementing early detection and intervention measures at three levels—the individual physician, health system and professional colleges, and external regulators—is crucial for preventing and alleviating stress and mental distress among residents. This study provided the first quantitative network analysis on the interactions of stress, burnout, anxiety, depression, quality of life and suicidal ideation among resident physicians.This study emphasizes the critical role of perceived helplessness, emerging as the most central and bridge symptom connecting stress and mental distress, driving comorbidity and impacting quality of life.Perceived helplessness may be a high-priority target for prevention and intervention.Burnout transcends workplace problems and is widely connected to depression, anxiety and quality of life.Our findings provide meaningful guidance for organizations and managers in implementing early detection and intervention measures. This study provided the first quantitative network analysis on the interactions of stress, burnout, anxiety, depression, quality of life and suicidal ideation among resident physicians. This study emphasizes the critical role of perceived helplessness, emerging as the most central and bridge symptom connecting stress and mental distress, driving comorbidity and impacting quality of life. Perceived helplessness may be a high-priority target for prevention and intervention. Burnout transcends workplace problems and is widely connected to depression, anxiety and quality of life. Our findings provide meaningful guidance for organizations and managers in implementing early detection and intervention measures.