Title: Stress From Uncertainty and Resilience Among Depressed and Burnt Out Residents
Description: Objective: To determine how stress from uncertainty is related to resilience among pediatric residents and whether these attributes are associated with depression and burnout.

Study Design and Setting: Cross-sectional study of 50 residents in pediatric residency programs from four urban freestanding children’s hospitals in the United States and Canada.

Main outcome measures: Stress from uncertainty using the Physicians’ Reaction to Uncertainty Scale, resilience using the 14-item Resilience Scale, depression using the Harvard national depression screening scale, and burnout using single item measures of emotional exhaustion and depersonalization from the Maslach Burnout Inventory.

Results: There was a strong correlation between stress from uncertainty and resilience (r=-0.597; p<0.00001). 5 residents (10%) met the criteria for depression and 15 residents (31%) met the criteria for high burnout. Depressed residents were more likely to be stressed by uncertainty (mean 51.6; SD 9.07 vs. mean 38.7; SD 6.73; p=0.0003) and to lack resilience (mean 56.6; SD 10.7 vs. mean 85.4; SD 7.97; p<0.0001) compared to residents who were not depressed. Burnt out residents were also more likely to be stressed by uncertainty (mean 44; SD 8.46 vs. mean 38.3; SD 7.13; p=0.0186) and to lack resilience (mean 76.7; SD 14.8 vs. mean 85.0; SD 9,77; p=0.0242) compared to residents who were not burnt out. We were able to identify the scores at which stress from uncertainty best predicts depression and burnout.

Conclusion: Depression and burnout are major problems among pediatric residents. We found strong correlations between stress from uncertainty, resilience, depression, and burnout. Efforts to enhance tolerance of uncertainty and resilience among residents may provide opportunities to mitigate resident depression and burnout.