What is an effective tool in assessing surgery residents' mental health status?

Effective Tools for Assessing Surgery Residents' Mental Health Status

The Patient Health Questionnaire-9 (PHQ-9) with a cutoff score of ≥8 is the recommended validated screening tool for detecting depression in medical populations, including surgery residents, and should be combined with systematic assessment of burnout using the abbreviated Maslach Burnout Inventory. 1, 2

Primary Screening Approach

Depression Screening

• Implement the 2-item PHQ-9 as first-line screening, assessing low mood and anhedonia over the past 2 weeks; if either item scores ≥2, complete the full 9-item questionnaire 1
• The PHQ-9 with cutoff ≥8 has been validated specifically for detecting depression in medical populations and is practical for routine use 1
• A score of 10 or greater on the PHQ-9 meets criteria for clinical depression and warrants immediate intervention 3

Burnout Assessment

• Use the abbreviated Maslach Burnout Inventory to assess burnout, which measures two critical dimensions: emotional exhaustion and depersonalization 2
• This tool identified 69% burnout prevalence among 566 surgical residents across training levels, demonstrating its sensitivity in this population 2
• Burnout assessment should be routine, as 75% of general surgery residents meet criteria for burnout in recent studies 3

Comprehensive Mental Status Components

Core Assessment Elements

• Systematically evaluate mood state, anxiety level, thought content and process, and suicidal ideation as essential components of mental health screening 1, 4
• Assessment for hopelessness is crucial, as it carries significant clinical implications for risk stratification 1
• Direct evaluation for suicidal ideation must include both active and passive thoughts of suicide or death, with 12% of residents reporting suicidal ideation in the past 2 weeks 1, 3

Additional Validated Tools

• The Perceived Stress Scale (PSS) effectively measures stress levels, with surgery residents scoring significantly higher than normative populations (21% above 90th percentile) 5
• The Symptom Checklist-90-R (SCL-90-R) provides comprehensive assessment of psychological distress, with 38% of surgery residents scoring above the 90th percentile compared to societal controls 5

Risk Stratification and Protective Factors

High-Risk Indicators Requiring Immediate Action

• High burnout is strongly associated with depression (OR 4.8), suicidal ideation (OR 5.7), and severe stress (OR 7.8), necessitating urgent mental health professional evaluation 2
• Persistent suicidal ideation, severe hopelessness, or inability to be adequately monitored require consideration for immediate psychiatric consultation 6
• Junior residents (PGY 1-3) demonstrate higher anxiety, obsessive-compulsive behavior, and interpersonal sensitivity compared to senior residents 5

Protective Factors

• Higher dispositional mindfulness is associated with dramatically lower risk: burnout (OR 0.24), stress (OR 0.15), anxiety (OR 0.21), suicidal ideation (OR 0.25), and depression (OR 0.26) 2
• Assessment of psychological safety in the workplace correlates with flourishing and reduced languishing among residents 7

Implementation Strategy

Screening Frequency and Context

• Conduct routine screening at multiple time points throughout training, as psychological distress remains high across all training levels with some improvement during research years 2
• Integrate screening into existing wellness programs rather than implementing as standalone "band-aid" interventions 7

Barriers to Address

• The top three barriers to seeking care are: inability to take time off for treatment (identified by 90% of residents), avoidance/denial of the problem, and negative stigma toward those seeking care 3
• Both residents and attendings significantly underestimate the true prevalence of depression (51% and 75% respectively underestimated), highlighting the need for education alongside screening 3

Critical Pitfalls to Avoid

• Do not rely solely on symptom counts when assessing depression; incorporate risk factors, functional impairment, and collateral information 1
• Never omit assessment of suicidal ideation—this is a required component and 9 of 77 residents (12%) reported suicidal ideation in recent studies 1, 3
• Avoid attributing all distress to "normal" training stress; 38% of surgery residents meet criteria for clinical psychological distress requiring intervention 5
• Do not assume attendings accurately perceive resident mental health status; only 23% of attendings correctly estimated burnout prevalence compared to 53% of residents 3
• Recognize that mental health disorders significantly impact surgical outcomes, including increased complications, readmissions, and mortality, making screening a patient safety issue 8

When to Escalate Care

• Immediate mental health professional evaluation is required for: PHQ-9 score ≥10, active suicidal ideation, severe hopelessness, or high burnout with depression 1, 6, 3
• Safety takes precedence over confidentiality when a resident is at imminent risk of self-harm 6
• Arrange same-day psychiatric evaluation for moderate to high suicide risk, with options including hospitalization, emergency department transfer, or urgent outpatient appointment 6