P3.196: Exploring the Rates of Depression, Anxiety and Stress Among Residents and the Role of Protective and Risk Factors among International Medical Graduates and American Medical Graduates.

Background: The mental health of medical residents has become an area of increasing concern with depression affecting about 28.8% of residents. Some studies have shown a higher rate of burnout among US medical graduates as compared to International Medical Graduates (IMGs). Most research focuses on the COVID-19 pandemic or specific specialties, lacking comparisons between IMGs (Non-US citizen IMGs and US IMGs) and American medical graduates (AMGs) in non-crisis settings. This study seeks to fill this gap by comparing depression, anxiety, and stress rates among IMGs and AMGs and exploring the role of protective and risk factors in their mental well-being.

Methods: Residents at a large community hospital completed a 37-item questionnaire that included the Depression Anxiety Stress Score-21 (DASS-21). Responses were collected anonymously over 4 weeks between February and March 2025. DASS-21 scores for depression, anxiety, and stress were categorized as normal, mild, moderate, severe, and extremely severe, with severe and extremely combined into a single category. Chi-square analysis was used for categorical variables followed by ordinal logistic regression to identify protective and risk factors associated with poor mental health outcomes (moderate-to-severe symptoms of depression, anxiety, and stress).

Results: 298 residents from various specialties received the survey of which 113 (39%) completed the survey. Rates of moderate to severe symptoms of depression, anxiety, and stress in the study population were 0.35, 0.38, and 0.30 (Table 2), respectively. Non-US IMG status correlated with lower odds of experiencing moderate-to-severe symptoms of stress (OR=0.12, p =0.006) and depression (OR=0.18, p=0.031). Residents who did not feel supported by faculty and co-residents had higher odds of experiencing moderate-to-severe symptoms of stress (OR=6.4 p=0.001), anxiety (OR=7.05 p=0.001), and depression (OR=5.01, p=0.004). Residents who did not engage in regular exercise had higher odds of stress (OR=2.7 p=0.068). IMG status did not significantly affect anxiety levels (p=0.46), and financial strain showed a weak correlation with anxiety (OR=0.45, p=0.097).

Conclusion: In this study, moderate to severe symptoms of depression, anxiety, and stress were highly prevalent among residents with non-US IMGs experiencing lower levels of stress and depression. Institutional support and IMG status were key factors influencing mental health outcomes, while physical activity and financial strain were potential contributors. Lack of support from faculty and peers was a strong predictor of poor mental health. There is thus the need for targeted interventions to mitigate stress and depression, particularly for US IMGs and AMGs. Further research should focus on the specific factors contributing to these differences and effective strategies for support.