Depression, Anxiety and Burnout Syndrome in Medical Residents of Family Medicine in Tijuana, Mexico

Research Article

J Fam Med. 2017; 4(6): 1131.

Depression, Anxiety and Burnout Syndrome in Medical Residents of Family Medicine in Tijuana, Mexico

Rendon-Sanchez JL1, Ramirez-Leyva DH1*, Bermudez-Villalpando VI1, Camacho-Romo JJ1, Grajeda-Gonzalez LB2 and Ramirez-Leyva PH3

¹Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

²Department of Psychiatry, Regional General Hospital #1 (IMSS), Baja California Delegation, Mexico

³Department of International Studies, Faculty of International Studies and Public Policies (UAS), Mexico

*Corresponding author: Ramirez-Leyva Diego Hazael, Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, México

Received: October 17, 2017; Accepted: November 14, 2017; Published: November 21, 2017


Background: Medical residents face constant processes of adaptation and learning; whose personal, educational and social implications can lead to serious mental disorders. Research reports prevalence of Burnout syndrome between (BOS) 41 and 76%, depression 47.5% and anxiety 39%, higher than in the general population.

Aim: The purpose of this study is to determinate prevalence of depression, anxiety, burnout syndrome and associated factors in residents of family medicine in Tijuana, Mexico.

Design and Setting: Comparative cross-sectional study.

Methods: Goldberg anxiety and depression scales were applied; Maslach Burnout Inventory for burnout syndrome, the study was conducted in July 2017 to medical residents of Family Medicine in Tijuana, Mexico. Surveys were conducted to obtain medical information; it was used 95% interval confidence; association was established by calculating odds ratios, chi-squared test for statistical significance (p<0.05). Data were processed with statistical software SPSS-20.

Results: The universe of study was 62 medical residents; 60% female and 40% male, mean age was 30 years. BOS was the most frequent disorder with 51%, Anxiety 44% and Depression 34%. The female gender being under 30 years and residents in first grade were the most affected. First grade was a risk factor for anxiety (p=0.02) and BOS (p<0.001).

Conclusion: Anxiety, Depression and Burnout Syndrome have high prevalence in medical residents of Family Medicine. It is important to periodically evaluate them in order to detect them in a timely manner.

Keywords: Depression; Anxiety; Burnout Syndrome; Medical residents


Medical residents (MRs) are professionals who are in a health unit for a full-time medical residency [1]. Medical residences are an educational system that helps complete the training of physicians in some specialty by performing professional activities, which are carried out under the supervision of tutors in health institutions with an approved educational program [2]. Burnout Syndrome (BOS) or work-consuming syndrome is a growing public health problem that affects the health of medical residents and the quality of care with patients, deteriorating the doctor-patient relationship and assuming a high cost, both social and economic [3]. BOS is defined as exhaustion due to excessive physical and emotional effort triggered by the work area and favoring depersonalization or instability towards the patient, with behaviors of indifference and negative attitudes toward work and patients [4]. BOS shares psychosomatic, behavioral and emotional symptoms with anxiety and depression; depression is considered the most frequent alteration of mood characterized by mood, cognitive, psychomotor and vegetative alterations [5]. Anxiety is a response that is triggered by a situation of physical or psychic threat, characterized by agitation and unpleasant restlessness whose purpose is to equip the energy body to cancel or counteract the danger, predominating psychic symptoms and the sensation of catastrophe or imminent danger [6].

Currently, mental disorders have a strong impact on life, family and society. Stress, mainly labor type, is the most frequent type of chronic stress that causes BOS and depression [7]. Stress is necessary to have adequate responses to threatening experiences, but prolonged exposure to high levels is the most recognized cause of Anxiety and Depression [8]. It has been argued that severe or prolonged stress causes an increase in the biogenic amines of the brain causing excessive use that exceeds synthesis and causes a fall in reserves to critical levels resulting in the development of depressive symptomatology [9]. Spiegel et al., found that the stress of physicians in training are exposed is perceived to be inversely proportional to their academic performance [10]. Depression is diagnosed by the presence of one or more depressive episodes with a minimum duration of two weeks. The emotional state is characterized by: depressive mood, loss of interest or pleasure in almost all activities, accompanied by at least four symptoms of a list that includes: changes in appetite or weight, sleep disorders, lack of energy, feelings of guilt, difficulty thinking, concentrating or making decisions and recurrent thoughts of death or suicidal ideation [11]. Anxiety is diagnosed by the presence of characteristic symptoms and continued concern about health, family, work and economic status [12].

There is currently no laboratory or radiological tests for diagnosis of BOS, depression and anxiety, but there are clinical instruments or scales that complement the clinical assessment and are used as screening for case detection, follow-up and research [13]. The most frequently test for BOS is the Maslach Burnout Inventory (MBI), which is validated, it has a high internal consistency and measures the main symptoms through 3 dimensions: emotional exhaustion, depersonalization and personal fulfillment, classifying the patient according to the score obtained in the following categories: with presence of BOS, predisposed to have it and absence of BOS [14].

The Goldberg Anxiety and Depression Scale is a screening tool for the initial diagnosis of depression and anxiety disorders. It is validated and has a sensitivity of 83.1%, a specificity of 81.8% and a predictive value of 95.3% [15]. Depression is classified into several types of disorders; the most common are severe depressive disorder and dysthymic disorder [16]. The consequences of depression are a danger to life. Ostrowsky et al., Found that 10-15% of people with severe depression commit suicide or attempt suicide [17]. Anxiety disorders are classified as generalized anxiety disorder and agoraphobia, panic attacks, social phobia, specific phobia, obsessive compulsive disorder and posttraumatic stress disorder. Social phobia is the most common in the general population [18].

Depression and BOS have high prevalence among MRs worldwide, it has been estimated that the prevalence of Depression is higher among MRs (17-40%) than in the general population (10%). Mascarúa-Lara et al., found a prevalence of mild anxiety of 28.5%, moderate of 10.7%, severe of 1.9% and depression of 19.7% in MRs of Family Medicine [20]. Another study conducted in Canada among Family Medicine MRs described a lower prevalence of depression and anxiety (20 and 12%, respectively), although this represented 3 to 4 times more than the general population of that country [21]. In MRs from Peru, BOS was found in 35%, depression in 46% of them, while 100% of MRs who had depression had BOS. The frequency of BOS in Mexico is similar to Argentina (35.5%), in contrast to North American literature describing frequencies between 18 and 84% [22].

The national and international prevalence of Anxiety is 16% and 8.1%, respectively. The reports in High Specialty Medical Units (UMAE) of the Mexican Social Security Institute (IMSS) range from 39% to 69.9% [23]. Tzischinsky et al. studied the impact of working hours with stress and psychological status among MRs during the first two years of residence found that sleep duration and workload explain the negative mood during afterguard [24]. As a result of fatigue, a significant number of MRs acknowledges that they have made serious mistakes during their care work [25]. Depression, anxiety and its relationship with medical errors were evaluated in the United States of America (USA), and results are consistent with other studies where depression is associated with poor work performance, poor academic performance and medical errors [26]. The health of physicians should be a priority; if MRs are depleted, the quality of care will decrease. The family nucleus of MRs should be concerned about their well-being, since professional experiences and attitudes can affect the family function. Residency programs must be concerned because the health of our society depends in part on health and effectiveness of MRs [27].

Materials and Methods

A comparative cross-sectional study was carried out, in the Family Medicine Unit #27 (FMU-27), of the Mexican Institute of Social Security (IMSS), located in Tijuana, Baja California, Mexico, in medical residents of Family Medicine in July 2017, which were selected by a consecutive sampling techniques that met the following inclusion criteria: medical residents of Family Medicine in FMU-27, any age, that accepted and signed the informed consent, MRs with psychiatric illness in treatment were not included and eliminated those who did not complete the survey. The following data were obtained directly from the patients or medical records: age, gender and grade of residence. Patients were assigned into two groups based on presence of BOS, depression and anxiety; there was no need to calculate the sample by including the entire universe of residents.

The Maslach Burnout Inventory was used to diagnose BOS; MBI is a validated scale, with a high internal consistency, consisting of 22 items in an affirmative dichotomous scale, this scale asks about the feelings and attitudes of the professional in their work and towards the patients, the function of this scale is to measure professional burnout. MBI evaluates 3 dimensions: emotional exhaustion (EE): Items 1, 2, 3, 6, 8, 13, 14, 16 and 20; depersonalization (DP): items 5, 10, 11, 15 and 22 and personal fulfillment (PF): items 4, 7, 9, 12, 17, 18, 19, 21. The presence of BOS was determined according to the criteria proposed by Grunfeld where a single dimension severely affected is needed for diagnosis. It is defined severely affected when EE and DP are in the upper tercile (more than 27 and 11 points respectively) and PF in the lower tercile (less than 35 points) [22]. Finally, the Goldberg Depression-Anxiety Scale, in its Spanish version; this screening test consists of two subscales for detection of symptoms of anxiety and depression, consisting of nine questions with a dichotomous (yes/no) response. Each of the subscales is structured into 4 initial items to determine whether or not a mental disorder is present and a second group of 5 items that are performed only if positive responses are obtained to the initial questions (2 or more in the subscale Anxiety, 1 or more in the subscale Depression) [15].

The data obtained was integrated into data collection sheets and analyzed using the SPSS program version 20 in Spanish, where we applied descriptive statistics; for qualitative variables frequencies and percentages were used and for quantitative variables mean and standard deviation were used. It was considered statistically significant a p <0.05, with a 95% confidence interval, all variables were dichotomized to apply odds ratio and chi square. The Protocol was authorized by the Local Committee of Research and Ethics in Health Research from the Regional General Hospital #20 and applied in FMU-27 where the study took place.


All MRs met the inclusion criteria for BOS, 98.3% for Depression and 95.1% for Anxiety (Figure 1). The mean age found was 30±4.06 years, range minimum 24 and range maximum 43 years. We found 21 MRs of first grade (R1=33.9%), 21 of second grade (R2=33.9%) and 20 of third grade (R3=32.3%). 37 MRs were younger than 30 years (59.6%) and 25 were equal or older than 30 years (40.3%). In gender, 59.7% were female and 40.3% male (Table 1). In R1 and R3 we found a higher prevalence of female gender, 76.1% and 60% respectively, male gender was more frequent in R2 (57.1%). We found prevalence of Anxiety 44%, Depression 34.4% and BOS 51.6%.