Open Access

ARTICLE

The impact of gender and institutional factors on depression and suicidality in urology residents

Daniel Marchalik^1,2, Charlotte Goldman¹, Jordan Alger¹, Ariel Rodriguez³, Andrew Catomeris³, John H. Lynch¹, Jamie Padmore², Mihriye Mete², Ross Krasnow¹

1 Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
2 MedStar Health, Office of Physician Well-being, Columbia, Maryland, USA
3 Georgetown University School of Medicine, Washington, District of Columbia, USA
Address correspondence to Dr. Daniel Marchalik, MedStar Georgetown School of Medicine, 3800 Reservoir Rd NW, 1-PHC, Washington, DC 20007 USA

Canadian Journal of Urology 2020, 27(6), 10471-10479.

Abstract

Introduction: Surgical trainees experience high rates of depression and suicidal ideation (SI). However, there remain a gap in knowledge on the drivers of depression and SI in trainees, especially within the field of urology.
Materials and methods: We conducted a national study of urology trainees using a 50-item questionnaire in May 2018. The survey included demographic, depression (Patient Health Questionnaire-9 (PHQ-9)), burnout (Maslach Burnout Inventory (MBI)), and quality of life (QoL) questions.
Results: Overall, 37 (17.6%) endorsed depression; 24 residents endorsed SI (11%). SI was higher in those with depression (p < 0.001). Burnout was also higher among depressed residents (97.3% versus 61.8%, p < 0.001) and those endorsing SI (16.1% versus 1.5%, p < 0.001). Depression was associated with female gender (29.2% versus 12.4%, p = 0.005), fatigue (29.5% versus 7.8%, p < 0.001), and lack of structured mentorship (23.7% versus 9.8%, p = 0.010). Access to mental health services was protective (p = 0.016). Older age, low QoL, dissatisfaction with work-life-balance (WLB), and fatigue were associated with SI.
On adjusted analysis, gender (OR 3.1 [95% CI 1.4-6.9], p = 0.006), fatigue (OR 3.8 [95% CI 1.6-9.0], p = 0.002), and burnout (OR 16.7 [95% CI 2.2-127.5], p = 0.007) increased the odds of depression. On exploratory analysis, self-reported burnout alone was predictive of SI (OR 7.6 [95% CI 2.5-23]), and performed similarly to an adjusted model (AUC Area 0.718 [95% CI 0.634-0.802] versus 0.825 [0.753-0.897]).
Conclusions: Urology trainees experience high rates of depression and SI. Female residents have significantly higher risk of depression. A single-item appears useful to screen for SI. Further investigation is needed to understand and promote urology resident wellness.

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