Open Access

ARTICLE

The Impact of Depression and Anxiety on Negative Ideation Among Standardized Residency Trainees: The Moderating Role of Individual Resilience Dimensions

Jie Zhang^#,1, Xiaoxu Zhi^1,#, Jiahui Chen², Paerhati Halisa², Lihai Chen^3,*, Minhao Zhang^2,*

1 Department of Nursing, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210000, China
2 Department of Anesthesiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210000, China
3 Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

* Corresponding Authors: Lihai Chen. Email: ; Minhao Zhang. Email:
# These authors contributed equally to this work

International Journal of Mental Health Promotion 2026, 28(2), 11 https://doi.org/10.32604/ijmhp.2025.071717

Received 11 August 2025; Accepted 09 December 2025; Issue published 27 February 2026

Abstract

Objectives: Although standardized residency trainees are at high risk for depression, anxiety, and suicidal ideation, the psychological pathways connecting depression and anxiety to suicidal ideation, especially the moderating role of resilience, remain elusive. This study aimed to examine the associations between depression, anxiety, and suicidal ideation among physicians undergoing standardized residency training, and to investigate the moderating roles of different dimensions of individual resilience, namely tenacity, strength, and optimism. Methods: A convenience sampling method was adopted to recruit 133 resident physicians. Validated instruments assessing individual resilience, depressive symptoms, anxiety levels, and suicidal ideation were administered. Spearman correlation analysis was used to evaluate the relationships among the variables. Hierarchical regression analysis was conducted to assess the moderating roles of tenacity, strength, and optimism in the associations between depression, anxiety, and suicidal ideation. Results: Depressive symptoms and anxiety levels were both positively associated with suicidal ideation (p < 0.001). All three resilience dimensions were negatively correlated with suicidal ideation (tenacity: r = −0.504, strength: r = −0.477, optimism: r = −0.440, all p < 0.001). Tenacity, strength, and optimism significantly moderated the associations between depression and suicidal ideation (all p < 0.05). When resilience levels in these dimensions were high, the associations between depression and suicidal ideation were weaker. Strength and optimism also moderated the associations between anxiety and suicidal ideation (strength: p = 0.028, optimism: p = 0.028). When the resiliences (strength and optimism) were high, the associations between anxiety and suicidal ideation were weaker. Conclusion: Individual resilience, particularly in the dimensions of tenacity, strength, and optimism, may serve as protective correlates for physicians in training, being associated with weaker relationships between depression, anxiety, and suicidal ideation. These findings highlight the potential value of resilience-enhancing strategies in clinical training settings, although causal inferences cannot be drawn due to the cross-sectional design.

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