• Zejun Li, Min Wu, Xiaoyu Zhang, Kewen Yan, Xin Wang, Huixue Xu, Peizhen Li, Yueheng Liu, Qijian Deng, Xueyi Li, Qianjin Wang, Manyun Li, Yunfei Wang, Yuzhu Hao, Li He, Yi-Yuan Tang, Tieqiao Liu, Pu Peng, and Qiuxia Wu.
• Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
• Ann. Med. 2024 Dec 1; 56 (1): 24330302433030.

BackgroundChinese resident physicians confront challenges such as staff shortages and heavy workloads, leading to a heightened prevalence of mental distress. This study aims to investigate the symptom network of stress, burnout, anxiety, depression (SBAD) and adverse personal outcomes in this cohort.MethodsFrom October 2020 to April 2022, 994 physicians were recruited across China through snowball sampling. Stress, burnout, anxiety and depression were assessed using the 10-item Perceived Stress Scale, a two-item burnout questionnaire, Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation) were collected. We constructed and visualized two networks, calculating expected influence (EI) and bridge EI indices to identify central and bridge symptoms.ResultsIn the SBAD network, perceived helplessness was the most central and critical bridge symptom connecting stress and mental distress, with emotional exhaustion identified as the secondary bridge symptom. Perceived helplessness, perceived self-efficacy and emotional exhaustion exhibited the highest negative correlations with QOL. Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlated with suicidal ideation. The estimated SBAD network showed excellent stability and accuracy.ConclusionsOur study emphasizes that perceived helplessness may be a high-priority target for preventing and intervening in mental distress and improving QOL among residents. Burnout transcends workplace problems and is widely connected to depression, anxiety and QOL. Implementing early detection and intervention measures at three levels-the individual physician, health system and professional colleges, and external regulators-is crucial for preventing and alleviating stress and mental distress among residents.

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