How do young chinese physicians cope with stress under standardized training? Investigating perceived stress, depression, and their interrelationships

Resident physicians undergoing standardized residency training (SRT) in China face substantial occupational stress, yet the extent of their psychological burden and the pathways linking stress to depressive symptoms remain incompletely characterized. This multicenter, cross-sectional study examined the psychological burden and its underlying pathways among 504 resident physicians in China's SRT system. Participants from teaching hospitals in southern China completed validated questionnaires assessing perceived stress (PSS-10), burnout (MBI-GS), effort-reward imbalance (ERI), and depressive symptoms (PHQ-9), and the data were analyzed using path analysis with bias-corrected bootstrapping to test for serial mediation. The prevalence of psychological problems was high: 38.49% reported high perceived stress, 83.13% experienced burnout (37.5% moderate or severe), 30.16% exhibited effort-reward imbalance, and 27.58% screened positive for probable depression. Mean scores were 17.61 ± 6.36 for perceived stress, 43.26 ± 13.04 for burnout, 0.94 ± 0.65 for ERI, and 7.83 ± 6.47 for depressive symptoms. All four variables were significantly and positively correlated (ρ = 0.338-0.631). The path analysis indicated a serial mediation pattern: higher perceived stress was associated with higher ERI (β = 0.43), higher ERI with greater burnout (β = 0.49), and greater burnout with more severe depressive symptoms (β = 0.37); perceived stress was also directly associated with depressive symptoms (β = 0.21). In conclusion, resident physicians in China experience a substantial psychological burden, characterized by a sequential association linking stress, effort-reward imbalance, burnout, and depressive symptoms. Because the design was cross-sectional, these pathways reflect associations rather than causal effects. Safeguarding trainee well-being and healthcare quality will require targeted interventions that reduce effort-reward imbalance through improved compensation and job security, mitigate burnout through workload management, and ensure access to mental health resources.