Prevalence and associated factors of depression and suicidal ideation among Syrian medical residents: a multicenter cross-sectional study

Medical residency is associated with a high psychological burden. These challenges are severely amplified in prolonged conflict-affected settings such as Syria. This study aimed to assess the prevalence of clinical depression and screen for suicidal ideation among Syrian medical residents, and to identify associated factors during the late pre-transition institutional period (July–September 2024). A multicenter cross-sectional study was conducted between July and September 2024 across seven major Syrian hospitals. Data were collected via an anonymous online questionnaire ( n = 834). To prevent measurement overlap, clinical depression was assessed using the Patient Health Questionnaire-8 (PHQ-8, cutoff ≥ 10). Suicidal ideation was screened—rather than clinically assessed in depth—using Item 9 of the PHQ-9. History of suicide attempts and self-harm were evaluated using study-specific questions. Multivariable logistic regression models were utilized to identify independent correlates rather than causal pathways. The prevalence of clinical depression was 43.0%, and 37.6% of participants screened positive for suicidal ideation. Previous suicide attempts and self-harm were reported by 4.8% and 10.3%, respectively. In multivariable analysis, factors independently associated with depression included current psychiatric treatment (aOR = 4.61), suicidal ideation (aOR = 2.89), history of self-harm (aOR = 2.28), poor workplace compatibility, and low social support; physical exercise was a protective correlate (aOR = 0.60). Suicidal ideation was strongly associated with a previous suicide attempt (aOR = 8.22), self-harm (aOR = 3.49), current psychiatric treatment (aOR = 3.29), and clinical depression (aOR = 2.83). Conversely, a moderate workload (6–9 monthly shifts) and engagement in extracurricular activities (aOR = 0.64) were inversely associated with suicidal ideation. Syrian medical residents experienced alarmingly high rates of clinical depression and suicidal ideation during the pre-transition period. These outcomes are strongly associated with clinical history, psychosocial environment, and occupational exhaustion. Addressing this crisis requires actionable institutional reforms, including strict workload regulation, protected rest periods, and enhanced peer support. Furthermore, establishing confidential mental health services and clear suicide-risk referral pathways—operating independently of professional evaluations—is urgently required.