One in Three OB-GYN Residents Faces Depression in Training, Study Finds

Every summer, more than 1,600 recent medical school graduates across the United States begin residency training in obstetrics and gynecology, stepping into an operating room, a delivery suite, and a clinic all at once. They learn to screen women for cervical cancer, deliver babies, and surgically treat ovarian cancer and uterine fibroids, often within the span of a single demanding day. Yet behind the professional milestones, a troubling pattern has emerged: according to a new study published in the American Journal of Obstetrics and Gynecology, roughly one-third of these first-year residents may develop clinical depression during their stressful intern year. Perhaps more striking, only about one-third of those who became depressed actually sought mental health help, a gap that researchers say demands urgent attention from the hospitals and national organizations that oversee physician training.

The findings arrive at a precarious moment for the specialty. Obstetrics and gynecology is the only predominantly female surgical specialty in American medicine, and it is confronting a well-documented national shortage of practicing obstetricians and gynecologists. At the same time, shifting reproductive health policies at the state and federal level have placed additional work-life and legal pressures on practitioners. Against that backdrop, losing trainees to burnout, depression, or attrition carries consequences that extend well beyond the individual physician, threatening the continuity of care for patients who depend on OB-GYNs for everything from routine preventive screening to complex surgical intervention and childbirth.

The research was conducted as part of the Health Equity and Retention in Obstetrics and Gynecology Project, known as HERO, a national research effort focused on understanding the factors that shape the OB-GYN workforce. The project’s co-principal investigators are Helen Kang Morgan, a clinical professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and senior author of the new study, and Abigail Ford Winkel of the New York University Grossman School of Medicine. The HERO team’s central goal is to identify ways to support physicians and keep them working in the specialty, ensuring that patients continue to have access to the care OB-GYNs provide. Morgan argues that the data reveal a systemic failure to address the mental health of trainees. A very large portion of those entering the specialty are struggling and not getting the help they need, she noted, and the field is not having meaningful discussions about how to help them. She suggested that shifting mental health services from an opt-in model, where residents must actively seek assistance, to one in which every resident automatically receives some form of support could be a promising step, pointing to evidence that such approaches have shown promise elsewhere.

The study drew on data collected through the larger Intern Health Study, a longitudinal research effort that for more than 20 years has enrolled annual cohorts of graduating medical students. Close to 30,000 interns across all fields of medicine have taken part, agreeing to track their mood, sleep, activity, and other measures as a way of studying the mental health impact of the known stresses of residency training. This long-running dataset offers a unique window on the triggers of depression and potential prevention strategies, with implications that could reach far beyond the medical profession itself, since the stresses of residency, long hours, disrupted sleep, and high-stakes performance, mirror conditions found in many demanding occupations.

The Intern Health Study focuses specifically on young physicians in their first year of training because that period is intensely stressful. Interns face long work hours, varying sleep and work schedules, and the pressure of acquiring clinical skills while trying not to make mistakes that could harm patients. In the OB-GYN analysis, 88 percent of the first-year residents studied were women, matching the current composition of the United States resident population in the field. More than 1,270 of them completed standardized depression screening tests and other surveys both before and during their intern year, providing a before-and-after picture of how the training environment reshapes mental health.

Elena Frank, director of the Intern Health Study and an associate research scientist at the Michigan Neuroscience Institute, explained that the analysis identified several factors most closely related to changes in depressive symptom scores between the pre-internship survey and those taken during training. Some of these factors predated residency entirely: a self-reported history of depression, depression symptoms present before the internship began, and higher scores on the personality trait known as neuroticism. Others were rooted in the training experience itself, including fewer sleep hours, higher work hours, and involvement in medical errors. The distinction matters for prevention, because while individual vulnerability cannot easily be changed, the structural features of residency, scheduling, workload, and error support systems, are within the control of program directors and training institutions.

Broader findings from the Intern Health Study reinforce the role of sleep and scheduling. Previous analyses have shown a higher risk of developing depression during the intern year among physicians with irregular sleep patterns and among those who work longer hours or more unpredictable schedules. There are, however, encouraging trends in the overall data. As hospitals that run residency programs and the national organizations that govern training have revised work hour rules and added support options, depressive symptoms still increase during intern year for many trainees, but the average size of that increase has decreased by 24 percent over time. Notably, this improvement has occurred more slowly in surgical training programs, a category that includes obstetrics and gynecology, suggesting that the specialty’s particular demands may require targeted interventions rather than one-size-fits-all reforms.

The study data were collected between 2009 and 2024, and the research effort is still expanding. In August 2026, in partnership with the HERO project, more than 500 prior OB-GYN intern participants completed follow-up surveys assessing their recent work and family experiences and well-being. More than 60 practicing OB-GYNs who completed the survey have volunteered to take part in interviews about their experiences since training. Frank, who is also a co-investigator on the HERO Project, said the data are still being gathered and analyzed. She also noted that the model is exportable: other medical and surgical specialties could partner with the Intern Health Study team to collect specialty-specific data in the same way the OB-GYN team did, allowing each field to understand its own unique stressors and retention challenges.

Beyond resident mental health, the HERO team is examining how the OB-GYN workforce has been affected by reproductive health policy decisions at the state and federal level, including the mental health and legal strain those decisions impose and the potential for supportive interventions tailored by region. The team recently published findings in the Journal of Women’s Health showing substantial geographic variation in the conditions under which members of the specialty are expected to deliver care. Those differences include baseline population health, access constraints, and system-level pressures. The researchers found that these conditions, and outcomes for patients, varied particularly based on policies related to reproductive care as well as rurality, meaning that two equally skilled OB-GYNs may face radically different professional environments depending on where they practice.

The HERO Project’s other research efforts are currently under way with support from philanthropic funding, and partners at hospitals, medical schools, and clinics across the country are participating. The OB-GYN intern analysis itself was supported by the Josiah Macy Jr. Foundation, while the Intern Health Study was originally supported by the National Institute of Mental Health, part of the National Institutes of Health. In addition to Morgan, Winkel, and Frank, the study’s authors include Julia Rossi, Zhuo Zhao, Karina Pereira-Lima, and Srijan Sen, the Intern Health Study’s principal investigator, who directs the Eisenberg Family Depression Center at the University of Michigan. Taken together, the work paints a picture of a specialty at a crossroads: a workforce that is overwhelmingly female, chronically stretched, and disproportionately exposed to policy turbulence, entering training with a one-in-three risk of depression and a help-seeking rate that lags far behind the need. The researchers’ message to the institutions that train these physicians is straightforward. Automatic, universal mental health support, rather than a system that waits for residents to ask for help, could protect both the physicians of tomorrow and the patients who will depend on them.

Subject of Research: Depression and mental health among first-year obstetrics and gynecology residents in the United States

Article Title: Depression in OB-GYN residents needs more attention, study suggests

Article References: Depression in OB-GYN residents needs more attention, study suggests. (n.d.). Original publication

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Keywords: OB-GYN residents, depression, intern year, physician mental health, residency training, HERO Project, Intern Health Study, workforce shortage, reproductive health policy, sleep deprivation, medical errors, women in medicine