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

Image Credits: AI Generated

DOI: Not provided

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

The numbers cited in the commentary are striking, even if they come from studies with different methods and samples rather than standardized national estimates. A cross-sectional survey of medical residents in Tehran found that 34.3 percent had experienced suicidal ideation. A meta-analysis estimated the prevalence of occupational stress among Iranian physicians at 70.1 percent. In a sample of 204 residents at a tertiary teaching hospital in Tehran, burnout was reported in 92.2 percent, typically in the context of long working hours and relentless clinical duties. Depression was observed in 43 percent of Iranian medical students and resident physicians in a cross-sectional study. Among emergency medicine residents, 90.7 percent reported verbal abuse in the workplace. Taken together, these figures suggest that psychological distress is not an anomaly in Iranian medicine but, in many settings, close to the norm.

The IMV model, developed by Rory O’Connor and Olivia Kirtley, describes suicidality as unfolding across three phases. The pre-motivational phase encompasses background vulnerabilities and the environmental context in which a person lives and works. The motivational phase centers on the emergence of feelings of defeat and entrapment, which can give rise to suicidal ideation. The volitional phase addresses the factors that determine whether ideation progresses to behavior, including impulsivity, access to lethal means, and prior exposure to self-harm or suicide. A key strength of the model is that it separates the emergence of suicidal thoughts from the transition to suicidal action, allowing researchers and prevention planners to identify distinct intervention points along a continuum rather than treating suicidality as a single undifferentiated phenomenon.

Applied to Iranian medicine, the pre-motivational phase is populated by structural stressors that vary with career stage. Interns face sudden immersion into rigid hospital hierarchies, sleep deprivation during clinical rotations, high responsibility paired with little authority, and repeated exposure to criticism or humiliation. The authors describe an identity threat in this stage: the gap between the expected image of the competent, resilient physician and the lived experience of vulnerability, fear of error, and dependence on senior staff. Residents encounter a different configuration of pressures, including long working hours, financial instability, absence of control over their training, fear of repercussions, and limited opportunities to leave or transfer from a program. Practicing physicians face yet another pathway involving medicolegal pressure, economic uncertainty, reduced professional autonomy, public mistrust, and gender-related vulnerabilities, although the authors caution that these latter pathways require further dedicated study in the Iranian context.

The analytical power of the IMV framework lies in its treatment of these factors as cumulative and interactive rather than parallel and independent. A single long shift or a single humiliating encounter is unlikely to produce suicidal ideation. But when excessive workload, financial insecurity, compulsory service placements, sleep deprivation, and fear of disclosure occur together and persist over years, they can create a professional environment in which distress becomes normalized and escape becomes difficult to imagine. Mandatory service in remote areas adds isolation and overload. Socially prescribed perfectionism, common among high-achieving medical students and professionals, heightens vulnerability to criticism and perceived failure. Social expectations that physicians remain competent, self-sacrificing, and emotionally controlled mean that distress is often experienced not merely as exhaustion but as personal failure and shame, deepening the psychological wound that institutional arrangements have produced.

The motivational phase of the model explains how this accumulated adversity converts into defeat and entrapment, the psychological states most closely linked to suicidal ideation. In Iranian hospitals and training institutions, the authors point to authoritarian and hierarchical workplace cultures in which physicians feel mistreated by superiors, and in which enduring suffering is equated with professionalism. Complaining about mistreatment is framed as a lack of resilience, discouraging trainees from seeking help. Entrapment is reinforced by structural constraints: until recently, entering a residency program often required substantial financial guarantees that made withdrawal extremely difficult even amid severe distress. Although those requirements were largely rescinded following multiple high-profile suicides, their legacy may continue to shape trainees’ perceptions of inescapability. The supervisor’s control over evaluation, referral, and career progression compounds the problem, because the institution that generates the stress also controls every avenue of escape from it, making reporting abuse a professionally dangerous act.

The volitional phase addresses the most lethal question: why do some physicians with suicidal thoughts act on them? The commentary identifies several occupationally specific moderators. Physicians have ready access to prescription medications and possess detailed medical knowledge that reduces fear of medical procedures. Emotional exhaustion and perceived entrapment can interact with this access in ways that raise risk beyond what ideation alone would predict. Exposure to a colleague’s suicide within closely connected professional networks may heighten vulnerability, operating through identification with the deceased, perception of shared working conditions, and the normalization of suicide as an exit from an intolerable situation, though the authors stress this process is psychologically complex and should not be reduced to simple imitation. They also warn that sensational or romanticized media coverage of physician suicides could exacerbate the problem, while responsible reporting could aid prevention.

Crucially, the IMV model does more than explain; it prescribes. Interventions targeting the pre-motivational phase should attack the structural production of distress by limiting excessive consecutive working hours, guaranteeing rest periods, paying salaries and overtime on time, improving protection against workplace violence, and removing unnecessary financial obligations attached to training. Strategies for the motivational phase would weaken defeat and entrapment: an independent complaints system for humiliation, harassment, and abuse; mentorship programs operating outside the hierarchical evaluative relationship; and the freedom for residents to discuss problems or explore leaving a program without punishment. Volitional-phase strategies include confidential suicide risk assessment and safety planning, restriction of access to lethal means, responsible media reporting, and postvention support for colleagues after a suicide or attempt. Each measure is designed to interrupt a specific pathway identified by the model, from background stressor to entrapment to action.

The commentary’s central implication is that these pressures become most dangerous when they converge: when professional identity is repeatedly damaged, exit options are restricted, confidential support is unavailable, and access to lethal means or exposure to colleague suicide raises the probability that ideation becomes behavior. The authors argue that prevention must therefore move beyond calls for individual resilience and toward institutional responsibility, proposing confidential screening for depression, burnout, and suicidal thoughts whose results are never shared with a resident’s direct supervisor, anonymous reporting systems for mistreatment and bullying, faculty mentoring outside the hierarchy, working-hour restrictions, hospital committees on workplace violence, and formal postvention procedures. Framed by the recent tragedy that prompted its writing, the analysis insists that the structure of risk revealed by the literature, not any single loss, is what demands urgent reform of how Iran trains, pays, protects, and supports its physicians.

Subject of Research: Suicide risk and suicidal ideation among physicians in Iran analyzed through the integrated motivational–volitional model

Article Title: Suicide risk and suicidal ideation among physicians in Iran from an integrated motivational volitional perspective

Article References: Msohfeghinia, R., Ghorbanpour, A., Mani, A., Rezaeian, M., & Molavi Vardanjani, H. (2026). Suicide risk and suicidal ideation among physicians in Iran from an integrated motivational volitional perspective. Discover Mental Health, 6(1), Article 189. https://doi.org/10.1007/s44192-026-00604-3

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00604-3

Keywords: suicide risk, physician mental health, Iran, integrated motivational-volitional model, burnout, suicidal ideation, medical residents, occupational stress, entrapment, workplace violence, suicide prevention, medical education

The study distributed an anonymous survey through the REDCap electronic data capture platform, reaching participants at every stage of medical careers, from students still in lecture halls to attending physicians running outpatient clinics. The investigators paired demographic questions with a questionnaire probing attitudes toward mental illness and with three well-validated screening instruments: the Patient Health Questionnaire-2, or PHQ-2, a two-item screen for depressive symptoms; the Generalized Anxiety Disorder-2 scale, or GAD-2, its counterpart for anxiety; and the CAGE questionnaire, a classic four-item screen for problematic alcohol use whose acronym stands for cutting down, being annoyed at criticism, feeling guilty, and needing an eye-opener drink in the morning. The brevity of these tools is precisely their strength, allowing researchers to capture symptom signals across a busy professional population without imposing a diagnostic interview.

Among the 277 participants who completed the survey, the headline finding on attitudes was genuinely encouraging. Roughly seven in ten respondents, 70.1 percent, agreed that mental illness should be regarded in the same way as any other medical condition. An even larger share, 77.8 percent, said they would be willing to receive care from a physician who has a mental illness, and 71.9 percent indicated that a colleague’s mental illness would not change their perception of that individual. These numbers suggest that the explicit, attitudinal layer of stigma, the kind measured by asking people directly what they believe, has eroded considerably within this academic medical community, and that the erosion holds across age groups.

Yet the symptom data tell a more troubling story. Screening-positive rates were 35.6 percent for anxiety symptoms and 18.7 percent for depressive symptoms, meaning more than a third of the physicians and trainees surveyed carried clinically significant anxiety signals. Most striking of all, 40.5 percent screened positive for problematic alcohol use on the CAGE questionnaire, a figure that was significantly higher among female respondents than male respondents. In a profession where alcohol misuse is often framed as a private coping mechanism, a positive rate above 40 percent on a validated screen is a signal that the occupational stressors of medicine are not being absorbed without cost.

The demographic patterns within the data add texture to that alarm. Anxiety symptoms were significantly more common among medical students than among their more senior colleagues, and among younger respondents overall, a gradient that the authors interpret as reflecting the acute pressures of training years. Self-reported history of mental illness diagnosis stood at 29.3 percent across the sample, and that figure was higher in women than in men, a difference that reached statistical significance. Rates of reported diagnosis also increased with the number of years out of residency and were highest, at 42.2 percent, among those working in outpatient practices, hinting that the cumulative weight of clinical responsibility, and perhaps the isolation of ambulatory practice, shapes mental health trajectories in ways that deserve closer study.

The single most consequential number in the paper, however, may be the smallest. Among respondents who reported having been diagnosed with a mental illness, only 11 percent had disclosed that diagnosis to their licensing board. This disclosure gap sits at the heart of the study’s conclusion. Physicians in the survey overwhelmingly endorse the principle that mental illness is illness, that a colleague with depression deserves the same regard as one with diabetes, and that they themselves would trust a mentally ill physician with their care. But when the question shifts from abstract attitudes to concrete administrative exposure, telling the state board that grants and can revoke their license, nearly nine in ten of those with a diagnosis stay silent.

That silence is not difficult to explain, and the authors point to the structural incentives that produce it. Licensing applications in many jurisdictions still ask probing questions about psychiatric history, and physicians reasonably fear that disclosure could trigger scrutiny, monitoring requirements, or professional repercussions that far exceed what the underlying condition would clinically warrant. Concerns about confidentiality compound the problem: in a profession built on referrals, reputation, and small professional communities, the perceived cost of being labeled can be career-defining. The result is a system in which the people most knowledgeable about psychiatric treatment are among the least likely to seek it through formal, documented channels.

The study’s methodology deserves attention when weighing these findings. As a cross-sectional, anonymous survey at a single academic institution, it captures a moment in time rather than a trajectory, and its 277 respondents, while spanning the career ladder, cannot be assumed to represent physicians everywhere. Screening instruments such as the PHQ-2, GAD-2, and CAGE are designed to flag symptoms that warrant fuller evaluation, not to deliver diagnoses, so the positive rates should be read as signals of probable morbidity rather than confirmed caseness. Self-reported history of mental illness, meanwhile, depends on respondents both remembering and being willing to report a diagnosis. The authors were careful to build in ethical safeguards, with approval from the Valleywise Institutional Review Board under study number 2023-003 and procedures conducted in accordance with the Declaration of Helsinki, and the anonymity of the design was itself a response to the sensitivity of the subject matter.

Even with those caveats, the convergence of the data is hard to dismiss. The pattern, favorable attitudes coexisting with high symptom burden and minimal disclosure, is exactly what models of layered stigma would predict. Explicit beliefs can modernize quickly, driven by education, generational change, and public conversation, while the structural and internalized barriers that govern actual behavior change far more slowly. A medical student may sincerely believe that depression is a medical condition and still decline to answer a licensing question honestly, because the perceived stakes of disclosure operate on a different axis than belief. The gender differences in both diagnosed mental illness and problematic alcohol use further suggest that the pressures of the profession are not distributed evenly, and that wellness interventions calibrated to a generic physician may miss the populations carrying the heaviest load.

The authors close with a call that is both modest and urgent: accessible and confidential mental health resources, and continued wellness initiatives embedded in medical education and practice. The study was presented at the Annual Meeting of the Arizona Psychiatric Society in Phoenix in April 2024, and the researchers report no funding from pharmaceutical companies and no competing interests. What the findings ultimately expose is a gap between the culture physicians say they want and the system they actually navigate. Until licensing questions, confidentiality protections, and institutional support align with the attitudes that younger generations of clinicians already hold, medicine will keep producing professionals who believe in mental health care for everyone, except, in practice, for themselves.

Subject of Research: Physician mental health stigma, self-reported psychiatric illness, and screening for anxiety, depression, and alcohol use across medical training

Article Title: Physicians attitudes towards mental health and self-reported rates of anxiety, depression, and alcohol use

Article References: Loomba, N., Bhattarai, B., Ramos, G., Haerter, S., & Sood, S. (2026). Physicians attitudes towards mental health and self-reported rates of anxiety, depression, and alcohol use. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08640-7

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08640-7

Keywords: physician mental health, stigma, anxiety, depression, alcohol use, medical students, residents, licensing boards, PHQ-2, GAD-2, CAGE questionnaire, BMC Psychiatry