Mental Health Outcomes in Plastic Surgery Residents during the COVID-19 Pandemic

The field of plastic surgery was inevitably affected by the severe acute respiratory syndrome coronavirus 2. Residents in plastic surgery programs, although originally not on the frontline, had significant changes to their schedules and were deployed to other medical services in the hospital to help with the surge of the coronavirus disease of 2019 (COVID-19) patients. In the setting of the COVID-19 pandemic, plastic surgery residents are at higher risk of psychological distress and other mental health symptoms.¹

To evaluate this, an American Council of Academic Plastic Surgeons–approved survey was distributed to plastic surgery residents in the United States. The nine-item Patient Health Questionnaire and the seven-item Generalized Anxiety Disorder scale were used to assess the severity of symptoms of depression and anxiety. A total of 116 residents responded to the survey from all four U.S. subregions and all levels of training (Table 1).

Table 1.

Demographics of Survey Respondents

	No. of Respondents	Percentage
Gender
Male	61	53%
Female	55	47%
Age
20–30 yr	44	38%
30–40 yr	71	62%
Level of training
PGY-1	15	13%
PGY-2	17	15%
PGY-3	19	17%
PGY-4	16	14%
PGY-5	16	14%
PGY-6	14	12%
Ind. PGY-1	7	6%
Ind. PGY-2	3	3%
Ind. PGY-3	8	7%
U.S. subregion
South	33	28%
West	24	20%
Midwest	29	24%
Northeast	34	28%

PGY, postgraduate year; Ind. PGY, independent postgraduate year.

Ten respondents (8.62 percent) reported chronic symptoms of depression or anxiety before the pandemic. During the pandemic, 57 respondents (49.1 percent) and 48 respondents (41.4 percent) had symptoms of depression (p < 0.0001) and anxiety (p<0.0001), respectively. Respondents with one or more children were more likely to report symptoms of depression (64.3 percent versus 42.9 percent; p = 0.033) and anxiety (66.7 percent versus 41.2 percent; p = 0.029). Increased planned physical activity by at least 30 minutes/week was associated with less severe symptoms of anxiety (30.1 percent versus 55.3 percent; p = 0.039) and depression (40.8 percent versus 52.6 percent; p = 0.272). Respondents who described their program’s emphasis on wellness as major compared with those who described it as minor were found to have less severe symptoms of anxiety (38.7 percent versus 57.4 percent, p = 0.006) and depression (44.9 percent versus 59.0 percent, p = 0.140). With regard to counseling, 58.9 percent reported that they did not know if participation in counseling wellness programs was confidential, and the majority (93.0 percent) did not use these activities due to long work hours and the stigma associated. Lastly, 38.7 percent of respondents reported an increase in alcohol intake and 7 percent reported an increase in tobacco product use.

These results suggest that plastic surgery residents had symptoms of depression and anxiety at the time of distribution of the survey. Certainly, a rise in symptoms of anxiety and coping responses to stress is expected during extraordinary circumstances; however, the increased prevalence of people with anxiety and depression increases the risk of burnout, which in turn may lead to decreased productivity, slower learning capacity, compromised patient safety, and engaging in harmful behaviors, such as suicide and self-harm.²

Reviewing the mental health outcomes from a structural point of view, residents who had increased physical activity and more emphasis on wellness activities were found to have less severe symptoms of anxiety and depression. Wellness activities have been proven to reduce anxiety, reduce depression, and improve productivity, morale, and overall performance among residents, as well as help to decrease the risks of burnout.^3–5 However, these activities must be well implemented and encouraged to avoid conveying feelings of weakness and stigma. Our findings corroborate the importance of established wellness programs and trust between faculty and residents in academic programs, as well as identifying residents at risk for burnout, as these effects can have longstanding sequelae and consequently remain, even when the COVID-19 pandemic is over or under control.

DISCLOSURE

The authors have no potential conflicts of interest to disclose.

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