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Prevalence of anxiety and depressive symptoms among medical residents in Tunisia: a cross-sectional survey
  1. Mehdi Marzouk,
  2. Lamia Ouanes-Besbes,
  3. Islem Ouanes,
  4. Zeineb Hammouda,
  5. Fahmi Dachraoui,
  6. Fekri Abroug
  1. Intensive Care Department, Teaching Hospital, Fatouma Bourguiba and Research Laboratory (LR12SP15), University of Monastir, Monastir, Tunisia
  1. Correspondence to Dr Fekri Abroug; f.abroug{at}


Objective To assess the prevalence of anxiety and depressive symptoms and the associated risk factors among Tunisian medical residents.

Design Cross-sectional survey.

Setting Faculty of Medicine, Tunis.

Participants All Tunisian medical residents brought together between 14 and 22 December 2015 to choose their next 6-month rotation.

Intervention The items of the Hospital Anxiety and Depression (HAD) questionnaire were employed to capture the prevalence of anxiety and/or depression among the residents. The statistical relationships between anxiety and depression (HAD score) and sociodemographic and work-related data were explored by Poisson regression.

Results 1700 out of 2200 (77%) medical residents (mean age: 28.5±2 years, female: 60.8%) answered the questionnaire. The mean working hours per week was 62±21 hours; 73% ensured a mean of 5.4±3 night shifts per month; and only 8% of them could benefit from a day of safety rest. Overall, 74.1% of the participating residents had either definite (43.6%) or probable (30.5%) anxiety, while 62% had definite (30.5%) or probable (31.5%) depression symptoms, with 20% having both definite anxiety and definite depression. The total HAD score was significantly associated with the resident’s age (OR=1.014, 95% CI 1.006 to 1.023, p=0.001); female gender (OR=1.114, 95% CI 1.083 to 1.145, p<0.0001); and the heavy burden of work imposed on a weekly or monthly basis, as reflected by the number of night shifts per month (OR=1.048, 95% CI 1.016 to 1.082, p=0.03) and the number of hours worked per week (OR=1.008, 95% CI 1.005 to 1.011, p<0.0001). Compared with medical specialties, the generally accepted difficult specialties (surgical or medical-surgical) were associated with a higher HAD score (OR=1.459, 95% CI 1.172 to 1.816, p=0.001).

Conclusion Tunisian residents experience a rate of anxiety/depression substantially higher than that reported at the international level. This phenomenon is worrying as it has been associated with an increase in medical errors, work dissatisfaction and attrition. The means of improving the well-being of Tunisian medical residents are explored, emphasising those requiring immediate implementation.

  • human resource management

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  • Contributors Study concept and design: MM and FA. Data acquisition: MM. Analysis and interpretation of the data: MM, LO-B, ZH, IO, FD, FA. All authors read and approved the final manuscript. MM and FA had full access to the data and take responsibility for its integrity and the accuracy of the analyses.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study protocol was approved by the local Institutional Review Board of Fatouma Bourguiba Teaching Hospital, Monastir (reference #2013/108).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data set is available by contacting FA at

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