Mental Well-Being, Depression, and Anxiety among Resident Physicians at a Tertiary University Teaching Hospital in Ethiopia: A Cross-Sectional Study

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These conditions can compromise personal health, clinical performance, and career sustainability. This study assessed the prevalence of depression and anxiety and explored associated factors among residents at Addis Ababa University College of Health Sciences. Methods A cross-sectional study was conducted among 313 residents across 22 departments. Data were collected using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), with scores ≥ 4 indicating depression or anxiety. Descriptive statistics summarized participants’ characteristics, and bivariate and multivariate logistic regression identified factors independently associated with depression and anxiety. Statistical significance was set at p < 0.05. Results Among 313 participants (63.6% male; mean age 29.3 ± 2.37 years), 46% exhibited depression and 40.6% exhibited anxiety. Depression was significantly associated with alcohol use, history of trauma, dissatisfaction with specialty, and intention to leave residency. Anxiety was linked to trauma, insufficient sleep, workplace injustice, family history of mental illness, and considering discontinuation of residency. Conclusion Depression and anxiety are prevalent among resident physicians and are influenced by personal, academic, and workplace stressors. Interventions that strengthen psychosocial support, promote adequate rest, and foster a supportive training environment are critical to enhance residents’ mental well-being, reduce burnout, and improve retention in residency programs. Resident physicians Depression Anxiety Mental well-being Ethiopia Figures Figure 1 Introduction Mental health is increasingly understood not merely as the absence of illness but as overall mental well-being, encompassing emotional, psychological, and social functioning, life satisfaction, and the ability to maintain meaningful relationships [ 1 ]. Positive mental well-being emphasizes autonomy, self-acceptance, personal growth, and purpose in life [ 2 ], and is influenced by social connections, financial stability, physical health, substance use, early life experiences, and genetics [ 3 ]. High mental well-being reduces the risk of mental disorders, while poor well-being is linked to unhealthy lifestyles, stress, and chronic illness [ 4 , 5 ]. For physicians, particularly resident doctors, maintaining mental well-being is critical. Residency often involves heavy workloads, long duty hours, and emotionally demanding clinical responsibilities, increasing vulnerability to depression and anxiety. These conditions can compromise residents’ quality of life, clinical performance, patient safety, and career sustainability. Globally, depression and anxiety are prevalent among resident physicians. A meta-analysis by Mata et al. reported a pooled prevalence of depressive symptoms at 28.8% across 54 studies [ 6 ]. Similar studies in the U.S., Brazil, Canada, Saudi Arabia, Lithuania, India, South Africa, and Tunisia report prevalence ranging from 19% to 45%, often associated with long work hours, insufficient sleep, workplace injustice, and poor social support [ 7 – 14 ]. In Ethiopia, high psychological burden among medical students and residents is increasingly recognized. At Jimma University, 35.03% of health science students experienced mental distress, influenced by gender, substance use, and department choice [ 15 ]. A recent study at Addis Ababa University found 51.3% of medical students had depression, 30.1% anxiety, and 21.2% comorbid symptoms, with female students, early-year students, poor social support, and recent stressful life events as major predictors [ 16 ]. However, research specifically addressing resident physicians, who face unique academic, clinical, and emotional demands, remains limited. This study aims to assess the mental well-being of resident physicians at Addis Ababa University College of Health Sciences, focusing on the prevalence of depression and anxiety and identifying associated sociodemographic and occupational factors. The findings will inform institutional policies and interventions to support residents’ mental health, enhance training outcomes, and improve workforce sustainability. Methods Study Setting This study was conducted at the College of Health Sciences, Addis Ababa University (AAU), established in 1963. The college comprises four schools: Medicine, Pharmacy, Public Health, and Allied Health Sciences. The School of Medicine provides both undergraduate and postgraduate training across 23 departments, with Tikur Anbessa Specialized Hospital (TASH) serving as the primary clinical training site. TASH is one of Ethiopia’s largest teaching hospitals, with over 700 beds, providing tertiary care and serving as the main training center for residents. Study Design A cross-sectional study design was employed to assess the prevalence of depression and anxiety and associated factors among resident physicians. Source and Study Population The source population included all residents enrolled in the School of Medicine during the study period. Residents from all years who were actively engaged in clinical duties and willing to participate were eligible. Residents on extended leave (academic, medical, or sick leave) during data collection were excluded. Sample Size Determination The sample size was calculated using a single population proportion formula based on a 51% prevalence of depression among residents, a 5% margin of error, and 95% confidence interval: Using a single population proportion to calculate the sample size n = z α/2 2 *P(1-P)/d 2 n = Sample Size P Proportion 51% d = Margin of error = 0.05 n = 1.96 2 *0.49(0.51)/0.05 2 n = 384 Given the total resident population (N = 952), a finite population correction was applied: Where n adj .= Adjusted sample size n calculated sample size N = Study population Nadj = 384/(1 + 384/952) Adjusted 274, adding 10% non-response rate: 301 is the final size of residents Sampling procedure Stratified systematic sampling was conducted based on the residency department. The number of residents selected from each department was proportional to the department size (see Supplementary 1: Table 1). Data Collection Data were collected via a structured, self-administered questionnaire. Content validity was assessed by professional psychiatrists, and the tool was pretested for clarity and reliability. The final questionnaire was distributed digitally via Google Forms, through departmental and institutional platforms, with coordination from department heads and chief residents. Responses were exported to Microsoft Excel for cleaning and then analyzed using SPSS version 20. (See Supplementary 2: annex 2) Study Variables Dependent variables: Prevalence of depression and anxiety, measured using PHQ-9 and GAD-7, respectively. Independent variables: Sociodemographic factors (age, sex, marital status, ethnicity, religion, income, department, year of residency), clinical factors (chronic illness), substance use (alcohol, khat, cigarettes), and psychosocial factors (family history of mental illness, social support). Operational Definitions Mental Wellbeing: Assessed using PHQ-9 and GAD-7 as proxies for depression and anxiety. Scores ≥ 4 indicated the presence of symptoms. PHQ-9 (Patient Health Questionnaire-9): The PHQ-9 is a 9-item self-report instrument used to measure depressive symptoms over the past two weeks. Each item is scored from 0 to 3, yielding a total score ranging from 0 to 27. The tool has been validated in Ethiopia for both clinical and research settings. Cut-off for depression: ≥4 Severity classification: 0–4: Minimal 5–9: Mild 10–14: Moderate 15–19: Moderately severe 20–27: Severe GAD-7 (Generalized Anxiety Disorder-7): The GAD-7 is a 7-item self-report tool assessing generalized anxiety over the past two weeks. Each item is scored from 0 to 3, giving a total score of 0–21. The tool is widely validated globally. Cut-off for anxiety symptoms: ≥4 Severity classification: 0–4: Minimal 5–9: Mild 10–14: Moderate 15–21: Severe Data Analysis Descriptive statistics summarized participant characteristics. Bivariate logistic regression identified variables associated with depression and anxiety (p ≤ 0.25), which were included in multivariate logistic regression to adjust for confounders. Statistical significance was set at p < 0.05. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Ethical Considerations Ethical approval was obtained from the Institutional Review Board of the Addis Continental Institute of Public Health. Written informed consent was obtained electronically. Confidentiality was strictly maintained, and participants were informed of their right to withdraw at any time. Results Participant Characteristics A total of 323 respondents participated in the study, of whom 313 with complete data were included in the final analysis. The majority of participants were male (63.6%), with a mean age of 29.28 years (SD = 2.37). Most respondents were from the fields of pediatrics and child health (14.1%; n = 44), surgery (12.8%; n = 40), and emergency and critical care (10.5%; n = 33). Regarding residency level, 38.7% (n = 121) were in their third year or higher. About 49.8% (n = 156) were single, and 96.2% (n = 301) reported a monthly income of less than 15,000 birr. Religious commitment varied, with 23% (n = 72) reporting being very highly committed. Most participants (84.7%; n = 265) reported having family and social support, and 29.1% (n = 91) were primary family providers (Table 2 ). Substance Use The prevalence of substance use among participants was low, with 8% (n = 25) reporting khat chewing, 15.3% (n = 48) alcohol consumption, 3.8% (n = 12) cigarette smoking, and 2.6% (n = 8) use of recreational drugs (Table 3 , Fig. 1 ). Work-Related and Academic Factors Among participants, 36.4% (n = 114) reported working more than 64 hours per week, while only 11.5% (n = 36) reported getting the recommended amount of sleep. Regarding breaks, 57.8% (n = 181) indicated that they did not take breaks during the workday. In terms of academic satisfaction, 76.4% (n = 239) were satisfied with their chosen specialty, whereas 69.6% (n = 218) reported dissatisfaction with the academic support provided. Over half of the residents (56.5%; n = 177) had considered discontinuing their residency program. The main reasons reported for considering withdrawal were an unfavorable academic environment (21.7%; n = 68), financial difficulties (8.9%; n = 28), combined academic and environmental challenges (7.0%; n = 22), a combination of academic, financial, and family-related issues (2.9%; n = 9), and other reasons (10.2%; n = 32). Psycho-social and Mental Health History A family history of mental illness was reported by 12.1% (n = 38) of participants, while 3.8% (n = 12) reported a personal history of mental illness. Regarding workplace experiences, 59.7% (n = 187) reported experiencing workplace injustice, 37.7% (n = 118) had been exposed to major traumatic events, and 35.8% (n = 112) reported workplace violence. Prevalence of Depression and Anxiety Overall, 46.0% (n = 144) of participants screened positive for depression (PHQ-9), with the following severity: mild (30.0%; n = 94), moderate (8.6%; n = 27), moderately severe (4.8%; n = 15), and severe (2.6%; n = 8). Anxiety prevalence (GAD-7) was 40.6% (n = 127), with mild (28.8%; n = 90), moderate (6.7%; n = 21), and severe (5.1%; n = 16) cases. Factors Associated with Depression Bivariate logistic regression identified several factors significantly associated with depression, including major trauma, workplace violence, alcohol use, insufficient sleep, long working hours (> 64 hours/week), lack of religious commitment, being the main family provider, prior mental illness, dissatisfaction with specialty, perceived workplace injustice, and consideration of quitting residency. In multivariate analysis, Alcohol use was associated with 2.33 times higher odds of depression (AOR = 2.33; 95% CI: 1.16–4.70; p = 0.018). Primary family providers had 1.81 times higher odds (AOR = 1.81; 95% CI: 1.04–3.13; p = 0.035). Major trauma exposure was linked to 2.83 times higher odds (AOR = 2.83; 95% CI: 1.70–4.74; p < 0.001). Dissatisfaction with specialty was associated with 2.80 times higher odds (AOR = 2.80; 95% CI: 1.52–5.18; p = 0.001). Considering discontinuation of study had 2.56 times higher odds (AOR = 2.56; 95% CI: 1.53–4.33; p < 0.001) (Table 4 ). Factors Associated with Anxiety Bivariate analysis identified major trauma, workplace violence, alcohol use, family history of mental illness, insufficient sleep, long working hours, dissatisfaction with specialty, workplace injustice, and consideration of leaving residency as significant predictors of anxiety. Being married was associated with lower anxiety levels. Multivariate analysis showed: Major trauma: AOR = 2.11 (95% CI: 1.25–3.56; p = 0.005). Considering discontinuation of residency: AOR = 2.25 (95% CI: 1.30–3.88; p = 0.040). Insufficient sleep: AOR = 3.05 (95% CI: 1.33–7.04; p = 0.009).Workplace injustice: AOR = 2.24 (95% CI: 1.29–3.90; p = 0.004). Family history of mental illness: AOR = 2.16 (95% CI: 0.99–4.70). Being married was protective, reducing the odds of anxiety by 49% (AOR = 0.51; 95% CI: 0.29–0.92; p = 0.025) (Table 4 ). Table 2 Socio-demographic Characteristics of Resident Physicians (N = 313) Variable Category Frequency (n) Percentage (%) Sex Male 199 63.6 Female 144 36.4 Age (years) < 27 61 19.5 27–31 204 65.2 32–36 34 10.9 36–48 4 1.3 Year of Residency First 92 29.4 Second 100 31.9 Third and above 121 38.7 Relationship Status Single 156 49.8 Boyfriend/Girlfriend 56 17.9 Married 98 31.3 Divorced 2 0.6 Widowed 1 0.3 Monthly Income (Birr) < 15,000 301 96.2 15,000–25,000 12 3.8 Department Emergency & Critical Care 33 10.5 Neurology 5 1.6 Oncology 13 4.2 Nuclear Medicine 6 1.9 Family Medicine 8 2.6 Surgical Departments 40 12.8 Pathology 8 2.6 Gynecology/Obstetrics 31 9.9 Maxillofacial 3 1.0 Ophthalmology 6 1.9 Pediatrics & Child Health 44 14.1 ENT 9 2.9 Anesthesiology, Pain & Critical Care 14 4.5 Dermatovenerology 8 2.6 Psychiatry 12 3.8 Orthopedics & Traumatology 15 4.8 Radiology 20 6.4 Internal Medicine 31 9.9 Religious Commitment Not committed 29 9.3 Weekly 38 12.1 Somewhat committed 110 35.1 Committed 64 20.4 Strongly committed 72 23.0 Family & Social Support Yes 265 84.7 No 48 15.3 Main Family Provider Yes 91 29.1 No 222 70.9 Table 3 Substance Use and Behavioral Risk Factors (N = 313) Substance Category Frequency (n) Percentage (%) Khat Yes 25 8.0 No 288 92.0 Alcohol Yes 48 15.3 No 265 84.7 Tobacco Yes 12 3.8 No 301 96.2 Recreational Drugs Yes 8 2.6 No 305 97.4 Table 4 Multivariate Analysis of Factors Associated with Depression and Anxiety (N = 313) A. Depression Variable Total n (%) Not Depressed n (%) Depressed n (%) AOR (95% CI) P-value Alcohol use 48 (15.3) 19 (6.1) 29 (9.3) 2.33 (1.16–4.70) 0.018 Main family provider 91 (29.1) 40 (12.8) 51 (16.3) 1.81 (1.04–3.13) 0.035 Major trauma 118 (37.7) 43 (13.7) 75 (24.0) 2.83 (1.70–4.74) < 0.001 Dissatisfaction with the specialty 74 (23.6) 22 (7.0) 52 (16.6) 2.80 (1.52–5.18) 0.001 Considering discontinuation of the study 177 (56.5) 73 (23.3) 104 (33.2) 2.56 (1.53–4.33) < 0.001 B. Anxiety Variable Total n (%) No Anxiety n (%) Anxiety n (%) AOR (95% CI) P-value Major trauma 118 (37.7) 52 (16.6) 66 (21.1) 2.11 (1.25–3.56) 0.005 Considering discontinuation of the study 177 (56.5) 84 (26.8) 93 (29.7) 2.25 (1.30–3.88) 0.040 Married 98 (31.3) 70 (22.4) 28 (8.9) 0.51 (0.29–0.92) 0.025 Insufficient sleep 36 (11.5) 10 (3.2) 26 (8.3) 3.05 (1.33–7.04) 0.009 Workplace injustice 187 (59.7) 91 (29.1) 96 (30.7) 2.24 (1.29–3.90) 0.004 Family history of mental illness 38 (12.1) – – 2.16 (0.99–4.70) – Discussion This study examined the prevalence and associated factors of depression and anxiety among resident physicians at Addis Ababa University. The findings revealed that 46% of residents experienced depression, while 40.6% exhibited anxiety, indicating a substantial mental health burden. The depression prevalence in this cohort exceeds the 28.2% reported among undergraduate students at Jimma University [ 15 ], but aligns with prior findings among medical students at Addis Ababa University (51.3%) [ 16 ]. Similarly, anxiety levels were higher than those reported among medical students (30.1%) [ 16 ], suggesting that the psychological stress associated with medical training intensifies during residency, likely due to increased clinical responsibilities, long working hours, and academic demands. Internationally, the observed depression prevalence (46%) is higher than pooled estimates from the U.S. and China (35.1%) [ 6 ], and ranges reported in systematic reviews (28.8–43.2%) [ 6 , 9 ]. Anxiety prevalence (40.6%) was slightly lower than that of Tunisian medical residents (43.6%) [ 14 ], though depression rates were markedly higher (46% vs. 30.5%). Studies from India reported lower rates of both depression (27.7%) and anxiety (36.6%) [ 12 ]. These variations may reflect differences in sample size, study settings, cultural context, diagnostic tools (PHQ-9, BDI-II, HADS, SRQ-20), and sociodemographic factors such as marital status, financial responsibilities, and workload. Factors Associated with Depression Age and gender were not significantly associated with depression, consistent with global reviews [ 6 ], though some studies in South Africa and Tunisia found a higher risk among female and older residents [ 13 , 14 ]. Income was not significantly related to depression in this cohort, though higher income has been shown to be protective in high-stress professions in other contexts [31]. Significant predictors of depression included alcohol consumption (AOR = 2.33), major trauma (AOR = 2.83), dissatisfaction with the chosen specialty (AOR = 2.80), being the primary family provider (AOR = 1.81), and considering discontinuation of residency (AOR = 2.56). These findings underscore the interplay of personal, financial, and academic stressors in contributing to depressive symptoms among residents. Factors Associated with Anxiety Age and gender were not significant predictors of anxiety, while marital status was protective (AOR = 0.51). Residents experiencing major trauma (AOR = 2.11), poor sleep quality (AOR = 3.05), perceived workplace injustice (AOR = 2.24), family history of mental illness (AOR = 2.16), or thoughts of quitting residency (AOR = 2.25) were at higher risk. These results highlight the combined impact of personal, familial, and occupational stressors on anxiety. Limitations of the study This study has some limitations. Its cross-sectional design prevents conclusions about causality, and the self-reported data may be subject to recall or social desirability bias. Additionally, cultural and contextual factors were not assessed, which may limit the generalizability of the findings. Conclusions Depression and anxiety are highly prevalent among resident physicians at Addis Ababa University, indicating a substantial mental health burden during residency training. Both conditions are significantly influenced by a combination of personal, academic, and occupational stressors, including major trauma, alcohol use, and dissatisfaction with the chosen specialty, poor sleep quality, perceived workplace injustice, and financial responsibilities. These findings underscore the urgent need to address the mental well-being of resident physicians to prevent burnout, impaired performance, and adverse patient outcomes. Abbreviations AAU Addis Ababa University AOR Adjusted Odds Ratio CI Confidence Interval ENT Ear, Nose, and Throat GAD 7 –Generalized Anxiety Disorder–7 n Number (frequency) N Total population PHQ 9 –Patient Health Questionnaire–9 SD Standard Deviation TASH Tikur Anbessa Specialized Hospital Declarations Acknowledgments I thank Dr. Finot Debebe, Emergency and Critical Care Specialist, for his guidance and support during this research. I also appreciate the Toronto Addis Ababa Academic Collaboration (TAACEM) for funding my Master of Public Health studies. Author Contributions Statement: Tigist Worku (T.W.) served as the principal investigator, responsible for developing the proposal, conceptual framework, and data collection tools. She conducted data collection, performed data analysis, wrote the majority of the manuscript, and prepared the tables for publication. Dr. Dagmawit Tewahido acted as mentor and advisor, providing technical guidance, supervising the study’s progress, and supporting data analysis. Dr. Lemlem Beza contributed to the manuscript by revising the text, providing critical feedback, and improving the overall write-up. Correspondence to: Dr. Lemlem Beza, Department of Emergency and Critical Care Nursing, Addis Ababa University, Email: [email protected] ; [email protected] Dr. Dagmawit Tewahido, Addis Continental Institute of Public Health, Email: [email protected] Funding This research received partial financial support from Toronto Addis Ababa University Emergency Medicine collaboration (TAACEM) as part of my master’s study of General public health at Addis continental institute of public health. Ethics Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was initially obtained from the Institutional Review Board of Addis Continental Institute of Public Health as part of the Master of Public Health program requirements. Subsequently, permission to conduct the study was granted by the College of Health Sciences, Addis Ababa University. Consent for Publication Not applicable. Availability of data and material The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing Interests The authors declare no competing interests and confirm compliance with the journal's policies on ethical publication. References WHO. Promoting Mental Health: Concepts, Emerging Evidence, Practice. Geneva: World Health Organization; 2005. Keyes CLM. The mental health continuum: from languishing to flourishing in life. J Health Soc Behav. 2002;43(2):207–22. Dodge R, Daly AP, Huyton J, Sanders LD. The challenge of defining well-being. 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1","display":"","copyAsset":false,"role":"figure","size":39665,"visible":true,"origin":"","legend":"\u003cp\u003eSubstance use among resident physicians\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8143376/v1/e1a2d613103f7a8c756ed824.png"},{"id":98783435,"identity":"c7e9b3bc-de93-4c20-a18c-f5644144242f","added_by":"auto","created_at":"2025-12-22 12:41:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1019850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8143376/v1/4f44875b-723f-469a-a7ab-e20d3112a8fb.pdf"},{"id":98779724,"identity":"b28a7e2c-ddf8-4458-b8a0-68b757eb5e90","added_by":"auto","created_at":"2025-12-22 12:30:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20258,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryedited.docx","url":"https://assets-eu.researchsquare.com/files/rs-8143376/v1/ebb6549180e3e5df7e6b53ea.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mental Well-Being, Depression, and Anxiety among Resident Physicians at a Tertiary University Teaching Hospital in Ethiopia: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health is increasingly understood not merely as the absence of illness but as overall mental well-being, encompassing emotional, psychological, and social functioning, life satisfaction, and the ability to maintain meaningful relationships [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Positive mental well-being emphasizes autonomy, self-acceptance, personal growth, and purpose in life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and is influenced by social connections, financial stability, physical health, substance use, early life experiences, and genetics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. High mental well-being reduces the risk of mental disorders, while poor well-being is linked to unhealthy lifestyles, stress, and chronic illness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor physicians, particularly resident doctors, maintaining mental well-being is critical. Residency often involves heavy workloads, long duty hours, and emotionally demanding clinical responsibilities, increasing vulnerability to depression and anxiety. These conditions can compromise residents\u0026rsquo; quality of life, clinical performance, patient safety, and career sustainability.\u003c/p\u003e \u003cp\u003eGlobally, depression and anxiety are prevalent among resident physicians. A meta-analysis by Mata et al. reported a pooled prevalence of depressive symptoms at 28.8% across 54 studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similar studies in the U.S., Brazil, Canada, Saudi Arabia, Lithuania, India, South Africa, and Tunisia report prevalence ranging from 19% to 45%, often associated with long work hours, insufficient sleep, workplace injustice, and poor social support [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ethiopia, high psychological burden among medical students and residents is increasingly recognized. At Jimma University, 35.03% of health science students experienced mental distress, influenced by gender, substance use, and department choice [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A recent study at Addis Ababa University found 51.3% of medical students had depression, 30.1% anxiety, and 21.2% comorbid symptoms, with female students, early-year students, poor social support, and recent stressful life events as major predictors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, research specifically addressing resident physicians, who face unique academic, clinical, and emotional demands, remains limited.\u003c/p\u003e \u003cp\u003eThis study aims to assess the mental well-being of resident physicians at Addis Ababa University College of Health Sciences, focusing on the prevalence of depression and anxiety and identifying associated sociodemographic and occupational factors. The findings will inform institutional policies and interventions to support residents\u0026rsquo; mental health, enhance training outcomes, and improve workforce sustainability.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Setting\u003c/p\u003e \u003cp\u003eThis study was conducted at the College of Health Sciences, Addis Ababa University (AAU), established in 1963. The college comprises four schools: Medicine, Pharmacy, Public Health, and Allied Health Sciences. The School of Medicine provides both undergraduate and postgraduate training across 23 departments, with Tikur Anbessa Specialized Hospital (TASH) serving as the primary clinical training site. TASH is one of Ethiopia\u0026rsquo;s largest teaching hospitals, with over 700 beds, providing tertiary care and serving as the main training center for residents.\u003c/p\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eA cross-sectional study design was employed to assess the prevalence of depression and anxiety and associated factors among resident physicians.\u003c/p\u003e \u003cp\u003eSource and Study Population\u003c/p\u003e \u003cp\u003eThe source population included all residents enrolled in the School of Medicine during the study period. Residents from all years who were actively engaged in clinical duties and willing to participate were eligible. Residents on extended leave (academic, medical, or sick leave) during data collection were excluded.\u003c/p\u003e \u003cp\u003eSample Size Determination\u003c/p\u003e \u003cp\u003eThe sample size was calculated using a single population proportion formula based on a 51% prevalence of depression among residents, a 5% margin of error, and 95% confidence interval:\u003c/p\u003e \u003cp\u003eUsing a single population proportion to calculate the sample size\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;z\u003csub\u003eα/2\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e *P(1-P)/d\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;Sample Size\u003c/p\u003e \u003cp\u003eP Proportion 51%\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Margin of error\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1.96\u003csup\u003e2\u003c/sup\u003e*0.49(0.51)/0.05\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;384\u003c/p\u003e \u003cp\u003eGiven the total resident population (N\u0026thinsp;=\u0026thinsp;952), a finite population correction was applied:\u003c/p\u003e \u003cp\u003eWhere n\u003csub\u003eadj\u003c/sub\u003e.= Adjusted sample size\u003c/p\u003e \u003cp\u003en calculated sample size\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Study population\u003c/p\u003e \u003cp\u003eNadj\u0026thinsp;=\u0026thinsp;384/(1\u0026thinsp;+\u0026thinsp;384/952)\u003c/p\u003e \u003cp\u003eAdjusted 274, adding 10% non-response rate: 301 is the final size of residents\u003c/p\u003e \u003cp\u003eSampling procedure\u003c/p\u003e \u003cp\u003eStratified systematic sampling was conducted based on the residency department. The number of residents selected from each department was proportional to the department size (see Supplementary 1: Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eData were collected via a structured, self-administered questionnaire. Content validity was assessed by professional psychiatrists, and the tool was pretested for clarity and reliability. The final questionnaire was distributed digitally via Google Forms, through departmental and institutional platforms, with coordination from department heads and chief residents. Responses were exported to Microsoft Excel for cleaning and then analyzed using SPSS version 20. (See Supplementary 2: annex 2)\u003c/p\u003e \u003cp\u003eStudy Variables\u003c/p\u003e \u003cp\u003eDependent variables: Prevalence of depression and anxiety, measured using PHQ-9 and GAD-7, respectively.\u003c/p\u003e \u003cp\u003eIndependent variables: Sociodemographic factors (age, sex, marital status, ethnicity, religion, income, department, year of residency), clinical factors (chronic illness), substance use (alcohol, khat, cigarettes), and psychosocial factors (family history of mental illness, social support).\u003c/p\u003e \u003cp\u003eOperational Definitions\u003c/p\u003e \u003cp\u003eMental Wellbeing: Assessed using PHQ-9 and GAD-7 as proxies for depression and anxiety. Scores\u0026thinsp;\u0026ge;\u0026thinsp;4 indicated the presence of symptoms.\u003c/p\u003e \u003cp\u003ePHQ-9 (Patient Health Questionnaire-9): The PHQ-9 is a 9-item self-report instrument used to measure depressive symptoms over the past two weeks. Each item is scored from 0 to 3, yielding a total score ranging from 0 to 27. The tool has been validated in Ethiopia for both clinical and research settings.\u003c/p\u003e \u003cp\u003eCut-off for depression: \u0026ge;4\u003c/p\u003e \u003cp\u003eSeverity classification:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e0\u0026ndash;4: Minimal\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e5\u0026ndash;9: Mild\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e10\u0026ndash;14: Moderate\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e15\u0026ndash;19: Moderately severe\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e20\u0026ndash;27: Severe\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eGAD-7 (Generalized Anxiety Disorder-7): The GAD-7 is a 7-item self-report tool assessing generalized anxiety over the past two weeks. Each item is scored from 0 to 3, giving a total score of 0\u0026ndash;21. The tool is widely validated globally.\u003c/p\u003e \u003cp\u003eCut-off for anxiety symptoms: \u0026ge;4\u003c/p\u003e \u003cp\u003eSeverity classification:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e0\u0026ndash;4: Minimal\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e5\u0026ndash;9: Mild\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e10\u0026ndash;14: Moderate\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e15\u0026ndash;21: Severe\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics summarized participant characteristics. Bivariate logistic regression identified variables associated with depression and anxiety (p\u0026thinsp;\u0026le;\u0026thinsp;0.25), which were included in multivariate logistic regression to adjust for confounders. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Institutional Review Board of the Addis Continental Institute of Public Health. Written informed consent was obtained electronically. Confidentiality was strictly maintained, and participants were informed of their right to withdraw at any time.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 323 respondents participated in the study, of whom 313 with complete data were included in the final analysis. The majority of participants were male (63.6%), with a mean age of 29.28 years (SD\u0026thinsp;=\u0026thinsp;2.37). Most respondents were from the fields of pediatrics and child health (14.1%; n\u0026thinsp;=\u0026thinsp;44), surgery (12.8%; n\u0026thinsp;=\u0026thinsp;40), and emergency and critical care (10.5%; n\u0026thinsp;=\u0026thinsp;33).\u003c/p\u003e \u003cp\u003eRegarding residency level, 38.7% (n\u0026thinsp;=\u0026thinsp;121) were in their third year or higher. About 49.8% (n\u0026thinsp;=\u0026thinsp;156) were single, and 96.2% (n\u0026thinsp;=\u0026thinsp;301) reported a monthly income of less than 15,000 birr. Religious commitment varied, with 23% (n\u0026thinsp;=\u0026thinsp;72) reporting being very highly committed. Most participants (84.7%; n\u0026thinsp;=\u0026thinsp;265) reported having family and social support, and 29.1% (n\u0026thinsp;=\u0026thinsp;91) were primary family providers (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSubstance Use\u003c/h3\u003e\n\u003cp\u003eThe prevalence of substance use among participants was low, with 8% (n\u0026thinsp;=\u0026thinsp;25) reporting khat chewing, 15.3% (n\u0026thinsp;=\u0026thinsp;48) alcohol consumption, 3.8% (n\u0026thinsp;=\u0026thinsp;12) cigarette smoking, and 2.6% (n\u0026thinsp;=\u0026thinsp;8) use of recreational drugs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eWork-Related and Academic Factors\u003c/h3\u003e\n\u003cp\u003eAmong participants, 36.4% (n\u0026thinsp;=\u0026thinsp;114) reported working more than 64 hours per week, while only 11.5% (n\u0026thinsp;=\u0026thinsp;36) reported getting the recommended amount of sleep. Regarding breaks, 57.8% (n\u0026thinsp;=\u0026thinsp;181) indicated that they did not take breaks during the workday.\u003c/p\u003e \u003cp\u003eIn terms of academic satisfaction, 76.4% (n\u0026thinsp;=\u0026thinsp;239) were satisfied with their chosen specialty, whereas 69.6% (n\u0026thinsp;=\u0026thinsp;218) reported dissatisfaction with the academic support provided. Over half of the residents (56.5%; n\u0026thinsp;=\u0026thinsp;177) had considered discontinuing their residency program. The main reasons reported for considering withdrawal were an unfavorable academic environment (21.7%; n\u0026thinsp;=\u0026thinsp;68), financial difficulties (8.9%; n\u0026thinsp;=\u0026thinsp;28), combined academic and environmental challenges (7.0%; n\u0026thinsp;=\u0026thinsp;22), a combination of academic, financial, and family-related issues (2.9%; n\u0026thinsp;=\u0026thinsp;9), and other reasons (10.2%; n\u0026thinsp;=\u0026thinsp;32).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePsycho-social and Mental Health History\u003c/h2\u003e \u003cp\u003eA family history of mental illness was reported by 12.1% (n\u0026thinsp;=\u0026thinsp;38) of participants, while 3.8% (n\u0026thinsp;=\u0026thinsp;12) reported a personal history of mental illness. Regarding workplace experiences, 59.7% (n\u0026thinsp;=\u0026thinsp;187) reported experiencing workplace injustice, 37.7% (n\u0026thinsp;=\u0026thinsp;118) had been exposed to major traumatic events, and 35.8% (n\u0026thinsp;=\u0026thinsp;112) reported workplace violence.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrevalence of Depression and Anxiety\u003c/h3\u003e\n\u003cp\u003eOverall, 46.0% (n\u0026thinsp;=\u0026thinsp;144) of participants screened positive for depression (PHQ-9), with the following severity: mild (30.0%; n\u0026thinsp;=\u0026thinsp;94), moderate (8.6%; n\u0026thinsp;=\u0026thinsp;27), moderately severe (4.8%; n\u0026thinsp;=\u0026thinsp;15), and severe (2.6%; n\u0026thinsp;=\u0026thinsp;8). Anxiety prevalence (GAD-7) was 40.6% (n\u0026thinsp;=\u0026thinsp;127), with mild (28.8%; n\u0026thinsp;=\u0026thinsp;90), moderate (6.7%; n\u0026thinsp;=\u0026thinsp;21), and severe (5.1%; n\u0026thinsp;=\u0026thinsp;16) cases.\u003c/p\u003e\n\u003ch3\u003eFactors Associated with Depression\u003c/h3\u003e\n\u003cp\u003eBivariate logistic regression identified several factors significantly associated with depression, including major trauma, workplace violence, alcohol use, insufficient sleep, long working hours (\u0026gt;\u0026thinsp;64 hours/week), lack of religious commitment, being the main family provider, prior mental illness, dissatisfaction with specialty, perceived workplace injustice, and consideration of quitting residency.\u003c/p\u003e \u003cp\u003eIn multivariate analysis, Alcohol use was associated with 2.33 times higher odds of depression (AOR\u0026thinsp;=\u0026thinsp;2.33; 95% CI: 1.16\u0026ndash;4.70; p\u0026thinsp;=\u0026thinsp;0.018). Primary family providers had 1.81 times higher odds (AOR\u0026thinsp;=\u0026thinsp;1.81; 95% CI: 1.04\u0026ndash;3.13; p\u0026thinsp;=\u0026thinsp;0.035). Major trauma exposure was linked to 2.83 times higher odds (AOR\u0026thinsp;=\u0026thinsp;2.83; 95% CI: 1.70\u0026ndash;4.74; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Dissatisfaction with specialty was associated with 2.80 times higher odds (AOR\u0026thinsp;=\u0026thinsp;2.80; 95% CI: 1.52\u0026ndash;5.18; p\u0026thinsp;=\u0026thinsp;0.001). Considering discontinuation of study had 2.56 times higher odds (AOR\u0026thinsp;=\u0026thinsp;2.56; 95% CI: 1.53\u0026ndash;4.33; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Anxiety\u003c/h2\u003e \u003cp\u003eBivariate analysis identified major trauma, workplace violence, alcohol use, family history of mental illness, insufficient sleep, long working hours, dissatisfaction with specialty, workplace injustice, and consideration of leaving residency as significant predictors of anxiety. Being married was associated with lower anxiety levels.\u003c/p\u003e \u003cp\u003eMultivariate analysis showed: Major trauma: AOR\u0026thinsp;=\u0026thinsp;2.11 (95% CI: 1.25\u0026ndash;3.56; p\u0026thinsp;=\u0026thinsp;0.005). Considering discontinuation of residency: AOR\u0026thinsp;=\u0026thinsp;2.25 (95% CI: 1.30\u0026ndash;3.88; p\u0026thinsp;=\u0026thinsp;0.040).\u003c/p\u003e \u003cp\u003eInsufficient sleep: AOR\u0026thinsp;=\u0026thinsp;3.05 (95% CI: 1.33\u0026ndash;7.04; p\u0026thinsp;=\u0026thinsp;0.009).Workplace injustice: AOR\u0026thinsp;=\u0026thinsp;2.24 (95% CI: 1.29\u0026ndash;3.90; p\u0026thinsp;=\u0026thinsp;0.004). Family history of mental illness: AOR\u0026thinsp;=\u0026thinsp;2.16 (95% CI: 0.99\u0026ndash;4.70). Being married was protective, reducing the odds of anxiety by 49% (AOR\u0026thinsp;=\u0026thinsp;0.51; 95% CI: 0.29\u0026ndash;0.92; p\u0026thinsp;=\u0026thinsp;0.025) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic Characteristics of Resident Physicians (N\u0026thinsp;=\u0026thinsp;313)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u0026ndash;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear of Residency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoyfriend/Girlfriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income (Birr)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,000\u0026ndash;25,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepartment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency \u0026amp; Critical Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical Departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecology/Obstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaxillofacial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOphthalmology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatrics \u0026amp; Child Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesiology, Pain \u0026amp; Critical Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDermatovenerology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthopedics \u0026amp; Traumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRadiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligious Commitment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot committed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat committed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly committed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily \u0026amp; Social Support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain Family Provider\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubstance Use and Behavioral Risk Factors (N\u0026thinsp;=\u0026thinsp;313)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKhat\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecreational Drugs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Analysis of Factors Associated with Depression and Anxiety (N\u0026thinsp;=\u0026thinsp;313) A. Depression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot Depressed n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDepressed n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.33 (1.16\u0026ndash;4.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain family provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.81 (1.04\u0026ndash;3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.83 (1.70\u0026ndash;4.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDissatisfaction with the specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.80 (1.52\u0026ndash;5.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsidering discontinuation of the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e104 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.56 (1.53\u0026ndash;4.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eB. Anxiety\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Anxiety n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnxiety n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.11 (1.25\u0026ndash;3.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsidering discontinuation of the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.25 (1.30\u0026ndash;3.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51 (0.29\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.05 (1.33\u0026ndash;7.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkplace injustice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.24 (1.29\u0026ndash;3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.16 (0.99\u0026ndash;4.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the prevalence and associated factors of depression and anxiety among resident physicians at Addis Ababa University. The findings revealed that 46% of residents experienced depression, while 40.6% exhibited anxiety, indicating a substantial mental health burden.\u003c/p\u003e \u003cp\u003eThe depression prevalence in this cohort exceeds the 28.2% reported among undergraduate students at Jimma University [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], but aligns with prior findings among medical students at Addis Ababa University (51.3%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, anxiety levels were higher than those reported among medical students (30.1%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], suggesting that the psychological stress associated with medical training intensifies during residency, likely due to increased clinical responsibilities, long working hours, and academic demands.\u003c/p\u003e \u003cp\u003eInternationally, the observed depression prevalence (46%) is higher than pooled estimates from the U.S. and China (35.1%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and ranges reported in systematic reviews (28.8\u0026ndash;43.2%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Anxiety prevalence (40.6%) was slightly lower than that of Tunisian medical residents (43.6%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], though depression rates were markedly higher (46% vs. 30.5%). Studies from India reported lower rates of both depression (27.7%) and anxiety (36.6%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These variations may reflect differences in sample size, study settings, cultural context, diagnostic tools (PHQ-9, BDI-II, HADS, SRQ-20), and sociodemographic factors such as marital status, financial responsibilities, and workload.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Depression\u003c/h2\u003e \u003cp\u003eAge and gender were not significantly associated with depression, consistent with global reviews [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], though some studies in South Africa and Tunisia found a higher risk among female and older residents [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Income was not significantly related to depression in this cohort, though higher income has been shown to be protective in high-stress professions in other contexts [31].\u003c/p\u003e \u003cp\u003eSignificant predictors of depression included alcohol consumption (AOR\u0026thinsp;=\u0026thinsp;2.33), major trauma (AOR\u0026thinsp;=\u0026thinsp;2.83), dissatisfaction with the chosen specialty (AOR\u0026thinsp;=\u0026thinsp;2.80), being the primary family provider (AOR\u0026thinsp;=\u0026thinsp;1.81), and considering discontinuation of residency (AOR\u0026thinsp;=\u0026thinsp;2.56). These findings underscore the interplay of personal, financial, and academic stressors in contributing to depressive symptoms among residents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Anxiety\u003c/h2\u003e \u003cp\u003eAge and gender were not significant predictors of anxiety, while marital status was protective (AOR\u0026thinsp;=\u0026thinsp;0.51). Residents experiencing major trauma (AOR\u0026thinsp;=\u0026thinsp;2.11), poor sleep quality (AOR\u0026thinsp;=\u0026thinsp;3.05), perceived workplace injustice (AOR\u0026thinsp;=\u0026thinsp;2.24), family history of mental illness (AOR\u0026thinsp;=\u0026thinsp;2.16), or thoughts of quitting residency (AOR\u0026thinsp;=\u0026thinsp;2.25) were at higher risk. These results highlight the combined impact of personal, familial, and occupational stressors on anxiety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis study has some limitations. Its cross-sectional design prevents conclusions about causality, and the self-reported data may be subject to recall or social desirability bias. Additionally, cultural and contextual factors were not assessed, which may limit the generalizability of the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDepression and anxiety are highly prevalent among resident physicians at Addis Ababa University, indicating a substantial mental health burden during residency training. Both conditions are significantly influenced by a combination of personal, academic, and occupational stressors, including major trauma, alcohol use, and dissatisfaction with the chosen specialty, poor sleep quality, perceived workplace injustice, and financial responsibilities. These findings underscore the urgent need to address the mental well-being of resident physicians to prevent burnout, impaired performance, and adverse patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAAU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAddis Ababa University\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eENT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEar, Nose, and Throat\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGAD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003e7\u003c/b\u003e\u0026ndash;Generalized Anxiety Disorder\u0026ndash;7\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003en\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNumber (frequency)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal population\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePHQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003e9\u003c/b\u003e\u0026ndash;Patient Health Questionnaire\u0026ndash;9\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTASH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTikur Anbessa Specialized Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eI thank Dr. Finot Debebe, Emergency and Critical Care Specialist, for his guidance and support during this research. I also appreciate the Toronto Addis Ababa Academic Collaboration (TAACEM) for funding my Master of Public Health studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTigist Worku (T.W.)\u003c/strong\u003e served as the principal investigator, responsible for developing the proposal, conceptual framework, and data collection tools. She conducted data collection, performed data analysis, wrote the majority of the manuscript, and prepared the tables for publication. \u003cstrong\u003eDr. Dagmawit Tewahido\u003c/strong\u003e acted as mentor and advisor, providing technical guidance, supervising the study\u0026rsquo;s progress, and supporting data analysis. \u003cstrong\u003eDr. Lemlem Beza\u003c/strong\u003e contributed to the manuscript by revising the text, providing critical feedback, and improving the overall write-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence to:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Lemlem Beza, Department of Emergency and Critical Care Nursing, Addis Ababa University, Email: [email protected]; [email protected]\u003c/p\u003e\n\u003cp\u003eDr. Dagmawit Tewahido, Addis Continental Institute of Public Health, Email: [email protected]\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received partial financial support from Toronto Addis Ababa University Emergency Medicine collaboration (TAACEM) as part of my master\u0026rsquo;s study of General public health at Addis continental institute of public health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was initially obtained from the Institutional Review Board of Addis Continental Institute of Public Health as part of the Master of Public Health program requirements. Subsequently, permission to conduct the study was granted by the College of Health Sciences, Addis Ababa University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests and confirm compliance with the journal\u0026apos;s policies on ethical publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Promoting Mental Health: Concepts, Emerging Evidence, Practice. 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Int J Ment Health Syst. 2019;13:30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13033-019-0287-6\u003c/span\u003e\u003cspan address=\"10.1186/s13033-019-0287-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Resident physicians, Depression, Anxiety, Mental well-being, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8143376/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8143376/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eResident physicians face intense academic, clinical, and emotional demands that increase vulnerability to poor mental well-being, including depression and anxiety. These conditions can compromise personal health, clinical performance, and career sustainability. This study assessed the prevalence of depression and anxiety and explored associated factors among residents at Addis Ababa University College of Health Sciences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted among 313 residents across 22 departments. Data were collected using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), with scores\u0026thinsp;\u0026ge;\u0026thinsp;4 indicating depression or anxiety. Descriptive statistics summarized participants\u0026rsquo; characteristics, and bivariate and multivariate logistic regression identified factors independently associated with depression and anxiety. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmong 313 participants (63.6% male; mean age 29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37 years), 46% exhibited depression and 40.6% exhibited anxiety. Depression was significantly associated with alcohol use, history of trauma, dissatisfaction with specialty, and intention to leave residency. Anxiety was linked to trauma, insufficient sleep, workplace injustice, family history of mental illness, and considering discontinuation of residency.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDepression and anxiety are prevalent among resident physicians and are influenced by personal, academic, and workplace stressors. Interventions that strengthen psychosocial support, promote adequate rest, and foster a supportive training environment are critical to enhance residents\u0026rsquo; mental well-being, reduce burnout, and improve retention in residency programs.\u003c/p\u003e","manuscriptTitle":"Mental Well-Being, Depression, and Anxiety among Resident Physicians at a Tertiary University Teaching Hospital in Ethiopia: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 10:36:30","doi":"10.21203/rs.3.rs-8143376/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"42869750590061981668210075489972182703","date":"2026-05-15T22:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239387442392923141514344150153654460729","date":"2026-04-09T10:12:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214350562877199782529868090353047480915","date":"2026-04-09T05:28:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-30T16:04:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42869750590061981668210075489972182703","date":"2026-01-26T13:13:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257867896007074293978044112601699250096","date":"2026-01-09T13:00:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-18T12:21:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T07:19:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-05T18:01:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-05T17:54:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36bd5651-4765-4268-9810-c9209d50052a","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"42869750590061981668210075489972182703","date":"2026-05-15T22:01:54+00:00","index":66,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T10:36:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 10:36:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8143376","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8143376","identity":"rs-8143376","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}