Physician Well-Being in Foreign Lands: Unmasking Mental Health Problems and Suicide Risk Among Egyptian Medical Expatriates

Physician Well-Being in Foreign Lands: Unmasking Mental Health Problems and Suicide Risk Among Egyptian Medical Expatriates | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Physician Well-Being in Foreign Lands: Unmasking Mental Health Problems and Suicide Risk Among Egyptian Medical Expatriates Mervat Said, Eman Mandour, Eman Fathey ElSemary, Hibatallah Magdy, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171595/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Moving to a new country for work can be incredibly stressful, especially for physicians who already face high-pressure jobs. This study explores the mental health challenges, like depression, anxiety, and suicidal risk, that Egyptian doctors experience while working abroad. Methods A cross-sectional online survey of 400 Egyptian immigrant physicians in Arab Gulf/Western nations was conducted via Facebook professional groups using comprehensive consecutive sampling. Data were collected using a questionnaire covering sociodemographic, clinical, and immigration-related factors, and history of suicidal ideation/ attempts, and the Hospital Anxiety and Depression Scale (HADS) was used to assess the severity of anxiety and depressive symptoms. Results About 16% of doctors reported moderate to severe depression. Women were 2.5 times more likely to experience it than men. Nearly 40% struggled with significant anxiety, especially those working more than 8 hours a day. 6.3% of doctors had suicidal thoughts, and almost 5% had attempted suicide. Younger physicians were found to be fourfold more likely to have suicidal risk compared to their older counterparts, while physicians who reported barriers to accessing mental health services had a 2.9-fold increased risk of suicidal risk. The reported barriers included a lack of insurance coverage, fear of losing their jobs, and stigma. Conclusion Egyptian migrant physicians face significant mental health burdens, exacerbated by being younger, long working hours, past mental health issues, and systemic barriers to care. Urgent interventions must address healthcare access, occupational safeguards, and culturally sensitive support to mitigate suicide risk and improve well-being in this critical workforce. migrant physicians anxiety depression suicide Figures Figure 1 Figure 2 Figure 3 Introduction Physician migration represents a global phenomenon with profound personal and professional implications [ 1 , 2 ]. Worldwide, migration commonly occurs from less-developed to more-developed countries [ 3 ]. Egyptian doctors increasingly seek opportunities abroad—primarily in the Gulf and Western countries—driven by systemic challenges including inadequate compensation, strenuous work environments, and limited professional autonomy in their home country. While such migration offers career advancement, the journey carries a significant psychological impact [ 4 ]. Despite growing recognition of mental health challenges among migrant populations globally [ 5 , 6 ], the unique burdens facing physician migrants remain critically understudied.Emergent research confirms that relocation itself amplifies vulnerability to psychological distress, with immigrants facing elevated risks of depression, anxiety, and identity conflicts [ 7 , 8 ]. Prior work identifies high rates of depression, substance use, and sleep disorders in general migrant workers [ 9 , 10 ]; therefore, physicians practicing abroad confront unique psychological burdens as they navigate licensing complexities, credential reevaluation, and high-pressure clinical contexts—all while adapting to unfamiliar cultural settings. Review of literature highlights the scarcity of studies on physician migrants’ mental health and suicide risk, a population where untreated distress jeopardizes both clinician well-being and patient safety [ 11 ]. Our research bridges this evidence gap by examining depression, anxiety, and suicidality among Egyptian physician expatriates, quantifying prevalence and identifying modifiable risk factors to shed light on rapid needed interventions. Study Design and Participant Recruitment We conducted a cross-sectional online survey targeting Egyptian physicians practicing abroad. Participants were recruited via country-specific, physician-exclusive Facebook groups across six destination countries: the Gulf Cooperation Council (GCC) countries (Kingdom of Saudi Arabia [KSA], United Arab Emirates [UAE], Kuwait) and Western regions (United States [USA], United Kingdom [UK], Germany). Sample Size and Eligibility Initially, 441 subjects participated in this study. Following screening, 41 respondents were excluded due to incomplete response (n = 29 ) or failure to meet the inclusion criteria (n = 12), yielding a final sample of 400 migrant physicians. The inclusion Criteria included licensed physicians of Egyptian origin, both sexes, actively practicing abroad for at least the last year, and with an age between 30–60 years. The Exclusion Criteria included severe comorbid physical illnesses (e.g., renal/hepatic failure, malignancy), Current substance use disorders, and those who returned to Egyptian practice during the last year. S ample Size & Sampling Method A minimum target sample of 385 participants was calculated using Open Epi software (Version 3.01), based on a conservative depression/anxiety prevalence estimate of 50% derived from physician population studies [ 12 , 13 ]. This calculation ensured 80% statistical power to detect significant effects within a 95% confidence interval and ± 5% margin of error. We employed comprehensive consecutive sampling to inclusively enroll all eligible Egyptian migrant physicians practicing in target destinations during a six-month recruitment window (September 2019–February 2020). Geographic coverage included: Gulf Cooperation Council (GCC) nations: KSA, UAE, Kuwait, and Oman, and Western countries: USA, UK, and Germany. Methods Data were collected via a structured electronic questionnaire assessing four domains: (1) Sociodemographic characteristics (age, sex, marital status, pre-migration Egyptian residence [urban/rural], current living arrangement “alone /with family”); (2) Clinical history (personal/family psychiatric history, current medical comorbidities, substance use disorders excluding nicotine); (3) Occupational and migration factors (professional title, specialty, daily work hours [≤ 8 vs. >8], weekly workdays, annual vacation days, and mental healthcare access barriers [dichotomized yes/no; open-text specification for reasons); and (4) Psychometric assessments, including the Hospital Anxiety and Depression Scale (HADS) [ 14 ], (An Arabic-validated form by Moussa et al. (2016) [ 15 ] was administered.). It is a 14-item self-report tool (7 anxiety + 7 depression items; 4-point Likert scales [0–3]; subscale range 0–21) with scores ≥ 11 indicating clinically significant symptoms. —alongside direct screening for suicide risk through two items assessing 1-month suicidal ideation ("Have you considered ending your life in the past month?") and attempts with yes/ no answers. Statistical analysis The collected data underwent digital processing and statistical analysis using IBM SPSS Statistics (Version 27.0). Categorical variables were summarized as frequency counts with proportional percentages, with between-group differences assessed via chi-square (χ²) tests. Continuous measures were reported as means ± standard deviations (SD), with independent samples t-tests comparing normally distributed variables across two groups. Univariate logistic regression initially screened variable associations, with significant predictors (p < 0.05) advancing to multivariable models controlling for confounders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model calibration was verified through Hosmer-Lemeshow goodness-of-fit testing. Statistical significance thresholds were defined as: p > 0.05 (non-significant), p ≤ 0.05 (significant), and p ≤ 0.001 (highly significant). Results The socio-demographic and clinical characteristics of the 400 participants are summarized in Table 1. The mean age of the subjects was 39.4 years (±6.3 SD). Most of them were male (62.3%, n = 249), married (87.8%, n = 351), residing in urban areas (91.3%, n = 365), and living with their family (74.5%, n = 298). Registrars constituted the largest professional group (58.0%, n = 232), followed by residents (18.5%, n = 74) and consultants (14.5%, n = 58). The most common specialties were Medicine (33.5%, n=134) and Surgery (26.8%, n=107). A minority reported a positive family history of psychiatric illness (19.7%, n=92), a past psychiatric history (24.7%, n=115), or a present medical history (26.0%, n=104). Table 1: The sociodemographic and clinical variables among the studied group: Variable Immigrant (n=400) Age Mean ± **SD 39.4 ± 6.3 Gender: Female Male 151 (37.8%) 249 (62.3%) Social status: Married *Non 351 (87.8%) 49 (12.3%) Residence: Rural Urban 35 (8.8%) 365 (91.3%) Living Arrangement: Alone With family 102 (25.5%) 298 (74.5%) Clinical title: Consultant **GP Registrar Resident 58 (14.5%) 36 (9%) 232 (58%) 74 (18.5%) Specialty: Medicine: Surgery: **ER: **ICU: **GP: Pediatrics: Academic: Others: 134 (33.5%) 107 (26.8%) 11 (2.8%) 38 (9.5%) 15 (3.8%) 50 (12.5%) 1 (0.3%) 44 (11%) Family history No Yes 374 (80.3%) 92 (19.7%) Past history: No Yes 351 (75.3%) 115 (24.7%) Present medical history: No Yes 296 (74%) 104 (26%) * Non-Married: includes single, divorced, and widowed. **Abbreviations: GP, General Practitioner; ER, Emergency Room; ICU, Intensive Care Unit; SD, Standard Deviation. Concerning the work-related patterns and mental healthcare barriers among immigrant physicians (N=400), the data showed that the mean vacation days per year is 33.4 (SD=9.6). Workload patterns revealed that 327 participants (81.8%) exceeded 8 daily working hours, while 371 (92.8%) worked more than 4 days weekly. Regarding mental healthcare access, 178 physicians (44.5%) identified significant barriers to service utilization. Regarding the frequency of mental health problems among the migrant physicians, our results showed that moderate-to-severe anxiety affected 39% (n=156) of participants, while 15.8% (n=65) reported moderate-to-severe depression levels. Notably, 11% (n=44) exhibited suicidal risk, comprising 6.3% (n=25) with active suicidal ideation and 4.7% (n=19) with suicide attempts during the last month, as shown in Figure (1). Anxiety correlates Concerning the Anxiety group: bivariate analyses examining demographic correlates of anxiety (moderate-to-severe vs. normal-to-mild) revealed no statistically significant associations regarding the age (p=0.226), sex (p=0.54), residence (p=0.185), living arrangement (being alone /with family) (p=0.321), clinical titles (p=0.234), and medical specialties(p=0.190). However, the anxiety group (n=156) was marginally younger (38.9 ± 6.0 years) than the non-anxiety group (n=244; 39.7 ± 6.5 years; p=0.226), and females represented 56.4% of the anxiety group versus 34.0% in the non-anxiety group (p=0.054). Notably, intensive care specialists represented 12.8% of the anxiety group versus 7.4% in the non-anxiety group—the largest proportional difference among specialties, though this did not reach statistical significance. Variables related to clinical history factors demonstrated significant associations with the level of anxiety. Participants with moderate-to-severe anxiety were more than twice as likely to report a past psychiatric history compared to those without anxiety (21.8% vs. 9.4%; χ²=10.8, p=0.001). However, there was no statistically significant relationship between significant anxiety level and positive family history of mental disorders (23.1% vs. 15.6%, p=0.059)/nor present medical history among anxious participants (30.8% vs. 23.0%, p=0.082) Table (2): Relationship between anxiety and work-related conditions among the IMMIGRANT studied group: Variable Without anxiety (n=244) With anxiety (n=156) P-value Vacation days: Mean ± SD 33.7 ± 9.9 33.01 ± 9.2 0.472 (NS) Working hours/day ≤ 8 hours >8 hours 208 (85.2%) 36 (14.8%) 119 (76.3%) 37 (23.7%) 0.02 (S) Working days/ week ≤ 4 days >4 days 14 (5.7%) 230 (94.3%) 15 (9.6%) 141 (90.4%) 0.144 (NS) Clinical title: Consultant GP Register Resident 42 (17.2%) 22 (9%) 139 (57%) 41 (16.8%) 16 (10.3%) 14 (9%) 93 (59.6%) 33 (21.2%) 0.234 (NS) Specialty: Medicine: Surgery: ER: ICU: GP: Pediatrics: Academic: Others: 89 (36.5%) 70 (28.7%) 6 (2.5%) 18 (7.4%) 10 (4.1%) 29 (11.9%) 1 (0.4%) 21 (8.6%) 45 (28.8%) 37 (23.7%) 5 (3.2%) 20 (12.8%) 5 (3.2%) 21 (13.5%) 0 (0%) 23 (14.7%) 0.190 (NS) Barriers to use the mental health services: No Yes 160 (65.6%) 84 (34.4%) 62 (39.7%) 94 (60.3%) 0.05 indicates a non-significant result; (S): P value of <0.05 indicates a significant result; (HS): a P value of <0.001 indicates a highly significant result. As regards work-related factors, our results revealed significant associations with anxiety status (Table 2). Physicians with moderate-to-severe anxiety were more likely to work >8 hours daily (23.7% vs. 14.8%; χ²=5.46, p=0.02) and nearly twice as likely to report barriers to mental health services (60.3% vs. 34.4%; χ²=25.2, p<0.001) compared to those without anxiety. Table (3): Regression analysis for anxiety’s predicting factors among immigrant physicians: Variable B Wald OR (95%CI) P-value Past history of psychiatric disorder: More than 8 hours working per day: Barriers to use mental health services: 0.884 0.478 1.022 8.414 3.016 22.51 2.4 (1.3-4.4) 1.6 (0.9-2.7) 2.7 (1.8-4.2) 0.004 (S) 0.082 (NS) 0.05 indicates a non-significant result; (S): P value of <0.05 indicates a significant result; (HS): a P value of <0.001 indicates a highly significant result. Multivariable regression (Table 3) identified two significant predictors of moderate-to-severe anxiety among immigrant physicians. Barriers to mental health services emerged as the strongest predictor (OR=2.7, 95%CI:1.8-4.2, p8 hours/day) showed a clinically relevant association (OR=1.6, 95%CI:0.9-2.7), this did not reach statistical significance (p=0.082). Depression correlates Results of our research showed that moderate-to-severe depression (vs. normal-to-mild) showed significant demographic and clinical correlates. Female physicians had over 2.5 times higher depression prevalence (57.1% vs. 34.1%; χ²=11.2, p=0.001). Clinical history revealed even stronger associations: those with depression were nearly three times more likely to report a history of mental illness (28.6% vs. 11.6%; χ²=14.9, p<0.001) and twice as likely to have current medical conditions (41.3% vs. 23.1%; χ²=8.9, p=0.003). -Work-related correlates of depression revealed one significant association: physicians with moderate-to-severe depression reported substantially higher barriers to mental health services compared to non-depressed counterparts (68.3% vs. 40.1%; χ²=17.2, p8 hours daily (77.8% vs. 82.5%; p=0.374), or Weekly working patterns (>4 days/week: 93.7% vs. 92.6%; p=0.117). Notably, depressed physicians averaged fewer vacation days (31.7 vs. 33.7) and showed higher rates of extended work hours (22.2% working ≤8 hours/day vs. 17.5%), though these differences were not statistically significant. Moreover, there was no significant relationship between the level of depression and clinical title or specialty. Table (4): Regression analysis for depression’s predicting factors among the immigrant physicians: Variable B Wald OR (95%CI) P-value Gender: Past history of psychiatric disorder: Present history of medical condition Barriers to use mental health services: 0.945 0.829 0.665 1.074 11.45 5.448 4.572 12.63 2.5 (1.4-4.4) 2.2 (1.1-4.5) 1.9 (1.1-3.5) 2.9 (1.6-5.2) 0.001 (HS) 0.02 (S) 0.03 (S) <0.001(HS) Abbreviations: (S): P value of <0.05 indicates a significant result; (HS): a P value of <0.001 indicates a highly significant result. Multivariable logistic regression (Table 4) identified four independent predictors of depression among immigrant physicians. Barriers to mental health services emerged as the strongest predictor (OR=2.9, 95%CI:1.6-5.2, p<0.001), nearly tripling depression odds. Female gender significantly increased depression risk (OR=2.5, 95%CI:1.4-4.4, p=0.001), as did past psychiatric history ( OR=2.2, 95%CI:1.1-4.5, p=0.02). Current medical conditions also demonstrated significant predictive value (OR=1.9, 95%CI:1.1-3.5, p=0.03). Correlates of Suicide Significant demographic differences emerged between physicians with suicidal risk (ideation/attempts) and their non-suicidal counterparts. The suicidal group was markedly younger (36.6 ± 6.1 vs. 39.7 ± 6.3 years; t=3.15, p=0.002) and had a higher representation of non-married individuals (22.7% vs. 11.0%; χ²=5.48, p=0.02). Additionally, suicidal risk was strongly associated with clinical title. Residents had significantly higher suicidal risk (29.5% vs. 17.1%). Regarding the specialty, G.P. (15.9% vs. 8.1%), Surgeons (36.4% vs. 25.6%), and ICU physicians (18.2% vs. 8.4%) had a higher risk of suicide (p=0.04). No associations were found for gender, residence type, or living arrangement (all p>0.05). Clinical history factors demonstrated strong associations with suicidal risk. Physicians with suicidal risk were nearly twice as likely to report positive family history of mental illness (31.8% vs. 16.9%; χ²=6.15, p=0.01) and 2.6 times more likely to have past psychiatric history (31.8% vs. 12.1%; χ²=14.2, p<0.001) compared to the non-suicidal group. In contrast, current medical conditions showed no significant association with suicidal risk (27.3% vs. 25.8%; p=0.838). Work-related factors, including clinical title, the specialty, and mental healthcare barriers, showed a significant association with suicidal compared to the non-suicidal group (p=0.01; p=0.04; p=0.007). No significant differences for vacation days (32.9±11.5 vs. 33.5±9.4 days; p=0.736), extended daily work hours (>8 hours: 25.0% vs. 17.4%; p=0.219) or weekly working patterns (>4 days/week: 86.4% vs. 93.5%; p=0.083). Table (5): Relationship between suicidal risk and frequency of anxiety, depression among immigrant physicians: Variable Without suicidal ideation (n=356) With suicidal ideation (n=44) P-value Anxiety: Absent: Present: 229 (64.3%) 127 (35.7%) 15 (34.1%) 29 (65.9%) <0.001 (HS) Depression: Absent: Present: 306 (86%) 50 (14%) 31 (70.5%) 113 (29.5%) 0.008 (S) Abbreviations: (S): P value of <0.05 indicates a significant result; (HS): a P value of <0.001 indicates a highly significant result. Significant links were observed between suicidal risk and psychiatric symptoms (Table 5). Physicians reporting suicidal risk exhibited substantially higher rates of moderate-to-severe anxiety/depression compared to those without such risk (65.9% vs. 35.7%; χ²=15.2, p<0.001; and 29.5% vs. 14.0%; χ²=7.1, p=0.008, respectively). Table (6): Regression analysis for predicting factors of suicide among the studied group: Variable B Wald OR (95%CI) P-value Age: Specialty (ICU): Unmarried social status: Last certificate (Bachelor’s degree, western certificate): Clinical title (resident): Family history of psychiatric disorder: Past history of psychiatric disorder: Barriers to use mental health services: Anxiety: Depression: 1.437 0.064 0.234 0.053 0.378 0.506 0.815 0.544 0.895 0.076 13.67 0.898 0.417 0.177 3.06 1.601 3.907 6.709 5.225 5.118 4.2 (1.9-9) 1.1 (0.9-1.2) 1.2 (0.6-2.5) 1.1 (0.8-1.3) 1.4 (0.9-2.2) 1.6 (0.7-3.6) 2.2 (1-5.1) 2.9 (1.2-3.9) 2.4 (1.1-5.2) 1.9 (1.3-2.5) <0.001 0.343(NS) 0.519(NS) 0.674(NS) 0.080(NS) 0.206(NS) 0.04 (S) 0.05 indicates a non-significant result; (S): P value of <0.05 indicates a significant result; (HS): a P value of <0.001 indicates a highly significant result. Multivariable logistic regression identified four independent predictors of suicidal risk among the migrant physicians (Table 6). This table shows that age, the presence of a history of psychiatric illness, the presence of anxiety, depression, and the presence of barriers against use of health services were found to be predictors for suicidal risk among the immigrant physicians. Younger physicians were found to be fourfold more likely to have suicidal risk compared to their older counterparts (OR=0.4.2 [1.9-9], p<0.001). Those having a past history of psychiatric illness were found to be nearly two-fold more likely to have suicidal risk compared to those without a history (OR=2.2 [1-5.1], P=0.04). Also, subjects who experienced anxiety and depression were at nearly two-fold risk of suicide compared to those who didn’t experience either of them (OR=2.4 [1.1-5.2], P=0.02, OR=1.9 [1.3-2.5], P=0.03), respectively. Interestingly, migrant physicians who showed they had barriers against using health services were found to have nearly three times higher risk of suicidal risk compared to those who hadn’t (OR=2.9 [1.2-3.9], P<0.001). Discussion This research addresses a critical gap in understanding the psychological well-being of expatriate physicians, a population facing unique transnational stressors yet markedly understudied. Our cross-sectional study of 400 Egyptian physician migrants practicing in the Arab Gulf and Western nations assessed depression and anxiety frequency while determining key modifiable risk factors for suicidality. Frequency of mental health problems: Depression and anxiety among migrant physicians This study revealed substantial mental health burdens among Egyptian physician migrants, with moderate-to-severe depression affecting 15.8% and clinically significant anxiety present in 39% of participants. These findings are matched with global migrant health patterns: Foo et al. (2018) [16] documented nearly identical depression prevalence (15.6%) across 16,121 migrants spanning 20 nations, while Chen et al. (2019) [17]. observed higher depression rates (24.3%) among Chinese migrant participants. Contemporary meta-analytic evidence reinforces these epidemiological patterns, with Hasan et al. (2021) [8]. documenting aggregate depression (39.0%) and anxiety (27.3%) rates, aligning closely with our results. Divergent prevalence patterns emerge when comparing our findings with prior migrant health studies. Hatch et al. (2016) [18]. documented lower depression (10.7%) and Generalized Anxiety Disorder GAD (6.9%) rates among their migrant cohort, while Adebayo et al. (2020) [19]. reported minimal anxiety prevalence (5%). These methodological discrepancies likely reflect differences in study populations and psychometric instrumentation rather than true epidemiological variation. Migration exerts profound and multifaceted impacts on mental health through interconnected stressors that extend through three temporal phases: pre-migration challenges—including socioeconomic precarity, disrupted social networks, trauma exposure, and political instability in origin countries; migration journey adversities—such as hazardous transit conditions, violence exposure, community separation, and resettlement uncertainty; and post-migration adjustments—featuring employment instability, social isolation, family separation distress, linguistic barriers, and cultural adaptation strains [20,9,21]. Physician migrants navigate additional profession-specific vulnerabilities wherein advanced education paradoxically amplifies psychological risk. Despite their qualifications, they frequently confront credential devaluation and language-mediated employment barriers [22]. While heightened educational attainment may foster critical consciousness of systemic inequities and elevate lifestyle expectations, creating cognitive dissonance when professional identities clash with occupational marginalization, ultimately generating distress pathways to mental disorders [23]. Frequency of Suicide among migrant physicians Our findings reveal significant suicide vulnerability among Egyptian physician migrants: 11% exhibited suicide risk (6.3% active ideation; 4.7% attempts), aligning with established evidence of elevated suicidality in immigrant populations [6, 24]. This confirms the results of the previous work by Amir (2020) [25], which included a meta-analysis of 51 studies (N=482,311 migrants) and reported 16% ideation and 6% attempt prevalence globally. Acculturation stress—the psychological strain of adapting to new cultural environments—remains a critical suicide precipitant [26]. Again, for physicians, this is amplified by profession-specific stressors, systemic healthcare disparities, institutional stigma around help-seeking, and fear of professional consequences further heighten risk. These gaps create cascading vulnerabilities where untreated distress escalates to suicidality—a pattern acutely observed in our research, particularly among early-career physicians facing occupational instability. Furthermore, pervasive "triple stigma" – encompassing personal shame, professional judgment, and institutional penalties – creates profound obstacles to care. Contemporary data confirms that a majority (68%) of distressed physicians, particularly migrants, avoid treatment due to licensure fears, showing minimal improvement despite awareness efforts [27]. Deeply ingrained self-reliance norms, originating from training cultures emphasizing invulnerability, demonstrably delay intervention and mediate distress (37%), resulting in critically low help-seeking rates even among those experiencing suicidal ideation [28]. Additionally, traits like perfectionism, traditionally selected for medical excellence, become potent risk factors under chronic stress. When coupled with workload, they contribute to professional identity erosion – a disintegration of clinical self-worth that precipitates a crisis [29]. Collectively, these factors necessitate targeted interventions addressing lethal means safety, stigma reduction, cultural shifts towards help-seeking, and support systems mitigating perfectionism and identity [28-30]. Significant predictors of mental health problems and suicidal risk by regression analysis 1. Sociodemographic predictors Regression analysis accounting for confounders identified female gender and comorbid medical conditions as significant predictors of depression; however, age was a highly significant factor for suicide among migrant physicians in our study. This aligns with extensive prior evidence demonstrating women's heightened vulnerability to depression across populations, attributed to interrelated biological (e.g., genetic predisposition, hormonal fluctuations), sociocultural (e.g., gendered roles, adverse experiences), and psychological factors (e.g., differential stress reactivity, coping styles) [31,32]. While these mechanisms likely contribute to observed disparities, the precise determinants remain incompletely elucidated [33, 32]. Our findings further corroborate established links between physical illness and depressive symptomatology. The frequent co-occurrence of medical conditions and major depressive disorder is increasingly understood through shared pathophysiological pathways, including common genetic variants, immune-inflammatory dysregulation, and illness-related psychosocial sequelae (e.g., altered social functioning) [34, 35]. These intersecting biological and environmental mechanisms substantiate the elevated depression burden observed in individuals managing chronic health challenges, consistent with recent epidemiological reports [35, 36]. One of the impressive findings in this research was that younger Egyptian physician expatriates (<40 years) showed a fourfold higher suicide risk than older colleagues (OR = 4.2 [1.9–9.0], *p* < 0.001). This aligns with global patterns: Lithuanian physicians under 45 exhibited elevated suicide risk due to career instability and inadequate coping [37]. Similarly, young Egyptian physicians face severe isolation and unsustainable workloads [38]. For expatriates, younger doctors’ limited cross-cultural adaptability exacerbates distress from workplace inequities or language barriers [39]. Their underdeveloped resilience and mentorship access heighten vulnerability during crises like COVID-19 [40]. Reinforcing this, physicians aged 30–50 experience 1.3× higher suicide mortality than the general population [41]. This convergence of evidence demands urgent, tailored support for early-career expatriates facing intersecting professional, financial, and acculturative stresses. 2. Clinical predictors Our Research identified a pre-existing psychiatric history as a robust independent predictor of concurrent depression, anxiety, and suicidality among migrant physicians . This finding aligns with established evidence indicating prior depressive episodes significantly increase vulnerability to relapse or recurrence, particularly under adverse conditions, reflecting an ongoing neurobiological and psychological susceptibility [42, 43]. Furthermore, the likelihood of recurrence escalates with both the number of past episodes and the presence of comorbid anxiety, suggesting a cumulative pathophysiological burden [44,45]. Critically, our research confirmed the profound link between active anxiety/depression and heightened suicide risk in this population. Affected participants exhibited nearly twice the odds of suicidality compared to unaffected peers (Anxiety: OR=2.4, 95% CI [1.1-5.2], p=0.02; Depression: OR=1.9, 95% CI [1.3-2.5], p=0.03). This corroborates the well-documented paradigm where psychiatric morbidity constitutes a primary driver of suicidal behavior, with epidemiological studies consistently reporting that >90% of suicide attempters experience significant psychiatric illness [46- 49]. Additionally, previous research found that both anxiety symptoms and depressive symptoms were independent risk factors for suicidal behaviors, which increase the risk for suicide [50-52]. Evidence indicates individuals with anxiety disorders frequently exhibit diminished distress tolerance and impaired emotion regulation capacities ([53, 54]. This compromised ability to process and modulate negative affective states may heighten vulnerability to viewing suicidality as a perceived means of escape from psychological anguish (Rodriguez & Kendall, 2014) [54]. Moreover, anxiety's contribution to suicide risk demonstrates differential effects contingent on the severity of co-occurring depressive symptoms [55]. Consequently, comprehensive clinical assessment must account for these frequent psychiatric comorbidities to accurately evaluate risk profiles [52]. 3. Work-related predictors One of the striking findings in our research is that barriers to mental healthcare access constitute a robust independent predictor for depression, anxiety, and suicidality among migrant physicians. Notably, these structural obstacles emerged as one of the strongest predictors for both anxiety (OR=2.7, 95%CI:1.8-4.2, p<0.001) and depression (OR=2.9, 95%CI:1.6-5.2, p<0.001). Participants facing healthcare barriers demonstrated nearly threefold elevated suicide risk compared to unimpeded counterparts (OR=2.9, 95%CI:1.2-3.9, p<0.001). Reported barriers included insurance deficits (most prevalent), termination fears, stigma, language limitations, and time constraints due to workload (Figure 2). This aligns with established evidence documenting heightened psychiatric morbidity among immigrants encountering healthcare access challenges [56, 57, 8]. Comparable structural challenges—including financial constraints, linguistic barriers, insurance gaps, legal status complications, temporal limitations from intensive work schedules, cultural preferences for traditional healing, and geographic inaccessibility—commonly restrict healthcare utilization in migrant populations [58-61]. Furthermore, profound mental health stigma within many immigrant communities substantially interferes with service utilization [62-65]. Previous studies have investigating barriers and facilitators to help seeking among distressed physicians, found that they have some beliefs about seeking help, which may prevent them from contact health services, such as being ill is a sign of failure, or weakness or not strong enough [66-68]. Our study shed light on the importance of access to mental health services for migrant physicians, which may minimize the mental burden of migration with better management of their mental health problems and ultimately reduce the suicidal risk and improve the quality of life. Limitations: This study had some limitations. First, it is a cross-sectional study, which limits the establishment of a cause-and-effect relationship. Second, it depends on self-reporting scales and questions, which raises the possibility of bias. Third, stigma about having a mental disorder, especially among physicians, may lead to an underestimation of results. Although this study has many limitations, it also has many strengths. This study is one of the few, if not the only, to assess the effect of immigration on the mental health of migrating physicians. It included a large number of participants from immigrants to Arab and Western countries. It investigated as many aspects (demographic, clinical, social, and occupational) as possible of the risk factors of mental illness among Egyptian migrant physicians. Conclusions Our study reveals the profound human cost of the physicians, borne by immigration: anxiety shadows 39% of the Egyptian medical expatriate, depression affects 15.7%, and 11% face suicidal risk. Behind these numbers lie critical vulnerabilities—a prior history of psychiatric distress significantly heightens susceptibility to all three conditions, while female physicians and those managing medical illnesses are particularly prone to depression. Alarmingly, younger expatriates carry a fourfold greater suicide risk. Crucially, the greatest predictor of heightened mental health struggles is the presence of barriers to healthcare access. This research underscores an urgent moral and practical imperative: ensuring migrant doctors have unimpeded, compassionate access to mental health support is not merely beneficial—it is essential for safeguarding their well-being, enriching their quality of life, and ultimately preserving the skilled, resilient workforce upon which their host communities depend. Future research should prioritize longitudinal and cohort research to map the progression of mental health outcomes in migrant physicians, accounting for the complex interplay of demographic, biological, psychological, environmental, occupational, and social factors. This evidence base is crucial for subsequently assessing the impact and efficacy of tailored psychological and social support interventions Abbreviations ER Emergency Room GAD Generalized Anxiety Disorder GCC Gulf Cooperation Council GP General Practitioner HADS Hospital Anxiety and Depression Scale ICU Intensive Care Unit KSA Kingdom of Saudi Arabia UAE United Arab Emirates UK United Kingdom USA United States Declarations Acknowledgements The authors are grateful to all participants in our study. This study would not have been possible without the invaluable contributions of the Egyptian medical expatriates who participated. We acknowledge with deep respect the significant trust placed in us as you shared sensitive experiences related to psychological distress and suicide risk while navigating life and practice in foreign lands. Funding The authors declare that no financial support was received for this study Availability of data and materials To support scientific transparency and collaboration, the datasets generated and analyzed during this study are maintained by the corresponding author and can be provided upon reasonable request. Ethics approval and consent to participate Zagazig University's Institutional Review Board granted ethical approval for this research, with Clinical Trial Number: #ZU-IRB 10307/10-1-2019. The study procedures strictly complied with the Declaration of Helsinki's ethical standards and its amendments. Before participation, all enrolled physicians provided digitally documented informed consent. Consent for publication Not applicable. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7171595","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500463906,"identity":"b4bfce02-3d38-43b1-9f2b-8612f4005a09","order_by":0,"name":"Mervat 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2","display":"","copyAsset":false,"role":"figure","size":29810,"visible":true,"origin":"","legend":"\u003cp\u003ePie diagram showing the frequency of barriers against seeking medical help among immigrant physicians.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7171595/v1/20fd4e64a1c3dfceaedc91fc.png"},{"id":89410326,"identity":"599f444d-5650-4099-a4bd-8cda04a68e6c","added_by":"auto","created_at":"2025-08-19 16:04:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":347268,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eInterconnected factors that amplify the risk of suicide among migrant physicians\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7171595/v1/60e31912ac816c4c77af4a00.png"},{"id":89411062,"identity":"1c9fa4ed-1340-483d-9bc2-f88b4f10db16","added_by":"auto","created_at":"2025-08-19 16:12:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2245334,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171595/v1/3536f524-0192-46e6-9b11-c49c644593f2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Physician Well-Being in Foreign Lands: Unmasking Mental Health Problems and Suicide Risk Among Egyptian Medical Expatriates","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePhysician migration represents a global phenomenon with profound personal and professional implications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Worldwide, migration commonly occurs from less-developed to more-developed countries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Egyptian doctors increasingly seek opportunities abroad—primarily in the Gulf and Western countries—driven by systemic challenges including inadequate compensation, strenuous work environments, and limited professional autonomy in their home country. While such migration offers career advancement, the journey carries a significant psychological impact [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite growing recognition of mental health challenges among migrant populations globally [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the unique burdens facing \u003cem\u003ephysician\u003c/em\u003e migrants remain critically understudied.Emergent research confirms that relocation itself amplifies vulnerability to psychological distress, with immigrants facing elevated risks of depression, anxiety, and identity conflicts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrior work identifies high rates of depression, substance use, and sleep disorders in general migrant workers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; therefore, physicians practicing abroad confront unique psychological burdens as they navigate licensing complexities, credential reevaluation, and high-pressure clinical contexts—all while adapting to unfamiliar cultural settings.\u003c/p\u003e\u003cp\u003eReview of literature highlights the scarcity of studies on physician migrants’ mental health and suicide risk, a population where untreated distress jeopardizes both clinician well-being and patient safety [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our research bridges this evidence gap by examining depression, anxiety, and suicidality among Egyptian physician expatriates, quantifying prevalence and identifying modifiable risk factors to shed light on rapid needed interventions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Design and Participant Recruitment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted a cross-sectional online survey targeting Egyptian physicians practicing abroad. Participants were recruited via country-specific, physician-exclusive Facebook groups across six destination countries: the Gulf Cooperation Council (GCC) countries (Kingdom of Saudi Arabia [KSA], United Arab Emirates [UAE], Kuwait) and Western regions (United States [USA], United Kingdom [UK], Germany).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample\u003c/b\u003e \u003cb\u003eSize and Eligibility\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInitially, 441 subjects participated in this study. Following screening, 41 respondents were excluded due to incomplete response (n = 29\u003cem\u003e)\u003c/em\u003e or failure to meet the inclusion criteria (n = 12), yielding a final sample of 400 migrant physicians. The inclusion Criteria included licensed physicians of Egyptian origin, both sexes, actively practicing abroad for at least the last year, and with an age between 30–60 years. The Exclusion Criteria included severe comorbid physical illnesses (e.g., renal/hepatic failure, malignancy), Current substance use disorders, and those who returned to Egyptian practice during the last year.\u003c/p\u003e\u003cp\u003eS\u003cb\u003eample Size \u0026amp; Sampling Method\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA minimum target sample of 385 participants was calculated using Open Epi software (Version 3.01), based on a conservative depression/anxiety prevalence estimate of 50% derived from physician population studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This calculation ensured 80% statistical power to detect significant effects within a 95% confidence interval and ± 5% margin of error. We employed comprehensive consecutive sampling to inclusively enroll all eligible Egyptian migrant physicians practicing in target destinations during a six-month recruitment window (September 2019–February 2020). Geographic coverage included: Gulf Cooperation Council (GCC) nations: KSA, UAE, Kuwait, and Oman, and Western countries: USA, UK, and Germany.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eData were collected via a structured electronic questionnaire assessing four domains: (1) Sociodemographic characteristics (age, sex, marital status, pre-migration Egyptian residence [urban/rural], current living arrangement “alone /with family”); (2) Clinical history (personal/family psychiatric history, current medical comorbidities, substance use disorders excluding nicotine); (3) Occupational and migration factors (professional title, specialty, daily work hours [≤ 8 vs. \u0026gt;8], weekly workdays, annual vacation days, and mental healthcare access barriers [dichotomized yes/no; open-text specification for reasons); and (4) Psychometric assessments, including the Hospital Anxiety and Depression Scale (HADS) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], (An Arabic-validated form by Moussa et al. (2016) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] was administered.). It is a 14-item self-report tool (7 anxiety + 7 depression items; 4-point Likert scales [0–3]; subscale range 0–21) with scores ≥ 11 indicating clinically significant symptoms. —alongside direct screening for suicide risk through two items assessing 1-month suicidal ideation (\"Have you considered ending your life in the past month?\") and attempts with yes/ no answers.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe collected data underwent digital processing and statistical analysis using IBM SPSS Statistics (Version 27.0). Categorical variables were summarized as frequency counts with proportional percentages, with between-group differences assessed via chi-square (χ²) tests. Continuous measures were reported as means ± standard deviations (SD), with independent samples t-tests comparing normally distributed variables across two groups. Univariate logistic regression initially screened variable associations, with significant predictors (p \u0026lt; 0.05) advancing to multivariable models controlling for confounders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model calibration was verified through Hosmer-Lemeshow goodness-of-fit testing. Statistical significance thresholds were defined as: p \u0026gt; 0.05 (non-significant), p ≤ 0.05 (significant), and p ≤ 0.001 (highly significant).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eThe socio-demographic and clinical characteristics\u003c/strong\u003e of the 400 participants are summarized in Table 1. The mean age of the subjects was 39.4 years (\u0026plusmn;6.3 SD). Most of them were male (62.3%, n = 249), married (87.8%, n = 351), residing in urban areas (91.3%, n = 365), and living with their family (74.5%, n = 298). Registrars constituted the largest professional group (58.0%, n = 232), followed by residents (18.5%, n = 74) and consultants (14.5%, n = 58). The most common specialties were Medicine (33.5%, n=134) and Surgery (26.8%, n=107). A minority reported a positive family history of psychiatric illness (19.7%, n=92), a past psychiatric history (24.7%, n=115), or a present medical history (26.0%, n=104).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: The sociodemographic and clinical variables among the studied group:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmigrant\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=400)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; **SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39.4 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e151 (37.8%)\u003c/p\u003e\n \u003cp\u003e249 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial status:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003e*Non\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e351 (87.8%)\u003c/p\u003e\n \u003cp\u003e49 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35 (8.8%)\u003c/p\u003e\n \u003cp\u003e365 (91.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving Arrangement:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003cp\u003eWith family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e102 (25.5%)\u003c/p\u003e\n \u003cp\u003e298 (74.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical title:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eConsultant\u003c/p\u003e\n \u003cp\u003e**GP\u003c/p\u003e\n \u003cp\u003eRegistrar\u003c/p\u003e\n \u003cp\u003eResident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58 (14.5%)\u003c/p\u003e\n \u003cp\u003e36 (9%)\u003c/p\u003e\n \u003cp\u003e232 (58%)\u003c/p\u003e\n \u003cp\u003e74 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialty:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedicine:\u003c/p\u003e\n \u003cp\u003eSurgery:\u003c/p\u003e\n \u003cp\u003e**ER:\u003c/p\u003e\n \u003cp\u003e**ICU:\u003c/p\u003e\n \u003cp\u003e**GP:\u003c/p\u003e\n \u003cp\u003ePediatrics:\u003c/p\u003e\n \u003cp\u003eAcademic:\u003c/p\u003e\n \u003cp\u003eOthers:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e134 (33.5%)\u003c/p\u003e\n \u003cp\u003e107 (26.8%)\u003c/p\u003e\n \u003cp\u003e11 (2.8%)\u003c/p\u003e\n \u003cp\u003e38 (9.5%)\u003c/p\u003e\n \u003cp\u003e15 (3.8%)\u003c/p\u003e\n \u003cp\u003e50 (12.5%)\u003c/p\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003cp\u003e44 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e374 (80.3%)\u003c/p\u003e\n \u003cp\u003e92 (19.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast history:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e351 (75.3%)\u003c/p\u003e\n \u003cp\u003e115 (24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent medical history:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 446px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e296 (74%)\u003c/p\u003e\n \u003cp\u003e104 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003cstrong\u003eNon-Married: includes single, divorced, and widowed.\u003cbr\u003e\u0026nbsp;**Abbreviations: GP, General Practitioner; ER, Emergency Room; ICU, Intensive Care Unit; SD, Standard Deviation.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcerning the work-related patterns and mental healthcare barriers among immigrant physicians (N=400), the data showed that the mean vacation days per year is 33.4 (SD=9.6). Workload patterns revealed that 327 participants (81.8%) exceeded 8 daily working hours, while 371 (92.8%) worked more than 4 days weekly. Regarding mental healthcare access, 178 physicians (44.5%) identified significant barriers to service utilization.\u003c/p\u003e\n\u003cp\u003eRegarding the frequency of mental health problems among the migrant physicians, our results showed that moderate-to-severe anxiety affected 39% (n=156) of participants, while 15.8% (n=65) reported moderate-to-severe depression levels. Notably, 11% (n=44) exhibited suicidal risk, comprising 6.3% (n=25) with active suicidal ideation and 4.7% (n=19) with suicide attempts during the last month, as shown in Figure (1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety correlates\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcerning the Anxiety group: bivariate analyses examining demographic correlates of anxiety (moderate-to-severe vs. normal-to-mild) revealed no statistically significant associations regarding the age (p=0.226), sex (p=0.54), residence (p=0.185), living arrangement (being alone /with family) (p=0.321), clinical titles (p=0.234), and medical specialties(p=0.190). However, the anxiety group (n=156) was marginally younger (38.9 \u0026plusmn; 6.0 years) than the non-anxiety group (n=244; 39.7 \u0026plusmn; 6.5 years; p=0.226), and females represented 56.4% of the anxiety group versus 34.0% in the non-anxiety group (p=0.054). Notably, intensive care specialists represented 12.8% of the anxiety group versus 7.4% in the non-anxiety group\u0026mdash;the largest proportional difference among specialties, though this did not reach statistical significance.\u003c/p\u003e\n\u003cp\u003eVariables related to clinical history factors demonstrated significant associations with the level of anxiety.\u0026nbsp;Participants with moderate-to-severe anxiety were more than twice as likely to report a past psychiatric history compared to those without anxiety (21.8% vs. 9.4%; \u0026chi;\u0026sup2;=10.8, p=0.001). However, there was no statistically significant relationship between significant anxiety level and positive family history of mental disorders (23.1% vs. 15.6%, p=0.059)/nor present medical history among anxious participants (30.8% vs. 23.0%, p=0.082)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table (2): Relationship between anxiety and work-related conditions among the IMMIGRANT studied group:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(n=244)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=156)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVacation days:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33.7 \u0026plusmn; 9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33.01 \u0026plusmn; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.472 (NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking hours/day\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026le; 8 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;8 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e208 (85.2%)\u003c/p\u003e\n \u003cp\u003e36 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e119 (76.3%)\u003c/p\u003e\n \u003cp\u003e37 (23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(S)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking days/ week\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026le; 4 days\u003c/p\u003e\n \u003cp\u003e\u0026gt;4 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (5.7%)\u003c/p\u003e\n \u003cp\u003e230 (94.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (9.6%)\u003c/p\u003e\n \u003cp\u003e141 (90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003cp\u003e(NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical title:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eConsultant\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGP\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRegister\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eResident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (17.2%)\u003c/p\u003e\n \u003cp\u003e22 (9%)\u003c/p\u003e\n \u003cp\u003e139 (57%)\u003c/p\u003e\n \u003cp\u003e41 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (10.3%)\u003c/p\u003e\n \u003cp\u003e14 (9%)\u003c/p\u003e\n \u003cp\u003e93 (59.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 33 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003cp\u003e(NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecialty:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedicine:\u003c/p\u003e\n \u003cp\u003eSurgery:\u003c/p\u003e\n \u003cp\u003eER:\u003c/p\u003e\n \u003cp\u003eICU:\u003c/p\u003e\n \u003cp\u003eGP:\u003c/p\u003e\n \u003cp\u003ePediatrics:\u003c/p\u003e\n \u003cp\u003eAcademic:\u003c/p\u003e\n \u003cp\u003eOthers:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89 (36.5%)\u003c/p\u003e\n \u003cp\u003e70 (28.7%)\u003c/p\u003e\n \u003cp\u003e6 (2.5%)\u003c/p\u003e\n \u003cp\u003e18 (7.4%)\u003c/p\u003e\n \u003cp\u003e10 (4.1%)\u003c/p\u003e\n \u003cp\u003e29 (11.9%)\u003c/p\u003e\n \u003cp\u003e1 (0.4%)\u003c/p\u003e\n \u003cp\u003e21 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (28.8%)\u003c/p\u003e\n \u003cp\u003e37 (23.7%)\u003c/p\u003e\n \u003cp\u003e5 (3.2%)\u003c/p\u003e\n \u003cp\u003e20 (12.8%)\u003c/p\u003e\n \u003cp\u003e5 (3.2%)\u003c/p\u003e\n \u003cp\u003e21 (13.5%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e23 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003cp\u003e(NS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers to use the mental health services:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e160 (65.6%)\u003c/p\u003e\n \u003cp\u003e84 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e62 (39.7%)\u003c/p\u003e\n \u003cp\u003e94 (60.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(HS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003e(NS):\u003cstrong\u003e\u0026nbsp;means P value of \u0026gt;0.05 indicates a non-significant result; (S): P value of \u0026lt;0.05 indicates a significant result; (HS): a P value of \u0026lt;0.001 indicates a highly significant result.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs regards work-related factors, our results revealed significant associations with anxiety status (Table 2). Physicians with moderate-to-severe anxiety were more likely to work \u0026gt;8 hours daily (23.7% vs. 14.8%; \u0026chi;\u0026sup2;=5.46, p=0.02) and nearly twice as likely to report barriers to mental health services (60.3% vs. 34.4%; \u0026chi;\u0026sup2;=25.2, p\u0026lt;0.001) compared to those without anxiety.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): Regression analysis for anxiety\u0026rsquo;s predicting factors among immigrant physicians:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.8039%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4183%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;OR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.8039%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast history of psychiatric disorder:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMore than 8 hours working per day:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers to use mental health services:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4183%;\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e1.022\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8.414\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3.016\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e22.51\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.4 (1.3-4.4)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e1.6 (0.9-2.7)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.7 (1.8-4.2)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004 (S)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.082 (NS)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(HS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e (NS): \u003cstrong\u003emeans P value of \u0026gt;0.05 indicates a non-significant result; (S): P value of \u0026lt;0.05 indicates a significant result; (HS): a P value of \u0026lt;0.001 indicates a highly significant result.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable regression (Table 3) identified two significant predictors of moderate-to-severe anxiety among immigrant physicians. Barriers to mental health services emerged as the strongest predictor (OR=2.7, 95%CI:1.8-4.2, p\u0026lt;0.001).\u0026nbsp;Past psychiatric history\u0026nbsp;also demonstrated significant predictive value (OR=2.4, 95%CI:1.3-4.4, p=0.004). While extended work hours (\u0026gt;8 hours/day) showed a clinically relevant association (OR=1.6, 95%CI:0.9-2.7), this did not reach statistical significance (p=0.082).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression correlates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults of our research showed that moderate-to-severe depression \u0026nbsp;(vs. normal-to-mild) showed significant demographic and clinical correlates. Female physicians had over 2.5 times higher depression prevalence (57.1% vs. 34.1%; \u0026chi;\u0026sup2;=11.2, p=0.001). Clinical history revealed even stronger associations: those with depression were nearly three times more likely to report a history of mental illness (28.6% vs. 11.6%; \u0026chi;\u0026sup2;=14.9, p\u0026lt;0.001) and twice as likely to have current medical conditions (41.3% vs. 23.1%; \u0026chi;\u0026sup2;=8.9, p=0.003).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Work-related correlates of depression\u003c/strong\u003e revealed one significant association: physicians with moderate-to-severe depression reported substantially higher barriers to mental health services compared to non-depressed counterparts (68.3% vs. 40.1%; \u0026chi;\u0026sup2;=17.2, p\u0026lt;0.001). On the other hand, no significant differences emerged for Vacation days (31.7\u0026plusmn;10.1 vs. 33.7\u0026plusmn;9.5 days; t=1.57, p=0.119), proportion working \u0026gt;8 hours daily (77.8% vs. 82.5%; p=0.374), or Weekly working patterns (\u0026gt;4 days/week: 93.7% vs. 92.6%; p=0.117). Notably, depressed physicians averaged fewer vacation days (31.7 vs. 33.7) and showed higher rates of extended work hours (22.2% working \u0026le;8 hours/day vs. 17.5%), though these differences were not statistically significant. Moreover, there was no significant relationship between the level of depression and clinical title or specialty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4): Regression analysis for depression\u0026rsquo;s\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;predicting factors among the immigrant physicians:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;OR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePast history of psychiatric disorder:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePresent history of medical condition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers to use mental health services:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.448\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.572\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.5 (1.4-4.4)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.2 (1.1-4.5)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.9 (1.1-3.5)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.9 (1.6-5.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001 (HS)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.02 (S)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.03 (S)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001(HS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(S): P value of \u0026lt;0.05 indicates a significant result; (HS): a P value of \u0026lt;0.001 indicates a highly significant result.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression (Table 4) identified four independent predictors of depression among immigrant physicians. \u003cstrong\u003eBarriers to mental health services\u003c/strong\u003e emerged as the strongest predictor (OR=2.9, 95%CI:1.6-5.2, p\u0026lt;0.001), nearly tripling depression odds. \u003cstrong\u003eFemale gender\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esignificantly increased depression risk (OR=2.5, 95%CI:1.4-4.4, p=0.001), as did \u003cstrong\u003epast psychiatric history\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eOR=2.2, 95%CI:1.1-4.5, p=0.02). \u003cstrong\u003eCurrent medical conditions\u003c/strong\u003e also demonstrated significant predictive value (OR=1.9, 95%CI:1.1-3.5, p=0.03).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelates of Suicide\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant demographic differences emerged between physicians with suicidal risk (ideation/attempts) and their non-suicidal counterparts. The suicidal group was markedly younger (36.6 \u0026plusmn; 6.1 vs. 39.7 \u0026plusmn; 6.3 years; t=3.15, p=0.002) and had a higher representation of non-married individuals (22.7% vs. 11.0%; \u0026chi;\u0026sup2;=5.48, p=0.02). Additionally, suicidal risk was strongly associated with clinical title. Residents had significantly higher suicidal risk (29.5% vs. 17.1%). Regarding the specialty, G.P. (15.9% vs. 8.1%), Surgeons (36.4% vs. 25.6%), and ICU physicians (18.2% vs. 8.4%) had a higher risk of suicide (p=0.04). No associations were found for gender, residence type, or living arrangement (all p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eClinical history factors demonstrated strong associations with suicidal risk. Physicians with suicidal risk were nearly twice as likely to report positive family history of mental illness (31.8% vs. 16.9%; \u0026chi;\u0026sup2;=6.15, p=0.01) and 2.6 times more likely to have past psychiatric history (31.8% vs. 12.1%; \u0026chi;\u0026sup2;=14.2, p\u0026lt;0.001) compared to the non-suicidal group. In contrast, current medical conditions showed no significant association with suicidal risk (27.3% vs. 25.8%; p=0.838).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWork-related factors, including clinical title, the specialty, \u0026nbsp;and mental healthcare barriers, showed a significant association with suicidal compared to the non-suicidal group (p=0.01; p=0.04; p=0.007). No significant differences for vacation days (32.9\u0026plusmn;11.5 vs. 33.5\u0026plusmn;9.4 days; p=0.736), extended daily work hours (\u0026gt;8 hours: 25.0% vs. 17.4%; p=0.219) or weekly working patterns (\u0026gt;4 days/week: 86.4% vs. 93.5%; p=0.083).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5): Relationship between suicidal risk and frequency of anxiety, depression among immigrant physicians:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout suicidal ideation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(n=356)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith suicidal ideation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=44)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAbsent:\u003c/p\u003e\n \u003cp\u003ePresent: \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e229 (64.3%)\u003c/p\u003e\n \u003cp\u003e127 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(HS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAbsent:\u003c/p\u003e\n \u003cp\u003ePresent: \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e306 (86%)\u003c/p\u003e\n \u003cp\u003e50 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (70.5%)\u003c/p\u003e\n \u003cp\u003e113 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(S)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(S): P value of \u0026lt;0.05 indicates a significant result; (HS): a P value of \u0026lt;0.001 indicates a highly significant result.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant links were observed between suicidal risk and psychiatric symptoms (Table 5). Physicians reporting suicidal risk exhibited substantially higher rates of moderate-to-severe anxiety/depression compared to those without such risk (65.9% vs. 35.7%; \u0026chi;\u0026sup2;=15.2, p\u0026lt;0.001; and 29.5% vs. 14.0%; \u0026chi;\u0026sup2;=7.1, p=0.008, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6): Regression analysis for predicting factors of suicide among the studied group:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;OR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSpecialty (ICU):\u003c/p\u003e\n \u003cp\u003eUnmarried social status:\u003c/p\u003e\n \u003cp\u003eLast certificate (Bachelor\u0026rsquo;s degree, western certificate):\u003c/p\u003e\n \u003cp\u003eClinical title (resident):\u003c/p\u003e\n \u003cp\u003eFamily history of psychiatric disorder:\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePast history of psychiatric disorder:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers to use mental health\u003c/strong\u003e \u003cstrong\u003eservices:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDepression:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.437\u003c/p\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13.67\u003c/p\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.06\u003c/p\u003e\n \u003cp\u003e1.601\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.907\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e6.709\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.225\u003c/p\u003e\n \u003cp\u003e5.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.2 (1.9-9)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1.1 (0.9-1.2)\u003c/p\u003e\n \u003cp\u003e1.2 (0.6-2.5)\u003c/p\u003e\n \u003cp\u003e1.1 (0.8-1.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.4 (0.9-2.2)\u003c/p\u003e\n \u003cp\u003e1.6 (0.7-3.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.2 (1-5.1)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.9 (1.2-3.9)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.4 (1.1-5.2)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.9 (1.3-2.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.343(NS)\u003c/p\u003e\n \u003cp\u003e0.519(NS)\u003c/p\u003e\n \u003cp\u003e0.674(NS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.080(NS)\u003c/p\u003e\n \u003cp\u003e0.206(NS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.04 (S)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001(HS)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.02(S)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.03(S)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: (\u003c/strong\u003eNS\u003cstrong\u003e): means P value of \u0026gt;0.05 indicates a non-significant result; (S): P value of \u0026lt;0.05 indicates a significant result; (HS): a P value of \u0026lt;0.001 indicates a highly significant result.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression identified four independent predictors of suicidal risk among the migrant physicians (Table 6). This table shows that age, the presence of a history of psychiatric illness, the presence of anxiety, depression, and the presence of barriers against use of health services were found to be predictors for suicidal risk among the immigrant physicians. Younger physicians were found to be fourfold more likely to have suicidal risk compared to their older counterparts (OR=0.4.2 [1.9-9], p\u0026lt;0.001). Those having a past history of psychiatric illness were found to be nearly two-fold more likely to have suicidal risk compared to those without a history (OR=2.2 [1-5.1], P=0.04). Also, subjects who experienced anxiety and depression were at nearly two-fold risk of suicide compared to those who didn\u0026rsquo;t experience either of them (OR=2.4 [1.1-5.2], P=0.02, OR=1.9 [1.3-2.5], P=0.03), respectively. Interestingly, migrant physicians who showed they had barriers against using health services were found to have nearly three times higher risk of suicidal risk compared to those who hadn\u0026rsquo;t (OR=2.9 [1.2-3.9], P\u0026lt;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research addresses a critical gap in understanding the psychological well-being of expatriate physicians, a population facing unique transnational stressors yet markedly understudied. Our cross-sectional study of 400 Egyptian physician migrants practicing in the Arab Gulf and Western nations assessed depression and anxiety frequency while determining key modifiable risk factors for suicidality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFrequency of mental health problems: Depression and anxiety among migrant physicians\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed substantial mental health burdens among Egyptian physician migrants, with moderate-to-severe depression affecting 15.8% and clinically significant anxiety present in 39% of participants. These findings are matched with global migrant health patterns: Foo et al. (2018) [16] \u0026nbsp;documented nearly identical depression prevalence (15.6%) across 16,121 migrants spanning 20 nations, while Chen et al. (2019) [17]. \u0026nbsp;observed higher depression rates (24.3%) among Chinese migrant participants. Contemporary meta-analytic evidence reinforces these epidemiological patterns, with Hasan et al. (2021) [8]. \u0026nbsp;documenting aggregate depression (39.0%) and anxiety (27.3%) rates, aligning closely with our results.\u003c/p\u003e\n\u003cp\u003eDivergent prevalence patterns emerge when comparing our findings with prior migrant health studies. Hatch et al. (2016) [18]. \u0026nbsp;documented lower depression (10.7%) and Generalized Anxiety Disorder GAD (6.9%) rates among their migrant cohort, while Adebayo et al. (2020) [19]. \u0026nbsp;reported minimal anxiety prevalence (5%). These methodological discrepancies likely reflect differences in study populations and psychometric instrumentation rather than true epidemiological variation.\u003c/p\u003e\n\u003cp\u003eMigration exerts profound and multifaceted impacts on mental health through interconnected stressors that extend through three temporal phases: pre-migration challenges\u0026mdash;including socioeconomic precarity, disrupted social networks, trauma exposure, and political instability in origin countries; migration journey adversities\u0026mdash;such as hazardous transit conditions, violence exposure, community separation, and resettlement uncertainty; and post-migration adjustments\u0026mdash;featuring employment instability, social isolation, family separation distress, linguistic barriers, and cultural adaptation strains [20,9,21]. Physician migrants navigate additional profession-specific vulnerabilities wherein advanced education paradoxically amplifies psychological risk. Despite their qualifications, they frequently confront credential devaluation and language-mediated employment barriers [22]. While heightened educational attainment may foster critical consciousness of systemic inequities and elevate lifestyle expectations, creating cognitive dissonance when professional identities clash with occupational marginalization, ultimately generating distress pathways to mental disorders [23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFrequency of Suicide among migrant physicians\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings reveal significant suicide vulnerability among Egyptian physician migrants: 11% exhibited suicide risk (6.3% active ideation; 4.7% attempts), aligning with established evidence of elevated suicidality in immigrant populations [6, 24]. This confirms the results of the previous work by Amir (2020) [25], which included a meta-analysis of 51 studies (N=482,311 migrants) and reported 16% ideation and 6% attempt prevalence globally.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcculturation stress\u0026mdash;the psychological strain of adapting to new cultural environments\u0026mdash;remains a critical suicide precipitant [26]. Again, for physicians, this is amplified by profession-specific stressors, systemic healthcare disparities, institutional stigma around help-seeking, and fear of professional consequences further heighten risk. These gaps create cascading vulnerabilities where untreated distress escalates to suicidality\u0026mdash;a pattern acutely observed in our research, particularly among early-career physicians facing occupational instability.\u003c/p\u003e\n\u003cp\u003eFurthermore, pervasive \u0026quot;triple stigma\u0026quot; \u0026ndash; encompassing personal shame, professional judgment, and institutional penalties \u0026ndash; creates profound obstacles to care. Contemporary data confirms that a majority (68%) of distressed physicians, particularly migrants, avoid treatment due to licensure fears, showing minimal improvement despite awareness efforts [27]. Deeply ingrained self-reliance norms, originating from training cultures emphasizing invulnerability, demonstrably delay intervention and mediate distress (37%), resulting in critically low help-seeking rates even among those experiencing suicidal ideation [28]. Additionally, traits like perfectionism, traditionally selected for medical excellence, become potent risk factors under chronic stress. When coupled with workload, they contribute to professional identity erosion \u0026ndash; a disintegration of clinical self-worth that precipitates a crisis [29]. Collectively, these factors necessitate targeted interventions addressing lethal means safety, stigma reduction, cultural shifts towards help-seeking, and support systems mitigating perfectionism and identity [28-30].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSignificant predictors of mental health problems and suicidal risk by regression analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1. \u0026nbsp;Sociodemographic predictors\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegression analysis accounting for confounders identified female gender and comorbid medical conditions as significant predictors of depression; however, age was a highly significant factor for suicide among migrant physicians in our study.\u0026nbsp;This aligns with extensive prior evidence demonstrating women\u0026apos;s heightened vulnerability to depression across populations, attributed to interrelated biological (e.g., genetic predisposition, hormonal fluctuations), sociocultural (e.g., gendered roles, adverse experiences), and psychological factors (e.g., differential stress reactivity, coping styles) [31,32]. While these mechanisms likely contribute to observed disparities, the precise determinants remain incompletely elucidated [33, 32].\u003c/p\u003e\n\u003cp\u003eOur findings further corroborate established links between physical illness and depressive symptomatology.\u0026nbsp;The frequent co-occurrence of medical conditions and major depressive disorder is increasingly understood through shared pathophysiological pathways, including common genetic variants, immune-inflammatory dysregulation, and illness-related psychosocial sequelae (e.g., altered social functioning) [34, 35]. These intersecting biological and environmental mechanisms substantiate the elevated depression burden observed in individuals managing chronic health challenges, consistent with recent epidemiological reports [35, 36].\u003c/p\u003e\n\u003cp\u003eOne of the impressive findings in this research was that younger Egyptian physician expatriates (\u0026lt;40 years) showed a fourfold higher suicide risk than older colleagues (OR = 4.2 [1.9\u0026ndash;9.0], *p* \u0026lt; 0.001). This aligns with global patterns: Lithuanian physicians under 45 exhibited elevated suicide risk due to career instability and inadequate coping [37]. Similarly, young Egyptian physicians face severe isolation and unsustainable workloads \u0026nbsp;[38]. For expatriates, younger doctors\u0026rsquo; limited cross-cultural adaptability exacerbates distress from workplace inequities or language barriers [39]. Their underdeveloped resilience and mentorship access heighten vulnerability during crises like COVID-19 [40]. Reinforcing this, physicians aged 30\u0026ndash;50 experience 1.3\u0026times; higher suicide mortality than the general population [41]. This convergence of evidence demands urgent, tailored support for early-career expatriates facing intersecting professional, financial, and acculturative stresses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2. \u0026nbsp;Clinical predictors\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur Research identified a pre-existing psychiatric history as a robust independent predictor of concurrent depression, anxiety, and suicidality among migrant physicians\u003cstrong\u003e.\u003c/strong\u003e This finding aligns with established evidence indicating prior depressive episodes significantly increase vulnerability to relapse or recurrence, particularly under adverse conditions, reflecting an ongoing neurobiological and psychological susceptibility [42, 43]. Furthermore, the likelihood of recurrence escalates with both the number of past episodes and the presence of comorbid anxiety, suggesting a cumulative pathophysiological burden [44,45].\u003c/p\u003e\n\u003cp\u003eCritically, our research confirmed the profound link between active anxiety/depression and heightened suicide risk in this population.\u0026nbsp;Affected participants exhibited nearly twice the odds of suicidality compared to unaffected peers (Anxiety: OR=2.4, 95% CI [1.1-5.2], p=0.02; Depression: OR=1.9, 95% CI [1.3-2.5], p=0.03). This corroborates the well-documented paradigm where psychiatric morbidity constitutes a primary driver of suicidal behavior, with epidemiological studies consistently reporting that \u0026gt;90% of suicide attempters experience significant psychiatric illness [46- 49].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAdditionally, previous research found that both anxiety symptoms and depressive symptoms were independent risk factors for suicidal behaviors, which increase the risk for suicide [50-52].\u003c/p\u003e\n\u003cp\u003eEvidence indicates individuals with anxiety disorders frequently exhibit diminished distress tolerance and impaired emotion regulation capacities ([53, 54]. This compromised ability to process and modulate negative affective states may heighten vulnerability to viewing suicidality as a perceived means of escape from psychological anguish (Rodriguez \u0026amp; Kendall, 2014) [54]. Moreover, anxiety\u0026apos;s contribution to suicide risk demonstrates differential effects contingent on the severity of co-occurring depressive symptoms [55]. Consequently, comprehensive clinical assessment must account for these frequent psychiatric comorbidities to accurately evaluate risk profiles [52].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3. \u0026nbsp;Work-related predictors\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the striking findings in our research is that barriers to mental healthcare access constitute a robust independent predictor for depression, anxiety, and suicidality among migrant physicians.\u0026nbsp;Notably, these structural obstacles emerged as one of the strongest predictors for both anxiety (OR=2.7, 95%CI:1.8-4.2, p\u0026lt;0.001) and depression (OR=2.9, 95%CI:1.6-5.2, p\u0026lt;0.001). Participants facing healthcare barriers demonstrated nearly threefold elevated suicide risk compared to unimpeded counterparts (OR=2.9, 95%CI:1.2-3.9, p\u0026lt;0.001). Reported barriers included insurance deficits (most prevalent), termination fears, stigma, language limitations, and time constraints due to workload (Figure 2).\u003c/p\u003e\n\u003cp\u003eThis aligns with established evidence documenting heightened psychiatric morbidity among immigrants encountering healthcare access challenges [56, 57, 8]. Comparable structural challenges\u0026mdash;including financial constraints, linguistic barriers, insurance gaps, legal status complications, temporal limitations from intensive work schedules, cultural preferences for traditional healing, and geographic inaccessibility\u0026mdash;commonly restrict healthcare utilization in migrant populations [58-61]. Furthermore, profound mental health stigma within many immigrant communities substantially interferes with service utilization [62-65].\u003c/p\u003e\n\u003cp\u003ePrevious studies have investigating barriers and facilitators to help seeking among distressed physicians, found that they have some beliefs about seeking help, which may prevent them from contact health services, such as being ill is a sign of failure, or weakness or not strong enough [66-68].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eOur study shed light on the importance of access to mental health services for migrant physicians, which may minimize the mental burden of migration with better management of their mental health problems and ultimately reduce the suicidal risk and improve the quality of life.\u003c/p\u003e\n\u003cp\u003eLimitations: This study had some limitations. First, it is a cross-sectional study, which limits the establishment of a cause-and-effect relationship. Second, it depends on self-reporting scales and questions, which raises the possibility of bias. Third, stigma about having a mental disorder, especially among physicians, may lead to an underestimation of results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough this study has many limitations, it also has many strengths. This study is one of the few, if not the only, to assess the effect of immigration on the mental health of migrating physicians. It included a large number of participants from immigrants to Arab and Western countries. It investigated as many aspects (demographic, clinical, social, and occupational) as possible of the risk factors of mental illness among Egyptian migrant physicians.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study reveals the profound human cost of the physicians, borne by immigration: anxiety shadows 39% of the Egyptian medical expatriate, depression affects 15.7%, and 11% face suicidal risk. Behind these numbers lie critical vulnerabilities\u0026mdash;a prior history of psychiatric distress significantly heightens susceptibility to all three conditions, while female physicians and those managing medical illnesses are particularly prone to depression. Alarmingly, younger expatriates carry a fourfold greater suicide risk. Crucially, the greatest predictor of heightened mental health struggles is the presence of barriers to healthcare access. This research underscores an urgent moral and practical imperative: ensuring migrant doctors have unimpeded, compassionate access to mental health support is not merely beneficial\u0026mdash;it is essential for safeguarding their well-being, enriching their quality of life, and ultimately preserving the skilled, resilient workforce upon which their host communities depend. Future research should prioritize longitudinal and cohort research to map the progression of mental health outcomes in migrant physicians, accounting for the complex interplay of demographic, biological, psychological, environmental, occupational, and social factors. This evidence base is crucial for subsequently assessing the impact and efficacy of tailored psychological and social support interventions\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eER\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Room\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\u003eGeneralized Anxiety Disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eGCC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGulf Cooperation Council\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eGP\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeneral Practitioner\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHADS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Anxiety and Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eICU\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eKSA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKingdom of Saudi Arabia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUAE\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Arab Emirates\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUK\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Kingdom\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUSA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to all participants in our study. This study would not have been possible without the invaluable contributions of the Egyptian medical expatriates who participated. We acknowledge with deep respect the significant trust placed in us as you shared sensitive experiences related to psychological distress and suicide risk while navigating life and practice in foreign lands.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no financial support was received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo support scientific transparency and collaboration, the datasets generated and analyzed during this study are maintained by the corresponding author and can be provided upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZagazig University\u0026apos;s Institutional Review Board granted ethical approval for this research, with Clinical Trial Number: #ZU-IRB 10307/10-1-2019. The study procedures strictly complied with the Declaration of Helsinki\u0026apos;s ethical standards and its amendments. Before participation, all enrolled physicians provided digitally documented informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare no conflicts of interest\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSyiam A, Dal Poz MR. Migration of health workers WHO code of practice and the global economic crisis. 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The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health. 2023;11:1133484. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2023.1133484\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2023.1133484\" 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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"migrant physicians, anxiety, depression, suicide","lastPublishedDoi":"10.21203/rs.3.rs-7171595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMoving to a new country for work can be incredibly stressful, especially for physicians who already face high-pressure jobs. This study explores the mental health challenges, like depression, anxiety, and suicidal risk, that Egyptian doctors experience while working abroad.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional online survey of 400 Egyptian immigrant physicians in Arab Gulf/Western nations was conducted via Facebook professional groups using comprehensive consecutive sampling. Data were collected using a questionnaire covering sociodemographic, clinical, and immigration-related factors, and history of suicidal ideation/ attempts, and the Hospital Anxiety and Depression Scale (HADS) was used to assess the severity of anxiety and depressive symptoms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAbout 16% of doctors reported moderate to severe depression. Women were 2.5 times more likely to experience it than men. Nearly 40% struggled with significant anxiety, especially those working more than 8 hours a day. 6.3% of doctors had suicidal thoughts, and almost 5% had attempted suicide. Younger physicians were found to be fourfold more likely to have suicidal risk compared to their older counterparts, while physicians who reported barriers to accessing mental health services had a 2.9-fold increased risk of suicidal risk. The reported barriers included a lack of insurance coverage, fear of losing their jobs, and stigma.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEgyptian migrant physicians face significant mental health burdens, exacerbated by being younger, long working hours, past mental health issues, and systemic barriers to care. Urgent interventions must address healthcare access, occupational safeguards, and culturally sensitive support to mitigate suicide risk and improve well-being in this critical workforce.\u003c/p\u003e","manuscriptTitle":"Physician Well-Being in Foreign Lands: Unmasking Mental Health Problems and Suicide Risk Among Egyptian Medical Expatriates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 15:48:07","doi":"10.21203/rs.3.rs-7171595/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-10T05:41:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-15T10:55:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76163340704913551366125470712190843952","date":"2025-09-05T11:38:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T13:35:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T21:08:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297151726338891719793992533812912003845","date":"2025-08-14T10:25:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87878425750604611212075773991291144338","date":"2025-08-11T18:49:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T18:37:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-24T19:01:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T11:54:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-22T11:52:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2025-07-20T19:50:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"132513f7-d22c-4ffe-8ad9-11a5bbbdc040","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-20T13:25:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 15:48:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171595","identity":"rs-7171595","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}