How psychiatrists and psychiatry trainees perceive their social support, work and loneliness associated with depression?

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Jarurin Pitanupong, Kanthee Anantapong, Warut Aunjitsakul This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3672690/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Feb, 2024 Read the published version in BMC Psychiatry → Version 1 posted 9 You are reading this latest preprint version Abstract Background This study aimed to survey the prevalence of depression and its associated factors (perceptions towards social support and work and loneliness) among psychiatrists and psychiatry trainees. Methods This cross-sectional study surveyed Thai psychiatrists and psychiatry trainees from January to February 2023 using an online questionnaire. The questionnaires consisted of 1) the demographic and work-related information; 2) perceptions towards social support and work; 3) the Patient Health Questionnaire-9 (PHQ-9) Thai version; and 4) the 6-item Revised UCLA Loneliness Scale Thai version. All data were analyzed using descriptive statistics, and the associated factors concerning depression were analyzed via multiple linear regression analyses. Results Of the 225 total participants, 52(23.1%) and 173 (76.9%) were psychiatry trainees and psychiatrists, respectively. Most of them were female (64.9%) with overall median age (interquatile) was 34 (30, 42) years. Regarding the PHQ-9 findings, the prevalence of depression among all participants was 12.4% (psychiatrists 13.9% and psychiatry trainees 7.7%). From regression analyses, depression was associated with loneliness and perceived levels of work satisfaction and work stress in psychiatrists, while in psychiatry trainees, depression was associated with loneliness and perceived level of ability to control work schedule. Conclusions 13.9% and 7.7% of psychiatrists and psychiatry trainees, respectively, had depression. Loneliness and perception about work satisfaction, work stress, and ability to control the work schedule were key contributing factors to depression. Although the prevalence of depression in this study was not extremely high, action is required to reduce the depression rate among mental health personnel. IRB / IEC Certification: 65-488-3-1 associated factors depression prevalence psychiatrist psychiatry trainee Figures Figure 1 Figure 2 Background Major depressive disorder (MDD) is a common illness [ 1 ] that has a negative impact on the afflicted individual as a consequence of altered functioning [ 2 ]. Previous studies reported that prevalences of MDD, depending on the instrument used, were 10.8–23.2% among physicians [ 3 – 5 ], and 20.9–43.2% among resident physicians [ 6 ]. A prior cross-sectional, multi-country online survey among psychiatry trainees in European countries reported that the prevalence of MDD was approximately 20.8%, using the Patient Health Questionnaire-9 (PHQ-9) [ 7 ]. Another study using the PHQ-9 reported that 16.1% of North American psychiatrists had MDD [ 8 ]. In Thailand, the number of psychiatrists remains short and relatively small compared to those found in more developed countries [ 9 ]. In 2016, numbers of psychiatrists per 100,00 people in countries such as the USA, Japan, or New Zealand were 10.54, 11.87 or 28.54, respectively, on the other hand in Thailand was 0.72 [ 10 ]. Consequencely, Thai psychiatrists reported low quality of life (QoL) [ 11 ] and suffered from high levels of burnout, increasing dramatically from 17.1–49.3% (from 2011 to 2018) [ 12 ]. Among the factors associated with MDD among psychiatrists, female gender, being in residency training or one’s early-career stage, practicing in a nonacademic setting, and burnout were significantly related to higher PHQ-9 scores or the presence of MDD [ 8 ]. Additionally, working more than 50 hours per week, a higher caseload or caring for more patients per day [ 12 , 13 ], feeling unsatisfied with one’s work and environment, and receiving insufficient support from family, workplace, and colleagues were associated with higher levels of burnout [ 12 ] and lower QoL [ 11 ]. Several studies investigate MDD mostly in psychiatrists, but less in psychiatry trainees; and mostly about burnout and quality of life, but less in work-related data, which may link to emotional distress. The factors related to work included, for example: perception of social support towards family, chief of department, and psychiatrist/psychiatry trainee friends; or perceptions towards work including ability to control one’s work schedule, work stress, satisfaction with one’s income and work. Furthermore, loneliness – an indicator of social well-being – can lead to various psychiatric disorders and various physical disorders [ 14 ], which higher level of loneliness could lead to poorer MDD, not only social support but development of psychological interventions required for MDD [ 15 ]. During the Coronavirus disease (COVID-19) pandemic, psychiatry colleagues around the world have faced mental health problems associated with the pandemic of patients and their families (such as anxiety, and panic) [ 16 ]. This outbreak still substantial challenges to psychiatry as it requires providing diagnostic and therapeutic services where and when they are needed [ 16 ], but there are not enough psychiatrists to meet this demand [ 17 ]. As a consequence of the pandemic, psychiatry, and mental health professionals have been negatively affected, their distresses linked to clinical work and pressures from personal lives. However, psychological supports were offered and provided just little to them [ 17 ]. Thus, this study was conducted in both psychiatrists and psychiatry trainees in Thailand to examine the prevalence of MDD. Associating factors of work related to MDD were also investigated because the factors have not yet been fully investigated among psychiatrists and psychiatry trainees. The findings from this study would be valuable to inform the relevant stakeholders on how to promote mental health of Thai psychiatrists and psychiatry trainees. Methods This cross-sectional study was an online-based questionnaire surveying from January to February 2023. Following the ethical principles of the Declaration of Helsinki, this survey was approved by the Human Research Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC.65-488-3-1). Participants All Thai psychiatrists and psychiatry trainees, who are members of the Royal College of Psychiatrists of Thailand were invited. The potential participants, who were aged between 20 and 70 years and able to use the Thai language, were included. Data collection Participants were recruited via the official social media platform of the Thai Royal College of Psychiatrists e.g., Facebook, Line application. The participants were invited to the survey by entering through the link or QR code from advertisements. On the first page, all participants were provided with the rationale and an overview of the survey to consider whether or not to take part in the study. If they agreed to participate in the survey, they then clicked continue to fill out the questionnaire. Adhering to the policy of strict confidentiality, the signatures of the participants were not required, and all of them were advised that they retained the right to withdraw from the survey at any time without giving any reason. Measurements The demographic data, e.g., age, gender, marital status, number of children in the family, and history of physical and psychiatric illness were collected. Work-related data were also collected, including career status (psychiatry trainees vs psychiatrists), type of psychiatrist (general psychiatrist vs child and adolescent psychiatrist), type of workplace (academic medical school vs psychiatric hospital vs general/community/private hospital or clinic), type of patient’s care (outpatient vs both outpatient and inpatient care) as well as: experience years as a psychiatrist or psychiatry trainee; patients seen per day; clinical hour per week; night shifts per month; paid days off per month; and death patients who committed suicide. In addition, we collected perceived social support, whether poor or good, provided by family, the head of the department, and peers. To explore the perception towards work, we used a visual analog scale (VAS), ranging from 1–10 (extremely low – extremely high) to document perception levels of ability to control one’s work schedule; work stress; and satisfaction with one’s income and work. Additionally, two instruments Thai version were used in this study, one for the measurement of depression and the other for loneliness, as follows. Depression The Patient Health Questionnaire-9 (PHQ-9) Thai version is a self-rating questionnaire to evaluate depression, which consists of 9 items. It employs a 4-point rating scale for each question: 0 (never), 1 (rarely), 2 (sometimes), and 3 (always). The total score can range from 0 to 27; 0–4 (no or minimal depression), 5–9 (mild depression), 10–14 (moderate depression), 15–19 (moderately severe depression), and 20–27 (severe depression). The PHQ-9 Thai version has been proven to have acceptable psychometric properties for the screening of MDD with a recommended cut-off score of nine or greater, with a sensitivity of 0.53 and a specificity of 0.98 and Cronbach's alpha coefficient of 0.79, [ 18 ]. In this study, the calculated Cronbach's alpha coefficient value was 0.81. Loneliness The 6-item Revised UCLA Loneliness Scale (RULS-6) Thai version is a self-rating questionnaire used to evaluate loneliness. It employs a 4-point rating scale for each question: 1 (never), 2 (rarely), 3 (sometimes), and 4 (always). The total score ranges from 6 to 24. The higher the score, the greater the degree of loneliness is indicated. The summed scores were grouped into three categories: ‘low’ for a score below the 25th percentile, ‘average’ for scores ranging from the 25th to the 75th percentiles, and ‘high’ for a score above the 75th percentile. The questionnaire has demonstrated good internal consistency as indicated by a Cronbach's alpha coefficient of 0.83 [ 19 ] and 0.87 regarding the data from this study. Statistical Analyses All data (e.g., demographic and work-related data and variables of interest) were analyzed using the descriptive statistic method comprising proportions, means, standard deviation (SD), median, and interquartile range (IQR) and using Pearson’s and Spearman’s correlation analyses for inter-correlation of variables, according to normal or non-normal distribution. The association between depression score and demographic data, work-related factors, and variables of interest were analyzed using multiple linear regressions performed via the R software program version 4.1.2 (R Foundation for Statistical Computing). All CIs were calculated at the 2-sided 95% level. Results Demographic characteristics 225 participants agreed to collaborate and complete the questionnaires, comprising 173 (76.9%) psychiatrists and 52 (23.1%) psychiatry trainees. The median (IQR) age among the psychiatrists and psychiatry trainees was 37 (33, 44) and 28 (27, 29) years old, respectively. The majority of the respondents were female (149, 64.9%), single/divorced (146, 64.9%), and had a previous history of physical (91, 40.4%) and psychiatric illnesses (19, 8.4%). The most common physical illnesses were allergies (10.2%) and dyslipidemia (7.6%), while psychiatric illnesses were MDD (6.2%), generalized anxiety disorder (1.4%), post-traumatic stress disorder (0.4%) and attention deficit hyperactivity disorder (0.4%). Regarding work-related characteristics, most participants were general psychiatrists (178, 79.1%), worked at a medical school (105, 46.7%), and worked from 40 to 50 hours per week (108, 48.0%), other details see Table 1 . Table 1 Demographic and work-related characteristics (N = 225) Variables Total (N = 225); N (%) Psychiatrists (n = 173); n (%) Psychiatry trainees (n = 52); n (%) Gender Male 79 (35.1) 64 (37.0) 15 (28.8) Female 146 (64.9) 109 (63.0) 37 (71.2) Age (years) Median (IQR) 34 (30, 42) 37 (33, 44) 28 (27, 29) Marital status Single/Divorced 146 (64.9) 99 (57.2) 47 (90.4) Married 79 (35.1) 74 (42.8) 5 (9.6) Number of children None 176 (78.2) 125 (72.3) 51 (98.1) One 29 (12.9) 28 (16.2) 1 (1.9) More than one 20 (8.9) 20 (11.6) 0 (0.0) Physical illness No 134 (59.6) 100 (57.8) 34 (65.4) Yes 91 (40.4) 73 (42.2) 18 (34.6) Psychiatric illness No 206 (91.6) 159 (91.9) 47 (90.4) Yes 19 (8.4) 14 (8.1) 5 (9.6) Experience as a psychiatrist (years) Median (IQR) 6 (3, 14) 9 (5, 15) 2 (1, 3) Type of Workplace Medical school 105 (46.7) 60 (34.7) 45 (86.5) Psychiatric hospital 24 (10.7) 17 (9.8) 7 (13.5) Other hospital (general/community/private hospital/clinic) 96 (42.7) 96 (55.5) 0 Types of a psychiatrist General psychiatrist 178 (79.1) 138 (79.8) 40 (76.9) Child and adolescent psychiatrist 46 (20.4) 35 (20.2) 11 (21.2) No answer 1 (0.4) 0 1 (1.9) Types of patient’s care Only outpatient 22 (9.8) 22 (12.7) 0 (0.0) Outpatient and inpatient 203 (90.2) 151 (87.3) 52 (100) Number of patients per day Median (IQR) 20 (10, 30) 25 (14, 35) 10 (6, 15) Working hours per week 50 59 (26.2) 41 (23.7) 18 (34.6) No answer 1 (0.4) 1 (0.6) 0 Number of night shifts per month Median (IQR) 6 (4, 10) 6 (2.8,10) 5.5 (4,9.2) Number of days off per month 0–2 21 (9.3) 13 (7.5) 8 (15.4) 3–5 48 (21.3) 39 (22.5) 9 (17.3) 6–8 101 (44.9) 68 (39.3) 33 (63.5) 8–10 46 (20.4) 44 (25.4) 2 (3.8) >10 9 (4.0) 9 (5.2) 0 (0.0) IQR: interquartile range Depression Of all participants, the median (IQR) for the PHQ-9 score was 3 (2, 6). Most participants reported no/minimal (143, 63.6%), mild (63, 28.0%), and moderate to severe depression (19, 8.4%) (Supplementary Table 1). 28 (12.4%) participants were considered as MDD due to their PHQ-9 score ≥ 9, including 24 (13.9%) psychiatrists and 4 (7.7%,) psychiatry trainees (Fig. 1 ). Additionally, among those with MDD, there were 3 psychiatrists and 1 psychiatry trainee who had a previous history of MDD. Categorized data by the PHQ-9 with other variables are shown in Supplementary Table 2. Regarding the symptoms of MDD according to the PHQ-9 findings, feeling down, feeling tired, lack of pleasure, having trouble concentrating, and the presence of sleep problems were the most frequently reported symptoms, see Fig. 2 . Regarding suicidal ideation, 14 participants were reported, and 9 (32.1%) of them were considered as MDD in this study. Loneliness Using the RULS-6, only 35 (15.6%) participants were found to experience a high level of loneliness, while the rest reported an average level (190, 84.4%), with the proportions of those with a high level among psychiatrists and psychiatry trainees were 17.3% and 9.6%, respectively (Supplementary Table 1). Among 14 participants with suicidal ideation, 5 of them experienced a high level of loneliness, the others reported an average level. There was no statistically significant association between the presence of suicidal ideation and loneliness. Perception towards social support and work Asking whether ‘poor’ or good’ about one’s perceived social support, most participants reported that they received good support from family, peers, and the head of the department were 199 (88.4%), 178 (79.1%) and 149 (66.2%), respectively. No significant difference in the social support between psychiatrists and psychiatry trainees was found. Meanwhile, self-rating perceptions towards works from 1 (extremely low) to 10 (extremely high), mean (SD) of participants’ perceptions were 5.9 (2.2), 6.0 (2.5), 6.4 (1.9) and 7.0 (1.8) of work stress, income’s satisfaction, ability to control work schedule and work satisfaction, respectively. Their medians (IQR) and their comparisons were shown in Supplementary Table 1. Perception of income satisfaction, ability to control work schedule, and work stress were statistically significant different between psychiatrists and psychiatry trainees ( p < 0.001, 0.023, and 0.045, respectively). Association of levels of depression with demographic, work-related characteristics, level of loneliness and perceptions towards social supports and works Any variable having a statistically significant univariate test result, which was based on a p -value of < 0.2, was selected as a candidate for inclusion in the multivariate analysis. The crude analysis revealed a statistically significant association between the levels of depression with age, number of children, psychiatric illness, number of experience years as a psychiatrist/psychiatry trainee, number of paid days off per month, and number of death patients who committed suicide (Supplementary Table 3). Also, the level of depression significantly positively correlated with loneliness among all participants (r = 0.43, p < 0.001) with psychiatrists and psychiatry trainees were 0.47 (p < 0.001) and 0.30 (p = 0.029), respectively. Among perceptions towards work, all participants’ levels of depression only positively correlated with work stress (r = 0.46, p < 0.001), the others showed negative correlations: work satisfaction (r=-0.42, p < 0.001), ability to control work schedule (r=-0.34, p < 0.001) and income’s satisfaction (r=-0.20, p = 0.002). Furthermore, the correlation coefficients of psychiatry trainees were generally weaker than those of psychiatrists. (Table 2 ) The multicollinearity among the independent variables was checked, using the variance inflation factor (VIF), and no multicollinearity issues were found. Table 2 Corrrelation between level of depression (using PHQ-9) and loneliness and perception towards works Variables Depression score Total (N = 225) Psychiatrists (n = 173) Psychiatry trainees (n = 52) ρ p-value ρ p-value ρ p-value Loneliness score 0.43 < 0.001 0.47 < 0.001 0.30 0.029 Perception levels of : Ability to control work schedule -0.34 < 0.001 0.34 < 0.001 -0.38 0.005 Work stress 0.46 < 0.001 0.52 < 0.001 0.24 0.100 Income satisfaction -0.20 0.002 -0.25 0.001 -0.13 0.368 Work satisfaction -0.42 < 0.001 -0.45 < 0.001 -0.33 0.016 ρ = Spearman correlation coefficient; IQR: Interquartile range; PHQ-9: Patient Health Questionnaire-9 Note: Perception towards works using self-rating from 1-10 (extremely low – extremely high) of each item, representing continuous data for correlation analyses The results of the multiple linear regression showed the level of depression was found to be significantly associated with the presence of previous psychiatric illness (Adjusted coefficients 1.44 (0.04, 2.84; p = 0.043)), loneliness score (0.3 (0.17, 043; p < 0.001)), perceived levels work satisfaction (-0.43 (-0.68, -0.17; p = 0.001)) and work stress (0.43 (0.23, 0.63; p < 0.001)) in all participants. When analyzed separately, in psychiatrists’ group loneliness score (0.29; 0.14, 0.44; p < 0.001), perceived levels of work satisfaction (-0.46; -0.78, -0.15; p = 0.004) and work stress (0.47; 0.23, 0.71; p < 0.001) remained significantly associated with the level of depression. Meanwhile, in the psychiatry trainees’ group loneliness score (0.28; 0.03, 0.53; p = 0.029) and perceived level of ability to control work schedule (-0.49; -0.91, -0.06; p = 0.027) were significantly associated with level of depression. (Table 3 ). Table 3 Linear regression analyses of level of depression (using PHQ-9) on candidate variables among all participants, psychiatrists and psychiatry trainees Candidate variables PHQ-9 score Total (N = 220) Psychiatrists (n = 171) Psychiatry trainees (n = 50) Crude coefficient (95% CI) Adjusted coefficient (95% CI) p-value (F-test) Crude coefficient (95% CI) Adjusted coefficient (95% CI) p-value (F-test) Crude coefficient (95% CI) Adjusted coefficient (95% CI) p-value (F-test) Presence of psychiatric illness 1.64 (-0.06, 3.33) 1.44 (0.04, 2.84) 0.043 Loneliness score 0.47 (0.34, 0.6) 0.3 (0.17, 0.43) < 0.001 0.50 (0.35, 0.65) 0.29 (0.14,0.44) < 0.001 0.38 (0.12, 0.64) 0.28 (0.03, 0.53) 0.029 Perception level of ability to control work schedule -0.54 (-0.99, -0.1) -0.49 (-0.91, -0.06) 0.027 Perception level of work satisfaction -0.87 (-1.11, -0.63) -0.43 (-0.68,-0.17) 0.001 -0.98 (-1.27, -0.69) -0.46 (-0.78, -0.15) 0.004 Perception level of work stress 0.71 (0.52, 0.91) 0.43 (0.23,0.63) < 0.001 0.80 (0.58, 1.02) 0.47 (0.23, 0.71) < 0.001 CI: Confidence interval; PHQ-9: Patient Health Questionnaire-9 Note: Adjusted R-square of models: all participants, psychiatrists and psychiatry trainees were of 0.33, 0.34 and 0.32, respectively Discussion This is the first national survey from Thailand aimed to explore the prevalence and associated factors of MDD among Thai psychiatrists and psychiatry trainees. Regarding the objectives, this study found that 13.9% of psychiatrists and 7.7% of psychiatry trainees were considered MDD. Higher loneliness score was associated with higher depression scores in both psychiatrists and psychiatry trainees. In psychiatrists, a high depression score was associated with a low perceived level of work satisfaction and a high perceived level of work stress, whereas in psychiatry trainees’ a high depression score was associated with a low perceived level of ability to control work schedule. As for the prevalence of MDD, the finding from this study of 13.9% of psychiatrists was found to be relatively comparable with the prior study in North America which 16.1% were identified as MDD [ 8 ]. Meanwhile, among psychiatry trainees in this study, the prevalence of MDD (7.7%) was different from prior studies with an average rate of 20.8%, nevertheless, there was a wide range of MDD prevalences from 7.1–50.0% depending on the country site [ 7 ]. A recent study among Thai residents found that 23.4% of them had MDD [ 20 ]. The inconsistency in the occurrence of MDD could be due to differences in work-related characteristics, sleep quality, and burnout of the study populations [ 21 ]. Other possible explanations may be the diverse depression assessment tools and characteristics of the samples, e.g., ethnicity, gender, age group, and level of family or social support. The majority of our participants perceived that they had good social support from family, the head of the department, and psychiatrist peers. These supports may help alleviate distress, and lead to low depression scores in our study. In addition, most psychiatrists and psychiatry trainees reported an average level of loneliness, this could help affirm that they may receive adequate social support in life [ 20 ]. According to this, it could help explain why the prevalence of MDD was relatively low in our sample. In this study, perception towards works was investigated using VAS (from 1–10), resulting in their perception levels sounding acceptable, as their median scores were from six to seven out of ten. Of note, the psychiatry trainees reported significantly lower perception levels of ability to control work schedule and income satisfaction as well as higher perception of work stress, compared to the psychiatrists. Additionally, perception of work stress and work satisfaction were found moderate correlation with MDD, particularly in the psychiatrist's group. Our findings suggest that professional mental health care requires a sense of belonging and empowerment or workplace efficiency, a workplace with a sufficient budget and health care teams on duty, and a healthy work-life balance and good relationships among people are crucial in the workplace [ 22 ]. These needs should be the focus of healthcare policymakers and stakeholders [ 22 ] From multiple regression analyses, similar to previous studies, loneliness was significantly associated with MDD in all samples [ 20 ]. Perception of work satisfaction and work stress were associated with contributing to MDD in psychiatrists [ 8 , 12 ], while in psychiatry trainees perception of ability to control work schedule was significant. It is undeniable that working as a psychiatrist has a unique performance, because he/she has to establish a good doctor-patient relationship professionally – being a good communicator and listener [ 23 ], but relatively low income [ 24 ]. Furthermore, they may get extreme mental pressure and be at risk in clinical practice despite that there is a shortage of psychiatrists these days [ 12 , 13 , 25 ]. COVID-19 during and after pandemic also causes stressors to psychiatrists [ 16 ]. As a result, psychiatrists can feel an emotional burden [ 26 ]. Psychiatry trainees could also suffer from distress in the same way, although they have lower responsibility and shorter contact with people with illness, compared to psychiatrists. Although more trainees to become psychiatrists have been rapidly recruited, because of a small number of psychiatrists [ 25 ], the quality of training in psychiatrists remains crucial and should be standardized. However, they still have loads of work with closer supervision. This could therefore create psychological distress among psychiatry trainees as well. In addition, having previous psychiatric illnesses, which were mostly MDD, was also a significant factor associated with depression in our samples. It could be that although they had been diagnosed with MDD, the treatment they received may have not been adequate to cure their depressive symptoms [ 27 ], they may still be suffering from the residual symptoms of MDD [ 28 , 29 ], or they may refuse to seek help due to stigma [ 30 ]. Therefore, psychiatry trainees and psychiatrists with a history of psychiatric illnesses should receive close attention from their families, supervisors, and professional colleagues [ 31 ] to ensure that they receive adequate medical intervention in terms of both sufficient medication and robust psychosocial support. We also found that there were high frequencies of reported depressive symptoms including feeling tired, feeling down, lack of pleasure, having trouble concentrating, and having sleep problems. This information could help suggest monitoring the early warning signs of MDD among them. Notably, action is still required to reduce MDD rates in both psychiatrists and psychiatry trainees, although the prevalence of MDD in our study (Thailand) was not extremely high. To our knowledge, this is the first study examining MDD and its associations such as work-related data, perception of social support, perceptions towards work, and loneliness. There were limitations in this study. Firstly, since the survey was conducted via an online platform, we failed to get participants who are not interested in or not involved in social media, such as people with MDD or with emotional distress. As it was subject to selection bias (nonresponse bias), our sample might not be representative of the psychiatry trainees and psychiatrists at the national level. Secondly, although we advertised adequately (emphasizing that whether participating in the survey or not their decision will not affect their work/academic training), the number of psychiatry trainees is lower than expected, resulting in a lack of power in some data analyses. However, our research objectives were met. Lastly, we did not collect current stressors which might help explain the MDD outcome. Future studies may seek to collect information about work, for example, different workplaces (e.g., rural or urban hospitals), types of welfare or insurance, and safety at the workplace. In addition, studying assertiveness to assist psychiatry trainees in getting a sense of control in workplaces; exploring factors linking to loneliness to alleviate emotional burden; or examining supporting factors to prevent distress, may yield valuable knowledge that would inform effective targeted interventions for MDD in mental health care or other professionals. Conclusion From the survey, 13.9% and 7.7% of psychiatrists and psychiatry trainees, respectively, had MDD. Among them, loneliness was a key contributing factor associated with MDD. Work satisfaction and work stress were significantly associated with MDD in psychiatrists, whereas in psychiatry trainees the perception of the ability to control work schedule was significant. Action against MDD among psychiatrists and psychiatry trainees needs to be taken into account, such as social support to prevent loneliness, increase work satisfaction, decrease work stress, or encourage flexibility in work schedule. Abbreviations MDD major depressive disorder PHQ-9 Patient Health Questionnaire-9 QOL quality of life RULS-6 the 6-item Revised UCLA Loneliness Scale Declarations We confirm that all methods were carried out in accordance with relevant guidelines and regulations. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC.65-488-3-1), who waived the requirement for obtaining informed consent as the participants could not be identified throughout the research process. All stages of the research were conducted in full compliance with the Declaration of Helsinki and the statements of the Ethics Committee of the Faculty of Medicine, Prince of Songkla University. Consent for publication Not applicable. Availability of data and materials The qualitative data of the current study cannot be made publicly available for confidentiality reasons, but they can be available on request by the corresponding author. Competing interests The authors declare that they have no conflicts of interest. Funding This study was fully supported by the Faculty of Medicine, Prince of Songkla University, Thailand. The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors ’ contributions JP: conception and design of the study, data collection, analysis of data; WA: design of the study, data collection, analysis of data, and drafting of the manuscript; KA: design of the study, data collection, analysis of data. All authors approved the final manuscript. Acknowledgments The authors would like to acknowledge the participants for their willingness to provide their information via the study questionaires. We would also like to also acknowledge the research assistants, Nisan Werachattawan and Kruewan Jongborwanwiwat, for their support and important role in the conduct of this study. The English of this article was proofread/edited by the staff of the Office of International Affairs, Faculty of Medicine, Prince of Songkla University. Author information 1 Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand References McKeever A, Agius M, Mohr P. A Review of the Epidemiology of Major Depressive Disorder and of its consequences for Society and the individual. Psychiatr Danub. 2017;29(Suppl 3):222–31. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9. 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A Study on the Comparison of Burnout Syndrome, Among Medical Doctors in the Restive Areas and Non-Restive Areas of the South Thailand Insurgency. J Health Sci Med Res. 2018;36(4):277–89. Mushtaq R, Shoib S, Shah T, Mushtaq S. Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness. J Clin Diagn Res. 2014;8(9):We01–04. Mann F, Wang J, Pearce E, Ma R, Schlief M, Lloyd-Evans B, Ikhtabi S, Johnson S. Loneliness and the onset of new mental health problems in the general population. Soc Psychiatry Psychiatr Epidemiol. 2022;57(11):2161–78. Kelly BD. Coronavirus disease: challenges for psychiatry. Br J Psychiatry. 2020;217(1):352–3. Kane H, Baumgart JG, Rusch E, Deloyer J, Fuenzalida C, Kelemen G, Krzystanek M, Marazziti D, Moraitou M, Reunanen M, et al. The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals. BMC Health Serv Res. 2022;22(1):1360. Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008;8:46. Wongpakaran N, Wongpakaran T, Pinyopornpanish M, Simcharoen S, Suradom C, Varnado P, Kuntawong P. Development and validation of a 6-item Revised UCLA Loneliness Scale (RULS-6) using Rasch analysis. Br J Health Psychol. 2020;25(2):233–56. Wiriyacosol PCK, Karawekpanyawong N, Orrapin S, Kawilapat S. The Prevalence and Associated Factors of Depression among Residents in Training in a Northern Thailand University: A Cross-sectional Study. Biomedical Sci Clin Med. 2023;62(1):9–17. Chatlaong T, Pitanupong J, Wiwattanaworaset P. Sleep Quality and Burnout Syndrome among Residents in Training at the Faculty of Medicine, Prince of Songkla University. Siriraj Med J. 2020;72(4):307–14. Yank V, Rennels C, Linos E, Choo EK, Jagsi R, Mangurian C. Behavioral Health and Burnout Among Physician Mothers Who Care for a Person With a Serious Health Problem, Long-term Illness, or Disability. JAMA Intern Med. 2019;179(4):571–4. Kim JH, Tor PC, King J, Seo JS. A Korean survey on qualities and definition of a good psychiatrist. J Korean Med Sci. 2015;30(5):632–8. Yao H, Wang P, Tang YL, Liu Y, Liu T, Liu H, Chen Y, Jiang F, Zhu J. Burnout and job satisfaction of psychiatrists in China: a nationwide survey. BMC Psychiatry. 2021;21(1):593. Korszun A, Dharmaindra N, Koravangattu V, Bhui K. Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees. The Psychiatrist. 2011;35(9):350–3. Heponiemi T, Aalto AM, Puttonen S, Vänskä J, Elovainio M. Work-related stress, job resources, and well-being among psychiatrists and other medical specialists in Finland. Psychiatr Serv. 2014;65(6):796–801. Quitkin FM, Petkova E, McGrath PJ, Taylor B, Beasley C, Stewart J, Amsterdam J, Fava M, Rosenbaum J, Reimherr F, et al. When should a trial of fluoxetine for major depression be declared failed? Am J Psychiatry. 2003;160(4):734–40. Pitanupong J, Sathaporn K, Tepsuan L. Residual symptoms and their associated factors among Thai patients with depression: a multihospital-based survey. Ann Gen Psychiatry. 2022;21(1):50. Romera I, Perez V, Ciudad A, Caballero L, Roca M, Polavieja P, Gilaberte I. Residual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis. BMC Psychiatry. 2013;13:51. Pitanupong J, Aunjitsakul W. Personal and perceived stigma in relation to diverse domains of quality of life among patients with major depressive disorder having residual symptoms: a hospital-based cross-sectional study in Thailand. Qual Life Res 2023. Pitanupong J, Tuntikitjakun C. Burden among Relatives of Individuals with Depression in Southern Thailand: A University Hospital-Based Cross-Sectional Survey. 2023 2023, 41(5). Additional Declarations No competing interests reported. Supplementary Files ManuscriptSurveyDepressionSupplementarymaterialv1.0.docx Cite Share Download PDF Status: Published Journal Publication published 05 Feb, 2024 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 27 Dec, 2023 Reviews received at journal 23 Dec, 2023 Reviewers agreed at journal 03 Dec, 2023 Reviewers agreed at journal 03 Dec, 2023 Reviewers invited by journal 28 Nov, 2023 Editor assigned by journal 28 Nov, 2023 Editor invited by journal 28 Nov, 2023 Submission checks completed at journal 28 Nov, 2023 First submitted to journal 27 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-3672690","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":253921032,"identity":"57db8548-a3e0-4a56-b781-4b1a4227e5ea","order_by":0,"name":"Jarurin Pitanupong","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jarurin","middleName":"","lastName":"Pitanupong","suffix":""},{"id":253921034,"identity":"be9b1f06-94c6-4169-8216-a8870c17c06b","order_by":1,"name":"Kanthee Anantapong","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kanthee","middleName":"","lastName":"Anantapong","suffix":""},{"id":253921036,"identity":"9a852549-56f4-4ec6-8e7b-e91221c7e56e","order_by":2,"name":"Warut Aunjitsakul","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYBADOTjLgCj1BxgYjGFsCaK1JDYQrcXg+Nln0h8Y7NK3858xYPhRw1BnTlDLmXQziQMMybk7Z+QYMPYcY5CwbCCgxexAGhtQC3Puhhs8Bgy8DUCHHSCk5fwzkJb6dIPzZwwY/xKl5QbYlsMJBgdyDJiJssX+xjNmizMGxw13zkgrOCxzTEJyAyEtkv1pjDcqKqrlzfkPb3z4psaGn6AtEGAAiXSgYgmi1MN1jYJRMApGwSjADgDLrjuG0iwwCwAAAABJRU5ErkJggg==","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Warut","middleName":"","lastName":"Aunjitsakul","suffix":""}],"badges":[],"createdAt":"2023-11-27 14:32:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3672690/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3672690/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-024-05569-7","type":"published","date":"2024-02-05T15:00:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":47398070,"identity":"e9d58709-8455-43ff-824f-e1f2b1f58931","added_by":"auto","created_at":"2023-11-30 19:43:23","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":215789,"visible":true,"origin":"","legend":"\u003cp\u003eThe presence of depression among psychiatry trainees and psychiatrists (N=225)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3672690/v1/047612640dc1a62c6d7139eb.jpeg"},{"id":47398072,"identity":"8ffcb225-6500-43bc-ab8d-a0c8e3f77e22","added_by":"auto","created_at":"2023-11-30 19:43:23","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":177402,"visible":true,"origin":"","legend":"\u003cp\u003eThe frequency of symptoms of depression according to the depression (N=28) and non-depression status (N=197)\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3672690/v1/bc8c772ee248e6eedb242d0d.jpeg"},{"id":51006165,"identity":"1a5a289c-ded9-4b1b-b1ec-362f34561ab0","added_by":"auto","created_at":"2024-02-12 15:14:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":680524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3672690/v1/a99e8372-f285-46a9-98d6-079fe2a4204c.pdf"},{"id":47398071,"identity":"86f76a97-8020-4272-a7b9-60787f8205fc","added_by":"auto","created_at":"2023-11-30 19:43:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":83090,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptSurveyDepressionSupplementarymaterialv1.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-3672690/v1/0f18ec3af07e2544fec8198f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"How psychiatrists and psychiatry trainees perceive their social support, work and loneliness associated with depression?","fulltext":[{"header":"Background","content":"\u003cp\u003eMajor depressive disorder (MDD) is a common illness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] that has a negative impact on the afflicted individual as a consequence of altered functioning [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Previous studies reported that prevalences of MDD, depending on the instrument used, were 10.8\u0026ndash;23.2% among physicians [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and 20.9\u0026ndash;43.2% among resident physicians [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA prior cross-sectional, multi-country online survey among psychiatry trainees in European countries reported that the prevalence of MDD was approximately 20.8%, using the Patient Health Questionnaire-9 (PHQ-9) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Another study using the PHQ-9 reported that 16.1% of North American psychiatrists had MDD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Thailand, the number of psychiatrists remains short and relatively small compared to those found in more developed countries [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In 2016, numbers of psychiatrists per 100,00 people in countries such as the USA, Japan, or New Zealand were 10.54, 11.87 or 28.54, respectively, on the other hand in Thailand was 0.72 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consequencely, Thai psychiatrists reported low quality of life (QoL) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and suffered from high levels of burnout, increasing dramatically from 17.1\u0026ndash;49.3% (from 2011 to 2018) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the factors associated with MDD among psychiatrists, female gender, being in residency training or one\u0026rsquo;s early-career stage, practicing in a nonacademic setting, and burnout were significantly related to higher PHQ-9 scores or the presence of MDD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, working more than 50 hours per week, a higher caseload or caring for more patients per day [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], feeling unsatisfied with one\u0026rsquo;s work and environment, and receiving insufficient support from family, workplace, and colleagues were associated with higher levels of burnout [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and lower QoL [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Several studies investigate MDD mostly in psychiatrists, but less in psychiatry trainees; and mostly about burnout and quality of life, but less in work-related data, which may link to emotional distress. The factors related to work included, for example: perception of social support towards family, chief of department, and psychiatrist/psychiatry trainee friends; or perceptions towards work including ability to control one\u0026rsquo;s work schedule, work stress, satisfaction with one\u0026rsquo;s income and work. Furthermore, loneliness \u0026ndash; an indicator of social well-being \u0026ndash; can lead to various psychiatric disorders and various physical disorders [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which higher level of loneliness could lead to poorer MDD, not only social support but development of psychological interventions required for MDD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring the Coronavirus disease (COVID-19) pandemic, psychiatry colleagues around the world have faced mental health problems associated with the pandemic of patients and their families (such as anxiety, and panic) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This outbreak still substantial challenges to psychiatry as it requires providing diagnostic and therapeutic services where and when they are needed [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], but there are not enough psychiatrists to meet this demand [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. As a consequence of the pandemic, psychiatry, and mental health professionals have been negatively affected, their distresses linked to clinical work and pressures from personal lives. However, psychological supports were offered and provided just little to them [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, this study was conducted in both psychiatrists and psychiatry trainees in Thailand to examine the prevalence of MDD. Associating factors of work related to MDD were also investigated because the factors have not yet been fully investigated among psychiatrists and psychiatry trainees. The findings from this study would be valuable to inform the relevant stakeholders on how to promote mental health of Thai psychiatrists and psychiatry trainees.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study was an online-based questionnaire surveying from January to February 2023. Following the ethical principles of the Declaration of Helsinki, this survey was approved by the Human Research Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC.65-488-3-1).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eAll Thai psychiatrists and psychiatry trainees, who are members of the Royal College of Psychiatrists of Thailand were invited. The potential participants, who were aged between 20 and 70 years and able to use the Thai language, were included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e Participants were recruited via the official social media platform of the Thai Royal College of Psychiatrists e.g., Facebook, Line application. The participants were invited to the survey by entering through the link or QR code from advertisements. On the first page, all participants were provided with the rationale and an overview of the survey to consider whether or not to take part in the study. If they agreed to participate in the survey, they then clicked continue to fill out the questionnaire. Adhering to the policy of strict confidentiality, the signatures of the participants were not required, and all of them were advised that they retained the right to withdraw from the survey at any time without giving any reason.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eThe demographic data, e.g., age, gender, marital status, number of children in the family, and history of physical and psychiatric illness were collected. Work-related data were also collected, including career status (psychiatry trainees \u003cem\u003evs\u003c/em\u003e psychiatrists), type of psychiatrist (general psychiatrist \u003cem\u003evs\u003c/em\u003e child and adolescent psychiatrist), type of workplace (academic medical school \u003cem\u003evs\u003c/em\u003e psychiatric hospital \u003cem\u003evs\u003c/em\u003e general/community/private hospital or clinic), type of patient\u0026rsquo;s care (outpatient \u003cem\u003evs\u003c/em\u003e both outpatient and inpatient care) as well as: experience years as a psychiatrist or psychiatry trainee; patients seen per day; clinical hour per week; night shifts per month; paid days off per month; and death patients who committed suicide. In addition, we collected perceived social support, whether poor or good, provided by family, the head of the department, and peers. To explore the perception towards work, we used a visual analog scale (VAS), ranging from 1\u0026ndash;10 (extremely low \u0026ndash; extremely high) to document perception levels of ability to control one\u0026rsquo;s work schedule; work stress; and satisfaction with one\u0026rsquo;s income and work. Additionally, two instruments Thai version were used in this study, one for the measurement of depression and the other for loneliness, as follows.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eDepression\u003c/h2\u003e \u003cp\u003eThe Patient Health Questionnaire-9 (PHQ-9) Thai version is a self-rating questionnaire to evaluate depression, which consists of 9 items. It employs a 4-point rating scale for each question: 0 (never), 1 (rarely), 2 (sometimes), and 3 (always). The total score can range from 0 to 27; 0\u0026ndash;4 (no or minimal depression), 5\u0026ndash;9 (mild depression), 10\u0026ndash;14 (moderate depression), 15\u0026ndash;19 (moderately severe depression), and 20\u0026ndash;27 (severe depression). The PHQ-9 Thai version has been proven to have acceptable psychometric properties for the screening of MDD with a recommended cut-off score of nine or greater, with a sensitivity of 0.53 and a specificity of 0.98 and Cronbach's alpha coefficient of 0.79, [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this study, the calculated Cronbach's alpha coefficient value was 0.81.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eLoneliness\u003c/h2\u003e \u003cp\u003eThe 6-item Revised UCLA Loneliness Scale (RULS-6) Thai version is a self-rating questionnaire used to evaluate loneliness. It employs a 4-point rating scale for each question: 1 (never), 2 (rarely), 3 (sometimes), and 4 (always). The total score ranges from 6 to 24. The higher the score, the greater the degree of loneliness is indicated. The summed scores were grouped into three categories: \u0026lsquo;low\u0026rsquo; for a score below the 25th percentile, \u0026lsquo;average\u0026rsquo; for scores ranging from the 25th to the 75th percentiles, and \u0026lsquo;high\u0026rsquo; for a score above the 75th percentile. The questionnaire has demonstrated good internal consistency as indicated by a Cronbach's alpha coefficient of 0.83 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and 0.87 regarding the data from this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eAll data (e.g., demographic and work-related data and variables of interest) were analyzed using the descriptive statistic method comprising proportions, means, standard deviation (SD), median, and interquartile range (IQR) and using Pearson\u0026rsquo;s and Spearman\u0026rsquo;s correlation analyses for inter-correlation of variables, according to normal or non-normal distribution. The association between depression score and demographic data, work-related factors, and variables of interest were analyzed using multiple linear regressions performed via the R software program version 4.1.2 (R Foundation for Statistical Computing). All CIs were calculated at the 2-sided 95% level.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003e225 participants agreed to collaborate and complete the questionnaires, comprising 173 (76.9%) psychiatrists and 52 (23.1%) psychiatry trainees. The median (IQR) age among the psychiatrists and psychiatry trainees was 37 (33, 44) and 28 (27, 29) years old, respectively. The majority of the respondents were female (149, 64.9%), single/divorced (146, 64.9%), and had a previous history of physical (91, 40.4%) and psychiatric illnesses (19, 8.4%). The most common physical illnesses were allergies (10.2%) and dyslipidemia (7.6%), while psychiatric illnesses were MDD (6.2%), generalized anxiety disorder (1.4%), post-traumatic stress disorder (0.4%) and attention deficit hyperactivity disorder (0.4%). Regarding work-related characteristics, most participants were general psychiatrists (178, 79.1%), worked at a medical school (105, 46.7%), and worked from 40 to 50 hours per week (108, 48.0%), other details see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and work-related characteristics (N\u0026thinsp;=\u0026thinsp;225)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;225); N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychiatrists\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;173); n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychiatry trainees\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52); n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (28.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (63.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (71.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (30, 42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (33, 44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (27, 29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle/Divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (90.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (98.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than one\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (90.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperience as a psychiatrist (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (3, 14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (5, 15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Workplace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (86.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther hospital (general/community/private hospital/clinic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTypes of a psychiatrist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral psychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 (79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild and adolescent psychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (21.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTypes of patient\u0026rsquo;s care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly outpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient and inpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of patients per day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (10, 30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (14, 35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (6, 15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking hours per week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of night shifts per month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (2.8,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.5 (4,9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of days off per month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (63.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIQR: interquartile range\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDepression\u003c/h2\u003e \u003cp\u003eOf all participants, the median (IQR) for the PHQ-9 score was 3 (2, 6). Most participants reported no/minimal (143, 63.6%), mild (63, 28.0%), and moderate to severe depression (19, 8.4%) (Supplementary Table\u0026nbsp;1). 28 (12.4%) participants were considered as MDD due to their PHQ-9 score\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;9, including 24 (13.9%) psychiatrists and 4 (7.7%,) psychiatry trainees (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, among those with MDD, there were 3 psychiatrists and 1 psychiatry trainee who had a previous history of MDD. Categorized data by the PHQ-9 with other variables are shown in Supplementary Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the symptoms of MDD according to the PHQ-9 findings, feeling down, feeling tired, lack of pleasure, having trouble concentrating, and the presence of sleep problems were the most frequently reported symptoms, see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Regarding suicidal ideation, 14 participants were reported, and 9 (32.1%) of them were considered as MDD in this study.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLoneliness\u003c/h2\u003e \u003cp\u003eUsing the RULS-6, only 35 (15.6%) participants were found to experience a high level of loneliness, while the rest reported an average level (190, 84.4%), with the proportions of those with a high level among psychiatrists and psychiatry trainees were 17.3% and 9.6%, respectively (Supplementary Table\u0026nbsp;1). Among 14 participants with suicidal ideation, 5 of them experienced a high level of loneliness, the others reported an average level. There was no statistically significant association between the presence of suicidal ideation and loneliness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePerception towards social support and work\u003c/h2\u003e \u003cp\u003eAsking whether \u0026lsquo;poor\u0026rsquo; or good\u0026rsquo; about one\u0026rsquo;s perceived social support, most participants reported that they received good support from family, peers, and the head of the department were 199 (88.4%), 178 (79.1%) and 149 (66.2%), respectively. No significant difference in the social support between psychiatrists and psychiatry trainees was found.\u003c/p\u003e \u003cp\u003eMeanwhile, self-rating perceptions towards works from 1 (extremely low) to 10 (extremely high), mean (SD) of participants\u0026rsquo; perceptions were 5.9 (2.2), 6.0 (2.5), 6.4 (1.9) and 7.0 (1.8) of work stress, income\u0026rsquo;s satisfaction, ability to control work schedule and work satisfaction, respectively. Their medians (IQR) and their comparisons were shown in Supplementary Table\u0026nbsp;1. Perception of income satisfaction, ability to control work schedule, and work stress were statistically significant different between psychiatrists and psychiatry trainees (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 0.023, and 0.045, respectively).\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssociation of levels of depression with demographic, work-related characteristics, level of loneliness and perceptions towards social supports and works\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAny variable having a statistically significant univariate test result, which was based on a \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.2, was selected as a candidate for inclusion in the multivariate analysis. The crude analysis revealed a statistically significant association between the levels of depression with age, number of children, psychiatric illness, number of experience years as a psychiatrist/psychiatry trainee, number of paid days off per month, and number of death patients who committed suicide (Supplementary Table\u0026nbsp;3). Also, the level of depression significantly positively correlated with loneliness among all participants (r\u0026thinsp;=\u0026thinsp;0.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with psychiatrists and psychiatry trainees were 0.47 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 0.30 (p\u0026thinsp;=\u0026thinsp;0.029), respectively. Among perceptions towards work, all participants\u0026rsquo; levels of depression only positively correlated with work stress (r\u0026thinsp;=\u0026thinsp;0.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the others showed negative correlations: work satisfaction (r=-0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ability to control work schedule (r=-0.34, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and income\u0026rsquo;s satisfaction (r=-0.20, p\u0026thinsp;=\u0026thinsp;0.002). Furthermore, the correlation coefficients of psychiatry trainees were generally weaker than those of psychiatrists. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) The multicollinearity among the independent variables was checked, using the variance inflation factor (VIF), and no multicollinearity issues were found.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrrelation between level of depression (using PHQ-9) and loneliness and perception towards works\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eDepression score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;225)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePsychiatrists\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;173)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePsychiatry trainees\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eρ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eρ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eρ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLoneliness score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception levels of\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility to control work schedule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eρ\u0026thinsp;=\u0026thinsp;Spearman correlation coefficient; IQR: Interquartile range; PHQ-9: Patient Health Questionnaire-9\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eNote:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Perception towards works using self-rating from 1-10 (extremely low \u0026ndash; extremely high) of each item, representing continuous data for correlation analyses\u003c/p\u003e \u003cp\u003eThe results of the multiple linear regression showed the level of depression was found to be significantly associated with the presence of previous psychiatric illness (Adjusted coefficients 1.44 (0.04, 2.84; p\u0026thinsp;=\u0026thinsp;0.043)), loneliness score (0.3 (0.17, 043; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)), perceived levels work satisfaction (-0.43 (-0.68, -0.17; p\u0026thinsp;=\u0026thinsp;0.001)) and work stress (0.43 (0.23, 0.63; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)) in all participants. When analyzed separately, in psychiatrists\u0026rsquo; group loneliness score (0.29; 0.14, 0.44; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), perceived levels of work satisfaction (-0.46; -0.78, -0.15; p\u0026thinsp;=\u0026thinsp;0.004) and work stress (0.47; 0.23, 0.71; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) remained significantly associated with the level of depression. Meanwhile, in the psychiatry trainees\u0026rsquo; group loneliness score (0.28; 0.03, 0.53; p\u0026thinsp;=\u0026thinsp;0.029) and perceived level of ability to control work schedule (-0.49; -0.91, -0.06; p\u0026thinsp;=\u0026thinsp;0.027) were significantly associated with level of depression. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression analyses of level of depression (using PHQ-9) on candidate variables among all participants, psychiatrists and psychiatry trainees\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCandidate variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003ePHQ-9 score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e (N\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePsychiatrists\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;171)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003ePsychiatry trainees\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(F-test)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrude coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(F-test)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCrude coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAdjusted coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(F-test)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of psychiatric illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003cp\u003e(-0.06, 3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003cp\u003e(0.04, 2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLoneliness score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003cp\u003e(0.34, 0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e(0.17, 0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003cp\u003e(0.35, 0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.29 (0.14,0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003cp\u003e(0.12, 0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003cp\u003e(0.03, 0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception level of ability to control work schedule\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.54\u003c/p\u003e \u003cp\u003e(-0.99, -0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.49\u003c/p\u003e \u003cp\u003e(-0.91, -0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception level of work satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.87\u003c/p\u003e \u003cp\u003e(-1.11, -0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003cp\u003e(-0.68,-0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.98\u003c/p\u003e \u003cp\u003e(-1.27, -0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.46\u003c/p\u003e \u003cp\u003e(-0.78, -0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception level of work stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003cp\u003e(0.52, 0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003cp\u003e(0.23,0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003cp\u003e(0.58, 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003cp\u003e(0.23, 0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eCI: Confidence interval; PHQ-9: Patient Health Questionnaire-9\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNote:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Adjusted R-square of models: all participants, psychiatrists and psychiatry trainees were of 0.33, 0.34 and 0.32, respectively\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first national survey from Thailand aimed to explore the prevalence and associated factors of MDD among Thai psychiatrists and psychiatry trainees. Regarding the objectives, this study found that 13.9% of psychiatrists and 7.7% of psychiatry trainees were considered MDD. Higher loneliness score was associated with higher depression scores in both psychiatrists and psychiatry trainees. In psychiatrists, a high depression score was associated with a low perceived level of work satisfaction and a high perceived level of work stress, whereas in psychiatry trainees\u0026rsquo; a high depression score was associated with a low perceived level of ability to control work schedule.\u003c/p\u003e \u003cp\u003eAs for the prevalence of MDD, the finding from this study of 13.9% of psychiatrists was found to be relatively comparable with the prior study in North America which 16.1% were identified as MDD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Meanwhile, among psychiatry trainees in this study, the prevalence of MDD (7.7%) was different from prior studies with an average rate of 20.8%, nevertheless, there was a wide range of MDD prevalences from 7.1\u0026ndash;50.0% depending on the country site [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A recent study among Thai residents found that 23.4% of them had MDD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The inconsistency in the occurrence of MDD could be due to differences in work-related characteristics, sleep quality, and burnout of the study populations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Other possible explanations may be the diverse depression assessment tools and characteristics of the samples, e.g., ethnicity, gender, age group, and level of family or social support. The majority of our participants perceived that they had good social support from family, the head of the department, and psychiatrist peers. These supports may help alleviate distress, and lead to low depression scores in our study. In addition, most psychiatrists and psychiatry trainees reported an average level of loneliness, this could help affirm that they may receive adequate social support in life [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. According to this, it could help explain why the prevalence of MDD was relatively low in our sample.\u003c/p\u003e \u003cp\u003eIn this study, perception towards works was investigated using VAS (from 1\u0026ndash;10), resulting in their perception levels sounding acceptable, as their median scores were from six to seven out of ten. Of note, the psychiatry trainees reported significantly lower perception levels of ability to control work schedule and income satisfaction as well as higher perception of work stress, compared to the psychiatrists. Additionally, perception of work stress and work satisfaction were found moderate correlation with MDD, particularly in the psychiatrist's group. Our findings suggest that professional mental health care requires a sense of belonging and empowerment or workplace efficiency, a workplace with a sufficient budget and health care teams on duty, and a healthy work-life balance and good relationships among people are crucial in the workplace [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These needs should be the focus of healthcare policymakers and stakeholders [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFrom multiple regression analyses, similar to previous studies, loneliness was significantly associated with MDD in all samples [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Perception of work satisfaction and work stress were associated with contributing to MDD in psychiatrists [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], while in psychiatry trainees perception of ability to control work schedule was significant. It is undeniable that working as a psychiatrist has a unique performance, because he/she has to establish a good doctor-patient relationship professionally \u0026ndash; being a good communicator and listener [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], but relatively low income [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, they may get extreme mental pressure and be at risk in clinical practice despite that there is a shortage of psychiatrists these days [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. COVID-19 during and after pandemic also causes stressors to psychiatrists [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As a result, psychiatrists can feel an emotional burden [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Psychiatry trainees could also suffer from distress in the same way, although they have lower responsibility and shorter contact with people with illness, compared to psychiatrists. Although more trainees to become psychiatrists have been rapidly recruited, because of a small number of psychiatrists [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], the quality of training in psychiatrists remains crucial and should be standardized. However, they still have loads of work with closer supervision. This could therefore create psychological distress among psychiatry trainees as well.\u003c/p\u003e \u003cp\u003eIn addition, having previous psychiatric illnesses, which were mostly MDD, was also a significant factor associated with depression in our samples. It could be that although they had been diagnosed with MDD, the treatment they received may have not been adequate to cure their depressive symptoms [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], they may still be suffering from the residual symptoms of MDD [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], or they may refuse to seek help due to stigma [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Therefore, psychiatry trainees and psychiatrists with a history of psychiatric illnesses should receive close attention from their families, supervisors, and professional colleagues [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] to ensure that they receive adequate medical intervention in terms of both sufficient medication and robust psychosocial support. We also found that there were high frequencies of reported depressive symptoms including feeling tired, feeling down, lack of pleasure, having trouble concentrating, and having sleep problems. This information could help suggest monitoring the early warning signs of MDD among them. Notably, action is still required to reduce MDD rates in both psychiatrists and psychiatry trainees, although the prevalence of MDD in our study (Thailand) was not extremely high.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study examining MDD and its associations such as work-related data, perception of social support, perceptions towards work, and loneliness. There were limitations in this study. Firstly, since the survey was conducted via an online platform, we failed to get participants who are not interested in or not involved in social media, such as people with MDD or with emotional distress. As it was subject to selection bias (nonresponse bias), our sample might not be representative of the psychiatry trainees and psychiatrists at the national level. Secondly, although we advertised adequately (emphasizing that whether participating in the survey or not their decision will not affect their work/academic training), the number of psychiatry trainees is lower than expected, resulting in a lack of power in some data analyses. However, our research objectives were met. Lastly, we did not collect current stressors which might help explain the MDD outcome.\u003c/p\u003e \u003cp\u003eFuture studies may seek to collect information about work, for example, different workplaces (e.g., rural or urban hospitals), types of welfare or insurance, and safety at the workplace. In addition, studying assertiveness to assist psychiatry trainees in getting a sense of control in workplaces; exploring factors linking to loneliness to alleviate emotional burden; or examining supporting factors to prevent distress, may yield valuable knowledge that would inform effective targeted interventions for MDD in mental health care or other professionals.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFrom the survey, 13.9% and 7.7% of psychiatrists and psychiatry trainees, respectively, had MDD. Among them, loneliness was a key contributing factor associated with MDD. Work satisfaction and work stress were significantly associated with MDD in psychiatrists, whereas in psychiatry trainees the perception of the ability to control work schedule was significant. Action against MDD among psychiatrists and psychiatry trainees needs to be taken into account, such as social support to prevent loneliness, increase work satisfaction, decrease work stress, or encourage flexibility in work schedule.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emajor depressive disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHQ-9\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient Health Questionnaire-9\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003equality of life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRULS-6\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe 6-item Revised UCLA Loneliness Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eWe confirm that all methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University\u0026nbsp;(REC.65-488-3-1), who waived the requirement for obtaining informed consent as the participants could not be identified throughout the research process.\u0026nbsp;All stages of the research were conducted in full compliance with the Declaration of Helsinki and the statements of the Ethics Committee of the Faculty of Medicine, Prince of Songkla University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative data of the current study cannot be made publicly available for confidentiality reasons, but they can be available on request by the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was fully supported by the Faculty of Medicine, Prince of Songkla University, Thailand.\u0026nbsp;The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJP:\u0026nbsp;conception and design of the study, data collection, analysis of data; WA:\u0026nbsp;design of the study, data collection, analysis of data, and drafting of the manuscript; KA:\u0026nbsp;design of the study, data collection, analysis of data.\u0026nbsp;All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the participants for their willingness to provide their information via the study questionaires.\u0026nbsp;We would also like to also acknowledge the research assistants, Nisan Werachattawan and Kruewan Jongborwanwiwat, for their support and important role in the conduct of this study.\u0026nbsp;The English of this article was proofread/edited by the staff of the Office of International Affairs, Faculty of Medicine, Prince of Songkla University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcKeever A, Agius M, Mohr P. 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JAMA Intern Med. 2019;179(4):571\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JH, Tor PC, King J, Seo JS. A Korean survey on qualities and definition of a good psychiatrist. J Korean Med Sci. 2015;30(5):632\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao H, Wang P, Tang YL, Liu Y, Liu T, Liu H, Chen Y, Jiang F, Zhu J. Burnout and job satisfaction of psychiatrists in China: a nationwide survey. BMC Psychiatry. 2021;21(1):593.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorszun A, Dharmaindra N, Koravangattu V, Bhui K. Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees. The Psychiatrist. 2011;35(9):350\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeponiemi T, Aalto AM, Puttonen S, V\u0026auml;nsk\u0026auml; J, Elovainio M. Work-related stress, job resources, and well-being among psychiatrists and other medical specialists in Finland. Psychiatr Serv. 2014;65(6):796\u0026ndash;801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuitkin FM, Petkova E, McGrath PJ, Taylor B, Beasley C, Stewart J, Amsterdam J, Fava M, Rosenbaum J, Reimherr F, et al. When should a trial of fluoxetine for major depression be declared failed? Am J Psychiatry. 2003;160(4):734\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitanupong J, Sathaporn K, Tepsuan L. Residual symptoms and their associated factors among Thai patients with depression: a multihospital-based survey. Ann Gen Psychiatry. 2022;21(1):50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomera I, Perez V, Ciudad A, Caballero L, Roca M, Polavieja P, Gilaberte I. Residual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis. BMC Psychiatry. 2013;13:51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitanupong J, Aunjitsakul W. Personal and perceived stigma in relation to diverse domains of quality of life among patients with major depressive disorder having residual symptoms: a hospital-based cross-sectional study in Thailand. Qual Life Res 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitanupong J, Tuntikitjakun C. Burden among Relatives of Individuals with Depression in Southern Thailand: A University Hospital-Based Cross-Sectional Survey. 2023 2023, 41(5).\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":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"associated factors, depression, prevalence, psychiatrist, psychiatry trainee","lastPublishedDoi":"10.21203/rs.3.rs-3672690/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3672690/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to survey the prevalence of depression and its associated factors (perceptions towards social support and work and loneliness) among psychiatrists and psychiatry trainees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study surveyed Thai psychiatrists and psychiatry trainees from January to February 2023 using an online questionnaire. The questionnaires consisted of 1) the demographic and work-related information; 2) perceptions towards social support and work; 3) the Patient Health Questionnaire-9 (PHQ-9) Thai version; and 4) the 6-item Revised UCLA Loneliness Scale Thai version. All data were analyzed using descriptive statistics, and the associated factors concerning depression were analyzed via multiple linear regression analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 225 total participants, 52(23.1%) and 173 (76.9%) were psychiatry trainees and psychiatrists, respectively. Most of them were female (64.9%) with overall median age (interquatile) was 34 (30, 42) years. Regarding the PHQ-9 findings, the prevalence of depression among all participants was 12.4% (psychiatrists 13.9% and psychiatry trainees 7.7%). From regression analyses, depression was associated with loneliness and perceived levels of work satisfaction and work stress in psychiatrists, while in psychiatry trainees, depression was associated with loneliness and perceived level of ability to control work schedule.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e13.9% and 7.7% of psychiatrists and psychiatry trainees, respectively, had depression. Loneliness and perception about work satisfaction, work stress, and ability to control the work schedule were key contributing factors to depression. Although the prevalence of depression in this study was not extremely high, action is required to reduce the depression rate among mental health personnel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB / IEC Certification: \u003c/strong\u003e65-488-3-1\u003c/p\u003e","manuscriptTitle":"How psychiatrists and psychiatry trainees perceive their social support, work and loneliness associated with depression?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-30 19:43:18","doi":"10.21203/rs.3.rs-3672690/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2023-12-27T05:01:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-12-23T10:33:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a62c92e8-f7ec-4b26-be97-e12b8faf0bba","date":"2023-12-03T16:56:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0eeef47d-b9f3-4a70-85c5-fffa494956bb","date":"2023-12-03T16:55:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-28T22:01:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-11-28T09:56:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-11-28T09:39:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-28T09:32:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2023-11-27T14:17:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d09941f1-3ef3-4429-96f2-c8e059504912","owner":[],"postedDate":"November 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-02-12T15:12:22+00:00","versionOfRecord":{"articleIdentity":"rs-3672690","link":"https://doi.org/10.1186/s12888-024-05569-7","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2024-02-05 15:00:53","publishedOnDateReadable":"February 5th, 2024"},"versionCreatedAt":"2023-11-30 19:43:18","video":"","vorDoi":"10.1186/s12888-024-05569-7","vorDoiUrl":"https://doi.org/10.1186/s12888-024-05569-7","workflowStages":[]},"version":"v1","identity":"rs-3672690","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3672690","identity":"rs-3672690","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}