Volume 13, Issue 3 (2025)                   Health Educ Health Promot 2025, 13(3): 495-501 | Back to browse issues page


XML Print


1- Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
2- Department of Medical Education, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
3- Department of Psychology, Faculty of Psychology, University of Airlangga, Surabaya, Indonesia
4- Department of Physical Medicine and Rehabilitation, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia
5- Department of Psychiatry, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
Abstract:   (308 Views)
Aims: This study aimed to determine the prevalence of depression and anxiety symptoms in pediatric residents, evaluate their perceptions of the clinical learning environment, and examine the influence of this environment on psychological symptoms.
Instrument & Methods: This cross-sectional study was conducted involving 66 pediatric residents at Dr. Soetomo Academic General Hospital. Depression and anxiety symptoms were evaluated using the validated Indonesian versions of the Beck Depression Inventory-II and Self-Rating Anxiety Scale, respectively. Perceptions of the clinical learning environment were assessed through the Postgraduate Hospital Educational Environment Measure. Data analysis included linear regression and mediation analysis using the Sobel test.
Findings: A total of 6 residents (9.1%) reported symptoms of depression, 8 residents (12.1%) reported symptoms of anxiety, and 4 residents (6.1%) experienced both. Residents’ perceptions of the clinical learning environment were generally positive. The perception of social support within the clinical learning environment significantly influenced depression symptoms (p=0.024). However, the residents’ perception of the clinical learning environment did not significantly affect anxiety symptoms. Additionally, the perception of social support significantly influenced anxiety symptoms indirectly through depression as a mediating factor (p=0.04).
Conclusion: The perception of social support within the clinical learning environment has a significant direct influence on depression symptoms and an indirect influence on anxiety through the mediation of depression symptoms.
Full-Text [PDF 612 kb]   (129 Downloads) |   |   Full-Text (HTML)  (17 Views)  
Article Type: Descriptive & Survey | Subject: Health Education and Health Behavior
Received: 2025/07/2 | Accepted: 2025/08/19 | Published: 2025/08/25
* Corresponding Author Address: Jl. Prof. Dr. Moestopo No.47, Surabaya, Jawa Timur, Indonesia. Postal Code: 60131 (mia-r-a@fk.unair.ac.id)

References
1. Shah SSNH, Laving A, Okech-Helu V, Kumar M. Depression and its associated factors: Perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya. BMC Psychiatry. 2021;21(1):444. [Link] [DOI:10.1186/s12888-021-03439-0]
2. Huang Z, Zhang L, Wang J, Wang T, Xu L, Yang X, Lu H. Nomogram reliability for predicting potential risk in postgraduate medical students with anxiety symptoms. Heliyon. 2022;8(10):e10803. [Link] [DOI:10.1016/j.heliyon.2022.e10803]
3. Meshram A, Jha RK, Muley P. A review article on the relation between anxiety and depression. J Pharm Res Int. 2021;33(39A):31-4. [Link] [DOI:10.9734/jpri/2021/v33i39A32137]
4. Tortella-Feliu M, Balle M, Sesé A. Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. J Anxiety Disord. 2010;24(7):686-93. [Link] [DOI:10.1016/j.janxdis.2010.04.012]
5. Hopwood M. Anxiety symptoms in patients with major depressive disorder: Commentary on prevalence and clinical implications. Neurol Ther. 2023;12(Suppl 1):5-12. [Link] [DOI:10.1007/s40120-023-00469-6]
6. Sadiq MS, Morshed NM, Rahman W, Chowdhury NF, Arafat S, Mullick MSI. Depression, anxiety, stress among postgraduate medical residents: A cross sectional observation in Bangladesh. Iran J Psychiatry. 2019;14(3):192-7. [Link]
7. Yao DC, Wright SM. National survey of internal medicine residency program directors regarding problem residents. JAMA. 2000;284(9):1099-104. [Link] [DOI:10.1001/jama.284.9.1099]
8. Hnish M, Deen NZ, Snoussi S, Mohamad H, Abdalla M, Abdelbagi I. Prevalence of generalized anxiety disorder among medical residents in Hamad Medical Corporation in 2020. World Fam Med. 2022;20(1):185-95. [Link] [DOI:10.5742/MEWFM.2022.95234]
9. Chi T, Cheng L, Zhang Z. Global prevalence and trend of anxiety among graduate students: A systematic review and meta-analysis. Brain Behav. 2023;13(4):e2909. [Link] [DOI:10.1002/brb3.2909]
10. Levey RE. Sources of stress for residents and recommendations for programs to assist them. Acad Med. 2001;76(2):142-50. [Link] [DOI:10.1097/00001888-200102000-00010]
11. Hassan H, Said Z, Ibrahim N. Validity and reliability of beck depression inventory (BDI) Bahasa Melayu version: A pilot study on public servants having symptoms of depression. Linguist Cult Rev. 2021;6(S4):1-12. [Link] [DOI:10.21744/lingcure.v6n4.1898]
12. Ginting H, Näring G, Van Der Veld W, Srisayekti W, Becker ES. Validating the Beck Depression Inventory-II in Indonesia's general population and coronary heart disease patients. Int J Clin Health Psychol. 2013;13(3):235-42. [Link] [DOI:10.1016/S1697-2600(13)70028-0]
13. Setyowati A, Chung M, Yusuf A. Development of self-report assessment tool for anxiety among adolescents: Indonesian version of the Zung Self-Rating Anxiety Scale. J Public Health Afr. 2019;10(S1):a1187. [Link] [DOI:10.4081/jphia.2019.1172]
14. Raharjanti NW, Ramadianto AS. Validity and reliability of postgraduate hospital educational environment measure-Bahasa Indonesia Version. Indones J Med Educ. 2016;5(3):157-62. [Link] [DOI:10.22146/jpki.25375]
15. Ministry of Health Republic of Indonesia. Ministry of Health Republic of Indonesia. Indonesian Health Survey. Jakarta: Ministry of Health Republic of Indonesia; 2023. [Indonesian] [Link]
16. Javaid SF, Hashim IJ, Hashim MJ, Stip E, Samad MA, Ahbabi AA. Epidemiology of anxiety disorders: Global burden and sociodemographic associations. Middle East Curr Psychiatry. 2023;30:44. [Link] [DOI:10.1186/s43045-023-00315-3]
17. Obeng Nkrumah S, Adu MK, Agyapong B, Da Luz Dias B, Agyapong VIO. Prevalence and correlates of depression, anxiety, and burnout among physicians and postgraduate medical trainees: A scoping review of recent literature. Front Public Health. 2025;13:1537108. [Link] [DOI:10.3389/fpubh.2025.1537108]
18. Kessler RC, Sampson NA, Berglund NA, Gruber MJ, Al-Hamzawi A, Andrade L, et al. Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiol Psychiatr Sci. 2015;24(3):210-26. [Link] [DOI:10.1017/S2045796015000189]
19. Hettema JM. What is the genetic relationship between anxiety and depression?. Am J Med Genet C Semin Med Genet. 2008;148C(2):140-6. [Link] [DOI:10.1002/ajmg.c.30171]
20. Moelyo AG, Riza M, Nur FT, Nugroho HW, Martuti S, Hidayah D, et al. Learning environment assessment on the pediatric residency program at Dr. Moewardi Hospital, Surakarta, Indonesia. J Nat Sci Biol Med. 2019;10(3):144-9. [Link]
21. Triasih R, Ang F, Kusuma W, Rahayu GR. Trainees' perceptions on learning environment based on the level of training in a pediatric training program in Indonesia. Paediatr Indones. 2022;62(4):249-56. [Link] [DOI:10.14238/pi62.4.2022.249-55]
22. Ong AM, Fong WW, Chan AK, Phua GC, Tham CK. Evaluating the educational environment in a residency programme in Singapore: Can we help reduce burnout rates?. Singapore Med J. 2020;61(9):476-82. [Link] [DOI:10.11622/smedj.2019094]
23. Posada UMA, González VV, Morales OC, Cataño C, Vásquez EM, Restrepo D. Educational environment and mental wellbeing of medical and surgical postgraduate residents in Medellin, Colombia. Rev Colomb Psiquiatr. 2023;52(1):20-8. [Link] [DOI:10.1016/j.rcpeng.2021.02.006]
24. Lucas MN, Samarage DK. Trainees' perception of the clinical learning environment in the postgraduate training programme in paediatrics. Sri Lanka J Child Health. 2008;37:76-80. [Link] [DOI:10.4038/sljch.v37i3.105]
25. Bari A, Khan RA, Rathore AW. Postgraduate residents' perception of the clinical learning environment; Use of Postgraduate Hospital Educational Environment Measure (PHEEM) in Pakistani context. J Pak Med Assoc. 2018;68(3):417-22. [Link]
26. Gonçalves PL, Marçal APM, De Almeida França R, Nogueira VSN. Scoping review of the application of the Postgraduate Hospital Educational Environment Measure (PHEEM) in medical residency. REVISTA BRASILEIRA DE EDUCAÇÃO MÉDICA. 2024;48(1):e024. [Link] [DOI:10.1590/1981-5271v48.1-2023-0048.ing]
27. Chan CY, Sum MY, Lim WS, Chew NW, Samarasekera DD, Sim K. Adoption and correlates of Postgraduate Hospital Educational Environment Measure (PHEEM) in the evaluation of learning environments-a systematic review. Med Teach. 2016;38(12):1248-55. [Link] [DOI:10.1080/0142159X.2016.1210108]
28. Nelwati, Putri TH, Rahayuningsih A. The relationship between clinical learning environment and anxiety levels in nursing students on the nursing education program. JURNAL KEPERAWATAN. 2012;8(1):16-22. [Indonesian] [Link] [DOI:10.25077/njk.v8i1.29]
29. Kim EY, Yang SH. Effects of clinical learning environment on clinical practice stress and anxiety in nursing students. J Korean Acad Nurs Adm. 2015;21(4):417-25. [Link] [DOI:10.11111/jkana.2015.21.4.417]
30. Penninx BW, Nolen WA, Lamers F, Zitman FG, Smit JH, Spinhoven P, et al. Two-year course of depressive and anxiety disorders: Results from The Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2011;133(1-2):76-85. [Link] [DOI:10.1016/j.jad.2011.03.027]
31. Jacobson NC, Newman MG. Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychol Bull. 2017;143(11):1155-200. [Link] [DOI:10.1037/bul0000111]

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.