Academic Psychiatry

, Volume 42, Issue 5, pp 630–635 | Cite as

A Qualitative Analysis of Stress and Relaxation Themes Contributing to Burnout in First-Year Psychiatry and Medicine Residents

  • Nicole M. Benson
  • Deanna ChaukosEmail author
  • Heather Vestal
  • Emma F. Chad-Friedman
  • John W. Denninger
  • Christina P. C. Borba
In Brief Report



Qualitative research on trainee well-being can add nuance to the understanding of propagators of burnout, and the role for interventions aimed at supporting well-being. This qualitative study was conducted to identify (i) situations and environments that cause stress for trainees, (ii) stress-reducing activities that trainees utilize, and (iii) whether trainees who report distress (high burnout and depression scores) describe different stressors and relaxation factors than those who do not.


The study was conducted with a convenience sample of first-year medicine and psychiatry residents at a large urban teaching hospital. Participants were asked to complete electronic stress and relaxation diaries daily for 1 week. Diary entries were coded for recurrent themes. Participants were screened for burnout and depression. Codes were compared by subgroup based on baseline burnout and depression status to elucidate if specific themes emerged in these subgroups.


Study sample included 51 interns. Sixteen (16/50, 32%) screened positive for burnout and three (3/50, 14%) had a positive depression screen. The most common stressors related to aspects of the learning environment, compounded by feeling under-equipped, overwhelmed, or out of time. The majority of relaxation activities involved social connection, food, other comforts, and occurred outside of the hospital environment.


This study reveals that interns (regardless of burnout or depression screen) identify stressors that derive primarily from organizational, interpersonal, and cultural experiences of the learning environment; whereas relaxation themes are diversely represented across realms (home, leisure, social, health), though emphasize activities that occur outside of the work place.


Well-being Burnout Residency Learning environment 



The authors would like to thank Dr. Felicia Smith and Dr. Hasan Bazari for their support of this research within the residency training programs in the departments of Medicine and Psychiatry, respectively, at Massachusetts General Hospital.

Author Contribution

Dr. Benson and Dr. Chaukos made equivalent contributions to this manuscript.


This pilot project was supported by an APIRE Janssen Resident Award (award recipient is corresponding author). Nicole M. Benson, MD is supported by the Massachusetts General Hospital/McLean Hospital Research Concentration Program R25MH094612. Dr. Christina Borba is supported by an NIMH Career Development Award: K01MH100428.

Compliance with Ethical Standards


Dr. Denninger receives support for unrelated investigator-initiated studies from Onyx Pharmaceuticals. Dr. Denninger receives support from Basis Inc. for materials related to investigator-initiated studies. This does not alter the author’s adherence to Academic Psychiatry policies on sharing data and materials.

Ethical Approval

Partners HealthCare Human Research Committee/IRB review.


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Copyright information

© Academic Psychiatry 2018

Authors and Affiliations

  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Mount Sinai HospitalUniversity of Toronto Faculty of MedicineTorontoCanada
  3. 3.McLean HospitalBelmontUSA
  4. 4.University of MarylandCollege ParkUSA
  5. 5.Boston Medical CenterBU School of MedicineBostonUSA

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