Posttraumatic Stress Disorder Symptoms in Resident Physicians Related to Their Internship


To evaluate whether stresses experienced by physicians during internship are associated with posttraumatic stress disorder (PTSD) symptoms, the authors administered a standardized questionnaire to assess PTSD symptoms, depressive and anxiety symptoms, and social supports to 212 residents. Thirteen percent of residents met diagnostic criteria for PTSD, including 20% of the women and 9% of the men. PTSD symptoms were significantly more frequent in residents who were single or divorced at the time the questionnaire was administered. There were significant positive correlations between PTSD symptoms and symptoms of both current anxiety and depression, and a significant negative correlation existed between social support and PTSD symptoms. PTSD symptoms attributed to stresses associated with internship, which may be deleterious to physician well-being and potentially to patient care, and suggest the importance of making major changes in postgraduate medical training.

This is a preview of subscription content, access via your institution.


  1. 1.

    Asch DA, Parker RM: The Libby Zion case: one step forward or two steps backward? N Engl J Med 1988; 318:771–775

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Gordon GH, Hubbell FA, Wyle FA, et al: Stress during internship. J Gen Intern Med 1986; 1:228–231

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Kirsling RA, Kochar MS, Chan CH: An evaluation of mood states among first-year residents. Psychol Rep 1989; 65:355–366

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Valko RJ, Clayton PJ: Depression in the internship. Diseases of the Nervous System 1975; 36:26–29

    CAS  PubMed  Google Scholar 

  5. 5.

    Friedman RC, Bigger TJ, Kornfeld DS: The intern and sleep loss. N Engl J Med 1971; 4:201–203

    Article  Google Scholar 

  6. 6.

    McCue JD: The distress of internship. N Engl J Med 1985; 312:449–452

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Reuben DB: Psychologic effects of residency. South Med J 1983; 76:380–383

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Pugno P: Psychologic stresses encountered by resident physicians. Fam Med 1981; 13:9–12

    Google Scholar 

  9. 9.

    Kirsling RA, Kochar MS: Suicide and the stress of residency training: a case report and review of the literature. Psychol Rep 1989; 64:951–959

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Kollar E, Slater G, Palmer J, et al: Stress in subjects undergoing sleep deprivation. Psychosom Med 1966; 28:101–103

    CAS  PubMed  Google Scholar 

  11. 11.

    Webb W, Agnew H: The effects of a chronic limitation of sleep length. Psychophysiology 1974; 11:265–274

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Friedman RC, Kornfeld DS, Bigger TJ: Psychological problems associated with sleep deprivation in interns. Journal of Medical Education 1973; 48:436–441

    CAS  PubMed  Google Scholar 

  13. 13.

    Sapira J: Dysphoria and impaired mentation in young physicians. South Med J 1977; 70:1305–1307

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Small GW: House officer stress syndrome. Psychosomatics 1981; 22:860–869

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised. Washington, DC, American Psychiatric Association, 1987

    Google Scholar 

  16. 16.

    Andreasen N: Posttraumatic stress disorder, in Comprehensive Textbook of Psychiatry, 4th Edition, edited by Kaplan HI, Sadock BJ. Baltimore, MD, Williams & Wilkins, 1985, pp 918–924

    Google Scholar 

  17. 17.

    Solomon SD, Gerrity ET, Muff AM: Efficacy of treatments for posttraumatic stress disorder. JAMA 1992; 268:633–638

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Heizer JE, Robins LN, McEvoy L: PTSD in the general population. N Engl J Med 1987; 317:1630–1634

    Article  Google Scholar 

  19. 19.

    Breslau N, Davis GC, Andreski P: Traumatic events and PTSD in an urban population of young adults. Arch Gen Psychiatry 1991; 48:216–222

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Norris FH: Epidemiology of trauma: frequency and impact of different potentially traumatic events in different demographic groups. J Consult Clin Psychol 1992; 60:409–418

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Hendin H, Pollinger A, Singer P, et al: Meanings of combat and the development of post-traumatic stress disorder. Am J Psychiatry 1981; 138:1490–1493

    CAS  PubMed  Google Scholar 

  22. 22.

    Bloch AM: Combat neurosis in inner-city schools. Am J Psychiatry 1978; 135:1189–1192

    CAS  PubMed  Google Scholar 

  23. 23.

    Hocking F: Extreme environmental stress and its significance for psychopathology. Am J Psychother 1970; 24:4–26

    CAS  PubMed  Google Scholar 

  24. 24.

    Sudman S: Mail surveys of reluctant professionals. Evaluation Review 1985; 9:349–360

    Article  Google Scholar 

  25. 25.

    Derogatis L: Symptom Checklist-90: administration, scoring, and procedures manual II. Towson, MD, Clinical Psychometric Research, 1983

    Google Scholar 

  26. 26.

    Flaherty J, Gaviria M, Pathak D: The measurement of social support: the social support network inventory. Compr Psychiatry 1983; 24:521–529

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Elliott DL, Girard DE: Gender and the emotional impact of internship. J Am Med Worn Assoc 1986; 41:54–56

    Google Scholar 

  28. 28.

    Smith MF, Andrasik F, Quinn SJ: Stressors and psychological symptoms of family practice residents and spouses. Journal of Medical Education 1988; 63:397–405

    CAS  PubMed  Google Scholar 

  29. 29.

    Landau C, Hall S, Wartman SA, et al: Stress in social and family relationships during the medical residency. Journal of Medical Education 1986; 61:654–660

    CAS  PubMed  Google Scholar 

  30. 39.

    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Assocation, 1994

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr. Debra L. Klamen M.D..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klamen, D.L., Grossman, L.S. & Kopacz, D. Posttraumatic Stress Disorder Symptoms in Resident Physicians Related to Their Internship. Acad Psychiatry 19, 142–149 (1995).

Download citation


  • Social Support
  • Anxiety Symptom
  • Ptsd Symptom
  • Academic Psychiatry
  • Posttraumatic Stress Disorder