Every summer, more than 1,600 recent medical school graduates start training to become obstetrician-gynecologists at hospitals across the United States.
But even as they learn to do everything from screening women for cervical cancer and delivering babies to surgically removing ovarian cancer and uterine fibroids, one-third of them may develop clinical depression in their stressful first year of training , a study finds.
Yet only one-third of the OB-GYN first-year residents in the study sample who developed depression actually sought mental health help.
The findings suggest a need for more support during residency, the authors say, especially considering the national shortage of obstetricians and gynecologists, and the additional work-life and public policy-related pressures faced by practitioners in the only surgical specialty predominantly made up of women.
In all, 88% of the first-year OB-GYN residents in the study were women, the same as the current U.S. resident population in that field. More than 1,270 of them completed standardized depression screening tests and other surveys before and during their first year of residency training, which is called the intern year.
The study was done as part of the Health Equity and Retention in Obstetrics and Gynecology, or HERO, Project , a national research effort focused on understanding the factors affecting the OB-GYN workforce. The HERO team hopes to identify ways to support physicians and keep them working in the specialty, which can ensure patients continue to have access to the care OB-GYNs can provide.
HERO's co-principal investigators are Helen Kang Morgan, M.D., a Clinical Professor at the University of Michigan Medical School's Department of Obstetrics and Gynecology and senior author of the new study, and Abigail Ford Winkel, M.D., MPHE, of the New York University Grossman School of Medicine and a co-author of the new study.
"These data show us that a very large portion of those entering our specialty are struggling and not getting the help they need, and we're not having meaningful discussions about how to help them," Morgan said. "Changing mental health services from an opt-in model where residents must seek help, to one where every resident automatically gets some form of support, might be a good step. It has shown promise elsewhere."
Part of the larger study of resident mental health
The study data were collected through the larger Intern Health Study , which over 20 years has enrolled annual cohorts of graduating medical students. Close to 30,000 interns in all fields have taken part, agreeing to track their mood, sleep, activity and more as a way of studying the mental health impact of the known stresses of residency training.
The IHS offers a unique window on depression's triggers and potential prevention, which could help people far beyond the medical profession.
It focuses on young physicians in their first year of training because they experience an intensely stressful year of long work hours, varying sleep and work schedules, and the pressure of acquiring clinical skills while trying not to make mistakes that could harm patients.
In general, IHS data have shown positive trends in recent years as the hospitals that run residency programs, and the national organizations that govern training, change work hour rules and add support options.
While depressive symptoms still increase during intern year for many, the size of the increase on average has decreased 24% over time. However, this trend has happened more slowly in surgical training programs.
Elena Frank, Ph.D., the director of the Intern Health Study and an Associate Research Scientist at the Michigan Neuroscience Institute , notes that the analysis of the data from OB-GYN interns shows several factors that were most related to a change in depressive symptom score from the survey they took before beginning their intern year, to those taken during their training.
The ones not related to their training experiences were a self-reported history of depression, pre-internship depression, and higher scores on a personality trait scale of "neuroticism." The factors related to their training were fewer sleep hours, higher work hours and being involved in medical errors.
Other Intern Health Study findings have also shown that there is a higher risk of developing depression during the intern year among those who have irregular sleep patterns, and those who work longer hours or more irregular schedules.
The study data were collected between 2009 and 2024. In August 2026, in partnership with the HERO project, more than 500 prior OB-GYN intern participants completed follow-up surveys assessing their recent work and family experiences and well-being. More than 60 practicing OB-GYNs who completed the survey have volunteered to take part in interviews about their experiences since that time. The data are still being gathered and analyzed, said Frank, who is also a co-investigator on the HERO Project.
Other medical and surgical specialties may be able to partner with the IHS team to collect specialty-specific data like the OB-GYN team did, Frank notes.
More OB-GYN workforce research through HERO
Another topic that the HERO team is looking at is how the OB-GYN workforce has been affected by reproductive health policy decisions at the state and federal level, including any mental health and legal strain and the potential for supportive interventions to be tailored by region.
They recently published findings in the Journal of Women's Health showing substantial geographic variation in the conditions under which members of the specialty are expected to deliver care , including differences in baseline population health, access constraints, and system-level pressures.
They especially found these conditions, and outcomes for patients, varied based on policies related to reproductive care, as well as rurality.
The HERO Project has other research efforts currently under way, supported by philanthropic funding. HERO partners at hospitals, medical schools and clinics across the country are taking part.
Additional authors: In addition to Morgan, Winkel and Frank, the study's authors are Julia Rossi, M.P.H. Zhuo Zhao M.S., Karina Pereira-Lima Ph.D., M.Sc., and IHS principal investigator Srijan Sen, M.D., Ph.D., who is the director of the Eisenberg Family Depression Center , a Professor of Psychiatry and Research Professor at MNI. He holds the Frances and Kenneth Eisenberg Professorship in Depression and Neurosciences.
Funding/disclosures: The analysis of OB-GYN intern data was supported by the Josiah Macy Jr. Foundation (P25-16). The Intern Health Study was originally supported by the National Institute of Mental Health, part of the National Institutes of Health.
Paper cited: Depressive symptoms and associated factors among obstetrics and gynecology first-year residents. American Journal of Obstetrics and Gynecology, DOI: 10.1016/j.ajog.2026.07.023
