Systematic mental health screening at medical residency induction: Feasibility, yield, and outcomes of an institutional quality improvement program

Objective: Incoming medical residents show high rates of depression and anxiety that threaten occupational health, workforce continuity, and patient safety, yet most hospital induction programs lack systematic screening before clinical exposure. We evaluated the feasibility, yield, acceptability, and referral outcomes of an institutional quality-improvement program that embedded standardized mental-health screening into mandatory residency induction and triggered a time-sensitive referral pathway.
Methods: A 30-minute screening protocol was implemented during the 2024 induction at a national high-specialty public teaching hospital in Mexico City, Mexico. Incoming residents completed the PHQ-9 and GAD-7 anonymously through a digital form. Critical results (either score ≥ 10 or a positive suicidality item) triggered proactive outreach by the liaison psychiatry service within 72 hours. Outcomes were participation rate (feasibility), organizational acceptability (survey), instrument reliability, symptom yield, and adherence to the referral pathway.
Results: Of 214 incoming residents, 201 completed the screening (93.9% response rate). Probable depressive disorder (PHQ-9 ≥ 10) was identified in 11.0% and probable anxiety disorder (GAD-7 ≥ 10) in 11.2%. Twelve residents (6.0%) endorsed a positive self-harm item, of whom 75% were evaluated in person within 72 hours; overall, 74% of the 35 flagged high-risk residents attended a clinical appointment within the first month. Institutional utility was rated high by 92% of participants. Internal consistency of both instruments was high (Cronbach = 0.84 and 0.86).
Conclusions: Integrating systematic mental-health screening into hospital induction is a low-resource, high-yield operational strategy that identifies hidden psychiatric morbidity and ensures rapid clinical triage, establishing a scalable model for hospital workforce risk management.