The Mental Health Challenges of Medical Postgraduates in Chengalpattu District, Tamil Nadu: Are they being Educated or Exploited?

Introduction Globally, psychological morbidity among medical postgraduates (PGs) is an often overlooked and underreported condition. The study was done to find the prevalence of depression and stress among PGs and to find and explore the associated factors contributing to their stress and depression.  Methodology The study followed a convergent parallel mixed-method approach, in which qualitative and quantitative data were collected simultaneously. The quantitative component was a cross-sectional study among 224 medical PGs pursuing their course in the Chengalpattu district of Tamil Nadu, India. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and stress was evaluated using the perceived stress scale (PSS). A convenience sampling technique was followed. A pre-tested structured questionnaire was used to collect data regarding their interpersonal relationships with peers, seniors, and faculty members; their sleep patterns; and details regarding their family. Data was collected via an online platform. The qualitative component was collected by three focus group discussions (FGDs) conducted on virtual video calls with eight members in each FGD. The topic guide included semi-structured questions regarding the challenges in their postgraduate course and areas they felt needed improvement in the medical education system. Quantitative data was analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA), and qualitative data was collected using QualCoder version 3.5 (Colin C, QualCoder, Massachusetts Institute of Technology, Cambridge, MA, USA) and analyzed using thematic analysis. Results The mean age of the study participants was 27± 3 years. The prevalence of depression was found to be 46.4%, and stress was found to be 53.2%. A logistic regression model using the enter method and a linear regression model at a 95% confidence interval were used to find the predictors of depression and stress, respectively, among the PGs. The major predictors of depression were age of less than 27 years, clinical subject stream, less than six hours of sleep per day, inadequate knowledge of the course, and unapproachable faculty in the department. The major predictors of stress included all of the above, along with the feeling of discrimination on the grounds of language and religion. By qualitative analysis, the major themes identified were emotional and mental challenges PGs face in the course, gaps in postgraduate training, exploitation and unfair practices in the department, systematic barriers to education, and recommendations for improvement as perceived by the PGs. Conclusion The study found that around half of the study participants were screened positive for depression and stress. Some of the PGs responded that they experienced emotional abuse from seniors and faculties, expressed their need for an unbiased and neutral psychologist on campus, and expressed the need for a proper grievance redressal cell in the institution. At the institutional and departmental levels, measures could be taken to understand the mental health challenges faced by the PGs in an empathetic, non-judgmental, and holistic manner to reduce the psychological morbidity among them.