Longitudinal trajectories of burnout, perceived stress, and depressive symptoms among pediatric residents enrolled in professional master’s programs in China: a repeated-measures cohort study

Abstract

Background Pediatric workforce sustainability is an important public health concern in China. Pediatric residents enrolled in professional master’s programs face simultaneous clinical training and academic demands, but longitudinal evidence on how their psychological burden changes during standardized residency training remains limited. This study aimed to characterize trajectories of burnout, perceived stress, and depressive symptoms across postgraduate year 1 (PGY1), postgraduate year 2 (PGY2), and postgraduate year 3 (PGY3). Methods This longitudinal repeated-measures cohort study included 50 pediatric residents enrolled in professional master’s programs at a tertiary teaching hospital in China. Each resident was assessed once in PGY1, PGY2, and PGY3, yielding 150 repeated observations. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey, perceived stress using the 10-item Perceived Stress Scale, and depressive symptoms using the Patient Health Questionnaire-9. Generalized estimating equation models with robust standard errors were used to estimate stage-related mean differences while accounting for within-person clustering and adjusting for sex and cohort year. An exploratory participant-level analysis enumerated each participant’s categorical burnout status across PGY1–PGY3 using the two previously defined burnout indicators. Results Across all repeated observations, mean scores were 27.65 ± 6.34 for emotional exhaustion, 15.80 ± 3.89 for depersonalization, 24.27 ± 5.48 for personal accomplishment, 67.19 ± 7.07 for the exploratory composite burnout index, 20.77 ± 5.87 for perceived stress, and 14.16 ± 4.72 for depressive symptoms. Descriptively, emotional exhaustion and the exploratory composite burnout index were higher at PGY3 than at PGY1. In adjusted GEE models, PGY3 was associated with higher emotional exhaustion compared with PGY1 (β = 2.740, 95% CI: 0.535–4.945, p = 0.0149) and a higher exploratory composite burnout index (β = 2.920, 95% CI: 0.417–5.423, p = 0.0222). No statistically significant PGY3-versus-PGY1 differences were observed for depersonalization, personal accomplishment, perceived stress, or depressive symptoms after adjustment. Participant-level transition analysis showed that 42 of 50 residents (84.0%) screened positive for burnout at all three stages, whereas 8 of 50 (16.0%) met the stricter three-dimension high-burnout definition at all three stages. Conclusion Among pediatric residents enrolled in professional master’s programs, the clearest stage-related difference was higher emotional exhaustion at PGY3, with a parallel increase in the exploratory composite burnout index. This pattern is consistent with greater occupational exhaustion in later training, but causal attribution to training stage is not possible. Repeated, stage-specific monitoring and targeted residency support may help protect trainee wellbeing and strengthen the sustainability of the pediatric workforce in China.