Health-promoting behaviors are associated with lower depression and anxiety in Ecuadorian medical residents: a cross-sectional study

INTRODUCTION: Mental health problems, hazardous drinking, and unhealthy behaviors are global concerns among medical residents, particularly in resource-limited regions such as Latin America. Long hours, heavy workloads, and stigma increase the risk of depression, anxiety, and substance misuse. This study assessed the prevalence of mental health symptoms, alcohol use, and health behaviors among residents in Ecuador.

METHODS: A cross-sectional online survey was conducted among 307 residents at the Pontificia Universidad Católica del Ecuador, after inviting all 1,122 enrolled residents to participate. Validated instruments assessed depression (PHQ-9), anxiety (GAD-7), hazardous drinking (AUDIT), and health behaviors (Health Behavior Inventory, HBI), alongside sociodemographic and training factors. Prevalence rates were estimated, and associations were analyzed using correlations and mixed-effects logistic regression.

RESULTS: The prevalence of depression, anxiety, and hazardous drinking was 38.8, 33.9, and 12.1%, respectively. Depression and anxiety were strongly correlated and inversely associated with health-promoting behaviors. Higher HBI scores significantly reduced the odds of depression (OR = 0.34, 95% CI 0.24-0.47, p < 0.001) and anxiety (OR = 0.52, 95% CI 0.39-0.69, p < 0.001). Hazardous drinking was independently associated with surgical programs and tobacco use.

CONCLUSION: Ecuadorian residents face substantial burdens of depression, anxiety, and hazardous drinking. Health-promoting behaviors were associated with better mental health, underscoring the importance of targeted interventions, workload reforms, and stigma reduction. From a public health perspective, supporting residents' well-being is critical not only for individual outcomes but also for patient safety and the sustainability of healthcare systems.