Artigos

Introduction
Residency programs of different healthcare professions, offer training with a focus on practice, stimulate the autonomy of health professionals with different degrees of complexity, with a considerable volume of patient care, develop clinical or surgical activities, and also perform regulatory, administrative, and conflict mediation roles.1
During this training period, residents are expected to balance learning, patient care, teaching, and managing healthcare services throughout working hours. In Brazil, residents work up to 60 hours per week;2 elsewhere, working hours for residents can reach 80 hours per week, as it is the norm regulated by "The Accreditation Council for Graduate Medical Education (ACGME)" in the United States of America (USA).3 The demands of this training modality have been associated with reduced sleep quality and exercise frequency, and distance from family and social relationships, culminating in an increase in diagnoses of anxiety, depression, and burnout syndrome.2,4,5
The prevalence of stress, anxiety, depression, and burnout in residents was analyzed in a sample of 606 medical residents from residency programs in Brazil, where 19% of residents had symptoms of depression, 16% of anxiety and 17.7% of stress. Burnout syndrome was present in 63% of the sample, as assessed by the high scores obtained on the emotional exhaustion subscale.6
Global estimates of the prevalence of stress, depression, and anxiety among residents show considerable variation. For instance, a study of 1,343 Chinese residents found rates of 12.8% for depression and 9.9% for anxiety.7 Similarly, an Iranian sample of 100 residents reported comparable figures, with 17.8% experiencing stress, 10.0% anxiety, and 10.4% depression.8 In contrast, a larger study in the United States revealed a higher prevalence, with 34.9% of 7,028 residents meeting the criteria for depression at least once during their training.9
Factors linked to stress and impaired well-being in resident are: long weekly working hours; the complexity of educational requirements; the high workload; lack of control; frequent changes of work environment; lack of reciprocity in professional relationships; changes in the circadian rhythm; social isolation; frequent exposure to trauma; fear of making mistakes and performing poorly; low income; and lack of self-care during available time.10-13
Residents living under this type of pressure tend to provide less than ideal patient care and are more likely to make errors.14,15 They also have higher rates of substance abuse, alcohol consumption, and suicidal thoughts,16,17 with suicide identified as the second leading cause of death among medical residents.18,19
Even when they realize they need help, many residents do not seek mental health services due to restricted schedules, feelings of guilt over the need for service coverage, and fear of the stigma of being considered unfit to perform their duties, in addition to long waiting lists for service availability.20
The World Health Organization recommends organizational interventions for mental health at work, such as flexible arrangements, participatory job design, and workload changes. Given residency programs' significant influence on trainee well-being and patient care quality, identifying such strategies for residents across healthcare fields is crucial.21 The strategies mapped might be useful to the development and institutionalization of interventions aiming at the improvement of residency programs and work-related mental health issues of residents.
Thus, the aim of this scoping review is to identify strategies for promoting mental health among residents from different health areas.
Methods
Protocol and registration
This is a scoping review, developed at the Health Technology Assessment Center, Hospital Sírio-Libanês, São Paulo, Brazil, and conducted following the recommendations of the Joanna Briggs Institute (JBI) manual for scoping reviews.22
A scoping review is a systematic review of literature developed as (i) a synthesis that precedes and directs the question of interest of a systematic review, aimed to (ii) identify the types of evidence available in a specific area, (iii) identify gaps of knowledge, (iv) clarify key concepts or definitions in the literature, (v) analyze how research on a topic has been conducted, or (v) identify key characteristics or factors related to a concept.23 This type of review was chosen due to its broad mapping of the literature, encompassing different types of publications, and study methodology, and, in turn, providing a wide view of what is available in the literature.
The review report followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR)24 (Supplement Material S1). The protocol for this review was made available in a SciELO preprint database before the start of the review.25
Methods for involving society and other stakeholders in the project
Stakeholder consultation was undertaken throughout the development of this review's protocol to increase the applicability of its results and support the communication and translation of results for practical use. To this end, the following interested parties were consulted: consumers of information (managers, residents, preceptors, program coordinators, and others) and experts on mental health and health residency.
The question of interest in this review was structured using the acronym PCC as follows:
“What are the strategies used for promoting mental health in residents of the healthcare area?”
? P (population, condition): residents of the healthcare area.
? C (concept): strategies for promoting mental health.
? C (context): any context.

Eligibility criteria
Criteria for inclusion of studies according to the components of the PCC acronym.
? P (population, condition): residents of any healthcare area without a known diagnosis of mental illness and who did not go under general or specialized care for treatment of a mental health condition.
? C (concept): mental health promotion strategies, including strategies applied at the individual or population level, within the scope of public or private health, at any level of health care. Therapeutic strategies for mental illnesses were not considered.
? C (context): strategies addressed to the work scenario (hospital, outpatient, laboratory, or others), academic, home, social, or virtual setting were considered.

Any primary (descriptive or analytical) or secondary study design addressing strategies for promoting mental health was considered. Studies including a mixed sample (residents and non-residents) were considered for inclusion, and those presenting only non-resident data were not included.
Information sources
On August 9th of 2022, a broad and sensitive literature search was carried out using structured search strategies (Supplementary Material S2), with relevant descriptors and synonyms, for the following databases or repositories:
? Virtual Health Library (VHL);
? Campbell Collaboration;
? Cochrane Library (via Wiley);
? Educational Resources Information Center (ERIC);
? Excerpta Medica dataBASE (EMBASE, via Elsevier);
? Joanna Briggs Institute (JBI);
? Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed);
? Online Education Database;
? PsycINFO (APA);
? UNESCO Databases of Resources on Education.
On December 30th, 2022, additional unstructured searches were conducted on the following sources related to health education/teaching or health systems:
? American Educational Research Association (AERA);
? Resident & Fellow Section (RFS), American Medical Association (AMA);
? Association for Medical Education in Europe (AMEE);
? Best Evidence Medical Education (BEME);
? CanMEDS Consortium;
? Cochrane Effective Practice and Organization of Care (EPOC).
Throughout the study selection process, manual searches were carried out by consulting the reference lists of relevant studies, and additional searches were carried out by contacting experts in the field.
The search strategies are available in the Supplementary Material S2. No language filters or restrictions were applied regarding study design or publication type. Full articles, abstracts presented at conferences and events, reports and online documents, theses, and dissertations were included.
Study selection process
The study selection process was carried out in two phases using the Rayyan platform.26 The first phase comprised the appraisal the titles and abstracts of all references retrieved by the search strategies and categorizing studies as “potentially eligible” or “eliminated”. The second phase was based on the assessment of the “potentially eligible” studies in full text to confirm their eligibility or definitively exclude them. Justifications for each exclusion in the second phase were presented. Both phases were conducted by two groups of independent researchers, and disagreements were resolved by a third researcher.
Data extraction
Data from the studies identified and included in this review were extracted by one researcher, and a second researcher checked the extracted data. The following data were collected for each study: author, year of publication, type of publication (article/report, full text/summary), study design, name and description of the mental health strategy, institution proposing the strategy, and source of study funding. The following data were collected, when available, for each identified strategy:
1. Category: Administrative/management (adding wellbeing programs to the residency or mental health interventions in the residency’s curriculum and others), psychological (applying tools for surveillance/tracking signs and symptoms of mental conditions, support groups, providing therapy sessions, mindfulness and others), physical activity (strategies to promote physical activity or exercise, individually or in group activities, and others), healthy diet (encouraging or providing healthy food or meals), sleep health (monitoring sleep and encouraging healthy sleep habits), social (socialization activities outside the work environment, mentoring and others), educational (curricular changes, webinars, lectures, among others), work hours and workload control (monitoring and controlling weekly working hours, reducing workhours or shifts), financial education (financial education strategies), and the use of specific technological tools (tools, mobile application or resources for monitoring behaviors and facilitating interventions). Multimodal strategies were classified by a combination of categories.
2. Strategy status: proposed, implemented and not evaluated, or implemented and evaluated.
3. Duration of the strategy: ongoing or temporary.
4. Delivery format: in person, virtual/remote or hybrid.
5. Strategy approach: individual, group (group of residents) or program (proposal or implementation of strategies in residency programs).
6. Strategy receiver: residents, residency program managers/coordinators, or a combination of both recipients.
7. Strategy implementation environment: residency program (hospital, outpatient, laboratory, or others), academic (curricula, lectures, courses, disciplines, or others), home environment/private life (personal environment), social life (group activities or social gatherings), external activity (outside of the hospital or workplace), retreat, tournament, or virtual. Strategies covering more than one environment were classified as a combination of these environments.
8. Costs: total cost predicted by study authors for implementing the strategy.
9. Barriers and facilitators: those identified by study authors for implementing the strategy.
The categories were proposed to help delimit the overall aim of the strategies proposed or implemented. Studies might be classified as having one or more categories due to the multidisciplinary nature of the proposed or applied strategy. Furthermore, for the strategies that were implemented and evaluated by the included studies, information was extracted regarding the population, comparator (when applicable), and the results. These strategies were subsequently classified by the review authors according to the possibility of implementation, immediately or after the adoption of actions, in the national scenario (Brazilian context). This classification was carried out considering the ease, costs, and need for regulation or local policies, regardless of the certainty of the available evidence, from the authors' perspective exclusively.
The authors of the included studies would be contacted if additional information was needed.
Assessment of quality/risk of bias of included studies
As the objective of this scoping review was to map strategies presented in descriptive studies or use parts of analytical studies that report strategies, the use of checklists or tools for assessing the methodological quality of studies were not applied, as recommended by the Joanna Briggs Institute for scoping reviews.22
Synthesis of results
The strategies were categorized based on the data described above. A narrative synthesis was presented using graphs and/or tables. Descriptive statistics were performed using Microsoft Excel® and STATA® software version 18.
Results
Search results
Structured searches of electronic databases yielded 9,630 references, and unstructured searches of additional sources retrieved no references. In total, 960 duplicates were identified and excluded. So, 8,670 references were analyzed by reading the titles and abstracts, of which 8,450 were eliminated for not meeting the eligibility criteria.
In the second phase of the selection process, 220 references were analyzed in full text. Of these, 55 were excluded, and the reasons for exclusion are detailed in Supplementary Material S3 (A and B). Lastly, this review included 165 references, corresponding to 161 studies (Figure 1).
Characteristics of the included studies
The main characteristics of the included studies and their references are detailed in Supplementary Material S4. Studies by the summarized quantitative characteristics are described in Table 1.
Table 1. Characteristics of included studies (n=161).

Tab.1

The proportion of studies over the years covers a range of 38 years, with publications from 1984 to 2022. However, 68.9% (111/161) of the selected studies were published in the last 6 years (2017 to 2022).
The majority (62.1%) of studies were carried out in the United States of America (100/161), followed by Brazil with 5% of the publications (8/161). Studies were selected from all continents, to a lesser extent.
Studies with a primary research design were the most frequent (76%), followed by secondary research studies (24%), such as reviews. Among the primary research design, the most recurrent were cross-sectional or surveys (42.8%, 69/161), and prospective cohort (8.1%, 13/161).
Characteristics of included strategies
The main characteristics of strategies and study’s references are detailed in Supplementary Material S5. The summary of characteristics of included strategies are presented in Table 2.
Table 2. Summary of characteristics of included strategies (n=161).

Tab.2

Strategies for promoting mental health in the context of residence were proposed in 64% of the studies (103/161), implemented and not evaluated in 5% (8/161), and implemented and evaluated in 31% (50/161).
Regarding the duration of interventions, most of the included strategies (82.6%, 133/161) were suggested as continuous interventions. The delivery format of strategies was mostly in person (91.3%, 147/161), with few studies reporting a virtual (5.6%, 9/161) or hybrid format (3.1%, 5/161).
The approach towards the strategy was varied, with the majority of proposed strategies (86%, 89/103) being a recommendation of intervention for the whole residency program, while group or individual approaches were more frequent in the implemented strategies.
Eighty-seven percent (140/161) of the strategies were aimed at residents, 5% (8/161) at managers or coordinators of residency programs, and 7% (12/161) applied to both groups. One study reported a mixed sample, presenting residents and medical students as recipients (1%).27 Furthermore, only one study, with three publications, and one dissertation presented nursing residents as a sample.28-31 One study had as sample dentistry residents of oral and maxillofacial surgery specialty.32 The remainder of the included studies reported samples of residents from medical specialties.
The most common environment for applying the strategies was the residency scenario (88.8%, 143/161), that is, in the residency program itself (teaching hospital, university hospital, and other institutions). Other scenarios for the implemented and proposed strategies included a single location or a combination of places, such as academic, social, and external locations, retreats, tournaments, and home environments. Only 3.7% (6/161) of the strategies were proposed in a virtual environment.
Categorization of included strategies
Most of the studies addressed strategies that were categorized in more than one category. It is noteworthy that most strategies (52.1%, 84/161) prioritized having a psychological component. Additionally, it was observed that a large volume of strategies presented an administrative component (47.2%, 76/161).
At a lower rate, an educational component was observed in 26% (42/161) strategies, followed by social (16.1%, 26/161), control of workhours (13.6%, 22/161), and physical activity (9.3%, 15/161).
The summary of the category of strategies is presented in Table 3.
Table 3. Summary of the categories of included strategies.

Tab.3

Results of implemented and not evaluated strategies
The main results of the studies of implemented strategies but not evaluated (n = 8) and their references can be found in Supplementary File S6.
Five of the strategies had a psychological component, associated or not to an administrative or an educational intervention. The other three studies focused on administrative interventions, associated or not to an educational, and/or social strategy. Some studies reported perceptions of participants towards the implemented strategy, however, without a structured assessment.
The psychological strategies were varied, with one reporting a free mental health professional available to residents after hours, with records of the therapy being stored outside the institution. Out of the 110 residents who reacted positively to the availability of psychological intervention, only 40 actually sought out care. The barriers identified by the residents to seek out care were confidentiality (58%), judgment from co-workers (55%), and licensing concerns (44%). Personal barriers to seeking mental health treatment were lack of time (77%), cost (57%), and convenience (53%).
One strategy was to implement a stress management course. The perception of residents measured through a questionnaire before the course, of mindfulness as a trait, was negatively associated with the perception of stress (p= -0.68), and depressive symptoms (p= -0.45) and positively associated with well-being (p= 0.51). No assessment was undertaken after the course to assess the resident’s perceptions of mindfulness, stress, or other symptoms.
In a mix of administrative and psychological strategies, the Department of Surgery, at the University of Michigan, managed a range of well-being initiatives, which mainly adjusted the resident program to promote a healthy environment for residents. The initiatives seemed to be well received by both faculty and residents. Another combined intervention sought to assess different emergency medicine program's resources on mental health. It was identified that 90% of 73 residency programs offered mental health resources during resident orientation.
The General Surgery Program at the University of British Columbia had the goal of optimizing resident well-being, through initiatives of practice efficiency, culture of well-being, and personal resilience. The program highlighted the importance of efficient delivery of information minimizing additional stress for residents, having backup staff, prioritizing resident safety, and taking burnout seriously.
Wellness resources were analyzed at 94 medical residency programs in Radiation Oncology. Fatigue management training is available in 50 programs, annual retreats were hosted in 24 programs, and 39 reported having mentoring programs for residents.
Similarly, a mentoring program was offered at two institutions, within orthopedics residency programs, with one-o-one meetings between residents and surgeon mentors. This mentorship was perceived as highly valuable for career counseling and as a support for residents during difficult times. Another educational initiative, implemented at the University of the Andes was comprised of pedagogical efforts focused on the humanized training (promoting a respectful environment) of professionals.
No information concerning the costs of the implemented and not evaluated strategies was reported in the studies.
Results of implemented and evaluated strategies
Fifty studies presented data on the implementation and evaluation of mental health strategies among residents. Due to the high heterogeneity of the implemented and evaluated strategies it is not possible to compare their effectiveness. The main results, identified barriers, perceptions, and potential for implementation of the strategies, along with the references of the studies are presented in the supplementary material S7.
The strategy most commonly implemented by studies was an adaptation or inclusion of administrative or curricular actions in residency programs. These interventions permeated educational actions, such as elective courses on well-being, training in communication skills and stress management, mentoring for residents, groups for interactive discussion of different topics, as well as proposals for changes to the curriculum, or insertion of well-being programs in residency programs.
Psychological strategies were also frequent, including the provision of a therapist or mental health team, coaching strategy, intervention based on cognitive-behavioral theory, and animal-assisted therapy.
The mindfulness strategy, also known as full attention or awareness of internal states and the environment, was implemented by nine studies. This intervention presented variations in implementation format, such as retreat interventions, 3- to 8-week programs, and multiple formats presented in the primary studies included in the reviews.
The 2021 systematic review with meta-analysis33 identified a small difference in stress levels immediately after the intervention, favoring mindfulness (standardized mean difference (SMD) -0.36, 95% Confidence Interval [CI] -0.60 to -0.13; P < 0.05, I2= 33%; 8 studies, 474 participants), with similar results for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0. 05, I2= 0%; 2 studies, 79 participants). Nevertheless, these are results with low or very low certainty of evidence.
To a lesser extent, this scoping review included studies that implemented strategies for reduced work hours in residency, sports interventions such as yoga, team sports, and technological interventions such as the use of sleep and physical activity monitoring devices and apps.
The costs presented in eight of the implemented and evaluated strategies ranged from $12.99 per month per resident, consisting of a subscription to a mindfulness practice app, to $30,000.00 per year, to pay for a psychologist service (free of charge for residents) and to provide amenities such as a stocked refrigerator with healthy options. A survey study that evaluated the implementation of well-being strategies in seven medical residency programs measured an average annual cost per institution of $6,000.00.
Residents commonly cited stigma, time constraints, and fear of professional repercussions as barriers to accessing wellness interventions. At an institutional level, the primary barriers were cost and concerns over clinical workflow.
The potential application of these strategies within the Brazilian context was evaluated subjectively, drawing on evidence from the studies that have implemented them. Two strategies were identified for immediate implementation in Brazil: reducing shift durations, a change manageable by program administration, and facilitating optional team sports, which rely on resident initiative outside work hours. Other reviewed activities, however, require significant planning, funding, and managerial support to be feasible.
Discussion
This scoping review was developed to identify available evidence on strategies for promoting mental health in healthcare residents, in addition to analyzing how the research on this topic has been conducted and potential gaps in the literature.
A total of 161 studies reporting 161 strategies were identified, which mainly addressed multicategory strategies involving curricular or educational changes, proposals or implementation of well-being programs, psychological interventions such as offering individual therapy, mindfulness, reducing weekly working hours or shifts, sports interventions, promotion of a healthy diet, promotion of sleep health, promotion of social interaction, and interventions with technological devices.
Some strategies identified could be implemented immediately in any scenario, such as defining maximum working hours for shifts and encouraging physical activity. Other possible strategies would require a commitment to institutional organization, analysis of possible costs, and management/resident engagement.
Key literature gaps include the lack of studies on non-medical residents, limited evidence on intervention effectiveness, and heterogeneous methods that prevent comparing strategies.
Comparison with the literature and discussion of results
Some recent publications present similarities in content or design with this scoping review, such as: (i) a review of the literature on burnout in residents in the era of Covid-19, with the objective of identifying common stressors and interventions or successful initiatives that can be effective for residency programs;34 (ii) a scoping review with the objective of examining the content, format, and effectiveness of interventions on burnout in medical residents, in published studies from the last ten years;35 and (iii) a scoping review that evaluated published studies on interventions and strategies to improve the well-being of surgical residents.36
The scoping review36 aimed at the population of medical residents in the area of surgery training included 51 studies, which corresponded to 39 different wellness programs. Emotional, occupational, and physical well-being were the most common domains addressed36, a finding consistent with prior research on longitudinal burnout interventions, which were predominantly multimodal (e.g., combining wellness training and physical activities).35 The present review corroborates this pattern, showing that effective programs integrate multiple strategies.
A narrative review34 examined burnout in the Covid-19 context, linking it to factors such as inexperience in a novel crisis, depersonalization, involuntary relocations, health concerns, and ethical dilemmas. Reported interventions included virtual classes, telemedicine, therapy, peer support, and open communication.34 Virtual interventions with technological devices were also identified in this review, however, with an emphasis on mental health monitoring and apps for health promotion.
No scoping review was identified with the same design, eligibility criteria, and question of interest.
When comparing Brazilian guidelines and regulatory systems for mental health at work to the findings of this scoping review, some similarities resonate with Brazil’s updated occupational health framework, particularly the amendments to the Regulatory Standard No. 1 (Norma Regulamentadora nº 1, NR-1), chapter 1.5 (Portaria MTE nº 1.419/2024).37 These amendments now explicitly mandate psychosocial risk management. The inclusion of psychosocial risks in occupational policies (effective May 2025) underscores the urgency of adopting evidence-based strategies like those cataloged in this review, emphasizing institutional adaptability to local resources and priorities.
The main strengths of this scoping review involve broad (in diverse sources of information) and sensitive searches (search strategies also include synonyms and free terms). A total of 9,630 references were returned in the searches and were screened by titles and abstracts, as shown in Figure 1. This review's methodological strengths include a prospectively registered protocol, duplicate study selection, and adherence to the Joanna Briggs Institute framework for scoping reviews.22 By identifying numerous strategies, it provides a comprehensive overview of implementable options for residency programs and clearly highlights persistent evidence gaps.
When planning this review (protocol phase), there was a nominal predefinition of possible categories of strategies; however, this definition was expanded during the data extraction process. Categories included were: healthy eating, sleep health, workload control, educational intervention (including financial), and technological interventions. The cultural category, previously defined, was incorporated into social interaction strategies. A deviation from the protocol consisted of extracting the study data individually, which was carried out by just one researcher.
Limitations in the included studies consisted of the combination of proposed or implemented sets of strategies. Due to this factor, it was not possible to quantify the exact number of different strategies addressed due to the high rate of overlap among their components. To mitigate this limitation, we chose to present a detailed table describing each strategy proposed (Supplementary Material S5) and implemented (Supplementary Material S6).
This scoping review aimed to map mental health strategies for healthcare residents that could inform future analyses of their efficacy and applicability across various contexts. To achieve this goal, a comprehensive approach was adopted by including studies of any methodological design, which enabled the identification and categorization of proposed or implemented strategies. Our results reveal that most included studies (42.8%) employed non-comparative cross-sectional designs, limiting direct efficacy assessments. While this review did not evaluate the methodological quality of the studies—a task for future systematic reviews derived from this mapping—the findings underscore the critical need for robust comparative studies to better establish the effectiveness of the identified strategies. Future investigations should particularly employ longitudinal designs and control groups to strengthen the available evidence.
Although 50 studies (31.1%) evaluated the implemented strategies, most of these evaluations were characterized by surveys of the resident’s satisfaction or perception. Few strategies were evaluated through comparative studies capable of estimating their effectiveness with greater certainty and less bias, with emphasis on the systematic review with meta-analysis,33 which evaluated the effectiveness of the mindfulness intervention. This lack of data on the effectiveness of strategies highlights the need for more studies, comparing strategies before and after their implementation to be able to gauge their actual impact on the mental health of residents.
More than half of the strategies (62%) were implemented in the USA, and almost all studies presented samples of medical residents, characterizing a limitation regarding the applicability of these strategies in different scenarios. Strategies for reducing weekly working hours to 80 hours, for example, are not applicable to the Brazilian context due to local laws that limit the workweek up to 60 hours.
Implications for practice and future research
The wide diversity of mental health promotion and mental disorder prevention strategies identified in this study broadened the range of options available to residency programs. Managers, coordinators, and administrators of residency programs can evaluate which of the strategies presented here match the profile of their program, in addition to analyzing possible costs and applicability. We highlight the combination of different strategies, including psychological interventions such as practicing mindfulness, expanding social interaction, encouraging sports, healthy eating habits, and sleep health. Reducing the work shift or the maximum load or frequency of work hours is an intervention that can be applied immediately in residency programs, adapting to the local reality and the capacity of the institution.
There are also limitations in generalizing the findings of this review to a multiprofessional residency scenario, given the lack of included studies focusing on these populations. Significant pedagogical and operational differences exist when comparing medical (uniprofessional) and multiprofessional health residencies. In Brazil, medical residencies and other uniprofessional residencies are defined as postgraduate specialization courses that prioritize supervised service-based training, reinforcing a specialty-focused, hierarchical model. In contrast, multiprofessional residencies, which are lato sensu postgraduate programs for health professionals (excluding medicine), emphasize interdisciplinary service-learning, requiring integration with national health policies, health councils, and matrix support teams.38 This contrast between uniprofessional residencies and multiprofessional programs creates divergent mental health risk profiles, such as excessive autonomy demands and hierarchical pressures in the uniprofessional scenario. On the other hand, multiprofessional programs face challenges like role ambiguity and fragmented institutional support. Future research should address these differences by developing context-specific mental health strategies, while also exploring potential synergies, and lessons learned between traditional uniprofessional residency models and innovative multiprofessional approaches.
An open and accepting dialogue regarding the prevention of mental disorders is necessary to remove barriers to the stigma associated with these disorders. The lack of confidentiality for diagnosis and treatment was also highlighted as a potential barrier to seeking psychological or psychiatric interventions. Furthermore, costs associated with treatment and the availability of time are also factors that impact the search for and maintenance of interventions to promote mental health. Providing confidential, free, or reduced-cost care options during shift breaks may be a potential strategy to increase adherence to interventions for the prevention and management of mental disorders in residents.
Concerning future research, this scoping review identified a number of knowledge gaps that can be addressed by studies with appropriate designs and methods. These gaps include evidence on (i) the effectiveness of the mindfulness strategy for managing stress and burnout, being evaluated through studies with representative samples, longitudinal monitoring, and a standardized intervention program; (ii) the effectiveness of multimodal well-being programs, assessed through longitudinal monitoring, with analysis before and after program implementation on mental health outcomes; (iii) the economic impact of adopting wellness programs and strategies in preventing and/or managing mental disorders among residents; (iv) the effects of programs and strategies for subgroups of residents from other health areas, in addition to medical specialties; and (v) the effects of programs and strategies for multiprofessional residency scenarios. Another aspect that might need further studies concerns the Covid-19 context, analyzing its long-term and post-pandemic impacts on residents' well-being.
Through this scoping review, it was possible to identify several strategies for promoting mental health and preventing mental disorders in residents. The most frequently implemented interventions were multicategory well-being programs or strategies, including screening for mental health issues, a wide range of therapeutic modalities, and promotion and encouragement strategies for healthy habits. Access to consultations with psychologists or counselors, free of charge or at a reduced cost and with assured confidentiality, was also a strategy with a positive impact on residents. Mindfulness was often used as a strategy for managing stress. Administrative and regulatory measures, such as limiting weekly working hours or shifts, were also cited as interventions with positive impacts on mental health promotion. The potential applicability of the findings of this review will depend on the context of insertion, the cost of the chosen strategies, and the institution's level of prioritization for mental health promotion.
Acknowledgments and funding
This study was supported by “Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) - 25000.011404/2018-97”, Brazilian Ministry of Health, Brazil.
Data Availability Statement
The dataset for this article is available in the SciELO Data repository on the Ciência & Saúde Coletiva Dataverse at the link: https://doi.org/10.48331/SCIELODATA.JNWTCB














Data Availability Statement
The databases used in the article, including the extraction codes, analyses and
results are available in the repository: https://doi.org/10.48331/SCIELODATA.


References
1. Sfez M, James A, Villevieille T, Arzalier-Daret S, Raucoules-Aimé M, French PPC. Resident well-being: The new frontier? Anaesth Crit Care Pain Med. 2020; 39(1), 1-3.
2. Meeks LM, Ramsey J, Lyons M, Spencer AL, Lee WW. Wellness and work: mixed messages in residency training. J Gen Inter Med. 2019; 34, 1352-1355.
3. Wilson MR. The new ACGME resident duty hours: Big changes, bigger challenges. Ochsner J. 2003; 5(2), 3-5.
4. Mata DA, Lin JS, Ramos MA. Can we predict future depression in residents before the start of clinical training. Med Educ. 2015; 49(7), 741-742.
5. Nobleza D, Hagenbaugh J, Blue S, Skahan S, Diemer G. Resident mental health care: a timely and necessary resource. Acad Psychiatry. 2021; 45, 366-370.
6. Pasqualucci PL, Damaso LLM, Danila AH, Fatori D, Lotufo Neto F, Koch VHK. Prevalence and correlates of depression, anxiety, and stress in medical residents of a Brazilian academic health system. BMC Med Educ. 2019; 19, 1-5.
7. Li Z, Liu D, Liu X, Su H, Bai S. The Association of Experienced Long Working Hours and Depression, Anxiety, and Suicidal Ideation Among Chinese Medical Residents During the COVID-19 Pandemic: A Multi-Center Cross-Sectional Study. Psychol Res Behav Manag. 2023; 1459-1470.
8. Kousha M, Bagheri HA, Heydarzadeh A. Emotional intelligence and anxiety, stress, and depression in Iranian resident physicians. J Family Med Prim Care. 2018; 7(2), 420.
9. Chen L, Zhao Z, Wang Z, Zhou Y, Zhou X, Pan H, et al. Prevalence and risk factors for depression among training physicians in China and the United States. Sci Rep. 2022;12(1):8170.
10. Dabrow S, Russell S, Ackley K, Anderson E, Fabri PJ. Combating the stress of residency: one school's approach. Acad Med. 2006;81(5):436-9.
11. Edmondson EK, Kumar AA, Smith SM. Creating a Culture of Wellness in Residency. Acad Med. 2018;93(7):966-968.
12. Oriel K, Plane MB, Mundt M. Family medicine residents and the impostor phenomenon. Fam Med. 2004;36(4):248-52.
13. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016;7:364-369.
14. Tempski P, Santos IS, Mayer FB, Enns SC, Perotta B, Paro HB, et al. Relationship among Medical Student Resilience, Educational Environment and Quality of Life. PLoS One. 2015;10(6):e0131535.
15. Wolf TM. Stress, coping and health: enhancing well-being during medical school. Med Educ. 1994;28(1):8-17; discussion 55-7.
16. Prenskly M. Digital native, digital immigrants. MCB Univers Press. 2001;9(5),16.
17. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-2236.
18. American Foundation of Suicide Prevention. Facts about mental health and suicide among physicians. 2019. Retrieved from: https://www.datocms-assets.com/12810/1578319045-physician-mental-health-suicide-one-pager.pdf
19. Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC Jr, Nasca TJ. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017;92(7):976-983.
20. Aaronson AL, Backes K, Agarwal G, Goldstein JL, Anzia J. Mental Health During Residency Training: Assessing the Barriers to Seeking Care. Acad Psychiatry. 2018;42(4):469-472.
21. World Health Organization. WHO guidelines on mental health at work. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. 2022. Retrieved from: https://iris.who.int/bitstream/handle/10665/363177/9789240053052-eng.pdf?sequence=1
22. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020.
23. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.
24. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473.
25. Riera R, Latorraca COC, Padovez RCM, Martimbianco ALC, Simões CM, Pacheco RL. Strategies for promoting mental health among residents: scoping review protocol. Scielo Preprints. 2022.
26. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
27. Whitman NA, et al. Student Stress: Effects and Solutions. ASHE-ERIC Higher Education Research Report No. 2, 1984. 1984. Publications Department, Association for the Study of Higher Education, One Dupont Circle, Suite 630, Washington, DC 20036.
28. Sampson M, Melnyk BM, Hoying J. The MINDBODYSTRONG Intervention for New Nurse Residents: 6-Month Effects on Mental Health Outcomes, Healthy Lifestyle Behaviors, and Job Satisfaction. Worldviews Evid Based Nurs. 2020;17(1):16-23.
29. Sampson M, Melnyk BM, Hoying J. Intervention Effects of the MINDBODYSTRONG Cognitive Behavioral Skills Building Program on Newly Licensed Registered Nurses' Mental Health, Healthy Lifestyle Behaviors, and Job Satisfaction. J Nurs Adm. 2019;49(10):487-495.
30. Sampson M. Intervention effects of a cognitive behavioral skills building program on newly licensed registered nurses. The Ohio State University. ProQuest Dissertations and Theses database. Dissertation/thesis number: 27534777; ProQuest document ID: 2272840745. 2019.
31. Vallois EC. O estresse na residência em saúde e a proposta de uma nova disciplina em busca do bem estar ocupacional do discente: um estudo à luz da fenomenologia. Dissertação (Mestrado Profissional em Ensino na Saúde) - Escola de Enfermagem Aurora de Afonso Costa, Universidade Federal Fluminense, Niterói. 2018; 81 f.
32. Smith C, Rao A, Tompach PC, Petersen A, Lyu D, Nadeau RA. Factors Associated With the Mental Health and Satisfaction of Oral and Maxillofacial Surgery Residents in the United States: A Cross-Sectional Study and Analysis. J Oral Maxillofac Surg. 2019;77(11):2196-2204.
33. Sekhar P, Tee QX, Ashraf G, Trinh D, Shachar J, Jiang A, et al. Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors. Cochrane Database Syst Rev. 2021;12(12):CD013740.
34. Zhang S, Ramalingam ND, Chandran C. Unmasking Resident Physician Burnout During the COVID-19 Era. Perm J. 2023;27(2):179-183.
35. Lu FI, Ratnapalan S. Burnout Interventions for Resident Physicians: A Scoping Review of Their Content, Format, and Effectiveness. Arch Pathol Lab Med. 2023;147(2):227-235.
36. Anand A, Jensen R, Korndorffer JR Jr. We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. J Surg Educ. 2023;80(11):1618-1640.
37. Brasil. Ministério do Trabalho e Emprego (BR). NR-1 - Gerenciamento de Riscos Ocupacionais (GRO): Guia de informações sobre os Fatores de Riscos Psicossociais Relacionados ao Trabalho. Brasília: Coordenação-Geral de Normatização e Registros; 2025. Retrieved from: https://cdn.protecao.com.br/wp-content/uploads/2025/04/Guia-Fatores-de-Riscos-Psicossociais-MTE.pdf
38. Ceccim RB. Residências em saúde: o caminho da regulação. In: Pulga VL, Silva SG, Schneider F, Ceccim RB, organizers. Residência multiprofissional em saúde: costurando redes de cuidado e formação no norte gaúcho. 1st ed. Porto Alegre (RS): Editora Rede Unida; 2022. Retrieved from: http://hdl.handle.net/10183/179762