Perceived Stress, Burnout, Depression, and Resilient Coping among Postgraduate Medical Residents in Kerala: A Cross-Sectional Study

<title>Abstract</title> <p> <bold>Background:</bold> Postgraduate medical residency involves heavy workload and sustained academic pressure, increasing vulnerability to burnout and depression. However, contemporary evidence regarding psychological morbidity among postgraduate medical residents in Kerala remains limited. <bold>Objectives:</bold> To estimate the prevalence of perceived stress, burnout, depressive symptoms, and resilient coping among postgraduate medical residents; examine their associations with selected sociodemographic characteristics; and explore relationships among these variables. <bold>Methods:</bold> A cross-sectional online survey was conducted among postgraduate medical residents at a Government Medical College in Kerala between November 2024 and June 2025. Validated instruments assessed perceived stress (PSS-10), burnout (abbreviated Copenhagen Burnout Inventory), resilient coping (Brief Resilient Coping Scale), and depressive symptoms (PSQ-4D). Associations were examined using Chi-square or Fisher's exact tests, and crude odds ratios with 95% confidence intervals were calculated for significant binary associations. <bold>Results:</bold> A total of 176 residents participated (64.8% female; mean age 26.9 ± 2.1 years). Burnout was present in 56.3% of residents, depressive symptoms in 50.0%, and low resilient coping in 51.7%. Moderate and high perceived stress were reported by 67.6% and 22.2% of participants, respectively. Burnout was significantly associated with depressive symptoms (OR = 10.17, 95% CI: 5.02–20.60; p &lt; 0.001), as well as with higher perceived stress and lower resilient coping (p &lt; 0.01). Perceived stress and depressive symptoms differed significantly across specialties, with surgical residents showing the highest prevalence of depressive symptoms. <bold>Conclusions:</bold> Burnout and depressive symptoms were highly prevalent and strongly associated with one another. Institutional strategies addressing workload, supervision, and mental health support may improve resident well-being. </p>