Psychiatric comorbidity of depression and anxiety in medical trainees: prevalence and predictors in Ecuador

Background: Depression and anxiety are highly prevalent among medical trainees, yet their comorbidity remains underexplored. Comorbid symptoms are linked to greater severity, functional impairment, and poorer outcomes than either disorder alone. This study examined the prevalence and predictors of depression–anxiety comorbidity among medical trainees in Ecuador. Methods: We conducted a cross-sectional survey of 700 students (393 undergraduates, 307 postgraduates) at a private university in Quito from January to March 2025. Depressive symptoms were assessed with the PHQ-9, anxiety with the GAD-7, and alcohol use with the AUDIT. Comorbidity was defined as PHQ-9 ≥10 and GAD-7 ≥10. Logistic regression identified sociodemographic, academic, and clinical predictors. Results: Clinically significant depression was reported by 47.71%, anxiety by 44.57%, and comorbidity by 36.71%. Prevalence was higher among undergraduates than postgraduates for depression (54.71% vs. 38.76%), anxiety (52.92% vs. 33.87%), and comorbidity (43.26% vs. 28.34%) (all p < 0.001). In multivariable analysis, higher odds of comorbidity were independently associated with female gender (AOR = 1.66, 95% CI: 1.15–2.40), chronic illness (AOR = 1.89, 95% CI: 1.30–2.77), and undergraduate status (AOR = 2.67, 95% CI: 1.55–4.65). Tobacco use and night shifts showed positive but nonsignificant associations. Conclusion: More than one-third of medical trainees reported depression–anxiety comorbidity, highlighting a distinct and underrecognized challenge in Latin America. Findings emphasize the need for early, stage-sensitive, and gender-responsive interventions, as well as accommodations for students with chronic illness. Addressing comorbidity is critical to improving trainee well-being and sustaining medical education quality.