Interrelationships between Perceived Stress, Burnout, Depression, and Resilient Coping among Postgraduate Medical Residents: An Analytical Cross-Sectional Study

Background: Postgraduate medical residency involves heavy workload and sustained academic pressure, increasing vulnerability to burnout and depression. However, the interrelationships among perceived stress, burnout, depression, and resilient coping remain under explored in the Indian residency context. Objectives: To estimate the prevalence of perceived stress, burnout, depressive symptoms, and resilient coping among postgraduate medical residents, and to identify independent predictors of burnout and depression. Methods: An analytical 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 χ² tests and multivariable logistic regression. An exploratory analysis examined whether burnout was associated with the stress–depression pathway. Results: A total of 176 residents participated (64.8% female). Burnout was present in 56.3%, depressive symptoms in 50.0%, and low resilient coping in 51.7%. Although only 22.2% reported high perceived stress, most experienced moderate stress (67.6%). Depression was strongly associated with burnout (OR = 10.17; p < 0.001). High perceived stress independently predicted burnout (aOR = 11.92) and depression (aOR = 37.20), while burnout independently predicted depression (aOR = 6.07). Resilient coping was not independently associated with either outcome. Conclusions: Burnout and depressive symptoms are highly prevalent among postgraduate residents. Burnout appears to be a key correlate linking perceived stress and depression, highlighting the need for organizational and structural interventions beyond individual resilience-focused strategies.