Supporting doctors

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. RESEARCH Supporting doctors’ mental health: Exploring the utility of a life skills programme for interns in rural Eastern Cape Province, South Africa Z Zingela,1 MMed (Psych), PhD ; S van Wyk,2 MMed (Psych), FCPsych (SA) Y Thungana,1 MMed (Psych), FCPsych ; E Abakisi,3 FCPsych (SA) ; ; Executive Dean’s Office, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa Western Health and Social Trust, Londonderry, UK 3 Tamale Teaching Hospital, Tamale, Ghana 1 2 Corresponding author: Z Zingela () Background. Occupational stress affecting junior doctors poses a serious risk to mental health, with consequences such as anxiety, burnout, substance misuse and suicide. Objectives. To evaluate the utility of a life skills training programme (LSTP) developed and implemented at Nelson Mandela Academic Hospital in the Eastern Cape Province, South Africa, in improving stress levels and coping abilities among second-year medical interns. Methods. We used a quasi-experimental pre-post quantitative design without a control group. Identical surveys were administered before and after the intervention, including the Perceived Stress Scale (PSS-10) and items on coping behaviours. Descriptive statistics, paired t-tests and Wilcoxon signed-rank tests were used for analysis. Results. Of 56 eligible interns, 45 (80.4%) completed both pre- and post-intervention assessments. Stress scores decreased significantly (from mean 2.92 to 2.51, p<0.001), while coping scores improved (from mean 3.26 to 3.48, p=0.001). Wilcoxon tests confirmed significant gains, with enhanced confidence in ethical reasoning (Z=–5.014, p<0.001), professionalism (Z=–2.673, p=0.008) and teamwork (Z=–2.357, p=0.018). Participants who were single or lived alone showed higher stress levels. Subgroup analysis also revealed that interns who were single or lived alone had lower coping scores. Conclusion. The LSTP improved interns’ mental wellbeing and coping mechanisms. Findings support integrating life skills training into internship programmes. Keywords: junior doctors, stress, coping, life skills training, internship, South Africa S Afr Med J 2026;116(2):e3770. https://doi.org/10.7196/SAMJ.2026.v116i2.3770 Doctors’ mental health has emerged as a major public health concern globally, with increasing evidence pointing to high levels of stress, burnout, anxiety, depression and psychological distress among medical professionals.[1-12] The COVID-19 pandemic further magnified these challenges, due to overwhelming clinical loads, fear of infection and ethical dilemmas, leading to increased levels of anxiety, depression, substance use, sleep disturbances and, in some cases, suicide.[13-16] Recommendations to mitigate this crisis have included improved access to mental healthcare, structural reform to reduce workplace stress and targeted interventions to improve psychological wellbeing.[14-18] South African (SA) studies mirror these global trends, with high levels of stress and psychological morbidity among doctors and medical students.[3,16,17] Young doctors, in particular, must navigate the dual pressures of adapting to new professional roles and coping with emotionally demanding environments. They transition from academic training to clinical responsibility, mastering clinical competencies, building confidence in decision-making and managing high expectations, while adjusting to long work hours and complex interpersonal dynamics.[19-21] Background The medical profession offers unique rewards, such as a sense of purpose and personal fulfilment, but also carries a heightened risk of mental health challenges, as already outlined.[21] The conse 62 quences of untreated mental distress among doctors extend beyond the individual, potentially affecting professionalism, patient safety and clinical outcomes.[22,23] Multifactorial causes underlie the mental health vulnerabilities of doctors, including the pressures of perfectionism, exposure to trauma, limited peer support and stigma around seeking help.[9] In the USA, an estimated 300 physicians die by suicide annually, with 1% of doctors reporting attempted suicide and 42% reporting burnout, as of 2020.[24] These rates have remained consistent over several years, reinforcing the need for systemic solutions. Until recently, physician wellbeing was not widely considered a key quality indicator for health systems, although this is beginning to change in the post-pandemic landscape.[25-27] A 2020 report from the Health Professions Council of SA (HPCSA) showed a rise in the number of impaired doctors. Of the newly referred cases, 55% were due to substance use disorders, either alone or in combination with other mental health diagnoses.[28] Medical practitioners constituted 96% of referrals for impairment, with interns accounting for 8% of the 96%. Despite the Eastern Cape being only the fourth most populous province in SA, it reported the second highest number of impaired interns, possibly suggesting a regionspecific vulnerability.[28,29] Various interventions have been developed to mitigate doctors’ psychological distress, including stress management workshops, March 2026, Vol. 116, No. 2 RESEARCH resilience-building programmes, mentorship, Balint groups, cognitive behavioural therapy and life skills interventions.[30-33] These approaches have produced variable results, and little consensus exists on which interventions are most effective for specific subgroups or settings. One notable example is an initiative by the US National Academy of Medicine, which promoted an intervention focused on enhancing communication, empathy, organisational skills and stress resilience.[26] Despite promising outcomes, burnout symptoms remained significantly higher in doctors than in the general population, reinforcing the need for tailored programmes that acknowledge the unique pressures of medical practice. Another example is a residency resiliency programme, also in the USA, which comprised interactive sessions for 10 residents, with a control group of 13.[34] The sessions focused on building self-awareness, coping skills, strength and meaning in work, time management, self-care and connections in and outside of medicine to support resident wellbeing, alongside systemic changes to foster wellness. Feedback from residents described the intervention as very useful, with an average score of 9.25 out of 11, but with a barrier to implementation of logistical arrangements. Sahebalzamani et al.[35] demonstrated the positive impact of life skills training on the general health of nursing students in Iran. In a quasi-experimental pre-test/post-test design with 40 students, the study found a significant 22-point reduction in General Health Questionnaire (GHQ) scores following life skills training (p<0.01), indicating improved psychological and overall health. Extending beyond general health, Jaworski et (...truncated)