{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:03:25Z","timestamp":1784311405861,"version":"3.55.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depression is highly prevalent among medical trainees and negatively affects academic performance, empathy, and patient care. While healthy lifestyle behaviors are known to support mental health, the contribution of cognitive-emotional orientations, such as Positive Mental Attitude (PMA), remains underexplored. This study examined the associations between health behaviors, PMA, and depressive symptoms among medical students and residents in Ecuador.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted in 2025 among 700 medical students and postgraduate residents at a private university. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and the Health Behavior Inventory (HBI). Logistic regression models estimated associations between total HBI scores, its four subscales, and screening positive for clinically significant depressive symptoms (PHQ-9\u2009\u2265\u200910), adjusting for sociodemographic and academic variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nearly half of participants screened positive on the PHQ-9 (score \u226510) (47.7%). Higher total HBI scores were associated with lower odds of depressive symptoms (AOR\u2009=\u20090.94, 95% CI: 0.93\u20130.95). When HBI subscales were analyzed simultaneously, only PMA remained independently associated with lower odds of depressive symptoms (AOR\u2009=\u20090.79, 95% CI: 0.74\u20130.84). Female gender, younger age, and the presence of comorbidities were also associated with higher odds of depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PMA emerged as the behavioral domain most strongly associated with lower odds of clinically significant depressive symptoms in medical trainees, after adjustment for other lifestyle domains. These findings underscore the relevance of cognitive-emotional orientations in behavioral medicine and support the inclusion of positive psychology approaches in medical education to promote well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354032","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:22:21Z","timestamp":1784308941000},"page":"e0354032","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Positive mental attitude and depressive symptoms among medical students and residents: a cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8258-8746","authenticated-orcid":true,"given":"Xavier","family":"S\u00e1nchez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Carrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Daniela","family":"Cortez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Merch\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"pone.0354032.ref001","volume-title":"Comprehensive Mental Health Action Plan 2013\u20132030","author":"World Health Organization","year":"2021"},{"issue":"21","key":"pone.0354032.ref002","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1001\/jama.2016.17324","article-title":"Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students","volume":"316","author":"LS Rotenstein","year":"2016","journal-title":"JAMA"},{"issue":"4","key":"pone.0354032.ref003","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/medu.12962","article-title":"Prevalence of depression amongst medical students: a meta-analysis","volume":"50","author":"R Puthran","year":"2016","journal-title":"Med Educ"},{"key":"pone.0354032.ref004","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.4065\/80.12.1613","article-title":"Medical student distress: causes, consequences, and proposed solutions","volume":"80","author":"LN Dyrbye","year":"2005","journal-title":"Mayo Clin Proc"},{"issue":"22","key":"pone.0354032.ref005","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1001\/jama.2015.15845","article-title":"Prevalence of Depression and Depressive Symptoms Among Resident Physicians","volume":"314","author":"DA Mata","year":"2015","journal-title":"JAMA"},{"key":"pone.0354032.ref006","volume-title":"Promoting mental health: concepts, emerging evidence, practice","author":"H Herrman","year":"2005"},{"issue":"2","key":"pone.0354032.ref007","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s10804-009-9082-y","article-title":"Mental Illness and Mental Health: The Two Continua Model Across the Lifespan","volume":"17","author":"GJ Westerhof","year":"2010","journal-title":"J Adult Dev"},{"issue":"12","key":"pone.0354032.ref008","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.2105\/AJPH.2010.192245","article-title":"Change in level of positive mental health as a predictor of future risk of mental illness","volume":"100","author":"CLM Keyes","year":"2010","journal-title":"Am J Public Health"},{"key":"pone.0354032.ref009","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/17439760.2015.1015156","article-title":"The bidirectional relation between positive mental health and psychopathology in a longitudinal representative panel study","volume":"10","author":"SMA Lamers","year":"2015","journal-title":"J Posit Psychol"},{"key":"pone.0354032.ref010","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jad.2019.04.051","article-title":"Recovery from mood and anxiety disorders: The influence of positive mental health","volume":"252","author":"M Schotanus-Dijkstra","year":"2019","journal-title":"J Affect Disord"},{"key":"pone.0354032.ref011","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1037\/a0021769","article-title":"Lifestyle and mental health","volume":"66","author":"R Walsh","year":"2011","journal-title":"American Psychologist"},{"issue":"6","key":"pone.0354032.ref012","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1097\/00006842-200111000-00009","article-title":"Is the glass half empty or half full? 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