Stress and its association with academic performance among dental undergraduate students in Fujian, China: a cross-sectional online questionnaire survey

The Relationship between Stress and Preclinical Dental Students' Performance: A Longitudinal Study

Background

The aim of this study was to evaluate the changing levels of stress among dental students during 8 months of a basic manual skills course in the preclinical year and to examine the association between stress and dental performance.

Methods

A longitudinal study was conducted in the 2023 academic year in a total of 58 (male = 17 and female = 41; mean age = 26.43, range 22-33) undergraduate dental students at Tel Aviv University of dentistry during their fourth year of study. Depression Anxiety Stress Scale (DASS-21) and Dental Environment Stress (DES) questionnaires were used to assess the psychological well-being and the severity of DASS symptoms experienced by the students. The students' dental performances were assessed using two manual tests on plastic teeth. The questionnaires and the manual tests were used at three periods of time, T0, T1, and T2. Wilcoxon signed-rank tests were performed to compare the DASS scores and DES stressors of dental students between T0, T1, and T2. Kendall's nonparametric correlations were calculated to investigate the relationships of DES stressors and depression, anxiety, and stress scores with manual performance.

Conclusions

The perception of high stress by dental students is due to the stressful education process of the preclinical year. There is an inverse correlation between the lower level of anxiety and the increase level of dental performance with 74% of the variance in dental performance explained by the anxiety score. Work-related stressors such as manual skills might reduce dental performance in contrast to non-work-related factors such as financial obligations, personal issues, and family factors, which might increase student dental performance.

Optimism and mental health in college students: the mediating role of sleep quality and stress

Objective

College students showed a high prevalence of stress, anxiety, and depression, with medical and nursing students experiencing particularly elevated levels of mental health challenges.Optimism significantly influences overall well-being by promoting a healthy lifestyle and cognitive responses. However, the association of optimism with sleep quality, stress, and mental health in college students remains unexplored. This study aimed to (1) explore the associations of optimism with sleep quality, stress, and mental health and (2) ascertain whether sleep quality and stress mediate the association between optimism and mental health among college students.

Methods

A cross-sectional study was conducted using online surveys with students from health science majors at a public university in the northeast United States from September to December 2022. A total of 222 students participated in the study, providing data on sociodemographics, optimism, sleep quality, stress, anxiety, and depression. Parallel and serial mediation models were utilized to examine the potential mediating roles of sleep quality and stress in the association between optimism and mental health.

Results

The study found that optimism influences anxiety and depression through both direct and indirect pathways. In line with predictions, the parallel mediation analysis revealed that the impact of optimism on anxiety (βtotal = -0.598, 95% confident interval [CI]: -0.778 to -0.392) and depression (βtotal = -0.724, 95% CI: -0.919 to -0.519) was mediated by stress and sleep quality. Furthermore, the serial mediation models revealed that stress and sleep quality co-mediated the relationship betweenoptimism and anxiety (indirect effect [IE] = -0.074, 95% CI: -0.135 to -0.029) or depression (IE = -0.084, 95% CI: -0.142 to -0.036) in a sequential manner.

Conclusion

Optimism was negatively correlated with poor sleep quality, stress, anxiety, and depression. Enhanced optimism was linked to high sleep quality and less stress, anxiety, and depression. These insights emphasize the potential for school-based optimism interventions to improve sleep quality, ameliorate stress-related concerns, and alleviate mental health challenges in college students.

Stress experienced by dental students performing clinical training in different dental disciplines: a cross-sectional study

OBJECTIVES

To assess the stress level, the impact of stress factors, and discrepancies between fourth- and fifth-year undergraduate clinical students at the University of Jordan.

METHODS

A cross-sectional study was conducted in the academic year 2022/2023. The study group included fourth- and fifth-year dental students at the University of Jordan (n = 382) who were asked to voluntarily fill in an online dental environment stress (DES) questionnaire. Analysis was conducted using Mann-Whitney U test, independent t-test, χ2 test, and Spearman ρ rank correlations. Statistical significance was inferred when P < .05.

RESULTS

Fourth-year students reported higher levels of nervousness before treating patients for the first time. Fifth-year students faced more difficulty, higher stress, and/or fear regarding the amount of assigned work, provided treatment, completed requirements, failing the course, time to finish assignments, patient comprehensive care, and financial expenses of the course. Comparison between groups revealed that the fifth-year students scored higher levels of stress on the total DES score and all partial DES scores. Furthermore, the total DES questionnaire scores were significantly correlated with grade point average (GPA) among the total study sample and the prosthodontics clinical course marks among the fourth-year students' group.

CONCLUSIONS

The stress level among students in clinical courses was influenced by their academic performance, gender, year level, and the type and time needed for the provided treatment. Completing course requirements was among the most commonly faced stressors. Future research endeavors might be considered to study each clinical factor, its impact on students' stress level, and how to manage and positively improve these factors.

Dynamically Changing Mental Stress Parameters of First-Year Medical Students over the Three-Year Course of the COVID-19 Pandemic: A Repeated Cross-Sectional Study

Numerous research results have already pointed towards the negative influence of increased mental stress on educational processes and motivational criteria. It has also been shown that the global public health crisis induced by COVID-19 was related to anxiety symptoms and elevated levels of distress. To holistically elucidate the dynamics of the pandemic-related mental stress of first-year medical students, the associated parameters of three different cohorts were measured at the beginning of the pandemic-related restrictions on university life in Germany (20/21), at the peak of the COVID-19-related restrictions (21/22) and during the easing of the restrictions in the winter term 22/23. In a repeated cross-sectional study design, the constructs of worries, tension, demands and joy were collected from first-year medical students (n = 578) using the Perceived Stress Questionnaire. The results demonstrate significantly increased values of the constructs worries (p < 0.001), tension (p < 0.001) and demands (p < 0.001) at the peak of the pandemic related restrictions compared to the previous and following year as well as significantly decreasing values of general joy of life during the observed period of 3 years (all p-values < 0.001). A confirmatory factor analysis was performed to verify the questionnaire's factor structure regarding the addressed target group during the pandemic (CFI: 0.908, RMSEA: 0.071, SRMR: 0.052). These data, collected over a period of three years, provide information regarding dynamically manifesting mental stress during the COVID-19 pandemic, and refer to new areas of responsibility for the faculties to adequately counteract future crisis situations.

Factors associated with poor academic performance among undergraduate dental students: A cross‐sectional study

OBJECTIVE

To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil.

METHODS

A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05).

RESULTS

In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance.

CONCLUSION

A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Evaluation of the Experience of Peer-led Mock Objective Structured Practical Examination for First- and Second-year Medical Students

BACKGROUND

The objective structured practical examination (OSPE) is used as an assessment tool of laboratory practical sessions. This study described the design and implementation of peer-led mock OSPE for first- and second-year medical students, investigated the perception of the students of the peer-led mock OSPE and the impact of attending the mock OSPE on the performance.

METHODS

This is a cross-sectional study. Two mock OSPEs were designed and conducted by third-, fourth- and fifth- year medical students for year one and two. Each mock OSPE involved six stations. Thirty-three medical students facilitated the OSPE. The OSPEs were conducted prior to the summative end of block exams. Following the mock OSPEs, an online survey was sent to the participants to assess their satisfaction, quality and benefits of the mock OSPE. The study also evaluated the impact of the mock OSPE on students' performance.

RESULTS

Out of 313 first-year students, 279 (89.1%) attended the mock OSPE and out of 298 second-year students, 213 (71.5%) attended. A total of 192 (68.8%) first-year medical students and 102 (47.9%) second-year medical students completed the questionnaire. There was no significant difference between attending and non-attending the mock OSPE in the students' performance in the summative OSPE. The majority of students felt more confident, less anxious, and lowered the levels of stress after attending the mock OSPE. More than half of the students felt that attending the mock OSPE helped in easing the steps, better preparation, provided sufficient orientation, well explained the materials and helped them to learn the concept of the final OSPE. The majority of students found the mock OSPE stimulating.

CONCLUSION

Attending the mock OSPE did not affect the students' performance in the summative OSPE. However, the peer-assessed mock OSPE improved the medical students' confidence and lowered the anxiety associated with OSPE.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.

Stress, Sleep Quality, and Academic Performance among Dental Students in Shiraz, Iran

Background

Quality of sleep and stress level can affect the health, capacity of learning, and academic performance of the students. This study aimed to investigate the association between stress and sleep quality with academic performance among undergraduate clinical dental students in Shiraz, Iran.

Methods

This cross-sectional study was conducted during the second semester of the academic year 2020–2021 among clinical dental students at Shiraz Dental School, Iran. A total of 138 students completed Pittsburgh Sleep Quality Index (PSQI) and dental environment stress (DES) questionnaire. The grade point averages (GPAs) of the previous terms of the participants were also collected. Data analysis was performed using Kolmogorov–Smirnov test, the one-way ANOVA, post hoc Duncan's test, nonparametric Kruskal–Wallis H test, Wilcoxon–Mann–Whitney test, and the chi-squared test. The p values of less than 0.05 were considered statistically significant.

Results

Clinical dental students participated in this study experienced moderate levels of stress and poor sleep quality. Mean total DES and PSGI scores did not differ by sex, year of study, marital status, and place of residence (p values >0.05). Most of the students (52.9%) had moderate GPAs. A significant relationship was observed between sex and GPA as well as between place of residence and GPA (p values <0.05). No significant differences were found between DES total score or PSQI score and GPA categories (p values >0.05). A significant direct relationship between DES total score and PSQI score was observed (p < 0.05).

Conclusion

Dental undergraduates in Shiraz, Iran, experienced moderate levels of stress and poor sleep quality. The results showed no significant difference between sleep quality or DES and academic achievement. However, a significant direct correlation was observed between sleep quality and dental environment stress.

The relationship of educational environment and preparedness to practice - perceptions of Malaysian dental graduates

Gauging dental graduates' perceptions of their university training and of how it prepares them for professional practice is useful in measuring the quality and adequacy of the curriculum to which they were exposed.

OBJECTIVES

This study aimed to evaluate the perceptions of dental graduates' educational environment as well as preparedness to practice, and how these two components are correlated.

METHODS

A self-administered, validated questionnaire, developed from previous studies, was distributed to dental graduates of a public Malaysian university (n = 178, response rate = 60%) via online and postal surveys. Bivariate analyses were carried out using Spearman's rank-order correlation (Spearman's Rho, significance level p < .01) to determine the correlation between (1) Global Preparedness Score and Global DREEM Score, (2) domains of DREEM Inventory and perceived preparedness, and (3) domains of perceived preparedness and DREEM Score.

RESULTS

The Global Preparedness Score was 191.52, with more than 90% of respondents feeling well prepared in the "General Patient Management," "Drug and Emergency Management" and "Practice Management" domains. The Global DREEM Score was 148.99/200, interpreted as "more positive than negative." The DREEM Inventory domains with the highest and lowest scores were "Students' Academic Self-Perception" (78.03%) and "Students' Social Self-Perception" (71.86%), respectively. A moderate positive correlation was found between Global Preparedness Score and Global DREEM Score (p < .01). In addition, moderate to large positive correlations were noted between perceived preparedness and "Student Perception of Learning," "Student Perception of Atmosphere" and "Student Academic Self-Perception" (p < .01). Moderate positive correlations were also found between the DREEM Score and most domains of perceived preparedness (p < .01).

CONCLUSIONS

The majority of graduates were well prepared to perform in most areas of clinical practice and perceived their overall educational environment as positive. In particular, those who viewed the educational environment in a positive light were also found to possess a good level of preparedness.

Influence of Environmental Aesthetic Value and Anticipated Emotion on Pro-Environmental Behavior: An ERP Study

Perceptual cues act as signals in the aesthetic value environment, which promote emotion regulation toward pro-environment behavior. This type of perception-emotion-behavior reactivity forms the core of human altruism. However, differences in pro-environmental behavior may result from variation across high-aesthetic-value (HAV) and low-aesthetic-value (LAV) environments. This study investigated the neural mechanisms underlying interaction effects between environmental context and emotion regulation on pro-environmental behavior by integrating behavioral and temporal dynamics of decision-making information processing with event-related potential (ERP) technique measures. The results indicated that changing anticipated emotions changes pro-environmental behavior. Regarding changing aesthetic value environments, while modulating emotion regulation, significant differences were found in brain regions and mean amplitudes of N1, P2, N2, and late positive potential (LPP) components, which anticipated emotion. The findings suggest that environmental aesthetic value and emotion regulation impact pro-environmental behavior.

Psychosocial Factors as Mediator to Food Security Status and Academic Performance among University Students

The interrelation between food security, academic performance, and psychosocial factors remains unclear. This study aims to identify psychosocial factors as mediators of food security status and academic performance among university students at one of Malaysia’s public universities. Respondents included 663 bachelor’s degree students from seven randomly selected programmes at the university. Data on demographic and socioeconomic characteristics, food security status (US Adult Food Security Survey Module, FSSM), psychosocial factors (DASS-21), and academic performance were collected using an online survey. The SPSS PROCESS macro was used to perform mediation analysis. The result (β = −0.0182, p < 0.001) indicates that food insecurity is associated with poor academic performance. As well as that, an increase in anxiety (β = −0.0027, p < 0.05) and depression (β = −0.0025, p < 0.05) was significant associated with a decrease in academic performance. Furthermore, anxiety and depression serve as significant mediators in the relationship between food security and academic performance. Alleviating food insecurity is not only a way to improve academic performance; it can also improve academic performance by reducing anxiety and depression.

Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study

Medical students (MSs) are healthcare workers and must also cope with education-related stressors. This study aims to assess factors associated with perceived stress in Italian MSs. A cross-sectional study was conducted in 12 Italian medical schools (MSCs) in November 2018. A questionnaire assessed socio-demographic characteristics, habits, opinions about MSC, and concerns about the future. Stress was assessed with the PSS-10. Descriptive and univariable tests were performed. A linear model was fitted to find associations of the PSS-10 score with characteristics. There were 2513 collected questionnaires. Median PSS-10 score was 18 (IQR 11). Median age was 22 (IQR 4) and 61% of the sample was female. Female gender, being part of a sexual minority, poor financial situation, competitive atmosphere, having hobbies, resting, and sleeping hindered by MSC were characteristics associated with higher PSS-10 scores. Current relationship, good family relationship, and no concerns about the future were protective factors. Being part of sexual minorities had greater effects in students not living away from home, while in the other group it was not having satisfying friendships. Medical students suffer higher levels of stress than the general population, and many MSC stressors are associated. Living away from home modifies risk and protective factors, offering the possibility to tailor group-specific interventions.

The Relationship between Stress Levels Measured by a Questionnaire and the Data Obtained by Smart Glasses and Finger Pulse Oximeters among Polish Dental Students

Stress is a physical, mental, or emotional response to a change and is a significant problem in modern society. In addition to questionnaires, levels of stress may be assessed by monitoring physiological signals, such as via photoplethysmogram (PPG), electroencephalogram (EEG), electrocardiogram (ECG), electrodermal activity (EDA), facial expressions, and head and body movements. In our study, we attempted to find the relationship between the perceived stress level and physiological signals, such as heart rate (HR), head movements, and electrooculographic (EOG) signals. The perceived stress level was acquired by self-assessment questionnaires in which the participants marked their stress level before, during, and after performing a task. The heart rate was acquired with a finger pulse oximeter and the head movements (linear acceleration and angular velocity) and electrooculographic signals were recorded with JINS MEME ES_R smart glasses (JINS Holdings, Inc., Tokyo, Japan). We observed significant differences between the perceived stress level, heart rate, the power of linear acceleration, angular velocity, and EOG signals before performing the task and during the task. However, except for HR, these signals were poorly correlated with the perceived stress level acquired during the task.

New psychometric evidences on the Dental Environment Stress questionnaire among Romanian students

BACKGROUND

The academic environment is a challenge for dental students due to the multiple sources of stress they face. For this reason, the present study analyzes the psychometric properties of the Dental Environment Stress (DES) questionnaire. The secondary objective was to identify the specific sources of stress perceived by dental students related to gender and years of study.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental students (n = 340; M_age= 22.45) from the Romanian University of Medicine and Pharmacy in October- December 2019. The factorial structure of the questionnaire was performed by means of the confirmatory factor analysis (CFA) and the multi group-CFA. The convergent and divergent validities were measured by associating DES with scales that measure depression, anxiety, and tension/stress (Depression Anxiety Stress Scale-21-R), perceived stress (Perceived Stress Scale-14), and life satisfaction (Satisfaction with Life Scale).

RESULTS

New measure obtained supported a five-factor and thirty-item structure, which is gender invariant. All the factors within DES have a significant positive correlation with depression, anxiety, tension/stress, and perceived stress and a negative correlation with life satisfaction. The Cronbach's α coefficients are acceptable (range: 0.67-0.89). The female students perceive aspects related to performance, the relations with the faculty, clinical responsibilities, and personal life to be more stressful than males. Senior students perceive more stressed aspects related to personal life, while freshmen have higher scores on stress associated with clinical responsibilities.

CONCLUSIONS

The present results show that DES has psychometric properties which are adequate for the assessment of dental stress in the case of Romanian students; nevertheless, it is necessary to extend the use of DES to students attending other universities and to dental practitioners.

The Impact of Self-Efficacy, Optimism, Resilience and Perceived Stress on Academic Performance and Its Subjective Evaluation: A Cross-Sectional Study

This study aimed to highlight the contribution of self-efficacy, optimism, resilience and perceived stress on academic performance (GPA) at medical undergraduate students. Additionally, we investigated the relationship established between abovementioned variables, gender and position in the academic cycle and the factors associated with satisfaction regarding own academic results. 118 students (25 men, 93 women, mean age 22.863, SD = 1.763) participated in the study. They were administered the General Self-Efficacy Scale (G-SES), the Revised Life Orientation test (LOT-R), the Brief Resilience Scale (BRS) and the Perceived Stress Scale (PSS). t, Wilcoxon-Mann-Whitney, chi-square tests, and linear regressions were performed, in order to test the strength of the hypothesized associations. Data analysis demonstrates a significant association between low optimism, low resilience, high perceived stress and poor academic performance. Even though preclinical students displayed greater perceived stress, it negatively correlated to GPA only in clinical students, this indicating a possible accumulation of stress-related effects. No gender differences were met for the studied variables. Students in clinical cycle were significantly less satisfied about their own performance. These results indicate solid associations between psychosocial variables and academic performance, and differences in the subjective evaluation of own performance, suggesting key points to address, when designing interventions against academic stress.

Perceived stress among university students in Oman during COVID-19-induced e-learning

Background

Higher education institutions across the world moved to e-learning in response to the disruptions caused by the pandemic. While e-learning has an advantage for students that they can attend to their courses from anywhere at their convenience, yet the sudden disruptive shift to e-learning during the pandemic saw students facing many challenges, which had strong ability to induce mental health issues among the students. This study aimed at examining the impact of COVID-19-induced e-learning on the university students’ stress perceptions in Oman.

Results

A total of 966 usable responses were received. The results showed that 96.9% (moderate stress = 82.5% and high stress = 14.4%) reported having experienced stress through e-learning during COVID-19. The results further indicated that there was a significant negative correlation between perceived stress and the students’ academic performance. The family support and institutional support were observed to have a significant effect on students’ stress perception.

Conclusions

Students are away from the physical campuses over a year now, continuing their courses and programs online. The numerous challenges they are facing through e-learning, together with the prevailing uncertainty, have intensified stress among them. The continued stress over time will not only affect their academic performance, but their mental and physical health as well, as the stress has proven to be one of the major causes of various physical and mental disorders. While e-learning seems to emerge as a new normal, the students require proper attention, help, and support from their families and institutions. The institutions should revisit their online courses and program delivery mechanisms, methods, and practices to ensure that students are not over stressed.

Identifying the subtypes of psychological profiles in senior undergraduate nursing students and its relationship with academic performance: A latent class analysis

BACKGROUND

Students' academic performance is closely related to their personal psychological factors. The subtypes and heterogeneity of psychological profiles among nursing students has not been systematically examined.

PURPOSE

To identify subtypes of psychological profiles among nursing students using latent class analysis (LCA).

METHODS

A cross-sectional study design included 379 senior nursing undergraduate students aged 18-22 from three medical colleges in Shanghai. The subjects were investigated by Ruminative Responses Scale, Academic Burnout Scale and Psychological Capital Scale and were categorized into subtypes by LCA.

RESULTS

Four latent classes were identified: Class 1 - General group; Class 2 - Negative psychological dominated group; Class 3 - Positive psychological dominated group; and Class 4 - Ambivalence psychological group. Students with higher exam failure rate were more likely to belong to Class 2. After adjusted for demographic variables, the subtypes of psychological profiles significantly correlated with academic performance.

CONCLUSIONS

The significant heterogeneities were noted between psychological profile subtypes and academic performance among senior undergraduate nursing students.

Perceived Stress Among Chinese Medical Students Engaging in Online Learning in Light of COVID-19

Purpose

After a year of the COVID-19 pandemic, countries have repeatedly imposed strict quarantine regimes as the virus mutates and becomes more contagious. Medical undergraduate education has been disrupted and transformed into prolonged home isolation and online learning. Although studies have reported that the COVID-19 pandemic tends to increase perceived stress (PS) and affect the mental health of medical students, the influencing factors are unclear. Therefore, based on the stress process model, this study will comprehensively evaluate the distribution of stressors of medical students and explore the personal and environmental predictors of PS during the epidemic.

Participants and Methods

An online survey was conducted among medical students (n=369) from three medical universities in western China who engaged in online learning. A stress process conceptual framework was formed to explore the influencing factors of PS. The survey items contained four sections: (a) the potential stressors derived from academic, psychosocial and health-related demands; coping resources such as (b) online learning environment support and (c) personal resilience, including online learning behavior and individual characteristics; and (d) PS, perception of imbalanced demands and coping resources.

Results

The mean PS score was 17.39 (SD=4.58), and over four-fifths (82.3%) of the students had moderate to high levels of stress. The average item scores of academic, psychosocial and health-related stressors were 2.72 (SD=0.55), 2.31 (SD=0.55) and 2.07 (SD=0.50), respectively. Gender, grade, psychosocial stressors, health-related stressors, specific online learning behavior (persistence, attitude and flexibility), and the online learning environment (teaching, social and cognitive presence) were predictors of PS.

Conclusion

Our results specify that a reduction in psychological and health-related stressor stimulation, specific online learning behavior promotion, and well-established online learning environment support could be considered essential for alleviating the negative impacts of COVID-19 on the psychosocial health of medical undergraduates.