Stress and behavior patterns throughout medical education - a six year longitudinal study

Workplace learning: the bidirectional relationship between stress and self-regulated learning in undergraduates

The present study focused on the relationships between various aspects of self-regulated learning (SRL) and stress among undergraduate health science students in workplace settings. Although both constructs are associated with academic achievement (Ahmady Set al., in J Educ Health Promotion 10:32, 2021, Cho KK et al., in BMC Med Educ 17:112, 2017), it is still unclear how they influence each other. Employing a longitudinal diary design, the aim of the present study was to examine whether perceived stress in the previous week impacts SRL-aspects in the current week and, conversely, whether SRL-aspects in the previous week impacts stress in the current week. Subjects were 192 undergraduate health sciences students in their workplace placements. SRL-aspects and stress were assessed using scales and previously tested single-item measures. The 21 SRL-aspects used in this study included cognition (learning strategies), motivation, emotion, perception of the learning environment, and regulation of these areas on a metalevel (monitoring and control). Data collected over 15 weeks were analyzed using multilevel vector autoregressive models, with the data nested within weeks and one model dedicated to each SRL-aspect and its relationship with stress. Among the 21 path estimates assessing the impact of prior stress on individual SRL-aspects, 10 were statistically significant. For individual SRL-aspects impacting stress, 7 out of 21 paths were statistically significant (p < .05). Notably, no model showed statistical significance of effects in both directions. Except for two results, cross-lagged relationships were negative, indicating that better SRL-aspects from the previous week resulted in reduced stress in the current week and vice versa. The effects for the cross-lagged paths from SRL-aspects to stress were predominantly of medium size, whereas the influence of stress on individual SRL-aspects was predominantly small. The present study highlights a potentially causal and mostly negative relationship between stress and various aspects of SRL, but also that the individual relationships require differentiated consideration. The results can be used to develop targeted interventions in the practical part of the training of health science students to reduce stress and improve specific aspects of SRL. Furthermore, these findings underscore assumptions regarding connections between anxiety and increased stress, negative relationships between stress and motivation, and the importance of effective time management strategies for stress reduction.

Stress levels and eating behavior among university students in Jordan: A cross-sectional study

BACKGROUND

Increased body weight is common among university students; transitioning from high school to university may increase perceived stress levels, thus changing dietary habits and metabolism to promote overweight or obesity. The current study investigates the association between stress and dietary habits among university students in Jordan.

MATERIALS AND METHODS

A cross-sectional study was conducted among 221 university students aged between 20 and 25 at Applied Science Private University [ASU]. A self-reported questionnaire was distributed to university students. The questionnaires were divided into three sections: the first was about general characteristics, body weight, change in body weight, and stress eating.

RESULT

The survey of 208 participants showed that 64.3% were females, and 84.2% of students lived with their families. Results showed that more than half [51.1%] of the respondents were dissatisfied with their eating habits. Females [57.7%] monitored their food intake more than males did. However, most males [77.2%] reported less eating during stress compared to females. In addition, the data analysis revealed that those who ate more were less likely to monitor their food intake [χ 2 =9.734, df = 1, P = .002] or quantity [χ 2 =16.704, df = 1, P < .001]. Only 20.8% of the participants preferred sports or hobbies as a stress reduction activity; 29.4% took showers, while 51.1% ignored what made them stressed. Finally, 56.3% of participants reported increased weight after starting university, and it was significantly correlated with stress eating while studying for exams [χ 2 =8.762, df = 2, P = .013]. Stress affects university students and can lead to unhealthy eating habits and health issues like obesity.

CONCLUSION

Many students face stress during their academic years, which affects their dietary choices. Policies promoting healthy eating habits and stress-reducing activities are important for university students.

Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study

BACKGROUND

The anatomy dissection course is a major part of the first two years of the traditional medical curriculum in Germany. The vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years of the course of study. Published interventions for specific stress reduction are scarce.

METHODS

In a randomized, controlled design two intervention groups were compared with a control group (CG) over the whole dissection course (nine measuring points before, during and after first and second semester). The 'Stress Management intervention (IVSM)' targeted at the setting of personal standards, the 'Friendly Feedback intervention (IVFF)' at the context of frequent testing. Quantitative surveys were distributed at nine measuring points. The questionnaire comprised validated instruments and self-developed items regarding stress, positive and negative affect, anxiety, intrinsic and extrinsic motivation, self-efficacy, and perceived performance.

RESULTS

Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. The experience of stress during the dissection course was significantly higher in the CG than in the IVFF. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation, and self-efficacy were higher than in the CG. For anxiety and negative affect in the IVSM this was especially seen at the end of the second semester. The self-perceived increase in both knowledge and preparedness for the first big oral and written examination did not differ between the study groups. About three quarters of the participants would choose the intervention 'Friendly Feedback' if given the choice.

CONCLUSIONS

Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance.

Psychological distress and sleep quality among Sri Lankan medical students during an economic crisis

OBJECTIVES

This study examined the evidence of the prevalence of psychological distress and poor sleep among medical students and its associations during an economic crisis.

DESIGN

This was a cross-sectional study using an online questionnaire. It included the Depression Anxiety Stress Scales and Pittsburgh Sleep Quality Index (PSQI).

SETTING AND PARTICIPANTS

This study included medical undergraduates from a large metropolitan university in Sri Lanka.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the prevalence of psychological distress, sleep quality, and factors associated with psychological distress. To evaluate the associations, we used logistic regression.

RESULTS

The majority (69.2%) had some form of distress (depression, anxiety or stress), while 23% had distress in all three. Anxiety was the most prevalent (50.7%). Poor sleep quality was reported in 41%. The highest contribution to global PSQI was from sleep latency, duration, and daytime dysfunction subscales. In bivariate analysis, sleep quality was directly related to depression (t245.65 = -6.75, p<0.001)., anxiety (t313.45 = -6.45, p <0.001), and stress (t94.22 = -5.14, p <0.001). In multinomial logistic regression models, sleep quality was independently associated with depression, anxiety and stress. In addition, frequent contact with friends was inversely associated with depression and anxiety. Also, social media use was inversely linked to depression, anxiety and stress. Clinical-year students had lower depression and anxiety than non-clinical students. Engaging in mindfulness activities was inversely associated with depression. However, models explained only a moderate amount of variance (Nagelkerke R-squared values were 0.21, 0.18, and 0.13 for depression, anxiety and stress, respectively).

CONCLUSIONS

Poor sleep quality and psychological distress are high among the undergraduates. The findings emphasize the importance of addressing sleep quality and psychological wellbeing in medical undergraduates. Further research with larger and more diverse samples is needed for a more comprehensive understanding of the factors associated with psychological distress among undergraduates.

Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis

Objectives

Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms.

Methods

We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic.

Results

The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%).

Conclusion

This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.

Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

Mental health and quality of life across 6 years of medical training: A year-by-year analysis

BACKGROUND

Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training.

OBJECTIVE

To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years.

METHODS

This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses.

RESULTS

The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels.

CONCLUSION

Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Prevalence and Associations of Night Eating Syndrome Among Medical Students in Saudi Arabia

Background

Medical students often experience elevated stress levels and disrupted sleep patterns, increasing the risk of developing Night Eating Syndrome (NES). Depression is prevalent among medical students, further emphasizing the need for investigation. This study aims to explore the occurrence of NES and its associated factors, primarily focusing on depression, among medical students at a university in Jeddah, Saudi Arabia.

Methods

In this cross-sectional study involving medical students, participants completed a self-administered questionnaire covering sociodemographic details, the Night Eating Syndrome Questionnaire (NEQ) with 14 items, and the Patient Health Questionnaire-2 (PHQ-2) for depression screening.

Results

The study involved 300 medical students, reflecting a diverse sample with an average age of 21.4 ± 1.9 years and a well-balanced distribution across academic years. Notably, 41 participants (13.7%) were identified as obese. Depression, as determined by PHQ-2 scores exceeding 3, was prevalent in 159 students (53.0%). A multivariable logistic regression analysis uncovered a significant independent association, revealing that being a second-year medical student was linked to depressive health conditions (odds ratio [OR]: 3.53, 95% confidence interval [CI]: 1.24-10.10, p = 0.02). Exploring NES, 22 students (7.3%) scored above the NEQ threshold of 25, indicating its presence. Intriguingly, multivariable logistic regression illustrated that the sole independent factor associated with NES was the presence of depression (OR: 4.4, CI: 1.4-13.2, p = 0.01).

Conclusion

The overall prevalence of NES was 7.3%, and it was found to be associated with depression in medical students. Additionally, being a second-year medical student was independently associated with depression. These findings underscore the importance of addressing mental health issues, including NES and depression, in medical students, particularly during the early stages of their training.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Association between screen time and depressive symptoms in a sample of Chinese medical students: Mediator role of empathy

Medical students are at high risk of psychological subhealth under heavy stress with increasing screen time. This study aimed to explore the association between screen time and depressive symptoms and determine empathy as a mediating factor. In this cross-sectional study, a total of 945 medical students were surveyed, and 924 medical students were ultimately included after standard exclusion criteria. They reported their daily screen time and completed the Chinese version of the Jefferson Scale of Empathy-Student Version (JSE-S) and the Self-Rating Depression Scale (SDS). t tests and analysis of variance showed a significant difference in empathy and depressive symptoms by sex, stage, and screen time. The correlation analysis revealed that both affective and cognitive empathy have inverse associations with depressive symptoms. The mediation model confirmed that cognitive empathy played a positive mediating role between screen time and depressive symptoms, reducing the impact of screen time on depressive symptoms. Our study may add empirical evidence to prevent and intervene in depressive symptoms. These findings call for considering controlling screen time and enhancing cognitive empathy as interventions for medical students' depressive symptoms.

Associations Between Temporomandibular Pain and Biobehavioral Variables in Dental Students in Response to an External Stressor

AIMS

To assess changes in temporomandibular disorder (TMD) pain and multiple biobehavioral variables relevant to TMDs in response to an external stressor.

METHODS

Self-reported data using online DC/TMD questionnaires were collected from volunteer dentistry graduate students. Data collection was performed on two occasions: during a non-exam period of the semester and during the subsequent exam period. Changes in the proportion of students with pain, differences in pain grade, and severity of biobehavioral status were measured and compared over the two periods. The association between severity of non-exam-period biobehavioral status and pain presence was also tested to assess whether biobehavioral variables can predict pain occurrence or persistence. Chi-square test, Wilcoxon signed-rank test, ANOVA, and Kruskal-Wallis tests were used for data analysis. P < .05 was considered significant.

RESULTS

Of the 213 enrolled students, 102 remained after data reduction. In the non-exam period, the proportion of individuals with pain was 24.5%; in the exam period, the proportion was 54.9%, and more students had a higher pain grade. The severity of all biobehavioral variables was higher in the exam period, but there was no association between changes in the presence of pain and changes in biobehavioral variables. Higher anxiety and parafunction levels were found in those who reported pain on both occasions.

CONCLUSION

Exam periods initiate readily measurable changes in the psychologic status of many students, as well as alterations in their temporomandibular pain. Higher levels of anxiety and oral behaviors during non-exam periods seem to be predictors for persisting pain.

The worldwide prevalence of self-reported psychological and behavioral symptoms in medical students: An umbrella review and meta-analysis of meta-analyses

OBJECTIVE

Medical students frequently experience a range of stressors, such as demanding academic requirements, competition and rivalry, self-doubt, and financial distress. As a result, they are at risk for psychological and behavioral symptoms (PBS) including: depression, anxiety, and sleep difficulties as well as maladaptive substance use.

METHODS

To determine the degree of risk for these symptoms, 13 databases, without language restriction., were searched.

RESULTS

A total of 32 meta-analyses were included in this umbrella review. A global analysis of all self-reported PBS combined yielded a pooled prevalence rate of 30.3% [26.9%; 33.7%]; 95% PI [2.2%; 58.3%]. The highest reported prevalence was for sleep problems 42.0% [35.6%; 48.4%], followed by stress 41.7% [35.3%; 48.1%], burnout 35.8% [25.7%; 45.8%], anxiety 32.5% [27.9%; 37.1%], depression 32.5% [28.8%; 36.1%], internet addiction 26.0% [5.5%; 46.5%], substance use 25.2% [18.9%; 31.6%], eating disorders 9.8% [1.1%; 18.4%], and suicidal thoughts/gestures/acts 8.9% [4.8%; 12.9%]. The prevalence estimates were deemed acceptable for all PBS.

CONCLUSION

The evidence shows that fully one-third of medical students experience a range of problematic PBS, likely attributable to the demanding and intense study environment, the hierarchical structure of medical training facilities, and the vulnerability of the young adulthood time period. Appropriately targeted assessment and intervention efforts are clearly warranted to decrease the psychological burden of medical student training. PROSPERO Identifier: CRD42023391800. Open Science Network (OSF) Identifier: DOI 10.17605/OSF.IO/SXQYN.

Depression, Anxiety, and Stress Among Medical Students During COVID-19 at Sultan Qaboos University in Oman

Introduction With the spread of COVID-19 around the world, several interventions have been reported to be useful to control disease transmission. However, the impact of the pandemic on the mental health of medical students is underreported in the Arab world. This study aimed to explore the rates of depression, anxiety, and stress among medical students at Sultan Qaboos University (SQU) and to identify the factors associated with a higher risk of these mental disruptions. Method This was a cross-sectional study where medical students were approached to answer an online questionnaire via emails from the administrative affairs in the College of Medicine in SQU from 16/01/2021 to 18/05/2021. A 21-item depression, anxiety, and stress (DASS-21) scale was used as a self-reporting tool to measure the negative feelings of depression, anxiety, and stress. Results Out of 700 students, 184 (26.3%) students responded fully to the study questionnaire. More than half of the participants were females (58.7%, n=108), and the mean (SD) age was 20.31 (1.642). Most students were Omani (93.5%, n=172), and 34.2% (n=63) lived in Muscat. More than half of the students (51.6%) were in phase 2 of the academic years, in which the majority were considered within the cohort ≥2017 (81%, n=149), with a mean (SD) GPA of 2.9 (1.5). Scores from the DASS-21 scale showed that 29.4% vs 27.2% vs 14.7% had extremely severe depression vs anxiety and vs stress. The proportion of students who reported lower GPAs was significantly associated with higher scores of severe-to-extremely-severe depression (P=0.001), anxiety (P=<0.001), and stress (P=0.001). Living in Muscat vs other regions was associated with severe anxiety and stress (P=0.038 and P=0.007, respectively). Conclusion Similar to a few studies in Oman, this study confirms the high rates of depression, anxiety, and stress among medical students during the COVID-19 pandemic. Results may be utilized to alert decision-makers, student academic council, and academic authority to the need to adopt a preventive mental health policy and design guidelines with resilience measures for college students, including prolonged cognitive-behavioral interventions and recovery programs.

Determinants of Poor Mental Health of Medical Students in Portugal-A Nationwide Study

Medical students are a population that is vulnerable to the development of anxiety, depression, and burnout. This observational cross-sectional study sought to assess the levels of distress and identify precipitating factors in all students enrolled in a Portuguese medical school during the academic year of 2022/23. Students (n = 768) were surveyed via validated instruments to measure anxiety, depression, and burnout. Sociodemographic information was also collected through a questionnaire. The study indicated that almost half of this population had depressive symptoms. No differences were found in distress levels between medical schools, and when comparing curricular years, higher levels of distress were found in the pre-clinical years in comparison to the clinical ones. Burnout, being a woman, the existence of physical health problems, homo- and bisexual orientations, affective family problems, problems with relationships in the academic community, difficulties in academic performance, and daily organization were identified as predictors of distress. On the other hand, satisfaction with the social support received and with academic ratings were identified as protective factors. In conclusion, there is a high prevalence of distress in medical students, which is associated with personal, physical, social, economic, and academic factors. The identification of predictive factors of distress may allow for the early identification of vulnerable students and for intervention and prevention strategies to be defined.

Work-related coping behaviour and experience patterns in university students: a review of 20 years of research

Work-related coping behaviour and experience patterns (WCEP) is the conceptualisation of personal experience with occupational stress and of the typical behavioural responses for coping with such stress. The objective of this review, which is based on 69 references that used the WCEP inventory in university students, is to offer a comprehensive overview of the findings on WCEP and their correlates in the student population. The results of the published studies consistently show that female students, teacher education students (compared to medical students) and students who receive insufficient social and financial support are at greater risk for being assigned to work-related patterns that indicate vulnerability to burnout and occupational health issues. Moreover, students assigned to these patterns, especially to the resigned (burnout) pattern, are prone to manifest other negative characteristics, such as less adaptive personality traits and coping strategies, vulnerability to stress, lower quality motivation, lack of commitment to the chosen career and suitability for the profession, and impaired physical and mental health. In contrast, the most desirable correlates, such as adaptive personality traits, higher quality motivation, commitment to the chosen career, suitability for the profession, stress resistance, adaptive coping and better physical and mental health, were related to the healthy ambitious pattern. Nevertheless, further research is needed to analyse work-related coping behaviour and experience patterns beyond the German speaking population to increase the generalisability of the findings.

Life satisfaction, resilience and coping mechanisms among medical students during COVID-19

PURPOSE

Life satisfaction influences well-being. Medical students often experience more stress as compared to their counterparts in other disciplines as they are required to meet the demands of both academic workload and clinical responsibilities. However, during the current pandemic, in addition to academic changes, inability to complete clinical placements, loss of peer interaction and social connectedness and, deployment to areas in times of crisis could exacerbate their stress. This would impact their ability to cope with stress and eventually influence their life satisfaction. Students approach these challenges in various ways, either positively, religiously, or by avoiding. This study aimed to explore the association between resilience, coping mechanisms and life satisfaction in medical students during the pandemic.

METHODS

A cross-sectional web-based survey was conducted from undergraduate medical students from year 1 to year 5. Three instruments were used to measure life satisfaction, resilience, and coping, namely The Brief Resilience Scale, The Satisfaction with Life Scale and the COPE inventory. Mean and standard deviation were calculated for all continuous variables. Robust linear regression model was used for analysis. Hierarchical (forward) stepwise model building technique was used for final model. Alpha cut off was kept at 0.05.

RESULTS

A total of 351 students (out of 500 students) completed the questionnaires. A moderately negative, slightly linear correlation between life satisfaction and avoidant coping was reported. Life satisfaction showed moderately positive, slightly linear correlation with resilience score. Three variables stayed significant in the final model: Resilience, avoidant coping, and religion coping.

CONCLUSION

Life satisfaction can be improved among medical students by focusing on strategies which enhance resilience. Religion is identified as a significant coping strategy among medical students. Students coping mechanism can vary and more research is needed to assess which types of coping strategies could contribute positively to the quality of their personal and professional lives.

Psychological distress and well-being among students of health disciplines in Geneva, Switzerland: The importance of academic satisfaction in the context of academic year-end and COVID-19 stress on their learning experience

INTRODUCTION

University students' psychological health is linked to their academic satisfaction. This study aimed to investigate students' psychological health and academic satisfaction in the context of COVID-19 and academic year-end stress.

MATERIALS AND METHODS

Standardized self-filled scales for anxiety, depression, stress, psychological well-being, academic satisfaction (subjective assessment of students' quality of life in their educational setting), and an ad-hoc scale for stress on the learning experience due to COVID-19 were used in this cross-sectional study. Participants were first- to third-year students of eight different health-related tracks in Geneva, Switzerland. Descriptive statistics and hierarchical regression analyses were applied.

RESULTS

In June 2020, out of 2835 invited students, 433 (15%) completed the survey. Academic satisfaction was a stronger mental health predictor than COVID-19 stress on the learning experience, which mainly predicted stress and anxiety. Lower academic satisfaction scores were significantly associated with stress (β = -0.53, p < 0.001), depression (β = -0.26, p < 0.001), anxiety (β = -0.20, p < 0.001), while higher scores with psychological well-being (β = 0.48, p < 0.001). Identifying as female was strongly associated with anxiety and stress but not with depression or psychological well-being. Lower age was associated with stress only. The nature of the academic training had a lesser impact on mental health and the academic year had no impact.

CONCLUSIONS

Academic satisfaction plays a more substantial role than COVID-19 stress on the learning experience in predicting students' overall mental health status. Training institutions should address the underlying factors that can enhance students' academic satisfaction, especially during the COVID-19 period, in addition to ensuring that they have a continuous and adequate learning experience, as well as access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.

Perceived stress and study-related behavior and experience patterns of medical students: a cross-sectional study

BACKGROUND

Distress and burnout are common in physicians. Both may already arise during medical training and persist throughout residency. An analysis of needs is necessary in order to develop target group specific curricular concepts at medical faculties. Aim of this study was to assess the perceived stress of medical students, to explore study-related behavior and experience patterns, and to investigate associated factors.

METHODS

We conducted a cross-sectional survey of medical students at the Hannover Medical School. The web-based questionnaire consisted of 74 items and included two standardized instruments: the "Work-related Behavior and Experience Patterns" (Arbeitsbezogene Verhaltens- und Erlebensmuster, AVEM) and the "Perceived Medical School Stress" scale (PMSS). Students were asked to state their self-perceived actual stress level on a scale from 0% (no stress at all) to 100% (maximum stress). We performed a classification and regression tree (CART) analysis to identify factors that can discriminate between the four different AVEM patterns.

RESULTS

Five hundred ninety-one medical students (female 75.8%, response rate: 34.0%) participated in the survey. The mean sum score of the PMSS was 37.2 (SD 8.3; median score 37, min.-max. = 18-65). Overall, 68.5% of the students showed a risk pattern (risk pattern A "overexertion": 38.9%; risk pattern B "burnout": 29.6%). Pattern G "healthy" was shown in 8.3% and pattern S "protection" in 23.1% of the students. Multilevel analysis revealed that the self-perceived stress level and the PMSS sum score were the most important predictors for the AVEM pattern assignment. Furthermore, academic year, gender, and financial dependency were relevant influencing factors: students in higher academic years with no financial support had a higher probability to be in risk pattern B whereas male students in the first academic year tended to be in pattern G.

CONCLUSIONS

The PMSS sum score could objectify medical students' high self-perceived stress level. The majority of participating students showed a risky study-related behavior and experience pattern. Medical faculties should be aware of the still existing and relevant problem of stress and burnout among medical students. Our results lay the groundwork for an evaluation and further development of medical curricula at the own faculty.

Mental Health of PhD Students at Polish Universities-Before the COVID-19 Outbreak

Background: A group particularly exposed to the occurrence of disorders in the sphere of the psyche are young people with a newly developing personality structure and a sense of identity. In the available literature there are few reports describing the mental health of doctoral students—a group that is affected by a particular group of stressors. The aim of the research was to assess the mental health of PhD students at Polish universities. Material and Methods: The Polish adaptation of the GHQ Questionnaire-28, developed by David Goldberg et al. was used in the research. PhD students from all universities associated in the National Representation of Doctoral Students were invited to take part in the research. A total of 576 completed questionnaires were received. Results: It was found that depression is statistically more frequent in doctoral students who are not in any relationship with another person; anxiety/insomnia is more common in women than men and less frequently in doctoral students of general than in technical universities. Conclusions: (1) More than half of the surveyed students complain about the deterioration of mental health. The most commonly reported symptom groups are anxiety and insomnia, followed by social dysfunctions and somatic symptoms. (2) Depression is statistically more common in people who are not in any relationship with another person and anxiety and insomnia are statistically more common in women than in men and statistically less frequent in doctoral students of general universities than technical universities. (3) In view of the presented results, educating young adults in the field of self-awareness in the field of mental health seems to be particularly important.

Work Stress, Mental Health and Validation of Professional Stress Scale (PSS) in an Italian-Speaking Teachers Sample

This study aimed validate the Italian version of the Professional Stress Scale (PSS). A questionnaire was translated into Italian and administered to two sample groups. The first group (n = 200) was the control group and the second (n = 1137) the experimental group. The participants in the study were students enrolled in a special needs training teacher course or a specialization course that aims to train support teachers. The study conducted two analyses; factor and reliability analyses. The factor analysis utilized the Kaiser-Meyer-Olkin (KMO) test which had a result of 0.925 for the scale; this was above the acceptable value of 0.7. The research studied 33 items and the BTS was significant for the 33 items scale (χ2 (528) = 4353.508, p < 0.001). Moreover, five eigenvalues greater than 1 were identified in the data, whereas the total variance explained was 63.7%. The reliability test utilized the Cronbach’s Alpha score (0.936) of the scale and the value is calculated based on the response of 1106 individuals. The value is well above the value of 0.80, which indicates a high internal consistency level of the different items of the scale. This study showed that the Italian version of the PSS is a reliable and valid measure that can be used for research and clinical purposes.