A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students

The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience

Background

As the COVID-19 pandemic continues, online learning and long-term isolation from social and clinical settings has exacerbated mental health problems and symptoms of academic burnout among medical students. However, few studies have discussed symptoms of academic burnout as a result of reduced social support, and increased stress among medical students during the process of online learning. To fill this gap, this study investigated the influencing factors and mechanism of academic burnout in medical students' online learning process. Both the positive inhibition effect of positive factors such as social support, and the negative aggravation effect of negative factors such as stress were explored, while the mediating and protecting role of resilience is also discussed.

Method

We collected survey data from a total of 817 medical students from a medical school in China who participated in online learning during the fall 2021 semester. An online questionnaire was sent to the students in January, 2022. Items adapted from the DASS Scale developed by Lovibond and Lovibond were used to measure medical students' stress levels. The perceived social support of medical students was assessed by the Gregory MSPSS. Resilience was evaluated by the 10-Item Connor–Davidson Resilience Scale (CD-RISC). Items from the Maslach Burnout Inventory–Student Survey (MBI-SS) were used to calculate students' academic burnout. Descriptive analysis, correlation analysis, hierarchical linear regression analysis and structural equation modeling were used to analyze the collected data.

Results

The results identified that in the context of online learning there was a positive correlation between medical students' stress and academic burnout, and their resilience played a partial mediating role. However, social support did not directly affect academic burnout, but inhibited the prevalence of academic burnout through resilience. In addition, stress was negatively related to resilience, while social support was positively related to resilience. Resilience was found to be negatively related to medical students' academic burnout in online learning.

Conclusion

The results of this study can provide a reference for the future development of appropriate educational strategies and coping measures to ameliorate the academic burnout of medical students.

Stress, Burnout, and Coping among First-Year Medical Undergraduates

Background and Objectives  Stress, burnout, and coping have been found to be interlinked with each other. Several adverse psychological outcomes have been associated with stress and burnout. Improving coping can decrease the stress and burnout. There is limited literature on perceived stress, coping, and burnout among first-year medical undergraduates from India. With this background, the study aimed to assess perceived stress, coping, and burnout among first-year medical undergraduates. Methods  It was a cross-sectional study assessing 100 undergraduates studying in the first year of medical school. Medical Students Stressor Questionnaire, Brief COPE questionnaire, and Maslach burnout inventory-student survey were applied for assessment of perceived stress, burnout, and coping, respectively. Socio-demographic profile was assessed by a semi-structured proforma. Results  Majority of students reported facing moderate level of stress in most of the domains, with stress being the highest for the academic aspects and least for social-related and drive- and desire-related areas. The stress was significantly greater in female students. Burnout was identified in 62% students by two-dimensional criteria and 30% by three-dimensional criteria. Among the coping strategies, active coping was most commonly used and substance use was less commonly used. No differences were found in coping between males and females except for active coping, which was significantly better in females. Conclusion  The stress was of moderate degree in majority of students and academic stress was the most common stress. Burnout was present in at least one-third of the students. However, majority of the students practiced active coping.

The mediating role of self-compassion between proactive coping and perceived stress among students

Proactive coping has been documented as a significant predictor of perceived stress. When facing stressful events, the more individuals use proactive coping strategies, the lower their stress level will be. However, there is still little research of possible latent factors participating in this relationship to explain how proactive coping can reduce of perceived stress, directly and indirectly. This study aimed to examine whether self-compassion can mediate the relationship between proactive coping and perceived stress among students. In a cross-sectional study carried out in 2019, we invited 384 undergraduate students in Hanoi (Vietnam) to voluntarily complete a self-report questionnaire that measured proactive coping, self-compassion and perceived stress scale. Results showed that proactive coping was positively related to level of self-compassion, and both proactive coping and self-compassion were negatively related to stress scores. The effect of proactive coping on stress was eliminated when self-compassion was controlled, showing the mediating role of self-compassion in the relationship between proactive coping and perceived stress score. Furthermore, among six factors contributing to the concept of self-compassion, data documented mediating role of "self-kindness,""self-judgment," and "mindfulness" while no mediating role of "common humanity,""isolation," and "over-identification" was observed. Among three mediating factors, mindfulness appeared to be the most important factor explaining the relationship between proactive coping and perceived stress. These results consolidate existing literature of the protective role of self-compassion on psychological health, and hence provide more support for the application of self-compassion, especially of mindfulness, in working with people with stress.

Factors associated with mental health of graduate nursing students in China

The increasing number of graduate nursing students in China has resulted in the wide concern for their mental health problems. Quantitative studies using validated questionnaires on mental health of graduate nursing students are rare. This study aimed to investigate the factors potentially involved in the level of mental health of graduate nursing students.The sample consisted of 339 graduate nursing students from 5 universities of China. The participants were evaluated using the Symptom Checklist-90 (SCL-90) and Chinese Perceived Stress Scale (CPSS) between March and November 2020. Multivariate stepwise linear regression analysis and spearman correlation test were performed to assess the association between various factors associated with mental health.The SCL-90 total score was 109.00 (96.00 -134.00) and psychological abnormalities (total score > 160) accounted for 14.2%. The highest score in the nine dimensions was compulsion dimension. The positive detection rate of compulsion dimension was 21.5% (dimensions score > 2),and the average of compulsion score was 1.50(1.20 -2.00). Multivariable stepwise linear regression analysis showed that grade, environmental adaptation level, number of good friends were independently associated with lower SCL-90 scores (both P < .05). SCL-90 scores were correlated with Chinese Perceived Stress Scale (r = .159, P = .003).Results indicate that learning about ways to adapt to the environment, strengthening good friends support and alleviating perceived stress can help improve graduate nursing students' level of mental health. The conclusions of this study can provide a reference to improve the psychological intervention strategies for graduate nursing students.

A preliminary study on the effectiveness of a stress management program for healthcare-related undergraduates with at-risk mental state

PURPOSE

This study aimed to examine the effects of a stress management program on stress perception and coping strategies for healthcare-related undergraduates with at-risk mental state (ARMS).

DESIGN AND METHODS

A randomized experimental design with pretest and posttest was used. Of the 2812 students screened, 65 were identified as having ARMS, 52 enrolled in the study, and 49 (75%) completed the study.

FINDINGS

Significance was found for subjects with schizotypal traits in emotion expression and problem-avoidance coping strategies. Subjects with trait anxiety improved significantly in interpersonal deficits after the program.

PRACTICE IMPLICATIONS

Students with different trait risks reported benefits in different stress-coping strategies from the program.

Burnout in medical students of a tertiary care Indian medical center: How much protection does resilience confer?

CONTEXT

Medical profession continues to grapple with burnout; even medical students are not spared of this self-destructive psychological experience. Attempts are being made to control and contain burnout in medical students by the medical fraternity.

AIMS

We intend to study the prevalence and determinants of burnout in medical students in a tertiary medical center and also to study the relationship of resilience with the experience of burnout.

SETTINGS AND DESIGN

This was a cross-sectional anonymous survey method.

MATERIALS AND METHODS

Randomized stratified sampling method was used wherein roll numbers of MBBS students belonging to four different semesters were chosen using randomization software. Based on prevailing prevalence of burnout, sample size calculation was done, and 196 completed questionnaires were included in analysis. The Maslach Burnout Inventory (MBI) and the Resilience Scale for Adults (RSA) were used. Two-dimensional approach toward diagnosing burnout was used.

STATISTICAL ANALYSIS

Association tests were carried out to analyze the association between means, and Spearman's rho was used to assess the correlation of MBI subscales with RSA subscales. We also used binary logistic regression to assess the relationship of burnout with resilience.

RESULTS

The prevalence of burnout was 16.84%, and high scores on depersonalization (DP) subscale were seen in males. Personal accomplishment (PA) scores were lower in the fifth and seventh semesters. A statistically significant correlation was observed between MBI and RSA subscales. Binary regression analysis revealed higher resilience scores were significantly associated with decreased likelihood of burnout in emotional exhaustion (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93-0.97), DP (OR = 0.95; 95% CI = 0.93-0.98), and PA (OR = 0.91; 95% CI = 0.84-0.98).

CONCLUSIONS

Burnout prevalence in our sample lies at the lower range of global prevalence rates. Resilience is protective from burnout.

Investigating Stress and Sources of Stress Among Female Health Profession Students in a Saudi University

Background

Health profession students experience tremendous levels of stress throughout their education. A high level of stress may have a negative effect on the cognitive functioning and learning of students.

Objective

The study sought to determine the levels and main sources of stress and its possible correlation with academic performance in the preclinical female health profession.

Methods

The cross-sectional design involved the use of self-administered questionnaires. Data were collected from 260 students in health profession programmes in Saudi Arabia. The Medical Student Stressor Questionnaire (MSSQ) was used to collect the data from all second-, third-, and fourth-year undergraduate students.

Results

A high level of stress was observed in 42.7% of the students, and a moderate stress level was observed in 41.5% of the students. The major source of stress experienced by students was related to the academic domain (mean= 2.7±0.73), followed by the group activity domain (mean= 2.1±0.91; p< 0.05). Second-year and third-year students were significantly less likely to show high stress levels compared with fourth-year students (AOR= 0.3; 95% CI: 0.1–0.8; p≤ 0.030 and AOR= 0.4; 95% CI: 0.1–0.5; p≤ 0.001, respectively). High stress levels were not found to be associated with students’ age and academic performance.

Conclusion

Half of the students experienced high and severe levels of stress. Academic and group activity domains were perceived as the major stressors. The year of study was the only significant factor associated with stress levels. Stress among female health profession students should be acknowledged, and efforts should be made to alleviate it. Students should be guided to reduce their stress levels, as this can enhance their quality of life and study experience.

Sleep Quality as a Mediator in the Relationship Between Perceived Stress and Job Burnout Among Chinese Nurses: A Structural Equation Modeling Analysis

Background: Job burnout has become an increasing prevailing phenomenon among nurses in both developed and developing countries. There is a paucity of research exploring the relationship between perceived stress (i.e., the level of one's perception or appraisal of stress rather than objective stressful events) and job burnout and no existing literature examining the mediating role of sleep quality in the relationship between these two constructs. The objective of the study was to examine if sleep quality mediates the relationship between perceived stress and job burnout. Methods: Cross-sectional data were collected from a total of 1,013 nurses working in six public tertiary hospitals in China. The self-administered questionnaire included demographic information, the Maslach Burnout Inventory-General Scale, the Pittsburgh Sleep Quality Index and the Perceived Stress Scale. Hierarchical multiple regression (HMR) analyses were performed to examine the contribution of each covariate to the prediction of job burnout. Structural equation modeling (SEM) was employed to test whether the proposed relationships between variables involved existed. Results: Both perceived stress and poor sleep quality exhibited strong positive associations with job burnout among Chinese nurses. The SEM analysis confirmed the direct pathway from perceived stress to burnout and the indirect pathway mediated by sleep quality. The direct effect of perceived stress on job burnout was found to be statistically significant and positive (β = 0.69, p < 0.05). There existed statistically significant effects of sleep quality on both perceived stress (β = 0.48) and job burnout (β = 0.29). The path coefficients of perceived stress on job burnout were significantly reduced (β = 0.56) when sleep quality was modeled as a mediator. The bias-corrected and accelerated bootstrap test revealed that sleep quality had a significant mediating effect on the relationship between perceived stress and job burnout (a ^* b = 0.139, BCa 95%, CI: 0.110~0.174). Conclusion: Perceived stress might exert significant effects on burnout both directly and indirectly through the mediating role of sleep quality. Efforts to reduce burnout among nurses in clinical settings may benefit from interventions for coping with perceived stress and practices for promoting healthy sleep.

Burnout, Perceived Stress, Sleep Quality, and Smartphone Use: A Survey of Osteopathic Medical Students

Context

Burnout is a psychological syndrome that results from prolonged exposure to stressful work activities and includes 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and low sense of personal accomplishment (PA). Burnout is a widespread problem in numerous professions but is particularly high among medical students, residents, and early-career physicians compared with college graduates of similar age. However, minimal research has addressed burnout in osteopathic medical students.

Objective

To assess levels of burnout in osteopathic medical students and to examine the relationship among burnout, perceived stress, sleep quality, and smartphone use.

Methods

This study used a cross-sectional study design and an anonymous, electronic questionnaire service to administer the Maslach Burnout Inventory, the Perceived Stress Scale-4, the Pittsburgh Sleep Quality index, and the Smartphone Addiction Scale Short Version.

Results

A total of 385 participants (mean [SD] age, 25 [2.4] years; 208 [54.0%] women; 286 [74.3%] white; 138 [35.8%] second-year osteopathic medical students [OMSs]) completed the survey. Of the 385 participants, 9 (2.3%) reported high EE, 67 (17.4) reported high DP, and 310 (80.5) reported a high level of low PA. When comparing dimensions of burnout by gender, only levels of PA differed by gender, with men reporting higher levels of burnout compared with women (χ1 2=5.2, P=.022). Further, levels of DP differed by year in medical school (χ2=17.3, P=.008), with post-hoc comparisons showing differences between OMS I and OMS III (F=4.530, df=3, P=.004). Linear regression models showed that higher perceived stress (standardized β=0.5, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.1, P<.001) were associated with higher EE. Similarly, higher perceived stress (standardized β=0.2, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.2, P=.001) were associated with higher DP. Only higher perceived stress was associated with higher levels of low PA (standardized β=−0.4, P<.001).

Conclusions

These findings suggest independent associations with EE, DP, perceived stress, sleep quality, and smartphone use. Additional research with a larger, more diverse sample is needed to confirm these findings. If confirmed, wellness interventions can be designed to target 2 modifiable factors: sleep quality and smartphone use.