|Year : 2017 | Volume
| Issue : 4 | Page : 370-374
Stress and coping styles in postgraduate medical students: A medical college-based study
Manjiri C Datar, Jyoti V Shetty, Nilesh M Naphade
Department of Psychiatry, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
|Date of Web Publication||17-Nov-2017|
Manjiri C Datar
Associate Professor, Department of Psychiatry, Bharati Vidyapeeth Medical College, Dhankawadi, Pune - 411 043, Maharasthra
Source of Support: None, Conflict of Interest: None
Background: Medical education is inherently stressful. Postgraduate medical students, in particular are vulnerable to experience stress. Considering the paucity of research on stress in postgraduate medical students, this study was conducted to assess their perceived stress and coping strategies. The study intends to provide inputs for future interventions to manage their stress. Objective: To study perceived stress, coping styles and psychological morbidity in postgraduate medical students Material & methods: This was a cross sectional study conducted on all postgraduate students willing to participate in the study, studying at this medical college and hospital. They were asked to fill a structured proforma to assess socio-demographic details and domains of stress. Stress was assessed by Perceived stress scale (PSS-10), coping strategies using BRIEF COPE and psychological morbidity screened by Self reporting questionnaire (SRQ). Descriptive analysis &Pearson correlation was done between stress levels, psychological morbidity and various coping strategies. Results: Postgraduate medical students had mean PSS-10 score of 17.96. Pearson correlation revealed positive correlation between stress levels measured by PSS-10 and psychological morbidity measured by SRQ (Correlation coefficient 0.639). There was also positive correlation independently between higher stress score and psychological morbidity with higher use of dysfunctional coping strategies (Correlation coefficient 0.44 & 0.421 respectively). Conclusion: Postgraduate students using dysfunctional coping strategies had higher stress and psychological morbidity, whereas those using healthy emotion focused coping strategies had lower stress levels and lower psychological morbidity.
Keywords: Stress, Coping, Postgraduate medical students
There is need for focused stress management programs to incorporate healthy coping strategies in postgraduate medical students
|How to cite this article:|
Datar MC, Shetty JV, Naphade NM. Stress and coping styles in postgraduate medical students: A medical college-based study. Indian J Soc Psychiatry 2017;33:370-4
|How to cite this URL:|
Datar MC, Shetty JV, Naphade NM. Stress and coping styles in postgraduate medical students: A medical college-based study. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Feb 20];33:370-4. Available from: http://www.indjsp.org/text.asp?2017/33/4/370/218604
| Introduction|| |
Stress is the mental and physical response and adaptation by our bodies to the real or perceived changes and challenges in our lives. A stressor is any real or perceived physical, social, or psychological event or stimulus that causes our bodies to react or respond.
Medical education is inherently stressful and demanding. A postgraduate medical student, in particular, is likely to face many stressors considering the various roles and responsibilities in personal and professional domains. Postgraduate medical students (medical residents) usually have long working hours, need to face various clinical emergencies, and also have academic as well as research works in their training period. Hence, they are vulnerable to suffer from stress and related disorders.
Chronic stress in medical professionals may have a negative impact on learning, performance, problem-solving and decision-making abilities, and ultimately patient care. Chronic stress leads to a predisposition to medical illnesses, such as cardiovascular disorders, peptic ulcers, asthma, psychocutaneous disorders, and many more, which is a well-known fact. Any stress if left unattended can lead to burn out and can predispose the individual to psychiatric disorders such as depression and anxiety, substance use, and even suicide. Incidence of suicide among young medical professionals is showing an upward trend. Hence, addressing to stress-related psychological problems in medical residents is a necessity of the hour.
Effects of stress are dependent on coping skills. A person's coping styles determine if he/she has negative consequences of stress. Coping refers to the thoughts and actions taken to deal with stress. It is a conscious effort to tolerate stress. The coping strategies can be adaptive or constructive that reduces stress levels. However, maladaptive or dysfunctional coping styles are counterproductive and can worsen stress. An insight into the coping styles of the medical residents can be effective for the purpose of addressing their stress.
This study was conducted to identify stressors, the perceived stress, coping strategies, and psychological morbidity in postgraduate medical students in this medical institution. There is a paucity of research on assessing stress and coping strategies of postgraduate medical students in India. Previous studies have focused on the assessment of stressors and its psychological consequences in undergraduate medical students. This study assesses the domains of stressors and correlates the psychiatric morbidity to perceived stress levels in postgraduate medical students. It also attempts to give insights into the use of specific coping strategies by them with correlation to the perception of stress and psychological morbidity. This study is an attempt to increase the awareness about stress faced by postgraduate medical students and their ways of dealing with it.
| Material and Methods|| |
This is a cross-sectional study conducted at a private medical college and hospital. The college admits about 80 postgraduate medical students per year in various specialties including medical, surgical, diagnostic, and nonclinical fields. All the students stay in a hostel located at the hospital campus. Residents when are posted for emergency duties or are on-call stay in their respective ward/department units. They receive stipend as per the stipulated norms. The study was approved by the institutional ethics committee.
A total of 233 postgraduate medical students enrolled during 2013-2015 were working in various departments of the medical college and hospital at the time of conducting the study. The exclusion criterion included students with preexisting psychiatric illnesses. However, no such student was detected. Two hundred students were willing to participate in the study and were included. A written informed consent was obtained from the participants.
The students were asked to fill a sociodemographic proforma, which included history of any medical illnesses also. The medical college and hospital has an active ''student counseling cell'' where many postgraduate students discuss about their issues. Taking into consideration the stress-related problems they had discussed, the domains of stressors were grouped as (1) work responsibilities, (2) academic performance, (3) future work prospects, (4) personal relationships, (5) work interpersonal issues, (6) family-related issues, and (7) financial concerns. Postgraduate medical students were asked to complete three scales administered to them (1) Perceived Stress Scale, (2) Brief Cope Scale, and (3) Self-reporting Questionnaire.
Cohen's Perceived Stress Scale (PSS-10) (1983) was used to assess the perceived stress of the students. The 10 items in PSS-10 ask about feelings and thoughts in last month to be graded on Likert's scale. The scores range from 0 to 40. Brief Cope by Carver (1997) was used to assess the coping strategies used by the students to deal with stress. It is a 28-item questionnaire that contains14 scales, each of which assesses the degree to which the respondent utilizes a specific coping strategy on a Likert scale. These scales include (1) self-distraction, (2) active coping, (3) denial, (4) substance use, (5) use of emotional support, (6) use of instrumental support, (7) behavioral disengagement, (8) venting, (9) positive reframing, (10) planning, (11) humor, (12) acceptance, (13) religion, and (14) self-blame, which are used to handle stress. The scores range from 1 to 4 for each item and 2 to 8 for each coping strategy used. Self-Reporting Questionnaire (SRQ-20), the self-reporting questionnaire has been developed by WHO (1983) as an instrument to screen psychological disturbances. The SRQ consists of 20 questions-four on physical symptoms and 16 on psychoemotional symptoms, which have to be answered as ''Yes'' or ''No'' taking the duration to be last 1 month. The score range is from 0 to 20.
Descriptive statistics was used for quantitative data variables. Qualitative data were expressed using frequency and percentages. Chi square/Fisher's extract test was used to find association between variables. Fisher Analysis of variance (ANOVA) test or two independent sample t test was applied for quantitative data variables. Pearson correlation coefficient was calculated for statistical significance. P value <0.05 was considered as significant. Data analysis was done using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc, Chicago, Illinois, USA) software.
| Results|| |
Two hundred postgraduate medical students completed the proforma given to them. 85.5% students were working in clinical departments. These included 26.5% in medicine and allied branches, 45.5% in surgery and allied branches, 11% in diagnostic branches, and 2.5% in community medicine. 14.5% students were working in nonclinical departments.
37.5% students were year residents, 36% second year, and 26.5% were third year residents. Twenty-four percent students were below the age of 25 years, 66% in the age group of 26–30 years, 7% in the age group of 31–34 years, and 3% were 35 years and above. 11.5% students had medical illnesses such as hypothyroidism, asthma, hypertension, migraine.
The mean PSS score of the entire sample was 17.96. On assessment of the domains of the stressors, 88% reported stress about their academic performance, 83% residents had stress due to responsibilities at workplace, 77.5% were stressed about their future career, 66% reported stress due to interpersonal problems at work, 45.5% had stress of personal relationships, 39.5% had stress related to financial issues, and 36.5% reported stress due to family problems. The mean SRQ score was 4.98.
The coping strategies on Brief Cope were divided as problem focused coping strategies (active coping, use of instrumental support, planning), emotion focused coping strategies (acceptance, positive reframing, use of emotional support, humor, religion/spirituality), and dysfunctional coping strategies (behavioral disengagement, denial, self-distraction, venting, blaming, substance use). The mean score on Brief Cope for emotion focused strategies was 21.52, problem focused strategies was 14.4 and dysfunctional coping strategies was 20.9.
There was no statistically significant difference in the mean scores on PSS and SRQ of male and female residents. Male residents significantly used more dysfunctional coping strategies than female residents (P = 0.045). The mean score on PSS in residents with medical illnesses was 20.7 and in those without illness was 17.6, which was statistically significant (P = 0.01). The mean score on SRQ in residents with illness was 7.61 and without illness was 4.63, which was also statistically significant (P = 0.008). Residents with medical illnesses were found to significantly use problem focused strategies as compared to those not having any medical illness (P = 0.03). There was no difference in the mean PSS scores of clinical specialties including medicine and allied, surgery and allied, diagnostics, community medicine, and nonclinical specialties. The mean SRQ score of residents in diagnostic specialties was significantly higher than other speciality groups. There was no statistically significant difference in the coping strategies used by various specialties [Table 1].
|Table 1 Specialty and gender-wise correlation of perceived stress levels, psychological morbidity, and coping styles|
Click here to view
The mean PSS, SRQ, and Brief Cope scale scores were correlated between residents of , second, and third year. There was no statistically significant relation yearwise in PSS, SRQ and the coping strategies on Brief Cope [Table 2].
|Table 2: Relation of year of residency with perceived stress, psychological morbidity, and coping styles|
Click here to view
The Pearson correlation between PSS and SRQ scores was significant (P < 0.001, correlation coefficient (r) = 0.639). PSS and SRQ scores of every student were correlated with their coping strategies of Brief Cope. There was significant correlation between PSS score and the use of dysfunctional coping strategies (P < 0.001, r = 0.44) and weak correlation with the use of problem focussed coping strategies (P = 0.025, r = 0.158). SRQ score significantly correlated with the use of dysfunctional coping strategies (P < 0.001, r = 0.421) [Table 3].
|Table 3: Correlation of perceived stress and psychological morbidity with coping styles|
Click here to view
| Discussion|| |
Academic performance was the major reported source of their stress. Eighty-eight percent students reported to have stress of academic perfomance, which was followed by stress of work responsibilities reported by 83% students. The findings are similar to study by Yusoff and Rahim that the major stressors in postgraduate medical training were related to academic and performance pressure.
There was no significant difference in PSS and SRQ scores between male and female residents, indicating no gender difference in perceived stress and self-reported psychopathology. A previous study by Dyson and Renk reports similar findings. Other studies reported use of more emotion focussed coping strategies in female college students., Our study did not find any gender difference in emotion focussed coping. However, it was observed that dysfunctional coping strategies were used significantly more by male residents. Previous studies have reported that male students used more dysfunctional coping strategies such as substance use to deal with stress than their female colleagues.,,
The students with medical illnesses had statistically significant higher stress scores and psychological morbidity than those without illness. Stress can be the result or a predisposing factor in causation of multiple illnesses such as hypertension, migraine and headache as indicated by studies.,,
There was significant correlation between the perceived stress and self-reported psychopathology. This indicates that high perceived stress in these students predisposed to psychiatric morbidity such as anxiety and depression. Previous study by Goebert et al. reports that high levels of stress in medical residents lead to depressive symptoms and suicidal ideations. The finding is replicated by various previous studies.,, It is hypothesized that stress-induced activation of hypothalamo-pituitary axis lead to changes in neurotransmitters serotonin, dopamine, and nor-epinephrine, which result in anxiety and depression.
Students with high levels of perceived stress used more of dysfunctional coping strategies such as self-distraction, denial, behavioral disengagement, venting, and self-blame. Coping strategies help in tackling stress. However, use of dysfunctional coping strategies may worsen stress. Previous studies report similar findings that use of dysfunctional coping strategies such as anger coping, distraction, avoidance lead to high levels of perceived stress.,,
There was also weakly significant correlation between high levels of perceived stress and use of problem focussed strategies indicating efforts by stressed individuals to take measures to eliminate or reduce the intensity of the stressor. The postgraduate medical students who were using more emotion focussed coping strategies had less perceived stress. This finding is contrary to the study by Eisenbarth et al., which concludes that emotion focussed strategies lead to high level of appraised stress and negative affect, whereas use of problem focussed strategies have low level of appraised stress. However, other studies replicate our findings and conclude that positive appraisal and use of healthy emotion focussed strategies lead to lower levels of perceived stress. The importance of healthy emotion focussed coping strategies to handle stress such as acceptance, humour and emotional support cannot be minimized. These emotion focussed strategies serve to decrease stress and need to be imbibed.,,,
Use of dysfunctional coping strategies were also associated with increased self-reported psychopathology indicating that use of dysfunctional coping strategies were predisposing factors for psychological morbidity. Similar finding is reported by previous studies that dysfunctional coping strategies correlated with psychiatric disorders of anxiety and depression.,,
| Conclusion|| |
Postgraduate medical students with higher levels of perceived stress have higher self-reported psychological morbidity. Students using dysfunctional coping strategies have higher levels of stress and psychological morbidity. Students using healthy emotion focussed strategies handle stress better. The findings indicate need for regular stress management programmes for postgraduate medical students with focus on inculcating healthy coping strategies. This will help enhance their physical and psychological wellbeing and improve productivity. The limitations were that the study was cross-sectional; hence, findings cannot be generalized over a period. Personality factors, which influence stress appraisal and coping, were not assessed. However, an insight into coping strategies and screening for stress and psychiatric morbidity in medical residents can be valuable in developing stress management programmes for them.
The authors wish to thank Hon. Principal, Vice Principal, All Heads of Departments, Psychiatry residents, Statistician-Mr. Shrivallabh Sane, Bharati Vidyapeeth Medical College and Research Centre.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Glanz K, Schwartz M. Stress, coping and health behavior. Rimer K, Vishwanath, editors. Health behavior and health education: theory, research and practice. 4th ed. San Francisco: Jossey-Bass publications; 2008. pp.210-36.
Yusoff M, Rahim A. Prevalence and sources of stress among postgraduate medical trainees. ASEAN J Psychiatry 2010;11:1-10.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross sectional study. Med Educ 2005;39:594-604.
Hurst M, Jenkins C, Rose R. The relationship of psychological stress to onset of medical illness. Ann Rev Med 1976;27:301-12.
Mohanty I, Mohanty N, Balasubramanium P, Joseph D, Deshmuk Y. Assessment of stress, coping strategies and lifestyle among medical students. Indian J Prev Soc Med 2011;42:294-300.
Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al.
Depressive symptoms in medical students and residents: A multischool study. Acad Med 2009;84:236-41.
Carver C, Scheier M, Weintraub J. Assessing coping strategies: A theoretically based approach. J Personality Soc Psychology 1987;56:267-83.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.
Carver C. You want to measure coping but your protocol is too long? Consider the Brief COPE. Int J Behav Med 1997;4:92-100.
Harding T, Climent C, Giel R, Ibrahim Murthy R, Suleman M, et al.
WHO collaborative study on strategies for extending mental health care II. The development of new research methods. Am J Psychiatry 1983;140:1474-80.
Cooper C, Katona C, Livingston G. Validity and reliability of the Brief COPE in carers of people with dementia. J Nerv Ment Dis 2008;196:838-43.
Dyson R, Renk K. Freshmen adaptation to university life: Depressive symptoms, stress and coping. J Clin Psychol 2006;62:1231-44.
Brougham R, Zail C, Mendoza C, Miller J. Stress, sex differences, and coping strategies among college students. Curr Psychol 2009;28:85-97.
Moffat K, McConnachie A, Ross S, Morrison J. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004;38:482-91.
Kieffer K, Cronin C, Gawet. Test and study worry and emotionality in the prediction of college students' reasons for drinking: An exploratory investigation. J Alcohol Drug Educ 2006;50:57-81.
Hobfoll S, Carla L, Dunahoo Ben-Porath Y, Monnier J. Gender and coping: The dual axis model of Coping. Am J Commun Psychol 1994;22:49-82.
Salleh R. Life events, stress and illness. Malay J Med Sci 2008;15:9-18.
Cohen S, Deverts D, Miller G. Psychological stress and disease. JAMA 2007;298:1685-7.
Schneiderman N, Ironson G, Siegel S. Stress and health: Psychological, behavioural and biological determinants. Annu Rev Clin Psychol 2005;1:607-28.
Thomas H, Mosley J, Sean G, Perrin M, Susan M, Neral et al.
Stress, coping and well-being among third year medical students. Acad Med 1994;9:765-7.
Kumar A, Rinwa P, Kaur G, Machawal L. Stress: Neurobiology, consequences and management. J Pharm Bioall Sci 2013;5:91-7.
] [Full text]
Stanton A, Kirk S, Cameron C, Danoff-Burg S. Coping through emotional approach: Scale construction and validation. J Personality Soc Psychology 2000;78:1150-69.
Galaif E, Sussman S, Chou C, Wills T. Longitudinal relations among depression, stress and coping in high risk youth. J Youth Adolesc 2003;32:243-58.
Eisenbarth C, Donna A, Champeau D, Dontanelle R. Relationship of appraised stress, coping strategies and negative affect on college students. Int J Psychology Behav Sci 2013;3:131-8.
Kuiper N. Humour and resiliency: Towards a process model of coping and growth. Eur J Psychol 2012;8:475-91.
[Table 1], [Table 2], [Table 3]