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1.  Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal 
Background
In recent years there has been a growing appreciation of the issues of quality of life and stresses involved medical training as this may affect their learning and academic performance. However, such studies are lacking in medical schools of Nepal. Therefore, we carried out this study to assess the prevalence of psychological morbidity, sources and severity of stress and coping strategies among medical students in our integrated problem-stimulated undergraduate medical curriculum.
Methods
A cross-sectional, questionnaire-based survey was carried out among the undergraduate medical students of Manipal College of Medical Sciences, Pokhara, Nepal during the time period August, 2005 to December, 2006. The psychological morbidity was assessed using General Health Questionnaire. A 24-item questionnaire was used to assess sources of stress and their severity. Coping strategies adopted was assessed using brief COPE inventory.
Results
The overall response rate was 75.8% (407 out of 525 students). The overall prevalence of psychological morbidity was 20.9% and was higher among students of basic sciences, Indian nationality and whose parents were medical doctors. By logistic regression analysis, GHQ-caseness was associated with occurrence of academic and health-related stressors. The most common sources of stress were related to academic and psychosocial concerns. The most important and severe sources of stress were staying in hostel, high parental expectations, vastness of syllabus, tests/exams, lack of time and facilities for entertainment. The students generally used active coping strategies and alcohol/drug was a least used coping strategy. The coping strategies commonly used by students in our institution were positive reframing, planning, acceptance, active coping, self-distraction and emotional support. The coping strategies showed variation by GHQ-caseness, year of study, gender and parents' occupation.
Conclusion
The higher level of psychological morbidity warrants need for interventions like social and psychological support to improve the quality of life for these medical students. Student advisors and counselors may train students about stress management. There is also need to bring about academic changes in quality of teaching and evaluation system. A prospective study is necessary to study the association of psychological morbidity with demographic variables, sources of stress and coping strategies.
doi:10.1186/1472-6920-7-26
PMCID: PMC1951961  PMID: 17678553
2.  Experienced stressors and coping strategies among Iranian nursing students 
BMC Nursing  2007;6:11.
Background
College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to affect students' health and academic functions. If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result. Effective coping strategies facilitate the return to a balanced state, reducing the negative effects of stress.
Methods
This descriptive cross-sectional study was performed to determine sources of stress and coping strategies in nursing students studying at the Iran Faculty of Nursing & Midwifery. All undergraduate nursing students enrolled in years 1-4 during academic year 2004-2005 were included in this study, with a total of 366 questionnaires fully completed by the students. The Student Stress Survey and the Adolescent Coping Orientation for Problem Experiences Inventory (ACOPE) were used for data collection.
Results
Most students reported "finding new friends" (76.2%), "working with people they did not know" (63.4%) as interpersonal sources of stress, "new responsibilities" (72.1%), "started college" (65.8%) as intrapersonal sources of stress more than others. The most frequent academic source of stress was "increased class workload" (66.9%) and the most frequent environmental sources of stress were being "placed in unfamiliar situations" (64.2%) and "waiting in long lines" (60.4%). Interpersonal and environmental sources of stress were reported more frequently than intrapersonal and academic sources. Mean interpersonal (P=0.04) and environmental (P=0.04) sources of stress were significantly greater in first year than in fourth year students. Among coping strategies in 12 areas, the family problem solving strategies, "trying to reason with parents and compromise" (73%) and "going along with family rules" (68%) were used "often or always" by most students. To cope with engaging in demanding activity, students often or always used "trying to figure out how to deal with problems" (66.4%) and "trying to improve themselves" (64.5%). The self-reliance strategy, "trying to make their own decisions" (62%); the social support strategies, "apologizing to people" (59.6%), "trying to help other people solve their problems" (56.3%), and "trying to keep up friendships or make new friends" (54.4%); the spiritual strategy, "praying" (65.8%); the seeking diversions strategy, "listening to music" (57.7%), the relaxing strategy "day dreaming" (52.5%), and the effort to "be close with someone cares about you" (50.5%) were each used "often or always" by a majority of students. Most students reported that the avoiding strategies "smoking" (93.7%) and "drinking beer or wine" (92.9%), the ventilating strategies "saying mean things to people" and "swearing" (85.8%), the professional support strategies "getting professional counseling" (74.6%) and "talking to a teacher or counselor" (67.2%) and the humorous strategy "joking and keeping a sense of humor" (51.9%) were used "seldom or never".
Conclusion
First year nursing students are exposed to a variety of stressors. Establishing a student support system during the first year and improving it throughout nursing school is necessary to equip nursing students with effective coping skills. Efforts should include counseling helpers and their teachers, strategies that can be called upon in these students' future nursing careers.
doi:10.1186/1472-6955-6-11
PMCID: PMC2203983  PMID: 17999772
3.  Causes of Stress and Coping Strategies Adopted by Undergraduate Health Professions Students in a University in the United Arab Emirates 
Objectives:
This study aimed to compare causes of stress and coping strategies adopted by a sample of undergraduate health-profession students at the Gulf Medical University, United Arab Emirates.
Methods:
An anonymous voluntary questionnaire-based survey was conducted, from January to July 2011, among first- and second-year medicine, dentistry, pharmacy and physiotherapy students (N = 212) to identify causes of stress. Coping strategies were studied using the Brief COPE Inventory.
Results:
Worries regarding the future (54.2%) and parental expectations (40.1%) were the major stressors. Poor diet (36.8%) and a lack of exercise (36.3%) were also reported to cause stress. Students used multiple strategies, mainly religion/praying (74.5%), planning (70.5%) and taking action (70.5%) to cope with stress. There were no significant differences observed in the stressors or coping strategies between genders or programmes. First-year students (62.5%) relied on emotional support significantly more (P <0.05) than second-year students (48.5%).
Conclusion:
The main causes of stress were worries regarding future and parental expectations. The majority of the students used positive coping strategies, with religion/praying found to be the most frequently used strategy.
PMCID: PMC3749029  PMID: 23984030
Stress, Psychological; Health Professions; Medical Education, undergraduate; Coping Behavior; United Arab Emirates
4.  Coping Styles and its Association with Sources of Stress in Undergraduate Medical Students 
Context:
The two ubiquitous factors that have been identified in medical courses to underlie mental health are stress and different coping styles adopted to combat stress.
Aim:
To find the association between coping styles and stress in undergraduate medical students.
Settings and Design:
A medical college in Central Kerala. A cross-sectional study design was adopted.
Materials and Methods:
Source and Severity of Stress Scale, Medical Student Version, was used to assess the source and nature of stress. Brief Cope was used to find out the coping styles adopted.
Statistical Analysis:
The statistical analysis was done using Statistical Package for Social Sciences version 20 and SAS. Chi-square analysis was used to find the association between coping styles and stress domains and with the overall stress score.
Results:
There is a significant positive association between overall stress score and coping styles (P=0.001) of ‘Negative cope’, ‘Blame’, and ‘Humor’. ‘Positive cope‘ and ‘Religion’ has significant positive association with ‘Academics’ (P=0.047) and 'self Expectations’ (P=0.009). ‘Blame’ (P<0.001) has very high significant positive association with ‘Academics’, 'self expectation’, and ‘Relationships’. Very high significant positive association is further found between ‘Humor’ (P<0.001) and 'self expectations’, ‘Living conditions’, and ‘Health and Value conflict’. ‘substance Use’ is positively associated in high significance to ‘Health and Value conflict’ (P<0.001).
Conclusions:
The outcome of the study emphasizes the need for stress management techniques in the medical school.
doi:10.4103/0253-7176.122235
PMCID: PMC3868092  PMID: 24379501
Coping styles; medical students; stress
5.  Conceptualization and Measurement of Coping During Adolescence: A Review of the Literature 
Purpose
The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.
Design
A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.
Methods
A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables.
Findings
Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination.
Conclusions
Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being.
Clinical Relevance
Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.
doi:10.1111/j.1547-5069.2009.01327.x
PMCID: PMC2904627  PMID: 20618601
Coping; adolescent; measurement; literature review; instrument
6.  Teaching strategies for coping with stress – the perceptions of medical students 
BMC Medical Education  2013;13:50.
Background
The undergraduate medical course is a period full of stressors, which may contribute to the high prevalence of mental disorders among students and a decrease in life’s quality. Research shows that interventions during an undergraduate course can reduce stress levels. The aim of this paper is to evaluate the Strategies for Coping with Professional Stress class offered to medical students of the Federal University of Goiás, at Goiânia, Goiás, in Brazil.
Methods
Qualitative research, developed with medical students in an elective class addressing strategies for coping with stress after a focal group (composed of nine of the 33 students taking this course) identified stress factors in the medical course and the coping strategies that these students use. Analysis of the results of the class evaluation questionnaire filled out by the students on the last day of class.
Results
Stress factors identified by students in the focus group: lack of time, excessive class content, tests, demanding too much of themselves, overload of extracurricular activities, competitiveness among students and family problems. Coping strategies mentioned in the focus group: respecting one’s limits, setting priorities, avoiding comparisons, leisure activities (movies, literature, sports, meeting with friends and family). Results of the questionnaires: class content that was considered most important: quality of life, strategies for coping with stress, stress factors, assertiveness, community therapy, relaxation, cognitive restructuring, career choice, breathing, social networking, taking care of the caregiver, music therapy and narcissism. Most popular methodologies: relaxation practice, drawing words and discussion them in a group, community therapy, music therapy, simulated jury, short texts and discussion. Meaning of the class: asking questions and reinforcing already known strategies (22.6%), moment of reflection and self-assessment (19.4%), new interest and a worthwhile experience (19.4%), improvement in quality of life (16.1%), expression’s opportunity (9.7%), other (6.4%).
Conclusion
The stressors perceived by the medical students are intense and diverse, and the coping strategies used by them are wide-ranging. Most students felt that the class was a worthwhile learning experience, incorporated new practices for improving quality of life and recognized the importance of sharing and reflecting on one’s stressors and life choices.
doi:10.1186/1472-6920-13-50
PMCID: PMC3627623  PMID: 23565944
Stress; Coping strategies; Medical under graduate education; Teaching strategies
7.  A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes 
Background
Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK.
Method
A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups.
Results
A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008).
Conclusion
There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.
doi:10.1186/1472-6920-9-60
PMCID: PMC2759915  PMID: 19747400
8.  Psychological Distress and Coping amongst Higher Education Students: A Mixed Method Enquiry 
PLoS ONE  2014;9(12):e115193.
Background
Psychological distress among higher education students is of global concern. Students on programmes with practicum components such as nursing and teacher education are exposed to additional stressors which may further increase their risk for psychological distress. The ways in which these students cope with distress has potential consequences for their health and academic performance. An in-depth understanding of how nursing/midwifery and teacher education students experience psychological distress and coping is necessary to enable higher education providers to adequately support these students.
Methods
This mixed method study was employed to establish self-reported psychological distress (General Health Questionnaire), coping processes (Ways of Coping Questionnaire) and lifestyle behaviour (Lifestyle Behaviour Questionnaire) of a total sample (n = 1557) of undergraduate nursing/midwifery and teacher education students in one university in Ireland. Individual interviews (n = 59) provided an in-depth understanding of students experiences of psychological distress and coping.
Results
A significant percentage (41.9%) of respondents was psychologically distressed. The factors which contributed to their distress, included study, financial, living and social pressures. Students used varied coping strategies including seeking social support, problem solving and escape avoidance. The positive relationship between elevated psychological distress and escape avoidance behaviours including substance use (alcohol, tobacco and cannabis) and unhealthy diet is of particular concern. Statistically significant relationships were identified between “escape-avoidance” and gender, age, marital status, place of residence, programme/year of study and lifestyle behaviours such as diet, substance use and physical inactivity.
Conclusion
The paper adds to existing research by illuminating the psychological distress experienced by undergraduate nursing/midwifery and teacher education students. It also identifies their distress, maladaptive coping and the relationship to their lifestyle behaviours. The findings can inform strategies to minimise student distress and maladaptive coping during college and in future professional years.
doi:10.1371/journal.pone.0115193
PMCID: PMC4266678  PMID: 25506825
9.  Academic distress, perceived stress and coping strategies among dental students in Saudi Arabia 
The Saudi Dental Journal  2013;25(3):97-105.
Objectives
To evaluate the sources of stress among students in the dental school environment, their perceived levels of stress and effective coping strategies.
Methods
This study was conducted during the first semester of the academic year, 2009–10, at the College of Dentistry, King Saud University, Saudi Arabia. The eligible study group consisted of 556 undergraduate dental students from all five class years; they were surveyed with a detailed assessment tool. The validated and translated questionnaire comprised the modified version of the dental environmental stress (DES) survey, the perceived stress scale (PSS) and the brief coping scale (BCS).
Results
The overall findings substantiated with multiple regression indicate that, out of 20 factors of both DES and BC instruments, six factors were significantly and independently related to perceived stress scores (F = 34.638; p < 0.0001). Especially, the factors self-efficacy and workload of DES and the factors behavioral disengagement, denial, positive reframing and venting of BC were positively and independently related to perceived stress scores.
Conclusions
Dental students displayed relatively high perceived stress scores. Female, advanced and married, compared with male, junior and single students reported more stress. Changes in certain environmental factors and coping strategies independently affected the perceived stress score. Strategies for stress management must be incorporated into dental education to ensure the output of effective dentists.
doi:10.1016/j.sdentj.2013.05.002
PMCID: PMC3809483  PMID: 24179318
Dental environmental stress; Perceived stress scale; Brief coping scale; Stress study; Dental students
10.  Associations Between Academic Stressors, Reaction to Stress, Coping Strategies and Musculoskeletal Disorders Among College Students 
Background
The adverse health effects of stress are enormous, and vary among people, probably because of differences in how stress is appraised and the strategies individuals use to cope with it. This study assessed the association between academic stress and musculoskeletal disorders (MSDs) among 1365 undergraduates.
Methods
This was a cross-sectional study conducted in a Nigerian university at the beginning of the 2010/2011 academic session with the same group of participants. The Life Stress Assessment Inventory, Coping Strategies Questionnaire, and Short Musculoskeletal Function Assessment were administered as tools of data gathering.
Results
Students' stress level and associated MSDs were higher during the examination period than the pre-examination periods. Stressors were significantly associated with increased risk of MSDs in both sexes were those related to changes (odds ratio (OR) = 1.7, p = 0.002) and pressures (OR = 2.09, p = 0.001). Emotional and physiological reactions to stress were significantly associated with MSDs in both sexes, with higher odds for MSDs in females, whereas cognitive and behavioral reactions showed higher odds (though non-significant) in males. The risk of MSDs was higher in respondents who adopted avoidance and religious coping strategies compared with those who adopted active practical and distracting coping strategies.
Conclusions
Stress among students could be significantly associated with MSDs depending on individuals' demographics, stressors, reactions to stress, and coping methods. Interventions to reduce stress-induced MSDs among students should consider these factors among others.
PMCID: PMC3742887  PMID: 23950626
Academic stressors; Coping strategies; Musculoskeletal disorders
11.  Relationships between stress, coping and depressive symptoms among overseas university preparatory Chinese students: a cross-sectional study 
BMC Public Health  2011;11:352.
Background
Mental health problems in young people are an important public health issue. Students leaving their hometown and family at a young age to pursue better educational opportunities overseas are confronted with life adjustment stress, which in turn affects their mental health and academic performance. This study aimed to examine the relationships among stress, coping strategies, and depressive symptoms using the stress coping framework in overseas Chinese university preparatory students in Taiwan.
Methods
A cross-sectional study was conducted at an overseas Chinese university preparatory institute in Taiwan. Of enrolled overseas Chinese university preparatory students at 2009, 756 completed a structured questionnaire measuring stress, strategies for coping with it, and the Center for Epidemiologic Studies Depression Scale.
Results
High levels of stress significantly predicted the adoption of active, problem-focused coping strategies (R2 = 0.13, p < .01) and passive, emotion-focused coping strategies (R2 = 0.24, p < .01). Acceptable CFI, SRMR, and RMSEA values from the structural equation modeling analysis demonstrated that the model satisfactorily fits the stress coping framework, after active coping strategies were eliminated from the model. Results from the Sobel test revealed that passive coping strategies mediated the relation between stress and depressive symptoms (z = 8.06, p < .001).
Conclusion
Our study results suggested that stress is associated with coping strategies and depressive symptoms and passive strategies mediate the relation between stress and depressive symptoms in overseas Chinese university preparatory students.
doi:10.1186/1471-2458-11-352
PMCID: PMC3118242  PMID: 21595974
12.  Psychological Health of First-Year Health Professional Students in a Medical University in the United Arab Emirates 
Objectives:
The aim of this study was to assess the psychological health of first-year health professional students and to study sources of student stress.
Methods:
All first-year students (N = 125) of the Gulf Medical University (GMU) in Ajman, United Arab Emirates (UAE), were invited to participate in a voluntary, anonymous, self-administered, questionnaire-based survey in January 2011. Psychological health was assessed using the 12-item General Health Questionnaire. A 24-item questionnaire, with items related to academic, psychosocial and health domains was used to identify sources of stress. Pearson’s chi-squared test and the Mann-Whitney U-test were used for testing the association between psychological morbidity and sources of stress.
Results:
A total of 112 students (89.6%) completed the survey and the overall prevalence of psychological morbidity was found to be 33.6%. The main academic-related sources of stress were ‘frequency of exams’, ‘academic workload’, and ‘time management’. Major psychosocial stressors were ‘worries regarding future’, ‘high parental expectations’, ‘anxiety’, and ‘dealing with members of the opposite sex’. Health-related issues were ‘irregular eating habits’, ‘lack of exercise’, and ‘sleep-related problems’. Psychological morbidity was not significantly associated with any of the demographic factors studied. However, total stress scores and academics-related domain scores were significantly associated with psychological morbidity.
Conclusion:
Psychological morbidity was seen in one in three first-year students attending GMU. While worries regarding the future and parental expectations were sources of stress for many students, psychological morbidity was found to be significantly associated with only the total stress and the academic-related domain scores.
PMCID: PMC3327568  PMID: 22548140
Psychological stress; Medical student; Health professions; Undergraduate medical education; United Arab Emirates
13.  Perceived Stress, Sources and Severity of Stress among medical undergraduates in a Pakistani Medical School 
Background
Recently there is a growing concern about stress during undergraduate medical training. However, studies about the same are lacking from Pakistani medical schools. The objectives of our study were to assess perceived stress, sources of stress and their severity and to assess the determinants of stressed cases.
Methods
A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of CMH Lahore Medical College, Pakistan during January to March 2009. Perceived stress was assessed using the perceived stress scale. A 33-item questionnaire was used to assess sources of stress and their severity.
Results
The overall response rate was 80.5% (161 out of 200 students). The overall mean perceived stress was 30.84 (SD = 7.01) and was significantly higher among female students. By logistic regression analysis, stressed cases were associated with occurrence of psychosocial (OR 5.01, 95% CI 2.44-10.29) and academic related stressors (OR 3.17 95% CI 1.52-6.68). The most common sources of stress were related to academic and psychosocial concerns. 'High parental expectations', 'frequency of examinations', 'vastness of academic curriculum', 'sleeping difficulties', 'worrying about the future', 'loneliness', 'becoming a doctor', 'performance in periodic examinations' were the most frequently and severely occurring sources of stress. There was a negative but insignificant correlation between perceived stress and academic performance (r = -0.099, p > 0.05).
Conclusion
A higher level of perceived stress was reported by the students. The main stressors were related to academic and psychosocial domains. Further studies are required to test the association between stressed cases and gender, academic stressors and psychosocial stressors.
doi:10.1186/1472-6920-10-2
PMCID: PMC2820489  PMID: 20078853
14.  Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia 
Annals of Thoracic Medicine  2010;5(3):145-148.
BACKGROUND:
Tobacco consumption is associated with considerable negative impact on health. Health professionals, including future doctors, should have a leading role in combating smoking in the community.
OBJECTIVES:
The aims of the study were to assess the prevalence of smoking among medical students of newly established medical colleges in Riyadh city, the capital of Saudi Arabia, as well as to assess students' attitude, practice and their knowledge on the risk factors of tobacco consumption.
METHODS:
A cross-sectional, questionnaire-based study of students from two medical colleges in Riyadh, Saudi Arabia was carried out. The questionnaire used was anonymous, self-administered and developed mainly from Global Adult Tobacco Survey (GATS).
RESULTS:
A total of 215 students participated in this study. Forty students (19%) indicated that they smoke tobacco at the time of the study. All of them were males, which raise the prevalence among male students to 24%. Tobacco smoking was practiced by males more than females (P value <0.0001) and by senior more than junior students (<0.0001). About 94% of the study sample indicated that smoking could cause serious illnesses. About 90% of the students indicated that they would advice their patients to quit smoking in the future and 88% thought that smoking should be banned in public areas. Forty-four students (20%) thought that smoking has some beneficial effects, mainly as a coping strategy for stress alleviation.
CONCLUSION:
Despite good knowledge about the hazards of tobacco consumption, about 25% of the medical students in this study continue to smoke. The main reported reasons should be addressed urgently by policy-makers. Special efforts should be taken to educate medical students on the effective strategies in managing stress during their study as they thought that tobacco smoking could be used as a coping strategy to face such a stress.
doi:10.4103/1817-1737.65044
PMCID: PMC2930652  PMID: 20835308
Medical students; Saudi Arabia; smoking
15.  Interactions between Adaptive Coping and Drinking to Cope in Predicting Naturalistic Drinking and Drinking Following a Lab-Based Psychosocial Stressor 
Addictive behaviors  2012;38(3):1672-1678.
Using alcohol to cope (i.e., coping motivation) and general coping style both are theorized and demonstrated empirically to lead to problematic drinking. In the present study, we sought to examine whether these factors interact to predict alcohol use, both retrospectively reported and in the lab following a stressor task. Social drinkers (N=50, 50% women) received the Trier Social Stress Test (TSST), and then consumed beer under the guise of a taste-test. A Timeline Followback interview to assess past month alcohol use, the Drinking Motives Questionnaire (DMQ), and the COPE (to assess adaptive coping) were administered prior to the laboratory challenge. Multiple regression models were used to examine DMQ coping motives, adaptive coping, and their interaction as predictors of milliliters (mls) of beer consumed in a clinical laboratory setting. The association between coping motives and mls beer was positive at both high and low levels of adaptive coping, but at low levels of adaptive coping, this association was stronger. In contrast, there was no interaction between adaptive coping and coping motives in predicting quantity and frequency of drinking in the prior month. Findings suggest that stronger coping motives for drinking predict greater alcohol consumption following a stress provocation to a greater extent when an individual is lacking in adaptive coping strategies. As both general coping skills and coping motives for alcohol use are responsive to intervention, study of the conditions under which they exert unique and interactive effects is important.
doi:10.1016/j.addbeh.2012.10.003
PMCID: PMC3558592  PMID: 23254217
alcohol; coping motives; adaptive coping; stress; clinical laboratory; Trier Social Stress Test
16.  Stress among Isfahan medical sciences students 
Background:
This study was undertaken to determine the prevalence of psychological stress among Isfahan medical sciences students.
Methods:
Cross-sectional, questionnaire-based survey was carried out among the 387 medical sciences students (medicine, pharmacy, and dentistry) of Isfahan, Iran through census. In academic year 2010-2011, Kessler-10 questionnaire was given to the students a month before semester examinations. Scores ≥20 were considered as indicative of positive stress symptoms.
Results:
The overall prevalence of stress among medical sciences students was found to be about 76.1%. The prevalence of stress among medicine students was 22.7% mild, 23% moderate and 21.4% severe while 32.8% showed no stress. The prevalence of stress among pharmacy students was 22.22%, 22.22%, 26.19%, and 29.36% mild, moderate, and severe and no stress, respectively. The prevalence of stress among dentistry students was 25% mild, 27% moderate, and 10% severe while 37.5% showed no stress. The prevalence of stress was higher (70.6%) in pharmacy students when compared with medicine (66.1%) and dentistry (62.5%) students. The odds of student having stress is higher in dentistry students (OR: 1.44, P= 0.33), where as the odds are decreasing in pharmacy student (OR: 1.16, P=0.66). There is no statistically significant association between gender, ages, and term and having stress symptoms.
Conclusions:
The high level of stress necessitates interventions like social and psychological support to improve the student's well-being. A prospective study is needed to study the association of psychological morbidity with sources of stress and coping strategies.
PMCID: PMC3526138  PMID: 23267406
Isfahan; Kessler; medical sciences students; stress; student support
17.  Graduate entry and undergraduate medical students’ study approaches, stress levels and ways of coping: a five year longitudinal study 
Background
Incorporating graduate students into undergraduate medical degree programs is a commonly accepted practice. However, it has only recently been recognized that these two types of students cope with their studies in various ways. The aim was to compare the learning approaches, stress levels and ways of coping of undergraduate (UG) and graduate entry medical students (GEMP) throughout their medical course.
Methods
From 2007–2011 each of the five year cohorts of undergraduate and GEMP students completed four components of the study. The components included demographics, The Biggs’ R-SPQ-2 F questionnaire which determines students’ approaches to learning, the Perceived Stress Scale (PSS) used to rate students perceived stress during the past four weeks, and the Ways of Coping (WOC) questionnaire used to assess students’ methods of coping with everyday problems.
Results
There was a consistent difference between UG and GEMP students approaches to learning over the five years. GEMP students preferred a deep approach while the UG students preferred a superficial approach to learning. This difference became more obvious in the clinical years. There was no statistically significant difference between the groups in stress levels. There were consistent differences in the ways the two groups coped with stress.
Conclusions
There were significant differences in approaches to learning and ways of coping with stress between the UG and the GEMP students. These need to be considered when introducing curriculum change, in particular, redesigning an UG program for post graduate delivery.
doi:10.1186/s12909-015-0284-7
PMCID: PMC4310038  PMID: 25616440
18.  The relationship between anxiety, coping strategies and characteristics of patients with diabetes 
Background
This study provided essential information, about Turkish patients with type I and type II diabetes, concerning: levels of anxiety, coping strategies used, and relationships that exist among anxiety, coping strategies, sociodemographic and medical characteristics.
Methods
A sample comprising 161 Turkish adults with both types of diabetes participated in the study. The trait anxiety scale, the brief COPE, sociodemographic and medical questionnaire were administered to patients with diabetes.
Results
The mean age was 49.01 (SD = 9.74), with a range from 20 to 60 years. The majority of the participants were female (60.9%) and type II diabetes (75.8%). 79% of the participants experienced anxiety. A clear majority of the participants reported to integrate their diabetes. Acceptance, religion, planning, positive reframing, instrumental support, emotional support, self-distraction and venting were the most frequently used coping strategies. The most frequently used problem-focused and the emotion-focused coping strategies were found to be similar in both type I and type II diabetes. However, participants with type II diabetes had relatively higher scores on the problem-focused strategies than those with type I. Participants with type I diabetes used humour, venting and self-blame more than those with type II diabetes. Other findings indicated that only a small minority responded to diabetes-related problems by denial, behavioural disengagement and substance use. Significant correlations were found among anxiety, coping strategies and sociodemographic characteristics of the participants. Moreover, Self-blame was found to be correlated significantly with both the problem-focused and emotion-focused coping strategies. Self-blame was also significantly correlated with both instrumental support and emotional support indicated that higher self-blame caused more frequent use of instrumental and emotional support by patients with diabetes.
Conclusion
The findings of this study indicate that care for patients with diabetes should address their physical, psychological, social and economic wellbeing and the findings point to the importance of taking individual coping strategies into account when evaluating the impact of diabetes on psychosocial wellbeing. Because of the mean of anxiety were not in normal range, for this study, health professionals need to pay attention to patient's psychological state. This is especially true for patients who are likely to use self-blame and behavioural disengagement as a coping strategy. Through psychosocial interventions, professionals need to assist patients in establishing positive self evaluations. Delineation of coping strategies might be useful for identifying patients in need of particular counselling and support.
doi:10.1186/1477-7525-6-79
PMCID: PMC2572593  PMID: 18851745
19.  Understanding recovery in children following traffic-related injuries: Exploring acute traumatic stress reactions, child coping, and coping assistance 
Millions of children incur potentially traumatic physical injuries every year. Most children recover well from their injury but many go on to develop persistent traumatic stress reactions. This study aimed to describe children’s coping and coping assistance (i.e., the ways in which parents and peers help children cope) strategies and to explore the association between coping and acute stress reactions following an injury. Children (N = 243) rated their acute traumatic stress reactions within one month of injury and reported on coping and coping assistance six months later. Parents completed a measure of coping assistance at the six month assessment. Children used an average of 5–6 coping strategies (out of 10), with wishful thinking, social support, and distraction endorsed most frequently. Child coping was associated with parent and peer coping assistance strategies. Significant acute stress reactions were related to subsequent child use of coping strategies (distraction, social withdrawal, problem-solving, blaming others) and to child-report of parent use of distraction (as a coping assistance strategy). Findings suggest that children’s acute stress reactions may influence their selection of coping and coping assistance strategies. To best inform interventions, research is needed to examine change in coping behaviors and coping assistance over time, including potential bidirectional relationships between trauma reactions and coping.
doi:10.1177/1359104513487000
PMCID: PMC3981392  PMID: 23677925
20.  A Study to Assess the Emotional Disorders with Special Reference to Stress of Medical Students of Agartala Government Medical College and Govinda Ballabh Pant Hospital 
Background:
Stress is very common psychological phenomena where medical students faced in day to day activities. Epidemiological studies have asserted that about 70-80% of the diseases may be related to stress. Research related to this stress especially among medical students is essential, considering their learning, role and responsibilities as a future physician and health intervention programs.
Objectives:
To estimate the prevalence of stress and identify stressors among medical students.
Materials and Methods:
A Cross-sectional study was carried out among undergraduate medical students and self administered GHQ-12 and stressor questionnaire were used to collect information regarding stress. Binary logistic regression analysis was performed to calculate odds ratio (OR).
Results:
Prevalence of stress was 94.52% and more common among females. 33.56% students felt constantly under strain and 25.34% had loss of sleep over worry. Majority of the students of all semesters had stress (P > 0.05) and stressors viz. ‘competition for marks’ (P = 0.005), ‘frequent examination’ (P = 0.001), ‘difficulty in finding time for recreation’ (P = 0.014) and ‘being away from home’ (P = 0.027) were predominantly experienced by the 1st year medical students. Multiple logistic regression analysis revealed the causal effect of main parameter on the GHQ caseness and students who found difficulties in following teaching language among the caseness had 81.59% higher chance of developing stress (OR = 8.159, CI = 1.228-54.213).
Conclusion:
The stress experience was more common due to academics and seen among all year of medical students. Strategy development for eliminating stressors is necessary for promoting healthy life.
doi:10.4103/0970-0218.120154
PMCID: PMC3831689  PMID: 24302820
Medical college; medical students; sources of stress; stress
21.  The Stress and Coping Responses of Certified Graduate Athletic Training Students 
Journal of Athletic Training  2004;39(2):193-200.
Objective:
To assess the sources of stress and coping responses of certified graduate athletic training students.
Design and Setting:
We interviewed certified graduate athletic training students 3 times over a 9-month period. We transcribed the interviews verbatim and used grounded theory analytic procedures to inductively analyze the participants' sources of stress and coping responses.
Subjects:
Three male and 3 female certified graduate athletic training students from a postcertification graduate athletic training program volunteered to participate in this investigation. The participants were full-time graduate students, with a mean age of 23 years, who had worked an average of 1.5 years as certified athletic trainers at the time of the first interview.
Measurements:
We used grounded theory analytic procedures to inductively analyze the participants' sources of stress and coping responses.
Results:
A total of 6 general sources of stress and 11 coping dimensions were revealed. The stress dimensions were labeled athletic training duties, comparing job duties, responsibilities as student, time management, social evaluation, and future concerns. The coping responses were planning, instrumental social support, adjusting to job responsibilities, positive evaluations, emotional social support, humor, wishful thinking, religion, mental or behavioral disengagement, activities outside the profession, and other outcomes.
Conclusions:
Certified graduate athletic training students should be encouraged to use problem-focused (eg, seeking advice, planning) and emotion-focused (eg, positive evaluations, humor) forms of coping with stress.
PMCID: PMC419515  PMID: 15173872
stress management; grounded theory; athletic training education
22.  Psychosocial Stressors and Patterns of Coping in Adolescent Suicide Attempters 
Context:
Different risk factors associated with adolescent suicide attempts have been identified including those of socio-demographic and clinical variables. Relatively, little research has been done in the area of their stressors and coping patterns.
Aims:
To study the recent psychosocial stressors and patterns of coping associated with adolescent suicide attempts.
Settings and Design:
Tertiary care hospital, case-control study.
Materials and Methods:
One hundred consecutive cases of adolescent attempted suicide admitted to the hospital and an equal number of controls, matched individually for age and sex, from the relatives and friends of other patients in the ward, were studied. Assessment included details regarding socio-demographic data, psychiatric and physical morbidity, their recent stressors, and patterns of coping. Stressors were assessed using Presumptive Stressful Life Event Scale and coping strategies by Ways of Coping Questionnaire (revised).
Statistical Analysis:
Chi-square test and multivariate logistic regression analysis.
Results:
The number of stressful life events and mean stress scores in the preceding 1 month and certain coping strategies such as confronting, distancing, and escape-avoidance were found to be significant risk factors associated with adolescent suicide attempts. Strategies such as self-control, seeking social support, accepting responsibilities, problem solving, and positive appraisal act as protective factors.
Conclusions:
Recent stressors and strategies such as confronting, distancing, and escape-avoidance are significant risk factors associated with adolescent suicide attempts, whereas certain coping strategies act as protective factors. Teaching adolescents these protective coping patterns may be a promising strategy for prevention of adolescent suicide attempts.
doi:10.4103/0253-7176.112200
PMCID: PMC3701358  PMID: 23833341
Adolescents; coping; psychosocial factors; suicide attempt
23.  Exploring the experiences and coping strategies of international medical students 
BMC Medical Education  2011;11:40.
Background
Few studies have addressed the challenges that international medical students face and there is a dearth of information on the behavioural strategies these students adopt to successfully progress through their academic program in the face of substantial difficulties of language barrier, curriculum overload, financial constraints and assessment tasks that require high proficiency in communication skills.
Methods
This study was designed primarily with the aim of enhancing understanding of the coping strategies, skill perceptions and knowledge of assessment expectations of international students as they progress through the third and fourth years of their medical degree at the School of Medicine, University of Tasmania, Australia.
Results
Survey, focus group discussion and individual interviews revealed that language barriers, communication skills, cultural differences, financial burdens, heavy workloads and discriminatory bottlenecks were key factors that hindered their adaptation to the Australian culture. Quantitative analyses of their examination results showed that there were highly significant (p < 0.001) variations between student performances in multiple choice questions, short answer questions and objective structured clinical examinations (70.3%, 49.7% & 61.7% respectively), indicating existence of communication issues.
Conclusions
Despite the challenges, these students have adopted commendable coping strategies and progressed through the course largely due to their high sense of responsibility towards their family, their focus on the goal of graduating as medical doctors and their support networks. It was concluded that faculty needs to provide both academic and moral support to their international medical students at three major intervention points, namely point of entry, mid way through the course and at the end of the course to enhance their coping skills and academic progression. Finally, appropriate recommendations were made.
doi:10.1186/1472-6920-11-40
PMCID: PMC3141796  PMID: 21702988
24.  Coping and resilience in adolescents with type 1 diabetes 
Background
Adolescents with type 1 diabetes (T1D) must cope with the ongoing stress of treatment management, so it is important to identify the most adaptive coping strategies. Previous studies, however, have typically measured broad categories of coping (e.g. approach/avoidance) and few used instruments specifically designed for this population.
Objective
This article aimed to use a developmentally sensitive coping measure to explore how the use of specific coping strategies impacts resilience (i.e. quality of life, competence and metabolic control) in adolescents with T1D.
Methods
Thirty adolescents with T1D between the ages of 10 and 16 and their mothers completed questionnaires on adolescents’ coping strategy use, competence and quality of life. Clinical data (i.e. HbA1c) were obtained from adolescents’ medical records.
Results
Greater use of primary control coping strategies (e.g. problem solving, emotional expression) was associated with higher competence scores, better quality of life and better metabolic control. Secondary control coping strategies (e.g. acceptance, distraction) were related to higher social competence, better quality of life and better metabolic control. Finally, the use of disengagement coping strategies (e.g. withdrawal or denial) was linked with lower competence and poorer metabolic control.
Conclusions
The results of this study support the use of developmentally sensitive coping measures by researchers and clinicians to determine the most effective coping strategies for adolescents with T1D.
doi:10.1111/j.1365-2214.2010.01184.x
PMCID: PMC3134245  PMID: 21143270
adolescent development; diabetes mellitus; resilience; type 1
25.  Well-being of medical students and their awareness on substance misuse: a cross-sectional survey in Pakistan 
Objective
To investigate psychological well-being and substance abuse among medical students in Pakistan.
Methods
A cross-sectional questionnaire-based survey was conducted in six medical colleges across Pakistan. Final-year medical students were interviewed by either a postgraduate trainee in psychiatry or a consultant psychiatrist.
Results
A total of 540 medical students were approached; 342 participated and the response rate was 64.5%. Mean age was 23.73 years (SD 2.45 years); 52.5% were male and 90% single. Two out of every five respondents reported that work/study at medical school affected their personal health and well-being. A considerable proportion of students were aware of alcohol and smoking as coping strategies for stress in medical students. The main factors causing stress were heavy workload (47.4%), relationship with colleagues (13.5%) and staff (11.9%). A total of 30% reported a history of depression and 15% among them had used an antidepressant. More than half were aware of depression in colleagues. The majority of respondents said that teaching provided on substance misuse in the areas of alcohol and illegal drugs, management/treatment of addiction, and models of addiction was poor. There was significant association (p = 0.044) between stress and awareness about alcohol as a coping strategy for stress among medical students. A significant negative association was also found between medical colleges in public sector (p = 0.052), female gender (p = 0.003) and well-being.
Conclusion
The majority of the medical students reported a negative impact of heavy workload on their psychological well-being. Significant numbers of medical students think that substance misuse is a coping strategy for stress. Teaching on addiction/addictive substances is poor at undergraduate level in Pakistani medical colleges.
doi:10.1186/1744-859X-8-8
PMCID: PMC2660326  PMID: 19228374

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