Medical students’ crisis-induced stress and the association with social support

  1. Vera M. A. Broks
  2. Karen M. Stegers-Jager
  3. Jeroen van der Waal
  4. Walter W. van den Broek
  5. Andrea M. Woltman

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Abstract

Medical schools are challenged to guard student wellbeing given the potential negative impact of the COVID-19 outbreak combined with an already high prevalence of mental distress. Although social support is generally associated with less crisis-induced stress, it is unknown whether this applies to medical students during the COVID-19 outbreak.

Objectives

The impact of the COVID-19 outbreak on perceived stress of medical students was assessed by comparing their perceived stress levels during the outbreak to both their own baseline and the previous cohort’s pre-COVID-19 stress levels. Then, the association between social support and stress during the COVID-19 outbreak was assessed.

Methods

Dutch Year-1 medical students of cohort 2019 ( n = 99) completed the 14-item Perceived Stress Scale (PSS-14) at two time points: baseline (pre-COVID-19) and final measurement (COVID-19). Social support—emotional-informational support and club membership—was assessed during the final measurement. PSS and social support scores were compared to similar measurements of cohort 2018 ( n = 196). Students’ baseline stress levels, gender, and study performance were controlled for when comparing final stress levels.

Results

In cohort 2018 (pre-COVID-19), students’ perceived stress levels did not differ significantly between the baseline and final measurements. Additionally, baseline stress levels of the two cohorts (2018 and 2019) were not found to be significantly different. Cohort 2019’s final stress levels (COVID-19) were significantly higher compared to their baseline stress levels (paired t-test: t = 6.07, p < .001) and cohort 2018’s final stress levels (linear regression: B = 4.186, p < .001). Only during the COVID-19 outbreak higher social support levels—i.e., emotional-informational support (B = -0.75, p < .001) and club membership (B = -3.68, p < .01)—were associated with lower stress levels.

Conclusions

During the COVID-19 outbreak, medical students’ perceived stress levels were higher—especially for students with lower social support levels. Our results suggest that medical schools should optimize social support to minimize crisis-induced stress.

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  1. Version published to 10.1371/journal.pone.0278577
  2. ScreenIT

    SciScore for 10.1101/2022.03.18.22272605: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Students provided informed consent for the data collected by questionnaires.
    IRB: The study was carried out in accordance with the Declaration of Helsinki and was deemed exempt from review after evaluation by the Medical Ethics Committee of Erasmus MC Rotterdam (MEC-2019-0448).
    Sex as a biological variableGender is categorized as male or female.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Further, a limitation of the present study is the lower response-rate for cohort 2019. This was possibly due to the COVID-19 outbreak, which resulted in a fully online data collection instead of a combination of data collection in class and online. Even though we were able to control for student characteristics in the analyses, a bias may still be present due to this lower response-rate. The present study focused on Year-1 students, and this appears to be a relevant group since students in early stages of medical and dental school seem susceptible to the negative impact of the COVID-19 outbreak [19, 50]. Whether the results described in the present study will be similar for students in advanced stages of medical school needs to be further investigated. This also applies to the generalizability of the results to students from other schools, since the relation between social support and perceived stress may be different for medical students compared to students from other schools due to the higher prevalence of mental distress in medical students compared to their age-matched peers [1, 2]. Even though medical schools are not able to change the current COVID-19 crisis or any future crisis, they can help students get through it. Our findings suggest that in times of crisis medical students’ wellbeing can benefit from social support. With the COVID-19 pandemic still not being over and potential new lockdowns are possible, medical schools could play a more active role themselves by...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.03.18.22272605v1 on medRxiv