Descriptive results for the perceived stress scale, and dimensions of the anxiety and coping scale.
The mean age of participants was 20.71± 3.89 years (range 18-46 years). Most students were female (86.5%) and 17.7% of the students had previous training in health sciences. Up to 52.1% of students were undergoing their first clinical placement in the second year.
Table 1. Means, standard deviation and skewness and kurtosis of the participants’ scores for perceived stress (PSS), anxiety (STAI) and dimensions of coping (CSI).
Constructs
|
Dimensions
|
M
|
SD
|
Min
|
Max
|
Skewness
|
Kurtosis
|
Stress
|
Perceived stress
|
22.78
|
8.53
|
5
|
47
|
.303
|
.155
|
Anxiety
|
Anxiety state
|
17.63
|
9.01
|
3
|
54
|
.894
|
.813
|
Anxiety trait
|
20.13
|
8.73
|
4
|
46
|
.541
|
-.126
|
Coping
|
Problem solving
|
15.08
|
3.43
|
4
|
20
|
-.450
|
-.072
|
Self-criticism
|
6.54
|
4.56
|
0
|
20
|
.484
|
-.152
|
Expression of emotion
|
9.88
|
4.37
|
0
|
20
|
-.127
|
-.406
|
Wishful thinking
|
9.45
|
5.15
|
0
|
20
|
.248
|
-.863
|
Social support
|
13.9
|
4.61
|
0
|
20
|
-.708
|
.067
|
Cognitive restructuring
|
12.51
|
3.78
|
2
|
20
|
-.212
|
-.188
|
Problem avoidance
|
7.36
|
1.62
|
3
|
13
|
-.018
|
.560
|
Social Withdrawal
|
6.28
|
3.70
|
0
|
19
|
.495
|
.012
|
N = 192; Skewness Standard Error =.175; kurtosis Standard Error = .349
The mean PSS score was 22.78 (±8.54), indicating a moderate level of stress. Furthermore, the stress scores ranged from 5 to 47 out of a possible 56. In our study, most participants (47.92%) indicated a moderate level of stress. The Anxiety state score was 17.64 (±9.01) classified as ‘no problem’ with a minimum score of 3 and maximum of 54 and Anxiety trait of 20.13 (±8.74) classified as ‘mild anxiety’ with a minimum score of 4 and maximum score of 46.
Comparative analysis between PSS, STAI and clinical placement.
Regarding the type of clinical placements, no significant differences were found when comparing the mean perceived stress (p=.352) using the ANOVA. However, significant differences were identified in relation to anxiety state (p=.002). When comparing clinical placements two by two, statistically significant differences were identified between Primary Care and Special Services (15.9 ±8.75 vs 23.77± 11.16, p=.006), Geriatrics and Special Services (16.18± 7.53 vs 23.77± 11.16, p=.004) and Internal Medicine and Special Services (16.14± 7.75 vs 23.77± 11.16, p=.001). Up to 100% of the students who displayed severe anxiety in the state STAI were in specialized services.
Table 2. Comparison of the level of stress and anxiety classified by type of clinical placement.
|
STAI STATE
(Mean±SD)
|
PERCEIVED STRESS
(Mean±SD)
|
Geriatrics
|
16.18± 7.53
|
24.35±8.65
|
Mental health
|
19.40± 10.72
|
25.40±6.87
|
Primary care
|
15.9 ±8.75
|
22.33±7.30
|
Internal medicine
|
16.14± 7.75
|
21.13±9.08
|
Specialized services
|
23.77± 11.16
|
23.64±9.00
|
Mother-child health
|
18.27 ±7.92
|
24.09±7.03
|
TOTAL
|
17.64±9.01
|
22.79±8.54
|
Relationships between gender, academic year and dimension of CSI.
The CSI displays significant differences between gender for the dimensions Expression of emotion, Social support and Problem avoidance, as, in all cases, the mean of these scores was higher among female students. However, for the total score, despite the fact that the mean score was higher in women (23.22±8.55) than in men (20±8.04), significant differences were not found regarding gender (p= .069) for the total score. Regarding the students’ academic year, the dimensions that were found to be statistically significant were wishful thinking and social withdrawal. The total mean score of the test for students in their second year was 21.30±8.65 and the total mean score for students in their third year was 24.40±8.16, the statistical analysis was significant (p= 0.009) (Table 3).
Table 3. Bivariate analysis of the mean score for the dimensions of the CSI compared by academic year and gender
|
Gender
|
(M, SD)
|
U
|
p value
|
Year
|
(M-SD)
|
U
|
p value
|
Problem solving
|
Female
|
15.22±3.42
|
1828.50
|
.208
|
2nd
|
15.33±3.49
|
4192.50
|
.287
|
Male
|
14.23±3.50
|
3rd
|
14.83±3.39
|
Self-criticism
|
Female
|
6.59±4.61
|
2051.00
|
.684
|
2nd
|
5.98±4.35
|
3952-50
|
.091
|
Male
|
6.27±4.30
|
3rd
|
7.16±4.74
|
Expression of emotion
|
Female
|
10.23±4.34
|
1432.01
|
.006**
|
2nd
|
10.14±4.28
|
4390.00
|
.584
|
Male
|
7.61±3.98
|
3rd
|
9.60±4.48
|
Wishful thinking
|
Female
|
9.59±5.25
|
1911.00
|
.348
|
2nd
|
8.62±5.28
|
3610.50
|
.010*
|
Male
|
8.58±4.51
|
3rd
|
10.36±4.90
|
Social support
|
Female
|
14.14±4.65
|
1594.00
|
.032*
|
2nd
|
14.01±4.65
|
4465.00
|
.725
|
Male
|
12.38±4.15
|
3rd
|
13.78±4.60
|
Cognitive restructuring
|
Female
|
12.68±3.87
|
1703.50
|
.083
|
2nd
|
12.51±3.83
|
4543.50
|
.883
|
Male
|
11.42±3.07
|
3rd
|
12.51±3.76
|
Problem avoidance
|
Female
|
7.47±1.56
|
1647.00
|
.048*
|
2nd
|
7.47±1.71
|
4270.00
|
.382
|
Male
|
6.69±1.89
|
3rd
|
7.25±1.52
|
Social withdrawal
|
Female
|
6.27±3.66
|
2135.50
|
.932
|
2nd
|
5.50±3.30
|
3509.00
|
.004*
|
Male
|
6.34±4.03
|
3rd
|
7.13±3.94
|
*p<.05; ** p < .01; U= U Mann Whitney
Correlation and hierarchical regression analysis
A Spearman’s rho correlation was used to investigate the relationship between total perceived stress and anxiety (state and trait) and the PSS score with the total score on the CSI and all subscales. The results displayed a significant correlation for the total on the PSS and the state STAI (r = .463, p<.01) and for the total PSS and the trait STAI (r =.718, p<.01). Regarding the perceived stress and the coping strategies, the results revealed a significant relationship between the total perceived stress and the following domains of the CSI: problem solving (r =-.452, p<.01), self-criticism(r =.408 p<.01), wishful thinking (r =.459, p<.01), social support (r =-.220, p<.01), cognitive restructuring (r =-.375, p<.01), and social withdrawal (r =.388, p<.01). (Table 4).
Table 4. Spearman’s correlation coefficient between perceived stress, STAI state and trait and dimension of CSI.
|
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
1.
|
1. Perceived stress
|
|
|
|
|
|
|
|
|
|
|
2. Anxiety state
|
.463**
|
|
|
|
|
|
|
|
|
|
3. Anxiety trait
|
.718**
|
.264**
|
|
|
|
|
|
|
|
|
4. Problem solving
|
-.452**
|
.050
|
-.180*
|
|
|
|
|
|
|
|
5. Self criticism
|
.408**
|
.144*
|
.316**
|
-.281**
|
|
|
|
|
|
|
6. Expression of emotion
|
-.086
|
.051
|
-.063
|
.269**
|
.059
|
|
|
|
|
|
7. Wishful thinking
|
.459**
|
.078
|
.313**
|
-.142
|
.534**
|
.196**
|
|
|
|
|
8. Social support
|
-.220**
|
.031
|
-.088
|
.439**
|
-.042
|
.591**
|
.085
|
|
|
|
9. Cognitive restructuring
|
-.375**
|
.003
|
-.145*
|
.573**
|
-.214**
|
.298**
|
-.071
|
.471**
|
|
|
10. Problem avoidance
|
.105
|
.423**
|
.461**
|
.053
|
.168*
|
.106
|
.120
|
.004
|
-.053
|
|
11. Social Withdrawal
|
.388**
|
.138
|
.289**
|
-.266**
|
.396**
|
-.104
|
.424**
|
-.275**
|
-.115
|
.091
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
* p < .05. ** p < .01.
Table 5 shows the hierarchical regression analysis developed in this study.
For the first step, the adjustment index of the model was significant F (1, 191) 212.186, p < .01 and the anxiety trait variable was a significant predictor of the perceived stress scale (β = .726, t = 14.56, p < .01).
The significant variables included in the second model were: anxiety trait (β = .624, t = 12.32, p < .01) and wishful thinking (β = .266, t = 5.26, p < .01), the adjustment was F (2, 191) 134.82, p < .01.
For the third model, the significant variables were: anxiety trait (β = .564, t = 11.28, p < .01), wishful thinking (β = .263, t = 5.47, p < .01), cognitive restructuring (β = -.211, t = -4.53, p < .01) and the adjustment was: F (3, 191) , 106.01 p < .01.
For the fourth model anxiety trait (β = .486, t = 8.98, p < .01), wishful thinking (β = .269, t = 5.72, p < .01), cognitive restructuring (β = -.215, t = -4.75, p < .01), and anxiety state (β = .162, t = 3.30, p < .05) were significant variables, and the adjustment was: F (4, 191) 86.44, p < .01.
For step 5: anxiety trait (β = .450, t = 8.15, p < .01), wishful thinking (β = .268, t = 5.79, p < .01), cognitive restructuring (β = -.133, t = -2.41, p < .05), anxiety state (β = .170, t = 3.52, p < .01), and problem solving (β = -.147, t = -2.56, p < .05) were significant variables, furthermore the adjustment was: F (5, 191) 72.53, p < .01. The fifth model explained 66.1% of the variance in perceived stress, representing the model with the best fit.
Table 5. Summary of Stepwise Regression Analyses to determine predictors of Perceived stress.
Independent Variables
|
B
|
SE B
|
β
|
t
|
Step 1
Anxiety trait
|
.709
|
.049
|
.726
|
14.56**
|
Step 2
Anxiety trait
Wishful thinking
|
.609
.440
|
.049
.084
|
.624
.266
|
12.32**
5.26**
|
Step 3
Anxiety trait
Wishful thinking
Cognitive restructuring
|
.550
.436
-.475
|
.049
.080
.105
|
.564
.263
-.211
|
11.28**
5.47**
-4.53**
|
Step 4
Anxiety trait
Wishful thinking
Cognitive restructuring Anxiety state
|
.474
.445
-.485
.153
|
.053
.078
.102
.046
|
.486
.269
-.215
.162
|
8.98**
5.72**
-4.75**
3.30*
|
Step 5
Anxiety trait
Wishful thinking
Cognitive restructuring Anxiety state
Problem solving
|
.439
.444
-.300
.161
-.364
|
.054
.077
.124
.046
.142
|
.450
.268
-.133
.170
-.147
|
8.15**
5.79**
-2.41*
3.52**
-2.56*
|
R2= .528 for step 1; R2=.588 for step 2; R2=.628 for step 3; R2=.649 for step 4; R2=.661 for step 5. * p < .05; **p < .01