The Covid-19 pandemic is putting enormous stress on all of us. In this study, we analyzed self-reported measures of stress, spirituality and altruism of 1105 Brazilian Medical students during the Covid-19 pandemic. We found moderate levels of perceived stress, moderate to high levels of spirituality, as well as high levels of altruistic attitudes. Participants with a previous diagnosis of mental disorder and women reported higher levels of stress during the Covid-19 pandemic. There was a significant negative correlation between level of stress and altruism, as well as a significant correlation between spirituality and altruism.
Being in social isolation or living in a state with high incidence of Covid-19 did not seem to influence the level of stress at least at the early stage of the pandemic. The level of stress was the same irrespective of being in direct contact with patients during the pandemic or being a suspected or confirmed case of Covid-19. Moreover, the level of stress was also the same in the five regions of Brazil. Taken together, these results suggest that the stress related to the pandemic is a more general preoccupation than a local phenomenon. The only regional difference was in spirituality, which was strongest in the Northeast and Midwest of Brazil. Previous research has identified an association between religiosity and poverty (Schweiger, 2019). In our study, participants’ level of spirituality was indeed lower in the South and Southeast region, which are the two richest Brazilian macro-regions.
Our results indicate that the mental health status before the Covid-19 pandemic influences the current level of stress, which was higher in the group of people who were already being monitored at a mental health service. People suffering from a mental illness seem to have more difficult to cope with the stress during the Covid-19 pandemic. There is evidence linking mental disorders with persistent hypercortisolemia, which may lead to stronger emotional responses to life events (Goh & Agius, 2010). Moreover, females had a higher level of stress when compared to males. Most epidemiological studies have demonstrated that women suffer more anxiety and depression than men (Kessler et al., 1994)(Wittchen et al., 1992) and that stress is more strongly related to psychiatric symptoms in women (Sandanger et al., 2004). A possible explanation for the greater stress vulnerability of females is that the rise of testosterone in males during adolescence may blunt their responsiveness to stress (Becker et al., 2007).
A recently published Chinese study showed that female gender, student status and poor self-rated health status were associated with a greater psychological impact of the outbreak of Covid-19 and higher levels of stress, anxiety, and depression (Wang et al., 2020). In our study, we found moderate levels of stress among Brazilian medical students during the pandemic. There was an inverse relationship between students’ hours of study and the level of stress, indicating a possible scenario of functional impact of stress during the Covid-19 pandemic. Previous research has shown that working engagement is negatively correlated with perceived stress in medical students (Agarwal et al., 2020). It is possible that studying may have contributed to reduce the level of perceived stress of some students amidst the Covid-19 pandemic.
We found high levels of self-reported altruistic attitudes (total sum) in medical students. The literature on altruistic attitudes of medical students is scarce. A qualitative study with nine medical students from the United Kingdom revealed that they do not consider altruism as essential to the role of a doctor. Nevertheless, participants express a preference to work with or be an altruistic doctor (Marynissen & Spurrier, 2018). Another study found that altruistic behaviors are rather infrequent among medical students, even though younger students tend to be more altruists (Sanjai & Gopichandran, 2018). In our study, the level of altruism was not influenced by year of medical school.
Among the diverse perspectives for understanding the altruistic attitude, Rosenberg and Hovland separate three components of altruism (Rosenberg et al., 1960). The cognitive component corresponds to what people think of altruistic attitude; the affective component, to how they feel about altruism; the behavioral component, to their commitment to altruistic behavior. Looking at the cognitive, affective and behavioral aspects of the Altruistic Attitudes Scale, we found that spirituality correlated positively with the cognitive and affective subscales, while stress correlated negatively with the behavioral subscale. This suggests that spirituality and cognitive and affective aspects of altruism may have more in common than we know, but only altruistic behavior is inversely related to stress.
It is generally assumed that people who lead a more spiritual life tend to develop more generous, less selfish attitudes and look more to their neighbor. Renowned authors such as Freud and Skinner postulated a positive relationship between religiosity/spirituality and altruism, however it has never been clear whether the values acquired in the practice of faith can be translated into altruistic behaviors (Saroglou, 2012). Huber and MacDonald investigated the relationship between altruism, empathy and spirituality in university students. They found a direct positive relationship between spiritual experiences and altruism as well as indirect positive effect of spiritual cognitions on altruism through empathy (Huber & MacDonald, 2012) . Here we observed a positive correlation between spirituality and altruism, in agreement with classic psychology theories. Spirituality correlated positively with altruistic thoughts and emotions, but not with altruistic behavior, which suggests a more cognitive impact of spirituality on altruism, that not necessarily leads to altruistic behavior.
In the present study, women reported more spirituality than men. This result parallels findings of studies showing that women consistently score higher than men on measures of spirituality and religious involvement (Dillon et al., 2003)(Maselko & Kubzansky, 2006). The strong spirituality among women can be related to charitable involvement, equanimity, and religious skepticism (Bryant, 2007). Although there are not many studies analyzing the level of spirituality of medical students, there is some evidence that spiritual, religious, and existential concerns are relevant to students as they search for meaning and purpose in their lives and develop effective stress-coping mechanisms (Avila, 2010)(Krägeloh et al., 2015).
This study is a cross-sectional study with limitations that deserve mention. Although we asked about participants’ mental health before the Covid-19 pandemic, we have no parameters to compare their previous level of stress, altruism and spirituality with the current level. It is therefore not possible to establish a causal relationship between the pandemic and the stress experienced by study participants. The correlations that we found between altruism and stress, and between spirituality and altruism are significant, but weak, indicating that their relationship explain only a small part of the investigated factors. Moreover, we used self-reported measures, which means that the levels of stress, spirituality and altruism reported are subjective measures that depend on participants’ level of insight and do not necessarily correspond to their feelings and daily behavior.