|Year : 2020 | Volume
| Issue : 3 | Page : 203-207
Assessment of academic stress and its correlation with self-efficacy and coping style among undergraduate medical students
Poornima Chandraprakash1, Vedalaveni Chowdappa Suresh1, Anjana Krishna Kumar1, C R. Wilma Delphine Silvia2
1 Department of Psychiatry, Akash Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
2 Department of Biochemistry, Akash Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
|Date of Submission||19-Oct-2019|
|Date of Decision||20-Feb-2020|
|Date of Acceptance||20-Mar-2020|
|Date of Web Publication||28-Sep-2020|
Dr. Vedalaveni Chowdappa Suresh
Department of Psychiatry, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru - 562 110, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Academic stress is one of the important issues associated with education, especially medical education due to the demanding curriculum. Coping mechanisms and student's self-belief that they can cope with academic pressures help in managing stress, but the effectiveness of such methods is unclear. The present study attempted to understand the correlation of academic stress, coping mechanism, and student self-efficacy. Subjects and Methods: This is a cross-sectional study, in which universal sampling was done among 2nd- and 3rd-year undergraduate medical students, among them 246 students consented to participate in the study. Out of which, 57.7% were 2nd-year students and 42.3% were 3rd-year students. The Academic Stress Inventory, Brief COPE, and Self-Efficacy Scales were used to collect data which were analyzed statistically. Results: The mean age of the students was 20.03 ± 1.01 years, among which 59.8% were females and 40.2% were males. The most common source of academic stress was stress from teachers, as reported by male (28.8 ± 6.35) and female students (28.8 ± 5.64). Students tried to manage stress by planning their activities in advance, and female students (5.59 ± 1.38) practiced this more frequently than males (5.22 ± 1.58) and this was statistically significant (P < 0.05). Male and female students were equally self-efficacious. A weak but significant correlation was found between coping styles and stress (r = 0.405; P < 0.05) and between self-efficacy and stress (r = 0.133; P < 0.05). Conclusion: The major source of academic stress was stress from teachers. Academic stress was more among female students. However, neither the coping styles nor students' self-efficacy had any role in reducing the academic stress experienced by medical students.
Keywords: Coping academic stress, medical students, self-efficacy, sources of academic stress
|How to cite this article:|
Chandraprakash P, Suresh VC, Kumar AK, Silvia C R. Assessment of academic stress and its correlation with self-efficacy and coping style among undergraduate medical students. Indian J Soc Psychiatry 2020;36:203-7
|How to cite this URL:|
Chandraprakash P, Suresh VC, Kumar AK, Silvia C R. Assessment of academic stress and its correlation with self-efficacy and coping style among undergraduate medical students. Indian J Soc Psychiatry [serial online] 2020 [cited 2023 Feb 6];36:203-7. Available from: https://www.indjsp.org/text.asp?2020/36/3/203/296251
| Introduction|| |
Stress has evolved as the most important lifestyle issue associated with the modern world and is considered as one of the main causes of psychological problems experienced by people regardless of age and gender. Academic stress is one of the prominent causes for depression, behavioral problems, and suicide among the students and is caused by environmental, academic, and personal factors. Students experiencing academic stress undergo mental distress in anticipation of academic challenges and academic failure, which eventually impacts their studies, interpersonal relationships, and overall well-being. Termed as “career stopper,” academic stress exerts a negative influence on the students' mental and physical health  and has a bearing on the wellness of the entire society.
Undergraduate medical students experience extreme academic stress, owing to the physically and emotionally draining curriculum, which results in burnout and causes various psychosomatic and mental disorders. While there are several factors that cause stress among medical students, intense study schedule and pressure to perform well are the most important sources of stress. While academic stress can be managed by adopting a few coping techniques, such as adequate sleep, advance planning, and listening to music, students also need to be more self-efficacious in order to handle stress better. Self-efficacy refers to individuals' belief that they are capable of behaving in a certain manner to get out of a difficult situation., When students believe that they can handle a stressful situation effectively, they are more likely to insulate themselves from the adverse effects of stress. Coping mechanisms and increased self-efficacy do help medical students handle academic stress, but it is unclear whether these methods remain effective in the wake of the pressure exerted by demanding curriculum, intense courses, and pressure to perform, which characterize medical education. Therefore, it is necessary to understand how far coping mechanisms and self-efficacy help medical students escape from academic stress. Thus, this study was undertaken to achieve the following objectives:
- To evaluate the sources of academic stress among undergraduate medical students and assess if they vary according to gender
- To estimate how medical students cope with stress and how it differs with regard to their gender
- To correlate the relationship between coping styles and academic stress
- To correlate the relationship between academic stress and general self-efficacy.
| Subjects and Methods|| |
The study was conducted in a recently opened medical college of South India which consists of only two batches of medical students of 150 each, who are currently studying in the 2nd year (2017–2018) and 3rd year (2016–2017) at our institution, and the study period extended over the 2-month duration from April to June 2019. The study was initiated after the institutional ethical committee clearance was obtained. In this study, a universal sampling technique was used which included all the 2nd and 3rd year medical students, and the study was conducted with one of the investigators addressing the students of each year in one of the lecture classes with prior permission from the respective professors. The nature of the study was explained to the students by the investigators during the allotted time. Consent forms were distributed among the study group. A total of 246 students consented for the study. A self-administered proforma was given to the students and was collected back by the investigator before the next lecture class. Anonymity was maintained about a student's individual identity. The following tools were administered: a structured questionnaire to collect data on their demographic details.
Academic Stress Inventory
It is a self-reporting scale used to measure the level of academic stress experienced by the students. This instrument was developed by Lin and Chen in 2009. This scale has 34 questions wherein each item is rated on a five-point Likert scale within 1 = completely disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = completely agree. The Academic Stress Inventory (ASI) assesses students' stress levels from 7 possible domains as follows stress from teachers, stress from results, stress from tests, studying in group stress, peer stress, time management stress, and self-inflicted stress. The Cronbach's reliability test of ASI shows an α-value of 0.90. Higher the scores indicate higher levels of stress in all the domains.
It is a self-reported questionnaire used to understand the different stress coping styles adopted by the students. It consists of 28 items and each item is rated on a four-point Likert scale ranging from “I have not been doing this at all (score 1)” to “I have been doing this a lot (score 4).” The higher score indicates greater coping by the respondents. The items were scored to produce 14 dimensions, each reflecting the use of a coping strategy. It is a validated instrument in which the Cronbach's alpha values range 0.50–0.90, with only three coping strategies falling below 0.60.
General Self-Efficacy Scale
This is a self-reported psychometric scale developed by Schwarzer and Jerusalem in 1995, which is used to measure the extent to which respondents believe in their ability to manage stressful situations. The scale has 10 items wherein each item is rated on a four-point Likert scale. The results are calculated by adding the responses to all the 10 questions to yield the final score with range from 10 to 40 with higher the scores indicating more self-efficacy.
Descriptive statistics, i.e., mean and standard deviation (SD), t-test, and correlation analyses, were employed to analyze the data statistically. P < 0.05 was considered as statistically significant. Data analysis was done using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp) software.
| Results|| |
A total of 300 medical students were given the questionnaires, of whom only 246 medical students of both the genders returned the completely filled questionnaires and were considered for analysis. Of the 246 students, 142 (57.7%) students were from the 2nd year and 104 (42.3%) students were from the 3rd year. The mean age of all the students was 20.03 ± 1.01 years (range: 18–23 years). Of the 246 students, 99 (40.2%) respondents were males and 147 (59.8%) were female students. The power of t-test was found to be 88%.
The mean and SD values of types of stress experienced by the medical students are presented in [Table 1]. Teachers were the most important sources of stress among male (M = 28.8 ± 6.35) and female students (M = 28.8 ± 5.64), fear of results was the second important source of stress among male (17.2 ± 4.72) and female (16.3 ± 4.31) students, this was followed by stress of studying in a group, which was experienced by males (14.6 ± 4.45) and females (15.1 ± 3.98), and there was no significant difference (P > 0.05) between the genders across all these three domains. Test stress (males: 12.4 ± 3.68; females: 13.3 ± 3.07), self-inflicted stress (males: 11.8 ± 3.57; females: 12.7 ± 3.16), and peer stress (males: 11.3 ± 3.27; females: 12.2 ± 3.02) were the other sources of academic stress, and there was a statistically significant difference (P < 0.05) between male and female students, with female students exhibiting more stress than the males. Finally, male (9.3 ± 3.30) and female (9.6 ± 2.80) students were least affected by time management stress, but there was no significant difference.
|Table 1: Sources of academic stress among students as per the Academic Stress Inventory|
Click here to view
The mean and SD values of different coping mechanisms adopted by the medical students are presented in [Table 2]. Planning activities in advance (5.22 ± 1.58), positive reframing (5.18 ± 1.41), acceptance (5.15 ± 1.41), and active coping (4.91 ± 1.31) were the popular coping styles among the male students. Likewise, planning activities in advance (5.59 ± 1.38), acceptance (5.55 ± 1.53), positive reframing (5.54 ± 1.48), and active coping (5.54 ± 1.43) were popular among female students. Significant differences (P < 0.05) existed in the coping styles of male and female students such as self-distraction, active coping, substance use, positive reframing, planning, acceptance, and religion, and female students practiced these mechanisms more than the males.
The self-efficacy of the medical students is that male (28.7 ± 5.56) and female (29.5 ± 5.18) undergraduate students were equally self-efficacious (P > 0.05) with regard to academic stress, i.e., they believed that they can manage stressful situations in academics. Thus, regardless of their gender, the students did believe that they are capable enough of tiding through stressful education.
The findings of the correlation analysis between the kinds of academic stress, the coping styles adopted by students, and general self-efficacy are presented in [Table 3]. There was a significant correlation (r = 0.405; P < 0.05) between academic stress and coping styles of medical students, and there was a significant correlation (r = 0.133; P < 0.05) between kinds of academic stressors and self-efficacy of the students. However, the correlation was substantially weak, implying that they are not strongly associated with one another.
|Table 3: Correlation between academic stress, coping styles, and general self-efficacy|
Click here to view
| Discussion|| |
The study was conducted among 246 undergraduate medical students, of which 99 respondents were male and 147 were female. Among these students, teachers and the fear of results were the most important sources of academic stress, implying that the medical education system and its stakeholders are responsible for the persistence of tremendous academic stress among the medical students. A study by Abouserie  found that results caused considerable stress among university students, which is almost in line with the findings of this study. The observation is in partial agreement with the findings of Gupta et al. who found that unsatisfactory relationship with teachers causes stress among students. Female students were found to experience higher stress levels compared to the males. Ghosal and Behera  and Varghese et al. also found that female medical students experienced more academic stress, and Ruzhenkova et al. found that female medical students are more likely to develop academic stress and anxiety compared to males. With regard to the coping mechanisms adopted by the students, most students indeed attempted to cope with academic stress; however, female students practiced coping methods to a greater extent compared to the males. Therefore, while female students were more prone to academic stress in medical education, they also did their best to manage stress by adopting better coping mechanisms. Iwasaki et al. found that although women and men have common mechanisms to handle stress, women follow certain female-specific measures, which help them manage the additional stress they experience by virtue of the gender. Further, male and female medical students were equally self-efficacious, implying that they both possessed a great deal of self-belief that they can handle stressful situations better.
However, neither the coping mechanisms nor the students' self-efficacy had any role in reducing the academic stress experienced by the medical students, implying the insufficiency of both external and internal factors used to handle stress. Whatever coping mechanism the students employed and however confident they were regarding their capability to handle stressful situations, they were unable to manage the academic stress entirely. An observation regarding coping mechanism contradicts the findings of Struthers et al., according to whom the students adopting coping mechanisms manage to reduce stress levels and perform better. The findings regarding self-efficacy are also contradictory to the observations of Skaalvik and Skaalvik, according to which self-efficacy and stress are inversely proportional. Likewise, Lannin et al. also found that self-efficacy helps manage stress better. The failure of coping mechanisms and self-efficacy to manage stress adequately indicates that medical students need external assistance to manage academic stress owing to the enormous stress they are exposed to. Various stress management mechanisms were listed by Fares et al., according to whom personal involvement, extracurricular activities, positive expression and reinterpretation of emotions, mentorship initiatives, and career counseling can help medical students cope with stress. Medical colleges and the government should develop stress management initiatives along similar lines in order to assist the medical students.
The limitations of the study are that the results cannot be generalized because it is a cross-sectional study pertaining to a single institution. The power of the study could not be calculated as the sampling method adopted was universal sampling. Even though anonymity of the students was maintained, there is a possibility of embarrassment of being discovered which could have led to biased responses. Moreover, since the assessment was done in a group, there is a chance of bias as students could have discussed among themselves and often fill a socially desirable response. It can be avoided in a one-to-one interview. Most other studies have looked at either coping styles or self-efficacy in relation to academic stress; however, in our study, we have assessed the role of both coping and self-efficacy in managing stress which could be the strength of the study.
| Conclusion|| |
Teachers and the pressure to obtain good results cause tremendous stress among male and female medical students, and they attempted to manage stress by planning their activity in advance and employing other mechanisms. Female students experienced more stress and adopted coping mechanisms to a larger extent, while male and female students demonstrated equal self-efficacy. However, coping mechanisms and self-efficacy were nonsufficient to manage academic stress, which indicates that the medical college teachers, administrators, and the policy-makers should take steps to boost stress management among the students. Further, female medical students should be further empowered to handle stress better, and teachers/professors at medical colleges need to take students into confidence so as to reduce academic stress levels.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Misra R, Castillo LG. Academic stress among college students: Comparison of American and international students. Int J Stress Manag 2004;11:132.
Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al
. Students, stress and coping strategies: A case of Pakistani medical school. Educ Health (Abingdon) 2004;17:346-53.
Fares J, Saadeddin Z, Al Tabosh H, Aridi H, El Mouhayyar C, Koleilat MK, et al
. Extracurricular activities associated with stress and burnout in preclinical medical students. J Epidemiol Glob Health 2016;6:177-85.
Ruzhenkova VV, Ruzhenkova VA, Lukyantseva IS, Anisimova NA. Academic stress and its effect on medical students' mental health status. Drug Invent Today. 2018;10:1171-4.
Lannin DG, Guyll M, Cornish MA, Vogel DL, Madon S. The importance of counseling self-efficacy: Physiologic stress in student helpers. J Coll Stud Psychother 2019;33:14-24.
Gupta S, Choudhury S, Das M, Mondol A, Pradhan R. Factors causing stress among students of a medical college in Kolkata, India. Educ Health (Abingdon) 2015;28:92-5.
Iwasaki Y, MacKay K, Mactavish J. Gender-based analyses of coping with stress among professional managers: Leisure coping and non-leisure coping. J Leis Res 2005;37:1-28.
Abouserie R. Sources and levels of stress in relation to locus of control and self-esteem in university students. Educ Psychol 1994;14:323-30.
Varghese R, Norman TS, Thavaraj S. Perceived stress and self-efficacy among college students: A global review. Int J Hum Resour Manag Res 2015;5:15-24.
Skaalvik EM, Skaalvik S. Teacher stress and teacher self-efficacy: Relations and consequences. In: Educator Stress. Springer; 2017. p. 101-25.
Struthers CW, Perry RP, Menec VH. An examination of the relationship among academic stress, coping, motivation, and performance in college. Res High Educ 2000;41:581-92.
Lin YM, Chen FS. Academic stress inventory of students at universities and colleges of technology. World Trans Eng Technol Educ 2009;7:157-62.
Carver CS. You want to measure coping but your protocol's too long: Consider the brief COPE. Int J Behav Med 1997;4:92-100.
Schwarzer R, Jerusalem M. Generalized self-efficacy scale. Meas Health Psychol User's Portf Causal Control Beliefs 1995;1:357.
Ghosal K, Behera A. Study on prevalence of stress in medical students. J Res Med Dent Sci 2018;6:182-6.
Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H. Stress, Burnout and coping strategies in preclinical medical students. N Am J Med Sci 2016;8:75-81.
[Table 1], [Table 2], [Table 3]