Stress and coping in a sample of medical students in
					Brazil

The study aimed to assess the prevalence of stress and coping in students of a public medical school in Brazil, comparing the groups from the first and sixth years of training.

Methods

Through a cross-sectional, observational study, a sample of 232 first and sixth-year regularly registered medical students has been evaluated. Students filled a socio-demographic questionnaire, the Lipp Inventory of Stress Symptoms (ISSL), and the Coping Strategies Inventory (CSI).

Results

From the total sample of 232 students, 110 were first-year students and 122 sixth-year students. Stress symptoms were significantly higher in first-year students (49.1%) than in the sixth-year group (33.6%; p = 0.018). Variables significantly associated with stress were: year of the training (1^st year > 6^th year), income (lower > higher income), satisfaction with the training (dissatisfied > satisfied) and the use of escape/avoidance copying strategy (positive association).

Discussion

Considering the higher stress symptoms among first-year medical students and the positive association of the escape/avoidance copying strategy with stress, strategies must be developed to enable students starting medical school to be better at coping with this stressful situations.

Students; medical; psychological stress; coping behavior; adaptation; psychological

Variables	1º year Frequency (%)	6º year Frequency (%)	Total Frequency (%)	p
Number of students	110 (47.4)	122 (52,6)	232	-
Age*	20.7 (SD 2.6)	25.34 (SD 2.7)	23.1 (SD 3.2)	-
Male students**	62 (56.4%)	55 (45.1%)	117 (50.4%)	0.113
Leisure time**	94 (87%)	109 (90.1%)	203 (88.6%)	0.605
Live with their family**	65 (59.6%)	56 (45.9%)	121 (52.4%)	0.051
Living in communal off-campus housing**	8 (7.3%)	8 (6.6%)	16 (6.9%)	> 0.999
Family income up to U$ 1.749,27^†**	43 (40.2%)	32 (26.7%)	75 (33.0%)	0.043
Perform paid activity**	11 (10.0%)	43 (35.5%)	54 (23.4%)	< 0.001
Coffee intake**	80 (74.1%)	101 (82.8%)	181 (78.8%)	0.147
Drug and alcohol use**	38 (35.2%)	66 (54.5%)	104 (45.4%)	0.005
Cigarette smoking**	5 (4.5%)	5 (4.2%)	10 (4.4%)	> 0.999
Presence of some illness**	28 (25.9%)	42 (35.0%)	70 (30.7%)	0.180
Use of medication**	36 (33.6%)	59 (51.3%)	95 (42.8%)	0.012
Low satisfaction	27 (24.5%)	27 (22.1%)	54 (23.3%)	0.780

	% of stress	Bivariate analysis		Poisson’s regression
	% of stress	Relative risk brut (I.C. 95%)	p	Relative risk adjusted (I.C. 95%)	p (adjus.)
Gender
Female	60 (52.2%)	1.74 (1.26 – 2.42)	0.001	1.30 (0.925 – 1.82)	0.131
Male	35 (29.9%)	1.00		1.00
Age
Lower than median (less than 23 years)	59 (48.4%)	1.48 (1.07 – 2.04)	0.018
Higher than median (more than 23 years)	36 (32.7%)	1.00
Course year
First year	54 (49.1%)	1.46 (1.07 – 2.00)	0.018	1.48 (1.07 – 2.05)	0.017
Sixth year	41 (33.6%)	1.00		1.00
Leisure activities
Practice leisure activities	84 (41.4%)	1.08 (0.64 – 1.80)	0.780
Do not practice leisure activities	10 (38.5%)	1.00
Living with their family
Live with their family	46 (38.0%)	0.85 (0.63 – 1.16)	0.314	0.93 (0.69 – 1.27)	0.668
Do not live with their family	49 (44.5%)	1.00		1.00
Living in communal off-campus housing*
Live in a republic	8 (50.0%)	1.24 (0.74 – 2.08)	0.412
Do not live in a republic	87 (40.3%)	1.00
Family income
Up to 2,915.45 dollars^†	38 (50.7%)	1.45 (1.06 – 1.98)	0.019	1.40 (1.04 – 1.89)	0.027
More than 2,915.45 dollars^†	53 (34.9%)	1.00		1.00
Performing a paid activity
Perform paid activity	18 (33.3%)	0.77 (0.51 – 1.16)	0.206	0.97 (0.61 – 1.54)	0.885
Do not perform a paid activity	77 (43.5%)	1.00		1.00
Coffee intake
Drink coffee	74 (40.9%)	1.00 (0.68 – 1.46)	0.993	0.95 (0.66 – 1.37)	0.780
Do not drink coffee	20 (40.8%)	1.00		1.00
Alcohol/Drug use
Use alcohol/drug	38 (36.5%)	0.82 (0.59 – 1.12)	0.211	0.94 (0.69 – 1.28)	0.698
Do not use alcohol/drug	56 (44.8%)	1.00		1.00
Cigarette smoking (tobacco)
Smokers	4 (40.0%)	0.96 (0.44 – 2.08)	0.914
Non-smokers	91 (41.7%)	1.00
Illness bearer
Bear an illness	38 (54.3%)	1.53 (1.3 – 2.07)	0.005	1.27 (0.92 – 1.76)	0.147
Do not bear any illness	56 (35.4%)	1.00		1.00
Medication use
Use medication	49 (51.6%)	1.42 (1.05 – 1.93)	0.022	1.37 (0.96 – 1.96)	0.084
Do not use medication	46 (36.2%)	1.00		1.00
Satisfaction with the course
Dissatisfied	29 (53.7%)	1.45 (1.06 – 1.98)	0.020	1.52 (1.09 – 2.13)	0.014
Satisfied	66 (37.1%)	1.00		1.00
Coping
Escape/avoidance		1.21 ( 1.12 – 1.31)	0.00	1.14 ( 1.04 – 1.25)	0.005
Social support		1.03 (0.99 – 1.07)	0.056	1.00 ( 0.97 – 1.04)	0.819
Confrontation		1.07 ( 1.02 – 1.13)	0.002	1.04 ( 0.99 – 1.01)	0.122
Self-control		0.99 ( 0.93 – 1.04)	0.616
Withdrawal/Detachment		1.02 ( 0.98 – 1.07)	0.317
Responsibility acceptance		1.04 ( 1.00 – 1.08)	0.036	1.00 ( 0.96 – 1.04)	0.918
Problem resolving		0.97 (0.91 – 1.04 )	0.396
Positive reevaluation		0.99 ( 0.97 – 1.03)	0.881

Faculdade de Medicina da Universidade de São Paulo Rua Ovídio Pires de Campos, 785 , 05403-010 São Paulo SP Brasil, Tel./Fax: +55 11 2661-8011 - São Paulo - SP - Brazil
E-mail: archives@usp.br

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[1] Address correspondence to: Ana Margareth Siqueira Bassols. Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre. Rua Ramiro Barcelos, 2350 – 90035-903 – Porto Alegre, RS, Brazil. Tel.: +55 (51) 3359-8294. E-mail: ambassols@gmail.com