|Year : 2020 | Volume
| Issue : 2 | Page : 170-174
A Cross-sectional study on personality, coping strategies, and quality of life of undergraduate medical students
T Sivailango, S SumithraDevi, P Ezhilarasi, S Arumuganathan, S Usaid, V Sethumadhavan
Department of Psychiatry, Karpaga Vinayaga Institute of Medical Sciences, Maduranthakam, Tamil Nadu, India
|Date of Submission||01-Apr-2020|
|Date of Decision||13-May-2020|
|Date of Acceptance||26-Jun-2020|
|Date of Web Publication||25-Nov-2020|
Dr. S Arumuganathan
Department of Psychiatry, Karpaga Vinayaga Institute of Medical Sciences, Maduranthakam, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Medical students experience high-stress levels that can impact on their learning and future care provision. Increased stress can precipitate episodes of anxiety and depression. Furtermore, it is one of the contributing factors of student suicide. As individual's vulnerability plays a major role, this study aims to understand the personality, coping strategies, and quality of life (QoL) of undergraduate medical students in a private medical college in South India. Materials and Methods: A cross-sectional study design with universal sampling was used to collect data from 411 undergraduate students. Instruments used were semi-structured proforma to collect socio-demographic details, Eysenck Personality Inventory (EPI), Coping Strategies Inventory-short form, and World Health Organization QoL-BREF. Statistical analysis was performed using SPSS version 20. Mean, standard deviation, percentages, Independent t-test, one-way ANOVA, and Pearson's correlation were used to describe and analyze the data. Results: Four hundred and three study participants were included in the analysis. About 53.3% of participants were female and >95% were from an urban background. Male students scored more on extroversion while females scored high on neuroticism. Female students applied engagement coping strategies than males. Interns used problem-focused disengagement strategies compared to other students. Females scored significantly higher in social and environmental domains of QOL, and within years of the study, 1st-year students scored low on physical domain, while 2nd-year students scored high on social and Interns on the environmental domain. Conclusion: Significant differences found in the personality, coping strategies and QoL across gender and within years of study. The findings will help to understand the student's vulnerability early and strengthen them to deal with stressors effectively.
Keywords: Coping strategies, personality, quality of life, undergraduate students
|How to cite this article:|
Sivailango T, SumithraDevi S, Ezhilarasi P, Arumuganathan S, Usaid S, Sethumadhavan V. A Cross-sectional study on personality, coping strategies, and quality of life of undergraduate medical students. Ann Indian Psychiatry 2020;4:170-4
|How to cite this URL:|
Sivailango T, SumithraDevi S, Ezhilarasi P, Arumuganathan S, Usaid S, Sethumadhavan V. A Cross-sectional study on personality, coping strategies, and quality of life of undergraduate medical students. Ann Indian Psychiatry [serial online] 2020 [cited 2021 Apr 20];4:170-4. Available from: https://www.anip.co.in/text.asp?2020/4/2/170/301429
| Introduction|| |
Medical education in India is witnessing major changes in curriculum, teaching-learning methods, and application of health-care technology. Available literature worldwide suggests that undergraduate medical students are prone to stress from different spheres of life and consequently may go on to develop stress-related disorders such as anxiety and depression.,, If not intervened properly, few students develop suicidal thoughts and may commit suicide. In India, recent statistics show one student commits suicide every hour. Irrespective of the external stressors, an individual's personality, coping strategies may play a major role in dealing with stress.
Personality is defined as “deeply ingrained characteristics of an individual” and develops through childhood and adolescence. Studies report a positive relationship between personality characteristics and mental health, coping, and academic success of medical students. Personality influences the way medical students adjust to college life. Hughes in 2002 concluded that it is important for students to have a stable personality during medical studies. Some studies showed extroversion and openness influence self-development, leadership, and problem-solving skills. While neuroticism has a negative correlation with satisfaction with clinical training.
Coping strategies are the acts or thoughts that people adopt to overcome the internal and external demands posed by a stressful encounter. Coping strategies are categorized as emotion-focused and problem-focused. Problem-focused coping are task-oriented, and the strategies include “taking control,” “information seeking” and “evaluating the pros and cons.” Problem-focused coping acts to remove the stressor by dealing with the root cause of the problem and provide a long-term solution. However, emotion-focused coping strategies include emotional responses, self-preoccupation, and fantasizing reactions that are effective in uncontrollable situations.,
Evaluation of coping strategies will help to understand the student's vulnerability in dealing with stressors. Strategies that involve engagement, including positive reinterpretation and problem-solving could facilitate easy adaptation, which in turn will reduce anxiety and depression and improve their overall mental well-being., Healthy and adaptive personality with effective coping strategies has an impact on student's quality of life (QoL).
The World Health Organization (WHO) defines QoL as “individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. It is a broad concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment.” This study becomes imperative with the increased number of medical students not just exposed to different types of stressors but who succumb to its effects. This study was undertaken to evaluate the personality characteristics, coping strategies, and QoL of undergraduate medical students and also identify differences based on gender and year of study on the above parameters.
| Methods|| |
Study design and participants
It was a cross-sectional study with universal sampling. The study population was undergraduate medical students of a private medical college in South India. The study was approved by the institutional ethics committee. The study objectives were briefed by one of the authors at the end of a lecture class and obtained written informed consent before distributing the questionnaire. Students were informed that participation is completely voluntary, and refusal to participate would have no academic consequences. To ensure anonymity and confidentiality, students were asked not to write their names and to drop completed questionnaires in the designated box. The study instruments were distributed to the students who were willing to participate in the study. It took approximately 20–30 min to complete the questionnaires.
Five hundred students were available for inclusion in the study from 1st year through to internship. Four hundred and eleven students consented and completed the questionnaires.
- Semi-structured pro forma to collect sociodemographic details including age, gender, year of study, religion, residence, and income of the household
- Eysenck's Personality Inventory (EPI) (extroversion/introversion). Developed by Hans and Sybil Eyesenck, it measures two personality dimensions, Extraversion-Introversion and Neuroticism-Stability, which account for most of the variance in the personality domain. Each form contains 57 “Yes/No” items with no repetition of items. EPI gives three scores. The “lie score” is out of 9. It measures how socially desirable they are trying to be in their answers. Participants who score 5 or more on this scale are probably trying to make themselves look good and are not being totally honest in their responses. The “E score” is out of 24 and measures how much of an extrovert a person is. The “N score” is out of 24 and measures how neurotic a person is
- Coping Strategies Inventory Short Form (CSI-SF): This brief 16-item scale was derived from the 78-item CSI. The items are rated on a 5-item Likert scale from 1 to 5 rated as never, seldom, sometimes, often, and almost always. The different forms of self-reported coping responses that are generally used when faced with difficult situations are evaluated through this scale. Coping responses are classified into emotion-focused and problem-focused, which are further sub-classified as either engagement type or disengagement type of strategy
- WHOQoL-BREF: The 26-item WHOQoL-BREF Scale encompasses physical health (8 items); psychological health (6 items); social relationship (3 items); environment (8 items) and overall QoL (1 item). It assesses the individual's perception in the context of their cultural and value system and their personal goals, standards, and concerns. The participants were required to evaluate their QoL during the past 2 weeks. The item scores ranged from 1 to 5, with a higher score indicating a better QoL for the corresponding item. The 26 BREF version and 100-item full version have a correlation of >0.89.
Data analysis was performed using SPSS version 20 (IBM, Armonk, New York, USA). Descriptive measures such as frequency, percentages, mean and standard deviation were used. Independent t-test was used to compare the groups based on gender, while groups based on year of the study were done using one-way ANOVA followed by post hoc Tukey test analysis. A P <0.05 was considered statistically significant.
| Results|| |
Four hundred and three students were included for the analysis as eight responses were incomplete. The response rate was found to be 82.2%. The mean age of the study participants was 19.8 (±1.5) years. The sample contained more female participants (53.3%) than males and had more or less equal representation of students from the first 4 years, with only 11.7% of interns. The majority of the students were Hindus (89.6%) and from the urban background (97%) [Table 1].
There was significant difference on personality subscales with male participants scored more on extroversion (t = 2.556; df = 400.87; P = 0.011), while female participants scored more on Neuroticism (t = −2.551; df = 382.40; P = 0.011). Post hoc analysis showed, significant differences exist between years of study in extroversion (F = 3.746; df = 4/398; P = 0.005) and neuroticism (F = 6.757; df = 4/398; P < 0.001) personality subscales. First-year students scored more on extroversion than 3rd years and interns. Furthermore, 1st year students scored significantly more on neuroticism than 2nd, 4th and internship year students [Table 2].
|Table 2: Scores on personality (Eysenck personality inventory) among undergraduate medical students based on gender and year of the study|
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On coping strategies short inventory form, female participants had significantly better engagement coping strategies (t = −4.489; df = 386.603; P < 0.001), including problem-focused (t = −5.024; df = 384.741; P < 0.001) and emotion-focused types (t = −2.225; df = 399.195; P < 0.001) of engagement than males. Within groups, interns scored significantly high on disengagement (F = 3.827; df = 4/398; P = 0.005) and particularly problem-focused disengagement (F = 5.088; df = 4/398; P = 0.001) [Table 3].
|Table 3: Scores on coping strategies among undergraduate medical students based on gender and year of the study|
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On WHOQoL-BREF scale, significant difference noted with female students scored better on social (t = −3.785; df = 392.631; P < 0.001) and environmental domains (t = −1.973; df = 392.63; P = 0.049) than their male counterparts. Significantly lower scores on physical domain (F = 3.266; df = 4/398; P = 0.012) by 1st year students than the 3rd year students and interns, 2nd year students scored higher than fourth years' on social domain (F = 2.547; df = 4/398; P = 0.039), while interns scored better than 1st year students on environmental domain (F = 2.368; df = 4/398; P = 0.052) [Table 4].
|Table 4: Quality of life scores among undergraduate medical students based on gender and year of the study|
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On Pearson's correlation, extroversion had positive correlation with problem focused engagement (PFE) and emotion focused engagement (EFE) coping strategies (PFE: r = 0.15; P = 0.005 and EFE: r = 0.19; P = 0.000) while neuroticism had negative correlation with emotion focused disengagement (r = 0.37; P = 0.000), overall QoL (r = 0.21; P = 0.000) and across all domains (physical: r = 0.29; P = 0.000, psychological: r = 0.30; P = 0.000, social: r = 0.18, P = 0.000 and environmental: r = 0.31; P = 0.000, respectively). Disengagement and emotion focused disengagement strategies had negative correlation with QoL.
| Discussion|| |
Although there are a lot of studies on stress and its impact on the mental health of medical undergraduates,, not much research focusing on personality and coping strategies of the student population. The authors believe that these inherent characteristics make an individual vulnerable to stress as equally as the nature of the stressors. More female participants in this study could be explained by the representation seen in most private medical colleges. The study involved students from all the years of study with less interns participating, which might be due to their work schedule compared to others. Almost all the students were from the middle or upper socioeconomic status as seen from the average income of the household and urban background, which is again related to the sample taken from a private medical college.
The findings on personality dimensions with male students scoring more on extroversion and females on neuroticism were concordant with studies done both in student and the general population. The 1st year students scoring significantly higher on extroversion could be explained by the fact that younger people are less shy and more sociable in the general population. They also scored high on neuroticism as there was more female representation in 1st year than other years of study.
Coping with stress is a dynamic and ongoing process for the survival, growth, and maintenance of the individual's integrity. In this study, female students found to have better-coping strategies than male students, which is contradictory to the results of Malaysian University study done by Salam et al., 2019. The difference in gender could be due to exposure of females to more stressors and early overall developmental maturation. Within years of the study, there are no differences in engagement strategies; however, interns employed more disengagement strategies, which the authors believe may be related to interns being bestowed with more responsibility of patient care and rotational training.
Overall, female students had better QoL, though not statistically significant. Male students had marginally better QoL on physical and psychological domains, but female students had significantly better QoL on social and environmental domains. The expectation of male students on the social and environmental aspects could explain this difference as the place of study offered limited resources on these domains. With increase in years of study, the students had better QoL that could be related to the nature of adaptability. Furthermore, intern's better QoL on physical and environmental domain, a finding similar to a study from Mumbai could be explained by the relief of exam stress and becoming more independent than previous years.
The study found that extraversion was positively correlated with problem-focused and emotional-focused coping style as well as better physical and psychological QoL that are similar to the findings of a study done in Iranian students. However, an increased level of neuroticism in a student can significantly impair their coping ability and all domains of QoL.
Strengths and limitations
There are limited studies on these parameters in the undergraduate student population in India. The study has a good sample size with representation from all years of study. The study instruments used had good reliability and validity. Inherent to the study design, it does not show any causality of students having poor coping strategies or QoL. The study was done in a private medical college where students come from an elite background, and hence, the results could not be generalized to the overall medical student population. Studies involving students from different backgrounds with the longitudinal design will help to understand the association of individual's personality and coping with stress, which will impact on QoL.
| Conclusion|| |
This study observed that male undergraduate medical students scored high on extroversion while female students scored high on neuroticism. Female students had better PFE and EFE strategies with good QoL than their male counterparts. There were significant differences noted within years of the study on personality, coping strategies and QoL. These findings will help to understand the individual's characteristics and coping resources early in the course and offer help to strengthen them. Ethical statement: This study was approved by Institutional Ethics Committee with reference number IEC Ref. No:47/2017 obtained on 23/01/2017
This study was approved by Institutional Ethics Committee with reference number 47/2017 obtained on January 23,2017.
Declaration of patient consent
Informed consent was taken from each participant as per institutional ethics committee approval for participation in the study and publication of the scientific results/clinical information/image without revealing their identity, name, or initials. The participant is aware that though confidentiality would be maintained anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]