Descriptive results for perceived stress scale, and dimensions of 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.
The mean PSS score was 22.78 (±8.54), indicating a moderate level of stress, and 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 of 46.
Comparative analysis between PSS, STAI and clinical placement.
Regarding type of clinical placements, no significant differences were found when comparing the mean perceived stress (p=.352) using 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). 100% of the students who displayed severe anxiety in the state STAI were in specialized services.
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 for the female sex. However, for the total score on the scale, despite the fact that the mean was higher in women (23.22±8.55) than in men (20±8.04), significant differences were not found between gender (p= .069) for the total scale 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 showed significance (p= 0.009) (Table 3).
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 stress perceived and the coping strategies, the results revealed a significant relationship between the total perceived stress and the following domains: 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), of the CSI. (Table 4).
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 variable anxiety trait was a significant predictor of perceived stress scale (B = .726, t = 14.56, p < .01).
The significant variable included at the second model were: anxiety trait (B = .624, t = 12.32, p < .01) and wishful thinking (B = .266, t = 5.26, p < .01) and the adjustment was F (2, 191) 134.82, p < .01.
For the third model: anxiety trait (B = .564, t = 11.28, p < .01), wishful thinking (B = .263, t = 5.47, p < .01), cognitive restructuring (B = -.211, t = -4.53, p < .01) and the adjustment was: F (3, 191) , 106.01 p < .01.
For the fourth model anxiety trait (B = .486, t = 8.98, p < .01), wishful thinking (B = .269, t = 5.72, p < .01), cognitive restructuring (B = -.215, t = -4.75, p < .01), anxiety state (B = .162, t = 3.30, p < .05) and the adjustment was: F (4, 191) 86.44, p < .01.
For the step 5: anxiety trait (B = .450, t = 8.15, p < .01), wishful thinking (B = .268, t = 5.79, p < .01), cognitive restructuring (B = -.133, t = -2.41, p < .05), anxiety state (B = .170, t = 3.52, p < .01), problem solving (B = -.147, t = -2.56, p < .05) and the adjustment was: F (5, 191) 72.53, p < .01. The fifth model explained 66.1% of the variance in perceived stress and it has been the model with the best fit.