Hawsawi, Aisha
(2024)
Factors associated with medical students' psychological
wellbeing, coping and personality, as well as wellbeing
support: A quantitative and qualitative exploration.
PhD thesis, University of Nottingham.
Abstract
Background
In recent years, there has been a notable shift in awareness towards the psychological wellbeing and mental health of healthcare professionals and students, emerging as a pressing public health concern with implications for the quality of care delivery. Healthcare professionals are confronted with numerous stressors in their daily roles, which can significantly impact their overall wellbeing. Particular emphasis has been placed on the mental health of medical students who, early on in their career path, have been documented to present with poor mental health levels that exceed those of the general student population worldwide and that have been attributed largely to the demanding nature of their studies; this challenge has been further exacerbated by the impacts of the COVID-19 pandemic. While research on the psychological wellbeing of medical students has been growing, much of the existing literature tends to concentrate on quantitative studies, which have primarily investigated the factors that negatively affect medical students' psychological wellbeing, often overlooking the potential positive influences on their academic and personal lives during their medical training. Hence, there is an identified need to adopt a more comprehensive approach that encompasses both positive and negative factors impacting medical students' psychological wellbeing in order to look into aspects that can promote wellbeing as well as ‘fix’ wellbeing issues; this necessitates a balanced exploration from both quantitative and qualitative perspectives in order to gain a deeper understanding into what determines the psychological wellbeing state of medical students. Furthermore, understanding medical students' utilisation of wellbeing support services is crucial. Despite existing wellbeing support resources, limited insight exists into students' acceptability of these resources and potential needs for tailored wellbeing support.
Aims
The present thesis aims to explore the psychological wellbeing of medical students, looking into factors influencing their psychological wellbeing and strategies for the enhancement of mental health and wellbeing support provision. Chapter 1 (Introduction) introduces key concepts in healthcare and medical education pertinent to mental wellbeing issues. It outlines core theoretical constructs integral to mental wellbeing and situates them within an overarching theoretical framework that supports the stance of this research. Relevant literature is reviewed, emphasising the need to address mental health challenges in the healthcare sector to advance understanding of factors impacting medical students' wellbeing, both positively and negatively, and to inform the provision of wellbeing support resources within medical education. Chapter 2 (Study 1) presents a systematic review which aims to identify and evaluate outcomes measured and methodological approaches used in studies focused on the psychological wellbeing of medical students, contributing to a more thorough understanding of how mental wellbeing has been conceptualised and indexed. Chapter 3 presents a mixed-method investigation (Study 2) of the impact of positive and negative factors on the psychological wellbeing of medical students through coping strategies, personality traits, and other factors contributing positively or negatively to overall wellbeing are explored, considering both pre-pandemic and pandemic periods. Chapter 4 (Study 3) begins with a scoping review to map the existing wellbeing interventions for medical students; and proceeds with a qualitative exploration of aspects regarding the utilisation of wellbeing support services among medical students, conducted through semi-structured interviews (an extension of Study 2) and followed by a series of focus groups. Finally, Chapter 5 (General Discussion) integrates the findings from the preceding chapters and synthesises them within the wider context of the literature too, in an attempt to offer a comprehensive perspective that takes into account the research questions that this PhD project was set to address. This chapter also identifies fundamental strengths, limitations, and implications of the research, suggesting future directions and offering recommendations to key stakeholders in medical education and university welfare services.
Methods
The first study component of this PhD project was a systematic review (Study 1), which involved searching published studies on medical students' psychological wellbeing, with a focus on mental health outcomes and methodological approaches used. Multiple databases, including OVID Medline, PsycINFO, Cochrane Library, and Web of Science, were searched. Grey literature was explored, and reference lists of included studies were reviewed. Initial screening of 2217 studies resulted in 45 included studies. Methodological quality was assessed using MERSQI for quantitative studies and CASP Qualitative Checklist for qualitative studies, with discrepancies resolved through discussion. Study 2 employed a mixed-method approach consisting of quantitative and qualitative methods; well-validated self-report questionnaires were administered through an online survey for the collection of quantitative data on medical students' psychological wellbeing. Questionnaire data was subjected to Generalized Linear Regression Models to decipher how the various aspects of psychological wellbeing relate to one another, while a moderation-mediation analysis was applied to look into the role of problem-focused coping in the stress-depression relationship among medical students. Qualitative data was collected through semi-structured interviews conducted online via Microsoft Teams. Study 3 employed a combined qualitative approach, utilising semi-structured interviews and focus groups, to further explore previously identified themes by gathering diverse perspectives from participants who shared similar experiences. Qualitative data from the interviews conducted in Study 2 and Study 3 was deemed appropriate to be subjected to thematic analysis following the Braun and Clarke (2006) 6-step approach, while a hybrid thematic analytic approach (Fereday & Muir-Cochrane, 2006; Swain, 2018) was applied for the focus groups in Study 3 in order to combine deductive and inductive data, allowing for both predefined themes and emergent patterns to be identified and analysed.
Results
The results of Study 1 revealed the use of a diverse array of methods and outcome measurements in studies that have assessed psychological wellbeing among medical students. Aspects of wellbeing that were used as outcomes mainly involved stress, depression, anxiety, burnout, and minor psychiatric disorders. Commonly employed measures included the general health questionnaire, Oldenburg Burnout Inventory, Perceived Stress Scale, and Depression Anxiety Stress Scale. Self-reported measures and quantitative designs were prevalent, focusing mainly on negative indicators of wellbeing. This systematic review highlighted the heterogeneity in measured outcomes and methods used in studies assessing psychological wellbeing in medical students. The results from Study 2 shed light on the nature of medical students' experiences, revealing a moderate to high prevalence of stress, depression, and anxiety levels, alongside slightly lower levels of life satisfaction. Notably, emotion-focused coping strategies were frequently drawn upon, followed by problem-focused coping ones, with avoidance strategies being less common. High-stress levels were found to correlate with reduced life satisfaction and increased risk of depression and anxiety; conversely, students experiencing depression and anxiety were found to have reduced life satisfaction. Through regression analysis, significant trends emerged, suggesting that problem-focused coping strategies positively influenced medical students' psychological wellbeing; conversely, emotion-focused and avoidance coping strategies showed adverse effects. Personality traits significantly predicted medical students’ psychological wellbeing, with high scores typically observed in openness, conscientiousness, and agreeableness, while lower scores were commonly observed in extraversion and neuroticism. Notably, conscientiousness appeared to buffer against the negative impact of emotion-focused coping on depression, while extraversion traits were shown to mitigate the effects of avoidance coping, lessening its detrimental influence; however, participants high in agreeableness who heavily relied on emotion-focused coping were likely to experience adverse effects on their psychological wellbeing. Additionally, problem-focused coping acted as a partial mediator in the stress-depression relationship, emphasising the critical importance of fostering effective problem-solving coping strategies to manage mental health effectively. The thematic analysis provided deeper insight into the diverse range of factors shaping the psychological wellbeing of medical students. Academic, personal, and organisational factors all seemed to exert significant influences, with the disruptive effects of COVID-19 exacerbating existing challenges in students' academic, personal, and social lives. On a positive note, factors including maintaining an effective study-life balance, achieving academic success, fostering meaningful relationships with faculty, and nurturing quality connections with friends and family were all reported to contribute positively to students' overall wellbeing. A noteworthy finding was that most students proactively managed their stress and mood by actively employing diverse stress-relief techniques, demonstrating a willingness to confront challenges directly and effectively.
In Study 3, among the key themes identified across both interview and focus group data was the presence of significant barriers hindering help-seeking behaviour; these barriers encompassed difficulties in accessing relevant wellbeing information, navigating complex procedures, encountering prolonged waiting lists, and experiencing a normalisation of stress that deterred individuals from seeking assistance. Moreover, hesitancy to seek help, lack of adequate support from staff members and personal tutors, academic stressors, fear of confidentiality breaches, and the stigma associated with mental health issues were also drawn out among the prevalent concerns. Amidst these reported challenges, a number of suggestions for improvements were put forward to be applied to wellbeing services and resource provisions; these included addressing cultural and organisational changes, enhancing accessibility to resources, reducing stigma, simplifying administrative procedures, introducing check-in sessions for students on waiting lists, strengthening the personal tutor scheme, promoting self-care practices, fostering supportive relationships, and cultivating a sense of belonging and safety within the academic environment. Furthermore, participants pointed out the importance of fostering better communication and offering workshops or seminars aimed at openly addressing stressors and providing effective management strategies; these measures were seen as crucial components in promoting positive factors that support psychological wellbeing among medical students.
Conclusions
The findings of the PhD project emphasise the importance of addressing both positive and negative factors influencing medical students' wellbeing. It highlights the need for improved and tailored wellbeing support that also considers individual personality traits impacting on coping strategies and mental health. The research sheds light on the challenges within medical education, calling attention to the demand for stress management programs, mental health support, and curricula promoting effective problem-solving skills. Within medical education institutions, initiatives to de-stigmatise mental health, foster supportive relationships, and enhance accessibility to support services seem to be critical in encouraging help-seeking behaviour and improving overall wellbeing in medical students. Ultimately, prioritising on promoting medical students' wellbeing will help promote good mental health in future professionals working in the medical field and, in turn, the future quality of healthcare provision.
| Item Type: |
Thesis (University of Nottingham only)
(PhD)
|
| Supervisors: |
Nixon, Elena
Nixon, Neil |
| Keywords: |
Psychological wellbeing, mental health, medical students, positive wellbeing, coping strategies, personality traits, support services, barriers, help-seeking |
| Subjects: |
W Medicine and related subjects (NLM Classification) > W Health professions
W Medicine and related subjects (NLM Classification) > WM Psychiatry |
| Faculties/Schools: |
UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences |
| Item ID: |
78360 |
| Depositing User: |
Hawsawi, Aisha Ali
|
| Date Deposited: |
12 Aug 2024 09:25 |
| Last Modified: |
12 Aug 2024 09:25 |
| URI: |
https://eprints.nottingham.ac.uk/id/eprint/78360 |
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