title: Perceived stress in first year medical students - associations with personal resources and emotional distress.
abstract: BACKGROUND
  Medical students have been found to report high levels of perceived stress, yet there is a lack of theoretical frameworks examining possible reasons. This cross-sectional study examines correlates of perceived stress in medical students on the basis of a conceptual stress model originally developed for and applied to the general population. The aim was to identify via structural equation modeling the associations between perceived stress and emotional distress (anxiety and depression), taking into account the activation of personal resources (optimism, self-efficacy and resilient coping).
  
  
  METHODS
  Within this cross-sectional study, 321 first year medical students (age 22 ± 4 years, 39.3% men) completed the Perceived Stress Questionnaire (PSQ-20), the Self-Efficacy Optimism Scale (SWOP) and the Brief Resilient Coping Scale (BRCS) as well as the Patient Health Questionnaire (PHQ-4). The statistical analyses used t-tests, ANOVA, Spearman Rho correlation and multiple regression analysis as well as structural equation modeling.
  
  
  RESULTS
  Medical students reported higher levels of perceived stress and higher levels of anxiety and depression than reference samples. No statistically significant differences in stress levels were found within the sample according to gender, migration background or employment status. Students reported more self-efficacy, optimism, and resilient coping and higher emotional distress compared to validation samples and results in other studies. Structural equation analysis revealed a satisfactory fit between empirical data and the proposed stress model indicating that personal resources modulated perceived stress, which in turn had an impact on emotional distress.
  
  
  CONCLUSIONS
  Medical students' perceived stress and emotional distress levels are generally high, with personal resources acting as a buffer, thus supporting the population-based general stress model. Results suggest providing individual interventions for those students, who need support in dealing with the challenges of the medical curriculum as well as addressing structural determinants of student stress such as course load and timing of exams.
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany. i.heinen@uke.de.
authors.forename: Ines
authors.identifier: http://orcid.org/0000-0001-7361-4554
authors.initials: I
authors.lastname: Heinen
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Bullinger
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
authors.forename: Rüya-Daniela
authors.initials: RD
authors.lastname: Kocalevent
mesh_terms: D000223:Adaptation, Psychological; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate; D004644:Emotions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D012577:Schools, Medical; D012931:Social Environment; D013315:Stress, Psychological / Q000453:epidemiology; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Anxiety; Coping; Depression; First year medical students; Joy; Optimism; Self-efficacy; Stress