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Correlation research on psychological health impact on nursing students against stress, coping way and social support
Nurse Education Today (2009) 29, 5–8
Nurse Education Today www.elsevier.com/nedt
Correlation research on psychological health impact on nursing students against stress, coping way and social support Yang Luo *, Honghong Wang Department of Clinical Nursing, Nursing School of Central South University, 172 Tongzipo Road, Changsha, Hunan Province 410013, China Accepted 28 May 2008
KEYWORDS
Summary The purpose of this study was to explore the factors affecting nurse students’ psychological status, and the interactions between mental symptoms and stressful factors, coping style and social support in their early clinical experiences. We assessed clinically 288 college nurse students during their first period by adopting College Seniors Stress Scale (CSSS), Trait Coping Style Questionnaire (TCSQ), Support Questionnaire and Symptom checklist 90 (SCL-90). The result of this study was that (1) positive correlations were found between stressful events, negative coping style and the total scores of SCL-90 (r = 0.487, 0.462, p < 0.01), while negative correlations related to positive coping style, social support and the total scores of SCL-90 (r = 0.192, 00.135, p < 0.05) and (2) stressful factors, negative coping style and social support all have main effects on mental symptoms (F = 34.062, 16.090, 20.898, P < 0.01), and positive coping style has no main effect on mental symptoms (F = 1.853, P > 0.05), but interactions relate to stressful factors and positive coping style (F = 14.579, P < 0.01), as well as negative coping style and social support. In order to improve the psychological condition of nursing students, aside from reducing the stress incidents and avoiding negative coping, it is very necessary to enhance the social support systems and to encourage them to adopt the positive coping styles. c 2008 Elsevier Ltd. All rights reserved.
Nursing students; Stress incidents; Coping style; Social support; Psychological condition
Background
* Corresponding author. Tel.: +86 731 221 2199; fax: +86 731 228 7060. E-mail address: [email protected] (Y. Luo).
Nursing students are predominantly a female special college student group. Whether their psychological condition is sound or not will exert a direct influence on their study and daily life, even
0260-6917/$ - see front matter c 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2008.05.019
6 the quality of their future nursing work and the stability of the nursing team. The psychological condition of the nursing students and rules of interaction among the impact factors have become the hot point of present research. The former researches mainly adopt correlation analysis, regressive analysis and structural equation model and so forth. This article will take undergraduate and vocational nursing students as the objects and employ the multi-factor variance analysis to explore the functional rules that stress incidents, coping style and social support influence the psychological symptoms of the undergraduate and vocational nursing students so as to provide the scientific evidence for the education of the psychological condition, mental quality training and the psychological health promotion of the nursing students.
Object and method Object Two hundred and eighty eight nursing students were selected by random inspection from two full-time undergraduate colleges and one vocational college, and then were given a questionnaire. We received 284 replies, with the efficiency of 98.6%. All the respondents were female aged from 18 to 25, averaged 21.5 ± 1.8, among whom there were 150 undergraduate students and 134 vocational students, accounting for 52.1% and 47.9% of the total, respectively.
Method We selected at random groups of students who have practiced for a month, and then three research workers undertook fieldwork. Before the investigation, we gave explanation of the aim and the significance of the research, and requested the students to finish the questionnaire, the completion process took about 30 min. The questionnaires included: (1) College Senior Stress Scale, prepared by Song and Lin (2005), including 20 items and five factors, i.e. the pressure of the examination, the pressure of employment, personal contacts, daily life concerns and important life events. (2) Trait Coping Style Questionnaire (Wang, 1999), assessing individual strategies against stress incidents. (3) Support Questionnaire (Wang, 1999): made by Xiao Shuiyuan, which assesses the utilization degree of objective support, subjective support and social support to the students. (4) The SCL-90 Symptom checklist (Wang, 1999), that assesses the psychological symptoms during the
Y. Luo, H. Wang recent week taking the total points as the assessment indexes.
Statistical analysis We explored the correlative factors which impact psychological symptom by adopting correlation Pearson analysis, and probed into the major effects of the impact factors on physical symptoms by employing multi-factor variance analysis, to judge whether the influence on psychological symptoms of the interaction between each factor is obvious or not.
Results The correlational analysis of Pearson of stress incidents, trait coping style, social support and the total points of psychological symptom refer to (Table 1) From Table 1, we can see that stress incidents and negative coping are positively correlated to psychological symptoms to some extent, and positive coping and social support are in negatively correlated with psychological symptoms.
The analysis of the major effects of stress incidents, coping style and social support effect to psychological symptoms With multi-factor variance analysis, we divided the students into a High Mark Group and a Low Mark Group on the corresponding marks of stress incidents, negative coping, positive coping and social support according to the dividing point of average marks – below the average is the Low Mark Group, and above the average is the High Mark Group. It shows that the major effects of stress incidents, negative coping and social support are remarkable, with their F value 34.062, 16.090, and 20.898, respectively, and all of their P values lower than 0.01. On the contrary, the major effect on psychological symptoms of positive coping is not distinct, with their F value 1.853, and P > 0.05.
The analysis of interaction between stress incidents, coping style, social support to psychological symptoms The above results indicate that the interactions between stress incidents and positive coping, between negative coping and social support obviously influence psychological symptoms. When we explored
Correlation research on psychological health
7
Table 1 The correlation coefficient of stress incidents, trait coping style, social support and psychological symptom Item
Total points of psychological symptoms
Stress incidents Negative coping Positive coping Social support
Stress incidents
Negative coping
Positive coping
**
0.487 0.426** 0.192* 0.315**
0.314** 0.206** 0.195*
0.432** 0.321**
0.252**
Notes: *P < 0.05, **P < 0.01.
the interactions, a further step by means of the simplex variance analysis of the main effect, the results indicate (refer to Tables 2 and 3) that the differences of psychological symptoms between the High Mark Group and the Low Mark Group for positive coping in the High Mark Group to be disposed to stress incidents are notable, and in the High Mark Group of negative coping, the differences of psychological symptoms between the High Mark Group and the Low Mark Group of social support are notable.
Discussion Psychological stress is a functional system which includes various factors, such as daily life incidents (the source of stress), coping style, social support and psychological and physical reactions. This study adopts the multi-factor variance analysis, which can not only examine whether there exist differences when the dependent variable is influenced by an independent variable (namely, whether the independent variable has a major effect towards the dependent variable), but can also analyze whether there are differences when the dependent variable is influenced by several independent variables interacting together (namely, whether several independent variables have an interactive effect towards the dependent variable). Stress incidents are the various problems to be met in daily life, and are the main stimulants which will cause psychological stress and which may further do harm to health. Many earlier studies indicate that stress incidents are closely related to psychological condition. They not only directly af-
Table 2
fect the psychological condition, but also indirectly influence it by coping style (Huang and Li, 2005). The results of this study show that stress incidents positively relate to psychological symptoms and have a conspicuous major effect towards psychological condition. The interaction between stress incidents and positive coping can also influence psychological condition, that is, the differences of psychological symptoms between the High Mark Group and the Low Mark Group for positive coping in the High Mark Group to dispose stress incidents are notable. It appears to us that in the practice of educational management, we should reduce the occurrences of stress incidents among nursing students, and lessen the intensity of influence on psychological condition caused by stress incidents so as to improve their psychological health. Coping is the individual cognitive evaluation towards stress and the measures adopted to balance one’s mental state. Sound coping style can change the individual subjective cognition, improve the ability of handling problems individually and ameliorate emotion. The results of this study reveal that negative coping is positively related to psychological symptoms and positive coping is negatively related to them; negative coping style has a conspicuous major effect towards psychological conditions and its interaction with social support evidently influences psychological condition. Namely, in the High Mark Group of negative coping, the differences of psychological symptoms between the High Mark Group and the Low Mark Group of social support are notable. Positive coping has no clear major effect to psychological symptoms, but influences it by its interaction with stress incidents. It
The analysis on the interaction between stress incidents and positive coping to psychological symptoms
Stress incidents
Positive coping
The number of samples
Averaged points on psychological symptom
Standard disparity
F-value
Average disparity
P-value
Low Mark Group Low Mark Group High Mark Group High Mark Group
Low Mark Group High Mark Group Low Mark Group High Mark Group
82 99 56 47
23.829 25.313 53.536 38.957
19.516 23.064 33.593 24.775
0.213
1.484
0.645
6.074
14.579
0.015
8
Y. Luo, H. Wang Table 3
The analysis on the Interaction between negative coping and social support to psychological symptoms
Stress incidents
Positive coping
The number of samples
Averaged points on psychological symptom
Standard disparity
Low Mark Group Low Mark Group High Mark Group High Mark Group
Low Mark Group High Mark Group Low Mark Group High Mark Group
53 86 82 63
26.151 22.291 52.805 26.286
18.785 17.635 33.689 20.984
is clear to us that it is necessary for us to organize the study of coping pertinently and teach coping to help students know relative coping knowledge and techniques, and improve their ability in coping, and lay a solid foundation for the individuals to cope positively and actively with various stress incidents and circumstances. As an external resource available to individuals in the process of stress, social support functions as a buffer, but its functional mechanism is still controversial. Some studies show that social support plays an independent role to improve psychological condition. Others hold that lacking social support itself may be a stress resource which develops a sense of long-term loneliness of individuals. Some manifest that social support can improve individual coping ability and resilience so as to indirectly cushion the influence of daily life and mitigate the stress reaction. Some also indicate that both mechanisms exist synchronously (Wu et al., 2005), while this study reveals that social support is negatively related to psychological symptoms, which is in accordance with the research results of Li Ping’s (Ping et al., 2003) group of the nursing students. It hints that in order to improve the students’ psychological condition, we should take measures not only on some objective factors, such as family, colleagues and friends, but also on perfecting relative support systems in school and hospital, actively exploring the nurture
F-value
Average disparity
P-value
1.497
3.86
0.223
30.050
26.519
0.000
method and management mechanism that are propitious to students’ psychological condition, and utilizing good social support to mitigate bad effects which the stress incidents and environment exert on students’ psychological condition. The results also show that social support has a conspicuous major effect towards psychological condition and its interaction with negative coping can also influence the psychological condition. It is obvious that the functional mechanism of social support towards psychological condition is complicated and needs further exploration.
References Huang, Yanping, Li, Ling, 2005. Stressor, coping style and mental health of college students. Chinese Mental Health Journal 19, 448–449. Li, Ping, Wang, Dong, Ma, Yongqing, et al., 2003. Analysis of anxiety, depression and social support of nursing students. Chinese Journal of Behavioral Medical Science 12, 136. Song, Chi, Lin, Wenjuan, 2005. The features of stressful events among college seniors. Chinese Mental Health Journal 19, 439–441. Wang, Xiangdong, 1999. Measured handbook of mental health. Chinese Mental Health Journal 13 (supplement to a periodical), 31–122. Wu, Zhixia, Jiang, Qijin, Zhong, Xia, 2005. Interactions between mental symptoms and stressful factors, coping style and social support. Chinese Journal of Practical Nursing 21, 63– 65.
Available online at www.sciencedirect.com
Nurse Education Today www.elsevier.com/nedt
Correlation research on psychological health impact on nursing students against stress, coping way and social support Yang Luo *, Honghong Wang Department of Clinical Nursing, Nursing School of Central South University, 172 Tongzipo Road, Changsha, Hunan Province 410013, China Accepted 28 May 2008
KEYWORDS
Summary The purpose of this study was to explore the factors affecting nurse students’ psychological status, and the interactions between mental symptoms and stressful factors, coping style and social support in their early clinical experiences. We assessed clinically 288 college nurse students during their first period by adopting College Seniors Stress Scale (CSSS), Trait Coping Style Questionnaire (TCSQ), Support Questionnaire and Symptom checklist 90 (SCL-90). The result of this study was that (1) positive correlations were found between stressful events, negative coping style and the total scores of SCL-90 (r = 0.487, 0.462, p < 0.01), while negative correlations related to positive coping style, social support and the total scores of SCL-90 (r = 0.192, 00.135, p < 0.05) and (2) stressful factors, negative coping style and social support all have main effects on mental symptoms (F = 34.062, 16.090, 20.898, P < 0.01), and positive coping style has no main effect on mental symptoms (F = 1.853, P > 0.05), but interactions relate to stressful factors and positive coping style (F = 14.579, P < 0.01), as well as negative coping style and social support. In order to improve the psychological condition of nursing students, aside from reducing the stress incidents and avoiding negative coping, it is very necessary to enhance the social support systems and to encourage them to adopt the positive coping styles. c 2008 Elsevier Ltd. All rights reserved.
Nursing students; Stress incidents; Coping style; Social support; Psychological condition
Background
* Corresponding author. Tel.: +86 731 221 2199; fax: +86 731 228 7060. E-mail address: [email protected] (Y. Luo).
Nursing students are predominantly a female special college student group. Whether their psychological condition is sound or not will exert a direct influence on their study and daily life, even
0260-6917/$ - see front matter c 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2008.05.019
6 the quality of their future nursing work and the stability of the nursing team. The psychological condition of the nursing students and rules of interaction among the impact factors have become the hot point of present research. The former researches mainly adopt correlation analysis, regressive analysis and structural equation model and so forth. This article will take undergraduate and vocational nursing students as the objects and employ the multi-factor variance analysis to explore the functional rules that stress incidents, coping style and social support influence the psychological symptoms of the undergraduate and vocational nursing students so as to provide the scientific evidence for the education of the psychological condition, mental quality training and the psychological health promotion of the nursing students.
Object and method Object Two hundred and eighty eight nursing students were selected by random inspection from two full-time undergraduate colleges and one vocational college, and then were given a questionnaire. We received 284 replies, with the efficiency of 98.6%. All the respondents were female aged from 18 to 25, averaged 21.5 ± 1.8, among whom there were 150 undergraduate students and 134 vocational students, accounting for 52.1% and 47.9% of the total, respectively.
Method We selected at random groups of students who have practiced for a month, and then three research workers undertook fieldwork. Before the investigation, we gave explanation of the aim and the significance of the research, and requested the students to finish the questionnaire, the completion process took about 30 min. The questionnaires included: (1) College Senior Stress Scale, prepared by Song and Lin (2005), including 20 items and five factors, i.e. the pressure of the examination, the pressure of employment, personal contacts, daily life concerns and important life events. (2) Trait Coping Style Questionnaire (Wang, 1999), assessing individual strategies against stress incidents. (3) Support Questionnaire (Wang, 1999): made by Xiao Shuiyuan, which assesses the utilization degree of objective support, subjective support and social support to the students. (4) The SCL-90 Symptom checklist (Wang, 1999), that assesses the psychological symptoms during the
Y. Luo, H. Wang recent week taking the total points as the assessment indexes.
Statistical analysis We explored the correlative factors which impact psychological symptom by adopting correlation Pearson analysis, and probed into the major effects of the impact factors on physical symptoms by employing multi-factor variance analysis, to judge whether the influence on psychological symptoms of the interaction between each factor is obvious or not.
Results The correlational analysis of Pearson of stress incidents, trait coping style, social support and the total points of psychological symptom refer to (Table 1) From Table 1, we can see that stress incidents and negative coping are positively correlated to psychological symptoms to some extent, and positive coping and social support are in negatively correlated with psychological symptoms.
The analysis of the major effects of stress incidents, coping style and social support effect to psychological symptoms With multi-factor variance analysis, we divided the students into a High Mark Group and a Low Mark Group on the corresponding marks of stress incidents, negative coping, positive coping and social support according to the dividing point of average marks – below the average is the Low Mark Group, and above the average is the High Mark Group. It shows that the major effects of stress incidents, negative coping and social support are remarkable, with their F value 34.062, 16.090, and 20.898, respectively, and all of their P values lower than 0.01. On the contrary, the major effect on psychological symptoms of positive coping is not distinct, with their F value 1.853, and P > 0.05.
The analysis of interaction between stress incidents, coping style, social support to psychological symptoms The above results indicate that the interactions between stress incidents and positive coping, between negative coping and social support obviously influence psychological symptoms. When we explored
Correlation research on psychological health
7
Table 1 The correlation coefficient of stress incidents, trait coping style, social support and psychological symptom Item
Total points of psychological symptoms
Stress incidents Negative coping Positive coping Social support
Stress incidents
Negative coping
Positive coping
**
0.487 0.426** 0.192* 0.315**
0.314** 0.206** 0.195*
0.432** 0.321**
0.252**
Notes: *P < 0.05, **P < 0.01.
the interactions, a further step by means of the simplex variance analysis of the main effect, the results indicate (refer to Tables 2 and 3) that the differences of psychological symptoms between the High Mark Group and the Low Mark Group for positive coping in the High Mark Group to be disposed to stress incidents are notable, and in the High Mark Group of negative coping, the differences of psychological symptoms between the High Mark Group and the Low Mark Group of social support are notable.
Discussion Psychological stress is a functional system which includes various factors, such as daily life incidents (the source of stress), coping style, social support and psychological and physical reactions. This study adopts the multi-factor variance analysis, which can not only examine whether there exist differences when the dependent variable is influenced by an independent variable (namely, whether the independent variable has a major effect towards the dependent variable), but can also analyze whether there are differences when the dependent variable is influenced by several independent variables interacting together (namely, whether several independent variables have an interactive effect towards the dependent variable). Stress incidents are the various problems to be met in daily life, and are the main stimulants which will cause psychological stress and which may further do harm to health. Many earlier studies indicate that stress incidents are closely related to psychological condition. They not only directly af-
Table 2
fect the psychological condition, but also indirectly influence it by coping style (Huang and Li, 2005). The results of this study show that stress incidents positively relate to psychological symptoms and have a conspicuous major effect towards psychological condition. The interaction between stress incidents and positive coping can also influence psychological condition, that is, the differences of psychological symptoms between the High Mark Group and the Low Mark Group for positive coping in the High Mark Group to dispose stress incidents are notable. It appears to us that in the practice of educational management, we should reduce the occurrences of stress incidents among nursing students, and lessen the intensity of influence on psychological condition caused by stress incidents so as to improve their psychological health. Coping is the individual cognitive evaluation towards stress and the measures adopted to balance one’s mental state. Sound coping style can change the individual subjective cognition, improve the ability of handling problems individually and ameliorate emotion. The results of this study reveal that negative coping is positively related to psychological symptoms and positive coping is negatively related to them; negative coping style has a conspicuous major effect towards psychological conditions and its interaction with social support evidently influences psychological condition. Namely, in the High Mark Group of negative coping, the differences of psychological symptoms between the High Mark Group and the Low Mark Group of social support are notable. Positive coping has no clear major effect to psychological symptoms, but influences it by its interaction with stress incidents. It
The analysis on the interaction between stress incidents and positive coping to psychological symptoms
Stress incidents
Positive coping
The number of samples
Averaged points on psychological symptom
Standard disparity
F-value
Average disparity
P-value
Low Mark Group Low Mark Group High Mark Group High Mark Group
Low Mark Group High Mark Group Low Mark Group High Mark Group
82 99 56 47
23.829 25.313 53.536 38.957
19.516 23.064 33.593 24.775
0.213
1.484
0.645
6.074
14.579
0.015
8
Y. Luo, H. Wang Table 3
The analysis on the Interaction between negative coping and social support to psychological symptoms
Stress incidents
Positive coping
The number of samples
Averaged points on psychological symptom
Standard disparity
Low Mark Group Low Mark Group High Mark Group High Mark Group
Low Mark Group High Mark Group Low Mark Group High Mark Group
53 86 82 63
26.151 22.291 52.805 26.286
18.785 17.635 33.689 20.984
is clear to us that it is necessary for us to organize the study of coping pertinently and teach coping to help students know relative coping knowledge and techniques, and improve their ability in coping, and lay a solid foundation for the individuals to cope positively and actively with various stress incidents and circumstances. As an external resource available to individuals in the process of stress, social support functions as a buffer, but its functional mechanism is still controversial. Some studies show that social support plays an independent role to improve psychological condition. Others hold that lacking social support itself may be a stress resource which develops a sense of long-term loneliness of individuals. Some manifest that social support can improve individual coping ability and resilience so as to indirectly cushion the influence of daily life and mitigate the stress reaction. Some also indicate that both mechanisms exist synchronously (Wu et al., 2005), while this study reveals that social support is negatively related to psychological symptoms, which is in accordance with the research results of Li Ping’s (Ping et al., 2003) group of the nursing students. It hints that in order to improve the students’ psychological condition, we should take measures not only on some objective factors, such as family, colleagues and friends, but also on perfecting relative support systems in school and hospital, actively exploring the nurture
F-value
Average disparity
P-value
1.497
3.86
0.223
30.050
26.519
0.000
method and management mechanism that are propitious to students’ psychological condition, and utilizing good social support to mitigate bad effects which the stress incidents and environment exert on students’ psychological condition. The results also show that social support has a conspicuous major effect towards psychological condition and its interaction with negative coping can also influence the psychological condition. It is obvious that the functional mechanism of social support towards psychological condition is complicated and needs further exploration.
References Huang, Yanping, Li, Ling, 2005. Stressor, coping style and mental health of college students. Chinese Mental Health Journal 19, 448–449. Li, Ping, Wang, Dong, Ma, Yongqing, et al., 2003. Analysis of anxiety, depression and social support of nursing students. Chinese Journal of Behavioral Medical Science 12, 136. Song, Chi, Lin, Wenjuan, 2005. The features of stressful events among college seniors. Chinese Mental Health Journal 19, 439–441. Wang, Xiangdong, 1999. Measured handbook of mental health. Chinese Mental Health Journal 13 (supplement to a periodical), 31–122. Wu, Zhixia, Jiang, Qijin, Zhong, Xia, 2005. Interactions between mental symptoms and stressful factors, coping style and social support. Chinese Journal of Practical Nursing 21, 63– 65.
Available online at www.sciencedirect.com