Stress and Resilience as Predictors of Quality of Life among Healthcare Students
Richardson D. Orines1*, Kize Azer A. Alomia1, Jan Margarette L. Canoy1, Kyra Mae D. J. Pascual1, Ma. Angelica I. Pol-ot 1, Andrea Fe R. Servas 1,
Shannen Denise T. Tan1
1Department of Psychology, Far Eastern University, Manila, Philippines
*Corresponding Author: [email protected] Received: 25 March 2023 | Accepted: 1 May 2023 | Published: 1 June 2023
DOI:https://doi.org/10.55057/ajress.2023.5.2.9
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Abstract: Students face the responsibilities of an emerging adults where they manage their academic life while learning to gain independence, causing stress. Resilience helps them to manage and face adversities that affect their quality of life. This study was conducted on 210 Filipino healthcare students that used a predictive correlational research design to determine if stress and resilience can predict their quality of life. Results showed significant relationships existed between stress, resilience, and quality of life. Multiple regression analysis suggested that stress and resilience combined, only resilience significantly predicted the quality of life among healthcare students.
Keywords: Healthcare Students, Quality of Life, Resilience, Stress
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1. Introduction
Healthcare, a vital academic field, demands students’ mental toughness, gritty well-being, and perseverance (Özer, 2021). As society’s forerunners, they are trained to be accountable for the future and lives of individuals but contain consequences that compromise them. Students experienced low levels of physical and mental quality of life caused by academic-related stress (Almhdawi et al., 2021). Studies showed stress can cause difficulty in the course subject, shifts in learning modalities, and workload burnout (Dalug et al., 2022; Keyserlingk et al., 2022;
Yusoff et al., 2021). Compared to the general population, students in healthcare courses are reported to have a much-heightened stress level (Macauley et al., 2018). Contrastingly, Lacomba-Trejo et al. (2022) explained that having psychological toughness and being flexible in facing adversities have a good quality of life. In relation, students who fostered a stronger focus and goal-driven behaviors that positively developed effective coping excel better (Haider et al., 2022). When students’ well-being is challenged, it affects their quality of life.
In the Philippines, inaccessibility to educational resources also contributed to the heightened stress of healthcare students, including the learning environment mandatorily done in laboratory and clinical settings (Barrot et al., 2021). Studies showed that when students lack interaction and stimulation, it is more difficult for them to balance studies impacting their motivation and holistic well-being (Rotas & Cahapay, 2020). These reflect physical symptoms caused by restlessness and overfatigue leading to stress. Filipino students who possess adaptive techniques improve their quality of life, life satisfaction, and well-being when faced with stress
Stress is a state of bodily response to any unavoidable internal and external stimuli from an environment that affects an individual to any extent or in any form (Ramón-Arbués et al., 2020). Healthcare students experience heightened stress and burnout, where they face more problems concerning stress than any health-related issues (Yang et al., 2021). Durbas et al.
(2021) determined that these students, at any year level, are reported to experience psychological distress, such as fear of their health affecting their mentality. Previous studies showed that the students in this field, attained high scores on measures of mental distress, experiencing moderate levels of despair and difficulties in concentration, sleep, and social interactions (Koohestani & Baghchegi, 2022; Kumar et al., 2021; Son et al., 2020). Hence, these may affect a student’s quality of life, impacting their future goals.
Resilience is defined as an individual’s capability to turn adversity into learning opportunities (Amsrud et al., 2019). Fostering an individual’s resilience is exhibited through empathy in building social relationships (Huffman et al., 2020). Van der Merwe et al. (2020) argued that despite experiencing academic stress, healthcare students tend to have higher resilience scores compared to others. Resilience promotes beneficial effects on an individual’s holistic quality of life. Studies showed that students who can regulate their emotions and develop resilience do not experience stress or depression (Merino-Godoy et al., 2022; Van Der Feltz-Cornelis et al., 2020). They acquire good well-being where they can actively adapt and withstand stress, lessen social isolation, and change their perception of their environment (Mai et al., 2021). In addition, they are personally independent, highly competent, and value cooperation and openness in their practice (Labrague, 2021; Miranda & Cruz, 2022).
Quality of life (QoL) is described as the perception of a person’s state, upbringing, morals, and value systems toward any goals and standards (Pequeno et al., 2020). Students’ perceptions of their health, well-being, and environment contributed to their academic performance, resulting in high levels in every domain of QoL (Chattu et al., 2020). Miguel et al. (2021) reported that acquiring a good self-perception about an individual’s physical health highly determines their subjective QoL. Studies found that male students who have high levels of stress and anxiety have a higher risk of low QoL levels (Algahtani et al., 2020). In relation, there is a significantly lower quality of life among junior and senior year level students compared to freshmen, and male students exhibited good psychological well-being compared to females, while females have good social relationships (Biswas et al., 2019).
Ribeiro et al. (2018) stated that any unmanaged stressor that progresses and worsens tends to develop higher depressive symptoms over time, leading to a degradation in the quality of life.
Previous studies emphasized that a significant increase in students’ stress levels leads to low QoL and that resilience is associated with students’ QoL (Cerqueira et al., 2021; Sun et al., 2021).
As stated in Lazarus and Folkman's transactional theory of stress and coping (1984), an individual can adjust to stress leading to positive or negative coping (Hamadi et al., 2021).
King and Rothstein's theory of resilience (2010) suggested that resilience is a coping strategy in which individuals can either be resilient or maladaptive in response to stress (Backmann et al., 2019). These theories rationalize that as an individual experiences stress and exhibit resilience, it affects their quality of life (Wurtz, 2022; Zarei & Fooladyand, 2022). Therefore, the present study aims to provide significant findings about the relationship between stress, resilience, and quality of life. Furthermore, it seeks to determine if stress and resilience are significant predictors of quality of life.
2. Methods
Research Design and Participants
This study utilized a predictive correlational research design. This design aimed to predict the association between the predictor (i.e., stress and resilience) and the criterion variable (i.e., quality of life). Also, we used a non-probability purposive sampling technique that identified the sample population with over 210 healthcare students from selected colleges and universities within Metro Manila, Philippines. Table 1 presented the demographics of the participants.
Table 1: Socio-demographic Profile of the Healthcare Students
Demographic Characteristics Total M (SD) %
Gender Male Female
57 153
27.1 72.9
Age 21.10 (1.28)
Degree/Course Nursing
Medical Technology Dentistry
Pharmacy Physical Therapy Radiological Technology
51 48 34 30 25 22
24.3 22.9 16.2 14.3 11.9 10.5
Research Instruments
Perceived Stress Scale-10 (PSS; Cohen et al., 1983) is a 10-item scale that measures an individual’s stress levels through a 5-point Likert scale (0 = never to 4 = very often). This scale contains statements that cover the degree to which respondents found events in their lives uncontrollable (e.g., “In the last month, how often have you felt that things were going your way?”). Scores are calculated by summing all the values in the respondents’ answers and interpreted accordingly (i.e., 0-13 = low stress, 14-26 = moderate stress, 27-40 = high stress).
This scale was validated locally by Labrauge (2021) on Filipino students with an internal consistency and reliability of 0.90. In this study, PSS-10 demonstrated an acceptable internal consistency and reliability, with Cronbach’s α = 0.78.
Connor-Davidson Resilience Scale-10 (CD-RISC; Connor & Davidson, 2003) is a 10-item scale that measures how well an individual is able to bounce back after a stressful event. It contains statements corresponding to flexibility (e.g., “I am able to adapt when changes occur”), self-efficacy (e.g., “I can deal with whatever comes my way”), ability to regulate emotion (e.g., “I am able to handle unpleasant/painful feelings”), optimism (e.g., “I try to see the humorous side of things when faced with problems”), and cognitive focus (e.g., “I stay focused under pressure”). This utilizes a 5-point Likert scale (0 = not true at all to 4 = true nearly all the time), and total possible scores range from 0 (low resilience) to 40 (high resilience). Scores are interpreted by calculating the sum of all the values in the respondent’s answers. The total scores are then interpreted accordingly, with higher scores indicating higher resilience. Berdida & Grande (2022) validated this scale locally on Filipinos and demonstrated an internal consistency of 0.91. In this study, CD-RISC-10 yielded good internal consistency and reliability, with Cronbach’s α = 0.88.
The Flanagan Quality of Life Scale (QOLS; Burckhardt et al., 1989) is a 16-item scale that measures the respondent’s perception of their current position in life. This scale utilizes a 7- point Likert scale (0 = Terrible to 7 = Delighted) to describe how satisfied the respondent is
are derived by summing all the values in the respondents’ answers. Total scores are then interpreted accordingly, with higher scores equating to higher QOL. The scale was validated locally by Fernandes et. al. (2012) on Filipinos, stating it as a valid instrument for measuring for measuring quality of life among cultures. In this study, QOLS demonstrated internal consistency and reliability, with Cronbach’s α = 0.89.
Data Procedure and Analysis
We obtained approval from Review Ethics Committee of the University. Next, we obtained informed consent from the participants. Afterward, we distributed the Google Form link online and by QR code to the students within Metro Manila with the following sequence of questionnaires: Personal Data Sheet, PSS, CD-RISC, and QOLS.
The Statistical Package for Social Sciences (SPSS ver. 29) was used to analyze the collected data. Multiple Correlation Coefficient was used to determine the relationship between the variables and Multiple Linear Regression used to determine the predictive relationship of stress and resilience towards the quality of life.
3. Results and Discussion
Stress, Resilience, and Quality of Life
Table 2 presents the results of descriptive statistics and multiple correlations between stress, resilience, and quality of life.
Table 2: Descriptive Statistics and Correlations of Stress, Resilience, and Quality of Life
M SD 1 2 3
1 Stress (PSS) 23.60 4.14 -
2 Resilience (CD-RISC) 27.32 5.60 -.30** -
3 Quality of Life (QOLS) 84.55 14.47 -.20** .46** -
n = 202, **p < .01
Results showed a moderate level of stress (M = 23.60, SD = 4.14) and resilience (M = 27.32, SD = 5.60) while an average level of quality of life (M = 84.55, SD = 14.47) was identified among healthcare students. Furthermore, results showed a significant relationship between stress, resilience, and quality of life. Significant negative correlation existed between stress and resilience (r = -.30, p < .01) and stress and quality of life (r = -.20, p < .01) which identified a weak negative association. Significant positive correlation existed between resilience and quality of life (r = .46, p < .01) which identified a moderate positive association.
Predictive Relationship of Stress and Resilience on Quality of Life
Table 3 presents the results of multiple regression analysis that shows the impact of stress and resilience on the quality of life of the healthcare students.
Table 3: Regression Coefficients of Stress and Resilience on Quality of Life
B SE 95% CI β p
LL UL
Stress -.24 .23 -.69 .21 .44 .290
Resilience 1.13 .16 .80 1.46 -.07 < .001
CI = Confidence Interval
The (R2 = .21) revealed that the predictors explained 21% variance in the outcome variable with F (2, 207) = 28.14, p < .001. The findings revealed that resilience positively predicted quality of life (β = .44, p < .001) whereas stress had no significant impact on quality of life (β
= -.07, p > .05).
Discussion
The present study sought to determine if there is a significant relationship between the variables and if stress and resilience can predict the quality of life among healthcare students. Results showed that healthcare students have moderate level of stress and resilience. This finding was supported by previous studies indicating that healthcare students are more stressful than non- healthcare students (Jordan et al., 2020; Leroy et al, 2021). Additionally, a previous study suggested that healthcare students are more resilient than non-healthcare students (Van der Merwe et al., 2020). Furthermore, an average level of quality of life was identified among healthcare students. This finding is in contrast with the previous study indicating that healthcare students have lower level of quality of life (Barrot et al., 2021).
Results showed that stress is negatively correlated with resilience and quality of life. These results implicated that stress negatively impacts healthcare students’ resilience and quality of life, which means that when they were presented with a stressful situation, which resulted in an increased level of perceived stress, there is a possibility that the level of resilience and quality of life decreases. Previous studies supported this finding suggested that stress such as transitioning of learning modality has inflicted on healthcare quality of life, which greatly contributed to their heightened psychological distress and burnout (Jordan et al., 2020; Kumar et al., 2021). These are caused by stressful life events like fear for their health leading to negative perceptions of life, difficulties in concentration and sleep, lowered motivation in life, and low quality of life (Rotas & Cahapay, 2020; Son et al., 2020; Yusoff et al., 2021).
On the other hand, results showed resilience is positively correlated with quality of life, which implicated that resilience positively impacts the healthcare students’ quality of life, which means using resilience as a coping strategy, it indicated that there is a possibility that the level of quality of life increases. Ozden & Atasoy (2020) stated that in education, psychological factors and personal characteristics determine students’ resilience. Resilience is made with empathy by building social relationships and has protective effects on students’ well-being (Huffman et al., 2020). Previous studies have emphasized that students can adapt and withstand stress where there’s a decrease in stress levels and develops a better perception of life and the environment leading to a good quality of life (Labrague, 2021; Mai et al., 2021).
Our study showed that a significant relationship existed between stress, resilience, and quality of life. Therefore, to further determine the predictive relationship of stress and resilience on quality of life, this study used multiple regression analysis. Results found that stress and resilience combined, only resilience can significantly predict the quality of life. Results implicated that resilience has a positive association with quality of life. When students are resilient amidst stressful situations, it maintains or increases their quality of life. Previous studies support this finding, that students’ perceived resilience affects their optimism and perception about their life. Resilience promotes beneficial effects on an individual’s well- being, where those who fostered psychological toughness can develop positive and effective coping, leading to a good quality of life (Haider et al., 2022; Lacomba-Trejo et al., 2022).
Results from the present study showed that stress is not associated in predicting students’
quality of life.
4. Conclusion
In conclusion, stress has a negative relationship with resilience and quality of life, indicating that healthcare students who experience an increased level of stress, have the possibility of being resilient and their quality of life decreases. On the other hand, resilience has a positive relationship with quality of life, indicating that resilience can either increase or decrease quality of life. Furthermore, stress combined with resilience, only resilience significantly predicted the quality of life. This implies that healthcare students who are resilient in times of stressful situations can maintain or increase their quality of life because stress can become insignificant when resilience is involved in association with quality of life.
5. Limitations and Recommendation
The present study provides evidence about the predictive relationship between stress, resilience, and quality of life. However, it is essential to acknowledge its limitations. First, this study is restricted to the perspectives of healthcare students in the Philippines. Secondly, it focuses only on healthcare and not on other academic fields. Lastly, students vary in terms of learning experiences and the school institutions in which they are enrolled.
It is recommended that the results of this study can be used to provide possible intervention programs and awareness of the schools/universities to look after the welfare of their students.
Also, studies highlighted that students’ stress levels are significantly increasing, which results in low quality of life, despite resilience being correlated with quality of life (Miguel et al., 2021; Sun et al., 2021). Moreover, future researchers can further investigate the absence of an association between stress and quality of life in this study and explore resilience as a possible moderator or mediator between the two variables.
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