Stressors Predicting Depression, Anxiety, and Stress in Korean Veterinary Students
Publication: Journal of Veterinary Medical Education
Volume 48, Number 4
Abstract
Psychological distress has a negative impact on professional development in health care professions. In this article, we measured the prevalence of students’ depression, anxiety, and stress using the DASS-21 questionnaire in 10 veterinary colleges in Korea to investigate the stressors that contribute to these forms of psychological distress. The prevalence of academic and relationship types of stressors were higher than others. The proportion of students above a severe level of depression, anxiety, and stress on the DASS-21 scales was 30.9, 35.8, and 43.2%, respectively. The DASS-21 scores mediated the relationship between the perceived frequency of stressors and the respondents’ satisfaction with their education and career. Statistical analysis revealed that female and pre-clinical students are more vulnerable to depression, anxiety, and stress. The findings of the article indicate the gravity of Korean veterinary students’ mental and psychological state, emphasizing the importance of comprehensive management of students’ mental health.
Introduction
Distress is perceived to be an unavoidable factor in medical education and has a negative impact on effective learning.1 A diversity of factors among veterinary students have been reported to cause clinical levels of psychological distress, such as anxiety and depression.2–6 In particular, students during educational transitions (from a 2-year pre-vet program to the first year of veterinary school) and female students experience higher levels of stress than their peers.3,5,7 The main identified stressors are academic factors such as excessive workload and concerns over academic performance, and non-academic factors such as debt, personal relationships, and a competitive atmosphere.3,5,8,9 In contrast, some previous studies reported that veterinary students’ stress is moderate and bearable or not necessarily bad;2,10,11 moreover, it has been found that exposure to stress during professional training may help students cope with stress in their veterinary practices.11 However, the weight of evidence shows veterinary medical students are overwhelmed by a heavy workload, worried about passing exams,8 sacrificing their private lives to devote more time to school,9 and not having enough time for self-reflection.12
The quality of life of medical students in Korea has been reported to be lower than that of other college students in terms of social relationships because they do not have enough time to sleep and relax, and lack opportunities for recreation or leisure.13 They are known to use fewer coping strategies than students in law, the sciences, and the humanities.14 Although there are no studies giving evidence that directly supports this, Korean veterinary students supposedly experience high levels of stress at university as well. They are exposed to a competitive learning environment similar to that of medical students, and furthermore, there may also be factors related to moral stress from using animals in their labs and subsequent ethical dilemmas in their studies. Because of this highly demanding learning environment, it should be a priority for veterinary educators to identify significant stressors and help students develop their own coping strategies.2,15–17
To improve veterinary students’ quality of life, the severity of their psychological distress and the stressors that cause it need to be analyzed and monitored. The aims of this study were to measure the prevalence of students’ depression, anxiety, and stress in 10 veterinary colleges in Korea, to investigate the main stressors, and their influence on the students’ psychological distress.
Methods
Questionnaire on Stress
Based on previous research on veterinary students’ stressors2,5,17 and a stress inventory for medical students in Korea,18 23 question items on a 4-point scale (“never,” “rarely,” “often,” and “almost always”) were divided into five types: academic; practice (lab and clinical practice); relational; career; and environmental (Cronbach’s α ranging from 0.722 to 0.805). The respondents also answered questions on their gender, class (pre-veterinary, pre-clinical, or clinical), university, and satisfaction with their career choice, current education, and potential future career.
DASS-21
The depression, anxiety, and stress scale (DASS) is used as a tool to assess common psychiatric disorders in a wide range of research and clinical settings.19,20 In this study, the Korean version of the DASS-21, available on the DASS website (www.psy.unsw.edu.au/dass), was used. We reviewed the translations of the questions and revised the Korean expressions without altering the intention of the original questions. The DASS is a self-reporting tool for assessing depression, anxiety, and stress, containing a total of 21 items on a 4-point scale ranging from 0 (“Did not apply to me at all”) to 3 (“Applied to me very much or most of the time”).20 The respondents’ scores for depression, anxiety, and stress were calculated by adding up the scores for the items in each group. Internal consistency of the questions was tested (Cronbach’s α of questions on depression, anxiety and stress were 0.888, 0.856, and 0.883). According to the recommended cutoff reference, the severity labels for the forms of psychological distress were indicated as “normal,” “mild,” “moderately severe,” and “extremely severe.”21
Data Collection and Statistical Analysis
After the survey obtained ethical approval from the university’s Institutional Review Board (E1804/003-001), the questionnaires were distributed through mobile messaging to approximately 3,300 students at 10 Korean veterinary colleges from April 16 to May 6, 2018, with the help of the Korean Veterinary Medical Student Association. Korean veterinary colleges make comprehensive consideration based on candidates’ academic/non-academic performance in high school and Korean College Scholastic Ability Test score for admission. The typical applicants are high school graduates in their early twenties. Korean veterinary colleges offer a 6-year academic program consisting of a 2-year pre-veterinary and 4-year veterinary program (which comprises a 2-year pre-clinical and 2-year clinical program, including rotations). Each college has about a hundred pre-veterinary and two hundred veterinary students. After a 2-year pre-veterinary curriculum of liberal studies and basic biomedical sciences, students begin the pre-clinical and clinical curriculum. The ratio of female to male students in Korea is close to 1:1.
Of the 1,071 responses (response rate 32.5%), 1,063 completed questionnaires were analyzed. Using t-test and ANOVA, we compared DASS-21 scores among respondents grouped by gender which were significant independent determinants of stress levels in previous studies2,9 and the classes which can influence academic load. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis22 was applied to select influential stressors on the respondents’ DASS depression, anxiety, and stress scores. To analyze the mediation effect of DASS scores between the frequency of stressors and satisfaction with career choice, current education, and potential future career we used SPSS process macro (http://processmacro.org). The Statistical Package for the Social Sciences (SPSS) 23.0 and Stata 16 (StataCorp LLC, College Station, TX, USA) were used in the statistical analysis of the data.
Results
In this study 52% of the respondents were male and the remaining 48% female. A total of 214 pre-veterinary (male, 104; female, 110), 503 pre-clinical (male, 251; female, 252), and 346 clinical students (male, 197; female, 149) answered the questionnaire.
Stressors
A high proportion of the respondents indicated they experienced academic type stressors. Over 80% of the veterinary students in this survey stated that they often or almost always suffer due to a heavy workload and frequent exams. Over 50% of the respondents were stressed due to fear of failing exams and too many lectures. Almost half of the students were concerned about getting low grade despite studying. Two thirds of them also had difficulties acquiring career-related information and choosing a future career path. About 50% of the responding students have little time to consider a future career and are concerned about their level of competency for their future career. Half of the students often or almost always faced stress due to relationships, for example, at the loss of a friendship outside of class or having difficulty in saying “no” to classmates. The students were also concerned over their future relationships, hierarchical relationships with professors, and difficulty in finding someone to talk to about their problems. A relatively smaller proportion of the respondents reported stress caused by their laboratory and clinical practices (fear of animal experiments or clinical practice, difficulty in understanding and performing clinical practice) and their environment (high debt, too many expectations from family) (Table 1).
| Type | Stressors | Never + Rarely | Often + Almost always | ||
|---|---|---|---|---|---|
| N | % | N | % | ||
| Academic | Heavy workload | 115 | 10.8% | 948 | 89.2% |
| Frequent exams | 191 | 18.0% | 872 | 82.0% | |
| Fear of failing exams | 328 | 30.9% | 735 | 69.1% | |
| Concern about low grade despite studying | 541 | 50.9% | 522 | 49.1% | |
| Too many lectures | 365 | 34.3% | 698 | 65.7% | |
| Practice | Fear of animal experiments | 765 | 72.0% | 298 | 28.0% |
| Difficulty in understanding and performing practice | 675 | 63.5% | 388 | 36.5% | |
| Perception of gap between theory and practice | 420 | 39.5% | 643 | 60.5% | |
| Fear of clinical practice | 731 | 68.8% | 332 | 31.2% | |
| Fear of harming animals during clinical practice | 340 | 32.0% | 723 | 68.0% | |
| Relationship | Loss of friendships outside of class | 485 | 45.6% | 578 | 54.4% |
| Difficulty in saying “no” to classmates and seniors concerning future relationships | 444 | 41.8% | 619 | 58.2% | |
| Hierarchical relationship with professors and seniors | 492 | 46.3% | 571 | 53.7% | |
| Ruined relationship due to competition in the college | 712 | 67.0% | 351 | 33.0% | |
| Difficulty in finding a person to talk to about problems | 523 | 49.2% | 540 | 50.8% | |
| Difficulty in communication | 710 | 66.8% | 353 | 33.2% | |
| Career | Difficulty in choosing a career path | 327 | 30.8% | 736 | 69.2% |
| Little time to think about career paths | 528 | 49.7% | 535 | 50.3% | |
| Little information on career paths | 248 | 23.3% | 815 | 76.7% | |
| Concern about failing to establish a career due to a lack of competence | 572 | 53.8% | 491 | 46.2% | |
| Environmental | Economic burden to family | 385 | 36.2% | 678 | 63.8% |
| High debt | 796 | 74.9% | 267 | 25.1% | |
| Too many expectations from family | 592 | 55.7% | 471 | 44.3% | |
Depression, Anxiety, and Stress
The DASS scores were different among gender and class groups (see Table 2). The mean DASS depression score was significantly higher in female students (mean = 8.96, 95% CI = 8.50–9.43) than in male students with (mean = 7.35, 95% CI = 6.91–7.79) (p < .001, t = −4.956, Cohen’s d = 0.303). A total of 30.9% of the respondents fell into the severe and very severe depression group (male 24.5%, female 37.8%; pre-vet 22.0%, pre-clinical 32.8%, clinical 33.5%). An ANOVA on the DASS depression yielded significant variation among class types (p < .001, F = 12.808, partial eta-square = 0.024). A post hoc Tukey HSD test showed that pre-clinical (mean = 8.63, 95% CI = 8.16–9.09, p < .001) and clinical students (mean = 8.40, 95% CI = 7.82–8.98, p < .001) experienced a higher level of depression than the pre-veterinary students (mean = 6.50, 95% CI = 5.83–7.16). There was no difference in DASS depression between the pre-clinical and clinical students (p = .81).
| Group | N | DASS Depression | DASS Anxiety | DASS Stress | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| M (SD) | Effect size* | p | M (SD) | Effect size | p | M (SD) | Effect size | p | |||
| Gender | Male | 552 | 7.35 (5.28) | 0.303 | < .001 | 5.87 (4.94) | 0.191 | < .01 | 10.43 (5.45) | 0.340 | < .001 |
| Female | 511 | 8.96 (5.34) | 6.82 (5.02) | 12.36 (5.28) | |||||||
| Class | Pre-vet | 214 | 6.50 (4.96) | 0.024 | < .001 | 4.77 (4.28) | 0.026 | < .001 | 8.60 (5.30) | 0.07 | < .001 |
| Pre-clinic | 503 | 8.63 (5.31) | 6.87 (4.98) | 12.41 (5.13) | |||||||
| Clinic | 346 | 8.40 (5.53) | 6.51 (5.25) | 11.55 (5.45) | |||||||
*
* Effect size between gender: Cohen’s d; among class types: partial eta-square
DASS anxiety levels also differed according to gender (p = .002, t = −3.103, Cohen’s d = 0.191) and class type (p < .001, F = 13.968, partial eta-square = 0.026). The mean DASS anxiety score for female students was 6.82 (95% CI = 6.39–7.26), while that for male students was 5.87 (95% CI = 5.46–6.29). A total of 35.8% of respondents were above the cutoff level for DASS anxiety (male 32.6%, female 39.3%; pre-vet 22.4%, pre-clinical 41.2%, clinical 36.4%). A post hoc comparison using Turkey HSD test indicated that pre-clinical (mean = 6.87, 95% CI = 6.44–7.31, p < .001) and clinical students (mean = 6.51, 95% CI = 5.95–7.06, p < .001) had a higher DASS anxiety index than the pre-vet students (mean = 4.77, 95% CI = 4.19–5.34). A difference in DASS anxiety between the pre-clinical and clinical students was not significant (p = .537).
The female students experienced a higher level of stress on the DASS scales than male students (p < .001, t = −5.860, Cohen’s d = 0.340). The mean DASS stress score was 12.364 (95% CI = 11.91–12.82) for female students and 10.433 (95% CI = 9.98–10.89) for male students. A total of 43.2% of the respondents fell into the severe and very severe DASS stress group (male 36.2%, female 50.6%; pre-vet 22.9%, pre-clinical 51.0%, clinical 44.2%). DASS stress levels were different among class types (p < .001, F = 39.643, partial eta-square = 0.07). A host hoc Turkey HSD test reveal that pre-clinical (mean = 12.41, 95% CI = 11.96–12.86, p < .001) and clinical students (mean = 11.55, 95% CI = 10.98–12.12, p < .001) had higher stress on the DASS scales than pre-vet students (mean = 8.60, 95% CI = 7.88–9.31). There was no significant difference in DASS stress between pre-clinical and clinical students (p = .052).
In this survey, there were significant differences in the DASS-21 scores between the 10 veterinary schools in Korea. However, it would be difficult to identify the causes because the schools have different academic policies. The relationship between the perceived frequency of stressors (sum of 23 items on a 4-point Likert scale), and the respondents’ satisfaction with their education and career (sum of 3 items on a 4-point Likert scale) was mediated by the depression, anxiety and stress on the DASS scales, which was determined using the SPSS PROCESS macro (Figure 1).
Figure 1: Simple mediation of DASS scales (depression, anxiety, and stress) on relationship between stressor frequency and satisfaction
a: effect of stressor frequency on mediator
b: effect of mediator on satisfaction
c’: direct effect of stressor frequency on satisfaction
Increased DASS depression (b = −0.0703, p < .001), anxiety (b = −0.0385, p < .01) and stress (b = −0.0341, p < .01) significantly accounted for students’ lower satisfaction in education and career. The perceived frequency of stressors was indirectly related to respondents’ satisfaction with their education and career through the depression, anxiety, and stress on the DASS scales (Table 3).
| Mediator | Direct effects coefficients | Indirect effect | Bootstrap indirect effect 95% CI* | |||
|---|---|---|---|---|---|---|
| a1 | b2 | c’3 | ab4 | Low limit | Upper limit | |
| DASS Depression | 0.3106‡ [alt + 0135] | −0.0703‡ [alt + 0135] | −0.0531‡ [alt + 0135] | −0.0218 | −0.0304 | −0.0134 |
| DASS Anxiety | 0.2583‡ [alt + 0135] | −0.0385† [alt + 0134] | −0.0650‡ [alt + 0135] | −0.0099 | −0.0171 | −0.0026 |
| DASS Stress | 0.3012‡ [alt + 0135] | −0.0341† [alt + 0134] | −0.0647‡ [alt + 0135] | −0.0103 | −0.0174 | −0.0026 |
1
a: effect of stressor frequency on mediator
2
b: effect of mediator on satisfaction
3
c’: direct effect of stressor frequency on satisfaction
4
ab: indirect effect
*
* Number of bootstrap samples for 95% CI = 5,000
†
† p <.01 ‡ p <.001
Stress Factors Predicting DASS Depression, Anxiety, and Stress
We assessed models for predicting DASS depression, anxiety, and stress scores using LASSO regression analysis to select the powerful stressors by dropping weak predictors. LASSO can produce coefficients that are zero with the penalty function and select highly correlated variances in the regression model.22 All 23 stress factors, and gender and class type (as dummy variables) were included in the models. The estimated standardized LASSO coefficients of the predictors are presented in Table 4.
| Stressor Variables | DASS Depression | DASS Anxiety | DASS Stress |
|---|---|---|---|
| B* | |||
| Gender (Female) | 0.440 | 0.231 | 0.510 |
| Class (Pre-vet) | – | − 0.287 | − 0.433 |
| Class (Pre-Clinical) | – | 0.027 | 0.295 |
| Heavy workload | 0.337 | 0.387 | 0.651 |
| Frequent exams | – | 0.135 | 0.327 |
| Fear of failing exams | 0.350 | 0.301 | – |
| Concern about low grade despite studying | 0.555 | 0.390 | 0.101 |
| Too many lectures | 0.046 | 0.124 | 0.243 |
| Fear of animal experiments | – | 0.068 | – |
| Difficulty in understanding and performing practice | 0.106 | 0.059 | – |
| Perception of gap between theory and practice | – | – | 0.051 |
| Fear of clinical practice | 0.068 | 0.296 | 0.177 |
| Fear of harming animals during clinical practice | − 0.172 | − 0.131 | 0.110 |
| Loss of friendships outside of class | 0.063 | 0.055 | 0.345 |
| Difficulty in saying “no” to classmates and seniors concerning future relationships | – | 0.199 | 0.230 |
| Hierarchical relationship with professors and seniors | 0.040 | – | 0.042 |
| Ruined relationship due to competition in the college | 0.455 | 0.569 | 0.724 |
| Difficulty in finding a person to talk to about problems | 0.751 | 0.452 | 0.570 |
| Difficulty in communication | 0.892 | 0.572 | 0.170 |
| Difficulty in choosing a career path | – | − 0.082 | – |
| Little time to think about career paths | 0.264 | 0.679 | 0.538 |
| Little information on career paths | – | − 0.360 | 0.083 |
| Concern about failing to establish a career due to a lack of competence | 0.889 | 0.221 | 0.095 |
| Economic burden to family | – | − 0.128 | 0.268 |
| High debt | 0.139 | 0.410 | – |
| Too many expectations from family | 0.750 | 0.551 | 0.578 |
LASSO = Least Absolute Shrinkage and Selection Operator
*
* B = standardized regression coefficients
LASSO regression for DASS depression yielded 17 non-zero predictors. Female veterinary students are more likely to have higher depression than male (B = 0.440). Four academic type stressors (concern about low grades despite studying, fear of failing exams, heavy workload, and too many lectures); three practice type stressors (fear of harming animals during clinical practice, difficulty in understanding and performing practice, fear of clinical practice); five relationship type stressors (difficulty in communication, difficulty in finding a person to talk to about problems, ruined relationships due to competition at college, loss of friendships outside of class, and hierarchical relationship with professors and seniors); two career type stressors (concern about failing to establish a future career due to lack of competence and little time to think about future career); and, two environmental type stressors (too many expectations from family and high debt) were significant predictors of depression.
Except for the 2 zero predictors (perception of gap between theory and practice and little information on future career), a total of 24 variables were significant for DASS anxiety. Female (B = 0.231) and pre-clinical students (B = 0.027) are likely to have higher anxiety than other groups. Pre-vet students are expected to have less anxiety than others.
For the DASS stress, gender and class (pre-vet, pre-clinical) are selected predictors as shown in DASS anxiety. The 5 zero predictors are fear of failing exams, fear of animal experiments, difficulty in understanding and performing practice, difficulty in choosing a future career, and high debt.
Discussion
While stress may be a common feature of professional education, it increases the risk of poor mental health in students.23 The results of this study suggest that Korean veterinary students suffer serious psychological distress. There is an urgent need for further studies to monitor the mental and physical health of veterinary students and to find ways to support students in coping with their stress. In our study, 43.2% of the respondents experienced stress on the DASS scales at a severe or very severe level. The prevalence of depression and anxiety at the severe level was 30.9% and 35.8%, respectively, which is similar to results of first-year veterinary students in the USA.6 Compared to the DASS-21 mean scores of the population norm,24,25 the DASS-21 scores for depression, anxiety, and stress measured in this study were higher.
Our results show that the female students are more likely to self-report psychological distress. A gender difference in perceived stress, depression, and anxiety has been reported in previous studies on veterinary students2,9,26 and in other health education settings.27,28 This difference has been explained by female students’ higher self-expectations in performance and success,28 different coping strategies,29 and different responses to stressors from a psychological and biological perspective.30 The higher prevalence of psychological distress in female students should be carefully discussed because of confounding factors such as personality, sociability,27 learning strategy,32 and sociocultural factors.33 However, the statistics have shown that female students and veterinarians more often experience severe psychological problems.34 Therefore, interventions considering different perceptions and coping strategies for female students need to be developed.
In the Korean veterinary education system, pre-clinical students have the most stressful time. The proportion of pre-clinical students who reported experiencing stress on the DASS scales at the severe and very severe level was 51%. Moreover, the prevalence of depression and anxiety among the clinical students was the highest at 33.6% and 36.4%, respectively. The sudden workload increase in the first year of the pre-clinical course can be a significant burden for students. In that year, students start learning anatomy, histology, embryology, physiology, biochemistry, pharmacology, and neurology along with lab work. To better manage the workload in the first year of the pre-clinical course, some veterinary colleges in Korea have reformed the pre-vet and pre-clinical curriculum. In the modified curriculum, pre-veterinary students learn anatomy, biochemistry, and microbiology, leaving them more time for elective courses or self-directed learning in the pre-clinical years.
The stressors of Korean veterinary students influenced their mental health differently. Academic type stressors such as heavy workload, fear of failing exams, and concern about low grades are universal stressors in veterinary study. Students need to build their own strategies for self-directed learning and to learn time management. Generally, universities provide students with training for self-directed learning trough specific organizations (for example, the Center for Teaching and Learning of Seoul National University). Veterinary colleges can develop those training programs for students with the help of universities. The findings in our study indicate that relationship type stressors such as difficulties in relationships and not having friends to talk to in a competitive environment, greatly contribute to depression, anxiety, and stress. Well-functioning relationships are known to lower depressive symptoms and improve ability to cope with academic expectations.35
Besides academic and relationship type stressors, an uncertain future career, high debt, and too many expectations from family are predictors of anxiety on the DASS scales. Veterinary students typically come from high-performing groups in high schools,36 where poor performance may not be tolerated in the kind of competitive and structured studies in Korea. Since the economic crisis in 1997, career and financial plans have been the top personal stressors for Korean students.37 Job-seeking stress has also been reported to negatively influence career maturity.38 Students are eager to gather career information and to reduce their career uncertainty, but there is a lack of self-reflection and tolerance toward uncertainty. In this study, the career type stressors (difficulty in choosing a future career path and little information on future career path) negatively influenced anxiety, which means that a quantity of career information would not lower their anxiety. Therefore, professional development programs in veterinary colleges may be a good way to reduce their anxiety and to prepare them for an uncertain future.23 In such programs, they could learn to analyze future challenges in their profession and to recognize their own needs in career development. Using a self-directed learning support system, such as an e-portfolio, students could focus on the process of learning and being a professional.39
In this study, too many expectations from family was a higher ranked significant predictor of depression (B = 0.750), anxiety (B = 0.551), and stress (B = 0.578) on the DASS scales. Korean students are known to have stable ties with their families and friends.40,41 However, they also have a great need for belonging and support as well as a higher sensitivity to social rejection.42 Veterinary students’ strong family ties causes high expectations, which may be experienced as pressure. They may think that they will be rejected by their disappointed family if they do not perform as well as expected in their professional education. Korean veterinary students start their professional education right after graduating high school, therefore, they experience a personal transition during their time in college. A college counseling service may be required for students in such transitional crises. To increase access to mental health support, some veterinary colleges provide on-site counseling services that have been successful.23,43 However, further efforts to eliminate the barrier to counseling services are needed.
Despite previous studies that bearable stress would not necessarily harm veterinary students and help them cope with stress,10,11 stressors can negatively impact students’ mental health and potential career satisfaction. Generally, stress has a negative impact on professional development in health care professions.31,44,45 Moreover, there has been concern that a stressful academic culture and environment appear to have a negative impact on the professionalism and resilience of veterinary professionals.2 In this regard, our results are in line with previous studies, as mediation effects of the DASS-21 scores was observed between perceived frequency of the stressors and students’ satisfaction with their education and career.
Conclusion
As the first survey of veterinary students’ stressors and their impact on the students’ mental health in Korea, this study showed a relatively high prevalence of depression, anxiety, and stress on the DASS scale among Korean veterinary students. Academic and relationship type stressors were mainly predictive of psychological distress, while career and environmental type stressors correlated differently to students’ depression, anxiety, and stress. Veterinary colleges have treated students’ stress management as a personal issue; however, improving the veterinary curriculum and teaching tools can systematically reduce such stress. Further studies on veterinary students’ stress in light of the impact of subtle sociocultural factors, at a personal level and at college level, are needed to overcome the inherent limitations of self-reported data and to provide deeper insights into student-centered curricular reform.
Acknowledgments
This work was supported by the Research Resettlement Fund for the new faculty of Seoul National University. The authors thank the Korean Veterinary Medical Student Association for help in collecting survey responses.
References
1 Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ 39(6):594–604, 2005. https://doi.org/10.1111/j.1365-2929.2005.02176.x. Medline: 15910436.
2 Strand EB, Zaparanick TL, Brace JJ. Quality of life and stress factors for veterinary medical students. J Vet Med Edu 32(2);182–192, 2005. https://doi.org/10.3138/jvme.32.2.182. Medline: 16078170.
3 Reisbig AM, Danielson JA, Wu T-F, Hafen Jr M, Krienert A, Girard D, Garlock J. A study of depression and anxiety, general health, and academic performance in three cohorts of veterinary medical students across the first three semesters of veterinary school. J Vet Med Edu 39(4):341–358, 2012. https://doi.org/10.3138/jvme.0712-065R. Medline: 23187027.
4 Siqueira Drake AA, Hafen Jr M, Rush BR, Reisbig AM. Predictors of anxiety and depression in veterinary medicine students: a four-year cohort examination. J Vet Med Edu 39(4):322–330, 2012. https://doi.org/10.3138/jvme.0112-006R. Medline: 23187025.
5 Hafen Jr M, Reisbig AM, White MB, Rush BR. Predictors of depression and anxiety in first-year veterinary students: a preliminary report. J Vet Med Edu 33(3):432–440, 2006. https://doi.org/10.3138/jvme.33.3.432. Medline: 17035221.
6 Hafen Jr M, Reisbig AM, White MB, Rush BR. The first-year veterinary student and mental health: the role of common stressors. J Vet Med Edu 35(1):102–109, 2008. https://doi.org/10.3138/jvme.35.1.102. Medline: 18339964.
7 Chigerwe M, Boudreaux KA, Ilkiw JE. Assessment of burnout in veterinary medical students using the Maslach Burnout Inventory-Educational Survey: a survey during two semesters. BMC Med Educ 14(1):255, 2014. https://doi.org/10.1186/s12909-014-0255-4. Medline: 25429983.
8 Collins H, Foote D. Managing stress in veterinary students. J Vet Med Educ 32(2):170–172, 2005. https://doi.org/10.3138/jvme.32.2.170. Medline: 16078168.
9 Kogan LR, McConnell SL, Schoenfeld-Tacher R. Veterinary students and non-academic stressors. J Vet Med Educ 32(2):193–200, 2005. https://doi.org/10.3138/jvme.32.2.193. Medline: 16078171.
10 Powers DE. Student perceptions of the first year of veterinary medical school. J Vet Med Edu 29(4):227–230, 2002. https://doi.org/10.3138/jvme.29.4.227. Medline: 12717641.
11 McLennan MW, Sutton RH. Stress in veterinary science students: a study at the University of Queensland. J Vet Med Edu 32(2):213–218, 2005. https://doi.org/10.3138/jvme.32.2.213. Medline: 16078173.
12 Rex M. Veterinary education in the world—changing attitudes. Aust Vet J 70(10):369–372, 1993. https://doi.org/10.1111/j.1751-0813.1993.tb00810.x. Medline: 8257314.
13 Min SK, Shin WC, Kim KI, Chung JI, Kim DK. Comparison of Quality of Life between Medical Students and General College Students. J Korean Neuropsychiatr Assoc 39(6):1054–60, 2000.
14 Kwak DI, Choi YK, Lim HJ, Oh HJ, Jung IK, Lee MS. A Study On The Stress, Copying and General well-being of Medical Students. Korean J Med Educ 12(2):227–239, 2000. https://doi.org/10.3946/kjme.2000.12.2.227.
15 Gregory K, Matthew S, Baguley J. Analysis of the costs of veterinary education and factors associated with financial stress among veterinary students in Australia. Aust Vet J 96(1-2):11–6, 2018. https://doi.org/10.1111/avj.12655. Medline: 29231249.
16 Weston JF, Gardner D, Yeung P. Stressors and protective factors among veterinary students in New Zealand. J Vet Med Edu 44(1):22–8, 2017. https://doi.org/10.3138/jvme.0116-014R1. Medline: 28206841.
17 Williams SM, Arnold PK, Mills JN. Coping with stress: a survey of Murdoch University veterinary students. J Vet Med Edu 32(2):201–12, 2005. https://doi.org/10.1080/10615800420004184.
18 Kim MJ, Park KH, Yoo HH, Park IB, Yim J. Development and validation of the medical student stress scale in Korea. Korean J Med Educ 26(3):197–208, 2014. https://doi.org/10.3946/kjme.2014.26.3.197. Medline: 25805262.
19 Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 44(2):227–39, 2005. https://doi.org/10.1348/014466505X29657. Medline: 16004657.
20 Sinclair SJ, Siefert CJ, Slavin-Mulford JM, Stein MB, Renna M, Blais MA. Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of U.S. adults. Eval Health Prof 35(3):259–79, 2012. https://doi.org/10.1177/0163278711424282. Medline: 22008979.
21 Oei TP, Sawang S, Goh YW, Mukhtar F. Using the depression anxiety stress scale 21 (DASS-21) across cultures. Int J Psychol 48(6):1018–29, 2013. https://doi.org/10.1080/00207594.2012.755535. Medline: 23425257.
22 Tibshirani R. Regression shrinkage and selection via the lasso. J Royal Stat Soc: Series B (Methodological) 58(1):267–88, 1996. https://doi.org/10.1111/j.2517-6161.1996.tb02080.x.
23 Hafen MJ, Siqueira-Drake A, Rush BR. Student Support and Wellness. In Hodgson JL, Pelzer JM, eds. Veterinary Medical Education: A Practical Guide. Hoboken, IN: John Wiley & Sons, 2017:540–557.
24 Ronk FR, Korman JR, Hooke GR, Page AC. Assessing clinical significance of treatment outcomes using the DASS-21. Psychol Assess 25(4):1103, 2013. https://doi.org/10.1037/a0033100. Medline: 23730826.
25 Mitchell M, Burns N, Dorstyn D. Screening for depression and anxiety in spinal cord injury with DASS-21. Spinal Cord 46(8):547, 2008. https://doi.org/10.1038/sj.sc.3102154. Medline: 18071354.
26 Killinger SL, Flanagan S, Castine E, Howard KA. Stress and depression among veterinary medical students. J Vet Med Edu 44(1):3–8, 2017. https://doi.org/10.3138/jvme.0116-018R1. Medline: 28206849.
27 Park Y. Gender Differences of Perceived Stress Type, Stress Response and Personality Characteristics of Lim's Character Style Inventory and Vulnerability of Personality in College Students. J Korean Acad Soc Nurs Educ 20(1):118–28, 2014. https://doi.org/10.5977/jkasne.2014.20.1.118.
28 Kogan LR, McConnell SL, Schoenfeld-Tacher R. Gender differences and the definition of success: male and female veterinary students’ career and work performance expectations. J Vet Med Edu 31(2):154–60, 2004. https://doi.org/10.3138/jvme.31.2.154. Medline: 15181598.
29 Brougham RR, Zail CM, Mendoza CM, Miller JR. Stress, sex differences, and coping strategies among college students. Curr Psychol 28(2):85–97, 2009. https://doi.org/10.1007/s12144-009-9047-0.
30 Verma R, Balhara YPS, Gupta CS. Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J 20(1):4, 2011. https://doi.org/10.4103/0972-6748.98407. Medline: 22969173.
31 Park H-J, Oh JW. The relationships of the clinical practice stress and the major satisfaction with the nursing professionalism of nursing college students. J Digit Converg 12(12):417–26, 2014. https://doi.org/10.14400/JDC.2014.12.12.417.
32 Laakkonen J, Nevgi A. Relationships between learning strategies, stress, and study success among first-year veterinary students during an educational transition phase. J Vet Med Edu 41(3):284–93, 2014. https://doi.org/10.3138/jvme.0214-016R1. Medline: 24981421.
33 Oh E, Blondin C, Cochran J, Williams R. Perceived stressors among college students in an American and a Korean university. Korean Soc Sci J 38(2):81–113, 2011. http://www.kossrec.org/wp-content/uploads/2015/04/04_KSSJ_11-01-03.pdf
34 Kim RW, Patterson G, Nahar VK, Sharma M. Toward an evidence-based approach to stress management for veterinarians and veterinary students. J Am Vet Med Assoc 251(9):1002–4, 2017. https://doi.org/10.2460/javma.251.9.1002. Medline: 29035658.
35 Hafen Jr M, Ratcliffe GC, Rush BR. Veterinary medical student well-being: depression, stress, and personal relationships. J Vet Med Edu 40(3):296–302, 2013. https://doi.org/10.3138/jvme.1112-101R. Medline: 23975073
36 Zenner D, Burns GA, Ruby KL, DeBowes RM, Stoll SK. Veterinary students as elite performers: preliminary insights. J Vet Med Edu 32(2):242–8, 2005. https://doi.org/10.3138/jvme.32.2.242. Medline: 16078178.
37 Lee DH, Kang S, Yum S. A Qualitative Assessment of Personal and Academic Stressors among Korean College Students: An Exploratory Study. Coll Stud J 39(3):442–449, 2005.
38 Kim E, Choi K. The Effects of the Depression and Job-Seeking Stress on the Career Maturity of University students. J Korean Liv Environ Sys 19(2):231–9, 2012. https://doi.org/10.6115/fer.2016.016.
39 Joyes G, Gray L, Hartnell-Young E. Effective practice with e-portfolios: How can the UK experience inform implementation? Australas J Educ Technol 26(1):15–27, 2010. https://doi.org/10.14742/ajet.1099.
40 Hofstede G, Bond MH. The Confucius connection: From cultural roots to economic growth. Organ Dyn 16(4):5–21, 1988. https://doi.org/10.1016/0090-2616(88)90009-5.
41 Kim O-S, Geistfeld LV. A comparative study of personal time perspective differences between Korean and American college students. J Stud Int Educ 11(2):227–38, 2007. https://doi.org/10.1177/1028315307299416.
42 Yamaguchi S, Kuhlman DM, Sugimori S. Personality correlates of allocentric tendencies in individualist and collectivist cultures. J Cross Cult Psychol 26(6):658–72, 1995. https://doi.org/10.1177/002202219502600609.
43 Pickles K, Rhind S, Miller R, Jackson S, Allister R, Philp J, et al. Potential barriers to veterinary student access to counselling and other support systems: perceptions of staff and students at a UK veterinary school. The Vet Rec 170(5):124, 2012. https://doi.org/10.1136/vr.100179. Medline: 22186377.
44 Mareiniss DP. Decreasing GME training stress to foster residents’ professionalism. Acad Med 79(9):825–831, 2004. https://doi.org/10.1097/00001888-200409000-00003. Medline: 15326004.
45 Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med 136(5):384–390, 2002. https://doi.org/10.7326/0003-4819-136-5-200203050-00011. Medline: 11874311.
Information & Authors
Information
Published In
Journal of Veterinary Medical Education
Volume 48 • Number 4 • August 2021
Pages: 470 - 476
PubMed: 32730171
Copyright
2021 AAVMC.
History
Published ahead of print: 29 July 2020
Published in print: August 2021
Published online: 2 August 2021
Key Words:
Authors
Metrics & Citations
Metrics
Related Content
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
Download article citation data for:
Journal of Veterinary Medical Education 2021 48:4, 470-476
Journal of Veterinary Medical Education 2021 48:4, 470-476