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Influence of Stress on the Physiological and Psychological Well-Being of Medical Students, As Measured By Heart Rate Variability and the Perceived Stress Scale

Author(s): Mark Miller, Matthew Miller, Samuel Weldon, Nathaniel Cintron, Cade Kelleher, Santiago Lorenzo

Background: It is well documented that stress poses a serious challenge to students’ health in medical school. The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. Heart rate variability (HRV) may provide an objective measure of the physiologic index of stress in medical students. This study investigated the impact of one semester of medical school on HRV and PSS in first-year medical students.

Methods: Forty-eight first-year medical students at the Lake Erie College of Osteopathic Medicine, Bradenton campus were recruited for a prospective observational study from January through December of 2021. HRV analysis via electrocardiogram was performed alongside PSS administration at the beginning, as well as at the end of a medical school semester. Paired t-tests were performed to assess HRV via SDNN, RMSSD, and PSS scores. Pearson Correlation analysis was performed to investigate correlations between HRV indices and PSS results.

Results: By the end of the academic semester, students presented with increased PSS scores compared to the beginning of the academic semester (12.674 ± 0.750 vs 20.587 ± 1.004, P < 0.001). There were also statistically significant decreases in HRV post semester as measured by SDNN (108.16 ± 13.86 vs 56.36 ± 4.07, P < 0.001) as well as RMSSD (127.43 ± 21.71 vs. 61.55 ± 34.92, P < 0.001). Pearson Product Moment Correlation was performed and revealed a statistically significant inverse relationship between percent changes in PSS compared to percent changes in SDNN (R-value -0.334, P = 0.0287) as well as percent changes in RMSSD (R-value -0.369, P = 0.0149).

Conclusion: These results demonstrate that first-year medical students are experiencing significant levels of stress after an entire academic semester. This study demonstrates that HRV may provide a reliable way to assess a student's level of stress that is objective and does not rely on subjective measures such as the PSS questionnaire. This study highlights the importance for medical schools to improve their student wellness initiatives and mental health monitoring.

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