Evaluation of mood,stress levels and sense of coherence in future physiotherapists

1 Introduction

The job of a physiotherapist has today become a profession of public trust, associated with increased pressure and stress levels during work [1]. Despite this, there is no decline in the popularity of physiotherapy as a field of study. The relationship between study and the mental well-being of students of various faculties is multidirectional in nature. It can serve as a protective factor (delaying the entrance into ‘adultlife ’) or it can be associated with stress and tension due to increased intellectual and emotional involvement [2].

Researchers suggest that physiotherapists are highly exposed to both the physical strains –such as long-lasting dynamic effort, high repetitiveness of movements, static loads, lifting and changing the position of disabled patients, work in involuntary, unnatural positions and the mental strains, such as contact with the suffering of another person, close contact with patients’ problems, work exceeding one’s capacity, time pressure, lack of support from society, lack of emotional support, a sense of loneliness, lack of understanding, inability to meet patients’ expectations regarding their full recovery in terms of health and physical capacity, and no feedback on the effectiveness of the therapy [3–6]. This is associated with an increased risk of mood disorders.

According to research, the average age of people exhibiting the first symptoms of depression is between 20 and 30 years [7, 8]. This applies to individuals completing higher education, especially in the medical professions [9]. This is confirmed by other reports, which indicate a large and systematically growing group of Polish students with symptoms of depression [8, 11].

It is difficult to expect empathy and willingness to help others in difficult life situations, from someone struggling with their own emotional problems [12]. A person who is themselves suffering, somewhat safeguards against the suffering of others through for instance the depersonalization of the patient, this is the main component of burnout syndrome and it significantly affects the impairment of future professional functioning [13, 14].

The period of learning is also about gaining life experiences and forming a sense of coherence. Sense of coherence is attributed as being a contributing factor to not only having a sense of greater satisfaction with life and career, but also to being less vulnerable to occupational burnout and emotional disorders [15, 16].

The results of screening tests for the incidence of mood disorders and testing the level of the sense of coherence of future physiotherapists can be of great importance in the process of education optimization and prevention of occupational burnout [16], especially that they will work in an environment that requires high resistance to stress and support for other ill people in a crisis situation.

Therefore, the aim of this study was to assess mood and the level of stress as well as a sense of coherence among students studying at the Department of Physiotherapy and to identify factors accompanying mood disorders in this group of people.

2 Material and methods

Research was conducted in the academic years 2015/2016 and 2016/2017 among the third-year bachelor students of the Department of Physiotherapy at the University School of Physical Education in Wroclaw, in winter semester, from October to November. Students were informed about the purpose of study and the possibility to withdraw at any stage. The study was in the form of a survey, without any intervention or experiment structure, carried out with the respondents’ consent and under the ethical and legal supervision of the Department of Physiotherapy at the University School of Physical Education in Wroclaw.

The study group consisted of 249 students, aged 22–25, including 181 females and 68 males. An exact description of the study group is shown in Table 1.

The following tests were used to conduct the research: the Beck Depression Inventory (BDI). Sense of Coherence Questionnaire (SOC-29) and the Perceived Stress Questionnaire (PSQ).

Additionally, respondents answered questions about their: physical activity; financial situation; paid work; place of residence; employment readiness within the profession; satisfaction with a chosen field of study; and the availability of someone who is close to them with whom they could discuss; their readiness to use the services of a psychologist if needs be.

The BDI is a screening tool used to determine the severity of depressive symptoms. The 21-point inventory consists of two parts: emotional and somatic. Depending on the number of points scored, the severity of depression can be assessed. The range of 0–11 points indicates absence of depression, 12–19 mild depression, 20–25 moderate, and 26–63 indicates severe depression. The BDI has a very high internal compliance –Cronbach’s alpha coefficient for the entire normalization sample is 0.93, and 0.95 for patients with depression [17, 18].

The SOC-29 questionnaire allows one to define the general level of sense of coherence and its three aspects: sense of comprehensibility, manageability and meaningfulness. It is made up of 29 questions. Results consist of the sum of points calculated in accordance with the key. It is assumed, however, that a score of <117 points indicates a low level of coherence, 117–156 points an average level, and a score of >156 points indicates a high level of coherence. The reliability of the Polish version for subscales range from 0.68 to 0.78 and 0.92 for the overall result [19].

The PSQ questionnaire consists of 27 statements, to which the respondent answers with one option out of five possible, with the far-ends of the scale being ‘true’ and ‘false’. Separate questionnaires for females and males have been created and three dimensions have been specified, namely: emotional strain, external stress, internal stress The total score indicates the general level of stress experienced. The higher the score, the greater the sense of stress. The reliability of the PSQ is satisfactory –Cronbach’s alpha internal consistency coefficients for the three subscales range from 0.69 to 0.81. In these tests, raw results were used for the analysis [20].

The characteristics of the study group were pre-sented using descriptive statistics. In statistical analysis, the Lilliefors test was used to check normality of distribution, in addition to descriptive statistics. Depending on the nature of the results, parametric tests for SOC-29 included: Student’s t-test, and in the case of more than two groups the ANOVA variance analysis. For BDI and for PSQ the non-parametric tests were used: the Mann–Whitney test for two groups and the Kruskal–Wallis test for more than two groups. The strength of the relationship between selected parameters was examined using the Spearman’s rank correlation coefficient. Statistical significance was determined at p < 0.05.

4 Results

The mean result of BDI in the whole group was 8.1 (±6.8). Mood disorder symptoms occurred in nearly 25% of the responding students (59 people), while moderate symptoms of depressed mood were demonstrated in 12 individuals (5%) and severe symptoms were shown in 6 people (2.5%). Among females and males surveyed, respectively, 27.1% (n = 49) and 14.7% (n = 10) exhibited symptoms of mood disorders. A significantly lower mood was observed in females, physically inactive students, students in a bad financial situation, students without the availability of someone who is close to them with whom they could talk to and students dissatisfied with the chosen field of study. Remaining data have been presented in Table 2.

The mean value of perceived stress in the examined group of students was low and amounted to 51.5 (±16.1). A high score was achieved by 6% of students (n = 15), an average score by 21.3% (n = 53) and a low score was achieved by 72.7% (n = 181). Significantly higher levels of perceived stress were observed in women, physically inactive students, students declaring a bad financial situation, those without someone close, students dissatisfied with the chosen field of study and those who were uncertain about becoming physiotherapists after graduation (Table 3).

In the case of sense of coherence (SOC-29), the mean score in the study group was 137.3 (±21.8). Mean results for the whole study group in the questionnaire’s individual subscales were as follows: sense of manageability 46.4 (±9.2); sense of comprehensibility 49.7 (±8.5); and sense of meaningfulness 41.2 (±6.8). Among the surveyed students, 47 people (18.9%) showed a low level of sense of coherence, 61.8% (154 people) had a medium and 19.3% (48 people) a high level of coherence. Significantly, the lowest level of coherence was also observed among women, physically inactive students, students declaring a bad financial situation and a lack of close companion, as well as students dissatisfied with the chosen field of study, last but not least those who were uncertain about becoming a physiotherapist after graduation (Table 4).

The correlation analysis showed a statistically significant relationship between all investigated parameters. A negative correlation was observed between PSQ and SOC-29, BDI and SOC-29, while a positive correlation was shown between PSQ and BDI (Table 5).

A review of earlier studies indicates a rising trend regarding the incidence of mood disorders among students of the Department of Physiotherapy at the University School of Physical Education. The analysis from 2008 showed that 20% of students suffered from mood disorders. In addition, 5% showed significant severity of symptoms [21, 22]. In the present study, the score was higher at 25% , in 2.5% of the subjects the disorders were severe. On the other hand, studies from 2014 of the fifth-year students showed that 29% of them exhibited disorders at least at a mild level [8].

Symptoms of mood disorders also concerned stu-dents of other universities –15.5% of students studying at the Medical University of Gdańsk achieved a result suggesting the presence of depressive disorders [23]. Research conducted among students of the Olsztyn University showed that one in eight people had mood disorders [24].

The presence of depressive disorders increases as the academic years progress. The smallest number of people with mood disorders in 2007 were first-year students [21]. In turn, Zagdańska and Kiejna showed that academic youth in the middle stage of their studies (third year) achieved worse results than their younger counterparts [2]. It is for this reason that authors decided to examine university students of the third year in this research. The euphoria associated with starting university life has probably subsided by this stage, and fears for the future and their professional career begin to surface.

Despite the fact that so many students showed mood disorders, the level of stress in the whole group was low. The sense of coherence of the students was at a medium level. Nevertheless, the correlation analysis unambiguously showed significant relationships between these parameters. The higher the sense of stress and the lower the sense of coherence of the investigated students, the lower was their mood.

Of the various factors which could determine the level of stress, the emotional state and the sense of coherence in studied group of students, the most significantly were: gender; physical activity; financial situation; having somebody close to them; and satisfaction with a chosen field of study.

The female students not only exhibited increased incidence of mood disorders and higher stress levels but also a lower sense of coherence. These results do not differ from the reports of other authors [24–26].

Moreover, the results indicate a protective role of physical activity. Similarly to the study by Jaworska et al., students exercising regularly had a lower number of depressive symptoms [8]. Many authors emphasize the positive effects of physical activity on the psychophysical condition of a human being [27].

Unfortunately, it is not always consciously used by students as a way of coping with stress and everyday challenges. In the study by Smoleń and Gazdowicz, 51.3% of students of pedagogy, nursing and agriculture rated their physical activity as good, and only 8.8% as very good [28]. Higher values (89%) recorded among physiotherapy students occurred in the study by Kochanowicz and Hansdorfer-Korzon [29]. In our research, 64% of students declared systematic physical activity; given the faculty and year of study, it would seem that this percentage should definitely be higher.

Additionally, the physically active students had lower level of stress and a higher sense of coherence. In the case of stress, this interdependence was particularly clear in the internal stress and emotional strain subscales. A similar result was obtained by Morga et al. [1]. However, in the case of coherence, a higher level was observed in the sense of meaningfulness and comprehensibility subscales. The same conclusions were reached by Mleczko and Zdebski, who showed that persons practicing sport recreationally had a higher level sense of coherence [30].

The financial situation of the investigated students was also an important factor, and in particular the need for financial stability during the studies. The worse the material situation declared by the student, the higher the level of depressive disorders, the higher sense of stress and the lower sense of coherence shown in the screening tests. A meta-analysis by Lorant et al. showed that a bad socio-economic situation triggers depressogenic mechanisms [31]. The worse the financial situation, the more difficulties and problems and stresses in meeting one’s needs and living at a certain standard –in some cases being dependent on, for example, parents or the need to take up a job –add to these issues. In the case of people with a low sense of coherence and a lowered mood, there may be problems with looking for additional activities, organization of time and decision-making, as well as worrying about one’s future. Barnard et al. indicated that the higher sense of coherence of employees, the higher the wages and the better their financial situation [32]. Thus, it can be assumed that students with a higher sense of coherence are better able to combine studying with employment and take care of their financial situation both now and in the future.

In this study, 16 students declared the absence of someone who is close to them with whom they could talk about their problems. This situation was related to the presence of a lowered mood, a higher level of stress and a lower sense of coherence among the respondents. This relationship was not confirmed in the study by Jaworska et al. [8]. Nevertheless, it is worth emphasizing, that as early as the 1980s, in the study conducted by Kessler and Essex, it was shown that married people suffer from depression less often than single people. Probably because they are less vulnerable to stressful situations and have the support they need in difficult times [33]. Perhaps the statistically significant result obtained in our research indicates the recurring need for support and the growing importance of interpersonal relations.

The results of study by Kurowska and Żmuda also show that those with a higher level of coherence have a lower need for support than people with a low level of coherence [34]. Therefore, it is disturbing that students who have a lower level of coherence, and hence are especially in need of support, do not have anyone who is close to them. Perhaps this very lack of a close friend is the reason for a reduced sense of comprehensibility, manageability and meaningfulness in the investigated subjects.

Students declaring satisfaction with a chosen field of study and declaring a sense of readiness for performing the job of a physiotherapist were characterized by a less frequent incidence of mood disorders, a lower sense of stress and a higher level of coherence. Interestingly, a good choice of the field of study (n = 222) was not always the decisive factor, in that students were feeling well prepared for performing the job of a physiotherapist (n = 133), which should lead to further analysis of this state of affairs and the introduction of modifications to the teaching process. Similar results were achieved by Szczepańska et al. and Jaworska et al. [8, 21]. Dissatisfaction with the career development direction taken was a source of stress for students. This result is confirmed in the study by Morga et al., where the lack of satisfaction with a field of study generated more stress, especially in the following subscales: emotional strain, external stress and internal stress [1].

People satisfied with their chosen field of study had a higher level of sense of coherence. This is confirmed in the study by Gilbar, which showed that people with a higher level of the sense of coherence are less exposed to the phenomenon of occupational burnout [35].

The research results certainly indicate an increase in the incidence of depressive disorders among students of the Department of Physiotherapy. It is worrying that one in every four students preparing for a profession in the medical sector, which is encumbered with a huge responsibility for others, exhibits lowered mood levels. This requires the implementation of effective psycho-preventive activities during the course of studies and a broadly defined education regarding psychophysical well-being.

6 Conclusions

A fourth of the third-year bachelor studies at the Department of Physiotherapy showed mood disorders. The investigated students exhibited an average level of the sense of coherence and a low level of perceived stress.

A higher level of sense of coherence and a lower level of perceived stress was associated with a better mood of undergraduate students of the Department of Physiotherapy, moreover a higher level of coherence determined a lower level of stress. The factors associated with the incidence of mood disorders, high levels of stress and low sense of coherence in study group of students were as follows: female gender, lack of regular physical activity, poor financial situation, lack of someone who is close to them and dissatisfaction with the chosen field of study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Declarations

The research presented in this work was carried out and funded as part of the statutory research of the Department of Physiotherapy, University School of Physical Education. The results presented in this paper have not been published previously in whole or part, except in abstract form in X International Days of Physiotherapy “Quality and lifestyle in the light of modern rehabilitation.” Wroclaw, 23–25 November 2017. Abstracts, pp.93-94.