The Association Between Perceived Stress Levels and the Coping Strategies Employed by Medical Residents at the University of Nairobi

Abstract

Background: Medical residency training is known to be a stressful period of career development with prevalence rates of perceived stress among medical residents documented to be higher than in the general population. Exposure to stress without utilizing appropriate coping strategies negatively impacts medical residents’ well-being and consequently patient care. Objective: This study aimed to determine the levels of perceived stress among medical residents at the University of Nairobi and the coping strategies they employed to deal with stress. Method: It was an online survey utilizing the Survey Monkey software where data was collected from 260 medical residents recruited via consecutive sampling. Stress levels were assessed using the ten item Perceived Stress Scale (PSS) while coping strategies were determined using the Brief Coping Orientation of Problems Experienced (COPE) inventory. Data pertaining to medical residents demographic and residency characteristics was collected using a researcher- designed questionnaire. Data analysis: Data was exported as a Microsoft excel file for cleaning and coding and then verified and analyzed using STATA 13.0. Continuous variables were presented as means and standard deviation while categorical variables were presented as tables of frequencies and percentages. Binary logistic regression odds ratio (95%CI) was used to determine the association between the dependent and independent variables with significant associations defined by a p value < 0.05. Spearman’s correlation was used to analyze the correlation between perceived stress and coping strategies employed. Significant correlations were defined by a p value < 0.05. Results: Of the 260 medical residents, 43 (16.5%, 95%CI: 11.7-20.5%) had mild stress, 165 (63.5%, 95%CI: 57.4-68.9%) had moderate stress and 52 (20%, 95%CI: 15.8-25.5%) had severe stress. The mean score for perceived stress was 20 (SD=6.8). The most commonly used adaptive strategies were planning (72.5%), acceptance (68.9%) and active coping (68.5%) with humor (50.9%) as the least. The most commonly used maladaptive coping strategies were self-distraction (63.8%), self-blame (56.1%) and venting (55.6%) with substance use (36.5%) as the least. Conclusion: Majority of the medical residents in this study were stressed. There was a significant association between perceived stress and sex, availability of training sponsorship and presence of a psychiatric illness. Medical residents employed adaptive coping strategies more frequently than maladaptive strategies. Higher perceived stress levels were reported among medical residents utilizing maladaptive coping strategies compared to those who employed adaptive coping strategies. Recommendation: Incorporation of programs that strengthen and encourage peer support, mentorship, social support and the appropriate utilization of adaptive stress-coping strategies as part of medical residency training may help to mitigate stress.