Stress, Spirituality, and Altruism of Brazilian Medical Students during the COVID-19 Pandemic: A Cross-sectional Analysis

Authors

DOI:

https://doi.org/10.33448/rsd-v11i7.29513

Keywords:

Psychological stress; Teaching; Altruism; Spirituality; COVID-19 pandemic.

Abstract

Spirituality and altruism may be critical coping strategies to minimize emotional pain during period of crisis. Here we aim to investigate how spirituality and altruism are related and whether they influence medical students' levels of stress during the COVID-19 pandemic. Data were collected when most Brazilian states had already been promoting social isolation in response to the COVID-19 pandemic using self-reported measures: the Perceived Stress Scale 4, the Self-Spirituality Rating Scale, and Altruistic Attitudes Scale, in an online questionnaire.  We found moderate levels of perceived stress, moderate to high levels spirituality, as well as high levels of altruistic attitudes. Reported stress was higher among participants with a previous diagnosis of mental disorder and women, while more altruistic individuals were less vulnerable to it. Most participants attributed their stress symptoms to the COVID-19 pandemic or to the social isolation and participants with higher level of stress were less able to study during the pandemic. Spirituality correlated positively with altruistic thoughts and emotions, but only participants who act altruistically reported lower levels of stress. Our results indicate that the mental health status before the COVID-19 pandemic is related to the actual level of stress and suggest that altruism may allow for collective coping of emotional burden during the health crisis.

References

Abdulghani, H. M., Sattar, K., Ahmad, T., & Akram, A. (2020a). Association of COVID-19 Pandemic with undergraduate Medical Students’ Perceived Stress and Coping. Psychology Research and Behavior Management, 13, 871–881. https://doi.org/10.2147/PRBM.S276938

Abdulghani, H. M., Sattar, K., Ahmad, T., & Akram, A. (2020b). Association of COVID-19 Pandemic with undergraduate Medical Students’ Perceived Stress and Coping. Psychology Research and Behavior Management, 13, 871–881. https://doi.org/10.2147/PRBM.S276938

Agarwal, G., Mosquera, M., Ring, M., & Victorson, D. (2020). Work engagement in medical students: An exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes. Medical Teacher, 42(3), 299–305. https://doi.org/10.1080/0142159X.2019.1679746

Andreou, E., Alexopoulos, E. C., Lionis, C., Varvogli, L., Gnardellis, C., Chrousos, G. P., & Darviri, C. (2011a). Perceived Stress Scale: Reliability and Validity Study in Greece. International Journal of Environmental Research and Public Health, 8(8), 3287–3298. https://doi.org/10.3390/ijerph8083287

Andreou, E., Alexopoulos, E. C., Lionis, C., Varvogli, L., Gnardellis, C., Chrousos, G. P., & Darviri, C. (2011b). Perceived Stress Scale: Reliability and Validity Study in Greece. International Journal of Environmental Research and Public Health, 8(8), 3287–3298. https://doi.org/10.3390/ijerph8083287

Aten, J. D., O’Grady, K. A., Milstein, G., Boan, D., & Schruba, A. (2014). Spiritually oriented disaster psychology. Spirituality in Clinical Practice, 1(1), 20–28. https://doi.org/10.1037/scp0000008

Avila, L. (2010). Avaliação da espiritualidade e religiosidade dos estudantes de medicina e implicações frente a sua formação médica. Arquivo de Ciencias Da Saúde, v. 17.

Bensley, R. J. (1991). Defining Spiritual Health: A Review of the Literature. Journal of Health Education, 22(5), 287–290. https://doi.org/10.1080/10556699.1991.10614636

Bormann, J. E., Smith, T. L., Becker, S., Gershwin, M., Pada, L., Grudzinski, A. H., & Nurmi, E. A. (2005). Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: a pilot study. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’Association, 23(4), 395–414. https://doi.org/10.1177/0898010105278929

Byrne, A., Barber, R., & Lim, C. H. (2021). Impact of the COVID-19 pandemic – a mental health service perspective. Progress in Neurology and Psychiatry, 25(2), 27–33b. https://doi.org/https://doi.org/10.1002/pnp.708

Cohen, S. (1988). Perceived stress in a probability sample of the United States. In The social psychology of health. (pp. 31–67). Sage Publications, Inc.

Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In: Spacapan S and Oskamp S (eds). The Social Psychology of Health., 31–68.

Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.

Dillon, M., Wink, P., & Fay, K. (2003). Is Spirituality Detrimental to Generativity? Journal for the Scientific Study of Religion, 42(3), 427–442. https://doi.org/10.1111/1468-5906.00192

Domaradzki, J., & Walkowiak, D. (2021). Does Religion Influence the Motivations of Future Healthcare Professionals to Volunteer During the COVID-19 Pandemic in Poland? An Exploratory Study. Journal of Religion and Health, 60(3), 1507–1520. https://doi.org/10.1007/s10943-021-01231-8

Esperandio, M. R. G., de Souza, Y. Q., Nadalin, O., & Hefti, R. (2021). Spirituality in Clinical Practice: The Perspective of Brazilian Medical Students. Journal of Religion and Health, 60(3), 2154–2169. https://doi.org/10.1007/s10943-020-01141-1

Faro, A. (2015). Confirmatory factor analysis of three versions of the perceived stress scale (PSS): A population-based study. Psicologia: Reflexao e Critica, 28(1), 21–30. https://doi.org/10.1590/1678-7153.201528103

Fehr, E., & Fischbacher, U. (2003). The nature of human altruism. Nature, 425(6960), 785–791. https://doi.org/10.1038/nature02043

Fekih-Romdhane, F., & Cheour, M. (2021). Psychological Distress Among a Tunisian Community Sample During the COVID-19 Pandemic: Correlations with Religious Coping. Journal of Religion and Health, 60(3), 1446–1461. https://doi.org/10.1007/s10943-021-01230-9

Filkowski, M. M., Cochran, R. N., & Haas, B. W. (2016). Altruistic behavior: mapping responses in the brain. Neuroscience and Neuroeconomics, 5, 65–75. https://doi.org/10.2147/NAN.S87718

Galanter, M., Dermatis, H., Bunt, G., Williams, C., Trujillo, M., & Steinke, P. (2007). Assessment of spirituality and its relevance to addiction treatment. Journal of Substance Abuse Treatment, 33(3), 257–264. https://doi.org/10.1016/j.jsat.2006.06.014

Gonçalves, A. M. de S., & Pillon, S. C. (2009a). Adaptação transcultural e avaliação da consistência interna da versão em português da Spirituality Self Rating Scale (SSRS). Archives of Clinical Psychiatry (São Paulo), 36(1), 10–15. https://doi.org/10.1590/S0101-60832009000100002

Gonçalves, A. M. de S., & Pillon, S. C. (2009b). Adaptação transcultural e avaliação da consistência interna da versão em português da Spirituality Self Rating Scale (SSRS). Archives of Clinical Psychiatry (São Paulo), 36(1), 10–15. https://doi.org/10.1590/S0101-60832009000100002

Gonçalves, J. P. B., Lucchetti, G., Menezes, P. R., & Vallada, H. (2015). Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials. Psychological Medicine, 45(14), 2937–2949. https://doi.org/10.1017/S0033291715001166

Gonçalves, L. M., Tsuge, M. L. T., Borghi, V. S., Miranda, F. P., Sales, A. P. de A., Lucchetti, A. L. G., & Lucchetti, G. (2018). Spirituality, Religiosity, Quality of Life and Mental Health Among Pantaneiros: A Study Involving a Vulnerable Population in Pantanal Wetlands, Brazil. Journal of Religion and Health, 57(6), 2431–2443. https://doi.org/10.1007/s10943-018-0681-4

Gouda, P., Kirk, A., Sweeney, A.-M., & O’Donovan, D. (2020). Attitudes of Medical Students Toward Volunteering in Emergency Situations. Disaster Medicine and Public Health Preparedness, 14(3), 308–311. https://doi.org/10.1017/dmp.2019.81

Guo, A. A., Crum, M. A., & Fowler, L. A. (2021). Assessing the Psychological Impacts of COVID-19 in Undergraduate Medical Students. International Journal of Environmental Research and Public Health, 18(6). https://doi.org/10.3390/ijerph18062952

Hall, R. C. W., Hall, R. C. W., & Chapman, M. J. (2008). The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. General Hospital Psychiatry, 30(5), 446–452. https://doi.org/10.1016/j.genhosppsych.2008.05.003

Huber, J. T., & MacDonald, D. A. (2011). An Investigation of the Relations Between Altruism, Empathy, and Spirituality. Journal of Humanistic Psychology, 52(2), 206–221. https://doi.org/10.1177/0022167811399442

Ingram, P. B. 4th, Clarke, E., & Lichtenberg, J. W. (2016a). Confirmatory Factor Analysis of the Perceived Stress Scale-4 in a Community Sample. Stress and Health: Journal of the International Society for the Investigation of Stress, 32(2), 173–176. https://doi.org/10.1002/smi.2592

Ingram, P. B. 4th, Clarke, E., & Lichtenberg, J. W. (2016b). Confirmatory Factor Analysis of the Perceived Stress Scale-4 in a Community Sample. Stress and Health: Journal of the International Society for the Investigation of Stress, 32(2), 173–176. https://doi.org/10.1002/smi.2592

Jung, C. G. (1969). Psychology and religion: West and east (2nd ed.). The collected works of C. G. Jung, Vol.11.

Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H. U., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19. https://doi.org/10.1001/archpsyc.1994.03950010008002

Krägeloh, C. U., Henning, M. A., Billington, R., & Hawken, S. J. (2015). The relationship between quality of life and spirituality, religiousness, and personal beliefs of medical students. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 39(1), 85–89. https://doi.org/10.1007/s40596-014-0158-z

Lancet, T. (2020). COVID-19: learning from experience. In Lancet (London, England) (Vol. 395, Issue 10229, p. 1011). https://doi.org/10.1016/S0140-6736(20)30686-3

Lazarus, R. S. (1993). From psychological stress to the emotions: a history of changing outlooks. Annual Review of Psychology, 44, 1–21. https://doi.org/10.1146/annurev.ps.44.020193.000245

Loureiro, A., & Lima, M. L. (2013a). Escala de atitudes altruístas: Estudo de validação e fiabilidade. Laboratório de Psicologia, 7(1), 73–83. https://doi.org/10.14417/lp.687

Loureiro, A., & Lima, M. L. (2013b). Escala de atitudes altruístas: Estudo de validação e fiabilidade. Laboratório de Psicologia, 7(1), 73–83. https://doi.org/10.14417/lp.687

MacDonald, D. A., Friedman, H. L., Brewczynski, J., Holland, D., Salagame, K. K. K., Mohan, K. K., Gubrij, Z. O., & Cheong, H. W. (2015). Spirituality as a scientific construct: testing its universality across cultures and languages. PloS One, 10(3), e0117701. https://doi.org/10.1371/journal.pone.0117701

Mahamid, F. A., & Bdier, D. (2021). The Association Between Positive Religious Coping, Perceived Stress, and Depressive Symptoms During the Spread of Coronavirus (COVID-19) Among a Sample of Adults in Palestine: Across Sectional Study. Journal of Religion and Health, 60(1), 34–49. https://doi.org/10.1007/s10943-020-01121-5

Maselko, J., & Kubzansky, L. D. (2006). Gender differences in religious practices, spiritual experiences and health: results from the US General Social Survey. Social Science & Medicine (1982), 62(11), 2848–2860. https://doi.org/10.1016/j.socscimed.2005.11.008

Michalsen, A., Grossman, P., Acil, A., Langhorst, J., Lüdtke, R., Esch, T., Stefano, G. B., & Dobos, G. J. (2005). Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 11(12), CR555-561.

Moreira-Almeida, A., Pinsky, I., Zaleski, M., & Laranjeira, R. (2010). Envolvimento religioso e fatores sociodemográficos: resultados de um levantamento nacional no Brasil. Archives of Clinical Psychiatry (São Paulo), 37(1), 12–15. https://doi.org/10.1590/S0101-60832010000100003

Nguyen, H. T., Do, B. N., Pham, K. M., Kim, G. B., Dam, H. T. B., Nguyen, T. T., Nguyen, T. T. P., Nguyen, Y. H., Sørensen, K., Pleasant, A., & Duong, T. Van. (2020). Fear of COVID-19 Scale-Associations of Its Scores with Health Literacy and Health-Related Behaviors among Medical Students. International Journal of Environmental Research and Public Health, 17(11). https://doi.org/10.3390/ijerph17114164

Pan American Health Organization. (2006). Protecting Mental Health During Epidemics. In Pan American Health Organization (p. 20).

Pollner, M. (1989). Divine relations, social relations, and well-being. In Journal of Health and Social Behavior (Vol. 30, Issue 1, pp. 92–104). American Sociological Assn. https://doi.org/10.2307/2136915

Post, S. G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine, 12(2), 66–77. https://doi.org/10.1207/s15327558ijbm1202_4

Ray, C., & Wyatt, T. R. (2018). Religion and Spirituality as a Cultural Asset in Medical Students. Journal of Religion and Health, 57(3), 1062–1073. https://doi.org/10.1007/s10943-017-0553-3

Rosenberg, M. J., Hovland, C. I., McGuire, W. J., Abelson, R. P., & Brehm, J. W. (1960). Attitude organization and change: An analysis of consistency among attitude components. (Yales studies in attitude and communication.), Vol. III. In Attitude organization and change: An analysis of consistency among attitude components. (Yales studies in attitude and communication.), Vol. III. Yale Univer. Press.

Ruisoto, P., López-Guerra, V. M., Paladines, M. B., Vaca, S. L., & Cacho, R. (2020a). Psychometric properties of the three versions of the Perceived Stress Scale in Ecuador. Physiology & Behavior, 224, 113045. https://doi.org/10.1016/j.physbeh.2020.113045

Ruisoto, P., López-Guerra, V. M., Paladines, M. B., Vaca, S. L., & Cacho, R. (2020b). Psychometric properties of the three versions of the Perceived Stress Scale in Ecuador. Physiology & Behavior, 224, 113045. https://doi.org/10.1016/j.physbeh.2020.113045

Sandanger, I., Nygård, J. F., Sørensen, T., & Moum, T. (2004). Is women’s mental health more susceptible than men’s to the influence of surrounding stress? Social Psychiatry and Psychiatric Epidemiology, 39(3), 177–184. https://doi.org/10.1007/s00127-004-0728-6

Sanjai, S., & Gopichandran, V. (2017). Selfless giving in medicine: a study of altruistic attitudes among medical students. Indian Journal of Medical Ethics, 3(1), 28–34. https://doi.org/10.20529/IJME.2017.082

Saroglou, V. (2013). Religion, spirituality, and altruism. In APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research. (pp. 439–457). American Psychological Association. https://doi.org/10.1037/14045-024

Serfaty, D. R., Lugasi, T., & Strous, R. D. (2021). Anxiety Reactions and Coping Modalities with the COVID-19 Pandemic: A Cross-Sectional Study Comparing a Population of Religious Patients with Mental Illness and their Health Caregivers. Journal of Religion and Health, 60(3), 1494–1506. https://doi.org/10.1007/s10943-021-01219-4

Shelly, & Narang, R. (2018). Effects of Gender and Stress on Altruism. The International Journal of Indian Psychology, 6(2), 1–8. https://doi.org/10.25215/0602.037

Sparrow, E. P., Armstrong, B. A., Fiocco, A. J., & Spaniol, J. (2019). Acute stress and altruism in younger and older adults. Psychoneuroendocrinology, 100, 10–17. https://doi.org/https://doi.org/10.1016/j.psyneuen.2018.09.025

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020a). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health, 17(5). https://doi.org/10.3390/ijerph17051729

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020b). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health, 17(5). https://doi.org/10.3390/ijerph17051729

Warttig, S. L., Forshaw, M. J., South, J., & White, A. K. (2013). New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4). Journal of Health Psychology, 18(12), 1617–1628. https://doi.org/10.1177/1359105313508346

Wittchen, H. U., Essau, C. A., von Zerssen, D., Krieg, J. C., & Zaudig, M. (1992). Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. European Archives of Psychiatry and Clinical Neuroscience, 241(4), 247–258. https://doi.org/10.1007/bf02190261

Ye, B., Wu, D., Im, H., Liu, M., Wang, X., & Yang, Q. (2020). Stressors of COVID-19 and stress consequences: The mediating role of rumination and the moderating role of psychological support. Children and Youth Services Review, 118, 105466. https://doi.org/10.1016/j.childyouth.2020.105466

Zandifar, A., Badrfam, R., Yazdani, S., Arzaghi, S. M., Rahimi, F., Ghasemi, S., Khamisabadi, S., Mohammadian Khonsari, N., & Qorbani, M. (2020). Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. Journal of Diabetes and Metabolic Disorders, 19(2), 1–8. https://doi.org/10.1007/s40200-020-00667-1

Zerbetto, S. R., Gonçalves, A. M. de S., Santile, N., Galera, S. A. F., Acorinte, A. C., & Giovannetti, G. (2017). Religiosity and spirituality: mechanisms of positive influence on the life and treatment of alcoholics. Escola Anna Nery - Revista de Enfermagem, 21(1). https://doi.org/10.5935/1414-8145.20170005

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14/05/2022

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LIMA JUNIOR, D. N. de; AGUIAR, R. G. P. de .; KUBRUSLY, B. S. .; MACEDO, D. S.; KUBRUSLY, M.; LIMA, D. L. F. .; SANDERS, L. L. O. . Stress, Spirituality, and Altruism of Brazilian Medical Students during the COVID-19 Pandemic: A Cross-sectional Analysis. Research, Society and Development, [S. l.], v. 11, n. 7, p. e1411729513, 2022. DOI: 10.33448/rsd-v11i7.29513. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/29513. Acesso em: 12 nov. 2024.

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Health Sciences