Stress among Dental Students in Saudi Dental Colleges: Part II: Factors Affecting Coping to Stress
by Alhanouf Al-Shamrani1, Abdulrahman Al-Thobaiti2, Ali BinAjian3, Mohammed Al-Dhubaiban4, Thakib Al-Shalan5*
1Pediatric Dentistry Graduate Students, College of Dentistry, Alexandria University, Egypt.
2General Dentist, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
3Graduate Student, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
4Assistant Professor at the Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
5Professor at the Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
*Corresponding author: Thakib Al-Shalan, Professor at the Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
Received Date: 04 December, 2024
Accepted Date: 16 December, 2024
Published Date: 19 December, 2024
Citation: Al-Shamrani A, Al-Thobaiti A, BinAjian A, Al-Dhubaiban M, Al-Shalan T (2024) Stress among Dental Students in Saudi Dental Colleges: Part II: Factors Affecting Coping to Stress. J Community Med Public Health 8: 485. https://doi.org/10.29011/2577-2228.100485
Abstract
Aim: Stress’ coping strategies are important for dental students to complete their studies and reach their goals. This study aimed to investigate factors that affect coping-to-stress methods among undergraduate dental students of Saudi dental colleges. Materials and Methods: A self-administered questionnaire was constructed and distributed to all students and interns in Saudi Dental Colleges by web link survey. Data were analyzed using SPSS program. Results: Results showed that in general no significant differences between male and female participants. Male and female students and interns used the method “Find comfort in my religion (praying or mediating) to cope with stress” a lot of time (52% and 54% respectively). For all the coping methods, no significant differences were found between the academic level of the participants and the coping methods. Students with low General Point Average (<2.75) used the method of “Blame myself for things that happened & caused me stressed” a lot of time (P<0.05). Majority (60%) of students with low GPA (<2.75) have not used the method of “Get emotional support and / or academic advice from other(s)”. Conclusion: Based on the results, it can be concluded that academic counseling is used by low number of students. It is important that dental colleges induce stress-coping methods in their academic activities.
Introduction
Stress is defined as the body’s reaction to a change that entails a physical, mental or emotional response that may be positive, stimulating and motivating individuals to do the best, or be negative, depressing and reducing their performance [1,2]. It has been reported that dental students are more susceptible to stress [3]. Furthermore, it has been shown that dental education causes stress for dental students [4]. The level of stress among dental students have been reported to be higher than stress levels in general population [5,6]. Furthermore, it has been shown that dental students had greater levels of stress than medical students [7,8].
The stress among dental students reach up to over 90% [9,10]. Sources of stress are different. Previously, it has been shown that stressors include fear of failure, fear of not completing their clinical requirements and workload and performance pressure [11]. Additional stressors related to academia, clinical requirements and professional future [10]. With the presence of stress, it has been shown that the stress adversely affects the academic performances of dental students as reported by Crego et al. [12] and Uraz et al. [13]. In addition, they may find difficulty to be socially and professionally interactive which may cause them to be distancing from others. With the reported high stress among dental students, it is important that dental students cope with the stress they face.
Coping is defined as a cognitive and behavioral effort taken by individuals to try to either alleviate or appreciate the requirements creating the disparity between the person and the coexisting environment [14]. The type of coping method might be dependent on students’ personal characteristics. While the literature has high number of publications that investigate stress levels and stressors among dental students, there are limited number of publications that study the coping strategies of dental students to stress. It has been reported that destructive coping mechanisms were more common among dental students compared to medical students [8]. Most common coping strategies by dental students involve active-functional coping, i.e. resting, talking with people who care, social interactions and hobbies [8,15]. Moreover, Harris et al. [8] reported that the use of dysfunctional coping mechanisms [15] such as alcohol, prescription medication, smoking, and recreational drugs were also greater among dental than medical students. Furthermore, previous studies reported that less than 15% of dental students sought professional counselling [8,16,17].
In our publication [17], we have shown that Saudi dental students and interns use different coping methods. The aim of this study was to investigate the effect of different factors (gender, level, and General Point Average) on the type and level of the coping strategies used by dental students and interns in Saudi Dental Colleges.
Materials and Methods
This is part of a cross-sectional study done on assessing the stress and coping-to-stress among dental students in Saudi dental colleges. The detailed description of the materials and methods were described previously [10].
In this study, a self-administered questionnaire was constructed and distributed to all dental students and interns from the 25 dental Colleges in Saudi Arabia. Participants were asked to answer the questionnaire sent to them by web link survey conducted through Survey Monkey The questionnaire consisted of two parts. Part one consisted of questions about the demographic characteristics of students. The second part consisted of questions related to the presence or absence of stress, coping strategies and level of usage used by dental interns and students, and factors that are perceived by participants to cause the stress (gender, level, and General Point Average). The research was approved by King Saud Medical City Institutional Review Board (No. E-22-6866) and registered in King Saud University College of Dentistry Research Center (No. FR 0642).
Statistical Analysis
All data from the online questionnaire was transferred to Statistical Package for the Social Sciences (SPSS version 26.0, SPSS, Inc., Chicago, Illinois, USA) for statistical analysis. Descriptive statistics frequency and percentage are present. For statistical testing of association Ch-squire and Fisher exact test were used. Moreover, level of significant were set at 0.05.
Results
The demographic characteristics of the participants are shown in Table 1. Table 2 shows coping-to-stress methods used by participants according to their gender. Male and female students and interns used the method “Find comfort in my religion (praying or mediating) to cope with stress” a lot of time (52% and 54% respectively). The method of “Take an action to make the stress-situation better like sleeping, resting, eating” is used a lot of time more by male participants (34%) compared to females (28%). Female students and interns used the methods “Get emotional support and / or academic advice from other(s)” and “Express my -ve feeling to let my unpleasant stress-feeling escape” more than males (P<0.05).
Characteristic |
N |
% |
|
Gender |
Male |
296 |
58.2 |
Female |
213 |
41.8 |
|
Academic Level in the College? |
1st Year in the Dental College, (3rd and/or 4th Semesters) |
44 |
8.6 |
2nd Year in the Dental College, (5th and/or 6th Semesters) |
35 |
6.9 |
|
3rd Year in the Dental College, (7th and/or 8th Semesters) |
69 |
13.6 |
|
4th Year in the Dental College, (9th and/or 10th Semesters) |
107 |
21.0 |
|
5th Year in the Dental College, (11th and/or 12th Semesters) |
121 |
23.8 |
|
Intern |
133 |
26.1 |
|
Cumulative Grade Point Average (GPA) out of 5 |
Less than 2.75 |
20 |
3.9 |
2.75 and less than 3.75 |
135 |
26.5 |
|
3.75 and less than 4.25 |
161 |
31.6 |
|
More than 4.25 |
193 |
37.9 |
Table 1: Demographic Characteristics of participants (N=509)* [10].
Coping Methods |
Gender |
Participants’ Choice: N (%) * |
P Value |
|||
1 |
2 |
3 |
4 |
|||
Do work or other activities (e.g. sport, watch movies) to think less about the stress |
Male |
33 (11) |
88 (30) |
106 (36) |
69 (23) |
0.530 |
Female |
29 (14) |
72 (34) |
68 (32) |
44 (21) |
||
Take an action to make the stress-situation better (like sleeping, resting, eating) |
Male |
32 (8) |
68 (23) |
105 (35) |
100 (34) |
0.453 |
Female |
17 (8) |
52 (24) |
86 (40) |
58 (28) |
||
Get emotional support and / or academic advice from other(s) |
Male |
111 (38) |
80 (27) |
69 (23) |
36 (12) |
0.000 |
Female |
42 (20) |
70 (33) |
58 (27) |
43 (20) |
||
Express my -ve feeling to let my unpleasant stress-feeling escape |
Male |
105 (35) |
82 (28) |
62 (21) |
47 (16) |
0.003 |
Female |
44 (21) |
65 (31) |
62 (28) |
42 (20) |
||
Looking for something good (what is happening in my life) |
Male |
29 (10) |
74 (25) |
109 (37) |
84 (38) |
0.186 |
Female |
30 (14) |
56 (26) |
61 (29) |
66 (31) |
||
Accept that I cannot control everything around me |
Male |
53 (18) |
80 (27) |
84 (28) |
79 (27) |
0.887 |
Female |
35 (16) |
64 (30) |
60 (29) |
84 (25) |
||
Blame myself for things that happened & caused me stressed |
Male |
52 (17) |
91 (31) |
76 (26) |
77 (26) |
0.599 |
Female |
33 (15) |
62 (29) |
51 (24) |
67 (32) |
||
Make jokes and fun of the stress-situation |
Male |
34 (11) |
97 (33) |
89 (30) |
76 (26) |
0.372 |
Female |
29 (14) |
77 (36) |
66 (31) |
41 (19) |
||
Find comfort in my religion (praying or mediating) to cope with stress |
Male |
13 (4) |
49 (17) |
79 (27) |
155 (52) |
0.986 |
Female |
10 (5) |
35 (16) |
54 (25) |
114 (54) |
||
*1= I have not done this at all, 2= I have been doing this slightly, 3= I have been doing this moderately, 4= I have been doing this a lot of time |
Table 2: Coping to stress methods used by participants’ gender (N=509).
For all the coping methods, no significant differences (p> 0.05) were found between the academic level of the participants and the coping methods (Table 3). For the coping method “Get emotional support and / or academic advice from other(s)”, majority of students in the first and second level have not done this at all (45% and 49% respectively). Similar finding was found for the method of “Express my -ve feeling to let my unpleasant stress-feeling escape”.
Coping Methods |
Level |
Participants’ Choice: N (%)* |
P Value |
|||
1 |
2 |
3 |
4 |
|||
Do work or other activities (e.g. sport, watch movies) to think less about the stress |
First |
9 (20) |
10 (23) |
13 (30) |
12 (27) |
0.468 |
Second |
7 (20) |
10 (29) |
13 (37) |
5 (14) |
||
Third |
8 (12) |
23 (33) |
24 (35) |
14 (20) |
||
Fourth |
12 (11) |
38 (36) |
40 (37) |
17 (16) |
||
Fifth |
9 (7) |
37 (31) |
41 (34) |
34 (28) |
||
Intern |
17 (13) |
42 (32) |
43 (32) |
31 (23) |
||
Take an action to make the stress-situation better (like sleeping, resting, eating) |
First |
3 (7) |
10 (23) |
12 (27) |
19 (43) |
0.674 |
Second |
4 (11) |
7 (20) |
16 (46) |
8 (23) |
||
Third |
4 (6) |
15 (22) |
33 (48) |
17 (25) |
||
Fourth |
10 (9) |
26 (24) |
40 (37) |
31 (29) |
||
Fifth |
11 (9) |
30 (25) |
38 (31) |
42 (35) |
||
Intern |
8 (6) |
32 (24) |
52 (39) |
41 (31) |
||
Get emotional support and / or academic advice from other(s) |
First |
20 (45) |
11 (25) |
9 (20) |
4 (9) |
0.076 |
Second |
17 (49) |
7 (20) |
5 (14) |
6 (17) |
||
Third |
19 (28) |
24 (35) |
13 (19) |
13 (19) |
||
Fourth |
33 (31) |
30 (28) |
31 (29) |
13 (12) |
||
Fifth |
32 (26) |
43 (36) |
30 (25) |
16 (13) |
||
Intern |
32 (24) |
35 (26) |
39 (29) |
27 (21) |
||
Express my -ve feeling to let my unpleasant stress-feeling escape |
First |
25 (57) |
6 (14) |
8 (18) |
5(11) |
0.055 |
Second |
14 (40) |
6 (17) |
8 (23) |
7 (20) |
||
Third |
18 (26) |
23 (33) |
17 (25) |
11 (16) |
||
Fourth |
28 (26) |
35 (33) |
26 (24) |
18 (17) |
||
Fifth |
33 (27) |
37 (31) |
31 (26) |
20 (17) |
||
Intern |
31 (23) |
40 (30) |
34 (26) |
28 (21) |
||
Looking for something good (what is happening in my life) |
First |
7 (16) |
15 (34) |
12 (27) |
10 (23) |
0.555 |
Second |
3 (9) |
12 (34) |
9 (26) |
11 (31) |
||
Third |
7 (10) |
17 (25) |
26 (38) |
18 (28) |
||
Fourth |
8 (7) |
26 (24) |
39 (36) |
34 (32) |
||
Fifth |
21 (17) |
28 (23) |
41 (34) |
31 (26) |
||
Intern |
13 (10) |
32 (24) |
43 (32) |
45 (34) |
||
Accept that I cannot control everything around me |
First |
6 (14) |
11 (25) |
18 (41) |
9 (20) |
0.803 |
Second |
7 (20) |
8 (23) |
12 (34) |
8 (23) |
||
Third |
12 (17) |
23 (33) |
20 (29) |
14 (20) |
||
Fourth |
21 (20) |
28 (26) |
30 (28) |
28 (26) |
||
Fifth |
21 (17) |
36 (30) |
26 (21) |
38 (31) |
||
Intern |
21 (16) |
38 (29) |
38 (29) |
36 (27) |
||
Blame myself for things that happened & caused me stressed |
First |
10 (23) |
10 (23) |
8 (18) |
16 (36) |
0.357 |
Second |
8 (23) |
12 (34) |
4 (11) |
11 (31) |
||
Third |
12 (17) |
20 (29) |
20 (29) |
17 (25) |
||
Fourth |
18 (17) |
37 (35) |
30 (28) |
22 (21) |
||
Fifth |
21 (17) |
29 (24) |
31 (26) |
40 (33) |
||
Intern |
16 (12) |
45 (34) |
34 (26) |
38 (29) |
||
Make jokes and fun of the stress-situation |
First |
8 (18) |
13 (30) |
15 (34) |
8 (18) |
0.889 |
Second |
4 (11) |
9 (26) |
10 (29) |
12 (34) |
||
Third |
9 (13) |
28 (41) |
20 (29) |
12 (17) |
||
Fourth |
12 (11) |
39 (36) |
35 (33) |
21 (20) |
||
Fifth |
13 (11) |
40 (33) |
36 (30) |
32 (26) |
||
Intern |
17 (13) |
45 (34) |
39 (29) |
32 (24) |
||
Find comfort in my religion (praying or mediating) to cope with stress |
First |
3 (7) |
6 (14) |
8 (18) |
27 (61) |
0.476 |
Second |
2 (6) |
2 (6) |
7 (20) |
24 (68) |
||
Third |
2 (3) |
15 (22) |
22 (32) |
30 (43) |
||
Fourth |
3 (3) |
22 (21) |
26 (24) |
56 (52) |
||
Fifth |
8 (7) |
17 (14) |
34 (28) |
62 (51) |
||
Intern |
5 (4) |
22 (17) |
36 (27) |
70 (53) |
||
*1= I have not done this at all, 2= I have been doing this slightly, 3= I have been doing this moderately, 4= I have been doing this a lot of time |
Table 3: Coping to stress methods used by participants’ academic level (N=509).
The effect of the General Point Average (GPA) of the participants on the coping methods is shown in Table 4. Students with low GPA (<2.75) used the method of “Blame myself for things that happened & caused me stressed” a lot of time (40%). This finding is statistically significant (P<0.05). Majority (60%) of students with low GPA (<2.75) have not done the method of “Get emotional support and / or academic advice from other(s)”.
Coping Methods |
GPA (5) |
Participants’ Choice: N (%)* |
P Value |
|||
1 |
2 |
3 |
4 |
|||
Do work or other activities (e.g. sport, watch movies) to think less about the stress |
<2.75 |
3 (15) |
9 (45) |
3 (15) |
5 (25) |
0.196 |
2.75 -<3.75 |
11 (8) |
45 (33) |
51 (38) |
28 (21) |
||
3.75 - <4.25 |
15 (9) |
48 (30) |
59 (37) |
39 (24) |
||
>4.25 |
33 (17) |
58 (30) |
61 (32) |
41 (21) |
||
Take an action to make the stress-situation better (like sleeping, resting, eating) |
<2.75 |
3 (15) |
7 (35) |
5 (25) |
5 (25) |
0.407 |
2.75 -<3.75 |
7 (5) |
29 (21) |
59 (44) |
40 (30) |
||
3.75 - <4.25 |
12 (7) |
34 (21) |
58 (36) |
57 (35) |
||
>4.25 |
18 (9) |
50 (26) |
69 (36) |
56 (29) |
||
Get emotional support and / or academic advice from other(s) |
<2.75 |
12 (60) |
3 (15) |
2 (10) |
3 (15) |
0.125 |
2.75 -<3.75 |
32 (24) |
44 (33) |
38 (28) |
21 (16) |
||
3.75 - <4.25 |
49 (30) |
42 (26) |
42 (26) |
28 (17) |
||
>4.25 |
60 (31) |
61 (32) |
45 (23) |
27 (14) |
||
Express my -ve feeling to let my unpleasant stress-feeling escape |
<2.75 |
7/35 |
26 (19) |
46 (29) |
70 (36) |
0.123 |
2.75 -<3.75 |
26 (19) |
46 (34) |
37 (27) |
26 (19) |
||
3.75 - <4.25 |
46 (29) |
45 (28) |
45 (28) |
25 (16) |
||
>4.25 |
70 (36) |
50 (26) |
38 (20) |
35 (18) |
||
Looking for something good (what is happening in my life) |
<2.75 |
4 (20) |
6 (30) |
5 (25) |
5 (25) |
0.154 |
2.75 -<3.75 |
7 (5) |
30 (22) |
51 (38) |
47 (35) |
||
3.75 - <4.25 |
21 (13) |
40 (25) |
58 (36) |
42 (26) |
||
>4.25 |
27 (14) |
54 (28) |
56 (29) |
56 (29) |
||
Accept that I cannot control everything around me |
<2.75 |
2 (10) |
6 (30) |
3 (15) |
9 (45) |
0.130 |
2.75 -<3.75 |
21 (16) |
47 (35) |
37 (27) |
30 (22) |
||
3.75 - <4.25 |
34 (21) |
46 (29) |
46 (29) |
35 (22) |
||
>4.25 |
31 (16) |
45 (23) |
58 (30) |
59 (31) |
||
Blame myself for things that happened & caused me stressed |
<2.75 |
5 (25) |
5 (25) |
2 (10) |
8 (40) |
0.025 |
2.75 -<3.75 |
14 (10) |
34 (25) |
43 (32) |
44 (33) |
||
3.75 - <4.25 |
24 (15) |
49 (30) |
44 (27) |
44 (27) |
||
>4.25 |
42 (21) |
65 (34) |
38 (20) |
48 (25) |
||
Make jokes and fun of the stress-situation |
<2.75 |
5 (25) |
5 (25) |
5 (25) |
5 (25) |
0.264 |
2.75 -<3.75 |
17 (13) |
43 (32) |
40 (30) |
35 (25) |
||
3.75 - <4.25 |
13 (8) |
61 (38) |
57 (35) |
30 (19) |
||
>4.25 |
28 (15) |
65 (34) |
53 (27) |
47 (24) |
||
Find comfort in my religion (praying or mediating) to cope with stress |
<2.75 |
1 (5) |
5 (25) |
5 (25) |
9 (45) |
0.694 |
2.75 -<3.75 |
4 (3) |
20 (15) |
34 (25) |
77 (57) |
||
3.75 - <4.25 |
9 (6) |
33 (20) |
40 (25) |
79 (49) |
||
>4.25 |
9 (5) |
36 (13) |
54 (28) |
104 (54) |
||
*1= I have not done this at all, 2= I have been doing this slightly, 3= I have been doing this moderately, 4= I have been doing this a lot of time |
Table 4: Coping to stress methods used by participants’ General Point Average (N=509).
Discussion
Stress is common among dental students. Developing coping-to-stress strategies early in students’ education career can make them more adaptive to stress which is important as they advance in their career. Furthermore, it has been reported that pro-active coping-to-stress strategies, i.e. strategies which are used before stress occurs, are associated with less stress compared to reactive strategies [18]. Students’ academic life has a relationship with the his/her ability to adapt to the various situations of the academic years. Students feelings of self-efficacy, self-confidence, and empowerment in the face of challenges, will make the student to experience less anxiety and depression and a sense of responsibility in dealing with the academic tasks and better academic success [19]. These characteristics might be affected by students’ factors. Previous study has reported that demographic factors had impact on the perceived stress factors and levels, as well as coping strategies [20]. This study investigated the effect of three factors (gender, academic level, and GPA) on the coping-to-stress methods used by dental students and interns in Saudi dental colleges.
With few exceptions, results showed that the coping-to-stress methods of the participants appears to be independent of gender, academic level, and GPA. The effect of gender showed no significant differences between male and female participants. This finding is consistent with Murphy et al. [7] who reported that no significant difference between male and female students. Results showed that turning to religion method “Find comfort in my religion (praying or mediating) to cope with stress” was highly used coping method by both male and female participants. This finding is consistent with Steiner-Hofbauer and Holzinger [21] who reported that turning to religion was slightly associated with higher stress among undergraduate medical students. It has been shown that social support based on counselling lessons have a significant positive effect on students’ stress [22].
The effect of the academic level on the type of academic level, results showed that students in the first and second level did not use the coping method of get academic advice. This finding is critical as it indicates that students are not familiar with the importance of academic advising. It has been reported that stress related to clinical works varied between students based on their academic level [7]. Future studies are important to understand the reasons behind this finding. The low utilization of professional care and guidance may have negative implications for the participants’ future practicing careers. It has been reported that reluctant of students to use professional counseling services might be their concerns about stigma and confidentiality [23].
Although GPA is an important factor in students’ study stress, results showed that students with low GPA choose the coping method “Blame myself for things that happened & caused me stressed” a lot of time (40%). In addition, results showed that students with low GPA did not seek academic assistant by means of consultation. Possible reason is the one reported by Ey et al. [23]. This finding confirms the importance of academic guidance that should be introduced to students once they join the college. In addition, colleges should closely monitor the students’ performance so students with low performance are supported and guided to overcome difficulties they face. Furthermore, it has been reported that one of the most significant parts affecting the psychological health and well-being of individuals is life skills training [7]. For that, it is important that Saudi dental colleges teach “life skills training” and stress management skills to improve the physical and psychological health of their students and interns.
Conclusion and Recommendation
Results of this study showed that dental students and interns in Saudi dental colleges utilize different coping-to-stress strategies. Seeking professional advice and support method is not used frequently. Based on that, it is important that dental colleges induce stress-coping methods in their academic activities.
References
- Cohen S, Kessler RC, Gordon LU (1995) Strategies for measuring stress in studies of psychiatric and physical disorders. In: Measuring stress: A guide for health and social scientists. New York; Oxford University Press: p 3-26.
- Folkman S (2013) Stress: Appraisal and Coping. In: Gellman MD, Turner JR (Editors). Encyclopedia of Behavioral Medicine. New York; Springer. Pp: 1913-1915.
- Cooper CL, Watts J, Kelly M (1987) Job satisfaction, mental health, and job stressors among general dental practitioners in the UK. Br Dent J 162: 77-81.
- Birks Y, McKendree J, Watt I (2009) Emotional intelligence and perceived stress in healthcare students: a multi-institutional, multi-professional survey. BMC Med Educ 9: 61.
- Dyrbye LN, Thomas MR, Shanafelt TD (2006) Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 81: 354-373.
- Schmitter M, Liedl M, Beck J, Rammelsberg P (2008) Chronic stress in medical and dental education. Med Teach 30: 97-99.
- Murphy RJ, Gray SA, Sterling G, Reeves K, DuCette J (2009) A comparative study of professional student stress. J Dent Educ 73: 328-337.
- Harris RC, Millichamp CJ, Thomson WM (2015) Stress and coping in fourth-year medical and dental students. N Z Dent J 111: 102-108.
- Alzahem AM, van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH (2011) Stress amongst dental students: A systematic review. Eur J Dent Educ 15: 8-18.
- Al-Dhubaiban M, BinAjian A, Al-Shumrani A, Al-Thobaiti A, Al-Shalan T (2023) Stress among Dental Students in Saudi Dental Colleges: Cross-Sectional Study. J Community Med Public Health 7: 387.
- Halboub E, Alhajj MN, AlKhairat AM, Sahaqi AM, Quadri MFA (2018) Perceived Stress among Undergraduate Dental Students in Relation to Gender, Clinical Training and Academic Performance. Acta Stomatol Croat 52: 37-45.
- Crego A, Carrillo-Diaz M, Armfield JM, Romero M (2016) Stress and academic performance in dental students: the role of coping strategies and examination-related self-efficacy. J Dent Educ 80: 165-172.
- Uraz A, Tocak YS, Yozgatligil C, Cetiner S, Bal B (2013) Psychological well-being, health, and stress sources in Turkish dental students. J Dent Educ 77: 1345-1355.
- Folkman S, Lazarus RS (1980) An analysis of coping in a middleaged community sample. J Health Soc Behav 21: 219-239.
- Prinz P, Hertrich K, Hirchfelder U, de Zwaan M (2012) Burnout, depression and depersonalisation – Psychological factors and coping strategies in dental and medical students. GMS Z Med Ausbild 29: 8-14.
- Dewan H, Loka SR, Mandal NB, Mogla S, Lenin KR, et al. (2022) Prevalence of Stress and Coping Disorders among Dental Students: An Original Research. J Pharm Bioallied Sci 14: S277-S279.
- Al-Thobaiti A, Al-Shamrani A, BinAjian A, Al-Dhubaiban M, Alabed A, et al. (2024) Stress among Dental Students in Saudi Dental Colleges: Part I: Coping Strategies. J Community Med Public Health 8: 483.
- Moring J, Fuhrman R, Zauszniewski JA (2011) Interrelatedness of proactive coping, reactive coping, and learned resourcefulness. Measurement and Evaluation in Counseling and Development 44: 204-214.
- Dehqanizadeh MH, Hosseinchari M (2012) Academic vitality and perception of family communication patterns; the intermediary role of -self-efficacy. Journal of Teaching and Learning Studies 4: 21-47.
- Ersan N, Dölekoglu S, Fisekçioglu E, Ilgüy M, Oktay I (2018) Perceived sources and levels of stress, general self-efficacy and coping strategies in preclinical dental students. Psychol Health Med 23: 567-577.
- Steiner-Hofbauer V, Holzinger A (2020) How to Cope with the Challenges of Medical Education? Stress, Depression, and Coping in Undergraduate Medical Students. Acad Psychiatry 44: 380-387.
- Baqutayan S (2011) Stress and social support. Indian J Psychol Med 33: 29-34.
- Ey S, Henning KR, Shaw DL (2000) Attitudes and factors related to seeking mental health treatment among medical and dental students. J Coll Student Psychother 14: 23-39.