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HEALTH PROFESSIONS STUDENTS' MENTAL WELL-BEING AND PERCEIVED

HEALTH - ТHE IMPACT OF OPTIMISM, RESILIENCE, RELIGIOSITY AND STRESS

Article in Psychological Thought · April 2023

DOI: 10.37708/psyct.v16i1.701

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Psychological Thought
psyct.swu.bg | 2193-7281 South-West University “Neofit Rilski”

Research Article
Health Professions Students' Mental Well-
Being and Perceived Health - Тhe Impact of
Optimism, Resilience, Religiosity and Stress
Kremena Mineva*a
[a] Trakia University, Stara Zagora, Bulgaria.

Abstract
The study explored the impact of optimism, resilience and religiosity on the mental well-being
and perceived health as well as their role in the perceived stress and mental well-being relation
in health professions’ students. The study was carried out online with a total of 123 students in
medicine, nursing, assistant-pharmacists and social workers. Analyses suggest that optimism
and resilience were associated with the stress appraisal as less intensive, less threatening and
more controllable. Religiosity was not associated with perceived stress. The mental well-being
was predicted positively by optimism, resilience and religiosity and negatively by stress, but
perceived health – only by stress. Resilience enhanced mental well-being both directly and
indirectly through the perceived stress (partial mediator). Optimism acted as a moderator of
stress and mental well-being relationship. Optimism, resilience and religiosity contribute to high
levels of students' positive functioning in the mental health domain, but not in physical health
domain as far as the subjective general physical health is concerned. Positive impact of
optimism and resilience on psychological functioning is related to their associations with
favorable stress appraisals and the buffering effect of optimism on stress. The positive influence
of subjective level of religiosity on mental well-being is unrelated to how stress is perceived.
Stress management programs as well as appropriate interventions and educational approaches
to enhance resilience could be offered to health professions’ students.

Keywords: optimism; resilience; religiosity; mental well-being; health; stress.

Table of Contents
Method
Measures
Results
Discussion
Limitations of this study and recommendations for future directions
Conclusions
References

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Psychological Thought, 2023, Vol. 16(1), 45-63, https://doi.org/10.37708/psyct.v16i1.701

Received: 2022-01-13. Accepted: 2022-07-10. Published (VoR): 2023-04-30.
Handling Editor: Irina Roncaglia, Chartered Practitioner Sport & Exercise Psychologist, The National Autistic Society
(NAS), United Kingdom. *Corresponding author at: Trakia university, Bulgaria E-mail: kremena.mineva@trakia-uni.bg

This is an open access article distributed under the terms of the Creative Common Attribution License
(https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Studying health disciplines is stressful due to the heavy academic load. There has been a
persistent data that health professions' students have had higher levels of perceived stress
compared to the general population and other undergraduates (Hasson et al., 2021; Heinen et
al., 2017). Perceived stress has been predominantly academic-related and remained
moderately high during training (McKerrow et al., 2020), but have increased significantly prior to
end of year examinations (Kulsoom & Afsar, 2015). The intensive stress has had a negative
impact on students' physical and mental health (McKerrow et al., 2020). Deterioration in various
aspects of health due to stress has led to deterioration in psychological and subjective well-
being of students (He et al., 2018; Ribeiro et al., 2018; Shi et al., 2015; Zaheer & Khan, 2022),
has impaired their perceived health (Teh et al., 2013) and health related quality of life
(Ogunsanya et al., 2018). Given that these students are future healthcare professionals, it is of
great importance that they maintain a high level of well-being during their studies, which in turn
highlights the need to explore the factors that predict it and reduce the impact of stress on it.

Two approaches have emerged in the well-being research: hedonic and eudemonic. The
hedonic approach has focused on the experience of positive affect and life satisfaction
(subjective well-being) and the eudemonic - on the optimal functioning (psychological and social
well-being) (Keyes et al., 2002). Overview of these two kinds of approaches to well-being has
discussed their conceptual and empirical overlap, has highlighted their differences and
complementarities, but has concluded by emphasizing their belonging to the same general
concept of mental well-being (Huta, 2017). Mental well-being refers to subjective, psychological
and social well-being taken together as a critically important part of mental health (Keyes,
2002).

In the scientific literature, optimism and resilience have been associated with positive mental
health outcomes under stress and with some of the domains of well-being in university students.
Optimism has reduced levels of perceived stress (Pathak & Lata, 2018) and has moderated its

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relationship with health by reducing the risk of psychological symptoms of distress during the
academic study and examinations (Hasson et al., 2021; Riolli et al., 2012). Optimism also
significantly has predicted students' psychological well-being (Datu & Valdez, 2016; Selvaraj &
Bhat, 2018) and has mediated the relationship of perceived stress with psychological well-being
(Zaheer & Khan, 2022), has increased life satisfaction directly (Cabras & Mondo, 2018) as well
as indirectly as a buffer to the negative effects of stress (Riolli et al., 2012).

Resilience refers to the adaptive coping capacity that maintains good psychological health in the
face of uncertainty, trauma and adversity (Smith et al., 2008). In medical students, resilience
has been associated with lower levels of distress under heavy workload in their study curriculum
(Kiziela et al., 2019) and has reduced the effect of academic stress on the occurrence of
burnout (Yu & Chae, 2020). The predictive role of resilience with psychological well-being in
medical students has been highlighted by a systematic review and meta-analysis (Solis &
Lotufo-Neto, 2019) and cross-sectional studies (Hasson et al., 2021; He et al., 2018; Smith &
Yang, 2017; Tempski et al., 2015; Yu & Chae, 2020; Zaheer & Khan, 2022). Resilience has
correlated positively with life satisfaction also (Mak et al., 2011). In addition to directly impact,
resilience indirectly increases medical students' well-being as a mediator of the relationship
between stress and life satisfaction (Shi et al., 2015) and academic burnout with psychological
well-being (Yu & Chae, 2020).

In recent decades, cross-sectional and longitudinal studies have examined the relationship
between religiosity as people's engagement with particular religious beliefs, principles and
activities and their mental health. For example, meta-analyses have found a positive
association of religiosity with well-being in adults (Garssen et al., 2020; Sholihin et al., 2021),
although according to others the association is positive but weak (Joshanloo et al., 2021).
Studies with undergraduates have shown that religiosity has predicted lower intensity of
perceived stress (Aftab et al., 2018) and better subjective perception of general health (Alipoor
et al., 2016). In contrast, other studies among students have found no such associations (Thao,
2020) or a positive impact of religiosity on mental health but negative on physical health
(Kioulos et al., 2015). Similarly, studies of medical students have suggested positive
associations between religiosity, life satisfaction and positive affect (Chesser et al., 2018;
Machado et al., 2018), as well as psychological well-being (Abdel-Khalek & Tekke, 2019;
Saleem & Saleem, 2017), but others have found these associations not to be significant
(Dlugosz et al., 2022; Oteri, 2018).

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In summary, some literature confirms the relationships of optimism and resilience, and
inconsistently of religiosity with hedonic and eudemonic well-being under stress in health
profession students. Insufficient research has examined the impact of these factors on well-
being, considering both hedonic and eudemonic approaches, representing mental well-being.
Given that latter concerns positive functioning predominantly in the mental health domain,
studies that examine the impact of optimism, resilience and religiosity including on physical
health would deepen understanding of their impact on the overall well-being. This would help to
suggest appropriate interventions to improve the quality of life of students and, as a result, the
quality of care provided to future patients.

Aim and hypotheses of the study

The first aim of the present study was to establish the relationship of optimism, resilience,
religiosity and perceived stress with mental well-being and perceived health in health
professions students. The second aim was to establish the role of optimism, resilience and
religiousity in the relationship between perceived stress and students' mental well-being.

H 1: It was hypothesized that high resilience, optimism and religiosity would be associated with
appraisals of less intense, higher controlled and lower threating stress.

H 2: Resilience, optimism and religiosity will positively predict mental well-being and perceived
health both directly and indirectly through appraisals of stress.

H 3: High optimism, religiosity and resilience will weaken the relationship between stress and
mental well-being.

Method
The study took place at the end of the academic year, 2 weeks before the beginning of the
exam session, in an online learning environment in pandemic settings. The study was
conducted with 123 students distributed as follows: by gender: males, 21 (15%); females, 102
(85%); by residence: large city, 36 (29%); small city, 61 (50%); rural, 26 (21%); by ethnicity:
(3%); and by age groups: 18-25 years - 69 (56%), 26-35 years - 15 (12%), over 35 years - 39
(32%); by specialty: medicine - 35 (28%), nursing - 53 (44%), assistant-pharmacist- 14 (11%),
social work - 21 (17%); by activity: study - 61 (49%), study and work - 62 (51%). All procedures
performed in the study were in accordance with the Declaration of Helsinki and its later

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amendments. Participation in the study was voluntary and completely anonymous. All
participants provided informed consent by clicking on the online questionnaire link.

Measures
Brief Resilience Scale (BRS) (Smith et al., 2008). The scale assesses the ability to recover from
stressful and traumatic experiences. The scale has one-factor structure and consists of 6 items,
which are assessed on a 5-point Likert type scale. A general score is formed, as a higher result
means a higher degree of endurance and a better ability to recover from the difficulties
experienced. High internal consistency of the scale in our study was found (Cronbach's α =
.827).

Life Orientation Test-Revised (LOT-R) (Ganeva, 2018). The scale contains 10 items about
which respondents state their consent on a 5-point Likert's scale from "1- I do not agree at all" to
"5 - I completely agree". To calculate the overall score for Optimism, negatively formulated
items 3, 7, 9 are reversed and then summed with the answers of items 1, 4, 10. In the present
study the scale demonstrated satisfactory consistency (Cronbach's α =. 507), which allowed
statistical analysis to be performed to test scientific hypotheses.

Positive Mental Health Scale (PMHS) (Lukat et al., 2016). The scale measures positive mental
health as a single concept which includes life satisfaction, emotional and psychological well-
being but not social well-being (Lukat et al., 2016). It contains 9 items, which are evaluated on a
4-point Likert scale, ranging from 1 - "I do not agree at all" to 4 -"I completely agree". A total
score is calculated, with higher scores being an indicator of better well-being. In our study high
internal consistency of the scale was found (Cronbach's α = .852).

Perceived Stress Scale (PSS) (Karayastoyanov & Hristova, 2000). The scale assesses the
extent to which life situations are perceived as threatening, unpredictable, uncontrollable without
specify the stressors. It contains 14 items (7 positively formulated to measure perceived control
and 7 negatively formulated - about perceived threat). For each item, respondents evaluate the
frequency of occurrence in the last month on a scale from 1 = "Never" to 5 = "Very often". To
calculate the general score of perceived stress, the positively formulated items № 4, 5, 6, 7, 9,
10, 13 are reversed and summed with the negatively formulated items. In the study internal
consistency of the scale was very high (Cronbach’s α = .85).

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Perceived health was measured by a single item self-rated health question: „In general, would
you say your physical health is poor, fair, good, very good or excellent? The respondents rates
their overall health using a 5-point scale (1 = excellent; 5 = poor).

Religiosity as a subjective perception of the overall level of religiosity was measured with the
question ”How religious one consider yourself?” on an ordinal scale where 1= non-religious, 2 =
slightly religious, 3 = moderately religious and 4= deeply religious.

Results
The correlation analyses found that optimism and resilience correlated significantly positively
with mental well-being and the degree of perceived control over stressors, as well as correlated
inversely with the degree of perceived threat from stressors and the appraisal of stress levels.
There were statistically significant positive correlation between resilience and perceived health,
but non-significant correlation between optimism and perceived health. Religiosity correlated
significantly positively with mental well-being and non-significantly with perceived health and
perceived stress. Mental well-being and perceived health inversely correlated with the level of
perceived stress and perceived threat, as well as positively with the level of perceived control
(see Table 1). Thus, hypothesis 1 was supported for resilience and optimism, but not for
religiosity.

Table1.
Correlation Analyses of Relationships Between Optimism, Resilience, Perceived Stress, Religiosity,
Mental Well-Being and Perceived Health (rs coefficients)
PS PC PD MWB PH
Resilience -.53*** .36*** - .57*** .55*** .21*
Optimism -.55*** .58*** -.50*** .55*** .13
Religiosity -.11 .10 -.07 .25*** -.12
PH -.39*** .41*** -.33*** .37*** 1
МWB -.64*** .61** -.55** 1 .37***
Note. *p < .05. **p < .01. ***p < .001. PS - Perceived stress, PD - Perceived danger, PC - Perceived control, МWB - Mental well-
being, PH - Perceived health

There were not statistically significant differences in the perceived stress and mental well-being
and perceived health by gender, age, ethnicity, residence, specialty and activity. Linear
regression analyses found that perceived health was significantly predicted by perceived stress
(F (2,121) = 22.298, p = .000, R² = .167). Perceived high levels of stress reduced self-rated
health status (β = - .394, p < .001). Statistically significant differences in perceived health

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according to levels of resilience (t (52) = 2.199, p = .032, 95% CI (-.85 - .04) and non-significant
differences according to levels of optimism and religiosity were found by independent samples
T-test. High resilient students rated their general health as better (M = 4.2; SD = .08) compared
with low resilient students (M = 3.4; SD = .07).

The conducted multiple hierarchical regression analysis found that perceived stress, optimism,
resilience and religiosity significantly predicted mental well-being (F (4,119) = 34.258, p < .001)
with small effect size (part correlation range: .18 - .27) explaining 53.7 % of the variance of the
dependent variable. (See Table 2).

Table 2.
Multiple Regression Model for Predicting Mental Well-Being by Perceived Stress, Optimism, Resilience
and Religiosity
DV IV B St. Error B β t
Mental well-being Constant 20.159 3.687 5.468***
Perceived stress -.176 .042 -.36 -4.24***
Optimism .339 .115 .241 2.961***
Resilience .222 .071 .235 3.113***
Religiosity .833 .071 .162 2.491**
Note. *p < .05. **p < .01. ***p < .001. DV- Dependent variable, IV- Independent variable

To check for any multicollinearity still existing in the model, variance inflation factors (VIF) for
each variable during analysis were calculated. The Durbin Watson value was close to 2,
tolerance (range: .54 – .89) and VIF (range: 1.07–1.84) did not indicate a multicollinearity and
autocorrelation problems in the regression model. Skewness and kurtosis values between +1.5
and –1.5 indicated that there is a normal distribution. Therefore, hypothesis 2 was supported for
the direct impact on mental well-being, but not on perceived health.

Further, hierarchical multiple analyses established the meditational role of perceived stress in
the relationship between resilience and psychological well-being, but not in the relationship
between optimism and mental well-being. As shown in Table 3, in the first step of verification,
resilience significantly predicted perceived stress (β = -.54, p < .001). In the second step of
verification, resilience significantly predicted mental well-being (β = .541, p < .001, 95% bias –
corrected bootstrap CI: 348-688) at an explanatory power of 29.3%. In the third step of
verification, when resilience and perceived stress were simultaneously incorporated into the
validation, the effect of resilience on mental well-being remained significant, although such
influence decreased (β =. 28, p < .05, 95% bias –corrected bootstrap CI: 123-410). The results
showed that perceived stress partially mediated the relationship between the resilience and the

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mental well-being, and the mediating effect was statistically significant (Sobel test Z = 3.58, p <
.001). Therefore, hypothesis 2 was supported for the indirect influence of resilience, but not for
optimism and religiosity.

Table 3.
Hierarchical Multiple Analysis of the Mediating Role of Perceived Stress Between Resilience and Mental
Well-Being Relationship
DV IV B St. Error B β t R² (adj. R²) F
PS Resilience -1.046 .148 -.540 -7.55** 291 (.286) 49.78***
MWB Resilience .513 .072 .541 7.076** 293 (.287) 50.074***
Resilience .265 .076 .280 3.506* .459 (.450) 50.815*
PS -.237 .039 -.484 -6.063*
Note. *p < .05. **p < .01. ***p < .001. DV- Dependent variable, IV- Independent variable, MWB - Mental well-being,
PS- Perceived stress

To establish the moderator effect of optimism, resilience and religiosity in the relationship
between perceived stress and mental well-being, three hierarchical regression analyses were
conducted. In the first step the centered variable perceived stress (predictor) was introduced,
followed by the centered values of potential moderator in the second step and the interaction
variable in the third step. The significant effect of the interaction of optimism with the level of
perceived stress on mental well-being (β = .183, p < .01) was found with small effect size (part
correlation = .158). The model was significant (F (2,121) = 30.410, p < .001, VIF = 1.329) and
explains 58% of the variation of the dependent variable. Optimism acted as a moderator of the
relationship between perceived stress and mental well-being, but resilience and religiosity did
not moderate that relation, as significant differences in the regression model were found only by
adding the variable of interaction of optimism with stress (sig. F change = .011). Thus,
hypothesis 3 was supported for optimism, but not for resilience and religiosity. The effects of
stress on the mental well-being depending on the optimism level are presented in Table 4. At
low levels of optimism, perceived stress had a statistically significant negative effect on the well-
being with large effect size (β = -.857, p = .000), but at high optimism the impact of stress on the
well-being had marginal p-value and the effect decreased (β = -.351, p = .049).

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Table 4.
Linear Regression Analysis of the Relationship Between Mental Well-Being and Perceived Stress in
Groups with High and Low Optimism

Optimism level B St. Error B β t p

Low optimism Constant 46.507 3.322 13.998 .000
Perceived stress -.495 .067 -.857 -7.422 .000
High optimism Constant 34.562 2.955 11.696 .000
Perceived stress -.168 .082 -.351 - 2.052 .049

Analyses found that there were significant differences in the mental well-being between
optimism level groups at high perceived stress (t (52) = 2.975, p = .013), high perceived danger
(t (32) = 4.07, p = .03) and low perceived control (t (21) = 2.15, p = .01). When stress was
perceived as more intense, high threatening and less controllable, the mental well-being of low
optimistic students was significantly lower than that of high optimistic students.

Discussion
The present study found that the mental well-being and perceived health of health professions
students depended on the level of perceived stress, and stress being perceived as high
decreases well-being and health evaluation. This was consistent with findings of other authors
regarding relationships between stress and well-being domains such as life satisfaction (Shi et
al., 2015), emotional, social and psychological well-being (He et al., 2018; Ribeiro et al., 2018;
Zaheer & Khan, 2022) and health (Teh et al., 2013).

Optimism and resilience were significantly associated with appraisals of stress as less intense,
less threatening, and more controllable which is in line with other studies with medical students
(Hassons et al., 2021; Heinen et al., 2017; Smith & Yang, 2017). The study found no
association of religiosity with perceived stress which is consistent with previous findings (Thao,
2020) but does not support others (Aftab et al., 2018; Maltby & Day, 2003). However, the
association of religiosity with stress perception in the cited studies has been referred to different
facets of religiosity. For example, an internal orientation in which religion is deeply personal to
the individual has been associated with appraisals of stress as low threat, whereas an external
orientation that emphasizes participation in religious social activities has been associated with
high loss and threat stress appraisals (Maltby & Day, 2003). This demonstrates the different
ways in which subjective overall religiosity and religious orientation are associated with stress
appraisals. Also, these results suggest that religiousness is not related to primary stress
appraisal in students, but this relationship may differ when examining other facets of religiosity.

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The conducted study showed that subjective level of religiosity positively predicted mental well-
being, but this relationship was not mediated by perceived stress. Other research also found
that perceptions of stress did not mediate the relationship between religious orientation and
psychological well-being (Maltby & Day, 2003). A literature review has pointed out that much of
the effect of religiosity on the well-being is mediated by other variables, such as meaning in life,
coping, social support, and emotion regulation (Kim-Prieto & Miller, 2018). Also, all aspects of
religiosity (such as religious beliefs, practices, and commitment) have been directly related to
the choice of positive or negative religious coping, which in turn determines subsequent health
outcomes and well-being during stress in medical students (Francis et al., 2019). A high level of
religiosity has determined the disposition toward positive religious coping. In turn, this type of
coping has been associated with appraisals of stress as a challenge that promotes personal
development and growth, and through this appraisal of stress, religious coping has enhanced
psychological well-being (Maltby, & Day, 2003). These results suggest that evaluation of stress
in terms of primary appraisal is not the cognitive mechanism through which overall religiosity
enhances students' psychological functioning, but it might be through other psychological
processes such as the choice of religious coping, for example.

Furthermore, the study found that religiosity did not protect psychological well-being from the
effects of stress. However, the moderating role of religiosity may depend on the type of stress.
For example, other authors have found that religiosity acted as a moderator of the association of
traumatic stress with students' mental health. Under conditions of traumatic stress, religiosity
was associated with positive reappraisal of stress, better mental health and posttraumatic
growth in university students (He et al., 2019). Under difficult life circumstances, religiosity has
reduced the effects of stress and has led to higher subjective well-being, but under regular
stress, religiosity did not have such a positive impact on the relationship between stress and life
satisfaction (Kim-Prieto & Miller, 2018).

According to findings, religiosity was not significantly associated with subjective perception of
physical health, which is not in line with another study among medical students (Alipoor et al.,
2016). The differences in the results may be due to the relative homogeneity of our non-clinical
sample in terms of health status. In addition, the self-rated health assessment likely resulted in
limited variability in individual outcomes, which may have influenced the obtained associations
of interest. Also, the sample of students in the study cited above were predominantly highly
religious, which is also due to the characteristics of their culture as highly valuing religiosity. An

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analytical review has stated that religiosity in the culture itself as the degree to which a culture
values religious belief or provides supports for the practice of religion, have moderated
religiosity and well-being relationship at an individual level (Kim-Prieto & Miller, 2018). For
example, religious culture, compared to secular culture, has been shown to enhance the impact
of religiosity on subjective well-being (Kim-Prieto & Miller, 2018) and has reduced the impact of
negative emotional experiences under stress on life satisfaction (Joshanloo, 2019).This
suggests that culture may moderate the relationships between religiosity and perceived health,
and in cultures where religious beliefs are more salient and strong, individual religiosity may be
more strongly related to positive self-assessment of health as well as reduce the effects of
stress on perceived health and well-being. This assumption might be further explored.

In contrast to religiosity, optimism acted as a buffer to the negative impact of intense, poorly
controllable and threatening stress on the mental well-being. Optimism predicted mental well-
being relative to high life satisfaction, positive affect, self-acceptance, autonomy, self-efficacy,
social belonging, and contribution to community, but not with the assessment of health. These
results partially corroborated findings that optimism positively predicted the mental and physical
well-being of students (Ramsay et al., 2013). The differences in the results may be due to the
way of measurement (perceived general health single question versus assessment of more
health dimensions) as well as to the specific characteristics of our study participants, specifically
their professional competence. Self-perception of general health represents both subjective and
objective aspects of health and is formed of respondent's information and knowledges, bodily
sensations and subjective evaluative attitudes (Kaplan & Baron-Epel, 2003). Furthermore,
general physical health can be viewed from the perspective of different assessment
approaches: biomedical, emotional and functional. For example, patients have evaluated their
health not as the presence of physical symptoms and dysfunctions, but as related to a general
sense of psychological vitality. In contrast, specialists have used traditional medical concepts
oriented towards disease (Kaplan & Baron-Epel, 2003). Moreover, one of the areas of
competence of health professionals relates to the application of evidence-based health
assessment. This implies that healthcare students apply a biomedical approach and have
developed such a precise and professional approach to assessing health, including their own
health. Perhaps the determinants of this cognitive process are their high health awareness,
professional knowledge and attitudes rather than personal predispositions such as optimism.

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According to the results, resilience was significantly associated with mental well-being and
positively predicted it. Also, it was associated with better perceived health without directly
predicting it. Other studies have also found that resilience predicted higher well-being in medical
students (Aboalshamat et al., 2018; Hassons et al., 2021; Riolli et al., 2012; Shi et al., 2015;
Smith & Yang, 2017) and positive perception of mental and physical health (Tempski et al.,
2015). Resilience increased well-being both directly and through its association with more
favorable stress appraisals. High resilience individuals' perception of stress as a challenge,
rather than a threat or loss, has increased positive emotions in a stressful situation (Kaczmarek,
2009). Positive emotions reduce the effects of stress on mental and somatic health, and might
explain the higher mental well-being and better perceived health in high resilient students.
Furthermore, the association of resilience with a triad of positive beliefs about self, the future,
and the stressful situation may be the cognitive mechanism that leads to positive perceptions of
well-being (Mak et al., 2011). In addition to relationship with high overall well-being, resilience
has been associated to learning and job satisfaction in medical professionals. Resilience was a
strong predictor for medical-school related quality of life, perception of the educational
environment, learning atmosphere, teachers and self-assessments for academic performance
(Tempski et al., 2015), more positive perception of the learning climate and acted as a
prtotective factor against burnout in medical students (Yu & Chae, 2020). According to that
impact of resilience, resilience building interventions are necessary to be implemented in
medical education. The development of resilience during training can be focused on three main
areas, namely: personal resilient qualities and behaviours, educational programmes and
transition (becoming a student and a part of medical team) (Walsh et al., 2020). There ara data
that some intervention such as couching programs, workshops and daily practices have
increased resilience of medical students and have help them maintain high mental and physical
well-being (Gheihman et al., 2021). Resilient qualities might be supported by educational
envinronment that is learner-centred and based on empowerment of students. Furthermore, an
application of some teaching and learning approaches as peer activities, reflective learning;
directed study, problem-based learning and experiential learning has promoted students
resilience also (Walsh et al., 2020).

Limitations of this study and recommendations for future directions

Several limitations of this study should be mentioned. First, only one cohort of medical students
from one medical school was studied. In addition, students were in different courses of study
and disproportionately distributed by gender, which do not allow to test the impact of gender and

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Mineva, Kremena 57

stage of training on stress and well-being. Second, it was proposed that experienced stress is
academic-related, but stress was measured as a general not to a specific type of stressor.
However, sources of stress may vary and affect well-being and health differently. Third, the data
relies on participants' self-perception and the study do not include objective measures of health.
The subjective assessment approach may distort the data obtained so that they do not
correspond to the objective states.

Given that the conducted study was cross-sectional, future studies could examine predictive
models of overall well-being by types of stress, gender, and year of training over the long term
during medical education. It would be appropriate to include spiritual well-being as a part of the
overall well-being. More research is needed to explore the underlying mechanism that ensure
positive impact of religiosity on mental well-being. It would be interesting to examine the
influence of other dimensions of religiosity on mental well-being and health, the mediating role
of religious coping and cognitive-emotional regulation in the religiosity and well-being relation ,
as well as the moderating role of stressor type and culture.

Conclusions
It can be concluded that stress negatively affects health professions students' mental well-being
and perception of general health. The study highlights that optimism, resilience and religiosity
contribute to high levels of students' positive functioning primarily in the mental health domain,
but not in the physical health domain as far as the subjective general physical health is
concerned. The positive effect of optimism and resilience on psychological functioning is related
to their associations with favorable stress appraisals and the buffering effect of optimism on
stress. The positive impact of subjective level of religiosity on mental well-being is unrelated to
how stress is perceived. Stress management programs, as well as appropriate interventions
and educational approaches to enhance resilience could be offered to health professions
students.

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Health Professions Students' Mental Well-Being 58

Funding/Financial Support
The author has no funding to report.

Other Support/Acknowledgement
The author has no support to report.

Competing Interests
The author has declared that no competing interests exist.

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About the Author

Kremena Mineva works as a chief assistant at the Medical Faculty of the Trakia University in
Bulgaria. Her main research interests are in the field of health and clinical psychology with a
focus on well-being and coping with stress in healthy people, as well as on illness perception
and psychosocial functioning in patients with chronic diseases.

Corresponding Author`s Address [TOP]

11 Armejska str.
6000, Stara Zagora
Bulgaria.
Email: kremena.mineva@trakia.uni-bg

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