Relationship Between Stress Factors and Occupational Engagement Among Occupational Therapy Graduate Students

PURPOSE: The purpose of this study is to understand what common stress factors are perceived by graduate students and whether there is a need to develop a course to emphasize stress coping strategies so students are able to incorporate skills in internship and clinical practice.

BACKGROUND: In the past 10 years, there has been an increase in the percentage of college students who report being frequently overwhelmed. Studies have shown that 75% to 80% of college students demonstrated moderate stress and 10% to 12% were severely stressed. Studies conducted among medical students have shown that perceived stress levels have detrimental effects on their academic performance, physical health, and psychological well-being. Female students tend to perceive more stress than male students.

In occupational therapy (OT), a female-dominant profession, common stress factors perceived by graduate students remain unclear. OT graduate students are expected to cope with stress during the intensive academic program, and yet little is known about how stress factors influence their daily lives. Students who do not have proper stress management and adaptive skills may experience psychological distress such as anxiety or depression, while others may engage in unhealthy risk-taking behaviors, such as substance use and binge eating disorders. Thus, this study is intended to provide an understanding of perceived stress levels and to identify common stress factors among OT graduate students. Moreover, the relationship between stress factors and occupational engagements was examined.

DESIGN: This is a survey study, and two standardized assessments were used: the Stress Profile and the Engagement in Meaningful Activities Survey (EMAS). The Stress Profile is a 123-item standardized assessment that measures total stress levels along with 15 stress factors, such as lifestyle, personality, social network, and cognitive coping skills. The EMAS is a 12-item questionnaire in which higher scores indicate having higher levels of engagement in meaningful activities; reliability and validity have been established.

METHOD: Flyers and online media were used for recruitment. Students were scheduled a 1-hr meeting time to complete the surveys. Seventy-two OT graduate students participated in the study. The majority of the participants were women (87.5%), and more than half were working part time (55%). Descriptive statistics were used to examine the stress factors and levels of occupational engagements on the EMAS. Pearson’s correlation was calculated to explore the relationship between stress factors and occupational engagement.

RESULTS: The majority of the participants were moderately stressed (79%). However, 80% of them were able to maintain high meaningful occupational engagement, whereas 3% of them were not able to sustain meaningful occupational engagement due to perceived severe stress levels. The most commonly identified stress factors included overall perceived stress, Type A behavior, negative appraisal, and behaviors related to the use of alcohol, recreational drugs, and cigarettes. Pearson’s correlation showed that there were several protecting factors to maintain meaningful engagement, which included having healthy habits (r = .31, p < .01), routine exercise (r = .29, p = .013), proper eating and nutrition (r = .35, p = .003), social support network (r = .25, p = .033), and positive appraisal (r = .36, p = .002). Results revealed a significant negative impact on occupational engagement (EMAS) when overall perceived stress was high (r = –.37, p = .001).

CONCLUSION: This study illustrates the importance of engagement in meaningful activities in achieving occupational balance and coping with stress among OT graduate students. As practitioners, it is a cornerstone of practice that we are promoting well-being and providing opportunities for engagement in meaningful activities. Thus, students must learn the skills while in school so they can transfer them later in practice. The preliminary results suggest that graduate students need to strive for implementing protective factors for better stress management while pursuing their occupational therapy degree. Future research needs to focus on assisting students who present as severely stressed or unable to engage in meaningful activities by providing consultation services or stress management courses because occupational therapists must recognize stress in themselves and their clients in order to achieve the most effective therapeutic outcomes and personal life balance.