Stressed Student
Hofstra Horizons Research

Identifying Stressors, Coping Strategies, and Utilization of Mental Health Support Services in Occupational Therapy Graduate Students

Robin Akselrud, OTD, OTR/L, Assistant Professor of Health Professions and Academic Fieldwork Coordinator,
Hofstra University
Occupational Therapy Program

Abstract

The purpose of this qualitative phenomenological study was to explore the impact of stress and coping strategies on students enrolled in a master’s level occupational therapy (OT) program in the northeast region of the United States. The study explored the use of on-campus mental health services and the differences in these factors between one Jewish women’s cohort and a traditional student cohort. Participants completed an information form and a semi-structured interview, followed by engagement in a focus group. All interviews were recorded and transcribed verbatim, and then coded and analyzed for categories and recurring themes. Three overarching themes emerged: (1) coping strategies matter, (2) priorities: school vs. family, and (3) mental health services utilization – suggesting that coping strategies are similar, priorities differ, and mental health services are not utilized among the participants.

Background

Graduate students face many forms of stress on a daily basis, which has an impact on their daily function and academic performance. Daily stressors include financial pressures, lack of effective coping skills, and meeting academic deadlines. Mental health surveys (American College Health Association, 2005) show that a large number of students drop out of college as a result of mental illness. Research studies also show that students’ level of stress affects their academic performance and GPA. Stress in graduate students can be positive or negative and can be attributed to both schoolwork and out-of-school responsibilities (Shields, 2001). Students are expected to juggle the stresses of completing reports and studying for tests, as well as meeting the needs of their significant others, spouses, and children. Aside from the stressors of being a student, students are overwhelmed by personal pressures related to finding a job or a spouse (Zivin, Eisenberg, Gollust, & Golberstein, 2009). Some students excel in their studies, despite family responsibilities and lack of social support; however, other students struggle within the same situation,
with or without fewer personal responsibilities. A decrease in social engagement often leads to poor self-esteem and disruption of healthy habits, routines, and roles (Misra, 2003).

Stress and Occupational Therapy Students

Stress is defined as the lack of ability to cope with a perceived threat to an individual’s mental, physical, emotional, and spiritual well-being, which often results in a series of physiological adaptations and responses (Seaward, 2016). Several studies have been conducted to investigate stress, coping, and social support with students of other disciplines (Walton, 2002), and Everly et al. (1994) surveyed occupational therapy students. These studies concluded that effective coping strategies are extremely important for students and that students have a high level of stress when enrolled in these educational programs.

Jewish Orthodox Women as College Students

Jewish Orthodox women traditionally have had roles as homemakers, mothers, teachers, and those who assist individuals in need in the community (Ringel, 2007). Nowadays, their roles have changed and expanded and many have chosen to attend college, earn a degree, and then balance a career and a family. Due to this group’s increased interest in obtaining an academic degree, many academic programs in highly populated Jewish Orthodox areas have created customized programs that address the specific needs of these groups of students.
Accommodations include scheduling classes around Jewish holidays, having all-female classes, having a separate refrigerator and microwave that are reserved for kosher food, designating a private room for nursing mothers, and not requiring students to wear pants or T-shirts during lab sections of courses, when hands-on techniques are taught to students. Because these changes in the roles of Jewish Orthodox women are recent, little research exists on this population’s needs and the relationship between religion and stress levels.

Significance to Occupational Therapy

Occupational therapists promote function and healthy living for people of all ages who have problems that interfere with daily living. Studying the causes of stress and effective and ineffective coping strategies may help educators promote success in occupational therapy students, providing them with stress management and coping strategies that will assist them in achieving their goals. A reduction in stress can improve their performance as students, spouses, parents, co-workers, friends, and community members. When working with the student population, as with all populations, it is important for educators to look at each student with a holistic approach. By identifying factors that affect students’ function, occupational therapy (OT) faculty can assist them with their individual educational needs.

Purpose of the Study

The purpose of this study is to better understand the perceived stress levels, stressors, role of religion, social supports, and out-of-school responsibilities among two groups of OT graduate students. The students who participated in this study were from two cohorts enrolled in a master’s-level OT program: a traditional group of students and a group of Jewish Orthodox female students. There is a lack of literature regarding the specific causes of stress in occupational therapy students; the coping methods that they utilize, including mental health services on campus; and whether religion and culture affect their stress, coping, and use of services. The results of this study will provide insight into these critical areas, as well as the extent to which they affect students and OT educators.

Results

Three themes emerged from the data obtained during the interviews and focus groups: (1) coping strategies matter,
(2) priorities: school vs. family, and
(3) mental health services utilization.

Coping Strategies Matter

Through semi-structured interviews, students in both cohorts discussed the importance of effective coping strategies for successful completion of the OT program. All participants, regardless of their point of study in the program, discussed the fact that they entered the program with ineffective or no coping strategies. The first semester was extremely stressful due to the academic demands of the course work, but also due to their lack of effective coping strategies. As they progressed toward the end of the first semester, all participants had established coping strategies that met their individual needs. All students in the Jewish cohort and three students in the traditional cohort discussed the positive impact of religion on their stress levels and coping abilities. Through prayer, the weekly Sabbath, and other rituals, students relayed that their stress levels decreased. All participants relied heavily on the physical and emotional support of their family, spouses, and friends throughout their studies.

PARTICIPANT DEMOGRAPHICS

Name

Gender

Religion

Marital/Relationship Status

Parental
Status

Employment Status

D. D.

F

Jewish Orthodox

Single, but dating

x

x

O. P.

F

Jewish Orthodox

Married

1 child

x

C. D.

F

Jewish Orthodox

Single, but dating

x

x

T. T.

F

Jewish Orthodox

Single

x

yes

E. M.

F

Jewish Orthodox

Married

x

x

J. K.

F

Catholic

In a relationship

x

x

M. D.

F

Catholic

Single

x

x

K. P.

F

Christian

Married

x

x

A. D.

F

Christian

Single

x

yes

N. R.

F

Spiritual

In a relationship

x

x

Priorities: School vs. Family

The Jewish cohort of students all discussed the emphasis in their religion on dating, marriage, and starting a family, while the traditional cohort emphasized academics and performance in the OT program as their top priority, unless there was a family emergency.

Mental Health Services Utilization

All participants in this study reported not utilizing on-campus mental health services but were aware that these services were available to them. As discussed by the students, they may not have used the services because of their individual effective coping strategies, fear of breach in confidentiality, conflicts with scheduling, and mental health stigma.

Implications for OT Students, Education, and/or Educators

The results of this study can aid in educating students on the importance of identifying and establishing individualized coping strategies before entry or upon entry to an OT graduate program. Through early identification, stress can be decreased and there can be improved academic success early in the program. This study also aids in understanding the needs of the Jewish Orthodox culture and the life priorities of this population while enrolled in an OT graduate program. Educators can best accommodate these students by understanding their life roles and responsibilities. The results of this study can also inform potential students about the demands of the program, and the need for social supports. Lastly, this study can educate educators on the need to familiarize students with the benefits and process of accessing on-campus mental health services, so that students will access them, if needed.

Limitations of the Study

Several limitations to this study should be noted; however, the biggest limitation in this study is the potential bias of the principal investigator, who identifies as a Jewish Orthodox woman. Other limitations include having a small sample size and having only female participants.

As the participants were randomly chosen, it was not possible to determine if this study included a representative sample. The students who participated were at different stages in the program when participating in the interviews; therefore, their feelings and perceptions may have differed due to the stressors and course work they were handling at the time.

Recommendations for Future Research

There were several areas related to this study that can direct future research, with the goal of acquiring evidence to guide practice. It would be helpful to explore students’ perceptions in a larger sample and with participants from other OT programs. This would be important, as their perspectives may differ based on their experiences, and may increase the generalizability of this study. It would also be beneficial to have participation by some male students, so that there is diversity in the findings, as gender roles are significantly different in the traditional Jewish Orthodox culture. Further, a study with a larger sample size will increase diversity both in gender and in the religion of participants. A study that explores the perceptions of specific groups of students with the same responsibilities but from different religious backgrounds, such as mothers, would give a better explanation of the feelings, perceptions, and specific needs of that group.

Conclusion

This study explored the perceived stressors, social supports, and coping strategies utilized by students in a master’s level occupational therapy (OT) program. The study also explored the effects of religion on stress levels, the student’s life priorities, and the utilization of on-campus mental health support services.

The study attempted to answer the question of whether students would have more success in completing a master’s level OT program if they had a better understanding of perceived stress, supports required, and priorities with regard to the program. The study also attempted to explore whether religion decreased the students’ stress levels and if mental health services were utilized, if needed. Students reported a high level of stress throughout the program, but especially during the first semester, when their coping strategies were not yet established. All students reported
having a decline in stress once they found coping strategies that were effective for their own needs. Most students reported that religion did in fact decrease their stress levels significantly and assisted them in coping with the demands of the program. All students relied heavily on their families and friends for support, and only two participants were able to keep their jobs while enrolled in the program. While the group of Jewish students described that their priorities while being in the program were to start a family, the traditional group of students reported that academics was always the priority for them, unless there was a family emergency. Mental health services both on and off campus were not utilized by any of the participants for various reasons, even when some participants reported that they were in need of this support.

References

  • American College Health Association. (2005). The American College Health Association National College Health Assessment (ACHA-NCHA), spring 2003 reference group report. Journal of American College Health, 53(5), 199.
  • Everly, J. S., Poff, D. W., Lamport, N., Hamant, C., & Alvey, G. (1994). Perceived stressors and coping strategies of occupational therapy students. American Journal of Occupational Therapy, 48(11), 1022-1028.
  • Misra, R., & McKean, M. (2000). College students’ academic stress and its relation to their anxiety, time management, and leisure satisfaction. American Journal of Health Studies, 16(1), 41.
  • Misra, R., Crist, M., & Burant, C. J. (2003). Relationships among life stress, social support, academic stressors, and reactions to stressors of international students in the United States. International Journal of Stress Management, 10(2), 137.
  • Ringel, S. (2007). Identity and gender roles of Orthodox Jewish women: Implications for social work practice. Smith College Studies in Social Work, 77(2-3), 25-44.
  • Seaward, B. L. (2016). Essentials of managing stress. Jones & Bartlett Publishers.
  • Shields, N. (2001). Stress, active coping, and academic performance among persisting and nonpersisting college students. Journal of Applied Biobehavioral Research, 6(2), 65-81.
  • Walton, R. L. (2002). A comparison of perceived stress levels and coping styles of junior and senior students in nursing and social work programs (doctoral dissertation, Marshall University, Huntington, WV).
  • Zivin, K., Eisenberg, D., Gollust, S. E., & Golberstein, E. (2009). Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders, 117(3), 180-185.

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