35
Análisis y Modicación de Conducta
2024, Vol. 50, Nº 183, 35-42
ISSN: 0211-7339
University students’ coping strategies in the face of
psychological distress
Estrategias de afrontamiento de los estudiantes
universitarios ante el malestar psicológico
Gabrieli Mariano
Sirlei Dallagnol
Degree in Psychology. FAG University Center. Brazil
Claudia Barbosa
PhD in Psychology. Unioeste. Brazil
Rafael Corrêa
PhD in Public Health and Health Education. Getúlio Vargas Foundation. – FGV. Brasil
Resumen
Introducción: El malestar psicológico se caracteriza por
un conjunto de signos y síntomas, así como por cualquier
tipo de reacción negativa ante acontecimientos estresantes
provocados por la vida cotidiana. Ante el malestar psicoló-
gico, las personas suelen desarrollar estrategias de afronta-
miento. Objetivo: Identicar las estrategias de afrontamien-
to utilizadas por estudiantes universitarios ante el malestar
psicológico. Metodología: Estudio cuantitativo, transversal
y descriptivo realizado a partir de una muestra aleatoria
estraticada proporcional y simple de 276 estudiantes ma-
triculados del 1º al 8º período del curso de medicina. Re-
sultados: La mayoría de los estudiantes presentó malestar
psicológico, 58,70%. Las estrategias de afrontamiento más
utilizadas fueron la evitación (10,48±5,09), el autocontrol
(10,20±3,78), la revalorización positiva (9,76±4,16) y la reso-
lución de problemas (9,58±4,12). Los estudiantes con ma-
lestar psicológico utilizaron las estrategias de afrontamien-
to de evitación-evitación (12,23±4,72; p=0,000) y acepta-
ción y responsabilidad (6,81±3,07; p=0,010), mientras que
aquellos sin malestar psicológico mostraron una mayor re-
solución de problemas (10,45±4,02; p=0,003) como estra-
tegia de afrontamiento. Conclusiones: Los estudiantes que
experimentan malestar psicológico desarrollan estrategias
de afrontamiento. Se sugieren investigaciones e interven-
ciones dirigidas a desarrollar estrategias de afrontamiento
ante el malestar psicológico.
PalabRas clave
Estudiantes universitários; Malestar psicológico; Estrate-
gias de afrontamiento.
abstRact
Introduction: Psychological distress is characterized
by a set of signs and symptoms, as well as any kind of
negative reaction to stressful events caused by everyday
life. In the face of psychological distress, people often
develop coping strategies. Objective: To identify the co-
ping strategies used by university students in the face
of psychological distress. Methodology: Quantitative,
cross-sectional and descriptive study carried out using a
stratied proportional and simple random sample of 276
students enrolled from the 1st to the 8th period of the
medicine course. Results: Most of the students presen-
ted psychological distress, 58.70%. The most frequently
used coping strategies were avoidance (10.48±5.09),
self-control (10.20±3.78), positive reappraisal (9.76±4.16)
and problem solving (9.58±4.12). Students with psycho-
logical distress used the coping strategies of avoidance-
avoidance (12.23±4.72, p=0.000) and acceptance and
responsibility (6.81±3.07, p=0.010), while those without
psychological distress showed greater problem-solving
(10.45±4.02, p=0.003) as a coping strategy. Conclusion:
Students who experience psychological distress develop
coping strategies. Research and interventions aimed at
developing coping strategies in the face of psychologi-
cal distress are suggested.
KeywoRds
University students; Psychological distress; Coping
strategies.
Correspondencia: Rafael Soares Corrêa. School of Public Policy and Government (EPPG). Getúlio Vargas Foundation. SGAN (Setor de Gran-
des Áreas Norte Quadra 602 - Módulos A, B e C - Asa Norte, 70830-051. Brasília, Federal District, Brazil. E-mail: rafael.correa@fgv.br
Recibido: 25/02/2024; aceptado: 14/05/2024
36 UNIVERSITY STUDENTS’ COPING STRATEGIES IN THE FACE OF PSYCHOLOGICAL DISTRESS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
Introduction
Psychological distress is characterized by
a set of signs and symptoms, such as anxie-
ty, neurasthenia, depression, suicidal idea-
tion, as well as any kind of negative reaction
to stressful events caused by everyday life. In
addition, people who suer from psycholo-
gical distress can show vital exhaustion, with
symptoms of irritability and demoralization
(Lima et al., 2016).
Among university students, between 15%
and 25% develop psychological distress, with
a higher percentage among medical students.
This high prevalence is due to various factors,
the most common being individual or external
demands, such as from the family, the institu-
tion (due to the exhausting workload), as well
as social demands on the new health profes-
sional who must face stressful situations ratio-
nally (Lima et al., 2016).
Faced with conditions of psychological dis-
tress, people often develop coping strategies
which can have both a positive and negative
impact on the decisions to be made in adver-
se situations, inuencing physical, mental, and
emotional health (Dias & Pais-Ribeiro, 2019).
Going to university is generally a desired
and planned situation with many expectations,
both on the part of the student and their close
family members. The whole process of prepara-
tion, the rst contacts with the institution and
with future colleagues, brings out the beliefs
that will accompany the student throughout
their academic life. However, it is important to
be prepared for the adversities that will arise
during the course, such as the study load and
the personal and interpersonal demands that
can contribute to the development of psycho-
logical distress (Azevedo, 2019).
One of the aspects that can be related to the
psychological suering of university students
is their life history together with the structure
of higher education, including the socio-histo-
rical conditions in which the individual is cons-
tituted (Xavier et al., 2008). In addition to the
stressful conicts during academic life, in this
phase of youth there are various transforma-
tions and changes relating to the biological,
psychological, and social aspects that are part
of the reality of this age group (Bastos et al.,
2019).
In addition, there are complex changes at
this stage when the individual enters univer-
sity, which can be considered a period of great
vulnerability, presenting various biopsychoso-
cial transformations (Papalia & Feldman, 2013).
When university students enter higher educa-
tion, they meet and experience new conicts
in a social space that is considered dierent, a
new universe full of rules, methodologies and
unknown people who have other cultural and
social values. Consequently, it is often neces-
sary to form new habits, and, as a result, their
identity is transformed, a process of abundant
idealizations, anxieties and conicts (Bastos et
al., 2019).
What’s more, this phase of a university
student’s life is not just a brief transition, as im-
portant changes are taking place and life deci-
sions are being made. For most young people,
it is therefore considered a time to satisfacto-
rily form problem-solving strategies. However,
it can represent a period of coping failures, lea-
37
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Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
ding to not only physical but also emotional
symptoms (Bastos et al., 2019).
It is important to evaluate the transforma-
tions in terms of the human being who is fa-
ced with pain and suering that can arouse
feelings and intrusive thoughts of impotence
and incapacity, thoughts that can be recurrent
and violent, causing emotional discomfort and
psychological suering (Pereira, 2014).
In the same context, studies show that
university students can reect stressors from
everyday life in their student life, which can tri-
gger a series of mental health imbalances. This
leads to physical exhaustion and, above all,
emotional exhaustion, thus aecting quality
of life, academic performance, social, physical,
and psychological relationships (Vieira et al.,
2021).
During their time at university, the authors
highlight some of the prevalent factors for
emotional distress, such as diculty adapting
to a new routine, living away from family, cri-
sis in interpersonal relationships, excessive
workload, nancial diculties, insecurity, lack
of time and the inability to reconcile personal
and social life, work, and study. It is worth no-
ting that mental suering can set in if univer-
sity students are unable to cope with stressful
events and do not use coping strategies to mi-
nimize or resolve the events (Vieira et al., 2021).
The study therefore highlights the impor-
tance of identifying which coping strategies
university students use in the face of psycholo-
gical distress. The same authors state that only
intentional and conscious attempts can be
considered coping strategies, given that every
coping process aims to improve quality of life
by adjusting and reducing stress, psychologi-
cal, physical, and emotional pressure, which
trigger psychological suering (Morero et al.,
2018).
Coping strategies can be classied into two
categories: the rst focuses on the problem,
while the second targets emotions. It is pos-
sible that the two are related, since one seeks
to identify the problem and get rid of it, while
the other seeks to reduce the anxiety caused
by the stressor. This poorly established rela-
tionship can expose the subject to substance
abuse, psychopathological conditions and
recurrence of suicidal thoughts and ideation,
thus increasing risk situations and psychologi-
cal vulnerabilities (Morero et al., 2018).
Therefore, it is understood that identifying
psychological distress and the coping strate-
gies used by university students in the acade-
mic sphere is important, since the use of this
information can contribute to future interven-
tions in this context, helping to minimize the
eects of stressors and prevent worsening.
Methods
The research is characterized as a quantita-
tive, cross-sectional and descriptive study. The
study followed ethical procedures with human
beings (CAAE 54266021.6.0000.5219) and the
Strengthening the Reporting of Observational
Studies in Epidemiology - STROBE protocol.
The total number of students enrolled in
the medical course in 2022 was 1284. Thus, to
make the sample economically viable, strati-
ed and proportional sampling was used with
students from the 1st to the 8th period of the
38 UNIVERSITY STUDENTS’ COPING STRATEGIES IN THE FACE OF PSYCHOLOGICAL DISTRESS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
medicine course (n=920), and the nal sample
consisted of 276 participants.
Based on the list of the number of students
per term previously provided by the Medicine
Course coordinators, contact was made with
the participants for data collection by means
of a rapport Data was collected using two
questionnaires. The rst was the Self Reporting
Questionnaire (SRQ-20). According to (Santos
et al., 2011), the instrument was developed by
the World Health Organization (WHO) with the
aim of assessing mental disorders in develo-
ped countries (WHO, 1994).
The SRQ-20 was validated in Brazil by Mari
& Williams (Mari & Williams, 1986). The scale is
made up of 20 dichotomous questions with
yes or no answers, with the aim of identifying
symptoms of mental health risk and acting
as a screening, i.e. measuring whether or not
psychiatric morbidity is present (Lima & Brito,
2018). Of the 20 questions, 4 assess physical
symptoms and 16 psycho-emotional altera-
tions; in addition, scores ≥ 7 (greater than or
equal to seven) indicate psychological distress.
The instrument has a Cronbach’s alpha of 0.80
(Santos et al., 2011).
The other instrument, called the Inventory
of Coping Strategies (IEC) (Folkman & Lazarus,
1988), was adapted and validated in Brazil by
Savóia (Savóia et al., 1996). The IEC is an in-
ventory made up of 66 items covering actions
and thoughts that individuals use to cope
with the demands of a specic stressful event.
Each item in the inventory has four response
options from zero to three, on a 4-point Likert
scale: 0-”I haven’t used this strategy”; 1-”I’ve
used it a little”; 2-”I’ve used it a lot”; and 3-”I’ve
used it a lot”. The inventory is also divided into
eight factors: confrontation (6,7,17,28,34,46),
withdrawal (12,13,15,21,41,44), self-con-
trol (10,14,35,43,54,62,63), social support
(8,18,22,31, 42,45), acceptance of respon-
sibility (9,25,29,51), escape and avoidance
(11,16,33,40,47,50,58,59), problem solving
(1,26,39,48,49,52) and positive reappraisal
(20,23,30,36,38,56,60) (Savóia et al., 1996). The
instrument has a Cronbach’s alpha of 0.90 (Fet-
sch et al., 2016).
Once the data had been collected, a data-
base was created using the Excel for Windows
program, with independent typing, and the
data was analyzed using descriptive statistics
(frequency, percentage, mean and standard
deviation) for the general population as a who-
le and by gender. The data was exported for
analysis using the Statistical Package for the
Social Sciences (SPSS) version 27.0. The t-test
was used to analyze the relationship between
the variables, with p<0.05 considered.
Results and discussions
Table 1 shows the distribution of psycho-
logical distress by medical course cycle. It was
found that 52.54% (n=145) were enrolled in
the basic cycle (1- 4 periods); of these, 21.38%
(59) were male and 31.16% (86) female. In the
clinical cycle (5-8 periods), 47.46% (n=131) of
participants were identied; of these, 10.51%
(29) were male and 36.95% (102) female.
About psychological distress by cycle,
41.3% (114) of the participants did not expe-
rience psychological distress; of these, 23.91%
(n=66) were from the basic cycle and 17.39%
39
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Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
(n=48) from the clinical cycle. However, 58.70%
(n=162) of the participants showed psycho-
logical distress; of these, 28.63% (n=79) were
from the basic cycle and 30.07% (n=83) from
the clinical cycle. In both cycles with suering,
females had a higher percentage, with 20.66%
(n=57) in the basic cycle and 24.27% (n=67) in
the clinical cycle.
Table 2 shows the distribution of coping
strategies used by medical students. It was
found that all the participants used coping
strategies. The coping strategy factors with the
highest means were avoidance (10.48±5.09),
self-control (10.20±3.78), positive reappraisal
(9.76±4.16) and problem solving (9.58±4.12).
Females showed greater coping strate-
gies in the factors Withdrawal (7.40±3.62),
Social support (9.48±4.52), Escape and avoi-
dance (11.02±4.85) and Positive reappraisal
(10.10±4.00).
Table 3 shows the relationship between
psychological distress and the coping strate-
gies used by medical students. Students who
experience psychological distress use coping
strategies such as avoidance (12.23±4.72,
p= 0.000) and acceptance of responsibili-
ty (6.81±3.07, p= 0.010). However, students
Variables Total % (n) Male % (n) Female % (n)
Course period 100 (276) 31.88 (88) 68.11 (188)
Basic cycle (1-4 period) 52.54 (145) 21.38 (59) 31.16 (86)
Clinical cycle (5-8 period) 47.46 (131) 10.51 (29) 36.95 (102)
No psychological distress 41.3 (114) 17.98 (50) 23.02 (64)
Basic cycle (1-4 period) 23.91 (66) 13.40 (37) 10.50 (29)
Clinical cycle (5-8 period) 17.39 (48) 4.71 (13) 12.68 (35)
With psychological distress 58.70 (162) 13.77 (38) 44.93 (124)
Basic cycle (1-4 period) 28.63 (79) 7.97 (22) 20.66 (57)
Clinical cycle (5-8 period) 30.07 (83) 5.80 (16) 24.27 (67)
Table 1
Distribution of psychological distress by medical course cycle, total and by Gender.
n= sample.
Variables Total Male Female
M±DP M±DP M±DP
Confrontation 6.56±3.00 6.28±2.90 6.69±3.05
Detachment 7.15±3.75 6.61±4.00 7.40±3.62
Self-control 10.20±3.78 9.88±3.80 10.35±3.77
Social support 8.93±4.54 7.77±4.39 9.48±4.52
Acceptance of responsibility 6.39±3.25 6.05±3.53 6.55±3.10
Escape-esque 10.48±5.09 9.33±5.43 11.02±4.85
Problem solving 9.58±4.12 9.68±4.12 9.53±4.13
Positive reappraisal 9.76±4.16 9.06±4.42 10.10 ±4.00
Table 2
Distribution of coping strategies used by medical students, total and by gender.
M- Mean, SD- Standard Deviation, IEC- Coping Strategies Inventory.
40 UNIVERSITY STUDENTS’ COPING STRATEGIES IN THE FACE OF PSYCHOLOGICAL DISTRESS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
without psychological distress used the pro-
blem-solving coping strategy (10.45±4.02,
p=0.003).
University students in the basic and clinical
cycle of the medical course suer from psycho-
logical distress. Psychological distress or com-
mon mental disorders include anxiety, stress,
and depression; these are considered a public
health problem in Brazil and worldwide (Mur-
cho et al., 2016).
The highest prevalence of psychological
distress in the clinical cycle of the medical
course has been identied as the clinical cycle
with a similar risk, as it deals with the practical
part of the degree, putting the student face to
face with the reality of the profession (Lima &
Brito, 2018). During this period there are a sum
of factors that inuence academic performan-
ce and well-being, which contribute to psycho-
logical distress (Azevedo, 2019).
Women showed greater psychological dis-
tress in both cycles. This result may be related
to the large number of activities carried out by
women in society, as well as hormonal issues
and mood swings (Lima & Brito, 2018).
Faced with the conditions of suering pre-
sented in this study, the coping strategies of
avoidance-avoidance stand out as being the
most used by students with psychological su-
ering. The avoidance-avoidance attitude is
the way that human beings seek to respond
to situations that require solutions, even if this
attitude does not have the response of modi-
fying the action that causes them discomfort
or suering, by avoiding or even withdrawing
when they perceive a dicult situation. Thus,
avoidance is an emotion-driven strategy,
which becomes negative as it prevents the in-
dividual from seeking help (Trindade & Vieira,
2013).
Another coping strategy identied in the
study was the strategy of accepting respon-
sibility, which was prevalent among students
with psychological distress. Acceptance of res-
ponsibility occurs when the person is faced
with a situation of incapacity and seeks help,
Coping strategies No suering With suering
M±DP p M±DP p
Confrontation 6.45±3.15 0.597 6.64±2.91 0.602
Detachment 6.96±3.51 0.476 7.28±3.92 0.468
Self-control 10.07±3.85 0.642 10.29±3.74 0.644
Social support 8.89±4.37 0.903 8.96±4.67 0.902
Acceptance of responsibility 5.68±3.41 0.009 6.81±3.07 0.010
Escape-esque 7.98±4.55 0.000 12.23±4.72 0.000
Problem solving 10.45±4.02 0.003 8.97±4.10 0.003
Positive reappraisal 10.30±4.34 0.074 9.39±3.99 0.078
Table 3
Relationship between psychological distress and coping strategies used by medical students.
M= mean; SD=standard deviation.
p<0.05
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Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
assumes their own limitations, does not run
away, remains even if they do not know the so-
lution now, in other words, they put into prac-
tice their ability to deal with a stressful situa-
tion (Trindade & Vieira, 2013).
Furthermore, it was found that students
who did not suer from psychological distress
used the coping strategy of problem-solving.
Problem-solving is characterized by the ability
to organize oneself in a reasonable and appro-
priate way when faced with adverse situations
(Cintra Damião et al., 2009). This coping strate-
gy is the ability to reect, help, seek help and
relieve undesirable eects of stress; in addi-
tion, the authors mention that this strategy
depends on various individual resources, such
as beliefs, culture, skills, social and family sup-
port and material resources (Trindade & Vieira,
2013).
Final considerations
The study conrms that undergraduate me-
dical students experience psychological dis-
tress and use the coping strategies of avoidan-
ce and acceptance of responsibility. However,
university students who do not have this con-
dition use the problem-solving strategy. Re-
search and interventions aimed at developing
coping strategies in the face of psychological
distress are suggested.
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