Stress, mental health, and protective factors in nursing students: An observational study

Background: Nursing students suffer high levels of stress, especially in the first year. Objectives: to compare academic stress at the beginning and end of nursing studies; to analyse the relationships between academic stress, mental health, and protective factors; and to examine whether resilience mitigates the effect of academic stress on psychological well-being. Design: A cross-sectional study. Setting and participants: Sample was 370 first- and fourth-year nursing students from Spain (University of CastillaLa Mancha, University of Cantabria, and University of Sevilla). Variables and data collection: We assessed academic and clinical stress, coping skills, anxiety, depression, psychological well-being, and resilience were measured. Data analysis: We performed a descriptive analysis of the study sample, as well as correlation and hierarchical regression models. Additionally, mediation models were estimated. Results: First-year students presented higher academic stress than fourth-year students. Clinical stress, anxiety, depression, and emotional coping predicted academic stress, while academic stress, depression, and coping skills predicted psychological well-being. Mediation models showed a significant path between academic stress, resilience, depression, and psychological well-being. Conclusion: Academic stress has a detrimental effect on the mental health. Coping strategies and resilience may be protective factors that should be encouraged in interventions designed to improve psychological well-being.