JMIR Publications

ABSTRACT

Background:

Resilience factors, such as self-esteem or social support, are known to reduce mental distress in the face of stress or adversity exposure. So far, knowledge on the promotive value of resilience factors over the time span from before to during and after the stress or adversity exposure is concerningly scarce. Such knowledge seems however important to eventually be able to leverage the most promising resilience factors at the right time. To shed light on this topic we designed the RESIST study, in which we assessed medical students (N=457) before, during and after their yearly exam period. Exam time is a period of notable stress in medical students and has been suggested to trigger mental health problems.

Objective:

Here we describe the study protocol and examine whether the exam period did indeed induced higher (di)stress.

Methods:

RESIST is a cohort-study in which exam stress functions as within-subject natural stress manipulation. In this manuscript we outline the sample, procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors and adversity) and ethical considerations. Moreover, we conducted a series of latent growth and bivariate latent change score models to analyse perceived stress and mental distress changes over the three time points.

Results:

We found that perceived stress and mental distress increased during exams compared to before exams, but decreased below pre-exam levels afterwards. Our findings further suggest that higher perceived stress before the exams may result in less recovery in mental distress after exams. Moreover, higher mental distress before the exams increased the chance of higher perceived stress during exams, which in turn increased the risk for a less successful (or quick) recovery of mental distress after exams.

Conclusions:

As expected, the exam period caused a temporary increase in (di)stress. Therefore, the RESIST study lends itself well to explore whether the promotive value of resilience factors changes from before to during and/or after stress exposure. Such knowledge will eventually help to find out which resilience factors lend themselves best as prevention and which as intervention targets for the mitigation of mental health problems that are triggered or accelerated by the stress exposure. Findings from the RESIST study may therefore inform student support services, mental health services and resilience theory.