Associations among stressors, perceived stress, and psychological distress in nursing students: a mixed methods longitudinal study of a Hong Kong sample
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Background: Nursing students are at risk for high-stress levels and psychological distress. Limited longitudinal studies have been conducted examining factors associated with stress levels and psychological distress of nursing students in their course of study. Purpose: The purpose of this study was to examine the levels of stress and corresponding stressors, particularly those predicting psychological distress, among nursing students over their 5 years of study. Methods: A longitudinal design, using questionnaires and focus group interviews of a single cohort of nursing students in Hong Kong and following them over their 5 years of training. The Stressors in Nursing Students Scale-Chinese version and the Chinese version of General Health Questionnaire-12 were used to assess stress levels and psychological distress, respectively. Results: Ninety-seven participants completed the questionnaires 5 times. Quantitative findings revealed that the overall stress levels of the nursing students increased over 5 years (from mean = 3.08 to 3.33), with the highest levels in the second wave (mean = 3.33). Nursing students experienced higher stress during years 2 ( p = 0.006) and 4 ( p = 0.037). Psychological distress was the highest in year 3 (sum score = 18.47) ( p = 0.002) but declined from year 4 ( p < 0.001). Thematic analysis revealed that academic performance issues, coping challenges, unfavorable learning environments, relationships were identified as the stressors. However, nursing students also used positive coping strategies to pursue success and seek support. Conclusion: This study suggests that the year of study is a significant predictor of stress levels among nursing students, especially during the first and senior years due to heavy academic workload. Psychological distress was observed among nursing students, and those who worked more part-time jobs tended to report higher levels of distress. The junior year was associated with higher levels of distress related to financial and time-related stress, while academic and personal problems were more prevalent during the senior year.
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High rates of distress may be attributed to the demanding nature of nursing education.
“These high rates of distress may be attributed to the inherently demanding nature of nursing education, which integrates rigorous theoretical coursework with intensive clinical practice [8].”
From Associations of psychological flexibility, mindfulness, and valued living with psychological distress among nursing students (2025) · cites this paper as [8]
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- Authors
- Cheng, W. L. S., Chow, P. P. K., Wong, F. M. F., & Ho, M. M.
- Affiliations
- Saint Francis University (HK)
- Tung Wah College (HK)
- University of Hong Kong (HK)
- Corresponding author
- Cheng, Winnie Lai Sheung
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2023-08-17
- Volume
- 14
- Pages
- 1234354-1234354
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC10469707
- OpenAlex
- W4385917653
- Cited by
- 34
- References
- 53
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 6 · 2023: 2
- FWCI
- 16.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- nursing students, perceived stress, psychological distress, stressors, academic workload, coping strategies, part-time work, financial stress, learning environment, peer relationships, Hong Kong
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