Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Design
- Phase 1: Five consecutive days (Mon–Fri, in March) ten weeks before the final exam constituted phase 1. During this week, students attended compulsory classes for a total of 24 h.
- Phase 2: The Tuesdays in the four weeks before the exam (the last of these Tuesdays being the day before the exam, in June) and the exam day constituted phase 2.
- Phase 3 included the eleven days (Thur–Sun) following the exam in July. During phases 2 and 3, no compulsory classes took place.
2.3. Variables
2.3.1. Independent Variable—Study Duration
2.3.2. Control Variables
- Sleep duration of the preceding night (self-reported) was included to control for present-day sleepiness.
- Proximity to exam (i.e., the number of days preceding or following the exam, based on the time stamp in the online tool) was included to control for variations in students’ changes in examination stress throughout the term.
- The previous day’s compulsory classes (yes/no, based on class schedule) and the previous day’s paid work (yes/no, self-report) were included to control for changes in the ability to control one’s study schedule because of other responsibilities.
- Time of questionnaire completion (based on the time stamp in the online tool) was included to control for strain-related effects of the circadian rhythm.
- Additionally, gender (self-report) was included.
2.3.3. Dependent Variables
- Fatigue was assessed with eight adjectives (e.g., “tired”) and had a scale reliability (Cronbach’s Alpha) of CA = 0.91.
- Vigor was assessed with seven adjectives (e.g., “full of energy”) with a scale reliability of CA = 0.94.
- Distress was assessed with five adjectives (e.g., “nervous”) and had a scale reliability of CA = 0.85.
2.4. Data Analysis
2.4.1. Descriptive Statistics
2.4.2. Hypotheses Testing
2.4.3. Transformation
2.5. Data Selection
- One individual was not included due to employed work of more than 20 h per week, which was against the recommendation for studying in the full-time program.
- The data from three students were excluded because the time stamp revealed that they self-rated their daily subjective strain “on bulk” for several days at the end of each phase instead of completing the questionnaire each day, as instructed.
- The data of six students were excluded because they were not compliant with the instruction to complete the rating as close to 18:00 as possible. Completing the rating after 22:00 or before 14:00 was arbitrarily defined as non-compliant.
3. Results
3.1. Descriptive Statistics
3.2. How Do Short Work Periods of Mentally Highly Demanding Work Impact Strain Reactions in Students Preparing for an Exam?
3.2.1. Fatigue (Hypothesis One)
3.2.2. Vigor (Hypothesis Two)
3.2.3. Distress (Hypothesis Three)
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Wirtz, A.; Nachreiner, F. The effects of extended working hours on health and social well-being—A comparative analysis of four independent samples. Chronobiol. Int. 2010, 27, 1124–1134. [Google Scholar] [CrossRef] [PubMed]
- Lavine, R.A.; Sibert, J.L.; Gokturk, M.; Dickens, B. Eye-tracking measures and human performance in a vigilance task. Aviat. Space Environ. Med. 2002, 73, 367–372. [Google Scholar] [PubMed]
- Hülsheger, U.R. From dawn till dusk: Shedding light on the recovery process by investigating daily change patterns in fatigue. J. Appl. Psychol. 2016, 101, 905–914. [Google Scholar] [CrossRef] [PubMed]
- Akerstedt, T.; Fredlund, P.; Gillberg, M.; Jansson, B. Work load and work hours in relation to disturbed sleep and fatigue in a large representative sample. J. Psychosom. Res. 2002, 53, 585–588. [Google Scholar] [CrossRef] [PubMed]
- Soliani, R.; Bueno, L. Occupational health and safety in the brazilian sector of cargo transportation: A systematic review on the category of self-employed drivers. In Studies in Systems, Decision and Control; Springer: Cham, Switzerland, 2022; Volume 406, pp. 613–620. [Google Scholar]
- Murphy, L.; Denis, R.; Ward, C.P.; Tartar, J.L. Academic stress differentially influences perceived stress, salivary cortisol, and immunoglobulin-a in undergraduate students. Stress 2010, 13, 365–370. [Google Scholar] [CrossRef] [PubMed]
- Park, J.; Kim, Y.; Chung, H.K.; Hisanaga, N. Long working hours and subjective fatigue symptoms. Ind. Health 2001, 39, 250–254. [Google Scholar] [CrossRef]
- Jansen, N.W.H.; Kant, I.; van Amelsvoort, L.G.P.M.; Nijhuis, F.J.N.; van den Brandt, P. Need for recovery from work: Evaluating short-term effects of working hours, patterns and schedules. Ergonomics 2003, 46, 664–680. [Google Scholar] [CrossRef]
- Josten, E.J.; Ng, A.T.J.E.; Thierry, H. The effects of extended workdays on fatigue, health, performance and satisfaction in nursing. J. Adv. Nurs. 2003, 44, 643–652. [Google Scholar] [CrossRef]
- Meijman, T.F.; Mulder, G. Psychological aspects of workload. In Handbook of Work and Organizational Psychology; Drenth, P.J.D., Thierry, H., Eds.; Psychology Press: Hove, UK, 1998; Volume 2, pp. 5–33. [Google Scholar]
- Kurzban, R.; Duckworth, A.; Kable, J.W.; Myers, J. An opportunity cost model of subjective effort and task performance. Behav. Brain Sci. 2013, 36, 661–679. [Google Scholar] [CrossRef] [Green Version]
- Dora, J.; van Hooff, M.; Geurts, S.; Kompier, M.; Bijleveld, E. The effect of opportunity costs on mental fatigue in labor/leisure trade-offs. J. Exp. Psychol. Gen. 2022, 151, 695–710. [Google Scholar] [CrossRef]
- Dienstbier, R.A. Arousal and physiological toughness: Implications for mental and physical health. Psychol. Rev. 1989, 96, 84–100. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Geurts, S.A.E.; Sonnentag, S. Recovery as an explanatory mechanism in the relation between acute stress reactions and chronic health impairment. Scand. J. Work. Environ. Health 2006, 32, 482–492. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Seery, M.D.; Holman, E.A.; Silver, R.C. Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience. J. Pers. Soc. Psychol. 2010, 99, 1025–1041. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ibrahim, A.K.; Kelly, S.J.; Adams, C.E.; Glazebrook, C. A systematic review of studies of depression prevalence in university students. J. Psychiatr. Res. 2013, 47, 391–400. [Google Scholar] [CrossRef]
- Lane, A.; McGrath, J.; Cleary, E.; Guerandel, A.; Malone, K.M. Worried, weary and worn out: Mixed-method study of stress and well-being in final-year medical students. BMJ Open 2020, 10, e040245. [Google Scholar] [CrossRef]
- Othman, N.; Ahmad, F.; El Morr, C.; Ritvo, P. Perceived impact of contextual determinants on depression, anxiety and stress: A survey with university students. Int. J. Ment. Health Syst. 2019, 13, 17. [Google Scholar] [CrossRef] [Green Version]
- Sonmez, Y.; Akdemir, M.; Meydanlioglu, A.; Aktekin, M.R. Psychological distress, depression, and anxiety in nursing students: A longitudinal study. Healthcare 2023, 11, 636. [Google Scholar] [CrossRef]
- Pelzer, A.; Sapalidis, A.; Rabkow, N.; Pukas, L.; Günther, N.; Watzke, S. Does medical school cause depression or do medical students already begin their studies depressed? A longitudinal study over the first semester about depression and influencing factors. GMS J. Med. Educ. 2022, 39, 1–21. [Google Scholar]
- Matthews, G.; Desmond, P.A. Task-induced fatigue states and simulated driving performance. Q. J. Exp. Psychol. Sect. A Hum. Exp. Psychol. 2002, 55, 659–686. [Google Scholar] [CrossRef]
- Hopstaken, J.F. A multifaceted investigation of the link between mental fatigue and task disengagement. Psychophysiology 2015, 52, 305–315. [Google Scholar] [CrossRef]
- Hockey, G.R.J.; Earle, F. Control over the scheduling of simulated office work reduces the impact of workload on mental fatigue and task performance. J. Exp. Psychol.-Appl. 2006, 12, 50–65. [Google Scholar] [CrossRef] [PubMed]
- Janssen, N.; Nijhuis, F.J. Associations between positive changes in perceived work characteristics and changes in fatigue. J. Occup. Environ. Med. 2004, 46, 866–875. [Google Scholar] [CrossRef] [PubMed]
- Wright, R.A.; Patrick, B.M.; Thomas, C.; Barreto, P. When fatigue promotes striving: Confirmation that success importance moderates resource depletion influence on effort-related cardiovascular response. Biol. Psychol. 2013, 93, 316–324. [Google Scholar] [CrossRef]
- Hockey, G.R.J. Compensatory control in the regulation of human performance under stress and high workload: A cognitive-energetical framework. Biol. Psychol. 1997, 45, 73–93. [Google Scholar] [CrossRef] [PubMed]
- Stetler, C.A.; Guinn, V. Cumulative cortisol exposure increases during the academic term: Links to performance-related and social-evaluative stressors. Psychoneuroendocrinology 2020, 114, 104584. [Google Scholar] [CrossRef]
- Koudela-Hamila, S.; Santangelo, P.S.; Ebner-Priemer, U.W.; Schlotz, W. Under which circumstances does academic workload lead to stress? Explaining intraindividual differences by using the cortisol-awakening response as a moderator. J. Psychophysiol. 2022, 36, 188–197. [Google Scholar] [CrossRef]
- Medical subject headings (mesh). In PubMed; National Library of Medicine: Bethesda, MD, USA, 2013.
- Thayer, R.E. Toward a psychological theory of multidimensional activation (arousal). Motiv. Emot. 1978, 2, 1–34. [Google Scholar] [CrossRef]
- Van Dongen, H.P.A.; Maislin, G.; Mullington, J.M.; Dinges, D.F. The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003, 26, 117–126. [Google Scholar] [CrossRef]
- Garett, R.; Liu, S.; Young, S.D. A longitudinal analysis of stress among incoming college freshmen. J. Am. Coll. Health 2017, 65, 331–338. [Google Scholar] [CrossRef]
- Blasche, G.; Zilic, J.; Frischenschlager, O. Task-related increases in fatigue predict recovery time after academic stress. J. Occup. Health 2016, 58, 89–95. [Google Scholar] [CrossRef] [Green Version]
- Monk, T.H. Subjective ratings of sleepiness—The underlying circadian mechanisms. Sleep 1987, 10, 343–353. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kraemer, S.; Danker-Hopfe, H.; Dorn, H.; Schmidt, A.; Ehlert, I.; Herrmann, W.M. Time-of-day variations of indicators of attention: Performance, physiologic parameters, and self-assessment of sleepiness. Biol. Psychiatry 2000, 48, 1069–1080. [Google Scholar] [CrossRef] [PubMed]
- Shapiro, C.M.; Flanigan, M.; Fleming, J.A.; Morehouse, R.; Moscovitch, A.; Plamondon, J.; Reinish, L.; Devins, G.M. Development of an adjective checklist to measure five faces of fatigue and sleepiness. Data from a national survey of insomniacs. J. Psychosom. Res. 2002, 52, 467–473. [Google Scholar] [CrossRef]
- Nitsch, J. Personal state scale—A hierarchical-multidimensional procedure to assess well-being. In Beanspruchung im Sport; Nitsch, J.R., Udris, I., Eds.; Limpert: Bad Hombug v.d.Höhe, Germany, 1976; pp. 81–102. [Google Scholar]
- Homish, G.G.; Edwards, E.P.; Eiden, R.D.; Leonard, K.E. Analyzing family data: A gee approach for substance use researchers. Addict. Behav. 2010, 35, 558–563. [Google Scholar] [CrossRef] [Green Version]
- de Melo, M.B.; Daldegan-Bueno, D.; Menezes Oliveira, M.G.; de Souza, A.L. Beyond anova and manova for repeated measures: Advantages of generalized estimated equations and generalized linear mixed models and its use in neuroscience research. Eur. J. Neurosci. 2022, 56, 6089–6098. [Google Scholar] [CrossRef] [PubMed]
- Deinzer, R.; Kleineidam, C.; Stiller-Winkler, R.; Idel, H.; Bachg, D. Prolonged reduction of salivary immunoglobulin a (siga) after a major academic exam. Int. J. Psychophysiol. 2000, 37, 219–232. [Google Scholar] [CrossRef]
- Robotham, D.; Julian, C. Stress and the higher education student: A critical review of the literature. J. Furth. High. Educ. 2006, 30, 107–117. [Google Scholar] [CrossRef]
- Schiller, H.; Lekander, M.; Rajaleid, K.; Hellgren, C.; Åkerstedt, T.; Barck-Holst, P.; Kecklund, G. The impact of reduced worktime on sleep and perceived stress—A group randomized intervention study using diary data. Scand. J. Work Environ. Health 2017, 43, 109–116. [Google Scholar] [CrossRef] [Green Version]
- Steptoe, A.; Wardle, J.; Lipsey, Z.; Mills, R.; Oliver, G.; Jarvis, M.; Kirschbaum, C. A longitudinal study of work load and variations in psychological well- being, cortisol, smoking, and alcohol consumption. Ann. Behav. Med. 1998, 20, 84–91. [Google Scholar] [CrossRef]
- Virtanen, M.; Ferrie, J.E.; Singh-Manoux, A.; Shipley, M.J.; Stansfeld, S.A.; Marmot, M.G.; Ahola, K.; Vahtera, J.; Kivimaki, M. Long working hours and symptoms of anxiety and depression: A 5-year follow-up of the whitehall ii study. Psychol. Med. 2011, 41, 2485–2494. [Google Scholar] [CrossRef] [Green Version]
- Kleppa, E.; Sanne, B.; Tell, G.S. Working overtime is associated with anxiety and depression: The hordaland health study. J. Occup. Environ. Med. 2008, 50, 658–666. [Google Scholar] [CrossRef] [PubMed]
- Doerr, J.M.; Ditzen, B.; Strahler, J.; Linnemann, A.; Ziemek, J.; Skoluda, N.; Hoppmann, C.A.; Nater, U.M. Reciprocal relationship between acute stress and acute fatigue in everyday life in a sample of university students. Biol. Psychol. 2015, 110, 42–49. [Google Scholar] [CrossRef]
- Macey, W.H.; Schneider, B. The meaning of employee engagement. Ind. Organ. Psychol. Perspect. Sci. Pract. 2008, 1, 3–30. [Google Scholar] [CrossRef]
- Crawford, E.R.; LePine, J.A.; Rich, B.L. Linking job demands and resources to employee engagement and burnout: A theoretical extension and meta-analytic test. J. Appl. Psychol. 2010, 95, 834–848. [Google Scholar] [CrossRef]
- Bennett, A.A.; Bakker, A.B.; Field, J.G. Recovery from work-related effort: A meta-analysis. J. Organ. Behav. 2018, 39, 262–275. [Google Scholar] [CrossRef]
- Hockey, G.R.J. A motivational control theory of cognitive fatigue. In Cognitive Fatigue: Multidisciplinary Perspectives on Current Research and Future Applications; American Psychological Association: Washington, DC, USA, 2011; pp. 167–187. [Google Scholar]
- Weigelt, O.; Siestrup, K.; Prem, R. Continuity in transition: Combining recovery and day-of-week perspectives to understand changes in employee energy across the seven-day week. J. Organ. Behav. 2021, 42, 567–586. [Google Scholar] [CrossRef]
- Blasche, G.; Bauböck, V.M.; Haluza, D. Work-related self-assessed fatigue and recovery among nurses. Int. Arch. Occup. Environ. Health 2017, 90, 197–205. [Google Scholar] [CrossRef]
- Bosch, J.A.; Ring, C.; de Geus, E.J.; Veerman, E.C.; Amerongen, A.V. Stress and secretory immunity. Int. Rev. Neurobiol. 2002, 52, 213–253. [Google Scholar] [PubMed]
- Sonnentag, S.; Binnewies, C.; Mojza, E.J. “Did you have a nice evening?” A day-level study on recovery experiences, sleep, and affect. J. Appl. Psychol. 2008, 93, 674–684. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Åkerstedt, T.; Axelsson, J.; Lekander, M.; Orsini, N.; Kecklund, G. Do sleep, stress, and illness explain daily variations in fatigue? A prospective study. J. Psychosom. Res. 2014, 76, 280–285. [Google Scholar] [CrossRef]
- Young, M.S.; Robinson, S.; Alberts, P. Students pay attention! Act. Learn. High. Educ. 2009, 10, 41–55. [Google Scholar] [CrossRef]
- Risko, E.F.; Anderson, N.; Sarwal, A.; Engelhardt, M.; Kingstone, A. Everyday attention: Variation in mind wandering and memory in a lecture. Appl. Cogn. Psychol. 2012, 26, 234–242. [Google Scholar] [CrossRef]
- Sonnentag, S. Work, recovery activities, and individual well-being: A diary study. J. Occup. Health Psychol. 2001, 6, 196–210. [Google Scholar] [CrossRef]
- Sonnentag, S.; Zijlstra, F.R.H. Job characteristics and off-job activities as predictors of need for recovery, well-being, and fatigue. J. Appl. Psychol. 2006, 91, 330–350. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kurimori, S.; Oka, T.; Karizaki, T. Evaluation of mental stress and fatigue induced by performance of a mental task. 2. An experiment in 11-h self-paced calculating task. Jpn. J. Ind. Health 1994, 36, 9–15. [Google Scholar]
- Coughlin, S.S. Recall bias in epidemiologic studies. J. Clin. Epidemiol. 1990, 43, 87–91. [Google Scholar] [CrossRef]
- Gardner, D.; Cummings, L. Activation theory and job design: Review and reconceptualization. Res. Organ. Behav. 1988, 10, 81–122. [Google Scholar]
- Teuchmann, K.; Totterdell, P.; Parker, S.K. Rushed, unhappy, and drained: An experience sampling study of relations between time pressure, perceived control, mood, and emotional exhaustion in a group of accountants. J. Occup. Health Psychol. 1999, 4, 37–54. [Google Scholar] [CrossRef]
- Grech, M.R.; Neal, A.; Yeo, G.; Humphreys, M.; Smith, S. An examination of the relationship between workload and fatigue within and across consecutive days of work: Is the relationship static or dynamic? J. Occup. Health Psychol. 2009, 14, 231–242. [Google Scholar] [CrossRef] [Green Version]
Phase 1 10 Weeks Pre-Exam 5 Days | Phase 2 4–1 Week(s) Pre-Exam 5 Days | Phase 3 Post-Exam 11 Days | Total | |||||
---|---|---|---|---|---|---|---|---|
n (observations) | 138 | 122 | 151 | 411 | ||||
Study duration | n | % | n | % | n | % | n | % |
0 h | 38 | 28% | 6 | 5% | 145 | 96% | 189 | 46% |
1–2 h | 45 | 33% | 11 | 9% | 3 | 2% | 59 | 14% |
3–4 h | 41 | 30% | 23 | 19% | 2 | 1% | 66 | 16% |
5–6 h | 11 | 8% | 37 | 30% | 0 | 0% | 48 | 12% |
≥7 h | 3 | 2% | 45 | 37% | 1 | 1% | 49 | 12% |
Control variables | m | sd | m | sd | m | sd | m | sd |
sleep duration (hours) | 6.8 | 1.5 | 7.4 | 1.4 | 7.8 | 2.1 | 7.4 | 1.7 |
proximity to exam (days(−1)) | 0.014 | 0.000 | 0.323 | 0.360 | 0.207 | 0.129 | 0.177 | 0.245 |
n | % | n | % | n | % | n | % | |
compulsory classes (yes) | 138 | 100% | 0 | 0% | 0 | 0% | 138 | 34% |
paid work (yes) | 7 | 5% | 9 | 7% | 17 | 11% | 33 | 8% |
m | sd | m | sd | m | sd | m | sd | |
questionnaire completion (hour, h.h) | 18.8 | 1.8 | 18.2 | 1.8 | 18.2 | 1.8 | 18.4 | 1.8 |
Fatigue | Vigor | Distress | |||||||
---|---|---|---|---|---|---|---|---|---|
B | S.E. | χ2 | B | S.E. | χ2 | B | S.E. | χ2 | |
Study duration | |||||||||
≥7 h | 6.3 | 1.3 | 23.023 ** | −0.98 | 1.3 | 0.591 | 4.8 | 0.79 | 36.858 ** |
5–6 h | 3.3 | 1.2 | 6.923 * | −1.2 | 1.2 | 0.932 | 4.8 | 1.0 | 21.665 ** |
3–4 h | 0.85 | 1.1 | 0.599 | 0.22 | 1.1 | 0.040 | 2.8 | 0.65 | 18.367 ** |
1–2 h | 1.2 | 1.2 | 0.956 | −0.86 | 1.2 | 0.520 | 1.7 | 0.76 | 4.89 * |
0 h | ref | ref | ref | ||||||
Control variables | |||||||||
sleep duration (hours) | −0.85 | 0.2 | 13.624 ** | 0.26 | 0.24 | 1.131 | 0.06 | 0.11 | 0.382 |
yesterday’s compulsory classes (yes) | 0.75 | 1.2 | 0.408 | −0.80 | 1.0 | 0.639 | −0.79 | 0.64 | 1.516 |
yesterday’s paid work (yes) | 2.1 | 2.2 | 0.939 | 0.25 | 2.1 | 0.014 | 1.3 | 1.5 | 0.790 |
proximity to exam (days(−1)) | 6.8 | 1.6 | 17.700 ** | −8.8 | 1.4 | 39.911 | 3.3 ** | 1.2 | 7.540 ** |
questionnaire completion (hour) | 0.26 | 0.19 | 1.824 | −0.38 | 0.2 | 2.559 | 0.07 | 0.16 | 0.200 |
gender (male) | 1.5 | 2.3 | 0.412 | −2.3 | 1.9 | 1.404 | −0.24 | 1.2 | 0.040 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Blasche, G.; Khanaqa, T.A.K.; Wagner-Menghin, M. Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students. Healthcare 2023, 11, 1674. https://doi.org/10.3390/healthcare11121674
Blasche G, Khanaqa TAK, Wagner-Menghin M. Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students. Healthcare. 2023; 11(12):1674. https://doi.org/10.3390/healthcare11121674
Chicago/Turabian StyleBlasche, Gerhard, Tav A. K. Khanaqa, and Michaela Wagner-Menghin. 2023. "Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students" Healthcare 11, no. 12: 1674. https://doi.org/10.3390/healthcare11121674