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 Table of Contents  
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 57-64

Exploring emotional wellness: The art of being cheerful about life at medical campus

1 Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
2 Human Development Program of Aga Khan University, Karachi, Pakistan
3 Dow University of Health Sciences, Karachi, Pakistan
4 iCAT Transmission, Islamabad, Pakistan
5 Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

Date of Web Publication30-Nov-2015

Correspondence Address:
Rehana Rehman
Department of Biological and Biomedical Sciences, Aga Khan University, Karachi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-2555.170723

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Objective: To identify and compare the awareness of emotional wellness (EW) in Private and Public Sector Medical University (MU) students of Pakistan. Materials and Methods: Qualitative and quantitative aspects of EW were evaluated by; a structured questionnaire tailored from wellness wheel by four points Likert's scale; score ranging from 0 to 3. Comparison of scores in Private and Public MU students was done by Mann–Whitney test. Focus group discussions (FGDs) were conducted with 20 students from each MU after taking the informed consent, a week after the questionnaires were administered. Results: The aggregate of EW scores was 21.36 ± 4.54 versus 20.54 ± 4.34 in Public versus Private MU students (P = 0.028). Private MU students were; significantly less cheerful and hopeful (P = 0.008), considered not always valued by their family and friends (P < 0.0001) as compared to Public MU candidates. Private students lived life autonomously and did not consider to consult or take help from parents or any other family members (P = 0.0003). They however consulted psychologist/psychiatrist more than Public MU students (P = 0.024). Both type of students nearby significantly helped people during emotional outbursts (P = 0.096). The results of FGDs highlighted the absence of formal advising, mentoring process, wellness organizations, and facilities available to cope with the emotional distress of medical students. Conclusion: Public MU students had sound emotional well-being and took help only from their family members rather than consultation with psychiatrists. The EW being an important indicator of mental health thus needs to be catered at the undergraduate level.

Keywords: Emotional wellness, medical students, Pakistan, wellness

How to cite this article:
Rehman R, Nadeem S, Hussain M, Khan R, Katpar S. Exploring emotional wellness: The art of being cheerful about life at medical campus. Eur J Psychol Educ Studies 2015;2:57-64

How to cite this URL:
Rehman R, Nadeem S, Hussain M, Khan R, Katpar S. Exploring emotional wellness: The art of being cheerful about life at medical campus. Eur J Psychol Educ Studies [serial online] 2015 [cited 2021 Jul 26];2:57-64. Available from: https://www.ejpes.org/text.asp?2015/2/2/57/170723

  Introduction Top

The concept of “health and well-being” has captivated people all over the world and now is gaining popularity in Public Health Sectors.[1] Wellness is not merely the absence of disease, but the ability to become aware of, and make selections of lifestyles in agreement to the work situations.[2] This is made possible by various dimensions of wellness wheel that includes: Physical, emotional, intellectual, social, spiritual, environmental, financial, and occupational aspects.[3]

Emotional well-being is the capability to comprehend the worth of sentiments and use them onward in positive directions. Wellness Center of Vanderbilt University defined emotional wellness (EW) as, “the awareness of feelings and their expression in a healthy manner with stability of mood, sense of self, positive attitude toward others, and the ability to cope with stress”.[4] Moreover, emotions have strong control on an individual's moods, thoughts, attitudes, determination, interests throughout the day and night, which help in taking decisions throughout the span of their lives.[5]

In relation to this emotional freedom is the ability to link body with feelings and take guidance and intuitions for existence and authorized configuration. Emotional health is based on self-respect, self-confidence, dignity about oneself for a better performance. Emotionally healthy person can understand and cope with stress and adapt to change with the circumstances. The emotional balance enables an individual to identify the heart's desires, take affirmative actions, and make changes in life devoid of worries, stress, and lead life with vision, inspired action, and an inner state of creativity.

In the years of adulthood, students come across with a number of challenges, emotional problems, and encounters that have an impact on a road map of their future life. It is a known fact that EW declines once students are exposed to the stress of medical curriculum.[6],[7] This is because of a number of strains experienced during the transition from school to university and alteration in roles from student to conversant physician.[4],[8] The extent of the medical curriculum and expectations from society, peers and parents adds to the stress that leads to impairment in mental health leading to anxiety, depression, and also suicidal tendencies in some students.[9]

As a developing country in Pakistan, there are public and private medical universities having different admission criteria, prospectus, and methods of assessment set by their respective regulatory bodies.[10] In Public Sector Medical Universities (Public MU), students gain admission that have a provincial domicile, comparatively secure high marks in higher school and entry test examination.[11] The remaining students who can pay substantially for Private MU gain entrance, due to soft admission policy into the medical profession.

Awareness of EW by medical students in health care setting will enable them to explore emotional aspects, build upon, and operate on strengths rather than concentrating on weaknesses. EW related with the harmony of mind and body with influence on everyday functioning will enable medical students to live a life far from stress, anxiety, depression, and grief embedded with happiness and security keeping in mind importance of personal priorities.[12] It is well-known that preventive approach is better than intervention after the appearance of a problem. A focus on EW can thus be helpful for students to live in the social world by developing skills such as resolving conflict and improving relationships that may boost their capacity to manage lifecycle. We are quite unfortunate that limited information is available on the well-being of medical students in developing countries.[2] Agreed with the importance of awareness of EW, the study is aimed to explore and compare awareness of EW in medical students of Public and Private MU of Karachi, Pakistan.

  Materials and Methods Top


The cross-sectional survey was carried out with enrolled 1st year medical students of five Private and three Public Sectors Colleges. The questionnaires were distributed among 300 Public and 500 Private MU students of both genders, all ethnic groups and age range from 19 to 24 years by convenient sampling.


Qualitative and quantitative aspects of EW were evaluated by; a structured questionnaire tailored from wellness wheel [13] pretested and validated on a group of 50 students. The questionnaire comprised of queries about the value of self-exploration and improvement, mood swings, stressors in life, anxiety attacks, and its management either by themselves or with help from others [Appendix I].

The reliability of the questionnaire was checked on a pilot survey of 50 students, and we got Cronbach's alpha of 81% which showed good consistency in terms of the responses received from students. All variables were judged on the basis of four-point Likert type scale (rarely ever, sometimes, most of the time and always) with a score range from 0 to 4 (lowest to highest).

A semi structure guideline was developed, the main focus of probing questions were to explore existence of wellness programs, formal mentoring, and advising from faculty, facilities available to students, experience with emotional distress or mental illness [Appendix II]. Focus group discussions (FGDs) were conducted with 20 students from each MU after taking the informed consent, a week after the questionnaires were administered. The FGD took place in conference room settings, were audio recorded and lasted about 30–40 min. As per protocol, assurance of honesty and confidentiality of students was maintained during the entire process.

Ethical considerations

The ethical approval for the study was obtained from the Ethics Review Committee of Bahria University Medical and Dental College. The informed consent was taken before conducted the survey and FGDs with students. The participation of students was entirely voluntary.

Data analysis

Quantitative section

Predictive Analysis Software (PASW 18.0, SPSS Inc., Illinois, Chicago, US) was used for analysis and interpretation of data. Categorical variables such as characteristics of EW were represented in frequencies and percentages whereas mean ± standard deviations were used for measurement variables such as scores of EW.

In order to extract common factors of EW in our setup, factor analysis (FA) extracted common factor of wellness in our study sample. The score of extracted factors and total emotional dimension score were obtained by summing up responses in related items. To compare scores between public and private medical universities, Mann–Whitney U-test was performed as scores were non normal which was assured with the application of Shapiro-Wilk's test (P > 0.05). Chi-square test employed for comparison of opinions between two medical universities, level of significance was set 5% to assert differences of emotion dimensions between Public and Private MU.

  Results Top

Quantitative section

The response rate was very high, and we received completely filled questionnaire (286/300; 95.3% and 450/500; 90%) from Public and Private MU students. Components of EW [Table 1] revealed that candidates studying in private institutes were significantly less cheerful and hopeful (P = 0.008). They were also found less passionate toward self-improvement. Though, significantly higher proportion of them reported that they were not always needed and valued by their family and friends (P < 0.0001). Eventually, they were less prone to cope with stressors than Public MU candidates (P = 0.014). Mood swings, anxiety before the examination, overcome such anxiety and taking help from friends were proportionally similar in both types of candidates. One hundred and thirty three (46%) candidates from Public MU did not seek advice from a mentor in their life. More than 30% (145) private candidates were admitted to be such advice seekers (P < 0.0001). Private students lived life autonomously as compared to students from Public MU as a large proportion of them did not consider to consult or take help from parents or any other family members (P = 0.0003). On the other hand, the proportion of consulting with the psychologist/psychiatrist [Table 2] is also found more in Private MU candidates then Public MU students (P = 0.024). Both type of students nearby significantly helped people during emotional outbursts (P = 0.096).
Table 1: Assessment of emotional wellness awareness in public and private medical university students

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Table 2: Management of emotional outbursts by students

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For FA, Keyser-Meyer-Olkin measure was 0.711 which defined sampling adequacy of performing FA. Bartlett's test of sphericity indicated that items were significantly associated (P < 0.0001); therefore, FA could be run on our data. The numbers of factors were extracted using criteria of Eigen values more than 1.0. Accordingly, a total of 4 factors were extracted. Variables with loading more than 0.30 were retained. Eventually, one item “I need my psychiatrist/psychologist to take me out of these spells” was excluded at this stage. Based on loading of retained variables, each factor was named accordingly. [Table 3] displayed the most common factor was related to “self-content” emotional characteristics. The second factor was loaded with characteristics implied seeking help from different social bounds; hence it was named as “dependent.” Third and fourth factor were named as “anxious” and “moody,” respectively.
Table 3: Emotional wellness dimensions extracted by factor analysis

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The comparison of factors scores and total emotional scores are shown in [Table 4]. It was revealed that students from Public MU were significantly more self-content as compared to their private counterparts (P < 0.0001). The dependent attitude was similar in both public and private medical students. Anxious behavior score was significantly higher in public students (P = 0.01). There was nearby significant difference between the moody behavior of public and private medical students (P = 0.051). Total EW score of candidates from public medical students was significantly more than private medical students (P = 0.028).
Table 4: Comparison of emotional dimensions scores between public and private medical universities of Karachi

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Qualitative section

Following themes emerged from focus group discussions

Formal mentorship and advising

Students from both MU reported with, having no experience of formal advising or mentoring system. One participant said: “We have a number of problems in the beginning, regarding the selection of books, preparation of module examination, and had difficulty to contact teachers. Our senior students helped us a lot.”

Student organizations focused on wellness

No student wellness organizations were identified by students from both MU.

“Our university does not offer any wellness programme” was the frequent response.

Burn out activities

Many of the students reported that they do not have any outlet for burnout. However, they want entertainment in addition to studies. Students of Private MU responded, “we want to play and participate in physical sports activities but don't have time to participate due to continuous assessment tests.”

Facilities available to students experiencing emotional distress or mental illness

There is a lack of facility available for students at MU, who suffered from distress even if the facilities are available, but the access is an issue. Both MU students highlighted the needs of student counselor in the medical universities. Private MU student responded;

“We don't have counselors in the medical campus. In case of a problem, we have to use our own references to take appointment from the psychiatrist at the student counseling center.”

Some said, “the student counselors are far from the university, how can we approach them?”

The Public MU students reported, “we have access to the psychiatrists since hospital campus is close to medical campus.”

  Discussion Top

Emotionally well-being defined by the Mental Health Foundation is “a positive sense of well-being which enables an individual to be able to function normally in society and meet the demands of everyday life; people in good mental health have the ability to recover effectively from illness, change, or misfortune.”[14] Awareness of EW in medical students can contribute to enhance their spirits which in return may enhance their coping abilities, self-esteem, performance, efficiency at work, and endurance to withstand episodes of mental stress, depression, and anxiety. The self-awareness will contribute to improve their physical, social, and mental health. The result of this study provided a glimpse of present emotional well-being status and the comparison between students of Public MU and to those studying in Private MU. The students of Public MU are emotionally sound as compared to Private MU. There could be several reasons for EW in MU's students.

The National Institute of Health claims that majority of diseases are caused or aggravated by accumulated unmanaged stress, which is increasing day by day. There are many factors that influence EW of medical students; one major factor is stress. The stress can damage physical, mental, and emotional well-being which may be manifested by headaches, hypertension, anxiety, sleeplessness, and mood swings ending in the collapse of mind and body. The intensity of stress depends on personal factors such as sex, coping mechanism, sleep habits, substance abuse, and environmental factors such as stay duration at hostel, travel hassles, parental expectations, and institutional factors such as medium of study, frequent exams, and lack of feedbacks.[15],[16]

The results of the current study found that students studying in public institutes were emotionally well. The recognized stressful environment in a medical school has a negative impact on students' academic performance, physical health, and psychosocial well-being.[17] Unfortunately in our country, the medical students are not prepared to care for themselves to monitor their own wellness. This may be because of failure from stakeholders to update the medical profession internationally. This aspect also needs to be explored and documented in Pakistan. Medical students undergo terrific stresses during various stages of the MBBS course thus complain of depressive disorders more than the general population.[4] A study conducted by Khan et al., in Karachi, found a high prevalence of depression among medical students.[18] Depressed medical students are more likely to experience burnout or drop out of medical school. Burnout is a syndrome of emotional exhaustion, depersonalization, and low personal achievement.[19] A higher incidence of suicide has been reported.[4],[8] The definitive number of medical students enrolled in terms of gender percentages in all medical colleges of Karachi is absent and needs to be documented, as this may also yield interesting results related to the status of EW.[20]

In a study done on medical students, it was observed that students in the 1st year are away from their family for the first time and may need more emotional support compared to the 2nd year students.[21] EW predetermined to have a positive attitude, high self-esteem, develops the capability to recognize and share a wide range of feelings among each other in an affirmative manner. These students encounter anxiety attacks when exposed to stresses in the understanding of the subject. Evidence supports that residents in Oncology, Surgery, and Neonatology felt burnt out mentally, more than half presented with high levels of exhaustion and reported depersonalization.[19] Generally, emotionally healthy people are able to adjust to and solve problems, and in doing so they also help others as well so as to get personal satisfaction out of life. In our study, Public MU students although had anxiety attacks before examinations, yet were able to overcome them to build their well-being.

In our study, medical students had frequent episodes of anxiety for which they sought help from their parents, family members and mentors. Medical students all over the world make use of multiple coping strategies such as praying, positive reframing, learning from the experience, and seeking help from others.[22],[23],[24] Psychological help and counseling may help the students to handle stress and anger in a healthier manner. Social support is another factor that promotes emotional well-being, a deficit of which leads to the depression and health problems in young adults.[17] In a study done by Nas et al., it was observed that medical students used support from family, friends, or mentors for their emotional well-being.[25] In this study, it was found that students of public institutions were seeking help from their friends and family members whereas 45% students from Private MU seldom took support from their friends and family members.

The coping strategy of mentorship was availed by Private MU students, whereas medical students from Public MU were not exposed to mentorship support system. It may be because of lack of mentorship program in Public MU or the belief that consultation with mentors is needed more in later stages when students choose their specialization field or clinical residency and clerkship. Another explanation is that during medical education students identify their role models that mostly depend on personality, clinical skills, competence, and teaching ability that influence their selection of residency field rather than having a mentor.[26] The results are contradictory to a study in which mentors helped in acquiring EW and enhancing intellectual capital.[25] Finally, in our scenario, in Public Sector Medical Colleges, mentors were not formally assigned although faculties do informal mentorship of their students in personal and professional development.

Hopefulness is a factor that comes from life satisfaction and happiness. It contributes to EW, and we observed that students of Public MU were more cheerful and hopeful, valued to self-improvement and considered the importance of friends and family members. In our study, we also found that those who perceived them as happy and cheerful were less stressful and recognized their stress with the ability to cope with them. These findings are consistent with the findings of Zhang et al., who reported that positive attitude toward life is associated with pro-social behaviors and negatively related with depression.[4]

Medical education aims to produce knowledgeable, skilled, and capable doctors who are confident can acknowledge their mood swings and are capable to overcome them.

The value of self-exploration and self-improvement with the observation of daily response or reactions to life can improve the spectrum of wellness wheel as well as their emotional health.[27],[28] Let us all realize that EW is like a deep well, clean water will give life to everyone who drinks from it. When the water is not processed for cleaning, it becomes contaminated which may become life threatening. Building EW will actually make our students capable of acquiring physical, mental, emotional, social, and spiritual well-being.

Relying on others, and also relying on yourself.

  Conclusion Top

Public Sector Medical students have sound emotional well-being than private students. Public MU students first consulted their family members, whereas private medical students consulted psychiatrists. In addition to this, our findings also conclude that those students who were satisfied with life were not prone to stress and had good coping mechanisms. This situation can be handled if reduced EW is catered during the undergraduate level. Thus, medical student's EW is an important indicator of future mental health and for maintaining healthy and normal social relationship.

Message for medical students

Step forward, realize your problems, your strength and weaknesses, make use of social support, take action to deal with your problems but do not forget to meet demands of daily living, and also step back to rest and re-energize yourself. Remember, help is available when needed.

Future directions

A detailed needs assessment is required to identify and relate specific stressors and wellness of medical students. In addition, incorporation of a formalized wellness curriculum is required in all Private and Public MU in Pakistan. The need for structured mentoring to improve medical student emotional well-being, resiliency, and sense of commitment to the field of medicine should be our destination. Similar studies should also be done at dental Institutes to explore this area and furthermore, exploration on the emotional intelligence of medical and dental students should also be done for all associated reasons.

Study limitations

This study has a number of weaknesses such as a collection of data from different medical colleges with different amenities, and provision of facilities. The data collection is limited to the city of Karachi only, and we did not mention whether the students were day scholars or hostilities. Mentorship program of neither university was not revealed nor was the respective medical faculty properly trained to do mentoring, etc. The study was cross-section in nature; the causal factor hence could not be studied.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]

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