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original article

Wien Med Wochenschr (2015) 165:100–106

DOI 10.1007/s10354-014-0341-6

Prevention of study-related stress symptoms:

health-promoting behavior among dental students
Stefanie Mache · Karin Vitzthum · David A. Groneberg

Received: 30 September 2014 / Accepted: 29 December 2014 / Published online: 28 January 2015
© Springer-Verlag Wien 2015

Summary Keywords  Burnout  · Dental education  · Health-pro-

Background  Training to become a dentist is one of the moting behavior · Medical performance · Study-related
most demanding professional education experiences. stress
There are very few studies on strategies and activities to
cope with study-related stress during dental training. We
therefore evaluated the prevalence of burnout symptoms Bewältigung von psychomentalen Belastungen
and coping activities among dental students. im Studium: Coping-Verhalten unter
Methods  A cross-sectional survey was performed Zahnmedizinstudenten
analyzing a sample of 239 dental students from Germany.
Students were asked to complete a survey containing Zusammenfassung
questions about burnout symptoms and coping behavior. Hintergrund  Das Studium der Zahnmedizin ist durch
Results  A total of 38 % of the dental students perceived hohe Anforderungen gekennzeichnet und stellt eines
symptoms of emotional exhaustion; 17 % reported symp- der herausforderndsten universitären Ausbildungswege
toms of personal accomplishment and 11 % perceived dar. Es werden häufig psychosoziale Probleme während
scores of depersonalization. Students reported on coping des Studiums berichtet. Bewältigungsmöglichkeiten im
activities, ranging from health-promoting techniques, Umgang mit Studienherausforderungen werden in der
such as exercising, to less recommendable health harm- Ausbildung bislang nur unzureichend vermittelt.
ing relaxation strategies, such as taking drugs. Die vorliegende Studie soll einen aktuellen Einblick in
Conclusion Our results indicate the need for relevant die Prävalenz psychischer Probleme (in Form der Burn-
health promotion and may aid decision makers in devel- out Symptomatik) unter Studierenden geben. Ebenso soll
oping health promotion programs. ein Überblick vermittelt werden, wie Studenten mit den
Herausforderungen im Studium umgehen, bzw. welche
Bewältigungsstrategien eingesetzt werden.
S. Mache, PhD, MSc, MHA () Methodik  Eine querschnittliche Fragebogenerhe-
Institute for Occupational and Maritime Medicine (ZfAM), bung wurde durchgeführt, die 239 Studenten der Zahn-
University Medical Center Hamburg-Eppendorf,
medizin einbezog. Die Studenten wurden gebeten, einen
Seewartenstraße 10,
Haus 1, 20459 Hamburg, Germany
Online-Fragebogen auszufüllen, der aus dem Maslach
e-mail: Burnout Inventory sowie Angaben zu individuellen
Stressbewältigungsstragien bestand.
Prof. D. A. Groneberg, MD · S. Mache, PhD, MSc, MHA Ergebnisse  Die subjektive Einschätzung psychischer
Institute of Occupational Medicine, Social Medicine and
Environmental Medicine, Johann Wolfgang Goethe-University,
Probleme zeigt eine mittlere Ausprägung. Bewälti-
Theodor-Stern-Kai 7, gungsstrategien rangieren im Bereich gesundheitsför-
60590 Frankfurt a. M, Germany derlicher Maßnahmen (z. B. Ausgleich durch Sport) bis
zu potenziell gesundheitsschädlichen Strategien (z.  B.
K. Vitzthum, PhD, MSc
Institute of Occupational Medicine, Charité—Universitätsmedizin
Berlin, Free University and Humboldt University, Schlußfolgerung Ein umfassender Einsatz von Auf­
Thielallee 69–73, klärungs- und Gesundheitsförderungsprogrammen wäh­
14195 Berlin, Germany rend des Zahnmedizinstudiums ist zwingend erforderlich.

100   Prevention of study-related stress symptoms: health-promoting behavior among dental students 13
original article

Schlüsselwörter Burnout · Gesundheitsförderung · Co- the prevalence of health promoting relaxation activities
ping · Stress · Studium or investigated the influence on students’ stress percep-
tion, health, and performance.

Aims of the study
In 2013, 14,820 students were enrolled in a German fac-
ulty of dentistry [1]. Dental education is known as one of The aims of the present study were: First, to describe the
the most demanding fields of study. It includes numer- prevalence of burnout symptoms among dental students;
ous sources of stress such as academic pressure, long second, to focus on dental students’ relaxation activities;
working hours, enormous amounts of learning mate- third, to investigate gender differences with regard to
rial, clinical problems, etc. [2]. Student drop-out from burnout symptoms and relaxation activities. Finally, we
German dental schools is approximately 5 % per study aimed to investigate associations between burnout and
year [3]. relaxation activities among dental students.
Previously published studies showed that den- This study aimed to address the following research
tal students are currently affected by stress: students questions:
show symptoms of emotional exhaustion (EE), com-
plain about a high degree of psychological distress, 1. To what extent are burnout symptoms perceived by
and perform less than in earlier times [4]. However, dental students?
potential stressors may have harmful effects on dental 2. What kind of relaxing strategies do German students
students’ mental or/and physical health [5]. Experienc- use to cope with daily hassles?
ing high levels of stress may result in burnout, a term 3. Are there gender differences among German dental
that describes the experience of long-term work-related students regarding perceived burnout symptoms?
exhaustion and diminished interest [6]. Although, many 4. Are there gender differences with regard to coping
studies described burnout as a “professional syndrome” activities?
some investigations showed that burnout symptoms can 5. Are there significant associations between burnout
also be found among students [7]. Researchers these symptoms and relaxing activities?
days considered burnout symptoms as a typical distress
in the educational process. For example, in the medical
field, recent studies by Dyrbye et al. [8] have investigated Methods
that up to 50 % of medical students show symptoms of
burnout. This cross-sectional survey study was conducted
To deal with study pressure and workloads, students have between 2012 and 2013. The study design consisted of
to prevent suffering from symptoms of burnout. Therefore, distribution of an e-mail that invited dental students to
there is a strong need for dental students to take a time-out participate in a survey by following a link to a web-based
after daily studies and to renew their subjective energy lev- questionnaire. Participation in the study was voluntary
els. Prevention strategies can help dental students avoid and anonymous.
stress-related disorders. Previous research studies have Dental students of a university in the north of Ger-
shown a positive association between using relaxation tech- many (at the Charité—Universitaetsmedizin Berlin) were
niques and coping with stress [9, 10]. asked to fill out an anonymous online questionnaire
A huge variety of relaxation activities and special tech- about their perception of individual burnout symptoms
niques exist. They can be categorized into health promot- and their personal use of different drugs, stimulants, and
ing and harming relaxation activities. Health promoting relaxation activities. The initial mailing list contained
relaxation activities are, for example, exercising/playing about 405 dental students enrolled at the university.
sports, yoga, healthy eating behavior, etc. Harming and Semesters 1–14 were included in the study. Totally, 239
unfavorable relaxation activities are, e.g., taking drugs/ questionnaires were analyzed (128 women/111 men).
tranquillizers, smoking, drinking alcohol, etc. Response rate was 59 %. We performed a sample size
Most of the published studies in this research field determination and power analyses to review and verify
refer to harming relaxation activities such as alcohol statistical power.
and other drug abusive behaviors [11, 12]. Many inves-
tigations have focused on students’ consuming behavior
regarding these substances. Students often reported that Instrument
they smoke cigarettes to manage high levels of distress
[13]. Further research studies have indicated that another 1. Sociodemographic data
means by which young people cope with psychological
distress is the consumption of alcohol [14]. The survey included questions regarding burnout, relax-
There are only few studies focusing on students’ ation activities and sociodemographic variables. The ini-
health promoting coping and relaxation activities; par- tial items on the questionnaire pertained to the students’
ticularly on dental students. Studies focused either on demographic characteristics, including gender, age,

13 Prevention of study-related stress symptoms: health-promoting behavior among dental students   101
original article

marital status, and number of study terms (completed Table 1  Absolute and relative frequencies of coping and re-
semesters). laxation activities (used at least once in a lifetime)
Dental students
2. Burnout inventory
n %

Burnout was measured using the three dimensions of the Meeting friends 197 83
22-item Maslach Burnout Inventory (MBI) [15, 16]. We Sleeping 189 80
used the German version of the MBI [17]. Healthy diet 185 78
Subdimensions are emotional exhaustion (EE; nine Exercising 182 77
items), depersonalization (DP; five items) and personal Watching TV 169 72
accomplishment (PA; eight items). Items were rated
Walking 166 70
on a 7-point scale (0 = “never,” 1 = “a few times a year,”
Cooking 163 69
2 = “monthly,” 3 = “a few times a month,” 4 = “weekly,”
5 = “a few times a week,” and 6 = “every day”). The sub- Drinking alcohol 125 53
scales were added up to a total value. Maslach et al. Spa treatments 116 49
defined that burnout is present if the total value of the Caffeine 102 43
sub-scales EE and DP are high and the value for PA is Yoga, PMR 71 30
low. Maslach et al. specified cut-off values in their third Smoking cigarettes 68 29
edition of the Maslach Burnout Inventory specifically
Cannabis/marijuana 19 8
for the medical field [16]. Cut-off values were specified
as followed: for EE, it is the sum value of ≥ 18, for DP, Sedatives 11 4
≥ 10 and for the PA, ≤ 33 [17]. Burnout is indicated if Performance enhancing stimulants 3 1.4
the values are above these cut-offs [16]. Quality criteria Cocaine/heroin 2 0.8
(e.g., reliability, internal consistency) have been proven Ecstasy 1 0.4
for the German version [17]. PMR progressive muscle relaxation
We also evaluated the quality criteria and found sat-
isfactory values: EE, Cronbach’s α = 0.80; DP, Cronbach’s
α = 0.69 and PA, Cronbach’s α = 0.76. Chi-square analyzes were used to test for differences
in frequency of use by sex, age, and number of terms.
3. Coping activity scale We analyzed the data with regard to their distribution
and consequently used parametric and nonparamet-
The following items pertained to the participants’ prac- ric tests. All differences or correlations were consid-
tice of relaxing activity items, explored by a multiple ered to be statistically significant at P < .05-level. T-tests
choice list. The content of the list was developed at the were used to analyze gender differences with regard to
Department of Occupational Medicine and proved by burnout symptoms and coping/relaxation activities.
the Department of Neurology at the Charité—Univer- Pearson’s and Spearman’s correlation coefficients were
sitaetsmedizin Berlin for its completeness and correct- analyzed to investigate on associations between burn-
ness. An overview of all relaxation activities included in out symptoms and coping/relaxation activities. For the
this study is shown in Table 1. correlation analyses we only analyzed data from those
The response options that were used for the coping students who had chosen response option 4 (often) or
and relaxing activities items followed the same pattern 5 (always) and calculated correlations with the equiva-
of ascending frequency as similar questionnaires in that lent MBI scores.
research field. The first question contained a table of An α-level of 0.05 was used for each statistical testing.
coping/relaxation activities (see Table 1). Students were Statistical analyses were performed using SPSS for Win-
asked if they had used one of these activities at least once dows Version 19.0.
in their lifetime (yes/no). In addition, we asked on fre-
quency of usage for each coping activity depending on Ethics:  All procedures followed were in accordance with
the answer of the first question (only if verified). the ethical standards of the responsible committee on
The response options were “never in my life” (1 = never), human experimentation and with the Helsinki Declara-
“have done or used but not in the last 2 months” tion of 1975.
(2 = rarely), “once in the last 2 months” (3 = sometimes),
“more than twice in the last two months” (4 = often) and
“every day or nearly every day” (5 = always). Results

The average age ± SD of the total sample was 23 ± 4.47

Statistical analysis years. The final sample was 64 % women and 36 % men.
At the time of the survey, the mean number of terms
At first, we analyzed descriptive statistics (frequencies, (German semesters) that had been completed by the stu-
percentages, means, and standard deviations (SDs)). dent subsample was 6 ± 4.11. In all, 12 % were married;

102   Prevention of study-related stress symptoms: health-promoting behavior among dental students 13
original article

Table 2  Burnout subdimension scores divided by age and students (n.s.; P > .05). However, the T-test results also
gender showed that significant gender differences were found
Burnout in the subdimensions EE and DP (P < .05). Female den-
Emotional exhaus- Depersonalization Personal accomplish-
tal students rated EE significantly higher than male stu-
tion (range 0–54) (range 0–54) ment (range 0–48)
dents (M = 19.62; SD = 9.37/M = 17.25; SD = 8.74, P < .05).
In contrast, male students rated DP significantly higher
Mean (SD)
than female students (M = 7.63; SD = 4.95/M = 5.15;
Overall 18.1 (8.8) 6.5 (4.8) 31.3 (7.9) SD = 3.51, P < .05). Reduced PA was perceived higher
Age by male students than by female students (M = 32.4;
  < 20 19.1 (7.3) 5.5 (3.4) 27.9 (3.8) SD = 8.1/M = 30.2; SD = 7.9), but this result did not reach
 21–25 19.8 (9.2) 6.2 (4.2) 29.4 (5.3) significance; n.s., P > .05).
 26–30 18.7 (8.9) 6.9 (5.1) 31.8 (7.9)
  > 30 17.3 (8.1) 7.1 (5.5) 32.8 (8.2)
Coping and relaxation strategies
 Female 19.62 (9.3) 5.1 (3.5) 30.2 (7.9) Table 1 illustrates absolute and relative frequencies of all
 Male 17.25 (8.7) 7.6 (4.9) 32.4 (8.1) coping/relaxation activities reported to be performed/
done/used by the participating dental students at least
once in a lifetime. As shown, the most common relaxation
the remainders were single or at least not living with a activities were meeting friends (83 % of the participating
partner. students) and sleeping (80 %). In addition, Table  1 also
illustrates frequencies for “eating healthy food” (78 %),
“watching TV” (72 %), and “going for a walk” (70 %) as
Burnout three relaxation strategies. More unhealthy activities were
also reported, such as drinking alcohol (53 %) and smok-
Our results show moderate burnout scores being per- ing cigarettes (29 %). Taking drugs to relax was reported
ceived by the dental students. An overview of all subdi- relatively rare; 0.4 % of the students reported taking
mensions of burnout is illustrated in Table 2. ecstasy, 0.8 % mentioned taking cocaine, heroin and 1.4 %
With regard to the three burnout dimensions, the described taking performance enhancing substances, e.g.,
subdimension EE had a mean of M = 18.1 (SD = 12.83). amphetamines. Of the students, 8 % mentioned that they
A total of 38 % of the dental students (n = 91) perceived have used cannabis and marijuana at least once in their
symptoms of EE (≥ 18). The burnout symptom PA stands lifetime. Sedatives and tranquillizers have been taken by
for a decrease of performance during the course of their 4.5 % of the participating students at least once.
dental medicine studies; 17 % of the students (n = 40) In addition, Table  3 gives more detailed information
reported sum scores of PA ≤ 33. The scale was scored with about the frequency of usage.
M = 31.4; SD = 7.6.
The subdimension DP was scored with M  = 
(SD = 4.83); 11 % of the dental students reported scores of Gender differences
DP ≥ 10 (n = 26).
T-tests showed that the overall scores for burnout We found significant gender differences in relaxation
did not significantly differ between female and male activities (see Table  4): Male students smoke cigarettes,

Table 3  Coping and relaxation activities among dental students: absolute and relative frequency of use
Coping and relaxation activities Frequency of use
Never (n/%) Seldom (n/%) Sometimes (n/%) Often (n/%) Always (n/%) n.a. (n/%)
Meeting friends 2/1 17/7.1 63/26.2 106/44.3 19/7.9 32/13.4
Sleeping 7/3 38/15.7 62/25.5 81/34.1 19/8.1 32/13.4
Healthy diet 13/5.6 47/19.5 59/24.6 65/27.4 22/9.3 32/13.4
Exercising 15/6.1 45/18.7 61/25.7 66/27.8 19/7.9 33/14.0
Walking 16/6.5 39/16.3 65/27.4 79/33.1 9/3.6 31/13.1
Watching TV 23/9.8 36/15.2 61/25.5 76/31.6 11/4.5 32/13.4
Drinking Alcohol 75/31.3 60/25 49/20.7 20/8.3 2/0.7 33/14.0
Smoking cigarettes 155/64.7 12/4.9 11/4.7 17/7.2 10/4.1 34/14.3
Cannabis/Marijuana 186/77.9 11/4.7 5/2.2 2/0.9 1/0.2 34/14.2
Caffeine 112/46.9 32/13.2 29/12.1 25/10.5 8/3.2 34/14.2
n.a. not answered

13 Prevention of study-related stress symptoms: health-promoting behavior among dental students   103
original article

Table 4  Gender differences in relaxation activities Burnout among dental students

Relaxation activities Male students Female students
Our results demonstrate that 38 % of the dental students
Mean (SD) scored above the recommended cut-off values in EE,
Exercising 3.25 (1.1) 3.08 (1.2) 11 % in DP, and 17 % in PA. The values for the MBI of this
Eating healthy food 2.92 (1.0) 3.33 (1.1) study do match previously published values from dif-
Cooking 2.59 (1.1) 2.89 (0.9) ferent studies. Similarities and differences were found
Walking 2.50 (1.1) 2.86 (1.0)
comparing our study results to former published results
between other dental and medical students. The study by
Spa/wellness 1.57 (0.8) 2.13 (0.9)
Guthrie et al. demonstrated the following burnout symp-
Yoga 1.31 (0.7) 1.79 (1.1) tom rates: 14.0–16.1 % for reduced PA, 9.6–12.9 % for EE,
Drinking alcohol 2.39 (1.1) 1.92 (0.9) and 3.8− 7.1 % for the DP sum scale [18]. In a more recent
Smoking 1.78 (1.3) 1.51 (1.1) study in dental students, 10 % had high scores of EE, 17 %
Taking cannabis/marijuana 1.23 (0.6) 1.09 (0.4) regarding PA and 28 % regarding DP [19].
Significant gender differences were also found in the
subdimensions. Female students have scored significantly
higher on EE than on DP and decrease of performance.
take cannabis and/or marijuana and drink alcohol signif- Male students, in contrast, rated significantly higher on
icantly more often than their female colleagues (P < .001). DP than on EE. These gender differences in the subdimen-
This difference has also been found for doing more exer- sions have also been found by Amin et al. [20]. Our find-
cises as a relaxation strategy (P < .001) (Table 4). In con- ings are also in-line with previous investigations among
trast, female students try to do more walking, yoga or spa dental students performed in various countries [21, 22].
wellness (P < .001). Female dental students try to relax
more often by cooking and/or by eating healthier food
(P < .001) (Table 4). Coping and relaxation activities
We found no significant gender difference with regard
to the following relaxing activities: watching TV, sleep- One of the most common favorable coping activities
ing, meeting friends, taking illicit drugs (e.g., ecstasy, were talking to and meeting friends. Previous research
cocaine), sedatives, cognitive enhancing substances confirmed that relationships and friendships have a pos-
(e.g., amphetamine) or uppers (e.g. caffeine). itive impact on health in general, particularly on men-
No significant differences could be found regarding tal health, as an act of social support [23–25]. Our data
sociodemographic variables such as age, field of study or also showed that exercising, yoga, etc. are activities often
number of semester. practiced by students to relax. As illustrated in previ-
ous studies there is a positive impact of these relaxation
activities on mental health, cardiovascular diseases, and
Associations between burnout and relaxation musculosceletal disorders. Previous study results show
strategies evidence that physical activity in general improves psy-
chological well-being [26, 27].
We found five small, but significant correlations between Only few students reported using drugs such as mari-
burnout symptoms and coping activities in the expected juana, cannabis, or other illicit stimulants for relaxation.
directions: meeting friends (EE: r = − .16, P < .01; DP: This is similar to findings of other studies demonstrating
r = − .11, P < .05), exercising (EE: r = − .11, P < .05; DP: comparable prevalence [28]. Compared with the use of
r = − .10, P < .05), taking sedatives (EE: r = .17, P < .01; DP: illicit drugs, drinking alcohol was more commonly used
r = .12, P < .05), taking performance enhancing stimu- for relaxation. Acute alcohol intoxication generally causes
lants (PA: r = .15; P < .01), and taking cannabis/marijuana short- or long-term health effects [29]. This conflicts
(DP: r = .10, P < .05). with binge drinking behavior which is becoming more
and more prevalent, especially in an even younger Ger-
man population [30–32]. It can harm physical and mental
Discussion health in the long term, and may lead to addiction [33].

The present study evaluated perceived burnout symp-

toms in combination with the practice of relaxation Gender differences
activities in a large, random sample of dental students
in Germany. The results add to the knowledge base of Our study results have shown several gender differences
prevention strategies on how to handle study-related in relaxation behavior. It seems as if female students try
stress and provide valuable information on associations to relax in a healthier way than male students.
between burnout symptoms and coping behavior in the Previous health promotion studies have confirmed
dental education field. these results. A study by Peker et al. [34] illustrated that

104   Prevention of study-related stress symptoms: health-promoting behavior among dental students 13
original article

female students engage in more responsible health survey distributed to them at home. Maybe we would
behaviors. Significant associations were found between have reached a higher response rate if we distributed the
overall health-promoting lifestyle behaviors, health questionnaires as a paper-and-pencil version. Second,
value, stress, and social support. In addition, our results the use of a cross-sectional design provided only a snap-
illustrated that women try to eat healthier compared with shot of the actual situation. Longitudinal studies are thus
male students, especially in stress situations. Previous recommended to verify our results. Third, all data regard-
studies focusing on gender differences in eating behavior ing coping and relaxation activities, burnout symptoms,
confirm our results. Women in general are more aware of etc. were collected by self-report, posing the risk of unreli-
their nutrition, have better nutrition knowledge, and eat able data. Finally, the results cannot be generalized to all
healthier than men [35]. dental students. Subsequent research studies with larger
With regard to alcohol drinking behavior, additional samples are strongly needed to investigate other parts of
studies verify our findings. A higher and more frequent Germany, Europe, etc. with more dental students.
consumption of alcohol among male students in gen-
eral has been previously reported [36–38]. It seems as if
being young, male and experiencing stress while study- Conclusion
ing at universities are risk factors that are reliably linked
to unhealthy behavior such as alcohol abuse. In this study, we describe the coping activities of 239 Ger-
Gender differences should be considered by health man dental students and their scores in the MBI. Nearly
prevention educators and insurances when planning 40 % of students suffer from EE. The more frequent use
educational interventions to promote students' healthy of healthy coping activities may help to reduce study-
lifestyle [34]. Special health prevention programs should related stress. Our findings indicate the need for relevant
be developed only for male or female students depend- health promotion and may aid decision makers in devel-
ing on their needs and state of health consciousness. oping health promotion programs.
In sum, these study results are to (1) increase sensi-
tivity for psychological strain during medical education,
Associations between burnout and relaxing/coping (2) rise awareness of the complex topic “burnout preven-
activities tion” among dental students, their educators, and other
researchers, and (3) contribute to the development of
Significant associations between burnout subdimen- specific prevention strategies for dental students. More-
sions and various coping strategies and relaxing activi- over, the information generated by our study provides
ties were found. These results indicate that students who evidence about the presence of health promotion activi-
reported performing “healthy relaxing activities after ties in dental education in a salutogenic manner.
a day of studying” frequently such as meeting friends,
doing exercises, etc. scored less on EE and DP. Students, Conflict of interest 
in contrast, who reported a frequent use of harmful The authors declare that there are no actual or potential
activities for relaxation such as taking drugs, etc. scored conflicts of interest in relation to this article.
higher on DP.
Few studies also showed that doing exercises, yoga,
wellness, etc. are helpful activities to prevent stress- References
related diseases such as burnout. Previous studies, in
contrast, illustrated that taking drugs, drinking a lot of  1. Statista. Anzahl der Studierenden im Fach Zahnmedizin
alcohol, etc. are often used in cases of stress and burnout in Deutschland nach Geschlecht vom Wintersemester
2006/2007 bis 2013/2014 In, http://destatistacom/statistik/
as destructive coping strategies [39–41].
Future studies should investigate possible influencing der-zahnmedizinstudenten/ (Hamburg: Statista GmbH;
factors. It would also be interesting if personal character- 2014). Accessed 23 August 2014.
istics have an influence on the usage of sedatives, drug   2. Polychronopoulou A, Divaris K. Dental students' perceived
abuse, and coping strategies in general. We found no sources of stress: a multi-country study. J Dent Educ.
study that focused on relations or causal effects between 2009;73:631–9.
using sedatives and EE or DP. Study results, however,   3. Kothe C, Korbmacher H, Hissbach J, et al. Welche Fähig-
keiten brauchen Zahnmedizinstudierende? Deut Zahnar-
illustrate relations between taking sedatives and mental
ztl Z. 2012;67:254–9.
disorders such as depression and anxiety [42].  4. Rada RE, Johnson-Leong C. Stress, burnout, anxi-
ety and depression among dentists. J Am Dent Assoc.
Limitations   5. Gorter RC, Storm MK, te Brake JH, Kersten HW, Eijkman
MA. Outcome of career expectancies and early profes-
This study faced several methodological limitations that sional burnout among newly qualified dentists. Int. Dent J.
should be mentioned in reviewing our findings. First, the   6. Divaris K, Polychronopoulou A, Taoufik K, Katsaros C, Eli-
use of this study method may reduce the response rate, as ades T. Stress and burnout in postgraduate dental educa-
dental students were requested to complete a web-based tion. Eur J Dent Educ 2012;16:35–42

13 Prevention of study-related stress symptoms: health-promoting behavior among dental students   105
original article

  7. Te Brake H Smits N Wicherts JM Gorter RC Hoogstraten 26. McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise
J. Burnout development among dentists: a longitudinal to improve cognitive function in adults with neurological
study. Eur J Oral Sci. 2008;116:545–51. disorders: a systematic review. Arch Phys Med Rehabil.
  8. Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life 2011;92:1044–52.
events and medical student burnout: a multicenter study. 27. Hagins M, Moore W, Rundle A. Does practicing hatha yoga
Acad Med. 2006;81:374–84. satisfy recommendations for intensity of physical activity
  9. Thornton L. Beating the stress: treat yourself right. Imprint. which improves and maintains health and cardiovascular
2007;54:60–5. fitness? BMC Complement Altern Med. 2007;7:40.
10. Netterstrom B, Bech P. Effect of a multidisciplinary stress 28. Lee MH, Hancox RJ. Effects of smoking cannabis on lung
treatment programme on the return to work rate for per- function. Expert Rev Respir Med. 2011;5:537–546 (quiz
sons with work-related stress. A non-randomized con- 547).
trolled study from a stress clinic. BMC Public Health. 29. Baum-Baicker C. The psychological benefits of moderate
2011;10:658. alcohol consumption: a review of the literature. Drug Alco-
11. Baldwin JN, Scott DM, Agrawal S, et al. Assessment of alco- hol Depend. 1985;15:305–322.
hol and other drug use behaviors in health professions stu- 30. Witkiewitz K, Desai SA, Steckler G, et al. Concurrent drink-
dents. Subst Abus. 2006;27:27–37. ing and smoking among college students: an event-level
12. Barber MW, Fairclough A. A comparison of alcohol and analysis. Psychol Addict Behav. 2011;1:13–20.
drug use among dental undergraduates and a group of 31. Parada M, Corral M, Mota N, et al. Executive functioning
non-medical, professional undergraduates. Br Dent J. and alcohol binge drinking in university students. Addict
2006;201:581–4 (discussion 576). Behav. 2012;37:167–72.
13. Nichter M, Carkoglu A. Reconsidering stress and smoking: 32. Dennhardt AA, Murphy JG. Associations between
a qualitative study among college students. Tob Control. depression, distress tolerance, delay discounting, and
2007;16:211–4. alcohol-related problems in European American and
14. Cooper ML, Frone MR, Russell M, Mudar P. Drinking to African American college students. Psychol Addict Behav.
regulate positive and negative emotions: a motivational 2011;25:595–604.
model of alcohol use. J Pers Soc Psychol. 1995;69:990–1005. 33. Rodgers B, Korten AE, Jorm AF, et al. Non-linear relation-
15. Maslach C, Jackson S. Maslach burnout inventory manual. ships in associations of depression and anxiety with alco-
Palo Alto: Consulting Psychologist Press; 1981. hol use. Psychol Med. 2000;30:421–32.
16. Maslach C, Jackson S, Leiter M. Maslach burnout inventory 34. Peker K, Bermek G. Predictors of health-promoting behav-
manual. Palo Alto: Consulting Psychologist Press; 1996. iors among freshman dental students at Istanbul Univer-
17. Enzmann D, Kleiber D. Helfer-Leiden: Stress und Burnout in sity. J Dent Educ. 2011;75:413–20.
psychosozialen Berufen. Heidelberg: Roland Asanger; 1989. 35. Heaney S, O'Connor H, Michael S, Gifford J, Naughton G.
18. Guthrie E, Black D, Bagalkote H, et al. Psychological stress Nutrition knowledge in athletes: a systematic review. Int J
and burnout in medical students: a five-year prospective Sport Nutr Exerc Metab. 2011;21:248–61.
longitudinal study. J R Soc Med. 1998;91:237–43. 36. Ranney ML, Whiteside L, Walton MA, et al. Sex differences
19. Pohlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and in characteristics of adolescents presenting to the emer-
health in the clinical period of dental education. Eur J Dent gency department with acute assault-related injury. Acad
Educ. 2005;9:78–84. Emerg Med. 2011;18:1027–35.
20. Amin WM, Al-Ali MH, Duaibis RB, Oweis T, Badran DH. 37. Brandao YS, Correia DS, de Farias MS, Antunes TM, da
Burnout among the clinical dental students in the Jorda- Silva LA. The prevalence of alcohol consumption among
nian universities. J Clin Med Res. 2009;1:207–11. the students newly enrolled at a public university. J Pharm
21. Prinz P, Hertrich K, Hirschfelder U, de Zwaan M. Burnout, Bioallied Sci. 2011;3:345–49.
depression and depersonalisation–psychological factors 38. Labrie JW, Lac A, Kenney SR, Mirza T. Protective behavioral
and coping strategies in dental and medical students. GMS strategies mediate the effect of drinking motives on alcohol
Z Med Ausbild. 2012;29:Doc10. doi:10.3205/zma000780. use among heavy drinking college students: gender and
22. Romaguera D, Tauler P, Bennasar M, et al. Determinants race differences. Addict Behav. 2011;36:354–61.
and patterns of physical activity practice among Spanish 39. Jahne A, Kriston L, M B, Berner MM. Alcohol use and con-
university students. J Sports Sci. 2011;29:989–97. sumption advice of medical students. Psychother Psycho-
23. Handley TE, Inder KJ, Kelly BJ, et al. You've got to have som Med Psychol. 2009;59:14–20.
friends: the predictive value of social integration and sup- 40. Bewick BM, Mulhern B, Barkham M, et al. Changes in
port in suicidal ideation among rural communities. Social undergraduate student alcohol consumption as they prog-
Psychiatry Psychiatr Epidemiol. 2012;47:1281–90. ress through university. BMC Public Health. 2008;8:163.
24. Suzuki M, Amagai M, Shibata F, Tsai J. Factors related to 41. Schmitter M, Liedl M, Beck J, Rammelsberg P. Chronic
self-efficacy for social participation of people with mental stress in medical and dental education. Med Teacher.
illness. Arch Psychiatr Nurs. 2011;25:359–65. 2008;30:97–9.
25. Hefner J, Eisenberg D. Social support and mental 42. Nordfjaern T. A population-based cohort study of anxiety,
health among college students. Am J Orthopsychiatry. depression, sleep and alcohol outcomes among benzodiaz-
2009;79:491–9. epine and z-hypnotic users. Addict Behav. 2012;37:1151–7.

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