Medical students' crisis-induced stress and the association with social support.

Background: Medical schools are challenged to guard student wellbeing given the potential negative impact of the COVID-19 outbreak combined with an already high prevalence of mental distress. Although social support is generally associated with less crisis-induced stress, it is unknown whether this applies to medical students during the COVID-19 outbreak.

Objectives: The impact of the COVID-19 outbreak on perceived stress of medical students was assessed by comparing their perceived stress levels during the outbreak to both their own baseline and the previous cohort's pre-COVID-19 stress levels. Then, the association between social support and stress during the COVID-19 outbreak was assessed.

Methods: Dutch Year-1 medical students of cohort 2019 (n = 99) completed the 14-item Perceived Stress Scale (PSS-14) at two time points: baseline (pre-COVID-19) and final measurement (COVID-19). Social support-emotional-informational support and club membership-was assessed during the final measurement. PSS and social support scores were compared to similar measurements of cohort 2018 (n = 196). Students' baseline stress levels, gender, and study performance were controlled for when comparing final stress levels.

Results: In cohort 2018 (pre-COVID-19), students' perceived stress levels did not differ significantly between the baseline and final measurements. Additionally, baseline stress levels of the two cohorts (2018 and 2019) were not found to be significantly different. Cohort 2019's final stress levels (COVID-19) were significantly higher compared to their baseline stress levels (paired t-test: t = 6.07, p < .001) and cohort 2018's final stress levels (linear regression: B = 4.186, p < .001). Only during the COVID-19 outbreak higher social support levels-i.e., emotional-informational support (B = -0.75, p < .001) and club membership (B = -3.68, p < .01)-were associated with lower stress levels.

Conclusions: During the COVID-19 outbreak, medical students' perceived stress levels were higher-especially for students with lower social support levels. Our results suggest that medical schools should optimize social support to minimize crisis-induced stress.