Previous studies have shown that students in healthcare fields experience substantial stress during their studies.^1-4 From a psychological perspective, stress refers to feelings of emotional pressure and strain, and it often results from a discrepancy between personal resources and environmental demands.⁵ For healthcare students, these demands can include anything from regular study-related activities, like exams and essays, to witnessing human suffering and even death.^6-9Persistent, poorly managed stress and associated changes in cognitive, parasympathetic and immunological functioning may lead to the development of psychological distress, such as depressive symptoms and anxiety.^10-13 Psychological distress can, in turn, impair academic performance^14,15 and increase the risk for future ill-being and burnout.¹⁶ Identifying factors that help students manage the stressors of their education is therefore highly important when training future healthcare professionals.

Social support has been shown to buffer the effects of perceived stress on psychological functioning, decreasing psychological distress when under stress.^17,18 Social support may facilitate the re-evaluation of stressful situations,¹⁸ and reduce the intensity of physiological stress responses through hormonal functioning.^19,20 Prior research on the stress-buffering effects of social support in students has explored mostly overall perceived social support, focusing on support from family, romantic partners and friends.^21-26However, only a few studies have explored the stress-buffering effects of source-specific social support,²⁷ despite being essential for understanding what type of support students need during their education. Furthermore, while support from teachers has been associated with lower levels of perceived stress^28-30and psychological distress in students^7,31 the ability of teacher support to buffer the effects of perceived stress is yet to be explored.

In addition to dyadic relationships, larger social systems, such as social media and communities, may also have stress-buffering effects.^32,33 Social media can offer information and other coping resources, such as peer support and opportunities to vent.³⁴ Research on social media’s role in stress and coping is still sparse, but previous findings suggest that the use of social media may indeed buffer the effects of stress.^35-39

Similarly, the student community can be a source of supportive and meaningful relationships with peers who share the stressors and experiences related to being a student, increasing the perception of available support.^32,40,41 So far, only few studies have explored the role of communities in students’ perceived stress and psychological distress. These studies have found the student community to buffer the effects of perceived stress on life satisfaction and depressive symptoms, but not anxiety.⁴² However, the sense of community belonging, the feeling of being an important and valued member of a social system or a group^43,44 could be a particularly important intervention target for students, as it appears relatively easy to improve.^45,46

Moreover, the ability to find meaning in adversity can impact how stressful conditions affect people.^47-49 Meaningfulness can motivate to take action to control the stressors⁵⁰ and increase available personal resources, like hope and self-efficacy⁵¹ buffering the effects of perceived stress on psychological distress. Meaningfulness has been a topic of growing interest in various occupational fields, and studies on employees have found meaningful work to moderate the effects of perceived stress on different indicators of strain.^52,53

Despite previous research on the stress-buffering effects of social support^21–26 less is known about the effects of source-specific support. Also, only limited research exists on the roles of teacher support, social media use and sense of community belonging in students’ perceived stress and psychological distress. Furthermore, to the best of our knowledge, the stress-buffering effects of meaningfulness of studying are yet to be investigated. Our study aims to add to the understanding of the supports healthcare students need, by exploring the relationship between perceived stress and two indicators of psychological distress, depressive symptoms and anxiety, and how social support from different sources (parents, partner, friends, peers, teachers, social media), sense of community belonging, and meaningfulness of studying impact these relationships.

Descriptives and Pearson’s correlation coefficients between the study variables are presented in Table 2. All significant correlations were in the expected direction.

Perceived stress had a significant positive effect on depressive symptoms in all models, with the explained variance of the models ranging from 19% to 27% (Table 3). Perceived stress had significant interaction terms with parent support (B = -.03, t₍₇₈₃₎ = -2.4, p < .001), partner support (B = -.05, t₍₇₈₃₎ = -4.3, p < .001), peer support (B = -.04, t₍₇₈₃₎  = -3.0, p < .001), sense of community belonging (B = -.06, t₍₇₈₃₎ = -2.7, p < .01) and meaningfulness of studying (B = -.12, t₍₇₈₃₎ = -4.5, p < .001) in predicting depressive symptoms. The results indicated that parent support, partner support, peer support, sense of community belonging and meaningfulness of studying moderated the effect of perceived stress on depressive symptoms, which was statistically significant at all three levels (mean +/- 1 SD) for all these variables, as the confidence intervals at 95% did not contain zero (Table 4).

Perceived stress had a significant positive effect on anxiety in all models, with explained variance ranging from 35% to 38% (Table 5). Perceived stress had significant interaction terms with parent support (B = -.05, t₍₇₈₃₎ = -3.8, p < .001), partner support (B = -.03, t₍₇₈₃₎ = -2.2, p < .05), peer support (B = -.05, t₍₇₈₃₎ = -3.5, p < .001), sense of community belonging (B = -.08, t₍₇₈₃₎ = -2.5, p < .01) and meaningfulness of studying (B = -.08, t₍₇₈₃₎ = -3.0, p < .01) in predicting anxiety. The results indicated that parent support, partner support, peer support, sense of community belonging and meaningfulness of studying moderated the effect of perceived stress on anxiety, which was statistically significant at all three levels (mean +/- 1 SD) for all these variables, as the confidence intervals at 95% did not contain zero (Table 6).

In this cross-sectional study of 800 medical, dental, psychology and speech therapy students, we aimed to examine the relationships between perceived stress and two indicators of psychological distress, depressive symptoms and anxiety, and the stress-buffering effects of different sources of social support, sense of community belonging and meaningfulness of studying. We found that higher perceived stress was associated with higher levels of both depressive symptoms and anxiety. These findings were consistent with previous studies^10–13 indicating the importance of supporting healthcare students to manage the stressors of their education to prevent psychological distress and its consequences.^14–16

Several sources of support, as well as the sense of community belonging and meaningfulness of studying, were found to buffer the effects of perceived stress on both depressive symptoms and anxiety. First, we found that perceived stress had a weaker effect on both depressive symptoms and anxiety among those who reported higher social support from parents and romantic partners. These findings support previous studies,^21–26 except for support from friends, which did not have an impact on the relationship between perceived stress and psychological distress in our study.

Second, perceived stress had a weaker effect on psychological distress at higher levels of peer support and sense of community belonging. These findings also support previous studies,^42,22 reflecting the importance of having supportive relationships with people who share the stressors and experiences of being a healthcare student. From a practical perspective, these findings are particularly significant, as peer support and the sense of community belonging could be intervention targets, that are both accessible to universities and also fairly responsive to intervention.^45,46

Third, perceived stress also had a weaker effect on psychological distress among students who reported higher meaningfulness of studying. To the best of our knowledge, there are no previous studies on the stress-buffering effects of the meaningfulness of studying. However, previous studies have found meaningful work to moderate the effects of perceived stress on different indicators of strain.^52,53 Our result supports these findings, suggesting a similar protective effect of meaningfulness for students as well. Certain stressors are unavoidable when pursuing healthcare education,^6-9but the stressors may be easier to tolerate when they feel meaningful.

Finally, no stress-buffering effects were found for teacher support, despite having been associated with lower levels of both stress ^28-30and psychological distress in students.^7,31 The levels of teacher support were also very low on average, suggesting that the students did not find it natural to turn to their teachers in stressful situations. Similarly, social media support did not buffer the effects of perceived stress, contrary to previous findings.^35-39However, we approached the use of social media from a different perspective than previous studies, asking in which study-related struggles the student might utilize social media for support, as opposed to investigating the number of social media contacts or social media behaviors. If social media is used to manage stress, it might not be done intentionally, i.e., people do not explicitly seek support from social media but rather receive it through their online behaviors.

There is a high prevalence of perceived stress and psychological distress among healthcare students^15-4which can have negative implications for students’ academic performance and increase the risk for future ill-being and burnout.^14-16To combat this, the findings of our study suggest that students should be encouraged to identify their sources of support and seek support from those sources in stressful situations. However, not all students have supportive relationship in their life outside of the university setting. Thus, it is particularly important to promote students’ sense of community belonging and provide opportunities for students to connect with their peers, both inside and outside of the classroom. Formal peer support programs have also yielded positive results on student well-being.⁵⁸ Furthermore, educators and student welfare providers should consider strategies for promoting the meaningfulness of studying in healthcare students.

Our study found that perceived stress predicted depressive symptoms and anxiety in healthcare students. Social support from parents, romantic partners and peers, as well as the sense of community belonging and meaningfulness of studying, were found to buffer the effects perceived stress had on psychological distress. These findings offer valuable information for healthcare educators and student welfare providers who seek to promote students’ well-being.