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. 2024 Nov 15;129(5):4223–4238. doi: 10.1177/00332941241300968

The Relationship Between Work Engagement, Depression, Anxiety, and COVID-19 Anxiety in Physician Assistant Students

Sydney N Pepper 1, Emily T Farrell 2, Robin M Dawson 3, Michael D Wirth 4,5,✉
PMCID: PMC13530360  PMID: 39545772

Abstract

Introduction: Physician assistants (PAs) are subject to high levels of burnout, depressive symptoms, and anxiety, which can negatively impact quality of care and patient outcomes. Learning how to handle stress in the classroom may increase success and engagement in PA programs. The goal of this study was to characterize burnout, depressive symptoms, and anxiety in current PA students and examine the relationship between these factors and work engagement.

Methods: This cross-sectional study surveyed PA students (n = 42) via convenience sampling from eighteen different PA programs across North and South Carolina in October, 2021. Questionnaires included the Utrecht Work Engagement Scale (UWES-17), the Patient Health Questionnaire (PHQ-2), the General Anxiety Disorder scale (GAD-7), and the COVID-19 Anxiety Scale (CIAS). Adjusted linear regression was used to assess associations between the GAD-7, PHQ-2, and CIAS and the three subscales of the UWES-17 (vigor, dedication, and absorption).

Results: Students were primarily female (79%), white (79%), second-year students (62%), and had an average body mass index of 21.0 ± 3.9 kg/m2. A one-unit increase in the GAD-7 was associated with a decrease in the vigor (β = −0.94, SE = 0.19, p < .01) and dedication (β = −0.42, SE = 0.15, p = .01) subscales. A one-unit increase in the PHQ-2 was associated with a decrease in the vigor subscale (β = −2.94, SE = 0.60, p < .01).

Conclusions: Recognizing warning signs of declining mental health early among PA school students may be key to increasing resilience, enthusiasm, and concentration, which may enhance school/work engagement. More work is needed to elucidate potential intervention targets to increase school/work engagement in PA students.

Keywords: work engagement, physician assistant students, anxiety, depressive symptoms, stress

Introduction

Physician assistants (PAs) play an important role in medicine. Formally introduced as a profession in 1965, the role was initially established in response to a need for greater access to medical services (Cawley, 2012). Today, PAs are well-known and respected healthcare providers that are responsible for conducting physical exams, diagnosing illnesses, interpreting tests, assisting in surgery, and prescribing medication under the supervision of a physician (Cawley, 2012). PA training is at the master’s degree level and takes a holistic approach, with an emphasis on preventative care and chronic illness management (AAPA, 2022). Currently, the United States is facing a shortage of physicians that is projected to only worsen with time (Zhang et al., 2020). The general population is aging, bringing with it an increased demand for health and healthcare services (Kirch & Petelle, 2017) and a need for non-physician healthcare professionals, such as PAs. It is anticipated that, due to such demands, the PA profession will grow 28% from 2021 to 2031, which is much faster than all other occupations, according to the Bureau of Labor Statistics (BLS, 2022).

PAs are susceptible to burnout, which is a state of emotional, physical, and mental exhaustion (West et al., 2018). As a result of healthcare worker burnout, the consequences are particularly severe and can negatively impact the health of the patient (Motluk, 2018). There is also a strong dose-response relationship between burnout and impaired job performance (including medical errors), negatively impacting patient safety (Motluk, 2018). Symptoms of impaired mental health (e.g., anxiety and depression) can also affect work engagement and productivity. A study examining the effect of depression and burnout in PAs found significant evidence that depression negatively impacted professional fulfillment (β = −0.76, 95% confidence interval [95%CI] = -1.08 to −0.45), with 46% of participants reporting work exhaustion and 80% reporting at least one medical error during their career (Blackstone et al., 2021). As PA students progress through their training, studies have found a noticeable decline in patient-care-related empathy, and this pattern is reflected across other health care providers’ educations (Mandel & Schweinle, 2012). Burnout is prevalent among students undergoing medical training and can persist long after graduation (Lee et al., 2020). Therefore, it is possible that the burnout seen in PAs begins during their formative PA education/program years.

The body of knowledge that PA students are expected to master continues to grow. Although PA training is much shorter than physician training, lasting two years versus the seven to eleven-year process that medical students endure (McNamara, 2012), the coursework is fast paced and maintains a similar level of rigor and intensity to that of medical school. PA students endure long hours of continuous work and studying with little to no free time, and this imbalanced schedule and consequential stress can easily translate from the classroom to the workplace (Johnson et al., 2020). Additionally, PA students experience distressing situations during their training (e.g., working with cadavers) which may elicit negative emotions such as shock, anxiety, and apprehension (Chang et al., 2018). PA students have a higher stress than the average population, and report feeling nervous, upset, and unable to manage personal problems (O'Brien et al., 2012). Medical student burnout has also been negatively correlated with career motivation, or the desire to achieve success at an enhanced and meaningful level, which can lead to lower school/work engagement (Gyorffy et al., 2016). Nearly 80% of PA students report high levels of emotional exhaustion, and over 90% rate stress reduction and burnout as important issues to address in the student population (Johnson et al., 2020). With 78% of PA students expressing interest in wellness intervention to address this burnout, exploring potential interventions is an important endeavor (Johnson et al., 2020)

This study was conducted during the height of the COVID-19 pandemic, and the unique circumstances surrounding the pandemic heightened the risk of burnout and mental health concerns in healthcare professionals, including PAs (Leo et al., 2021). As a consequence of the pandemic, healthcare workers experienced progressively longer workdays, elevated patient load, dwindling medical supplies, and the imminent risk of contracting the virus in a high-risk environment (Leo et al., 2021). These additional stressors may exacerbate negative emotions in a PA or PA student that is already struggling and further contribute to systemic burnout.

Work engagement, the “positive opposite” of burnout, overall reflects a fulfilling state of mind when it comes to work and, with PA students, their academic studies (Fiabane et al., 2013). One longitudinal study explored the relationship between work engagement and symptoms of anxiety and depression from several occupational groups, with a majority consisting of healthcare workers, found that elements of quality work engagement, such as vigor and dedication, are negatively associated with anxiety and depression, with work engagement being an important modifier of health (Innstrand et al., 2012). While there is copious research available concerning medical doctors, nurses, and PAs, minimal research exists regarding mental health concerns that PA students experience, that, when left unresolved, can spill into their professional career (Roberts et al., 2020). It is especially valuable to investigate the elements of their studies that allow PA students to persevere and how modifiable factors impact this engagement. Increased work engagement is associated with improved job performance, learning motivation, and job satisfaction, which are key attributes of being an effective employee and healthcare professional (Schaufeli & Bakker, 2004). Increasing work engagement in PA students may decrease PA burnout and give rise to PAs that are highly motivated, engaged, and resilient when faced with stressors.

The primary goal of this research was to survey current PA students on their levels of healthy work engagement, depression, and anxiety (especially related to COVID-19) using several standardized study instruments to further elucidate the role of mental health on engagement in education and coursework, which may aid in future development of intervention targets to enhance engagement in PA programs. It was hypothesized that higher levels of anxiety and depressive symptoms would be associated with lower levels of school or classwork engagement.

Materials and Methods

Study Design and Population

This was a cross-sectional survey that was facilitated via an electronic survey mainly consisting of four standardized surveys. Participants were only considered eligible if they were current PA students at the time of the survey distribution. Respondents were from eighteen different PA programs across North Carolina and South Carolina, and surveys were administered via REDCap. PA program directors were encouraged via email to share a link to the REDCap survey with current students. The four standardized questionnaires included in the survey were the Utrecht Work Engagement Scale (UWES-17), the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder Scale (GAD-7), and the COVID-19 Induced Anxiety Scale (CIAS). Participants were also prompted to share demographic information including race, gender, year in PA program, height, weight, and prevalence of alcohol consumption. This study was considered exempt by the Institutional Review Board at a university in the Southeast United States. Given the exempt status of this work, completion of the survey was deemed to be consent.

UWES-17

The UWES-17 is a validated measurement tool that examines three dimensions of work engagement: vigor, dedication, and absorption (Seppala et al., 2009). Analysis of the scale has found high levels of internal consistency (α coefficient values of 0.87, 0.82, and 0.90, high test-retest reliability), showing that the three related factors fit better than a one-factor description of work engagement (Carmona-Halty et al., 2019) For this study, questions concerning work engagement referred to PA how students engaged with their studies. Vigor refers to high levels of mental resilience and persistence while working. Dedication refers to being strongly involved and experiencing a sense of enthusiasm and pride. Absorption refers to being fully concentrated and engrossed in one’s work, with time passing quickly (Schaufeli & Bakker, 2004). The UWES-17 consists of seventeen items allocated to each of the three dimensions of work engagement and uses a seven-point Likert scale that ranges from 0 (never) to 6 (every day). Six questions measure the vigor aspect, five questions measure the dedication aspect, and six questions measure the absorption aspect, with the values from each question summed within each subscale (Seppala et al., 2009). Higher vigor indicates high energy and stamina while working, higher dedication indicates strong identification and pride in one’s work, and higher absorption indicates higher levels immersion and concentration while working (Schaufeli & Bakker, 2004).

PHQ-2

The PHQ-2 is a validated measurement tool used to screen for depressive symptoms (Kroenke et al., 2003). The questionnaire has a sensitivity of 83% and a specificity of 92% for major depressive disorder, displaying both construct and criterion validity (Kroenke et al., 2003). It is a two-part inventory that measures if the respondent has felt anhedonia, which is little interest in doing things, or generally felt hopeless over the past two weeks; the responses are ranked from a scale 0–3 with a summed score of 0-6. Scoring below three indicates minimal depressive symptoms, while scoring three or above indicates presence of at least mild depressive symptoms (Kroenke et al., 2003).

GAD-7

The GAD-7 is a validated measurement tool effective for screening for GAD and assessing its severity (Spitzer et al., 2006). The scale has demonstrated excellent internal consistency and test-retest reliability (89% sensitivity, 82% specificity) and yields similar results between both self-administered tests and those administered by a mental health professional (Spitzer et al., 2006). The GAD-7 is a seven-item scale with increasing scores indicating multiple domains of functional impairment ranging from minimal anxiety to severe anxiety. A score from 0–4 indicates minimal anxiety, from 5–9 indicates mild anxiety, from 10–14 indicates moderate anxiety, and from 15–21 indicates severe anxiety (Spitzer et al., 2006).

CIAS

The CIAS is a validated measurement tool used to measure COVID-19 induced anxiety and protective behaviors (Silva et al., 2022). Studies have shown that the CIAS displays high internal consistency, and furthermore displays a significant positive relationship between other measures of anxiety, offering additional support to its construct validity (Silva et al., 2022). It is a ten-item scale that assesses anxiety from specific sources including leaving the house, disease-related stigma, and clinical symptoms (Riad et al., 2020). Low CIAS scores indicate low levels of COVID-19 induced anxiety, while increasing CIAS scores indicate higher levels of anxiety.

Statistical Analyses

The independent variables were the GAD-7, PHQ-2, and CIAS, while the dependent variables consisted of the three subscales of work engagement (vigor, dedication, and absorption), each assessed independent of one another. Frequencies and percentages or mean and standard deviations were calculated to describe the study population. Spearman correlations were conducted to derive initial relationships between each of the scales. Linear regression was conducted to analyze the relationships between each of the three work engagement subscales and anxiety, depression, and COVID-19 anxiety in separate models. Covariates, including race/ethnicity, gender, year in PA program, height, weight, and prevalence of alcohol consumption, were assessed as potential confounders. Race/ethnicity was condensed into two categories, to “White/Caucasian” and “Other,” due to sample size. It was decided, a priori, that PA year, gender, and race would remain in all models. Then, alcohol and BMI were evaluated as confounders. Additionally, due to the categorical nature of the GAD-7 and PHQ-2, linear regression with least square means were conducted to obtain adjusted mean values for the work engagement subscales by GAD-7 and PHQ-2 categories. The GAD-7 typically consists of four categories, but was condensed into three (“Minimal”, “Mild”, and “Moderate/Severe”) due to small sample sizes. The PHQ-2 was categorized as a binary predictor (“Minimal or No Depressive Symptoms” and “Depressive Symptoms”).

After examining residuals across all final models, the assumptions of linear regression were not violated. Analyses were conducted using SAS (version 9.4, Cary, NC). Data can be made available for collaborative efforts through contact of the corresponding author.

Results

Forty-two PA students responded to the surveys distributed to eighteen different PA programs throughout North and South Carolina. Participants were primarily female (79%), white (79%), and in their second year of PA school (62%). On average, participants had a BMI of 21.0 ± 3.87 kg/m2 and 83% had consumed at least one alcoholic drink per month in the past twelve months. The average score on the UWES was 20.3 ± 7.1 for the vigor subscale, 23.0 + 4.7 for the dedication subscale, and 17.4 + 7.0 for the absorption subscale. The PHQ-2 resulted in 12% scoring 3 or above, indicating symptoms of depression. For the GAD-7, 31% of participants showed symptoms of minimal anxiety, 36% showed symptoms of mild anxiety, 33% showed symptoms of moderate/severe anxiety, with an average GAD-7 score of 7.8 ± 5.7. The average score on the CIAS was 24.5 ± 6.0 (Table 1).

Table 1.

Population Characteristics Among all Participants of the Study.

Characteristics Participants (n = 42)
Gender
 Female 33 (79%)
 Male 8 (19%)
 Other 1 (2%)
Year in PA school
 First 16 (38%)
 Second 26 (62%)
Race
 White/Caucasian 33 (79%)
 Other 9 (21%)
BMI
Mean ± STE 21.0 ± 3.9
Alcohol in the last 12 months
 No 7 (17%)
 Yes 35 (83%)
GAD7 – Categorical
 Minimal 13 (31%)
 Mild 15 (36%)
 Moderate/Severe 14 (33%)
GAD7
Mean ± STE 7.8 ± 5.7
PHQ-2 - categorical
 No/Minimal symptoms 37 (88%)
 Depressive symptoms 5 (12%)
PHQ-2
Mean ± STE 1.3 ± 1.5
CIAS
Mean ± STE 24.5 ± 6.0
Vigor
Mean ± STE 20.3 ± 7.1
Dedication
Mean ± STE 23.0 ± 4.7
Absorption
Mean ± STE 17.4 ± 7.0
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Strata totals may not equal column total due to missing data. Abbreviations: PA = physician assistant, UWES = Utrecht work engagement scale, VI = vigor, DE = dedication, AB = absorption, PHQ-2 = patient health questionnaire, GAD-7 = anxiety, CIAS = covid-19 anxiety scale.

There was a strong negative correlation between scores on the GAD-7 and the vigor subscale of the UWES (r = −.62, p < .01), between scores on the PHQ-2 and the vigor subscale of the UWES (r = −.65, p < .01) score and between the PHQ-2 and the vigor subscale of the UWES (r = −.65, p < .01, Table 2).

Table 2.

Spearman’s Correlations Between the Independent (GAD-7, PHQ-2, and CIAS Results) and Dependent (Three Subscales of Work Engagement).

UWES - Vigor UWES - Dedication UWES - Absorption Score PHQ-2 Score GAD-7 Score CIAS
UWES - vigor 1
UWES - dedication .61 p < .01 1
UWES - absorption .40 p < .01 .36 p.02 1
Score PHQ-2 −.64 p < .01 −.14 p = .36 .05 p = .77 1
Score GAD-7 −.63 p < .01 −.27 p = .09 .01 p = .97 .75 p < .01 1
Score CIAS −.08 p = .61 −.18 p = .26 .07 p = .67 .13 p = .42 .32 p = .04 1
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Abbreviations: UWES = Utrecht work engagement scale, VI = vigor, DE = dedication, AB = absorption, PHQ-2 = patient health questionnaire, GAD-7 = anxiety, CIAS = covid-19 anxiety scale.

For every one-unit increase in the GAD-7, the vigor subscale of the UWES decreased (β = −0.94, SE = 0.19, p < .01), as did the dedication subscale of the UWES (β = −0.42, SE = 15, p = .01). For every one-unit increase in the PHQ-2, the vigor subscale of the UWES decreased (β = −2.94, SE = 0.60, p < .01). No other statistically significant findings were observed when treating the GAD-7, PHQ-2, and CIAS continuously (Table 3).

Table 3.

Linear Regression Between the Independent (GAD-7, PHQ-2, and CIAS Results) and Dependent (Three Subscales of Work Engagement) Variables.

Psychological Questionnaire
Score		 Utrecht Work Engagement Scale (UWES-17) Category
Vigor p-value Dedication p- value Absorption p- value
GAD-7
 Minimal (Ref) 27.1 (22.5, 31.7) - 23.8 (20.2, 27.5) - 18.4 (13.0, 23.9) -
 Mild 19.0 (13.5, 24.5) <.01 20.2 (15.8, 24.6) .07 14.6 (8.1, 21.1) .18
 Moderate/Severe 14.2 (7.9, 20.5) <.01 18.8 (13.7, 23.9) .03 14.2 (6.7, 21.7) .20
 Continuous −0.94 (0.19) <.01 −0.42 (0.15) .01 −0.23 (0.23) .33
PHQ-2
 No/Minimal symptoms 25.5 (20.8, 30.2) - 23.2 (19.8, 26.6) - 17.2 (11.9, 22.5) -
 Symptoms 15.5 (8.2, 22.8) <.01 17.7 (12.4, 23.0) .02 17.1 (9.0, 25.2) .98
 Continuous −2.94 (0.60) <.01 −0.84 (0.52) .11 −0.30 (0.76) .70
CIAS
 Continuous −0.06 (0.21) .78 −0.21 (0.14) .14 0.03 (0.19) .86
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Abbreviations: UWES = Utrecht work engagement scale, VI = vigor, DE = dedication, AB = absorption, PHQ-2 = patient health questionnaire, GAD-7 = anxiety, CIAS = covid-19 anxiety scale.Adjustments: Models for vigor and the PHQ-2 and absorption and the CIAS were adjusted for year in PA school, race, and gender. All other models were additional adjusted for body mass index.P-values derived using multiple linear regression in comparison to the designated reference category.

Table 3 also displays the LS means of the UWES by depressive symptom and anxiety symptom categories. The mean UWES vigor subscale among those with depressive symptoms and those without was 15.5 and 25.5, respectively (p < .01). The mean UWES dedication subscale among those with depressive symptoms and those without was 17.7 and 23.2, respectively (p = .02). As for anxiety, those with mild (p < .01) and moderate/severe anxiety (p < .01) had lower vigor scores compared to those with minimal or no anxiety (14.2 vs. 19.0 vs. 27.1, respectively). For the dedication subscale of the UWES, only those with moderate/severe anxiety showed lower scores compared to minimal or no anxiety (18.8 vs. 23.8, p = .03, Table 3).

Discussion

Salient results include a negative association between depressive symptoms/anxiety and work engagement. Specifically, those with more depressive symptoms or anxiety, compared to their counterparts without, had lower levels of vigor and dedication to their studies. Vigor is defined as experiencing a sense of mental resilience and persistence (Schaufeli & Bakker, 2004). A study conducted in 2020 administered surveys to a group of college students measuring their levels of resilience, poor mental health status, and positive mental health three times over a four-year period and found a bidirectional relationship between negative mental health status and resilience (Wu et al., 2020). There is also an established relationship between higher levels of anxiety and depression and lower scores on the vigor and dedication subscales of work engagement, specifically when referring to graduate students (Gallea et al., 2021). A study conducted by Gallea and colleagues examined several attributes of burnout and work engagement in 153 graduate students studying science-related fields such as physics, chemistry, and biology, and found that only 9% of students presented high levels of work engagement while 68% showed anxiety symptoms and 50% showed depressive symptoms. They found that as the amount of time in graduate school increased, UWES scores also decreased significantly (r = −.424, p < .05) (Gallea et al., 2021). While graduate students and PA students occupy a similar age group and endure a comparable workload, it is worth noting that the type of work conducted differs between the two groups (Gallea et al., 2021). Graduate students focus on research, writing, and navigating a work-life balance, whereas PA students experience clinicals and rigorous medical training in addition (Gallea et al., 2021). Medical students, whose training model is comparable to PA students, have been found to have higher stress levels than those of non-medical graduate students, with 75.6% attributing their stress to studies alone (Jafri et al., 2017).

There were no associations between symptoms of impaired mental health and the absorption subscale of work engagement. This differs from previous literature, which has associated depressive symptoms with impaired cognitive function, such as learning and processing speed (Keller et al., 2019). One notable study highlighted significant impact on ability to concentrate and intellectual engagement with material in undergraduate students conducting scientific research (Cooper et al., 2020). This may be attributed to the nature of PA students and their curriculum compared to undergraduate students: students pursuing a professional degree typically have a special interest in the topic, and heightened passion allows concentration to come more naturally (Peixoto et al., 2021). Additionally, undergraduate students are more likely to be employed and have more responsibilities occupying both time and mental capacity, with around 70% of college students working while enrolled (Carnevale et al., 2015). A survey distributed across several PA programs found that only 43% of participants were employed during their first year, while 88% stated their school encouraged unemployment while enrolled (Neill et al., 2019). With their studies typically being their number one priority, ability to absorb oneself and concentrate on the material may be easier for a PA student compared to undergraduate students and, possibly, graduate students in non-medical disciplines.

An unexpected, non-significant relationship between any work engagement subscale and COVID-19 anxiety was found in the present study. COVID-19 has taken a major toll on the day-to-day lives of students as one study assessing the relationship between COVID-19 and mental health found that 71% of surveyed college students experienced increased stress and anxiety due to the pandemic, with 89% reporting a decreased ability to concentrate and 82% expressing heightened concerns about academic performance (Son et al., 2020). A possible explanation for the insignificant association between each subscale of work engagement and the COVID-19 anxiety scale is the nature of the relationship between PA students and COVID-19 exposure. While active healthcare workers spent long days in the hospital and experienced consequences of the pandemic firsthand, many PA students, especially ones in their first year, were in the classroom and did not experience the severe burden COVID-19 created. Although the fear may have been present, they were not directly encountering those diagnosed with COVID-19 in a hands-on way that currently practicing PAs were.

This study possesses several strengths. While there has been extensive research conducted on undergraduate, graduate, and medical students, PA students are an understudied population. Particularly, the impact of anxiety and depressive symptoms on work engagement is a relationship that has yet to be fully explored, especially in PA students. On one hand, that makes this research novel. On the other hand, comparison with previous literature is difficult because of differences between undergraduate, graduate, medical, and PA students, as well as due to differences in program requirements and difficulty. Additionally, the metrics used to assess the population are validated surveys. This study also highlighted which particular aspects of work engagement are negatively impacted by poor mental health, which serves as guidance for what needs to be initially addressed while developing interventions to reduce PA student stress.

This study also had several noteworthy limitations. The sample size was relatively small, and stratified analyses by race or sex were not feasible. The sample was also recruited from only South Carolina and North Carolina PA programs. The surveyed population was quite homogeneous, as the vast majority of the participants were white women. While this is reflective of the average demographic makeup of PA programs (Bradley-Guidry et al., 2022), this lack of diversity may have yielded different survey results than ones derived from a more varied group of students. Additionally, this was a cross-sectional study that did not allow for determination of a causal relationship. Reverse causation is possible, and lower levels of work engagement may be responsible for anxiety or depressive symptoms instead of the inverse. Lastly, confounding due to unmeasured factors may exist, as several other variables were not assessed such as diet, physical activity levels, and socioeconomic status that may impact levels of anxiety and depression (Hoebel et al., 2017).

Conclusion

Recognizing warning signs for mental health concerns proactively and adjusting behavior to combat consequent symptoms are key to increasing resilience, enthusiasm, and concentration to achieve successful work engagement (Ojo et al., 2022). Developing healthy habits in a work-life balance, managing a comfortable and effective level of productivity, and prioritizing mental health are extremely important, especially when considering future healthcare professionals. Working long hours with little free time is common for PA students and can translate from the classroom to the workforce, but this is not easily sustained. Based on the notable associations between mental health and work engagement found in the present study, it is recommended that larger prospective studies are conducted. While implementing sustainable interventions is an effective solution to reducing anxiety and depressive symptoms in PA students, more information is necessary to fully understand the factors that influence school engagement and burnout in PA students, as well as what influences burnout as they transition into the healthcare workforce. Reducing burnout and poor mental health symptomology among PA students should be a priority to ultimately reduce the likelihood of professional burnout among PAs. There is evidence to suggest that incorporating stress management programs that emphasize mindfulness and decentering training have a positive effect on PA student stress (Hoover et al., 2020). Stress reduction techniques including meditation have been utilized by PA students, but currently only 16% of current students report frequent use of these techniques (Hoover et al., 2022). Future research should continue to assess PA student burnout and implement an intervention that addresses factors that contribute to burnout while promoting healthy work engagement. Surveying a PA student population before and after undergoing a stress reduction program may be a worthwhile endeavor to assess the practical impact of these interventions. Additionally, while this study surveyed PA students, negative associations between work engagement and mental health may be seen in several other populations including graduate students and more specifically graduate students studying a healthcare discipline. Therefore, this line of research may be applicable to other similar populations such as medical and nursing students.

Author Biographies

Sydney N. Pepper was an undergraduate student in the Arnold School of Public Health, University of South Carolina, at the time of this work. Currently, she is enrolled in Physician Assistant Studies (MSPAS) at Medical University of South Carolina (MUSC).

Emily T. Farrell, MPH, was a Graduate Assistant of Dr. Michael Wirth, and was enrolled in the MPH program in Epidemiology at the Arnold School of Public Health, University of South Carolina.

Dr Robin M. Dawson, PhD, RN, CPNP-PC, is an Associate Professor in the Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina. She also is the Interim Associate Dean for Academics and Accreditation.

Dr Michael D. Wirth, MSPH, PhD, FACE, is an Assistant Professor at the University of South Carolina with a joint appointment between the Department of Biobehavioral Health and Nursing Science, College of Nursing, and the Department of Epidemiology and Biostatistics, Arnold School of Public Health.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

IRB Statement: This study was considered exempt by the Institutional Review Board at the University of South Carolina.

ORCID iD

Michael D. Wirth https://orcid.org/0000-0001-7610-8008

Data Availability Statement

Data can be made available by the corresponding author by request and appropriate data transfer agreements.

References

  1. AAPA . (2022). What is a PA? American Academy of PAs. https://www.aapa.org/what-is-a-pa/ [Google Scholar]
  2. Blackstone S. R., Johnson A. K., Smith N. E., McCall T. C., Simmons W. R., Skelly A. W. (2021). Depression, burnout, and professional outcomes among PAs. Journal of the American Academy of Physician Assistants, 34(9), 35–41. 10.1097/01.JAA.0000769676.27946.56 [DOI] [PubMed] [Google Scholar]
  3. BLS . (2022). Occupational outlook handbook, physician assistants. Bureau of Labor Statistics, U.S. Department of Labor. https://www.bls.gov/ooh/healthcare/physician-assistants.htm [Google Scholar]
  4. Bradley-Guidry C., Burwell N., Dorough R., Bester V., Kayingo G., Suzuki S. (2022). An assessment of physician assistant student diversity in the United States: A snapshot for the healthcare workforce. BMC Medical Education, 22(1), 680. 10.1186/s12909-022-03717-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carmona-Halty M. A., Schaufeli W. B., Salanova M. (2019). The Utrecht work engagement scale for students (UWES-9S): Factorial validity, reliability, and measurement invariance in a Chilean sample of undergraduate university students. Frontiers in Psychology, 10. 10.3389/fpsyg.2019.01017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carnevale A. P., Smith N., Melton M., Price E. W. (2015). Learning while earning: The new normal. Georgetown University Center on Education and the Workforce. [Google Scholar]
  7. Cawley J. F. (2012). Physician assistants and their role in primary care. Virtual Mentor, 14(5), 411–414. 10.1001/virtualmentor.2012.14.5.pfor2-1205 [DOI] [PubMed] [Google Scholar]
  8. Chang H. J., Kim H. J., Rhyu I. J., Lee Y. M., Uhm C. S. (2018). Emotional experiences of medical students during cadaver dissection and the role of memorial ceremonies: A qualitative study. BMC Medical Education, 18(1), 255. 10.1186/s12909-018-1358-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cooper K. M., Gin L. E., Barnes M. E., Brownell S. E. (2020). An exploratory study of students with depression in undergraduate research experiences. CBE-Life Sciences Education, 19(2), ar19. 10.1187/cbe.19-11-0217 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fiabane E., Giorgi I., Sguazzin C., Argentero P. (2013). Work engagement and occupational stress in nurses and other healthcare workers: The role of organisational and personal factors. Journal of Clinical Nursing, 22(17-18), 2614–2624. 10.1111/jocn.12084 [DOI] [PubMed] [Google Scholar]
  11. Gallea J. I., Medrano L. A., Morera L. P. (2021). Work-related mental health issues in graduate student population. Frontiers in Neuroscience, 15, 593562. 10.3389/fnins.2021.593562 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gyorffy Z., Birkas E., Sandor I. (2016). Career motivation and burnout among medical students in Hungary - could altruism be a protection factor? BMC Medical Education, 16, 182. 10.1186/s12909-016-0690-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hoebel J., Maske U. E., Zeeb H., Lampert T. (2017). Social inequalities and depressive symptoms in adults: The role of objective and subjective socioeconomic status. PLoS One, 12(1), e0169764. 10.1371/journal.pone.0169764 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hoover E. B., Butaney B., LeLacheur S., Straker H., Bernard K., Coplan B., Carr C., Blesse-Hampton L., Naidu A. (2022). Wellness in physician assistant education: Exploring mindfulness, well-being, and stress. J Physician Assist Educ, 33(2), 107–113. 10.1097/JPA.0000000000000427 [DOI] [PubMed] [Google Scholar]
  15. Hoover E. B., Butaney B., Stoehr J. D. (2020). Exploring the effectiveness of mindfulness and decentering training in a physician assistant curriculum. J Physician Assist Educ, 31(1), 19–22. 10.1097/JPA.0000000000000288 [DOI] [PubMed] [Google Scholar]
  16. Innstrand S. T., Langballe E. M., Falkum E. (2012). A longitudinal study of the relationship between work engagement and symptoms of anxiety and depression. Stress and Health, 28(1), 1–10. 10.1002/smi.1395 [DOI] [PubMed] [Google Scholar]
  17. Jafri A. S., Zaidi A., Aamir I., Aziz H., Din I., Shah M. (2017). Stress level comparison of medical and non-medical students: A cross sectional study done at various professional colleges in Karachi, Pakistan. Acta Pyschopathologica, 3(2), 1–6. [Google Scholar]
  18. Johnson A. K., Blackstone S. R., Simmons W., Skelly A. (2020). Assessing burnout and interest in wellness programs in physician assistant students. J Physician Assist Educ, 31(2), 56–62. 10.1097/JPA.0000000000000303 [DOI] [PubMed] [Google Scholar]
  19. Keller A. S., Leikauf J. E., Holt-Gosselin B., Staveland B. R., Williams L. M. (2019). Paying attention to attention in depression. Translational Psychiatry, 9(1), 279. 10.1038/s41398-019-0616-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kirch D. G., Petelle K. (2017). Addressing the physician shortage: The Peril of ignoring demography. JAMA, 317(19), 1947–1948. 10.1001/jama.2017.2714 [DOI] [PubMed] [Google Scholar]
  21. Kroenke K., Spitzer R. L., Williams J. B. (2003). The patient health questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. 10.1097/01.MLR.0000093487.78664.3C [DOI] [PubMed] [Google Scholar]
  22. Lee K. P., Yeung N., Wong C., Yip B., Luk L. H. F., Wong S. (2020). Prevalence of medical students' burnout and its associated demographics and lifestyle factors in Hong Kong. PLoS One, 15(7), e0235154. 10.1371/journal.pone.0235154 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Leo C. G., Sabina S., Tumolo M. R., Bodini A., Ponzini G., Sabato E., Mincarone P. (2021). Burnout among healthcare workers in the COVID 19 Era: A Review of the existing literature. Frontiers in Public Health, 9. 10.3389/fpubh.2021.750529 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mandel E. D., Schweinle W. E. (2012). A study of empathy decline in physician assistant students at completion of first didactic year. J Physician Assist Educ, 23(4), 16–24. 10.1097/01367895-201223040-00005 [DOI] [PubMed] [Google Scholar]
  25. McNamara S. (2012). Does it take too long to become a doctor? Medical Journal of Australia, 196(9), 595–597. 10.5694/mja12.10720 [DOI] [PubMed] [Google Scholar]
  26. Motluk A. (2018). Do doctors experiencing burnout make more errors? Canadian Medical Association Journal, 190(40), E1216–E1217. 10.1503/cmaj.109-5663 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Neill K., Snyder Z., Thakkar B., Andreeff R., Edwards S. (2019). Effect of employment on PA school performance. Journal of the American Academy of Physician Assistants, 32(12), 1. [Google Scholar]
  28. O'Brien L., Mathieson K., Leafman J., Rice-Spearman L. (2012). Level of stress and common coping strategies among physician assistant students. J Physician Assist Educ, 23(4), 25–29. 10.1097/01367895-201223040-00006 [DOI] [PubMed] [Google Scholar]
  29. Ojo A. O., Fawehinmi O., Yusliza M. Y. (2022). Survey data on the social, personal, and work resources associated with work engagement among knowledge workers in Malaysia amid the COVID-19 pandemic. Data in Brief, 40, 107690. 10.1016/j.dib.2021.107690 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Peixoto E. M., Pallini A. C., Vallerand R. J., Rahimi S., Silva M. V. (2021). The role of passion for studies on academic procrastination and mental health during the COVID-19 pandemic. Social Psychology of Education, 24(3), 877–893. 10.1007/s11218-021-09636-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Riad A., Huang Y., Zheng L., Elavsky S. (2020). COVID-19 induced anxiety and protective behaviors during COVID-19 Outbreak: Scale development and validation. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3594370
  32. Roberts A., Angoff N. R., Brissette D., Dupee D., Fahs D., Honan L., Korbey S., Roessler E., Schwartz M., Shabanova V., Tetrault J., Wu B., Colson E., Encandela J. (2020). Burnout among beginning first-year students from three health professional training programs. Med Sci Educ, 30(2), 879–883. 10.1007/s40670-020-00969-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Schaufeli W., Bakker A. (2004). Utrecht work engagement scale: Preliminary manual. Utrecht University Occupational Health Psychology Unit. [Google Scholar]
  34. Seppala P., Mauno S., Feldt T., Hakanen J., Kinnunen U., Tolvanen A., Schaufeli W. (2009). The construct validity of the Utrecht work engagement scale: Multisample and longitudinal evidence. Journal of Happiness Studies, 10(4), 459–481. 10.1007/s10902-008-9100-y [DOI] [Google Scholar]
  35. Silva W. A. D., de Sampaio Brito T. R., Pereira C. R. (2022). COVID-19 anxiety scale (CAS): Development and psychometric properties. Current Psychology, 41(8), 5693–5702. 10.1007/s12144-020-01195-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Son C., Hegde S., Smith A., Wang X., Sasangohar F. (2020). Effects of COVID-19 on college students' mental health in the United States: Interview survey study. Journal of Medical Internet Research, 22(9), e21279. 10.2196/21279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Spitzer R. L., Kroenke K., Williams J. B., Lowe B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. 10.1001/archinte.166.10.1092 [DOI] [PubMed] [Google Scholar]
  38. West C. P., Dyrbye L. N., Shanafelt T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529. 10.1111/joim.12752 [DOI] [PubMed] [Google Scholar]
  39. Wu Y., Sang Z. Q., Zhang X. C., Margraf J. (2020). The relationship between resilience and mental health in Chinese college students: A longitudinal cross-lagged analysis. Frontiers in Psychology, 11, 108. 10.3389/fpsyg.2020.00108 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Zhang X., Lin D., Pforsich H., Lin V. W. (2020). Physician workforce in the United States of America: Forecasting nationwide shortages. Hum Resour Health, 18(1), 8. 10.1186/s12960-020-0448-3 [DOI] [PMC free article] [PubMed] [Google Scholar]

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