Correlation between Stress and Meaning in Life in Early Career Doctors in Pakistan

To assess the correlation between using non-probability convenience sampling with early career doctors in Pakistan as the subjects. The data was collected using a form distributed online that included demographic variables, Purpose in Life (PIL) test and Perceived Stress Scale (PSS). SPSS 26.0 was used for data entry and analysis. Results: The average score on PIL test was 67.64 ± 15.20 and PSS was 20.20 ± 5.88. Women doctors reported higher perceived stress (18.82 ± 6.11) than men (20.75 ± 5.07). A statistically signi�cant negative correlation between the PIL and PSS was found, r (215) = -.610, p <0.01. r = -0.610 represents a large effect size. Conclusions: Higher meaning in life is associated with lower perceived stress in doctors. Interventions that focus on meaning in life may help improve the well-being of doctors.

distributed through social media. Informed consent was taken from all participants. The sur vey included participants' sociodemographic characteristics (age, gender, marital status, education, job designation, total duration of work, work in COVID units) and psychometric scales i.e. Purpose in Life (PIL) test and Perceived Stress Scale (PSS). PIL test, developed by Crumbaugh & Maholick in 1964, is a self-rated scale intended to assess level of meaning in life. Each of the 20 items has a range from 1-5. Higher score indicates higher meaning. The Perceived Stress Scale (PSS) gauges the extent to which a person perceives their present circumstances as stressful. It is a 10-item scale with response range 0-4. To obtain the PSS scores, four positively worded items (4, 5, 7, and 8) are reversed, and results are totaled. Higher scores suggest higher perceived stress. Statistical analyses were performed using SPSS version 26.0. Quantitative variables were described with mean and standard deviation. Categorical variables were represented using frequencies and percentages. Cronbach's alpha was calculated to assess the internal consistency of each scale with an acceptable value above 0.7. Independent sample t-test and analysis of variance (ANOVA) were run to assess the impact of demographic characteristics on meaning and stress. Pearson's correlation coe cient was calculated with p<0.05 considered signi cant.

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affects on the stress response, resilience, ability to endure adverse circumstances and post-traumatic growth [11]. They draw on Viktor Frankl's Logotherapy, which posits that life is potentially meaningful under all conditions. Even under the most miserable situations, meaning can be discovered by exercising the freedom to choose one's attitude to inescapable suffering and self-transcendence. This allows one to have optimism, altruism, spiritual grounding, social relationships and active coping, which are well known to mitigate stress. From the perspective of health, a greater sense of purpose in life is associated with better cardiovascular indicators, endocrine pro les, cognitive aging and restorative sleep as well as reduced mortality in both young and older adults [12]. Moreover, stress exposure was associated with depression when the presence of meaning in life was low but with high meaning, the association does not hold [13]. The sense of meaning decreases negative appraisals of the situations [14] and repetitive negative thinking after an unpleasant event, leading to healthier coping strategies [15]. It enhances positive affect [16], subjective well-being and life satisfaction [17]. Apart from the indirect effects on the response to stress, empirical evidence suggests a direct effect meaning has on subjective distress experienced by the individuals. A study conducted on palliative care professionals demonstrated that meaning of work and perceived stress were negatively correlated [17]. Similarly, presence of meaning was related to less mental distress in hospice nurses [16]. Moreover, several recent studies con rmed that meaning in life and meaning-centered coping alleviated the coronavirus pandemic stress [18,19]. However, there were no available studies that investigated the effect of meaning in life on stress experienced by Pakistani doctors. This study was planned to pave the way for further empirical research in this area and if the ndings are consistent with the literature presented above, meaning-centered interventions can eventually be designed to improve the well-being of doctors, especially in the aftermath of the global pandemic.
This study was done using a cross-sectional survey. The sample size was calculated using correlation coe cient -0.52 from a previous study [20], 5% signi cance level and 95% con dence interval. Data were collected from earlycareer doctors working in Pakistan between March and May 2021 using convenience sampling. The inclusion criteria were that participants (i) were early career doctors (i.e. those working for 10 years or less) and (ii) were working for a minimum of past 6 months. Those currently under treatment for a psychiatric disorder were excluded. All par ticipants were asked to complete an online questionnaire prepared using Google Forms and R E S U L T S Average age of the participants was 27.45 ± 2.82 years and the average duration they had worked was 3.88 ± 2.62 years. Table 1  was inversely correlated with distress, r (88) = −.53, p < .001 [15]. Another local study looked at the same variables as the current study but the population investigated was medical students. The reported correlation coe cient was -0.52, p<0.05 [20]. The only other published study done on Pakistani doctors reported a signi cant negative correlation between perceived stress and psychological well-being among doctors. Even though this used the Ryff psychological well-being scale, it did not report the correlation between the purpose in life subscale and stress [21]. A local study found a higher mean PSS score 26.09 ± 8.141 and that stress correlated negatively with age and number of years at work, in contrast to this study. However, they also reported that woman doctors had signi cantly higher perceived stress scores compared to men and that the effects of marital status and specialty were not signi cant [22]. Similarly, Park and Baumeister showed that less current stress was described by those who had a greater meaning in life, r (153) = −0.28, p < 0.01 [23]. Hill et al., indicated that sense of purpose is not only associated with lower levels of perceived stress but also with decreased secretion of cortisol, even though the amount of daily stressors experienced remains constant. This may mean that meaning fosters an optimistic attitude and active coping [13]. The research conducted speci cally on medical professionals points in the same direction. Moreno-Milan et al., [17] also reported that palliative care workers who found greater meaning in their work scored lower on the measure of perceived stress, increasing their satisfaction with life. Another study conducted on hospice nurses frequently dealing with mortality revealed the presence of meaning in life was associated with less stress, burnout and negative emotional states, and with more positive emotional states [16]. Even though it was not our primary aim to report on the level of stress in doctors and its relationship with demographic variables, an important nding was that female doctors were more stressed than male doctors but the genders did not differ signi cantly with respect to meaning in life. Moreover, older doctors with longer duration of career experienced greater meaning. Interestingly, marital status, educational attainment, job designation, specialty and frontline work in COVID-19 pandemic were found to have no signi cant difference effect on either variable. Another study from Faisalabad con rmed the higher degree of stress in female doctors but also suggested that being married was associated with greater stress [7]. Arif et al., [24] showed that house o cers have the most stress, followed by medical o cers or trainees, and consultants have the least. The differences with the present study may be explicable by sociodemographic and personality factors. To consider the strengths and limitations of the study

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The Cronbach's α value for Perceived Stress Scale (PSS) was 0.85 and Purpose in Life (PIL) test was 0.93, which indicated good reliability of the scales administered. The mean score on PIL test was 67.64 ± 15.20 and PSS was 20.20 ± 5.88. To compare the mean PIL scores of males and females, as well as those of frontline workers and others, independent sample t-tests were used. In either comparison, there were no signi cant differences in PIL scores between the groups. Additionally, t-tests were used to compare the mean PSS scores between genders and frontline workers versus others. PSS scores differed signi cantly between males (18.82 ± 5.07) and females (20.75 ± 6.11); t (215) = -2.198, p=0.03. There were no signi cant differences in PSS scores between those who worked in COVID units and others. The effect of marital status, education, job designation, and specialty on PIL and PSS scores was compared using one-way ANOVA tests. There were no statistically signi cant differences in either score between the groups. Pearson correlation coe cient was calculated to assess the relationship between PIL and PSS scores, which showed signi cant negative correlation between the PIL and PSS, r (215) =-.610, p<0.01. r=-0.610 represents a large effect size. Age and the duration of work as a doctor showed a signi cant positive correlation with PIL scores, although the effect size was small,  presented, it has been especially useful as it opens a new avenue for research on the mental well-being of Pakistani doctors, since there were no other studies on the topic available. The sample included both genders with a wide distribution across job designations and specialties. However, correlational studies cannot conclusively prove the relationship between variables and self-reported measures can introduce bias. We hope that future research would rectify these shortcomings. The current time is signi cantly stressful for doctors, making such research the need of the hour, so that we have interventions in our arsenal that enable better stress management.
Experiencing higher meaning in life leads to lower perceived stress in early career doctors from Pakistan.
Interventions that focus on meaning in life may help improve the well-being of doctors.
The authors declare no con ict of interest.

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The author(s) received no nancial support for the research, authorship and/or publication of this article S o u r c e o f F u n d i n g R E F E R E N C E S