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Management of Stress and Anxiety Among PhD Students During Thesis Writing: A Qualitative Study

Bazrafkan, Leila PhD; Shokrpour, Nasrin PhD; Yousefi, Alireza PhD; Yamani, Nikoo MD, PhD

doi: 10.1097/HCM.0000000000000120

Today, postgraduate students experience a variety of stresses and anxiety in different situations of academic cycle. Stress and anxiety have been defined as a syndrome shown by emotional exhaustion and reduced personal goal achievement. This article addresses the causes and different strategies of coping with this phenomena by PhD students at Iranian Universities of Medical Sciences. The study was conducted by a qualitative method using conventional content analysis approach. Through purposive sampling, 16 postgraduate medical sciences PhD students were selected on the basis of theoretical sampling. Data were gathered through semistructured interviews and field observations. Six hundred fifty-four initial codes were summarized and classified into 4 main categories and 11 subcategories on the thematic coding stage dependent on conceptual similarities and differences. The obtained codes were categorized under 4 themes including “thesis as a major source of stress,” “supervisor relationship,” “socioeconomic problem,” and “coping with stress and anxiety.” It was concluded that PhD students experience stress and anxiety from a variety of sources and apply different methods of coping in effective and ineffective ways. Purposeful supervision and guidance can reduce the cause of stress and anxiety; in addition, coping strategy must be in a thoughtful approach, as recommended in this study.

Author Affiliations: Department of Medical Education, Medical Education Research Center, University of Medical Sciences, Isfahan (Drs Bazrafkan, Yousefi, and Yamani); and Applied Linguistics, Shiraz University of Medical Sciences (Dr Shokrpour), Shiraz, Iran.

Authors' Contributions: Leila Bazrafkan developed the study design, conducted the interviews and analysis, ensured trustworthiness, and drafted the manuscript. Alireza Yousefi, as the supervisor, participated in the study design, supervised the codes and data analysis process, and revised the manuscripts. Nikoo Yamani and Nasrin Shokrpour, as research consultants, participated in the study and advised during the study.

Funding/Support: The present article was extracted from the thesis written by Leila Bazrafkan and was financially supported by Esfahan University of Medical Sciences (grant no. 92-6746).

The authors have no conflicts of interest.

Correspondence: Nikoo Yamani, MD, PhD, Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Esfahan, Iran (

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