Protective Effect of Self-efficacy Against Burnout in Colombian Dental Students

Objectives: Dental students experience considerable levels of stress during their training. “Some stress” is inherent in dental education, but prolonged or excessive levels can lead to clinically-manifested psychological distress and eventually burnout, especially in susceptible individuals. In this study we sought to a) test the hypothesis of stress being associated with distress and burnout among dental students and b) determine whether students’ self-efficacy is protective against distress and burnout.
Methods: We used data from a large-scale survey of dental students’ wellness (n=5,520; 69% females; mean age=21 yrs.) conducted in 17 Colombian dental schools. Information on stress was obtained via a 17-item version of the Dental Environment Stress questionnaire, psychological distress using the 10-item version of the Symptom Checklist Revised, burnout using the student version of the Maslach Burnout Inventory, and general self-efficacy using the 10-item General Self-Efficacy Scale. Using structural equation modeling (SEM) we developed measurement models for each construct and examined how stress affects distress and burnout. We used Mplus v.8.1 to estimate standardized coefficients (B) and corresponding standard errors (se) and applied a conventional p<0.05 criterion for hypothesis testing.
Results: The structural model demonstrated acceptable fit: RMSEA=0.038, CFI=0.90, TLI=0.90, and SRMR=0.06. We confirmed the existence of significant direct effects of stress on distress (B=0.93, se=0.03), distress on burnout (B=0.36, se=0.02), stress on burnout (B=0.66, se=0.04), self-efficacy on distress (B=-0.43, se=0.04) and self-efficacy on burnout (B=-0.18, se=0.04) and indirect effects of stress on burnout (B=0.35, se=0.01). Importantly, we found that all these associations were moderated by the protective influence of students’ self-efficacy (p<0.05).
Conclusions: Acknowledging the limitations of the study’s cross-sectional design, our results highlight key pathways underlying dental students’ mental health and psychological morbidity development. Future research should elucidate the temporality of these associations and identify specific approaches for the alleviation of stress and the promotion of self-efficacy in dental education.