Predictors of stress, anxiety, depression, study engagement and academic performance in physiotherapy students, including a subgroup receiving a mindfulness training program


  • Janet McConville Latrobe University
  • Richard Chambers Monash University
  • Craig Hassed Monash University
  • Eric Morris Latrobe University
  • Andrew Hahne LaTrobe University



student, mindfulness, psychological distress, academic performance


Introduction: Student wellbeing is a growing concern for physiotherapy and other health professional students, with potential impacts on academic success, patient care and future personal wellbeing. The purpose of this study was to determine the predictors of future stress, anxiety, depression, study engagement and academic performance in physiotherapy students, including a subgroup who undertook a mindfulness training program.

Methods: Predictors of outcome were obtained from a prospective cohort study involving 83 penultimate-year physiotherapy students, who could volunteer to participate in a 6-week mindfulness training program during semester (n = 17) or complete outcome measures without mindfulness training (n = 66). Baseline predictors of outcome were obtained at the start of Semester 1: age, gender, trait mindfulness, study engagement, training (mindfulness training or no training), stress, anxiety and depression. Outcomes were measured at the end of Semester 1 (study engagement, stress, anxiety, depression, grade point average) and at the end of the course (grade point average). Multiple regression was used to determine the ability of baseline characteristics to predict outcomes.

Results: Psychological distress (stress, anxiety and depression) increased across the full study cohort between the start and end of the semester as exams approached (p < .05). Completion of mindfulness training was significantly associated with better academic performance and lower levels of depression at follow-up. Female gender, lower baseline depression scores and higher study engagement were also significant predictors of superior academic performance, while older age and higher trait mindfulness predicted greater study engagement at end of semester (p < .05).

Conclusions: Potentially modifiable factors (study engagement, depression and mindfulness training) were associated with future wellbeing and academic success in physiotherapy students. Further research is warranted to explore interventions to address these outcomes in randomised controlled trials.

Author Biographies

Janet McConville, Latrobe University

Discipline of Physiotherapy, Senior lecturer

Richard Chambers, Monash University

Campus Community Division

Craig Hassed, Monash University

Department of General Practice, A/Prof

Eric Morris, Latrobe University

School of Psychology and Public Health, Senior Lecturer

Andrew Hahne, LaTrobe University

Discipline of Physiotherapy, Senior Lecturer


Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D, Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., & Kessler, R. C. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638.

Bailey, N., Opie, J. L., Hassed, C. S., & Chambers, R. (2019). Meditation practice, dispositional mindfulness, personality and program outcomes in mindfulness training for medical students. Focus on Health Professional Education, 20(1), 50–68.

Bakker, A. B. (2011). An evidence-based model of work engagement. Current Directions in Psychological Science, 20(4), 265–269.

Beilock, S. L., & Carr, T. H. (2005). When high-powered people fail: Working memory and “choking under pressure” in math. Psychological Science, 16(2), 101–105.

Burton, W. N., Chen, C. Y., Li, X., & Schultz, A. B. (2017). The association of employee engagement at work with health risks and presenteeism. Journal of Occupational and Environmental Medicine, 59(10), 988–992.

Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., McClay, J., Mill, J., Martin, J., Braithwaite, A., & Poulton, R. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301(5631), 386–389.

Casuso-Holgado, M. J., Cuesta-Vargas, A. I., Moreno-Morales, N., Labajos-Manzanares, M. T., Barón-López, F. J., & Vega-Cuesta, M. (2013). The association between academic engagement and achievement in health sciences students. BMC Medical Education, 13, Article 33.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354–373.

Edgar, S. (2015). Identifying the influence of gender on motivation and engagement levels in student physiotherapists. Medical Teacher, 37(4), 348–353.

Eisenberg, D., Golberstein, E., & Hunt, J. B. (2009). Mental health and academic success in college. The BE Journal of Economic Analysis & Policy, 9(1), Article 40.

Fahrenkopf, A. M., Sectish, T. C., Barger, L. K., Sharek, P. J., Lewin, D., Chiang, V. W., Edwards, S., Wiedermann, B., & Landrigan, C. P. (2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. British Medical Journal, 336(7642), 488–491.

Gallagher, C. T., Mehta, A. N., Selvan, R., Mirza, I. B., Radia, P., Bharadia, N. S., & Hitch, G. (2014). Perceived stress levels among undergraduate pharmacy students in the UK. Currents in Pharmacy Teaching and Learning, 6(3), 437–441.

Gallasch, D., Conlon-Leard, A., Hardy, M., Phillips, A., Van Kessel, G., & Stiller, K. (2022). Variable levels of stress and anxiety reported by physiotherapy students during clinical placements: A cohort study. Physiotherapy, 114, 38–46.

Hakanen, J. J., Schaufeli, W. B., & Ahola, K. (2008). The job demands–resources model: A three-year cross-lagged study of burnout, depression, commitment, and work engagement. Work and Stress, 22(3), 224–241.

Hammond, J. A. (2009). Assessment of clinical components of physiotherapy undergraduate education: Are there any issues with gender? Physiotherapy, 95(4), 266–272.

Harris, L. M., Cumming, S. R., & Campbell, A. J. (2006). Stress and psychological well-being among allied health professionals. Journal of Allied Health, 35(4), 198–207.

Hassed, C. (2007). “Healer know thyself”: Mindfulness in the training of health professionals. Psychotherapy in Australia, 13(4), 58.

Hassed, C., & Chambers, R. (2014). Mindful learning: Reduce stress and improve brain performance for effective learning. Exisle Publishing.

Hassed, C., De Lisle, S., Sullivan, G., & Pier, C. (2009). Enhancing the health of medical students: Outcomes of an integrated mindfulness and lifestyle program. Advances in Health Sciences Education, 14(3), 387–398.

Hathaisaard, C., Wannarit, K., & Pattanaseri, K. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis. Asian Journal of Psychiatry, 69, Article 102997.

Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.

Hernández-Torrano, D., Ibrayeva, L., Sparks, J., Lim, N., Clementi, A., Almukhambetova, A., Nurtayev, Y., & Muratkyzy, A. (2020). Mental health and well-being of university students: A bibliometric mapping of the literature. Frontiers in Psychology, 11, Article 1226.

Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the academic productivity of university students. Journal of Mental Health Policy and Economics, 8(3), 145–151.

Jacob, T., Itzchak, E. B., & Raz, O. (2013). Stress among healthcare students: A cross disciplinary perspective. Physiotherapy Theory and Practice, 29(5), 401–412.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press.

Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.

Kakoschke, N., Hassed, C., Chambers, R., & Lee, K. (2021). The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PLoS One, 16(10), Article e0258999.

Katz, M. (2006). Study design and statistical analysis: A practical guide for clinicians. Cambridge University Press.

Klingbeil, D., Fischer, A., Renshaw, T., Bloomfield, B., Polakoff, B., Willenbrink, J., Copek, R., & Chan, K. (2017). Effects of mindfulness‐based interventions on disruptive behavior: A meta‐analysis of single‐case research. Psychology in the Schools, 54(1), 70–87.

Larcombe, W., Finch, S., & Sore, R. (2015). Who's distressed? Not only law students: Psychological distress levels in university students across diverse fields of study. Sydney Law Review, 37(2), 243–273.

Larcombe, W., Finch, S., Sore, R., Murray, C. M., Kentish, S., Mulder, R. A., Lee-Stecum, P., Baik, C., Tokatlidis, O., & Williams, D. A. (2016). Prevalence and socio-demographic correlates of psychological distress among students at an Australian university. Studies in Higher Education, 41(6), 1074–1091.

Leland, M. (2015). Mindfulness and student success. Journal of Adult Education, 44(1), 19–24.

Lindsay, R., Hanson, L., Taylor, M., & McBurney, H. (2008). Workplace stressors experienced by physiotherapists working in regional public hospitals. Australian Journal of Rural Health, 16(4), 194–200.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.

Maslach, C., & Leiter, M. P. (2008). The truth about burnout: How organizations cause personal stress and what to do about it. John Wiley & Sons.

McConville, J., Lewis, D., Chambers, R., & Hassed, C. (2019). Physiotherapy student experience of a mindful movement and mindful stress-reduction intervention: A qualitative study. New Zealand Journal of Physiotherapy, 47(3), 172–182.

McConville, J., McAleer, R., & Hahne, A. (2017). Mindfulness training for health profession students—the effect of mindfulness training on psychological well-being, learning and clinical performance of health professional students: A systematic review of randomized and non-randomized controlled trials. Explore, 13(1), 26–45.

McEwen, B. S. (2004). Protection and damage from acute and chronic stress: Allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032(1), 1–7.

Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Psychological Science, 24(5), 776–781.

Nagarajan, R., Scutari, M., & Lèbre, S. (2013). Bayesian networks in R: With applications in systems biology. Springer.

Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., Peters, D., Hodkinson, A., Riley, R., & Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Internal Medicine, 178(10), 1317–1331.

Pritchard, M. E., & Wilson, G. S. (2003). Using emotional and social factors to predict student success. Journal of College Student Development, 44(1), 18–28.

Sanchez-Campos, M., Archibald, D., MacLean, H., Koszycki, D., & Gosalves, C. (2020). Mindfulness in medical education: Students’ perceptions and four recommendations for implementation of a mindfulness intervention. International Journal of Whole Person Care, 7(2), 3.

Schaufeli, W. B., & Bakker, A. B. (2003). UWES–Utrecht work engagement scale: Test manual. Department of Social and Organisational Psychology, Utrecht.

Schaufeli, W. B., Bakker, A. B., & Salanova, M. (2006). The measurement of work engagement with a short questionnaire: A cross-national study. Educational and Psychological Measurement, 66(4), 701–716.

Schaufeli, W. B., Martinez, I. M., Pinto, A. M., Salanova, M., & Bakker, A. B. (2002). Burnout and engagement in university students: A cross-national study. Journal of Cross-Cultural Psychology, 33(5), 464–481.

Sinclair, S. J., Siefert, C. J., Slavin-Mulford, J. M., Stein, M. B., Renna, M., & Blais, M. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of US adults. Evaluation and the Health Professions, 35(3), 259–279.

Spinelli, C., Wisener, M., & Khoury, B. (2019). Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials. Journal of Psychosomatic Research, 120, 29–38.

Stoikov, S., Maxwell, L., Butler, J., Shardlow, K., Gooding, M., & Kuys, S. (2022). The transition from physiotherapy student to new graduate: Are they prepared? Physiotherapy Theory & Practice, 38(1), 101–111.

Vaez, M., & Laflamme, L. (2008). Experienced stress, psychological symptoms, self-rated health and academic achievement: A longitudinal study of Swedish university students. Social Behavior and Personality: An International Journal, 36(2), 183–196.

Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness: The Freiburg mindfulness inventory (FMI). Personality and Individual Differences, 40(8), 1543–1555.

Walsh, J. M., Feeney, C., Hussey, J., & Donnellan, C. (2010). Sources of stress and psychological morbidity among undergraduate physiotherapy students. Physiotherapy, 96(3), 206–212.

Zeidan, F., Johnson, S. K., Diamond, B. J., David, Z., & Goolkasian, P. (2010). Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition, 19(2), 597–605.




How to Cite

McConville, J., Chambers, R., Hassed, C., Morris, E., & Hahne, A. (2022). Predictors of stress, anxiety, depression, study engagement and academic performance in physiotherapy students, including a subgroup receiving a mindfulness training program. Focus on Health Professional Education: A Multi-Professional Journal, 23(4), 52–72.