Trait emotional intelligence as predictor of psychological health in undergraduate medical students: A hierarchical multiple regression approach

INTRODUCTION

Emotional intelligence (EI) broadly signifies an ability to perceive, evaluate and manage intrapersonal as well as interpersonal emotions. Early conceptualisation of EI referred to it as “Ability EI,” representing a distinct group of cognitive abilities related to emotions and its information processing, assessed mainly by maximum performance-based test.^[1] Subsequently, “Trait EI” (TEI) gained attention as a relevant EI measure. TEI is defined as an umbrella construct of emotion related self-perceptions and dispositions, located at the lower level of personality hierarchies, measured through self-reported questionnaires and rating scales.^[2] Essentially, TEI focuses on social-emotional competencies such as well-being, self-control, emotionality, sociability adaptability, as well as self-motivation. These attributes mainly encompass the affective aspects which are instinctive, involuntary and subjective to each individual and are different from conscious thinking, thereby fitting within the lower-order personality dimension framework.^[2] Interestingly, TEI skills can be subjected to learning process and are modifiable too.^[3]

Significant association of TEI on physical and mental health, emotional regulation and performance, life satisfaction and work success of an individual has been put forth.^[4] Individuals with higher TEI have been found to be able to effectively express and manage their emotions as well as possess good stress management skills.^[5] In addition, individuals with higher levels of TEI showed more adept decision-making in their career as compared to those who possessed lower TEI skills.^[6] Furthermore, a negative association of TEI with depression^[7] and psychosomatic complaints was also reported.^[8] These findings suggest that TEI can contribute significantly in promoting psychological well-being in a person and protect against the negative mental health outcomes.^[9] However, this is not a universal finding and contradictory results have also been reported.^[10] For instance, individuals with higher TEI have been shown to react more strongly under adverse circumstances, leading to greater psychological distress and maladaptive consequences in them.^[11]

Recently, some researchers have also explored the relation between measures of psychological illness and TEI in medical students.^[12] The prevalence of self-reported psychological morbidity was found to be more in those undergraduate students who scored lesser on TEI skills as compared to those who had higher scores.^[13] Mental well-being is an issue of concern in the field of medicine with alarmingly, increasing trends in the prevalence of psychological morbidity being consistently reported from across the world among various health-care professionals.^[14] There is an important need to identify predictors of mental well-being especially in budding doctors as development of psychological distress symptoms has been reported to occur even in the psychologically healthy students during their formative years in medical institutes.^[15]

This, in turn, predisposes to decreased attention and learning ability in them during the student life and is potentially detrimental during their clinical practice in future.^[16]

Considering the potential beneficial role of TEI in promoting mental well-being, a worthwhile next step would be to assess whether they are valid predictors of psychological health (PH) domains. Preliminary evidence suggests that measures of TEI might actually be useful in predicting a wide range of psychological outcomes. For instance, TEI facets such as well-being and self-control have been linked to outcome variables such as stress reactivity,^[17] symptoms of borderline personality disorder,^[18] and use of adaptive coping strategies.^[4] Research in this area is however, still in an incipient stage. Moreover, questions pertaining to its overall distinctiveness and incremental validity have also been raised. If the addition of TEI is able to demonstrate its unique variance in the dependent criterion that is not already explained by other existing predictors of PH such as social, demographic and environmental factors, it would be an encouraging step forward in providing evidence in favour for its incremental validity. To date, there are only few studies addressing the issue of utility of TEI in predicting mental well-being of undergraduate students. Much less is known about how TEI influences the psychological well-being in Indian population.

The purpose of the current work was to assess the association between TEI and PH of medical undergraduate students and to evaluate the incremental validity of TEI in predicting PH of these students.

MATERIALS AND METHODS

This cross-sectional study was conducted in department of Physiology, Maulana Azad Medical College, New Delhi after obtaining ethical clearance from the Institutional Ethical Committee.

RESULTS

HMRA

Hierarchical multiple regression (HMR) was performed to examine the relationship between three sets of independent variables (sociodemographics, educational factors and TEI) against one dependent variable PH. Preliminary analyses were conducted to ensure that there were no violation of the assumptions of normality, linearity and homoscedasticity. Regression models did not appear to be affected by multicollinearity among predictors (Tolerance between 0 and 1; variance inflation factors <1.2).

[Table 3] presents regression statistics. In the first step of HMR, sociodemographic predictors were entered. This model was statistically not significant F (5,126) = 0.79; P > 0.05 and explained 3% of variance in DASS-21. After entry of educational factors in Step 2, total variance explained by the model as a whole was 12%; F (7,124) = 2.41; P < 0.05. Introduction of educational factors explained additional 9% of variance in DASS-21, after controlling for sociodemographics [Table 3]. In the final adjusted model, introduction of TEIQuesf explained additional 25% of variance in DASS-21, after controlling for sociodemographics and educational factors. This model as a whole was statistically significant F (8,123) = 9.05; P < 0.001 [Table 3]. In the final model, three out of eight predictor variables were statistically significant, with TEIQuesf recording the highest beta value (β = −0.53, P < 0.001). The β coefficients for career choice and number of attempts (0.17 and 0.16, respectively) were significant at P < 0.05 [Table 3].

DISCUSSSION

The present study was undertaken to assess the association between TEI and PH of medical students and to evaluate the incremental validity of TEI in predicting psychological distress in them beyond sociodemographic and educational factors. TEIQue-sf and DASS-21 scales were used to assess TEI and PH, respectively. Reliability analysis revealed that both measures had a high internal consistency as their Cronbach’s alpha value was >0.7.^[23]

We assessed PH as an outcome for two main reasons. Firstly, over the past decades, disturbing trends toward global increase in prevalence of depression, anxiety, stress,^[13,24] burnout, substance abuse as well as suicidal ideations in doctors and medical students in comparison to their peer groups and general population have been consistently reported.^[14] Second, more and more studies are recently reporting development of symptoms of psychological distress quite early among budding doctors during their formative years in medical institutes.^[12,13] This, in turn, poses hindrance in their academic capabilities during student life and can have deleterious effects in their clinical acumen in future.^[25] To enable us to accurately measure the PH of students as a continuum rather than, as distinct series of separate conditions,^[26] we considered the total DASS-21 scores only. Moreover, to rule out the issue of multicollinearity among various subscales of TEIQue-sf, we relied on its global score for explaining the construct’s incremental variance in PH outcomes.^[27]

Apart from looking at the descriptive of all the study variables, we also used inferential HMR statistics to examine independent contribution of each set of the predictor variables in the explanation of PH of medical students. We grouped conceptually similar independent variables and added them in a block for analysis. Family forms an innate, integral and indispensable part of every person. From perspective of an individual, family not only provides the initial ‘social interaction’ to a person, but also provides basic social needs such as love, loyalty, self-esteem and the sense of being a part of a group.^[28] These initial interactions provide psychological aid to an individual and go a long way in determining one’s mental well-being. As a child starts going to school, in addition to family and sociodemographics, school and social environment in that place begin to gain importance, which can alter the psychological dynamics of the person. These environments have the potential of not only motivating an individual positively but, are also capable of creating negative emotional and affective effects in a person. This, in turn, could be reflected as, lack of confidence, unsociable character, negative life thoughts and not being satisfied with one’s life. Since, PH of an individual is based on the likelihood of being influenced or modified successively by the various predictor variables, we entered them in the form of three blocks in sequential order in regression analysis.

No significant difference was observed in global TEIQuesf or DASS-21 scores of the participants on basis of sociodemographics including gender. This could be attributed to the fact that majority of our study participants had similar sociodemographic profiles, hailing primarily from urban, upper-middle or upper SEC families^[20] and were day-scholars. In India, selection in medical colleges is through purely academic, highly competitive entrance examinations without any interview or personality assessment. It is quite plausible that majority of medical aspirants are self-motivated having similar personality traits and psychological dispositions. This could account for our observation of significantly better TEI and PH among students who had opted for medical profession on their own as compared to those who joined medical profession at their parent’s behest. Lack of enthusiasm and motivation coupled with lower self-esteem and confidence among students who had joined medical field due to parental pressure or were selected in more than one attempt, could have contributed to significantly higher DASS-21 scores in them in our study sample.^[29] However, since our study sample was confined to medical undergraduate students, these observations need further statistical validation before their extrapolation to general population.

Consistent with prior studies, our correlational analysis data illustrated the beneficial effect of TEI on PH of medical students.^[13,14] Negative association seen between global TEIQue-sf and DASS-21 scores indicates that students who possessed higher TEI skills experienced fewer symptoms of stress, anxiety and depression and were psychologically healthier as compared to their counterparts with lower TEI. Moreover, results of regression analysis revealed that TEI explained a statistically significant portion of variance in DASS-21 scores not explained by socio-demographics and educational dimensions. More specifically, TEIQue-sf scores increased the predictive ability of regression model by 25%. It is noteworthy that the predictive power of TEI was captured despite taking into consideration only global TEIQue-sf scores. In light of multifactorial structure of TEIQue, this may seem to represent a considerable increase. It is plausible that common method variance (i.e., Likert scale response format; single-respondent and single-occasion) might have artificially inflated TEI-outcome relationships in the presence of various contextual and situational factors. However, identification of career choice and number of attempts as significant variables along with the small amount of variance accounted for by these educational factors (9%) in regression model indicates that analyses were not unduly affected by bias arising from shared methodology. These findings suggest that TEI predicts affect-related variables, concerned essentially with individuals’ perceptions of their emotional abilities.^[10] Since, regression analysis was performed on DASS-21 scores from the domain of effect, it is unlikely that the predictive validity of TEIQue-sf at global composite level might have been compromised in our study.^[30]

Overall, our results indicate that TEI emerged as best predictor of psychological well-being of medical students followed by educational factors. However, sociodemographic profile as an attribute failed to demonstrate significant capacity to predict PH of our participants. Demonstrating the role of TEI in predicting psychological distress over and above conceptually related attributes provides empirical evidence in support of the distinctiveness of TEI. These findings are particularly important in context of medical students. One of the objectives of medical education involves development of skills for managing one’s own emotions, self-awareness, emotional self-control, empathy and proper handling of relationships with their patients. From theoretical perspective, TEI constitutes exactly such competence. Moreover, being a modifiable trait, it can even be enhanced by training. Considering the incremental ability of TEI in predicting psychological morbidity, the study assumes even more relevance in our country, where the doctors are continuously exposed to working under extremely stressful environments, both in terms of duty hours and patient load. Hence, if sufficient measures in the form of holding TEI training workshops or imparting education about these skills to medical students in formative years of their careers are adopted, it might enable them to be emotionally more competent and cope better in stressful conditions, thereby reducing psychological distress in them. This may pave way for better academic performance, patient care and satisfaction in life among budding doctors.

CONCLUSION

Our results demonstrate that there was a significant negative association between TEIQue-sf and DASS-21 scores, thereby indicating that TEI plays a positive role in promoting psychological well-being among medical students. Results, further, demonstrated the incremental validity and unique variance of TEI in predicting lower psychological distress and better PH in these students beyond sociodemographics and educational variables.