SOCIAL BEHAVIOR AND PERSONALITY, 2009, 37(2), 163-172

© Society for Personality Research (Inc.)

DOI 10.2224/sbp.2009.37.2.163

The Relationships among Coping Styles,

Personality Traits and Mental Health of
Chinese Medical Students

Weiling Wang
Fourth Military Medical University , Xi’an, People’s Republic of China, and
Xi’an Jiaotong University, Xi’an, People’s Republic of China
Danmin Miao
Fourth Military Medical University, Xi’an, People’s Republic of China

The purpose of this study was to examine the relationships among coping styles, personality
traits, and mental health in medical students at Xi’an Jiaotong University School of Medicine.
276 participants were administered the Eysenck Personality Questionnaire (EPQ; Eysenck
& Eysenck, 1975; Chinese version, Gong, 1986), Coping Style Questionnaire (as adapted
by Xiao, 1996), and the Symptoms Checklist-90 (Derogatis, 1975; Chinese version, Chen,
1999). The students displayed a wide range of coping skills including problem solving, help
seeking, and fantasizing. Male students’ coping styles were slightly different from those of
female students and some relationships were found among coping style, personality, and level
of emotional health. Coping styles and the EPQ were closely correlated with psychological
health. The analysis of multiple regression showed neuroticism, paranoid ideation, and ration-
alization, father’s education level, fantasizing and academic stress were influencing factors in
the psychological/emotional health of the respondents.

Keywords: coping styles, personality, Eysenck Personality Questionnaire, mental health,

medical students.

The relationships among coping styles, personality traits and mental health
of medical school students have been discussed in numerous previous studies
(Dyrbye, Thomas, & Shanafelt, 2005; Hojat, Gonnella, Erdmann, & Vogel, 2003;

Weiling Wang, PhD; and Danmin Miao, PhD, Department of Psychology, School of Aerospace
Medicine, Fourth Military Medical University, Xi’an, People’s Republic of China.
Appreciation is due to anonymous reviewers.
Please address correspondence and reprint requests to: Danmin Miao, PhD, Department of
Psychology, School of Aerospace Medicine, Fourth Military Medical University,169 Changle Xilu,
Xi’an 710033, Shaanxi Province, People’s Republic of China. Phone: 029-84774814; Fax: 029-
84774814; Email: psych@fmmu.edu.cn

163
164 Coping styles, personality traits, and mental health

Park & Adler, 2003). The importance of understanding coping behaviors has
also been emphasized in numerous investigations (Connor-Smith & Flachsbart,
2007; Hudek-Knez̆ević & Kardum, 2000; Kardum & Hudek-Knez̆ević, 1996).
Furukawa, Suzuki-Moor, Saito, and Hamaraka (1993) describe coping as an
important variable, playing a significant role in psychological and physical
health. Vaillant (1992) found that mental health can be predicted through a
person’s self-rated use of defense styles in crisis situations. The development
of a successful coping behavior is likely to reduce stress and enable a person to
solve self problems, while maintaining psychological balance and health (Silber
& Hamburg, 1961). Primary and secondary control engagement coping responses
are associated with fewer depressive symptoms, whereas disengagement coping
and involuntary engagement responses are associated with more depressive
symptoms (Wadsworth, Rieckmann, Benson, & Compas, 2004).
There is also evidence that personality traits are significant short- and long-
term predictors of coping styles (Vollrath, Torgersen, & Alnaes, 1995). Parker
(1986) also states that extraversion has a significant positive effect on active,
problem-focused coping, while neuroticism is linked to less effective coping
styles. Kardum and Hudek-Knez̆ević (1996) found a significant positive link
between extraversion and emotion-focused coping and between neuroticism
and avoidance coping, while psychoticism is negatively linked to emotion and
problem-focused coping and positively linked to avoidance coping. In laboratory
tests, Evans and Fearn (1985) found that in a stressful situation Type A individuals
adopt more active coping styles than those of Type B individuals. When facing
stress, an individual with inefficient coping skills may be at a disadvantage
compared with a person who has more highly developed coping skills, while
persons with highly developed coping skills will be at an advantage compared
with the average person (Kessler, 1997); these findings were subsequently
confirmed by Vingerhoets and Flohr (1984).
College students, who are often at a crucial stage in their psychological and
personality development, frequently adopt coping styles that will affect their
physical and emotional development. To be a student in medical school can
be stressful (Radcliffe & Lester, 2003; Saipanish, 2003). Previous studies have
shown relatively high levels of distress, such as symptoms of depression (Dahlin,
Joneborg, & Runeson, 2005), and suicidal thoughts (Tyssen, Hem, Vaglum,
Gronvold, & Ekeberg, 2004) in medical school students. Because students who
employed coping efforts characterized by engagement strategies suffered from
fewer depressive symptoms, this suggests that training in these types of strategies
may be a useful intervention to lessen the negative consequences of stress among
medical students (Mosley et al., 1994).
But there has been very little research carried out on the relationships among
coping styles, personality traits, and mental health of Chinese medical students.
 Coping styles, personality traits, and mental health 165
In recent years, interest in medical careers has increased dramatically in China.
As the main source of doctors, medical school students should have more
formal education in mental health and coping with stress. Some research results
showed the importance of the faculty understanding and acknowledging different
student personality types and related learning preferences as a way to initiate
improvement of students’ education, promote student motivation, and allow for
an expression of learning style preference (Jessee, O’Neill, & Dosch, 2006).
The aim of the present research was to examine the relationships among coping
styles, personality traits, and mental health for Chinese medical students in order
to investigate trends that can be utilized by researchers and educators.

METHOD

Sample
Three hundred undergraduate medical school students at Xi’an Jiaotong
University were given questionnaires of which 276 (92%) were returned (males
= 130; females = 146; mean age = 20.96, SD = 1.0).

Measures
A demographic questionnaire elicited basic background information including
age, gender, academic major, parental marital status, self-assessment of quality of
interpersonal relationships with classmates, subjective reports of academic/study
pressure, family socioeconomic status (SES), family history of mental illness and
other basic demographic information.
Eysenck Personality Questionnaire (EPQ) The Chinese version of the EPQ
(Eysenck & Eysenck, 1975; adapted into Chinese, Gong, 1986) comprising
four scales was used: extraversion, neuroticism, psychoticism, and lying.
Internal consistency coefficients alpha obtained from this sample were 0.82 for
extraversion, 0.80 for neuroticism, 0.52 for psychoticism, and 0.82 for lying.
Coping Styles Questionnaire Coping styles were measured using an adapted
Coping Styles Questionnaire by Xiao and Xu (1996), which was revised
using the research questionnaires developed by Folkman and Lazarus (1980)
and Bond, Gardner, Christian, and Sigal (1983) on coping and defenses and
contains 62 items and six factors: problem solving, self blame, help seeking,
fantasizing, avoidance, and rationalization. The six factors comprise the three
coping style types: mature type (problem solving, help seeking), mixed type
(rationalization), and immature type (self-blame, fantasizing, avoidance). Internal
consistency coefficients alpha obtained for this sample were 0.80 for problem
solving, 0.82 for self-blame, 0.85 for help seeking, 0.81 for fantasizing, 0.80 for
avoidance and 0.90 for rationalization.
166 Coping styles, personality traits, and mental health

Symptoms Checklist-90 (SCL-90) Mental health status was measured using the
Chinese version of the SCL-90 (Derogatis, 1975; adapted into Chinese, Chen,
1999) comprising ten scales: somatization, obsessive-compulsive, interpersonal
sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation,
psychoticism, and additional items. For this sample, the internal consistency
coefficient alphas for the nine symptom dimensions ranged from 0.75 for
psychoticism, to a high of 0.88 for depression.
The questionnaires were in paper and pencil format and standard preprinted
forms. All participants were assured that the completed questionnaires would
remain anonymous and would have no influence on their selection. All subjects
participated in the study voluntarily.

RESULT

The Type and Employing Frequency of Each Coping Style of Medical

School Students
We found that students reported one of three types of coping style: Mature
Type: 103 (male = 43, female = 60); Mixed Type: 141 (male = 72, female = 69);
Immature Type: 32 (male = 15, female = 17); (x2 = 2.0976, p > 0.05).
The employing frequency of each coping style of the respondents indicated that
they chose the following styles (listed from most frequently to least frequently
chosen): problem solving, help seeking, fantasizing, avoidance, rationalization,
and self-blame.

Difference of Coping Style Between Male and Female Medical

Students
The research results showed that the male students were more inclined to
choose problem solving, self-blame, avoidance, and rationalization coping styles
than were female students, however, fantasizing and help seeking were more
likely to be chosen by female students than male students. Among these coping
style factors, rationalization was significantly different between these two groups
(p < 0.01) but the other factors were not found to be significantly different
between the two groups (p < 0.01).

Differences of Mental Health Status in Coping Styles of Medical

Students
Table 1 shows the comparison of SCL-90 scale scores for the different coping
style types of the respondents. The results indicated that the immature type had
the highest score, followed by the mixed type and mature type respectively.
Statistical analysis revealed significant differences among the coping styles
(p < 0.01).
 Coping styles, personality traits, and mental health 167
Differences of Personality Traits in Coping Styles of Medical
Students
Table 1 shows the comparison of EPQ scale scores for the different coping
styles of the students. The results indicated that in terms of the factors
of psychoticism and neuroticism, the immature type gained the highest
scores, followed by the mixed and then the mature type; on the extraversion
factor, the mature type gained the highest scores, followed by the mixed
and then the immature type; on the lying factor, the mature type gained the
highest scores, followed by the immature type and then the mixed type.
Statistical analysis revealed significant differences among the coping styles
(p < 0.01).

Table 1
Comparison of SCL-90 Scales Scores in the Different Coping Style Types of Medical
Students (x̄ + s)

SCL-90 mature type mixed type immature type F

(N = 103) (N = 141) (N = 32)

Somatization 1.27 ± 0.34 1.49 ± 0.53 1.46 ± 0.58 7.02*

Obsessive-compulsive 1.76 ± 0.46 2.27 ± 0.74 2.48 ± 0.90 22.40*
Interpersonal sensitivity 1.73 ± 0.55 2.27 ± 0.73 2.43 ± 0.83 22.93*
Depression 1.64 ± 0.62 2.03 ± 0.72 2.20 ± 0.83 12.42*
Anxiety 1.52 ± 0.47 1.81 ± 0.69 1.90 ± 0.78 7.87*
Hostility 1.52 ± 0.50 1.74 ± 0.64 1.84 ± 0.74 5.24*
Phobic anxiety 1.29 ± 0.35 1.54 ± 0.53 1.64 ± 0.60 11.09*
Paranoid ideation 1.60 ± 0.51 1.95 ± 0.55 2.13 ± 0.75 13.21*
Psychoticism 1.48 ± 0.64 1.75 ± 0.63 1.81 ± 0.71 6.75*
P 3.83 ± 2.48 5.52 ± 2.89 6.28 ± 3.20 14.91*
E 12.33 ± 4.31 11.46 ± 4.18 7.91 ± 3.90 13.60*
N 8.38 ± 3.72 13.63 ± 4.50 14.28 ± 4.81 51.62*
L 10.77 ± 3.04 8.91 ± 3.17 9.28 ± 2.59 11.23*

Note: * = p < 0.01, P = psychoticism, E = extraversion, N = neuroticism, L = lying.

Correlation Analysis on the factors of EPQ, Coping Styles and

SCL-90
Table 2 shows the correlation analysis of the factors of EPQ, coping style,
and SCL-90. A review of the results of SCL-90, EPQ, and the coping styles
indicated fairly consistent positive (psychoticism, neuroticism, self-blame,
fantasizing, avoidance, and rationalization) correlations for some categories,
and fairly consistent negative (extraversion, lying, problem solving) correlations
for others; only one category (help seeking) yielded both positive and negative
correlations.
 168

Table 2
Correlation Coefficient of the Factors on SCL-90, EPQ, and Coping styles (r)

Factor P E N L Problem Self- Help Fantasy Avoidance Rationa-

solving blame seeking lization

Somatization 0.1577* -0.0528 0.2580** -0.1449 -0.0948 0.2583** 0.0351 0.2476** 0.1725* 0.1344
Obsessive-compulsive 0.2725** -0.1469 0.4491** -0.1639* -0.2045** 0.3711** 0.0176 0.2180** 0.2844** 0.2210**
Interpersonal sensitivity 0.2522** -0.1166 0.4765** -0.1961* -0.1785** 0.3936** 0.0215 0.2967** 0.2690** 0.2648**
Depression 0.1758* -0.1045 0.4167** -0.1777* -0.1335 0.3640** -0.0356 0.1828* 0.2344** 0.2042**
Anxiety 0.2437** -0.0832 0.4019** -0.1706* -0.1367 0.2711** 0.0182 0.2262** 0.2106** 0.1245
Hostility 0.2276** -0.0847 0.2812** -0.0674 -0.1086 0.2364** -0.0385 0.1532 0.1573* 0.0932
Phobic anxiety 0.1758* -0.0614 0.3274** -0.1450 -0.1339 0.2044** 0.0503 0.2028** 0.1845* 0.1594*
Paranoid ideation 0.2165** -0.1048 0.3761** -0.1970* -0.1502 0.3997** 0.0378 0.3271** 0.2673** 0.2478**
Psychoticism 0.1905* -0.0842 0.3616** -0.2245** -0.1119 0.3685** 0.0148 0.2127** 0.2627** 0.1773*
Note:  = p < 0.05; * = p < 0.01; * = p < 0.001
P = psychoticism, E = extraversion, N = neuroticism, L = lying.
Coping styles, personality traits, and mental health
 Coping styles, personality traits, and mental health 169
Analysis of Multiple Regression on the Factors Related to the
Mental Health of Medical Students
The dependent variable was total score on the SCL-90; the independent
variables included 39 variables, such as the significant difference variables of
SCL-90, EPQ, and coping styles on t test, ANOVA, and correlation analysis,
gender, age, academic major, parental marital status, quality of interpersonal
relationships with classmates, study pressure, family SES, history of mental
illness in the family and so on. Stepwise multiple regression was adopted. The
results are shown in Table 3 where the first six factors related to the mental health
of medical students were neuroticism, paranoid ideation, rationalization, father’s
education level, fantasizing, and study pressure.

Table 3
Analysis of Multiple Regression on the Factors Related to the Mental Health of
Medical Students

Variable BETA B SE t p SIG T

Neuroticism 0.2567 0.0257 0.0061 4.199 0.0001 **

Paranoid ideation 0.2295 0.3526 0.0874 4.035 0.0001 **
Rationalization 0.1674 0.1683 0.0534 3.152 0.0018 *
Father’s education 0.1325 0.1078 0.0426 2.530 0.0120 
Fantasizing 0.1294 0.2103 0.0849 2.477 0.0139 
Study pressure 0.1263 0.1053 0.0450 2.340 0.0200 
Enjoying major 0.1018 0.0817 0.0419 1.952 0.0520
Psychoticism -0.0876 -0.0150 0.0097 -1.535 0.1259

Note:  = p < 0.05; * = p < 0.01; ** = p < 0.001

BETA = standardized regression coefficient, B = regression coefficient.

DISCUSSION

An individual’s coping style is the product of the interaction between the

individual’s personality traits and the stressful situation. An individual will
choose a different coping style depending on the different situation and the stress
experienced (Lazarus & Folkman, 1984). Coping styles are the methods and
means by which an individual can release tension, maintain psychological balance,
and control behavior in order to meet the demands of the external world (Freud,
1937). In this study we found that the respondent medical students we tested
usually employed the following coping styles: problem solving, help seeking,
and fantasizing, but they seldom employed avoidance, rationalization, and self-
blame. This indicates that the coping style of the students was generally rational,
and they used cognitive coping skills even in the face of difficulty and pressure.
They were able to confront various difficulties optimistically. They conducted
their daily lives with maturity and a considerable degree of emotional stability.
170 Coping styles, personality traits, and mental health

Carter, Bendell, and Matarazzo (1985) reported that male students were more
mature in their coping styles than were female students. By contrast, we found
that while there was little gender difference in their coping behavior, the ration-
alization coping factor scores of male and female students in our study were
significantly different according to gender. The reason for this is probably that
with the development of Chinese society, females’ sense of participation has been
enhanced and their social status has been improved.
We found differences in mental health based on a number of factors reflective
of the coping styles of each individual respondent. As measured on the Coping
Styles Questionnaire, those who usually adopted mature coping styles had
comparatively good mental health; those who commonly used immature
coping styles had poor mental health; and those who were most likely to use
mixed coping styles between the above two styles (mature and immature) were
moderately mentally healthy.
The results obtained indicated that extraversion has a direct positive effect on
a mature coping style, while neuroticism and psychoticism have direct positive
effects on an immature coping style, and those students who often use mixed
coping styles displayed a mixed array of features.
Lower scores on problem solving coupled with high scores on self-blame,
fantasizing, avoidance, and rationalization were generally associated with a lower
score on overall mental health. Scores on self-blame, fantasizing, avoidance, and
rationalization were also found to be good indicators of the respondents’ overall
physical health. Results for the help seeking scale were more ambiguous.
Additionally, the neuroticism and psychoticism factors showed significant
positive correlations with overall mental health, while the extraversion and
lying scales were significantly negatively correlated. Generally, the greater the
individual scores on the neuroticism and psychoticism scales, the greater were
the individual’s scores on social maladjustment and poor mental health. This is
consistent with Lu’s (1994) finding that neuroticism and psychoticism are more
important in predicting mental health than extraversion-introversion.
The analysis of multiple regression indicated that personality, mental health,
and coping style, as well as family and study environment, were the primary
factors in assessing the mental health of medical students in our study. We found
that neuroticism, paranoid ideation, rationalization, father’s education level,
fantasizing, and academic stress were influencing factors in the psychological/
emotional health of the respondents.
Generally, the results obtained show that coping styles are linked to general
personality traits and mental health. Our results also support the findings of
previous studies of the relationships among personality traits, mental health,
and coping styles that were carried out with medical student samples. Poor
personality traits and negative coping styles appear to play a role in the physical
and psychological health of medical students.
 Coping styles, personality traits, and mental health 171
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