Network analysis of psychological factors related to academic pressure faced by medical students in the central and highland regions of Vietnam

Figures & data

Table 1. General characteristics and psychological factor scores of study participants

Variable	Total (N = 878)	Male (N = 376)	Female (N = 502)	p-value a	Freshman (N = 255)	Junior (N = 297)	Senior (N = 326)	p-value b
Age (years) (Mean ± SD)	21.3 ± 1.9	21.2 ± 2.0	21.4 ± 1.9	0.13	19.0 ± 0.7	21.2 ± 0.9	23.3 ± 0.7	<0.001
Gender
Male	376 (42.8%)	376 (100%)	0 (0.0%)	NA	124 (48.6%)	119 (40.1%)	133 (40.8%)	0.08
Female	502 (57.2%)	0 (0.0%)	502 (100%)		131 (51.4%)	178 (59.9%)	193 (59.2%)
Academic standing
Freshman (First)	255 (29.0%)	124 (33.0%)	131 (26.1%)	0.08	255 (100%)	0 (0.0%)	0 (0.0%)	NA
Junior (Third)	297 (33.8%)	119 (31.6%)	178 (35.5%)		0 (0.0%)	297 (100%)	0 (0.0%)
Senior (Fifth)	326 (37.1%)	133 (35.4%)	193 (38.4%)		0 (0.0%)	0 (0.0%)	326 (100%)
Type of housemate
With family	97 (11.0%)	59 (15.7%)	38 (7.6%)	<0.001	31 (12.2%)	31 (10.4%)	35 (10.7%)	<0.001
Alone	568 (64.7%)	237 (63.0%)	331 (65.9%)		141 (55.3%)	202 (68.0%)	225 (69.0%)
With roomate	194 (22.1%)	67 (17.8%)	127 (25.3%)		74 (29.0%)	60 (20.2%)	60 (18.4%)
With relatives	13 (1.5%)	10 (2.7%)	3 (0.6%)		9 (3.5%)	3 (1.0%)	1 (0.3%)
Other	6 (0.7%)	3 (0.8%)	3 (0.6%)		0 (0.0%)	1 (0.3%)	5 (1.5%)
Monthly support
<67 USD	84 (9.6%)	47 (12.5%)	37 (7.4%)	0.001	34 (13.3%)	22 (7.4%)	28 (8.6%)	0.05
67-<111 USD	306 (34.9%)	109 (29.0%)	197 (39.2%)		91 (35.7%)	102 (34.3%)	113 (34.7%)
111-<156 USD	334 (38.0%)	144 (38.3%)	190 (37.8%)		87 (34.1%)	131 (44.1%)	116 (35.6%)
≥156 USD	151 (17.2%)	73 (19.4%)	78 (15.5%)		42 (16.5%)	42 (14.1%)	67 (20.6%)
Other	3 (0.3%)	3 (0.8%)	0 (0.0%)		1 (0.4%)	0 (0.0%)	2 (0.6%)
Academic grading
Excellent	48 (5.5%)	21 (5.6%)	27 (5.4%)	0.46	14 (5.5%)	25 (8.4%)	9 (2.8%)	<0.001
Very good	271 (30.9%)	116 (30.9%)	155 (30.9%)		71 (27.8%)	127 (42.8%)	73 (22.4%)
Good	427 (48.6%)	173 (46.0%)	254 (50.6%)		122 (47.8%)	120 (40.4%)	185 (56.7%)
Fairly good	108 (12.3%)	52 (13.8%)	56 (11.2%)		42 (16.5%)	21 (7.1%)	45 (13.8%)
Average	22 (2.5%)	13 (3.5%)	9 (1.8%)		5 (2.0%)	4 (1.3%)	13 (4.0%)
Weak	2 (0.2%)	1 (0.3%)	1 (0.2%)		1 (0.4%)	0 (0.0%)	1 (0.3%)
Sleeping time (hours)	7.3 ± 1.5	7.4 ± 1.7	7.3 ± 1.3	0.11	7.6 ± 1.5	7.1 ± 1.2	7.4 ± 1.6	0.18
Smoking
Yes	21 (2.4%)	21 (5.6%)	0 (0.0%)	<0.001	2 (0.8%)	4 (1.3%)	15 (4.6%)	0.004
No	857 (97.6%)	355 (94.4%)	502 (100.0%)		253 (99.2%)	293 (98.7%)	311 (95.4%)
Alcohol drinking
Yes	193 (22.0%)	143 (38.0%)	50 (10.0%)	<0.001	42 (16.5%)	71 (23.9%)	80 (24.5%)	0.04
No	685 (78.0%)	233 (62.0%)	452 (90.0%)		213 (83.5%)	226 (76.1%)	246 (75.5%)
Physical activity
Never	62 (7.1%)	16 (4.3%)	46 (9.2%)	<0.001	6 (2.4%)	31 (10.4%)	25 (7.7%)	<0.001
1–2 times/months	220 (25.1%)	53 (14.1%)	167 (33.3%)		36 (14.1%)	87 (29.3%)	97 (29.8%)
3–4 times/months	246 (28.0%)	114 (30.3%)	132 (26.3%)		85 (33.3%)	88 (29.6%)	73 (22.4%)
1–2 times/week	196 (22.3%)	108 (28.7%)	88 (17.5%)		68 (26.7%)	59 (19.9%)	69 (21.2%)
≥3 times/week	154 (17.5%)	85 (22.6%)	69 (13.7%)		60 (23.5%)	32 (10.8%)	62 (19.0%)
Study motivation (Mean ± SD)	18.6 ± 3.1	18.6 ± 3.1	18.6 ± 3.0	0.90	19.3 ± 3.1	18.5 ± 3.0	18.0 ± 3.0	<0.001
Study environment (Mean ± SD)	24.4 ± 4.7	24.5 ± 5.0	24.3 ± 4.4	0.62	26.6 ± 4.3	23.7 ± 4.3	23.3 ± 4.6	<0.001
Study condition (Mean ± SD)	21.7 ± 4.4	21.9 ± 4.7	21.7 ± 4.3	0.48	24.0 ± 4.0	20.8 ± 4.3	20.9 ± 4.3	<0.001
Teacher quality (Mean ± SD)	31.5 ± 4.9	31.4 ± 5.4	31.6 ± 4.4	0.52	32.3 ± 5.0	31.2 ± 4.8	31.1 ± 4.8	0.006
Training program (Mean ± SD)	22.7 ± 4.5	23.0 ± 4.6	22.5 ± 4.3	0.15	24.7 ± 3.9	21.9 ± 4.3	21.9 ± 4.6	<0.001
Managing system (Mean ± SD)	19.0 ± 3.8	19.0 ± 4.2	19.0 ± 3.5	0.82	20.3 ± 3.6	18.6 ± 3.8	18.3 ± 3.9	<0.001
Evaluation activity (Mean ± SD)	17.0 ± 3.0	17.1 ± 3.3	16.8 ± 2.8	0.19	17.4 ± 2.9	17.0 ± 3.0	16.6 ± 3.1	0.002
Extracurricular activity (Mean ± SD)	18.3 ± 4.0	18.3 ± 4.3	18.4 ± 3.7	0.77	19.9 ± 3.4	17.9 ± 3.8	17.4 ± 4.1	<0.001

^ap-values are calculated from a t-test for continuous variables and a chi-square test for categorical variables for the differences between males and females. ^bp-values are calculated from the ANOVA test for continuous variables and a chi-square test for categorical variables for the differences between academic standings. Bold fonts indicate statistical significance. NA, not applicable.

Table 2. Centrality indices of the multidimensional network of psychological factors in a sample of 878 medical students

Population	Factor	Strength	Closeness	Betweenness
Total	Study motivation	0.37	0.013	0
	Study environment	0.71	0.017	2
	Study condition	0.85	0.02	1
	Teaching quality	0.91	0.018	0
	Training program	0.96	0.021	4
	Managing system	0.97	0.019	1
	Evaluation activity	0.76	0.017	2
	Extracurricular activity	0.56	0.016	3
Male	Study motivation	0.28	0.013	0
	Study environment	0.83	0.018	2
	Study condition	0.74	0.016	0
	Teaching quality	0.87	0.017	0
	Training program	1.00	0.022	4
	Managing system	1.04	0.02	3
	Evaluation activity	0.79	0.017	2
	Extracurricular activity	0.52	0.017	2
Female	Study motivation	0.42	0.014	0
	Study environment	0.76	0.019	3
	Study condition	0.90	0.022	6
	Teaching quality	0.75	0.018	2
	Training program	0.90	0.019	3
	Managing system	0.85	0.019	0
	Evaluation activity	0.72	0.016	2
	Extracurricular activity	0.34	0.015	0
Freshman	Study motivation	0.135	0.012	0
	Study environment	0.591	0.016	0
	Study condition	0.735	0.020	2
	Teaching quality	1.241	0.026	11
	Training program	0.957	0.020	4
	Managing system	0.896	0.020	1
	Evaluation activity	0.844	0.022	1
	Extracurricular activity	0.314	0.013	0
Junior	Study motivation	0.206	0.011	0
	Study environment	0.714	0.022	10
	Study condition	0.992	0.023	10
	Teaching quality	0.700	0.019	0
	Training program	0.773	0.019	1
	Managing system	0.890	0.017	1
	Evaluation activity	0.522	0.017	0
	Extracurricular activity	0.474	0.016	6
Senior	Study motivation	0.203	0.013	0
	Study environment	0.733	0.020	5
	Study condition	0.744	0.016	0
	Teaching quality	0.854	0.022	0
	Training program	1.000	0.021	8
	Managing system	0.917	0.022	3
	Evaluation activity	0.982	0.019	2
	Extracurricular activity	0.376	0.015	0

Figure 1. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among a total of 878 medical students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Figure 2. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among 376 medical male students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Figure 3. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among 502 medical female students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Figure 4. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among 255 freshmen medical students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Figure 5. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among 297 junior medical male students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Figure 6. (a) Network structure and (b) centrality indices of psychological beliefs and attitudes among 326 senior medical female students

Nodes reflect psychological factors, and edges reflect the conditional dependencies between psychological factors. The thickness of edges represents the strength of correlations.

Table 3. Maximum proportions to retain correlation of 0.7 between node centrality and the original sample

Population	Strength	Closeness	Betweenness
Total	74.9%	43.8%	5.0%
Male	67.3%	36.3%	0
Female	51.6%	28.3%	5.0%
Freshman	59.6%	43.9%	5.1%
Junior	51.5%	28.3%	12.8%
Senior	59.5%	36.2%	4.9%

Figure 7. Graphical depiction for the stability of network centrality indices of (a) total, (b) male, (c) female, (d) freshmen, (e) junior; and (f) senior students

The percentage of the original data sampled is on the x-axis and the correlation of node centrality with the original sample is on the y-axis. Higher correlations indicate more stable indices.