Main Article Content

Saba Aslam
Sadia Saleem
Zahid Mahmood


OBJECTIVE: To find out the relationship of mental toughness, emotion regulation, and mental health problems among doctors and to identify the mediating role of emotion regulation between mental toughness and mental health problems among doctors.

METHODS: This cross-sectional study was conducted from February to September 2019. Two hundred medical doctors (100 house officers & 100 postgraduates including 50 males and 50 females in each group) working in five government hospitals were selected through stratified sampling technique. The participants were given Mental Toughness Scale (MTS), Emotion Regulation Scale (ERS) and Depression Anxiety Stress Scale (DASS-21). Correlation and mediation analysis were carried out to find out the relationship and mediating role among all variables.

RESULTS: Age of 200 doctors ranged from 22 to 36 years with mean age of 26.17±1.83 years. Mental toughness was found to have negative correlation with emotion dysregulation (-.31**) and mental health problems (-.34**) while had positive correlation with emotion regulation (.43). Mediation analysis highlighted that MTS was no longer the predictor of mental health problems after the effect of mediator as the indirect effect was (b=-.29, SE=.05) and direct effect was (b=-.35, SE=.05). The value of c prime indicated the partial mediating effect of emotion regulation between mental toughness and mental health problems among doctors.

CONCLUSION: Emotion regulation and mental toughness both work as a protective factor for mental health problems among doctors. Emotion regulation was working as a positive factor with the combination of mental toughness against mental health problems among doctors.

Article Details

How to Cite
Aslam, S., S. Saleem, and Z. Mahmood. “MENTAL TOUGHNESS AND MENTAL HEALTH PROBLEMS IN DOCTORS; A MEDIATING ROLE OF EMOTION REGULATION”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 13, no. 1, Mar. 2021, pp. 10-14, doi:10.35845/kmuj.2021.19923.
Original Articles


1. Khalid F, Abbasi A. Challenges faced by Pakistani healthcare system: clinician's perspective. J Coll Physicians Surg 2018;28(12):899-901. DOI: 10.29271/jcpsp.2018.12.899.
2. Jowett M, Brunal MP, Flores G, Cylus J. Spending targets for health: no magic number, health financing working paper, World Health Organization. 2016; WHO reference number: WHO/HIS/HGF/HF Working Paper/: 16(1).
3. Cox E. Violence in the healthcare workplace. U.S. News Health. 2017.
4. Gohil RK, Singh PK, Saxena N, Patel G. Work place violence against resident doctors of a tertiary care hospital in Delhi, India. Int Surg J 2019; 6(3): 975-981. DOI: 10.18203/2349-2902.isj20190834.
5. Akbar AN. Quality versus quantity: Nurses workload and patient's safety. J Pioneering Med Sci 2016; 6(70). DOI:10.3390/admsci7010007.
6. Gawande AV, Barnwal RK, Narlawar UW. Psychological stress among post-graduate medical resident doctors: A cross-sectional study in a tertiary care hospital in Central India. Int J Med Sci Public Health 2019;8(4):275-9.
7. Kalmbach DA, Fang Y, Arnedt JT, Cochran AL, Deldin PJ. Effects of sleep, physical activity, and shift work on daily mood: a prospective mobile monitoring study of medical interns. J Gen Intern Med 2018; 33:914-920. DOI: 10.1007/s11606-018-4373-2.
8. Mian A, Kim D, Chen D, Ward WL. Medical student and resident burnout: A review of causes, effects, and prevention. J Fam Med Dis Prev 2018; 4:094. DOI:10.23937/2469-5793/1510094.
9. Kumar M, Verma M, Das T, Pardeshi G, Kishore J, Padmanandan A. A study of workplace violence experienced by doctors and associated risk factors in a tertiary care hospital of South Delhi, India. J Clin Diag Res 2016;10(11):LC06-LC10. DOI: 10.7860/JCDR/2016/22306.8895.
10. Williams N, Horrells L, Edmiston D, Brady M. The impact of positive psychology on higher education. The William & Mary Educational Review 2018;5(1):83-94.
11. Jiang Y, Guan YJ, Dai DW, Huang W, Huang ZY. Prevalence of stress and its determinants among residents enrolled in China Standardized Training Program for Resident Doctor (C-STRD) program. A cross-sectional study. PLoS One 2019 Jan 7;14(1):e0207258. DOI: 10.1371/journal.pone.0207258.
12. Akpinar S, Akpinar O. The relationship with the personality and mental toughness at athletes. J Inter Soc Res 2018;11(61):1252-5.
13. Arthur CA, Fitzwater J, Hardy L, Beattie S, Bell J. Development and validation of a military training mental toughness inventory. Mil Psycol 2015;27(4):232-41. DOI: 10.1037/mil0000074.
14. Anderson C, Turner AC, Heath RD, Payne CM. On the meaning of grit and hope and fate control and alienation and locus of control and self-efficacy and effort optimism. Urban Rev 2016; 48(2): 198-219. DOI: 10.1007/s11256-016-0351-3.
15. Delaney PF, Goldman JA, King JS, Nelson GRO. Mental toughness, reinforcement sensitivity theory, and the five-factor model: Personality and directed forgetting. Psychology 2015;83:180-4. DOI: 10.1016/J.PAID.2015.04.020.
16. Kelly DR, Matthews MD, Bartone PT. Grit and hardiness as predictors of performance among west point cadets. Mil Psychol 2014;26(4):327-42. DOI: 10.1037/mil0000050.
17. Verzeletti C, Zammuner VL, Galli C, Agnoli, S. Emotion regulation strategies and psychosocial well-being in adolescence. Cogent Psychol 2016;3(1):119-294. DOI: 10.1080/23311908.2016.1199294.
18. Lin DT, Liebert CA, Tran J, Lau JN, Salles A. Emotional intelligence as a predictor of resident wellbeing. J Am Coll Surg 2016 Aug;223(2):352-8. DOI: 10.1016/j.jamcollsurg.2016.04.044.
19. Aslam S, Saleem S, Mahmood Z. The development of a mental toughness scale for doctors: A psychometric study. J Liaqat Univ Med Health Sci 2019; 18(3): 214-8. DOI: 10.22442/jlumhs.191830630.
20. Daurani S. Unpublished Development of Scale Doctoral Thesis. Institute of Clinical Psychology, University of Management and Technology Lahore Pakistan. 2016.
21. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005;44(2):227-39. DOI: 10.1348/014466505X29657.
22. Jamal Y, Niloferfarooqi Y. Professional life stress and coping strategies used by house job doctors. Ethno Med 2016;10(2):132-9. DOI: 10.1080/09735070.2016.11905481.
23. Ibrahim TAS. Association between depression, anxiety, stress, social support, resilience and internet addiction: A structural equation modeling. Malays Online J Educ Technol 2019;3(7):1-12. DOI: 10.17220/mojet.2019.03.001.
24. Kalinin R, Balazsi R, Pentek I, Duica S, Hanțiu L. Relationship between competitive anxiety and mental toughness: a latent regression analysis. Health Sports Rehab Med 2019;2(20):70-4. DOI: 10.26659/pm3.2019.20.2.70.
25. Young KS, Sandman CF, Craske MG. Positive and negative emotion regulation in adolescence: links to anxiety and depression. Brain Sci 2019;9(76):1-20. DOI: 10.3390/brainsci9040076.
26. Saleem S, Khan IQ, Saleem T. Anxiety and emotional regulation; anxiety and emotional regulation among pupils of a state-owned medical institution: a gender perspective. Profess Med J 2019; 26(5):734-41. DOI: 10.29309/TPMJ/2019.26.05.3469.