To investigate coping strategies adopted by chiropractic college students and how these strategies affect student-perceived stress levels.


Four hundred seven (407) 1st-quarter students were recruited during 2014 and 2015. The validated Brief COPE inventory was used to assess coping strategies during the 1st week of classes. Perceived Chiropractic College Stress (PCCS) was assessed via a modification of Vitaliano Perceived Medical School Stress survey instrument. The modified coping instrument was administered during the 1st quarter (PCCS1) and 6 months later during the 3rd quarter (PCCS2).


Mean perceived stress levels were greater after 6 months. Although perceived stress increased more for females than for males over that period, it was not statistically significant. Male and female coping strategies differed only in the preferential use of emotional support by females. Students generally adopted active coping strategies (eg, active coping and planning) rather than avoidant strategies (eg, substance abuse). Regression analysis revealed a moderate positive relationship between avoidant-emotion coping and PCCS1 with a weaker positive correlation between problem-focused coping, sex, and PCCS1. Avoidant-emotion coping also demonstrated a moderate positive correlation with PCCS2. Neither sex nor the 3 coping strategies were predictors of PCCS change (PCCS2 – PCCS1).


This study is a starting point for exploring the relationship between perceived stress and coping behaviors in a chiropractic training institution. Students generally used healthy adaptive coping strategies with minimal sex differences. Avoidant-emotion coping appears to be a reliable predictor of PCCS, with sex being a poor predictor.

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Author notes

Niu Zhang is a professor at Palmer College of Chiropractic Florida (4777 City Center Parkway, Port Orange, FL 32129; niu.zhang@palmer.edu). Charles Henderson is a senior adjunct research staff for Life Chiropractic College West and a consultant with Henderson Technical Consulting (5961 Broken Bow Lane, Port Orange, FL 32127; cnrhenderson@gmail.com).

Concept development: NZ, CNRH. Design: NZ, CNRH. Supervision: NZ. Data collection/processing: NZ. Analysis/interpretation: NZ, CNRH. Literature search: NZ, CNRH. Writing: NZ, CNRH. Critical review: NZ, CNRH.