Bienestar psicológico en estudiantes de una universidad pública de Lima, Perú

The objective of this study was to determine the psychological well-being of students at a public university in Lima, Peru. This is a quantitative, non-experimental, descriptive and cross-sectional study. The sample consisted of 199 students; a probabilistic sampling was used. The Psychological Well-Being Scale for Young People questionnaire by Casullo (2000), whose reliability has been shown to be high (Cronbach’s alpha of 0.9), was applied. Among the results, of the total number of students, 51.76 % present an adequate psychological well-being and 48.24 % an inadequate one. Most of the students present an adequate psychological well-being globally, as well as particularly in the dimensions related to the establishment of bonds, having a life project and control of the environment; while they denote weakness in self-acceptance, in which dimension more than half of the students present an inadequate level, which shows that they are not satisfied with their body, their way of being and feel that they do not arouse sympathy.


Introduction
Health is defined as complete physical, social and mental well-being.The latter, psychological well-being, is an essential element in the individual to develop their abilities, face the stresses of life, work productively and contribute to the community (García, 2013), as well as to deploy their potential in coexistence, work and recreation (World Health Organization [WHO], June 17, 2022).Likewise, it is conceived as a relatively stable and permanent characteristic of the person (Barradas, Sánchez, Guzmán and Balderrama, 2015).
And it is determined by genetic and environmental factors that condition emotional wellbeing, essential to achieve the competencies and expectations of every human being (Etienne, 2018).
Taking care of mental health is just as valuable as taking care of the physical dimension, among other things to minimize the risk of presenting tensions that, if not treated promptly, progress to mental disorders.This implies maintaining the balance of the person with the environment, which guarantees their participation in all areas of life to achieve their well-being, which alludes to a positive way of thinking, acting, expressing emotions and enjoying life (Araujo and Savignon, 2018).
Psychological well-being as a key element of mental health has had different conceptualizations over time.Conceptually, it originated in the United States and was vigorously developed in industrialized entities (Castillo, 2018).Currently, his study is part of positive psychology, from where a consensus has been reached regarding the fact that well-being is a feeling of tranquility, comfort and personal satisfaction.
Historically, the study of psychological well-being has been approached from two perspectives: 1) the hedonic, which is related to pleasure, and 2) the eudaimonic, which encompasses the development of individual capacities and the realization of their true nature.
To this day, the eudaimonic vision predominates, characterized by positive traits such as adequate interpersonal relationships, purpose in life, mastery of the environment, selfacceptance, autonomy and personal development (Flores, Muñoz and Medrano, 2018).It is based on Abraham Maslow's humanist theory, specifically on the satisfaction of social needs, recognition and self-realization, which, together with a congruent and coherent system of goals, enable healthy psychological functioning (Muratori, Zubieta, Ubillos, González & Bobowik, 2015), which is built through the mental development of the person and the ability to relate and relate in a positive and integrated way with life experiences.(Sandoval, Dorner y Véliz, 2017).
According to Martina and Castro (2000), psychological well-being is a positive item that expresses the person's connection with himself and his environment, a connection that favors his growth as a person and as a professional.For this reason, it is important to identify psychological well-being in the student population, since many of its members are at risk of acquiring habits that can affect their mental health and thus impair their personal development, according to reports (Cassaretto, Martínez and Tavera, 2020 ).A study on coping with stress and emotional well-being carried out in Peru reports that students from the city of Lima had higher scores in autonomy and personal growth compared to students from Huancayo (Matalinares et al., 2017).
Regarding the impact of mental problems, the WHO (November 17, 2021) points out that these account for 13% of the global burden of morbidity in adolescents; In addition, suicide stands out as the second cause of mortality in individuals aged 15 to 29 (WHO, 2021).
In Latin America, about 15% of the total of this age group suffers from some mental disorder (NCC News, 2021).Furthermore, during the 2019 coronavirus disease (COVID-19) crisis, nearly two-thirds of a survey of Latin American youth revealed that they needed to request support regarding their physical and mental well-being (Fondo de las United Nations for Children [Unicef], 2021).
In the university environment, it is difficult for the student to maintain mental balance because they face multiple responsibilities that generate academic overload (Cuamba and Zazueta, 2020).Indeed, many times the responsibilities exceed his ability to cope, which produces some degree of stress as a negative response to these demands.In this regard, various investigations have shown that this can cause dropout from the career, lack of motivation and high levels of anxiety, anguish, among other factors that affect their academic performance (Ross, Salgado, Fernández and López, 2019).
At the Universidad Nacional Mayor de San Marcos (UNMSM) a mental health study was carried out in first-year undergraduate students and among the results it stands out that 21.9% presented homicidal thoughts, 18.9% dissocial behavior, 7.5% suicidal attempt, 4.8% alcoholism , 8.5% depression and 3.2% anguish.It is necessary to specify that as the years of study go by, the prevalence of mental illnesses was higher (Perales et al., 2019).
The Pan American Health Organization (PAHO) warns of the urgency of promoting mental health in young people.And in response to that call, Peru has the National Multisectoral Policy for Adolescents (El Peruano, June 25, 2021) and the commitment to adopt measures that improve mental health.In Peruvian universities, the National Superintendence of Higher University Education promotes positive mental health and a culture of peace.Health professionals must not only possess the skills required to work with the person, family and community in complex, changing contexts and in critical situations, but it is also desirable that they have the psychological well-being that makes it possible to understand people without prejudice and provide quality care.
Taking into account what has been said so far, it is pertinent to investigate the psychological well-being of students in order to propose, from the university, projects that respond to real needs; to help students find meaning in life and self-realization (Delgado, Oyanguren, Reyes, Zegarra and Cueva, 2021); to reduce the appearance of physical, psychological and social pathologies that have a high personal, family and institutional cost; to adopt educational policies that provide support for students with inadequate results (Zubieta and Delfino, 2010).For all these reasons, the objective of this study was to determine the psychological well-being of students from a public university in Lima.

Materials and methods
This is an investigation with a quantitative, descriptive and cross-sectional approach (Hernández and Mendoza, 2018).The population was 389 boarding students from the five professional schools of the Faculty of Medicine of the UNMSM.The formula of proportions for a finite population was used, with a confidence level Z = 95% (1.96) and an error of 10%.
Therefore, the sample size was 199 students.Sampling was stratified random probabilistic (see table 1).Each school was considered as a stratum, this allowed greater precision and representativeness in the sample.Likewise, the inclusion criteria of being boarding students, who carry out pre-professional practice and regular enrollment were followed.The instrument includes four dimensions and a total of 13 items: Acceptance (three questions), Links (four questions), Control (four questions) and Projects (two questions).The response options were presented on a three-point Likert-type scale, where 1 = Disagree, 2 = Neither agree nor disagree, and 3 = Agree, so that the higher the score, the greater the psychological well-being.Additionally, adequate reliability was found for this study (global Cronbach's alpha coefficient of 0.9; by dimensions: Control = 0.72, Links = 0.84, Projects = 0.9 and Acceptance = 0.86, and an item-test correlation greater than 0.2).
For the data collection, the authorization of the directors of each school was requested, then it was coordinated with each of the teachers responsible for the internship by career.The date of application of the survey was established for the day that the monthly change of rotation meeting with all the students was scheduled.Prior to the application of the instrument, the signed informed consent was requested from the enrolled students who, according to the table of random numbers, were chosen and asked to stay to develop the survey.The purpose of the research was explained to them, that their participation was voluntary, anonymous, and that the data would only be used for the purposes of this study.
The survey lasted an average of 20 minutes.
The study was reviewed and approved by the Ethics Committee of the UNMSM School of Medicine.
Data were analyzed using SPSS version 22 software.Descriptive statistics with mean and standard deviations were used for ordinal scores, as they present variation coefficients close to 0.20.An exploratory analysis was carried out that allowed evaluating the components of psychological well-being.To optimize the variability of the scale, the scores of each dimension were selected to enter the factorial model.Subsequently, the scores of the wellbeing scale and the factorial scores were compared with the analysis of variance test (Anova) and multiple post hoc comparisons with the Scheffé test.p values less than 0.05 were considered significant.
Regarding the ages, 66.83% were between 24 and 26 years old, 22.11% between 21 and 23 years old, 9.05% were over 27 years old and 2.01% were between 18 and 20 years old.Regarding the place of origin: 84.42% was from the coast, 13.56% from In an exploratory way, the scores of the dimensions in the factorial components of the students were evaluated.Table 3 shows that there are no significant differences for the Social Bonds and Self-Acceptance component; however, differences are observed for the Life Project and Situation Control component between schools (p value < 0.001, Anova).When calculating the average psychological well-being, higher scores were observed for the Situation Control dimension, followed by Life Project and Self-Acceptance, and the one with the lowest score was Social Bonds (see figure 1).

Exploratory factor analysis
In relation to the exploratory factor analysis, two factors with eigenvalues greater than one were extracted.The matrix was rotated with the varimax method.The general adequacy, according to the Kaiser-Meyer-Olkin test, obtained a value of 0.934.The P value of the Bartlett's test was less than 0.001, indicating an adequate factor analysis.The elements of each component have a factor load greater than 0.5 (table 3).We will call component one Social ties and self-acceptance, which explains 42.6% of the variance, and component two Life project and control of situations, which explains 26.1% of the variance.
Regarding psychological well-being in professional schools, in table 4, according to the Anova globally, significant differences are observed (p < 0.001).In the post hoc analysis with the Scheffé test, only significant differences were identified between Medicine students and Nutrition (p value = 0.014) and Obstetrics (p value = 0.001).
These differences are visualized in Figure 2.

Discussion
Psychological well-being is positive when the individual accepts his personality structure as a whole and is aware of his strengths and weaknesses, considers past decisions as a choice and opportunity for development, and takes into account interactions between people based on trust, in addition of altruism.
The findings show that more than half of the students from the five professional health schools present an adequate psychological well-being at a global level (Table 2).Due to its subjective nature, it is closely linked to physical, mental and social aspects, in addition to having a significant relationship with resilience.According to Vásquez, Hervás, Rahona and Gómez (2009), it allows to enjoy life in a better way and to resist pain, disappointment and sorrow, as well as to have a greater conviction of one's own dignity and of the people around; In short, to be in a position to face the challenges that the university imposes on students to achieve their objectives.Related studies in populations with other characteristics show levels of psychological well-being that are mostly medium and the minority high (Escudero, 2018;Mamani, 2018), similar to the results found in the present investigation, so it is necessary to consider other investigations with populations similar to the one studied.
Psychological well-being was approached here from four dimensions (table 3) (figure 1).
Undoubtedly, it is an element that constitutes a positive sign between a person's bond with himself and the environment that surrounds him, it takes into account traces of value and emotions that, merged, are projected into the future and give meaning to life (Cuadra , Cáceres and Guerrero 2016;Oramas, Del Castillo and Vergara, 2017).In relation to Social ties, despite being the dimension with the lowest score, most of the students establish adequate intrapersonal and interpersonal ties, being the indicator of getting along with other people the one that obtains the highest score; this indicates that they establish warm, satisfactory, trustworthy and mutually helpful interpersonal relationships.These findings differ from what was reported by Sandoval et al. (2017), who found that close to half of the students present positive relationships with a low level, which could limit their social nature as a human being.However, there is a quarter of the population studied that establishes inadequate intrapersonal and interpersonal ties, which constitutes a weakness due to the fact that health personnel work in constant interaction with team members and users of the health service.From this perspective, the close relationship with the other can produce a high psychological exhaustion, due to the complexity of each human being; For this reason, it is essential that this area be strengthened in university education with the intention of deploying actions that promote the development of their capacities and that allow them to establish an empathic relationship of trust, respect, and teamwork.
Regarding the Life Project, the clarity of the participants regarding their goals and the feeling of continuous development stands out; results that are similar to those found by Ross et al. (2019), in whose research the majority of students presented a high level in the aspect of life purpose.In the same line is the study by Tello (2018), in which a number of students presented a high level.It should be noted that this type of research is part of the current of positive psychology and that "they have the purpose of contributing to a more complete and balanced scientific understanding of the human experience and transmitting valuable lessons about how to build a happy, healthy, productive and meaningful" (Park, Peterson and Sun, 2013, p. 11).Even with everything, returning to the dimension in turn, a good percentage of students have an inadequate perception, which is why it constitutes a starting point to undertake studies that deepen the factors that affect this state of well-being of life project.
Regarding Control of situations, the results indicate an adequate level, that is, they take charge of their actions, accept their mistakes and try to improve, as well as admit when something goes wrong, the findings denote similarity with those of Cruz et al.
. (2020).These results could be due to the fact that the highest scores for university admission are those of health careers, especially medicine, that is, there is a high selectivity in the entrants, which can be constituted as a strength, because it encourages applicants to learn from their mistakes; however, a minority of students denote inadequate well-being in this dimension, so it is important that this is developed during professional training.
In relation to the Self-Acceptance dimension, the participants' scores indicate inadequate acceptance, being more marked in the items related to not being satisfied with their body, their way of being and perceiving that people do not like them.Acceptance is characterized by the fact that the individual makes a positive self-evaluation of himself, of the different spheres of the self, of his past life, which of course includes qualities and weaknesses (García, 2013).Studies carried out report that a positive university climate favors self-acceptance and the acceptance of others, which contributes to making appropriate decisions and having better control of life.In this regard, Silva and Mejía (2015) point out that situations controlled by students are favored by a positive climate, which improves self-esteem and academic performance (Pendones, Flores, Espino, & Durán, 2021).It is important to emphasize that self-acceptance is a pillar of self-esteem.And according to Branden (2011, quoted in Espinoza, 2021), it implies exercising it in the daily life, which will condition some psychological and social adaptations of the person.
Lastly, if we analyze the data obtained according to professional schools (table 4) (figure 2), the participants in Medicine and Nursing denote an adequate well-being, while those in Obstetrics, Nutrition and Medical Technology, an inadequate one.In addition, according to dimensions, there are significant differences in Life Project and Situation Control in regard to Medicine and Nursing (Table 5), but Nutrition and Medicine have a higher score in Self-Acceptance.No similar studies have been found in students in the area of health; only that of Escudero (2018), who reports that close to half of the psychology students in his sample present an average level of well-being.For this reason, it is necessary to address similar studies that involve health sciences students, due to their skills, commitment and dedication to serving the population.

Conclusions
Most of the university students in the area of health present an adequate psychological well-being, which could influence their social relationships, their personal growth and academic performance.
The majority of university students present an adequate level in relation to establishing relationships, having a life project and control of the environment, however, more than half of the students have an inadequate level in the Acceptance dimension, which is related to that they are not satisfied with the body they have, people do not like them and that they are not satisfied with the way they are, which influences their self-esteem and academic performance.
The majority of university students present inadequate psychological wellbeing in the schools of Medical Technology, Nutrition and Obstetrics, and adequate psychological well-being in the schools of Medicine and Nursing.
One of the limitations of this study was that not many previous works have been found that allow other comparisons to be made. http://www.scielo.org.ar/scielo.php?script=sci_abstract&pid=S1851-16862010000100027&lng=es&nrm=iso&tlng=es.

Table 1 .
Sample distribution of students according to professional schools from UNMSMthat participated were Medicine (with 154 students), Nursing (65), Nutrition (55), Obstetrics (55), Medical Technology (60), whose total number of students was 389 students.The sample was distributed as follows: Medicine = 69, Nursing = 52, Nutrition = 21, Obstetrics = 42 and Medical Technology = 15, giving a total of 199 students.The technique used was the survey.The instrument, the Youth Psychological Well-Being Scale (BIEPS-J) developed byMartina and Castro (2000) in Argentina, was validated for application in Peru byMartínez and Morote in 2001 (cited Mamani, 2018), who found adequate reliability (Cronbach's alpha of 0.57 and an item-test correlation greater than 0.2).In addition,Mamani (2018) herself validated the instrument with 384 students from the faculties of health sciences and engineering of a private university in Lima: she obtained a Cronbach's alpha of 0.86 globally and by dimensions she obtained the following: Control = 0.69, Links = 0.72, Projects = 0.71 and Acceptance = 0.56.

Figure 1 .
Figure 1.Mean Likert scores of the BIEPS-J dimensions applied to students from a public university in Lima, Peru.January, 2020

Table 2 .
the mountains and 2.01% from the jungle; 39.69% lived in East Lima, 20.10% in North Lima, 17.08% in Metropolitan Lima, 13.06% in South Lima and 10.05% in West Lima.In addition, 68.34% lived at the time of the survey with their parents, 11.06% only with their mother, and 7.03% alone.Finally, 79.30% were Catholics, 10.55% Evangelicals, 6.53% atheists, and 3.51% other religions.Regarding psychological well-being, it was found that of the total, 51.76% was adequate and 48.24% inadequate (table2).Psychological well-being in students of a public university in Lima, Peru.January,

Table 3 .
Rotated dimensions of the BIEPS applied to students of a public university in Lima,

Table 4 .
Mean BIEPS-J Likert Scores by Vocational School

Table 5 .
Average factorial scores of the life project component and control of situations