European Journal of Cardiovascular Medicine

Stress is an inescapable subjective feeling that arises from complex interactions between an individual and their surroundings. It typically happens when an individual's situational demands are greater than his available resources. Excessive stress has also been shown to impact academic performance, personal and professional development, and lower self-esteem.1

Anxiety and stress frequently follow one another. However, stress can be temporary and is usually brought on by an outside factor. Conversely, anxiety is characterized by excessive and ongoing anxieties that persist even when there are no stressors present. However, their symptoms are nearly identical. Anxiety and stress are frequently caused by interactions between people and their surroundings that are thought to be taxing or going beyond their capacity for adaptation.2 The educational and extracurricular activities in medical school have been found to cause anxiety & tension in the students. Medical students' perceived stress and anxiety have a detrimental impact on their academic achievement as well as their physical and mental health.1-4

Numerous studies have found that between 20.9% and 94.5% of medical students experience stress. Medical students face a variety of pressures, including the extensive academic program, clinical responsibilities, extended emergency shifts, being away from family, the testing system, and administration. Stress is known to impair a person's capacity for sustained attention, judgment, and decision-making, all of which can have a significant effect on academic achievement.2-4

The goal of medical school curricula is to provide students the professionalism, knowledge, and abilities needed to become qualified physicians. Unfortunately, students' mental health may be at risk due to the demanding nature of medical school. Research has indicated that medical

students experience more psychological anguish than the general population. According to earlier research, the training environment and practice add to a variety of stressors that might result in high psychological morbidity. A meta-analysis that discovered a 13.5% rise in depressive symptoms among medical students after they started medical school makes this clear. This is a concerning trend because poorer academic performance, greater dropout rates, diminished empathy, and suicide thoughts are all associated with higher distress levels.5

Undergraduate medical students from a tertiary care medical college in northern Karnataka participated in a cross-sectional survey. A standardized questionnaire including questions regarding sociodemographic information, habit details, and stress assessment using the perceived stress scale (PSS) was used to interview the students. By considering the prevalence of occurrence of stress among medical students by using Perceived stress scale (PSS) as 50%, the sample size calculated was minimum 100 by using the formula n=4pq/E2 whereas n=sample size, p= prevalence of occurrence of stress among medical students, q=non prevalence of occurrence of stress among medical students, E- allowable error of 10. The PSS, or perceived stress scale, A more precise assessment of personal stress can be obtained by using a range of instruments designed to help measure stress levels in individuals. The first of these is called the Perceived Stress Scale. The Perceived Stress Scale (PSS) is one of the most conventional instruments for measuring stress. Based on the cumulative score (range 0–40), the PSS score was categorized as "low stress" if it was between 0 and 13, "moderate" if it was between 14 and 26, and "high" if it was between 27 and 40. Since its creation in 1983, the tool has been utilized extensively to help us understand how different situations affect our feelings and perceived stress.6,7 Each feature was given a detailed synopsis. The summary statistics of N, mean, and standard deviation (SD) were used for continuous variables. Numbers and percentages were used to summarize data for categorical data, and the data was then presented diagrammatically, subjected to a t-test for mean comparison, and a Chi-square test for association.

Around 310 students enrolled in to the study and analysis found about 84.8% reported moderate stress levels, 8.9% had high stress, and 6.3% experienced low stress as shown in figure I.

Figure I – Perceived stress levels among undergraduate medical students

According to the figure I, about 84.9% of the students perceived low stress and 6.1% high stress levels whereas 9% of them found to have moderate perceived stress levels.

Table I – distribution of students according to socio-demographic variables (n=310)

Table I shows, nearly equal number of students from all the four phases and both genders were enrolled in to the study whereas most of the high and moderate stress students were females compared to male. Majority of the male students living in the hostel perceived stress. Tight schedule of the course, little recreation or leisure time and feel of exams were found the predictors of the mental stress significantly compared to the hours spent in library and for sports.

Table II – distribution of students according to PSS & different variables

Table II shows the distribution of the use of tobacco in chewing and smoking forms and alcohol use among the undergraduate students, which was found significantly more in moderate and high stress level compared to low stress levels.

Approximately 310 students participated in the survey, and the analysis revealed that 84.9% of them reported low stress, 9% reported moderate stress, and 6.1% indicated high stress. Exams, a rigorous course schedule, and little free time were proven to be predictors of mental stress.

A total of 356 out of 450 students returned the questionnaire, yielding a response rate of 79.11%. 324 (91%) of the 356 participants reported having significant levels of stress. Additional stress was caused by a number of factors, including the breadth of the curriculum, the frequency of exams, peer competition, exam performance, future anxiety, loneliness, relationships with people of the opposite sex, and food quality.1

Among Haramaya University undergraduate medical students, the prevalence of stress was 44% (95% CI: 40.2%–48.2%) and anxiety was 48.9% (95% CI: 44.6%−53.3%). Stress and anxiety were substantially correlated with living off-campus (AOR=1.75, 95% CI: 1.12–2.73) and being female (AOR=1.90, 95% CI: 1.28–2.81). In contrast, stress was associated with both alcohol use (AOR=2.26, 95% CI: 1.50–3.50) and cigarette smoking (AOR=3.50, 95% CI: 1.58–7.73). Poor psychosocial support was substantially linked to anxiety (AOR=1.93, 95% CI: 1.20–3.20).2

About 27.85 was the average PSS score. Overall, 55% of students reported feeling stressed (52% of male students and 60% of female students), with no discernible gender difference. Stress levels were higher among basic science students than among clinical clerkship students. Higher stress was produced by academic pressures, while moderate stress was caused by other factors. Exams, insufficient study time, low grades, a large amount of studying material, and the pressure to perform well on the test were the main sources of stress. Active coping, acceptance, planning, self-distraction, and instrumental assistance were the five most often employed coping mechanisms. The usage of drugs was the least popular coping strategy. The overall PSS score had a positive correlation with each MSSQ domain. The main coping mechanisms used by students with higher PSS scores were probably self-blame, venting, and behavioral disengagement.8

Twenty-four (23%) of the study participants were under severe stress, sixty-five (63%) were under moderate stress, and fifteen (14%) were under low stress, based on the perceived stress scale. Regarding the link between stress and sex, women's stress levels were statistically significantly greater than men's. There was no statistically significant difference in the mean stress levels of married and single participants, who both displayed moderate levels of stress. There was no statistically significant difference in the stress levels of the preclinical, paraclinical, and clinical divisions. Third-year postgraduate students had the lowest stress levels (17.33), while second-year students had the highest (22.52), and first-year postgraduate students had the highest (20.04). These groups' differences were not statistically significant.9

The study subjects' mean score on the Perceived Stress Scale (PSS) was 26.24 ± 6.411, with a minimum score of 11 and a maximum score of 47. Nursing students reported the highest levels of stress, followed by students enrolled in other courses. The largest percentages of menstruation disorders were seen among nurses, with a prevalence of 69.3%. Of those with menstrual health issues, 177 (85.1%) indicated high levels of stress, whereas 31 (14.9%) reported no stress. The findings show a substantial correlation between stress levels and menstrual health issues (?² = 4.405, p = 0.04).10

Medical students deal with particular pressures, like acclimating to unfamiliar surroundings, learning a new language, and rigorous coursework, all of which greatly raise stress levels. Early detection and management of stress is crucial to reducing its detrimental effects on one's physical and mental well-being.

1.             Satpathy P, Siddiqui N, Parida D, Sutar R. Prevalence of stress, stressors, and coping strategies among medical undergraduate students in a medical college of Mumbai. J Educ Health Promot. 2021 Aug 31;10:318. doi: 10.4103/jehp.jehp_1395_20

2.             Asfaw, H., Fekadu, G., Tariku, M., & Oljira, A. (2021). Anxiety and Stress Among Undergraduate  Medical  Students  of  Haramaya  University,  Eastern Ethiopia. Neuropsychiatric      Disease  and         Treatment, 17,     139–146. https://doi.org/10.2147/NDT.S290879

3.             Rois, R., Ray, M., Rahman, A. et al. Prevalence and predicting factors of perceived stress among Bangladeshi university students using machine learning algorithms. J Health Popul Nutr 40, 50 (2021). https://doi.org/10.1186/s41043-021-00276-5

4.             Melaku L, Bulcha G, Worku D. The prevalence and severity of depression, anxiety, and stress among medical undergraduate students of Arsi University and their association with substance use, Southeast Ethiopia. Education Research International. 2021;2021(1):9936157.

5.             Arif, N. M. N. A., Roslan, N. S., Ismail, S. B., Nayak, R. D., Jamian, M. R., Mohamad Ali Roshidi, A. S., Edward, T. C., Kamal, M. A., Mohd Amin, M. M., Shaari, S., & Shaharudin Basri, M. F. (2021). Prevalence and Associated Factors of Psychological Distress and Burnout among Medical Students: Findings from Two Campuses. International Journal of Environmental  Research               and                Public     Health, 18(16),   8446.

https://doi.org/10.3390/ijerph18168446

6.             Al Sunni, Ahmed; Latif, Rabia. Perceived stress among medical students in preclinical years: A Saudi Arabian perspective. Saudi Journal for Health Sciences 2014;3(3):155-159.

7.             Agrawal, Nishtha, Sharma, Hitakshi, Dabas, Aashima, Mishra, Anurag. Perceived Stress Among Medical Students and Doctors in India During COVID-19 Pandemic. MAMC

Journal   of            Medical Sciences 7(1):p     14-20,    Jan–Apr 2021.

10.4103/mamcjms.mamcjms_17_21

8.             Paudel U, Parajuli A, Shrestha R, Kumari S, Adhikari Yadav S, Marahatta K. Perceived stress, sources of stress and coping strategies among undergraduate medical students of Nepal: a cross-sectional study. F1000Res. 2024 Jan 3;11:167. doi: 10.12688/f1000research.75879.3.

9.             Gokhale S, Phadke A, Joshi A. ASSESSMENT OF STRESS STATUS IN HEALTH PROFESSIONALS IN A TERTIARY CARE HOSPITAL. Int J Acad Med Pharm. 2024;6(6):949-52.

10.          Paudel U, Parajuli A, Shrestha R, Kumari S, Yadav SA, Marahatta K. Perceived stress, sources of stress and coping strategies among undergraduate medical students of Nepal: a cross-sectional study. F1000Research. 2024 Jan 3;11:167.