Abstract
Introduction: In recent years, there is growing appreciation of the stresses involved in medical training. It is critical for medical educators to understand the prevalence and causes of student distress, potential adverse consequences, and institutional factors that can influence student health.
Aim: To assess prevalence of perceived stress, identify sources of stress, their severity, determinants of stressed cases and coping strategies adopted by undergraduate medical students.
Materials and Methods: A cross-sectional study using self-administered questionnaires was conducted among 150 second year medical undergraduate students of Rama Medical College, Hapur. Prevalence and severity of stress was assessed using a 14-item “Perceived stress scale”. Stressors related to academic, health and psychological domains were assessed using a 39- item questionnaire and common coping strategies used by the students were identified by a brief COPE inventory. Data was analyzed statically to calculate frequency distributions, odds ratio and confidence intervals. Logistic regression analysis was done to find out determinants of stressed cases. Friedman ANOVA was done to find out significant levels of utility of coping strategies.
Results: Total 147 students completed the questionnaire. Overall prevalence of stress was 48.98%. Mean PSS score was 27.0 + 6.41. Female students reported significantly higher mean PSS scores than males. Stressed cases were found to be associated with female gender, occurrence of academic and health- related stressors. Quality of food in mess, high self- and parental expectations, frequency and performance in examinations, living conditions in hostel and lack of entertainment in the institution were the most frequent and severe sources of stress. Coping strategies commonly used were planning, acceptance, active coping, positive reframing, self- distraction, emotional support and religion. Perceived stress was significantly likely to engender the use of “self-blaming” and “acceptance”.
Conclusion: A higher level of perceived stress was reported by medical undergraduate students. The main determinants were female gender, academic and health stressors. Prospective studies are required to test association between stressed cases and gender, academic and health-stressors, and the coping strategies adopted by the students.
Keywords: perceived stress, sources of stress, undergraduate medical students, coping strategies.
References
1. Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS Jr, Power DV, et al. Race, ethnicity, and medical student well-being in the United States. Arch Intern Med 2007; 167: 2103-9.
2. Mehanna Z, Richa S. Prevalence of anxiety and depressive disorders in medical students. Transversal study in medical students in the Saint-Joseph University of Beirut. Encephale 2006; 32: 976-82.
3. Saki M, Martinac M, Skobi H, Jakovljevi M. Depression among students of the Medical Faculty and doctors in Mostar. Med Arh 2005; 59: 19-22.
4. Facundes VLD, Ludermir AB. Common mental disorders among health care students. Rev Bras Psiquiatr 2005; 27: 194-200.
5. Assadi SM, Nakhaei MR, Najafi F, Fazel S. Mental health in three generations of Iranian medical students and doctors - A cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 57-60.
6. Supe AN: A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998; 44: 1-6.
7. Rosenham, D. L. & Seligman, M.E. Abnormal psychology, 2nd edn. New York: Norton, 1989.
8. Myers D.G. Stress and Health, in: Exploring Psychology, 6th edn, pp. 402. New York: Worth Publishers, 2005.
9. Lazarus R.S. Theory-Based Stress Measurement. Psychology Inquiry, 1990; 1 (1): 3-13.
10. Linn, B. S. & Zeppa, R. Stress in junior medical students: relationship to personality and performance. J Med Educ, 1984; 59(1): 7-12.
11. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross- sectional study. Med Edu 2005; 39:594-604.
12. Saipanish R. Stress among medical students in a Thai medical school. Medical Teacher 2003; 25 (5); 502-506.
13. Shapiro SL, Shapiro DE and Schwartz GE. Stress management in medical education: a review of the literature. Acad Med, 2000; 75(7): 748-759.
14. Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y and Hebert JR. A longitudinal study of students' depression at one medical school. Acad Med, 1997; 72(6): 542-546.
15. Clark EJ and Rieker PP. Gender differences in relationships and stress of medical and law students. J Med Educ, 1986; 61(1): 32-40.
16. Niemi PM and Vainiomaki PT. Medical students' distress - quality, continuity and gender differences during a six-year medical programme. Med Teach, 2006; 28(2): 136-141.
17. Newbury-Birch D, White M and Kamali F. Factors influencing alcohol and illicit drug use amongst medical students. Drug Alcohol Depend, 2000; 59(2): 125-130.
18. Pickard M, Bates L, Dorian M, Greig H and Saint D. Alcohol and drug use in second-year medical students at the University of Leeds. Med Educ, 2000; 34(2): 148-150.
19. Flaherty JA and Richman J.A. Substance use and addiction among medical students, residents, and physicians. Psychiatric Clin North Am, 1993; 16(1): 189-197.
20. Liselotte ND, Matthew RT, and Tait DS. Medical students distress: causes, consequences, and proposed solutions. Mayo Clin Proc, 2005; 80 (12): 1613-1622.
21. Sreejith S Nair., Ramesh.,Hiremath S.G., Chethana K.V. and Raghunath P. Perceived stress among medical undergraduates in a private medical college in Raichur, India. Intern J of Recent Scientific Research, April 2013; 4(4): 428-431.
22. Hays LR et al. Medical Student Suicide, 1989–1994. Am J Psychiatry. 1996; 153(4):553–555.
23. Morrison F, Moffat K. More on medical student stress. Med Edu 2001; 35: 617-618.
24. Kaufman DM, Day V and Mensink D. Stressors in 1st-year medical school: comparison of a conventional and problem-based curriculum, Teaching and Learning in Medicine, 1996; 8 (4): 188-194.
25. Kaufman DM, Day V and Mensink D. Stressors in Medical School: Relation to curriculum format and year of study, Teaching and Learning in Medicine, 1998; 10 (3): 188-194.
26. Yusoff MSB, Rahim AFA and Yaacob MJ. The development and validity of the Medical Student Stressor Questionnaire (MSSQ). ASEAN Journal of Psychiatry, Jan-June 2010; 11 (1). Available online at http://www.ase
27. Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, Khan S. Students, stress and coping strategies: a case of Pakistani medical school. Educ Health (Abingdon) 2004; 17:346-53.
28. Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia 2004; 59: 207-11.
29. Carver CS.You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997; 4(1): 92-100.
30. Sreeramareddy C.T., Shankar P.R., Binu V.S., Mukhopadhyay C., Ray B. and Menezes R.G. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Medical Education 2007; 7:26.
31. Shah M., Hasan S., Malik S., Sreeramareddy C.T. Perceived Stress, Sources and Severity of Stress among medical undergraduates in a Pakistani Medical School. BMC Medical Education 2010; 10:2.
32. Amr M, Gilany AH, El-Hawary. Does gender predict students’ stress in Mansoura, Egypt? Med Educ Online 2008; 13:12.
33. Muller L, Spitz E. Multidimensional assessment of coping: validation of the brief COPE among French population. L’Encéphale 2003; 29 (6): 507-518.
34. Inam SNB, Saqib A, Alam E. Prevalence of anxiety and depression among medical students of private university. JPMA 2003; 53 (2): 44-47.
35. Krutarth R. Brahmbhatt, Nadeera V.P., Prasanna K.S., Jayram S. Perceived stress and sources of stress among medical undergraduates in a private Medical College in Mangalore, India. IJBAR (2013); 04 (02): 128-36.
36. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385-96.
37. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. The Social Psychology of Health: Claremont Symposium on Applied Social Psychology Newbury Park, CA. Sage Spacapam S, Oskamp S 1988, 31-67.
38. Hall NC, Chipperfield JG, Perry RP, Ruthig JC, Goetz T. Primary and secondary control in academic development: gender-specific implications for stress and health in college students. Anxiety Stress Coping 2006; 19: 189-210.
39. Mane Abhay B, Krishnakumar MK, Niranjan Paul C, Hiremath Shashidhar G. Differences in Perceived Stress and its Correlates Among Students In Professional Courses. Journal of Clinical and Diagnostic Research, 2011 November (Suppl-1); 5(6): 1228-1233.
40. Finkelstein C, Brownstein A, Scott C, Lan YL. Anxiety and stress reduction in medical education: an intervention. Med Educ 2007; 41: 258-64.
41. Redwood SK, Pollak MH: Student-led stress management program for first-year medical students. Teach Learn Med 2007;19: 42-6.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.102
