ORIGINAL RESEARCH ARTICLE

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Study of Depression, Anxiety and Stress among Undergraduate

Medical Students of a Teaching Medical Institution
Subita P Patil1, Snehashree Sadhanala2, Seema S Bansode Gokhe3

Financial Support: None declared

Conflict of Interest: None declared
ABSTRACT
Copy Right: The Journal retains the
copyrights of this article. However, re- Background: The global prevalence of mental and behavioral dis-
production is permissible with due ac- orders among the adult population is estimated to be 10% and con-
knowledgement of the source.
tributed to four of the ten leading causes of disability. Psychologi-
How to cite this article:
cal distress has a negative impact on student abilities and worst
Patil SP, Sadhanala S, BansodeGokhe outcome may result in development of behavioral problems.
SS. Study of Depression, Anxiety and Aims & Objectives: To assess levels of depression, anxiety and
Stress among Undergraduate Medical
stress among the medical students and study their socio demo-
Students of A Teaching Medical Insti-
tution . Natl J Community Med
graphic variables.
2018;9(8):566-569 Methodology: This cross sectional study was conducted among
the complete batch of VII semester medical students (101) posted
Author’s Affiliation:
in the department during August 2016 to January 2017 with a pre-
1Asst. Prof.; 2SMO (Speciality Medical
Officer); 3Prof & Head; Dept of Com-
designed, pre tested, semi-structured questionnaire consisting of 2
munity Medicine, LTMMC & GH, Sion parts: socio demographic details and DASS 21 (Depression Anxi-
Mumbai ety and Stress Scale) after taking their valid informed consent and
Institutional Ethical Committee approval.
Correspondence
Dr.Subita P Patil Findings: Out of 101 students,58 were males and 43 were females
psubita@gmail.com with a mean age of 21.03 ± 0.96years.Anxiety was more prevalent
compared to depression and stress and male students showed a
Date of Submission: 23-11-17 higher preponderance to anxiety than female students.
Date of Acceptance: 02-08-18
Date of Publication: 31-08-18 Conclusion: Students were more anxious than depressed or
stressed. Male students were more affected than female students.
Keywords: Medical students, DASS 21

INTRODUCTION determine the increased risk to developing psycho-

logical distress. Hence, this study is an attempt to
Depression can lead to suicide. Over 8 lac people
find out level of depression, stress and anxiety
die due to suicide every year and is the second
among medical students.
leading cause of death amongst 15-29 years old
globally.1The global prevalence of mental and be- Previous studies have revealed a rate of psycho-
havioural disorders among the adult population is logical distress among medical students ranging
estimated to be 10% and contributed to four of the from 21.6 to 50%.3One in five students strongly felt
ten leading causes of disability, with one in four the need to conceal mental or emotional problems.
families suffering the burden. It is estimated that Following fears were there- discrimination, stigma-
by 2020, 15% of the disability-adjusted life-years tization, breach in privacy & stigmatization, em-
(DALYs) lost would be due to mental and behav- barrassment etc.4Psychological distress among
ioural disorders, up from 10% in 1990 and 12% in medical students was associated with anxiety and
2000.2 depression, interpersonal conflict, sleeping prob-
lems, and lower academic and clinical perform-
Stress and medical school are intricately related
ance. Also, it has a negative impact on students’
with a tendency of being under diagnosed. The
abilities to develop a rapport with patients, to con-
environment and social structure of a student also
centrate and focus on their training, and to make

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 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816

decisions, which in turn may lead to dissatisfaction (80%)belonged to small/ nuclear families i.e. had a
during their clinical practice later on4 or develop- family size of less than 5 while only 20% had
ment of behavioural problems like suicide, drug large/joint families i.e. family size of more than
abuse, and / abuse of alcohol.5Ganguli HC6 re- 6.On using the B G Prasad Scale 8,9we observed
ported prevalence of depression as 34/1000 and that majority(85%) of students belonged to upper
anxiety 16/1000 in India. A study by Salt and col- class families while only 15% belonged to upper
leagues 7, reported that Harvard and Tufts medical middle class, middle class ,lower middle class and
students showed an increase in depression from lower class. More than half of them were hostellers
13% at the beginning of medical school, to 24.5% (55%),only 1/3rd(38%) of them took more than 30
by the end of the second year. minutes to commute, almost half of them used
public transport (44%)or either walked (45%)to col-
The present study was conducted to find levels of
lege, half of them (51%)were non vegetarians
depression, anxiety and stress among the medical
,almost half (47%)got lunch from home. Around
students and to study their socio demographic
half of them (40%) exercise and participated in
variables.
sports (51%) regularly. Nearly half of them (44%)
of them spent>100Rs/-per day.
METHODOLOGY The respondents whose score was moderate/ se-
This cross sectional study was carried out on the vere/ extremely severe were referred for further
complete batch of VII semester (101 students) counseling. Overall, 34% were depressed,35% were
posted in the department from August 2016 to anxious and 15% were stressed.
January 2017.The Institutional ethics committee
approval was obtained and valid informed consent
Table 1: Distribution of participants for socio
from the participants was taken. A pre designed,
demographic and other variables
pre tested, semi structured questionnaire was used,
covering their socio demographic variables like Variable Frequency (%)
age, sex, housing, food habits etc. and DASS 21 Admission for MBBS Course through
(Depression Anxiety and Stress Scale)The DASS-21 All India quota 15(14.8)
Maharashtra CET 86(85.1)
questionnaire categorizes each condition into five
Family size
subcategories, namely, normal, mild, moderate,
< 5 members 81(80.1)
severe, and extremely severe.5All the three scores >6 members 20(19.8)
would be added as follows: Socio economic status (B. G. Prasad)
DASS 21 questionnaire categorization on the basis Class I 86(85.1)
Class II to V 15(14.8)
of scores:
Residence
Category Depression Anxiety Stress Hostelite 56(55.4)
Normal 0-4 0-3 0-7 Localite 45(44.5)
Mode of commute to college
Mild 5-6 4-5 8-9
Walking 45(44.5)
Moderate 7-10 6-7 10-12
Personal vehicle 12(11.8)
Severe 11-13 8-9 13-16 Public transport 44(43.5)
Extremely severe 14+ 10+ 17+ Time taken to commute to college
<30 minutes 63(62.3)
Each question was scored from 0 to 3.If a student >30 minutes 38(37.6)
scored >14 for depression,>10 for anxiety and > 19 Dietary preference
for stress, they were referred for further counsel- Vegetarian 36(35.6)
ling. Ovo vegetarian 13(12.8)
Non vegetarian 52(51.4)
Statistics: The data were analyzed with SPSSv20.0 Source of lunch
software (IBM Corp., Armonk, NY).Chi square test Home made 47(46.5)
was used wherever applicable. Dabba 33(32.6)
Others 21(20.7)
Exercise regularly
Yes 40(39.6)
RESULTS
No 61(60.3)
Out of 101 students 58 (57.4%) were males and Participation in sports
43(42.6%) were females with a mean age Yes 52(51.4)
21.03±0.96years. Table 1:Majority of the stu- No 49(48.5)
Money spent every day (Rs./- per day)
dents(85%) took admission through the state quota
>100 44(43.5)
while 15% came from the All India quota of Pre < 100 57(56.4)
medical entrance .Majority of the students

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 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816

Table 2: Association of Depression with relation- to relationship status), 37% were observed to be
ship status, fruits and junk food consumption: anxious while out of 19 committed,26 % were anx-
Variable Depression Total P value
ious.
Present (%) Absent (%) Table 4: There was no statistical association of
Sex stress with any of the variables considered in this
Male 21(20.8) 38 (37.6 ) 59 0.313
study. But, out of 82 who were single, 13% were
Female 13(12.9) 29(28.7 ) 42
observed to be stressed while out of 19 committed,
Relationship status
Single 27(26.7 ) 55(54.5 ) 82 0.372 21 % were stressed.
Committed 7(6.9 ) 12(11.9) 19
Consumption of fruits
< 2 times/week 17(16.8) 45(44.5) 62 0.123 Table 5: Distribution level of depression, anxiety
> 3 times/week 15(14.8 ) 24(23.8 ) 39 and stress (based on DASS 21 questionnaire)
Consumption of junk food
Levels Depression Anxiety Stress
Yes 32(31.7 ) 64(63.4) 96 0.429*
(%) (%) (%)
No 2(2.0) 3(3.0 ) 5
Normal 42(41.5) 36(35.6) 69(68.3)
* Yates correction; p <0.05 indicate non significance
Mild 25(24.7) 30(29.7) 17(16.8)
Moderate 25(24.7) 17(16.8) 10(9.9)
Table 3: Association of anxiety with relationship Severe 3(2.9) 6(5.9) 4(3.9)
status, fruits and junk food consumption Extremely Severe 6(5.9) 12(11.8) 1(0.9)
Variable Anxiety Total P
Present (%) Absent (%) value
DISCUSSION
Sex
Male 22(21.8) 36(35.6 ) 58 0.21 We observed 9% of students to be depressed, 18%
Female 13(12.9) 30(29.7) 43 to be anxious and 5 % to be stressed. A study by
Relationship status Iqbal et al10 found 17.5% students had severe or ex-
Single 30(29.7) 52(51.5) 82 0.20 tremely severe depression, 33.4% had anxiety and
Committed 5 (5.0 ) 14(13.9 ) 19
13.1 % had stress. The mean scores of depression
Consumption of fruits
< 2 times/week 21(20.8) 41(40.6) 62 0.42
and stress for all students were found to be at mild
> 3 times/week 14(13.9) 25(24.8) 39 level and the scores of anxiety at moderate level.
Consumption of junk food Moutinho et al 11 found 8.8% had depression,
Yes 33(32.7) 63(62.4 ) 96 0.41* 12.2% had anxiety and 17.4% had stress while Su-
No 2 (2.0) 3(3.0 ) 5 maya Basudan et al. observed abnormal levels of
* Yates correction; p <0.05 indicate non significance depression, anxiety and stress were observed in
55.9%, 66.8% and 54.7% of the respondents12.
Table 4: Association of stress with relationship
Mehta P et al4study observed that 10% were de-
status, fruits and junk food consumption
pressed,23% were anxious and 5 % were stressed.
Variable Stress Total P Higher scores of depression, anxiety and stress
value were associated with female gender, lower semes-
Present (%) Absent (%) ter, younger age and non-smokers. Shendarkar13
Sex
observed that anxiety was associated with feeling
Male 9 (8.9) 49 (48.5 ) 58 0.41
Female 6 ( 5.9) 37 (36.6 ) 43 NS
of loneliness, peer competition, long hours and loss
Relationship status of social time. Helmers et al found out that medical
Single 11 ( 10.9) 71 (70.3 ) 82 0.31* student were not untowardly stressed but the tran-
Committed 4 (4.0 ) 15 (14.8) 19 sition of basic to clinical training was associated
Consumption of fruits with stress13.
< 2 times/week 10 ( 9.9) 52 (51.5) 62 0.32
> 3 times/week 5 (5.0 ) 24 (23.8 ) 39 Shendarkar13 found that independent living was
Consumption of junk food found out to be an important factor for stress ori-
Yes 15 (14.8 ) 81 (80.2 ) 96 0.38* gin. Hostelites were susceptible to stress according
No 0 (0 ) 5 (5.0 ) 5 to a study in Nepal14, while females were more
* Yates correction; p <0.05 indicate non significance prone to stress in a study by Waghacha-
vare15.Nationality, marital status, residence state,
Table 2: There was no statistical association of de- and smoking status did not appear to significantly
pression with relationship status, fruit consump- affect the probability of being psychologically dis-
tion or junk food consumption. tressed16,17.Arab M et al found correlation of de-
pression, anxiety and stress with happiness18. Low
Table 3: There was no statistical association of
self-esteem, pessimism about oneself and poor
anxiety with any of the variables considered in this
academic performance are undeniably the factors,
study. But out of 82 who were single (with respect

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 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816

which are interlinked to each other are the reason 3. Dr. Muhamad Saiful Bahri Yusoff. A Multicenter Study on
Validity of the Medical Student Stressor Questionnaire
for the psychological disturbances as well19.
(MSSQ). International Medical Journal 2011;18(1):14 – 18.
Likely reasons for depression were change in cul- 4. Prakash Mehta et al. Exploratory Study to Access Anxiety,
tural background as hailing from different parts of Depression and Stress among Medical Students, Freshly
Maharashtra, parental pressure for medical admis- Starting Their Medical Education in a Medical College.
Scholars Journal of Applied Medical Sciences 2013;1(6):819-
sion, high expectations from parents, inadequate
822.
time management, losing interest in academics,
personal issues etc. The plausible reasons for stress 5. Muhamad Saiful Bahri Yusoff et al. A Study of Psychologi-
cal Distress in Two Cohorts of First Year Medical Students
were vast syllabus, demanding curriculum, multi- That Underwent Different Admission Selection Processes.
ple parallel postings and / lecture series and ex- Malysian Journal of Medical Sciences 2012;19(3):29-35.
ams, academic performance etc. The probable rea-
6. Ganguli H.C. Epidemiological findings on prevalence of
sons that the singles were anxious were looks, per- mental disorders in India. Indian Journal of Psychiatry 2000;
sonality and academic performance. Likely reasons 42 (1):14-20.
for committed being less anxious were companion- 7. Salt P, Nadelson C, Notman. Depression and Anxiety
ship and satisfaction in their personal lives. The among Medical students. Los Angeles: New Research Ab-
plausible reasons for stress were vast syllabus, stract, 13APA Annual Meeting 1984.
demanding curriculum, multiple parallel postings 8. Sharma R. Revision of Prasad’s social classification and
and / lecture series and exams, academic perform- provision of an online tool for real-time updating. South
ance, etc. Asian J Cancer 2013;2(3):157.
9. Sharma R. Online interactive calculator for real-time update
Conclusion: This cross sectional study indicated 25 of the Prasad’s social +classification. Available at:
%, 17% and 9% of moderate level of depression, www.prasadscaleupdate.weebly.com (Accessed on 26th Nov
anxiety and stress respectively. There was 9%, 18% 2017)
and 5% of severe level of depression, anxiety and 10. Shawaz Iqbal, Sandhya Gupta, E. Venkatrarao. Stress, anxie-
stress respectively among the study participants. ty & depression among medical undergraduate students &
Students were more anxious than stressed or de- their socio-demographic correlates. Indian Journal of Medi-
cal Research March 2015;141: 354-357.
pressed. Also, males were more affected than their
female counterparts. Relationship status, fruits 11. Moutinho ILD et al. Depression, stress and anxiety in medi-
consumption and junk food consumption were not cal students: A cross-sectional comparison between students
from different semesters. Rev Assoc Med Bras. 2017;
affecting their depression, anxiety or stress. 63(1):21-28.
The variables studied were not statistically signifi- 12. Basudanet al. Depression, anxiety and stress in dental stu-
cant with DASS, this indicates a need to study dents. International Journal of Medical Education 2017;
other variables which are affecting depression, 8:179-186
anxiety and stress. Early screening and subsequent 13. Shendarkar Ajay,Patil Vijay.A study of stressors in medical
interventions for behavioral problems should be college students (Hostilities) in Northern Maharashtra.J In-
dian Acad Forensic Med. 2013; 35 (3) : 227-229.
promoted among the medical students.
14. Kunwar D, Risal A, Koirala S. Study of depression, anxiety
We recommend some of the measures like staying and stress among the medical students in two medical col-
healthy, forming a study group, maintaining a leges of Nepal. Kathmandu Univ Med J. 2016;53(1):22-26.
close group of friend, engaging in social activities, 15. Waghachavare Vivek B. et al. Gore. A Study of Stress
participating in extracurricular events etc. among Students of Professional Colleges from an urban
area in India. Sultan Qaboos University Med Journal 2013;
Acknowledgment: Students who participated in 13(3): 429-436.
this study.
16. Al Saadi et al. Psychological distress among medical stu-
dents in conflicts: a cross-sectional study from Syria. BMC
Medical Education 2017; 17:173-180.
REFERENCES
17. Kulsoom B and Afsar NA. Stress, anxiety, and depression
1. World Health Organization: Factsheets on Depression. among medical students in a multiethnic setting. Neuropsy-
Available at chiatric Disease and Treatment 2015; 11:1713-1722.
http://www.who.int/mediacentre/factsheets/fs369/en/.A
18. Arab M et.al. Stress, anxiety and depression among medical
ccessed February 9th, 2017.
university students and its relationship with their level of
2. National Commission on Macroeconomics and Health, Min- happiness. IOSR Journal of Nursing and Health Science
istry of Health & Family Welfare, Government of India. 2016;5(1):44-47.
NCMH Background Papers–Burden of Disease in India,
19. Singh M, Goel NK, Sharma MK, Bakshi RK. Prevalence of
New Delhi,2005.
Depression, Anxiety and Stress among Students of Punjab
University, Chandigarh. Natl J Community Med. 2017;
8(11):666-671.

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