|Year : 2015 | Volume
| Issue : 4 | Page : 209-213
Perceived stress and prevalence of depression among first-year medical students
Endreddy Ananda Reddy1, Venkata Venu Gopala Raju Srijampana2, Bhagawan Rajana1, Sri Sai Tejaswini Muddana1
1 Department of Psychiatry, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
2 Department of Physiology, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
|Date of Web Publication||14-Dec-2015|
Endreddy Ananda Reddy
Department of Psychiatry, Katuri Medical College and Hospital, Guntur - 522 019, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Modern life is full of hassles, deadlines, frustrations, and demands. For many people, stress is so common that it has become a way of life. Stress is not always bad. In small doses, it can help a person perform and motivate to do the best. Procuring medical degree is a tedious job. People undergo enormous stress during the course of medical education.
Aims: Our study was aimed to explore the patterns of stress perceived and the prevalence of depression among first-year medical students.
Materials and Methods: A cross-sectional study was performed on first-year medical students by using the Perceived Stress Scale (PSS) and Zung Self-Rating Depression Scale (ZSRDS) to assess the level of perceived stress and depression, respectively. The data were tabulated using MS Excel sheet and were analyzed using Statistical Package for the Social Sciences (SPSS) version 16. The difference in the patterns of perceived stress and prevalence of depression among males and females was analyzed by Chi-square test.
Results: Among the study sample of 143 medical students, 58% of the students were females and 42% were males. Out all the subjects, 3.5% students scored in low stress group, 21.7% students scored in average stress, 38.5% students scored in the group of high stress, and 35.7% students scored in very high stress group. The level of perceived stress was higher in females. The number of students who scored in mild depression was 7.7% and the number of students who scored in moderate depression was 1.4%. Statistically significant correlation was observed between the high stress and prevalence of depression.
Conclusion: Our study pointed out the need of providing attention to medical students during their entire tenure, especially during exams.
Keywords: Depression, medical students, prevalence, stress
|How to cite this article:|
Reddy EA, Raju Srijampana VV, Rajana B, Muddana ST. Perceived stress and prevalence of depression among first-year medical students. J NTR Univ Health Sci 2015;4:209-13
|How to cite this URL:|
Reddy EA, Raju Srijampana VV, Rajana B, Muddana ST. Perceived stress and prevalence of depression among first-year medical students. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Apr 9];4:209-13. Available from: http://www.jdrntruhs.org/text.asp?2015/4/4/209/171689
| Introduction|| |
Medical education is inherently stressful and demanding. Overwhelming burden of information leaves a minimal opportunity for the student to relax and recreate. Stress and depression have been consistently linked to mental and physical health effects.  Stress among medical students is often overlooked.  Studies have proved that compared to the general population, medical students are the most distressed students.  An optimal level of stress, referred to earlier as "favorable stress," can enhance learning.  However, excessive stress can lead to physical and mental health problems.  It can reduce the students' self-esteem and may affect academic achievement and personal or professional development. ,
Studies among medical students have found that stress is associated with anxiety and depression, , interpersonal conflict,  sleep disturbances,  and poor academic or clinical performance.  Stress was also found to decrease attention, reduce concentration, impinge on decision-making, and reduce students' abilities to establish good relationships with the patients.  As a consequence, students have reported feelings of inadequacy and dissatisfaction with clinical practice in the future. This may affect the lives of patients and the health of a community. Moreover, stress has also been linked to the suicidal tendencies among medical students. 
Depression among medical students represents a neglected public health problem in India. It is very important to prevent the ill effects of depression on one's educational attainment and career through early detection and proper interventional measures. Few studies have been conducted at a global level to assess the prevalence of depression among medical students. All these studies have been conducted in the Western countries and in other parts of the world. ,,,, Epidemiological studies on depression among medical students are scanty in India.
The World Health Organization has identified depressive disorders of adolescence as "priority mental health disorder." Globally, its prevalence rate is 15-20% and recurrence rate is 60-70%, whereas in India it is reported as 11.2%. However, studies have reported that 50% of cases remain undiagnosed. The consequences of depression are serious, causing suicide, school dropout, and drug abuse. 
Young medical students are no exception to this trend. Studies have already reported that depression is the most common mental disease affecting them.  The rate of depression and suicide has been found to be higher among medical students compared to other undergraduate students. Academic burden, though have been identified as a source of depression,  cannot be changed. So other determinants of depression should be worked out which could be treated and contribute for the benefit of the students.
With this background, our study was aimed to explore the patterns of perceived stress and the prevalence of depression among first-year medical students.
| Materials and Methods|| |
A cross-sectional study was carried out on first-year medical students of both sex, belonging to Katuri Medical College, in the city of Guntur, Andhra Pradesh, South India. The study period was March-April 2014. Institutional Ethical Committee's approval was taken before starting the study.
- First-year medical students.
- Both the sex.
- Willing to give consent.
1. Not willing to give valid consent.
The information was obtained by using a semistructured pro forma that contained details of demographic data. The given questionnaire was in English language, which is the medium of instruction in all medical colleges. Students were instructed to exclude names and identifying information. Students were assured that results of survey will not have any negative repercussions for them. The Perceived Stress Scale (PSS) and Zung Self-Rating Depression Scale (ZSRDS) were used to assess the level of perceived stress and depression, respectively. The data were tabulated by using MS Excel sheet and further analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 16 (SPSS-Inc., Chicago, US). The responses obtained were expressed in proportions. The difference in the patterns of perceived stress and prevalence of depression among males and females was analyzed by Chi-square test. Students identified with clinically significant depression were offered counseling or appropriate help.
The perceived stress scale
The PSS is a questionnaire used to measure a person's perception of stress over the past month and to determine the likelihood of whether perceived stress might be making them more susceptible to stress induced compromise of their health.
The PSS is a questionnaire comprised of 10 questions with the scale ranging 0-4 for each question. Higher PSS scores are associated with higher levels of stress and indicate greater likelihood for stress, interfering with factors such as lifestyle changes. Higher scores are also associated with increased susceptibility to stress-induced illness.
Zung self-rating depression scale
This scale was preferred to others as this tool evaluates depression in normal nonpsychotic individuals. This scale assesses the perceived feelings of the students regarding their emotional status. The tool consists of 20 items with score ranging from 1 to 4 for each item. The total score ranges from 20 to 80. Depression was considered as a continuous variable ranging from low to high degree of experienced feeling. Score more than or equal to 40 was considered as depression.
| Results|| |
The study questionnaires were administered in first-year medical students and responses were obtained from 143 medical students. Among these students, 83 (58%) students were females and 60 (42%) were males. Based on the PSS scores, students were divided into groups with different levels of stress [Table 1]. Only one student scored in the group of very low stress. Five (3.5%) students scored in low stress group, 31 (21.7%) students scored in average stress, 55 (38.5%) students scored in the group of high stress, and 51 (35.7%) students scored in very high stress group.
|Table 1: Distribution of Medical Students According to the Perceived Stress Scale|
Click here to view
Comparison between the male and female students in first three groups with PSS scores 0-15 with the last two groups with PSS scores 16-40 revealed that the level of perceived stress is higher in females (Chi-square test: 4.49, P < 0.05). Among the total sample of 143 first-year medical students, 106 (74%) students scored in the last two groups of PSS, who had high and very high level of health concern.
Scores obtained in the ZSRDS were in normal range for 130 (91%) students, and it indicates that these students had no depression. The number of students who scored in mild depression was 11 (7.7%). The number of students who scored in moderate depression was 2 (1.4%). No student scored in severe depression on the ZSRDS [Table 2].
|Table 2: Distribution of Medical Students According To The Zung Self-Rating Depression Scale|
Click here to view
Comparison was made between the groups of students with PSS scores 0-15 (less than average to average stress) and 16-40 (high to very high stress) with the groups of students with ZSRDS scores 20-44 (no depression) and 45-80 (mild, moderate, and severe depression), 93 students scored high on the PSS but not shown depression. Remaining 13 students who scored high on the PSS had shown mild-to-moderate depression. Statistically significant correlation (P < 0.05, by Fisher's exact test) was observed between the high stress and prevalence of depression [Table 3]. On the other side of the spectrum, 37 students scored less on both the PSS and ZSRDS.
|Table 3: Comparison of Pss Scores With Zung Self-Rating Depression Scale Scores|
Click here to view
| Discussion|| |
A number of studies have been conducted across the world, especially among medical students with respect to stress and its sources, depression, and suicides. ,,,, Our study was a preliminary step toward understanding the extent of severity of perception of stress and prevalence and patterns of depression among first-year medical students in the Indian context.
In our study, the overall response rate was 95.3%. This high response rate in our study was similar to that of the study done by Marie et al.,  which had shown a response rate of 80% and of another study done by Hamza et al.,  which had shown a response rate of 83%.
In our study, most of the students (74.12%) scored in the range of high to very high scores on the PSS; these findings were consistent with the findings of a study done by Priti et al.  A gender difference regarding stress levels was also observed, where women reported higher levels of stress than men. These findings in our study are consistent with the studies done by Supe et al.  and Hamza et al.  Higher levels of stress was observed in men when compared to females in the study done by Nazma,  which was in contrast to our findings.
In our study, the prevalence of depression among medical students was 9.09%. Out of 143 first-year medical students, 13 students (5 males and 8 females) scored in the range of depression on the ZSRDS. Our findings are in line with the results of study done by Marie et al.  and Quince et al.,  where the prevalence of depression ranged between 5.7% and 10.6%. Higher rates of depression in first-year medical students have been reported by Basnet et al. 
In our study, there was no significant association between the factors such as age and sex and depression, but in a study done by Marie et al.,  the prevalence of depression was 16.1% among female students and 8.1% among male students.
Limitations of our study
- First-year medical students from only one medical college were included in our study.
- Small sample size.
Medicine as a profession has always been regarded as a popular choice. This makes medical profession competitive and stressful for the students. In spite of the limitations of our study, it does well to point out need of providing attention to medical students during their entire tenure, especially at the time of exams.
| Implications|| |
It is suggested that larger, multi-institutional, and longitudinal studies to be carried out to find the sources of coping strategies to alleviate performance of students and reduce stress levels. Proper guidance and counseling by medical faculty may help improve the present scenario.
The authors would like to thank Dr Chaitanya Gujjarlapudi, Associate Professor, Department of Community Medicine, Katuri Medical College & Hospital, Guntur, for his support in the data analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hoe DC, Wah CK, Rian CA, Eliza Au E, Goud BK, Kamath U. Stress manifestations of medical students and its relation with gender and life style changes. Int Med J Stud Res 2012;2:37-45.
Sidhu JK. Effect of stress on medical students. IeJSME 2007;1:52-3.
Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry 1984;25:552-65.
Kaplan HI, Saddock BJ. Learning Theory. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8 th
ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p.148-54.
Niemi PM, Vainiomaki PT. Medical students′ academic distress, coping and achievement strategies during the pre-clinical years. Teach Learn Med 1999;11:125-34.
Silver HK, Glicken AD. Medical student abuse. Incidence, severity, and significance. JAMA 1990;263:527-32.
Shapiro SL, Shapiro DE, Schwartz GE. Stress management in medical education: A review of the literature. Acad Med 2000;75:748-59.
Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students′ depression at one medical school. Acad Med 1997;72:542-6.
Clark EJ, Rieker PP. Gender differences in relationships and stress of medical and law students. J Med Educ 1986;61:32-40.
Niemi PM, Vainiomäki PT. Medical students′ distress-quality, continuity and gender differences during a six-year medical programme. Med Teach 2006;28:136-41.
Linn BS, Zeppa R. Stress in junior medical students: Relationship to personality and performance. J Med Educ 1984;59:7-12.
Hays LR, Cheever T, Patel P. Medical student suicide, 1989-1994. Am J Psychiatry 1996;153:553-5.
Clark DC, Zedlow PB. Vicissitude of depressed mood during four years of medical school. JAMA 1988;260:2521-8.
Levine RE, Litwins SD, Frye AW. An evaluation of depressed mood in two classes of medical students. Acad Psychiatry 2006;30:235-7.
Chan DW. Depressive symptoms and depressed mood among Chinese medical students in Hong Kong. Compr Psychiatry 1991;32:170-80.
Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. J Affect Disord 1986;11:91-6.
Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al
. Childhood and adolescent depression: A review of the past 10 years, Part I. J Am Acad Child Adolesc Psychiatry 1996;35:1427-39.
Basker M, Moses PD, Russell S, Russell PS. The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India. Child Adolesc Psychiatry Ment Health 2007;1:8.
Vaidya PM, Mulgaonkar KP. Prevalence of depression, anxiety and stress in undergraduate medical students and its correlation with their academic performance. Ind J Occu Therapy 2007; 39:7-10.
Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998;44:1-6.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39: 594-604.
Abdulghani HM. Stress and depression among medical students: A cross sectional study at a medical college in Saudi Arabia. Pak J Med Sci Q 2008;24:12-7.
Solanky P, Desai B, Kavishwar A, Kantharia SL. Study of psychological stress among undergraduate medical students of government medical college, Surat. Int J Med Sci Public Health 2012;1:38-42.
Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: A cross sectional study at a college of medicine of Saudi Arabia. J Health Popul Nutr 2011;29:516-22.
Sultana N. Stress and depression among undergraduate medical students of Bangladesh. Bangladesh J Med Educ 2011;2:6-9.
Quince TA, Wood DF, Parker RA, Benson J. Prevalence and persistence of depression among undergraduate medical students: A longitudinal study at one UK medical school. BMJ Open 2012;2. pii: e001519.
Basnet B, Jaiswal M, Adhikari B, Shyangwa PM. Depression among undergraduate medical students. Kathmandu Univ Med J (KUMJ) 2012;10:56-9.
[Table 1], [Table 2], [Table 3]