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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 56-60

Stress, its determinants and its association with academic performance among the students of a medical college in Kerala


Department of Community Medicine, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India

Date of Submission30-Jul-2019
Date of Acceptance02-Apr-2020
Date of Web Publication5-Jun-2020

Correspondence Address:
Sudarshan B Puttaswamy
Department of Community Medicine, DM Wayanad Institute of Medical Sciences, Meppadi P.O., Wayanad - 673 577, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_62_19

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  Abstract 


Introduction: Medical education is one of the most stressful academic curricula worldwide, negatively affecting the health of medical students. Stress in medical students if not tackled in time, can have professional ramifications, as well as personal consequences. Hence, in this background, this study was undertaken to find out the prevalence of stress among medical students, its determinants and its association with academic performance.
Material and Methods: This was a cross-sectional study done at a medical college, Wayanad district, between January and June 2019. All the undergraduate medical students of the college were the study subjects. Data were collected using a predesigned and pretested self-administered questionnaire, the first part of which had questions pertaining to basic sociodemographic details, factors affecting stress, and their academic performance, and the second part was the Medical Student Stress Questionnaire. Completed responses were obtained from a total of 605 students.
Results: About 29.8%, 53.6%, 16.7% and 0% were found to have no/mild stress, moderate stress, high stress and severe stress respectively. The prevalence of moderate/high stress was more among 25–26 years, males, married, Phase I MBBS, government quota, Muslim, urban origin, and day scholar students. However, only religion and place of origin were found to have a significant association (P = <0.01 and 0.048 respectively). The median stress score was highest for the academic domain 1.5 and least for drive and desire related and group activities related domain (1 for both). There was a very weak positive correlation (r = 0.007) between the percentage of marks obtained and total stress scores, and the correlation was found to be statistically insignificant (P = 0.868).
Conclusion: The prevalence of stress among the participants was low. Muslim religion and urban origin were found to have a significant association with the prevalence of moderate/high stress. There was a very weak positive correlation between the percentage of marks obtained and total stress scores.

Keywords: Kerala, medical college, Medical Students Stress Questionnaire, stress, students


How to cite this article:
Madhusudan M, Puttaswamy SB, Krishna K M, Farsana P K, Angela A S, Muneer I, Thomas T. Stress, its determinants and its association with academic performance among the students of a medical college in Kerala. Indian J Community Fam Med 2020;6:56-60

How to cite this URL:
Madhusudan M, Puttaswamy SB, Krishna K M, Farsana P K, Angela A S, Muneer I, Thomas T. Stress, its determinants and its association with academic performance among the students of a medical college in Kerala. Indian J Community Fam Med [serial online] 2020 [cited 2020 Jul 7];6:56-60. Available from: http://www.ijcfm.org/text.asp?2020/6/1/56/286031




  Introduction Top


Stress is defined as the body's nonspecific response or reaction to demands made on it, or to alarming events in the environment. It is not only an aggravation or a response but also it is a process by which we get acquainted and cope with environmental threats and challenges. Personal and environmental events that cause stress are known as stressors.[1] Some stress in medical school training is needed for learning. Stress which promotes and facilitates learning is called “favorable stress” and stress which inhibits and suppresses learning is called “unfavorable stress.” The same stressors may be perceived differently by different medical students, depending on their cultural background, personal traits, experience and coping skills.[2]

Medical education has come a long way since Hippocrates era and has evolved into a more organized and effective mechanism. However, some aspects of training may have produced some unintended negative stress on medical students' mental and emotional health.[3] Medical education has been reported to be one of the most stressful academic curricula worldwide, negatively affecting the physical and mental health of medical students.[4] It is well documented in previously conducted studies that higher education is very stressful and medical education is even more stressful as compared to other professional courses.[5]

A medical student can be stressed due to different reasons or stressors such as academic, financial problem, health problems or loss of close family members or friends, etc., It is the person's ability to face the everyday challenges which will determine whether he/she will be stressed or not.[6] Learning a whole lot of new information in a relatively short time, with the pressure of examiations, possibly leads to the development of stress in medical students.[7]

Most students experience stress during medical school. This stress manifests itself in a variety of forms, including burnout, depressive symptoms, poor quality of life, and fatigue. The greater the number of forms of stress experienced by an individual student, the higher the risk of recent suicidal ideation or serious thoughts of dropping out of medical school.[8] Stress in medical students if not tackled in time, it can have professional ramifications, including damaging effects on empathy, ethical conduct, and professionalism, as well as personal consequences such as substance abuse, burnouts, broken relationships, and suicidal ideation.[9]

Different studies conducted in India have reported the prevalence of stress among medical students in the range of 55.7%–84%.[10],[11] However, there are hardly any studies conducted in this part of the country. Hence, in this background, the present study was undertaken.

Objectives

  1. To find out the prevalence of stress among medical students
  2. To find out the determinants of stress
  3. To find out the association between stress and academic performance.



  Material and Methods Top


This was a cross-sectional study done at a medical college, Wayanad district, Kerala, between January and June 2019. All the undergraduate medical students of the college (i.e., Phase I MBBS to Interns) willing to participate in the study were the study participants. After obtaining approval from the college administration, the students were approached individually in their hostel rooms and briefed about the purpose of the study. Participation in the study was voluntary. Oral informed consent was taken from the participants and data were collected using a predesigned and pretested self-administered questionnaire, the first part of which had questions pertaining to basic sociodemographic details, possible factors affecting stress and their academic performance and the second part was the Medical Student Stress Questionnaire (MSSQ), which is a validated instrument to assess the prevalence and intensity of stress among the medical students. There are 40 items in MSSQ that represent the possible sources of stress in medical students and are grouped into six main domains as follows: academic-related stressors, intrapersonal and interpersonalrelated stressors, teaching and learning-related stressors, social-related stressors, drive and desire related stressors, group activities-related stressors. The students were asked to give a score to each of the 40 items on a scale of 0–4, based on their experience and perception in the medical college life (0 for “causing no stress at all,” 1 for “causing mild stress,” 2 for “causing moderate stress,” 3 for “causing high stress” and 4 for “causing severe stress”). The average score of each domain as well as of all the 40 items was calculated. Interpretation of the scores is as follows: 0–1.00→ no/mild stress, 1.01–2.00→ moderate stress, 2.01–3.00→high stress, and 3.01–4.00→severe stress.[12] Completed responses were obtained from a total of 605 students. The respondents were asked not to mention their names for maintaining anonymity and also to encourage participation and elicit a truthful response. Data were kept confidential.

Data were entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 22.0, IBM Corp, Armonk, NY, USA. Descriptive statistics such as mean and percentage and also inferential statistics like Chi-square test to find out association and correlation were used.


  Results Top


The total number of participants was 605, of which 130 (21.5%) were male and 475 (78.5%) were female. 12 (2%), 238 (39.3%), 145 (24%), 123 (20.3%), and 87 (14.4%) were from Phase I MBBS, Phase II, Phase III Part I, Phase III, Part II, and internship, respectively. The mean age of the participants was 21.78 ± 1.67 years.

Out of the total 605 participants, 180 (29.8%), 324 (53.6%), 101 (16.7%) and 0 (0%) were found to have no/mild stress, moderate stress, high stress and severe stress respectively [Graph 1].



The prevalence of moderate/high stress was more among 25–26 years age-group compared to other age groups, males compared to females, married compared to unmarried, Phase I MBBS students compared to other phases, government quota students compared to other quotas, Muslim students when compared to other religions, urban origin students when compared to the rural origin and day scholars when compared to hostelites. However, only religion and place of origin were found to have a statistically significant association (P = <0.01 and 0.048 respectively) [Table 1].
Table 1: Factors affecting the grades of stress

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The median stress score was highest for the academic domain 1.5 (0.92, 21.4, 0.3,) and least for drive and desire related 1 (0.73, 3, 0) and group activities related domain 1 (0.75, 3.75, 0) [Table 2].
Table 2: Median stress scores of various domains

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The median stress score was higher among 22–24 years and 25–26 years age group, compared to 19–21 years group, among males compared to females, married compared to unmarried, Phase I MBBS compared to other phases, government quota compared to other quotas, Christians compared to other religions, urban origin students compared to rural origin, day scholars compared to hostelites, students who had passed the last university examination/internal assessment with distinction compared to those who had passed with other classes. However, only academic performance was found to have a statistically significant association with stress scores, with median stress score highest among those who had secured distinction and least among those who had failed or passed in pass class. Post-hoc test showed that there was a statistically significant difference between the scores of pass class and distinction, pass class and I class and pass class and II class (P = <0.01 for all) and no significant difference between the scores of I class and II class, I class and distinction and II class and distinction (P = 1, 0.172, and 0.589, respectively) [Table 3].
Table 3: Comparison of the median stress scores across different variable categories

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There was a very weak (or negligible) positive correlation (r = 0.007) between the percentage of marks obtained in previous university examination/internal assessment and total stress scores, and the correlation was found to be statistically not significant (P = 0.868) [Graph 2 and [Table 4].
Table 4: Correlation between percentage of marks obtained in previous university exam and total stress scores

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  Discussion Top


In the present study, 70.2% of the subjects were found to have moderate-to-high stress, which is lower when compared to other studies which have reported prevalence of 84% and 91.1% but higher than that reported by Srivastava et al. (55.7%). This difference could be attributed to differences in the sociocultural background, demography, and academic grade of the study subjects. In the studies by Gupta et al., Srivastava et al., and Krishnappa et al., the participants are from the 5th semester, 6th, and 7th semesters and Phase I to Phase III respectively, whereas in our study the subjects are from all the years including internship.[4],[10],[11]

The prevalence of moderate/high stress was more among 25–26 years age-group compared to other age groups, males compared to females, married compared to unmarried, Phase I MBBS students compared to other phases, government quota students compared to other quotas, Muslim students when compared to other religions, urban origin students when compared to the rural origin and day scholars when compared to hostelites. However, only religion and place of origin were found to have a statistically significant association. Krishnappa et al. have noted that the prevalence of moderate/high stress was more among females compared to males, Phase II students compared to other phases and both these associations were found to be significant. Srivastava et al. have also found that the prevalence of moderate/high stress was more among females compared to males, but the association was not statistically significant. This difference could be attributed to differences in the sociocultural background, demography, and academic grade of the study subjects.

The mean stress score was highest for the academic domain, and least for drive and desire related. Similar findings were observed by Adikane et al.[13]

There was a very weak (or negligible) positive correlation between the percentage of marks obtained in previous university examination/internal assessment and total stress scores and the correlation was found to be statistically not significant. However, Melaku et al., have noted a very weak (or negligible) significant negative correlation between stress and last semester cumulative grade point average. The difference could be attributed to the differences in sociocultural background, demography, academic grade of the study subjects, questionnaires used (Melaku et al., have used the MSSQ-20 questionnaire), and also the differences in the ways academic performance is measured in India and Ethiopia.[14]

Limitations

The study participants were from a single college. Hence, the findings cannot be generalized to the medical students' community of the country or world.


  Conclusion Top


  • The prevalence of stress among the subjects was lower compared to other studies
  • The prevalence of moderate/high stress was more among 25–26 years age-group compared to other age groups, males compared to females, married compared to unmarried, Phase I MBBS students compared to other phases, government quota students compared to other quotas, Muslim students when compared to other religions, urban origin students when compared to the rural origin and day scholars when compared to hostelites. However, only religion and place of origin were found to have a statistically significant association
  • The mean stress score was highest for the academic domain, and least for drive and desire related
  • There was a very weak (or negligible) statistically insignificant positive correlation between the percentage of marks obtained in previous university examination/internal assessment and total stress scores.


Acknowledgments

The authors would like to sincerely acknowledge the support provided by Professor and head, Department of Community Medicine, and Management of the DMWIMS in conducting the study and also UG medical students of DMWIMS for their cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yusoff MSB. A multicenter study on validity of the medical student stressor questionnaire (MSSQ). Int Med J 2011;18:14-8.  Back to cited text no. 1
    
2.
Habeeb KA. Prevalence of stressors among female medical students. J Taibah Univ Med Sci 2010;5:110-9.  Back to cited text no. 2
    
3.
Yee LW, 'Yusoff MSB. Prevalence and sources of stress among medical students in Universiti Sains Malaysia. Educ Med J 2013;5:34-41.  Back to cited text no. 3
    
4.
Gupta S, Choudhury S, Das M, Mondol A, Pradhan R. Factors causing stress among students of a medical college in Kolkata, India. Educ Health (Abingdon) 2015;28:92-5.  Back to cited text no. 4
    
5.
Salam A, Mahadevan R, Rahman AA, Abdullah N, Harith AA, Shan CP. Stress amongFirst and Third Year Medical Students at University Kebangsaan Malaysia. Pak J Med Sci 2015;31:169-73.  Back to cited text no. 5
    
6.
Siraj HH, Salam A, Roslan R, Hasan NA, Jin TH, Othman MN. Stress and its association with the academic performance of undergraduate fourth year medical students at Universiti Kebangsaan Malaysia. Int Med J Malaysia 2014;13:19-24.  Back to cited text no. 6
    
7.
Shelke US, Kunkulol RR, Narwane SP. Level of stress in final year MBBS students at Rural Medical College: A cross-sectional study. Int J Med Res Heal Sci 2014;3:886-91.  Back to cited text no. 7
    
8.
Dyrbye LN, Harper W, Durning SJ, Moutier C, Thomas MR, Massie FS Jr., et al. Patterns of distress in US medical students. Med Teach 2011;33:834-9.  Back to cited text no. 8
    
9.
Manjunath SM, Raju N, Singh RK. A cross-sectional study on the sources and levels of stress among second year undergraduate medical students. Natl J Med Res 2014;4:314-7.  Back to cited text no. 9
    
10.
Krishnappa K, Singh NP, Jain PK, Sharma A, Mehra J, Nayak KS. Medical school and stress: A cross-sectional study of stress among medical students in Uttar Pradesh University of Medical Sciences in district Etawah. Indian J Community Health 2018;30:239-46.  Back to cited text no. 10
    
11.
Srivastava DK, Bansal M, Gour N, Srivastava M, Jain PK. The prevalence of stress and its possible association with demographic features: A cross sectional study. J Med Educ 2018;17:230-7.  Back to cited text no. 11
    
12.
Yusoff MSB, Rahim AFA, Yaacob MJ. The development and validity of the medical student stressor questionnaire (MSSQ). ASEAN J Psychiatry 2010;11:1-12.  Back to cited text no. 12
    
13.
Adikane H, Kaware A, Thakre S. Stress among medical students of a tertiary health care centre in tribal area of central India: A prospective observational study. Int J Community Med Public Health 2018;5:3084-9.  Back to cited text no. 13
    
14.
Melaku L, Mossie A, Negash A. Stress among medical students and its association with substance use and academic performance. J Biomed Educ 2015;3:1-9.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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