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 Table of Contents  
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 90-94

Stressors among medical college undergraduates

1 Post Graduate, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
2 Professor and Head of the department, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
3 Professor, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
4 Clinical Psychologist, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India

Date of Submission18-Feb-2020
Date of Acceptance22-Jun-2020
Date of Web Publication14-Jan-2021

Correspondence Address:
Dr. Pramod K. R. Mallepalli
Professor and Head of the Department, Department of Psychiatry, Mamata Medical College, Khammam, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AMH.AMH_15_20

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Background: Medical colleges are accountable for training medical students to have sound knowledge and ability before they take up the professional responsibilities. Therefore, medical colleges typically use a curriculum of orations, simulations supervised practice, mentoring, and hands-on experience to enhance undergraduate's skill. In such a process unfortunately few areas of the training process have unintentional negative effects on student's physical and mental health.
Aims and Objectives: The aim of this study is to assess stressors among medical undergraduate students. The objectives of this study are i. To compare stressors among government medical college. Undergraduates and private medical college undergraduates. ii. To compare stressors among gender. iii. To compare stressors among various years of study.
Materials and Methods: This cross-sectional study consisted a sample size of 1568 participants who are undergraduate students from various medical colleges across India. The samples were drawn using convenience sampling method. The Medical Student Stressor Questionnaire (MSSQ) was the tool used to collect data for this study.
Results: Academic Related Stressors (Mean score = 2.156) was higher in medical college undergraduates followed by teaching and learning related stressors, group activities related stressor, Interpersonal and intrapersonal related stressors, social related stressors and Drive and desire related stressors with mean scores of 1.711, 1707, 1.599, 1.385 and 1.243 respectively.
Conclusions: Academic stress was the most broadly source of stress found and thus most often contributed to overall stress scores. Females show more stress as compared to males. Private medical college undergraduates had more medical stress compared to government medical undergraduates. Final year undergraduates had more medical stress followed by first year. This needs attention towards curriculum change process in medical education.

Keywords: Medical undergraduate students, stress, stressors, the medical student stressor questionnaire

How to cite this article:
Nihal N G, Mallepalli PK, Babu RS, Sakamudi M. Stressors among medical college undergraduates. Arch Ment Health 2020;21:90-4

How to cite this URL:
Nihal N G, Mallepalli PK, Babu RS, Sakamudi M. Stressors among medical college undergraduates. Arch Ment Health [serial online] 2020 [cited 2021 Jun 18];21:90-4. Available from: https://www.amhonline.org/text.asp?2020/21/2/90/306859

  Introduction Top

Stress and its psychological manifestations are immanent in humans and are a prime source of concern in this current society.[1] The presence of stress relies on the of stressors which can be anything that evaluates an individual's adaptability, body, or mentality. Stress can be due to various factors such as environmental, psychological, biological, and social and its effect can be either positive or negative to an individual, based on the strength of the stress, prolonged existence of the stress, the individual's nature, a cognitive judgment of the stress, and social support.[2] Excessive stress has also been reported to result in physical and mental health problems and reduced self-esteem, as well as affect academic achievement and personal and professional development. The level of stress among medical students has been reported to depend on the medical curriculum, examination system, and the setting of the medical college. Stress has an impact on students' academic performance by decreasing concentration and affecting decision-making skills.[3]

Stress is a major reason for declining empathy among medical undergraduates. This is further progressed by the observation that every 5th medical student at the beginning of their study shows high commitment and tendency to exhaustion.[4]

An undergraduate life can be stressful due to various reasons or stressors such as poor academic performance, financial problem, health problem, or loss of loved ones. It is the persons ability to face daily challenges which determines whether the person will be stressed out or not. Stress in the academic scenario can have positive as well as negative consequences. Stress can hinder earning, i.e., unfavorable stress and can be associated with the downfall of students academic performance. The medical education in India is testing as far as students efforts are concerned. It has been reported that medical college environments in India are tremendously stressful and has even resulted in suicidal attempts by the undergraduates across the country. Fear of failure in the examination, enormous content that has to be learned within a limited period and unable to meet parent's high expectations are observed to be the most common sources of stress.[5]

Stress in medical colleges can result in difficulties later in professional life which might result in compromising patient care. Stress can result in anxiety, depression, and psychological symptoms which might have a negative consequence on student's academic performance. Stress in medical colleges has been a worldwide issue.[6] As stress can also effect on decision-making skills, and reduce undergraduates' capabilities to establish good relationships with patients resulting in their feeling scanty and unstated with their clinical practice in the future. This might affect their patients' lives and the community's health.[7]

The present study was aimed to assess stressors among medical college undergraduates across India.

  Materials and Methods Top

This is a descriptive, cross-sectional study conducted at various medical colleges across India through an online questionnaire with a sample size of 1568 medical undergraduates where 574 were male and 994 were female. The data collection was done from June to December 2019.

Medical undergraduates willing to participate in the study are included in this study and undergraduates who are not willing to participate in the study were excluded from this study.

Sociodemographic profile includes sex, religion, type of college (government/private), and year of study.

Medical student stressor questionnaire (MSSQ) was used to assess stressors among medical college undergraduates. The responses were marked on a Likert scale ranging from causing no stress at all as 0 to causing severe stress as 4. This 40-item questionnaire were addressed to 6 domains of stress which were academic-related stress (ARS), skills related to intrapersonal and interpersonal development (IRS), teaching and learning-related stress (TLRS), social-related stress (SRS), desire-related stress (DRS) and group activities related stress (GARS). Higher the scores in particular stressor groups is proportional to the stress perceived.[8]

Statistical analysis

It was done using SPSS software (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp). for statistical analysis version 22. Sociodemographic data of the undergraduates were obtained using frequencies, descriptive statistics. Means of samples were calculated. One-way ANOVA for a group of samples was done to compare stress between various years of under graduation. P < 0.05 was set at statistical significance.

  Results Top

In the present study, [Table 1] shows sample consists of 1568 undergraduates out of which 994 were female (994) and 574 were male. In religions, the majority of the sample consisted of Hindus (1290) followed by Muslims (144), Christian (98), and others (36) such as Jains, Buddhists, Atheists. Majority of undergraduates are from government colleges (1008) compared to private colleges (560). Majority of the sample is from an urban area (1176). All the years of MBBS i.e., 1st year (376), 2nd year (492), 3rd year (272), and final year (428) participated in this study.
Table 1: Sociodemographic profile

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[Table 2] and [Figure 1] suggest that ARS (Mean score = 2.156) was higher in medical college undergraduates followed by TLRS, GARS, IRS, SRS, and DRS.
Table 2: Sources of stress

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Figure 1: Source of stress

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[Table 3] and [Figure 2] suggest that female undergraduates have significantly more stress than male undergraduates. ARS, IRS, TLRS, and GARS are significantly higher in females compared to males. Overall medical-related stress is significantly higher in females (m = 73.23) than males (m = 65.31).
Table 3: Comparison of stressors among females and males

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Figure 2: Comparison of stressors among females and males. Academic-related stress, skills related to intrapersonal and interpersonal development, teaching and learning related stress, social related stress, desire-related stress, and group activities related stress

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[Table 4] and [Figure 3] suggest that SRS is significantly higher in the 1st year undergraduates. DRS is significantly higher in the final year undergraduates. Overall medical-related stress is significantly higher in the final year (m = 73.06) followed by 1st year (m = 71.84), 2nd year (m = 69), and 3rd year (m = 66.38).
Table 4: Comparison of medical related stressors among various years of study

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Figure 3: Comparison of medical related stressors among various years of study

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  Discussion Top

Medical undergraduates have more academic hours per year including study hours in some private colleges, more teaching sessions and more frequent examinations to assess student's performance, consequently ending up to more number's hours of study, lack of rest, and enormous stress, factors which can affect mental health.

This study once again brought into light that academic-related stressors continue to be the prime pernicious problem affecting a student's mental health and well-being. Academic-related stressors pose the greater contribution to stress and caused high stress to undergraduates. To meet self as well as parent's expectation while trying to outshine others in competition with the heavy workload but ending up getting poor marks leading to stress. Quota system in examination caused severe stress among 26.5% of undergraduates. Excess of ARS can intensify psychological and physical complications such as depression, anxiety, and stress-related disorders, which lead to their poor academic results.

Female undergraduates significantly had more medical-related stress than male undergraduates as males have better-coping strategies than females.[9] ARS, IRS, TLRS, and GARS are significantly higher in females than males as females have higher expectations to do well. In general, females are harder on themselves than males and hold themselves to higher standards of perfection, in addition to taking on more activities.

Private college medical undergraduates significantly have more medical-related stress than government college medical undergraduates as they are subjected to the pressure of academics with a task to be successful, an unreliable future, and difficulties of incorporating into the system with constant scrutiny from the management and staff of the private colleges.

Final year undergraduates had more medical-related stress as students have pressures of clinical responsibilities, passing the course, university internal examinations, and making important career decisions such as taking up work or continuing to do postgraduation studies within the short span.

Surwase et al. found that ARS which was on top of the list with other stressors followed by, IRS, TLRS, GRS, SRS, and DRS.[5]

Gupta, et al. (2015) found that high prevalence of stress among 1st year MBBS students. Academic-related stressors pose the major source to the overall stress.[10]

Sivan and Rangasubhe reported that high prevalence of stress among 1st year undergraduates and ARS was the prime source of stress.[1]

Melaku et al. found that ARS was the leading cause of stress on students while TLRS and DRS were the second and third causes of stress.[11]

The findings of this study have to be seen in the light of some limitation. Although the responses were taken from various colleges across the country, the sample size is still small with the number of undergraduates across the country and responses maximum received are from Andhra Pradesh and Telangana. It is also a cross-sectional study.

  Conclusion Top

There is a need to rethink about the evaluation and examination system and to provide more time and amenities in the medical college for extracurricular activities to make it less stressful to the students.

Medical colleges should expose the students to various coping strategies such as stress management, decision-making in a tough situation, managing diversity, spiritual development, reflective skills, and interfaith discussion, to promote and produce stress-free holistic confident practitioners.

This needs attention toward curriculum change process in medical education, especially in 1st year MBBS, where the three basic science subjects are taught within 9–10 months.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sivan S, Rangasubhe P. Prevalence of stress and its associated factors. J Evolut Med Dent Sci 2013;2:9386-94.  Back to cited text no. 1
Zegeye A, Mossie A, Gebrie A, Markos Y. Stress among Postgraduate Students and Its Association with Substance Use. J Psychiatry 2018;21:448.  Back to cited text no. 2
Fasoro AA, Oluwadare T, Ojo TF, Oni IO. Perceived stress and stressors among first-year undergraduate students at a private medical school in Nigeria. J Taibah Univ Med Sci 2019;14:425-30.  Back to cited text no. 3
Bergmann C, Muth T, Loerbroks A. Medical students' perceptions of stress due to academic studies and its interrelationships with other domains of life: A qualitative study. Med Educ Online 2019;24:1603526.  Back to cited text no. 4
Surwase K, Bagdey P, Adikane H. A cross sectional study of stress among Medical Students in Government Medical College, Nagpur. Sch J App Med Sci 2016;4:3229-32.  Back to cited text no. 5
Eva EO, Islam MZ, Mosaddek AS, Rahman MF, Rozario RJ, Iftekhar AF, et al. Prevalence of stress among medical students: A comparative study between public and private medical schools in Bangladesh. BMC Res Notes 2015;8:327.  Back to cited text no. 6
Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6.  Back to cited text no. 7
Yusoff MS, Rahim AF, Yaacob MJ. The development and validity of the Medical Student Stressor Questionnaire (MSSQ). ASEAN J Psychiatry 2010;11:231-5.  Back to cited text no. 8
Anbumalar C, Dorothy AP, Jaswanti VP, Priya D, Reniangelin D. Gender differences in perceived stress levels and coping strategies among college students. Int J Indian Psychol 2017;4:22-33.  Back to cited text no. 9
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. 10
Melaku L, Mossie A, Negash A. Stress among medical students and its association with substance use and academic performance. J Biomed Educ 2015;2015:1-9.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3]

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


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