• Users Online: 93
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 391-396

Study of stress, anxiety, depression, coping, and associated factors among medical students from central India

1 Department of PSM, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
2 Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
3 Department of Psychiatry, BRLSABVM Medical College, Rajnandgaon, Chhattisgarh, India
4 Department of Respiratory Medicine, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India
5 Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Wardha, Maharashtra, India
6 Department of Forensic Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission18-Jun-2020
Date of Decision30-Jun-2020
Date of Acceptance30-Jul-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Sachin Ratan Gedam
Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_226_20

Rights and Permissions

Objectives: Previous studies worldwide have reported that medical students are subjected to stress and related psychological morbidities. Stress could lead to psychological problems such as depression and anxiety. The objectives were to estimate the prevalence of depression, anxiety, and stress; to identify sources of stress and coping strategies; and their association with depression, anxiety, and stress scores (Depression, Anxiety and Stress scale (DASSs)). Materials and Methods: this cross-sectional survey was conducted among 2nd-year MBBS students during June–July 2017 from Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha, Maharashtra. A total of 169 students were assessed through semi-structured pro forma, Depression, Anxiety and Stress scale (DASS), coping inventory for the stressful situation, and sources of academic stress among students for data collection. Results: The overall prevalences of depression, anxiety, and stress among the students were found to be 60.94%, 73.37%, and 37.27%, respectively. The most common source of stress was found to be academic factors, with coping strategy being task-oriented. A significant association of student's satisfaction with depression and stress; gender with stress; depression with emotion and task-oriented coping strategies; emotion oriented with stress and anxiety; and all stress sources with DASS had been found. Conclusion: The students were subjected to depression, stress, and anxiety. Academic factors were found to be the important stressor. Hence, appropriate strategies need to be conducted to decrease the burden of students.

Keywords: Anxiety, coping strategies, depression, medical students, stress

How to cite this article:
Babar V, Gedam SR, Manore S, Dewangan K, Gaikwad P, Patond S. Study of stress, anxiety, depression, coping, and associated factors among medical students from central India. J Datta Meghe Inst Med Sci Univ 2020;15:391-6

How to cite this URL:
Babar V, Gedam SR, Manore S, Dewangan K, Gaikwad P, Patond S. Study of stress, anxiety, depression, coping, and associated factors among medical students from central India. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 25];15:391-6. Available from: http://www.journaldmims.com/text.asp?2020/15/3/391/308562

  Introduction Top

Stress is the most common and process-oriented obstacle in medical education, which may exert a negative effect on the physical health, academic performance, and psychological well-being of the students.[1] Previous studies have reported increasing stress and high levels of distress, such as depressive symptoms among medical undergraduates.[2],[3],[4],[5] The factors such as physical, academic, and emotional factors are found to be greater perceived causes of stress among students.[6] Factors such as age, gender, ethnicity, and marital status influence the severity of stress and academic performance of the students.[7],[8],[9] Increase stress may affect students' academic achievement; reduce their self-esteem, physical and mental health issues.[10],[11] Previous studies have classified sources of stress into three main areas: social issues, academic pressures, and financial problems.[12]

Review of literature reported coping strategies of medical students with stresses of undergraduate education have identified the use of alcohol and other substances such as tobacco and drugs as a coping strategy.[13],[14],[15],[16],[17],[18] Whereas a study from Pakistan reported that music, sports, and hanging out with friends were common coping strategies.[19] Studies on medical students from developing countries such as India, Pakistan, Thailand, and Malaysia have reported stress among them and have underscored the role of academics as a source of stress.[6],[19],[20],[21] Several studies have assessed the correlation between sources of stress and psychological morbidity in medical undergraduates. Anxiety and depression have been associated with concerns about personal endurance and ability, mastering knowledge, lack of time for other activities, feeling of anonymity, long hours, peer competition, and loss of social time.[12],[22]

At the JNMC Sawangi (Meghe) Wardha (India), 200 students from different states of the country are admitted every year and most of them are from other states. They have diverse socioeconomic, cultural, and educational backgrounds and get exposed to a new environment. This sudden change could lead to stress of varying severity and there could be other stressors that could hamper the students' academic performance. Hence this study was undertaken with the objectives of (1) to estimate the prevalence of stress; (2) to identify the severity of depression and anxiety; and (3) to identify the sources of stress and coping strategies among students.

  Materials and Methods Top

A cross-sectional survey was conducted among medical undergraduate students of Jawaharlal Nehru Medical College in the city of Wardha, Maharashtra, during the period of June–July 2017. A total of 169 MBBS students (2nd year) aged 19–22 years were selected through simple random sampling. The study was conducted after obtaining approval from the ethics committee of the college. The informed consent was taken from students after explaining the nature and purpose of the study. The data were collected by self-administering questionnaires, as mentioned below:

  1. The semi-structured pro forma that contains age, gender, religion, educational qualification, socioeconomic status, addiction status, attendance in classes, physical problems, and satisfaction with studies
  2. Depression, anxiety and stress scale (DASS-21):[23] It is a 21 item self-report questionnaire designed to measure the severity of core symptoms of depression, anxiety, and stress. Each item is scored from 0 to 3. It is a short-form version of the DASS (the long-form has 42 items). DASS-21 is reported to have a very good Cronbach's alpha value for depression and anxiety (0.84 and 0.74, respectively). The cut-off scores have been developed for defining mild/moderate/severe/extremely severe scores for each DASS scale
  3. Coping inventory for stressful situations21:[24] It is assumed to assess coping by three basic coping strategies such as avoidance, emotion oriented, and task oriented. It contains 21 items with each subscale consists of 7 items measured on 5-point Likert-scale. Higher score of each factor indicates the more frequent use and greater effectiveness of that specific coping strategy. It has also reported high internal consistencies for all the three subscales and also provide as a good factor structure
  4. Sources of academic stress among students:[25],[26] The questionnaire consisted of 30 items and potential stressors were divided into four categories such as relationship factors (6 items), personal factors (9 items), academic factors (9 items) and environmental factors (6 items). It was measured on five-point Likert scale ranging from 1 = no stress to 5 = highly stressful. The higher score indicates more specific stressor.

Data were analyzed using SPSS version 24.0 (SPSS Inc., Chicago, Ill., USA). The analysis was performed by descriptive and inferential statistics using the Chi-square test and t-test. Value of P < 0.05 considered as significant.

Ethical clearance

The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Jawaharlal Nehru Medical College, Sawangi(M), Wardha. Date: 6th Jan 2017 with Reference no DMIMS(DU)/IEC/2019/35.

  Results Top

A total of 169 students of 2nd MBBS participated in the present survey. There were total 66 (39.1%) males and 103 (60.9%) females with a mean age of 19.76 (±0.98) years. Majority of them were Hindu (85.2%), belonged to upper socioeconomic status (99.4%) and moderately satisfied with their studies (66.3%). Most of the students had regular attendance in class (86.4%), no physical problems (89.9%), nonsmoking status (94.4%) and 57.99% of participants reported no addiction other than smoking [Table 1].
Table 1: Sociodemographic data of medical students

Click here to view

The overall prevalences (mild to very severe) of depression, anxiety, and stress among the students were found to be 60.94%, 73.37%, and 37.27%, respectively [Table 2]. In the present study, coping strategies used by the students to deal with their stressors were task oriented (22.83 ± 5.61) followed by avoidance (21.23 ± 5.23) and emotion oriented (21.02 ± 5.86) [Table 3]. The most common source of stressors faced by participants includes academic factors (22.46 ± 7.24) followed by personal (17.69 ± 5.57), environmental (12.66 ± 4.35), and relationship factors (12.27 ± 4.36) [Table 4].
Table 2: Severity of depression, anxiety, and stress among the students

Click here to view
Table 3: Coping strategies of the Medical students

Click here to view
Table 4: Academic stressors among the medical students

Click here to view

The student's satisfaction with studies had a significant association with depression and stress, while gender had a significant association with stress only (P < 0.05). Anxiety and other sociodemographic variables were not significantly associated (P > 0.05) [Table 5]. Depression was significantly associated with emotion and task-oriented coping strategies, whereas anxiety and stress were associated with emotion oriented (P < 0.05) [Table 6].
Table 5: Association between sociodemographic variables and depression, anxiety, and stress scores

Click here to view
Table 6: Association between depression, anxiety, and stress scores and coping strategies

Click here to view

The all source of stressors such as relationship, personal, environmental, and academic factors were significantly associated with depression, anxiety, and stress (P < 0.05) [Table 7].
Table 7: Association between depression, anxiety, and stress scores and sources of stress

Click here to view

  Discussion Top

A total of 169 MBBS students (2nd year) participated in the present survey with the aim of estimating the prevalence of stress, anxiety, and depression; sources of stress and their coping strategies. The psychological morbidity in our study was variable compared to previous study from developed countries. The overall prevalence of psychological morbidity among medical students was found to be 20.9% by Sreeramareddy et al.[9] A study from the Agha Khan University of Pakistan reported more than 90% of students felt stressed during their course.[19] Indian study reported 73% of the students' perceived stress during their medical school.[6] Studies from Australia, Singapore, and the United Kingdom have reported different rates of psychological morbidity among medical students.[27],[28],[29] In the present survey, satisfaction with academic performance had a significant association with depression and stress, while age is associated with stress only.

In the present study, academic and personal factors as compared to environmental and relationship factors were found to be important stressors for medical students. Barikani identified economic and accommodation-related factors as probable stressors among medical students, while Vivek found environmental and social factors as important stressors in his study.[30],[31] Researchers such as Al-Dabal et al., Abu-Ghazaleh et al., and Behere et al., have studied the importance of various academic factors in the development of stress.[32],[33],[34] Hence, our finding is in accordance with that of the above researchers. All sources of stressors were significantly different with respect to depression, anxiety, and stress. Academic factors were found to have comparatively more mean score on all DASS scores as compared to other source of stressors.

Coping strategies refer to the specific efforts, both psychological and behavioral that people employ to master, reduce tolerate or minimize stressful events.[35] Avoidance-oriented coping strategies describes activities, and cognitive changes aims at avoiding the stressful situation while task-oriented coping is described as purposeful task effort aimed at solving the problem or attempt to alter the situation. Emotion-oriented coping describes turning to religion, positive reinterpretation, acceptance and seeking of emotional support.[36],[37] In the present survey, most common coping strategies used by students was task oriented followed by avoidance and emotion, which is similar to the findings of a study conducted by Wan Salwina et al. and Salam A et al.[36],[38] Further depression was significantly different with emotion and task-oriented coping strategies, whereas anxiety and stress were significantly associated with emotion-oriented in the current study. The difference observed in the findings of current and previous studies could be due to differences in methodological evaluation and study population.

There are certain limitations of this study. The findings cannot be generalized since this study was conducted in a single medical college. The self-administered scales used, and hence the results could be biased. Stress at different periods was not considered in this study. Compounding factors such as the participants' personality or current emotional state may be present. This was a cross-sectional study, and small sample size was used.

  Conclusion Top

The prevalences of depression, anxiety, and stress have been found to be variable in the current study as compared to previous literature. The main source of stress found to be academic factors with task-oriented strategy is the main coping mechanism to deal with their stressors by the students. Hence need for specific and targeted to decrease substantially the burden of students. Teaching techniques and the college environment should be adapted to the need of the students. Therefore, the promotion of healthy dietary and lifestyle habits should be encouraged.[39],[40],[41],[42],[43],[44],[45],[46]

  References Top

Mosley TH Jr., Perrin SG, Neral SM, Dubbert PM, Grothues CA, Pinto BM. Stress, coping, and well-being among third-year medical students. Acad Med 1994;69:765-7.  Back to cited text no. 1
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.  Back to cited text no. 2
Zocolillo M, Murphy GE, Wetzel RD. Depression among medical students. J Affect Disord 1986;11:91-6.  Back to cited text no. 3
Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: A nationwide and prospective study of prevalence and predictors. J Affect Disord 2001;64:69-79.  Back to cited text no. 4
Tyssen R, Hem E, Vaglum P, Grønvold NT, Ekeberg Ø. The process of suicidal planning among medical doctors: Predictors in a longitudinal norwegian sample. J Affect Disord 2004;80:191-8.  Back to cited text no. 5
Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med 1998;44:1-6.  Back to cited text no. 6
Hatcher L, Prus JS. A measure of academic educational constraints: Out-of-Class circumstances that inhibit college students development. Educ Psychol Meas 1991;51:953-63.  Back to cited text no. 7
Hammer LG, Grigsby TL, Woods S. The conflict in demand of work, family and school among students of an urban university. J Psychol 1998;132:220-7.  Back to cited text no. 8
Sreeramareddy CT, Shankar PR, Binu VS, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007;7:26.  Back to cited text no. 9
Silver HK, Glicken AD. Medical student abuse. Incidence, severity, and significance. JAMA 1990;263:527-32.  Back to cited text no. 10
Niemi PM, Vainiomaki PT. Medical students' academic distress, coping and achievement strategies during the pre-clinical years. Teach Learn Med 1999;11:125-34.  Back to cited text no. 11
Vitaliano PP, Russo J, Carr JE, Heerwagen JH. Medical school pressures and their relationship to anxiety. J Nerv Ment Dis 1984;172:730-6.  Back to cited text no. 12
Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Embarking upon a medical career: Psychological morbidity in first year medical students. Med Educ 1995;29:337-41.  Back to cited text no. 13
Firth J. Levels and sources of stress in medical students. Br Med J (Clin Res Ed) 1986;292:1177-80.  Back to cited text no. 14
Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Psychological stress in medical students: A comparison of 2 very different university courses. Stress Med 1997;13:179-84.  Back to cited text no. 15
Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: A five-year prospective longitudinal study. J R Soc Med 1998;91:237-43.  Back to cited text no. 16
Miller PM, Surtees PG. Psychological symptoms and their course in first-year medical students as assessed by the Interval General Health Questionnaire (I-GHQ). Br J Psychiatry 1991;159:199-207.  Back to cited text no. 17
Ashton CH, Kamali F. Personality, lifestyles, alcohol and drug consumption in a sample of British medical students. Med Educ 1995;29:187-92.  Back to cited text no. 18
Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al. Students, stress and coping strategies: A case of Pakistani medical school. Educ Health (Abingdon) 2004;17:346-53.  Back to cited text no. 19
Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6.  Back to cited text no. 20
Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia 2004;59:207-11.  Back to cited text no. 21
Stewart SM, Betson C, Lam TH, Marshall IB, Lee PW, Wong CM. Predicting stress in first year medical students: A longitudinal study. Med Educ 1997;31:163-8.  Back to cited text no. 22
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales, Psychology Foundation. 2nd ed. Sydney, Australia: Sydney Psychology Foundation of Australia; 1995.  Back to cited text no. 23
Endler NS, Parker DA. Coping Inventory for Stressful Situations (CISS): Manual. 2nd ed. Toronto: Multi Health Systems; 1999.  Back to cited text no. 24
Yumba W. Academic Stress: Case of Undergraduates Students; 2008. Available from: http://www.Essays.se/essay/8e3578712pdf. [Last accessed on 2019 Dec 11]  Back to cited text no. 25
Dema K. Sources of Academic Stress: A study on selected Tertiary Institutions in Bhutan, RIM. Am J Public Health Res 2015;5:50-5.  Back to cited text no. 26
Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004;38:482-91.  Back to cited text no. 27
Ko SM, Kua EH, Fones CS. Stress and the undergraduates. Singapore Med J 1999;40:627-30.  Back to cited text no. 28
Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Med J Aust 2004;181:357-60.  Back to cited text no. 29
Barikani A. Stress in medical students. J Med Edu 2008;11:41-4.  Back to cited text no. 30
Waghachavare VB, Dhumale GB, Kadam YR, Gore AD. A study of stress among students of professional colleges from an urban area in India. Clin Basic Res 2013;13:429-36.  Back to cited text no. 31
Al-Dabal BK, Koura MR, Rasheed P, Al-Sowielem L, Makki SM. A comparative study of perceived stress among female medical and non-medical university students in Dammam, Saudi Arabia. Sultan Qaboos Univ Med J 2010;10:231-40.  Back to cited text no. 32
Abu-Ghazaleh SB, Rajab LD, Sonbol HN. Psychological stress among dental students at the University of Jordan. J Dent Educ 2011;75:1107-14.  Back to cited text no. 33
Behere SP, Yadav R, Behere PB. A comparative study of stress among students of medicine, engineering, and nursing. Indian J Psychol Med 2011;33:145-8.  Back to cited text no. 34
[PUBMED]  [Full text]  
Carver CS. You want to measure coping but your protocol's too long: Consider the brief COPE. Int J Behav Med 1997;4:92-100.  Back to cited text no. 35
Wan Salwina WI, Raynuha M, Ainsah O, Idayu BI, Aniza I. Stress and coping styles: The experience of nursing staff working at two public hospitals in Klang Valley, Malaysia. Med Health 2009;4:101-7.  Back to cited text no. 36
Nikmat AW, Mariam M, Ainsah O, Salmi R. Psychological well being, stress and coping style among pre clinical medical students. Res management in state, University Teknol; 2010. Available from: http://eprints.ptar.uitm.edu.my/3218/1/LP_AZLINA_WATI_NIKMAT_10_?24.pdf. [Last accessed on 2013 Nov 30].  Back to cited text no. 37
Salam A, Mahadevan R, Abdul Rahman A, Abdullah N, Abd Harith AA, Shan CP. Stress among first and third year medical students at University Kebangsaan Malaysia. Pak J Med Sci 2015;31:169-73.  Back to cited text no. 38
Pande G, Kute P, Chitriv YU. To Study the Relationship of Dietary Habits and Physical Activity with BMI in Medical Students. Int J Pharm Res 2019;11:1145-7. Available from : https://doi.org/10.31838/ijpr/2019.11.01.201. [Last accessed on 2020 Feb 18].  Back to cited text no. 39
Rathi A, Ransing RS, Mishra KK, Narula N. Quality of Sleep among Medical Students: Relationship with Personality Traits. J Clin Diagn Res 2018;12:VC01-4. Available from: https://doi.org/10.7860/JCDR/2018/24685.12025. [Last accessed on 2020 Feb 18].  Back to cited text no. 40
Sharma P, Fulzele P, Chaudhary M, Gawande M, Patil S, Hande A. Introduction of Key Feature Problem Based Questions in Assessment of Dental Students. Int J Cur Res Rev 2020;12:56-61. Available from: https://doi.org/10.31782/IJCRR.2020.121412. [Last accessed on 2020 Feb 18].  Back to cited text no. 41
Bains SK, John P, Nair D, Acharya S, Shukla S, Acharya N. Aptitude of Medical Research in Undergraduate Students of a Medical University - Miles to Go before We Sow. J Clin Diagn Res 2017;11:JC07-11. Available from: https://doi.org/10.7860/JCDR/2017/29318.10972. [Last accessed on 2020 Feb 18].  Back to cited text no. 42
Chhabra KG, Sharma A, Chhabra C, Reddy JJ, Deolia SG, Mittal Y. Knowledge, Attitude, and Practices Regarding Pharmacovigilance and Adverse Drug Reaction Reporting among Dental Students in a Teaching Hospital, Jodhpur, India: A Cross-Sectional Study. Contemp Dent Pract 2017;18:964-9. Available from: https://doi.org/10.5005/jp-journals-10024-2157. [Last accessed on 2020 Feb 18].  Back to cited text no. 43
Gaidhane S, Khatib N, Zahiruddin QS, Gaidhane A, Telrandhe S, Godhiwal P. Depression, Anxiety and Stress among the General Population in the Time of COVID-19 Lockdown: A Cross-Sectional Study Protocol. Int J Res Pharm Sci 2020;11:360-4. Available from: https://doi.org/10.26452/ijrps.v11iSPL1.2726. [Last accessed on 2020 Feb 18].  Back to cited text no. 44
Giri D, Wairagade S, Desai P, Agrawal A, Jha RK. Relation between Prakriti and Stress Handling Capacity: An Observational Study. Int J Cur Res Rev 2020;12:103-9. Available from: https://doi.org/10.31782/IJCRR.2020.121512. [Last accessed on 2020 Feb 18].  Back to cited text no. 45
Ghogare AS, Patil PS. A Cross-Sectional Study of Co-Morbid Generalized Anxiety Disorder and Major Depressive Disorder in Patients with Tension-Type Headache Attending Tertiary Health Care Centre in Central Rural India. Niger Postgrad Med J 2020;27:224-9. Available from: https://doi.org/10.4103/npmj.npmj_23_20. [Last accessed on 2020 Feb 18].  Back to cited text no. 46


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Tables

 Article Access Statistics
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal