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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 16-20

Prevalence of depression, anxiety, and stress among medical students of one private medical college


General Practitioner, Primary Health Care Center, Wadi al-Tayeen, Oman

Date of Submission18-Dec-2020
Date of Decision01-Mar-2021
Date of Acceptance03-Mar-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Shaik Riyaz Ameer
General Practitioner, Primary Health Care Center, Wadi al-Tayeen
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_31_20

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  Abstract 


Background: Data show that the prevalence of depression, anxiety, and stress is more among medical students compared to general population and thus proving that the community of the medical students is a vulnerable group or high-risk group, where we need to take adequate measures to counter this issue among this particular community.
Objective: The objective of the study was to study the prevalence of depression, anxiety, and stress among one of the private Medical college students.
Materials and Methods: An institution-based cross-sectional study was conducted in a private medical college among 450 medical students of 1st, 2nd, 3rd, and 4th year and interns and postgraduate (PG) students for 6 months. “Depression Anxiety Stress Scale 21” which was already validated and standardized was used for the present study. “The internal consistency, i.e., Cronbach's alpha value was 0.87 that was suggestive of high reliability.” Data collection was done in batches for undergraduates and for interns and PGs, whenever they were free and available. Anonymity was maintained.
Results: Prevalence of depression, anxiety, and stress among medical students was 58.2%, 68.7%, and 35.3%, respectively. The most common was moderate grade of depression (30.7%), severe anxiety (39.6%), and moderate stress (15.8%). After testing for associated factors with depression, anxiety, and stress, it was fond that only belonging to joint family type and being undergraduate were found to be significantly associated with high levels of stress (P < 0.05).
Conclusion: Prevalence of depression, anxiety, and stress among medical students was very high in this medical college. These results cannot be generalized to other medical students of other medical colleges but definitely reflect that medical students are depressed, anxious, and stressed.

Keywords: Anxiety, association, depression, prevalence, stress, variables


How to cite this article:
Ameer SR. Prevalence of depression, anxiety, and stress among medical students of one private medical college. MRIMS J Health Sci 2021;9:16-20

How to cite this URL:
Ameer SR. Prevalence of depression, anxiety, and stress among medical students of one private medical college. MRIMS J Health Sci [serial online] 2021 [cited 2021 Jun 20];9:16-20. Available from: http://www.mrimsjournal.com/text.asp?2021/9/1/16/312604




  Introduction Top


Medical education is vast and challenging. This puts heavy burden on the medical students. The long college hours, compulsion of attendance, heavy competition to secure good marks, and vast syllabus keep them busy and are thus demanding heavily. This stretches their psychological distress and thus they become vulnerable to depression, anxiety, and stress. Thus, compared to other systems of education, medical education is now known to put heavy burden on the students.[1] Studies are documenting that there is an increase in the incidence of anxiety, depression, and stress among medical students. Mental health of medical students is getting affected negatively as the course duration is very long.[2],[3]

Examination burden and challenge to pass or score brilliant marks in the exams in addition to economic burden due to medical education puts a lot of stress on the medical students. Other factors also contribute to this stress like nature of the curriculum, the patients (how the patients undergo trauma; how they develop complication while on treatment, etc.) they see and ethical dilemmas, etc., Sometimes lack of support from family and friends adds to these issues. Medical students are prone to insomnia, diet irregularities, and they fall prey to substance abuse, addictions, etc., due to overload of the work.[4]

It has been found from all over the world the prevalence of stress was about 25%–90%. Stress is an important risk factor for anxiety and depression.[5],[6] A systematic review was carried out to study the prevalence of stress and suicidal ideation which included data of 183 eligible studies and these data were from 43 countries. This review found that 27.2% (95% confidence interval = 24.7%–29.9%) of medical students were stressed. The prevalence of suicidal ideation was 11.1%.[7] However, a large population survey from Southern India found that the prevalence of depression was about 15.9% in the general population.[8] These data show that the prevalence of depression, anxiety, and stress is more among medical students compared to general population and thus proving that the community of the medical students is a vulnerable group or high-risk group, where we need to take adequate measures to counter this issue among this particular community.

More and more data are thus required to study the prevalence of depression, anxiety, and stress among the medical students and try to find out the associated risk factors to plan preventive and promotive health strategies, especially for the medical students.

Hence, the present study was carried out to study the prevalence of depression, anxiety, and stress among one of the private medical students in Hyderabad, Telangana, India.


  Materials and Methods Top


Study design

It is an Institution-based cross-sectional study conducted in a private medical College.

Study population

Medical students from 1st, 2nd, 3rd, and 4th year and interns and postgraduate (PG) students of one private medical college were included in the study.

Study period

The study period was 6 months from August 2019 to January 2020.

Sample size

All students available on the days of the data collection were included, and thus we could include 450 students from 1st, 2nd, 3rd, and 4th year, interns, and PG students of one private medical college.

Sampling technique

The one private medical college was chosen to be included in the present study conveniently, and convenient sampling technique (Judgmental or Purposive sampling) was used for selection of the medical students as the time was not sufficient to complete the study. We tried to reduce the effect of selection bias by taking large sample of 450 students.

Inclusion criteria

Students freely willing to take part in the study after being informed that the study is anonymous.

Exclusion criteria

  1. Students who did not gave consent
  2. Student who were absent during the day of data collection.


Ethical issues

Ethical clearance was obtained from the Institution Ethics Committee. Informed consent was taken from all students. Anonymity of the data was maintained.

Study tool

“Depression Anxiety Stress Scale (DASS 21)” which was already validated and standardized was used for the present study. “The internal consistency, i.e., Cronbach's alpha value was 0.87 that was suggestive of high reliability.”[9],[10]

“DASS (21 item) is a short scale that allows the simultaneous assessment of the three emotional states of depression, anxiety, and stress and each domain contains seven items, divided into subscales with similar content. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, and lack of interest/involvement, anhedonia, and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The stress scale is sensitive to levels of chronic nonspecific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive, and impatient.”[9],[10]

Data collection

Anonymous self-reporting questionnaire was administered to all 450 willing students. One batch on one single day was contacted, and all present undergraduate students were given the study questionnaire. Same procedure was repeated for all batches. For PG students and interns, the data were collected whenever they were on duty and were able to spare time for the present study. Voluntary participation was planned, and written informed consent was taken from all participants. English language was used for the present study questionnaire as all students were comfortable with the English language.

Statistical analysis

Open Epi (Open Source Epidemiologic Statistics for Public Health version 3.01) statistical software was used for data analysis. To study the association, Yates corrected Chi-square test was applied, and a two-tailed P value was used for significance. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] shows prevalence of depression among medical students. Prevalence of depression among medical students was 58.2%. The most common was moderate grade of depression seen in 30.7% of the medical students.
Table 1: Prevalence of depression among medical students

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[Table 2] shows the association of various factors with depression among medical students. Various factors such as gender, student category, religion, family type, addictions, and residence were studied but were not found to be significantly associated with depression.
Table 2: Association of various factors with depression among medical students

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[Table 3] shows the prevalence of anxiety among medical students. The prevalence of anxiety among medical students was 68.7%. Severe anxiety was the most common grade of anxiety seen among 39.6% of the medical students.
Table 3: Prevalence of anxiety among medical students

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[Table 4] shows the association of various factors with anxiety among medical students. Various factors such as gender, student category, religion, family type, addictions, and residence were studied but were not found to be significantly associated with anxiety.
Table 4: Association of various factors with anxiety among medical students

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[Table 5] shows the prevalence of stress among medical students. The prevalence of stress among the medical students was found out to be 35.3%. The most common grade of stress was moderate stress among 15.8% of the medical students.
Table 5: Prevalence of stress among medical students

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[Table 6] shows the association of various factors with stress among medical students. Among the variables studied such as gender, student category, religion, family type, addictions, and residence; only belonging to joint family type and being undergraduate was found to be significantly associated with high levels of stress.
Table 6: Association of various factors with stress among medical students

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  Discussion Top


Prevalence of depression, anxiety, and stress among medical students was 58.2%, 68.7%, and 35.3%, respectively. The most common was moderate grade of depression (30.7%); severe anxiety (39.6%), and moderate stress (15.8%). After testing for associated factors with depression, anxiety, and stress, it was found that only belonging to joint family type and being undergraduate were found to be significantly associated with high levels of stress (P < 0.05).

Sarkar et al.[11] noted from their systematic review that the prevalence of depression was 39.2% which is lower than the present study and that of anxiety was 34.5% which is also lower than the present study and that for stress was 51.3% which is higher than the present study.

Reang and Bhattacharjya.[12] assessed emotional disorders among medical students and found that the prevalence of stress was very high, i.e., 94.52% which is very high compared to the 35.3% documented from the present study. They noted that constant strained feeling was present in 33.56% of the students.

Velayudhan et al.[13] studied the effect of behavioral intervention on the depression and anxiety among medical students and observed that it significantly reduced the anxiety and depression among them. In the present study, we did not carry out this aspect.

Harsha Kumar et al.[14] carried out a study on depression and associated factors among undergraduate medical students. They found that the prevalence of depression was 19.74% which is very low compared to the present study (58.2%). They noted that mild depression was more common in 46.2% of the students, while we observed that moderate depression was more common in 30.7% of the students. They noted that factors such as addictions, pressure from the peer, and academic stress were significantly associated with depression, while we found that these factors were not significantly associated with the depression. The variation in two studies may be due to sample size, sampling technique, and the study tool used. Most importantly, these questionnaires are subjective in nature and subjective bias is most common in such studies.

Kumar et al.[15] used the Beck Depression Inventory to find the prevalence of depression among medical students and they observed that the prevalence of depression was 71.25% which is very high compared to the present study of 58.2%. This difference may be due to difference in the study tool used as we used DAS 21 scale to assess the depression among the medical students. They noted that 80% had mild depression which is again high compared to the present study where we noted that the only 18.4% had mild depression. They found that the year of study and the grade of depression were significantly associated. We did not find this association.

Eva et al.[16] studied the prevalence of stress among medical students and found that 54% of them had stress. Whereas we found that only 35.3% of the medical students had stress.

Sidana et al.[17] used PHQ-9 tool to assess the depression among medical students and found that the prevalence of depression was 21.5% which is very low compared to 58.2% found in the present study. This difference is clearly due to difference in the study tool used, as we used DAS-21 scale to assess the prevalence of depression among the medical students.


  Conclusion Top


Prevalence of depression, anxiety, and stress among medical students was very high in this medical college. These results cannot be generalized to other medical students of other medical colleges but definitely reflect that medical students are depressed, anxious, and stressed. The variables studied were not found to be significantly associated with depression and anxiety and stress except being undergraduate and belonging to joint family which were significantly associated with stress only.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian population – The Chennai urban rural epidemiology study (CURES-70). PLoS One 2009;4:e7185.  Back to cited text no. 8
    
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Lovibond SH, Lovibond PF. Manual for the Depression Anxiety and Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.  Back to cited text no. 9
    
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Crawford JR, Henry JD. The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. Br J Clin Psychol 2003;42:111-31.  Back to cited text no. 10
    
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Sarkar S, Gupta R, Menon V. A systematic review of depression, anxiety, and stress among medical students in India. J Mental Health Hum Behav 2017;22:88-96.  Back to cited text no. 11
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Reang T, Bhattacharjya H. A study to assess the emotional disorders with special reference to stress of medical students of Agartala Government Medical College and Govinda Ballabh Pant Hospital. Indian J Community Med 2013;38:207-11.  Back to cited text no. 12
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Velayudhan A, Gayatridevi S, Bhattacharjee RR. Efficacy of behavioral intervention in reducing anxiety and depression among medical students. Ind Psychiatry J 2010;19:41-6.  Back to cited text no. 13
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Harsha Kumar HN, Malipatil V, Supriya H. A study on depression & its determinants among undergraduate medical students from coastal south India. Indian J Public Health Res Dev 2015;6:188-92.  Back to cited text no. 14
    
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Kumar GS, Jain A, Hegde S. Prevalence of depression and its associated factors using beck depression inventory among students of a medical college in Karnataka. Indian J Psychiatry 2012;54:223-6.  Back to cited text no. 15
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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. 16
    
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Sidana S, Kishore J, Ghosh V, Gulati D, Jiloha R, Anand T. Prevalence of depression in students of a medical college in New Delhi: A cross-sectional study. Australas Med J 2012;5:247-50.  Back to cited text no. 17
    



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



 

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