Introduction
As per the World Health Organisation mental health is an important aspect of our health. A person is diagnosed as having depression is he/she reports of low mood, decreased interest in pleasurable activities, disturbed sleep, agitation, fatigability, feelings of guilt, disturbed appetite and decreased concentration.1, 2 As per the American Psychological Association, anxiety and stress can be characterised by worrying thoughts, tension and physical changes. Where stress can be related to irritability and impatience and anxiety is related to situations, autonomic and muscular tensions.3, 4
Medical education at undergraduate level is quite hectic and strenuous. It’s a long duration curriculum of study and training lasting 5-6 years. The study is very dynamic owing to the evolving objectives and expanding knowledge. During this course of time period the students are required to obtain a good level of theoretical knowledge, skills, professional know how and a good attitude to able to deal with the highly competitive and professional life of being a doctor independently. The rigorous demands of medical education along with the training and learning can lead adverse effects on the mental and physical health of students. Significant psychological pressure and stress can be caused on medical undergraduate students as a result of the medical education. 5 Psychological comorbidity of a significant and considerable level has been reported amongst medical students with a range from interpersonal problems, stress and suicidal ideas to psychiatric disorders. Also in comparison with the general population the medical students seem to have higher levels of psychological distress.6
Medical education is challenging with lots to study and lots to learn along with acquiring the proficiency in attaining new skills to be a future doctor. Thus this study aims to know the levels of stress, anxiety and depression amongst the undergraduate 1st year medical students of Gian Sagar Medical College.
This study aims to find the level of stress, anxiety and depression amongst 1st year MBBS students in a medical college.
Materials and Methods
It is a cross sectional study that was conducted over a 1 month period. The sample size consisted of 150 undergraduate MBBS 1st year students studying at Gian Sagar Medical College and Hospital. After taking approval from the institutional ethical committee, informed consent from participants was obtained for further assessment. 1st year MBBS students from 18-23 year age group were included in the study. After taking consent students were given a semi structured performa to fill which included socio-demographic profile such as age, gender, residence, substance use and any past psychiatric illness history.
The second performa was the Depression, Anxiety and Stress Scale (DASS-42). This scale has 42 questions to assess the stress, anxiety and depression. This is a self-reporting instrument. DASS-42 has three components that are used to measure depression, anxiety and stress independently. Each one of items measures the frequency of symptoms in the past week on a 4-point scale, with a score of 0, 1, 2, and 3.
Scores can be determined by adding scores acquired for all of the relevant items. Based on summative scores, depression can be categorised as normal (0–9), mild (10–13), moderate (14–20), severe (21–27), and extreme (28+). Similarly, anxiety can be categorised as normal (0–7), mild (8–9), moderate (10–14), severe (15–19), and extreme (20+). Similarly stress can be categorised as normal (0-14), mild (15-18), moderate (19-25), severe (26-33) and extremely severe (34+). The cut-off scores from the results collected for anxiety stress and depression were evaluated using DASS scale that have been previously validated (7).
The data was compiled systematically and then subjected to statistical analysis. All the Data Analysis was done using SPSS (Statistical Package for the Social Sciences) version 23.0 IBM.
Results
Table 1
Socio-demographic profile of respondents (n = 150)
Total of 150 first year undergraduate MBBS students studying in a medical college participated in this study. The students were provided with the DASS 42 scale and a semi structured questionnaire, the results of the socio demographic profile of the participants is shown in Table 1 . The majority of the participants in the study were females (57.3%). Most of the participants involved were of the age group between 18-20 years (89.3%) and all of them were unmarried (100%). All of the participants were residing in the hostel (100%). Majority of the participants had never used any substance (98.7%) with a few reporting any substance use (1.3%). Out of the 150, 8% reported having history of any prior psychiatric illness whereas 92 % had no prior history of psychiatric illness. Family history of psychiatric illness was reported only in 10% with 90 % reporting as having none. Out of the 150, 50% reported intermediate social support, 42.7% reported good social support and 7.3% reported low social support. Majority reported to having stress (86.7%).
Table 2
Prevalence of Stress, Anxiety and Depression in students (n=150)
The prevalence of stress, anxiety and depression in the undergraduate students is shown in Table 2. On the DASS 42 scale, prevalence of depression was reported to be 56% with the percentage of it being 16.7% mild, 16.7% moderate, 11.3% severe and 11.3% extremely severe. The prevalence of anxiety was 68.7% with percentage being 6% mild, 28.7% moderate, 18.7% severe and 15.3% extremely severe. The prevalence of stress was reported in 61.3% with 14.7% being mild, 23.3% moderate, 15.3% severe and 8% extremely severe.
Table 3
Causes of stress
Table 3 shows the reason and causes of stress amongst the students. While 13.3% had reported no stress, majority 72.7% had reported academics as the only reason of stress and 0.7% as only familial reason. Academics and familial combined were reported by 2%, academics and personal by 8.7% and all three academics, familial and personal by 2.7%. No responses were present for only personal or for familial and personal.
Table 4
Demonstrates single vs multi responses given by students
|
Responses |
Single Response |
130 |
86.7% |
|
|
Multi Responses |
20 |
13.3% |
Table 4 shows that majority (86.7%) had single reason responses as compared to multi reasons responses (13.3).
Discussion
Our study of the undergraduate students showed the prevalence of depression, anxiety and stress to be 56%, 68.7% and 61.3% respectively. These findings were similar to the ones conducted by Irfa Naqshbandi et al. where the prevalence was found to be 40%, 50% and 37.5% for depression, anxiety and stress respectively. 7, 8 Similarly a study conducted on medical students by Iqbal S et al. revealed prevalence of depression, anxiety and stress to be 51.3%, 66.9% and 53% respectively. 9 Similarly in a study done by Taneja N et al. it was seen that 60 (32.0%), 75 (40.1%), and 82 (43.8%) students were affected by depression, anxiety, and stress, respectively. 10 Another study conducted by Dr Subhrajyoti Naskar et al. showed prevalence of depression, anxiety and stress in medical students to be 57.15%, 64% and 62.86%. 11
Stress amongst students may restrict their professional progress and development. 12, 13 It can cause a detrimental effect on their academic performance and growth, this effect has increased during the pandemic. 14 It can further affect the patient care and safety. Most of the studies done on medical undergraduates suggest that they are affected by depression anxiety and stress. 15, 16 There is a need to handle their stress and counsel them regarding the associated factors that may lead to stress in the life of a medical student.
The findings of this study have to be seen in light of some limitations. A larger study sample could be taken to see the prevalence of depression, anxiety and stress in undergraduate medical students. There is a lot of scope and a need to look into the mental health of medical students. A multi centric study can be conducted to assess the depression, anxiety and stress faced by the medical students in different regions. Further a study can be conducted amongst different professional study undergraduate students to foresee the difficulties they face and to assess their mental health issues.
We can conclude that further detailed studies need to be taken up in medical colleges to assess and determine the reasons, risk factors and conditions that can lead to depression, anxiety and stress in medical students.
