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 Table of Contents  
Year : 2017  |  Volume : 61  |  Issue : 1  |  Page : 55-57  

Perceived psychological stress among undergraduate medical students: Role of academic factors

1 Independent Researcher, Department of Community Medicine, North Bengal Medical College, Kolkata, West Bengal, India
2 Assistant Professor, Department of Community Medicine, North Bengal Medical College, Kolkata, West Bengal, India
3 Assistant Professor, Department of Community Medicine, Burdwan Medical College, Kolkata, West Bengal, India
4 Associate Professor, Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India
5 Professor and Head, Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication16-Feb-2017

Correspondence Address:
Ranadip Chowdhury
CHRD-SAS, 45, Kalu Sarai, New Delhi - 110 016
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-557X.200253

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Recently, there is a growing concern about stress during undergraduate medical training. The objectives of our study were to assess perceived stress among undergraduate medical students and to find out academic factors as determinants. A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of R. G. Kar Medical College, India, during July 2011–June 2012. Perceived stress was assessed using the Perceived Stress Scale-14. A 10-item questionnaire was used to assess academic sources of stress and their severity. The overall mean perceived stress score was 29.58 (standard deviation [SD] = 6.60), and 46.3% of the participants were in the group of more stressed (perceived stress score ≥28). The academic stressor factors predicted 78% of variability of perceived stress. A higher level of perceived stress was reported by the students. The students should be taught different stress management techniques to improve their ability to cope with a demanding professional course.

Keywords: Academic stressors, perceived stress, undergraduate medical students

How to cite this article:
Chowdhury R, Mukherjee A, Mitra K, Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health 2017;61:55-7

How to cite this URL:
Chowdhury R, Mukherjee A, Mitra K, Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health [serial online] 2017 [cited 2023 Apr 1];61:55-7. Available from:

Stress has been defined as the extent to which persons perceive their demands exceed their ability to cope. Stress has been identified as an important indicator of the students' overall health as it has been consistently associated with mental and physical health effects.[1] Studies from developing countries in Southeast Asia have reported stress among medical students.[2],[3],[4] However, none of the studies used the Perceived Stress Scale (PSS). The PSS, an objective assessment tool, measures the degree to which situations in one's life are appraised as stressful.[5] An objective assessment of the perceived stress among medical undergraduates using the PSS and determination of the academic stressors will provide a baseline for comparing educational interventions in future.

A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of R. G. Kar Medical College, India, during July 2011–June 2012. Assuming prevalence of stress among undergraduate medical students to be 29.75%,[6] with 95% confidence limit, 10% relative precision, and 10% nonresponse rate, the sample size was calculated to be 480 applying finite population correction. An equal number of students (96) from each year were included in the study by simple random sampling. Anonymity of the responses was ensured. At the end, the students were requested to put the completed study tool into a drop box.

“Perceived stress” was measured using the PSS-14 which comprised 14 questions with responses varying from 0 to 4 for each item on the basis of their occurrence during 1 month before the survey.[5] The PSS has an internal consistency of 0.85 (Cronbach's α coefficient) and test-retest reliability during a short retest interval (several days) of 0.85.[5] The PSS-14 has a possible range of scores from 0 to 56; 28 was taken as the operational cutoff value.[7] The students with perceived stress score ≥28 were labeled as more stressed and students with perceived stress score <28 were labeled as less stressed. A questionnaire was designed incorporating the sociodemographic variables and potential academic stressors. For each potential stressor, the frequency of occurrence was classified as never, rarely, sometimes, often, and always. The severity of each stressor was rated using a Likert scale (1–10) ranging from not severe to very severe.

The data were analyzed using Statistical Package for Social Sciences (SPSS) 16.0 for Windows (SPSS, Inc., Chicago, IL, USA). The mean scores of perceived stress were calculated year-wise. Median and interquartile range were calculated for severity of stressors, and Kruskal-Wallis test was applied to assess differences across the years. Multiple logistic regression was done to calculate odds ratio (95% confidence interval [CI]) of the potential academic stressors. The area under the receiver operating characteristics (ROC) curve was calculated to assess the predictability of the model.

A total of 480 students were approached for participation in the study. A total of 460 students (95.83%) completely filled the questionnaires and they were included in the analysis. The mean age of the students was 20.95 (SD = 1.97) years. More than two-third (68.04%) of the participants were male. Overall, the majority (96.09%) of the students were Hindu.

The overall mean perceived stress score was 29.58 (SD = 6.60), and 46.3% (95% CI: 36%–56%) of the participants were in the group of more stressed. The mean score of perceived stress was highest in the 1st year and lowest in the 3rd year.

“Vastness of academic curriculum/syllabus” was rated the most severe academic stressor by the participants, followed by “frequent examinations.” “Dissatisfaction with the class lectures,” “worry about future,” “frequent examinations,” “becoming a doctor (expectations on all fronts),” and “lack of time for recreations” were different in severity across years [Table 1].
Table 1: Median and interquartile range of severity of potential academic stressors among students of all

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“Dissatisfaction with the class lectures” (adjusted odds ratio [aOR]: 2.04; 95% CI: 1.32–3.16), “vastness of academic curriculum/syllabus” (aOR: 1.9, 95% CI: 1.08–3.35), “worry about future” (aOR: 3.09; 95% CI: 2.00–4.76), “lack of special guidance from faculty”(aOR: 1.98; 95% CI: 1.24–3.16), and “competition with peers” (aOR: 2.25;95% CI: 1.33–3.81) were found to be statistically significant factors in more stressed students [Table 2].
Table 2: Determinants of academic stressors in more stressed cases by logistic regression

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The predictive probabilities generated through the logistic regression model were used to create a ROC model. The ROC showed 78% (represented by the area under curve) predictability of the multivariate logistic model for more stressed students for academic stressors [Figure 1].
Figure 1: Receiver operating characteristics curve showing predictive ability of academic stressor. Hosmer-Lemeshow goodness-of-fit statistics, P = 0.763.

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Our study showed a high level of perceived stress among undergraduate medical students. A study from Pakistan reported that more than 90% students experienced stress at 1 time or the other during their course.[4] A study from India reported 73% of the students had stress at some point during their medical schooling.[2] 61.4% of students in a Thai Medical School had come across some degree of stress calculated by the Thai Stress Test.[3]

Similar to the findings of our study, 1st-year medical students of developed countries also showed more stress.[8]

Our study showed most students had experienced academic stressors. Among academic stressors, “frequent examinations” and vastness of academic curriculum/syllabus were the chief sources of stress. Despite this, frequent examinations are important in the medical training as a standard for evaluation/assessment. Furthermore, examinations encourage students' learning and also provide feedback to the teachers. The previous study had also reported that academics/examinations were common sources of stress among medical students.[9] The absence of graded marks at medical school in Sweden actually served as a buffer for study stress as it reduced competition and enhanced peer support. Social support is a well-known moderator of stress according to the demand-control model, especially so for women. There may be a need to revisit the evaluation/examination system to make it less stressful to the students. An overloaded curriculum and quality of teaching methods were the causes of stress in the present study, which was almost similar to the findings of the study by Al-Dabal et al.[10]

There is need to address these stressors by student advisors, peer education, and counseling. The students should be taught different stress management techniques to improve their ability to cope with a demanding professional course. There is also need to bring about changes in the quality of teaching and evaluation system.

Since the information was collected on self-administered questionnaires, there remains the possibility of information bias. The cross-sectional design of the study precludes evaluation of temporal associations. Prospective studies are necessary to study the associations between occurrence of stressors and incidence of stress. Finally, there might be other potential academic stressor factors which were not included in the questionnaire.


We would like to thank students of R. G. Kar Medical College, Kolkata, who participated in this study for their valuable time given for completing the questionnaires.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Aldwin CM, Revenson TA. Does coping help? A reexamination of the relation between coping and mental health. J Pers Soc Psychol 1987;53:337-48.  Back to cited text no. 1
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. 2
Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6.  Back to cited text no. 3
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. 4
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 5
Sayed MM, Mishra BN. Are future doctors low on mental health and self esteem: A cross-sectional study from rural health university. Indian J Prev Soc Med 2009;40:189-93.  Back to cited text no. 6
Amr M, Hady El Gilany A, El-Hawary A. Does gender predict medical students' stress in mansoura, egypt? Med Educ Online 2008;13:12.  Back to cited text no. 7
Coburn D, Jovaisas AV. Perceived sources of stress among first-year medical students. J Med Educ 1975;50:589-95.  Back to cited text no. 8
Ko SM, Kua EH, Fones CS. Stress and the undergraduates. Singapore Med J 1999;40:627-30.  Back to cited text no. 9
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. 10


  [Figure 1]

  [Table 1], [Table 2]

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