Innovative Journal of Medical Health Science

IJMHS 9 (8), 578–588 (2019) ISSN (O) 2277:4939 | (P) 2589:9341

“SAD”- A medical undergraduate centered cross-sectional study from

a teaching tertiary medical institution in North east India

Ms. Yashika Parashar1, Dr. Sharat Agarwal2*, Dr. Manika Agarwal3

1
MBBS Student, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences
(NEIGRIHMS), Shillong (India)
2
Associate Professor (Orthopaedics & Trauma), North Eastern Indira Gandhi Regional Institute of
Health & Medical Sciences (NEIGRIHMS), Shillong (India)
3
Associate Professor (Obstetrics & Gynaecology), North Eastern Indira Gandhi Regional Institute of
Health & Medical Sciences (NEIGRIHMS), Shillong (India)

Reviewed By: Dr. ABSTRACT

Background- Stress, Anxiety and Depression disorders are common problems
Daniel V.
among the youth today especially among the students of professional courses.[1] Our
Department: Medical study aims to find the levels of stress, anxiety and depression among medical
students, their probable causes and suggest certain measures to control them.
Undergraduate medical education in India comprises strenuous study and training for
5.5 years. It has been reported that medical students consequently suffer from
depression, anxiety, and stress. It has been reported that healthy students develop
depression and stress after commencing their medical education. [2] The competition
for getting postgraduate training and seeking job opportunities could be an additional
trigger for psychological illness. It has also been reported that physicians tend to
have a higher suicide rate than the general population. [3]
Aim- Our study was aimed at finding stress, anxiety and depression levels amongst
MBBS students of North East India.
Methods- A total of 120 questionnaires were distributed among the MBBS Students
of different academic years out of which 108 responses were received out of which
100 were completed questionnaires and were included for the study. The remaining
20 questionnaires were either not returned or were incomplete, hence were excluded
from the study. Results-Among the mental health problems that were assessed,
anxiety disorders are the most common. Following anxiety, students are affected the
most by depression while stress disorders are the least common. Most of the students
felt that they were under academic stress and it can possibly be one of the major
reasons for anxiety and stress among them. Interestingly, it was found that the
participants felt that gender doesn’t play an important role in causing stress but the
stress, anxiety and depression levels were found to be higher or equal among the
females than the males.The students feel that drug intake and peer pressure was not
the cause for adding on to their mental stress. However, the increased usage of
internet and time spent on social media can be correlated to the increasing problems
among the students as was found in our study.
Conclusion-There is an urgent need to tackle the problem of increasing mental
⋆Corresponding author. health problems among medical students as emphasised through this study conducted
†Email: in a tertiary care level medical institute in the North Eastern part of India.
[email protected] Key words- MBBS students, Northeast India, Stress, Anxiety, Depression
.
579 Dr. Sharat Agarwal et al.

INTRODUCTION: Material & Methods:

Stress, Anxiety and Depression disorders are It is a descriptive cross sectional study which
common problems among the youth today was conducted among the medical students of
especially among the students of professional NEIGRIHMS, India from May 2018 to June
courses.[1] Our study aims to find the levels of 2018 in NEIGRIHMS, Shillong after getting
stress, anxiety and depression among medical clearance from the Institution Ethics Committee
students, their probable causes and suggest (vide no. NEIGR/IEC/M2/F13//17, DATED
certain measures to control them. As per World 22ND SEPTEMBER 2017).
Health Organization „Health is a state of Informed written Consent was obtained from all
complete physical, mental and social well-being the participants of the study. The study tool
and not merely the absence of disease or used was DASS 21 Questionnaire prepared by
infirmity‟. [2] Mental health is therefore an Psychology Foundation of Australia.
important part of it. Depression is more than The DASS-21 questionnaire categorizes
just sadness.[3] People with depression may stress, anxiety and depression into five
experience a lack of interest and pleasure in subcategories, namely, normal, mild, moderate,
daily activities, significant weight loss or gain, severe, and extremely severe. The questionnaire
insomnia or excessive sleeping, lack of energy, has 7 questions on each of the following
inability to concentrate, feelings of conditions stress, anxiety and depression. 6
worthlessness or excessive guilt and recurrent questions were added to identify possible
thoughts of death or suicide as per “The correlates to peer pressure, academic stress,
American Psychological Association”.[3] A number of hours spent on social media, drug
person could be termed depressed if he/she abuse, gender, and any other cause for stress,
shows a variable combination of low mood; loss anxiety and depression.
of interest or pleasure; feelings of guilt; low Name and details of the participants were not
self-esteem; disturbed appetite; disturbed sleep; taken on the questionnaire. However
or disturbed concentration.[4] demographic details (name, age, sex, address,
Undergraduate medical education in India year of admission in MBBS) were collected on
comprises strenuous study and training for 5.5 the Consent Form.
years. The curricular objectives are dynamic Questionnaires were distributed to the
due to expanding knowledge and evolving participants and they were requested to fill them
therapies. During this period, medical students up as per their convenience. The questionnaires
should acquire adequate professional were collected from the participants later. The
knowledge, skill, and attitudes in order to collected data was tabulated and analysed using
prepare themselves to deal with life-long Microsoft Excel software.
professional challenges independently. Observations and Results:
However, the demands of the learning and A total of 120 questionnaires were distributed
training might adversely affect the student‟s among the MBBS Students of different
physical and mental health. academic years. 108 questionnaires were
It has been reported that medical students returned out of which 100 were completed
consequently suffer from depression, anxiety, questionnaires that were included in the study
and stress. It has been reported that healthy for analysis. The remaining 20 questionnaires
students develop depression and stress after were either not returned or were incomplete,
commencing their medical education. [5] hence were excluded from the study. There was
proportionate representation of all the batches.

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

 “SAD”- A medical undergraduate centered cross-sectional study from a teaching tertiary medical
institution in North east India 580

Among the participants, there were 50 Males NEIGRIHMS, Shillong for more than 6 months.
and 50 Females. All the 100 participants were They were residing in NEIGRIHMS hostel for
Indians and were studying MBBS in more than 6 months.

Table 1: Stress level among MBBS students based on DASS 21

Overall Male Female Among all students

Stress NumberPercentage Number Percentage Number Percentage
normal 33 66 25 50 58 58
mild 8 16 14 28 22 22
moderate 5 10 8 16 13 13
severe 3 6 2 4 5 5
extremely 1 2 1 2 2 2

Total 50 100 50 100 100 100

severe

Score
Among the participants, 50(50%) were males faced mild to extremely severe stress. 14 (28%)
and 50(50%) were females. Among the male girls faced mild stress whereas 8(16%) faced
students, 33 (66%) of them were normal. 17 moderate stress. Overall, 58 students were
(34%) were stressed amongst which 3(6%) normal, 22 students faced mild stress and 13
and1(2%) were under severe and extremely students were under moderate stress. 5 students
severe stress respectively. Among the female were under severe stress and 2 faced
extremely severe stress. 42% students were
students, 25(50%) were normal but 25 (50%)
under some stress.

Graph 1: Stress level among MBBS students based on DASS 21 Score

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

581 Dr. Sharat Agarwal et al.

Table 2: Anxiety level among MBBS students based on DASS 21 Score

Overall Male Female Among all students
Anxiety N umber Percentage Number Percentage Number Percentage
normal 19 38 19 38 38 38
mild 5 10 3 6 8 8
moderate 15 30 14 28 29 29
severe 5 10 5 10 10 10
extremely 6 12 9 18 15 15

severe
Total 50 100 50 100 100 100

Among the participants, 50(50%) were males and 28% faced moderate anxiety issues. 28%
and 50(50%) were females. 19 (38%) males did females faced severe to extremely severe
not have anxiety issues. 5(10%) of them faced anxiety problems. Overall, 62% students were
mild anxiety issues while 15 (30%) faced facing mild to extremely severe anxiety
moderate anxiety issues. 11 students faced problems and only 38% were normal.
severe to extremely severe anxiety problems.
Among the females, 38% were normal while
6% faced mild anxiety issues

Graph 2: Anxiety level among MBBS students based on DASS 21 Score

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

 “SAD”- A medical undergraduate centered cross-sectional study from a teaching tertiary medical
institution in North east India 582

Table 3: Depression level among MBBS students based on DASS 21

Overall Male Female Among all students

Depressio Number Percentage Number Percentage Number Percentag e

normal 25 50 22 44 47 47
n
mild 10 20 10 20 20 20
moderate 11 22 12 24 23 23
severe 1 2 2 4 3 3
extremely 3 6 4 8 7 7

Total 50 100 50 100 100 100

severe

Score of depression. 12 (24%) were under

moderate depression while 8% were under
Among the participants, 50(50%) were males
extremely severe depression. Overall 47%
and 50(50%) were females. 25 (50%) male
students were normal, 10 (20%) were under mild students were normal while 53% were under
depression. 22% were under moderate mild to moderate depression.
depression however 6% were under severe Based on the DASS 21 Scores, overall levels of
depression. Among the females, 44% were stress, anxiety and depression among the
normal whereas 56% were under some sorts students were 42%, 62%, 53% respectively.

Graph 3: Depression level among MBBS students based on DASS 21 Score

For Questions A, B, D, E The chi-square statistic is 84.058. The p-value is < 0.00001

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

583 Dr. Sharat Agarwal et al.

Table 4: Do you feel you are under peer pressure? (Question A)

Question A
Yes 19
No 79
Don’t Know 2
19% students feel that they are under peer pressure while 79% don‟t feel that. 2% students are not
sure about it.
Table 5: Do you feel you are under academic stress? (Question B)
Question B
Yes 71
No 26
Don’t Know 3
71% students feel that they are under academic stress while 26% don‟t feel that. 3% students are not
sure about it
Table 6: Do you take any drugs or have tried any (cigarette, alcohol, opium etc.)?
(Question D)
Question D
Yes 29
No 69
Didn’t answer 2
29% students have tried alcohol, cigarette, opium etc. while 69% have not tried anything. 2%
students didn‟t answer the question.
Table 7: Do you feel your gender plays a role in you being stressful? (Question E)
Question E
Yes 19
No 79
Don’t Know 2
19% students feel that gender does play a role in causing stress while 79% don‟t feel that. 2%
students are not sure about it.

Graph 4: Do you feel you are under peer pressure? (Question A)

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

 “SAD”- A medical undergraduate centered cross-sectional study from a teaching tertiary medical
institution in North east India 584

Graph 5: Do you feel you are under academic stress? (Question B)

Graph 6: Do you take any drugs or have tried any (cigarette, alcohol, opium etc.)?
(Question D)

Graph 7: Do you feel your gender plays a role in you being stressful? (Question E)

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

585 Dr. Sharat Agarwal et al.

Table 8: How many hours do spend on social media?

No. of hours spent on social media Percentage Overall

Don’t know 5
Variable 3
0 3
1 9
2 14
3 16
4 20
5 7
6 8
7 2
8 7
9 0
10 1
11 0
12 1
13 1
14 0
15 0
16 0
17 0
18 1
19 0
20 1
21 0
22 0
23 0
24 1
Total 100

Among the participants, 20% students spent 4 hours on social media while 16% spent 3 hours and
14% spent 2 hours. 7%, 8%, 7% students spent 5, 6, 8 hours on social media respectively. Only
3% students didn‟t spend an hour on social media.

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

 “SAD”- A medical undergraduate centered cross-sectional study from a teaching tertiary medical
institution in North east India 586

Graph 8: How many hours do spend on social media?

DISCUSSION: India has the 6th highest suicide rates in the

The aim of the study was to assess the stress, world. And unfortunately depression is a major
anxiety and depression levels among Medical reason for suicides. In this scenario when more
Undergraduate students of North East India. than half the medical students (53%) of North
East are under depression, there is a pressing
It was seen that 42% of the student population
need to take serious steps to control this
studied suffered from stress disorders. Most of
problem amongst them.
them were under mild to moderate stress. It was
observed that 34% of male students were under Peer pressure is considered a major cause of
stress however 50% of female students were stress, anxiety or depression by various
under stress indicating that females are studies.[7] Interestingly only 19% students felt
1.47 times more stressed than their male peers. that they were under Peer Pressure in contrast to
This is very similar to the studies done in other the number of students under any of the
mentioned problems.
parts of the world.[6]
Academics have always been a cause of
Anxiety disorders are universally more
psychological stress to the students. Be it school
common and a similar pattern was seen
or college, it is one of the major reasons for
among medical undergraduate students of North
stress among children. Supporting the usual
East India.[6] In our study, more than half the trend, 79% students felt that they were under
students were facing anxiety problems. Only academic pressure. Studies have established that
38% of the students who participated in the drug intake is a major cause for causing mood
study were normal without any anxiety disorder.
disorders.[7] However contrary to the fact that
Interestingly moderate levels of anxiety was
most of the students were under either stress or
more common than mild anxiety levels as
anxiety or depression, 69% have never tried any
compared to the stress levels. Another important
form of drugs.
finding was that the anxiety levels are similar in
males and females. There is no significant 79% students feel that gender doesn‟t play a
difference in anxiety levels among the different role in falling prey to any mood disorder
genders. however contrary to this, more female
students were under stress and depression. It

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

587 Dr. Sharat Agarwal et al.

is interesting to note that both the gender had their problems with their friends, teachers and
equal proportion of students facing anxiety family. The study has highlighted the high level
problems. of depression among the students which needs to
be taken care of. With the increasing number of
It is said that increasing use of internet in day to
suicides among the medical students, proper steps
day life disconnects a person from the physical
should be taken to diagnose clinical depression
world and pushes him or her into depression.
at an early stage so that proper remedial
We tried to explore the relation between the
measures can be undertaken at the right time.
time spent on internet, mainly social media, and
it was found that 20% students spend 4 hours on There is a necessity of formulation and
social media every day, 16% 3 hours and 14% 2 implementation of strict guidelines for improving
hours. Probably the reason which we could figure and maintaining mental health of medical
out was that the internet connects them to the students by Government of India and Medical
virtual world but disconnects them from the real Council of India. Psychiatrists and clinical
world thus taking away the buttressing which psychologists with the help of other health
would have been otherwise possible by face to professionals should create awareness about
face communication and interaction. mental health amongst medical students and
encourage them to not ignore the problem. An
The present study has helped in assessing the
aware medical student will not only help oneself
mental health of the medical students. With the
but also create awareness amongst the
increasing prevalence of mental health problems,
community, thereby creating a wave of positive
it is important to take note of the same amongst
transformation in the society as a whole.
medical students as they face a lot of stress on
all fronts of life, both professional and personal Further studies can be carried out to assess
and especially with limited avenues to cope up mental health among senior consultants, resident
with these problems. doctors and paramedical staff to diagnose any
underlying mental health problems.
There were certain limitations to our study. A
few questionnaires were returned to the SUMMARY
investigator at a later time as the participants
Mental health problems have remained hidden in
were busy at the moment or unwilling to the society and what we see is just the tip of the
participate. The responses to the questions were iceberg and they have been a taboo since
entirely based on self-assessment by the forever. No one is encouraged to talk about it
participants and may not accurately represent and if any one comes out and talks about it,
their mental health. Thus, we cannot rule out he/she is either asked to remain silent or ridiculed
subject bias on the part of the participants. by the society. Awareness about certain danger
CONCLUSION: signs like social withdrawal, seeking refuge to
drug abuse, or other vices or even resorting to
The present study was done to find the stress,
suicide or other activities that are harmful to
anxiety and depression levels and it has indeed
oneself should be made widely known to all so
highlighted the increasing levels of the same
that proper measures can be taken to identify and
amongst MBBS students of North East India. It
manage such victims.
is indeed important to take urgent steps to
counsel the students to come out and talk. It is Our study was aimed at finding stress, anxiety
required to arrange for counselling sessions for and depression levels amongst MBBS students of
the students to encourage them to discuss about North East India. A total of 120

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)

 “SAD”- A medical undergraduate centered cross-sectional study from a teaching tertiary medical
institution in North east India 588

questionnaires were distributed among the 2. World Health Organization. (2017).

MBBS Students of different academic years out World Health Organization. [online]
of which 108 responses were received. Available at: http://www.who.int/en/
[Accessed 8 Aug. 2017].
Among the mental health problems that were
3. http://www.apa.org. (2017).
assessed, anxiety disorders are the most common.
Following anxiety, students are affected the most American Psychological Association
(APA). [online] Available at:
by depression while stress disorders are the least
http://www.apa.org/ [Accessed 8 Aug. 2017].
common.
4. Marcus M, Yasamy MT, van
Most of the students felt that they were under Ommeren M, Chisholm D, Saxena S.
academic stress and it can possibly be one of the Depression, A Global Public Health
major reasons for anxiety and stress among them. Concern. Geneva: World Health
Interestingly, it was found that the participants Organization; [Accessed July 13, 2014].
felt that gender doesn‟t play an important role in Availablefrom:http://www.who.int/mental_health
causing stress but the stress, anxiety and /management/depression/who_paper_depression_
depression levels were found to be higher or wfmh_2012.pdf.
equal among the females than the males. 5. Henning K, Ey S, Shaw D.
Perfectionism, the imposter phenomenon and
The students feel that drug intake and peer
psychological adjustment in medical, dental,
pressure was not the cause for adding on to their
nursing and pharmacy students. Med Educ.
mental stress. However, the increased usage of
1998;32:456–
internet and time spent on social media can be
464.
correlated to the increasing problems among the
6. Al-Dabal BK, Koura MR, Rasheed P,
students as was found in our study.
Al-Sowielem L, Makki SM. A comparative
There is an urgent need to tackle the problem of study of perceived stress among female
increasing mental health problems among medical and non-medical university students
medical students as emphasised through this in Dammam, Saudi Arabia. Sultan
study conducted in a tertiary care level medical QaboosUniv Med J. 2010;10(2):231–40.
institute in the North Eastern part of India. 7. Brenneisen Mayer F., Souza Santos I.,
REFERENCES: Silveira P., Itaqui Lopes M., de Souza A.,
Campos E., de Abreu B., Hoffman II I.,
1. Afsar N. and Kulsoom B. (2015). Magalhães C., Lima M., Almeida R., Spinardi
Stress, anxiety, and depression among M. and Tempski P. (2016). Factors associated
medical students in a multiethnic setting. to depression and anxiety in medical
Neuropsychiatric Disease and Treatment, students: a multicenter study. BMC Medical
p.1713. Education, 16(1).

AUTHOR BIOGRAPHY

Ms. Yashika Parashar, MBBS Student, North Eastern Indira Gandhi Regional Institute of Health & Medical
Sciences (NEIGRIHMS), Shillong (India)
Dr. Sharat Agarwal, Associate Professor (Orthopaedics & Trauma), North Eastern Indira Gandhi Regional
Institute of Health & Medical Sciences (NEIGRIHMS), Shillong (India)
Dr. Manika Agarwal, Associate Professor (Obstetrics & Gynaecology), North Eastern Indira Gandhi Regional
Institute of Health & Medical Sciences (NEIGRIHMS), Shillong (India)

Innovative Journal of Medical Health Science, Vol 9 Iss 8, 578–588 (2019)