ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES

A comparative study of stress among medical

and dental students
Bijaya Adhikari1, Niroj Maharjan2, Grishma Baskota3, Archana Bhaila4, Hari Sundar Shrestha5
1,2,3,4,5
Lecturer, Department of Physiology, Kist Medical College, Kathmandu

Submission: 06-10-2020 Revision: 22-11-2020 Publication: 01-02-2021

ABSTRACT
Background: Many researches in the past have proved that medical students experience Access this article online
elevated level of stress throughout their medical school life. Aims and Objective: The aim
Website:
of the study is to study the prevalence and degree of stress among medical and dental
http://nepjol.info/index.php/AJMS
students, find out the various stressors among them and the association of stress with
various sociodemographic variables. Materials and Methods: A cross-sectional study was DOI: 10.3126/ajms.v12i2.31817
conducted among 159 medical and dental students of first and second year in Kist medical E-ISSN: 2091-0576
P-ISSN: 2467-9100
college and hospital. 81 medical and 78 dental students participated in the study. General
Health Questionnaire (GHQ-12) and Medical students stress Questionnaire (MSSQ-40) was
used. Statistical analysis was done by using SPSS version 25. Chisquare test was done Copyright (c) 2020 Asian Journal of
to find the association of stress with various factors and to compare the degree of stress Medical Sciences
between medical and dental students. Results: Among 159 medical and dental students,
109 students (68.6%) were found to have stress. 48 out of 81 (59.3%) were medical
students and 61out of 78 (78.2%) were dental students. Moderate stress was observed in
50/81(61.7%) medical students and 38/78 (48.7%) dental students. Similarly, high stress
was observed in 10/81(12.3%) medical students and 11/78 (14.1%) dental students.
Difference in the degree of stress between dental and medical students was not statistically This work is licensed under a Creative
significant (p value >.05). Academic related stress was the major source of stress in both Commons Attribution-NonCommercial
4.0 International License.
medical and dental students. Gender, accommodation and motivation for study were found
to be significantly associated with stress. Conclusions: The first two years of medical and
dental students is stressful with academic related stress being the most prevalent stressor.
Prevalence of stress was found to be more in dental students and the difference in the degree
of stress between medical and dental students was not statistically significant.
Key words: Medical Education; Dental Education; Stress; Stressors

INTRODUCTION levels of stress leading to serious stress-related disorders

like depression in undergraduate students of medical
Stress is a result of certain external physical or mental schools.5 It is not just the undergraduate period but the
factors that affect an individual’s physical and psychological stress might continue during the internship, postgraduate
well-being.1 period and during the whole life as a physician.6 If the
students who are susceptible to stress are identified in the
Various professions have their own level of stress. It has early phase of medical education and essential support is
been proved through various researches that medical provided, it can lessen the negative consequences of stress
students experience elevated stress levels throughout in future.7
their medical school life.2 Causes may vary from their
interpersonal problems to their course overload to their Only few studies have been conducted in Nepal to study
uncertainties of future career prospects.3 Excessive stress the prevalence and degree of stress among medical and
can lead to psychological problems like depression and dental students.8,9 So this study is focused on prevalence
anxiety.4 Previous studies have shown presence of high and degree of stress among dental and medical students.

Address for Correspondence:

Dr. Bijaya Adhikari, Lecturer, Department of Physiology, Kist Medical College, Kathmandu. Mobile No: +977-9849200065.
E-mail: [email protected]

30 Asian Journal of Medical Sciences | Feb 2021 | Vol 12 | Issue 2

 Adhikari, et al.: A comparative study of stress among medical and dental students

It also aims to find out the potential stressors in these two what is expected of me’, and ‘Lack of recognition for
groups and association of stress with various factors. work done’.
4. Social related stressors.
5. Drive and desire related stressors which consist of
MATERIALS AND METHODS
items like unwillingness to study medicine, family
Data was collected among first year and second year medical responsibilities etc.
and dental students (N=159) by using self-administered
The MSSQ is scored by assigning a value of 0-4 for
questionnaire after getting clearance from institutional
each of the respective responses; A response of ‘causing
ethical committee. The sample size was calculated by using
no stress at all would be scored as 0 and causing severe
a formula for known population with 95% confidence
stresses would be scored as 4. Mean score of 0.01 to
interval and 5% margin of error. The known population
1.00 - indicate mild stress, 1.01 to 2.00- moderate stress,
in our study was first and second year medical and dental
2.01 to 3.00- high stress and 3.01 to 4.00- severe stress.
students. The study enrolled 159 students out of which 81
Mild stress means very little stress or insignificant stress,
were medical and 78 were dental students. General Health
moderate stress signifies reasonable stress and severe and
Questionnaire with 12 items (GHQ-12)10 and Medical
high stress signifies emotional disturbance with or without
Students Stress Questionnaire with 40 items (MSSQ-40)11
compromising daily activities.
were used. Students were selected by simple random
sampling and verbal consent was taken from students Statistical analysis
before administering questionnaire. The students were told The collected data was entered and analyzed using SPSS
about the objective of the study and were well instructed version 25.0 software. Chi square test was done to find
for completing the questionnaire within 20 minutes. the association of stress with different variables and to
They were asked to respond genuinely and were assured compare the degree of stress between medical and dental
of confidentiality and anonymity as well. Demographic students. P value >.05 was considered to be significant.
information was noted which consisted of age, address,
gender, accommodation, academic performance in recent
exam, motivation for studying medicine and dentistry etc. RESULTS

General Health questionnaire (GHQ-12) is a tool developed Among 159 medical and dental students, 109 students
in 1970 by Sir David Goldberg and Paul Williams which (68.6%) were found to have stress according to cut off
helps in screening psychiatric problems such as stress. The point of General Health questionnaire (GHQ) as shown in
items in the questionnaire represent 12 manifestations of Table 1. Among these 48 (59.3%) were MBBS students and
stress and students were asked to rate presence of each 61(78.2%) were BDS students. Similarly, among 159 students,
of these manifestations in themselves during the past six 64 were males and 95 were females. 75.8% of females and
months. The study participant’s responds were noted by 57.8% of males were found to be under stress. 55.3% of
choosing one from four typical responses: “not at all”, “no students were under moderate stress as shown in Table 2.
more than usual”, “rather more than usual”, and “much Only 13.2% of total students were found to have high stress
more than usual”. A binary scoring method (0-0-1-1) is and not much difference (p value >.05) was seen in degree
used to evaluate responses. Total scores of 4 and above of stress among males and females as shown in Table 2.
were considered to be positive for stress.10 Though a greater number of dental students was found to
be under stress, moderate stress was found to be more in
The MSSQ-40 is a rating instrument developed in a medical medical students. It was observed among 61.7% of medical
school in Malaysia and validated to measure stress and its students while it was only 48.7% among dental students but
sources within students. It consists of 40 items collectively it was not statistically significant (p value >.05). Surprisingly
addressing six domains of stressors.11 in both medical and dental students, students in their second
1. Academic-related stressors, with items ‘Tests/ year reported to have more stress (MBBS 81.6% and BDS
examinations’, ‘Getting poor marks’, ‘Large amount 83.3%). Nobody was found to be under severe stress in both
of content to be learnt’, and ‘Having difficulty medical and dental students on MSSQ stress level.
understanding the content’.
2. Intrapersonal and interpersonal-related stressors: with According to MSSQ, among six stressors domain,
items like ‘Conflict with other students’, ‘Verbal or academic related stress was the major source of stress
physical abuse by teachers’, and ‘Conflict with personnel’. in both medical and dental students as all medical and
3. Teaching and learning related stressors, with items like dental students have some degree of academic stress
‘Lack of guidance from the teacher’. ‘Uncertainty of (Table 3 and Table 4). But 81.1% (129/159) of the

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 Adhikari, et al.: A comparative study of stress among medical and dental students

Table 1: Sociodemographic variables and distribution of stress

Sociodemographic variables Total Presence of Stress
N % Yes No
N % N %
Gender Male 64 40.3 37 57.8 27 42.2
Female 95 59.7 72 75.8 23 24.2
Stream MBBS 81 50.9 48 59.3 33 40.7
BDS 78 49.1 61 78.2 17 21.8
Year MBBS 1st 43 27.04 17 39.5 26 60.5
MBBS 2nd 38 23.89 31 81.6 7 18.4
BDS 1st 36 22.64 26 72.2 10 27.8
BDS 2nd 42 26.41 35 83.3 7 16.7
Accommodation Hostel& Rented homes 81 50.9 45 55.5 36 44.5
Parents’ house 78 49.05 64 82 14 17.9

Table 2: Severity of stress based on MSSQ

Total Male Female Male & Female MBBS BDS MBBS& BDS
(N=159) (N=64) (N=95) p value (N=81) (N=78) p value
Mild stress 50 (31.4) 21 (42) 29 (58) 0.90 21 (25.9) 29 (37.2) 0.09
Moderate stress 88 (55.3) 36 (56.3) 52 (54.7) 0.85 50 (61.7) 38 (48.7) 0.17
High stress 21 (13.2) 7 (10.9) 14 (14.7) 0.40 10 (12.3) 11 (14.1) 0.74

Table 3: Different stressors domain as a source Table 4: Different stressors domain as a source
of stress and severity of stress among medical of stress and severity of stress among dental
students based on MSSQ (n=81) students based on MSSQ (n=78)
Stressors Domain Severity of stress Stressors Domain Severity of stress
Mild Moderate High Severe Mild Moderate High Severe
N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%)
Academic related 17 (21) 42 (51.9) 21 (25.9) 1 (1.2) Academic related 13 (16.7) 35 (44.9) 25(32.1) 5 (6.4)
stressors (ARS) stressors (ARS)
Group activities 35 (43.2) 33 (40.7) 12 (14.8) 1(1.2) Group activities 32 (41) 34 (43.6) 11(14.1) 1 (1.3)
related stress (GARS) related stress (GARS)
Social related 38 (46.9) 39 (48.1) 3 (3.7) 1 (1.2) Interpersonal 51 (65.4) 18 (23.1) 9 (11.5) 0
stressors (SRS) related stressors (IRS)
Interpersonal 52 (64.2) 21 (25.9) 6 (7.4) 2 (2.5) Desire and drive 59 (75.6) 15 (19.2) 3 (3.8) 1 (1.3)
related stressors (IRS) related stressors (DRS)
Desire and drive 50 (61.7) 26 (32.1) 5 (6.2) 0 Teaching and learning 35 (44.9) 25 (32.1) 13(16.7) 2 (2.6)
related stressors (DRS) related stressors (TLRS)
Teaching and learning 36 (44.4) 28 (34.6) 16 (19.8) 1 (1.2) Social related stressor 39 (50) 23(29.48) 8 (10.3) 1 (1.3)
relatedstressors (TLRS)

Significant association was found between stress and gender

students were found to be having major academic related
as more percentage of females were found to be under
stress which includes moderate, high and severe stress.
stress than males (p value=.01) as depicted in Table 5. In
Among medical students, 51.9% (42/81) had moderate
stress, 25.9% (21/81) had high stress and only 1.2% our study, students who were living at parents’ home were
(1/81) had severe academic related stress. Similarly, in found to be more stressed than students living in hostel (p
dental students 35/78 (44.9%) had moderate academic value=.003). Most of the students 115/159 (72.3%) were
stress, 25/78 (32.1%) had high academic stress and 5/78 found to be self-motivated to learn medicine and dentistry
(6.4%) had severe academic stress. In both medical and rather than under parents’ pressure. 72/115 (62.6%) of
dental students, group activities related stress (GARS) was those were found to be under stress whereas 86.9 % of
found to be second source of stress including moderate, those who came under parents’ pressure were found to be
high and severe stress (56.7% and 58.9% respectively) stressed (p value=0.03).
followed by teaching and learning related stress (TLRS)
as depicted in table 3 and table 4. So the major source of So, there was significant association between stress
stress was almost similar in both MBBS and BDS students and motivation for studying medicine or dentistry. We
with slight variance. tried to find if students do any sort of substance abuse

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 Adhikari, et al.: A comparative study of stress among medical and dental students

Table 5: Association of stress with various factors (57.8%) which was quite similar with study done by
Sociodemographic variables Total Stress
Kharel Sushil et al, Hamza et al and Eva et al where
N N % p value
prevalence of stress was more in females than males
unlike the study done in the university of Ethiopia by
Gender Male 64 37 57.8 0.01
Female 95 72 75.8 Leta Malaku et al where not much gender difference
Accommodation Hostel 71 40 56.3 0.003 was seen among prevalence of stress (52.9% males and
Parents’ or 88 69 78.4 50.6% females).15
guardians home
Motivation Self 115 72 62.6 0.03
Parents’ pressure 23 20 86.9 In our study the prevalence of stress in students was
Confused 21 17 80.95 more in second year than in first year students which was
quite opposite to many studies.8,9,12 The increase in stress
(smoking, alcohol, tobacco chewing etc.) to relieve among dental students could be due to increased burden
stress. Only 25 students under stress were found to be of the practical assignments they have to complete in time
using these substances but most of them reported to and strict faculties. In medical students it could be due to
use occasionally. seriousness and sincerity of second year students towards
their studies than first year medical students.
DISCUSSION Among the various stressors academic stressors were the
major source of stress in both medical and dental students
Medical profession is one of the most stressful (81.1%) followed by group activities related stressors
professions and the stress begins from the day a student (GARS) and teaching and learning related stressors (TLRS)
enters the medical or dental college. Extreme burden of which is consistent with the study done by Patel SP et al,10
academics, examination fear, peer pressure, high parental
Manandhar SA.13 Our study results are further supported
expectations are some of the factors contributing stress
by the study done by Kholoud which shows academic
which can ultimately impact a student’s physical and
overload, frequent examinations, depth and vastness of
mental health.
the syllabus to be completed within limited time were the
The overall prevalence of stress among first year and major contributors of stress among the students.16 This
second year students was 68.6% according to cutoff results show that the medical college should be equally
point of general health questionnaire (GHQ-12) which concerned towards dental students as well, as medical
was similar to study done by Spanish in Thailand (61.4%), students gain more attention in every medical school.
Manandhar SA et al (65%),12-13 and study done in Saudi But dental students are equally under academic pressure
Arabia( 63.7%) but higher than study done by Kharel as medical students, in fact even more as shown by our
Sushil et al (39%) and a combined study done in KUSMS studies.
Dhulikhel and Manipal college(27%).6,8,14 The possible
reasons for variability in stress prevalence could be due The excessive amount of stress predisposes students to have
to difference curriculum, teaching facilities, experience of difficulties in solving problems and reduced concentration
the instructors, the level of care given to the students and and finally develop depression leading to substance abuse
lack of academic counseling. Moreover, the differences by the students as a means of coping strategies.14 In our
in various studies could be also due to difference in their study, 18.8% students reported occasional use of smoking,
diagnostic tool. Among them, the prevalence of stress was alcohol etc. Among them, 15.7% had presence of stress.
more in BDS (78.2%) than MBBS students (59.3%). This Thus, there was significant association of stress with use
was quite similar to the study done by Manandhar SA et al of smoking, alcohol etc (p value =.05). This was quite low
where prevalence of stress was more in BDS students than the studies done by Leta Malaku et al where 62.77%
(68.62%) than MBBS students (63.15%) but different (9% smoking and 35% alcohol) of the students reported
than the study done by Kharel Sushil et al where medical to use smoking, alcohol and tobacco chewing which was
students were found to be more under stress (41%) than quite high than our students.15 Smoking falsely creates
dental students (35%). The high prevalence of stress among feelings of relief but in fact it does not alleviate stress. The
dental students may be due to high amount of practical level of stress increases as they develop regular patterns of
assignments they have to complete along with academic smoking.17 Similarly alcohol also produces false feelings of
pressure. relief from stress but it actually stimulates production of
stress hormones. In the previous studies done by Britton in
Similarly, higher percentage of females were found to 2004 and Braddy & Sonne in 1999 shows positive relation
be under stress (75.8%) than their male counterparts between stress and alcohol use.18,19

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 Adhikari, et al.: A comparative study of stress among medical and dental students

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Author’s Contribution:
BA - Concept and design of study, preparation of first draft of manuscript, statistical analysis, result interpretation; NM - Statistical analysis; GBN - Editing of the
manuscript; AB - Data collection and entry; HS - Data collection and entry.

Work attributed to:

Kist medical college and hospital.

Orcid ID:
Dr. Bijaya Adhikari - http://orcid.org/0000-0001-8409-8073
Dr. Niroj Maharjan - https://orcid.org/0000-0002-6303-7391
Ms. Grishma Baskota - https://orcid.org/0000-0003-1785-6297
Ms. Archana Bhaila - https://orcid.org/0000-0001-6830-9344
Mr. Hari Sundar Shrestha - https://orcid.org/0000-0002-5689-6753

Source of Funding: Nil, Conflict of Interest: None declared.

Asian Journal of Medical Sciences | Feb 2021 | Vol 12 | Issue 2 35