Stress and Its Effects on Medical Students: A Cross-sectional Study at a College of Medicine in Saudi Arabia
TL;DR: Preventive mental health services could be made an integral part of routine clinical services for medical students, especially in the initial academic years, to prevent such occurrence.
Abstract: Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school This cross-sectional study was conducted to determine the prevalence of stress among medical students and to observe an association between the levels of stress and their academic performance, including the sources of their stress All the medical students from year one to year five levels from the College of Medicine, King Saud University, were enrolled in the study The study was conducted using Kessler10 psychological distress (K10) inventory, which measures the level of stress according to none, mild, moderate, and severe categories The prevalence of stress was measured and compared with the five study variables, such as gender, academic year, academic grades, regularity to course attendance, and perceived physical problems The response rate among the study subjects was 87% (n=892) The total prevalence of stress was 63%, and the prevalence of severe stress was 25% The prevalence of stress was higher (p<05) among females (757%) than among males (57%) (odds ratio=23, χ 2 =272, p<00001) The stress significantly decreased as the year of study increased, except for the final year The study variables, including being female (p<00001), year of study (p<0001), and presence of perceived physical problems (p<00001), were found as independent significant risk factors for the outcome variables of stress Students’ grade point average (academic score) or regularity to attend classes was not significantly associated with the stress level The prevalence of stress was higher during the initial three years of study and among the female students Physical problems are associated with high stress levels Preventive mental health services, therefore, could be made an integral part of routine clinical services for medical students, especially in the initial academic years, to prevent such occurrence
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TL;DR: Quality of life was frequently negatively associated to stress and factors as insomnia and burnout were also associated with its deterioration, highlighting the negative association between stress and QoL in university students.
258 citations
TL;DR: A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students’ study skills and coping with their stressful environment.
Abstract: Introduction Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. Methods This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. Results A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p Conclusion The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students’ study skills and coping with their stressful environment.
228 citations
Cites background or result from "Stress and Its Effects on Medical S..."
...Locally, the prevalence of stress among medical students is reported as 63% at King Saud University [7], and 53% at King Faisal University [8]....
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...%) and in the previous local studies (30% in King Abdulaziz University [27] and 37% in King Saud University [13]) that were done before the new SCHS admission requirements....
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...%) of the medical students at King Saud University have abnormal sleep habits [13]....
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...In contrast, a few studies did report that being a female medical student was a significant predictor of a high stress level [7,36] and sleep disorder [13]....
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TL;DR: This cross-sectional study among university students in France revealed that perceived stress was associated not only with known riskssuch as alcohol misuse, but also with new risks such as eating disorders and cyber addiction.
Abstract: University students face multiple stressors such as academic overload, constant pressure to succeed, competition with peers as well as concerns about the future. Stress should not be considered on its own, but should be associated with potential risk behaviors leading to onset of substance use and related problems heightened during the university period. The aim of this study was to determine the prevalence of main substance use and behavioral addictions among students in higher education in France and to examine the relationship with perceived stress. A self-administered questionnaire was filled out by university student volunteers from Upper Normandy (France) either by anonymous online questionnaire or by paper questionnaire. Data collected included socio-economic characteristics, Perceived Stress Scale (PSS), substance use (tobacco, alcohol, and cannabis) and hazardous behaviors: alcohol abuse problems, smoking, consumption of cannabis, eating disorders, and cyber addiction. A total of 1876 students were included. Mean PSS score was 15.9 (standard deviation = 7.2). Highly stressed students (4th quartile) were compared with lesser stressed students (1st quartile). A positive relation was observed between female gender, regular smokers, alcohol abuse problems, risk of cyberaddiction and especially eating disorders (AOR = 5.45, 95% CI = 3.42-8.69), and increasing PSS score. PSS score however, was not significantly related to the curriculum, regular alcohol use, drunkenness or binge drinking even after additional controlling for use of other substances. We found a significant negative association between stress and practice of sport: students with the most physical activity were less likely to report perceived stress (4th quartile: AOR = 0.57, 95% CI = 0.39-0.80). This cross-sectional study among university students in France revealed that perceived stress was associated not only with known risks such as alcohol misuse, but also with new risks such as eating disorders and cyber addiction. These results could help to develop preventive interventions focussing on these risk behaviors and subsequently improving stress coping capacity in this high-risk population.
227 citations
Cites result from "Stress and Its Effects on Medical S..."
...Whilst some previous studies found similar results to ours [39], others reported that gender was not a risk factor for stress [40]....
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TL;DR: It is concluded that depression, anxiety and stress symptoms are common in medical students of Assiut University relative to other schools and female gender was significantly correlated with these findings.
Abstract: Poor psychological health in medical students has been reported nationwide This study estimated the prevalence of depression, anxiety and stress symptoms among medical students who were enrolled in a public university in Upper Egypt and determine the association of these morbidities with the students' basic socio-demographic variables This cross-sectional study included 700 students A self-administered, questionnaire for the socio-demographic characteristics, Depression Anxiety Stress Scale (DASS 21) and Pittsburgh Sleep Quality Index (PSQI) questionnaire were used for assessment High frequencies of depression (65%), anxiety (73%) and stress (599%) were reported Stress scores were significantly higher than depression and anxiety (P=0001) 557% were poor sleepers In univarate analysis, females, those living in the University campus/students' residence facility, in the preclinical years and with lower academic achievement had higher scores of DASS and PSQI compared to their comparative partners Significant correlations were reported between stress with depression, anxiety and PQSI scores (P=00001) In multivariate analysis, stress scores were significantly associated with female sex, depression and anxiety scores We conclude that depression, anxiety and stress symptoms are common in medical students of Assiut University relative to other schools and female gender was significantly correlated with these findings
223 citations
Journal Article•
TL;DR: The study showed a diversity of stress sources and a high level of stress in the medical students and the results show that higherlevel of stress is associated with poor academic performance.
Abstract: OBJECTIVE To determine the relationship of stress and academic performance in first year medical students and to identify sources of stress, levels of stress and relevant coping strategies. STUDY DESIGN Mixed method sequential. PLACE AND DURATION OF STUDY Allama Iqbal Medical College, Lahore, from March to December 2010. METHODOLOGY Survey questionnaire and in-depth interviews were carried out in the first year students with their consent. Two hundred and fifty students were surveyed, out of whom 120 students responded. Twelve students with their consent were interviewed. Non-probability purposive sampling was employed for both types of data collection. SPSS version 20 was used. The qualitative data generated through structured in-depth interviews, were analyzed by content analysis. RESULTS Low level of stress was found in 7.5% (score ‹150), moderate level of stress was present in 71.67% (score between 150 and 300), and high level of stress was observed in 20.83% (score ›300) of the students. There is moderate negative (-0.583) and significant (p < 0.01) correlation between academic performance and sources of stress. Similarly there is moderate negative (-0.478) and significant (p < 0.01) correlation between academic performance and levels of stress. There was strong positive (0.799) and significant (p < 0.01), correlation between stress level and number of stress sources. CONCLUSION The study showed a diversity of stress sources and a high level of stress in the medical students. The results also show that higher level of stress is associated with poor academic performance.
220 citations
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TL;DR: The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys.
Abstract: Background. A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). Methods. Initial pilot questions were administered in a US national mail survey (N fl 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N fl 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N fl 1000 telephone screening interviews in the first stage followed by N fl 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N fl 36116) and 1998 (N fl 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N fl 10641) Australian National Survey of Mental Health and Well-Being. Results. Both the K10 and K6 have good precision in the 90th‐99th percentile range of the population distribution (standard errors of standardized scores in the range 0‐20‐0‐25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV}SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0‐87‐0‐88 for disorders having Global Assessment of Functioning (GAF) scores of 0‐70 and 0‐95‐0‐96 for disorders having GAF scores of 0‐50. Conclusions. The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.
7,570 citations
"Stress and Its Effects on Medical S..." refers methods in this paper
...We used the Kessler10 Psychological Distress instrument (K10) developed by Kessler and colleagues (19)....
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TL;DR: This study aims to assess the exposure to different stressors and the prevalence of depression among medical students at different levels of education, taking gender differences into account.
Abstract: Objective To assess the exposure to different stressors and the prevalence of depression among medical students at different levels of education, taking gender differences into account.
Design Students were asked to complete a new stress inventory called the Higher Education Stress Inventory (HESI), the Major Depression Inventory (MDI), slightly modified, and questions on suicidal ideation developed by Meehan.
Setting The study was carried out at the Karolinska Institute Medical University, Stockholm, Sweden. Matched controls from the general population were used.
Participants All registered students in Years 1, 3 and 6 were enrolled in the study (n = 342). The response rate was 90.4%.
Results Year 1 students gave high ratings to the workload and lack of feedback stressors. Year 3 students gave high ratings to ‘Worries about future endurance/competence’ and ‘Pedagogical shortcomings’. In Year 6, both the latter factors were rated highly, but Year 6 students also gave higher ratings than the 2 other groups to ‘Non-supportive climate’. In all 3 cohorts students complained of lack of feedback. Female students gave higher ratings than males to 4 out of 7 factors. Several stress factors were identified as being associated with depression. The prevalence of depressive symptoms among students was 12.9%, significantly higher than in the general population, and was 16.1% among female students versus 8.1% among males. A total of 2.7% of students had made suicide attempts, but none during the previous year.
Conclusion Year 1 students indicated experiencing the highest degree of pressure from studies. A gender difference regarding stress levels was also seen, where women reported higher levels of stress than men. Medical students had higher depression rates than the general population, and women students had higher rates than men.
1,026 citations
"Stress and Its Effects on Medical S..." refers background in this paper
...7% of students had made suicidal attempts (6)....
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...A wide range of different measures have been used for addressing psychological distress and depressive symptomatology among medical students, such as Beck’s Depression Inventory (13), General Health Questionnaire (GHQ) (11), and other common and less common instruments (6,18)....
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...High level of stress may have a negative effect on cognitive functioning and learning of students in the medical school (6)....
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01 Dec 2005
TL;DR: The manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress are reviewed.
Abstract: The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.
854 citations
"Stress and Its Effects on Medical S..." refers background in this paper
...JHPN 520 a medical school and remains poor throughout the course (25), especially in the transition from basic science teaching to clinical training (26)....
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TL;DR: Levels of stress, as measured by the general health questionnaire, were assessed in 318 medical students in their fourth year at three British universities, and mean scores were higher than those in other groups within the general population.
Abstract: Levels of stress, as measured by the general health questionnaire, were assessed in 318 medical students in their fourth year at three British universities. Mean scores were higher than those in other groups within the general population, and the estimated prevalence of emotional disturbance was 31.2%, a proportion similar to that reported in medical students in the United States. There were no differences in prevalence or in mean scores of stress between the sexes. Twelve (4%) students reported high intake of alcohol, and almost half of the students had increased their intake in the past two years. The four categories most commonly cited in answers to an open ended question on recent stressful events were talking to psychiatric patients, effects on personal life, presenting cases, and dealing with death and suffering. Relationships with consultants raised the strongest negative feelings, with 102 (34%) students finding these particularly stressful. Stress among medical students should be acknowledged and attempts made to alleviate it.
511 citations
TL;DR: It is suggested that a small group of students repeatedly experience psychological distress during their medical training, and the best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1.
Abstract: The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. 172 (84.3%), 157 (77.0%) and 155 (75.9%) students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. 18 students were above threshold on the GHQ-12 on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a 'case'. Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.
433 citations