Level of Perceived Stress and Coping Strategies Prevailing Among 1 st year Medical Undergraduate Students : A Cross-sectional Study from South India

Copyright © 2017 Phcog.Net. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article : Shakthivel N, Amarnath AM, Ahamed F, Rath RS, Sethuraman AR. Rizwan AS. Level of perceived stress and coping strategies prevailing among 1st year medical undergraduate students: A cross-sectional study from south India. Int J Med. Public Health. 2017; 7(2):111-5. INTRODUCTION


INTRODUCTION
3][4][5] Excessive stress may lead to health problems like anxiety, depression, suicidal ideation, drug abuse and other complications. 6,7Different individuals, depending on their cultural background and coping skills, may perceive stressors differently.People differ in the way they think about and react to the stressful situations.Therefore, this study aimed to determine the prevalence of stress and associated coping strategies among medical undergraduate students in a south Indian medical college.

SUBJECTS AND METHODS
This was a cross-sectional, college based survey conducted in 2014 on all students enrolled for the first year MBBS.course of a private medical college in Tamil Nadu, India.All consenting students were included in the study.No explicit exclusion criteria were employed.All participants were given a copy of the self-administered questionnaire and detailed instructions to fill it.

Study instruments
To assess the stress level we used the Perceived Stress Scale (PSS), and to assess the coping strategies the Brief COPE inventory was used. 8,9Socio-demographic characteristics data was collected by semistructured questionnaire.

Statistical analysis
All analyses were conducted using STATA 11. Results were expressed as proportions, means with standard deviation and associations expressed as odds ratio with 95% CI.

Ethical statement
The study was approved by the Institutional Review Board of the medical college.Written informed consent was obtained from all participants.

RESULTS
Socio-demographic description: A total of 135 out of 148 students completed the study (response rate 91%).Majority of the students were girls (68.8%) and had a mean (SD) age of 18 (0.5) years.Basic sociodemographic details are given in Table 1.Perceived Mental Stress Level: Mean (SD) PSS score was 18 (6.5) in boys, 17 (6.4) in girls and 17 (6.5)International Journal of Medicine and Public Health, Vol 7, Issue 2, Apr-Jun, 2017 overall.About 80% of the boys and 75% of the girls reported a moderate or higher stress level according to the PSS, a higher percentage of boys reported moderate stress (50%) as compared to girls (39%).However, there was no statistical difference between boys and girls (p=0.30)(Table 2).
Coping strategies among students who reported moderate or high stress: Among students who reported moderate or high level stress, the most commonly employed coping mechanism was found to be religion (25%) followed by self distraction (19%), instrumental support (19%), positive reframing (19%) and humour (16%).Among boys, the most common mechanism was humour (26%) followed by self blaming (19%), whereas in girls the most common strategy was religion (30%) followed by positive reframing (22%).Statistically, gender comparison of coping strategies showed that more boys (as compared to girls) employed humour (26% vs. 11%, p = 0.02) and self blaming (19% vs. 6.5%, p = 0.02) whereas more girls (as compared to boys) employed religion (30% vs. 14%, p = 0.05) to overcome their stress (Table 2).Association between socio-demographic variables and stress level: Bivariate analysis using binary logistic regression could not find any statistically significant variables that were associated with stress level (Table 3).

DISCUSSION
In our study mean (SD) PSS score was 18 (6.5) in boys, 17 (6.4) in girls and 17 (6.5)overall.About 80% of the boys and 75% of the girls reported a moderate or higher stress level according to the PSS, a higher percentage of boys reported moderate stress (50%) as compared to girls (39%).
Studies have used, across India, various scales as measurement tools for stress.In this study PSS-10 was used to assess the perceived stress.A study done by Chilukuri H et al also used the PSS scale for assessing the stress factors among medical students. 4The mean score in PSS scale obtained was 16.7 with standard deviation of 5.9, which is similar to the result found the current study.Many other studies have used other measurement tools for stress.5]10 Similar results were also obtained by Supe AN, Nandi M et al and Reang T et al. [2][3][4][5] The prevalence of stress reported in this study was comparable with the study from Mumbai, India. 11A study by Saipanish R showed that about 61% of medical students had some degree of stress. 12The perceived stress score found in this study among medical students was lower than that studied by Singh et al. in Nursing students. 13The participants reported using a wide range of coping strategies.The most common coping strategy used by boys was humor and among girls common strategies were religion and self-blaming while religion was the commonest strategy in the overall sample (20%).
A study by Cherkil et al showed that humor was the commonest method associated with severe stress. 14 bivariate analysis none of the factors were found significantly associated with the stress.3][4] But a study by Iqbal et al found significant differences by gender, semester and smoking status. 10 Limitations Lack of generalizability, information bias are the main limitations of the study.

CONCLUSION & RECOMMENDATIONS
Moderate to high level of stress is common among first year medical students in this private medical college.Students employed a variety of coping strategies, among which humour and religion were most common.Stress management and coping skills training would be more effective if it is taken to the classroom in the form of a subject in medical curriculum beginning from the first year.A brief group Mindfulness-based Cognitive Therapy (b MBCT/ Mindful-Gym) programme has been developed to help medical students cope more effectively with stress and was found successful in University Putra Malaysia (UPM).One of the training methodologies used in the programme, 'Mindful -S.T.O.P. ' , was particularly popular among the students. 15Such programmes can be developed with a much more local perspective and implemented in Indian medical colleges as well.

Table 1 : Socio-demographic details of the study participants.
Note: Father's details were missing for five students and mother's details for one student.

Table 2 : Prevalence of perceived mental stress level and coping strategies among the study participants and gender dif- ferentials.
Note: All other p values are from chi square test, * Students t test, # multiple response sets.

Table 3 : Bivariate analysis -association between socio-demographic variables and perceived mental stress level among the study participants.
International Journal of Medicine and Public Health, Vol 7, Issue 2, Apr-Jun, 2017