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Title: ASSOCIATION BETWEEN PSYCHOLOGICAL STRESS AND DEPRESSION AMONG UNDERGRADUATE MEDICAL STUDENTS

Authors: Thanashree Rajamanickam, Preeya Subramaniam, Sri Mahalakhsmi Somasundaram, Santhrahaasan Ramamoorthy, Sharine Tan Shey Lin, Nishanthieny Balakrishnan Nair, Tan Soon Wai, Navin Raj Kathiravelu, Shaheena Sanggeth Hariaran, Shahrul Akmal Bin Nor Hisham, Dr. Roy Rillera Marzo

Topic: Education

Abstract:

Background: Stress is a term that refers to the sum of physical, mental and emotional strains or tensions on a person. Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Psychological Stress among medical students is common as compared to other professional courses. The aim of the study is to study the association between Psychological Stress and Depression among undergraduate medical students in Asia Metropolitan University. 

Methods: A Cross sectional study was undertaken among 75 medical students in a private medical college, Johor Bahru. Validated questionnaires such as General Health Questionnaire (GHQ-12) and Beck depression Inventory (BDI) were used to screen Psychological Stress and Depression respectively.

Results: Prevalence of Psychological Stress was 39.7% and Depression was 38.2% among medical students. There was a significant association between Psychological stress and Depression among medical students because the p-value <0.01. 

Conclusion: Emphasize should be laid on the importance of screening for Depression of medical students on a regular basis for early detection and rendering appropriate intervention like student Mentorship Program, group counseling, stress management training to protect the future professionals


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    COMMENT - 1

  • Dr. AJIT V PANDYA (Viewer) 17th Nov 2015 - 8:23 PM
    Good morning from Dr. Ajit V Pandya form Ahmedabad ..India
    My questions / suggestion (s) are as follows…my email id is ajit1sujit@gmail.com
    Watsapp no. 91 8905599852

    .good study......
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 11:20 AM
      Thank you so much for your reply.

      1. When did they have maximum stress...i.e. during exam time or result time?
      We conducted our study during one month prior to year 1 and year 2 professional exam, therefore we believe it’s during examination, but we hope to compare the same study during results time too.

      2. was it permanent or temparary..?
      We believe its temporary, but its more significant if conduct again after few months to compare the condition.

      3. was it have corelation with blood pressure ?
      Our study Correlation of Psychological Stress and Depression among medical
      Students.
      Questionnaires were regarding as follows:
      • Psychological Stress based on the General Health Questionnaire (GHQ-12) to screen for common symptoms of Psychological Stress among medical students.
      • Beck Depression Inventory (BDI) to determine the level of Depression among medical students

      4. what do you suggest them to relif from stress..?

      Regarding the suggestion to relief of stress, we have included in our recommendation which involves:
      1. Enhancing the personal development of each student, establishing mentor relationships and placing a greater emphasis on health programs including stress management, in order to help students cope with the stress of tertiary education.
      2. Medical faculties should introduce Foundation Courses for new students which provide an overview of what to expect in medical school, as well as lectures on study techniques, stress and time management.
      3. Student Mentorship Program which offers consultation to students from academic staff and senior medical students.
      The questions involve regarding mentee’s:
       Socio-demographic feature and academic results
       Situation causing the most stress for them
       Their ways of coping with stress


      Monitoring of each mentee’s will be every month and they are required to provide feedback on their needs, academic difficulties and how they try to overcome their stress. Based on feedback provided, Counseling students, who affect by psychological stress and lead to depression during study period in medical university, will be sending to counselor of respective institute for counseling session.

      The purpose of counseling:
       To understanding students problems in daily life and academic achievement
       To consult students to overcome their problem
       To learn coping skills against stress
       To modify students attitude and behavior status

      The counseling session will be conducting every month, prior to examination, after examination and after obtaining academic results.

      4. Modifying the curriculum and study environment. The purpose of the
      modification in the curriculum is mainly to achieve a balance between
      the content and time distribution among medical students.
      Few changes and requirement at studying campus, such as:
       More student-friendly campus, teaching and assessing methods, establishing a student counseling centre in the campus with qualified and experienced staff,
       Improving the facilities and interesting program for extracurricular activities in the campus to reduce Psychological Stress, and strengthening and activating a tutorial system in the colleges.
       It is also necessary to undertake further study focusing on academic issues to identify the specific factors associated with stress among medical students

      5. Greater emphasis should be placed on health programs including as mentioned above such as stress management to help students cope with the stress of tertiary education. These programs should in fact be implemented in all universities. The ultimate aim is to help medical students to understand what is required of them and to adapt to stressful environment as quickly as possible
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 11:24 AM
      Dr Ajit thank you so much for appreciating our study research. God bless you always.
    • Amina Jangu Alhassan (Viewer) 24th Nov 2015 - 4:06 AM
      What makes it a good study Dr.? I am interested in submissions to that effect.

  • COMMENT - 2

  • Dr. AJIT V PANDYA (Viewer) 17th Nov 2015 - 8:30 PM
    from ajit pandya....
    1. when did they have maximum stress...i.e. during exam time or result time ?
    2. was it permanent or temparary..?
    3. was it have corelation with blood pressure ?
    4. what do you suggest them to relif from stress..?
    please reply...
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 11:22 AM
      Thank you so much for your reply.

      1. When did they have maximum stress...i.e. during exam time or result time?
      We conducted our study during one month prior to year 1 and year 2 professional exam, therefore we believe it’s during examination, but we hope to compare the same study during results time too.

      2. was it permanent or temparary..?
      We believe its temporary, but its more significant if conduct again after few months to compare the condition.

      3. was it have corelation with blood pressure ?
      Our study Correlation of Psychological Stress and Depression among medical
      Students.
      Questionnaires were regarding as follows:
      • Psychological Stress based on the General Health Questionnaire (GHQ-12) to screen for common symptoms of Psychological Stress among medical students.
      • Beck Depression Inventory (BDI) to determine the level of Depression among medical students

      4. what do you suggest them to relif from stress..?

      Regarding the suggestion to relief of stress, we have included in our recommendation which involves:
      1. Enhancing the personal development of each student, establishing mentor relationships and placing a greater emphasis on health programs including stress management, in order to help students cope with the stress of tertiary education.
      2. Medical faculties should introduce Foundation Courses for new students which provide an overview of what to expect in medical school, as well as lectures on study techniques, stress and time management.
      3. Student Mentorship Program which offers consultation to students from academic staff and senior medical students.
      The questions involve regarding mentee’s:
       Socio-demographic feature and academic results
       Situation causing the most stress for them
       Their ways of coping with stress


      Monitoring of each mentee’s will be every month and they are required to provide feedback on their needs, academic difficulties and how they try to overcome their stress. Based on feedback provided, Counseling students, who affect by psychological stress and lead to depression during study period in medical university, will be sending to counselor of respective institute for counseling session.

      The purpose of counseling:
       To understanding students problems in daily life and academic achievement
       To consult students to overcome their problem
       To learn coping skills against stress
       To modify students attitude and behavior status

      The counseling session will be conducting every month, prior to examination, after examination and after obtaining academic results.

      4. Modifying the curriculum and study environment. The purpose of the
      modification in the curriculum is mainly to achieve a balance between
      the content and time distribution among medical students.
      Few changes and requirement at studying campus, such as:
       More student-friendly campus, teaching and assessing methods, establishing a student counseling centre in the campus with qualified and experienced staff,
       Improving the facilities and interesting program for extracurricular activities in the campus to reduce Psychological Stress, and strengthening and activating a tutorial system in the colleges.
       It is also necessary to undertake further study focusing on academic issues to identify the specific factors associated with stress among medical students

      5. Greater emphasis should be placed on health programs including as mentioned above such as stress management to help students cope with the stress of tertiary education. These programs should in fact be implemented in all universities. The ultimate aim is to help medical students to understand what is required of them and to adapt to stressful environment as quickly as possible
    • Amina Jangu Alhassan (Viewer) 24th Nov 2015 - 4:11 AM
      I see your comments as more suggestions for future research. They are very good suggestions for any researcher willing to seek more answers to the current research problem.

  • COMMENT - 3

  • Valentina Arkorful (Viewer) 19th Nov 2015 - 11:11 AM
    1.A good topic .
    2.A good conceptual framework
    3.A mixed method approach would have given you a complete picture
    4. Please clarify the period for stress
    4.Good work!
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 11:18 AM
      Period for stress:
      Thank you so much for your comments.
      There were no specific criteria for period of stress; we conducted the study through emailed questionnaires.
      Students from each batch were told to fill up the questionnaires, after data collection and data analyses, the most affected batch were year 2 and followed by batch year 1.
      Once check on the internal and external factor with the students, we found out this batch were in their final preparation for their yearly professional exam.
      Therefore, we believe that their Psychological stress and Depression may be due to examination. However, still cannot be neglected because it shows students do not have good adaptation to stress.

  • COMMENT - 4

  • Bhavita Patel (Viewer) 19th Nov 2015 - 9:24 PM
    Hiii... Really a good topic....does this stress have some relation with good marks scoring students and poor students...what can be done for reducing stress & depression ??
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 12:56 PM
      1. Our study focuses on Association between Psychological Stress and Depression among undergraduate medical students
      General Characteristics:
      - Gender, age, ethnicity
      - Academic year in Medical

      School
      - Friends
      - Exercise and free time activity
      - Sharing problem
      - Staying place
      - Parents’ status
      - Financial status
      - Part-time job
      - Family income

      Psychological stress (independent variable):
      - Symptoms of Psychological stress

      Our study more concern on student's Psychological Stress based on the General Health Questionnaire (GHQ-12) which may indirectly affect in their academic performance.
      This study can be conduct on the same sample, to assess specific on their academic performance to find association of Psychosocial stress with their academic performance.




      2. Reduce stress & Depression, we have included in our recommendation which involves:

      1. Enhancing the personal development of each student, establishing mentor relationships and placing a greater emphasis on health programs including stress management, in order to help students cope with the stress of tertiary education.

      2. Medical faculties should introduce Foundation Courses for new students which provide an overview of what to expect in medical school, as well as lectures on study techniques, stress and time management.

      3. Student Mentorship Program which offers consultation to students from academic staff and senior medical students.

      The questions involve regarding mentee’s:

      § Socio-demographic feature and academic results

      § Situation causing the most stress for them

      § Their ways of coping with stress





      Monitoring of each mentee’s will be every month and they are required to provide feedback on their needs, academic difficulties and how they try to overcome their stress. Based on feedback provided, Counseling students, who affect by psychological stress and lead to depression during study period in medical university, will be sending to counselor of respective institute for counseling session.



      The purpose of counseling:

      § To understanding students problems in daily life and academic achievement

      § To consult students to overcome their problem

      § To learn coping skills against stress

      § To modify students attitude and behavior status



      The counseling session will be conducting every month, prior to examination, after examination and after obtaining academic results.



      4. Modifying the curriculum and study environment. The purpose of the

      modification in the curriculum is mainly to achieve a balance between

      the content and time distribution among medical students.

      Few changes and requirement at studying campus, such as:

      § More student-friendly campus, teaching and assessing methods, establishing a student counseling centre in the campus with qualified and experienced staff,

      § Improving the facilities and interesting program for extracurricular activities in the campus to reduce Psychological Stress, and strengthening and activating a tutorial system in the colleges.

      § It is also necessary to undertake further study focusing on academic issues to identify the specific factors associated with stress among medical students



      5. Greater emphasis should be placed on health programs including as mentioned above such as stress management to help students cope with the stress of tertiary education. These programs should in fact be implemented in all universities. The ultimate aim is to help medical students to understand what is required of them and to adapt to stressful environment as quickly as possible

  • COMMENT - 5

  • OLAWUWO Samuel Olutunde (Viewer) 21st Nov 2015 - 4:07 AM
    Good study, but no institutional affiliation for authors. Secondly, the study has being published elsewhere- Journal of community Medicine. In the light of this, this will amount to double publication.
    • Roy Rillera Marzo (Author) 21st Nov 2015 - 11:34 AM
      Hello Dr Olawuwo.
      This is a research from our students in Public Health but I guided all through out their study. I am Fellow and Masters in Public Health and Occupational Medicine. Currently, I am the Deputy Dean of the said university. We haven't published our research for other journals, if there is, please let me know specifically where we can access. Thanks a lot.
      • OLAWUWO Samuel Olutunde (Viewer) 23rd Nov 2015 - 12:50 PM
        Thanks Dr ROY RILLERA MARZO ,
        I appreciate your explanation. I saw Journal of Community Medicine as the running head on the copy of your work which I downloaded on the conference site.
        • Roy Rillera Marzo (Author) 24th Nov 2015 - 6:43 PM
          Hello Dr. I checked in the Journal of Community Medicine, there is one study about Depression also among medical students but not same authors.

  • COMMENT - 6

  • Amina Jangu Alhassan (Viewer) 24th Nov 2015 - 3:52 AM
    Hello Rajamanickam et al
    Is it possible for you to have design your own data collection instrument? The prevalence rates of 39.7% and 38.2% for psychological stress and depression respectively among medical students is alarming. I think the findings of the study should be a wake-up call for all medical teaching institutions.
    • Roy Rillera Marzo (Author) 24th Nov 2015 - 6:48 PM
      Hello Ms Amina. I strongly agree with you. I presented this study in the management and for the next year, applicants of medical students in our university will go through Psychological test because we cannot deny the fact that in medical course, it is very demanding and stressful environment. Then maybe after 2 years, we will conduct another study if this recommendation we did is really helpful to our medical students especially in handling stress. Thanks for your comments Mam.