|Year : 2015 | Volume
| Issue : 3 | Page : 121-126
Perceived sources of stress among dental college students: An Indian perspective
Tegbir Singh Sekhon1, Simran Grewal2, Ramandeep Singh Gambhir3, Sumit Sharma4
1 Department of Periodontology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India
2 Department of Physiology, MM University, Solan, Himachal Pradesh, India
3 Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
4 Department of Periodontology, Surendra Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
|Date of Web Publication||21-Aug-2015|
Ramandeep Singh Gambhir
Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura - 140 601, Punjab
Source of Support: None, Conflict of Interest: None
Background: Identification of the potential sources of stress is important in dental education program, as it gives opportunity to take various measures to prevent stress in the dental school environment. The purpose of the present study was to address various sources of stress among dental school students and its relation with gender and year of the study. Materials and Methods: A questionnaire based cross-sectional study was conducted among 3 rd and 4 th year students of a dental school. Questionnaire used in the study comprised the modified version of the questionnaire used in Dental Environmental Stress. A four-point Likert scale was used to record the responses from the subjects. A total of 174 subjects participated in the study. Statistical analysis was done using SPSS package version 16. Results: Of the participants, 39% (68) were males and 61% (106) were females. Majority of students felt stressed about academic performance, clinic/patient related stress, and career related stress. Top stressors in academic performance related stress were exam and grade stress (95%), followed by fear of failing (90.5%), lack of time between tests/clinics, and criticism at work (94%). Mean stress scores were significantly related to year and gender of students. Conclusion: Worries about fulfilling clinical requirements, academics, exam stress, and insecurity regarding career were the major sources of stress reported by the clinical year dental students in the present study.
Keywords: Dental students, environment, performance, profession, stress
|How to cite this article:|
Sekhon TS, Grewal S, Gambhir RS, Sharma S. Perceived sources of stress among dental college students: An Indian perspective. Eur J Gen Dent 2015;4:121-6
|How to cite this URL:|
Sekhon TS, Grewal S, Gambhir RS, Sharma S. Perceived sources of stress among dental college students: An Indian perspective. Eur J Gen Dent [serial online] 2015 [cited 2019 Dec 9];4:121-6. Available from: http://www.ejgd.org/text.asp?2015/4/3/121/163335
| Introduction|| |
Stress is a part of everyone's life. Stress is defined as the pattern of specific and nonspecific responses an organism makes to stimulus events that disturb its equilibrium and tax or exceed its ability to cope.  It is normal for everybody to experience stress to some extent, but too much stress may be harmful. Attending a school, college or university is a rewarding experience but it is also a time of considerable anxiety and stress for students.  Students are subjected to different kinds of experiences which makes them vulnerable to undergo a lot of stress. Stress may affect students' social, physical, and mental health.  Deterioration in the health of students may affect learning ability and academic performance as well as goal achievement.
Education of dentistry is viewed as a complex, demanding, and pedagogical learning experience.  It has been widely acknowledged that dentistry students need to acquire diverse proficiencies such as theoretical knowledge, clinical competencies, and interpersonal skills which are associated with high levels of stress.  Expertise in dentistry require clinical and patient management skills which contribute toward stress perceived by students. The academic demands, manual dexterity, and clinical management skill requirement expose dental students toward stresses which are quite dissimilar as compared to students in other academic fields. This stress can lead to depression, anxiety, absenteeism, diminished work efficiency, and burnout in the students. 
Scientific evidence shows the multifactorial nature of stress among students. Data from previous studies indicate that academics, examination, fear of failing, clinical training, financial resources, fear of facing parents after failure, and fear of unemployment cause major stress in students. ,, Hence, the multifactorial etiology of the stress in dental education requires evaluation for complexity and eradication in the near future.
Though a few studies have been carried out on exploring the stressors and coping styles of medical and dental undergraduates, , there is a dearth of work regarding stress sources in Indian undergraduate dental students. Hence, this study was aimed to determine the potential sources of stress in undergraduate dental students. This knowledge could be used to institute requisite institutional changes, and encourage the healthy active strategies to combat stress and improve academic performance and psychological well-being of dental students.
| Materials and Methods|| |
Study setting and ethical clearance
An institutional cross-sectional study was conducted among undergraduate students of Sarabha Dental College in Punjab to evaluate the sources of stress among students in the dental school environment. Ethical clearance for conducting the study was obtained from the Institutional Ethics Committee. Informed consent was obtained from every subject prior to the start of the study.
Study population and sample
Study population consisted of 3 rd and 4 th (final) clinical year undergraduate students of the dental college. A universal sample of all 200 students who were enrolled in these 2 years batches were included in the study and participation in the study was voluntary. The response rate was 87%, therefore, the final sample comprised 174 subjects. A pilot survey was conducted on 10% of the study population to assess the feasibility of the study. The purpose of the study was explained well in advance to the students before the start of the study.
Measurement and instrument
A self-administered paper questionnaire was distributed to the students in their classes prior to lectures. An opportunity to ask questions were provided and clarifications were made. Questionnaire used in the present study comprised the modified version of the questionnaire used in Dental Environmental Stress (DES) survey, which was validated and translated to suit the Indian dental environment. Finally, 45 items were included in the questionnaire after removing and adding topics.  The stressors included in the questionnaire were derived by reviewing the literature. In the present study, stressors were modified according to the study requirements. There were six domains in the questionnaire namely academic performance, clinical and patient responsibility, faculty relations, personal issues, accommodation, and professional identity/career. The responses to the items were based on a four-point Likert scale with response options of 1 = not stressful, 2 = slightly stressful, 3 = moderately stressful, and 4 = very stressful. Students were asked to respond to each stressor referring to this scale. The students were given 30 min to complete the questionnaires. They were not allowed to discuss it among themselves during this time.
All the variables were entered into a personal computer and analyzed statistically. Results were statistically analyzed using SPSS package version 16.0 (SPSS, Chicago, IL, USA). The present study conducted the descriptive statistical analysis. Number and percentages were used to compute results on categorical measurements. Student's t-test was used for two group comparison. Comparison with gender and year of study was done by using analysis of variance (ANOVA). Statistical significance was set at P < 0.05.
| Results|| |
A total of 174 subjects participated in the present study. The students were in the age group of 18-23 years, with mean age group 20.49. Of 174 students, 39% (68) were males and 61% (106) were females. Female students outnumbered the male students in both the years [Figure 1].
|Figure 1: Distribution of study population according to year of study and gender|
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Various categories of stress perceived by students
While calculating the proportion of items considered as stressful in a dichotomous manner, the degree of perceived stress was ignored at this stage. [Table 1] depicts the percentage of students (3 rd and 4 th year) perceiving different sources of stress. Majority of students felt stressed about academic performance, clinic/patient related stress, and career related stress.
|Table 1: Distribution of various stresses among dental students in terms of percentages|
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Among clinical requirements, five items except were reported to be stressful by more than 80% of the students. Completion of clinical cases (100%), lack of confidence in making clinical decisions (96.5%), difficulty in learning precision skills (88), and patient being late or not showing up for appointments (98%) were the top stresses in this category.
Among academic performance related sources of stress (9 questions), five questions were reported to be stressful by >75% students. The stressors which topped the list were, exam and grade stress (95%), followed by fear of failing (90.5%), lack of time between tests/clinics, and criticism at work (94%).
Among faculty/institution related stress, the atmosphere created by faculty (83%) and rules or regulations at the workplace (65.5%) were the main stressors. Lack of recreational facilities (89%) and satisfaction regarding food quality (78%) were the top two stressors in accommodation related stress. Moreover, 67.5% of subjects also felt stressful while living away from home.
In the profession/career related stressors annexure (7 questions), six items were reported to be stressful by >85% of the students. Clinic set up (86.5%), lack of confidence to succeed (88%), insecurity concerning dental career (91%), unemployment fear (92%), and possibility to pursue postgraduation (85.5%) were the main stressors in this category. Lack of time for relaxation, financial constraints, lack of recreational facilities, traveling to college and back etc., were among the other factors, which were cited as sources of stress by more than 75% students.
Comparison with gender and year of study
The difference between genders was found to be statistically significant, and it was observed that male students had higher mean stress scores (DES) than their female counterparts (P = 0.02, Student's t-test). [Table 2] depicts the comparison of mean stress scores with gender and year of the study. Univariate analysis (ANOVA) indicated a significant difference of mean stress scores by the year of the study as well as gender (P < 0.05).
| Discussion|| |
Dental education has shown to be very stressful for students as reported by large number of studies. The findings are consistent across different countries, universities, and curriculums. , Clinical training includes learning clinical procedures, completion of specified number of patient procedures coupled with attending lectures and studying for examinations require the dental students to work harder and longer and adding to the overall stress.
Clinical and patient requirements were the greatest stressors reported by both 3 rd and 4 th year dental students. This finding is supported by earlier literature, which also suggested that clinical training issues impose a highest level of stress in dental students.  This stress could be because the dental students are required to complete a certain quota of cases to be eligible to appear in the final examination. Absence of early clinical exposure also triggers an anticipatory stress reaction in regard to the upcoming encounter with the patients and using their clinical skills to treat the patient at an early stage. This finding is in agreement with the findings of some previous study.  Attempt should be made to include soft skills required to handle patient as an integral part of the curriculum.
In academic performance related domain, exams, grade stress along with the fear of failing was reported as one of the major stressors reported by both the year students. Similar findings were reported in other studies conducted in some other part of the world. , This may be due to the fact that the dental curriculum requires lots of study and students feel overloaded by high academic demands. Large amount of information required to master in a short time makes them fearful of scoring well in the exams.
The exam and grade related stress was cited as major stressors by 95% of the subjects regarding academic performance related stresses in the study. Various other academic and clinical requirement factors were reported to be stressful in the present study and some other studies. , While some stress is inherent in dental education and probably normal, this universal phenomenon may be attributed to the academic pattern of some institutions (rules and regulations of workplace) which lays emphasis on scoring marks and passing the exams, rather than the process of actual learning. Thus, there is an urgent need to analyze and improve our evaluation system. Insecurity regarding future professional career was also high among both the years in the present study and another study conducting on Egyptian dental students.  Significant stress was reported by students for items dealing with anxieties regarding future, namely, fear of unemployment, pursuing postgraduation, the clinic set up, and to be a successful dentist. This is in agreement with previous literature.  The reason may be that the major issue affecting the present dental education system in India is heavy competition to gain a job following graduation or to achieve admission to postgraduation course.
The atmosphere created by the faculty was also reported stressful among students in the study. Students often receive criticism from the staff for the clinic and academic work. Students might feel stressed when criticized in front of the patients. Similar finding has been reported in some other Indian study.  However, the approachability and communication with teachers was not perceived stressful by the students in our study, suggesting that the students find it easier to communicate with the faculty in the institution.
The hostellers experienced more stress than day scholars as lack of recreational facilities, satisfaction regarding food quality, and living away from home were cited as stressful by a majority of subjects in the study. This may be related to the fact that students living away from parents encounter difficulties with adaptation to living alone in a new environment and being self-dependent.  Hence, this suggests that the quality of living and food in hostels should be improved, adequate facilities for recreation to be provided for relaxation, mentors and matrons should be appointed to make the students feel at home.
Financial resources and high parental expectations as nonacademic sources of stress were reported by many students in the present study and similar studies conducted in other countries. , Stress due to financial constraints can be explained by the fact that the cost of studying professional course like dentistry is high. Some parents finance their children through bank loans, books and instruments used during the academic tenure also costs very high. All these give the students the anxiety about the financial resources. The academic overload also results in a lack of time for relaxation, resulting in stress.
Statistically, significant difference was reported when mean stress scores were compared with year and gender of the students. Similar results were revealed in some other studies. , However, male students had comparatively more mean stress scores as compared to female students which is contrary with the findings of one of the above studies. 
The least stress provoking factor reported by both year students were related to interpersonal relationships, such as making friends and relationship with the opposite sex, indicating that the interpersonal communication skills of the students are fairly good. Besides this, drug, alcohol dependency and language barrier were also not perceived stressful by the students. This in accordance with study results of a study conducted in Bangalore, India. 
| Conclusion|| |
Our study confirms the findings of other studies that the prevalence of perceived stress is high among dental students. In our study, worries about fulfilling clinical requirements, academics, exam stress, and insecurity regarding career were the major sources of stress reported by the clinical year dental students. Male students suffered from higher stress as compared to females. Students should be taught positive coping strategies and various stress managing techniques to improve the ability to cope with the demanding professional course. A congenial learning environment needs to be created for better learning with less anxiety and fear.
| References|| |
Dyson R, Renk K. Freshmen adaptation to university life: Depressive symptoms, stress, and coping. J Clin Psychol 2006;62:1231-44.
Dahan H, Bedos C. A typology of dental students according to their experience of stress: A qualitative study. J Dent Educ 2010;74:95-103.
Divaris K, Barlow PJ, Chendea SA, Cheong WS, Dounis A, Dragan IF, et al.
The academic environment: The students′ perspective. Eur J Dent Educ 2008;12 Suppl 1:120-30.
Rajab LD. Perceived sources of stress among dental students at the university of Jordan. J Dent Educ 2001;65:232-41.
Pöhlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ 2005;9:78-84.
Kumar S, Dagli RJ, Mathur A, Jain M, Prabu D, Kulkarni S. Perceived sources of stress amongst Indian dental students. Eur J Dent Educ 2009;13:39-45.
Morse Z, Dravo U. Stress levels of dental students at the Fiji school of medicine. Eur J Dent Educ 2007;11:99-103.
Polychronopoulou A, Divaris K. A longitudinal study of Greek dental students′ perceived sources of stress. J Dent Educ 2010;74:524-30.
Nandi M, Hazra A, Sarkar S, Mondal R, Ghosal MK. Stress and its risk factors in medical students: An observational study from a medical college in India. Indian J Med Sci 2012;66:1-12.
Cherkil S, Gardens SJ, Soman DK. Coping styles and its association with sources of stress in undergraduate medical students. Indian J Psychol Med 2013;35:389-93.
Al-Omari WM. Perceived sources of stress within a dental educational environment. J Contemp Dent Pract 2005;6:64-74.
Heath JR, Macfarlane TV, Umar MS. Perceived sources of stress in dental students. Dent Update 1999;26:94-8, 100.
Sanders AE, Lushington K. Effect of perceived stress on student performance in dental school. J Dent Educ 2002;66:75-81.
Al-Saleh SA, Al-Madi EM, Al-Angari NS, Al-Shehri HA, Shukri MM. Survey of perceived stress-inducing problems among dental students, Saudi Arabia. Saudi Dent J 2010;22:83-8.
Telang LA, Nerali JT, Telang A, Chakarvarthy PV. Perceived sources of stress among Malaysian students. European J Gen Dent 2013;2:300-7.
Murphy RJ, Gray SA, Sterling G, Reeves K, DuCette J. A comparative study of professional student stress. J Dent Educ 2009;73:328-37.
Muirhead V, Locker D. Canadian dental students′ perceptions of stress. J Can Dent Assoc 2007;73:323.
Alzahem AM, Van der Molen HT, De Boer BJ. Effect of year of study on stress levels in male undergraduate dental students. Adv Med Educ Pract 2013;4:217-22.
Al-Samadani KH, Al-Dharrab A. The perception of stress among clinical dental students. World J Dent 2013;4:24-8.
Tangade PS, Mathur A, Gupta R, Chaudhary S. Assessment of stress level among dental school students: An Indian outlook. Dent Res J (Isfahan) 2011;8:95-101.
Acharya S. Factors affecting stress among Indian dental students. J Dent Educ 2003;67:1140-8.
Sedky NA. Perceived sources of stress among junior and mid-senior Egyptian dental students. Int J Health Sci (Qassim) 2012;6:141-57.
Gomathi KG, Ahmed S, Sreedharan J. Psychological health of first-year health professional students in a medical university in the United Arab Emirates. Sultan Qaboos Univ Med J 2012;12:206-13.
Musser LA, Lloyd C. The relationship of marital status and living arrangement to stress among dental students. J Dent Educ 1985;49:573-8.
Harikiran AG, Srinagesh J, Nagesh KS, Sajudeen N. Perceived sources of stress amongst final year dental under graduate students in a dental teaching institution at Bangalore, India: A cross sectional study. Indian J Dent Res 2012;23:331-6.
[Table 1], [Table 2]