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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 37  |  Issue : 2  |  Page : 198-206

Comparison of stress, anxiety, depression, and coping between medical and engineering students


1 Department of Psychiatry, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India
2 Department of Forensic Medicine, Jawaharlal Nehru Medical College, Sawangi, Maharashtra, India
3 Department of Civil Engineering, B.D. College of Engineering, Wardha, Maharashtra, India
4 Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
5 Department of PSM, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India

Date of Submission05-May-2020
Date of Decision30-Jun-2020
Date of Acceptance08-Jul-2020
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Sachin Ratan Gedam
Department of Psychiatry, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_101_20

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  Abstract 


Background: The various studies globally emphasized that the students from professional courses are subjected to a higher level of stress, anxiety, depression, and suicides. Objectives: The aim of this study is to estimate the prevalence's of stress, anxiety, and depression among medical and engineering students; to assess the source of stressors and coping strategies among them and to determine the association of anxiety and depression between both the fields of students with stress. Materials and Methods: This cross-sectional study was conducted among 319 students from medical and engineering colleges. They were assessed using semi-structured data; depression, anxiety and stress scale-21; coping inventory for stressful situations-21 and sources of academic stress among students. Results: The levels of stress, anxiety, and depression among medical students were found to be 37.27%, 73.37%, and 60.94%, respectively, while that among engineering students were 29.3%, 78%, and 59.3%, respectively. There was significant difference between medical and engineering students, who fall under the category of stress on the basis of age, gender, religion, socioeconomic status, and satisfaction with the academic performance (P < 0.05). The significant differences were also observed between both the fields of students with anxiety and depression (P < 0.05). Conclusion: The stress, anxiety, and depression levels were found to be high among both the groups of students. Academic factors were main source of stressors and both the field of students adopted task-oriented coping strategy a little more to deal with their stressors. Thus, professional students should be provided with appropriate counseling and stress relieving activities to improve quality of life.

Keywords: Anxiety, coping strategy, depression, engineering students, medical students, stress


How to cite this article:
Gedam SR, Patond S, Saklecha P, Vaidya M, Babar V. Comparison of stress, anxiety, depression, and coping between medical and engineering students. Indian J Soc Psychiatry 2021;37:198-206

How to cite this URL:
Gedam SR, Patond S, Saklecha P, Vaidya M, Babar V. Comparison of stress, anxiety, depression, and coping between medical and engineering students. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Nov 28];37:198-206. Available from: https://www.indjsp.org/text.asp?2021/37/2/198/320217




  Introduction Top


Stress can be defined as “any challenge to homeostasis,” or to the body's internal sense of balance.[1] There are well-known definitions which emphasize stress as “any factor that has an adverse effect on the functioning of the body or threatens the health of an individual” (Oxford Medical Publications, 1985). In today's era, every other day people are getting introduced to newer and remarkable discoveries with intention to make their lives easier. Although the betterment of the country lies on the whole nation, it is the young adults who are considered to be the most responsible part of the entire population. The pressure on the young students is increasing day by day because of pressure to compete, work hard, such other requirements and to excel in every area of life which puts them under utmost pressure and are being affected in a variety of ways.[2] The stress experienced by students may adversely affect their personal well-being, academic achievement and long-term professional capabilities.[3] Students of medical and engineering courses face many stressful changes in their life due to living away from home, making the transition to a more independent but less supported condition, high parental expectations and huge fees.[4] Academic factors such as long hours of preparation along with emotional factors such as little peer support, authoritative and officious faculty, competitive environment, financial difficulties, staying in hostels away from home, lack of facilities for recreation, and uncertain future may lead to stress and anxiety among medical and engineering students.[5]

Stress can lead to interruptions of both physical and mental health. It can cause depression and anxiety coping with the help of analgesics, drugs; smoking, alcohol and eating actually are counterproductive and may worsen the stress. Some students find it hard to cope with the stress and lag behind while others see the pressure as challenge to work harder.[6] University students are almost four times more prone toward stress, anxiety, and depression that might be attributed to the increasing demand of universities' curriculum.[7] Depression in clinical terms refers to a condition which involves persistent low or irritable mood along with the feelings of hopelessness, helplessness, lack of interest, and joy in everyday happenings.[8] The term anxiety refers to subjective feelings of apprehension and fear of some unexpected happening which are often accompanied by physical sensations such as hypertension, high heart rate, and so forth.[9]

Review of literature reported that the students who are enrolled in medical are more vulnerable to stress, anxiety and depression.[10] Other study shows that anxiety symptoms were found to be slightly higher in social sciences students, while medical students had more depressive symptoms.[11] Leahy et al. observed that distress level was higher in engineering students as compared to the health disciplines (medical and psychology).[12] Various studies around the globe have emphasized that students in medical, dental, and engineering courses experience higher stress owing to the academic schedule of the courses.[13] Further family and society have very high expectations from them and they need to read many hours a day routinely to understand vast field of the study.[14] Some studies have observed that medical students face more distress as compared to engineering students, but there are few from India.[15]

The stress, anxiety, and depression among medical and engineering students affect not only their academic performance but also their health. However in India, there is limited research on this area of comparative study. Here, the students from different profession were selected to understand whether there are any differences in factors affecting stressors between both the groups. It might help the students to deal with such factors to improve their performance. The study also become pertinent as is being carried out with a view to know the opinion of students toward the problems and difficulties being faced in medical and engineering. The objectives of the present study were: (1) to estimate prevalence of stress, anxiety, and depression among medical and engineering students; (2) to assess source of stressors and coping strategies among them; and (3) to determine association between medical and engineering students who fall under the category of stress, anxiety, and depression with sociodemographic factors.


  Materials and Methods Top


A cross-sectional survey was conducted on medical students of Jawaharlal Nehru Medical College and engineering students of B D College of Engineering in the city of Wardha, Maharashtra during June-July 2017. The study was conducted after obtaining approval from the Ethics committee of concerned university and permission from both college authorities. The written informed consent was obtained from students before collecting the data. The total number of student as much as available in the lecture was selected and it covered about 332 students aged 18–26 years through simple random sampling. Of the total participants, 13 student's data were excluded from the study due to incomplete or incorrect submission of the forms. Thus, a total of 319 students included in the present study and there was no reward for participation. The students were evaluated as groups in classrooms after justifying the purpose of study and necessary instructions were given.

Tools

The data were collected by the following tools:

  1. The semi-structured data that contained the details of age, gender, religion, educational qualification, socioeconomic status, addiction status, attendance in classes, physical problems, satisfaction with studies and addiction other than smoking as per other substance-related disorder criteria
  2. Depression, Anxiety and Stress scale (DASS-21):[16] It is a 21 item self-report questionnaire designed to measure the severity of core symptoms of depression, anxiety and stress. Each item is scored from 0 to 3. It is a short form version of the DASS (the long form has 42 items). DASS-21 is reported to have very good Cronbach's alpha value for depression and anxiety (0.84 and 0.74, respectively). The cutoff values have been developed for defining mild/moderate/severe/extremely severe scores for each DASS scale
  3. Coping Inventory for stressful situations-21:[17] It is assumed to assess coping by three basic coping strategies such as avoidance, emotion-oriented, and task-oriented. It contains 21 items with each subscale consists of 7 items measured on 5-point Likert scale. Higher score of each factor indicates the more frequent use and greater effectiveness of that specific coping strategy. It has also reported high internal consistencies for all the three subscales, and also provide as a good factor structure
  4. Sources of academic stress among students:[18],[19] The questionnaire consisted of 30 items and potential stressors were divided into four categories such as relationship factors (6 items), personal factors (9 items), academic factors (9 items), and environmental factors (6 items). It was measured on five-point Likert scale ranging from 1 = no stress to 5 = highly stressful. The higher score indicates more the specific stressor.


Statistical analysis

Statistical analysis was performed by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test and software used in the analysis were SPSS 24.0 version. Value of P < 0.05 is considered as significance level.


  Results Top


In the present survey, 319 students participated which included 169 MBBS students and 150 engineering students. The mean age of the MBBS students was 19.76 (±0.98) years and that of engineering students was 20.52 (±1.55) years. Female students (60.9%) were more among MBBS and male students (57.3%) were more among engineering comparatively. Most of the participants belong to Hindu religion and coming from upper socioeconomic status in both the groups. Further majority of the students were found to be moderately satisfied with their studies, regular in attendance, had no physical problems, nonsmokers, and no addiction status. The sociodemographic factors such as gender, religion, socioeconomic status, satisfaction with academic performance, attendance, and addiction other than smoking were found to be significantly different between medical and engineering students [Table 1].
Table 1: Sociodemographic characteristics of the study participants

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The overall prevalence's of stress, anxiety, and depression (mild to very severe) among the medical students were found to be 37.27%, 73.37%, and 60.94%, respectively, whereas that among the engineering students were found to be 29.3%, 78%, and 59.3%, respectively. There were no significant associations of DASS scores between medical and engineering students [Table 2].
Table 2: Comparison of depression, anxiety, and stress scale scores between medical and engineering students

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The coping strategies such as avoidance, emotion-oriented, and task-oriented had significant difference between the medical and engineering students (P < 0.05). Among the source of stressors, academic factor was found to be significantly different between both the groups (P < 0.05), while others such as relationship, personal, and environmental factors had no significant difference (P > 0.05) [Table 3] and [Table 4].
Table 3: Comparison of coping strategies among study participants

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Table 4: Comparison of stressors among study participants

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The sociodemographic variables such as age, gender, religion, socioeconomic status, and satisfaction with the academic performance found to be significantly different between both the stressful groups of students with high stress among students belong to Hindu religion, upper socioeconomic status and those who were moderately satisfied with academic performance (P < 0.05). Between both the fields of students with anxiety symptoms; the socioeconomic factors such as gender, religion, socioeconomic status, satisfaction with the academic performance, regularity of attendance and addiction other than smoking had significant difference with higher level anxiety reported among students belong to Hindu religion, upper socioeconomic status, those who were moderately satisfied with academic performance, regular in attendance and no addiction other than smoking (P < 0.05). Whereas, between those with the depressive symptoms, the variables such as gender, religion, socioeconomic status, satisfaction with the academic performance, regularity of attendance, and addiction other than smoking had significant difference with higher depression scores reported among students belong to Hindu religion, upper socioeconomic status, those who were moderately satisfied with academic performance, regular in attendance and no addiction other than smoking (P < 0.05) [Table 5], [Table 6], [Table 7].
Table 5: Association of sociodemographic variables between stressful medical and engineering students

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Table 6: Association of sociodemographic variables between medical and engineering students with anxiety

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Table 7: Association of sociodemographic variables between medical and engineering students with depression

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  Discussion Top


In the present study, total prevalence's of stress among medical and engineering students were found to be 37.27% and 29.3%; that of anxiety were found to be 73.37% and 78%; while that of depression were found to be 60.94% and 59.3%, respectively, according to the DASS scale. This finding is in accordance with the previous study stating that medical students are more prone to stress as compared to engineering students. Khan et al. in their study reported that 62% of medical students and 36% of engineering students had stress in their lives; depression (mild to moderate) was reported in 62% of MBBS students and 36% of engineering students; whereas 54% of MBBS and 38% of engineering students had phobia.[20] In another comparative study, the levels of depression and anxiety were more in medical students as compared to engineering students.[21] Naveen et al. in their study as per DASS scale observed that the proportion of stress, anxiety, and depression among MBBS students was 32.9%, 46.7%, and 38.2%, respectively. While that among the engineering students was 34.2%, 52%, and 37.5%, respectively.[22] Further, Muddgal A and Pyari D in their study observed that mean total scores of stress and anxiety were more in engineering students as compared to medical students while mean total score of depression was more in medical students as compared to engineering students.[23] The stress levels of medical students found to be higher than those of engineering students could be due to the vastness of course that has to be covered in a relatively short amount of time, too many deadlines that are difficult to meet and inability to relax due to feelings of guilt by MBBS students.[6] The different screening methods used to determine the stress may have contributed to the differences in the observed prevalence of stress in various studies.[24]

In this study, stress, anxiety, and depression scores had no significant difference between the two group of students (P < 0.05). Our findings are contradictory to that of previous studies such as Khan et al., reporting that depression, phobia and academic stressors were statistically significant between medical and engineering students.[20] Another comparative study of depression and stress among medical and engineering students also reported significant difference of anxiety and depression levels between these two groups of students.[21] Naseem and Munaf further observed a significant difference in the level of depression, anxiety, and stress among medical, engineering, and social sciences students. The insignificant difference in the present study could be because students from different faculties seek treatment for their problems and almost equal levels of depression and anxiety present among students from different disciplines.[2]

The results also reported that sociodemographic variables such as age, gender, religion, socioeconomic status, and satisfaction with academic performance were statistically significant between medical and engineering students with stress. This finding is almost similar to that reported by Waghachavare et al. in his study that the stress among different professionals was significantly associated with participant's field of education, gender, age, and permanent residence.[24] Balaji et al. found that age of the students; gender, socioeconomic status and academic performance were significantly associated with stress among medical and engineering students. Its implying that socioeconomic status and academic performance influences the stress among students. The probable reason could be that impaired concentration, difficulty in the retrieval of learned information, other physiological and psychological changes, slowing of cognitive processes reduce the performance levels in examinations and thus reduce academic performance.[25] Our results reported that females in the medical field and males in the engineering field were more stressful, which may be attributed to the fact that females and males outnumber in medical and engineering colleges, respectively.

In the present study, both the medical and engineering students mostly adopted task-oriented coping strategies to deal with their stressors as compared to avoidance and emotion-oriented. All the coping strategies were significantly different between both groups of students (P < 0.05). Coping strategies refer to the specific efforts, both psychological and behavioral, that people employ to master, reduce, tolerate, or minimize stressful events.[26] Avoidance-oriented coping strategies describes activities and cognitive changes aims at avoiding the stressful situation; task-oriented coping is described as purposeful task effort aimed at solving the problem, or attempt to alter the situation; while emotion-oriented coping describes turning to religion, positive reinterpretation, acceptance and seeking of emotional support.[27],[28] Previous studies also reported that active coping strategies were used more than the avoidant strategies by the students of medical and engineering streams. In the medical stream, strategies such as active coping, positive reframing, planning, and acceptance were used most frequently, while avoidant strategies like substance abuse were least used. The problem-solving strategy leads to the attainment of a higher level of academic achievement and success.[3],[25],[29],[30],[31],[32]

In the current study, among the source of stressors, academic factors were found to be comparatively more in both the field of students, but academic stressors were a little less in medical as compared to engineering students, probably because of less frequent examinations when compared to engineering stream. The academic factor was the only stressor found to be significantly different between both the fields of students (P < 0.05). In contrast, a study in Malaysia on medical students reported that important sources of stressors were worries of the future, financial difficulties, study in general, hearing bad news, and interpersonal conflicts. On the other hand, poor communication skills by faculty, careless marking by them, and added responsibilities by family may cause stress and anxiety in engineering students.[3],[33] Whereas researchers such as Al-Dabal et al., Abu-Ghazaleh et al., and Behere et al., studied the importance of various academic factors in the development of stress among the students, which are in accordance with the findings of the present study.[15],[34],[35]

In the present study, a significant association between both the group of students with anxiety and depression were reported with respect to gender, religion, socioeconomic status, satisfaction with academic performance, regularity of attendance and addiction other than smoking (P < 0.05). Balaji et al., in their study, observed the significant association of gender, socioeconomic status, and academic performance with anxiety among medical and engineering students, which are in accordance with our findings.[25] The probable reason of increased anxiety among medical students was the fear of failure and losing 6 months that makes them to be separated from the main batch for the rest of the study period, adjustment problems with their environment, the vastness of syllabus and complexity of the subjects. In the case of engineering students, the reason of anxiety could be fear of failure in examination, losing 6 months and falling back from the main batch; and the role of parental pressure.[25] Further, a negative relationship was found between anxiety and academic performance, wherein increased anxiety caused decreased performance. The probable reason could be increased anxiety affects the speed of cognitive processing, process of registration, and retrieval during the examination time. There is also impaired concentration and difficulty in reading for a long number of hours. These factors lead to the loss of confidence in self, frustration, and inability to handle the situation.[25] On the other hand, less anxious students sustain their focus throughout information processing and retrieval and build up acceptable study habits. They stay on task and perform well in examinations because they have less disruptive thoughts and less cognitive breakdowns.[5],[30],[36],[37] In contrast, few studies have reported that anxiety caused better performance in students.[38],[39]

The variations were observed in the results of our study and previous literature with respect to levels of stress, depression, and anxiety; coping strategies; sources of stressor and its correlations among the study participants. These variations could be attributed to geographical and social variations and differences in methodological evaluation. It was tried to demonstrate the association of stress, anxiety, and depression with related factors between two fields of students in this study. These findings will help us to identify the factors related to stress and psychological symptoms and design a more effective intervention for this susceptible group. Similar results need to be conducted in different colleges among large samples so that the results can be generalized.

Limitations

The sample size is small, the results cannot be generalized as this study includes participants from a single region, and social desirability bias can be present.


  Conclusion Top


The level of stress was higher among medical students as compared to engineering students. The anxiety and depression levels were also found to be high among both the field of students in comparison to previous literature. Academic factors were the main source of stressors, hence the need for specific and targeted measures to decrease substantially the burden of stress on the students. College environments and teaching techniques should be adapted to the needs of the students. Both medical and engineering students used task-oriented coping strategies little more than the avoidant strategies to deal with their stress. Thus, the majority of students were in favor of stress management techniques, and hence, steps should be taken to include those in curriculum. Health is a major concern of students, and therefore, the promotion of healthy lifestyle and dietary habits should be encouraged. Stress-reducing techniques need to be encouraged in professional courses, and counselors should be provided in professional courses for effective addressing and solving the problems. Finally, adequate preparation and regular study habits can help students to avoid stress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mane AB, Krishnakumar MK, Niranjan PC, Hiremath SG. Differences in perceived stress and its correlates among students in professional courses. J Clin Diagn Res 2011;5:1228-33.  Back to cited text no. 1
    
2.
Naseem S, Munaf S. Suicidal ideation, depression, anxiety, stress, and life satisfaction of medical, engineering, and social sciences students. J Ayub Med Coll Abbottabad 2017;29:422-7.  Back to cited text no. 2
    
3.
Al-Dubai SA, Al-Naggar RA, Alshagga MA, Rampal KG. Stress and coping strategies of students in a medical faculty in Malaysia. Malays J Med Sci 2011;18:57-64.  Back to cited text no. 3
    
4.
Barikani A. Stress in medical students. J Med Educ 2007;11:41-4.  Back to cited text no. 4
    
5.
Singh I, Jha A. Anxiety, optimism and academic achievement among students of private medical and engineering colleges: A comparative study. J Educ Dev Psychol 2013;3:222-33.  Back to cited text no. 5
    
6.
Jafri SA, Zaidi E, Aamir IS, Aziz HW, Imad-Ud-Din, Shah AH. Stress level comparison of medical and nonmedical students: A cross sectional study done at various professional colleges in Karachi, Pakistan. Acta Psychopathologica 2017, 3:2.  Back to cited text no. 6
    
7.
Meglio F. Stress Takes Its Toll On College Students; 2012. Available from: http://www.businessweek.com/articles/2012-05-10/stresstakes- its-toll-on-college-students. [Last accessed on 2012 Nov 09].  Back to cited text no. 7
    
8.
National Institute for Health and Clinical Excellence. Depression–Background Information; 2011. Available from: http://www.cks.nhs.uk/depression/backgroundinformation/definition. [Last accessed on 2012 Nov 10].  Back to cited text no. 8
    
9.
Tabrizi EA, Yaacob SN. Relationship between creative thinking and anxiety among adolescent boys and girls in Tehran, Iran. Int J Humanit Soc Sci 2011;1:60-6.  Back to cited text no. 9
    
10.
Baldassin S, Alves TC, de Andrade AG, Nogueira Martins LA. The characteristics of depressive symptoms in medical students during medical education and training: a cross sectional study. BMC Med Educ 2008;8:60.  Back to cited text no. 10
    
11.
Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression in medical students and in humanities students: relationship with big-five personality dimensions and vulnerability to stress. Int J Soc Psychiatry 2008;54:494-501.  Back to cited text no. 11
    
12.
Leahy CM, Peterson RF, Wilson IG, Newbury JW, Tonkin AL, Turnbull D. Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study. Aust N Z J Psychiatry 2010;44:608-15.  Back to cited text no. 12
    
13.
Sharifirad G, Marjani A, Abdolrahman C, Mostafa Q, Hossein S. Stress among Isfahan medical sciences students. J Res Med Sci 2012;17:402-6.  Back to cited text no. 13
    
14.
Modi K, Kumar D. Anxiety and depression in medical students and its association with coping methods adopted by them. IJRRMS 2013;3:20-2.  Back to cited text no. 14
    
15.
Behere SP, Yadav R, Behere PB. A comparative study of stress among students of medicine, engineering, and nursing. Indian J Psychol Med 2011;33:145-8.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed.. Sydney, Australia: Psychology Foundation; 1995.  Back to cited text no. 16
    
17.
Endler NS, Parker DA. Coping Inventory for Stressful Situations (CISS): Manual. 2nd ed.. Toronto: Multi Health Systems; 1999.  Back to cited text no. 17
    
18.
Yumba Wycliffe. Academic Stress: A Case of the Undergraduate students; 2010. Available from: https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A556335. [Last accessed on 2012 Sep 27].  Back to cited text no. 18
    
19.
Dema K. Sources of Academic Stress: A study on selected. RIM: Tertiary Institutions in Bhutan; 2015.  Back to cited text no. 19
    
20.
Khan M, Fatima A, Shanawaz M, Fathima M, Mantri A. Comparative study of stress and stress related factors in medical and engineering colleges of a South Indian City. J Evol Med Dent Sci 2016;5:3053-6.  Back to cited text no. 20
    
21.
Devi LS, Fatma N. A comparative study of depression and anxiety among medical and engineering students. Int Educ Res J 2016;2:116-7.  Back to cited text no. 21
    
22.
Naveen S, Swapna M, Jayanthkumar K, Manjunatha S. Stress, anxiety and depression among students of selected medical and engineering colleges, Bangalore a comparative study. Int J Public Ment Health Neurosci 2015;2:14-18.  Back to cited text no. 22
    
23.
Muddgal A, Pyari D. A comparative study of anxiety, depression and stress among medical and engineering students. Int J Sci Res 2016;5:41-4.  Back to cited text no. 23
    
24.
Waghachavare VB, Dhumale GB, Kadam YR, Gore AD. A study of stress among students of professional colleges from an urban area in India. Sultan Qaboos Univ Med J 2013;13:429-36.  Back to cited text no. 24
    
25.
Balaji NK, Murthy PS, Kumar DN, Chaudhury S. Perceived stress, anxiety, and coping states in medical and engineering students during examinations. Ind Psychiatry J 2019;28:86-97.  Back to cited text no. 25
[PUBMED]  [Full text]  
26.
Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997;4:92-100.  Back to cited text no. 26
    
27.
Wan Salwina WI, Raynuha M, Ainsah O, Idayu BI, Aniza I. Stress and coping styles: The experience of nursingn staff working at two public hospitals in Klang Valley, Malaysia. Med Health 2009;4:101-7.  Back to cited text no. 27
    
28.
Nikmat AW, Mariam M, Ainsah O, Salmi R. Psychological well being, stress and coping style among pre clinical medical students. Res management in state. University Teknol 2010. Available from: http://eprints.ptar.uitm.edu.my/3218/1/LP_AZLINA_WATI_NIKMAT_10_24.pdf. [Last accessed on 30 November 20].  Back to cited text no. 28
    
29.
Sreeramareddy CT, Shankar PR, Binu VS, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007;7:26.  Back to cited text no. 29
    
30.
Afzal H, Afzal S, Siddique SA, Naqvi SA. Measures used by medical students to reduce test anxiety. J Pak Med Assoc 2012;62:982-6.  Back to cited text no. 30
    
31.
Gade S, Chari S, Gupta M. Perceived stress among medical students: To identify its sources and coping strategies. Arch Med Health Sci 2014;2:8-86.  Back to cited text no. 31
    
32.
Gaudreau P, Miranda D. Coping across time, situations, and contexts: A conceptual and methodological overview of stability, consistency, and change. In: Nicholls AR, editor. Coping in Sport: Theory, Methods, and Related Constructs. Hauppauge (NY): Nova Science Publishers; 2010. p. 10-32.  Back to cited text no. 32
    
33.
Rajput MS, Alvi MS, Rizwan A. Analysis of factors affecting the stress level of engineering students. Int J Eng Educ 2010;26:681-6.  Back to cited text no. 33
    
34.
Al-Dabal BK, Koura MR, Rasheed P, Al-Sowielem L, Makki SM. A comparative study of perceived stress among female medical and non-medical University students in Dammam, Saudi Arabia. Sultan Qaboos Univ Med J 2010;10:231-40.  Back to cited text no. 34
    
35.
Abu-Ghazaleh SB, Rajab LD, Sonbol HN. Psychological stress among dental students at the University of Jordan. J Dent Educ 2011;75:1107-14.  Back to cited text no. 35
    
36.
Elias H, Ping WS, Abdullah MC. Stress and academic achievement among undergraduate students in University Putra Malaysia. Procedia Soc Behav Sci 2011;29:646-55.  Back to cited text no. 36
    
37.
Chapell MS, Blanding ZB, Silverstein ME, Takahashi M, Newman B, Gubi A, et al. Test anxiety and academic performance in undergraduate and graduate students. J Educ Psychol 2005;97:268-74.  Back to cited text no. 37
    
38.
Siraj HH, Salam A, Roslan R, Hasan NA, Jin TH, Othman MN. Stress and its association with the academic performance of undergraduate fourth year medical students at University Kebangsaan Malaysia. Int Med J Malaysia 2014;13:19-24.  Back to cited text no. 38
    
39.
Rafidah K, Azizah A, Norzaidi MD, Chong SC, Salwani MI, Noraini A. Stress and academic performance: Empirical evidence from university students. Acad Educ Leadersh J 2009;13:37-51.  Back to cited text no. 39
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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