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Cover page of the Journal of Health Sciences

 Table of Contents  
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 87-91

Does psychological health of future doctors affects academic performance? unmasking the masked

1 Department of Physiology, JIIUS Indian Institute of Medical Science and Research, Jalna, Maharashtra, India
2 Department of Biochemistry, JIIUS Indian Institute of Medical Science and Research, Jalna, Maharashtra, India

Date of Submission20-Sep-2021
Date of Decision08-Dec-2021
Date of Acceptance14-Dec-2021
Date of Web Publication24-Jan-2022

Correspondence Address:
Dr. Afshan Kausar
Department of Physiology, JIIUS Indian Institute of Medical Science and Research, Warudi, Badnapur, Jalna - 431 202, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kleuhsj.kleuhsj_226_21

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INTRODUCTION: Psychological health of a medical student remains affected throughout the course. Medical education is usually seems to be associated with substantial extent of psychological morbidity. Thus, objective of the study was to collect data regarding depression, anxiety, and stress in 1st-year undergraduate medical students and to correlate it with their academic performance.
MATERIALS AND METHODS: Forty-two item Depression Anxiety Stress Scale questionnaire was administered to 1st-year medical students. First terminal marks scored by students were recorded. Data were statistically analyzed.
RESULTS: The study confirmed that the amount of stress and depression was comparatively higher than anxiety. Incidence of stress was 53.007%, anxiety 36.05%, and depression 44.03%. Negative correlation was found between stress, anxiety, and depression with academic performance.
CONCLUSION: There is a considerable amount of depression and stress in 1st-year medical students that had affected academic performance. To conclude, there is a need for early detection, counseling, and rehabilitation to minimize the academic loss and improve the quality of health care.

Keywords: Academic performance, medical students, psychological health

How to cite this article:
Kausar A, Parveen SS. Does psychological health of future doctors affects academic performance? unmasking the masked. Indian J Health Sci Biomed Res 2022;15:87-91

How to cite this URL:
Kausar A, Parveen SS. Does psychological health of future doctors affects academic performance? unmasking the masked. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Jul 6];15:87-91. Available from: https://www.ijournalhs.org/text.asp?2022/15/1/87/336303

  Introduction Top

Medical education demand highest level of dedication, devotion, commitment, and responsibility. Yet, medical course is one of the most desired professional courses among the aspiring students. However, psychological health of a medical student remains affected throughout the career probably due to the reasons such as difficulty in integrating the vast course content, long hours of study and hard work, sleep deprivation, burden of mastering lot of skills, examinations, economic difficulties, high expectation from family, loneliness, peer competition, and above all the uncertainty associated with future.[1],[2]

Thus, medical education is usually seems to be associated with substantial extent of psychological morbidity among the medical students, extending from varying degrees of stress, interpersonal problems, and suicidal ideation to psychiatric disorders.[3],[4],[5],[6] These stressors with time turn out to be an important determinant of depression and anxiety.[7],[8] Depression is an illness involving the mood, thoughts, and body. Furthermore, it influences behavior, the way one feels about oneself, persons eating and sleeping patterns, etc.[9]

Medical students are our future doctors and thus very precious human resource; these psychological morbidities of stress and depression among them may perhaps exert negative consequences on academic achievement, learning abilities, and physical health as well. In addition, adversely influence the medical career and patient care.[10],[11] Thus, identification of mental illnesses among medical students to improve their well-being is essential. Consequently, early detection, timely and proper interventional measures are needed to reduce the morbidities.

However, numerous studies from different countries and other parts of the world[12],[13],[14],[15] have reported high rates of stress, anxiety, and depression in medical students, but data are lacking on Indian medical students, particularly of private colleges of rural origin. Hence, we conducted the study with the objectives to assess the prevalence of depression, anxiety, and stress among 1st-year medical students with gender differences and to find association with academic achievement. With the perspectives of quantifying the mental health problem, detection, and their counseling and rehabilitation so as to minimize the academic loss and improve the quality of health care and health education.

  Materials and Methods Top

This cross-sectional study was conducted at the Department of Physiology, JIIUS IIMSR Noor Hospital, Jalna, Maharashtra, in January 2019. One hundred undergraduate medical students of 1st-year based on convenient sampling, who gave written consent for the study were included. Participants were informed and explained about objectives of the study in detail. Personal information regarding age, gender, medium of previous education, mother tongue, marks obtained in 12th, stay in hostel, mode and time of travel, and other possible causes of psychological distress such as family problems, family history of depression, and drug addiction were collected in detail. Thus, it was ensured that the participant must not have any psychological morbidities because of the abovementioned causes and such participants were excluded from the study.

The tool used for evaluating psychological well-being was 'Depression, Anxiety, and Stress Scale (DASS)'. The test consists of 42 items. The scale has 14 items each of depression, anxiety, and stress. Each item is rated on a scale from 0 to 3, and the total score is 126. A score of 0–9 is considered normal, 10–13 mild depression, 14–20 moderate depression, 21–27 severe depression, and 28+ is very severe depression. For stress, score of 0–14 is considered normal, 15–18 mild stress, 19–25 moderate stress, 26–33 severe stress, and 34+ is very severe stress. For anxiety, 0–7 is considered normal, 8–9 mild, 10–14 moderate, 15–19 severe, and 20+ is extreme anxiety.

The students were asked to complete the questionnaire and returned to the author in the same session. They were also instructed not to reveal identity on questionnaire. Students were assured about their confidentiality. Since anxiety was noted to be the highest in preexam periods, questionnaire was not applied shortly before examinations. The data were collected after 1 month of the internal assessment exam. First terminal marks scored by the students were recorded. Data were entered into Microsoft Excel and statistically analyzed. Data were expressed in terms of proportion or percentages.

Ethical approval

Ethical Clearance was obtained from Institutional Ethical Committee, JIIUS Indian Institute Of Medical science & research, Noor Hospital, Jalna, Maharashtra, with Ref no IEC/IRB no. 23/18-19 dated 19.10.2018.

  Results Top

Among 100 1st-year medical students, 54 were females and 46 were male. One student had not returned the questionnaire; thus, only 45 males were included in the study. The mean age was 19.2 ± 1.85, 19 ± 1.03 years of males and females, respectively. In the present study, stress, anxiety, and depression rates were 53%, 36%, and 44%, respectively [Figure 1]. Among all males, 55%, 40% and 22% males, among females, 66%, 50% and 48%were stressed, depressed and anxious respectively [Figure 2]. It was observed that anxiety, stress, and depression areis more in females as compared to male, but the difference was not significant. The percentage of mild, moderate, severe, and very severe anxiety, stress, and depression among males and females are given in [Figure 3] and [Figure 4].
Figure 1: Stress anxiety and depression rate in subjects

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Figure 2: Percentage of stress, anxiety, and depression among males and females

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Figure 3: Percentage of stress, anxiety, and depression among males

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Figure 4: Percentage of stress, anxiety, and depression among females

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Terminal exam scores were found to have negative correlation with all parameter, i.e., stress (r = −0.78), anxiety (r = −0.72), and depression (r = −0.63) [Correlation [Graph 1], [Graph 2], [Graph 3].

  Discussion Top

This descriptive study using DASS-44 was suggestive of a high prevalence of depression 44%, anxiety 33%, and stress 53% among medical students of rural private medical college of Maharashtra. The psychological morbidity is more with females than males. The incidence of stress was most prevalent which could be attributed to the overwhelming burden of the medical curriculum and eagerness to perform better. These findings were consistent with a study done by Lakshmi et al.[16] 74.12% of students were stressed and females reported higher levels of stress than males. Priti et al.[17] also had similar study findings. The study of Pratibha et al.[18] stress was found to be 51.37% and depression 39.44%. These findings in our study are consistent with the study done by Supe[19] Hamza et al.[20] However, in the study done by Nazma,[21] higher levels of stress were observed in males when compared to females which were in contrast to our findings.

Our study reported a negative correlation of academic performance with stress, anxiety, and depression. These findings were in line with the findings of Yusoff et al.[22] reporting a higher risk of failing an examination with moderate-to-severe stress levels. Similarly, Farooqi et al.[23] reported an inverse relationship between anxiety and academic performance. While Prathiba et al. l[18] found no correlation between the prevalence of stress, anxiety, and depression with academic performance (r − 0.0063, −0.0109, and 0.0176).

Anxiety and depression in medical students in India were significantly higher as compared to the students in some Western countries. The prevalence of depression among medical students in the University of Michigan Medical School in 2010 was reported 14.3%.[24] The United Kingdom reported 24% of their students to be depressed.[25] In comparison, our study reported 44% of Indian medical students to be depressed.

Medical students initiate professional journeys with high expectations from one self, but they are burdened with loads of new information to be mastered in specified and limited duration. Which at times become difficult for them to cope up. It is not surprising that students' emotional state is disturbed since they leave the supportive, protected, and pampered environment of their family and joins medical college, stay in the hostel under highly competitive environment. This could be contributing to the higher prevalence of depression, anxiety, and stress seen in 1st-year medical students in this study. This may lead to negative consequences of less productivity, reduced quality of life affecting patient care and service toward humanity.

  Conclusion Top

This study has shown that the prevalence of stress, anxiety, and depression in medical students is high and seems to affect the academic performance. The medical institute must take effort for early detection. Screening, psychiatric counseling, and timely intervention is the need of the hour for shielding future doctor from psychological morbidities. Protective measures in the form of emotional support from family, friends, and teachers, various recreational activities, exercise, sports, healthy lifestyle, proper sleep, etc., must be planned to help the students to cope with stress. Furthermore, apart from counseling services, new programs must be evaluated, for instance, formalized wellness curricula as an element of medical education are essential. Thus, it will be ensured that the mentally healthy doctors will provide best health-care services to society in future.


Our study has numerous limitations. Since the study was cross-sectional in nature, there are probabilities that students' responses might have been influenced by temporal stressors. It was based on the results from a self-administered questionnaire, hence reporting bias cannot be totally eliminated. The data collected were anonymous, participants possibly hesitant to report psychological feelings of depression may had led to underreporting. Moreover, medical students at only one time were surveyed and not followed up after a certain period to improve the validity of result. Still, the large sample size and high response rate in the study hold up the validity of findings.


The authors would like to thank medical students for their participation in the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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