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ORIGINAL ARTICLE
Year : 2012  |  Volume : 3  |  Issue : 3  |  Page : 180-185

Perceived sources and coping mechanisms of stress among undergraduate Indian dental students


1 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
2 Department of Public Health Dentistry, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, Karnataka, India

Date of Web Publication19-Feb-2013

Correspondence Address:
H V Amith
Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhanpur, Bhopal - 462 037, Madhya Pradesh
India
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DOI: 10.4103/0976-433X.107398

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  Abstract 

Context: The dental profession is the most stressful of all the health professions, and this is true for all stages of the dental career, i.e., for established dentists, young dentists and dental students. Aim: To identify the various sources and coping mechanisms of stress as perceived by Indian undergraduate dental students. Settings and Design: Descriptive cross-sectional questionnaire study. Materials and Methods: A modified version of the self-administered dental environment stress (DES) questionnaire was used. The responses were based on a four-point Likert scale (1 = little, 2 = moderate, 3 = considerable and 4 = great). Statistical Analysis Used: Descriptive analysis was carried out for the study variables. Results: Examinations, short lunch breaks, relationships, not knowing the local language, competition for sports and cultural activities, counseling rounds, difficulty of getting patients, portion and quota completion were the highest stressors. Having friends, planning and problem solving were the methods adopted by most of the students to cope with stress. Conclusions: The undergraduate dental students in India had high levels of perceived stress. Academic and nonacademic perceived sources of stress should be considered in curriculum planning and in the working environment for dental education.

Keywords: Academics, coping mechanisms, dental students, stress, stressors


How to cite this article:
Amith H V, D'Cruz AM, Srivastav T, Soumya R, Sony B K, Thomas SP. Perceived sources and coping mechanisms of stress among undergraduate Indian dental students . SRM J Res Dent Sci 2012;3:180-5

How to cite this URL:
Amith H V, D'Cruz AM, Srivastav T, Soumya R, Sony B K, Thomas SP. Perceived sources and coping mechanisms of stress among undergraduate Indian dental students . SRM J Res Dent Sci [serial online] 2012 [cited 2020 May 28];3:180-5. Available from: http://www.srmjrds.in/text.asp?2012/3/3/180/107398


  Introduction Top


The term "stress" describes external demands (physical or mental) on an individual's physical and psychological well-being. [1] The dental profession is the most stressful of all the health professions, and this is true for all stages of the dental career, i.e., for established dentists, young dentists and dental students. [2] In recent decades, stress among dental students has appeared to be a major concern for dental educators.

Several studies have shown significant amount of stress among dental students in relation to different variables. Stressors identified in various studies conducted in different countries on dental students include: time and scheduling pressures, managing nervous patients, financial and business issues, patients' unfavorable perception of dentists, staff and equipment problems and the extremely fine and exacting nature of the work, the need to meet academic and clinical requirements; interaction with student colleagues, clinical teachers and support staff; and relationships with partners, friends and family. [3],[4],[5],[6],[7],[8],[9],[10],[11]

Contemporary curricula require dental students to attain diverse proficiencies, including the acquisition of theoretical knowledge, clinical competencies and interpersonal skills. [12],[13] Stress has been shown to manifest as fatigue, tension, dizziness, sleeplessness, tachycardia, gastrointestinal symptoms, irritability, anxiety and cynicism, which can eventually lead to depression, substance abuse, absenteeism, diminished work efficiency and burnout. [3],[4],[5],[13] In addition to this, a negative association has been reported between stress and academic performance of dental students. [5]

Hence, it is important for dental colleges to identify sources of stress among its students when planning the curriculum for dental education to create a more student-friendly, less stressful, working environment. In India, the duration of the Bachelor of Dental Surgery program is of 4 years, with examination at the end of each year, followed by 1 year rotatory internship in dental colleges, and is governed by the Dental Council of India.

The objective of this study was to identify various sources and coping mechanisms of stress as perceived by the Indian undergraduate dental students.


  Materials and Methods Top


A descriptive cross-sectional quantitative study was carried out using a self-administered questionnaire among 100 second to fourth year Bachelor of Dental Surgery students of A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India. Clearance was obtained from the Institutional Ethical Committee prior to initiation of the study. All undergraduate students who had completed at least 1 successful year in the dental college were included in the study. The questionnaire was developed in English, and included questions regarding demographic data such as the participant's gender and the academic year. The age of the sample ranged from 18 to 22 years, the overall mean age being 20.4 years.

To investigate the possible sources of stress, a modified version of the self-administered Dental Environment Stress (DES) questionnaire [5] applicable to the Indian dental education background was used. The questionnaire was categorized into 10 domains, and each domain had four items. The first eight domains included all possible sources of stress and the last two domains were regarding the coping mechanisms against stress. The responses to the questionnaire were based on a four-point Likert scale with response options of 1 = little, 2 = moderate, 3 = considerable and 4 = great. Participation in the research was on a voluntary basis and no incentives were used for the respondents. Students present on the days of the survey were included.


  Results Top


A 100% response rate was obtained with the questionnaire. This study was carried out at the beginning of the academic year among second to fourth year students, and it discussed experiences of the preceding academic years. [Table 1] shows the demographics of the study population. Among the participants, 50% were males and 50% were females. There was no significant difference across the gender and year of the study among the study participants. The age of the sample ranged from 18 to 22 years, the overall mean age being 20.4 years.
Table 1: Demographic characteristics of the study population


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[Table 2] shows the mean scores for each of the 32 stressors across each of the three academic years' studies. Academically, examination was the highest stressor across all the years, having a highest overall mean score of 3.020 ± 1.092. The second year students had the highest mean score of 3.940 ± 0.240. Competition among the batch mates was the least stressor academically (overall mean score 1.790 ± 1.038).

With regard to the facilities provided, the provision of short lunch break scored the highest across all the years (overall mean score 2.720 ± 1.036), and hostel scored the least across all the years of study (overall mean score 2.380 ± 1.153).
Table 2: Mean scores for each stressor across all the three academic years


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Emotionally, relationships was the highest overall stressor (mean score 2.760 ± 1.232) and jealousy was the least stressor (mean score 2.060 ± 0.919). Although this was analogous among the second and third years, the fourth year students felt that criticism was the highest stressor (1.160 ± 0.374), and relationship and jealousy scored the least.

Among the social domain, not knowing the local language was the highest stressor across all the years (overall mean score 2.780 ± 1.050). Overall, cultural difference scored the least in the social domain (mean score 2.100 ± 0.916). Although the second year students felt that cultural difference was less stressful, staying away from family and peer pressure were the least stressors among the third and fourth years, respectively. Staying away from family (mean score 3.600 ± 0.535), peer pressure (mean score 3.600 ± 0.495) and local language (mean score 3.600 ± 0.495) were scored equally by the second year students as the highest stressors.

With seniors, competition for sports and cultural activities scored the highest (overall mean score 2.750 ± 1.167), and ragging scored the least (overall mean score 2.180 ± 1.158).

With staff, counseling rounds had the highest overall mean score of 2.670 ± 1.264 and fear of person scored the least (mean score 2.200 ± 1.137). Although this was equivalent with the second year students, the third and the fourth year students scored more with regard to the fear of getting noted by the staff (mean score 2.160 ± 0.374 and 1.520 ± 0.520, respectively).

Difficulty of getting patients for clinical study was the highest stressor across all the years (overall mean score 2.910 ± 1.111). Irregularity of patient recall and patient not adhering to the appointment time scored the least in this domain (overall mean score 2.130 ± 0.895). However, the third year students felt that not knowing the patient's language was less stressful.

Portion and quota completion scored the highest across all the years of study (overall mean score 2.950 ± 1.140), and insufficient study leave scored the least in this domain (overall mean score 2.290 ± 1.094).

[Table 3] describes the stress reduction factors among the students. Having friends topped the list as a stress reduction factor among all the years (overall mean score 3.170 ± 1.120). Practicing yoga and meditation scored the least (overall mean score 2.010 ± 1.227), which was the also the fact for the third and fourth year students. For the second year students, sports and culturals scored the least as stress reduction factors.
Table 3: Stress reduction factors among the students: Differences between years of study


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[Table 4] shows the stress management strategies among the students. Across all the years, students felt that planning and problem solving was the best way out (overall mean score 3.300 ± 1.020). Showing aggressive behavior had the least scores across all the years (overall mean score 1.810 ± 1.061).
Table 4: Stress management by the students: Differences between years of study


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[Table 5] shows the differences between genders for each of the stressor items. Significant differences were seen in the stress scores among the males and females. Mean score of males was higher with respect to quota completion, examination, short lunch break, not knowing the local language, interaction with seniors, fear of getting noted by staff and portion and quota completion before exams.
Table 5: Mean scores for each stressor: Differences between gender


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[Table 6] and [Table 7] highlight the differences between genders for the stress reduction factors and stress management factors, respectively. Significant differences were seen across the genders for all the stress reduction factors, with males having a higher mean score. Significant differences were seen across the genders for all the stress management factors of detachment of oneself and planning and problem solving, with males having a higher mean score, except for showing aggressive behavior, where females had a higher mean score.
Table 6: Stress reduction factors among the students: Differences between gender


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Table 7: Stress management by the students: Differences between gender


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  Discussion Top


Dental education has shown to be very stressful for the students as reported by a large number of studies in the literature. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] The findings are consistent across different countries, different universities and curricula. To become a responsible dental professional, students have to reach high levels of knowledge and professional skill as well as develop good attitudes toward patient care, all within a short period of time. [14] Identification of potential problems is important in dental education programs, as it might give students, faculty and administrators an opportunity to take precautionary measures to prevent dental stress. [10] The present study aimed to identify various sources of stress as perceived by the students and coping mechanisms with regard to stress reduction and management.

Among the second year students, it was seen that examination and coping with portions were the fields that caused major stress academically. However, among the clinical students, completion of quota was a major stress factor, followed by examination and completion of portion. In order to be eligible to appear for the final exams, it is mandatory that a fourth year student complete certain quotas in terms of patients treated. Tangade et al. [4] Naidu et al. [9] and Sanders et al.[10] have reported that stress associated with examinations was high across classes. However, Westermann et al. [7] did not consider examination as a major stress factor.

The second year students have adjusted well in their hostels, although other facilities such as transport, library hours and a short lunch break contribute to their stress. Short lunch break was a stress factor among the third and fourth year students as well. Relationships seem to top the toll in emotional problems among the second year students, and other factors such as jealousy, criticism and fights are almost equally distributed and are not major contributing factors to stress.

Although they were fresh in college in the past academic year, surprisingly, staying away from family caused little stress among the second year students. These findings were in contrast to those reported by Tangade et al. [4] and Naidu et al. [9] Not knowing the local language was a major factor for stress across all the years, followed by peer pressure. The students however have adjusted well with people from different cultures.

Sports and cultural competitions with seniors and interaction with the seniors closely followed by ragging are the pressure the preclinical students undergo. Academic competition with seniors however did not contribute to stress. As clinical students are the seniors among undergraduate students, ragging and interaction with seniors was not a problem. The major stress factor was sports and cultural competition, as each batch wanted their own batch to be the best in this regard.

Counseling rounds were the most dreaded factor. Fear of the person and fear of getting noted did not cause much stress among the preclinical students. However, it was a major source of stress among the clinical students.

Although not communicating with patients yet, the second year students thought they would most probably face problems with getting a patient and also getting a positive cooperation from the patient. The students were confident of being able to communicate with the patient at ease and felt that irregularity of patient recall would not be a major problem. Although the clinical students did not have a major problem with regard to patient cooperation, getting patients in the various clinical departments was a major concern.

Before exams, completing portions and quota as well as viva voce were the most feared factors. There was always a flurry of activity to complete portions and quota toward the end of term, which was a major stressor among students. Study leave insufficiency caused considerable stress in some, whereas other students thought the study leave provided was sufficient.

Spending time with friends helped the students reduce stress. Some resorted to personal hobbies and sports or cultural activities. Planning and problem solving were the methods sought by students across all the years to cope with stress. Also observed was the maintenance of a positive outlook. Aggressive behavior and detachment of oneself were the least sought methods.

Within the limitations of this study, the findings indicated that the undergraduate dental students in India had high levels of perceived stress. The results of the present study showed that the demands of the profession related to both quality and quantity of academic performance were potent sources of stress. Hence, both academic and nonacademic perceived sources of stress should be considered in curriculum planning and the working environment for dental education.

 
  References Top

1.Atkinson JM, Millar K, Kay EJ, Blinkhorn AS. Stress in dental practice. Dent Update 1991;18:60-4.  Back to cited text no. 1
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10.Yap AU, Bhole S, Teo CS. A cross cultural comparison of perceived stress in the dental school environment. J Dent Educ 1996;60:459-64.  Back to cited text no. 10
    
11.Ahmad MS, Md Yusoff MM, Abdul Razak I. Stress and its relief among undergraduate dental students in Malaysia. Southeast Asian J Trop Med Public Health 2011;42:996-1004.  Back to cited text no. 11
    
12.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.  Back to cited text no. 12
    
13.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.  Back to cited text no. 13
    
14.Sugiura G, Shinada K, Kawaguchi Y. Psychological well-being and perceptions of stress amongst Japanese dental students. Eur J Dent Educ 2005;9:17-25.  Back to cited text no. 14
    



 
 
    Tables

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


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