|Year : 2019 | Volume
| Issue : 1 | Page : 41-47
Factors affecting stress among students in dental colleges of neo-capital state in India
Parveen Sultana Shaik1, Srinivas Pachava1, Chinna Babu Palli2
1 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India
|Date of Submission||20-Mar-2018|
|Date of Acceptance||21-Jan-2019|
|Date of Web Publication||15-Mar-2019|
Dr. Srinivas Pachava
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Stress in dental students may be multifactorial, arising from the academic and sociocultural environment. Identifying the sources of stress helps in advocating policy changes and strategies to alleviate the stress. Aim: To evaluate the factors affecting stress among undergraduate and postgraduate dental students of Andhra Pradesh, India. Materials and Methods: A self-administered Modified Dental Environmental Stress questionnaire was distributed among 390 dental students who participated voluntarily. Data were analyzed using IBM SPSS Statistics, version 20, and ANOVA and Student's t-test were conducted where P ≤ 0.05 was considered statistically significant. Results: Students perceived more stress from domains related to the future prospects (2.53 ± 0.97) and personal factors (2.35 ± 0.66) followed by stress associated with faculty (2.12 ± 0.78) and clinical/academic factors (2.12 ± 0.55), with a statistically significant difference (P = 0.001). Third- and final-year undergraduate students perceived higher levels of stress regarding future, clinical/academic factors, and personal factors. Students who chose dentistry as their first choice of admission experienced less stress compared to the students whose choice of admission was medicine or other courses. Conclusion: Overall stress levels were slight to moderate and were significantly higher among the third- and final-year undergraduate students.
Keywords: Dental education, dental students, India, occupational stress, professional burnout
|How to cite this article:|
Shaik PS, Pachava S, Palli CB. Factors affecting stress among students in dental colleges of neo-capital state in India. J Indian Assoc Public Health Dent 2019;17:41-7
|How to cite this URL:|
Shaik PS, Pachava S, Palli CB. Factors affecting stress among students in dental colleges of neo-capital state in India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Mar 18];17:41-7. Available from: http://www.jiaphd.org/text.asp?2019/17/1/41/254336
| Introduction|| |
According to a report of the Global Congress in Dental Education (2008), “Dental Education is regarded as a complex, demanding and often stressful pedagogical exposure. It involves acquisition of required academic, clinical and interpersonal skills during the course of learning.” Practicing dentistry requires clinical and patient management skills, characteristics that also add to the stress perceived by the students.
The term STRESS describes external demands (physical or mental) on an individual's physical and psychological well-being, leading to a deleterious effect on academic performance. Stressors associated with dentistry include time and scheduling pressures, highly technical and intensive nature of work, and managing uncooperative patients. This resulting stress can lead to depression, anxiety, substance misuse, absenteeism, diminished work efficiency, and burnout. The roots of this occupational stress may have their origin in the educational process as dental students experience high levels of stress during training. Lovallo defined “Occupational stress” as a state of physical and mental tension resulting from excessive demands or lack of resources.
In chronic or extreme circumstances, occupational stress can precipitate a state of “burnout” in the susceptible practitioner. Maslach and Jackson elucidated “burnout” as a unique response to frequent and intense clinician–patient contacts consisting of the following three components: emotional exhaustion (mental fatigue), depersonalization (psychological distancing from others), and reduced personal accomplishment. Professional burnout shows symptoms such as fatigue, sleeplessness, risk of infectious diseases (such as hepatitis B, hepatitis C, and human immunodeficiency virus), headaches, low resistance, irritation, suspicion, overconfidence, drug abuse, negative attitude, boredom, and lack of challenge.
In India, the duration of the Bachelor of Dental Surgery program is of 4 calendar years with progression examination at the end of each year, followed by 1-year rotatory internship in the dental colleges which is governed by the Dental Council of India. During the first 2 years of graduation, students are taught the basic sciences and preclinical dentistry, whereas the later years are dedicated for imparting clinical education. Several studies identified the major academic stressors among dental college students to be examinations, competition for grades, fear of failing the year, and inadequate time for relaxation.
Cooper et al. reported that the dental profession was ranked the most stressful when compared to other health-care professions. Previous investigators have found that 10% of dental students suffered from severe emotional exhaustion, 17% complained about a severe lack of accomplishment, and 28% reported severe depersonalization symptoms.
The ability to cope well with stress is important because stress can result in health-damaging behaviors and psychological morbidity. Recent research indicates that psychological morbidity, pathological anxiety, and emotional exhaustion in dental students are not uncommon. Hence, the purpose of this study was to identify the factors affecting stress among dental students of Andhra Pradesh.
| Materials and Methods|| |
A cross-sectional questionnaire-based survey was conducted among undergraduate and postgraduate dental students of two dental colleges residing in the neo-capital city of Andhra Pradesh, of which one is a government dental college and the other one is a private dental college. After obtaining ethical approval, permission was sought to survey the students at the end of the whole class lectures for each of the academic years. Students were briefed on the objectives of the study and ensured that participation was voluntary and anonymous, which might help in getting their true perceptions.
A detailed review of the multipronged aspect of the research and about the surrogate consent of the participants was elaborated for acceptance and approval from the Institutional Ethical Committee (Pr. 14/IEC-SIBAR/2016). The anonymity of the participants was secured by following the ethical principles of the World Medical Association Declaration of Helsinki.
Overall, 390 undergraduate and postgraduate students including 89 students of 1st-year BDS, 89 students of 2nd-year BDS, 35 students of 3rd-year BDS, 78 students of 4th-year BDS, 49 interns, and 50 postgraduates participated willingly.
Prior to the study, an informed written consent was obtained from all the individuals willing to participate and also enacted from parents or legal guardians of students aged below 18 years followed by the assent from students.
All willing students who were present on the day of the survey were included, and on every alternative day, an effort was made to trace the students who remained absent on the survey day.
Pretested, self-administrated, modified Dental Environmental Stress (DES) Questionnaire was used in the study to measure the sources of stress. This 34-item questionnaire was further divided into four domains: (1) stress due to clinical and academic factors, (2) stress due to faculty, (3) stress about career, and (4) personal stress. The investigated items were based on those examined previously by several researchers in studies of stress among dental students.,,
The questionnaire consists of two sections; in the first section, demographic characteristics such as age, gender, and year of the study were included. The second section included 34 questions related to possible sources of stress which are divided into four domains. Each item was scored using a 5-point Likert scale of severity where 1 = not stressful, 2 = slightly stressful, 3 = moderately stressful, 4 = severely stressful, and 5 = not applicable. In addition to this questionnaire, two more questions were asked about their choice of joining dentistry, that is, whether dentistry is their own choice or due to parental pressure, and the second question was about their first choice of course, that is, whether it is medicine, dental, or other courses [Appendix I]. A pilot study was conducted to test the internal consistency and reliability of the questionnaire, by considering a convenience sample of 50 from the same population. Cronbach's alpha was computed to measure the modified DES scale's internal consistency and had an alpha of 0.928.
Data were entered and analysis was performed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive statistics, Student's t-test, and one-way ANOVA were employed for data presentation and analysis. Descriptive statistics were used to describe the samples' covariate characteristics (gender, age, and year of the study) and the responses to the stress items. P ≤ 0.05 was considered statistically significant.
| Results|| |
A total of 390 dental students participated in the study, out of which 24.4% were male and 75.6% were female, and majority of the participants belong to 17–21 years' (62.6%) age group, with percentage of participation as 22.8%, 22.8%, 19.1%, 20%, 12.6%, and 12.8% for 1st-, 2nd-, 3rd-, and 4th-year BDS students, interns, and postgraduates, respectively [Table 1].
Overall 57.2% (n = 223) of students opted dentistry out of his or her own will and 42.8% (n = 167) opted dentistry due to parental pressure; 78% (n = 304) of students' first choice of admission was medicine, whereas only 13% (n = 51) of students' first choice was dentistry.
Stressors in dental students
The mean DES score perceived by the dental students was high for the stress domain of stress about future (2.53 ± 0.55) followed by the domains, namely personal stress (2.35 ± 0.55), stress associated with faculty (2.12 ± 0.78), and clinical/academic stress (2.12 ± 0.55) [Figure 1], and there was no statistically significant difference in various stress domains with respect to gender (P = 0.907).
|Figure 1: Mean (standard deviation) Dental Environmental Stress scores according to the stress domains|
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Students who opted dentistry due to parental pressure and students whose first choice of admission was medicine and other courses showed higher level of stress for all the domains [Table 2].
|Table 2: Mean scores of perceived sources of stress according to student's reason of joining dentistry and their first choice of admission|
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[Table 3] shows the comparison of means of stressors according to academic classes where 3rd-year BDS students perceived higher levels of stress for domains such as stress due to clinical/academic factors (2.46 ± 0.51, P < 0.001), stress about future (2.89 ± 1.04, P < 0.001), and personal stress (2.53 ± 0.81, P = 0.169), where 4th-year BDS students perceived higher stress for domains such as stress associated with faculty (2.51 ± 0.80, P < 0.001) when compared to their counterparts. Private college dental students expressed higher level of stress for domains such as stress associated with faculty (2.16 ± 0.79) and personal stress (2.35 ± 0.66), whereas government college dental students expressed higher level of stress for domains such as stress due to clinical/academic factors (2.16 ± 0.50) and stress about future (2.72 ± 1.03) [Table 4].
|Table 3: Comparison of different stressors' mean according to academic years of the participants|
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|Table 4: Comparison of stressors' mean according to the study institutes of the participants|
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Tukey's post hoc test was done to find out the difference between all possible pairs of academic years within the domains of stress due to clinical/academic factors and stress associated with faculty. It was identified that the students from the preclinical years were significantly different from their counterparts with regard to their mean score associated with stress due to clinical/academic factors. No significant differences were found in this regard between students from different clinical years. However, no clear pattern was observed in the mean scores associated with stress from faculty [Table 5].
|Table 5: Multiple pair-wise intergroup comparison of stress domains according to the participants' academic year|
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| Discussion|| |
Today, India has the largest dental education system in the world with 310 dental colleges, of which 268 are private and 42 are government colleges, with 26,000 undergraduate and 5400 postgraduate dentists graduating every year. It is likely that, by 2020, India might have a surplus of about 1 lakh dentists in the country. The rapid growth in the production of dentists has not helped to address the problems of the public health system further; instead, it has led to the imbalance in distribution and unemployment, indicating the public health dentist's role in planning dental health workers' availability and addressing the existing inequality. This inequality leads to an increase in insecurity toward settlement and opportunities, which could be the reason for the high stress levels toward career/future prospect in dental students in this study.
Stress levels were notably least in students who joined dentistry by their own choice and in students whose first choice of admission was dentistry, as the increased likelihood for the dentistry allows the committed students work more comfortably and positively accepting challenges and stress. However, students who joined dentistry unwillingly showed high levels of stress which could be due to their low opinion and pessimistic outlook towards the dental course and its future. These findings were in accordance with the study done at Davangere (India), Lagos (Nigeria), and Tokyo (Japan).
Overall mean scores for all the domains were observed to increase through the year of the study, with peak in the third year which is the transition period from preclinical to a clinical acquaintance, and these results are in accordance with those of the studies conducted at Nellore (India), Riyadh (Saudi Arabia),, and Quebec (Canada), but they are contrary to the longitudinal studies conducted at seven European dental schools (Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool, and Manchester) and a cross-sectional study conducted in London (UK). In the present study, there was no gender discrimination in the distribution of stress levels, which is in contrast with a West Indies study where female students perceived more stress than male students.
Several factors influence the perceived stress levels of students in both government and private dental colleges. These factors vary in a wide range among private and government colleges, where the level of stress related to faculty in government dental students was the least influencing factor for stress as observed in the study and is in contrast with private college dental students.
Many dental students need to be economically independent after the graduation course. The uncertainty of settlement in dentistry makes the student feel more stressed, keeping their future in mind. This was mostly observed in the students of government dental colleges where they receive a decent stipend in their internship and postgraduate program, which was not guaranteed immediately after the completion of course.
The main limitation of this study is the generalizability as the results may differ with varying sociocultural contexts. However, this study identified the potential stressors among undergraduate and postgraduate dental students, which paves way for further research to investigate the impact of stress on personality traits, behavior, performance, and its changing trends. The factors identified are needed to be tackled by incorporating the stress-coping measures, to reduce the stress, as well as to bring out the best performance from students in a healthy and stress-free environment. It is necessary to include subjects such as stress management, practice management, and communication skills. Future research needs to consider the use of a more precise measure to evaluate the stress level to aid in better understanding of dental students' experience and accordingly improving their learning environment.
The dental educational system should deal with the potential stressors of students by the following stress-coping measures:
- Parents should be counseled prior related to the ill effects of pressuring their children in joining an educational program and for academic excellence
- Identifying vulnerable stressful individuals early for improving their emotional and professional well-being
- Measures such as changes in length and type of curriculum, small group assignments, student-centered methodologies, reduction of educational costs, individual counseling, formative assessment of student rather than summative assessment, faculty-incorporated advising systems, and quota reduction should be implemented
- Advocating health promotion policies to ensure a future supply of effective dentists
- A public health dentist's roles are summarized as follows:
- A public health dentist can be assigned as an academic advisor to each student throughout his or her education
- Can collect data on what students think impossible and motivate them toward positivity
- Also, can counsel and mold students psychologically to tackle the stress levels by making them aware of the stress consequences such as psychological disorders and help them to cope up with the problems.
| Conclusion|| |
Overall stress levels were slight to moderate which were significantly higher among third- and final-year undergraduate students, and the major stressors are stress about career/future and personal stress. Effective assistance from teaching staff, institutional administrators, and families is essential to cope up with the stress in dental students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]