Perceived stress, sources of stress and coping strategies among undergraduate medical students of Nepal: a cross-sectional study

Abstract

Background: Medical students are subjected to various stressors throughout their training, which has a considerable impact on their physical and mental health. Some students have positive ways of coping, while others take to maladaptive coping measures. This study aims to assess severity, sources of stress, and coping strategies among medical students of a non-Western low-income country from South Asia. Methods: A self-administered questionnaire-based cross-sectional study was carried out. Demographic variables were collected and stress level was assessed using PSS 14 (Perceived Stress Scale 14). The sources of stress were assessed using MSSQ (Medical Student Stressor Questionnaire) and coping strategies were evaluated using the Brief-Coping Orientation to Problems Experienced 28. Results: The response rate was 95%. The mean PSS score was 27.85. Overall, 55% of students were stressed (male 52%, female 60%), the difference among gender was not significant. Basic science students perceived higher levels of stress than clinical clerkship students. Academic related stressors caused higher stress, whereas other variables caused moderate stress. The major stressors were examinations, inadequate time to study, poor marks, extensive amount of learning content, and the need to performing well in the exam. The five most common coping strategies used were active coping, acceptance, planning, self-distraction, and instrumental support. The least common coping mechanism was substance use. All MSSQ domains positively correlated with the total PSS score. Students with higher PSS scores were likely to use behavioral disengagement, venting, and self-blame as the primary coping strategies. Conclusions: Stress level among the medical students is high and mainly in relation to academia. Inadequate guidance from teachers contributed significantly. Stressed students were likely to use maladaptive coping strategies. Strategies to enhance teacher-student communication and adaptive coping measures should be implemented. Further studies should be done to evaluate the effects of stress on the academic outcomes of students.