Prevalence of stress amongst postgraduate residents by using DASS-21 and perceived stress scale: a cross-sectional study at a tertiary care centre

INTRODUCTION

The Medical education is a very long duration, challenging and complex process for both undergraduate and postgraduate who, in future will be caretakers for physical and mental well-being of patients.^1,2 During this process they are responsible for patients care, have research assignments and participate in teaching programmes.^3,4 Therefore they considered as “backbone of entire medical system”. Due to long working hours they are at risk of acquiring various degrees of hospital acquired infections, health related risks and a lot of stress.⁵ Stress is an important occupational health problem among medical profession. United Nation labelled stress as “The 20th century Diseases”. The many studies in the world found that the prevalence of stress among postgraduate residents is very high. In International PG residents, prevalence is 54%, in South Eastern USA 48.9%, 55.1% in Pakistan and our country it was 52%. Similarly, the multi-institution-based study conducted in Indian university by using DASS 42 scale found that prevalence of stress was higher than depression and anxiety.⁶

Objectives

To determine the prevalence of stress among post graduate residents by using DASS-21 and perceived stress scale to find out causes of stress among resident doctors.

METHODS

The present cross-sectional study was conducted amongst the postgraduate residents of a tertiary care hospital of a medical college. The study duration period was for 4 months i.e., from July 2025 to October 2025.The study was approved by the institutional ethics committee. All the postgraduate students were explained the purpose of the study and requested to participate in the study after getting the list from admission section of college. There were 171 postgraduate students in the college of which 165 participated in the study; Six participants didn’t give any response after repeated visits so they were excluded from the study considering them not willing to participate. They were personally contacted by the principal investigator for data collection. A predesigned closed questionnaire was used for collecting the data which was to be self-filled by the participant. It contained identification data, habits or addictions if any, details of academics like, department studying, year of residency, number of working days and daily duration of work.

PSS DASS-21 scale was used to assess the stress amongst them. They were asked to mention the factors related to stress if any. PSS is the instrument for stress assessment which containing 10 questions with five alternatives to choose; 0–never, 1–almost never, 2–sometimes, 3–fairly often, 4–very often. Question numbers 4, 5, 7 and 8 to be scored with reverse scores. Total score of 0 to 13 to be considered as low stress, 14 to 26 as moderate and 27 to 40 as high perceived stress. DASS–21 contains twenty-one questions related to depression, anxiety and stress. In the present study, only the questions related to stress were considered for assessment i.e., scale was customized for stress. The participants had to give score from 0 to 3. The total score was to be multiplied by two to get the final score. So, the final score of 0 to 14 was to be considered as normal, 15 to 18 as mild, 19 to 25 as moderate, 26 to 33 as severe and more than 34 was considered as extremely severe stress. The data was entered in Microsoft excel and was analyzed by frequencies, percentages and chi square test using Epi info version 7.2.2.6.

RESULTS

Table 1 shows age wise distribution of PG residents. The maximum age being 43 years and minimum is 24 years. Among 165 post graduate residents, nearly 72.12% (119) were between age group of 24 to 29 years and very few i.e., 3.03% (05) were between 35 to 43 years. Table 2 shows that about 32.72% PG residents were suffered from mild to extremely severe degree stress and about 67.27% (111) were included under normal level according to DASS-21 scale. Table 3 shows the distribution of PG residents according to PSS score. Out of 165 PG residents, highest i.e., 93 (56.36%) were included in moderate level of stress.

Table 4 shows association between socio-demographic factors and presence of stress according to DASS-21 scale. Stress level was significantly higher among unmarried and clinical department residents, with P value of 0.014 and 0.009 respectively. Those who work for all days of week and duration were between 12 to 18 hours per day shows higher level of stress with P value of 0.04 for both factors. Residents who took fresh admission have higher level of stress with p value of (0.02) as compared to In-service candidate. Those who stay at hostel was found to be significantly associated with high level of stress with p value of 0.001. There is no significant association between other socio-demographic factor such as sex, year of residency and place of residence.

The causes of stress as perceived by PG residents were noted in table no.5. The highest rated academic causes were heavy workload or long working schedule (73.33%), lack of time for study (64.24%), insufficient working staff at workplace (62.42), academic load (47.88%). The highest rated psychological causes were not enough time for recreational activities or hobbies (75.15%), not enough holidays or leaves (71.52%), sleeping difficulties or not enough sleep (57.58%), poor food quality in mess or tiffin (52.12%), living away from home (46.67%) and living condition in hostel (43.64%). Table 6 shows that which measures taken by PG residents to cope up with stress. Among 165 residents, 125 (75.76%) have read books to relieve stress. About 110 (66.67%) were watch movie, 54.55% were do web surfing, 52.12% were chat on social media and very less i.e., 0.61% were consume alcohol to cope up with stress.

*Probability by Fischer Exact probability test.

DISCUSSION

Stress is an additional pressure to every individual. Now a days it is commonest risk factor for development of various diseases. In the study, prevalence of stress among resident’s doctors was 32.7% (Table 2). In a similar study conducted by Saini et al in a tertiary care institute in Delhi that prevalence was 32.8%.⁷ The most common age group in study was 24 to 43 years as consistent with study by Issa et al where it was 26 to 46 years due to competitive nature of residency training.⁶ In present study, about 56.36% (Table 2) post graduate residents were found to have moderate level of stress according to PSS. Similar study conducted on junior residents, in Bangalore city shows that about 72.2% PG residents were under stress as per PSS. Stress level among residents of clinical departments in our study was 37.5% (Table 4) which was higher as compared to pre and para clinical residents (11.54%) and it was statistically significant. Similar, findings were seen in another study by Gobbur et al in which stress levels among clinical residents was 33.33% But it was not statistically significant.³ The cause behind this might be inadequate time for recreational activities, criticism from staff for academics and coping with faculty mood swings. The statistically significant association was seen between marital status and stress with proportion of 61.54% in unmarried postgraduate and 15.38% in married residents (Table 4) which is consistent with study conducted by Gobbur et al.³ Contrasting results were found in study conducted in Sahastrabuddhe et al that married PG graduate found more stress i.e., 45.5% as compared to unmarried 35.3% because, they had to take care of their families and also study which can be described as dual career.⁹ The proportion of stress among fresh candidate was more (35.33%) (Table 4) than in service, because they had an experience of handling difficult cases at periphery level and had done work in various administrative fields. The residents staying at hostel were more (37.86%) stressed as compared to those who were living with their family or relatives (4.17%) (Table 4), as families are shock- absorber to every individual. Authors inferenced from the study that, not only did the hostelites handled various personal problems, but also faced factors like improper living conditions (43.64%), poor food quality in mess or tiffin (52.12%) and living away from home (46.67%). The present study showed that about 73.33% were stressed due to heavy workload or long working schedule and similar finding were seen in study conducted by Issa et al which showed that about 89% residents were high clinical workload.⁶ The reason may be more clinical work with simultaneous completion of thesis. Most of residents read book (75.7%) and watched movies (66.6%) rather than talking to friends (12.7%) and relative (1.8%) (Table 6).

CONCLUSION

In the present study it has been found that postgraduate residents were suffering from moderate stress. It affect their physical and mental health. The both academic & psychological were the leading causes of stress. Management of stress consists of various preventive measures such as improving time management, coping skills to optimize the balance between professional and social commitment. Fixed duty hours, better hostel, mess facilities and social support would go a long way to improve the physical and mental wellbeing of these young doctors.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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