Journal of Education and Health Promotion

Abstract BACKGROUND: Medical education is competitive across the globe. The long duration of the medical
and paramedical courses and exposure to clinical settings potentially causes mental health issues.
The aim of this study was to estimate the prevalence of depression, anxiety and stress among
undergraduate students in a private medical college in South India.
MATERIALS AND METHODS: This cross‑sectional study was conducted among paramedical and
medical students at a private medical college hospital and research center in South India in the
year 2021. The required sample size was calculated as 783 with an expected prevalence of 53%,
95% confidence interval (CI), design effect 2.0, and non‑response of 10%. The study participants
were selected based on simple random sampling. After obtaining informed consent, the data was
collected using an email questionnaire. Standard data collection tools such as the Perceived Stress
Scale (PSS); and the Depression, Anxiety and Stress Scale ‑ 21 (DASS‑21) questionnaire were
used. The investigator computed the odds ratio (OR) and adjusted odds ratio (aOR) with a 95% CI.
RESULTS: Out of 1200 students, 1015 (85%) responded to the email questionnaire. Among them, 639
were females (63%), and 925 were paramedics (91%). Prevalence of depression, anxiety and stress
were 59%, 43% and 11%, respectively. Almost 95% of students experienced moderate‑to‑severe
stress in the last one month. Prevalence was higher among females and students of medical
courses. Students of final year of college (aOR = 2.0; 95% CI = 1.2–3.5) and students of medical
course (aOR = 1.5; 95% CI = 1.1–2.4) were independently associated with stress among the study
participants.
CONCLUSION: There is high prevalence of depression, anxiety and stress among medical college
students in south India. The final year of study and medical course were independently associated
with higher stress than others. We recommend periodic assessment of mental health status and
additional mental health care for final year students and medical students.

Abstract BACKGROUND: Workplace causes tress which negatively affects the physical as well as the
emotional well‑being of individuals. However, it is widely reported in the literature that a number of
factors have received significant attention in the professional life, stressing their significance to the
individual’s psychological, social, and professional life.
MATERIALS AND METHODS: The research is a descriptive that study adopted a quantitative
method, involving 40 female teachers. A survey method was randomly distributed to teachers who
are identified to have worked with students with disability using randomly sampling, and data were
then exposed to the descriptive statistics and Pearson correlation.
RESULTS: The results showed that respondents had good psychological resilience level with
moderate occupational stress level. Furthermore, a significant correlation between psychological
resilience and occupation stress is supported.
CONCLUSION: The present study indicated that the participants have acceptance level of
psychological resilience which helps them to reduce their stress when performing their work. The
study, therefore, encouraged decision academicians to regularly organize several positive counseling
and psychological training to the teachers.

Abstract BACKGROUND: The trainee teacher seems to be more and more faced with frustration and
stress during the training phase, caused by accumulation of requirements and duties, making them
susceptible to the risk of burnout. The purpose of this work is to study the academic burnout of trainee
teachers at the Rabat‑Sale‑Kenitra region’s Regional Center for Education and Training Professions
during the COVID‑19 pandemic.
MATERIALS AND METHODS: Seven hundred thirty‑nine trainee teachers responded to a
self‑questionnaire comprising the Maslach Burnout Inventory–Student Survey scale in its French
validated version, as well as stress factors during the academic year 2020–2021. Both inferential
and descriptive methods of data analysis were used to represent the effect of sociodemographic
variables on burnout levels during the COVID‑19 pandemic.
RESULTS: In agreement with the literature, most of trainee teachers show moderate and high levels
of academic exhaustion; the main stressors presented are financial instability and training overload,
and the level of study influences the scale of burnout among trainee teachers.
CONCLUSION: The result of this study can serve as a predictor of academic burnout among
Moroccan trainee teachers.

Abstract Coronavirus disease 2019 (COVID‑19) has caused different kinds of psychological consequences.
Identifying and providing psychological plans and protocols can be effective in promoting patients’
mental health. The study was conducted to investigate the effect of psychological interventions in
response to stress, anxiety, and depression in COVID‑19 patients. The present study was performed
based on a systematic review. The studies were done by using different combinations of keywords
in databases such as Science Direct, ProQuest, PubMed, and Google scholar search engines and
in Persian databases such as Magiran, SID, Iranmedex from July 25 to September 7, 2020. Out
of 4533 articles that were found after extensive search, 9 articles were evaluated and qualitatively
analyzed for data extraction with the 2010 consort checklist. The final articles were from different
countries of China, the USA, France, Italy, and Iran and were about COVID‑19 patients and their
health‑care providers. Interventions ranged from relaxation, music therapy to mental health and
extensive psychological skills including adaptation methods, mindfulness and self‑care, and crisis
management. Anxiety was the highest and then stress and depression were the next indicators. The
results showed a positive effect of these interventions on stress, anxiety, depression, and even the
quality of life, sleep and family and child function. The number of studies in this field is increasing. We
see a variety of psychological and educational interventions every day. It is hoped that by designing
standard protocols for psychological intervention, effective steps can be taken to improve the mental
health of patients and health‑care providers.

Abstract BACKGROUND: The coronavirus disease‑2019 (COVID‑19) crisis has changed many aspects of 
frontline nurses’ lives. Nurses caring for patients with COVID‑19 reported experiencing significant 
psychological distress and work‑related anxiety. This study aimed to assess the perceived stress 
and quality of life among frontline nurses fighting against COVID‑19.
MATERIALS AND METHODS: This web‑based cross‑sectional study was conducted on 322 
frontline nurses fighting against COVID‑19 in hospitals affiliated to Mazandaran University of Medical 
Sciences. Data were collected using the two following online questionnaires: the Perceived Stress 
Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 
2020, to November 25, 2020. Data were analyzed using the independent sample t‑test, Pearson’s 
correlation test, and regression analysis test in the SPSS‑21.
RESULTS: Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average 
quality of life subscale scores consist of physical health, psychological health, social relationships, and 
environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), 
respectively. There was an inverse significant association between all the subscales of quality of life 
and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables 
of age, gender, marital status, and perceived stress were the significant predictors of quality of life 
subscales.
CONCLUSIONS: Paying serious attention to addressing the concerns of frontline nurses, especially 
those who are at high risk, is necessary. It is recommended to take action as soon as possible to 
reduce the perceived stress and improve quality of life on nurses who care for patients with COVID‑19.

Abstract BACKGROUND: Fertility is highly valued in most cultures. In contrast, infertility as a crisis has the 
potential to threaten the stability of individuals, relationships, and communities. Many infertile people 
are at risk in the early stages of infertility treatment for health and mental health problems and severe 
stress. The present study was conducted to assess the relationship between the social health of 
infertile women and the stress of infertility treatment.
MATERIALS AND METHODS: This study was performed descriptively longitudinal correlation 
on 2020 women in infertility canters in Isfahan. Data collection tool in this study was three parts 
questionnaire. The first contained demographic information, the second was stress, and the third 
was the social health dimension questionnaire. Analyze the data was performed using the descriptive 
statistical methods for the quantitative variables Pearson correlation coefficient. P < 0.05 was 
considered significant.
RESULTS: The results showed that the mean standard deviation (SD) of social health was 
155.1 (16.46), and the mean (SD) score of treatment stress was 22.91 (7.93). Pearson correlation 
coefficient showed that treatment stress score was not significantly related to overall social health 
score and its dimensions (P > 0.05).
CONCLUSIONS: In this study, no statistically significant relationship was identified between these 
two variables. Probably, due to the living conditions of the people of our country in these years and 
the existence of stress and their great concern about economic issues, etc. The results were not 
observed contrary to the researcher’s expectations.

Abstract BACKGROUND: The depression, anxiety, and stress is a major educational problem among 
students all around the world. The purposes of this study were to determine the depression, anxiety, 
and stress among the high school adolescent children in public and private schools in Rangareddy 
district, Telangana state.
MATERIALS AND METHODS: The present study was a cross‑sectional study. The study sample 
considered 120 children from private schools and 259 children from public schools were studied. The 
study tool used was a questionnaire containing DASS (Depression, Anxiety, and Stress scale and 
sociodemographic characteristics. The data were expressed as proportion and mean values (Analysis 
of variance, independed t‑test, and Pearson correlation) spatially tests were used at a significance 
level of P < 0.05).
RESULTS: The overall prevalence of depression in children from the public school was found to 
be only 5%, that of anxiety was 20.8%, and that of stress was 15.8%; the overall prevalence of 
depression in children from private schools was found to be 1.9%, that of anxiety was 20.5%, and 
that of stress was 20.1%.
CONCLUSION: In both schools, anxiety and atress were found to be more among study participants. 
Depression was observed to be less. But if they have more anxiety and stress and if not taken proper 
care at this point of time, it might get converted into a state of Depression.

Abstract BACKGROUND: The mental health of health‑care workers with their unique role in responding
to the COVID‑19 pandemic is strictly essential. Hence, to react effectively to the pandemic, it is
essential to collect further data on the stressors and adaptation strategies. The aim of this study is
to explain the health‑care workers’ experiences of stressors and adaptation strategies used during
the COVID‑19 pandemic outbreak.
MATERIALS AND METHODS: A qualitative content analysis approach was employed in this
study, with semi‑structured in‑depth interviews. Nineteen health‑care workers participated in the
study by purposeful sampling method. The study setting included selective educational hospitals
that admitting patients infected with COVID‑19. The data were analyzed using content analysis
method.
RESULTS: Stressors were classified under four major categories: idiopathic, i.e., arising from
unknown causes, individual and familial, stressful work environment, and socially imposed stressors.
The adaptation strategies were classified under inactive and active adaptation strategies.
CONCLUSIONS: The stressors include the stresses arising from the unknown nature of the disease,
stressful work environment, individual and familial stresses, and the socially imposed stresses. The
adaptation strategies include inactive and active adaptation strategies. Identification of these factors
can help workers and management to effectively react to the pandemic.

Abstract BACKGROUND: COVID‑19 pandemic has changed the life of people in many facets, economic,
social, and psychological. Frontline health‑care workers (HCWs) fighting against this pandemic faced
some psychological as well as social issues which are of major concern. The objective of the study is
to evaluate the magnitude of mental health problems, namely depression, anxiety, and stress among
frontline HCWs as well as their perception on ongoing events and surroundings.
MATERIALS AND METHODS: It was a prospective, observational study on n = 85 HCWs over
a 4‑month period. Study participants were sampled purposively in accordance with inclusion and
exclusion criteria; data were collected by online survey method. A semi‑structured scale was used:
Part A of which assessed the demography and perception of HCWs on surrounding along with ongoing
social events and Part B consisted of the Depression, Anxiety, and Stress Scale‑21 that was used
to assess mental health issues. All the associations were tested in percentages and proportions.
Statistics was calculated by using SPSS 24th version.
RESULTS: Majority of the participants were female doctors and belonged to 21–30 years’ age
group. Most of them were marginally worried of contacting infection (73%) but were substantially
apprehensive of transmitting infection to their family (56.5%) and hoped positive outcome ultimately
in the form of recovery from infection. Majority (96.4%) gathered information from authentic sources
and were confident of adequacy of their knowledge. Majority (88.3%) were satisfied about their
occupational safety and responded on scientific solution of pandemic. However, we got a mixed
result about their professional appreciation. Depression symptom score was higher than anxiety and
stress symptom score in our participants.
CONCLUSIONS: Doctors and nurses both were suffering from mental health issues, and provision
of adequate information and occupational safety may lessen these burdens.

Abstract BACKGROUND: Substance use disorders (SUDs) are one of the most stigmatized health conditions
that impact drug user’s treatment engagement. However, to date, little is known about perceived
stigma and its correlates with psychological factors among high‑risk groups such as people with
SUDs in the criminal justice system. This study aimed to determine the association of psychological
factors and perceived stigma of addiction among women with SUDs.
MATERIALS AND METHODS: This cross‑sectional design was conducted on 652 women with SUDs
who were treated in all 7 compulsory drug detention centers in Thailand with consecutive sampling
technique. The data were collected by standardized interviewers with interviewing questionnaire.
Multiple logistic regression was applied to examine the effect of psychological factors and perceived
stigma.
RESULTS: More than half of SUD patients (57.2%) were methamphetamine abuse or dependence,
approximately 69.9% reported high level of perceived stigma, 56.7% had mild depression, 34.8% had
low level of perceived social support, and the average perceived stress score was 19.2 (standard
deviation, 7.5). The perceived stigma was positively related to depressive symptom and perceived
stress while was inversely related to perceived social support.
CONCLUSION: The psychological factors were strongly associated with perceived stigma of addiction.
Thus, the detection of psychological problems among SUD patients may be benefit clinicians for
identifying which patients are most at risk of perceived stigma and are the potential targets of
intervention to reduce stigma in clinical practice.

Abstract BACKGROUND: It is evident that the novel coronavirus disease pandemic inevitably resulted in
increased stress and anxiety in the general population. Pregnancy is a challenging period, and
COVID‑19 has added risk to women pregnant during the pandemic.
AIM: The present study was aimed to assess the emotional difficulties in pregnant females who
tested positive for COVID‑19. The current study estimated the prevalence of depression, anxiety,
and stress among 63 pregnant ladies who tested positive for COVID‑19.
MATERIALS AND METHODS: The study was conducted in Child and Maternity Hospital of GMC
Anantnag, Kashmir, India, from April to December 2020. A total of 63 pregnant females who tested
positive for COVID‑19 participated in the study. The COVID‑positive pregnant ladies were interviewed
in the outpatient department of the child and maternity clinic 2 weeks after the infection. The interview
scale used was Depression, Anxiety, and Stress Scale‑21. The data were analyzed using Chi‑square
test and Fisher’s exact test.
RESULTS: We found that the mean age of participants was 33.5 ± 7.4. We found that 38.1% of the
females had positive bad obstetric history. The prevalence of depression, anxiety, and stress was
33.32%, 50.83%, and 60.3%, respectively. In correlation analysis, notably bad obstetric history and
working females were significant independent factors for higher levels of depression, anxiety, and
stress. The depression was also found more in literate females and the third trimester.
CONCLUSION: The study indicates high levels of depression, anxiety, and stress in pregnant females
who tested positive for COVID‑19. The emotional difficulties were found to be higher in educated and
working females. The bad obstetric history was found to be an independent factor for higher levels of
emotional difficulties in COVID‑positive pregnant females. This calls for extra measures to promote
the mental health and resilience of pregnant females, especially during a crisis.

Abstract BACKGROUND: Health‑care workers (HCWs) are highly vulnerable to depression during an
epidemic outbreak. Protecting the mental well‑being of HCWs is a priority while battling with
COVID‑19. However, documentation on COVID‑19‑related depression among HCWs is scarce
due to the limited availability of measuring scales. Hence, this study was purposed to develop
a scale to measure depression relating to COVID-19 and evaluate its psychometric properties
among HCWs.
MATERIALS AND METHODS: A validation study was carried out among 320 HCWs including
physicians of various medical specialties, dental specialists, and nurses in the year 2020. Exploratory
factor analysis using Promax rotation with Kaiser normalization for the determination of factor structure
was employed in data analysis using SPSS version 16 software.
RESULTS: COVID-19 Depression Scale for HCWs (CDS‑HW) demonstrated a two-component
structure identified as “work‑related anxiety” and “psychological distress.” The mean CDS‑HW score
of the study participants was observed to be 23.67 ± 2.82, and the scale demonstrated good internal
consistency reliability (Cronbach’s alpha: 0.741).
CONCLUSION: CDS‑HW is a rapidly administrable, valid, and reliable tool that can be used to
measure COVID-19-related depression among HCWs.

Abstract BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Abstract BACKGROUND: The challenges of dental education place students at high risk of stress. Because
dental education is a highly demanding and challenging course, placing heavy demands on the
mental resources of the students, making them vulnerable to high levels of stress, this study aimed to
determine the prevalence of depression, suicidal ideation, and suicidal behaviors in dental students.
MATERIALS AND METHODS: A descriptive cross‑sectional study was done on a convenience
sample of 388 dental students in a teaching dental institution. Data were collected using standard,
prevalidated, self‑administered questionnaires (Patient Health Questionnaire‑9 and Suicidal
Behaviours Questionnaire‑Revised [SBQ‑R]). Analysis was done using SPSS version 20. Descriptive
statistics, Chi‑square test, and logistic regression were performed.
RESULTS: At least half of the students were in major depression with different levels of severity.
When students from different years were analyzed, majority from each year fell under II and III
categories (P < 0.001). Most of the students reported that they do not have any suicidal ideation
or behavior (SBQ‑R). Nearly 16% of the students either presented the threat of suicidal attempt
or likelihood of suicidal behavior in future. Almost 13% of the dental students thought of killing
themselves in the past year for at least two times. Around 16% of them expressed to someone about
their thought of committing suicide.
CONCLUSION: Even though depression and suicidal tendencies were not prominent in dental
students, there is a need to shed light on those who responded positively and take necessary reforms
to relieve academic stress.

Abstract BACKGROUND: Internet addiction (IA) is a severe problem, especially in academic communities.
The association between IA and unfavorable emotional conditions (e.g., anxiety, stress, and
depression) can harm students’ relationships and academic and career performance. The present
study evaluated (a) the prevalence of IA in a sample of medical sciences university students; (b) the
association between IA and depression, anxiety, stress, and sleep disorders; and (c) the association
between demographic characteristics and IA, depression, anxiety, and stress.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 268 students from Abadan
University of Medical Sciences were selected using Morgan Table. The participants responded to
the Young Internet Addiction Test, the Depression Anxiety Stress Scales‑42, and the Pittsburgh
Sleep Quality Index. Data were analyzed using descriptive statistics, Pearson correlation coefficient,
independent sample t‑test, one‑way ANOVA, and least significant difference.
RESULTS: The mean score of IA was 45.65 ± 35.40. IA was found to be significantly related to
depression, anxiety, stress, and sleep disorders (except for sleep disturbance) (P < 0.001). Males
were found to be more likely than females to suffer from IA, depression, anxiety, stress, and sleep
disorders. Furthermore, age was inversely related to IA, depression, and stress. Finally, medical
sciences students suffered from depression, anxiety, and stress more than students majoring in
other fields.
CONCLUSIONS: The simultaneous occurrence of IA and depression, anxiety, stress, and sleep
disorders in students indicates that IA is associated with other psychological problems. Therefore,
researchers and policymakers need to identify preventive measures to help internet‑addicted students.

Abstract BACKGROUND: Having a baby admitted to a neonatal intensive care unit (NICU) is so stressful, has
a negative impact on mother well‑being, and also disrupts mother‑infant bonding process because
the infant spend the first several weeks or months in the NICU. Previous studies have shown the
positive association of the mindfulness and various health conditions. This study investigated the
relationship between mothers’ dispositional mindfulness and level of stress and bonding in mothers
with infants in the NICU.
MATERIALS AND METHODS: A cross‑sectional study was performed during 2019 on 140 mothers
with newborns admitted to the NICUs in two hospitals in Qom city in Iran. The self‑report measures of
dispositional mindfulness, Parental Stressor Scale: NICU, and the Postpartum Bonding Questionnaire
were administered to mothers on the 2nd–5th day after birth. The data analysis was carried out by
using a stepwise multiple regression model.
RESULTS: The mean scores of mindfulness, stress, and bonding were 3.32 ± 0.52, 2.32 ± 0.77,
and 0.47 ± 0.37, respectively. There was a statistically significant inverse relationship between total
mindfulness score and stress (P < 0.001). Furthermore, high scores of mindfulness were associated
with better bonding (P = 0.04).
CONCLUSIONS: Improvement in mindfulness helps mothers to reduce stress and make better
bonding with infants. It is recommended that mindfulness interventions use during pregnancy also
after birth, especially for mothers that their infants admitted to in the NICUs.

Abstract BACKGROUND: Stress is a subjective experience which creates an obstacle in a person’s path of
achieving his or her goals. It creates negative outcomes among the population. Medical curriculum
is very vast and stressful. As doctors are the very important part of society, medical students must
be allowed to learn their trade in a stress‑free environment. The present study aimed to assess the
perceived stress, various sources of stress among medical undergraduate students, and the coping
strategies adopted.
MATERIALS AND METHODS: This was a cross‑sectional study conducted among medical
under‑graduate students studying at a tertiary care hospital situated in Mumbai city of Maharashtra
between January and June 2018. Using purposive sampling technique, a total of 450 medical students
from 1st year to final year were invited to participate in the study. A self‑administered questionnaire
consisting of sociodemographic details and perceived stress scale questions was used. Logistic
regression analysis was carried out to assess the determinants of stress. Odds ratio, 95% confidence
interval was calculated. P < 0.05 was considered statistically significant.
RESULTS: The overall response rate was 79.11%, with 356 out of 450 students returning the
questionnaire. Among 356 participants, 324 participants (91%) were suffering from high levels
of stress. Factors such as curriculum vastness, frequency of examination, competition with peer,
performance in examinations, worry about future, loneliness, relation with opposite sex, and quality
of food played a major role in creating additional stress.
CONCLUSIONS: The perceived stress was higher among female medical students. Academic factors
are greater perceived cause of stress in medical students in this study. A substantial proportion of
medical undergraduate students were found to be stressed which necessitates appropriate and timely
interventions. Reframing the academic curriculum along with examination and evaluation patterns,
incorporating extracurricular activities, and establishment of counselling cells in the institution is the
need of the hour.

Abstract BACKGROUND: The academic environment is a challenge for dental students due to the multiple
sources of stress they face. For this reason, the present study analyzes the psychometric properties
of the Dental Environment Stress (DES) questionnaire. The secondary objective was to identify the
specific sources of stress perceived by dental students related to gender and years of study.
MATERIALS AND METHODS: A cross‑sectional study was conducted among dental
students (n = 340; Mage = 22.45) from the Romanian University of Medicine and Pharmacy in
October– December 2019. The factorial structure of the questionnaire was performed by means
of the confirmatory factor analysis (CFA) and the multi group‑CFA. The convergent and divergent
validities were measured by associating DES with scales that measure depression, anxiety, and
tension/stress (Depression Anxiety Stress Scale‑21‑R), perceived stress (Perceived Stress Scale‑14),
and life satisfaction (Satisfaction with Life Scale).
RESULTS: New measure obtained supported a five‑factor and thirty‑item structure, which is gender
invariant. All the factors within DES have a significant positive correlation with depression, anxiety,
tension/stress, and perceived stress and a negative correlation with life satisfaction. The Cronbach’s
α coefficients are acceptable (range: 0.67–0.89). The female students perceive aspects related to
performance, the relations with the faculty, clinical responsibilities, and personal life to be more
stressful than males. Senior students perceive more stressed aspects related to personal life, while
freshmen have higher scores on stress associated with clinical responsibilities.
CONCLUSIONS: The present results show that DES has psychometric properties which are adequate
for the assessment of dental stress in the case of Romanian students; nevertheless, it is necessary
to extend the use of DES to students attending other universities and to dental practitioners.

Abstract BACKGROUND: The objective was to assess the prevalence and the associated demographic
factors of stress, anxiety, and depression among undergraduate (UG) Indian dental students and
determine whether the pattern is different in government‑run institutions and those managed by
private authorities.
MATERIALS AND METHODS: A cross‑sectional study was conducted among dental UG students
from five dental colleges. Snowball sampling was used to approach 776 potential participants, resulting
in a complete response from 507 students. The questionnaire consisted of demographic data; year
of study; type of college; accommodation; and Depression, Anxiety, and Stress Scale (DASS)‑42.
Descriptive data and inferential statistics were obtained. Chi‑square test was applied for categorical
data to test for significance, and higher analysis was done using multiple linear regression.
RESULTS: Females and males comprised 71.8% (n = 364) and 28.2% (n = 143) of the study
population, respectively. The prevalence of anxiety was highest (66.86%, n = 339), followed by
depression (57.39%, n = 291) and stress (43.99%, n = 223). In terms of severity also, anxiety was
the most prevalent condition as more than one‑fourth of the students presented with severe and
very severe scores in this aspect (25.43%, n = 129) compared to depression (14.39%, n = 73) and
stress (10.09%, n = 51). Regression analysis revealed age as a strong positive predictor for all the
three conditions, while staying in the hostel was a positive predictor for anxiety and stress. Being
female was also an independent predictor for the high prevalence of stress.
CONCLUSION: Stress, anxiety, and depression are highly prevalent among Indian dental students.
Clinical students and interns have a higher prevalence of stress than preclinical students. Age,
being female, and staying in the hostel are positive predictors for the severity of stress. There is no
significant difference between government and private colleges, regarding the prevalence of any
psychological condition.

Abstract BACKGROUND: Although a certain amount of stress is essential, excessive stress can adversely
influence the physiological and mental health. Hence, this study aims to assess common stressors
and coping strategies among university students.
MATERIALS AND METHODS: This qualitative study was conducted from October to November
2019 in Iran. Twelve students were recruited based on purposeful sampling to participate focus group
discussions (FGD). Transcripts of three sessions of FGD were analyzed applying Graneheim and
Lundman (2004) approach, and a thematic network was applied to illustrate the findings.
RESULTS: The finding emerged 78 codes, 14 subthemes, and 4 main themes. Stressors were
classified in two main themes, including individual stressors and the social ones. Behavioral strategies
and the cognitive ones were among two categories of coping strategies. According to the thematic
network, a full stress student affecting the precious stressors and the social, cultural, and the economic
context may manage his/her stress applying the coping strategies.
CONCLUSION: The findings revealed that university students experienced different kinds of stress,
and usually, they do not apply right coping strategies. It is important to establish stress counseling
programs for university students. Besides, it is proposing to provide 1st year university students with
workshops about the cause of stress and effective coping strategies.

Abstract BACKGROUND: Given the relationship between positivity interventions and psychological problems,
this study aimed to investigate the effect of positive thinking training on stress, anxiety, depression,
and quality of life of hemodialysis patients.
MATERIALS AND METHODS: This is a quasi-experimental and interventional study conducted
on 70 hemodialysis patients referred to Fasa hemodialysis centers, Iran, between April 2019 and
October 2019. Patients were selected using a simple sampling method and randomly divided into
control (n = 35) and intervention (n = 35) groups. The intervention group was trained on positive
thinking skills in eight sessions of a workshop. Before and after the intervention, stress, anxiety,
depression, and quality of life in both the groups were measured using the Depression, Anxiety,
and Stress Scale-21 and Short Form-36 Questionnaire. Data were analyzed using paired t-test,
independent t-test, Kolmogorov–Smirnov, and Chi-square tests.
RESULTS: There was no significant difference in the mean scores of stress, anxiety, depression,
and quality of life in the two groups before the intervention.(P > 0.05), and in the control group, there
was no statistically significant difference before and after the intervention (P = 0.092, P = 0.228,
0.280, respectively). In the intervention group, the mean score of stress and anxiety decreased from
23.65 ± 4.12 to 16.68 ± 4.41 (P < 0.001) and from 17.77 ± 5.15 to 14.57 ± 4.18 (P = 0.002), respectively,
and that of the patients’ quality of life also increased from 35.19 ± 10.07 to 55.98 ± 11.71 (P < 0.001).
However, the mean score of depression did not change significantly after the intervention (P = 0.689).
CONCLUSION: According to the results of this study, the use of positive thinking intervention
programs with other methods for hemodialysis patients’ care and treatment is recommended as a
nonpharmacological, cost-effective, and uncomplicated method.

Abstract BACKGROUND: Coronavirus (COVID‑19) a worldwide pandemic has significantly affected
life of people around the globe. It has also caused various psychological issues among public
such as uncertainty, fear, anxiety, and of course stress. Globalization has facilitated it and has
added greater complexity to the containment of infection leading to urgent call for public health
challenge. Consequently, a multilevel stress coping adjustment process is going on. Hence, it is
imperative to explore how people are affected psychologically and how they are coping with it.
People are adopting different strategies for coping up from this challenging situation. In this sense,
the present study intended to: explore which coping strategies were of relevance for people for
adjusting in COVID‑19 crises and were sociodemographic factors influencing the coping strategies.
MATERIALS AND METHODS: The research is descriptive study. For the present study, a sample
of 475 participants was asked for coping strategies used by them using valid and reliable scales.
RESULTS: Results revealed that positive attitude and trust in God were the most used adaptive
coping strategies and sociodemographic variables were playing a significant role in adaptive coping
strategies.
CONCLUSION: Hence, understanding and identification of coping strategies and their relationship
with demographic variables can help health professionals to direct interventions to control stressors
related to the pandemics.

Abstract BACKGROUND: The psychological impact of anxiety, stress, and depression among health care
and nonhealth‑care professionals in India contribute significantly to the global burden of mental
illness in the world. Impaired mental health and stress influence the efficiency and productivity of
work. Long‑term professional stress among individuals can lead to chronic illness, increased blood
pressure, and many systemic disorders. The aim of this study was to assess the prevalence of
anxiety, stress, and depression among the health care and nonhealth‑care professionals in India.
MATERIALS AND METHODS: This prospective survey‑based study included 200 study
participants (80 nonhealth care and 120 health‑care workers) who were asked to submit their
feedback and opinion on a questionnaire survey. Depression, stress, and anxiety were scored as
per patient health questionnaire‑4 and UCLA scale. The reliability of questionnaires was assessed
using the Cronbach’s alpha (r = 0.90). The statistical analysis was done using the Chi‑square test.
RESULTS: Higher prevalence ratio of anxiety, depression, and stress was observed among nonhealth
care compared to health‑care professionals.
CONCLUSION: Psychological disturbances were found to be higher among nonmedical when
compared to health‑care workers or professionals. Thus, psychological counseling is required to
manage the stress levels in both health care and nonhealth‑care professionals.

Abstract Identifying the learners’ problems is important. Besides, many factors are associated with academic
failure, among which time management and stress are more important than any others based
on evidence. By using a systematic review and meta‑analysis, this study aims to synthesize the
findings of studies about the correlation of time management and stress with academic failure
to suggest a more in‑depth insight into the effect of these two factors on academic failure. Four
databases were searched from the inception of January 2018. Publication bias was evaluated visually
using funnel plots and sized up by Egger’s test. Ninety‑four articles were found to be qualified for
inclusion after full‑text review and additional manual reference made. Of these, 8 were studies of
educational interventions that were reviewed in this paper. Regarding the relation of stress and
academic performance, the Funnel plot (results not shown) and Egger’s test showed no publication
bias in the studies (P = 0.719). Based on this result, the estimated pooled correlation (reverted by
hyperbolic tangent transformation) between stress and academic performance was found to be −0.32
(95% confidence interval: −0.38–−0.25). In conclusion, the review recognized a series of potentially
mutable medium‑to‑large correlates of academic achievement, time management, and stress. It
would be essential to have experimental data on how easily such self‑regulatory capacities can be
altered, and these interventions could help students enhance their potential, providing empirical tests
for offered process models of academic achievement.

Abstract INTRODUCTION: Health promotion is one of the most important aspects in pregnancy, and
health‑promoting behaviors are one of the major determinants of health under the influence of various
factors. This study aimed to determine the association between social support and psychological
factors with health‑promoting behaviors in pregnant women.
MATERIALS AND METHODS: This cross‑sectional was performed on 375 pregnant women when
they had 24–28 weeks in Ilam, October 2018 to May 2019. Two‑stage cluster sampling was performed
after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were
completed in self‑report form. The collected data were analyzed by the descriptive and inferential
tests with the SPSS software version 19.
RESULTS: The mean score of health‑promoting behaviors was 139.87 (21.26) and self‑healing and
physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively.
Linear regression analysis showed a significant difference between different level of stress, anxiety,
depression, and social support with health‑promoting behaviors (P < 0.001). The results showed
that one‑point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and
24.1% reduction of health‑promoting behaviors, respectively, and one‑point score increase in social
support resulted in 40% increase in health‑promoting behaviors (P < 0.001).
CONCLUSION: A negative association was found between psychological factors and a positive
relationship with health‑promoting behaviors. Although perceived moderate health promotion
behaviors and perceived social support were moderate, they did not have a good status in terms of
psychological factors. Given awareness of the issues under study in each region is essential and
planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate
behaviors through planned interventions are required.