Document Type : Original Article


Department of Biochemistry, SRM Medical College and Hospital and Research Center, Kattankulathur, Chengalpet District, Tamil Nadu, India


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
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.


1. NaserAY, DahmashEZ, Al‑RousanR, AlwafiH, AlrawashdehHM,
Ghoul I, et al. Mental health status of the general population,
healthcare professionals, and university students during 2019
coronavirus disease outbreak in Jordan: A cross‑sectional study.
Brain Behav 2020;10:e01730.
2. Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical
student psychological distress and mental illness relative to the
general population: A canadian cross‑sectional survey. Acad Med
3. Gabal HA, Wahdan MM, Gamal Eldin DA. Prevalence of anxiety,
depression and stress among medical students, and associated
factors. Egypt J Occup Med 2022;46:55‑74.
4. Alsaad F, Binkhamis L, Alsalman A, Alabdulqader N, Alamer M,
Abualait T, et al. Impact of action video gaming behavior on
attention, anxiety, and sleep among university students. Psychol
Res Behav Manag 2022;15:151‑60.
5. Bower P, Knowles S, Coventry PA, Rowland N. Counseling
for mental health and psychosocial problems in primary
care. Cochrane Database Syst Rev 2011;2011:CD001025. doi:
6. Pokhrel NB, Khadayat R, Tulachan P. Depression, anxiety, and
burnout among medical students and residents of a medical
school in Nepal: A cross‑sectional study. BMC Psychiatry
7. Agrawal N, Sharma H, Dabas A, Mishra A. Perceived Stress
Among Medical Students and Doctors in India During COVID‑19
Pandemic. MAMC J Med Sci 2021;7:14.
8. Jessop DC, Reid M, Solomon L. Financial concern predicts
deteriorations in mental and physical health among university
students, Psychol Health 2020;35:196‑209.
9. McGrady A, Brennan J, Lynch D, Whearty K. A wellness program
for first‑year medical students. Appl Psychophysiol Biofeedback
10. Phillips MS, Steelesmith DL, Brock G, Benedict J, Muñoz J,
Fontanella CA. Mental health service utilization among medical
students with a perceived need for care. Acad Psychiatry
11. Hillis J, Morrison S, Alberici F, Reinholz F, Shun M, Jenkins K.
‘Care factor: Engaging medical students with their well‑being.
Med Educ 2012;46:509–10.
12. Galvin J Smith AP. Stress in U.K. mental health training:
A multidimensional comparison study. Br J Educ Soc Behav Sci
13. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety, and
depression among medical undergraduate students and their
socio‑demographic correlates. Indian J Med Res 2015;141:354–7.
14. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source
Epidemiologic Statistics for Public Health, Version. www.OpenEpi.
com, updated 2013/04/06. Retrieved 13 November 2021. Available
15. Mads Haahr, RANDOM.ORG ‑ True Random Number Service.
Retrieved 13 November 2021. Available from https://www.
16. Depression Anxiety Stress Scales—DASS. Psychology Foundation
of Australia. Updated 26th July 2018. Retrieved 20 January 2022.
Available from:
17. Denovan A, Dagnall N, Dhingra K, Grogan S. Evaluating
the Perceived Stress Scale among UK university students:
Implications for stress measurement and management. Stud High
Educ 2019;44:120‑33.
18. Dean, Andrew G.; Sullivan, Kevin M. (Kevin Mark); Zubieta,
Juan.; et al. Epi Info™, a database and statistics program for public
health professionals. CDC, Atlanta, GA, USA, 2011.
19. Neha Taneja, Sandeep Sachdeva, Nidhi Dwivedi. Assessment
of depression, anxiety, and stress among medical students
enrolled in a medical college of New Delhi, India. 2018. Retrieved
13 November 2021. Available from:
20. Moutinho IL, Maddalena NC, Roland RK, Lucchetti AL,
Tibiriçá SH, Ezequiel OD, et al. Depression, stress, and anxiety in
medical students: A cross‑sectional comparison between students
from different semesters. Rev Assoc Med Bras 2017;63:21–8.
21. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al.
The global prevalence of anxiety among medical students:
A meta‑analysis. Int J Environ Res Public Health 2019;16:E2735.
22. Behera S, Paluri SS, Mishra A. Mental health status of students
pursuing professional training: A questionnaire‑based study.
J Edu Health Promot 2021;10:399.
23. Singh KK, Jyotirmay, Kumar A, Goel A, Gulati S, Nayak BB.
Prevalence of anxiety, stress, and depression among health care
and nonhealth‑care professionals in India. J Edu Health Promot