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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

PROJECT TITLE

STRESS & DEPRESSION AMONG MEDICAL


STUDENTS

Abstract
Medical education is very important and contributes lots in human life. Quite a few
talented students hardly managed a chance in medical college, but it is the matter of
sorrow they suffer a lots of difficulties in the way of completing their MBBS course.
Our main focus what are the main key factors behind it. The psychological stress
and depression among medical students are concretely increased day by day in
recent time. It was also been happened in Bangladeshi medical students. We will
find out the causes and solution of psychological stress and depression among
medical students. The general objective of the proposed study is to investigate
psychological problems such as stress, depression and anxiety among Bangladeshi
medical students. The specific objective of this study is to identify the related factors
associated with the depression in the medical students being their medical studies.
The ultimate objective of this study is to recommend the appropriate solutions to
reduce the depression among medical students. We will see the association between
depression and some related study variables such as education year, sex,
lengthiness of MBBS course, family income etc. The study will be conducted
between November 2010 and April 2011 by a group of 15 researchers of the
Department of Statistics, Biostatistics & Informatics, and University of Dhaka. We
will collect the data through structured questionnaire. For selecting the respondents
we will use convenience sampling, because of time and cost limitations. Proper
instructions will be given to the respondents about our questionnaire. For simplicity
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

we will use the students of Dhaka medical college which is situated nearby in Dhaka
University. We will consider first year to fifth year students of Dhaka Medical
College. Information about respondents age, sex, family income, political affiliation
etc. will be collected through questionnaire. Among the fifteen researchers, seven of
them will be deployed in the Dhaka Medical College, who will supply the
questionnaire to the medical students. All coding, editing and data processing will
be done in Department of Statistics, Biostatistics & Informatics. A final study report
will be made available by April, 2011. Funds of BDT 3400.00 are required to meet
the expenses on travel, printing questionnaires and report and accessories.

Background of the Research


In recent time, it may be well-concerned about the mental stress of medical students
as a problem in many countries as well as Bangladesh. Here we focus on Dhaka
Medical College where many brilliant students get chance to complete the
undergraduate program but on the way of their learning it is sometimes seen that
they fall on depth of stress caused by many unexpected factors which should be
resolved. No research has been done before on this discipline in our country. The
prevalence of psychological problem among medical students, the factors
responsible for this should be well-understood. Academic performance stress were
staying in hostel high parental expectation, vastness of syllabus test/exam,
unwilling behavior of teachers sometimes, increased work hours, lack of time and
facilities for entertainment. Principle stressors are in particular uncertainty about
individual study behavior, progress & aptitude, with specific concern about
assessment and the availability of learning materials. Sometimes students are
influenced by hearing of getting better position of students of private medical
college on finishing the undergraduate program. The students generally used active
copying strategies and so many students are attempting to take alcohol/drugs either
committed suicide. So it is very much essential to look forward to this situation
otherwise we will continue to lose many bright students of Bangladesh.

STRESS & DEPRESSION AMONG MEDICAL STUDENTS

Its time to take for serious concern about the problem .Psychological problem
needs for intervention like social and psychological support to improve the quality
of life for these medical students. Student advisors and counselors may train
students about stress management. There is also need to bring about academic
changes inequality of teaching and evaluation system.

Research Objectives
The general objective of the present study is to determine the prevalence of
depression among medical students and to identify its associated factors. We will
work on here several study variables (education year, sex, lengthiness of MBBS
course etc.) among Dhaka Medical College students.
The specific objectives are,
To assess the relationship between depression & education year.
To assess the relationship between depression & sex.
To assess the relationship between depression & lengthiness of MBBS
course.
To assess the relationship between depression & family income.
To assess the relationship between depression & medical family
background.
To assess the relationship between depression & excessive study load.
The ultimate objective of this study is to recommend the appropriate solutions to
reduce the depression among medical students.

STRESS & DEPRESSION AMONG MEDICAL STUDENTS

Literature Review
M S Sherina et al. (2004) seen that studies on psychological problems such as
stress, depression and anxiety among medical students have found that these
disorders are under diagnosed and under treated. Failure to detect these disorders
unfortunately leads to increase psychological morbidity with unwanted effects
throughout their careers and lives. Early detection of psychological problems
shortens the duration of an episode and results in far less social impairment in the
long term. The objective of this study was to determine the prevalence of
psychological stress among medical students, to identify its symptoms and to
determine the association with depression. Medical students are expected to learn
and master a huge amount of knowledge and skills. The personal and social sacrifice
they have to make in order to maintain good academic results. In a highly
competitive environment puts them under a lot of stress. Undergraduate medical
students have been the most distressed group of students compared to any other
course undergraduates. A cross sectional study was conducted in the Faculty of
Medicine at a local university in Malaysia. A self-administered instrument similar to
the General Health Questionnaire (GHQ -12) was used to screen for symptoms of
psychological stress. Another questionnaire similar to the Beck Depression
Inventory (BDI) was also used to screen for depression in the respondents. Out of
414 medical students, 396 students participated and completed the questionnaires
giving a response rate of 95.6%.Based on the GHQ-12 scores, the prevalence of
psychological stress among the respondents. The prevalence of psychological stress
was only slightly higher among the females (42.2%) compared to the males
(41.4%). There was significant association between psychological stress an d
depression among the respondents (X 2=4.636, df=l, p<0.05). Factors include:
student debt, greater material expectations, greater pressure on academic
institutions and staff, and expansion of student numbers. Leaving one's family and
making a new start elsewhere also contributes to stress. As many students place
great value on social and familial support, a change in environment can disrupt this
support and it may take some time to find adequate substitutes. This study found
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

that the prevalence of psychological stress among medical students was high
(41.9%), which corresponds to other studies among medical students. When
examining the stress of medical education, the General Professional Education of
Physician (GPEP) Report, Association of American Medical Colleges, suggested
placing a greater emphasis on health programs including stress management to help
students cope with the stress of tertiary education. Students who are prepared with
more realistic expectation in their academic pursuits, coupled with stress
management techniques and good social support would have an advantage in
coping. The ultimate aim is to help medical students understand what is required of
them and to adapt as quickly as possible.

Alessandro de Moura Almeida et al. ( 2007) examined that medical students have
been indicated as a risk population for the development of CMD (Common mental
disorders).They conducted study to identify factors involved in the social, economic
and academic life of these students that could be related to the presence of CMD.
Common mental disorders are related to somatoform disorders, to anxiety and
depression which has a high impact on the quality of life because they have been
caused for the development of more serious disorders. In their study the
responsible factors are excessive study load, personal striving, lack of leisure time
and contact with death, in addition to other factors. They have conducted a cross sectional study and administered 20 items self-reported questionnaire to 223
medical students. In their study they have found high prevalence of CMD in the
participants. These findings may serve as a stimulus for future studies designed to
identify causal effects among the associated factors, and may serve in the
reformulation not only of the curricula, but also the teaching/learning process, to
ensure that medical school does not exert any negative effect on the mental health of
future health professionals.

STRESS & DEPRESSION AMONG MEDICAL STUDENTS

Hamza Mohammad Abdulghani(2008)

conducted Study that have observed

medical students experience a high incidence of personal distress during their


undergraduate course . It is important for medical educators to know the prevalence
and causes of student distress, which not only affects his health, but also his
academic achievement at different time points of their study period. This increased
level of stress indicates a decrease of psychological health in students which may
impair students behavior, diminish learning, and, ultimately, affect patient care. The
estimated prevalence of emotional disturbance was found in different studies higher
than in general population. There were 494 responses with total student population
of approximately 600 with the response rate of 83%. They have supplied K10 selfadministered Arabic Version questionnaires. Overall prevalence of stress in this
study is 57%.The study suggest that first and second year students who have the
higher level of stress should be supported well by student support system as they
may be able to cope up with the stress properly in later years and at higher level of
education. It is also important to target prevention strategies. Wellness and mental
health programs are needed to help students.

Marjani A et al. (2008) observed that many studies have shown high rates of
psychological morbidity in medical students at various stages of their training,
respectively. Medical school stress is likely to predict later mental health problems,
but students seldom seek help for their problems. Their study was undertaken to
estimate the prevalence of psychological stress and association between the levels
of stress and study variables (academic year, regular to course and physical
problems) among Gorgan medical students. There is growing apprecia tion of the
stresses involved in medical training. This can lead to mental distress and has a
negative impact on cognitive functioning and learning. Studies which have examined
sources of stress among medical students generally points to three main areas:
academic pressures, social issues and financial problems. It is suggested that the
greatest stress occurs during the later years of medical education, while Guthrie et
al found that the percentages of students who had psychological morbidity were
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

very similar in years 1 and 4.However Stewart et al indicated that in year 2, medical
students had higher scores of anxiety and depression than in year 1. Study of
Sherina et al and Saipanish showed that the prevalence of stress was 41.9%. All the
three year medical students (129 basic sciences students) in the Gorgan Faculty of
Medicine were asked to complete the Kessler 10 self administrated Persian version
questionnaire during the academic year 2008. Questionnaires were given to medical
students to fill, a month before beginning of the examination period. The overall
response rate was 94.57%, 91.83% (n=45) in first year, 97.91 %( n=47) in second
year and 93.75% (n=30) in third year. The prevalence of stress of all types was
found to be about 61.47%. The prevalence of stress was higher (73.33%) in first
year of study followed by second year (55.31%) and third year (53.33%). There is
statistically significant association between the year of study and the stress levels.
They have found that the level of stress decreases as the year of study increases. The
other reason for stress could be due to excessive load of basic science subjects. In
Iran education is free and small amount of monthly stipend is given to each student
during their study (it is funded by the Ministry of Health Education), while in other
foreign medical schools, students are plagued by financial worries, which is an
important cause of their stress. After found the results they have explained that
medical students also may be able to cope stress with the help of student support
center. By providing such courses and reducing stress level, medical students may
improve their medical education.

Sergio Baldassin et al. (2008) found that medical students experienced less stress
than law students, graduate students, and the general population, although medical
students had elevated scores on stress and depressed mood inventories at the
transition from basic-to-clinical training. However, it does not seem to be an
adequate comparison, considering that they are different populations, with very
different curriculum characteristics and methods of teaching-learning. Medical
education and training can directly contribute to the development of depression
and behavioral problems, such as alcohol and drug abuse. During the first semester,
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

there are significant changes in the student's daily habits. Other issues may lead to
the development of depressive symptoms among medical students. On the other
hand, some authors have focused their studies in identifying risk factor s for
development of depression

in medical students. Better

knowledge and

understanding of the symptoms involved in the depression in medical students


could assist in the development of specific target programs (like mentoring and
tutoring), thus helping professors and medical educators to better understand and
identify students at risk in each year of education or level of training and to reduce
the impact of any disturbances in attitudes and behavior which are imperative in
order to make the students aware of their own risk factors. A total of 603 students
were found to be potentially eligible. The questionnaires were anonymous and were
distributed to all students who were present at the classrooms before their
academic activities. The 481 (79.8%) students (21. 9 2.4 years old) from the basic
(n = 163, 33.8%), intermediate (n = 164, 34.1%), and internship period s
(154,32.1%) were assessing using the Beck Depression Inventory(BDI).This is the
first study that directly evaluated, in a cross-sectional design, the characteristics of
depressive symptoms by applying clusters. The increased rate of BDI scores during
the internship period of medical school are associated with a decrease in student
health, and probably refers to periods when professors and educators should be
aware about suicidal thoughts and risk. Future studies specifically addressing this
aspect should be designed in order to investigate the suicide risk among medical
students.
The findings of this study must be interpreted with caution due to its
methodological shortcomings, including the use of self-administered inventories
and no structured interviews for clinic diagnoses. Findings of a greater frequency
and severity higher depressive scores among medical students on internship period
years and lower scores on intermediate period, as well the better knowledge of the
characteristics of each cluster symptoms, are involved could help us to develop
programs (like mentoring and tutoring) specifically designed for each level to
prevent the development of depression and its consequence, as well as, preparing
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

medical students and faculty members for their daily practice and teaching
perceptions.

Benefits of the Study


Medical education is perceived as being stressful environment. In Bangladesh, many
students hardly get chance in medical colleges. But it is a matter of sorrow that, so
many students suffer from depression and psychological stress. This type of
problems increase during the period of undergraduate medical education. Studies
on psychological problems such as stress, depression and anxiety among medical
students have found that these disorders are under diagnosed and under treated.
The study is therefore important to be aware of the symptoms of psychological
stress in medical students, especially those which are significantly associated with
depression in order to facilitate early detection and treatment of these problems.
So we are interested to find the specific causes of depression and psychological
stress among the students which may be very much helpful to reduce such type of
problems.
Though the scope of the study is much broad but it will not possible for us to carry
out extensive research work involving several differentials that may important in
this context. We will focus on the very initial part of such study. But this can be used
as the pilot survey for further extensive studies.

Methodology
The research will be conducted by using the Dhaka Medical College students as the
respondents (i.e. primary data). The BDI (Beck Depression Inventory) will be used
to identify the depression level among the medical students. Also some questions
will be included to the questionnaire, which will help us to identify some risk factors
(study variables) associated with depression among them. The study type we are to
use here is cross sectional and causal study. We will work on here several study
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

variables such as political affairs, medical family background, excessive study load
etc. We will provide 249 questionnaires to the Dhaka Medical College students. For
collecting data here we will use convenience sampling, because of time, man power
and cost limitations. Because the study will be conducted purely for academic
purpose. There is no scope for us to study on vital respects of the proposed subject.
We have to work with small sample and only some basic information about the
respective subject can be obtained by this research. If it would possible for us to
conduct a cross sectional study in a proper manner then with exact financial and
intellectual support it could be a rich study with vital information. It will be not
possible for us to fulfill all the assumptions of cross sectional study in a proper way.
This study will help other researchers to gather information when further broad
research will be conducted.

Data Collection
Data will be collected in a systematic manner by a well structured questionnaire.
Among the fifteen researchers, seven of them will be deployed in the Dhaka Medical
College, who will supply the questionnaire to the medical students. For collecting
data here we will use convenience sampling, because of time, manpower and cost
limitations. Proper instructions will be given to the respondents about the
questionnaire. They will be given 4/5days to do the job very carefully. After getting
the data, we will check or detect if there is any missing values present. Each
questionnaire will be scored manually on the basis of BDI. We will organize them in
year basis and will distribute to all researchers to enter data in the computer. Five of
our researchers will work on editing and coding of the variables

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Work Plan
Our work plan is given in the following Gantt chart:
Work plan
Activities

Month
1

1. Preparatory
activities
2. Literature
review
3. Questionnaire
development
4. Data collection
5. Data editing,
coding and entry
6. Data analysis
7. Final report

This chart shows that preparatory activities will begin at the start of the first month
and will continue two months. By this time literature review will be over. Soon after
development of the questionnaire will be finished. After that field teams will be sent
for the data collection. During data collection the editing of data may be started.
After that data analysis will be started and the final report will be available any time
during the last month of the project life.

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Plan for Data Analysis


The collected data will be analyzed by personal computer following a planned
analysis strategy. This plan will largely follow the objectives of the survey. As early
we have said that our objective is to find the prevalence of depression among the
undergraduate medical students and also to find associated factors (lengthiness of
the MBBS course, excessive study loads, Family income level, political affair, and
person belongs to medical education). For this purposes, univariate analysis,
bivariate analysis and Pearson chi-square test will be done. Univariate analysis will
be used to analyze a single variable to count the number of cases in each category. A
dummy table and chart is shown below. This type of table and charts will be used
for univariate analysis.
Table: Frequency table for Age Categories.
Age Category

Frequency

Percent

18

13

6.7

19

24

12.3

20

28

14.4

21

33

16.9

22

23

11.8

23

50

25.6

24

18

9.2

25

3.1

Total

195

100.0

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And a chart related to this table will be look like this

Age
60

50

50

40

Frequency

18
19
20

33

30

21

28

22

24

20

23

23

24

18
10

25

13
6

18

19

20

21

22

23

24

25

Age

Figure: Age of the respondents.

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Bivariate analysis will places two variables together in a single table (contingency
tables) in such a manner that the interrelation between two variables can be
examined .A dummy bivariate table and chart is given below. This type of table and
charts will be use for our purpose.
Table: Bivariate table for Education year and levels of depression
Depression Level

Education Year
1

Total

Moderate

Total

None

Mild

Severe

16

31

3.6%

8.2%

2.6%

1.5%

15.9%

14

32

3.6%

7.2%

3.6%

2.1%

16.4%

19

37

2.6%

3.6%

9.7%

3.1%

19.0%

23

3.6%

3.6%

3.1%

1.5%

11.8%

23

21

21

72

11.8%

10.8%

10.8%

3.6%

36.9%

49

65

58

23

195

25.1%

33.3%

29.7%

11.8%

100.0%

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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

And the type of bivariate chart which will be use will be look like this

Education Year Vs. Depression Levels


25

20

Frequency

15
none
mild
moderate

10

severe

0
1

Year

Figure: Multiple Bar Diagram for Education year and Depression


Levels
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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

Finally to assess the association between the depression and the possible risk factor
Pearson chi square test will be done. This delineation is not however final, further
tables and analysis may be considered if needed. The statistical analysis may range
from simple univariate analysis to multivariate techniques leading to testing the
statistical significance of the results. The SPSS version 11.5 will be used for data
analysis.

Qualification of the Key Persons


All the researchers (group-05) belongs to 4th year B.S.(Hons.), session 2006-2007,
Department of Statistics, Biostatistics & Informatics, University of Dhaka. This
project work is a partial requirement for the academic purposes.

Budget
The proposed budget details for this research are given below:
Subjects

Taka

A. Materials, supplies and


computer services
1. Questionnaire printing

1500.00

2. Administrative supply

200.00

3. Report printing

B. Travel
Total

1500.00

200.00
3400.00

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Limitations
In this research we will use convenience sampling design, which is not the proper
way to draw sample for our research. Because convenience sampling is especially
used in market research & public opinion surveys and it has no control to ensure
precision.
For sampling purpose, we will consider the samples only from Dhaka Medical
College. Because it will save our time and money factor. The researchers here are
the students of 4th year B.S. (Hons.) so it will difficult for us to carry out a broader
study with proper finance and time.
Though the scope of the study is much broad but it will not possible for us to carry
out extensive research work involving several differentials that may important in
this context. We will focus on the very initial part of such study.
To obtain the accurate results from BDI (Beck Depression Inventory) tools, it is
necessary to provide this to the respondents at least 3 months before their
examination. But for time limitations, we will not be able to provide this to them.

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www.mathsteacher.com.au/year8/ch17_stat/03.../freq.htm.
www.experiment-resources.com Experimental Research.
hmcrc.srph.tamhsc.edu/Measures/GranteeMeasures/Rimer.pdf

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Appendix
BDI: The BDI (Beck Depression Inventory) is a 21item self reported inventory
designed to measure the severity of depressive symptoms. For the BDI the answers
are dichotomized between the presence and absence of major depressive
symptoms. The cut off points for the BDI are minimal or none (09), mild (1016),
moderate (1729) and severe (3063).
K10: The Kessler10 Psychological Distress (K10) has been developed by Kessler
and Colleagues, to measure current (1-month) distress. It has been designed to
measure the level of distress and severity associated with psychological symptoms
in population surveys. The K10 comprises 10 questions of the form, how often in
the past month did you feel ... and offers specific symptoms such as tired out for no
good reason, nervous, and sad or depressed. The five possible responses range
from none of the time to all of the time and are scored from 1 to 5; the items are
assumed to obtain a total score. A score of less than 20 was considered not to
represent a case possibility of mental disorder. A score of 20-24 was considered to
present a mild stress, 25-29 was considered to present moderate stress and >=30
was considered to represent as severe stress.
Mental Disorder: A mental disorder or mental illness is a psychological or
behavioral pattern generally associated with subjective distress or disability that
occurs in an individual, and which are not a part of normal development or culture.
CMD: Common mental disorders are related to somatoform disorders and to anxiety
and depression (Mari and Jorge, 1997). Characteristic symptoms include insomnia,
fatigue, irritability, forgetfulness, difficulty in concentrating and somatic complaints,
though psychotic, personality-related disorders and chemical dependence are not
involved (Goldberg and Huxley, 1992).

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Convenience Sampling: It is a non-probability sampling technique where subjects


are selected because of their convenient accessibility and proximity to the
researcher.
Gantt Chart: It is a type of bar chart that illustrates a project schedule. Gantt charts
illustrate the start and finish dates of the terminal elements and summary elements
of a project. Terminal elements and summary elements comprise the work
breakdown structure of the project. Some Gantt charts also show the dependency
(i.e., precedence network) relationships between activities. Gantt charts can be used
to show current schedule status using percent-complete shadings and a vertical line.
Univariate Analysis: Univariate analysis is concerned with the description or
summarization of individual variables in a given data set.
Bivariate Analysis: Bivariate analysis is one of the simplest forms of the
quantitative (statistical) analysis. It involves the analysis of two variables (often
denoted as X, Y), for the purpose of determining the empirical relationship between
them. In order to see if the variables are related to one another, it is common to
measure how those two variables simultaneously change together (see also
covariance). Bivariate analysis can be helpful in testing simple hypotheses of
association and causality checking to what extent it becomes easier to know and
predict a value for the dependent variable if we know a case's value on the
independent variable (see also correlation).
Frequency Table: Frequency Table is constructed by arranging collected data
values in ascending order of magnitude with their corresponding frequencies.
Study Variables: Study variables were selected on the basis of theories, conceptual
models and study hypotheses, to assure consistency with other studies and
feasibility use.
Structured Questionnaire: They are based predominantly on closed questions
which produce data that can be analyzed quantitatively for patterns and trends. It is
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a list of standard questions to ask people who are incumbent in the target job. This
may be laid out as a set of questions or a checklist. The agenda is entirely
predetermined by the evaluator and provides little flexibility for respondents to
qualify their answers.

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Questionnaire
This questionnaire is for conducting a research on Stress and Depression among the
Medical College Students. You are cordially requested to read this questionnaire and
fill it up carefully. We are expecting your kind response.
N.B: Information that, you are providing through this questionnaire, will be kept
confidential and used only for academic research purpose.
1. Name

2. Age

3. Education year

4. Sex:
o Male
o Female
5. Marital Status:
o Married
o Unmarried

Beck Depression Inventory (BDI)


This questionnaire consists of 21 groups of statements. After reading each group of statements
carefully, select the number next to the one statement in each group which best describes the
way you have been feeling during the past week, including today. If several statements within a
group seem to apply equally, circle each one. Be sure to read all the statements in each group
before making your choice.
1. Sadness
0 I do not feel sad.
1 I fell sad much of the time.
2 I am sad all the time.
3 I am so sad or unhappy that I cant stand it.

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STRESS & DEPRESSION AMONG MEDICAL STUDENTS

2. Pessimism
0 I am not discouraged about my future.
1 I feel more discouraged about my future than I used to be.
2 I do not expect things to work out for me.
3 I feel my future is hopeless and will only get worse.
3. Past Failure
0 I do not feel like a failure
1 I have failed more than I should have.
2 As I look back, I see a lot of failures.
3 I feel I am a total failure as a person.
4. Loss of Pleasure
0 I get as much pleasure as I ever did from the things I enjoy.
1 I dont enjoy things as much as I used to.
2 I get very little pleasure from the things I used to enjoy.
3 I cant get any pleasure from the things I used to enjoy.
5. Guilty Feelings
0 I dont feel particularly guilty.
1 I feel guilty over many things I have done or should have done.
2 I feel quite guilty most the time.
3 I feel guilty all of the time.
6. Punishment Feelings
0 I dont feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7. Self-Dislike
0 I feel the same about myself as ever.
1 I have lost confidence in myself.
2 I am disappointed in myself.
3 I dislike myself.
8. Self-Criticalness
0 I dont criticize or blame myself more than usual.
1 I am more critical of myself than I used to be.
2 I criticize myself for all of my status.
3 I blame myself for everything bad that happens.

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9. Suicidal Thoughts or Wishes


0 I dont have any thoughts of killing myself.
1 I have any thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10. Crying
0 I dont cry anymore than I used to.
1 I cry more than I used to.
2 I cry over every little thing.
3 I feel like crying, but I cant.
11. Agitation
0 I am no more restless or wound up than usual.
1 I feel more restless or wound up than usual.
2 I am so restless or agitated that its hard to stay still.
3 I am so restless or agitated that I have to keep moving or doing something.
12. Loss of Interest
0 I have not lost interest in other people or activities.
1 I am less interested in other people or things than before.
2 I have lost most of my interest in other people or things.
3 Its hard to get interested in anything.
13. Indecisiveness
0 I make decisions about as well as ever.
1 I find it more difficult to make decisions than usual.
2 I have much greater difficulty in making decisions than I used to.
3 I have trouble making any decisions.
14. Worthlessness
0 I do not feel I am worthless.
1 I dont consider myself as worthwhile and useful as I used to.
2 I feel more worthless as compared to other people.
3 I feel utterly worthless.
15. Loss of Energy
0 I have as much energy as ever.
1 I have less energy than I used to have.
2 I dont have enough energy to do very much.
3 I dont have enough energy to do anything.

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16. Changes in Sleeping Pattern


0 I have not experienced any change in my sleeping patterns.
1a I sleep somewhat more than usual.
1b I sleep somewhat less than usual.
2a I sleep a lot more than usual.
2b I sleep a lot less than usual.
3a I sleep most of the day.
3b I wake up 1-2 hours early & cant get back to sleep.
17. Irritability
0 I am no more irritable more than usual.
1 I am more irritable more than usual.
2 I am much more irritable more than usual.
3 I am irritable all that time.
18. Changes in Appetite
0 I have not experienced any change in my appetite.
1a My appetite is somewhat less than usual.
1b My appetite is somewhat more than usual.
2a My appetite is much less than before.
2b My appetite is greater than usual.
3a I have no appetite at all.
3b I crave food all the time.
19. Concentration Difficulty
0 I can concentrate as well as ever.
1 I cant concentrate as well as usual.
2 Its hard to keep my mind on anything for very long.
3 I find I cant concentrate anything.
20. Tiredness or Fatigue
0 I am no more tired or fatigue more than usual.
1 I get more tired or fatigue more easily than usual.
2 I am too tired or fatigued to do a lot of the things I used to do.
3 I am too tired or fatigued to do most of the things I used to do.
21. Loss of Interest in Sex
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I am much less interested in sex now.
3 I have lost interest in sex completely.

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Additional Questions:
1. Does your family contain any person who belongs to medical education?
a) Yes
b) No
2. Are you related to some political affairs?
a) Yes
b) No
3. Do you think MBBS course is a long term course to bear?
a) Yes
b) No
4. Do you feel excessive study loads during your undergraduate program?
a) Yes
b) No
5. Family Information:
Fathers Occupation:.; Designation:.
Organization: ..; Monthly Income:
Mothers Occupation:..; Designation:
Organization: ..; Monthly Income:
Or
Guardians Occupation:; Designation:.
Organization: ; Monthly Income: .

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