|Year : 2018 | Volume
| Issue : 2 | Page : 59-63
Stress among medical students and advantages of metallisation therapy in general: A review of literatures
Vidya Bhagat1, Mainul Haque2, Nordin Bin Simbak1, Rohayah Husain1
1 Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400 Kuala Terengganu, Terengganu, Malaysia
2 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
|Date of Web Publication||8-May-2018|
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
Stress is a constraining force that causes bodily or mental tension and may be a factor in disease causation. The study showed that medical students have more proneness to higher stress than students study in non-medical fields. The objective of this study is to discover the stress as evident among Malaysian medical students and general positive effects of mentation programmes in stress management. The current study was worked with the review of literature of the past study reports regarding stress in Malaysian medical students and general positive effect of mentation in stress management. The study had used electronic databases for rummaging and reviewing literature articles published on stress and other psychological determinants among medical students and mindfulness in the management of stress. Stress, mindfulness and related terminologies are used in searching related articles. In the current study, data were extracted through reviewing various related research articles focussing more on the prevalence and stress management in medical students. Stress among medical students found to be more than 50% needs close attention and monitoring. The academically related stressors were found to be high with the existence of other stressors with financial and relationship problem. Mentors help and religious sources were used as coping strategy. Medical education is found to be highly stressful. Developing awareness effects of managing stress through mindfulness and mentation among students and teachers and facilitate students to cope with academic and other stress that can negatively affect students' mental health. Prospective studies are encouraged using matured mentation programmes in medical schools.
Keywords: Coping strategy, Malaysia, medical students, mentation, mindfulness, stress, stressor
|How to cite this article:|
Bhagat V, Haque M, Simbak NB, Husain R. Stress among medical students and advantages of metallisation therapy in general: A review of literatures. Adv Hum Biol 2018;8:59-63
|How to cite this URL:|
Bhagat V, Haque M, Simbak NB, Husain R. Stress among medical students and advantages of metallisation therapy in general: A review of literatures. Adv Hum Biol [serial online] 2018 [cited 2019 Jul 22];8:59-63. Available from: http://www.aihbonline.com/text.asp?2018/8/2/59/232026
| Introduction|| |
Stress is a disturbed state of an organism due to the numerous demands of life situations that demand more adjustments from individuals. It is a normal physical response to demanding life events which are rather complex. Stress is a state of an individual that caused by his/her perceived threat from their environment disturbs their well-being. The stress system in individual coordinates the generalised stress response, which takes place when a stressor of any kind exceeds a threshold. Activation of the stress system leads to behavioural and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances of survival. Yet, time the environmental factors can directly upset the mental and physical homeostasis of the individual in the extent of distress. Perhaps, in the stressful situations, the individual is affected by his/her mental ability to carry out on-going responsibilities of life.,, It has been stated that field of education by itself needs a lot of adjustments thus highly stressful to students. Since they face demanding adjustment from their university life the need ability to cope, but student's ability varies to manage with campus life and alter to these new challenges, and some students confront more obstacles than others. Admission to medical school is frequently the realisation of long-held dreams and the reward for many years of hard work. Although students may be prepared academically, many are not prepared emotionally for the rigors of the curriculum and the demands of their new lifestyle. Several factors can contribute to severe stress and functional impairment. Thus, medical education is even more stressful as evidenced by the high prevalence of stress among medical students. The sense of powerlessness experienced by medical students that further contributes to overall stress.
The three main stressors identified are examinations, workload and financial responsibilities. Several other factors such as dissecting cadavers, pathologic processes, the physically examining the patient, acquiring diseases from patient and hospital environment, commonly the felt inadequacy and not ready for treating patients, medical hierarchies and harassment are some common aspects that cause depression among medical students. Metallisation is a new term for processing of thinking and feeling about self and others. Metallisation behavioural therapy combines analytical and non-analytical approaches in its clinical practice.,, Metallisation therapy is helpful in adaptation. Its focus is helping people to differentiate and separate out their thoughts and feelings from those around them. Mindfulness is also introduced for the therapeutic benefit.
In the current study report, describes the findings of stress among medical students in Malaysia. Stress and stress-related anxiety, depression and other psychological disturbances among medical students. The review addresses the following aspects:
- Level of stress and distress observed among medical students in various developed and developing countries
- Stress management.
| Stress among Medical Students in the Most Developed Countries|| |
The current study analysis makes appraisal if stress level basing prevalence rate of stress among medical students. Some study reports regarding stress and burnout among medical students find that about 50% of medical students have experienced 'burnout' and about 10% have experienced suicidal ideation at some point during medical school. Medical school in the USA has recognised undergraduate medical student's that 23% had clinical depression and 57% were under psychological stress.,, Studies have shown that the medical students of in the USA sufferers from a very rate of depression. Anxiety, depression and a general sense of 'burnout' may all result from the increased stress experienced by medical students., The level of structural integration of the associated with stress experience, i.e., a positive 'model of self' can have a stress-protective effect that has been observed in medical students with good structural. In this stress-related study on medical students, it has been observed that a low level of structural integration among the medical students was associated with higher stress experience when transitioning to study. The study has revealed that affected students with this regard need the preventive measures enabling the students for sustainable preparation of their transitional period and good structural integrity. It has been observed that traditional undergraduate medical students during the first 2 years at the UK medical schools showed the need for interventions to prevent maladaptive coping styles. This study has encouraged students to develop positive coping skills that can help them during their medical training and in their future career which is inherently stressful. Thus, current study observes stress in medical students from various perspectives of that evidence the commonality in inheriting stress in medicals schools of these developed countries.
| Stress among Medical Students in Developing Countries|| |
Reviewed Indian studies on stress among medical students showed high-level stress, depression, and anxiety depression. Study evidenced that females reported higher level stress than that of the male. Another aspect they found is that perception of self-assessment in academics associated with the higher level stress. Studies revealed that the substantial proportion undergraduate medical students found to be having depression, anxiety and stress thus the recommendation to focus on students' psychology. The study also recommended the need of counselling services and its accessibility to students to curb the morbidities of stress, depression and anxiety. The current study observations have further revealed that calculated stress levels among the Pakistani medical students were as high as 54.6%. They showed higher level stress compared to non-medical professional students. This study expressed the need for counselling and other stress management programmes to manage the effects of elevated stress levels that influence their physical and mental health. Furthermore, the study has also specified the necessity providing an appropriate counselling and stress relieving activities to prevent the long-term antagonistic level comparison of medical and nonmedical students has been emphasised in this study. Analysis of the literature reviews of Bangladeshi study on medical students revealed that more than half medical students are suffering from measurable academic stress this fact has been evidenced by the study conducted on 990 Bangladeshi medical students 54% and 55% of male and female, respectively, showed higher level stress. This study has shown need to make the provisions to have a conducive-learning environment to help the medical students. Thus, the current study has been analysed stress among medical students inherits regardless in developed and underdeveloped countries. In consequence, the prerequisite needs for stress management programmes for medical students.
One Malaysia compressive study evaluated students stress/emotional disorder/social anxiety disorder prevalence has been observed very high (56%). In the review analysis, it has been found that the lowest prevalence rate was identified as 14.3%. The Current study has reviewed one study on social anxiety problem among postgraduate medical students was 36.45%., Depressive symptoms rate was identified in review analysis 21.7%. Another revealed that clinical depression, anxiety and stress as 5.5%, 24.5% and 7.3%, respectively and non-clinical depression, anxiety and stress as 36.4%, 35.5% and 30%, respectively.
Stress normally get managed with healthy habits such as exercises, diet, self-discipline and self-management, these self-care activities monitors general health in response to the time demands of medical school unfortunately many medical students eliminate these healthy habits and become victims of stress-related depression and anxiety. Several studies have explored the incidence of stress and related illness such as anxiety and depression among the medical profession are increasing as the days passed. The current study has observed the prevalence rate of stress among Malaysian medical students of different universities varies from 44% to 56%. The similar study explores that educational process dispensing the negative effect on students' mental health with a high frequency of depression, anxiety and stress among medical students.,,,,,,, Analysis of literature of past reviews has evidenced Malaysian medical students' level of stress, and negative effect on their mental health is found high. The efforts towards the management of stress seem to be less or lack of evidence. Thus, the current study recommends focussing on stress management and related research that can help students and progress of future research with this regard.
| Stressors and Distress among Medical Student|| |
Stress in medical school is helpful because it motivates the students to move and adapt to the curriculum. When academic stressors get added on to other stressors or coping difficulties in academics can lead the stress into distress. It has been observed in the literature that curriculum in medical schools that is including examination and academic-related factors were the most significant stressors.,,,,, Academic examinations are shown in the reviews that cause higher stress., Generally observed facts regarding factors causing stress has been observed in series of academic stressors such as examinations and its preparations, time management to organising studies, poor examination scores, a desire to do well in medical practice, lack of skill, difficulty understanding the content, falling behind in schedule of learning materials, heavy workload and inability to reach the teachers expectations.,,,, The review analysis paves a way in learning that stress with significant associations with students undergoing worries of the future, fanatical problem, study load, interpersonal conflicts, family problems, low self-esteem, staying away from home, parental support and conflict with room partners, new ways of living. These aspects are more demanding and found to be stressful. Early clinical exposures and infrastructural facilities were also part of significant for stress among students. Analysis of various studies related students stress/leading distress has been revealed increased prevalence for emotional disorder/social anxiety disorder., Observation of the past literature showed psychometric assessment has been indicated that multimodal student selection has been proved medical students with good psychological health. Social anxiety problem the expression led by distress among medical students was  and among postgraduate medical students' distress found with social anxiety problem like undergraduate though the extent was less., Distress commonly paves the way for depression and anxiety symptoms among medical students', and multiple research works of literature have supported this fact.,
The emotional disturbance reported in different studies among medical students was higher than that in the general population. In three British universities stress was 31.2%, while in a Malaysian medical school it was 41.9% and observed in the analysis as high as 56% and in a Thai medical school 61.4%. other studies also found with medical students from Saudi Arabia, India and Thailand identified a high frequency of stress.,, Thus, current study reports the Malaysian and Thai medical schools have more frequency for higher stress prevalence. Malaysian medical schools need to be focused on the future making some programmes for stress management in medical schools.
| Stress Management (Mentation or Medimind)|| |
Researches related to intervention and stress management among medical students is found to be limited. However, it has been observed that students under intervention group attended a workshop as shown stress reduction. The significant reduction of anxiety and depression that brief after intervention found to be effective. Medical students commonly deal with traumatic events such as death and dying, their ethical dilemmas yet time make them vulnerable to depression. The factors such as family support, personal traits important aspects influencing vulnerability. Medical students' workload, examinations, presentations and assessment brings the new changes need more adoption. Indeed, it influences their sleep, irregular and diet, many get involved in unhealthy habits such as alcohol and smoking to cope with the pressure which is an element of stress.,, Failing to cope with the stressors paves a way for deterioration in academic and professional performances and psychological distress. Stress which is due to the transition to a new environment is the most common stress among the new students. The management of stress should go with students' level of stress and ability to cope. The current study has analysed the existing literature and observed that the stress prevalence rate is variable among the medical students from Year I–IV.,, Lower stress prevalence observed among first (26.3%) and final year students (21.9%) than that of students of 2nd, 3rd and 4th year.
Thus, the stress management programme indifferent level has its own benefits to the students. Stress management programmes are more in western countries that have been found to be benefit to medical students. The current study had observed in the literature of that German medical school has explored in their studies understanding personality traits assuming them to work as specific risk factors in medical training and adapting stress prevention training like MediMind will be able to affect them positively. Mindfulness-based stress reduction programmes are associated with high levels of satisfaction when delivered on an optional basis. These satisfaction levels appear to increase over time and with increased understanding.
| Conclusion|| |
Accordingly, this review concludes that living with high levels of stress that means putting oneself at risk for entire well-being. Stress inflicts havoc on emotional equilibrium and physical health medical students. It narrows your ability to think clearly, function effectively, and enjoy life. Consequently, the study suggests effective stress management that can help to cope better with stress and be happier, healthier and more productive. It is much important for medical students to learn stress management skill to lead a quality life, with time for work, relationships, relaxation, fun and the resilience to hold up under pressure and meet challenges head-on. Mentalisation or different types of mindfulness would be useful in stress management that's can be experimented and find out what works best for according to the coping ability of students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 1992;267:1244-52.
Yasin MA, Dzulkifli MA. Differences in depression, anxiety and stress between low-and high-achieving students. J Sustain Sci Manage 2011;6:169-78.
Khodarahimi S, Hashim IH, Mohd-Zaharim N. Perceived stress, positive-negative emotions, personal values and perceived social support in Malaysian undergraduate students. Int J Psychol Behav Sci 2012;2:1-8.
Khodarahimi S, Hashim IH, Mohd-Zaharim N. Attachment styles, perceived stress and social support in a Malaysian young adults sample. Psychol Belgs 2016;6:65-79.
Habeeb KA. Prevalence of stressors among female medical students Taibah university. J Taibah Univ Med Sci 2010;5:110-9.
Tinto V. Leaving College: Rethinking the Causes and Cures of Student Attrition. 2nd
ed. Chicago, IL: University of Chicago Press; 1993.
Jeong Y, Kim JY, Ryu JS, Lee KE, Ha EH, Park H, et al.
The associations between social support, health-related behaviors, socioeconomic status and depression in medical students. Epidemiol Health 2010;32:e2010009.
Levin R. Beyond “the men of steel”. The origins and significance of house staff training stress. Gen Hosp Psychiatry 1988;10:114-21.
Wolf TM, Faucett JM, Randall HM, Balson PM. Graduating medical students' ratings of stresses, pleasures, and coping strategies. J Med Educ 1988;63:636-42.
Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al.
Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008;149:334-41.
Bateman AW, Fonagy P. Handbook of Mentalizing in Mental Health Practice. 1st
ed. Arlington, VA: American Psychiatric Publishing Inc.; 2011.
Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry 2010;9:11-5.
Bateman A, Fonagy P. Mentalization-based treatment. Psychoanal Inq 2013;33:595-613.
Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia 2004;59:207-11.
Sherina MS, Kaneson N. The prevalence of depression among medical students. Malay J Psychiatry 2003;11:12-7.
Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clin Proc 2005;80:1613-22.
Stecker T. Well-being in an academic environment. Med Educ 2004;38:465-78.
Kulsoom B, Afsar NA. Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr Dis Treat 2015;11:1713-22.
Kumar S. Burnout and doctors: Prevalence, prevention and intervention. Healthcare (Basel) 2016;4: pii: E37.
Bugaj TJ, Müksch C, Ehrenthal JC, Köhl-Hackert N, Schauenburg H, Huber J, et al.
Stress in medical students: A Cross-sectional study on the relevance of attachment style and structural integration. Psychother Psychosom Med Psychol 2016;66:88-92.
Zvauya R, Oyebode F, Day EJ, Thomas CP, Jones LA. A comparison of stress levels, coping styles and psychological morbidity between graduate-entry and traditional undergraduate medical students during the first 2 years at a UK medical school. BMC Med Educ 2017;10:93.
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.
] [Full text]
Muhammad Jafri SA, Zaidi E, Aamir IS, Aziz HW, Imad-ud-Din, Husnain Shah MA. Stress level comparison of medical and non-medical students: A cross sectional study done at various professional colleges in Karachi, Pakistan. Acta Psychopathol 2017;3:2.
Eva EO, Islam MZ, Mosaddek AS, Rahman MF, Rozario RJ, Iftekhar AF, et al.
Prevalence of stress among medical students: A comparative study between public and private medical schools in Bangladesh. BMC Res Notes 2015;8:327.
Aziz AA, Salina AA, Abdul Kadir AB, Badiah Y, Cheah YC, Nor Hayati A, et al.
The national mental health registry (NMHR). Med J Malaysia 2008;63 Suppl C: 15-7.
Yusoff MS, Rahim AF, Baba AA, Ismail SB, Esa AR. A study on psychological distress of two batches of first-year medical students underwent different selection admission processes. Malays J Med Sci 2012;19:29-35.
Yusoff MS, Rahim AF. Impact of the medical students' well-being workshop on the medical students' stress level: A preliminary study. ASEAN J Psychiatry 2010;11:1-8.
Salam A, Bakar SM, Yousuf R, Haque M. Stress among medical students in Malaysia: A systematic review of literatures. Int Med J 2013;20:649-55.
Yusoff MS, Saiful M, Fuad AA, Yaacob MJ. The prevalence of final year medical students with depressive symptoms and its contributing factors. Int Med J 2011;18:305-9.
Stewart SM, Betson C, Marshall I, Wong CM, Lee PW, Lam TH, et al.
Stress and vulnerability in medical students. Med Educ 1995;29:119-27.
Singh G, Hankins M, Weinman JA. Does medical school cause health anxiety and worry in medical students? Med Educ 2004;38:479-81.
Ngasa SN, Sama CB, Dzekem BS, Nforchu KN, Tindong M, Aroke D, et al.
Prevalence and factors associated with depression among medical students in Cameroon: A cross-sectional study. BMC Psychiatry 2017;17:216.
Stewart SM, Betson C, Lam TH, Marshall IB, Lee PW, Wong CM, et al.
Predicting stress in first year medical students: A longitudinal study. Med Educ 1997;31:163-8.
Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 2006;81:354-73.
Lei XY, Xiao LM, Liu YN, Li YM. Prevalence of depression among Chinese university students: A Meta-analysis. PLoS One 2016;11:e0153454.
Saravanan C, Wilks R. Medical students' experience of and reaction to stress: The role of depression and anxiety. ScientificWorldJournal 2014;2014:737382.
Abdel Rahman AG, Al Hashim BN, Al Hiji NK, Al-Abbad Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J Prev Med Hyg 2013;54:195-9.
Yusoff MS, Abdul Rahim AF, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malays J Med Sci 2010;17:30-7.
Rahman NI, Ismail S, Seman TN, Rosli NF, Jusoh SA, Dali WP, et al
. Stress among preclinical medical students of Universiti Sultan Zainal Abidin. J App Pharm Sci 2013;3:76-81.
Rahman NI, Ismail SB, Ali RM, Alattraqchi AG, Dali WP, Umar BU, et al
. Stress among first batch of MBBS students of faculty of medicine and health sciences, Universiti Sultan Zainal Abidin, Malaysia: When final professional examination is knocking at the door. Int Med J 2015;22:254-9.
Borjalilu S, Mohammadi A, Mojtahedzadeh R. Sources and severity of perceived stress among Iranian medical students. Iran Red Crescent Med J 2015;17:e17767.
Siraj HH, Salam A, Roslan R, Hasan NA, Jin TH, Othman MN. Stress and its association with the academic performance of undergraduate fourth year medical students at Universiti Kebangsaan Malaysia. Int Med J Malay 2014;13:19-24.
O'Reilly E, McNeill KG, Mavor KI, Anderson K. Looking beyond personal stressors: An examination of how academic stressors contribute to depression in Australian graduate medical students. Teach Learn Med 2014;26:56-63.
Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC Med Educ 2010;10:2.
Murphy RJ, Gray SA, Sterling G, Reeves K, DuCette J. A comparative study of professional student stress. J Dent Educ 2009;73:328-37.
Sedky NA. Perceived sources of stress among junior & mid-senior Egyptian dental students. Int J Health Sci (Qassim) 2012;6:141-57.
Gomathi KG, Ahmed S, Sreedharan J. Causes of stress and coping strategies adopted by undergraduate health professions students in a university in the United Arab Emirates. Sultan Qaboos Univ Med J 2013;13:437-41.
Ekpenyong CE, Daniel NE, Aribo EO. Associations between academic stressors, reaction to stress, coping strategies and musculoskeletal disorders among college students. Ethiop J Health Sci 2013;23:98-112.
Waghachavare VB, Dhumale GB, Kadam YR, Gore AD. A study of stress among students of professional colleges from an urban area in India. Sultan Qaboos Univ Med J 2013;13:429-36.
Al-Dubai SA, Al-Naggar RA, Alshagga MA, Rampal KG. Stress and coping strategies of students in a medical faculty in Malaysia. Malays J Med Sci 2011;18:57-64.
Adlina S, Narimah AH, Hakimi ZA, Suthahar A, Hisyam RM, Ruhaida MK, et al.
The stress inducing factors among preclinical students in a public University in Selangor. Malay J Public Health Med 2007;7:56-9.
Salina M, Ng CG, Gill JS, Chin JM, Chin CJ, Yap WF. Social anxiety problem among medical students in Universiti Malaya Medical Center (UMMC): A cross-sectional study. Malay J Psychiatry 2008;17:17-22.
Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: A cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr 2011;29:516-22.
Mannapur B, Dorle AS, Hiremath ID, Ghattargi CH, Ramadurg U, Kulkarni KR. A study of psychological stress in undergraduate medical students at S N
medical college, Bagalkot, Karnataka. J Clin Diagn Res 2010;4:2869-74.
Abhay MB, Krishnakunar MK, Naranjan PC, Hiremath SG. Differences in perceived stress and its correlates among students in professional courses. J Clin Diagn Res 2011;5:1228-33.
Yusoff MS. Effects of a brief stress reduction intervention on medical students' depression, anxiety and stress level during stressful period. ASEAN J Psychiatry 2011;12:1-14.
Baldassin S, Alves TC, de Andrade AG, Nogueira Martins LA. The characteristics of depressive symptoms in medical students during medical education and training: A cross-sectional study. BMC Med Educ 2008;8:60.
Tamaki T, Kaneita Y, Ohida T, Yokoyama E, Osaki Y, Kanda H, et al.
Prevalence of and factors associated with smoking among Japanese medical students. J Epidemiol 2010;20:339-45.
Zailinawati AH, Teng CL, Chung YC, Teow TL, Lee PN, Jagmohni KS, et al.
Daytime sleepiness and sleep quality among Malaysian medical students. Med J Malaysia 2009;64:108-10.
Deasy C, Coughlan B, Pironom J, Jourdan D, Mannix-McNamara P. Psychological distress and coping amongst higher education students: A mixed method enquiry. PLoS One 2014;9:e115193.
Paro HB, Morales NM, Silva CH, Rezende CH, Pinto RM, Morales RR, et al.
Health-related quality of life of medical students. Med Educ 2010;44:227-35.
Zaid ZA, Chan SC, Ho JJ. Emotional disorders among medical students in a Malaysian private medical school. Singapore Med J 2007;48:895-9.
Kuhlmann SM, Bürger A, Esser G, Hammerle F. A mindfulness-based stress prevention training for medical students (MediMind): Study protocol for a randomized controlled trial. Trials 2015;16:40.
Aherne D, Farrant K, Hickey L, Hickey E, McGrath L, McGrath D, et al.
Mindfulness based stress reduction for medical students: Optimising student satisfaction and engagement. BMC Med Educ 2016;16:209.