OJHAS Vol. 10, Issue 2:
in Students of Medical College and Science and
Art College Students - A Comparative
|Priyanka Mahawar, Assistant Professor, Department of
Community Medicine, Sri Aurobindo
Institute of Medical Sciences, Indore,
Sameer Phadnis, Assistant Professor, Department of
Community Medicine, Peoples College of Medical
Sciences & Research, Bhopal,
Gargi Ghosh, Demonstrator, Department of
Community Medicine, MGM Medical College, Indore,
OP Kataria, Demonstrator, Department of Community Medicine, MGM Medical College, Indore,
Sanjay Dixit, Professor & Head, Department of Community Medicine, MGM Medical College, Indore.
Address for Correspondence
Institute of Medical Sciences,
Mahawar P, Phadnis S, Ghosh G, Kataria OP, Dixit S. Psychological Morbidity
in Students of Medical College and Science and
Art College Students - A Comparative
Study. Online J Health Allied Scs.
Submitted: Apr 2,
2011; Accepted: Jul 20, 2011; Published: Jul 30, 2011
Considering the importance
of quality of life in medical students we have conducted a cross
sectional & descriptive study
on screening of mental illness of 60 medical students of prefinal year and comparing it with
60 students of third
year of Science and Art College. Students were selected via
random sampling. GHQ-12 was used
as a screening tool and after obtaining scores students were graded
in 3 categories - individuals screened positive for psychological
morbidity were of Grades 2 and 3 and individuals screened negative
for psychological morbidity were of Grade 1 and they were compared according to college, gender & residence.
positive for psychological morbidity as per GHQ-12 were found
higher in medical college (87%) as compared to Science and Art College (45%) and a statistically significant association
was found between psychological
morbidity and medical students. Psychological morbidity was
not significantly associated with residence and gender.
GHQ -12; Medical
from the change in an individual’s thinking and their lifestyle nowadays.
Now, individuals have changed in their perceptions and the way they
interpret this life. Students in their teens are the ones who are going
through the transitional phase, which is an intermediate of childhood
and adulthood. During the teen years, a lot of biological, physical,
mental and emotional changes are happening, as well as the changes in
responsibility and role. In order to stabilize these changes, the students
are always confronted with problems and conflicts. For some students
who are not capable of dealing with it, the changes will create stress
and tension to them. If it is not dealt with in the early stages, the
student may experience mental problems.1 Medical education
is perceived as being stressful. It is characterized by many psychological
changes in students. Medical students encounter multiple anxieties in
transformation from insecure student to young knowledgeable physician.
There is a growing concern about stress in medical training. Studies
have observed that medical students experience a high incidence of personal
distress during their undergraduate course.2
study was conducted among students of Mahatma Gandhi Memorial Medical
College (MGM Medical college) and Holkar Science and arts College, Indore, between June 2010 to November 2010.
Sixty five students were enrolled
in a particular section of science in Holkar College. The respondents
completed a self-administered designed questionnaire and a standard
instrument - The General Health Questionnaire (GHQ 12). The GHQ belongs to a family of instruments for assessing
psychiatric morbidity in both community and non-psychiatric settings.1 The original GHQ comprised of 60 items
and versions with fewer items have been developed from this,
e.g. the GHQ - 30, GHQ - 28 and GHQ- 12.3,4 The GHQ -12
is a brief, well validated 12-item instrument used to identify psychiatric morbidity,3 designed for assessing and detecting psychiatric
morbidity.5 Six of the items are positively worded; the other
six are negatively worded. There are four response categories for each
item, i.e. "Better than usual", "Same
as usual", "Less
than usual" and "Much
less than usual".
were administered in 1-hour sessions and participation was voluntary.
The original dichotomous scoring system (0-0-1-1), has been advocated
to identify individuals with existing psychiatric morbidity. In
this procedure, the first two anchors represent non-presentation of
symptoms and so are both scored zero. The next two responses represent
a presentation of symptoms and are therefore are scored as one.
With Goldberg scale used, out
of four options, 0= 2 options referring to less psychological morbidity
and 1= 2 options referring to more psychological morbidity; maximum score is 12, minimum
is=0, with a range of 0 to 12. Threshold score is 4
i.e. score more than 4 is considered positive in screening test. Score of 0 to 4
is graded as 1, 5 to 8 as 2 and 9 to 12 as 3. Thus individuals screened
positive for psychological morbidity are of Grades 2 and 3 whereas
individuals screened negative for psychological morbidity are
of Grade 1.
Only 60 students gave consent
for involvement in the study. The responses were noted and the statistical
package SPSS, version 12.0, was used for data analysis.
In MGM Medical College, the
grade detected in highest frequency was grade 2 (score 5-8)>grade
3(9-12)>grade 1(1-4) i.e. 87% students were screened as positive
for GHQ-12 where as only 45% students were screened as positive for
GHQ-12 in Holkar Science College, Indore.(Fig 1)
Figure 1: Distribution of students according to GHQ 12 scale.
Table 1: Comparison of Students according to GHQ -12 responses.
MGM Medical College
Holkar Science College
|Able to concentrate
|Loss of sleep
|Able to enjoy
|Able to face
of self as worthless
With the advent of globalisation
and economic boom, even developing nations are slowly moving from
the infectious diseases to life style diseases or chronic diseases. More
and more competition in every field has threatened the economic
stability of an individual and a family, thus leading to stress and
This competition is on continuous rise in medical field and
this has lead to stress which is impairing the quality of life in medicos
.This negative effects of long and tiring medical education on the psychological
status of students have been shown in several studies.
Our study done on psychological morbidity via GHQ-12 also revolves
around medical students. Considering the limited
number of interviewed students and their proportion of the original
sample (n = 120), we do not present the numbers as estimates of prevalence. In our study
the number of medical students screened positive for psychological morbidity as
per GHQ-12 (87%) are more than most other studies
from India and from other countries like Nepal and Pakistan. Guthrie et al in U.K. in a
5-year prospective longitudinal cohort study found that a small group
of students repeatedly experience psychological distress during their
medical training.6 In Pakistan
a cross-sectional descriptive study was carried out on all interns
and residents at the Aga Khan University Hospital by use of General
Health Questionnaire (GHQ-12)
and found that more than 46% of the trainees scored over
the threshold of more than 4 for
morbid stress.7 Blanco and his colleagues, who have studied mental
health of college students, concluded that “urgent action” is needed
to improve detection and early treatment
in this group.8 Our study did not show any
significant association of stress with gender and residence.
In the present study 12-item GHQ was used. Earlier studies from United
Kingdom used a more conservative cut off score of 3–4 for
allowing comparability of results with other studies from United Kingdom. We considered a cut off score of 4–5 to identify probable
cases. However, the actual cut off score chosen depends on the purpose
and context of each study, and relates to the relative importance of
sensitivity and specificity . But some studies on stress have either
not used GHQ or used various other instruments for measuring the stress
levels among the medical students There are also variations in the
socio-cultural contexts and the medical curricula of the settings
where such studies were carried out. Hence the results of the studies
cited above may not be comparable.
We carried out our survey
during the middle of the session to avoid the stressful time
of sessional and university examinations. Therefore, the stress status
measured may represent the natural level of stress among medical students.
Despite the variability of
cut-offs used to estimate the prevalence, psychiatric morbidity reported
in our study can be considered as high.
design did not allow us to study the cause-and-effect relationship of
psychological morbidity with stress and coping strategies. Therefore
a prospective study is necessary to study the association of psychological
morbidity with demographic variables, sources of stress and coping strategies.
Sulaiman et al. The Level of Stress Among Students in Urban and Rural
Secondary Schools in Malaysia. European Journal of Social Sciences.
- Dahlin M, Joneborg N, Runeson
B. Stress and depression among medical students: a cross-sectional study.
Med Educ 2005;39:594-604.
D, Williams P. A User's Guide to the General Health Questionnaire Windsor: NFER-Nelson;
DP, Hillier VF. A scaled version of the General Health Questionnaire.
Psychol Med 1979;9:139-145.
U, Goldberg DP, Yalcin I, Üstün BT. The stability of the factor structure of
the General Health Questionnaire.
Psychol Med 2000;30:823-829.
- Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F.
Psychological stress and burnout in medical students: a five-year prospective
Journal of Royal society of Medicine. 1998 May;91(5):237-243
- Kasi PM et al. Studying the association between postgraduate trainees’ work hours,
stress and the use of maladaptive coping strategies. Journal Ayub Medical College Abbottabad 2007;19(3):37-41
- Blanco C, Okuda M, Wright
C, Hasin DS, Grant BF, Liu Sh et al. Mental Health of college students and their
non–college attending peers. Arch Gen Psychiatry 2008;65(12):1429-1437.