A cross-sectional study of stress among junior college students in a rural area of Sangli district of Maharashtra, India.

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Innovative Journal of Medical and Health Science 3 : 6 November – December (2013) 294 - 297.
Contents lists available at www.innovativejournal.in
INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCE
Journal homepage: http://www.innovativejournal.in/index.php/ijmhs
294
A CROSS-SECTIONAL STUDY OF STRESS AMONG JUNIOR COLLEGE STUDENTS IN A
RURAL AREA OF SANGLI DISTRICT OF MAHARASHTRA.
Waghachavare V B, Chavan V M, Dhumale G B, Gore A D.
Dept. of Community Medicine. Bharati Vidyapeeth Deemed University Medical College & Hospital, Sangli (MH) India
ARTICLE INFO
ABSTRACT
Corresponding Author:
Dr. Waghachavare Vivek B,
Dept. of Community Medicine
(PSM), Bharati Vidyapeeth Deemed
University Medical College &
Hospital, Sangli, Maharashtra, India
– 416414.
vivek416416@gmail.com
Keywords: Psychological Stress;
Secondary School; Adolescents;
Depression.
Objectives: Higher secondary school certificate examination is considered to be
one of the most important year in an academic career. Excessive Stress during
this year could results in increased prevalence of psychological problems like
depression and anxiety. This could ultimately have negative impact on the
outcome of the achievements. The objective of the current study is, to assess the
stress and its association with various academic factors among students of
higher secondary school from a rural area in Sangli district of Maharashtra.
Methods: It is cross-sectional study, conducted among the students of a
randomly selected higher secondary school from the rural area in Sangli district
of Maharashtra, India. Sampling technique used in the study was stratified
random sampling and calculated sample size. The study was conducted during
September 2012 to February 2013. A pretested self administered questionnaire
was used for the data collection. Analysis was done using percentage, chi-square
test. Results: Among the 396 students participated in the study, 118 (30.2%)
were positive for stress. Stress was observed in 69 (38.1%) female students and
49 (23.3%) male students; the association with gender was statistically
significant. Association between stress and stream of education was not
observed. Stress was significantly associated with depression and perceived
academic stressors. Conclusion: Students from all the three fields are exposed
to stress. Academic stress is an important factor in development of stress.
Introduction of stress management education in the curriculum can prove useful
in dealing with the problem.
©2013, IJMHS, All Right Reserved
Advances in knowledge:
1. Studies, regarding the stress among higher secondary school students from the rural area are very few. The current research addresses the issue.
2. This study shows that along with academic stresses and the burden of expectations can play an important role in development of stress.
Application to patient care:
1. The research highlights the need of incorporation of stress management education in the curriculum, as well as development of mechanism for
decreasing stress among students in higher secondary schools.
2. Similarly, it highlights importance of better teaching practices and realization of limitations before expectations to decrease the stress among
students.
INTRODUCTION
Stress can be defined as, any change in the body’s
equilibrium. Any negative stress is also known as distress.
Distress occurs when while performing a task or
throughout a day to day activity tension builds up, there is
no longer any fun in it and there seems to be no relief. This
may lead to poor decision making. The general
characteristics of the person in distress are, over-aroused,
tense, unable to relax, touchy, easily upset, irritable, easily
startled, nervy, jumpy, fidgety and intolerant of
interruption or delay. Excessive stress results in increased
prevalence of psychological problems like depression,
anxiety, substance abuse and suicide ideation.1, 2
Higher secondary school education is a very
important turning point in the academic life of the
individual. It is equivalent of GCE- A level of schooling in
the countries like Great Britain. At this stage the academic
performance of the adolescents plays a crucial role in
deciding about next higher stage of education, and
probably career too.3 The expectations of parents, teachers,
peers and one’s own related to academic achievement and
future career can act as a important motivators for an
adolescent to study harder. However when there is a
disparity in expectations and actual capabilities,
considering all the aspects like environment, facilities,
quality of guidance, personal determination and hard work;
then this motivation can lead to development of stress.1
Adolescence which spans from age of 10 – 19 years is an
stressful period due to physical, psychological, sexually
changes and maturity.4 The academic factors can
exaggerate the already present stress of growth and
maturity in adolescents, this may lead to development of
chronic health disorders, which could haunt them for
lifetime.
There are very few studies regarding the stress among
higher secondary school students in India and fewer are
concerned to rural area.5 Such studies virtually nonexistent

Vivek et.al/A cross-sectional study of stress among junior college students in a rural area of Sangli district of Maharashtra.
295
in this locality. Hence the objective of the current study is
to, to assess the stress and its association with various
academic factors among students of 12th grade of higher
secondary school from a rural area in Sangli district of
Maharashtra.
METHODS:
It is a cross-sectional study conducted in a rural
area of Sangli district from Maharashtra, India. The
institutional ethical committee approved the study. The
sample size was calculated which was 325. However taking
into the consideration the percentage of incomplete
questionnaires, it decided to collect 25% extra samples,
hence 410 subjects were included in the study. Sampling
technique used was stratified random sampling. A college
from the study area, was randomly selected and requisite
permissions were taken. The students from 12th grade,
from all the three fields of education i.e. arts, commerce
and science were included in the study. Out of the total
available students, number of the randomly selected for
participants from each grade was proportional to the ratio
of sample size to the number of total available students
from the decided grades in the college. On acquisition of
written self consent in case of students above 18 years of
age and parents consent in case minors, students were
asked to complete the questionnaire. If the selected student
rejected to consent then another student was randomly
selected for participating in the study. Total four visits
were made to collect the data and data collection was done
by the principal author. The study was conducted during
September 2012 to February 2013.
Pretested, self administered questionnaire was
used as the study instrument. It was developed with the
help of published literature.6 A pilot study was conducted
to make necessary changes and finalization of the
questionnaire. To ensure anonymity there was no mention
of student’s or institutes name or address on the
questionnaire. It was divided in three sections, first section
covered socio-demographic factors like age, gender,
educational details, area of upbringing, parents’ education
and parents’ occupation. Similarly, questions regarding felt
need by the students for inclusion of mental health
education in the curriculum and presence of health cell in
the college were included in the questionnaire. Second
section comprised of “DASS-21” (depression, anxiety and
stress scale – short form), a validated screening tool that
can be used to identify depression.6 The Stress scale,
measures a syndrome that is factorially distinct from
depression and anxiety, characterised by nervous tension,
difficulty relaxing and irritability. It is quite similar to the
DSM-IV diagnosis of Generalized Anxiety Disorder
(GAD).The Depression scale assesses dysphoria,
hopelessness, devaluation of life, self-deprecation,
anhedonia, inertia and lack of interest.
The third section consisted of academic factors,
like whether the students is stress due to the factors like
extent of syllabus, own performance of study, method of
teaching, thinking about examination, thought of future
career, higher education choices, parents’ expectation,
friends’ or others expectations, teachers’ expectations and
their own expectations. While answering the statements a
respondent should indicate how much each statement
applies to him or her. Each statement had to be answered
of five answers based on a scale of intensity of social phobia
ranging from "Not at all" to "Extremely". The answers are
awarded a score ranging from zero to four. The total score
of 20 and above indicates the presence of academic as
stressors.
Analysis was done using percentage and chi-
square test. Softwares used for the analysis were Microsoft
Excel 2007 and Epi Info 7. Data from the pilot study was
not included in the final analysis.
RESULTS:
Out of the total 410, students included in the study, 391
(95.4%) had completed the questionnaires and thus
included in the final analysis. Students belonged to age 15
to 19 years, with the mean age of 16.9 years. While 181
(46.3 %) students were female and 210 (53.7 %) were
male. Considering distribution according to field of
education, 141 (36.1%) were from arts faculty, 156
(39.9%) were from commerce faculty and 94 (24%) were
from science faculty.
Out the 391 students stress was observed in 118 (30.2%)
students. Mild stress was present in 49 (12.5%) students,
moderate stress in 42 (10.7%) students and severe stress
in 27 (6.9%) students.
Table 1: Gender distribution of stress
Stress
Gender
Total
Female
Male
Absent
112
161
273
61.9%
76.7%
69.8%
Present
69
49
118
38.1%
23.3%
30.2%
Total
181
210
391
100%
100%
100%
2 = 10.0893, d.f. = 1, p = 0.001
Considering gender distribution of the stress, 69 (38.1%)
females students had stress as compared to 49 (23.3%)
male students had stress. Gender was statistically
associated with stress, with female preponderance. (Table
1)
Table 2: Age distribution of stress
Stress
Age (in years)
Total
15
16
17
18
19
Absent
7
75
120
56
15
273
53.8%
67%
66.7%
82.4%
83.3%
69.8%
Present
6
37
60
12
3
118
46.2%
33%
33.3%
17.6%
16.7%
30.2%
Total
13
112
180
68
18
391
100%
100%
100%
100%
100%
100%
2 = 9.4861, d.f.= 4, p = 0.05
Considering the distribution of stress according age, there
was a statistically significant association between the two
variables (Table 2). Higher stress was observed in younger
students as compared to the older students. Thus stress
had reverse trend with age. (Fig 1)

Vivek et.al/A cross-sectional study of stress among junior college students in a rural area of Sangli district of Maharashtra.
296
Table 3: Distribution of stress according to the field of education
Stress
Stream
Total
Arts
Commerce
Science
Absent
95
115
63
273
67.4%
73.7%
67%
69.8%
Present
46
41
31
118
32.6%
26.3%
33%
30.2%
Total
141
156
94
391
100%
100%
100%
100%
2 = 1.874, d.f. = 1, p = 0.392
Considering the distribution of stress according to the field
of education, 31 (33%) science students, 46 (32.6%)
commerce student and 41 (26.3%) arts students had stress.
However statistically significant association was not
present in field of education and stress (Table 3). Stress
was not associated with socioeconomic status.
Table 4: Association of stress with depression
Stress
Depression
Total
Absent
Present
Absent
219
54
273
80.2%
19.8%
100%
Present
37
81
118
31.4%
68.6%
100%
Total
256
135
391
65%
35%
100%
2 = 87.021, d.f. = 1, p = 0.000
Depression was present in 135 (35%) students.
Stress was statistically associated with depression, with
comorbidity observed 81 (68.6%) out of 118 students who
had stress. (Table 4)
Anxiety was present in 126 (32.2%) students. Out
the students who had stress, 71 (60.2%) had anxiety; their
association was statistically significant.
On considering the academic factors 152 (38.9%)
students had a score of ≥20, i.e. they perceived academic
stress. Association of stress with the perceived academic
stress was statistically significant. (Table 5)
Table 5: Association of stress with perceived academic stress
Stress
Perceived academic stress
Total
Absent
Present
Absent
213
60
273
78%
22%
100%
Present
26
92
118
31.4%
68.6%
100%
Total
239
152
391
61.1%
38.9%
100%
2 = 106.3420, d.f. = 1, p = 0.000
On question of introduction of health cell in the school and
inclusion of stress management education in the
curriculum, the positive response was given by 278
(71.1%) and 305 (78%) students respectively.
DISCUSSION
In the current study 30.2% students had stress.
Moderate to severe stress was present in 17.6% students.
Stress was associated with gender with female students
showing greater tendency to develop stress. Similarly it
was also observed that the students with lower age were
more prone to develop stress as compared with students
with higher age. Stress was present in the students
studying in all the three fields of education. Similarly a
strong association of stress with depression and anxiety
was observed. The important finding of the current study
was that academic stressors like syllabus, teaching process,
facilities, and expectation had major role in the
development of stress.
Yusoff et. al,(2011) observed that the prevalence of
distressed adolescents in Kota Bharu, Malaysia was 32.8%.7
Sahoo and Kher (2010) observed that stress was present
among 20% college students from Ranchi.8 A study by Al-
Gelban (2007) in Saudi Arabia among male adolescents
observed the prevalence of stress to be 35.5%.9 When
considering prevalence of stress among Turkish students,
Bayram and Bilgel (2008) observed that 27% of them were
having moderate to severe stress 4. Observed stress in
current study was 30.2% students while moderate to
severe stress was observed in 17.6% students. Results
obtained in current study are in accordance with study of
Yusoff et al, but higher than study of Sahoo et al. But the
Sahoo et al., had studied stress among only male students.
In the current study 23.3% male students had stress. Hence
the results are similar. However, according to Al-Gelban
study higher percentage of Saudi male students had stress.
Similarly based on the findings of Bayram et al, higher
percentage of Turkish students had moderate to severe
stress. The difference observed when compared to these
two studies and the current study could be attributed to
geographical and cultural variations in the study
population.
CONCLUSION
Students from all the three streams are exposed to
stress. Females and younger students are particularly
vulnerable. The academic and expectation pressure is one
the major precursor of the stress. Stress can play a vital
role in the development of depression and anxiety.
Academic problems play an important role in the
development of stress. Hence, measures targeted
specifically towards academic factors, can substantially
decrease the stress among the students. Teaching
technique should be more flexible to the needs of the
students. Productive utilization of existing student welfare
systems, development of more “Student-Friendly”
environment and regular periodic extra-curricular
activities with universal participation can prove useful
stress busters. Steps should be taken to incorporate Stress
Management Education in the curriculum. Health is major
concern and deviation from it adds to stress, so
incorporation of healthy dietary and lifestyle habits should
be encouraged. Teachers, parents and even students should
rethink about the undue expectations. The regular studies
and adequate preparation helps a lot in avoiding stress.
LIMITATIONS OF THE STUDY
This is a self administered questionnaire based
study, hence reporting bias cannot be totally eliminated.
There is a lack of geographical coverage since the study is
conducted in a single higher secondary school. Many
confounders like current emotional state, personality etc.
may be present. Similarly, difference in stress during pre-
exam, exam and post-exam period is not considered.
CONFLICT OF INTEREST
All the authors declare that there is no conflict of
interest. The research was self funded by the authors.
ACKNOWLEDGEMENTS
The authors would like to thank all the students
and the institute participated in the study.
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