CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2022; 58(02): 106-117
DOI: 10.1055/s-0042-1743138
Original Article

Psychological Morbidities and Coping Styles: A Rural Institution-Based Cross-Sectional Comparative Study between Undergraduate Medical Students Undergoing Different Phases of Training

Sunny Garg
1   Department of Psychiatry, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
Alka Chauhan
1   Department of Psychiatry, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
› Author Affiliations


Background Psychological morbidities are high among undergraduate medical students. They experience the transition between pre-/para-clinical and clinical training as a stressful period, and cope differently. Research studies from India in this regard are lacking.

Aims The aim of this study is to assess and compare the prevalence of psychological morbidities and their respective associated factors and coping styles between pre-/para-clinical and clinical undergraduate medical students.

Materials and Methods This institution-based cross-sectional observational design study was conducted among undergraduate medical students (a total of 382) in pre-/para-clinical and clinical years by using a questionnaire in the period between April and June 2019. A stratified random sampling technique was used to select the study participants. The survey included standard self-administered questionnaires like General Health Questionnaire-28 (GHQ-28) and Lin–Chen's coping inventory to assess psychological morbidities and coping styles, respectively. Associated factors for psychological morbidities and coping styles between two groups were compared using the Chi-square test, independent t-test, and binary logistic regression analysis.

Results Out of the 382 responders, psychological morbidities (GHQ-28 score > 23) were found in 61% participants. Both groups reported high levels of psychological morbidities; a slightly higher preponderance in clinical (61.5%) than in pre-/para-clinical students (60.6%) with a nonsignificant difference. Compared with the pre-/para-clinical group, the clinical group was found to have more substance consumption behavior (p < 0.001), dissatisfaction with academic performance (p < 0.001), sought psychiatric consultation (p < 0.004), and at that time on psychiatric treatment (p < 0.04). Active problem coping behavior was more significantly used by the pre-/para-clinical group, while passive problem coping and passive emotional coping behaviors were positively significantly correlated with psychological morbidities in the clinical group.

Conclusion This study suggests a significant correlation between psychological morbidities and passive coping styles in the clinical group. These students need interventions to encourage the use of more active coping styles during training to provide advances in future career. A strong correlation between psychological morbidities and dissatisfied academic performance may be a call for an efficient and more student-friendly curriculum.

Publication History

Article published online:
07 March 2022

© 2022. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Saxena SK, Mani RN, Dwivedi AK, Ryali VSSR, Timothy A. Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India. Ind Psychiatry J 2019; 28 (02) 160-169
  • 2 Hj Ramli NH, Alavi M, Mehrinezhad SA, Ahmadi A. Academic stress and self-regulation among university students in Malaysia: mediator role of mindfulness. Behav Sci (Basel) 2018; 8 (01) 12-21
  • 3 Adiele D, Judith CA, Morgan GP, Catherine B, Carolyne LM. Association of academic stress, anxiety and depression with socio-demographic among medical students. Int J Soc Sci Stud 2018; 6: 27-32
  • 4 Joseph N, Nallapati A, Machado MX. et al. Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large midwestern university. Curr Psychol 2020; 40: 2599-2609
  • 5 Beniwal RP, Bhojak MM, Nathawat SS, Jakhar K. Mental morbidity among medical students in India. J Med Sci Clin Res 2017; 5: 32023-32033
  • 6 Cuttilan AN, Sayampanathan AA, Ho RC-M. Mental health issues amongst medical students in Asia: a systematic review [2000-2015]. Ann Transl Med 2016; 4 (04) 72
  • 7 January J, Madhombiro M, Chipamaunga S, Ray S, Chingono A, Abas M. Prevalence of depression and anxiety among undergraduate university students in low- and middle-income countries: a systematic review protocol. Syst Rev 2018; 7 (01) 57
  • 8 Sarkar S, Gupta R, Menon V. A systematic review on depression, anxiety and stress among medical students in India. J Mental Health Hum Behav 2017; 22: 88-96
  • 9 Mangalesh S, Dudani S, Dave ND. Assessment of mental health in medical students during the coronavirus disease-2019 pandemic. Indian J Soc Psychiatry 2021; 37: 105-110
  • 10 Jamshidi F, Mogehi S, Cheraghi M, Jafari SF, Kabi I, Rashidi L. A cross-sectional study of psychiatric disorders in medical science students. Mater Sociomed 2017; 29 (03) 188-191
  • 11 Sidana S, Kishore J, Ghosh V, Gulati D, Jiloha R, Anand T. Prevalence of depression in students of a medical college in New Delhi: a cross-sectional study. Australas Med J 2012; 5 (05) 247-250
  • 12 Jafari N, Loghmani A, Montazeri A. Mental health of medical students in different levels of training. Int J Prev Med 2012; 3 (Suppl. 01) S107-S112
  • 13 Alharbi H, Almalki A, Alabdan F, Haddad B. Depression among medical students in Saudi medical colleges: a cross-sectional study. Adv Med Educ Pract 2018; 9: 887-891
  • 14 Bassols AM, Okabayashi LS, Silva AB. et al. First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?. Br J Psychiatry 2014; 36 (03) 233-240
  • 15 Moutinho IL, Maddalena NC, Roland RK. et al. Depression, stress and anxiety in medical students: a cross-sectional comparison between students from different semesters. Rev Assoc Med Bras (1992) 2017; 63 (01) 21-28
  • 16 Satheesh BC, Prithviraj R, Prakasam PS. A study of perceived stress among undergraduate medical students of a private college in Tamil Nadu. Int J Sci Res (Ahmedabad) 2015; 4: 994-997
  • 17 Rotenstein LS, Ramos MA, Torre M. et al. Prevalence of depression, depressive symptoms and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 2016; 316 (21) 2214-2236
  • 18 Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Med Educ 2007; 7: 6
  • 19 Godefrooij MB, Diemers AD, Scherpbier AJ. Students' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts; a focus group study. BMC Med Educ 2010; 10: 28
  • 20 Kumar R, Maurya A, Singh DK, Dudeja P. Assessment of well-being and coping abilities among medical and paramedical trainees in a government medical college Uttar Pradesh, India. Int J Med Sci Public Health 2020; 9: 229-233
  • 21 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 Res Notes 2017; 10 (01) 93
  • 22 Bamuhair SS, Al Farhan AI, Althubaiti A, Agha S, Rahman S, Ibrahim NO. Sources of stress and coping strategies among undergraduate medical students enrolled in a problem-based learning curriculum. J Biomed Educ 2015; 575139: 1-8
  • 23 Toews JA, Lockyer JM, Dobson DJ. et al. Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine. Acad Med 1997; 72 (11) 997-1002
  • 24 Moayedi F, Bastami MM, Ashouri FP, Hamadiyan H, Rasekhi S. Comparison of sources and perceived stress between paramedical and medical students. Int J Med Res Health Sci 2016; 5: 183-190
  • 25 de La Rosa-Rojas G, Chang-Grozo S, Delgado-Flores L. et al. Level of stress and coping strategy in medical students compared with students of other careers [in Spanish]. Gac Med Mex 2015; 151 (04) 443-449
  • 26 Shao R, He P, Ling B. et al. Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students. BMC Psychol 2020; 8 (01) 38
  • 27 Chou WP, Yen CF, Liu TL. Predicting effects of psychological inflexibility/experiential avoidance and stress coping strategies for internet addiction, significant depression and suicidality in college students: a prospective study. Int J Environ Res Public Health 2018; 15 (04) 788-796
  • 28 Wu L, Farquhar J, Ma J, Vidyarthi AR. Understanding Singaporean medical students' stress and coping. Singapore Med J 2018; 59 (04) 172-176
  • 29 Sterling M. General Health Questionnaire - 28 (GHQ-28). J Physiother 2011; 57 (04) 259
  • 30 Farahangiz S, Mohebpour F, Salehi A. Assessment of mental health among Iranian medical students: a cross-sectional study. Int J Health Sci (Qassim) 2016; 10 (01) 49-55
  • 31 Lin YM, Chen FS. A stress coping style inventory of student at universities and colleges of technology. World Trans Eng Technol Educ 2010; 8: 67-72
  • 32 Kiran U, Padma M, Pratap K, Kalyan C, Vineela P, Varma SC. Assessment of psychiatric morbidity among health care students in a teaching hospital, Telangana state: a cross-sectional questionnaire-based study. Indian J Dent Sci 2017; 9: 105-108
  • 33 Kumar GS, Jain A, Hegde S. Prevalence of depression and its associated factors using Beck Depression Inventory among students of a medical college in Karnataka. Indian J Psychiatry 2012; 54 (03) 223-226
  • 34 Sreeramareddy CT, Shankar PR, Binu VS, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007; 7: 26
  • 35 Biswas B, Haldar A, Dasgupta A, Sembiah S, Karmakar A, Mallick N. An epidemiological study on burden of psychological morbidity and their determinants on undergraduate medical students of a government medical college of Eastern India. Indian J Community Health 2018; 30: 280-286
  • 36 Imran N, Tariq KF, Pervez MI, Jawaid M, Haider II. Medical students' stress, psychological morbidity and coping strategies: a cross-sectional study from Pakistan. Acad Psychiatry 2016; 40 (01) 92-96
  • 37 Falade J, Oyebanji AH, Babatola AO, Falade OO, Olumuyiwa TO. Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: a cross-sectional analytical study. Pan Afr Med J 2020; 37: 53-66
  • 38 Esan O, Esan A, Folasire A, Oluwajulugbe P. Mental health and wellbeing of medical students in Nigeria: a systematic review. Int Rev Psychiatry 2019; 31 (7-8): 661-672
  • 39 Konjengbam S, Laishram J, Singh BA, Elangbam V. Psychological morbidity among undergraduate medical students. Indian J Public Health 2015; 59 (01) 65-66
  • 40 Borjalilu S, Mohammadi A, Mojtahedzadeh R. Sources and severity of perceived stress among Iranian medical students. Iran Red Crescent Med J 2015; 17 (10) e17767
  • 41 Desalegn GT, Wondie M, Dereje S, Addisu A. Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: an institution-based cross-sectional study. Ann Gen Psychiatry 2020; 19: 44
  • 42 Taneja N, Sachdeva S, Dwivedi N. Assessment of depression, anxiety, and stress among medical students enrolled in a medical college of New Delhi, India. Indian J Soc Psychiatry 2018; 34: 157-162
  • 43 Rafique N, Al-Asoom LI, Latif R, Al Sunni A, Wasi S. Comparing levels of psychological stress and its inducing factors among medical students. J Taibah Univ Med Sci 2019; 14 (06) 488-494
  • 44 Shawahna R, Hattab S, Al-Shafei R, Tab'ouni M. Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students. BMC Psychiatry 2020; 20 (01) 244
  • 45 Arun P, Ramamurthy P, Thilakan P. Indian medical students with depression, anxiety and suicidal behavior: Why do they not seek treatment?. Indian J Psychol Med 2021; 43: 1-7
  • 46 Shanafelt TD, Balch CM, Dyrbye L. et al. Special report: suicidal ideation among American surgeons. Arch Surg 2011; 146 (01) 54-62
  • 47 Roh MS, Jeon HJ, Kim H, Cho HJ, Han SK, Hahm BJ. Factors influencing treatment for depression among medical students: a nationwide sample in South Korea. Med Educ 2009; 43 (02) 133-139
  • 48 Dunham L, Dekhtyar M, Gruener G. et al. Medical student's perceptions of the learning environment in medical school change as students transition to clinical training in undergraduate medical school. Teach Learn Med 2017; 29 (04) 383-391
  • 49 Neufeld A, Malin G. How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents. BMC Med Educ 2021; 21 (01) 299
  • 50 Erschens R, Loda T, Herrmann-Werner A. et al. Behaviour-based functional and dysfunctional strategies of medical students to cope with burnout. Med Educ Online 2018; 23 (01) 1535738
  • 51 Singh S, Prakash J, Das RC, Srivastava K. A cross-sectional assessment of stress, coping, and burnout in the final-year medical undergraduate students. Ind Psychiatry J 2016; 25 (02) 179-183
  • 52 Schiller JH, Stansfield RB, Belmonte DC. et al. Medical students' use of different coping strategies and relationship with academic performance in preclinical and clinical years. Teach Learn Med 2018; 30 (01) 15-21