Depression, Anxiety and Stress among Nursing Students

Namrata Sachan¹, Neeraj Yadav¹, Priyanka Masih¹, Priyanka Spencer¹, Rashmi Gautam¹, Rashmi Rawat¹, Alwin Issac²*

¹College of Nursing, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.

²All India Institute of Medical Sciences, Bhubaneswar.

*Corresponding Author Email: sonalsachan1@gmail.com, neerajahir1993@gmail.com, masihpriyanka8@gmail.com, priyaspencer1995@gmail.com, rashmirg.rg@gmail.com, rawatrashmi1711@gmail.com, aimalwinissac@gmail.com

ABSTRACT:

Background: Acquiring enrolment into a collegiate course of study marks the commencement of accomplishing a vocational destination. Nonetheless, the asperity of collegiate educational activity can be arduous. There isn’t any incertitude that nursing is a worthwhile and rewarding job for all those who dream of a career in healthcare. Although the profession has its own perks, demanding and frantic schedule isn’t oblivious. Stress, depression, and anxiety have the potency to intervene with learning, impact academic achievements, and spoil clinical practice performance. Methodology: With this view in mind, a cross sectional descriptive study was carried out among the Nursing colleges in the district of Lucknow, Uttarpradesh to assess the level of stress, depression and anxiety among the second, third and fourth year B.Sc nursing students using DASS-21 scale. Results: It was quite astonishing to find out that, among the 300 students who were enrolled into the study; fourth year B.Sc nursing students had a higher level of stress, depression and anxiety. Conclusion: Managing stress in a profession like nursing is not easy as pie, yet adaptive techniques should be employed to palliate the pressure and retrieve control. The key to this lies within each individual, which is to experiment and find out own stress management techniques that works best for each.

KEYWORDS: Nurses, Students, Depression, Anxiety, Adolescent, Stress

INTRODUCTION:

No doubt, nursing is a fruitful and rewarding job for those who dream of a successful career in health care. Along with certain benefits, it comes with a demanding and frenzied schedule. Nursing students undergo heightened levels of stress and anxiety end-to-end their education.¹ In fact students of nursing encounter additional anxiety, especially test anxiety, than students from any of the other healthcare fields of study.^2–4

Having to equipoise didactic and clinical courses while concurrently counterbalancing financial, family and other life issues has the potency to exasperate any stress or anxiety induced by the nursing course alone.⁵ The high grimness of the nursing syllabus also steers to stress and anxiety; because being a loser in either a course or a program results in lost time and investment in the student’s education, which in turn causes a holdup in futurity earning potency.⁶ Heightened levels of stress have been linked to mediocre health and depression.⁷ Regrettably stress and anxiety can have an innumerable damaging consequences on a student, which faculty see daily.⁸  Stress can impact health, memory, problem-solving, and the potential to deal, all of which can steer to reduced scholastic performance.⁹  Later on, reduced academic performance can steer to elevated stress levels, catching the student in an unhealthful wheel of distress. Fortuitously, academicians and decision-makers can enforce many schemes in the nursing curriculum to reduce stress in scholars. It is imperative to address these heightened levels of distress in nursing students, as they can have a detrimental effect on their performance and well-being.

In Northern India, there is circumscribed evidence relating to mental health troubles among undergraduate nursing students. Owing to a dearth of data, this study intended to assess the prevalence of Depression, Anxiety and Stress (DAS) among nursing students and its pattern as the academic year progresses.

METHODOLOGY:

A Cross sectional descriptive study was conducted. Nursing Colleges in the District of Lucknow were selected randomly. From the selected colleges, 300 samples were drawn by Disproportionate Stratified Random Sampling with 100 samples each from 2^nd, 3^rd and 4^th year B. Sc Nursing students. DAS were assessed by DASS-21 scale.

The following data collection instruments were used in order to obtain the relevant data

Tool 1: Demographic proforma

It consisted of 10 questions and was developed to collect the information on sample characteristics. The characteristic included: Year of student, Gender, Family income, Residence (Hostelite/Non-hostelite), Hours of sleep, Hours spend on social media, Spiritual practice, Outdoor games, Reason for selecting nursing profession, Prior history of mental illness.

Tool 2: DASS-21 scale

Tool consists of 21 questions to assess the level of DAS. The tool has 21 questions and of the 21 questions, seven questions are based on depression, seven questions are on anxiety, and seven questions are on stress. Each question is to be answered on a 5 point rating scale. Each of the total score obtained for DAS is multiplied by 2. For depression 0-9 is normal, 10-13 is mild, 14-20 is moderate 21-27 is severe and >28 is extreme severe. For anxiety 0-7 is normal, 8-9 is mild, 10-14 is moderate, 15-19 is severe, >20 is extreme severe. For stress 0-14 is normal, 15-18 is mild, 19-25 is moderate, 26-33 is severe and >34 is extreme severe. Reliability score of DASS-21 is p=0.94¹⁰

Data was collected after a formal approval from principals of selected Nursing colleges. Then Demographic proforma and DASS-21 scale were given to the students with a brief explanation on the purpose of the study. They were also assured about the confidentiality of their responses. The data was analyzed by using statistical measurements and tabulated.

RESULTS AND DISCUSSION:

1) Sample characteristics:

Among 2^nd year B. Sc nursing students, majority were female (79%), 57% of them stays in hostel, 52% has 6-7 hours of sleep, 53% did not indulge in spiritual activities and majority (58%) did not indulge in outdoor activities. Majority (63%) were of the opinion that they choose nursing as a profession by choice. (Table-1)

Among 3^rd year B. Sc nursing students, majority were female (67%), 53% of them stays in hostel, 42% has 6-7 hours of sleep, majority (55%) did not indulge in spiritual activities and 55% did not indulge in outdoor activities. Majority (67%) were of the opinion that they choose nursing as a profession by choice. (Table-1)

Among 4^th year B. Sc nursing students, majority were female (82%), 56% of them stays in hostel, majority (51%) has 6-7 hours of sleep, 53% spends 1-2 hour on social media, 66% did not indulge in outdoor activities. Majority (67%) were of the opinion that they choose nursing as a profession by choice. (Table-1)

Table 1: Description of sample characteristics (N=300)

Sl. No.	Demographic Proforma	2^nd year		3^rd year		4^th year
		Frequency (N=100)	Percentage (%)	Frequency (N=100)	Percentage (%)	Frequency (N=100)	Percentage (%)
1.1	Year of student	100	100	100	100	100	100
1.2	Gender a) Male b) Female	21 79	21 79	33 67	33 67	18 82	18 82
1.3	Income a) < 10,000 Rs b) 10,000 – 20,000 c) 20,000 – 30,000 d) >30,000	10 16 36 38	10 16 36 38	9 18 26 47	9 18 26 47	15 23 28 34	15 23 28 34
1.4	Resides in a) Hostel b) Home	57 43	57 43	53 47	53 47	56 44	56 44
1.5	Hours of sleep a) 2 - 6 hrs b) 6 – 7 hrs c) 7 – 8 hrs d) >8 hrs	25 52 19 4	25 52 19 4	24 42 27 7	24 42 27 7	25 51 12 12	25 51 12 12
1.6	Hours spent on social media a) <1 hr b) 1 – 2 hr c) 2 – 3 hrs d) NA	28 36 16 20	28 36 16 20	19 37 37 7	19 37 37 7	17 53 21 9	17 53 21 9
1.7	Indulgence in spiritual practice a) Yes b) No	53 47	53 47	45 55	45 55	50 50	50 50
1.8	Indulgence in outdoor games a) Yes b) No	42 58	42 58	45 55	45 55	34 66	34 66
1.9	Reason for selecting this course a) by force b) by choice	57 63	57 63	33 67	33 67	33 67	33 67
1.10	Prior history of mental illness a) Anxiety b) Depression c) Stress d) None	3 3 15 79	3 3 15 79	1 0 17 82	1 0 17 82	4 4 14 78	4 04 14 78

2) Depression among nursing students:

Assessment of depression level among B.Sc nursing students revealed that among 2^nd year B.Sc nursing students 7(7%) has severe depression and 2(2%) has extremely severe levels of depression. Among 3^rd year 6(6%) has severe levels of depression and 5(5%) has extremely severe levels of depression. Among 4^th year 10(10%) has severe levels of depression and 10(10%) has extremely severe levels of depression. (Figure 1)

Figure 1: Level of depression among nursing students

3) Anxiety among nursing students:

Assessment of anxiety level among B.Sc nursing students revealed that among 2^nd year B.Sc nursing students 16(16%) has severe anxiety and 14(14%) has extremely severe levels of anxiety. Among 3^rd year 9(9%) has severe levels of anxiety and 19(19%) has extremely severe levels of anxiety. Among 4^th year 18(18%) has severe levels of anxiety and 13(13%) has extremely severe levels of anxiety. (Figure 2)

Figure 2: Level of anxiety among nursing students

4) Stress among nursing students:

Assessment of stress level among B.Sc nursing students revealed that among 2^nd year B.Sc nursing students 12(12%) has severe stress and 4(4%) has extremely severe levels of stress. Among 3^rd year 10(10%) has severe levels of stress and 2(2%) has extremely severe levels of stress. Among 4^th year 10(10%) has severe levels of stress and 13(13%) has extremely severe levels of stress. (Figure 3)

Figure 3: Level of stress among nursing students

DISCUSSION:

Similar findings were reported from a study conducted from the Kolar district of Karnataka state, which assessed the prevalence of DAS among nursing college students.¹¹ The study reported that majority of their participants were close to sadness and a few of them reported self-harm thoughts. A higher prevalence of depression was reported by those participants who were victims of family conflicts, and whose parents were known cases of depression. It’s quite astonishing and worrisome to detect such detrimental levels of DAS among medical professionals.¹² From way back, it has been found that nursing students experience enormous levels of stress and anxiety in their educational environment. It’s high time that the nursing educators intervene^13–15 and aid those students experiencing stress or anxiety through bringing in the reformation in the nursing curriculum or through counselling cum wellness centres.¹⁶ An enormous amount of stress and anxiety is attributed to the fear of professional examination and the vast quantity of syllabus. Peer mentoring¹⁷ and forming study groups has been found beneficial in curtailing stress and anxiety. ^18,19

The study calls forward apt measures to enhance the accessibility to mental health support services for those students in need. Establishing counselling cum wellness centres within the institute can be one of the many solutions to tackle this situation. ^20,21 Though stress management in the nursing profession is not as easy as pie, there are strategies that could be adopted to relieve the pressure and regain control.^22–24 The cardinal step to speedy stress relief is to experiment and discover the unparalleled sensory experience that works best for you.

CONCLUSION:

Nursing educatee battle to manage numerous stressors prevalent in higher education institutions, and anxiety towards clinical placements. In the long haul, it is imperative that competent nurses be reared to ameliorate the touchstone of healthcare and patient’s quality of life.

ACKNOWLEDGEMENT:

The authors are highly indebted to all the participants and administrators of the institute who lend their helping hands in completion of the study.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 18.12.2020         Modified on 10.06.2021

Accepted on 28.08.2021   ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2022; 12(1):70-74.

DOI: 10.52711/2349-2996.2022.00014