A cross sectional study to estimate the psychological stress level in medical students during Covid-19 pandemic

Introduction: Stress and anxiety have been a common topic of discussion among the medical students in normal circumstances owing to the burden of immense studies, clinical rotations, regular exams and assessments. Material and methods: A cross sectional study consisting of 330 medical students studying in various medical colleges in various states like Himachal, Karnataka, Haryana, Rajasthan, Bihar, Punjab, Delhi etc. was conducted using online forms that were shared in various WhatsApp college groups. The questionnaire was a simple 10 question form consisting of the Kessler's psychological distress scale questions. The stress levels were defined according to the Kessler's psychological distress scale k10. Results: The results of the study showed that 72.5% of total participants suffered from mild to moderate levels of stress with 20.6% students suffering from mild stress, 15.5% from moderate stress and significant 36.4% from severe stress. Similarly, various socio-demographic determinants have also been studied for any relation to these high stress levels. The treatment seeking behaviour among medical students also reflected poorly when it came to seeking help from health professionals. Conclusion: It was found that during the covid-19 lockdown, medical students suffered from severe stress levels which is a topic of concern for the authorities and calls for a timely intervention to control the situation. The treatment seeking behaviour is also a topic of concern as medical students being most exposed to the knowledge of mental health do not themselves prefer to take treatment from a health professional.


Introduction
The covid pandemic which started in December in Wuhan China has spread to almost all parts of the world causing great concerns all over the world.
With no medicine or vaccine available for Covid-19, the situation has turned worrisome and source of stress for everyone. More than a third of the world's population had been put under lockdown with restricted movements to contain the spread of the virus. People have been strictly advised to maintain social distance, wear a mask, and sanitize their hands frequently.
India, the second most populous country is no different from the rest of the world when it came to lockdown and almost 135 crore people were restricted to their homes. For us Indians, challenges in the medical sector, further deepens the worries that heighten psychological distress. The lack of adequate medical facilities to all, cost of treatment and increasing deaths have been the primary source of concern to everyone.
In times of an epidemic the fear of getting infected with the virus/disease, people tend to experience anxiety, stress depression etc.
Stress can be explained as a feeling of emotional and physical tension which arises from any event that threatens our homeostasis [1]. On the other hand, the fear of the unknown is termed as anxiety, that is the body's natural response to stress.

Study design
A cross sectional study was conducted among students studying in medical colleges across the country.
The questionnaire was conducted using Google Forms and a request to participate in the study was sent to all students through WhatsApp groups.

Study population
The study population consisted of medical students     Mental health and issues are more often than not ignored by common people and are not considered illness by many. This view is mainly due to lack of knowledge in the subject of mental health.

Interpretation of scores
When it comes to medical students, they get alot of exposure and knowledge related to mental health and illness and have easy accessibility to health professionals for concerned issues. However, it is observed that even medical students who have more knowledge than a common man, fail to follow it and prefer not to visit a health professional. It is surprising to see that even though 72.5 % of students suffered from mild to severe levels of stress. About 69.6% believed they didn't require any help. The ones who were aware of the problem turned to their friends for help (59%), 27% took help from parents while only 7% seeked help from a health professional and 7% from other sources.
Apart from the ones suffered, a general perception of medical students was also checked and was found 44% students would seek help from friends if they ever require help, 33% from parents and 15% from a health professional.  17% students did not think about the issue of mental health or ways to improve it during the lockdown and seemed to be indifferent.

Discussion
The fact that more than half of the study population of students fall into the severely stressed level is alarming and calls for an intervention for an improvement. Mental health is often a neglected topic and has been since many decades. With the current lockdown and pandemic, students have been facing severe stress which is not being taken care of. The current curriculum of online classes focuses on the academic aspect only, while it is difficult for the common medical student to stay emotionally motivated due to the immense stress and anxiety as seen in the results. What may be the possible reasons and solutions to this problem is a topic that needs to be discussed in every medical college to ensure the well being of the students during such a stressful period.
Deteriorating mental condition should be of major concern to parents and teachers because without a good state of mind, students will not be able to perform up to their potential and will consecutively lag behind. Online teaching and being locked at home has caused a great amount of stress in medical students which needs to be addressed as

Conclusion
According to the study, 36.4% students have been severely stressed during the lockdown due to the Covid-19 pandemic.
What does the study add to the existing knowledge?
This is a topic of concern and should be looked into by the authorities so as to improve the state of mind of the medical students. A healthy mind is equally important as a healthy body and proper attention must be given in order to ensure well being of the students. The budding doctors are the future of our country, on whose hands the health system will rely in the coming years; but will they be able to serve if their own mental condition is being ignored? Today's generation is the future of our country and how we help them overcome this hurdle, is what will paint the future of the healthcare system of the country.