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. Depression is viewed as a state of disinterest that affects daily activities. It is surmised that people facing a pandemic with no vaccination or treatment would result in fear of the unknown (in this case, the coronavirus) making them anxious, stressed and depressed.

Keeping in mind the concerns regarding psychological distress raised around the globe, Xiang et al [2] have argued for a timely action on mental health during the Covid-19 pandemic. Furthermore, the World Health Organization [3] has also issued public interest guidelines to address psychological issues that may arise.

As these may be seen in common people, medical students may have been at a greater risk of developing stress and anxiety owing to the change in routine, lack of social interactions and burden of studies. Staying at home has caused a lot of challenges in academics for the students and teachers alike.

The Kessler Psychological Distress Scale (K10) [4] is designed to measure anxiety and depression through a 10-item questionnaire. Each question pertains to an emotional state and each has a five-level response scale. This instrument uses a consumer self-report measure making it a desirable method of assessment.

The options for choice were as below for each question asked above:

All of the time (score 5)

Most of the time (score 4)

Some of the time (score 3)

A little of the time (score 2)

None of the time (score 1)

Scoring/ statistical analysis

Each item was scored from one ‘none of the time’ to five ‘all of the time’. Scores of the 10 items were then summed, yielding a minimum score of 10 and a maximum score of 50. Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.

Interpretation of scores

The 2001 Victorian Population Health Survey [5] adopted a set of cut-off scores that may be used as a guide for screening for psychological distress. The cut off score for classifying psychological stress level is detailed below.

K10 Score: Likelihood of having a mental disorder (psychological distress)

10 - 19 Likely to be well

20 - 24 Likely to have a mild disorder

25 - 29 Likely to have a moderate disorder

30 - 50 Likely to have a severe disorder

In the research conducted a total of 330 students participated out of which 98 were males and 232 females. The students participated from various states across India, with maximum participation from Himachal Pradesh (38%) followed by Haryana (21%), Karnataka (19%), Chandigarh, Punjab, Delhi and other states. (Table no.1.e)

Table-1: Socio-demographic characteristics of participants

When the stress levels were observed for males and females individually, it was seen that 16% males were under mild stress, 19% under moderate stress and 38% under severe stress. Among females, 22% were under mild stress, 13% were moderate stress and a 35% under severe stress. This data shows the maximum proportion of males and females suffered from severe stress during the lockdown.

Relations between the area that the students reside in were also taken into consideration while associating the level of stress and it was found that among the students living in rural areas 20% suffered from mild stress, 12% from moderate stress, and 37% from severe stress. Among students living in urban areas, 20% suffered from mild stress, 17% from moderate and 35% suffered from severe stress. Thus the comparative data between rural and urban doesnt show a significant difference and hence we can conclude that the stress levels were similar irrespective of the place of residence of the students( urban or rural).

Relation between the stress levels and type family was also calculated and found among students living in a nuclear family 19% suffered from mild stress, 14% from moderate and 37% suffered from severe stress and students living in a joint family showed that 23% suffered from mild stress, 18% moderate stress, 34% from severe stress.

Similarly, an association between the professional year and stress levels were observed and found that 37% students in first year suffered from severe stress, 33% students in second year and 37% students in final prof suffered from severe stress levels. Thus we can clearly see that there is not much difference among the stress levels and the year that the student is studying is as they experienced almost equal levels of stress irrespective of the year.

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.

17% students did not think about the issue of mental health or ways to improve it during the lockdown and seemed to be indifferent.

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 soon as possible. Motivational sessions, regular feedbacks and reducing the burden of academics are few possible solutions into the problem, According to CDC, the persons who are more risk to stress are the older adults with chronic illness who are at high risk category for COVID-19, children, teens, health care workers, persons with mental health problems and substance use [6].

There are mainly four ways to cope with the stress i.e. first is taking break from news of COVID-19 which is upsetting, second is taking care of body by exercise, yoga, meditation, good sleep hours, balanced diet, avoid drugs and alcohol use, third is to activities which we are good, indoor activities, or any productive working, studying, learning and fourth is connecting with friends and family to letting out the feeling [7].

In a study done by Dangi Ravi Rai, Dewett Parul & Joshi Pallav [8] investigators found that 73.26% participants had severe stress levels after 15 days of lockdown and when it was again assessed after 21 days of lockdown, a total of 80.86% participants were having severe stress levels.