By Author
  By Title
  By Keywords

April 2019, Volume 69, Issue 4

Short Reports

Identification of stressors and Perceptional difference of stress in first and final year Doctor of Physical Therapy students; a comparative study

Ayesha Afridi  ( Bahria University Medical and Dental College, Karachi, Pakistan. )
Muhammad Faisal Fahim  ( Bahria University Medical and Dental College, Karachi, Pakistan. )


The aim of the study is to identify the main causes of stress and to identify the perception difference of stress in first and final year DPT students Students in universities can experience stress in balancing the different demands on them - academic, interpersonal, intrapersonal, and professional or work related. A comparative Cross-sectional study was conducted using self-administered questionnaires including socio demographics A total of 177 university students (first year 109& final year 68 students) were included in the period March, to September 2015 in a private medical college Islamabad. Significantly valid tool (The Medical Student Stressor Questionnaire) (MSSQ) was used to measure the stress level. The research was conducted according to the principles of the Declaration of Helsinki. Three stressors academic related inter/intrapersonal related and group activities related stressors were causing high stress in all DPT students. There was significant difference in perception of stressors among first and final year DPT students.
Keywords: stress, academic stressor, doctor of physical therapy & students.


Doctor of physical therapy is a new immerging health related field with more and more complicated practices and technologies. To excel in the field of physical therapy there is a huge amount of stress and pressure on the students to cope with upcoming new techniques of efficiently treating patients.1 Previous researches have determined that stress and anxiety is increasing in university students which adversely affects their academic performance.2 Medical and allied health students are considered to be the most stressed due to their long term and expenses. Many studies reported different causes of stress in first and final year medical and allied health students. First year stress is due to totally changed life style and environment of medical school while final year stress in students is considered due to shift of routine from preclinical to clinical section. 3 within a limited time duration, memorizing and cramming of many small details in a single topic, strict examination procedures with many assignments, presentations etc.4 Social life stress is caused by dealing with patients in pain, morbidity and mortality and personal problems. Financial crisis related stress can affect the medical students private and social life at the university. 3 Even in developed countries offering many facilities for good education on fifty percent of medical students experience stress and physical exhaustion. This stress and physical exhaustion has long term drastic effects on health professionals as well as on patient's satisfaction level, treated by those health care professionals. 5 A limited number of studies on stress in medical students are reported in developing countries, while Malaysian studies show that thirty percent of medical students are facing different types of stress with various causative factors. A few Asian studies have found almost the same results.6 Researches to identify the stressors and prevalence of stress in medical students have shown that prevalence ranges from 21.6% to 56%.7 It is normal to take stress in life up to some extent as it enhances the performance in academic work load, but if threshold for stress exceeds the limits, it considerably effects the academics, social and personal life of medical students especially in first year. These events can effect first year medical students from their first day at university followed to final year.8 One of the most important stimulus, triggering stress is considered to be the year of study in five years course during this time stress is incessant and growing with time.9 This study was not conducted in a university, so ethical approval letter was not taken in consideration and questionnaire was sent to first and final year students using email and social media. The research was conducted according to the principles of the Declaration of Helsinki. Comparative cross sectional survey was conducted to identify the main stressors and perceptional differences among first and final year students.

An online questionnaire was sent to the students who were asked  to send it back to researcher through mail and social media account. It took almost 6 months to get the responses (March to September 2015). A convenient sampling method was used. There were 109 responses were from first year students while 68 were from final year. From total 177 students, 60 were males and 117 were females, age ranging from 17 to 24 years. There was no specific sample size calculation method applied, all the students of 1st and final year were included. Only completely filled questionnaire were included. All the participants were asked to provide a written consent. This questionnaire included six categories of different stressors bothering the medical and rehabilitation students. These six domains were covered in 40 questions which were scored on 0-4 Likert scale.

1: Academic related stressors (ARS)

Examinations, assignments, quizzes, expended course work, short time span for preparation of exams, difficultcourse content, and high competition in academics, high expectations of teachers, parents and self are related to ARS.

2: Inter/Intrapersonal Related Stressor

Students relationship with colleagues, teachers, administration, patients and with students own self, least motivation to study, low self-confidence, any physical verbal or emotional abuse by someone are related to IRS.

3: Teaching and Learning Related
Stressor (TLRS)

Teacher's capabilities to clear the concepts of students well, least appreciation and encouragement from teachers are related to TLRS.

4: Social Related Stressor

spending time on extra-curricular activities, with friends and family and listening to the problems of patients are related to SRS.10

5: Drive and Desire Related Stressor

(DRS) Behaviours, emotions, thinking power disturbances due to self and others bad attitudes, mentally not satisfied and ready to study in college, choosing wrong career, demotivation after knowing about field scope are related to DRS.10

6: Group Activities Related Stressor

Presentations, problem based learning and group discussions are all included in GARS.10 Data was entered and analyzed using statistical packages for social sciences (SPSS) version 23. Distribution and frequency was examined on demographics and chi square test was applied on 2 groups fo r percept io n c ompari son .


Table 1 shows that first year 61 (56.0%) students reported moderate stress while final year 45 (66.2%) students reported high stress, in response to academic related  stressors. This perceptional difference among first and final year students was highly significant (p-value 0.000).Among all students (first & final year) majority of students scored high stress in response to academic related stressors. Inter/Intrapersonal Related Stressor response was high stress in both first and final year students (44.0% & 58.8% respectively) and perceptional difference among first and final year was significant (p-value 0 .0 24). Teaching and learning related stressor was scored with moderate stress in 53.2% first year students while final year students47.1% perceived this stressor differently as high stress. (P-value 0.000) .

Table 2 shows that first and final year students scored moderate stress (57.8% & 41.2% respectively) but perceptional difference was significant (p-value 0.000). 48.6% first year and 57.4% final year students were moderately stressed over drive and desire related stressor. There was not significant perceptional difference related to drive and desire related stressor among them (p-value greater than 0.05). Group activity related stressor was causing high stress in first year 47.7% students while moderate stress in 51.5% final year students. Perceptional difference existed with p-value less than 0.05. All stressors were perceived differently in first and final year students except drive and desire related stress which was equally moderately affecting the first and final year students. This stressor was also noted as the main cause of stress among students 52.0%. Second leading causeof stress was social related stressor 51.4% while academic  and teaching and learning related stressors were equallyaffecting the students of DPT 45.2% and least affecting stressor was group ac tivity related with 41.8%.

Conclusions and Recommendations

Academic burden, choice of studying medical related course, choosing wrong career and worrying about scope, is prominently affecting the DPT students with moderate stress. To suppress these stress causing factors, rehabilitation colleges should properly arrange the seminars an d workshops on career counseling throughout the DPT course for students.

Disclaimer: None.
Conflict of Interest: None.
Funding: None


1. Association APT. Guide to Physical Therapist Practice. Alexandria, VA : American Physical Therapy Association; 2014.
2. Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. J Affect Disord 2013; 148: 1-11.
3. Omigbodun OO, Odukogbe AT, Omigbodun AO, Yusuf OB, Bella TT, Olayemi O. Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria. Soc    Psychiatry Psychiatr Epidemiol 2006; 41: 415-21.
4. Lyndon MP, Strom JM, Alyami HM, Yu TC, Wilson NC, Singh PP, et  al. The relationship between academic assessment and psychological distress among medical students: a systematic review. Perspectives Med Educ 2014; 3: 405-18.
5. Youssef FF. Medical student stress, burnout and depression in Trinidad and Tobago. Acad Psychiatry 2016; . 40: 69-75.
6. Shamsuddin K, Fadzil F, Ismail WS, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatr 2013; 6: 318-23.
7. Yusoff MSB, Rahim AFA. Stress, stressors and coping strategies: first year medical students in Malaysian public universities. VDM Publishing, 2011.
8. Rahman NI, Ismail S, Ali RM, Alattraqchi AG, Dali WPEW, Umar BU,et al., Stress among first batch of MBBS students of Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Malaysia: when final professional examination is knocking the door. Int Med J 2015; 22: 1-6.
9. Ali HM, Attar DM, Al-Abdulwalid F, Juma FA, Al-Mezail HI, Al-Jalahma JA, et al., Comparison between the first and sixth year medical students in the arabian gulf university of bahrain regarding anxiety and depression. Int Neuropsych Dis J 2014; 2: 85-93.
10. Yusoff MSB, Fuad A. The Medical Student Stressor Questionnaire(MSSQ) Manual. Universiti Sains Malaysia; 2010.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: