Strides in Development of Medical Education

Document Type : Original Article


1 Operative Dentistry Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

2 Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

3 Oral and Maxillofacial Pathology Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran


Background Dental students are exposed to various stressors that are related to treatment procedures, training, and administrative challenges in the college. Objectives The aim of this study was to assess the stress, anxiety, and depression levels of dental students and their relationships with demographic factors. Methods This was a descriptive-analytical cross-sectional study on 297 dental students enrolled at the Kerman University of Medical Science in 2015 - 2016. The stress, anxiety, and depression levels were measured using the depression anxiety stress scale-21 (DASS-21). Data on demographic characteristics were also obtained. The statistical analysis was carried out by SPSS (version 11.0) using the chi-squared test. P < 0.05 was set as the level of significance. Results The mean age of the participants was 23.80 ± 1.2 years; 58.9% were female, 88.9% were married, and 33.7% were dormitory students. Free education was provided for 64% of the students while the others were charged a tuition fee. The prevalence rates of moderate to extremely severe levels of stress, anxiety, and depression were 39.7%, 39.4%, and 35.7%, respectively. Stress, anxiety, and depression were not significantly associated with the year of academic study, gender, marital status, and place of residence (P > 0.05). The students with higher scores in the entrance exam who were free of charge presented significantly higher levels of severe-to-extremely severe stress and depression (P = 0.003 and P = 0.033, respectively) than students who were charged tuition fees. Conclusions Based on the findings of the present study, the high prevalence of depression, anxiety, and stress among dental students in Kerman is alarming. This emphasizes the need for interventions, with the development of appropriate support services for this group. However, further studies should be conducted to find major sources of depression, anxiety, and stress.


  1. Humphris G, Blinkhorn A, Freeman R, Gorter R, Hoad-Reddick G, Murtomaa H, et al. Psychological stress in undergraduate dental students: Baseline results from seven European dental schools. Eur J Dent Educ. 2002;6(1):22–9. doi: 10.1034/j.1600-0579.2002.060105.x. [PubMed: 11872070].
  2. Pohlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ. 2005;9(2):78–84. doi:10.1111/j.1600-0579.2004.00359.x. [PubMed:15811155].
  3. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadianmedical students. Acad Med. 2006;81(4):354–73. doi:10.1097/00001888-200604000-00009. [PubMed: 16565188].
  4. Muirhead V, LockerD. Canadian dental students’ perceptions of stress and social support. Eur J Dent Educ. 2008;12(3):144–8. doi: 10.1111/j.1600-0579.2008.00512.x. [PubMed: 18666895].
  5. Levi L. Occupational stress. Spice of life or kiss of death? Am Psychol. 1990;45(10):1142–5. doi:10.1037/0003-066X.45.10.1142. [PubMed:2252232].
  6. Garbee WH Jr, Zucker SB, Selby GR. Perceived sources of stress among dental students. J Am Dent Assoc. 1980;100(6):853–7. doi:10.14219/jada.archive.1980.0279. [PubMed: 6929835].
  7. Wexler M. Mental health and dental education. J Dent Educ. 1978;42(2):74–7. [PubMed: 271659].
  8. Westerman GH, Grandy TG, Lupo JV, Mitchell RE. Relationship of stress and performance among first-year dental students. J Dent Educ. 1986;50(5):264–7. [PubMed: 3457830].
  9. Cecchini JJ, Friedman N. First-year dental students: Relationship between stress and performance. Int J Psychosom. 1987;34(3):17–9. [PubMed: 3479407].
  10. Koh KB, Choe E, Song JE, Lee EH. Effect of coping on endocrinoimmune functions in different stress situations. Psychiatry Res. 2006;143(2-3):223–34. doi: 10.1016/j.psychres.2005.04.008. [PubMed:16831469].
  11. Sofola OO, Jeboda SO. Perceived sources of stress in Nigerian dental students. Eur J Dent Educ. 2006; 10(1):20–3. doi: 10.1111/j.1600-0579.2006.00391.x. [PubMed: 16436080].
  12. Al-Omari WM. Perceived sources of stress within a dental educational environment. J Contemp Dent Pract. 2005;6(4):64–74. [PubMed:16299608].
  13. Akbari M, Nejat A, Dastorani S, Rouhani A. [Evaluation of stress level and related factors among students of mashhad dental school (Iran) in academic year of 2008-2009]. J Mash Dent Sch. 2011; 35(3): 165–76. Persian.
  14. Amini P, Karimi-Afshar M, Torabi-Parizi M, Jafaree B. [The stress level and related factors in students of school of dentistry, Kerman University of Medical Sciences, Iran]. J Strides Dev Med Educ. 2014; 10(4): 467–72. Persian.
  15. Polychronopoulou A, Divaris K. Dental students’ perceived sources of stress: A multi-country study. J Dent Educ. 2009;73(5):631–9. [PubMed:19433538].
  16. Naidu RS, Adams JS, Simeon D, Persad S. Sources of stress and psychological disturbance among dental students in the West Indies. J Dent Educ. 2002;66(9):1021–30. [PubMed: 12374261].
  17. Polychronopoulou A, Divaris K. A longitudinal study of Greek dental students’ perceived sources of stress. J Dent Educ. 2010;74(5):524–30. [PubMed: 20442430].
  18. Eremsoy CE, Çelimli ¸S, Gençöz T. Students under academic stress in a Turkish University: Variables associated with symptoms of depression and anxiety. Curr Psychol. 2005;24(2):123–33. doi:10.1007/s12144-005-1011-z.
  19. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995; 33(3):335–43. [PubMed: 7726811].
  20. Sahebi A, Asghari MJ, Salari RS. [Validity of depression, anxiety and stress scale (DASS-21) for an Iranian population]. J Iranian Psychol. 2005;1(4):299–312. Persian.
  21. Aghebati N. [Effects of touch therapy on pain and psychiatric symptoms (depression, anxiety and stress) of cancers patients]. Tarbiat Modares Univ Fac Med Sci. 2005:65–70. Persian.
  22. Moradipanah F. [Effects of music therapy on anxiety, stress and depression of patients undergoing cardiac catheterization]. Tarbiat Modares Univ Fac Med Sci. 2005:42–8. Persian.
  23. Rezaei-Adryani M, Azadi A, Ahmadi F, Azimi AV. [Comparison level of stress, anxiety, depression and quality of life in dormitory resident students]. Iran J Nursing Res. 2007;4(2):31–8. Persian.
  24. Bolhari J, Ehsanmanesh M, Karimi Kaisami E. [Relationship between the stressors, stress symptoms, and reliance on God (Tavakkol) in Medical students]. Iran J Psychiatry Clin Psychol. 2000;6(1):20–5. Persian.
  25. Cooper CL, Watts J, Kelly M. Job satisfaction, mental health, and job stressors among general dental practitioners in the UK. Br Dent J. 1987;162(2):77–81. doi: 10.1038/sj.bdj.4806030. [PubMed: 3468971].
  26. Sugiura G, Shinada K, Kawaguchi Y. Psychological well-being and perceptions of stress amongst Japanese dental students. Eur J Dent Educ. 2005;9(1):17–25. doi: 10.1111/j.1600-0579.2004.00352.x. [PubMed:15642019].
  27. Murphy RJ, Gray SA, Sterling G, Reeves K, DuCette J. A comparative study of professional student stress. J Dent Educ. 2009;73(3):328–37.[PubMed: 19289722].
  28. Tedesco LA. A psychosocial perspective on the dental educational experience and student performance. J Dent Educ. 1986;50(10):601–5. [PubMed: 3463599].
  29. Sanders AE, Lushington K. Effect of perceived stress on student performance in dental school. J Dent Educ. 2002;66(1):75–81. [PubMed:12358103].
  30. Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK. Stress management for dental students performing their first pediatric restorative procedure. J Dent Educ. 2003;67(5):542–8. [PubMed:12809189].
  31. Rubenstein LK, May TM, Sonn MB, Batts VA. Physical health and stress in entering dental students. J Dent Educ. 1989;53(9):545–7. [PubMed:2768639].
  32. Galan F, Rios-Santos JV, Polo J, Rios-Carrasco B, Bullon P. Burnout, depression and suicidal ideation in dental students. Med Oral Patol Oral Cir Bucal. 2014;19(3):e206–11. doi: 10.4317/medoral.19281. [PubMed:24121916]. [PubMed Central: PMC4048106].
  33. Shahravan A, Karimi-Afshar M, Torabi M, Safari S. [Assessment of dental environment stress among clinical dentistry students in Kerman dental school, Iran, in 2014]. J Strides Dev Med Educ. 2016; 12(4): 586–95.Persian.
  34. Shahbazi Mogadam M, Nasoohi N, Zahirodin A, Valaee N, Etedal Monfared S. [Evaluation of stress level, its sources and related factors among senior dental students at Islamic Azad University in year 2010]. J Res Dent Sci. 2011;8(3):130–4. Persian.
  35. Shariati M, Yunesian M, Vash JH. Mental health of medical students: A cross-sectional study in Tehran. Psychol Rep. 2007;100(2):346–54. doi:10.2466/pr0.100.2.346-354. [PubMed: 17564208].
  36. Tangade PS, Mathur A, Gupta R, Chaudhary S. Assessment of stress level among dental school students: An Indian outlook. Dent Res J (Isfahan). 2011;8(2):95–101. [PubMed: 22013469]. [PubMed Central:PMC3177400].
  37. Westerman GH, Grandy TG, Ocanto RA, Erskine CG. Perceived sources of stress in the dental school environment. J Dent Educ. 1993;57(3):225–31. [PubMed: 8454777].
  38. Sedky NA. Perceived sources of stress among junior & mid-senior Egyptian dental students. Int J Health Sci (Qassim). 2012;6(2):141–57. doi: 10.12816/0005990. [PubMed: 23580895]. [PubMed Central:PMC3616944].
  39. Ayers KM, Thomson WM, Newton JT, Rich AM. Job stressors of New Zealand dentists and their coping strategies. Occup Med (Lond). 2008;58(4):275–81. doi: 10.1093/occmed/kqn014. [PubMed:18296684].
  40. Al-Sowygh ZH, Alfadley AA, Al-Saif MI, Al-Wadei SH. Perceived causes of stress among Saudi dental students. Saudi J Dent Res. 2013;4(1):7–15. doi: 10.1016/j.ksujds.2012.11.002.