Study of stress, anxiety, depression and coping strategies among nursing students in a tertiary care teaching hospital, South India

Biranchi Narayan Das, Anu Mohandas, Saba Syed


Background: Nursing students are at extremely high risk for experiencing stress, anxiety, and depression due to their varied circumstances. Indian studies has revealed, moderate stress among 77-82% of nursing students. The better the nursing students can manage their stress and anxiety and adopt healthy coping strategy, the more successful they can be in their clinical training and academic performance. Objective of the current study was to estimate the prevalence of depression, anxiety, and stress among the BSc nursing students and its association with socio-demographic and academic factors and to find the coping strategies adopted by them.

Methods: A cross sectional study was conducted among 149BSc nursing students in a teaching hospital in Hyderabad. The data was collected by pre-validated questionnaire with 3 parts. Part I: socio-demographic and academic parameters, part II: psychological information (DASS-21) and part III: coping strategies (brief COPE). Data was analysed using SPSS version 24.The percentages of stress, anxiety and depression was found and categorised to mild, moderate, severe and extremely severe and associations analyzed with Chi-square test. The mean score and percentages were calculated for coping strategies.

Results: The mean age of nursing students was 20±1.6 years. The proportion having depression, anxiety and stress were 67.7%, 85.3% and 46.9% respectively. The coping strategies ‘used a lot’ were spirituality (43.6%), Information support (30.9%) and active coping (28.2%). The study showed depression (p=0.05) and stress (p=0.002) to be higher among 2nd and 4th year students. Lack of leisure time (p=0.036) and difficulty in academics (p= 0.017) were identified as stressors.

Conclusions: This study noted high levels of psychological disturbances among nursing students. There is urgent need to plan stress management programmes with peer instructors, mentorship, more leisure and outdoor learning activities.


Depression, Anxiety, Stress, Coping strategy, Nursing students

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Floyd J. Depression, anxiety, and stress among nursing students and the relationship to grade point average. Union Univ. 2010;27(2):162-8.

Ratanasiripong P, Ratanasiripong N, Kathalae D. Biofeedback intervention for stress and anxiety among nursing students: a randomized controlled trial. Int Scholarly Res Not. 2012;2012:52-9.

Moscaritolo LM. Interventional strategies to decrease nursing student anxiety in the clinical learning environment. J Nurs Educ . 2009;48(1):17-23.

Chris E, Pais M. Perceived self-esteem amongst first-year nursing students: a cross-sectional survey. J Soc Welfare Manag. 2012;4(3):125-31.

Pulido‐Martos M, Augusto‐Landa JM, Lopez‐Zafra E. Sources of stress in nursing students: a systematic review of quantitative studies. Int Nurs Rev. 2012;59(1):15-25.

Stress in nursing university students and mental health. Available at: books/health-and-academic-achievement. Accessed on 24 April 2021.

Beck DL, Srivastava R. Perceived level and sources of stress in baccalaureate nursing students. J Nurs Edu.1991;30(3):127-33.

Nicholl H, Timmins F. Programme‐related stressors among part‐time undergraduate nursing students. J Adv Nurs. 2005;50(1):93-100.

Suliman WA, Halabi J. Critical thinking, self-esteem, and state anxiety of nursing students. Nurs Edu Today. 2007;27(2):162-8.

Jimenez C, Navia‐Osorio PM, Diaz CV. Stress and health in novice and experienced nursing students. J Adv Nurs. 2010;66(2):442-55.

Singh N, Kohli C. Stress reaction and coping strategies among nursing students in Delhi. Asian J Nurs Edu Res. 2015;5(2):274.

Nebhinani M, Kumar A, Parihar A, Rani R. Stress and coping strategies among undergraduate nursing students: a descriptive assessment from Western Rajasthan. Indian J Comm Med. 2020;45(2):172-5.

Definition stress, anxiety and depression. Available at: Accessed on 09 April 2021.

Definition of stress. Available at: http://www.stress. org/Definition of stress.htm. Accessed on 09 April 2021.

Definition of Coping strategies, MacArthur Foundation. Available at: research/psychosocial/coping.php. Accessed on 09 April 2021.

Tully A. Stress, sources of stress and ways of coping among psychiatric nursing students. J Psychi Mental Health Nurs. 2004;11(1):43-7.

Folkman S, Lazarus RS, Dunkel-Schetter C, DeLongis A, Gruen RJ. Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. J Persone Soc Psychol. 1986;50(5):992-1003.

Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation; 1995.

Carver, C. S. You want to measure coping but your protocol’s too long: Consider the Brief COPE. Int J Behav Med. 1997;4:92-100.

Cheung T, Wong SY, Wong KY, Law LY, Ng K, Tong MT, et al. Depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong: a cross-sectional study. Int J Environ Res Public Health. 2016;13(8):779.

Maharaj S, Lees T, Lal S. Prevalence and risk factors of depression, anxiety, and stress in acohort of Australian nurses. Int J Env Res Public Health. 2019; 16(1):61.

Dhar R, Walia I, Das K. A descriptive study to assess the causes of stress and coping strategies used by the newly admitted basic B.Sc. Nursing students. Nurs Midwifery Res J. 2009;5(1):31-7

Kumar R. Nancy. Stress and coping strategies among nursing students. Nurs Midwifery Res J. 2011; 7(4):141-51.

Singh A, Chopra M, Adiba S, Mithra P, Bhardwaj A, Arya R, et al. A descriptive study of perceived stress among the North Indian nursing undergraduate students. Iran J Nurs Midwifery Res. 2013;18(4):340.

Sharif F, Masoumi S. A qualitative study of nursing student experiences of clinicalpractice. BMC Nurs. 2005;4(1):1-7.