Skip Navigation
Skip to contents

JEEHP : Journal of Educational Evaluation for Health Professions



Page Path
HOME > J Educ Eval Health Prof > Volume 11; 2014 > Article
Brief Report
Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan
Khadija Qamar1*orcid, Muhammad Rizwan Bash Kiani1orcid, Aisha Ayyub2orcid, Atif Ahmed Khan3orcid, Mohammad Osama4orcid

Published online: October 9, 2014

1Department of Anatomy, National University of Sciences and Technology Army Medical College, Islamabad, Pakistan

2Department of Chemical Pathology, National University of Sciences and Technology Army Medical College, Islamabad, Pakistan

3Department of Physical Medicine and Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan

4Department of Economics, Lahore University of Management Sciences, Lahore, Pakistan

*Corresponding email:


• Received: June 7, 2014   • Accepted: September 30, 2014

© 2014, National Health Personnel Licensing Examination Board of the Republic of Korea

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 162 Download
  • 10 Web of Science
  • 10 Crossref
  • The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).
Medical students encounter intense and stressful circumstances in the course of their academic studies. This stress may be exacerbated by their educational responsibilities, as well as the overall environment [1]. This study aims to determine the stress level of students enrolled in an army medical school in Pakistan, since the military environment and the maintenance of a focal discipline may produce more stress than in other medical schools. The sex differences in stress levels and the relationship between severity of stress and academic year were also examined.
This cross sectional, descriptive study was carried out from January 2014 to April 2014. Students enrolled in the first four years of the army medical school were included in the study through non-probability consecutive sampling. The study objectives and questionnaire items were clearly explained to the participants, and written informed consent was obtained.
A self-administered, English version of The Kessler Psychological Distress Scale (K10) instrument was distributed to the students [2]. Questionnaires of students who did not provide their consent or those that contained incomplete responses were excluded from the study. The number of potential participants for the study was 800. Out of 445 students who participated, 405 returned completed questionnaires. Each of the ten items was scored on a Likert-type scale from 1 to 5, and scores were summed to provide a total (K10) score. The lowest possible total score was 10 and the highest possible score was 50. Participants’ scores were categorized as follows: 20 to 24 as mild stress, scores of 25 to 29 as moderate stress, and scores of 30 to 50 as severe stress.
Data were analyzed using IBM SPSS ver. 19.0 (IBM Co., Armonk, NY, USA). Descriptive statistics, i.e., mean and SD, were used to provide the results. A t-test was conducted to determine the difference in stress level by sex. A chi-square test was conducted to ascertain the association between stress and academic year.
Out of 405 students, there were 254 males (62.7%) and 151 females (37.3%). One hundred and fifteen students (28.4%) were in their first year, 82 (20.2%) were in the second year, 99 (24.4%) were in the third year, and 109 (26.9%) were in the fourth year. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43 (Fig. 1). Stress was experienced by 169 students (41.7%): 92 males (54.4%) and 77 females (45.5%). Mild stress was experienced by 81 students (47.92%), moderate stress by 47 students (27.81%), and severe stress by 41 students (24.26%). Stress scores for female students (13.0%) were greater than scores for males (11.2%; P=0.011). Most students complained of stress symptoms ‘a little of the time’ during their daily routine. The medical syllabus or course was found to be stressful by the undergraduate medical students, during their first and third academic years, but not in their second and fourth academic years. There was no significant association between stress and academic year (P=0.392) (Fig. 2).
The above results revealed that students’ stress was more frequent in the first and third year of the undergraduate medical program than in the other academic years; however, there was no significant association between stress levels and the academic year of study participants. The stress factor appears to be more profound during the first academic year. Thus, identifying stress levels during the first year of medical classes and introducing organized strategies to rectify academic-related problems may help undergraduate medical students to overcome stress. Higher stress in female students could be explained by specific psychosocial profiles [1]. Higher levels of stress could harm the psychological health of medical students by affecting their learning and cognitive behavior which ultimately results in inferior patient care. Therefore, there is a need to include stress management education in the curriculum of undergraduate medical students, who experience more stress and depression than the general population does.

No potential conflict of interest relevant to this article was reported.

Audio recording of the abstract.
Fig. 1.
Distribution of stress scores for 405 students enrolled in an army medical school in Pakistan, surveyed from January 2014 to April 2014 (mean±SD, 19.61±6.761; N=405).
Fig. 2.
Comparison of stress scores according to academic year for 405 medical students enrolled in an army medical school in Pakistan, surveyed from January 2014 to April 2014.

Figure & Data



    Citations to this article as recorded by  
    • Family support and psychological distress among commuter college students
      Jennifer Parker, Abigail Yacoub, Sahira Mughal, Fadi Mamari
      Journal of American College Health.2023; 71(2): 479.     CrossRef
    • Mental well-being in Sri Lankan medical students: a cross-sectional study
      Courtney E. Wimberly, Harshini Rajapakse, Lawrence P. Park, Ashley Price, Rae Jean Proeschold-Bell, Truls Østbye
      Psychology, Health & Medicine.2022; 27(6): 1213.     CrossRef
    • Alcohol use disorder and its associated factors among residents in Southern Ethiopia during the era of COVID-19
      Habtamu Endashaw Hareru, Abdene Weya Kaso, Berhanu Gidisa Debela, Lulu Abebe, Daniel Sisay W/tsadik, Reta Kassa Abebe, Chalachew Kassaw
      SAGE Open Medicine.2022; 10: 205031212211050.     CrossRef
    • The impact of COVID‐related economic shocks on household mental health in Pakistan
      Victoria Baranov, Pauline Grosjean, Fatima Jamal Khan, Sarah Walker
      Health Economics.2022; 31(10): 2208.     CrossRef
    • Difference of Psychological Distress among First- and Third-year Indonesian Medical Students
      Cut Rika Pratiwi, Bahagia Loebis, Vita Camellia, Elmeida Effendy
      Open Access Macedonian Journal of Medical Sciences.2022; 10(T7): 150.     CrossRef
    • A novel model to predict mental distress among medical graduate students in China
      Fei Guo, Min Yi, Li Sun, Ting Luo, Ruili Han, Lanlan Zheng, Shengyang Jin, Jun Wang, Mingxing Lei, Changjun Gao
      BMC Psychiatry.2021;[Epub]     CrossRef
    • The assessment of stress level, anxiety, depressive symptoms, and defense mechanisms among Polish and English medical students
      M. Pawlaczyk, J. Siembida, K. Balaj, A. Rajewska-Rager
      Annals of General Psychiatry.2020;[Epub]     CrossRef
    • Helping Students Keep the Promise: Exploring how Kalamazoo Promise Scholars’ Basic Needs, Motivation, and Engagement Correlate to Performance and Persistence in a 4-Year Institution
      Daniel Collier, Ceceilia Parnther, Dan Fitzpatrick, Chelsea Brehm, Andrea Beach
      Innovative Higher Education.2019; 44(5): 333.     CrossRef
    • Coming to College Hungry: How Food Insecurity Relates to Amotivation, Stress, Engagement, and First-Semester Performance in a 4-Year University
      Daniel Collier, Dan Fitzpatrick, Chelsea Brehm, Eric Archer
      SSRN Electronic Journal.2019;[Epub]     CrossRef
    • Prevalence and correlates of psychological stress among teachers at a national key comprehensive university in China
      Wenjun Li, Changgui Kou
      International Journal of Occupational and Environmental Health.2018; 24(1-2): 7.     CrossRef

    We recommend

    JEEHP : Journal of Educational Evaluation for Health Professions