Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : September | Volume : 17 | Issue : 9 | Page : ZC01 - ZC05 Full Version

Psychosocial Impact, Perceived Stress Levels and their Learning Effect among the Undergraduate Dental Students during the Transition from Preclinicals to Clinicals: A Questionnaire-based Cross-sectional Study

Published: September 1, 2023 | DOI:
Paspuleti Swetha, Ponukupati Yasaswi, KSV Ramesh, Ravikanth Manyam, NVSG Sruthima

1. Professor, Department of Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. 2. Student (Undergraduate), Department of BDS, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. 3. Associate Professor, Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. 4. Professor and Head, Department of Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. 5. Professor, Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India.

Correspondence Address :
Dr. Swetha Paspuleti,
Professor, Department of Oral Pathology, Vishnu Dental College, Vishnupur, Bhimavaram-534202, Andhra Pradesh, India.


Introduction: Dentistry is known as the most challenging and stressful profession. Dental education enhances students’ ability to provide high-caliber work in the clinical field. To fulfill this criterion, students are required to develop professional conduct, competencies, and psychological and cognitive abilities in due course of time. The shift from preclinical to clinical is considered one of the most crucial stages for dental undergraduates. During this period, individuals often experience unique emotional and social challenges, leading to stress, anxiety, and depression.

Aim: The aim of this study is to assess the perceived stress levels, psychosocial impacts, as well as depression and anxiety levels among dental undergraduates during their transition from preclinical (2nd year) to clinical (3rd year) practice.

Materials and Methods: A cross-sectional questionnaire-based study was conducted among second and third-year dental undergraduates from different dental colleges in South India from February 2022 to June 2022. Two questionnaires, the Dental Environmental Stress (DES) scale (25 items) and the Depression Anxiety Stress Scale (DASS) (21 items), were utilised to measure stress, depression, and anxiety levels. The questionnaire was designed using Google Forms and distributed via WhatsApp. The snowball sampling technique was used, and data from 489 self-selected participants were collected and sent for statistical analysis. Descriptive statistics (mean, 95% Confidence Interval [CI]) were used to identify major stressors and their perceived magnitude. The responses were recorded on a 4-point Likert scale.

Results: This study included a total population of 489 participants, with 360 (73.6%) females and 129 (26.3%) males, respectively. According to the DES results, the educational environment and clinical domain were the most stressed domains, with mean values of 1.7859±0.47929 and 1.7639±0.43729, respectively. The top five stressors identified were lack of relaxation time, fear of failure, financial burden, assigned work, and examinations/grades. The DASS results revealed the highest prevalence of stress (15.22±5.92), followed by anxiety (13.39±6.01) and depression (12.60±8.66).

Conclusion: The results of this study indicate that dental undergraduates experience higher levels of perceived stress, psychosocial effects, depression, and anxiety during the transition from preclinical (2nd year) to clinical (3rd year) practice. Structured student support systems, such as counselling programmes and effective communication skills, can help create an environment that reduces stress and enhances student well-being.


Anxiety, Depression, Psychological stress, Stressors

Stress is a bodily response that requires attention due to physical, emotional, or psychological strain. A large body of literature states that professional courses like dental education, which involve course-related stressful experiences, were noted through surveys to be comparatively higher than the general population (1),(2),(3),(4),(5). There is ample evidence stating that dental students experience more stress than medical students, depending on various personal or institutional circumstances. Different individuals have different stressors and stress levels (6),(7),(8). These stressors have detrimental effects on dental students, including physical symptoms (musculoskeletal problems), psychological distress, emotional exhaustion, and burnout (2),(3). Dental undergraduate students have to deal with several factors, such as academic demands, clinical responsibilities, communication skills with patients, peers, and faculty (6),(9). These psychosocial impacts affect perceived stress levels and make it challenging for individuals to cope with the transition from preclinicals to clinicals. In extreme or long-term circumstances, stress can lead to burnout in vulnerable students’ lives. Burnout, characterised by emotional weariness (mental tiredness), depersonalisation (psychological detachment from others), and decreased personal accomplishment, hinders students from demonstrating empathy (an emotional component) and compassion (a behavioural component) in intensive clinician-patient interactions (8). These factors are vital for successful treatment, patient satisfaction, and the quality and efficiency of medical care. Students studying dentistry also experience significant rates of burnout and its negative impacts, leading to difficulties in patient engagement and communication with friends and colleagues (2),(4),(5),(10).

When undergraduates enter clinics, they must apply their basic and preclinical knowledge to their clinical training. While studies have focused primarily on stress with less emphasis on depression and anxiety, it is important to recognise that all three are interrelated (1),(2),(6),(7),(8). To date, the DES and DASS questionnaires have been employed individually to assess stress levels and psychosocial impacts. Therefore, the novelty and aim of the present study is to analyse depression, anxiety, and stress by adapting a combined questionnaire (DES and DASS) among dental undergraduates during their transition from preclinical to clinical phase.

Material and Methods

A cross-sectional questionnaire-based study was conducted among dental undergraduate students at different dental schools in South India from February 2022 to June 2022. The study protocol was approved by the Institutional Ethical Committee (IECVDC/22/UG01/OP/Q/54).

Inclusion criteria: The study included second and third-year dental undergraduate students who were willing to participate.

Exclusion criteria: First-year students, final-year students, interns, and postgraduate students were excluded from the study to align with the study’s objectives. Unwilling participants were also excluded.

Sample size calculation: The sample size was calculated using the single population proportion formula, assuming a 95% Confidence Interval (CI), a standard normal variable (Z-score) of 1.96, a margin of error of 3%, and a precision of 5%. Considering a target population of approximately nine hundred students, it was determined that a minimum of 489 subjects were required for the study. The sample size calculation formula used was n0=z2pq/e2 (where n is the sample size, z is the level of confidence, p is the prevalence, q is 1-p, and e is the margin of error). In this case, p was assumed to be 0.0165.

Study Procedure

Questionnaire: The study tools used in the present study were the Modified DES questionnaire (25 items) (4),(11) and the Modified Depression Anxiety Stress Scale (21 items) (12).

Questionnaire: The questionnaire consisted of a total of 49 items divided into seven sections. The first section was confined to the demographic details, with three questions. The second, third, fourth, fifth, and sixth sections each comprised five questions about the participants’ opinions on different domains of stressors related to the modified DES. The questions were selected from the original DES questionnaire, which as previously mentioned, originally included 38 questions. Only the questions that were relevant for second and third-year students were chosen. The seventh section of the questionnaire contained twenty-one items from the DASS. The questions from both the DES and DASS questionnaires were rephrased for better understanding by the study participants.

The DASS, developed by Lovibond SH and Lovibond PF, was used to assess the core symptoms of depression, anxiety, and stress and has also been used to evaluate patients’ responses to treatment (12). The DASS-21 is a condensed version of the original 42-item survey, consisting of seven items for each of the three scales designed to measure negative emotional states (12).

A panel of experts checked the face validity of the modified questionnaire, and the approved questionnaire was then circulated among ten undergraduate students from three different dental colleges to assess its validity and clarity. This pilot test helped refine the items in the questionnaire through rephrasing. The validity of the questionnaire was assessed using Cronbach’s alpha value, which was found to be 0.924, indicating good internal consistency.

Data collection: A validated questionnaire was randomly sent to students at different institutes via Google Forms. Participants accessed the form by clicking the provided link, where they were prompted to read and accept the informed consent before answering the questionnaire. A snowball sampling technique was used to collect information, with participants encouraged to share the questionnaire with as many students as possible. Participants were assured that their identification and data would be kept confidential.

Responses for the modified DES questionnaire were evaluated using a four-point Likert scale (0=not stressful to 3=very stressful). In the case of the DASS-21 questionnaire, it consisted of three self-reported measures for evaluating depression, anxiety, and stress. Each measure included seven items and was evaluated on a Likert scale ranging from 0 to 3 (13). The scale values were interpreted as follows:

• 0-Did not apply to me at all,
• 1-Applied to me to some degree or some of the time,
• 2-Applied to me to a considerable degree or a good part of the time,
• 3-Applied to me very much or most of the time.

The scores for relevant items were added together to generate depression, anxiety, and stress scores. Recommended cut-off scores for conventional severity labels were graded as shown in (Table/Fig 1). Scores on the DASS-21 questionnaire needed to be multiplied by two to calculate the final scores, as it is a modified version of the DASS-42.

Statistical Analysis

Microsoft Excel (Microsoft) was used for data processing and generating data charts. The International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp) was used to analyse the data. Descriptive statistics, including mean and 95% confidence intervals, were used to identify major stressors and their perceived magnitude. Pearson’s chi-square test and one-way analysis of variance (ANOVA) were used to measure the differences between different years of study.


Demographic profile: A total of 489 students participated in the study, resulting in a response rate of 100%. The mean age of the students was 20.39±1.19 years. The majority of the participants were females (n=360, 73.6%). The socio-demographic details are depicted in (Table/Fig 2).

Mean stress values by different stressors in dental undergraduates: The major stress domains reported were the educational environment (1.7859±0.47929), followed by the clinical (1.7639±0.43729), academic (1.6779±0.49722), personal (1.6525±0.43392), and living (1.6406±0.47265) domains, respectively (Table/Fig 3). In the educational environment domain, the highest stressors recorded were moving away from home, food and accommodation issues. In the academic domain, examination and grades, and the amount of assigned work were the major stressors. In the clinical domain, completing the given quota, student-patient relationships, and interaction with the staff were the highest stressors recorded (Table/Fig 4).

The second-year undergraduate students reported difficulty in completing the assigned work (1.8±0.4), the amount of assigned preclinical work (1.5±0.003), and strict rules by management (1.2±0.31). This study also found moderate stressors in the non-academic domains, such as a lack of home atmosphere, peer relationship issues, and the disparity between expectations and reality of the dental college. No significant difference was observed between the second- and third-year students in any domain (p-value=0.05).

DASS results: Based on the data acquired and categorised according to DASS criteria, the overall scores for anxiety were 13.39±6.01, followed by depression with 12.60±8.66, and stress with a value of 15.22±5.92. In terms of severity, anxiety was the most prevalent condition, with more than one-fourth of the students displaying high scores in this aspect. The distribution of the DASS scores is depicted in (Table/Fig 5).

Year of study: All three conditions (anxiety, depression, and stress) were commonly reported in the third-year students, followed by the second-year students. Statistically, the three variables were higher in the third year and decreased gradually in the second year.


According to the Dental Council of India, undergraduate dental education follows a five-year curriculum. The first two years of the course focus on fundamental, medical, and dental sciences, while the next three years involve rigorous clinical training and theoretical study to develop diagnostic abilities for effective treatment planning. The clinical years are considered the most important time in a dental professional’s life, as the experience gained during this period will be evident in their future clinical practice.

During the transition from the second year to the third year, the authors analysed data from several dental institutions and found significant statistical variances, as revealed by the findings. The present study identified the clinical and educational environmental domains as major stressors. Within each of the five domains, stressors such as lack of relaxation time, fear of failure or being caught up, responsibilities and financial burden, amount of assigned work, and examination and grades were identified as major concerns among dental undergraduate students. However, third-year undergraduates specifically reported lack of relaxation time and the amount of assigned quota as their highest stressors.

These findings are consistent with a study by Shehada MR et al., which concluded that clinical factors, academic work, and the educational environment were the major domains of stress (6). Interactions with patients and learning clinical procedures were identified as major clinical stressors (6). They also noted that the difference in clinical and educational environment stressors may be due to faculty factors and inadequate technical capacity when dealing with a large number of students.

In the present study, second-year undergraduates expressed examination stress, lack of decision-making, completing quotas, and interaction with faculty as major stressors during preclinicals. Other studies have also reported similar stressors, including staying far from home, lack of relaxation time, and moving away from home (1),(2),(6). In the academic domain, 56% of the study participants (undergraduate students) identified examinations and grades as the major stressor, which is consistent with findings from other studies (7),(8),(10),(14). Ahmad MS et al. also reported that undergraduate students faced issues with examinations, grades, and the fear of failing during preclinical examinations (15). They confront it because being medical subjects requires enough time to study, which indirectly affects relaxation time. Students were also concerned about adjusting to the environment and the college rules and regulations. Bakar NA et al. also found a high prevalence of academic-related stress. They provided sufficient evidence showing an increase in psychological stress along with the year of study, with second-year students experiencing more stress (3). They also stated that mental well-being is better than not having mental health disorders, as their population norm showed lower mental well-being, which aligns with the present study. However, during the transition from preclinicals to clinicals, undergraduate students began to develop more concerns about the scope of dentistry and information on higher studies. In the present study, the stressors were more focused within the clinical domain, such as interactions with patients, the decision-making process, completing assigned quotas within a given period, and balancing theoretical subjects. Other major stressors recorded included the time factor and lack of a home atmosphere. This data suggests that the dental curriculum is demanding, requiring expertise and multitasking ability, according to Malinta QU et al. (16). Sarkar S et al. have stated that completing clinical quotas, comparisons with other professions, balancing theoretical examinations with clinicals, and getting introduced to the vast nine subjects required for graduation were the highest stressors recorded, which aligns with our study results (17). The shift from preclinical to clinical appears to be a more demanding stress feature for third-year undergraduates. Several studies have also shown similar patterns of stress during this transition (3),(4),(5),(10). In contrast, a Malaysian study reported that the clinical domain was a moderate stressor for undergraduate students compared to clinical years (2). In the present study, faculty and administration were among the top five major stressors; however, these were also identified as top concerns in other studies (2),(4),(5). This raises concerns about student-faculty communication and interpersonal relationships in various dental colleges. In the current study, when comparing these “pentagon of domains,” major stressor scores were reported in the workload. The present data showed a higher occurrence of stress among dental students compared to clinical students during the preclinical phases. According to Ahad A et al., this can be attributed to a higher risk of depression and anxiety among dental students (18). Therefore, in this study, alongside the DES questionnaire, the DASS-21 scale was also incorporated to assess the relationship between depression, anxiety, and stress. It was evident that dentistry was not the first choice for the majority of undergraduate students in India (19),(20). This condition was attributed to various factors such as limited attempts, financial situations, age considerations, and more (16),(17). In the present study, when assessing the DASS, dental students showed a significant presence of mild and moderate depression and anxiety, which aligns with Ahad A et al., who reported a higher prevalence of stress leading to depression and anxiety among Indian dental students. They also found that over 60% of students joined the BDS program because they had no other choice, and 69% were compelled by their parents’ will. In the present study, students expressed mild depression, which appeared slightly higher compared to medical undergraduates when using DASS-21 or DASS-42 (4). A Turkish and Indian study comparing medical and dental undergraduates also discovered a higher incidence of depression and anxiety among dental students (15),(20).

Anxiety is a psychophysiological signal indicating the initiation of the stress response. This potentially debilitating condition is reported to be predictive of reduced performance. The present study found a significant incidence of anxiety among dental undergraduates (45% among second-year students and 55% among third-year students), which is consistent with previous results from Indian and Turkish studies using DASS-21 or DASS-42 (18),(21). When compared to second-year undergraduates, third-year undergraduates experienced higher stress, which is in line with another study (19). Reasons for this stress could be the sudden transition from preclinicals to clinicals, where students are required to complete assigned clinical work within a stipulated time frame and manage exam schedules (22). Second-year students were shown to be less prone to anxiety compared to third-year students, which is consistent with previous findings. This could be attributed to the limited time period and extensive workload that third-year students face, as they have to improve their hands-on experience while simultaneously preparing for university examinations (18).


Response bias is a limitation of this study since there is a lack of actual interaction with the participants. Questionnaires usually have a low response rate because responding to them can be tedious compared to one-to-one verbal interaction.


The findings of the present study imply an increasing level of stress, accompanied by significant levels of depression and anxiety, among undergraduate dental students during the transition from preclinicals to clinicals. The educational and clinical domains had the highest mean scores for psychological impact. Lack of relaxation time, completing assigned quotas, and student-teacher-patient relationships were identified as the major stressors overall. Preclinical (2nd year) students experienced considerable levels of anxiety, while clinical (3rd year) students exhibited the highest levels of stress and depression. Dental students often face a substantial amount of stress. To mitigate this buildup and its negative consequences, it is crucial to consider these findings. Implementing organised student support systems, such as counseling services and mentorship programmes, can help create an environment that reduces stress and enhances student well-being. The results should assist dental educators in understanding the stressors and concerns that students encounter. Future multicentre studies with a more clinical approach, such as conducting interviews and sessions, are recommended to achieve more significant results at a national level.


We would like to express our gratitude to all the study participants for dedicating their valuable time, as well as the management of Vishnu Dental College, Andhra Pradesh, India, for their support in conducting this research.


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DOI and Others

DOI: 10.7860/JCDR/2023/62451.18356

Date of Submission: Dec 23, 2022
Date of Peer Review: Jan 19, 2023
Date of Acceptance: Apr 22, 2023
Date of Publishing: Sep 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Dec 24, 2022
• Manual Googling: Mar 10, 2023
• iThenticate Software: Apr 20, 2023 (12%)

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