See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/296846088
Prevalence of Stress among School Adolescents in Delhi
Article · January 2015
CITATIONS
READS
7
4,149
4 authors, including:
Jugal Kishore
Charu Kohli
Vardhman Mahavir Medical College and Safdarjung Hospital
Maulana Azad Medical College
276 PUBLICATIONS 3,128 CITATIONS
61 PUBLICATIONS 490 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Adolescent Health View project
Dietary Patterns among TB Patients View project
All content following this page was uploaded by Jugal Kishore on 05 March 2016.
The user has requested enhancement of the downloaded file.
SEE PROFILE
Research Article
Prevalence of Stress among School Adolescents in Delhi
Bhaskar Khobraji Watode*, Jugal Kishore**, Charu Kohli***
Abstract
Objectives: In the present scenario, as the society is influenced by modernization and
westernization, the path from adolescence to adulthood is endowed with stress. This is true,
especially in the case of adolescents in the middle income group families as they have to face
greater stress in the form of parental ambitions and highly competitive academic
environments. The objective of the current study is to assess the prevalence of stress and
stress causing factors among school adolescents of Delhi.
Methods: It is a cross-sectional study, conducted among the adolescents of conveniently
selected secondary schools from the central and eastern district of Delhi, India. Sampling
technique used in the study was simple random sampling and calculated sample size. The
study was conducted from January 2012 to March 2013. A pretested self administered
questionnaire was used for the data collection. Analysis was done using percentage, chisquare test.
Results: Among the 397 students participated in the study, 348 (87.6%) were positive for
stress. Stress was observed in 139 (89.7%) female students and 209 (86.4%) male students;
the association with gender was not statistically significant. Association between education of
parents and stress was not observed. Academics, parents, teachers and friends were major
stressors.
Conclusion: School going adolescents are exposed to stress. Females are particularly at higher
risk. The academic pressure is one of the major precursors for the stress. Introduction of
stress management techniques in school curriculum can be helpful.
Keywords: Adolescent stress, Stressors, Perceived stress scale.
Introduction
Period of life that can be labeled as adolescence was
defined by World Health Organization as between 10-19
years.1 The National Council of Educational Research
and Training (1999) defined adolescence as a period of
physical, psychological and social maturity from
childhood to adulthood. It is characterized by great
physical changes in the body brought on by the onset of
puberty. Such physical changes can influence self-image,
a search for sexual and personal identity, and impact
personality factors like “self-esteem, confidence,
shyness, and anxiety”.3 In the present scenario, as the
society is influenced by modernization and
westernization, the path from adolescence to adulthood
is endowed with stress. This is true, especially in the
*
case of adolescents in the middle income group families
as they have to face greater stress in the form of
parental ambitions and highly competitive academic
and job environments.4
Compas (1987) differentiated two types of stress: acute
and chronic. He described acute stresses as single
events such as a life transition or an uncharacteristic
event. Examples would be a first date, sickness, or
getting into trouble in school. Chronic stress refers to
recurring demands such as financial difficulties,
academic concerns, or disability. Acute stressors can
turn into chronic stressors, if they prevail for a longer
time.5
Assistant Professor, Dept of Community Medicine, Teerthanker Mahavir Medical College, TMU, Moradabad, Uttar Pradesh.
Professor and Head, Dept of Community Medicine, Vardhaman Mahavir Medical College, New Delhi.
**
Senior Resident, Dept of Community Medicine, Maulana Azad Medical College, New Delhi.
Correspondence to: Dr Bhaskar Khobraji Watode, Dept of Community Medicine (PSM), Teerthanker Mahavir Medical College & Research
Centre, Moradabad, Uttar Pradesh, India-244001. E-mail Id: bhaskarwatode@gmail.com
**
© ADR Journals 2015. All Rights Reserved.
Ind. J. Youth Adol. Health 2015; 2(4)
In addition to their personal experiences of stress and
distress, studies identify many other sources of stress,
including academic, parents, teachers, school
administrators, and larger societal origins.6 Hence the
objective of the current study is to assess the
prevalence of stress and various factors causing stress
among schools adolescent in Delhi.
Materials and Methods
Study Settings
It was a school based cross sectional study conducted in
two schools of Delhi from January 2012 to March 2013.
First group belonged to a public school situated in East
Delhi. Second group was situated in Central Delhi. Both
the schools had over 1000 students studying in various
standards. Schools were conveniently selected.
Study Participants
The study population consisted of students studying in
9th and 11th standard at the time of research study.
There were 4 sections for each standard in both the
schools and approximately 50 students were studying in
each section.
Sample size was calculated based on previous study
conducted by Sahoo S and Khess CR in 2010 with
prevalence of stress as 20% and was calculated to be
256.16
th
th
Two sections each of 9 and 11 grade students were
randomly selected from each school having
approximately 200 students. i.e., a total of 400 students
were expected in the study.
Total 411 students participated in the study from both
the schools while 397 students were included in the
final analysis as 14 students become ineligible because
of incomplete reporting of questionnaire.
Study Instruments
A pre-tested, semi structured, self administered
questionnaire containing items on socio demographic
profile like adolescent’s age, gender, and family
structure etc. was used. It also had information about
parental age, education, income and occupation,
parents’ relationship with adolescent, time spent etc
along with information about academic and
extracurricular performance of students last year and in
the last term examination and also their involvement in
extracurricular activities.
5
Watode BK et al.
Perceived stress scale was used to find prevalence of
stress among study subjects. Perceived stress scale
(PSS-10) was developed by Cohen et al. Group mean
scores were used for comparisons and greater scores
indicated higher perceived stress. It is a 10-item scale
which measures the degree to which situations in one’s
life is appraised as stressful during the past month.
There are six negative and four positive questions for
which the subjects were required to choose from a scale
of 5 alternatives ‘never’, ‘almost never’, ‘sometimes’,
‘fairly often’, and ‘very often’ relating to their feeling of
being stressed on a 0-4 scale. The 4 positive items were
reverse scored and added up to the 6 negative items to
get the total score.7
Before administrating the questionnaire to study
subjects, the questionnaire was pretested in a similar
setting and was suitably modified before finalization.
The items were also reviewed for suitability, relevance,
and accuracy by experts.
Methodology
Authorities in the selected schools were explained
about the nature and procedure of the study. Schools
had shown their willingness to participate and therefore
permission from both the schools was sought. Informed
consent was taken from parents for participation in this
study.
Principles/ Vice-principals were requested to fix suitable
date and time for collecting information from the
students of IX and XI standards, keeping in view
vacations, holidays and examination periods of the
students.
Selected classes were approached on the prefixed days
and time to collect information from the students. As
the selected schools were English medium schools, the
questionnaire in the English was distributed to students
in the selected sections. In the presence of the
investigator, students were briefed about the questions
and how to record answers on the questionnaires.
Students were given 40-45 minutes to fill the
questionnaire. Although the questionnaire was pretested and semi-structured, researchers remained
available to clarify any matter related to the
questionnaire while students filled it up.
Statistical Analysis
Data was coded and compiled using Microsoft Excel,
and analyzed using Epi-info and SPSS software.
ISSN: 2349-2880
Watode BK et al.
Ind. J. Youth Adol. Health 2015; 2(4)
Outcome variable was the prevalence of stress in
adolescents. The association of prevalence of stress with
socio-demographic variables was assessed using
qualitative tests such as chi-square or fisher exact tests.
was 14.87±1.06 yrs. More than half of the school
adolescents participating in the study were males. There
were 242 (61%) male adolescents and 155 (39%) female
adolescents included in the study.
Results
Table 1 reveals that the fathers of maximum number of
adolescents (180 (46.2%)) were postgraduates, followed
by graduate and below graduate fathers while majority
of mothers 168 (42.6%) had educational level below
graduation followed by graduate or higher degree
holders.
Age (years)
Sex
Male (%)
20 (52.6)
87 (66.9)
51 (58.6)
74 (56.5)
10 (90.9)
242 (61)
Father’s
Education (%)
180 (46.2)
Female (%)
13
18 (47.4)
14
43 (33.1)
15
36 (41.4)
16
57 (43.5)
17
1 (09.1)
Total
155 (39)
Education
of
Mother’s
parents
Education (%)
Post graduation
97 (24.6)
and above
Graduation
158 (40.5)
129 (32.7)
Below
52 (13.3)
168 (42.6)
graduation
Total (N)
390 (100)
394 (100)
Table 1.Sociodemographic profile of school adolescents
Table 1 shows the age distribution of the participating
adolescents in the study. Students were within the
range of 13 to 17 yrs. The mean age of the adolescents
Age (years)
Stress
Normal (%)
High (%)
13 (N=38)
06 (15.8)
32 (84.2)
14 (N=130)
16 (12.3)
114 (87.7)
15 (N=87)
07 (08.0)
80 (92.0)
16 (N=131)
19 (14.5)
112 (85.5)
17 (N=11)
01 (09.1)
10 (90.1)
Total
49 (12.3)
348 (87.6)
Table 2.Age wise distribution of stress among
adolescents
Considering the distribution of stress according to age,
higher stress was observed in older students as
compared to the younger students (Table 2, Fig. 1). Low
stress was seen in early adolescence while in mid
adolescence higher stress was noted.
FIG 1: AGEWISE DISTRIBUTION OF STRESS (%)
94
92
90
88
% OF STUDENTS
WITH HIGH STRESS
(%)
86
84
82
80
13
14
15
16
17
Figure 1.Agewise Distribution of Stress (%)
Education of Parents
Father’s education and stress
Mother’s education and stress
Normal (%)
High (%)
Normal (%)
High (%)
Post graduation and above
21 (11.7)
159 (88.3)
10 (10.3)
87 (89.7)
Graduation
23 (14.6)
135 (85.4)
13 (10.1)
116 (89.9)
Below graduation
5 (9.6 )
47 (90.4)
26 (15.5)
142 (84.5)
2
, df, P-value
1.11, 2, 0.573
2.48, 2, 0.288
Table 3.Education of parents and stress among school adolescents
ISSN: 2349-2880
6
Ind. J. Youth Adol. Health 2015; 2(4)
Watode BK et al.
Table 3 shows that stress was present in 159 (88.3%),
135 (85.4%), 47 (90.4%) adolescents whose fathers’
education was post graduate and above, graduate and
below graduation respectively while stress was present
in 87 (89.7%), 116 (89.9%), 142 (84.5%) adolescents
whose mothers’ educational level was post graduation
and above, graduation and below graduation
respectively. However statistically significant association
was not present in educational level of parents and
stress among adolescents.
Table 4 reveals the prevalence of stress among male
and female adolescents in school. Out of total 242
(61.0%) male students 209 (86.4%) and out of total 155
(39.0%) female students 139 (89.7%) were found to be
having high stress. Only 33 (13.6%) male students and
16 (10.3%) female adolescents were found to be having
normal stress. 89.7% of female adolescents had shown
higher prevalence of stress as compared to 86.4% of
male adolescents.
Gender
Stress
Normal (%) High (%)
Male
33 (13.6)
209 (86.4)
Female
16 (10.3)
139 (89.7)
2
, df, P-value 0.959, 1, 0.327
Total (%)
242 (61.0)
155 (39.0 )
*N=390
Table 4.Comparison between stress of male
and female students
80%
60%
40%
20%
0%
Academics Parents
Teachers
Friends
Others
Figure 2.Prevalence of stressors among school going adolescents
The results of Fig. 2 revealed the stressors among the
school adolescents. Various stressors contributed from
3% and 70%. An event such as studies and exams (70%)
has contributed to a lot of stress, followed by friends
(3.0%), parents (11.8%), teachers (6.3%) and other
factors (49.7%) recorded as major stressors.
Discussion
In the present era, the phenomenon of stress is not
confined to adults alone but also affects children and
adolescents.8 In this study, an attempt has been made
to identify situation specific stressors experienced by
the students of high school.
The study was conducted in two schools of Delhi. The
first group was chosen from a school in Central Delhi
while the second group was from a school located in
East Delhi. Four sections of standard IX and XI were
included from both the schools.
Participants were aged between 13-17 years. Therefore
group belonging to mid-late adolescence was chosen as
it is considered as an appropriate age for developing
ability to think abstractly, to understand consequences
and to solve problems.
7
Thus it was singled out as a critical moment of
opportunity to build stress management skills and
positive habits.
Male to female ratio in schools was nearly 3:2 (M-61%,
F-39%, 1.56:1). The sex ratio in this study was
corroborated with national data on enrolment of
adolescents in secondary school which is 59% for males
and 38% for females (1.55:1).9
This study revealed that adolescents with mothers’
education below graduation are less stressed as
compared to students whose mothers had higher
educational level. Contrary to this, adolescents with
fathers’ educational level below graduation were more
stressed.
This result was similar to the results stated by Daniel M.
Finkelstein et al. (2007) who revealed that adolescents
from families with lower parent education are less
optimistic than from more educated families. This
pessimism may be a mechanism through which lower
SES increases stress in adolescence.15
Our study has shown prevalence of stress among the
male adolescents to be 86.4% and prevalence of stress
ISSN: 2349-2880
Watode BK et al.
Ind. J. Youth Adol. Health 2015; 2(4)
in female adolescents to be 89.7%. Overall prevalence
of stress among adolescents is 87.7%.
Steps should be taken to introduce Stress Management
Education in the curriculum.
Similar results were obtained in the study conducted by
Dinesh S in Kerala that 93 to 100% of the children aged
4 to 17 years showed medium to moderate stress while
1.9% had severe stress. Only 1.79% came under normal
group. This result agrees with the observations made by
many psychologists, doctors and counselors that most
of the children today are facing severe stress which they
find very hard to cope with.10
Healthy dietary and lifestyle habits should be
encouraged.
The results revealed that when boys and girls are
compared, more girls were found to have higher stress
than boys. The study points out that there was gender
and age variation in stress levels of children. Statistical
analysis was further carried out and it was found that
variation shown between stress in boys and girls was
statistically non significant.
This result was similar with the result of Mathew (2006)
and Latha and Reddy (2006) which stated that girls were
having more stress than boys.11 But it is contrary to the
results of Vijayalakshmi and Lavanya (2006), Carlson and
Grant (2008) which indicated that boys tend to have
significantly higher stress than girls.12
This study revealed that school related work i.e. studies
and exams were the major stressors in school going
adolescents. Similar findings were reported in the study
by De Anda et al. (1997) who argued that the greatest
stress is school related, with school stressors being
reported with the highest frequency.13
Various stressors contributed from 3% to 70%. An event
such as studies and exams (70%) contributed to a lot of
stress, followed by friends (3.0%), parents (11.8%),
teachers (6.3%) and other factors (49.7%) recorded as
major stressors.
These finding were in comparison with another study by
MA Strydom, PJ Pretorius, G Joubert which stated that
schoolwork (81.4%), relationship with friends (31.6%),
parents (43.1%), teachers (12.1%), and other factors
(8.6%) are major stress causing factors among
adolescents.14
Conclusions
School going adolescents are exposed to stress. Females
are particularly at higher risk. Academic pressure is one
of the major precursors of stress.
Teachers, parents and friends should
communication about stress causing factors.
ISSN: 2349-2880
have
Limitations of the Study
This was a self administered questionnaire based study,
hence reporting bias cannot be totally eliminated. Many
confounders like current emotional state, personality
etc. may be present. Similarly, difference in stress
during pre-exam, exam and post-exam period was not
considered.
Acknowledgements
The authors would like to thank all the students and the
institutes that participated in the study.
Conflict of Interest
All the authors declare that there is no conflict of
interest. The research was self funded by the authors.
References
1. World Health Organization. Adolescence: The
Critical Phase: The Challenges and the Potential.
New Delhi: Regional Office of the South East Asia,
1997: 1.
2. Cohen S, Kessler RC, Gordon LU. Strategies for
measuring stress in studies of psychiatric and
physical disorders. In Cohen S, Kessler RC, Gorden
LU. Measuring Stress. A Guide for Health and Social
Scientists. Oxford: Oxford University Press, 1995.
3. Frydenberg E, Lewis R, Bugalski K et al. Prevention is
better than cure: Coping skills training for
adolescents at school. Educational Psychology in
Practice 2004; 20(2): 117-34.
4. Chaudhary S, Joseph PM. Adolescents’ perceptions
about coping with stress: A Qualitative view from
India. International Journal of the Humanities 2010;
7(11): 87-110.
5. Frydenberg E, Lewis R. Coping with stressors and
concerns during adolescence: a longitudinal study.
Paper presented at the Annual Meeting of the
American Educational Research Association,
Chicago, 1997: 1-22.
6. Lee M, Larson RW. The Korean “Examination Hell”:
Long hours of studying, distress, and depression.
Journal of Youth and Adolescence 2000; 29: 249-72.
7. Cohen S, Kamarck T, Mermelstein R. A global
measure of perceived stress. J Health Soc Behav
1983; 24: 386-96.
8
Ind. J. Youth Adol. Health 2015; 2(4)
8. Chopra H. Overview of Adolescent health in India.
Paper presented at: 31st Annual National
Conference of Indian Association of Preventive and
Social Medicine, 2004 Feb, Chandigarh.
9. Katyal S, Vasudeva P. Effects of socio-personal
factors in academic stress among adolescents.
Indian Journal of Applied Psychology 1998; 35: 3537.
10. Dinesh S, Syamakumari S. Prevalence of stress
among school children in Kerala. 2010. Available
from: http://www.articlesbase.com/mental-healtharticles/prevalence-of-stress-among-school-childr
en-in-kerala-1868702.html.
11. Mathew B, Jayan C. Academic stress and coping
styles among plus-two students. Indian Psychol Rev
2006; 66(1): 41-48.
12. Carlsan GA, Grant KE. The roles of stress and coping
in explaining gender differences in risk for
psychopathology among African American urban
adolescents. The Journal of Early Adolescents 2008;
28(3): 375-404.
9
View publication stats
Watode BK et al.
13. Anda DD, Bradley M, Collada C et al. A study of
stress, stressors, coping strategies among middle
school adolescents. Social Work in Education 1997;
19(2): 87-98.
14. Strydom MA, Pretorius PJ, Joubert G. Depression
and anxiety among Grade 11 and 12 learners
attending schools in central Bloemfontein. S Afr J
Psychiatr 2012; 18: 3.
15. Finkelstein DM. Socio-Economic Differences in
Adolescent Stress: The role of Psychological
Resources. Journal of Adolescent Health Feb 2007;
40(2): 127-34.
16. Sahoo S, Khess CR. Prevalence of depression,
anxiety, and stress among young male adults in
India: a dimensional and categorical diagnosesbased study. J Nerv Ment Dis 2010; 198(12): 901904.
Date of Submission: 05th Oct. 2015
Date of Acceptance: 02nd Jan. 2016
ISSN: 2349-2880