EXAMINATION-INDUCED ANXIETY AMONG MEDICAL STUDENTS: A REPEATED-MEASURES STUDY USING THE HAMILTON ANXIETY RATING SCALE
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DOI:
https://doi.org/10.37762/jgmds.13-1.775Keywords:
Examination Stress, Anxiety, Medical Students, Hamilton Anxiety Rating Scale, Academic StressAbstract
ABSTRACT
OBJECTIVES
To evaluate changes in examination-related anxiety before and during examinations among first- and second-year MBBS female students using the Hamilton Anxiety Rating Scale (HAM-A).
METHODOLOGY
A repeated-measures observational study was conducted at the Department of Physiology, Peoples University of Medical and Health Sciences for Women, Shaheed Benazir Abad, from April to October 2020. A total of 110 healthy first- and second-year MBBS students were recruited using non-probability convenience sampling. Anxiety levels were assessed using the HAM-A questionnaire two weeks before examinations and again during the examination period. Paired t-tests were used to compare pre- and during-exam anxiety within groups, and independent t-tests were used to compare first- and second-year students.
RESULTS
First-year students demonstrated a significant increase in anxiety during examinations (17.16±10.62) compared with before examinations (8.00±9.15; p<0.001). Second-year students also showed a significant increase (12.96±9.28 vs 8.05±7.68; p<0.001), but their anxiety levels remained significantly lower than those of first-year students during examinations (p<0.01). Most HAM-A symptom domains, including anxious mood, tension, insomnia, autonomic symptoms, and somatic complaints, worsened significantly during the examination period, particularly in first-year students.
CONCLUSION
Examinations are associated with a marked escalation of anxiety symptoms among medical students, with first-year students being particularly vulnerable. These findings emphasize the need for structured psychological support and stress-management interventions during the early phase of medical education.
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Tan SY, Yip A. Hans Selye (1907–1982): Founder of the stress theory. Singapore Med J. 2018;59(4):170–1. doi:10.11622/smedj.2018040. PMID: 29619152 DOI: https://doi.org/10.11622/smedj.2018043
Palkar D, Panigrahi S, Shatadal P, Mehta R. Impact of Jacobson's progressive muscle relaxation on stress levels of exam-going MBBS students of a medical college in South Gujarat, India. J Clin Diagn Res. 2021;15(8):CC05–CC08. doi:10.7860/JCDR/2021/49027.15215 DOI: https://doi.org/10.7860/JCDR/2021/48607.15269
Tran NT, Franzen J, Jermann F, Rudaz S, Bondolfi G, Ghisletta P. Psychological distress and well-being among students of health disciplines in Geneva, Switzerland: The importance of academic satisfaction in the context of academic year-end and COVID-19 stress on their learning experience. PLoS One. 2022;17(4):e0266612. doi:10.1371/journal.pone.0266612. PMID: 35394879 DOI: https://doi.org/10.1371/journal.pone.0266612
Rehmani N, Khan QA, Fatima SS. Stress, anxiety and depression in students of a private medical school in Karachi, Pakistan. Pak J Med Sci. 2018;34(3):696–701. doi:10.12669/pjms.343.14664. PMID: 30034433 DOI: https://doi.org/10.12669/pjms.343.14664
Abed HA, Abd-Elraouf MS. Stress, anxiety, depression among medical undergraduate students at Benha University and their socio-demographic correlates. Egypt J Hosp Med. 2022;86(1):27–32 DOI: https://doi.org/10.21608/ejhm.2021.209974
Chhetri B, Goyal LM, Mittal M, Battineni G. Estimating the prevalence of stress among Indian students during the COVID-19 pandemic: A cross-sectional study from India. J Taibah Univ Med Sci. 2021;16(2):260–7. doi:10.1016/j.jtumed.2020.12.010. PMID: 33767806 DOI: https://doi.org/10.1016/j.jtumed.2020.12.012
Ringeisen T, Lichtenfeld S, Becker S, Minkley N. Stress experience and performance during an oral exam: The role of self-efficacy, threat appraisals, anxiety, and cortisol. Anxiety Stress Coping. 2019;32(1):50–66. doi:10.1080/10615806.2018.1528528. PMID: 30226409 DOI: https://doi.org/10.1080/10615806.2018.1528528
Alghwiri AA, Almomani F, Alghwiri AA, Whitney SL. Predictors of sleep quality among university students: the use of advanced machine learning techniques. Sleep Breath. 2021;25(2):1119–26. doi:10.1007/s11325-020-02168-3. PMID: 32970344 DOI: https://doi.org/10.1007/s11325-020-02150-w
Zhang D, Qu Y, Zhai S, Li T, Xie Y, Tao S, et al. Association between healthy sleep patterns and depressive trajectories among college students: a prospective cohort study. BMC Psychiatry. 2023;23(1):182. doi:10.1186/s12888-023-04713-1. PMID: 36943542 DOI: https://doi.org/10.1186/s12888-023-04596-0
Finell J, Sammallahti E, Korhonen J, Eklöf H, Jonsson B. Working memory and its mediating role on the relationship of math anxiety and math performance: A meta-analysis. Front Psychol. 2022;12:798090. doi:10.3389/fpsyg.2021.798090. PMID: 35185842 DOI: https://doi.org/10.3389/fpsyg.2021.798090
Morales A, Rodríguez-Menchón M, Espada JP, Orgilés M. Examining academic self-concept as a mediator of the relationship between anxiety and depression: A longitudinal study. Child Adolesc Ment Health. 2023;28(3):354–62. doi:10.1111/camh.12674. PMID: 37391086 DOI: https://doi.org/10.1111/camh.12577
Melaku L, Bulcha G, Worku D. Stress, anxiety, and depression among medical undergraduate students and their coping strategies. Educ Res Int. 2021;2021:9880309. doi:10.1155/2021/9880309 DOI: https://doi.org/10.1155/2021/9880309
Mirza AA, Milaat WA, Ramadan IK, Baig M, Elmorsy SA, Beyari GM, et al. Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: an epidemiological comparative cross-sectional study. Neurosciences (Riyadh). 2021;26(2):141–51. doi:10.17712/nsj.2021.2.20200129. PMID: 33850907 DOI: https://doi.org/10.17712/nsj.2021.2.20200127
Sacramento BO, Anjos TL, Barbosa AG, Tavares CF, Dias JP. Symptoms of anxiety and depression among medical students: study of prevalence and associated factors. Rev Bras Educ Med. 2021;45(1):e021. doi:10.1590/1981-5271v45.1-20200080 DOI: https://doi.org/10.1590/1981-5271v45.1-20200394.ing
Amanvermez Y, Rahmadiana M, Karyotaki E, de Wit L, Ebert DD, Kessler RC, Cuijpers P. Stress management interventions for college students: A systematic review and meta-analysis. Clin Psychol Sci Pract. 2023;30(4):423. doi:10.1037/cps0000080 DOI: https://doi.org/10.1111/cpsp.12342
Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis. PLoS One. 2023;18(10):e0286387. doi:10.1371/journal.pone.0286387. PMID: 37787162 DOI: https://doi.org/10.1371/journal.pone.0286387
Bergmann C, Muth T, Loerbroks A. Medical students’ perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study. Med Educ Online. 2019;24(1):1603526. doi:10.1080/10872981.2019.1603526. PMID: 31042115 DOI: https://doi.org/10.1080/10872981.2019.1603526
Almansour M, Almoayad F. Exploring challenges and perceptions in the learning environment: an online qualitative study of medical students. BMC Med Educ. 2024;24(1):147. doi:10.1186/s12909-024-05394-2. PMID: 38352719 DOI: https://doi.org/10.1186/s12909-024-05116-8
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Copyright (c) 2025 Rehnaz Shaikh, Masood Nabi Noor, Altaf Memon, Nida Khaskheli, iftikhar Rathore, Benazir Zulfiqar Noorani, Masood Ahmed Unar

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