A Cross Sectional Study of Stress and Anxiety among Dental Students at Ajman University

This study was conducted to investigate and analyze the level of stress & anxiety among dental clinical students in Ajman University of both campuses. A descriptive cross sectional study, questionnaire based study performed on students of both campuses of dental college in Ajman University. The study was conducted on dental students of 4 th & 5 th year, a total number of 307 participants with collected answered questionnaires. A high level of stress is mainly scored in both 4 th & 5 th years due to examinations& assigned work. Medical& dental clinical students are expressed with high stress& anxiety levels due to the environment of the work& study of these colleges& the psychology of the students attending to these colleges.


Introduction:
Dental education programs should make every effort to balance the demands of academic and clinical training of students, provide a reasonable quality of life and adequately prepare them for the continuing stress involved in the profession; this challenge has led to considerable interest in identifying sources of stress for students in dental education programs (1) .Stress is a subjective sensation with a varied degree of perception, stress is influenced by the person's system of beliefs and attitudes, the stressors may lower academic performance due to different results, such as performance anxiety during both practical and theoretical examinations, gloominess, and lack of confidence (2) .

REVIEW OF THE LITERATURE:
Professional dentistry is stressful and dental schools are among stressful educational environments, in addition to the stresses of clinical environment originating from the nature of dentistry field 9 -87 ) 2017 ( (2) 5 ….A Cross Sectional Study of Stress 88 significantly different from procedures on phantom heads and fulfillment of clinical requirements pose great challenges to dental students, the phenomenon occurs almost across all years of dental education training and is prevalent indifferent countries with a different education system, evaluating the factors influence student perception, might allow programmatic changes designed to enhance students' psychosocial well-being and academic performance (10) .Rahele et al (11) reported in a study there is a gender difference among dental students, in which the girls show a significant reaction toward the educational life than boys.Lakshmi et al (12) stated high levels of anxiety in clinical students during examinations in teaching clinic& due to learning requirements.In another survey, it was clarified that dental students of both sexes show a variable degree of anxiety in inability to pass the exams& or to complete the clinical requirements (13) .Also it has been reported in a study in which the major stressors for the fifth year students were: stress of not completing the clinical requirements, patients being late to appointments, examinations& amount of assigned work (14) .The aim of this study is to investigate the different levels of stress& anxiety among dental students& to evaluate their causes in Ajman University.

Data analysis:
The data collected was expressed by descriptive percentage statistics.

Results:
This study was take place in Ajman University of both campuses, the total number of students participated in this study was (307), 204 from Ajman campus and 103 from Fujairah campus, the participated in both campuses was (194) Female and (113) Male .asrevealed in Table (1).Table (2) Shows the number of questions marked as (very stressful) and ( stressful ) that represents more than 30% of participated students in Ajman campus, In Which : The most scored question (very stressful ) was Q{7} : Unavailability of patients , that represents (36%) of the total number of students in Ajman campus , as seen in the Fig. (1).The Second most marked question scored as (very stressful) was Q {3}: Fear of being unable to continue the requirements, which was (69) students out of 204 that made up (35%) of the students, as shown in the Fig. (2)  3).For Ajman campus the question which wore marked as (stressful) were:-The first question that scored as (stressful) was Q {17}: Inability of patient to continue or to complete the prescribed care plan in which 134 out of 204 students which represents 66% of students, as seen in the Fig. ( 4) & clarified in Table (2).The Second questions scored (stressful ) was Q{19} : Stress due overloaded dental specialist subjects in which 120 students out of 204 marked on (stressful) that constitute 59% of students , as seen in Fig.
( 5) & as shown in Table (2).Lack of confidence to be a successful professional Question number {16} that had been scored as (stressful) by ( 109) students which constitute (53%) of Ajman students, as described in Table (2).The Fifth question marked as (stressful) was availability of certain materials for a critical clinical case Q {18} that represents (53%) of students, as clarified in Table (2).Table (3) expresses the top marked questions as (very stressful) & (stressful) for students of Fujairah campus.In which : The most questions that scored as (very stressful) wore :-Q{1} : Stress due to examinations& grades , Q{2} : Anxiety due to amount of assigned work& requirements , Q{17} : Inability of patient to continue or to complete the prescribed care plan , that constitute (52%) , (49%) , and (50%) respectively , that were 54 , 52 , and 51 out of 103 of the 4 th and 5 th year in Fujairah students, as seen in Fig. (6).While the questions that marked as ( stressful ) were :-the first question was Q{19} : Stress due overloaded dental specialist subjects , in which 56 out of 103 express stress for this question that represent 55% of total students in Fujairah campus , as revealed in Fig. (7).Unavailability of patients Q {7} was the second question scored as (stressful) that constitute (48%) of students, as seen in Fig. (8).Fig. (9) expresses the percentage of both questions {3} and {16}: Fear of being unable to continue the requirements, and Lack of confidence to be a successful professional, scored as (stressful) represent (45%) and (42%) from the total Fujairah student respectively.In Fujairah campus students: question {1}: Stress due to examinations& grades was (very stressful) and question {2}: Anxiety due to amount of assigned work& requirements was (very stressful) in compared to Ajman campus, as expressed in Fig. (10).While Unavailability of patients question {7} was (very stressful) in Ajman that represents (36%) of the students and (27%) in Fujairah campus, as seen in Fig. (11).Also the inability of patient to continue or to complete the prescribed care plan question {17}, scored as (very stressful) in Fujairah in compared to Ajman, it was in Fujairah (50%) while in Ajman was (8%).In this study scoring was calculated for the female of the 4 th year stage in both campuses as expressed in Table (4).The first scored (very stressful) answered question was Q {7}: Unavailability of patients, that constitute (39%) of these students.Also the second scored very stressful was question {3}: Fear of being unable to continue the requirements that constituted 35%.While the questions that scored stressful for female 4 th year were: Firstly was question {19}: Stress due overloaded dental specialist subjects that constitute 61% of the total female student which was 114.Second was question {17}: Inability of patient to continue or to complete the prescribed care plan that is equal 59%.Question {16} in scored stressful 63 of 4 th year female student's lack of confidence that represents 55% of the total number.Which is the most question that marked as stressful with Q {17}, in which both of these two questions represents 41% and 48% respectively.Table (5) Shows the total number of the Male student 4th year 56 of both campuses, and their answers, the most (very stressful) scored question was Q {2} : Anxiety due to amount of assigned work & requirements , that made up (45%) of the total number .Table (6)  Shows the scoring answers of the 5 th year female students, clarifies the most very stressful and stressful marked questions, in which: -the first question that was scored very stressful was question {3}: Fear of being unable to continue the requirements, that constitute 30% of the total number, in 9 -87 ) 2017 ( (2) 5 ….
A Cross Sectional Study of Stress 89 which the total number of the 5 th year female students in both campuses was 80.While question {2}: Anxiety due to amount of assigned work& requirements, which represents (66%) of the total number.Question {1}: Stress due to examinations& grades and Question {18}: Availability of certain materials for a critical clinical case, both questions are marked as (60%) and (62%) respectively.Table (7) Shows the number of the 5 th year Male students and their most (very stressful) and (stressful) marked questions, in which the total number of the students in both campuses was (57).The first Question {1}: Stress due to examinations& grades, has been marked as (very stressful) that constitute (35%) of the students, and the second question that scored (very stressful) were questions {3}, {17} that represents (51%) and (53%) respectively.

Discussion:
Stress is defined as beliefs and attitudes which one feels frequently.When someone exposes to a challenging environment, a wide range of psychological and emotional responses are triggered according to its severity and type.Stress is a double edged sword which can lead to stimulation and encouragement of students for gaining the maximum capability or decreasing their efficiency (15)   .It was informed in previous studies that the Dental education has long been recognized as a complex and highly demanding training and hence can be one of the reasons for stress that can also persist in professional life (16) .The purpose of study was to assess the main sources of stress and anxiety among dental undergraduate students in AUST.As well, it aimed to see if any certain stressors were related to specific gender.In this study, the highest stressful factors were found to be examinations, inadequate time to complete work & clinical requirement, and students ensuring they get good grades, these results are in agreement with other studies as Obarisiagbon et al (13) & a study performed by Abu ghazaleh et al (14) .Fear of not completing clinical requirements was higher among female dental student than male dental student, females students noticed higher stress than males due to clinical atmosphere such results are agreed with a study conducted by Nabila A. Sedky (17) .This study clarifies the difference in answering (Q2): the amount of assigned work & requirements, it was very stressful for Ajman campus students (29%) which is scored less than the students of Fujairah campus (54%), & as a stressful answer for 55% for Ajman & 44% for Fujairah, that is brought in parallel or accordance with the scoring of Q7 for the unavailability of patients which had been marked as very stressful for Ajman campus students, this scoring might be due to large number of clinical students in Ajman in compared to Fujairah campus.As a consequence of patient availability& attendance it is clear that attendance of patient in Ajman campus is not a serious stress impact for the students their because of their limited number of patients in comparing to Fujairah, due to less number of students& increased number of patients it is scored as very stressful 50% for Fujairah students in comparing with 8% of Ajman campus, which may be due to inadequate administrative procedure& scheduling of patients appointments.

Conclusions:
Stress is experienced in dental students, and is affecting both male and female student.

Fig. ( 1 )
Fig. (1): Shows the percentage of scoring for Q 7 for unavailabity of patients in Ajman campus.

Table ( 1
): Shows the total number of students in Ajman University in both Campuses.

Table ( 4
): Describes the answers of the 4 th year female student in both Campuses

Table ( 5
): Shows the answers of 4 th year stage male students in both campuses .

Table ( 6
): Shows the scoring answers of the 5 th year female students in both Campuses.Table(7): Expresses the numbers of the 5 th year Male students and their answers in both Campuses.