Prevalence and Level of Stress among Final-year Students at a Health Science Institute in Bangladesh

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Jonaied Alam, Mahmudul Islam Khan Pratik, Abid Hasan Khan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4495151/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Health science institutes can contribute to stress among final-year students, potentially leading to negative academic and professional outcomes, as psychological disorders like anxiety and depression are often underdiagnosed and untreated. Methods A prospective cross-sectional study involving 134 final-year students at Bangladesh Health Professions Institute (BHPI), in Bangladesh assessed stress using the Academic Stress Scale (ASS-40). Data was collected through face-to-face interviews and analyzed using SPSS software 25.0. Both descriptive and inferential statistics were used to analyse the data which was retrieved from the participants. Results In this study, 31.40% of 134 participants were in a normal state, while 68.60% were in a stressful state. The highest level of stress was fear of failure, followed by personal inadequacy. Addressable stress areas included teacher-pupil relationship/teaching method. A negligible association (p > 0.05) was found between age of the participants and level of stress of the participants. Conclusion This implies that the educational system, means of teaching, teaching materials, system of materials, teachers as well as the services provided by the institutions cannot provide a conducive environment for effective learning as well as creating a secure future for the students as long as they are able to cope with the academic pressure. A student's educational career is being nipped in the bud due to the weak system of our education and institutional system. Mental health Academic stress Study facilities Fear Figures Figure 1 Figure 2 Introduction Mental distress is indeed a complex phenomenon that can encompass a wide range of symptoms and experiences. It can include feelings of depression, anxiety, panic, and somatic symptoms such as physical pain or discomfort. Additionally, mental distress may involve confused or overwhelmed emotions, hallucinations, and other related symptoms that go beyond mere physical illness 1 . There’s a growing body of research indicating that college can be a particularly challenging time for many students, with increasing rates of mental health problems such as depression and anxiety. Recognizing the importance of addressing mental health issues on college campuses, many institutions have been implementing initiatives to provide better support and resources for students. These may include counseling services, mental health awareness campaigns, and efforts to reduce stigma surrounding mental illness 2 . The increased utilization of college counseling centers across the United States is another significant indicator of the growing mental health challenges faced by students in higher education 3 . The high rates of melancholy and burnout among scientific students are indeed concerning, particularly given the critical role these students play in the future healthcare workforce. Medical schools strive to produce highly qualified and resilient graduates who are equipped to handle the demands of clinical practice and provide quality patient care. However, when students experience high levels of stress, depression, or burnout during their training, it can have significant implications for their well-being, academic performance, and future career satisfaction. In a learn about conducted at six clinical schools at some stage in 2003–2004, the average charge of depression among college students was once 21% 4 . In contrast with a charge of 8–15% in different graduate students and in a similar fashion aged adult 5 . Stress plays a significant role in the development and exacerbation of various psychological illnesses that affect individuals in today’s society 6 . The findings from the survey conducted by the American Psychological Association (APA) and the American Institute of Stress in 2014 are indeed striking. The fact that 73% of people reported experiencing some level of psychological symptoms caused by stress underscores the pervasive impact of stress on mental health in today’s society 7 . It’s widely recognized that young people, particularly students, experience significant stress related to academic performance and school pressure. The findings from studies, such as those conducted in 2009, highlight the persistent issue of stress among students and its impact on their well-being 8 . The findings from the latest study involving clinical students suggest a positive association between higher levels of physical activity and indicators of personal success, as well as lower levels of emotional exhaustion. This highlights the potential benefits of regular physical activity for the well-being and resilience of individuals, particularly those in demanding academic or professional settings such as clinical training programs 9 . Studies have consistently shown that medical students are at increased risk for developing depression compared to the general population and other student groups. The demanding nature of medical education, combined with the stressors and challenges inherent in clinical training, can contribute to the development of depression among medical students 10 . The perception of medical education as inherently stressful is widely recognized both nationally and internationally. Medical courses, whether in undergraduate or postgraduate settings, are often characterized by rigorous academic demands, intense clinical training, and high-stakes examinations 11 . Studies have consistently shown that psychological problems such as academic stress, anxiety, and depression are prevalent among medical students, yet they are often underdiagnosed and undertreated. This is a significant concern given the potential impact of these disorders on the well-being, academic performance, and future professional competency of medical students 12 . The statistics highlighted the significant prevalence of emotional distress among tertiary education students in various countries, including Singapore, the United States, Malaysia, and Australia. These findings underscore the global nature of the issue and its impact on students' mental well-being across different cultural and socio-economic contexts 13 . Mental health refers to a person's overall psychological well-being, including their emotional, cognitive, and social functioning. It encompasses the ability to cope with stress, maintain positive relationships, and adapt to life's challenges. It is the state of any person who is functioning at a high-quality stage of emotional and behavioral adjustment. Assessing the prevalence and level of stress among final year students at a Health Science Institute in Bangladesh is an important endeavor that can provide valuable insights into the mental health needs of students in the healthcare field. Conducting such a study can help identify factors contributing to stress among these students and inform the development of targeted interventions to support their well-being. Materials and Methods A cross-sectional study was conducted from May to September, 2021 at the Bangladesh Health Professions Institute (BHPI), which is an academic institute of Center for the Rehabilitation of the Paralysed, Savar, Dhaka affiliated with Faculty of Medicine, University of Dhaka. Medical ethics approvals were obtained from the Institutional Review Board (IRB) of BHPI (CRP/BHPI/IRB/06/2021/460). Informed consent was taken from each respondent before participation in this study. For this study, a convenience sampling had been used to carry out the research. A total of 134 students had participated in this study. These students had been asked to fill out and complete a structured questionnaire to gather specific information. Data was collected through face to face interviews. Face-to-face interviews allow researchers to gather detailed information directly from participants while also providing them with the opportunity to express themselves freely and elaborate on concepts. The inclusion criteria for the respondents were final year male and female students of Bachelor of Science in Physiotherapy, Occupational therapy, Speech & language therapy in BHPI. This study had included only final year students because due to COVID-19 pandemic only final year students were present on that time in the institute due to their academic clinical placement. Students having Mental illness (Psychosis), Speech problem and who were not interested to participate in this study had been excluded. In the present study, a self-structured questionnaire was used to collect socio-demographic information of the students and stress level was measured by Academic stress scale (ASS). Academic stress refers to the scores obtained by the students through Students’ Academic Stress Scale (ASS). This (ASS) consists of 40 items and each item has five alternative responses as follow; “No Stress” (NS), “Slightly Stress” (SS), “Moderate Stress” (MS), “Highly Stress” (HS) and “Extremely High Stress” (ES). All data were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY). The sociodemographic variables of the students were described using descriptive analysis. Pearson Correlation Co-efficient test was used to analyze the relation between components of academic stress scale and the sociodemographic factors of the students. Association of independent variables with p value < 0.05 were considered to be statistically significant association with academic stress. Results Total 147 final year students were approached from July to August, 2021 (Fig. 1 ). Six students declined to participate due to time constraints, three were absent in the campus due to illness and four were refused to give any information. A total of 134 students were finally recruited into this study after they had given consent. [insert Fig. 1 ] The mean age for students was 24.54 ± 1.08 years old. Male participants were great in number 60.4% (n = 81) and 75.4% (n = 101) of the students were unmarried, 9.0% (n = 12) of them were engaged to be married. Most of them were from nuclear family 82.8 (n = 111). About 49.6% (n = 66) of the students were from rural areas and 42.5% (n = 57) were from urban areas. Among the students 8.2% (n = 11) had physical and 4.5% (n = 6) had mental health problem. About 36.6% (n = 49) students said that they had chosen to study on their self-interest but alarmingly 31.3% (n = 42) students said that they chose to study here because of family pressure (Table 1 ). Table 1 The Sociodemographic characteristics of the students Variables (n = 134) % (n) Age , Mean ± SD, Years 24.54 ± 1.08 Gender Male 60.4 (81) Female 39.6 (53) Marital status Unmarried 75.4 (101) Engaged 9.0 ( 12 ) Married 15.7 ( 21 ) Family type Nuclear family 82.8 (111) Joint family 17.2 ( 23 ) Living area Rural 49.3 (66) Urban 42.5 (57) Semi-urban 8.2 ( 11 ) Physical disability Yes 8.2 ( 11 ) No 91.8 (123) Mental health problem Yes 4.5 ( 6 ) No 95.5 (128) Way of enrolling in these bachelor course Due to self interest 36.6 (49) Due to family pressure 31.3 (42) Due to situation 32.1 (43) [insert Table 1 ] Among the 134 students who were recruited, 68.60% (n = 91) admitted that they were in stressful state while studying in this courses and other 31.40% (n = 43) had said that they think it is normal as studying in a health science institute. They did not feel it as pressure or stress on their study (Fig. 2 ). [insert Fig. 2 ] According to Academic Stress Scale, it was found that among 91 stressed students in terms of personal inadequacy 25.20% (n = 23) students was in extreme stress level, 24.20% (n = 21) was in high stress level and 25.0% (n = 22) was in moderate stress level. About fear of failure 29.20 (n = 29) students was in high stress level, 23.40% (n = 20) had moderate stress and 22.60% (n = 19) had extreme stress. In case of interpersonal difficulties with teachers, 28.80% (n = 26) students was in high stress level; also 28.80% (n = 26) students was on high stress level due to teacher – pupil relationship/ teaching method and due to inadequate study facilities, 25.50% (n = 23) students expressed moderate level and 16.80% (n = 17) students expressed high level of stress (Table 2 ). Table 2 Level of Stress among the students (According to Academic Stress Scale) Variables (n = 91) % (n) Personal inadequacy No stress 8.50 ( 8 ) Slight stress 16.80 ( 17 ) Moderate stress 25.00 ( 22 ) High stress 24.20 ( 21 ) Extreme stress 25.50 ( 23 ) Fear of failure No stress 4.90 ( 5 ) Slight stress 19.90 ( 18 ) Moderate stress 23.40 ( 20 ) High stress 29.20 (29) Extreme stress 22.60 ( 19 ) Interpersonal difficulties with teachers No stress 6.90 ( 6 ) Slight stress 16.80 ( 17 ) Moderate stress 27.60 ( 25 ) High stress 28.80 (26) Extreme stress 19.90 ( 18 ) Teacher – pupil relationship/ Teaching method No stress 19.90 ( 18 ) Slight stress 6.90 ( 6 ) Moderate stress 27.60 ( 25 ) High stress 28.80 (26) Extreme stress 16.80 ( 17 ) Inadequate study facilities No stress 24.20 ( 21 ) Slight stress 25.00 ( 22 ) Moderate stress 25.50 ( 23 ) High stress 16.80 ( 17 ) Extreme stress 8.50 ( 8 ) [insert Table 2 ] There is a negligible correlation found between age and stress level of the students (p > 0.05) which simplifies that students stress level while studying in their academic institution has little association with their age (Table 3 ). Table 3 Correlation between of the age of the students and total score of Academic Stress scale (ASS) (Pearson Correlation Co-efficient Test) Variables Correlation Coefficient (r) p-value Age of the student 0.121 0.255 Total score of Academic Stress scale [insert Table 3 ] Discussion According to all accounts, clinical subject students experience high levels of observed stress, which will generally have an impact on their academic performance as well as all aspects of wellbeing and related findings since the prevalence of observed stress appears to be widespread with little difference between male and female students 14 . In other study it was concerned that stress of clinical understudies and tracked down that those 7.80% was no stress, 19.10% was slight stress, 25.50% was moderate stress, 26.70% was high stress, and 20.90% was in outrageous stress level 15 . The predominance of stress was found higher among women than among men 16 . One more review was led at Dhaka Medical College during the time of April 2009 tracked down that more than 33% (34.6%) had gentle stress, (39.8%) moderate stress and around one fourth (24.9%) was experiencing extreme stress as per Academic Stress Scale 17 . The finding that 68.60% of students reported elevated levels of stressful symptoms in the final year of their health sciences graduate programs is indeed concerning. This high percentage suggests that a significant proportion of students in these programs may be experiencing considerable stress and its associated symptoms. The comparison between the prevalence of elevated stressful symptoms in this study and the findings reported in other recent research is striking. This study indicates a much higher percentage of students experiencing elevated stress levels in the final year of their health sciences graduate programs compared to the prevalence rates of depression, generalized anxiety, and suicidal ideation reported in the other research 3 . Specifically, this study found that 68.60% of students reported elevated levels of stressful symptoms, while the other research reported prevalence rates of 17.3% for depression, 7% for generalized anxiety, and 6.3% for suicidal ideation. These comparisons suggest that the level of stress experienced by students in the final year of health sciences graduate programs is substantially higher than the prevalence rates of these specific mental health issues reported in the other research 2 . Poor mental health can significantly impact an individual’s ability to function effectively in various aspects of life, including academic performance 18 . The finding that daily academic hassles were reported as the most stressful in this study aligns with similar findings reported by Bedewy and Gabriel, who also used the same instrument to assess stress among students. In their research, Bedewy and Gabriel found that students experienced the most stress from academic overload and academic evaluation procedures 19 . This consistency in findings across studies suggests that academic demands and pressures are significant sources of stress for students in various academic settings. Daily academic hassles, such as managing coursework, meeting deadlines, preparing for exams, and navigating academic evaluation processes, can contribute to heightened stress levels among students 23 . The findings highlight the importance of addressing academic-related stressors in efforts to promote student well-being and academic success. Implementing strategies to help students manage academic workload effectively, develop study skills, cope with exam stress, and seek support when needed can be beneficial in reducing stress levels and improving overall student outcomes. The agreement between the findings of the present study and those of Nakalema and Ssenyonga regarding daily academic hassles being the most stressful among university students further reinforces the significance of this issue. When multiple studies using different samples and methodologies yield similar results, it increases the confidence in the reliability and generalizability of the findings 20 . The finding that personal problems, such as perceived prejudice, religious activities, relationship problems, and medical issues, were reported as the least stressful factors in the academic environment in your study is indeed unexpected and interesting. These findings suggest that while academic stressors like daily academic hassles may be predominant, personal problems may not be perceived as significant stressors in the academic context among the study participants 21 . Personal, familial, social, and administrative factors may not be perceived as major stressors among university students in the current study, it’s essential for academic institutions to remain attentive to the diverse needs and challenges faced by students 24 . Providing resources and support services that address a wide range of stressors, including those outside the academic realm, can contribute to the overall well-being and academic success of students 22 . The fact that the respondents were all in their clinical years and research semester further restricts the generalizability of the findings to students in similar academic stages or programs 19 . Variations in academic structures, curriculum designs, institutional cultures, and student demographics across different universities may influence the prevalence and impact of academic stress, study habits, and academic performance. While the study provides valuable insights into the relationship between academic stress, study habits, and academic performance within the specific context of the sampled undergraduates, it is essential to recognize the limitations in generalizing these findings to broader populations or settings. 25 . Indeed, the limitation of a small sample size is an important consideration when interpreting the findings of the study. With only 134 completed questionnaires received from the respondents, representing a 68.60% response rate, the study sample may not fully represent the diversity of students in similar academic programs or other universities. As a result, caution should be exercised when attempting to generalize the findings to a broader population of undergraduates or other academic institutions. Replication of the study with larger and more diverse samples, including undergraduates at different academic stages and from various universities, would strengthen the validity and generalizability of the results. Strategies to reduce stress include interventions, stress management, and self-report measures. Institutional barriers, such as lack of qualified teachers and quality study materials, hinder students' learning. Further research on educational instrument requirements and ergonomic modifications in educational settings could benefit students. Conclusion This study highlights the poor arrangement of educational systems, including lesson dissemination, teaching aids, and materials, leading to academic stress and pressure for students in their final year of study. This stress is exacerbated by institutional lack of management, teacher incompetence, and interpersonal communication difficulties. It calls for in-house counseling services and mentorship programs in medical colleges to address these issues and promote resilience, personal fulfillment, and improved professionalism. Declarations Acknowledgment The authors are grateful to the Final year students of Session 2015-16 of Bangladesh Health Professions Institute (BHPI), CRP, Savar, Dhaka, Bangladesh, for providing support and continuous assistance. Author Contributions Statement MJA and AHK wrote the main manuscript, MIKP and MSI prepared the supplementary files and MMH supervised and revised the manuscript. All authors reviewed and approved the manuscript. Data Availability Statement The “all data” sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Funding Statement This study is solely a self-funded and academic work. Conflict of Interest Statement The authors declare that they do not have any conflicts of interest. References Bao Giang K, Viet Dzung T, Kullgren G, Allebeck P. Prevalence of mental distress and use of health services in a Rural District in Vietnam. Glob Health Action. 2010;3(1):2025. 10.3402/gha.v3i0.2025 . Eisenberg D, Hunt J, Speer N. Mental health in American colleges and Universities. J Nerv Ment Dis. 2013;201(1):60–7. 10.1097/nmd.0b013e31827ab077 . Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord. 2015;173:90–6. 10.1016/j.jad.2014.10.054 . Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: A Multischool Study. Acad Med. 2009;84(2):236–41. 10.1097/acm.0b013e31819391bb . 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Generalizing study results. Epidemiol. 2017;28(4):553–61. 10.1097/ede.0000000000000664 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4495151","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314321024,"identity":"8f6a4b57-ac02-4ac7-bfde-4b4faecff084","order_by":0,"name":"Md. Jonaied Alam","email":"","orcid":"","institution":"Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Jonaied","lastName":"Alam","suffix":""},{"id":314321029,"identity":"528768cd-b064-40f8-b16c-18f9b3485aa5","order_by":1,"name":"Mahmudul Islam Khan Pratik","email":"","orcid":"","institution":"Education Engineering Department, Ministry of Education, Dhaka","correspondingAuthor":false,"prefix":"","firstName":"Mahmudul","middleName":"Islam Khan","lastName":"Pratik","suffix":""},{"id":314321033,"identity":"2da19326-88d0-489a-a826-4056102c5e3b","order_by":2,"name":"Abid Hasan Khan","email":"data:image/png;base64,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","orcid":"","institution":"Department of Physiotherapy and Rehabilitation, Jashore University of Science \u0026 Technology (JUST), Jashore","correspondingAuthor":true,"prefix":"","firstName":"Abid","middleName":"Hasan","lastName":"Khan","suffix":""},{"id":314321035,"identity":"0d4df618-6dbb-4396-83bd-4de25271ce65","order_by":3,"name":"Muhammad Shahidul Islam","email":"","orcid":"","institution":"Department of Physiotherapy, Saic College of Medical Science and Technology (SCMST), Mirpur-14, Dhaka","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Shahidul","lastName":"Islam","suffix":""},{"id":314321039,"identity":"2dc1f579-570d-48b1-8900-a5bc91a5c4d8","order_by":4,"name":"Muhammad Millat Hossain","email":"","orcid":"","institution":"Department of Rehabilitation Science, Bangladesh Health Professions Institute (BHPI), CRP, Savar, Dhaka","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Millat","lastName":"Hossain","suffix":""}],"badges":[],"createdAt":"2024-05-29 07:37:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4495151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4495151/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58753838,"identity":"94ff8019-a7d2-4169-a874-91378e54b677","added_by":"auto","created_at":"2024-06-20 16:20:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26843,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4495151/v1/125c0de9f88b9c557107f670.png"},{"id":58753829,"identity":"e333dcd2-5a7e-4a43-95af-5119e6c211ff","added_by":"auto","created_at":"2024-06-20 16:20:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22645,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Stress among the students\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4495151/v1/37b0b8eea524f87e8481f6d1.png"},{"id":67190594,"identity":"931e5ae9-01b8-4af9-85b1-022633cab203","added_by":"auto","created_at":"2024-10-22 08:17:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517576,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4495151/v1/454a131d-12ea-45d3-b0e9-76e6fc496e92.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Level of Stress among Final-year Students at a Health Science Institute in Bangladesh","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental distress is indeed a complex phenomenon that can encompass a wide range of symptoms and experiences. It can include feelings of depression, anxiety, panic, and somatic symptoms such as physical pain or discomfort. Additionally, mental distress may involve confused or overwhelmed emotions, hallucinations, and other related symptoms that go beyond mere physical illness\u003csup\u003e1\u003c/sup\u003e. There\u0026rsquo;s a growing body of research indicating that college can be a particularly challenging time for many students, with increasing rates of mental health problems such as depression and anxiety. Recognizing the importance of addressing mental health issues on college campuses, many institutions have been implementing initiatives to provide better support and resources for students. These may include counseling services, mental health awareness campaigns, and efforts to reduce stigma surrounding mental illness\u003csup\u003e2\u003c/sup\u003e. The increased utilization of college counseling centers across the United States is another significant indicator of the growing mental health challenges faced by students in higher education\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe high rates of melancholy and burnout among scientific students are indeed concerning, particularly given the critical role these students play in the future healthcare workforce. Medical schools strive to produce highly qualified and resilient graduates who are equipped to handle the demands of clinical practice and provide quality patient care. However, when students experience high levels of stress, depression, or burnout during their training, it can have significant implications for their well-being, academic performance, and future career satisfaction. In a learn about conducted at six clinical schools at some stage in 2003\u0026ndash;2004, the average charge of depression among college students was once 21%\u003csup\u003e4\u003c/sup\u003e. In contrast with a charge of 8\u0026ndash;15% in different graduate students and in a similar fashion aged adult\u003csup\u003e5\u003c/sup\u003e. Stress plays a significant role in the development and exacerbation of various psychological illnesses that affect individuals in today\u0026rsquo;s society\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe findings from the survey conducted by the American Psychological Association (APA) and the American Institute of Stress in 2014 are indeed striking. The fact that 73% of people reported experiencing some level of psychological symptoms caused by stress underscores the pervasive impact of stress on mental health in today\u0026rsquo;s society\u003csup\u003e7\u003c/sup\u003e. It\u0026rsquo;s widely recognized that young people, particularly students, experience significant stress related to academic performance and school pressure. The findings from studies, such as those conducted in 2009, highlight the persistent issue of stress among students and its impact on their well-being\u003csup\u003e8\u003c/sup\u003e. The findings from the latest study involving clinical students suggest a positive association between higher levels of physical activity and indicators of personal success, as well as lower levels of emotional exhaustion. This highlights the potential benefits of regular physical activity for the well-being and resilience of individuals, particularly those in demanding academic or professional settings such as clinical training programs\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudies have consistently shown that medical students are at increased risk for developing depression compared to the general population and other student groups. The demanding nature of medical education, combined with the stressors and challenges inherent in clinical training, can contribute to the development of depression among medical students\u003csup\u003e10\u003c/sup\u003e. The perception of medical education as inherently stressful is widely recognized both nationally and internationally. Medical courses, whether in undergraduate or postgraduate settings, are often characterized by rigorous academic demands, intense clinical training, and high-stakes examinations\u003csup\u003e11\u003c/sup\u003e. Studies have consistently shown that psychological problems such as academic stress, anxiety, and depression are prevalent among medical students, yet they are often underdiagnosed and undertreated. This is a significant concern given the potential impact of these disorders on the well-being, academic performance, and future professional competency of medical students\u003csup\u003e12\u003c/sup\u003e. The statistics highlighted the significant prevalence of emotional distress among tertiary education students in various countries, including Singapore, the United States, Malaysia, and Australia. These findings underscore the global nature of the issue and its impact on students' mental well-being across different cultural and socio-economic contexts\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMental health refers to a person's overall psychological well-being, including their emotional, cognitive, and social functioning. It encompasses the ability to cope with stress, maintain positive relationships, and adapt to life's challenges. It is the state of any person who is functioning at a high-quality stage of emotional and behavioral adjustment. Assessing the prevalence and level of stress among final year students at a Health Science Institute in Bangladesh is an important endeavor that can provide valuable insights into the mental health needs of students in the healthcare field. Conducting such a study can help identify factors contributing to stress among these students and inform the development of targeted interventions to support their well-being.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA cross-sectional study was conducted from May to September, 2021 at the Bangladesh Health Professions Institute (BHPI), which is an academic institute of Center for the Rehabilitation of the Paralysed, Savar, Dhaka affiliated with Faculty of Medicine, University of Dhaka. Medical ethics approvals were obtained from the Institutional Review Board (IRB) of BHPI (CRP/BHPI/IRB/06/2021/460). Informed consent was taken from each respondent before participation in this study.\u003c/p\u003e \u003cp\u003eFor this study, a convenience sampling had been used to carry out the research. A total of 134 students had participated in this study. These students had been asked to fill out and complete a structured questionnaire to gather specific information. Data was collected through face to face interviews. Face-to-face interviews allow researchers to gather detailed information directly from participants while also providing them with the opportunity to express themselves freely and elaborate on concepts.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for the respondents were final year male and female students of Bachelor of Science in Physiotherapy, Occupational therapy, Speech \u0026amp; language therapy in BHPI. This study had included only final year students because due to COVID-19 pandemic only final year students were present on that time in the institute due to their academic clinical placement. Students having Mental illness (Psychosis), Speech problem and who were not interested to participate in this study had been excluded.\u003c/p\u003e \u003cp\u003eIn the present study, a self-structured questionnaire was used to collect socio-demographic information of the students and stress level was measured by Academic stress scale (ASS). Academic stress refers to the scores obtained by the students through Students\u0026rsquo; Academic Stress Scale (ASS). This (ASS) consists of 40 items and each item has five alternative responses as follow; \u0026ldquo;No Stress\u0026rdquo; (NS), \u0026ldquo;Slightly Stress\u0026rdquo; (SS), \u0026ldquo;Moderate Stress\u0026rdquo; (MS), \u0026ldquo;Highly Stress\u0026rdquo; (HS) and \u0026ldquo;Extremely High Stress\u0026rdquo; (ES).\u003c/p\u003e \u003cp\u003eAll data were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY). The sociodemographic variables of the students were described using descriptive analysis. Pearson Correlation Co-efficient test was used to analyze the relation between components of academic stress scale and the sociodemographic factors of the students. Association of independent variables with p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered to be statistically significant association with academic stress.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTotal 147 final year students were approached from July to August, 2021 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Six students declined to participate due to time constraints, three were absent in the campus due to illness and four were refused to give any information. A total of 134 students were finally recruited into this study after they had given consent.\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe mean age for students was 24.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 years old. Male participants were great in number 60.4% (n\u0026thinsp;=\u0026thinsp;81) and 75.4% (n\u0026thinsp;=\u0026thinsp;101) of the students were unmarried, 9.0% (n\u0026thinsp;=\u0026thinsp;12) of them were engaged to be married. Most of them were from nuclear family 82.8 (n\u0026thinsp;=\u0026thinsp;111). About 49.6% (n\u0026thinsp;=\u0026thinsp;66) of the students were from rural areas and 42.5% (n\u0026thinsp;=\u0026thinsp;57) were from urban areas. Among the students 8.2% (n\u0026thinsp;=\u0026thinsp;11) had physical and 4.5% (n\u0026thinsp;=\u0026thinsp;6) had mental health problem. About 36.6% (n\u0026thinsp;=\u0026thinsp;49) students said that they had chosen to study on their self-interest but alarmingly 31.3% (n\u0026thinsp;=\u0026thinsp;42) students said that they chose to study here because of family pressure (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Sociodemographic characteristics of the students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.4 (81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.6 (53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.4 (101)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.0 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.7 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.8 (111)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoint family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.2 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.3 (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.5 (57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSemi-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical disability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.8 (123)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental health problem\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.5 (128)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWay of enrolling in these bachelor course\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDue to self interest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.6 (49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDue to family pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.3 (42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDue to situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.1 (43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e[insert Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 134 students who were recruited, 68.60% (n\u0026thinsp;=\u0026thinsp;91) admitted that they were in stressful state while studying in this courses and other 31.40% (n\u0026thinsp;=\u0026thinsp;43) had said that they think it is normal as studying in a health science institute. They did not feel it as pressure or stress on their study (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to Academic Stress Scale, it was found that among 91 stressed students in terms of personal inadequacy 25.20% (n\u0026thinsp;=\u0026thinsp;23) students was in extreme stress level, 24.20% (n\u0026thinsp;=\u0026thinsp;21) was in high stress level and 25.0% (n\u0026thinsp;=\u0026thinsp;22) was in moderate stress level. About fear of failure 29.20 (n\u0026thinsp;=\u0026thinsp;29) students was in high stress level, 23.40% (n\u0026thinsp;=\u0026thinsp;20) had moderate stress and 22.60% (n\u0026thinsp;=\u0026thinsp;19) had extreme stress. In case of interpersonal difficulties with teachers, 28.80% (n\u0026thinsp;=\u0026thinsp;26) students was in high stress level; also 28.80% (n\u0026thinsp;=\u0026thinsp;26) students was on high stress level due to teacher \u0026ndash; pupil relationship/ teaching method and due to inadequate study facilities, 25.50% (n\u0026thinsp;=\u0026thinsp;23) students expressed moderate level and 16.80% (n\u0026thinsp;=\u0026thinsp;17) students expressed high level of stress (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLevel of Stress among the students (According to Academic Stress Scale)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePersonal inadequacy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.50 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlight stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.00 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.20 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtreme stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.50 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear of failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.90 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlight stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.90 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.40 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.20 (29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtreme stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.60 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInterpersonal difficulties with teachers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlight stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.60 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.80 (26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtreme stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.90 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeacher \u0026ndash; pupil relationship/ Teaching method\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.90 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlight stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.60 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.80 (26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtreme stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInadequate study facilities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.20 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlight stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.00 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.50 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtreme stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.50 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere is a negligible correlation found between age and stress level of the students (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) which simplifies that students stress level while studying in their academic institution has little association with their age (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between of the age of the students and total score of Academic Stress scale (ASS) (Pearson Correlation Co-efficient Test)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of the student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score of Academic Stress scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to all accounts, clinical subject students experience high levels of observed stress, which will generally have an impact on their academic performance as well as all aspects of wellbeing and related findings since the prevalence of observed stress appears to be widespread with little difference between male and female students\u003csup\u003e14\u003c/sup\u003e. In other study it was concerned that stress of clinical understudies and tracked down that those 7.80% was no stress, 19.10% was slight stress, 25.50% was moderate stress, 26.70% was high stress, and 20.90% was in outrageous stress level\u003csup\u003e15\u003c/sup\u003e. The predominance of stress was found higher among women than among men\u003csup\u003e16\u003c/sup\u003e. One more review was led at Dhaka Medical College during the time of April 2009 tracked down that more than 33% (34.6%) had gentle stress, (39.8%) moderate stress and around one fourth (24.9%) was experiencing extreme stress as per Academic Stress Scale\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe finding that 68.60% of students reported elevated levels of stressful symptoms in the final year of their health sciences graduate programs is indeed concerning. This high percentage suggests that a significant proportion of students in these programs may be experiencing considerable stress and its associated symptoms. The comparison between the prevalence of elevated stressful symptoms in this study and the findings reported in other recent research is striking. This study indicates a much higher percentage of students experiencing elevated stress levels in the final year of their health sciences graduate programs compared to the prevalence rates of depression, generalized anxiety, and suicidal ideation reported in the other research\u003csup\u003e3\u003c/sup\u003e. Specifically, this study found that 68.60% of students reported elevated levels of stressful symptoms, while the other research reported prevalence rates of 17.3% for depression, 7% for generalized anxiety, and 6.3% for suicidal ideation. These comparisons suggest that the level of stress experienced by students in the final year of health sciences graduate programs is substantially higher than the prevalence rates of these specific mental health issues reported in the other research\u003csup\u003e2\u003c/sup\u003e. Poor mental health can significantly impact an individual\u0026rsquo;s ability to function effectively in various aspects of life, including academic performance\u003csup\u003e18\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe finding that daily academic hassles were reported as the most stressful in this study aligns with similar findings reported by Bedewy and Gabriel, who also used the same instrument to assess stress among students. In their research, Bedewy and Gabriel found that students experienced the most stress from academic overload and academic evaluation procedures\u003csup\u003e19\u003c/sup\u003e. This consistency in findings across studies suggests that academic demands and pressures are significant sources of stress for students in various academic settings. Daily academic hassles, such as managing coursework, meeting deadlines, preparing for exams, and navigating academic evaluation processes, can contribute to heightened stress levels among students\u003csup\u003e23\u003c/sup\u003e. The findings highlight the importance of addressing academic-related stressors in efforts to promote student well-being and academic success. Implementing strategies to help students manage academic workload effectively, develop study skills, cope with exam stress, and seek support when needed can be beneficial in reducing stress levels and improving overall student outcomes.\u003c/p\u003e \u003cp\u003eThe agreement between the findings of the present study and those of Nakalema and Ssenyonga regarding daily academic hassles being the most stressful among university students further reinforces the significance of this issue. When multiple studies using different samples and methodologies yield similar results, it increases the confidence in the reliability and generalizability of the findings\u003csup\u003e20\u003c/sup\u003e. The finding that personal problems, such as perceived prejudice, religious activities, relationship problems, and medical issues, were reported as the least stressful factors in the academic environment in your study is indeed unexpected and interesting. These findings suggest that while academic stressors like daily academic hassles may be predominant, personal problems may not be perceived as significant stressors in the academic context among the study participants\u003csup\u003e21\u003c/sup\u003e. Personal, familial, social, and administrative factors may not be perceived as major stressors among university students in the current study, it\u0026rsquo;s essential for academic institutions to remain attentive to the diverse needs and challenges faced by students\u003csup\u003e24\u003c/sup\u003e. Providing resources and support services that address a wide range of stressors, including those outside the academic realm, can contribute to the overall well-being and academic success of students\u003csup\u003e22\u003c/sup\u003e. The fact that the respondents were all in their clinical years and research semester further restricts the generalizability of the findings to students in similar academic stages or programs\u003csup\u003e19\u003c/sup\u003e. Variations in academic structures, curriculum designs, institutional cultures, and student demographics across different universities may influence the prevalence and impact of academic stress, study habits, and academic performance. While the study provides valuable insights into the relationship between academic stress, study habits, and academic performance within the specific context of the sampled undergraduates, it is essential to recognize the limitations in generalizing these findings to broader populations or settings.\u003csup\u003e25\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIndeed, the limitation of a small sample size is an important consideration when interpreting the findings of the study. With only 134 completed questionnaires received from the respondents, representing a 68.60% response rate, the study sample may not fully represent the diversity of students in similar academic programs or other universities. As a result, caution should be exercised when attempting to generalize the findings to a broader population of undergraduates or other academic institutions. Replication of the study with larger and more diverse samples, including undergraduates at different academic stages and from various universities, would strengthen the validity and generalizability of the results. Strategies to reduce stress include interventions, stress management, and self-report measures. Institutional barriers, such as lack of qualified teachers and quality study materials, hinder students' learning. Further research on educational instrument requirements and ergonomic modifications in educational settings could benefit students.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the poor arrangement of educational systems, including lesson dissemination, teaching aids, and materials, leading to academic stress and pressure for students in their final year of study. This stress is exacerbated by institutional lack of management, teacher incompetence, and interpersonal communication difficulties. It calls for in-house counseling services and mentorship programs in medical colleges to address these issues and promote resilience, personal fulfillment, and improved professionalism.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the Final year students of Session 2015-16 of Bangladesh Health Professions Institute (BHPI), CRP, Savar, Dhaka, Bangladesh, for providing support and continuous assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMJA and AHK wrote the main manuscript, MIKP and MSI prepared the supplementary files and MMH supervised and revised the manuscript. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \u0026ldquo;all data\u0026rdquo; sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is solely a self-funded and academic work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they do not have any conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBao Giang K, Viet Dzung T, Kullgren G, Allebeck P. Prevalence of mental distress and use of health services in a Rural District in Vietnam. 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Epidemiol. 2017;28(4):553\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ede.0000000000000664\u003c/span\u003e\u003cspan address=\"10.1097/ede.0000000000000664\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental health, Academic stress, Study facilities, Fear","lastPublishedDoi":"10.21203/rs.3.rs-4495151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4495151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth science institutes can contribute to stress among final-year students, potentially leading to negative academic and professional outcomes, as psychological disorders like anxiety and depression are often underdiagnosed and untreated.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective cross-sectional study involving 134 final-year students at Bangladesh Health Professions Institute (BHPI), in Bangladesh assessed stress using the Academic Stress Scale (ASS-40). Data was collected through face-to-face interviews and analyzed using SPSS software 25.0. Both descriptive and inferential statistics were used to analyse the data which was retrieved from the participants.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this study, 31.40% of 134 participants were in a normal state, while 68.60% were in a stressful state. The highest level of stress was fear of failure, followed by personal inadequacy. Addressable stress areas included teacher-pupil relationship/teaching method. A negligible association (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) was found between age of the participants and level of stress of the participants.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis implies that the educational system, means of teaching, teaching materials, system of materials, teachers as well as the services provided by the institutions cannot provide a conducive environment for effective learning as well as creating a secure future for the students as long as they are able to cope with the academic pressure. A student's educational career is being nipped in the bud due to the weak system of our education and institutional system.\u003c/p\u003e","manuscriptTitle":"Prevalence and Level of Stress among Final-year Students at a Health Science Institute in Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 16:20:22","doi":"10.21203/rs.3.rs-4495151/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e539eb4-a4d0-4761-af72-0d850e452791","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-22T08:09:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-20 16:20:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4495151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4495151","identity":"rs-4495151","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}