Effect of stress and anxiety on 1st year medical students

Context: Medical students are exposed to various stresses such as demanding medical education and different teaching protocols.[4],[5] Heart rate variability (HRV) is a simple and noninvasive indicator for the detection of cardiac autonomic dysfunction. This study was done to assess the effect of stress and anxiety on HRV. Aims: This study aims to assess the perceived stress, anxiety, and HRV in 1st year medical students and to correlate stress and anxiety to HRV. Subjects and Methods: The study included 110, 1st year MBBS students, excluding students with any infections, metabolic diseases, cardiorespiratory diseases, and medications which alter the autonomic functions. Anxiety and stress were measured using Spielberger State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale (PSS) questionnaires, respectively. Based on the scores, students were assigned to stress and nonstress group and anxious and nonanxious group. The electrocardiogram (ECG) was recorded using a house built analog ECG amplifier, which was further analyzed using HRV analysis software. Results: STAI and PSS were analyzed; those who have STAI score of above 40 come under anxious group and those with PSS score of 13 and above comes under stress group. Sixty-two percent students are both anxious as well as stressed. The parameters, namely, mean heart rate, standard deviation of normal to normal, root mean square successive difference (RMSSD), low-frequency (LF) normalized unit, and high-frequency (HF) normalized unit were correlated with stress and anxiety scores. During state-anxiety, there is a significant increase in heart rate, RMSDD, LF domain, and LF/HF and during trait-anxiety, there is significant increase in RMSDD and LF/HF ratio. In this study, perceived stress is not significant with HRV. Conclusions: This study shows that during anxiety there is increased activity toward sympathetic, but no difference in parasympathetic activity and during perceived stress, there is no significance with HRV.