Stress Levels and Coping Strategies in Medical Students and its Association with Salivary IL-6 Levels


  • Monica Karanth MBBS Intern. Father Muller Medical College, Mangalore-575002, India.
  • Anahita R Shenoy Basti MD Physiology. Father Muller Medical College, Mangalore-575002, India.
  • Chandralekha N MD Pharmacology. Father Muller Medical College, Mangalore-575002, India.
  • Cleeta Reberio MSc. Father Muller Medical College, Mangalore-575002, India.



Stress, Coping Strategies, Medical Students, IL-6 levels


BACKGROUND: Medical students experience stress throughout their training period, to which they have built their own coping mechanisms. Stress alters various physiological processes, including markers like IL-6, a pro-inflammatory marker. The present study was conducted to assess the stress levels and coping strategies in medical students and its association with salivary IL-6 levels.

METHODS: This descriptive study was conducted after obtaining institutional ethical clearance. Total of 76 undergraduate medical students who gave their consent, answered the Cohen’s perceived stress scale and BriefCOPE questionnaire. Unstimulated saliva  was used to assess salivary IL-6 levels using Diaclone human IL-6 ELISA kit and data obtained was analyzed.

RESULTS: Out of the 76 participants, 59(77.6%) were females and 17(22.4%) were males. Mild stress was perceived by 9 students, moderate and severe stress by 53 and 14 students respectively. Based on Kruskal-Wallis p test, in all grades of stress, approach method of coping had a higher score. Approach is form of active coping strategy where the students deal with the stressor in order to solve the issue and plan for the future. Approach coping has shown better responses for adversity, physical health and emotional responsiveness. Most commonly used coping strategies in mild and medium stress was acceptance, positive-refrain and planning. Students with severe stress adopted planning, self-distraction and self-blame. In spite of the perceived stress, there was no significant difference in the salivary IL-6 levels among the three categories.

CONCLUSION: The common coping strategies employed by students to handle stress was ‘approach’. As described in the BriefCOPE, it has been shown to be associated with better outcomes. In spite of this, a vast number of students have reported to experience stress. Therefore, more effective coping strategies are needed to handle stress and demands of the profession. The study also emphasizes on need for further research with a large sample size to assess the relation between salivary IL-6 and stress levels.


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Ghosal K., Behera A. Study on prevalence of stress in medical students. J of Research in Medical and Dental Science 2018; 6:182-186.

Datar MC, Shetty JV, Naphade NM. Stress and Coping Styles in Postgraduate Medical Students: A Medical College – based study. Indian J Soc Psychiatry 2017;33:370-4.

Bamuhair S S, Farhan A, Althubaiti A et al. Sources of Stress and Coping Strategies among Undergraduate Medical Students Enrolled in a Problem based Learning Curriculum. J of Biomedical Education 2015.8.

Maydych V, Claus M, Watzl C. Et al. Attention to Emotional Information is Associated Cytokine Responses to Psychological Stress. Front Neurosci 2018;12:687.

Fratta IL, Tatangelo R, Campagna G et al. The plasmatic and salivary levels of IL-1β, IL-18 and IL-6 are associated to emotional difference during stress in young male. Scientific reports 2018;8:3031.

Chen JY, Chin WY, Tiwari A, Wong J et al. Validation of perceived stress scale in medical and health sciences students in Hong Kong. The Asia Pacific Scholar. 2021;6(2):31-37

Carver, C. S.. You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine.1992;4;92-100

Dineshkumar T, Ashwini BK, Rameshkumar A, et al. Salivary and serum Interleukin – 6 levels in oral premalignant disorders and Squamous Cell Carcinoma: Diagnostic value and Clinicopathologic Correlations. Asia Pac J /cancer Prev. 2016;17(11);4899-4906

Perceived stress and source of stress among undergraduate medical students of Government Medical College, Mysore International Journal of Community Medicine and Public Health Bhavani Nivetha M et al. Int J Community Med Public Health. 2018 Aug;5(8):3513-3518.

Shadid A, Shadid A M, Shadid A, et al. Stress, Burnout, and Associated Risk Factors in Medical Students. Cureus 2020;12(1): e6633.

Amr M, Hady El Gilany A, El-Hawary A. Does gender predict medical students’ stress in Mansoura, Egypt? Med Educ Online. 2008;13:12.

Das P, Sahoo R. Stress and depression among post graduate students. Int J Sci Res Public. 2012;2:1–5.

Saravanan C, Wilks R. Medical students’ experience of and reaction to stress: the role of depression and anxiety. Sci World J. 2014;2014:737382.

Supe AN. A study of stress in medical students at Seth G.S. Medical College. J Postgrad Med. 1998 Jan-Mar;44(1):1-6.

Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia. 2004 Jun;59(2):207-11.

Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, Khan S. Students, stress and coping strategies: a case of Pakistani medical school. Educ Health (Abingdon). 2004 Nov;17(3):346-53.

Yusoff MSB, Jie TY, Esa AR. Stress, stressors and coping strategies among house officers in a Malaysian Hospital. ASEAN J Psychiatr. 2011;12(1).

Abdulghani HM, Irshad M, Al Zunitan MA, et al. Prevalence of stress in junior doctors during their internship training: a cross-sectional study of three Saudi medical colleges’ hospitals. Neuropsychiatr Dis Treat. 2014;10:1879–1886.

AlJaber MI, Alwehaibi AI, Algaeed HA, Arafah AM, Binsebayel OA. Effect of academic stressors on eating habits among medical students in Riyadh, Saudi Arabia. J Family Med Prim Care. 2019;8(2):390-400.

Kathapillai M. Awareness about yoga asana and its benefits among undergraduate medical students: A descriptive study. International Journal of Yoga, Physiotherapy and Physical Education 2019;4:2:20-23.

Ashton CH, Kamali F: Personality, lifestyles, alcohol and drug consumption in a sample of British medical students. Med Educ 1995, 29:187-92.

Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F: Psychological stress and burnout in medical students: a 5-year prospective longitudinal study. J Roy Soc Med 1998, 91(5):237-243.

Ragab, E.A., Dafallah, M.A., Salih, M.H. et al. Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation. Middle East Curr Psychiatry 2021; 28:75.

Slah Eddine, B. F., and Adawi, T. R. T. Perceived stress and coping strategies among University students. Eur. J. Res. Med. Sci.2020; 8 :19–25

Yikealo, D., Tareke, W. Stress Coping Strategies among College Students: A Case in the College of Education, Eritrea Institute of Technology. Open Science Journal. 2018; 3: 10.

Awoke M, Mamo G, Abdu S, Terefe B. Perceived Stress and Coping Strategies Among undergraduate Health Science students of Jimma University Amid The COVID-19 Outbreak: Online Cross-Sectional Survey. Front. Psychol. 2021; 12:639955.

Dijkstra, M., and Homan, A. C. Engaging in rather than disengaging from stress: effective coping and perceived control. Front. Psychol. 2016; 7:1415.

Melaku L, Bulcha G. Evaluation and Comparison of Medical Students Stressors and Coping Strategies among Undergraduate Preclinical and Clinical Year Students Enrolled in Medical School of Arsi University, Southeast Ethiopia. Education Research International 2021;12.

Canestrari C, Bongelli R, Fermani A, Riccioni I, Bertolazzi A, Muzi M and Burro R Coronavirus disease stress among Italian healthcare workers: The role of coping humor. Front. Psychol. 11:601574.

Dodek PM, Culjak A, Cheung EO, et al. Active coping in medical students is associated with less burnout and higher resilience; 2019.

Abouammoh N, Irfan F, Alfaris E. Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study BMC Medical Education 2020;20:124

Edan BJ, Mohammed SB, Al-Sultani AJM et al. Effect of exam stress on salivary IL-6 in healthy students. Medical J of Babylon 13; 4:786-790

Vernaza P, Chavarria J, Dueñas R, Niño V, Ávila G, Klínger J, Londoño J. Relationship between perceived academic stress and Interleukin 6 levels in health students. Ciencia e Innovación en Salud. 2020; 68:1-19

Izawa S, Sugaya N, Kimura K, Ogawa N, Yamada KC, Shirotsuki K, et al. An increase in salivary interleukin-6 level following acute psychosocial stress and its biological correlates in healthy young adults. Biol Psychol. 2013 Oct;94(2):249-54.




How to Cite

Karanth, M., Shenoy Basti, A. R., Chandralekha N, & Reberio, C. (2023). Stress Levels and Coping Strategies in Medical Students and its Association with Salivary IL-6 Levels. International Journal of Medical Students, 11, S124.



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