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Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v10.i1.2023.XX-XX 

Original Article 

The physical manifestations of stress among 
the Medical Students of TSMU, Georgia: An 
Original Study 
Gayathri Pramil Menon , Aarsha Aji, Niveditha Selvakumar , 

Rohit Vassan , Ranjan Tejas Venkanna  & Maduri Balasubramanian
Tbilisi State Medical University, Department of Medicine, Tbilisi, Georgia 

Abstract 
Background: Medical students experience stress due to their daily routines, which 
tend to be responsible for higher burnout rates. The mental stress experienced by 
these students manifests itself in various physical situations. As a result, they 
might acquire various coping strategies with positive and negative outcomes. 
Methodology: A survey was designed and circulated among the medical students 
of TSMU, Georgia, with questions to collect data related to the subject. 
Results: In the conducted survey, a total number of 203 responses was recorded. 
A majority, 65.5% (n=133) were females. The percentage of male participants in the 
survey was 34.5%. This study aims to observe the various physical manifestations 
of stress in pre-clinical and clinical year medical students from Tbilisi State Medical 
University. Multiple factors like age, year of study, prior medical conditions, etc., 
were considered to understand how physical manifestations exhibit themselves 
and how the different stress levels worsen them. 
Conclusion: This study proves the prevalence of various physical manifestations 
of stress among medical students. The highest percentage was reported among the 
age group of 22, with female students being more affected. First-year students also 
experienced increased stress due to adaptability issues. 

Keywords 
Stress, Physical, Psychology, Medical Students. 

 

Citation: Menon GP, Aji A, Selvakumar N, 
Vassan R, Venkanna RT, Balasubramanian 
M. The physical manifestations of stress 
among the Medical Students of TSMU,
Georgia: An Original Study. APP. 2023;
10(1): 01-07 

Corresponding Author Email: 
maduribalasubramanian@gmail.com 

DOI: 10.29052/2412-3188.v10.i1.2023.01-
07 

Received 16/03/2023 

Accepted 26/05/2023 

Published 01/06/2023 

Copyright © The Author(s). 2023. This is 
an open-access article distributed under 
the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author and 
source are credited.  

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 

https://doi.org/10.29052/2412-3188.v10.i1.2023.
0000-0002-3685-4214
0000-0002-1239-2238
0000-0002-3328-624X
0009-0009-3454-7630
0000-0002-5634-6057
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02 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

Introduction 
The importance currently placed on mental 
health is monumental. Due to the various 
challenges in the healthcare community, this 
conversation has been amplified. Medical 
students and Doctors in training also 
experience chronic stress daily. A person 
may develop stress due to many factors, 
including academics, occupation, 
relationships, and society, among many 
others. Stress reduces an individual's 
productivity or zest to accomplish day-to-
day activities or goals. These moments bud 
from lack of rest and many daily tasks the 
students are expected to carry out. Medical 
students experience physical manifestations 
of this stress in the form of headaches, panic 
attacks, hair fall, gastrointestinal problems, 
sleep deprivation, binge eating, etc1. Studies 
have shown first-year medical students 
experience stress mainly due to high 
parental expectations1. Mental health has 
become an important issue to consider over 
recent years. Medical students need regular 
counseling and periods of leisure to recharge 
and invigorate themselves. Universities 
need to place importance on students' 
mental health and overall well-being. The 
adverse effects of stress could have harmful 
implications for patient care, as previous 
studies have shown that anxious medical 
students were less empathetic and less 
enthusiastic when caring for patients with 
chronic illnesses2. De-stigmatization of 
mental illnesses and promoting help-seeking 
behavior is vital to sustain student's overall 
mental wellness2. Without effective outlets 
to relieve stress, negative coping 
mechanisms such as the use of substances 
and alcohol could be utilized by students. 
We also believe that healthcare professionals 
being open about their mental health 
struggles will forge a path for more 
discussion about the subject. This study 
aimed to determine the most common 
physical manifestations of stress prevalent in 

the medical student population of TSMU, 
Georgia.    

Methodology 
The data collection for this study was 
conducted using a survey made from 
reading through different psychological 
questionnaires, consisting of 19 questions, 
created on Google Forms, circulated on 
various social media platforms to reach the 
target audience. The inclusion criteria were 
medical students from Tbilisi State Medical 
University.  

The survey was designed to collect data on 
the overall mental health status of the 
students and the physical symptoms they 
experienced during this time. Patients were 
asked for consent to use data before filling 
out the survey, and responses of those who 
did not want to be added were excluded.   

The survey was anonymous, and no 
participant emails were collected. The 
survey consisted of multiple-choice 
questions and open-ended questions. There 
was also no time limit given. 

The first question in the survey required the 
consent of the participant. Upon giving their 
consent to move forward with the survey, 
the following questions were asked: 

• Please specify your age

• Please specify your sex

• Year of Study

• Do you experience stress as a medical
student?

If the participant answered 'yes,' the 
questions asked next were: 

• Do you find yourself stressed out due
to the following reasons? (e.g., fear of
examinations, lack of leisure time,
etc.)



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APP| Published By AEIRC| Volume 10 Issue 1 

• When do you find yourself
particularly stressed out? (during
examinations or frequently
throughout the semester)

• If you have any pre-existing
psychological condition for which
you currently take medications,
kindly specify the condition.

• What do you do to relieve stress?
(e.g., smoking, drinking alcohol,
meditating, etc.)

On a scale of 1 to 5 (with 1 being the least and 
5 being the highest), the rate at which of the 
following physical symptoms do you tend to 
experience stress: 

• Chest Pain

• Heart Palpitations

• Fatigue (without any strenuous
exercise)

• Insomnia

• Headache

• GI symptoms (e.g., vomiting,
diarrhea, abdominal pain)

• Panic Attacks

• Hyperventilation

• Poor Appetite

• Disturbances in the menstrual cycle
(provided no pre-existing hormonal
conditions such as PCOS, thyroid,
etc.)

• Please specify if you experience any
symptoms other than the ones listed
above.

Upon completing the survey, the 
participants clicked submit, and the data was 
collected. 

Result 
The duration of this study was 2.5 months, 
from April to mid-June. After the survey was 
closed, data analysis of the study was 
conducted to clean the data by removing 
incomplete or incorrectly completed 
responses, and we used descriptive analysis 
to create and understand the trends in the 
responses.  

The survey does not report students' mental 
status but mentions the physical symptoms 
seen when under a lot of stress, which can be 
due to multiple factors.  

This study is to observe the various physical 
manifestations of stress in pre-clinical and 
clinical year medical students from Tbilisi 
State Medical University. A survey was 
conducted using Google Forms, and a total 
of 203 responses were recorded. The age of 
the participants ranged from 18-32 (Table 1).

Table 1: Study Participants Age 

Age of Participants Responses (%) 

18 4.9 

19 17.2 

20 14.8 

21 18.7 

22 20.2 

23 12.8 

24 0.5 

25 6.4 



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APP| Published By AEIRC| Volume 10 Issue 1 

26 1.5 

27 0.5 

28 0.5 

29 0.5 

30 0.5 

31 0.5 

32 0.5 

The curated survey consisted of 19 questions. A response rate of 96.5% was received when asked 
if the participants experienced stress. A total of 203 responses were recorded, and 195 usable 
responses were considered to calculate.  

In the conducted survey, a total number of 203 responses was recorded. A majority, 65.5% (n=133) 
were females. The percentage of male participants in the survey was 34.5% (Table 2). 

Table 2: Study participant's distribution on Gender base 
Sex of Participants Responses (%) 

Females 65.5 

Males 34.5 

So what are the signs of stress, and what coping skills along with stressors are observed? 

Factor analysis revealed three hidden factors for stress in this group, namely, depression, 
nervousness, and age. Stress that's left unchecked can contribute to many health problems, such 
as high blood pressure, heart disease, menstrual problems, obesity, and diabetes. 

The most commonly seen physical signs are (Table 3) 

1. Among 139 responses for chest pain, 47.5%(n=66) of students experience mild chest pain,
while 2.9% (n=4) experience severe chest pain during stress.

2. 22.3%(n=35) students experience mild heart palpitations and 8.3%(n=13)  of students
suffer from severe heart palpitations during stress.

3. Among 153 responses for panic attacks, 30.7%(n=47) of students experience mild panic
attacks, while 12.4%(n=19) of students experience severe panic attacks during stress.

4. Among 131 responses for menstrual cycle disturbances, 42%(n=55) of students experience
mild disturbances, while 15.3%(n=20) of students experience severe disturbances during
stress.

Table 3: Commonly physical signs observed by Study Participants 
Scale Level Responses (%) 

Chest Pain 

1 47.5 

2 21.6 

3 24.5 

4 3.5 

5 2.9 



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APP| Published By AEIRC| Volume 10 Issue 1 

Panic Attacks 

1 30.7 

2 19 

3 19 

4 18.9 

5 12.4 

Disturbance in 
the Menstrual 

Cycle 

1 42 

2 11.5 

3 14.5 

4 16.8 

5 15.2 

Hence, the coping methods used and how harmful they are is an understatement. Among the 195 
responses, 20% (n=137) students said they sleep when they feel stressed, 16.5% (n=90) students 
said they binge eat, and 13.5% (n=65) students said they do exercise are the top three coping 
mechanisms observed. Failure to recognize manifestations of stress and to assist with the 
development of positive coping skills causes detrimental effects on one's mental, physical, and 
emotional health (Table 4). 

Table 4: Stress Relievers Commonly Used by Medical Students 

Stress Relievers Responses (%) 

Sleeping 20 

Binge Eating 16.5 

Exercise 13.5 

Smoking 12.8 

Meditation 9.5 

Drinking Alcohol 6.2 

Hobbies 5.5 

Doing Nothing 4.5 

Use of Recreational Drugs 4 

Watching television 3 

Social Media 2 

Confide in a Friend 1.5 

games 1 

Discussion 
In psychological sciences, stress is a feeling 
of mental pressure and tension. Low levels 
of stress might be desired, useful, and even 
healthy. Stress, in its positive form, can 
improve biopsychosocial health and 
facilitate performance. However, high levels 

of stress could have potentially harmful 
implications.  

A high prevalence of stress among medical 
students indeed requires attention as it may 
impair their learning ability and may 
ultimately affect the quality of patient care 
they provide after graduation. From our 



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APP| Published By AEIRC| Volume 10 Issue 1 

curated survey, a majority of students 
reported that they experience stress. This is 
in concordance with medicine being one of 
the most challenging professions. 

A sizable number of participants reported 
stress due to the fear of examinations. This is 
in concordance with a study by Sanjukta 
Padhi, who reported that school 
examinations were one of the major stressors 
in students3. This could be due to the 
voluminous amount of information they are 
required to learn and retain in a short 
amount of time. It has also been reported 
that pre-clinical students experience higher 
stress due to fear of examinations. Possible 
reasons are adaptation issues, anxiety due to 
new subjects, and a new environment. 

This stress could, in turn, inhibit and 
suppress learning, which is called 
'unfavorable stress' and is associated with 
the inhibition of students' academic 
performance, leading to accelerated levels of 
stress during exams4.  

A study found that academic stress was 
correlated to a high degree with financial 
and social stress, which can be related to the 
fact that a majority of the participants are 
immigrants, and a change in the social 
environment and surviving on their own can 
impose difficulties5. This can be further 
reinforced by a study that stated: "As 
immigrant youth adapt and acculturate, they 
encounter a multitude of new challenges and 
stressors”5. High parental pressure was also 
noted as one of the major stressors. This 
could be due to unrealistic or high 
expectations set by parents, which result in 
anxiety and stress in students.    

Lack of leisure time was also noted to be one 
of the stressors due to the high workload, 
tight schedules, and deadlines for medical 
students. Financial problems are a stressor 
because medicine is an expensive course in 

many countries, and plenty of students 
immigrate for education, which increases 
their expenditure. Relationship disharmony, 
either familial, romantic, or peer, has also 
been noted as one of the less prominent 
stressors. 

A majority of the participants responded 
that they were more stressed throughout the 
semester than only during the examinations, 
again in concordance with the heavy 
workload and responsibilities for medical 
students, which impacted their mental well-
being. 

Some participants reported pre-existing 
psychological conditions such as depression, 
anxiety, panic attacks, and insomnia. These 
conditions, coupled with stress, could exert 
abundant emotional pressure on the 
participants.  

A set of physical manifestations was given, 
and the participants were asked if they 
experienced these symptoms when stressed. 
The majority of people responded that they 
experienced severe headaches (intensity 5). 
The other physical manifestations reported 
were fatigue without strenuous exercise, 
insomnia, heart palpitations, poor appetite, 
panic attacks, hyperventilation, GI 
symptoms, chest pain, and disturbances in 
the menstrual cycles.  

Exposure to stress results in alterations of the 
brain-gut interactions ("brain-gut axis"), 
ultimately leading to the development of a 
broad array of gastrointestinal disorders. 
This explains the manifestation of GI 
symptoms among the participants6.  

Positive and negative coping mechanisms 
were noted in the participants. The major 
positive coping method that was recorded 
was sleep, followed by exercise and 
meditation, and a few others, like confiding 



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ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

in a friend, praying, and engaging in 
hobbies, were recorded in the participants.  

Negative coping mechanisms like binge 
eating, alcohol consumption, smoking, use 
of recreational drugs, procrastination, and 
binge-watching shows were also noted. 

A few limitations observed during data 
collection were the small sample size, the 
frequency and intensity of alcohol 
consumption, the frequency of nicotine 
intake, psychosomatic symptoms, and 
emotional disturbances that could cause a 
menstrual cycle in females that could point 
to gender bias. 

Conclusion 
This study provides evidence of various 
physical manifestations of stress among 
medical students. The highest percentage 
was reported among the age group of 22, 
with female students being more affected. 
The most common symptoms seen were 
chest pain, menstrual cycle disturbances, 
and panic attacks. Coping mechanisms 
adopted by these students were sleeping, 
binge eating, and exercising. 

Recommendations 
Early detection of these symptoms is 
necessary for managing these stressors as 
well as to provide mental & physical stability 
for medical students. Medical universities 
must look to initiate policies to help their 
students cope with their daily activities and 

the psychological stress accompanying 
them. 

Acknowledgment 
This study is dedicated to all stress and 
trauma survivors.  

References 
1. Ragab EA, Dafallah MA, Salih MH, Osman

WN, Osman M, Miskeen E, Taha MH,
Ramadan A, Ahmed M, Abdalla ME, Ahmed
MH. Stress and its correlates among medical
students in six medical colleges: an attempt to
understand the current situation. MECP.
2021;28(1):75.

2. Tian-Ci Quek T, Wai-San Tam W, X. Tran B,
Zhang M, Zhang Z, Su-Hui Ho C, Chun-Man
Ho R. The global prevalence of anxiety among
medical students: a meta-analysis. IJERPH.
2019;16(15):2735.

3. Padhi S. EXAMINATION PHOBIA AND ITS
MEASURES. Available at:
https://www.researchgate.net/publication/
344395951_EXAMINATION_PHOBIA_AND
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4. Manning-Geist B, Meyer F, Chen J, Pelletier A,
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5. Brooke T, Brown M, Orr R, Gough S. Stress
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6. Bear T, Dalziel J, Coad J, Roy N, Butts C, Gopal
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