Perceived Stress Levels in Pakistani Dental Students During COVID-19 Lockdown


  •   Hina Zafar Raja

  •   Muhammad Nasir Saleem

  •   Tayyaba Saleem

  •   Haroon Rashid

  •   Saroosh Ehsan

  •   Saman Hakeem

  •   Asif Hanif


Objective: The objective of this study is to assess the stress levels of Pakistani dental students through an established stress assessment tool during lockdown for COVID-19 pandemic.

Materials and methods: A cross-sectional quantitative study using a self-administered, voluntarily filled online questionnaire was conducted on undergraduate dental students from first to fourth (Final) years of dental institutes across Pakistan, accredited by the Pakistan Medical & Dental Council (PMDC). Study questionnaire contained questions on demographic details; gender, province of college, province of residence and perceived stress scale of 10 questions.  It also contained questions about the presence of any symptoms relevant to a particular type of stress. i.e. emotional stress, physical (body related) stress, behavioral stress and cognitive stress. Descriptive statistics were calculated for gender, residence of participants, location of institutes, levels of stress and symptoms signifying a particular stress type. Multiple variables of each stress type were compared with categories of perceived stress scores using chi square test.

Results: 706 dental students responded. 53.5% were going through high stress levels, 43.4% were going through moderate stress levels while 2.9% were having low stress levels. Majority of the participants with moderate and high stress levels were from institutions located in provinces with increased number of COVID-19 positive cases. Among moderate and highly stressed participants, more than 68% were females. A significant number of dental students reported symptoms pertaining to emotional, physical, cognitive and behavioral stress due to the COVID-19 disease.

Conclusion: Majority of Pakistani dental students are suffering from moderate to high stress levels specially in provinces with a higher number of COVID-19 affected reported cases. There are considerable effects on emotional, physical, cognitive and behavioral states of Pakistani dental students due to the spread of this disease.

Keywords: Students, Dental; Stress, Psychological; Pandemics; Infections; Academies and Institutes


Information about COVID-19/ Coronavirus in Pakistan. Available at:

Stress symptoms Available at:

Ahmad FA, Karimi AA, Alboloushi NA, et al. (2017) Stress Level of Dental and Medical Students: Comparison of Effects of a Subject-Based Curriculum versus a Case-Based Integrated Curriculum. Journal of Dental Education 81(5): 534-544.

Ahmed MA, Jouhar R, Ahmed N, et al. (2020) Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak. International Journal of Environmental Research and Public Health 17(8): 2821.

Arnsten AFT (2009) Stress signalling pathways that impair prefrontal cortex structure and function. Nature reviews. Neuroscience 10(6): 410-422.

Backer JA, Klinkenberg D and Wallinga J (2020) Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance 25(5): 2000062.

Basudan S, Binanzan N and Alhassan A (2017) Depression, anxiety and stress in dental students. Int J Med Educ 8: 179-186.

Buschman TJ and Miller EK (2007) Top-down versus bottom-up control of attention in the prefrontal and posterior parietal cortices. Science 315(5820): 1860-1862.

Cai H, Tu B, Ma J, et al. (2020a) Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID‑19) in Hubei, China. Med Sci Monit 26: e924171.

Cai Q, Yang M, Liu D, et al. (2020b) Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study. Engineering. DOI:

CDC (2020) Influenza (Flu): Weekly U.S. Influenza Surveillance Report. Available at: (accessed April 18).

Chen J (2020) Pathogenicity and transmissibility of 2019-nCoV-A quick overview and comparison with other emerging viruses. Microbes Infect 22(2): 69-71.

Coenen A and Flik G (2017) Effects of stress on behavior and sleep. Cortisol: a stress hormone and a wake hormone? Праці наукового товариства ім. Шевченка. Медичні науки.(49): 53-57.

Cohen S, Kamarck T and Mermelstein R (1983) A Global Measure of Perceived Stress. Journal of Health and Social Behavior 24(4): 385-396.

Collin V, Toon M, O'Selmo E, et al. (2019) A survey of stress, burnout and well-being in UK dentists. British Dental Journal 226(1): 40-49.

Denovan A, Dagnall N, Dhingra K, et al. (2019) Evaluating the Perceived Stress Scale among UK university students: implications for stress measurement and management. Studies in Higher Education 44(1): 120-133.

Duan L and Zhu G (2020) Psychological interventions for people affected by the COVID-19 epidemic. The Lancet Psychiatry 7(4): 300-302.

Guan W-j, Ni Z-y, Hu Y, et al. (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine 382(18): 1708-1720.

Heath JR, Macfarlane TV and Umar MS (1999) Perceived sources of stress in dental students. Dent Update 26(3): 94-98, 100.

Hewitt PL, Flett GL and Mosher SW (1992) The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample. Journal of Psychopathology and Behavioral Assessment 14(3): 247-257.

Ishaque MY, Farid H and Yasmeen S (2015) Perceived causes of stress among dental undergraduates at army medical college, Rawalpindi. Pakistan Oral & Dental Journal 35(1).

Kang L, Li Y, Hu S, et al. (2020) The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry 7(3): e14.

Khan NI (2015) VALIDITY ASSESSMENT OF COPING STYLES SCALE (CSS). Pakistan journal of psychology 46.

Lavoie JAA and Douglas KS (2012) The Perceived Stress Scale: Evaluating Configural, Metric and Scalar Invariance across Mental Health Status and Gender. Journal of Psychopathology and Behavioral Assessment 34(1): 48-57.

Lee E-H (2012) Review of the Psychometric Evidence of the Perceived Stress Scale. Asian Nursing Research 6(4): 121-127.

Li C-sR and Sinha R (2008) Inhibitory control and emotional stress regulation: neuroimaging evidence for frontal-limbic dysfunction in psycho-stimulant addiction. Neuroscience and biobehavioral reviews 32(3): 581-597.

Mariotti A (2015) The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future science OA 1(3): FSO23-FSO23.

Merriam-Webster (2020) Lockdown | Definition of Lockdown. Available at: (accessed April 6).

Ramirez MT and Hernandez RL (2007) Factor structure of the Perceived Stress Scale (PSS) in a sample from Mexico. Span J Psychol 10(1): 199-206.

Roberti JW, Harrington LN and Storch EA (2006) Further Psychometric Support for the 10-Item Version of the Perceived Stress Scale. Journal of College Counseling 9(2): 135-147.

Rogers MA, Lemmen K, Kramer R, et al. (2017) Internet-Delivered Health Interventions That Work: Systematic Review of Meta-Analyses and Evaluation of Website Availability. J Med Internet Res 19(3): e90.

Sahu P (2020) Closure of Universities Due to Coronavirus Disease 2019 (COVID-19): Impact on Education and Mental Health of Students and Academic Staff. Cureus 12(4): e7541.

Shah M, Hasan S, Malik S, et al. (2010) Perceived Stress, Sources and Severity of Stress among medical undergraduates in a Pakistani Medical School. BMC Medical Education 10(1): 2.

Shaikh B, Kahloon A, Kazmi M, et al. (2004) Students, stress and coping strategies: a case of Pakistani medical school. Education for Health 17(3): 346-353.

Spoorthy MS, Pratapa SK and Mahant S (2020) Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian Journal of Psychiatry 51: 102119.

System TS (2012) Sample Size Calculator. Available at: (accessed April 8).

T S (2015) Perceived sources of stress in the academic environment in undergraduate dental students. Thesis, Univerity Institute of Public Health, The University of Lahore.

Wind TR, Rijkeboer M, Andersson G, et al. (2020) The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interventions 20: 100317.

Wu KK, Chan SK and Ma TM (2005) Posttraumatic stress after SARS. Emerging infectious diseases 11(8): 1297-1300.

Zhai L, Zhang Y and Zhang D (2015) Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 49(11): 705-709.

Zhang L and Liu Y (2020) Potential interventions for novel coronavirus in China: A systematic review. Journal of Medical Virology 92(5): 479-490.


How to Cite
Raja, H. Z., Saleem, M. N., Saleem, T., Rashid, H., Ehsan, S., Hakeem, S., & Hanif, A. (2020). Perceived Stress Levels in Pakistani Dental Students During COVID-19 Lockdown. European Journal of Dental and Oral Health, 1(4).