Effect of examination stress on mood, performance and cortisol levels in medical students.

Stress produces definable mental and physiological reactions in the body. Mild stress is beneficial in cognitive tasks and performance but persistently high stress may lead to neuropsychiatric illnesses like anxiety and depression. Examinations act as stressor and activate hypothalamic-pituitary adrenal axis causing an increase in cortisol level, which is reflected in saliva. Present study was done on 35 medical students. Their mood parameters were assessed, using Depression Anxiety Stress Scale (DASS) scoring, and salivary cortisol levels using quantitative ELISA. Subjects were evaluated for mood parameters two times, one during relaxed state (with no examinations in preceding 2 weeks and in coming 2 weeks) and another during stressed state (on the day of viva voce examination). The levels of mood parameters and salivary cortisol were significantly raised during examination stress. The changes in stress level significantly correlated with change in levels of anxiety and salivary cortisol though there was no significant effect on the performance. Males and females showed similar changes in mood parameters. This study suggests that as examinations act as unavoidable stressors, the medical educators as well as students should be made aware of the negative consequences of stress faced during medical training. Efficient relaxation program as well as counseling services should be provided to stressed students so that they are able to cope better with examination stress.