Assessment of Dental Students’ Stress Level Using the Validated Pss-14 Questionnaire
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Abstract
Introduction: Stress is an important factor affecting education and clinical practice of dental students. The purpose of the present study was to assess stress levels of dental students using the validated PSS-14 questionnaire in Iran. Materials and Methods: A cross-sectional study was conducted in 2024 using stratified non-random sampling method on Iranian undergraduate dental students. Following ethical clearance, the concurrent validity of the DASS-21 and the PSS-14 questionnaires was assessed on a sample of dental students. The Persian version of the PSS-14 questionnaire in addition to demographic characteristics, history of COVID-19 vaccination status and systemic disease in student/family member was used for data collection electronically. Data was analyzed using SPSS ver. 26.0, descriptive and analytical analysis performed (p < 0.05). Results: In the first phase, 211 subjects responded and the concurrent validity was confirmed (r = 0.621, p < 0.001). In the second phase, 420 students replied 53.1% were female (n = 223) and 46.9% were male (n = 197), with a mean age of 23.5 (SD = 2.7) years. The mean stress score of the respondents was 26.7± 8.1 out of 56 (female: 43.14 (SD = 7.90) and male: 38.18 (SD = 7.54). There was a significant association between stress level and being female (B = -0.344, p = 0.000), having lower Grade Point Average (GPA) (B = -0.136, p = 0.008), having systemic disease in students’ family (B = 0.158, p = 0.001), and studying in Type I universities (B = -0.105, p = 0.036). Conclusion: PSS-14 and DASS-21 questionnaires exhibited high concurrent validity. In the post-COVID-19 era, stress levels were modest among dental students in Iran. There is a need for stress management training, especially for high-risk students. Keywords: COVID-19; Students; Dental; Pandemics; Stress disorders; Post-traumatic.
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19. Jain P, Jandu K. A comparative study of school adjustment of adolescent girls and boys of employed and non-employed mothers in age group 14–18 years. Journal of Education Research and Extension. 1998;35(2):14-21.
20. Rabiei M, Samami M, Ramzi A. Iranian dental students’ distress level and attitude towards their professional Future following the COVID-19 pandemic (2020). Journal of Occupational Health and Epidemiology. 2021;10(4):249-57. doi: 10.52547/johe.10.4.249.
21. Vanderlinden J. Young informal carers in higher education: The impact of care responsibilities on mental health. European Journal of Public Health. 2025 Oct;35(Supplement_4):ckaf161-1457.
22. Çimenli Y, Aydemir C, Cengiz C, Kartal M, Encu M, Arslantaş G, Madi S, Boşnak Ş, Asadi S, Kılıç EB, Atadağ YB. Perceived Stress among First-and Sixth-Year Medical Students: A Cross-Sectional Analysis of Sociodemographic Correlations. Journal of Medical Education and Family Medicine. 2026 Apr 4;3(1):23-30.
23. Al-Roomy M. Assessing the correlation between perceived stress and academic achievement among health sciences students. Frontiers in Medicine. 2025;12:1734838.
24. Eames D, Thomas S, Norman K, Simanton E, Weisman A. Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine. BMC Medical Education. 2024 Mar 29;24(1):348.
25. Drachev SN, Stangvaltaite-Mouhat L, Bolstad NL, Johnsen JA, Yushmanova TN, Trovik TA. Perceived stress and associated factors in Russian medical and dental students: a cross-sectional study in north-west Russia. International Journal of Environmental Research and public health. 2020 Aug;17(15):5390. doi: 10.3390/ijerph17155390.
26. Šorgo A, Crnkovič N, Cesar K, Selak Š, Vrdelja M, Gabrovec B. The influence of anxiety and fear of COVID-19 on vaccination hesitancy among postsecondary students. Scientific Reports. 2022 Nov 29;12(1):20564. doi: 10.1038/s41598-022-25221-2.
27. Ye W, Ye X, Liu Y, Liu Q, Vafaei S, Gao Y, et al. Effect of the novel coronavirus pneumonia pandemic on medical students’ psychological stress and its influencing factors. Frontiers in Psychology. 2020;11:548506. doi: 10.3389/fpsyg.2020.548506.
2. Wang X, Zhang N, Pu C, Li Y, Chen H, Li M. Anxiety, depression, and PTSD among college students in the post-COVID-19 era: a cross-sectional study. Brain Sciences. 2022;12(11):1553. doi: 10.3390/brainsci12111553.
3. Loch C, Kuan IB, Elsalem L, Schwass D, Brunton PA, Jum'ah A. COVID‐19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact. Journal of Dental Education. 2021;85(1):44-52. doi: 10.1002/jdd.12402.
4. Sreeram M, Mundada MA. Survey to assess perceived causes of stress, its manifestations and coping strategies among dental college students in Maharashtra during COVID-19 lockdown. Biomedical and Pharmacology Journal. 2021;14(1):53-60. doi: 10.13005/bpj/2098
5. Nguyen TTT, Seki N, Morio I. Stress predictors in two Asian dental schools with an integrated curriculum and traditional curriculum. European Journal of Dental Education. 2018;22(3):e594-e601. doi: 10.1111/eje.12358.
6. Shadman, N., Raoof, M., Hoseinifar, R., Torabi, M., Haghani, J., Mohammad-Alizadeh, S., Mahdian, M. Evaluation of stressors in various dentistry departments in Kerman University of Medical Sciences, Iran, in the academic year of 2015-2016: A cross-sectional study. Journal of Oral Health and Oral Epidemiology, 2020; 9(2): 73-79. doi: 10.22122/johoe.v9i2.1042.
7. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of health and social behavior. 1983 Dec 1:385-96.
8. Maroufizadeh S, Zareiyan A, Sigari N. Psychometric properties of the 14, 10 and 4-item “Perceived Stress Scale” among asthmatic patients in Iran. Payesh (Health Monitor). 2014;13(4):457-65.
9. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy. 1995;33(3):335-43. doi: 10.1016/0005-7967(94)00075-U.
10. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Journal of Iranian Psychologists. 2005; 1 (4).
11. Donyavi T, Holakouie Naieni K, Nedjat S, Vahdaninia M, Najafi M, Montazeri A. Socioeconomic status and mortality after acute myocardial infarction: a study from Iran. International Journal for Equity in Health 2011 10:9. ed doi:10.1186/1475-9276-10-9.
12. Zrineh A, Al-Usta M, Alwawi A. Sampling methods and sample size determination in clinical research: an educational review. Journal of General and Family Medicine. 2026 Jan 2;27(1): e70096. doi: 10.1002/jgf2.70096. PMID: 41696722; PMCID: PMC12897549.
13. Du X, Liu X, Zhao Y, Wang S. Psychometric testing of the 10-item perceived stress scale for Chinese nurses. BMC nursing. 2023;22(1):430. doi: 10.1186/s12912-023-01602-4.
14. Andreou E, Alexopoulos EC, Lionis C, Varvogli L, Gnardellis C, Chrousos GP, et al. Perceived stress scale: reliability and validity study in Greece. International Journal of Environmental Research and Public Health. 2011;8(8):3287-98. doi: 10.3390/ijerph8083287.
15. Reyes M, Resuento AD, Ripalda A. Evaluating the psychometric properties of Cohen’s Perceived Stress Scale in the context of Filipino college students in the height of the COVID‑19 pandemic. Asian J Educ Soc Stud. 2023;49(3):199‑213. doi: 10.9734/AJESS/2023/v49i31148
16. Jowkar Z, Masoumi M, Mahmoodian H. Psychological stress and stressors among clinical dental students at Shiraz School of Dentistry, Iran. Advances in Medical Education and Practice. 2020:113-20. doi: 10.2147/AMEP.S236758
17. Alamoush RA, Al-Sawaeir S, Baker DA, Aljamani SA, Alomoush SA, Al-Omiri MK. Stress experienced by dental students performing clinical training in different dental disciplines: a cross-sectional study. Journal of Occupational Health. 2024;66(1):uiae006. doi: 10.1093/joccuh/uiae006.
18. Randall SE, Seastedt H, Abazari SM, Aguilar L, Feffer M, Thilges S. Stress and resilience among first-year medical students: a cross-sectional application of the medical student stress scale. BMC Med Educ. 2026 May 2;26(1):999. doi: 10.1186/s12909-026-08883-8. PMID: 42067863; PMCID: PMC13281592.
19. Jain P, Jandu K. A comparative study of school adjustment of adolescent girls and boys of employed and non-employed mothers in age group 14–18 years. Journal of Education Research and Extension. 1998;35(2):14-21.
20. Rabiei M, Samami M, Ramzi A. Iranian dental students’ distress level and attitude towards their professional Future following the COVID-19 pandemic (2020). Journal of Occupational Health and Epidemiology. 2021;10(4):249-57. doi: 10.52547/johe.10.4.249.
21. Vanderlinden J. Young informal carers in higher education: The impact of care responsibilities on mental health. European Journal of Public Health. 2025 Oct;35(Supplement_4):ckaf161-1457.
22. Çimenli Y, Aydemir C, Cengiz C, Kartal M, Encu M, Arslantaş G, Madi S, Boşnak Ş, Asadi S, Kılıç EB, Atadağ YB. Perceived Stress among First-and Sixth-Year Medical Students: A Cross-Sectional Analysis of Sociodemographic Correlations. Journal of Medical Education and Family Medicine. 2026 Apr 4;3(1):23-30.
23. Al-Roomy M. Assessing the correlation between perceived stress and academic achievement among health sciences students. Frontiers in Medicine. 2025;12:1734838.
24. Eames D, Thomas S, Norman K, Simanton E, Weisman A. Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine. BMC Medical Education. 2024 Mar 29;24(1):348.
25. Drachev SN, Stangvaltaite-Mouhat L, Bolstad NL, Johnsen JA, Yushmanova TN, Trovik TA. Perceived stress and associated factors in Russian medical and dental students: a cross-sectional study in north-west Russia. International Journal of Environmental Research and public health. 2020 Aug;17(15):5390. doi: 10.3390/ijerph17155390.
26. Šorgo A, Crnkovič N, Cesar K, Selak Š, Vrdelja M, Gabrovec B. The influence of anxiety and fear of COVID-19 on vaccination hesitancy among postsecondary students. Scientific Reports. 2022 Nov 29;12(1):20564. doi: 10.1038/s41598-022-25221-2.
27. Ye W, Ye X, Liu Y, Liu Q, Vafaei S, Gao Y, et al. Effect of the novel coronavirus pneumonia pandemic on medical students’ psychological stress and its influencing factors. Frontiers in Psychology. 2020;11:548506. doi: 10.3389/fpsyg.2020.548506.
| Files | ||
| Issue | Vol 13, No 3 (Summer 2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| COVID-19; Students; Dental; Pandemics; Stress disorders; Post-traumatic. | ||
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How to Cite
1.
Salimian S, Pakdaman A, Aalaei S, Kharrazifard MJ. Assessment of Dental Students’ Stress Level Using the Validated Pss-14 Questionnaire. J Craniomaxillofac Res. 2026;13(3):352-359.
