Research Article
Open Access
Effect of examination stress on Autonomic functions,
Eating behavior and Quality of life in Dental students
with Type D personality
Aneesa Safiya1, Kumar Sai Sailesh2*, Amarnath P3, Movva Swathi4, Siri Chandana1,
KrovvidiSaiVivek1, Sudhakar Reddy R5 and SuseelammaD6
1First Year BDS Student, Vishnu Dental College, Bhimavaram, West Godavari District, India
2Assistant Professor & HOD (I/C), Department of Physiology, Vishnu Dental College, Bhimavaram, West Godavari
District, India
3Lecturer, Department of Anatomy, Vishnu Dental College, Bhimavaram, West Godavari District, India
4Lecturer, Department of Physiology, Vishnu Dental College, Bhimavaram, West Godavari District, India
5Professor & HOD, Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, West Godavari District, India
6Professor & HOD, Department of Anatomy, Vishnu Dental College, Bhimavaram, West Godavari District, India
*Corresponding author: SaiSailesh Kumar G, Assistant Professor & HOD (I/C), Department of Physiology, Vishnu Dental College, Bhimavaram, West
Godavari District, India, E-Mail:
@
Received: July 24, 2018; Accepted: August 6, 2018; Published: August 10, 2018
Citation: Sai Sailesh K, Aneesa S, Chandana S, Sai Vivek K, Amarnath P, Swathi M, et al. (2018) Effect of examination stress on Autonomic functions, Eating behavior and Quality of life in Dental students with Type D personality. J Adv Res Biotech 3(2):1-4. DOI:
http://dx.doi.org/10.15226/2475-4714/3/2/00135
Abstract
Dental education was reported to be stressful and higher levels of stress were reported in dental students when compared with the general population of same age groups. Individuals with higher levels of negative affectivity (more negative feelings) and social inhibition (those do not
share the emotions with others) are labeled as Type D personality. The present study was undertaken to observe the effect of examination stress on
autonomic functions, eating behavior and quality of life in dental students with type D personality. 64 apparently healthy students belonging to the
first year of the BDS course who were willing to participate voluntarily, were included in the study. Based on the scores of DS 14 of the questionnaires,
they were grouped into Type-D and Non-Type D. After grouping them, rest of the data was collected using standard methods mentioned in the
literature. Data was collected during pre examination period that is 48 hours before the practical examinations. There was no significant difference
in the demographic data of type D and non type D individuals. Perceived stress score was significantly high in type D personalities when compared
with non-type D personalities (P< 0.05). Systolic BP (P< 0.05), Diastolic BP (P< 0.001) and heart rate (P< 0.001) was significantly higher in type
D personalities when compared with non-type D personalities. EAT-26 scores were not significantly different among type D and non type D
individuals. Physical health score, psychological health, social relationships and environmental scores were lower in type D personalities when
compared with non-type D personalities. However, the difference was not statistically significant. In conclusion, there was a significant higher level
of stress, impaired autonomic function in individuals with type D personality during pre examination period. Eating behavior and quality of life was
not significantly different among type D and non type D personalities. We recommend further detailed, multi centre studies to understand and to
develop effective coping mechanisms for management of type D personalities in general.
Key words: Examination stress; type D personality; Dental students; Quality of life
Introduction
Dental education was reported to be stressful and higher
levels of stress were reported in dental students when compared
with the general population of same age groups [1]. Long-term
stress may causes deleterious effects on different body systems
and reduces the physical and mental well being of the students,
which further decrease their academic performance and quality
of life [2]. Examination is a well known stressor to any student
population and in dental education fear of failure was reported
to be the most frequent cause of stress during the examinations.
Hence, it is the need of time to diagnose the students who are
highly stressed and help him to cope-up with the stress by
effective methods. Individuals with higher levels of negative
affectivity (more negative feelings) and social inhibition (those
do not share the emotions with others) are labeled as Type D
personality [3]. Higher levels of depression, anxiety and stress
were reported in Type D individuals when compared to nontype
D [4]. Further, it was reported that the two components of
type D personality are risk factors for development of coronary
heart diseases. In these individuals the activity of sympathetic
system was very high and the activity of parasympathetic system
was decreased. This leads to increased activity of cardio vascular
system and persistent hypertension that leads to cardio vascular
disorders [5, 6]. It is well known that stress alters the eating
behavior like change in the food preferences and eating food with
high calories etc. This results in increase in the body weight and
body fat mass and eventually obesity [7, 8]. Prolonged and poorly
managed stress leads to increase in the cortisol levels which are
responsible for alteration in the eating behavior [8]. High levels of
stress effects all the systems of the body and deteriorates the body
functioning and decreases the quality of life [9,10].The present
study was undertaken to observe the effect of examination stress
on autonomic functions, eating behavior and quality of life in
dental students with type D personality.
Materials and Methods
Study population
64 apparently healthy students belonging to the first year
of the BDS course, who were willing to participate voluntarily,
were included in the study. Students suffering from any diseases,
those under any kind of therapy or treatment or practicing
any stress management method were excluded from the study.
After recruiting to the study, one copy of DS-14 questionnaire
(questionnaire to assess Type-D personality) was given to
the students and they were asked to fill it and handover to the
researchers. Based on the scores of the questionnaires, they
were grouped into Type-D and Non-Type D. The grouping was
not disclosed to students in the group, however, the details
was informed them individually after collection of data and
also started training them with effective coping methods. After
grouping them, rest of the data was collected using standard
methods mentioned in the literature. Data was collected during
pre examination period that is 48 hours before the practical
examinations.
Study setting
The present cross-sectional study was conducted at
Department of Physiology, Vishnu dental college, Bhimavaram,
West Godavari District, Andhra Pradesh.
Assessment of stress
Stress levels were assessed by using a perceived stress scale
which is standard questionnaire [11].
Assessment of autonomic functions
Blood pressure and heart rate was recorded using JSB fully
automatic upper arm style Blood Pressure Monitor (Model:
DBP05 digital arm BP monitor).
Eating behavior
The EAT-26 was used to assess the eating behavior [12].
Assessment of quality of life
The WHOQOL BREF questionnaire is used to assess the
quality of life [13]. This was a standardized tool to assess quality
of life prepared by World Health Organization. Prior permission
was obtained to use the questionnaire from WHO.
Ethical consideration
The study was approved by the Scientific Review Board of
Vishnu Dental College, Bhimavaram. Written informed consent
was obtained from all the participants after explaining the need
of the study and clarifying their doubts. Confidentiality of the
data was ensured.
Data analysis
Data was analyzed using SPSS 20.0. Student t test was used
to observe the significance of difference between the groups. P
value less than 0.05 was considered as significant.
Results
Table 1 presents the demographic data of the participants.
There was no significant difference in the demographic data
of type D and non type D individuals. Table 2 presents data of
perceived stress, Blood Pressure, heart rate, EAT-26. Perceived
stress score was significantly high in type D personalities when
compared with non-type D personalities (P< 0.05). Systolic BP
(P< 0.05), Diastolic BP (P< 0.001) and heart rate (P< 0.001) was
significantly higher in type D personalities when compared with
non-type D personalities. EAT-26 scores were not significantly
different among type D and non type D individuals. Physical
health score, psychological health, social relationships and
environmental scores were lower in type D personalities when
compared with non-type D personalities. However, the difference
was not statistically significant.
Table 1: Demographic data of the participants
Parameter |
Type- D |
Non-Type-D |
P value |
Age (years) |
18.62 ± 1.44 |
19.21 ± 2.12 |
0.1976 |
Height (cm) |
156.4 ± 3.28 |
158.29 ± 4.96 |
0.0771 |
Weight(kg) |
52.43 ± 4.72 |
53.38 ± 2.12 |
0.3030 |
Data was presented as mean ±SD. * P< 0.05 is significant, **P< 0.01 is significant, ***P< 0.001 is significant.
Table 2: Perceived stress, autonomic functions and eating behavior among Type D and Non Type D personalities
Parameter |
Type- D |
Non-Type-D |
P value |
Perceived stress score |
21.06 ± 6.82 |
16.94 ± 5.55 |
0.01* |
Systolic BP (mmHg) |
129 ± 16.17 |
119 ± 18.24 |
0.0236* |
Diastolic BP (mmHg) |
82 ± 13.44 |
69 ± 15.6 |
0.0007*** |
Heart rate (beats/min) |
92 ± 6.12 |
74 ± 8.48 |
0.0001*** |
Eat-26 |
18.06±10.10 |
15.44 ± 7.72 |
0.2474 |
Data was presented as mean ±SD. * P< 0.05 is significant, **P< 0.01 is significant, ***P< 0.001 is significant.
Table 3: Quality of life among Type D and Non Type D personalities
Parameter |
Type- D |
Non-Type-D |
P value |
Physical health score (T1) |
67.78 ± 12.22 |
70.28 ± 10.50 |
0.3835 |
Psychological score (T2) |
52.84 ± 8.08 |
56.25 ± 7.98 |
0.0949 |
Social relationship score (T3) |
63.19 ± 12.91 |
65.81 ± 11.44 |
0.3925 |
Environmental score (T4) |
63.25 ± 13.97 |
64.38 ± 12.99 |
0.7398 |
Data was presented as mean ±SD. * P< 0.05 is significant, **P< 0.01 is significant, ***P< 0.001 is significant.
Discussion
Personality plays a key role in the professional education as
it specifies the relationship and behavior of an individual with
his co-workers, patients and students. Type D personality is
specific as it has higher levels of negative emotions and also social
inhibition. Hence, it must be diagnosed in early stages to prevent
further damage to the body systems. The prevalence of type D
personality was reported to be 31.3 percentages in professional
students [23].The morbidity and mortality related to cardiac
disorders was reported to be higher in type D personality when
compared to general population [14]. In fact, it was reported that
the prevalence of cardiac diseases is 4.7 times greater in type
D personalities when compared with non-type D [15]. Earlier
studies reported that the activity of sympathetic system was
higher and activity of parasympathetic system was decreased
leading to autonomic imbalance [16]. Examinations are
considered as natural stress for all students. In the present study
we have used standardized scale DS14 to identify the individuals
with type D personality and observed the stress, autonomic
functions, eating behavior and quality of life and compared
with non type D personality during examination period. There
was significantly higher stress and higher blood pressure and
heart rate in type D individuals. Eating behavior scores was not
significantly different among type D and non-type D individuals.
The scores of four domains of quality of life was lower in type
D personalities, however, the difference was not statistically
significant. This may be due to lower sample size.
Earlier studies reported that the type D personalities have
higher levels of stress and they practices mal coping methods
to relieve stress like withdraw from the competition or course
and resignation from job. These methods will further increases
stress levels and may leads to burnout. It was reported that in
type D individuals there was poor glucose regulation, systemic
inflammation and impaired autonomic functions [17]. Further
there was sleep disturbances and lack of social support in type
D personalities [17]. Interestingly, it was reported that insomnia
was associated with decreased heart rate variability and disturbed
autonomic balance [18]. The present study results support these
studies as we have observed significantly higher BP and heart
rate in type D individuals. Impaired autonomic functions was
further related to less context appropriate emotional responses,
social threat and social anxiety [19,20]. Further, decreased
vagal activity also contributes to poor health outcomes in type
D individuals. Vagus nerve innervates different systems of the
body and transmits the information about the immune status
and blood glucose levels [18]. Earlier studies reported that type
D personality individual’s posses more unhealthy behavior and
less healthy behavior when compared with general population
[21]. As there is impairment in autonomic functions the type D
individuals may not be able to regulate the visceral functions
effectively and this has a negative impact on homeostasis and
contributes in decrease in the quality of life. It was reported that
there was decrease in the quality of life in type D personality
individuals when compared with healthy individuals [22]. Hence,
changing the life style may improve the quality of life in these
individuals. As type D personalities has higher stress at rest
itself, during the examinations it may still increases and provoke
them to adopt mal coping methods like alcohol consumption
or sometimes suicides. Hence, it is need of time to consider the
assessment of type D personality and help them to cope up with
effective methods.
Limitations
A significant limitation of the current study is lower sample
size and study was conducted at one centre, which limits
generalization of the results.
Conclusion
In conclusion, there was a significant higher level of
stress, impaired autonomic function in individuals with type D
personality during pre examination period. Eating behavior and
quality of life was not significantly different among type D and
non type D personalities. We recommend further detailed, multi
centre studies to understand and to develop effective coping
mechanisms for management of type D personalities in general.
Acknowledgement
We sincerely thank Dr M. C. Suresh Sajjan, Principal and Dr
Venkata Rama Raju. A, Vice-Principal, Vishnu dental college, for
their extensive support and co-operation throughout the study.
Our special thanks to the management of Vishnu Dental College
for providing necessary facilities for the study. We would like
to acknowledge the support of JSB Health Care, New Delhi, for
sponsoring the Digital BP apparatus for the study.
Source of funding
Self
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