Association between Teaching and Learning Related Stressor and Anxiety Level among Medical Students during COVID-19 Pandemic


  • Melia Fatrani Rufaidah Universitas Indonesia
  • Helda Helda Universitas Indonesia
  • Sarah At Tauhidah Syarif Hidayatullah State Islamic University Jakarta


Background: The COVID-19 pandemic has led to various impacts on public health, one of which is the mental health of medical students who are recognized as an at-risk group for developing anxiety disorders due to the teaching and learning system that has changed dramatically. This study aimed to assess the relationship between teaching and learning-related stressor (TLRS) and their anxiety levels during the COVID-19 pandemic.

Subjects and Method: This was a cross-sectional study. The population was medical students at the Faculty of Medicine, Syarif Hidayatullah State Islamic University Jakarta, Indonesia, during September-October 2021. Sampling was carried out using purposive sampling. The dependent variable was anxiety levels during the COVID-19 pandemic. The independent variable was teaching and learning-related stressor based on Medical Student Stressor Questionnaire (MSSQ) instrument. The data were collected through questionnaires and analyzed by Cox proportional regression.

Results: A half of medical students experienced anxiety (50.4%), but the data shows a non-significant difference when controlled with other stressor variables (Adjusted PR= 1.485; 95% CI= 0.71 to 2.97; p= 0.300).

Conclusion: There is no significant relationship between teaching and learning-related stressor and anxiety level among Medical Students during COVID-19 pandemic.

Keywords: mental health, anxiety, stressor, COVID-19, medical students


Helda. Department of Epidemiology, Faculty of Public Health Universitas Indonesia. A Building 1st Floor Kampus Baru UI Depok 16424. E-mail: Phone: +6285216688437

Journal of Health Promotion and Behavior (2021), 06(04): 263-271

Author Biographies

Melia Fatrani Rufaidah, Universitas Indonesia

Departemen of Epidemiology, Faculty of Public Health

Helda Helda, Universitas Indonesia

Departemen of Epidemiology, Faculty of Public Health

Sarah At Tauhidah, Syarif Hidayatullah State Islamic University Jakarta

Department of Community Medicine, Faculty of Medicine


Abdulghani HM, Sattar K, Ahmad T, Akram A (2020). Association of COVID-19 pandemic with undergraduate medical students’ perceived stress and coping. Psychol Res Behav Manag. 13, 871-881. DOI: 10.2147/PRBM.S276¬9-38

AL-Husban N, Alkhayat A, Aljweesri M, Al-har¬bi R, Aljazzaf Z, Al-Husban N, Elmuhtaseb MS, et al. (2021). Effects of COVID-19 pandemic on medical students in Jordanian universities: A multi-center cross-sectional study. Ann Med Surg (Lond). 67, 1-8. DOI: 10.1016/j.amsu.2021.102466

Bassi M, Negri L, Delle Fave A, Accardi R (2021). The relationship between post-traumatic stress and positive mental health symptoms among health workers during COVID-19 pandemic in Lombardy, Italy. J Affect Dis. 280, 1–6. DOI: 10.1016/j.jad.2020.11.065

Bolatov AK, Seisembekov TZ, Askarova, AZ, Baikanova RK, Smailova DS, Fabbro E (2021). Online-Learning due to COVID-19 Improved Mental Health Among Medical Students. Med Sci Educ. 31, 183–192. DOI: 10.1007/s4-0670-020-01165-y

Dadds MR, Vasey MW (2001). The developmental psychopathology of anxiety. New York, NY: Oxford University Press Inc. DOI: 10.1093/med:psych/9780195123630.001.0001

Dhahri AA, Arain SY, Memon AM, Rao A, Medical Education Pakistan collabolator group, Mian MA (2020). The psyc-hological impact of COVID-19 on medical education of final year students in Pakistan: A cross-sectional study. Ann Med Surg. 60, 445–450. DOI: 10.1016/j.amsu.2020.11.025

Fares J, Al Tabosh H, Saadeddin Z, El Mouhayyar C, Aridi H (2016). Stress, burnout and coping strategies in preclinical medical students. North Am J Med Sci. 8(2), 75-81. DOI: 10.4103/1947-2714.177299.

Guo AA, Crum MA, Fowler LA (2021). Asses¬sing the psychological impacts of COVID-19 in undergraduate medical students. Int. J. Environ. Res. Public Health. 18, 2952. DOI: 10.3390/ijer-ph18062952

Kuman Tunçel Ö, Taşbakan SE, Gökengin D, Erdem HA, Yamazhan T, Sipahi OR, Pullukçu H, et al. (2021). The deep impact of the COVID-19 pan-demic on medical students: An online cross-sectional study evaluating Turkish students’ anxiety. Int J Clin Pract.

, 1–9. DOI: 10.1111/ijcp.14139

Lasheras I, Gracia-Garcia P, Lipnicki D, Bue¬no-Notivol J, López-Antón R, de la Cámara C, Lobo A, et al. (2020). Prevalence of anxiety in medical students during the COVID-19 pandemic: A rapid systematic review with meta-analysis. Int. J. Environ. Res. Public Health. 17, 6603. DOI: 10.33-90/ijerph17186603

Madhyastha S, Latha KS, Kamath A (2014). Stress, Coping and Gender Differences in Third Year Medical Students. J Health Manag. 16(2), 315–326. DOI: 10.1177/0972063414526124

Manning-Geist B, Meyer F, Chen J, Pelle¬tier A, Kosman K, Chen X, Johnson NR (2020). Pre-clinical Stress Management Workshops Increase Medical Students’ Knowledge and Self-awareness of Coping with Stress. Med Sci Edu. 30, 235–241. DOI: 10.1007/s40-670-019-00881-4

Mofatteh M (2021). Risk factors associated with stress, anxiety, and depression among university undergraduate students. AIMS Public Health. 8(1), 36–65. DOI: 10.3934/public health.2021-004

Natalia D and Syakurah RA (2021). Mental health state in medical students during COVID-19 pandemic. J Educ Health Promot. 10, 208. DOI: 10.4103/jehp.jehp_1296_20

O’Byrne L, Gavin B, Adamis D, Lim YX, McNicholas F (2021). Levels of stress in medical students due to COVID-19. J Med Ethics. 47, 383–388. DOI: 10.1136/medethics-2020-107155

Pokhrel NB, Khadayat R, Tulachan P (2020). Depression, anxiety, and burn out among medical students and residents of a medical school in Nepal: A cross-sectional study. BMC Psychiatry. 20, 298. DOI: 10.1186/s12-888-020-02645-6

Quek TTC, Tam WWS, Tran BX, Zhang M, Zhang Z, Ho CSH, Ho RCM (2019). The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis Int. J. Environ. Res. Public Health. 16, 2735. DOI: 10.3390/ijer-ph16152735

Ramdan IM (2019). Reliability and Validity Test of the Indonesian Version of the Hamilton Anxiety Rating Scale (HAM-A) to Measure Work-related Stress in Nursing. Jurnal Ners. 14(1), 33. DOI: 10.20473/jn.v14i1.10673

Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M (2003). Mind-fulness-Based Stress Reduction Lowers Psychological Distress In Medical Students. Teach Learn Med. 15(2), 88–92. DOI: 10.1207/S15328015¬TL-M1502_03

Saravanan C and Wilks R (2014). Medical Students’ Experience of and Reaction to Stress: The Role of Depression and Anxiety. Sci World J. 2014, 1–8. DOI: 10.1155/2014/737382

Satuan Tugas Penanganan COVID-19 (20-21). Analisis Data COVID-19 Indonesia: per 22 Agustus 2021. Available from:

Schiller JH, Stansfield RB, Belmonte DC, Pur¬¬kiss JA, Reddy RM, House JB, Santen SA (2018). Medical Students Use of Different Coping Strategies and Relationship With Academic Performance in Preclinical and Clinical Years. Teach Learn Med. 30(1),

–21. DOI:10.1080/10401334.2017.134706

Tsegay L, Shumet S, Damene W, Gebreeg-ziabhier G, Ayano G (2019). Prevalence and determinants of test anxiety among medical students in Addis Ababa Ethiopia. BMC Med Educ. 19(1), 423. DOI: 10.1186/s12909-019-1859-5

Yusoff MSB, Rahim AFA, Yaacob, MJ (2010). The development and validity of the medical student stressor questionnaire (MSSQ). ASEAN Journal of Psychiatry, 11(1), 13–24




How to Cite

Rufaidah, M. F., Helda, H., & Tauhidah, S. A. (2022). Association between Teaching and Learning Related Stressor and Anxiety Level among Medical Students during COVID-19 Pandemic. Journal of Health Promotion and Behavior, 6(4), 263–271. Retrieved from