|SURVEY STUDY: ORIGINAL ARTICLE
|Year : 2021 | Volume
| Issue : 3 | Page : 181-188
A preliminary study on correlation between stress and Satva sara among students of ayurveda college
Resmy A Raj1, M Abhilash2, Chitra M Gawande1, Jeevan Jagadeesh Kulkarni3
1 Department of Shareera Kriya, SDM Institute of Ayurveda and Hospital, Bengaluru, Karnataka, India
2 Department of Shareera Kriya, Government Ayurveda College, Tripunithura, Kerala, India
3 Department of Samhitha and Sidhantha, SDM Institute of Ayurveda and Hospital, Bengaluru, Karnataka, India
|Date of Submission||28-Aug-2020|
|Date of Decision||18-Apr-2021|
|Date of Acceptance||21-Apr-2021|
|Date of Web Publication||25-Sep-2021|
Resmy A Raj
Department of Shareera Kriya, SDM Institute of Ayurveda and Hospital, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Stress is a physical, mental, or emotional factor that causes physical or psychological tension. Various researches conducted in the field of stress revealed that stress is the common inhibitor on academic performances and students in professional colleges exposes to higher levels of stressors than their peers. In addition to stressors of everyday life, the medical students must deal with stressors such as examinations, chances of failure, lack of leisure time, workload, relationships with peers, etc. Therefore, early detection and estimation of stress and its intervention is very much essential to prevent or minimize the effects of distress on the students in future. Methods: 200 students of 1st and 2nd year BAMS were selected for the study. Their stress as evaluated with perceived stress scale-10. Satva sara was evaluated with a validated Satvasara assessment tool. Statistical tests were employed to find out the prevalence of stress and correlational studies were conducted to find out the relationship between stress and Satvasarata. Results and Conclusion: About 80% of Ayurveda College students were recorded as having moderate stress, 6% has mild and remaining 14% suffer from high perceived stress. A significant negative correlation is found in between stress and Satvasara with a spearman's correlation coefficient of - 0.332 and P < 0.001. Implementing methods to enhance the Satvasara of subjects with behavioral therapies like chanting mantra, yoga, meditation, pranayama could be more useful and effective in controlling stress among medical students.
Keywords: Perceived stress scale scores, Rajas, Satva, Satvasara, stress, Tamas
|How to cite this article:|
Raj RA, Abhilash M, Gawande CM, Kulkarni JJ. A preliminary study on correlation between stress and Satva sara among students of ayurveda college. J Ayurveda 2021;15:181-8
|How to cite this URL:|
Raj RA, Abhilash M, Gawande CM, Kulkarni JJ. A preliminary study on correlation between stress and Satva sara among students of ayurveda college. J Ayurveda [serial online] 2021 [cited 2021 Dec 1];15:181-8. Available from: http://www.journayu.in/text.asp?2021/15/3/181/326716
| Introduction|| |
Stress is a physiological response of an organism to any demand from the external environment. It is the sum of the physical and psychological tensions on a person that developed due to negative effects of life pressures and events. Physical and mental health are affected adversely by major life changes like the death of a close family member, personal injury or illness, change in financial state, etc., and also by day to day experiences like conflicts with family, relationship problems, changes in sleeping or eating habits, change in residence or schools, etc.
Research conducted by American College Health Association found out that stress is the most commonly reported obstacle to academic performance among college students. Various studies across the globe have highlighted that the students who are in professional courses, such as medical and engineering streams are facing higher stress compared to their peers from any other courses. The estimated prevalence of stress in modern medical students is 71.9% in Saudi Arabian Medical School, 31.2% in the British universities, 41.9% in Malaysian medical school and 61.4% in a Thai medical school.
Main stressors in the academic sector include high academic ambitions, vast syllabus, financial difficulties, peer pressure, problems in romantic relations, difficulties managing personal and academic life, long hours of rote learning, semester grading system, high expectations of parents, concern about the future jobs, homesickness, etc. Stress has been found to be associated with anxiety, sleep problems and lower academic performance. It was also reported to decrease concentration, impede decision-making, and reduce student's abilities to establish good relationships with patients resulting in the feeling of dissatisfaction with clinical practice in the future. These facts confirmed the association of distress with mental, emotional, and physical morbidity. Such situations perpetually affect patients' lives and the health of the community.
The experience of too much stress over time can have adverse consequences on the physiological system and produce ailments like increase heart rate and blood pressure, tension, migration type of headache and it also can affect brain-gut communication, may trigger pain, bloating and other gut discomfort too. Studies have also shown that short-term stress can boost the immune system, but chronic stress has a significant negative effect on the immune system as it raises catecholamine and suppress T-cells levels, which suppress the immune system.
Different behavioral therapies have already been practiced for the reduction of stress like meditation, pranayama, breathing exercises, mantra chanting, etc. These therapies definitely meant to enhance the Satvaguna (qualities of mind) of the individual and thus help in building mindfulness. Ayurveda describes life as the complex combination of Sharira (body), Indriya (senses), Satva (mind), and Atma (soul). Knowledge occurs when self (Atma), mind (Manas), sense organs (Indriya) and objects (Indriyartha) are connected in sequence. Satva (equanimity), Rajas (activity), and Tamas (inactivity) are identified as Mano guna (quality of mind). Mano doshas (Raja and Tamas) are responsible for the attachment of self to worldly pleasures. Just as synchronization of tridoshas produce physical health, harmony of triguna produces mental health. Satvaguna always accompanies rajas and tamogunas for normal functioning of mind.
Features of Satvasara also signify that ideal Manasaprakruti is having a predominance of Satva then Rajas and then Tamas. Acharya Charaka has explained 13 Satvasara lakshanas in Vimanasthana of Charakasamhita. Smriti (memory), Bhakti (devotion and submission to one's commitment), Krutanja (gratefulness), Prajna (interest to update knowledge), Suchi (Cleanliness in body, speech and in mind), Suvyavasthitagati (ability of a person to concentrate on work till its completion), Gambheerabuddhicheshta (decision making and problem-solving capacity) and Kalyanaabhinivesham (positive attitude) of Satvasara is contributed by Satvaguna and Mahotsaha (Enthusiasm to do the activities), Daksha (Skillful), Dheera (Courageous) and Samara vikranta (constant and steady efforts to win) contributed by Rajoguna. Ignorance is attributed to Tamoguna. Tamoguna helps a person to ignore unpleasant emotions and this is vital for the maintenance of normal mental health.
The imbalance of satva, rajas and Tama from the normalcy of psychic functions may lead to Mano vikaras (psychic disease). Among the Ashtavidha dhatu sara pareeksha, examination of Satva sara gives inference of mental health. Satvasarata is of 3 types: Pravara (high), Madhya (moderate), and avara (low). The threshold for allostatic load will be higher in pravara dhatu sara. Madhya satva persons can endure the diseases, due to their, medium pain bearing capacities. Hina satva persons are more easily susceptible to wear and tear on the body due to chronic and repeated exposure of stressors and they are susceptible to more diseases.
Due to faulty diet and lifestyle, derangement (Vibhramsha) of Dhee (acquisition of new information) Dhriti (regulation, retention, and processing of the new information) and Smriti (memory) happens and it leads to unwholesome activities. Due to these intellectual errors (Pranjaparadham), the tridosha and triguna imbalance occurs and it, in turn, creates a favorable environment for various physical and psychological disorders like stress, anxiety, and depression, etc.
Hence, at present, one needs to focus on the early detection of stress to reduce it and to achieve high academic, clinical outcomes from students. Studies should be conducted to find out the association of stress and Satvasara so that the probable mechanism of action of alternative behavioral therapies like Mantra, meditation, Pranayama, etc., on stress can be corroborated in-front of the scientific community and the same can be used as an effective intervention in the management of stress.
| Review of literature|| |
Various textbooks, journals, etc., were reviewed for the current study. All related literature regarding stress were collected. The details of stress assessment scales, stress ailments, educational stress, and Ayurvedic concept of Satva, Raja, Tama, Satvasara assessment tool were also reviewed.
| Methodology|| |
Materials used for the study
Perceived stress scale 10
The present study used Perceived stress scale (PSS) as a psychological instrument to measure the perceived stress. It was developed by Sheldon Cohen and his colleagues and it measures the degree to which situations in one's life are appraised as stressful. The PSS was published in 1983 and has become one of the most widely used psychological instruments for measuring nonspecific perceived stress. It is a self-report measure intended to capture the degree to which persons perceive situations in their life as excessively stressful relative to their ability to cope. To date, there are three standard versions of the PSS: The original 14-item form (PSS-14), the PSS-10, and a four-item form (PSS-4). PSS-10 was developed after removing four poorly performed items from PSS 14. It contains four positively stated items and 6 negatively stated questions. Each item is rated on a on a five-point Likert scale (0 = never, 1 = almost never, 2 = sometimes, 3 = fairly often, and 4 = very often). The Scores on PSS 10 demonstrated moderate convergent validity and high reliability (0.78). As a result, PSS-10 was chosen as the best form of the PSS and recommended its use in future research. Hence the scale was administered to rate the stress of students in the present study.
Satvasara assessment tool
Satvasara questionnaires were obtained from the dissertation “A descriptive study to develop a tool for the assessment of satvasara” developed by DrAswathy V. This tool was structured as a closed ended questionnaire anddesigned like a self-assessment tool for normal subjects. The tool contains 36 items in a five point Likert scale format with the scores ranging from one to five. There are 29 positive and 7 negative questions. The tool yields a quantitative measure of intellectual domain, attitude domain and activity domain of a person with 9 items assigned for intellectual domain, 22 items for attitude domain and 5 items for activity domain. Overall range of possible scores is 133–655 considering the total number of items. Higher scores indicate higher levels of Satvasarata. The scores above 498 are considered as Pravara satva sara and the scores in between 400–498 is Madhyama Satva sara and the scores below 400 is of Avara in nature. Cronbach's alpha was found to be 0.85 for the refined tool. All dimensions of Satva sara are included in the questionnaire which gave the tool a high content validity. Face Validity was also done by subject experts and they concluded that the tool can provide a good measurement of Satvasarata. The tool was compared with emotional intelligence inventory, a tool that measures a person's emotional development, maturity, and general mental health and a Pearson's correlation coefficient of 0.6 is found out; hence it proved the criterion validity of the scale as well.
Topiwala National Medical College Prakriti 2004 questionnaire
Prakriti was assessed using a multiple-choice TNMC Prakriti 2004 questionnaire which was designed based on literature in Ayurvedic texts and it comprising 37 objective questions related to the person's physical characteristics, psychological make-up, and physiological habits. Each of the questions had three options to choose from referring to a property attributed to Vata, Pitta, or Kapha. The score obtained by a person for answers in these domains were summed up and the person was identified as having a specific prakriti depending on scores obtained. The questionnaire was validated by pretesting where the results obtained by the questionnaire were confirmed by the clinical assessment of the prakriti independently by two Ayurveda physicians in 30 participants. More than 90% concordance was observed in the prakriti assessment by the two clinicians by the questionnaire.
A detailed presentation of the study was done before the ethical committee. The ethical committee analyzed different aspects of the study including aims, objectives, methodology collection of data, ethical issues, etc., and granted permission to conduct the study with IEC no SDMIAH/IEC/07/2019.
To estimate the prevalence of stress in students of Ayurveda College.
To find out the association between stress and Satvasarata.
Data collection procedure
The study was planned as an observational study at SDM Institute of Ayurveda College and Hospital in Bengaluru. Two months were required for the data collection. 200 subjects were initially screened and 160 subjects of the moderate stressed group were selected for the study.
- Ist and 2nd-year BAMS students who are willing to participate in the study
- Subjects who are in the age group of 17–22 years
- Students who are mentally and physically healthy.
- Subjects who refuse to give the written consent
- Subjects who are on medication
- Subjects who are having acute or chronic illness.
The study was carried out on 200 BAMS (1st and 2nd year) students who were staying in the hostel/campus of an Ayurveda College in Bengaluru and who were devoid of any acute or chronic physical and mental illness. Screening of stress was done with PSS-10 and 160 students who were in moderate stress were selected. Subjects were asked to fill a proforma related to their socio-demographic data concerning their age, gender, economic status, Prakriti (TNMC 2004 questionnaire), etc., and were requested to sign an informed consent regarding their willingness in participation in this study. Subject's Satvasara assessment were also done. Attrition rate of. 056% was observed for the study. The study was conducted during January 2020.
Statistical analyses were performed using SPSS 16 :233 South Wacker Drive, 11th Floor, Chicago, trademarks of Apple Computer, Inc., registered in the U.S. Descriptive analyses (such as percentages, means, and standard deviations) were done for different variables. Spearman's correlation test was performed to investigate the possible links between PSS scores and Satvasara. The significance limit was set at P < 0.05.
| Results|| |
General characteristics of the sample
200 subjects were selected for initial screening. The final sample consisted of 151 students who were under moderate stressed group with 9 dropouts from the study, of whom the majority was female participants (78.14%). The average age was 19.06±0.94.Majority of participants belonging to the Hindu religion (94%). Most of the students were from upper-middle-class families (76.821%). This sample included subjects who belong to mainly Pitta or a combination of pitta with other doshajaprakriti (92.05%) [Table 1].
Results of questionnaire used
About 80% of Ayurveda College students were recorded having moderate stress and 6% has mild and the remaining 14% suffer from high perceived stress when analyzed with PSS-10 [Graph 1] and [Graph 2]. questionnaire [Table 2]. 86.09% of participants belong to Madhyama satvasara category, 12.58% from Avara group and the rest belongs to Pravara satvasara group.
Results obtained from perceived stress scale-10 questionnaires
Distribution of stress scores in negatively stated perceived stress scale questions
Distribution of stress scores in positively stated PSS questions.
Results of the links between stress and domains of Satvasara
Results showed a significant inverse association between stress scores and Satvasara of subjects [Table 3]. A significant negative correlation is seen in the intellectual domain of Satvasara against PSS 6th question. Attitude domain of Satvasara tool shows significant negative correlation 5th and 10th question of PSS. Significant positive correlation was proven between the attitude domain against 6th and 7th questions. In activity domain Satvasara, significant negative correlations were observed in the 3rd and 10th questions [Table 4].
|Table 3: Results of the correlation between stress and Satva Sara scores|
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|Table 4: Bivariate analysis between each domain of Satvasarawith 10 questions of Perceived Stress Scale|
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No significant correlation found between perceived stress score with variables like age, gender, economic status, diet, exercise, Prakriti, Sara. Analyses did not show any significant correlation between Satvasara score and the above mentioned variables except gender [Table 5].
| Discussion|| |
Prevalence of stress evaluated in Ayurveda College students sample
From the study, it gets proved that the majority of students are either in moderately or in the highly stressed group. As Ayurveda began to be incorporated into the modern pattern of institutionization, some of the merits of ancient Gurukula, the traditional teaching and learning system, seem to have compromised. The system now focuses more on time-bound and memory-oriented learning. Students have to learn a lot of portions from modern medicine as well as from Ayurveda. Many of the subjects including the Sanskrit language are new to BAMS students after the present intermediate level curriculums. All these factors along with consistent medical academic stressors may generate high stress among Ayurveda college students.
Link between the inverse relationship of stress and Satvasarata
The body and mind are in inseparable relationship. Faulty diet and lifestyle always have a negative influence on the physical and psychological health of the human being. Psychological health always depends on the quality of food consumed and the wholesome rule of dietetics. Excessive consumption of junk food, spicy, salty, incompatible, and stale food results in physical and mental disorders. In the present scenario, with the advent of newer technologies, there are considerable changes in the life style like excessive exposure to digital media, imbalances in duration of sleep, alcohol, Faulty nicotine abuses, and lack of mindfulness can adversely affect the mental health as well. All these misdeeds result in the derangement of Dhee, Dhruti and Smriti.
Deranged Dhee interpret the knowledge incorrectly and consider the beneficial as non-beneficial and looks immortal as mortal etc., Dhruti in its normal state prevents mind and sense organs from doing harmful things whereas when it gets disturbed, sense organs gets attracted into harmful sense objects and lead to inappropriate behavioral disorders. Disturbance of Smriti hampers decision-making and results in impairment of memory. A person with deranged Dhee, Dhruti and Smriti subject himself into unwholesome activities (Prajnaparadham) which is the root cause of all physical and psychosomatic diseases.
Prajnaparadham aggravates Tridosha and Triguna and thereby reduces Satvasarata and creates favorable environment for psychological disorders like stress ailments, depression, anxiety, depression, etc., From the present study, an inverse relationship of stress with Satvasara gets substantiated as well.
Correlation of Satvasara domains and stress scores
From the analysis, it's found out that there is a significant negative correlation in between stress scores and all domains of Satvasarata. The negative correlations were significant in attitude and activity domains.
Attitude domain of the Satvasara tool was formulated with items; Bhakti (devotion and submission to one's commitment), Krutanja (gratefulness), Suchi (cleanliness in body, speech, and in mind), Dheera (courage), Samaravikranthayodhina (constant and steady effort to win), Tyakthavishada (pleasant mind) and Kalyanabhinivesham (positive attitude) are included. Activity domain includes statements generated from Mahotsaha (enthusiasm to do the activities) and Dakshya (skillfulness).The intellectual domain consists of items from Smriti (emotional memory), gambheerabudhicheshta (decision making and problem-solving capacity), Prajna (interest to update knowledge), Suvyavasthithagati (ability of a person to concentrate on work till its completion). All these domains show an inverse relationship with stress scores. All these domains show an inverse relationship with stress scores.
Bhakti in attitude domains indicates obedience, respect or devotion towards God, fellow being, job, etc. People with Krutanja always have characteristics like mindfulness, have a sense of abundance, appreciate simple pleasures like those pleasures that are readily available to most people, appreciate others contribution to their well-being. Shuchi trait of Satvasara explains the cleanliness in body, psyche and speech. Persons with Samaravikranthayodhina attribute of always have perseverance to achieve the goal. Those with Tyakthavishadha quality always have a positive attitude and optimistic mind to face obstacles. Kalyanaabhinivesha represents positive attitude to him and to society. It is well understood that a grateful disposition, optimism, self-esteem, self-restraint, self-efficacy, etc., is associated with life satisfaction, subjective well-being, positive effect, and stress-free life.
Activity domains of the Satvasara tool include zest and skillfulness. Zest is the mental and physical vigor and it's about approaching life with vitality, enthusiasm and hope. As a coping strategy for stress, zest always established as a proven method.
Intellectual domain of Satvasara tool analyze Smriti by the recollection of objects which are seen, heard and otherwise perceived. Prajna is the trait with which a person has knowledge about science other than Vaidyasaastra (medicine).Gambheerabuddhicheshta is analyzed with processing of language which is vital for new learning, creativity, and attention and also by the in depth knowledge of language. Gambeeracheshta aspect has been related to actively encoding, retrieval of information, updating and maintaining the contents of working memory. Steady mind and activities represent Suvyavasthitagati. It is well understood that, the college-going children with these qualities must be highly goal and target oriented and they should definitely have comparatively less stress scores than their peers.
Gender differences with stress and Satvasara scores
Overall, psychological stress was higher in women than men when it came to perceived stress. However, the significant differences could not get proved between female and male participants. In the present study, the women outnumbered the men; hence the nonsignificant findings may be attributed to lower power to detect an effect also. This finding replicates with many previous research performed by different scholars.
Age differences with stress and Satvasara scores
When it comes to the link between stress and age, we found an insignificant inverse relation between these two variables. This result is in line with some studies which show a negative association between perceived stress and age while some other studies denied this relation., In the case of age and Satvasara scores, a direct nonsignificant relationship estimated.
Link between stress, Satvasara scores and diet, exercise, socioeconomic status in students
The analysis indicates that as the diet shifted from vegetarian to mixed, the Satvasara increases and perceived stress scores decreases. But since the P value is not significant we can't confirm the analysis. Here also the data are insufficient to arrive at the conclusion.
Same contrary results obtained in exercise and in socioeconomic status too. Since the proforma was a self-reporting one, these insignificant results might have occurred.
Potential shortcomings and limitations
This research has a number of limitations. It is limited by a small sample size, which reduced statistical power. Participants mainly consisted of female subjects and were principally recruited from only one Ayurveda college at Bangalore, which is not representative of all Ayurveda students' population. In addition, our sample had around nine dropouts too. The assessment was solely based on self-reported questionnaires and their results were not validated by a semi-structured interview. Additionally, the cross-sectional design of our study investigates associations rather than causality. Thus, future research needs to replicate these findings using a longitudinal design to estimate the association between students' stress, Satvasara with age, exercise, gender, and socioeconomic status, etc.
This study presents evidence that high prevalence of stress is seen among Ayurveda medical college students with preponderance in female subjects and there is a significant inverse relationship exists between stress and Satvasarata. Future research should be done to include more homogeneous samples with respect to gender, age, etc., and to recruit students from Ayurveda colleges of different states.
The author would like to thank all the participants at the college for their participation in the study. Also special thanks to Dr. Aswathy V, Assistant Professor, Dept of Kriya sareera, Gov. Ayurveda College Trivandrum, for her valuable advice regarding the Satva sara tool.
Financial support and sponsorship
The article is prepared as a part of preliminary research project funded by Rajeev Gandhi University of Health Sciences; Bangalore. The author acknowledges the University for the Immense Support given by the university in carrying out the research project too.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]