Depression, anxiety, and stress among the nursing students during clinical placement in Sylhet, Bangladesh

Clinical placements are a required component of nursing education. However, the high-demanding nature of these settings may heighten students' risk for adverse mental health outcomes. This study aimed to investigate the prevalence and factors associated with depression, anxiety, and stress among nursing students during clinical placements.

We conducted a cross-sectional study between June 20 and July 12, 2025, among nursing students at a selected nursing college in Sylhet, Bangladesh. Eligible participants must have at least 6 months of clinical placement experience. The study included socio-demographic, academic, and clinical placement-related variables. The Depression, Anxiety, and Stress (DASS-21) scale was used to assess depression, anxiety, and stress symptoms. The DASS-21 scale is a screening tool that assesses symptom severity rather than a diagnostic tool. Data were analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation, and multiple linear regression.

A total of 382 nursing students participated, with a mean age of 21.69 years. The prevalence of depression, anxiety, and stress symptoms (mild to extremely severe) was 74.6%, 77.8%, and 53.1%, respectively. Being female, having poor peer relationships, lacking rest opportunities, and being dissatisfied with the behaviour of nurses were significantly associated with depression. Female students, those who had no rest opportunities, and those who spent 100% of their clinical hours standing, were significantly associated with anxiety. Female students, those with poor peer relationships, and those dissatisfied with the behaviour of nurses were significantly associated with stress. Depression, anxiety, and stress scores were strongly correlated.

Although clinical placements are fundamental to nursing education, students often face mental health challenges during these training periods. Our findings reveal a high prevalence of depression, anxiety, and stress and several factors associated with these outcomes. Therefore, strengthening support systems and improving clinical placement conditions may be crucial for both student well-being and the sustainability of a resilient nursing workforce in Bangladesh.