Perceived Stress and Cardiac Autonomic Function Among Indian Medical Undergraduates: A Cross-Sectional Heart Rate...

Chronic stress is linked to impaired academic performance, emotional strain and autonomic dysregulation. Heart rate variability (HRV) is an objective, non-invasive marker of autonomic function. However, Indian undergraduate cohorts remain underrepresented in integrative studies combining perceived stress, HRV and lifestyle correlates within the competency-based curriculum framework.

To assess the prevalence and dominant domains of perceived stress using the Medical Students' Stressor Questionnaire (MSSQ), and analyse associations between perceived stress and HRV parameters among MBBS students.

In this cross-sectional study, 406 MBBS students across four academic years at a government medical college were assessed using the MSSQ-40. Resting 10-second ECG recordings were used to derive ultra-short-term time-domain HRV indices. Group comparisons were performed using non-parametric methods, and multivariable ordinal logistic regression was used to identify factors independently associated with perceived-stress severity.

Overall, 77.09% of students reported moderate-to-high perceived stress. Academic-related and teaching-learning-related stressors were prominent contributors to the overall stress profile. HRV indices did not differ significantly across mild, moderate and high stress categories in the overall cohort. Academic-year groups showed differences in selected HRV indices, including RMSSD; however, these differences did not follow a consistent monotonic pattern across academic seniority. In multivariable ordinal logistic regression, sex, balanced-meal frequency, leisure engagement, physical activity and academic year were not independently associated with stress severity after correction for multiple comparisons.

Perceived stress was common among Indian medical undergraduates, particularly in academic and teaching-learning domains. Broad perceived-stress categories were not associated with significant differences in ultra-short-term ECG-derived HRV. Selected HRV indices varied across academic-year cohorts, but these cross-sectional findings should be considered exploratory and should not be interpreted as evidence of progressive autonomic change during medical training.