INTRODUCTION:

Background of the study

In a study by Mousumi Basu and Debashis Sinha on depression, anxiety, stress among nursing students, Kolkata, shows a result of about 33.33% students suffer from moderate level of depression, 56.59% had moderate to extreme levels anxiety and 23.26% experienced moderate to extreme levels of stress among 129 students.¹

A study conducted by WU.SM (2002) in I-Shou University, Japan on stress, anxiety, depression and self esteem of undergraduates, both qualitative and quantitative analysis were utilised to evaluate the changes of the participants. The findings indicated that the experimental group demonstrated a reduction in anxiety immediately after the music therapy and after a 2 months follow-up, but only reduced depression after the follow up, moreover, the experimental group expressed that they experienced more positive changes including more pleasure, relaxation, and confidence, and fewer negative emotions.²

A study conducted by Dr. Shereen Mohammad Abo-El yazeed (2018) in Tanta University in Tanta city, Egypt on stress, anxiety and depression among Baccalaureate Nursing students, an descriptive research design was employed in the present study, study tool was consisted of two parts, part 1: Socio demographic data and academic data; it was developed by researcher. RPart 2: DASS -42; it was developed by Lovibond S.h and Lovibond P.F (1995). The result of the present study concluded that symptoms of stress, anxiety and depression are highly among undergraduate nursing students. There is a positive association between stress anxiety and depression.³

A study conducted by Sherry Manansingh, Stephanie L Tatum, Elsa Sofia Morote (2019) in baccalaureate nursing (BSN) student on academic stress and anxiety, to evaluate the effects of using relaxation techniques, 45 students participated in a 6-week relaxation technique intervention and a focus group. A pretest was disseminated the first week of class and a posttest was disseminated at the end of the semester, followed by a focus group interview. Results: The paired-sample t test indicated that students who used relaxation techniques significantly decreased in academic stress and test anxiety. A thematic analysis of the focus group interview indicated relaxation techniques prior to examinations helped to reduce mental and physical stress and fear of failure and increased the likelihood of their intention to stay in the nursing profession.⁴

A study conducted by Wanda M Chernomas, Carla Shapiro (2013) in Canada on Stress, Depression, Anxiety among undergraduate nursing students. Cross sectional descriptive study was used in this study. This article will present significant findings including levels of SDA; comparison between sample and a normative sample on the dimensions of SDA, and the results of multiple regression analysis identifying significant predictors of 9 each dimension. Themes from the qualitative comments from 251 of the participants were identified and added depth and clarity to the quantitative findings. The predominant themes represented were: perceptions of clinical practice, coping, personal issues, and balancing school, work, and personal life.⁵

A study conducted by Sarita T Fernandes 1, Fatema D’ Silva (2019) on depression, anxiety and stress among haemodialysis patients, Research design adopted for the study was quasi experimental research design with pretest post test with randomization control group. Data were collected using demographic questionnaire and DASS (Depression Anxiety Stress Scale) tool. Results: - For this study 40 subjects had been identified and majorities of 29 (72.5%) were males. Around 15 (45%) participants were in the age group 64 years. Among the 40 subjects, a group of 20 received music therapy. There was a difference in mean depression (p= 0.016), anxiety (p=0.035 and stress (p=0.028) between the experimental and control group. In the experimental group there was a difference in mean Systolic Blood Pressure and Diastolic Blood pressure (p < 0.05) after the music therapy. In the control group, there was a difference in SBP (p <0.005) and no significant difference was found in the Diastolic Blood Pressure. (p = 0.297).⁶

A study conducted by Madisen S. Martin (2022), in school of nursing honours, Rhode Island College on anxiety of nursing studentThe General Anxiety Disorder-7 (GAD-7) was the first scale used to measure the presence of anxiety in the participants (See Appendix A). The second scale that was used is the Beck Anxiety Inventory (BAI). The GAD-7 results were representative of all 35 participants who were interested in filling out the initial questionnaire. The mean score of the GAD-7 was 10.74 which indicated that the average level of anxiety was moderate for participants. The median score of the GAD was 9. The mean score on the BAI pretest was 21.75 which indicates low anxiety and if this score was rounded up, it would be considered moderate anxiety. The mean score on the BAI posttest was 4 which indicates a decreased score of anxiety after the music intervention was implemented.⁷

A Study conducted by Moradipanah F., Mohammadi E., Mohammadil A Z (2009) on anxiety, stress and depression, Control of stress and anxiety and the promotion of comfort are challenges facing health practitioners involved in catheterization. Differences in pre- and post-intervention scores demonstrated that there were significant decreases in mean scores of state anxiety (P = 0.006), stress (P = 0.001) and depression (P = 0.02) in the intervention group, who listened to 20 minutes of relaxing music, as compared with the control group who had 20 minutes of bed rest.⁸

A study conducted by Eyuboglu G, Baykara G Z, Eyikara E (2020) in the Department of Nursing, Faculty of Health and Sciences, Turkey on the effect of music therapy on anxiety level and vital signs on nursing students'.Data were collected between February and June 2018 using the Informative Features Form, State-trait Anxiety Inventory, Vital Signs Assessment Form, Skill Checklists, and Focus-group Interview Form.The blood pressure values of the experimental group before and after the exam were significantly lower than those of the control group (p < 0.05). No significant difference was observed between exam success and anxiety levels between the two groups. In the focus group interviews, students said they found music therapy suitable for reducing anxiety in their daily lives, but not before the exam.⁹

A Study conducted by kyoung Son H, Wi-Young so, and Kim Myoungsuk (2019) at sungshin Women's University, Korea on Anxiety, stress, and Fundamental Nursing skills in Nursing students. Complementary alternative methods, such as aromatherapy and music therapy, have effectively alleviated such negative emotions among nursing students. A double-blinded randomised controlled trial design was used. Ninety-eight female nursing students participated in the study. Subjects were categorised under three groups: aromatherapy (n = 32), music therapy (n = 32), and aromatherapy combined with music therapy (n = 34). Twenty-minute interventions were performed. Aromatherapy combined with music therapy had a significant effect on test anxiety (F = 4.29, p = 0.016), state anxiety (F = 4.77, p = 0.011), stress (F = 4.62, p = 0.012), and performance of fundamental nursing skills (F = 8.04, p = 0.001) compared with aromatherapy and music therapy as separate interventions.¹⁰

A Study conducted by Moasheri BN, Sharifzadeh G, Nahardan M. (2016) at Birjand University of Medical Sciences, Iran, on depression Among Students. The pretest-posttest quasi-experimental study was done on 236 male dormitory students, who had been recruited through systematic random sampling. The intervention included music therapy by using pieces of light soft music. The students were asked to listen to music tracks 20 minutes per day for 2 consecutive months. During these 2 months, they were monitored weekly to ensure their adherence to the intervention. The study intervention significantly reduced the mean score of depression from 11.00±9.32 to 8.43±9.6.¹¹

Need of The Study:

The nursing profession is renowned for its high-stress environment, and nursing students are particularly vulnerable to mental health issues. Research indicates that 40-80% of nursing students experience depression, anxiety, and stress, which can negatively impact their academic performance, retention, and overall mental helth. Despite the growing demand for cost-effective, non-pharmacological interventions, there is a paucity of research on relaxation listening as a coping mechanism specifically tailored for nursing students in Kolkata, West Bengal.

A study conducted by Shinganjude Shraddha Sudhir, HardePornima Diliprao, Arpana Grace George and Diker Dev Joshi, 2021, Bangalore, Karnataka on Stress among physiotherapy students. Google form of Perceived Stress Scale were distributed among 145 students of various colleges of Bangalore ,7 minutes of music therapy was given for one month. The results shows out of 120 students out of 145 students, there was significant effect of music therapy on stress among physiotherapy students ¹²

A study conducted by Samarpita Chatterjee Mukherjee and Roan Mukherjee, 2019, West Bengal India on depression, anxiety, stress and insomnia among elderly adults. A cross sectional,single group pretest post test intervention research design was used among 39 individuals, DASS-21 and ISI questionnaire tool was used for the study, Both the scale were used before music therapy and after finishing music therapy at 4th week (1 month) and 8th week (2 month), Raga Darbari Kanada of Indian Classical music was used as a intervention.The results revealed that the two months music therapy intervention program progressively and significantly (p<0.001) lowered depression, anxiety, stress, as well as sleeping problems in the subjects. This indicated that raga Darbari Kanada may be beneficial for the management of the psychological health and sleeping difficulties in elderly adults¹³

PROBLEM STATEMENT:

Effectiveness of relaxed listening on Depression, Anxiety and Stress among Nursing students, Kolkata, West Bengal.

OBJECTIVES:

● To assess the pre-interventional level of stress, anxiety and depression among the nursing students.

● To assess the after post interventional level of stress, anxiety and depression among the Nursing student.

● To evaluate the effectiveness of relaxed listening by comparing the pre test and post test value of depression, anxiety and stress among Nursing students.

● To find out the association of pre interventional levels of depression, anxiety and stress among Nursing students with their selected socio-demographic variables.

ASSUMPTION:

Nursing students have some amount of stress, anxiety and depression.

DELIMITATION:

1st year Bsc nursing students.

OPERATIONAL DEFINITION:

· Depression: In this study Depression refers to dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest / involvement, anhedonia and inertia. (Items 3, 5, 10, 13, 16, 17, 21) measured by DASS-42.

· Anxiety: In this study Anxiety refers to autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. (Items 2, 4, 7, 9, 15, 19, 20) measured by DASS-42.

· Stress: In this study Stress refers to levels of chronic nonspecific arousal, difficulty relaxing, nervous arousal, and being easily upset / agitated, irritable / over-reactive and impatient. (Items 1, 6, 8, 11, 12, 14, 18) measured by DASS-42.

· Effectiveness: In this study Effectiveness refers to effectiveness refers to the improvement of depression, anxiety and stress among nursing students measured by DASS 42.

· Relaxed Listening: In this study relaxed listening refers to listening to Rabindrik instrumental music for 20 minutes followed by making art /drawing for 5 minutes by using available materials on any topic selected by participants by the Nursing students.

· Nursing students: In this study Nursing students refers to 1st year BSc. Nursing students.

VARIABLES:

· Dependent Variables: Stress, anxiety and depression among nursing students.

· Independent Variable: Relaxed listening.

· Socio-demographic variables: Age, gender, family income, education, religion, type of family, socio-economic status, social culture, family background.

· Extraneous Variables (during the intervention)- ritual beliefs, listening to anything other than intervention.

HYPOTHESIS:

● H01: There is no significant difference between pre and post test level of stress, anxiety and depression among nursing students after giving relaxed listening intervention at 0.05 level of significance.

● H02: There is no significant association between socio demographic variables (age, gender, education level, year of study, residence) and pre-interventional levels of depression, anxiety, and stress among Nursing students at 0.05 level of significance.

RESEARCH METHODOLOGY:

Research design: Quasi experimental one group pretest post- test design.

Table 2: Data collection tool and technique:

Name of the tool	Variable to be measured	Technique
Tool 1 section A: Semi- structured questionnaire on demographic data	Variable- Background or personal/ demographic	Technique -paper pencil test
Tool 2 section B: Standardised tool for Depression, Anxiety and Stress scale 42 – DASS (42)	Variable - Depression, Anxiety and Stress.	Technique -paper pencil test

Validity of tool:

The tool was validated by five experts from Mental Health Nurse (1), Psychiatrist (1), Psychologist (1), Psychologist and Music therapist (1) and Med - Surg. Nurse (1) Experts were chosen on the basis of their clinical expertise, experience and interest in the problem area. Experts were requested to verify the items for relevance, accuracy and appropriateness.

Reliability:

Reliability of the tool was done on 10 B.Sc. Nursing students to check clarity of items, feasibility, practicality and ambiguity of the language. The average time taken is 20 minutes for answering the questions.

Table 3: Reliability of tool:

Tool

Method

‘r’ value

Semi -structured questionnaire on Demographic data

Intra-rater method

0.93

DASS-42

Cronbach’s Alpha

D: 0.89

A:0.96

S: 0.96

Setting of Study:

Pilot Study - Department of Nursing, Aliah University.

Final Study - College of Nursing, Calcutta National Medical college and Hospital.

Rationale for selecting the settings:

· Availability of samples.

· Feasibility of conducting the study.

· Easy accessibility.

· Familiarity with the setting.

· Expectation of administrative approval.

· Expected cooperation from students and Institution authority.

Population of the study: B.Sc. Nursing students.

Sample:

Final Study - 46, 1st year B.Sc. Nursing students from College of Nursing, Calcutta National Medical and Hospital.

Sampling techniques: Non probability convenience sampling technique.

Criteria for selection of sample:

Inclusion Criteria:

· Students who are not diagnosed with any acute or chronic physical or mental illness or consuming regular medicines.

· Students who are not exposed to any other means of relaxation therapy at least for 1 year.

· Students who do not have any traumatic experience at least for 6 months.

Ethical consideration:

· Permission taken from the ethical committee of a respected hospital.

· Information given to students about-

· About the purpose the study

· Duration of time involvement

· Type of involvement

· Volunteer willingness for participation of students

· Harm and benefit of study

· Informed consent taken from students

· Confidentiality and anonymity had been maintained.

Pilot Study:

The study was conducted in the Department of Nursing, Aliah University at Gorachand road, Beniapukur, Kolkata, West Bengal, 700014. Pilot study was done with 10 students. A convenient sampling technique is used for the selection of Nursing Colleges.

ANALYSIS AND INTERPRETATION OF THE DATA:

Section I: Description of Socio-demographic characteristics of 1st year BSc.Nursing students.

Fig - 1: Bar diagram showing frequency and percentage distribution according to Age

The data presented in this figure show that the majority of the sample 85% belongs to the (18-20 years) age group.

Fig - 2: Pie diagram showing frequency and percentage distribution according to Religion

The data presented in this figure show that the majority of the sample, 80%, are Hindu.

Fig - 3: Pie diagram showing frequency and percentage distribution of Residence

Fig - 4: Pie diagram showing frequency and percentage distribution of Education of Sample's Father

The data presented in this figure show that the majority 67% of the sample's father completed Graduation.

Fig - 5: Pie diagram showing frequency and distribution of Additional Qualification of the Respondent after H.S

The data presented in this figure shows that all are studying in the 2nd Semester.

Fig-6: Pie diagram showing frequency and distribution of Education of Mother

The data presented in this figure shows that majority 43.5% sample’s mother completed Graduation.

Fig-7: Pie diagram showing frequency and distribution of no family members.

The data presented in this figure shows that the majority 82.6% sample’s families have (3-5) no members.

Fig - 8: Bar diagram showing frequency and Percentage distribution According to Occupation of Father

The data presented in this figure show that the majority 28.3% sample’s fathers are doing Private Service.

Fig no-9: Bar diagram showing frequency and Percentage distribution According to Occupation of Mother

The data presented in this figure show that majority sample's (76.09%) mother are homemakers

Fig No-10: Pie diagram showing frequency and Percentage distribution According to Family Income

The data presented in this figure show that the majority (45.7%) sample's Family Income is (>25k).

Fig No11: Pie Diagram showing frequency and Percentage Distribution According to Emotionally Attached in family.

The data presented in this figure show that the majority (41.3%) sample are Emotionally Attached with Mother.

Fig no-12: Pie diagram showing frequency and Percentage Distribution according to Emotionally Attached Apart From Family.

The data presented in this figure show that the majority (58.7%) sample are Emotionally Attached with Best friends.

Fig No-13: Pie Diagram showing frequency and percentage distribution according to Academic Performance.

The data presented in this figure show the majority (41.3%) sample’s academic performance (61-70%).

Fig No-14: Pie Diagram showing frequency and Percentage Distribution according to Screen Time.

The data presented in this figure show that the majority (60.9%) sample’s screen time is (4-6hr)

Calculated t value is less than table value that's why it is not Significant at 0.05 level of significance except stress t value.

DISCUSSION:

There is no significant association between depression and socio demographic variables. There is no significant association between anxiety and socio demographic variables. There is no significant association between stress and socio demographic variables.

A study conducted by W.U.S.M (2002) in I-Shou University, Japan on stress, anxiety, depression and self esteem of undergraduates, both qualitative and quantitative analysis were utilised to evaluate the changes of the participants. The findings indicated that the experimental group demonstrated a reduction in anxiety immediately after the music therapy and after a 2 months follow-up, but only reduced depression after the follow up, moreover, the experimental group expressed that they experienced more positive changes including more pleasure, relaxation, and confidence, and fewer negative emotions.

CONCLUSION:

The objective of the study has full fill. There is no significant relationships between Depression, Anxiety and stress with demographic variables. We found that music therapy is effective in stress but not in depression and anxiety.

LIMITATIONS:

· Lack of generalisation due to small sample size.

· Lack of control group.

· Absenteeism of students.

· Shortage of time for giving intervention.

RECOMMENDATION:

· A similar study can be replicated with a larger sample for making generalisation.

· A quasi-experimental study with pre test post test control group design for assessment of the effectiveness of relaxed listening on mental health.

· A similar study can be replicated with more demographic variables.

· Future studies can explore comparative effectiveness of music therapy with other relaxation techniques, such as progressive muscle relaxation and mindfulness meditation, to identify optimal interventions for reducing depression, anxiety, and stress in nursing students.

REFERENCE:

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Received on 14.01.2025 Revised on 07.03.2025

Accepted on 16.04.2025 Published on 21.05.2025

Available online from May 22, 2025

Asian J. Nursing Education and Research. 2025;15(2):81-88.

DOI: 10.52711/2349-2996.2025.00018

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Sl no.	Findings	Pretest M	Pretest Mdn	Pretest Sd	Post test M	Post test Mdn	Post test Sd	‘t’ value
1.	Depression	17.58	17	116.89	15.52	17	110.63	1.54#
2.	Anxiety	16.93	16.5	8.46	15.22	14	8.43	1.45#
3.	Stress	21.58	23.5	8.41	18.54	19	8.84	3.27*