Evaluation of Various Stress Management Strategies among Chennai People-A Cross Sectional Study

Background: Feeling stressed is a part of everyone's life. A feeling of emotional or physical tension is known as stress. Relaxation strategies play an important role in overcoming stress. Objective: To evaluate the different stress patterns, their perceived stress and effects of different stress management strategies. Methods: A cross sectional study was conducted through a convenience sampling method. The participants were administered with a self developed questionnaire consisting of 11 questions. The responses were collected using google forms. Descriptive statistics, frequency analysis and chi square test was used to analyse the data. Results: The present study reported that the majority of respondents were stressed due to academic and personal reasons and among the various stress relaxation methods, respondents felt that music and yoga relieved them from stress. Conclusion: The study concluded an innovative finding that music and yogic exercises when adopted provided a decent stress management strategy that suits the respondents.


INTRODUCTION
Stress is a normal physiological reaction that happens to everyone in response to a stressor. By nature, the human body is designed to experience stress and react to it. When you experience changes or challenges (stressors), the body produces physical and mental responses [1]. There are various reasons that produces a stress response like poor sleep habits, working long hours, financial reasons, academic reasons, working long hours, problems in relationships or emotional problems. The fight or flight response is an automatic physiological reaction to an event produced by frightening [2]. The perception of threat activates the systema nervus system and triggers an acute stress response that prepares the body to fight or flight response [3]. Not only human studies, but animal models too were also observed by scientists that when animals were threatened by exposure to a predator for example, their bodies released the hormones like adrenaline or epinephrine which would lead to a series of bodily changes including increased pulse and respiration. The hormone that regulates a stress response is Cortisol. Cortisol regulates processes throughout the body including metabolism and immune reaction [4]. It also has a very important role in helping the body respond and overcome the reaction to stress. Studies report that Chronic academic stress results in decreased academic performance, depression, physical, irritability, drug or alcohol experimentation and illness [5]. Hypothalamic pituitary axis (HPA) ensures that the body can respond quickly to stressful events and return to normal state rapidly. [6] When an organism experiences stress, the HPA axis response begins with the discharge of corticotropin-releasing factor (CRF) from the hypothalamus, stimulating the discharge of adrenocorticotropic hormone (ACTH) from the pituitary [7] . Stress coping methods are cognitive, behavioral and efforts to deal with stress. Stress leads to anxiety, irritability, depression and problems with memory and concentration. Physical effects of stress are Headaches, low energy, disturbed stomach, including constipation, diarrhea, and nausea, pains, tense muscles, Aches. Chest pain and rapid heartbeat, Insomnia, Frequent colds and infections, loss of sexual desire, Commonly used methods to relieve stress are Meditate, picture yourself relaxed, breathe deeply, look around you, drink hot tea, show some love, try self-Massage or Take a Time-Out [8]. Our team has extensive knowledge and research experience that has translate into high quality publications [9][10][11][12][13].
The aim of the research is to evaluate the different stress patterns, their perceived stress and effects of different stress management strategies adopted by the participants for stress relaxation by cross sectional method.

MATERIALS AND METHODS
The present cross sectional study was conducted using an online questionnaire.
Questionnaire consisted of 11 closed ended questions. Survey was conducted in Google forms among the normal healthy population in Chennai. People suffering from depression or other psychotic illnesses were excluded from study because their response to stress and adopted methods would be quite difficult compared to normal healthy individuals. Frequency analysis and chi square test was done using SPSS version 23.

RESULTS
The present study observed that about 70% of respondents were students, 20% were professional workers, 5% of respondents were sports persons and 5% of respondents were homemakers (fig 1). About 60% of respondents were of age group 18-20, 20% were of age group 21-30, 20% were of age group 31-40. About 65% of respondents said academic reason is the main reason for stress, 20% of respondents said official reason is the main reason, 10% of respondents said personal reasons is the main reason ( fig 4). If academic reason was the main reason, about 40% of respondents said huge syllabus and time management was the main reason, 28% of respondents said huge syllabus and time management, strict attitude of staff, pressure from parents to get good marks are the main reasons for stress. If personal problems were the main reason 40% of respondents said the problem with friends is the main reason, 28% of respondents said financial problems are the main reason for stress. About 52% of respondents said listening to music helped them to relieve stress, 12% of respondents said spending time with pet animals helps them relieve stress, 9% practise yoga, 7% of respondents exercises, 8% said they pray during stressful events, 6% of respondents said they keep quiet during problems (fig 2). About 56% of respondents said they consume antidepressant drugs. About 37% said drinking tea helps them relieve stress. About 28% of respondents said they experience insomnia, 23% of respondents said they experience headache, 20% of respondents said they forget things, and 18% of respondents said they experienced loss of appetite (Fig 3).

Cross Tab Evaluation
The association between gender and different stress management techniques was analysed. More number of male prefer listening to music and among females many responded praying helps them escape stress. Pearson chi square value was found 0.000. Hence, it is statistically significant ( Table  1).
The association between gender and reason for stress was analysed and males responded that huge syllabus and time management was the main reason for stress and the value was statistically significant. Pearson chi square value was found 0.000. Hence, it is statistically significant (  The bar graph shows the association between gender and stress management techniques. X axis represents the gender and the y axis represents the number of respondents. Followed. Blue denotes yoga, green denotes meditation, brown denotes exercise, purple denotes music, yellow denotes spending time with pets, red denotes humor, cyan denotes praying and grey denotes keeping quiet during problems. It is evident that majority of male prefer listening to music compared to females and the value was found to be statistically significant as in chi square test, p value = 0.000. (p<0.05)

0.000
In the present study, most of the respondents reported that they felt better with stress relaxation after yoga and exercise. Previous reports also suggested that physical activity can help improve your sleep And better sleep improves stress management. Physical Exercise also improves the mood changes in a person and the reason being the stimulation of the body to release a number of hormones like endorphins and endocannabinoids that block pain signals and also improve sleep, and sedate you. Few reports suggested that release of endocannabinoids may be responsible for the euphoric feeling of stress relaxation.
[24] Previous reports claimed that Listening to good music can produce a tremendous relaxing effect on our minds and bodies. This is more with slow, quiet classical music. They can produce a beneficial effect on our physiological functions with reduction in pulse and heart rate, low blood pressure, and decreasing the levels of stress hormones. Thus previous report suggest that Music, in short, can act as a powerful stress relaxing strategy [25].

CONCLUSION
Thus the present study concluded that male were more stressed and they majority of them suffered from insomnia and headache. The reasons for their stress were mainly academic and official reasons. Among the various stress relaxing methods, our participants responded more with music, yoga and spending time with pet animals.

LIMITATIONS OF THE STUDY
The limitations of study include only participants of the age group 18-40 years were included in the study. This population does not represent the total population.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.