<p>More than one billion individuals throughout the globe suffer from iron-deficiency anemia (IDA). It is mostly caused by dietary deficits. In the Indian context, studies linking psychological stress to anemia and iron deficiency are limited. To investigate the association between iron deficiency anemia and psychological stress. This cross-sectional investigation was carried out on 385 IDA patients. Blood samples were obtained for the analysis of complete blood count, vitamin D, iron markers, folate, TSH, and vitamin B₁₂. Psychological stress was assessed by evaluating perceived stress and life events stress using standardized approved score tests. 385 IDA patients and 102 controls were included. Age and BMI were comparable in both groups. IDA patients had significantly higher perceived stress (<i>p</i> = 0.005), but life event stress was not different between groups (<i>p</i> = 0.16). Hemoglobin, hematocrit, RBC count, red cell indices, ferritin, and hepcidin were significantly lower, but transferrin and TIBC were significantly higher in IDA patients (all <i>p</i> &lt; 0.0001). In multivariable analyses, higher perceived and combined stress scores were independently associated with lower hemoglobin, hematocrit, RBC count, MCH, and MCHC and higher RDW-CV (all Bonferroni-adjusted <i>p</i> &lt; 0.05). Stratified analyses showed a stepwise deterioration of hematological parameters with higher perceived stress (<i>p</i> &lt; 0.001), while life event stress was only weakly associated except for higher platelet counts and lower vitamin B₁₂ and folate levels in higher stress groups. Psychosocial stress showed a significant association with a worse hematological profile in patients with iron deficiency anemia. Incorporating stress management and lifestyle change-related strategies in clinical evaluation may complement standard IDA treatment and improve patient outcome. Future randomized trials must be conducted to confirm stress as a risk factor.</p>